Helle Terkildsen Maindal

Helle Terkildsen Maindal
Aarhus University | AU · Department of Public Health

Professor, PhD MPH

About

187
Publications
31,140
Reads
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2,529
Citations
Citations since 2017
119 Research Items
2299 Citations
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20172018201920202021202220230100200300400500
20172018201920202021202220230100200300400500
Additional affiliations
January 2012 - present
Aarhus University
Position
  • Head of Section for Health Promotion and Health Services

Publications

Publications (187)
Article
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Objectives: to explore how cross-sectional healthcare and treatment is experienced a) by patients with advanced heart failure and multimorbidity and b) by hospital-employed healthcare professionals. Methods: Individual telephone interviews with 18 patients and close relatives were conducted. Furthermore, a focus group session was conducted with...
Article
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Background Physical activity (PA) at moderate intensity is recommended for healthy pregnant women. The three-arm FitMum randomised controlled trial showed that it was possible to increase PA level during pregnancy with structured supervised exercise training (EXE) compared to standard care. Motivational counselling on PA (MOT) did not increase PA....
Article
Aims To assess trajectories in cardiometabolic markers among people with type 1 and type 2 diabetes with varying health literacy levels. Methods Survey data assessing self-reported health literacy among 1401 people with type 1 diabetes and 910 people with type 2 diabetes were linked to prospective clinical data. Mixed effects modelling was used to...
Article
Background A pregnant woman’s health literacy refers to her knowledge, motivation, and skills to access, understand, appraise, and apply health information to make decisions in everyday life concerning her health. Inadequate health literacy increases the risk of adverse pregnancy and birth outcomes. This systematic review aimed to explore existing...
Preprint
BACKGROUND Improving childhood health is complex due to the multi-factorial nature and interaction of determinants. To facilitate shared understanding of structures and relationships that determine children's health behavior, participatory system approaches has shown promising potential. OBJECTIVE This paper describes a design to examine the feasi...
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Loneliness is widely acknowledged as a growing public health concern, accelerated by the onset of the COVID-19 pandemic. However, our knowledge about the effectiveness of interventions to reduce loneliness across the lifespan, including knowledge of different intervention strategies, is limited. This preregistered systematic review and meta-analysi...
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Background Gestational diabetes mellitus (GDM) affects an increasing number of pregnant women globally. Although studies have identified psychosocial ramifications associated with GDM, stigma in the form of experienced discrimination and self-blame and its consequences have received limited attention. Our objective was to examine the current eviden...
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Background Obesity in pregnant women is increasing worldwide, affecting the health of both mother and baby. Obesity may be associated with inadequate health literacy, a central competence when navigating antenatal health information and services. This study explores women’s health literacy by examining their knowledge, motivation and skills to acce...
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Objectives The aim of this scoping review was to review existing self-reported instruments measuring different elements of domains of PL.Method We reviewed Education Research Complete, Cochrane, Medline, ScienceDirect, Scopus and SPORTDiscus. The reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for...
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Definitions of health literacy have evolved from notions of health-related literacy to a multidimensional concept that incorporates the importance of social and cultural knowledge, practices and contexts. This evolution is evident in the development of instruments that seek to measure health literacy in different ways. Health literacy measurement i...
Article
Background and Aims Fathers’ participation in antenatal and postnatal (perinatal) health services is widely recommended, yet rarely achieved at desired levels. One barrier may be health services’ poor understanding of fathers’ health literacy. This study aimed to investigate (a) health literacy strengths and barriers, and (b) associations between h...
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Background Children’s health is generally considered a complex interplay between multiple factors. Interventions building on community-based participatory research and system dynamics have shown promising potential in improving children's health behavior and well-being. This presentation aims to present how physical literacy can be used to guide an...
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Background: Health services hold a critical role in mitigating the effect of health literacy challenges. Several tools and approaches have been developed to support health organizations in responding to their target population's health literacy needs. One of these is the OS! approach, which is an adapted and less rigorous version of the Australian...
Article
Participatory methodologies have become imperative when developing health promotion programmes. However, the concrete adoption of co-creation and its implications for intervention development are less reported. This article aims to convey how fidelity and adaptation were balanced in a structured intervention design by co-creating intervention compo...
Article
Intervention research is rapidly evolving and the updated Medical Research Council's framework from 2021 recommends a number of elements to consider when developing, adapting and evaluating complex interventions. We aimed to introduce the framework into the Danish language, and it is now ready for use in the efforts to developing and evaluating int...
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Refugees health status after receiving asylum in their new country is often poor, both physical and mentally. Despite that, European countries rarely offer programmes specifically targeted health and health behaviour for newly arrived refugees. This study investigated newly arrived refugees’ perspective on health and in particularly physical activi...
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A pregnant woman needs adequate knowledge, motivation, and skills to access, understand, appraise, and apply health information to make decisions related to the health of herself and her unborn baby. These skills are defined as health literacy: an important factor in relation to the woman’s ability to engage and navigate antenatal care services. Ev...
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Introduction. Insufficient cultural competences among health care professionals (HCPs) working with ethnic minorities may result in poorer quality of care. This study aimed to develop a cultural intervention for HCPs. Method. The intervention was designed using the Behavior Change Wheel. The development phase contained empirical studies of patients...
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Background Exploring mediators of preventive intervention effects has important implications for the planning of complex interventions. Our aim was to assess the extent to which knowledge, skills and confidence to manage health, here measured as “patient activation”, was a mediator of the effect of the intervention “Live your life without diabetes”...
Article
Background: Previous research suggests that it would be useful to view health literacy as a set of 'distributed competencies', which can be found dispersed through the individual's social network, rather than an exclusively individual attribute. However, to date there is no focused exploration of how distributed health literacy has been defined, c...
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Background Following COVID-19 and the lockdowns, maternity care and support for women after delivery have been temporary restructured. Studies show that COVID-19 adversely impacts pregnant and peripartum women in the general population, but experiences among women in the first year after delivery/in the wider postpartum period remain unexplored. Mo...
Article
Low health literacy (HL) is associated with adverse health behaviors and poor health, and brief, high-quality instruments for measuring HL in children are scarce. The Health Literacy for School-Aged Children (HLSAC) instrument is a 10-item theory-based and internationally validated tool for measuring HL. The purpose of this study was to translate a...
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Background Gestational diabetes (GDM) impacts 8–18% of pregnancies and greatly increases both maternal and child risk of developing non-communicable diseases such as type 2 diabetes and obesity. Whilst lifestyle interventions in pregnancy and postpartum reduce this risk, a research translation gap remains around delivering implementable interventio...
Article
In this systematic review and realist synthesis, we aimed to identify strategies to improve dietary and physical activity behaviors for parents with small children. A systematic literature search was conducted in MEDLINE, Embase, CINAHL, and PsycINFO in July 2021. Included studies had to: (i) target one or both parents with at least one child (0–3...
Article
Objective: Timely diagnosis of cancer is important for prognosis. Patients' health literacy (HL) may impact differences of diagnostic delays. Thus, we aim to explore the association between HL and diagnostic intervals in cancer. Methods: Questionnaire data were obtained from patients with cancer diagnosed in 2016 and their general practitioner (...
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Aim: Individuals with multimorbidity often have complex healthcare needs challenging their health literacy skills. This study aimed to investigate the association between the number of physical conditions and health literacy and to examine the difference in health literacy levels between individuals with multimorbidity based on physical conditions...
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Background The Patient Assessment of Chronic Illness Care (PACIC) scale is the most appropriate for assessing self-reported experience in chronic care. We aimed to validate the PACIC questionnaire by (1) assess patients’ perception of the quality of care for Danish patients with type 2 diabetes, (2) identify which factors are most important to the...
Article
Aims: This study aims to identify physical inactivity-related challenges and motives, based on reviews and supplemented by expert interviews with Danish national experts on physical inactivity, providing a general discussion of the subject ultimately generating knowledge useable in a Scandinavian context. Methods: This study is framed as a narrativ...
Preprint
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Background: Obesity in pregnant women is increasing worldwide, affecting the health of both mother and baby. Obesity may be associated with inadequate health literacy, a central competence when navigating antenatal health information and services. This study explores women’s health literacy experiences among a sample of pregnant women with a prepre...
Article
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Background Women with prior gestational diabetes mellitus (GDM) are at high risk of developing type 2 diabetes; however, this risk can be reduced by engaging in positive health behaviours e.g. healthy diet and regular physical activity. As such behaviours are difficult to obtain and maintain there is a need to develop sustainable behavioural interv...
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Objective To explore perceptions of risk and motivation for healthy living among immigrant women from non-western countries with prior gestational diabetes mellitus (GDM) living in Denmark. Design Seventeen semi-structured interviews were conducted with 12 female immigrants with prior GDM from non-western countries living in Denmark. The women wer...
Article
We have read the recent debate paper in Health Promotion International ‘Which literacy for health promotion: health, food, nutrition or media?’ (Truman et al., 2020) with great interest. Health promotion and health literacies such as health, food and media are highly relevant to today’s societal and political health challenges. In this response, we...
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Background Health checks have been suggested as an early detection approach aiming at lowering the risk of chronic disease development. This study aimed to evaluate the effectiveness of a health check programme offered to the general population, aged 30–49 years. Methods The entire population aged 30–49 years (N=26 216) living in the municipality...
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Postpartum depression (PPD) is one of the most common mental health problems among new parents. Past studies have examined PPD in women; however, the condition is less understood in men. This study aimed to explore the lived experiences of men or fathers with PPD and to understand the barriers and facilitators of help-seeking among fathers with PPD...
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Introduction A physically active lifestyle during pregnancy improves maternal and offspring health but can be difficult to follow. In Denmark, less than 40% of pregnant women meet physical activity (PA) recommendations. The FitMum study aims to explore strategies to increase PA during pregnancy among women with low PA and assess the health effects...
Article
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Gestational diabetes mellitus (GDM) increases the risk of adverse outcomes during and after pregnancy, including a long-term risk of type 2 diabetes. Women with GDM are treated by numerous healthcare professionals during pregnancy and describe a lack of preventive care after pregnancy. We aim to investigate healthcare professionals’ perspectives on...
Preprint
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Background: Women with prior gestational diabetes mellitus (GDM) are at high risk of developing type 2 diabetes; however, this risk can be reduced by engaging in e.g. healthy diet and regular physical activity. As such behaviours are difficult to obtain there is a need to develop sustainable behavioural interventions following GDM. We aimed to repo...
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Aims To present an overview of reviews of interventions for the prevention of diabetes in women after gestational diabetes mellitus (GDM) with the overall aim of gaining information in order to establish local interventions. Methods Six databases were searched for quantitative, qualitative or mixed‐methods systematic reviews. All types of interven...
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This paper presents a novel conceptual framework combining the concepts of health literacy and life-course to guide public health planning and research. Health literacy is a key competence that enables individuals to navigate health-care systems and health promotion activities. The life-course perspective places emphasis on how disease risk accumul...
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Background: The objective of the study was to examine the impact of health literacy on mortality in the general population and among individuals with cardiovascular disease (CVD), chronic obstructive pulmonary disease (COPD), diabetes, and mental illness. Methods: Data from a large Danish health survey (n = 29,473) from 2013 were linked with nat...
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Background Understanding individual health literacy needs is crucial when designing supportive and effective health care. However, tools assessing health literacy in practice are lacking. The Conversational Health Literacy Assessment Tool (CHAT) was recently developed, but its ability to assess health literacy remains unexplored. We aimed to invest...
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Introduction: Mothers with gestational diabetes mellitus (GDM) are at high risk of future diabetes. An active area of research examines health behavior change strategies in women within 5 years of a GDM pregnancy to prevent diabetes after pregnancy. We aimed to develop a core outcome set (COS) to facilitate synthesis and comparison across trials....
Preprint
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Background: Gestational diabetes increases the risk of complications during and after pregnancy, including a long-term risk of type 2 diabetes. Women with gestational diabetes have to navigate a complex treatment pathway during pregnancy, which they often experience as incoherent. These women also report a lack of preventive care after pregnancy. T...
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Introduction Poor mental health is an important public health concern, but mental health problems are often under- recognised. Providing feedback to general practitioners (GPs) on their patients’ mental health status may improve the identification of cases in need of mental healthcare. Objectives To investigate the extent of initiation of mental h...
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Background Health literacy (HL) as an enabler of health equity and health promotion. HL is closely linked to other social determinants of health such as age, sex, education, social status and ethnicity. HL responsiveness is the degree to which systems or organizations make it easier for people to navigate, understand, and use information and servic...
Article
Background Non-communicable diseases impact to the globally unequal distribution of health. From a public health perspective, health literacy (HL) may be a promising modifiable social determinant, suggested to be associated with adverse health outcomes. Few studies have explored how HL is related to mortality in the general population and in subgro...
Article
Background Evidence for health literacy (HL) as an important determinant of health and health behaviour is increasing. Brief and generic tools for measuring HL in children are few. One such tool is the Health Literacy for School-Aged Children (HLSAC) instrument, which is a 10-item theory-based tool developed in Finland for measuring HL in children...
Article
Background: Lower adherence and lower retention to HIV-care among migrant populations is an emerging problem among people with HIV, probably due to social and cultural disparities. The aim was to explore reasons for missed appointments and non-adherence to treatment among African HIV-infected migrants in Denmark to identify important areas for opti...
Article
This report focuses on the development of health literacy in two European countries, Denmark and the Netherlands. Denmark is part of the Nordic region, while the Netherlands is situated in the Western part of Europe. The report includes examples on Danish and Dutch health literacy research and lessons learned from practice. In Denmark, supported by...
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Background Adults with early-onset Type 2 Diabetes Mellitus (T2DM) are an emerging high-risk population who may experience social challenges related to diabetes management. Objective To explore the disclosure of T2DM and how disclosure affects diabetes self-management and the psychosocial adjustment to life with diabetes among adults with early-on...
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Purpose: We examined the association between sociodemographic, personal, and disease-related determinants and referral to a new model of health care that uses patient-reported outcomes (PRO) measures for remote outpatient follow-up (PRO-based follow-up). Methods: We conducted a prospective cohort study among outpatients with epilepsy at the Depa...
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Background: Health literacy concerns the ability of citizens to meet the complex demands of health in modern society. Data on the distribution of health literacy in general populations and how health literacy impacts health behavior and general health remains scarce. The present study aims to investigate the prevalence of health literacy levels an...
Article
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Background: Previous research from the USA has shown that low health literacy is associated with higher hospitalization rates and higher rates of emergency service use. However, studies in a European context using more comprehensive health literacy definitions are lacking. The aim was to study the impact of low health literacy on healthcare utiliz...
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Working toward equity in health requires attention to local needs. Organizational health literacy responsiveness is defined as the way health information and resources are made available and accessible to people. This case study aims to investigate the feasibility of the the Organizational Health Literacy Responsiveness (Org-HLR) process in develop...
Article
Aim Among adults aged 20–45 years with type 2 diabetes mellitus, we examined the perceived quality of chronic care, and its associations with (i) sociodemographic and clinical characteristics, and (ii) diabetes distress. Methods In total, 216/460 (47%) completed a self-administered survey assessing sociodemographic characteristics, patient assesse...
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Background: There is no long-term evidence on the effectiveness of training for motivational interviewing in diabetes treatment. Aim: Within a trial of intensive treatment of people with screen-detected diabetes, which included training in motivational interviewing for GPs, the study examined the effect of the intervention on incident cardiovasc...
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Background: Gestational diabetes mellitus (GDM) is associated with an increased risk of future diabetes in both mother, father and offspring. More knowledge is needed about how to effectively reduce the risk of diabetes through sustained behavioural interventions in these families. The Face-it intervention is a complex health promotion interventio...
Article
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For health services, improving organizational health literacy responsiveness is a promising approach to enhance health and counter health inequity. A number of frameworks and tools are available to help organizations boost their health literacy responsiveness. These include the Ophelia (OPtimising HEalth LIteracy and Access) approach centered on lo...
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Health literacy has been identified as an important and changeable intermediary determinant of health equity. Vocational education and training (VET) schools are a relevant setting for health behavior interventions seeking to diminish health inequities because many VET students come from low socio-economic status backgrounds. This study examines VE...
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Diabetes prevention intervention studies in women with previous gestational diabetes have increased, but no consensus exists on core outcomes to support comparisons and synthesis of findings. We aimed to systematically catalogue outcomes in diabetes after pregnancy prevention interventions with the goal of developing a core outcome set. Embase, Med...
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Health literacy (HL) is a dynamic determinant of health and a promising target of health equity interventions in noncommunicable disease prevention. Among people referred to a cardiac rehabilitation program, we examined the associations between (1) HL and participation in cardiac rehabilitation and (2) HL and health-related quality of life (HRQoL)....
Article
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Background: The use of patient-reported outcome (PRO) could potentially contribute to the reorganization of the health care system. AmbuFlex is a PRO system used in remote patient monitoring, in which questionnaires are sent to patients at fixed intervals. The PRO data are used by clinicians to decide whether patients need clinical attention. Bett...
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Background Cardiac tele-rehabilitation is defined as using information and communication technology to support rehabilitation services. However, it requires a high level of patient activation and health literacy; this has not yet been explored. Aims The purpose of this study was to evaluate patient activation and health literacy in tele-rehabilita...
Article
Background Intersectoral coordination of disease prevention is highly complex. The case of women who develop diabetes during pregnancy (GDM) is a case in point: intersectoral coordination mainly concerns diabetes prevention and thus stretches over the life course of women and their families. Our study aims to analyse how health professions through...
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The burden of noncommunicable diseases (NCDs) is increasing worldwide with the European Region of no exception. This poses economic and social challenges, which contribute to persisting health inequities. Sustainable Development Goal (SDG) target 3.4 specifically focuses on reducing premature mortality from NCDs by a third through prevention and tr...
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Background: Early detection of lung disease may help reduce disease development. Detection through preventive health checks may be beneficial. Nevertheless, the knowledge is sparse on how to enhance the participation rate in health checks among citizens at risk of developing lung disease. This study investigates if focused information on spirometr...
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Introduction: Intersectoral coordination typically relates to services that respond to particular needs people are experiencing. This acuteness helps to contain intersectoral coordination in terms of activities, time and target group. In comparison, intersectoral coordination of disease prevention is more complex: it can encompass a broad range of...
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Background: Health literacy is an important, modifiable, social determinant of health. This study aims to explore health literacy challenges of people with long-term illness or multimorbidity and provide detailed profiles revealing health literacy strengths and weaknesses within a Danish population. Methods: In this cross-sectional study among D...
Article
Aims: To establish the prevalence of diabetes distress, perceived stress and depressive symptoms among adults with early-onset Type 2 diabetes, and to examine their association with socio-demographic and clinical characteristics. Methods: A cross-sectional survey was performed among individuals with Type 2 diabetes aged 20-45 years who were incl...