Annsofie Adolfsson

About Annsofie Adolfsson

Associate Professor Adolfsson has completed his PhD at the age of 46 years from Linköping University and postdoctoral studie from University of Washington, Seattle, US and Skovde University colleger of Sweden. She is the Professor of University college of southeast Norway and Associate Professor of Örebro University Medical sciences. Se has published more than 58 papers in reputed journals and has been speaker at several conferences and reviewer at journals.

EKC-Model gives empathy knowledge and care to women in their issue during the reproductive health life approach to caring requires that healthcare workers are also knowledgeable in how to confirm that a patient has suffered one or more suspected miscarriage or IUFD. Through understanding and training in the EKC approach healthcare professionals increase their ability to be sympathetic and empathetic to a patient’s needs, whether they are meeting with them or talking to them on the telephone.

Sexual and Reproductive Health and how interact in peoples and families life’s and physical and psychological health and wellbeing. Sexual and Reproductive Health is a cross-sectional science and include medicine, psychology, sociology and caring science. In the area of Spontaneous Abortion, Miscarriage, Invitro fertilization and Adoption. Widespread Sexual Violence: Impact on post assault reproductive health practices by women victims and on health system.

Intimate knowledge about how the grieving process works is essential to be able to provide optimum support to the patient. It may be that this support gives them the courage to try to conceive again. One key aspect of the EKO-model is open and clear communication between the healthcare personnel and the patient, whether face-to-face or remotely. The structured EKC conversation provides a viable tool to help healthcare professionals assist patients in coming to terms with their loss.

Research shows that, when the EKC-model is used, patients feel that they have received the proper professional care when they needed it. The EKC-model recommends offering to meet the patient one or two times but more sessions can be scheduled as necessary.

The MODIAB-Web RESEARCH PROJECT

The overall aim of the MODIAB-Web research project was to investigate well-being and diabetes management in women with type 1 diabetes mellitus (T1DM) during pregnancy and in early motherhood the first six months after childbirth.

This was studied through explorative, observational studies, a qualitative interview study, and through an intervention with a randomized controlled study (RCT) design. In the RCT, we tested a web-based support program directed to the women with T1DM during pregnancy and up to six months after childbirth. The study is reported in 14 scientific papers^1-14, 11 Abstracts in proceedings of scientific conferences (7 poster and 4 oral presentations), one PhD thesis, 4 master thesis, and two popular scientific publications. 

To capture the needs and usefulness, content and layout of the Web support was developed based on a synthesis of existing scientific evidence including a specific questionnaire to the target group¹¹, and including essential theories, and through a participatory design. Participating stakeholders were project managers, advisory and scientific reference groups, technical producers, and mothers with T1DM³. Overall guiding theoretical perspective for the web-based support was to have a person-centered approach¹⁰. Guiding theories focused: participatory design, learning (“communities of practice”), salutogenesis, social support and transition to motherhood^9,10. In a substudy we described and compared the Modiab-web project with another three person-centered internet based support projects, although with different target groups and different theoretical perspectives¹⁴.

The Web-based support consisted of three main components^2,3: 1) specific information about pregnancy, childbirth, and early motherhood in relation to type 1 diabetes^7,13; 2) a self-care diary, including a device for documenting and evaluating blood glucose levels, insulin doses, food intake, physical activities, and overall well-being; and 3) a forum for communication between women with type 1 diabetes in the childbearing period. The software prototype was pilot tested by a group of mothers with T1DM¹ and some minor changes were made in the final version of the web- support. The RCT with web-based support compared to only usual care was offered in the RCT November 2011 to March 2016, first at two hospital based antenatal care units, and successively another four hospital based antenatal care units in Sweden were added. No changes of the web support was done during the study period, except adding some specific information on miscarriage¹³. The hypothesis was that women receiving web-based support in addition to usual care to a higher degree should manage their diabetes and have a higher degree of well-being^2,3 at 6 months after birth compared to the control group receiving only standard care².

In early pregnancy, a higher degree of diabetes management correlated positively with self-perceived health and well-being and with less worry about diabetes distress and hypoglycemia. This was found in the whole composite group, both control group and intervention group, measured before the web-based support was offered⁸. 

The web-based support and standard care was not superior to standard care alone in terms of general well-being or self-efficacy of diabetes management at six months postpartum. Few participants had a high activity level⁵. We critically analysed the adherence to the technological elements and study design in the web-based intervention and found that technology and study design do matter and might mutually influence each other, particularly when it includes components of social support. We also made some essential recommendations when planning for and running a web based support and also questioned if it is optimal to evaluated a such intervention with the use of an RCT¹².

Associations between well-being, diabetes management and breastfeeding postpartum were investigated in the composite group of control- and intervention group. Women who experienced less negative impact of breastfeeding on daily diabetes management routines reported significantly better well-being, sense of coherence and self-efficacy of diabetes management. Unstable blood glucose levels were associated with lower degree of well-being two months after childbirth. Participants with lower scores of general well-being and sense of coherence expressed a need for more professional support to manage their diabetes than they were provided⁶. A qualitative study on the episode after birth identified that becoming a mother was a turning point towards a greater awareness and acceptance of prioritizing diabetes management and health. To reprioritize life comprised three parts: adjusting to motherhood, taking command of the diabetes, and seeking like-minded women. There was a gap in provision of diabetes care after birth and during the time of early motherhood compared with during pregnancy⁴.

In conclusion: Becoming a mother is related to increased demands for women with type 1 diabetes mellitus, and the findings confirm that well-being and diabetes management are closely linked during the childbearing period^5,6,8. The web-based support did not show any higher degree of diabetes management and wellbeing⁵, but this can be explained by study design, technical devises and the contemporary development of medico-technical devises for managing diabetes¹². More research is needed to identify the needs for support in everyday living, also to identify the most vulnerable women with T1DM in pregnancy as well as the first months after having given birth. Providing alternative sources for health information and peer support could improve the situation during this season of life. Further evaluated interventions are needed to identify optimal models of perinatal care for women with diabetes mellitus.  

References

1. Adolfsson A, Jansson M. Prototype for Internet support of pregnant women and mothers with type 1 diabetes: focus group testing. Psychology research and behavior management 2012; 5: 97.

2. Adolfsson A, Linden K, Sparud-Lundin C, Larsson PG, Berg M. A web-based support for pregnant women and new mothers with type 1 diabetes mellitus in Sweden (MODIAB-Web): study protocol for a randomized controlled trial. Trials 2014; 15(1): 513.

3. Berg M, Adolfsson A, Ranerup A, Sparud-Lundin C. Person-centered Web support to women with type 1 diabetes in pregnancy and early motherhood--the development process. Diabetes technology & therapeutics 2013; 15(1): 20-5.

4. Carlsson I-M, Berg M, Adolfsson A, Sparud-Lundin C. Reprioritizing life: A conceptual model of how women with type 1 diabetes deal with main concerns in early motherhood. International Journal Of Qualitative Studies On Health And Well-Being 2017.

5. Linden K, Berg M, Adolfsson A, Sparud-Lundin C. Person-centred, web-based support in pregnancy and early motherhood for women with Type 1 diabetes mellitus: a randomized controlled trial. Diabetic medicine : a journal of the British Diabetic Association 2018; 35(2): 232-41.

6. Linden K, Berg M, Adolfsson A, Sparud-Lundin C. Well-being, diabetes management and breastfeeding in mothers with type 1 diabetes - An explorative analysis. Sex Reprod Healthc 2018; 15: 77-82.

7. Linden K, Berg M, Sparud-Lundin C. Web-based information for pregnant women and new mothers with type 1 diabetes-a description of the development process. BMC Medical Informatics and Decision Making 2012; 12(1): 134.

8. Linden K, Sparud-Lundin C, Adolfsson A, Berg M. Well-Being and Diabetes Management in Early Pregnant Women with Type 1 Diabetes Mellitus. International journal of environmental research and public health 2016; 13(8).

9. Ranerup A, Sparud-Lundin C, Koinberg I, Skärsäter I, Jenholt-Nolbris M, Berg M. Role of Theories in the Design of Web-Based Person-Centered Support: A Critical Analysis. International Journal of Chronic Diseases 2014: 9.

10. Sparud-Lundin C, Josefsson U, Berg M, et al. Use of participatory design in the development of person-centred web-based support for persons with long-term illness. European Journal for Person Centered Healthcare 2013; 1(2): 369-80.

11. Sparud-Lundin C, Ranerup A, Berg M. Internet use, needs and expectations of web-based information and communication in childbearing women with type 1 diabetes. BMC Med Inform Decis Mak 2011; 11: 49.

12. Berg M, Linden K, Adolfsson A, Sparud Lundin C, Ranerup A. Web-Based Intervention for Women With Type 1 Diabetes in Pregnancy and Early Motherhood: Critical Analysis of Adherence to Technological Elements and Study Design. Journal of medical Internet research 2018; 20(5): e160.

13. Adolfsson A, Arbhede E, Marklund E, Larsson P-G, Berg M. Miscarriage - Evidence Based Information for the Web and Its Development Procedure. 2015.

14. Josefsson U, Berg M, Koinberg I, et al. Person-centred web-based support - development through a Swedish multi-case study.(Case study). BMC Medical Informatics and Decision Making 2013; 13(1).

Date 2018-08-27