Håvar Brendryen

• Potthoff, Sebastian; Brendryen, Håvar; Bosnic, Haris; Bhardwaj-Gosling, Rashmi; Iden, Kristina Riis & Njå, Anne-Lill Mjølhus [Show all 8 contributors for this article] (2026). Implementing pragmatic case finding to address alcohol use in general practice: a mixed methods feasibility study. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 44(1), p. 1–13. doi: 10.1080/02813432.2025.2598835. Full text in Research Archive Show summary

  Background Screening and brief interventions (SBIs) for alcohol use are effective but challenging to implement in primary care settings. Universal screening is resource-intensive and may not align with general practitioners’ (GPs) perceived professional role. Pragmatic case finding (PCF), which integrates alcohol discussions into clinically relevant contexts, may provide a feasible alternative to traditional SBI. Aim This study aimed to assess the feasibility and acceptability of tailored, theory-based educational outreach visits (EOVs) to embed PCF in primary care, explore its influence on professional practice in addressing alcohol, and examine changes in determinants of GP behaviour pre- and post-implementation. Design and setting Four EOVs were delivered in GP clinics in Stavanger and Oslo, Norway, involving 37 GPs and 22 support staff, to enhance GPs’ ability to manage alcohol-related health problems. Method A mixed-methods feasibility study comprising semi-structured group interviews and quantitative surveys. Group interviews explored GPs’ experiences, while the Determinants of Implementation Behaviour Questionnaire (DIBQ) assessed changes in knowledge, skills and intentions. Qualitative data were thematically analysed. Quantitative data were analysed using descriptive statistics. Results GPs (n = 10) perceived the EOVs as feasible and acceptable, preferring in-person over remote delivery. Key themes included greater awareness of alcohol’s health impacts, sustaining awareness of hidden cases, reducing stigma through normalised discussions, and balancing motivation with the challenge of changing entrenched habits. Survey findings (n = 19) showed a gradual, positive shift in GPs’ knowledge, skills, and goals to discuss alcohol. Conclusion The EOVs were feasible and acceptable for embedding PCF in primary care. They may strengthen GPs’ capacity to address alcohol in routine consultations, but further research is needed to assess fidelity, sustainability, and patient-level outcomes.

• Ericson, Øystein Bruun; Eide, Desiree; Brendryen, Håvar; Lobmaier, Philipp Paul & Clausen, Thomas (2024). Scaling up! Staff e-learning for a national take-home naloxone program. Frontiers in Digital Health. 6. doi: 10.3389/fdgth.2024.1404646. Full text in Research Archive
• Potthoff, Sebastian; Brendryen, Håvar; Bosnic, Haris; Njå, Anne-Lill Mjølhus; Finch, Tracy & Lid, Torgeir Gilje (2024). Recommendations for implementing digital alcohol interventions in primary care: lessons learned from a Norwegian feasibility study. Frontiers in Health Services. 4. doi: 10.3389/frhs.2024.1343568. Full text in Research Archive Show summary

  Introduction: Excessive alcohol consumption is a leading global risk factor for ill-health and premature death. Digital alcohol interventions can be effective at reducing alcohol consumption, but their widespread adoption is lagging behind. This study aimed to identify factors promoting or inhibiting the implementation of a digital alcohol intervention in Norwegian primary care, by using Normalization Process Theory (NPT). Methods: A mixed methods feasibility study combining quantitative and qualitative methods. A digital alcohol intervention called “Endre” was implemented across four GP practices in Stavanger and Oslo. Usage of the intervention was logged on the digital platform. General practitioners (GPs) reported their perceived uptake of the intervention via a web-based survey. The Normalization MeAsure Development (NoMAD) survey was used to measure support staff's perceived normalization of the intervention. Qualitative data were analyzed using the NPT framework, with quantitative data analyzed descriptively and using χ2 and Wilcoxon signed-rank test for differences in current and future normalization. Results: Thirty-seven GPs worked in the clinics and could recruit patients for the digital intervention. Thirty-six patients registered for the intervention. Nine patients dropped out early and 25 completed the intervention as intended. Low normalization scores at follow-up (n = 27) indicated that Endre did not become fully embedded in and across practices. Nonetheless, staff felt somewhat confident about their use of Endre and thought it may become a more integral part of their work in the future. Findings from six semi-structured group interviews suggested that limited implementation success may have been due to a lack of tailored implementation support, staff's lack of involvement, their diminished trust in Endre, and a lack of feedback on intervention usage. The outbreak of the Covid-19 pandemic further limited opportunities for GPs to use Endre. Conclusion: This study investigated the real-world challenges of implementing a digital alcohol intervention in routine clinical practice. Future research should involve support staff in both the development and implementation of digital solutions to maximize compatibility with professional workflows and needs. Integration of digital solutions may further be improved by including features such as dashboards that enable clinicians to access and monitor patient progress and self-reported outcomes.

• Baumel, Amit; Brandes, Or; Brendryen, Håvar; Muench, Fred; Kane, John M. & Saar, Chen (2023). The impact of therapeutic persuasiveness on engagement and outcomes in unguided interventions: A randomized pilot trial of a digital parent training program for child behavior problems. Internet Interventions. ISSN 2214-7829. 34. doi: 10.1016/j.invent.2023.100680. Full text in Research Archive
• Kulhánek, Adam; Lukavska, Katerina; Gabrhelík, Roman; Novák, Daniel; Burda, Václav & Prokop, Jindřich [Show all 8 contributors for this article] (2022). Comparing Reminders Sent via SMS Text Messaging and Email for Improving Adherence to an Electronic Health Program: Randomized Controlled Trial. JMIR mhealth and uhealth. 10(3), p. e31040–e31040. doi: 10.2196/31040. Full text in Research Archive
• Potthoff, Sebastian; O'Donnell, Amy Jane; Karlsen, Andrea Taksdal; Brendryen, Håvar & Lid, Torgeir Gilje (2022). Pragmatic approaches for addressing alcohol in general practice: Development of a tailored implementation intervention. Frontiers in Health Services. 2. doi: 10.3389/frhs.2022.940383. Full text in Research Archive
• Holter, Marianne Therese Smogeli; Ness, Ottar; Johansen, Ayna Beate & Brendryen, Håvar (2020). Making Come-Alive and Keeping Un-Alive: How People Relate to Self-Guided Web-Based Health Interventions. Qualitative Health Research. ISSN 1049-7323. 30(6), p. 927–941. doi: 10.1177/1049732320902456. Full text in Research Archive Show summary

  Health interventions delivered online (self-guided web-based interventions) may become more helpful through a person-to program “working alliance.” In psychotherapy, the working alliance signifies a therapeutically useful client–therapist relationship and includes an emotional bond. However, there exist no theories of how program users relate to online programs, or that explain a person-to-program bond theoretically. Addressing this gap, we conducted qualitative interviews with and collected program data from users of a self-guided web-based intervention. Using grounded theory, the analysis arrived at a model of relating based on two relational modes—making comealive and keeping un-alive. Different combinations of these modes could describe a range of ways of relating to the program, including a nonsocial interaction, a semi-social interaction, and a semi-social relationship. A person-to-program bond is explained by the model as an experienced supportive social presence, enabled by making come-alive and a positive program interaction.

• Johansen, Ayna Beate; Helland, Pål Fylling; Wennesland, Dag Kosòl; Henden, Edmund & Brendryen, Håvar (2019). Exploring online problem gambler's motivation to change. Addictive Behaviors Reports. ISSN 2352-8532. 10(100187), p. 1–6. doi: 10.1016/j.abrep.2019.100187. Full text in Research Archive Show summary

  The treatment for drug addiction is considered a difficult path for the most of patients. As matter of fact, individuals with Substance Use Disorder (SUD) experience numerous challenges before, during and after the treatment (e.g. tackling an unpredictable, uncertain and paradoxically negative future, tackling the anxiety and anticipatory fear of physical pain associated with abstinence; decide to go beyond self-justification and selfdeception). Courage could be considered a positive and functional resource to help people with SUD to face challenges and difficulties related to treatment. In connection therewith, the aim of this study was to examine, using an embedded mix method analysis, the personal stories of courage of 80 individuals with SUD in order to identify the themes and types of courage used in their life. The analysis carried out showed that individuals with SUD reported more frequently stories of courage related to their SUD condition respect to other life situation. Moreover, the quantitative analysis showed that participants used more frequently psychological courage respect to moral and physical courage when these stories were referred to their SUD condition then other life situations.

• Danaher, Brian G; Tyler, Milagra S.; Crowley, Ryann C.; Brendryen, Håvar & Seeley, John R. (2019). Outcomes and Device Usage for Fully Automated Internet Interventions Designed for a Smartphone or Personal Computer: The MobileQuit Smoking Cessation Randomized Controlled Trial. Journal of Medical Internet Research (JMIR). ISSN 1439-4456. 21(6), p. e13290–e13290. doi: 10.2196/13290. Full text in Research Archive Show summary

  Background: Many best practice smoking cessation programs use fully automated internet interventions designed for nonmobile personal computers (desktop computers, laptops, and tablets). A relatively small number of smoking cessation interventions have been designed specifically for mobile devices such as smartphones. Objective: This study examined the efficacy and usage patterns of two internet-based best practices smoking cessation interventions. Methods: Overall, 1271 smokers who wanted to quit were randomly assigned to (1) MobileQuit (designed for—and constrained its use to—mobile devices, included text messaging, and embodied tunnel information architecture) or (2) QuitOnline (designed for nonmobile desktop or tablet computers, did not include text messages, and used a flexible hybrid matrix-hierarchical information architecture). Primary outcomes included self-reported 7-day point-prevalence smoking abstinence at 3- and 6-month follow-up assessments. Program visits were unobtrusively assessed (frequency, duration, and device used for access). Results: Significantly more MobileQuit participants than QuitOnline participants reported quitting smoking. Abstinence rates using intention-to-treat analysis were 20.7% (131/633) vs 11.4% (73/638) at 3 months, 24.6% (156/633) vs 19.3% (123/638) at 6 months, and 15.8% (100/633) vs 8.8% (56/638) for both 3 and 6 months. Using Complete Cases, MobileQuit’s advantage was significant at 3 months (45.6% [131/287] vs 28.4% [73/257]) and the combined 3 and 6 months (40.5% [100/247] vs 25.9% [56/216]) but not at 6 months (43.5% [156/359] vs 34.4% [123/329]). Participants in both conditions reported their program was usable and helpful. MobileQuit participants visited their program 5 times more frequently than did QuitOnline participants. Consistent with the MobileQuit’s built-in constraint, 89.46% (8820/9859) of its visits were made on an intended mobile device, whereas 47.72% (691/1448) of visits to QuitOnline used an intended nonmobile device. Among MobileQuit participants, 76.0% (459/604) used only an intended mobile device, 23.0% (139/604) used both mobile and nonmobile devices, and 0.1% (6/604) used only a nonmobile device. Among QuitOnline participants, 31.3% (137/438) used only the intended nonmobile devices, 16.7% (73/438) used both mobile and nonmobile devices, and 52.1% (228/438) used only mobile devices (primarily smartphones). Conclusions: This study provides evidence for optimizing intervention design for smartphones over a usual care internet approach in which interventions are designed primarily for use on nonmobile devices such as desktop computers, laptops. or tablets. We propose that future internet interventions should be designed for use on all of the devices (multiple screens) that users prefer. We forecast that the approach of designing internet interventions for mobile vs nonmobile devices will be replaced by internet interventions that use a single Web app designed to be responsive (adapt to different screen sizes and operating systems), share user data across devices, embody a pervasive information architecture, and complemented by text message notifications.

• Holter, Marianne T. S.; Ness, Ottar; Johansen, Ayna Beate & Brendryen, Håvar (2019). Getting Change-Space: A Grounded Theory Study of Automated eHealth Therapy. The Qualitative Report (TQR). ISSN 1052-0147. 24(7), p. 1636–1657. doi: 10.46743/2160-3715/2019.3988. Full text in Research Archive Show summary

  A promising tool for bettering people’s health is eHealth (or “mHealth”) programs: fully automated, web-based health interventions. However, we know surprisingly little about eHealth’s working mechanisms. One possible working mechanism is that program users benefit from a collaborative “relationship”—a “working alliance”—with the program. Although evidence support the existence of a person-to-program alliance it is unclear if and how it influences change. Therefore, we conducted a grounded theory study of how relating to an eHealth program for quitting smoking influenced the participants’ change processes. The ensuing model focuses on how participants got change-space—feeling free from social forcing and able to work constructively on changing—and how the relational processes “making come-alive” and “keeping un-alive” were instrumental in this process. By presenting evidence that relating may influence change in automated therapy, this study supports the person-to-program alliance as a working mechanism in eHealth.

• Holter, Marianne T. S.; Johansen, Ayna Beate; Ness, Ottar; Brinkmann, Svend; Høybye, Mette Terp & Brendryen, Håvar (2019). Qualitative Interview Studies of Working Mechanisms in Electronic Health: Tools to Enhance Study Quality. Journal of Medical Internet Research (JMIR). ISSN 1439-4456. 21(5). doi: 10.2196/10354. Full text in Research Archive Show summary

  Future development of eHealth programs (automated web-based health interventions) will be furthered ifprogram design can be based on knowledge of eHealth’s working mechanisms. A promising and pragmaticmethod for exploring potential working mechanisms is qualitative interview studies, in which eHealthworking mechanisms can be explored through the perspective of the program user. Qualitative interviewstudies are promising because they are suited for exploring what is yet unknown, building new knowledgeand constructing theory. They are also pragmatic, because the development of eHealth programs oftenentails user interviews for applied purposes (e.g. getting feedback for program improvement or identifyingbarriers for implementation). By capitalizing on these existing (applied) user interviews to also pursue (basic)research questions of how such programs work, the knowledge base of eHealth’s working mechanisms cangrow quickly. To be useful, such interview studies need to be of sufficient quality, which entails that theinterviews should generate enough data of sufficient quality relevant to the research question (i.e. “richdata”). However, getting rich interview data on eHealth working mechanisms can be surprisingly challenging,as several of the authors have experienced. Moreover, when encountering difficulties as we did, there arefew places to turn to: there are currently no guidelines for conducting such interview studies in a way thatensure their quality. In this paper, we build on our experience as well as the qualitative literature to addressthis need, by describing five challenges that may arise in such interviews and presenting methodologicaltools to counteract each challenge. We hope the ideas we offer will spark methodological reflections andprovide some options for researchers interested in using qualitative interview studies to explore eHealth’sworking mechanisms.

• Kulhánek, Adam; Gabrhelík, Roman; Novák, Daniel; Burda, Václav & Brendryen, Håvar (2018). eHealth intervention for smoking cessation for Czech tobacco smokers: Pilot study of user acceptance. Adiktologie. ISSN 1213-3841. 18(2), p. 81–85. Full text in Research Archive
• Riper, Heleen; Hoogendoorn, Adriaan; Cuijpers, Pim; Karyotaki, Eirini; Boumparis, Nikolaos & Mira, Adriana [Show all 30 contributors for this article] (2018). Effectiveness and treatment moderators of internet interventions for adult problem drinking: An individual patient data meta-analysis of 19 randomised controlled trials. Nature Methods. ISSN 1548-7091. 15:e1002714(12), p. 1–26. doi: 10.1371/journal.pmed.1002714. Full text in Research Archive
• Brendryen, Håvar; Johansen, Ayna Beate; Duckert, Fanny & Nesvåg, Sverre (2017). A Pilot Randomized Controlled Trial of an Internet-Based Alcohol Intervention in a Workplace Setting. International Journal of Behavioral Medicine. ISSN 1070-5503. 24(5), p. 768–777. doi: 10.1007/s12529-017-9665-0. Full text in Research Archive
• Bewick, Bridgette M; Ondersma, Steven J; Hoybye, Mette; Blakstad, Oskar; Blankers, Matthijs & Brendryen, Håvar [Show all 12 contributors for this article] (2017). Erratum to: Key Intervention Characteristics in e-Health: Steps Towards Standardized Communication. International Journal of Behavioral Medicine. ISSN 1070-5503. p. 1–1. doi: 10.1007/s12529-017-9658-z. Full text in Research Archive
• Bewick, Bridgette M; Ondersma, Steven J; Høybye, Mette T; Blakstad, Oskar; Blankers, Matthijs & Brendryen, Håvar [Show all 12 contributors for this article] (2017). Key Intervention Characteristics in e-Health: Steps Towards Standardized Communication. International Journal of Behavioral Medicine. ISSN 1070-5503. 24(5), p. 659–664. doi: 10.1007/s12529-016-9630-3. Full text in Research Archive
• Bjelland, Ingerid Elgesem; Johansen, Ayna Beate; Darnell, Farnad & Brendryen, Håvar (2017). Using a Film Intervention in Early Addiction Treatment: a Qualitative Analysis of Process. International Journal of Behavioral Medicine. ISSN 1070-5503. 24(5), p. 740–748. doi: 10.1007/s12529-017-9654-3. Full text in Research Archive
• Holter, Marianne Therese Smogeli; Johansen, Ayna Beate & Brendryen, Håvar (2016). How a Fully Automated eHealth Program Simulates Three Therapeutic Processes: A Case Study. Journal of Medical Internet Research (JMIR). ISSN 1439-4456. 18(6), p. e176–e176. doi: 10.2196/jmir.5415. Full text in Research Archive Show summary

  Background: eHealth programs may be better understood by breaking down the components of one particular program and discussing its potential for interactivity and tailoring in regard to concepts from face-to-face counseling. In the search for the efficacious elements within eHealth programs, it is important to understand how a program using lapse management may simultaneously support working alliance, internalization of motivation, and behavior maintenance. These processes have been applied to fully automated eHealth programs individually. However, given their significance in face-to-face counseling, it may be important to simulate the processes simultaneously in interactive, tailored programs. Objective: We propose a theoretical model for how fully automated behavior change eHealth programs may be more effective by simulating a therapist’s support of a working alliance, internalization of motivation, and managing lapses. Methods: We show how the model is derived from theory and its application to Endre, a fully automated smoking cessation program that engages the user in several “counseling sessions” about quitting. A descriptive case study based on tools from the intervention mapping protocol shows how each therapeutic process is simulated. Results: The program supports the user’s working alliance through alliance factors, the nonembodied relational agent Endre and computerized motivational interviewing. Computerized motivational interviewing also supports internalized motivation to quit, whereas a lapse management component responds to lapses. The description operationalizes working alliance, internalization of motivation, and managing lapses, in terms of eHealth support of smoking cessation. Conclusions: A program may simulate working alliance, internalization of motivation, and lapse management through interactivity and individual tailoring, potentially making fully automated eHealth behavior change programs more effective.

• Danaher, Brian; Brendryen, Håvar; Seeley, John R.; Tyler, Milagra S. & Woolley, Tim (2015). From black box to toolbox: Outlining device functionality, engagement activities, and the pervasive information architecture of mHealth interventions. Internet Interventions. ISSN 2214-7829. 2(1), p. 91–101. doi: 10.1016/j.invent.2015.01.002. Full text in Research Archive
• Drozd, Filip; Haga, Silje Marie; Brendryen, Håvar & Slinning, Kari (2015). An Internet-Based Intervention (Mamma Mia) for Postpartum Depression: Mapping the Development from Theory to Practice. JMIR Research Protocols. 4(4). doi: 10.2196/resprot.4858. Full text in Research Archive Show summary

  Background: As much as 10-15% of new mothers experience depression postpartum. An Internet-based intervention (Mamma Mia) was developed with the primary aims of preventing depressive symptoms and enhancing subjective well-being among pregnant and postpartum women. A secondary aim of Mamma Mia was to ease the transition of becoming a mother by providing knowledge, techniques, and support during pregnancy and after birth. Objective: The aim of the paper is to provide a systematic and comprehensive description of the intervention rationale and the development of Mamma Mia. Methods: For this purpose, we used the intervention mapping (IM) protocol as descriptive tool, which consists of the following 6 steps: (1) a needs assessment, (2) definition of change objectives, (3) selection of theoretical methods and practical strategies, (4) development of program components, (5) planning adoption and implementation, and (6) planning evaluation. Results: Mamma Mia is a fully automated Internet intervention available for computers, tablets, and smartphones, intended for individual use by the mother. It starts in gestational week 18-24 and lasts up to when the baby becomes 6 months old. This intervention applies a tunneled design to guide the woman through the program in a step-by-step fashion in accordance with the psychological preparations of becoming a mother. The intervention is delivered by email and interactive websites, combining text, pictures, prerecorded audio files, and user input. It targets risk and protective factors for postpartum depression such as prepartum and postpartum attachment, couple satisfaction, social support, and subjective well-being, as identified in the needs assessment. The plan is to implement Mamma Mia directly to users and as part of ordinary services at well-baby clinics, and to evaluate the effectiveness of Mamma Mia in a randomized controlled trial and assess users’ experiences with the program. Conclusions: The IM of Mamma Mia has made clear the rationale for the intervention, and linked theories and empirical evidence to the contents and materials of the program. This meets the recent calls for intervention descriptions and may inform future studies, development of interventions, and systematic reviews.

• Brendryen, Håvar; Lund, Ingunn Olea; Johansen, Ayna; Riksheim, Marianne; Nesvåg, Sverre & Duckert, Fanny (2014). Balance-a pragmatic randomized controlled trial of an online intensive self-help alcohol intervention. Addiction. ISSN 0965-2140. 109(2), p. 218–226. doi: 10.1111/add.12383. Full text in Research Archive Show summary

  Aims To compare a brief versus a brief plus intensive self-help version of ‘Balance’, a fully automated online alcohol intervention, on self-reported alcohol consumption. Design A pragmatic randomized controlled trial. Participants in both conditions received an online single session screening procedure including personalized normative feedback. The control group also received an online booklet about the effects of alcohol. The treatment group received the online multi-session follow-up program, Balance. Setting Online study in Norway. Participants At-risk drinkers were recruited by internet advertisements and assigned randomly to one of the two conditions ( n = 244). Measurements The primary outcome was self-reported alcohol consumption the previous week measured 6 months after screening. Findings Regression analysis, using baseline carried forward imputation (intent-to-treat), with baseline variables as covariates, showed that intervention significantly affected alcohol consumption at 6 months (B = 2.96; 95% confidence interval = 0.02–5.90; P = 0.049). Participants in the intensive self-help group drank an average of three fewer standard alcohol units compared with participants in the brief self-help group. Conclusions The online Balance intervention, added to a brief online screening intervention, may aid reduction in alcohol consumption compared with the screening intervention and an educational booklet

• Lund, Ingunn Olea; Brendryen, Håvar & Ravndal, Edle (2014). A longitudinal study on substance use and related problems in women in opioid maintenance treatment from pregnancy to four years after giving birth. Substance Abuse: Research and Treatment. 8, p. 35–40. doi: 10.4137/SaRt.S15055. Full text in Research Archive Show summary

  Women in opioid maintenance treatment (OMT) have a past characterized by drug abuse, which is a challenging start for parenthood. Studies of mothers in OMT are typically limited to pregnancy and early infancy. Knowledge about how they cope with substance use and related problems in the years following birth is therefore important. The aims of the study were to examine changes in mothers' substance use, psychological problems, and other challenges; from one to four years after their children were born, and describe kindergarten attendance and prevalence and type of child protective services involvement when the children were four years old. A four-year prospective cohort study of mothers in OMT. The European severity index was used to map substance use and related problems during the third trimester of pregnancy, one and four years after birth. At the four-year follow-up, use of illegal substances remained low (4%) and use of legal substances (39%) was similar to the one-year follow-up. The proportion of women with psychological problems was significantly higher than at one-year follow-up (69 vs. 39%, P = 0.009). At age four, most children (89%) attended kindergarten, and the child protective services were following 73% of the families, mostly with voluntary measures. Mothers in OMT cope well with substance use over time, given access to sufficient support. The findings imply that a preventive governmental strategy with close support of mother and child, have a positive impact contributing to making OMT and motherhood more compatible.

• Johansen, Ayna; Brendryen, Håvar; Darnell, Farnad & Wennesland, Dag Kosòl (2013). Practical support aids addiction recovery: the positive identity model of change. BMC Psychiatry. 13. doi: 10.1186/1471-244X-13-201. Full text in Research Archive Show summary

  Background There is a need for studies that can highlight principles of addiction recovery. Because social relationships are involved in all change processes, understanding how social motivations affect the recovery process is vital to guide support programs. Methods The objective was to develop a model of recovery by examining addicted individuals’ social motivations through longitudinal assessment of non-professional support dyads. A qualitative, longitudinal study design was used, combining focus groups and in-depth interviews with addicted individuals and their sponsors. Data were analyzed using the principles of grounded theory: open coding and memos for conceptual labelling, axial coding for category building, and selective coding for theory building. The setting was an addiction recovery social support program in Oslo, Norway. The informants included nine adults affected by addiction, six sponsors, and the program coordinator. The participants were addicted to either alcohol (2), benzodiazepines (1), pain killers (1) or polydrug-use (5). The sponsors were unpaid, and had no history of addiction problems. Results Support perceived to be ineffective emerged in dyads with no operationalized goal, and high emotional availability with low degree of practical support. Support perceived to be effective was signified by the sponsor attending to power imbalance and the addict coming into position to help others and feel useful. Conclusions The findings appear best understood as a positive identity-model of recovery, indicated by the pursuit of skill building relevant to a non-drug using identity, and enabled by the on-going availability of instrumental support. This produced situations where role reversals were made possible, leading to increased self-esteem. Social support programs should be based on a positive identity-model of recovery that enable the building of a life-sustainable identity.

• Haga, Silje Marie; Drozd, Filip; Brendryen, Håvar & Slinning, Kari (2013). Mamma Mia: A Feasibility Study of a Web-Based Intervention to Reduce the Risk of Postpartum Depression and Enhance Subjective Well-Being. JMIR Research Protocols. 2(2). doi: 10.2196/resprot.2659. Full text in Research Archive Show summary

  Background: Currently, 10-15% of women giving birth suffer from symptoms of postpartum depression. Due to a lack of knowledge of this condition and the stigma associated with it, as well as few treatment options, a large proportion of postpartum women with depression remain untreated. Internet-based interventions have been found effective in treating depression, anxiety, phobias, and addictions. Hence, we developed such program (“Mamma Mia”) with the aim of reducing the risk for postpartum depression and enhance subjective well-being. Mamma Mia is based on positive psychology, metacognitive therapy, and couples therapy. It starts in gestational week 22, and lasts until 6 months after birth. During pregnancy, Mamma Mia is delivered weekly (every Monday). After birth, Mamma Mia is delivered three times per week for six weeks. The remaining weeks, the program is delivered more sporadically. In total, Mamma Mia consists of 44 sessions. The program is individualized, interactive, and tunneled (ie, the user is guided through the program in a pre-determined manner). Objective: The purpose of the present study was to pilot test the intervention in order to assess the feasibility and acceptance among program users. Methods: The present paper reports a feasibility study that combined quantitative survey data with semi-structured interviews. Participants (N=103) were recruited via hospitals, well-baby clinics, and Facebook. Due to time constraint in completing the current study, our results were based on participation in one of the two phases: pregnancy or maternity. Participants in the pregnancy phase were surveyed 4 and 8 weeks after intervention enrollment, and participants in the postnatal phase were surveyed 2 and 4 weeks after intervention enrollment. The survey assessed perceived usefulness, ease-of-use, credibility, and unobtrusiveness. All measures were filled in by participants at both measurement occasions. Data were analyzed by running descriptives and frequencies with corresponding percentages. Binomial tests were carried out to investigate whether demographics differed significantly from a 50/50 distribution. Paired sample t tests were used to examine differences between time 1 and 2. Four participants were interviewed in the qualitative follow-up study, where they were given the opportunity to address and elaborate on similar aspects as assessed in the survey. Results: More than two-thirds of users found Mamma Mia to be of high quality and would recommend Mamma Mia to others. By far, most also found the amount of information and frequency of the intervention schedule to be appropriate. Mamma Mia was perceived as a user-friendly and credible intervention. Conclusions: Overall, the user acceptance of Mamma Mia was good and our findings add to the feasibility of the program. The effect of Mamma Mia on depression and subjective well-being will be evaluated in a large randomized controlled trial, and if found to be effective, Mamma Mia could serve as a low-threshold prevention program.

• Brendryen, Håvar; Johansen, Ayna; Nesvåg, Sverre; Kok, Gerjo & Duckert, Fanny (2013). Constructing a Theory- and Evidence-Based Treatment Rationale for Complex eHealth Interventions: Development of an Online Alcohol Intervention Using an Intervention Mapping Approach. Journal of Medical Internet Research (JMIR). ISSN 1439-4456. 2(1). doi: 10.2196/resprot.2371. Full text in Research Archive
• Brendryen, Håvar; Kraft, Pål & Schaalma, Herman (2010). Looking Inside the Black Box: Using Intervention Mapping to Describe the Development of the Automated Smoking Cessation Intervention ‘Happy Ending’. Journal of Smoking Cessation. 5(1), p. 29–56. Full text in Research Archive Show summary

  The digital therapy intervention for smoking cessation, ‘Happy Ending’, has been shown to be efficacious in two previous randomised controlled trials. The aim of the current article is to disentangle the rationale of the intervention and describe its development. For this purpose, Intervention Mapping is used as a descriptive tool. The intervention is fully automated and delivered by means of the Internet and mobile phones. It is based on self-regulation theory, social cognitive theory, cognitive– behaviour therapy, motivational interviewing and relapse prevention. The ordering of the content is based on a reasoned chronology, modelled according to psychological processes that people experience at certain time points in a process of therapy-supported self-regulation. The design of the intervention is innovative in that it combines four media channels (SMS, IVR, e-mail, and web), and in the combination of just-in-time therapy and a tunnelling strategy based on the natural chronology of quitting. The two forms of just-in-time therapy are a craving helpline (mainly targeting negative affect), and the provision of relapse therapy based on a daily assessment of the target behaviour. The present article meets the recent calls for more thorough descriptions of interventions, and may inform systematic reviews and the development of interventions.

• Brendryen, Håvar (2009). Happy Ending: The significance of age for treatment efficacy and intervention adherence. Research and Practice of Health Promotion. ISSN 1432-3214. 14, p. 79–88. Full text in Research Archive
• Brendryen, Håvar & Kraft, Pål (2008). Happy Ending: a randomized controlled trial of a digital multi-media smoking cessation intervention. Addiction. ISSN 0965-2140. 103. doi: 10.1111/j.1360-0443.2007.02119.x. Full text in Research Archive
• Brendryen, Håvar; Drozd, Filip & Kraft, Pål (2008). A Digital Smoking Cessation Program Delivered Through Internet and Cell Phone Without Nicotine Replacement (Happy Ending): Randomized Controlled Trial. Journal of Medical Internet Research (JMIR). ISSN 1439-4456. 10(5). doi: 10.2196/jmir.1005. Full text in Research Archive Show summary

  Background: Happy Ending (HE) is an intense 1-year smoking cessation program delivered via the Internet and cell phone. HE consists of more than 400 contacts by email, Web pages, interactive voice response, and short message service technology. HE includes a craving helpline and a relapse prevention system, providing just-in-time therapy. All the components of the program are fully automated. Objective: The objectives were to describe the rationale for the design of HE, to assess the 12-month efficacy of HE in a sample of smokers willing to attempt to quit without the use of nicotine replacement therapy, and to explore the potential effect of HE on coping planning and self-efficacy (prior to quitting) and whether coping planning and self-efficacy mediate treatment effect. Methods: A two-arm randomized controlled trial was used. Subjects were recruited via Internet advertisements and randomly assigned to condition. Inclusion criteria were willingness to quit on a prescribed day without using nicotine replacement and being aged 18 years or older. The intervention group received HE, and the control group received a 44-page self-help booklet. Abstinence was defined as “not even a puff of smoke, for the last seven days” and was assessed by means of Internet surveys or telephone interviews 1, 3, 6, and 12 months postcessation. The main outcome was repeated point abstinence (ie, abstinence at all four time points). Coping planning and self-efficacy were measured at baseline and at the end of the preparation phase (ie, after 2 weeks of treatment, but prior to cessation day). Results: A total of 290 participants received either the HE intervention (n=144) or the control booklet (n=146). Using intent-to-treat analysis, participants in the intervention group reported clinically and statistically significantly higher repeated point abstinence rates than control participants (20% versus 7%, odds ratio [OR] = 3.43, 95% CI = 1.60-7.34, P = .002). Although no differences were observed at baseline, by the end of the preparation phase, significantly higher levels of coping planning (t261 = 3.07, P = .002) and precessation self-efficacy (t261 = 2.63, P = .01) were observed in the intervention group compared with the control group. However, neither coping planning nor self-efficacy mediated long-term treatment effect. For point abstinence 1 month after quitting, however, coping planning and self-efficacy showed a partial mediation of the treatment effect. Conclusions: This 12-month trial documents a long-term treatment effect of a fully automated smoking cessation intervention without the use of nicotine replacement therapy. The study adds to the promise of using digital media in supporting behavior change.

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• Novák, Daniel; Brendryen, Håvar & Tulu, Bangisu (2015). Handbook of Research on Holistic Perspectives in Gamification for Clinical Practice. IGI Global. ISBN 9781466695221. 637 p. Full text in Research Archive

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• Holter, Marianne Therese Smogeli; Ness, Ottar; Johansen, Ayna & Brendryen, Håvar (2015). Challenges in qualitative interviewing about user experience in eHealth: Moving beyond the superficial user interview. Full text in Research Archive
• Drozd, Filip; Haga, Silje Marie; Brendryen, Håvar & Slinning, Kari (2015). Tjenesteutvikling fra teori til praksis – Utviklingen av en internett intervensjon (‘Mamma Mia’) for helsestasjonene. Full text in Research Archive Show summary

  Bakgrunn: Mamma Mia er en internettbasert selvhjelpsintervensjon utviklet for å forebygge fødselsdepresjon og fremme god psykisk helse hos mor og barn, fra svangerskap til barnet er om lag 6 måneder. Målgruppen er alle gravide, og programmet er gratis og åpent tilgjengelig via Norske Kvinners Sanitetsforening. En målsetting er å tilby programmet til alle gravide, men forskning viser at spredning og implementering av internett intervensjoner i helsetjenestene er en stor utfordring. Formål: Hensikten er derfor å gi en systematisk beskrivelse av en ny internett-basert tjeneste for helsestasjonen som inkluderer utviklingen av intervensjonen, men også arbeidet knyttet til implementeringen av Mamma Mia. Metode: Til dette formålet har vi brukt ‘Intervention Mapping’ (IM) protokollen. IM danner et rammeverk for utvikling og beskrivelse av intervensjoner, hvor hver fase og beslutning baserer seg på teori og empiri. IM består av 6 trinn; (1) behovsanalyse, (2) definisjon av læringsmål, (3) seleksjon av teori-baserte og praktiske metoder, (4) utvikling av innhold, (5) planlegging av implementeringen og (6) planlegging av prosess- og effektevaluering. Resultater: Gjennom IM-protokollen av Mamma Mia, samt intervjuer av deltakere i programmet, ble det avdekket et behov for å implementere Mamma Mia som en del av det ordinære helsevesenet, primært gjennom helsestasjonene. En viktig forutsetning er at jordmødre og helsesøstre er godt kjent med Mamma Mia. Opplæring i Mamma Mia bør knyttes opp mot temaer som jordmødre og helsesøstre er pålagt å dekke under konsultasjoner med gravide og barselkvinner, og deres partnere gjennom nasjonale retningslinjer. Valg av teori-baserte og praktiske metoder i opplæringen bygger på metodene som er brukt i Mamma Mia, og som er beskrevet i IM-protokollen (f.eks. Trygghetssirkelen, elementer fra Nyfødt observasjon og subjektiv velvære). Opplæringen inkluderer en veileder for implementeringen av Mamma Mia. Jordmødre og helsesøstre får tildelt praktiske oppgaver med å forberede og iverksette Mamma Mia i sin helsestasjonstjeneste mellom opplæringsdagene. Utviklingen av implementeringsveilederen har i sin tur bidratt til kvalitetsutvikling av Mamma Mia, ved å re-designe programmet om til et veiledet tiltak hvor jordmødre og helsesøstre både vil oppmuntre gravide og barselkvinner til å ta programmet i bruk, og styrke bruken ved å være faglig samtalepartnere og veiledere for de som trenger noe ekstra. Dette har gjennom tidligere forskning vist å styrke gjennomføringsgraden og effekten av internett intervensjoner. Planen er å evaluere opplæringen og gjøre en implementeringspilot med de første helsestasjonene som melder seg på opplæringen. Konklusjon: Bruk av IM-metodikken har bidratt til utviklingen av opplæringen i Mamma Mia og en veileder for implementering på helsestasjonene. Fremtidig evaluering vil avgjøre effekten av opplæringen og implementeringen, men denne studien viser hvordan en systematisk dokumentering av intervensjonsutvikling kan danne grunnlaget for og bidra til utviklingen av nye tiltak for helsetjenestene for foreldre og barn.

• Brendryen, Håvar; Danaher, Brian G; Johansen, Ayna & Holter, Marianne Therese Smogeli (2014). Testing the Efficacy of an Automated Lapse Management System: an RCT-Protocol of an Internet-Delivered Smoking Cessation Intervention. Full text in Research Archive
• Brendryen, Håvar; Johansen, Ayna; Lund, Ingunn Olea; Riksheim, Marianne; Nesvåg, Sverre & Duckert, Fanny (2014). Effekten av et nettbasert program for alkoholforebygging (Balance). Full text in Research Archive
• Lund, Ingunn Olea; Brendryen, Håvar & Ravndal, Edle (2014). Mødre i LAR: Rus og relaterte problemer over tid? Rus & samfunn. ISSN 1500-8614. 8. årgang(4), p. 16–18. Full text in Research Archive
• Brendryen, Håvar (2014). eHealth Interventions in Addiction Treatment. Full text in Research Archive
• Danaher, Brian G; Seeley, John R; Brendryen, Håvar & Tylor, Milagra S (2014). Smartphone Smoking Cessation Intervention: Features & Planned RCT. Full text in Research Archive
• Brendryen, Håvar (2014). Lapse management systems in online interventions for alcohol and smoking cessation. Full text in Research Archive
• Holter, Marianne Therese Smogeli; Brendryen, Håvar; Johansen, Ayna & Danaher, Brian G (2014). What’s therapeutic alliance got to do with it? A qualitative (ongoing) study of how the user’s relationship to an eHealth program for smoking cessation might be important for program adherence and treatment outcome. Full text in Research Archive
• Brendryen, Håvar (2013). Internett og mobiltelefon som verktøy for å hjelpe folk ut av avhengighet. Full text in Research Archive
• Brendryen, Håvar (2013). Evaluering av tidlig-intervensjoner for alkohol. Full text in Research Archive
• Brendryen, Håvar; Duckert, Fanny; Nesvåg, Sverre & Johansen, Ayna (2012). An RCT of a web-based early-intervention for hazardous drinkers. Full text in Research Archive
• Johansen, Ayna; Franzen, Elizabeth; Bjelland, Ingerid Elgesem; Wennesland, Dag Kosòl & Brendryen, Håvar (2012). Toward a theory of working alliance in media-based addiction treatment. Full text in Research Archive
• Brendryen, Håvar (2011). Testing the feasibility and acceptance of an internet based early-intervention for at-risk student drinkers. Full text in Research Archive
• Brendryen, Håvar; Duckert, Fanny & Nesvåg, Sverre (2011). An RCT of an internet based early intervention for alcohol. Full text in Research Archive
• Brendryen, Håvar (2010). Testing the feasibility and acceptance of an internet based early-intervention for at-risk drinkers. Full text in Research Archive
• Brendryen, Håvar & Kraft, Pål (2008). Preventing relapse in a digital smoking cessation intervention. Full text in Research Archive
• Brendryen, Håvar (2008). Happy Ending and age. Full text in Research Archive
• Kraft, Pål & Brendryen, Håvar (2008). A digital smoking cessation intervention evaluated as an information system. Full text in Research Archive
• Brendryen, Håvar (2008). The Implications of Advances in Information Technology (IT): The Happy Ending Experience. Full text in Research Archive
• Brendryen, Håvar; Kraft, Pål & Drozd, Filip (2007). Two randomized controlled trials of a digital smoking cessation program. Full text in Research Archive
• Brendryen, Håvar; Kraft, Pål & Drozd, Filip (2007). Facilitating happy endings for motivated quitters – Two randomized controlled trials of a digital smoking cessation program. Full text in Research Archive
• Brendryen, Håvar & Kraft, Pål (2006). Happy Ending: A randomized controlled trial of an internet and cell-phone based smoking cessation intervention. Full text in Research Archive
• Brendryen, Håvar & Kraft, Pål (2006). En randomisert kontrollert studie av en automatisert røykesluttintervensjon basert på bruk av internett og mobiltelefon. Full text in Research Archive
• Brendryen, Håvar & Kraft, Pål (2006). A RCT of an internet and cell-phone based smoking cessation intervention. Psychology and Health. ISSN 0887-0446. 21, p. 23–24. Full text in Research Archive
• Brendryen, Håvar (2011). Utprøving av Balance blant studenter - Balance er bra ... men ikke for meg. AKAN - Arbeidslivets kompetansesenter for rus- og avhengighetsproblematikk.. ISSN 9788299813426. Full text in Research Archive
• Brendryen, Håvar (2009). Digital Behavior Change Interventions and smoking Cessation: Testing the Efficacy and Describing the Rationale of a Fully Automated Smoking Cessation Intervention (Happy Ending), delivered by means of the Internet, Computers and Cell-Phones. Universitetet i Oslo. Full text in Research Archive

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