The subjective experience of financial stress has profound implications for well-being, health, cognitive performance, and decision-making. In a sample of Dutch households (N = 1114), we studied... Show moreThe subjective experience of financial stress has profound implications for well-being, health, cognitive performance, and decision-making. In a sample of Dutch households (N = 1114), we studied the association of five economic factors - income, saving, debts, income volatility, and employment - with a four-factor measure of financial stress: 1) an appraisal of insufficient financial resources, 2) an appraisal of lack of control over one's financial situation, 3) financial worries and rumination, and 4) a short-term focus. This enabled us to examine the economic factors' relative contributions to predicting5 financial stress. We found that the combination of economic factors predicted financial stress better than income alone. Particularly, buffer savings had a large contribution to predicting financial stress. The number of debts had a smaller relative contribution to predicting financial stress, whereas we did not find support for debt amount as a predictor of financial stress. Employment was negatively associated with financial stress, but only for households with the lowest incomes. We found no support for income volatility predicting financial stress. These results imply that research and policy on financial stress should have a broader scope than income alone and should take a more integrative approach to households' financial situation, considering savings, number of debts, and unemployment. Show less
Simonse, O.; Dillen, L.F. van; Dijk, W. van; Dijk, E. van 2024
Sociale voorzieningen zoals toeslagen bieden inkomenszekerheid aan financieel kwetsbarehuishoudens. Toch vraagt lang niet iedereen deze voorzieningen aan. Om te achterhalen hoe ditkomt, namen we... Show moreSociale voorzieningen zoals toeslagen bieden inkomenszekerheid aan financieel kwetsbarehuishoudens. Toch vraagt lang niet iedereen deze voorzieningen aan. Om te achterhalen hoe ditkomt, namen we een vragenlijst af bij meer dan 700 Nederlanders die recht hebben op zorgtoeslagen gingen we de straat op om mensen te interviewen die moeten rondkomen van weinig geld. Show less
Boer, H.C. de; Vliet, A. van der; Egelmeers, T.; Koivusaari, S.; Dijk, W. van; Mors, E. ter 2023
Researchers have suggested that the overconsumption of food, alcohol, and drugs could be explained by chronically elevated approach tendencies to rewarding but unhealthy stimuli. Here, we use the... Show moreResearchers have suggested that the overconsumption of food, alcohol, and drugs could be explained by chronically elevated approach tendencies to rewarding but unhealthy stimuli. Here, we use the example of food to show that dysregulated rather than chronically elevated approach tendencies are associated with adverse health outcomes. To this end, we developed a new smartphone-based paradigm to measure dynamic changes in food approach tendencies outside the laboratory (piloted with n = 48). We demonstrated in three preregistered experiments (total N = 367) that food approach tendencies decrease from before to after people have eaten. We further show that in overweight and obese participants, these dynamics are disrupted as their food approach tendencies increase rather than decrease after meals. In addition to showing these effects based on traditional reaction time-based food approach tendencies, we also demonstrate these patterns in a novel measure of response force—a measure that has long been used to study motivation in animals but has received little attention in humans. Together, our findings suggest that both reaction time-based and force-based approach tendencies change dynamically in accordance with people’s need states and that disruptions in these dynamics are associated with adverse health outcomes, such as overweight and obesity. Show less
Dijkstra, R.; Seip, E.C.; Hilgevoord, V.W.; Marr, S.; Dijk, W. van 2023
Background: Implementation of an LHS in cardiology departments presents itself with ethical challenges, including ethical review and informed consent. In this qualitative study, we investigated... Show moreBackground: Implementation of an LHS in cardiology departments presents itself with ethical challenges, including ethical review and informed consent. In this qualitative study, we investigated stakeholders' attitudes toward ethical issues regarding the implementation of an LHS in the cardiology department.Methods: We conducted a qualitative study using 35 semi-structured interviews and 5 focus group interviews with 34 individuals. We interviewed cardiologists, research nurses, cardiovascular patients, ethicists, health lawyers, epidemiologists/statisticians and insurance spokespersons.Results: Respondents identified different ethical obstacles for the implementation of an LHS within the cardiology department. These obstacles were mainly on ethical oversight in LHSs; in particular, informed con sent and data ownership were discussed. In addition, respondents reported on the role of patients in LHS. Respondents described the LHS as a possibility for patients to engage in both research and care. While the LHS can promote patient engagement, patients might also be reduced to their data and are therefore at risk, according to respondents.Conclusions: Views on the ethical dilemmas of a LHSs within cardiology are diverse. Similar to the literary debate on oversight, there are different views on how ethical oversight should be regulated. This study adds to the literary debate on oversight by highlighting that patients wish to be informed about the learning activities within the LHS they participate in, and that they wish to actively contribute by sharing their data and identifying learning goals, provided that informed consent is obtained. Show less
Simonse, O.; Knoef, M.G.; Dillen, L.F. van; Dijk, W. van; Dijk, E. van 2023
We empirically test an integral model for healthcare and child support benefits take-up using a probabilitysample of the Dutch population (N = 905). To examine how different psychological factors,... Show moreWe empirically test an integral model for healthcare and child support benefits take-up using a probabilitysample of the Dutch population (N = 905). To examine how different psychological factors, in conjunction,explain take-up, we apply model averaging with Akaike’s Information Criterion (AICC). For both types ofbenefits, people’s perceptions of eligibility best explain take-up. For healthcare benefits, take-up also relatesto perceptions of need. Exploratory analyses suggest that for healthcare benefits but not for child supportbenefits, executive functions, self-efficacy, fear of reclaims, financial stress, and welfare stigma explainperceived eligibility. We find no support for knowledge, support, and administrative burden as explanatoryfactors in take-up. We discuss the results in relation to the Capability Opportunity Motivation Behaviour(COM-B) model for developing behavioural change interventions. Show less
Simonse, O.; Vanderveen, G.; Dillen, L.F. van; Dijk, W. van; Dijk, E. van 2022
Waarom maken veel financieel kwetsbare huishoudens geen gebruik van sociale voorzieningen, zoals toeslagen? Wij vroegen het aan degenen die dit het beste weten, namelijk mensen met een laag inkomen... Show moreWaarom maken veel financieel kwetsbare huishoudens geen gebruik van sociale voorzieningen, zoals toeslagen? Wij vroegen het aan degenen die dit het beste weten, namelijk mensen met een laag inkomen. In diepte-interviews gaven zij uitgebreid inzicht in de redenen. De overheid staat voor een grote opdracht om hun vertrouwen te herstellen. Maar het kán wel. Show less
Simonse, O.; Dijk, W. van; Dillen, L.F. van; Dijk, E. van 2022
Using longitudinal data before and during the first six months of the COVID-19 pandemic for a representative sample of Dutch households, we examined the role of financial stress, defined as the... Show moreUsing longitudinal data before and during the first six months of the COVID-19 pandemic for a representative sample of Dutch households, we examined the role of financial stress, defined as the subjective experience of lacking financial resources to cope with demands, in mental health changes. Also, we examined financial stress and mental health relations with households’ income, savings, and debts. The data revealed that average mental health did not change during the first six months of the pandemic but showed considerable underlying heterogeneity. Results showed that financial stress changes significantly explained this heterogeneity. Increases in financial stress predicted decreases in mental health, whereas decreases in financial stress predicted increases in mental health. While income did not explain financial stress changes, fewer savings and more debts were related to increased financial stress, which was, in turn, negatively related to mental health. We discuss the implications of our findings for mental health care and financial security policy and provide suggestions for future research. Show less
Dijk, W. van; Werf, M.M.B. van der; Dillen, L.F. van 2022
In nine studies (total N = 12,249), we evaluated the psychometric properties of the Psychological Inventory of Financial Scarcity (PIFS). The PIFS assesses experienced financial scarcity and... Show moreIn nine studies (total N = 12,249), we evaluated the psychometric properties of the Psychological Inventory of Financial Scarcity (PIFS). The PIFS assesses experienced financial scarcity and captures four aspects of this subjective experience: an appraisal of insufficient financial resources, an appraisal of lack of control over one's financial situation, financial rumination and worry, and a short-term focus. Results showed that the PIFS has a good internal consistency (Studies 1-5) and a good test-retest reliability (Study 6). Factor analyses indicated that, as intended, the PIFS can be used both as a one-factor scale and a four-factor scale (Studies 1-5). The predictive and concurrent validity of the PIFS was supported by expected relations with executive functioning (Studies 7-8). Furthermore, results showed that scores on the PIFS explain variance in psychological well-being (mental health, self-esteem, and life satisfaction) over and above personality traits and demographic variables (including income) and mediate the relationship between financial problems and psychological well-being (Study 9). Together, our evaluation indicates that the PIFS is a reliable and valid measure of experienced financial scarcity, and a helpful instrument to study the impact of financial hardship on people's lives. Show less
Velde, L.A. van der; Dijk, W. van; Numans, M.E.; Kiefte-de Jong, J.C. 2022
ObjectiveTo examine whether an extended Theory of Planned Behavior (TPB) that included finance-related barriers better explained dietary quality.DesignCross-sectional survey.ParticipantsOne... Show moreObjectiveTo examine whether an extended Theory of Planned Behavior (TPB) that included finance-related barriers better explained dietary quality.DesignCross-sectional survey.ParticipantsOne-thousand and thirty-three participants were included from a Dutch independent adult panel.Main OutcomeDietary quality.AnalysisFive TPB models were assessed: a traditional TPB, a TPB that included direct associations between attitude and subjective norm with dietary quality, a TPB that additionally included financial scarcity or food insecurity, and a TPB that additionally included financial scarcity and food insecurity simultaneously. Structural relationships among the constructs were tested to compare the explanatory power.ResultsThe traditional TPB showed poorest fit (χ2/degrees of freedom = 11; comparative fit index = 0.75; root mean square error of approximation [95% confidence interval], 0.10 [0.091–0.12]; standardized root mean square residual = 0.049), the most extended TPB (including both financial scarcity and food insecurity) showed best fit (χ2/degrees of freedom = 3.3; comparative fit index = 0.95; root mean square error of approximation [95% confidence interval], 0.050 [0.035–0.065]; standardized root mean square residual = 0.018). All 5 structure models explained ∼42% to 43% of the variance in intention; however, the variance in dietary quality was better explained by the extended TPB models, including food insecurity and/or financial scarcity (∼22%) compared with the traditional TBP (∼7%), indicating that these models better explained differences in dietary quality.Conclusions and ImplicationsThese findings highlight the importance of accounting for finance-related barriers to healthy eating like financial scarcity or food insecurity to better understand individual dietary behaviors in lower socioeconomic groups. Show less
Mors, E. ter; Lelieveld, G.-J.; Noordewier, M.; Vliet, A. van der; Hilgevoord, V.; Dijkstra, R.; Dijk, W. van 2022
Objectives To investigate whether the Charlson Comorbidity Index (CCI) predicted short-term and long-term mortality in patients with a bloodstream infection visiting the emergency department (ED)... Show moreObjectives To investigate whether the Charlson Comorbidity Index (CCI) predicted short-term and long-term mortality in patients with a bloodstream infection visiting the emergency department (ED) and compare it to the often-validated National Early Warning Score (NEWS). Design A retrospective cohort study. Setting A tertiary hospital in the Netherlands. Participants Adult patients attending the ED with a blood culture-proven infection between 2012 and 2017 were included. We collected the comorbidities from the CCI and the vital signs from the NEWS. Main outcomes Short-term mortality (30-day) and long-term mortality (1 year). We assessed the predictive performance by discrimination, expressed as the area under the curve (AUC). Results We included 1039 patients with a blood culture-proven infection. Mortality was 10.4% within 30 days and 27.8% within 1 year. On average patients had two comorbidities (ranging from 0 to 6). Highly prevalent comorbidities were malignancy (30.2%) and diabetes mellitus (20.5%). The predictive performance of the CCI was highest for 1-year mortality (AUC 0.696 (95%CI) (0.660 to 0.732)) and better compared with the NEWS (AUC (95% CI) 0.594 (0.555 to 0.632)). For prediction of 30-day mortality, the NEWS was superior (AUC (95% CI) 0.706 (0.656 to 0.756)) to the comorbidities of the CCI (AUC (95% CI) 0.568 (0.507 to 0.628)). Conclusions We found that presenting comorbidity (ie, the CCI) is most useful to prognosticate long-term outcome in patients with bloodstream infection in the ED. Short-term mortality is more accurately predicted by deviating vital signs (ie, the NEWS). Show less
Werf, M.M.B. van der; Dijk, W. van; Schonewille G.A.; Steeg, M.W. van der; Dillen, L.F. van 2022
Rising student debt, overborrowing among Dutch students, and the complexity of students’ loan decisions signal the need for interventions that evoke more thoughtful loan decisions among Dutch... Show moreRising student debt, overborrowing among Dutch students, and the complexity of students’ loan decisions signal the need for interventions that evoke more thoughtful loan decisions among Dutch students. In a large field experiment (N= 48,700) we addressed this need by testing interventions that encourage them to recalibrate their monthly loan amount. We compared a control condition to four interventions, in which we provided students with different kinds of personalised information about the future costs of their student loan and about how easily the height can be adjusted. Although all interventions increased recalibration, the intervention that provided students with the most elaborate personalised information about the future costs of their student loan yielded the most stable effects. These students were more likely to decrease their monthly loan amount (OR=1.28 [95% CI: 1.08, 1.52]), and when they did, they decreased it to a larger extent (B=−4.28 [95% CI: −7.99, −0.57]) than students in the control condition. Limitations and policy implications will be discussed. Show less
Dijkstra, R.; Vliet, A. van der; Dijk, W. van 2022
De Nederlandse woningmarkt kent een aantal urgente problemen. 1 De huizenprijzen blijven stijgen waardoor de toegankelijkheid verslechtert. Daarnaast zijn kopers, met name starters, steeds meer... Show moreDe Nederlandse woningmarkt kent een aantal urgente problemen. 1 De huizenprijzen blijven stijgen waardoor de toegankelijkheid verslechtert. Daarnaast zijn kopers, met name starters, steeds meer bereid financiële risico’s te nemen om daadwerkelijk een huis te bemachtigen, en dit koopgedrag maakt hen financieel kwetsbaar. 2 Een belangrijke oorzaak van de huidige problemen op de woningmarkt is de schaarste aan beschikbare woonruimte. Het geraamde woningtekort was 279.000 woningen begin 2021, en zal naar verwachting nog verder oplopen. 3 Het wordt daarom steeds moeilijker om aan een passende woning te komen, zowel voor kopers als huurders. Show less
ObjectiveClinical practice universally assumes that appropriate empirical antibiotic therapy improves survival in patients with bloodstream infection. However, this is not generally supported by... Show moreObjectiveClinical practice universally assumes that appropriate empirical antibiotic therapy improves survival in patients with bloodstream infection. However, this is not generally supported by previous studies. We examined the association between appropriate therapy and 30-day mortality, while minimizing bias due to confounding by indication.MethodsWe conducted a retrospective cohort study between 2012 and 2017 at a tertiary university hospital in the Netherlands. Adult patients with bloodstream infection attending the emergency department were included. Based on in vitro susceptibility, antibiotic therapy was scored as appropriate or inappropriate. Primary outcome was 30-day mortality. To control for confounding, we performed conventional multivariable logistic regression and propensity score methods. Additionally, we performed an analysis in a more homogeneous subgroup (i.e. antibiotic monotherapy).ResultsWe included 1.039 patients, 729 (70.2%) received appropriate therapy. Overall 30-day mortality was 10.4%. Appropriately treated patients had more unfavorable characteristics, indicating more severe illness. Despite adjustments, we found no association between appropriate therapy and mortality. For the antibiotic monotherapy subgroup (n = 449), patient characteristics were more homogeneous. Within this subgroup, appropriate therapy was associated with lower mortality (Odds Ratios [95% Confidence Intervals] ranging from: 0.31 [0.14; 0.67] to 0.40 [0.19; 0.85]).ConclusionsComparing heterogeneous treatment groups distorts associations despite use of common methods to prevent bias. Consequently, conclusions of such observational studies should be interpreted with care. If possible, future investigators should use our method of attempting to identify and analyze the most homogeneous treatment groups nested within their study objective, because this minimizes residual confounding. Show less
Mors, E. ter; Dijk, W. van; Lans, A.; Droog, M.; Leeuwen, E.A.C. van; Staats, H.J.A.M.; ... ; Bos, B. 2018
