The Dutch healthcare system is facing multiple challenges which have put a strain on the healthcare system in terms of finances and workforce shortages. eHealth offers innovative and promising ways... Show moreThe Dutch healthcare system is facing multiple challenges which have put a strain on the healthcare system in terms of finances and workforce shortages. eHealth offers innovative and promising ways of providing healthcare, including remote and digital care. However, despite the potential of eHealth to transform healthcare and improve patient outcomes, its wide-spread adoption and implementation have been limited. One major obstacle is limited usage, often due to the insufficient engagement of end-users, including patients, in the early design phase. The dissertation underscores the importance of participatory design to actively involve users. Another challenge is the short-term usage of eHealth applications, often a result of inadequate user engagement. The integration of "Persuasive games," incorporating game elements to promote behavioural change, is suggested to enhance engagement and encourage sustained use. The digital divide presents a third challenge, affecting specific user groups like those with limited (e)health literacy. Bridging this gap necessitates not only access to digital technologies but also promoting ehealth literacy and involving users in eHealth development. Moreover, a lack of evidence on the effectiveness of eHealth interventions impedes widespread acceptance. Traditional research designs, like randomized clinical studies, often overlook the complexity of intervention contexts. The dissertation seeks to address these challenges through practical research projects, emphasizing participatory design, evaluating effectiveness in real-world settings, translating and assessing the eHealth Literacy questionnaire, and creating tools for effective knowledge transfer. Advocating for early end-user engagement and a critical review of existing research paradigms, the dissertation offers valuable insights for overcoming challenges and advancing eHealth for improved patient and healthcare outcomes. Show less
Molenaar, J.M.; Boesveld, I.C.; Struijs, J.N.; Jong, J.C.K. de 2023
BackgroundIn 2018, the Dutch government initiated the Solid Start program to provide each child the best start in life. The program focuses on the crucial first thousand days of life, which span... Show moreBackgroundIn 2018, the Dutch government initiated the Solid Start program to provide each child the best start in life. The program focuses on the crucial first thousand days of life, which span from preconception to a child’s second birthday, and has a specific focus towards (future) parents and young children in vulnerable situations. A key program element is improving collaboration between the medical and social sector by creating Solid Start coalitions. This study aimed to describe the implementation of the Dutch Solid Start program, in order to learn for future practice and policy. Specifically, this paper describes to what extent Solid Start is implemented within municipalities and outlines stakeholders’ experiences with the implementation of Solid Start and the associated cross-sectoral collaboration.MethodsQuantitative and qualitative data were collected from 2019 until 2021. Questionnaires were sent to all 352 Dutch municipalities and analyzed using descriptive statistics. Qualitative data were obtained through focus group discussions(n = 6) and semi-structured interviews(n = 19) with representatives of care and support organizations, knowledge institutes and professional associations, Solid Start project leaders, advisors, municipal officials, researchers, clients and experts-by-experience. Qualitative data were analyzed using the Rainbow Model of Integrated Care.ResultsFindings indicated progress in the development of Solid Start coalitions(n = 40 in 2019, n = 140 in 2021), and an increase in cross-sectoral collaboration. According to the stakeholders, initiating Solid Start increased the sense of urgency concerning the importance of the first thousand days and stimulated professionals from various backgrounds to get to know each other, resulting in more collaborative agreements on cross-sectoral care provision. Important elements mentioned for effective collaboration within coalitions were an active coordinator as driving force, and a shared societal goal. However, stakeholders experienced that Solid Start is not yet fully incorporated into all professionals’ everyday practice. Most common barriers for collaboration related to systemic integration at macro-level, including limited resources and collaboration-inhibiting regulations. Stakeholders emphasized the importance of ensuring Solid Start and mentioned various needs, including sustainable funding, supportive regulations, responsiveness to stakeholders’ needs, ongoing knowledge development, and client involvement.ConclusionSolid Start, as a national program with strong local focus, has led to various incremental changes that supported cross-sectoral collaboration to improve care during the first thousand days, without major transformations of systemic structures. However, to ensure the program’s sustainability, needs such as sustainable funding should be addressed. Show less
Schootbrugge-Vandermeer, H.J. van de; Lansdorp-Vogelaar, I.; Jonge, L. de; Vuuren, A.J. van; Dekker, E.; Spaander, M.C.W.; ... ; Toes-Zoutendijk, E. 2023
BackgroundHigh participation rates are essential for a screening programme to be beneficial. To reach non-participants in a targeted manner, insight in characteristics of non-participants is needed... Show moreBackgroundHigh participation rates are essential for a screening programme to be beneficial. To reach non-participants in a targeted manner, insight in characteristics of non-participants is needed. We investigated demographic differences between participants and non-participants in the Dutch faecal immunochemical test-based colorectal cancer (CRC) screening programme.MethodsIn this population-based cohort study, we included all invitees for CRC screening in 2018 and 2019. Participation status, birth year, and sex were extracted from the Dutch national screening information system and linked to demographic characteristics from Statistics Netherlands, including migration background, level of education, socioeconomic category, household composition, and household income. A multivariable logistic regression was used to assess the association between demographic factors and participation.ResultsA total of 4,383,861 individuals were invited for CRC screening in 2018 and 2019, of which 3,170,349 (72.3%) participated. Individuals were less likely to participate when they were single and/or living with others (single with other residents versus couple: odds ratio [OR] 0.34, 95% confidence interval [CI]: 0.31–0.38), had a migration background (e.g. Moroccan migrant versus Dutch background: OR 0.43, 95% CI: 0.42–0.44), or had a low income (lowest versus highest quintile: OR 0.45, 95% CI: 0.44–0.45). Although to a lesser extent, non-participation was also significantly associated with being male, being younger, receiving social welfare benefits and having a low level of education.ConclusionWe found that individuals who were single and/or living with others, immigrants from Morocco or individuals with low income were the least likely to participate in the Dutch CRC screening programme. Targeted interventions are needed to minimise inequities in CRC screening. Show less
