The healthcare landscape is constantly evolving. eHealth (electronic health) presents opportunities to alleviate pressure in healthcare, for example by empowering patients to take more control over... Show moreThe healthcare landscape is constantly evolving. eHealth (electronic health) presents opportunities to alleviate pressure in healthcare, for example by empowering patients to take more control over their care. This thesis has examined various digital applications that have already been (partially) implemented. The research primarily focuses on the user-friendliness and effectiveness of these digital applications, aiming to promote self-management and accessibility of healthcare. The digital applications in this thesis relate to requesting diagnostic tests, both with and without involvement of healthcare professionals. Diagnostic tests enable the detection of conditions, such as sexually transmitted diseases for instance. Additionally, research has been conducted on the effectiveness of a self-management program for asthma and COPD. The results generally indicate that patients and citizens, particularly the younger generation, are receptive to online applications aimed at supporting their self-management of health and illness. Nevertheless, certain factors influence their acceptance, such as reliability and user-friendliness. Therefore, it is essential to promote collaboration among all stakeholders to enhance usability and ensure that online applications effectively meet their intended purpose and objectives. Show less
Aims/hypothesis There is a lack of e-health systems that integrate the complex variety of aspects relevant for diabetes self-management. We developed and field-tested an e-health system (POWER2DM)... Show moreAims/hypothesis There is a lack of e-health systems that integrate the complex variety of aspects relevant for diabetes self-management. We developed and field-tested an e-health system (POWER2DM) that integrates medical, psychological and behavioural aspects and connected wearables to support patients and healthcare professionals in shared decision making and diabetes self-management.Methods Participants with type 1 or type 2 diabetes (aged >18 years) from hospital outpatient diabetes clinics in the Netherlands and Spain were randomised using randomisation software to POWER2DM or usual care for 37 weeks. This RCT assessed the change in HbA(1c) between the POWER2DM and usual care groups at the end of the study (37 weeks) as a primary outcome measure. Participants and clinicians were not blinded to the intervention. Changes in quality of life (QoL) (WHO-5 Well-Being Index [WHO-5]), diabetes self-management (Diabetes Self-Management Questionnaire - Revised [DSMQ-R]), glycaemic profiles from continuous glucose monitoring devices, awareness of hypoglycaemia (Clarke hypoglycaemia unawareness instrument), incidence of hypoglycaemic episodes and technology acceptance were secondary outcome measures. Additionally, sub-analyses were performed for participants with type 1 and type 2 diabetes separately.Results A total of 226 participants participated in the trial (108 with type 1 diabetes; 118 with type 2 diabetes). In the POWER2DM group (n=111), HbA(1c) decreased from 60.6 +/- 14.7 mmol/mol (7.7 +/- 1.3%) to 56.7 +/- 12.1 mmol/mol (7.3 +/- 1.1%) (means +/- SD, p<0.001), compared with no change in the usual care group (n=115) (baseline: 61.7 +/- 13.7 mmol/mol, 7.8 +/- 1.3%; end of study: 61.0 +/- 12.4 mmol/mol, 7.7 +/- 1.1%; p=0.19) (between-group difference 0.24%, p=0.008). In the sub-analyses in the POWER2DM group, HbA(1c) in participants with type 2 diabetes decreased from 62.3 +/- 17.3 mmol/mol (7.9 +/- 1.6%) to 54.3 +/- 11.1 mmol/mol (7.1 +/- 1.0%) (p<0.001) compared with no change in HbA(1c) in participants with type 1 diabetes (baseline: 58.8 +/- 11.2 mmol/mol [7.5 +/- 1.0%]; end of study: 59.2 +/- 12.7 mmol/mol [7.6 +/- 1.2%]; p=0.84). There was an increase in the time during which interstitial glucose levels were between 3.0 and 3.9 mmol/l in the POWER2DM group, but no increase in clinically relevant hypoglycaemia (interstitial glucose level below 3.0 mmol/l). QoL improved in participants with type 1 diabetes in the POWER2DM group compared with the usual care group (baseline: 15.7 +/- 3.8; end of study: 16.3 +/- 3.5; p=0.047 for between-group difference). Diabetes self-management improved in both participants with type 1 diabetes (from 7.3 +/- 1.2 to 7.7 +/- 1.2; p=0.002) and those with type 2 diabetes (from 6.5 +/- 1.3 to 6.7 +/- 1.3; p=0.003) within the POWER2DM group. The POWER2DM integrated e-health support was well accepted in daily life and no important adverse (or unexpected) effects or side effects were observed.Conclusions/interpretation POWER2DM improves HbA(1c) levels compared with usual care in those with type 2 diabetes, improves QoL in those with type 1 diabetes, improves diabetes self-management in those with type 1 and type 2 diabetes, and is well accepted in daily life.Trial registration ClinicalTrials.gov NCT03588104.Funding This study was funded by the European Union's Horizon 2020 Research and Innovation Programme (grant agreement number 689444). Show less
Strengthening social support has been recognized as a potentially effective strategy to enhance parenting self-efficacy, but empirical evidence is limited. This study examined the association... Show moreStrengthening social support has been recognized as a potentially effective strategy to enhance parenting self-efficacy, but empirical evidence is limited. This study examined the association between perceived social support and parenting self-efficacy.Data of 647 parents of children aged 0–8 years, gathered in the CIKEO cohort study in the Netherlands, were analysed. Data were collected between October 2017 and December 2019. Multivariable linear regression models were used to examine the association between social support and parenting self-efficacy. The mean age of the participants was 33.8 years (SD = 4.9); 94.9% mothers. At the start of the study, 15.1% parents perceived low to moderate social support. Parents who experienced lower levels of social support at the start of the study reported lower parenting self-efficacy at follow-up (β: 0.13; 95% CI: 0.05, 0.21), independent of potential socio-demographic confounders. Experiencing an increase in perceived social support during the study period was associated with an increase in parenting self-efficacy (β: 0.15; 95% CI: 0.10, 0.21).Our findings indicate perceived social support is associated with parenting self-efficacy among parents of children aged 0–8 years. Future longitudinal studies need to confirm our findings and may examine which social support interventions are effective in strengthening parenting self-efficacy. Show less
Shen, H.X.; Kleij, R. van der; Boog, P.J.M. van der; Wang, W.J.; Song, X.Y.; Li, Z.Y.; ... ; Chavannes, N. 2022
Background: A growing body of evidence supports the potential effectiveness of electronic health (eHealth) self management interventions in improving disease self-management skills and health... Show moreBackground: A growing body of evidence supports the potential effectiveness of electronic health (eHealth) self management interventions in improving disease self-management skills and health outcomes of patients suffering from chronic kidney disease (CKD). However, current research on CKD eHealth self-management interventions has almost exclusively focused on high-income, western countries. Objective: To inform the adaptation of a tailored eHealth self-management intervention for patients with CKD in China based on the Dutch Medical Dashboard (MD) intervention, we examined the perceptions, attitudes and needs of Chinese patients with CKD and health care professionals (HCPs) towards eHealth based (self -management) interventions in general and the Dutch MD intervention in specific. Methods: We conducted a basic interpretive, cross-sectional qualitative study comprising semi-structured interviews with 11 patients with CKD and 10 HCPs, and 2 focus group discussions with 9 patients with CKD. This study was conducted in the First Affiliated Hospital of Zhengzhou University in China. Data collection continued until data saturation was reached. All data were transcribed verbatim and analyzed using a framework approach. Results: Three themes emerged: (1) experience with eHealth in CKD (self-management), (2) needs for supporting CKD self-management with the use of eHealth, and (3) adaptation and implementation of the Dutch MD intervention in China. Both patients and HCPs had experience with and solely mentioned eHealth to 'inform, monitor and track' as potentially relevant interventions to support CKD self-management, not those to support 'interaction' and 'data utilization'. Factors reported to influence the implementation of CKD eHealth self-management interventions included information barriers (i.e. quality and consistency of the disease-related information obtained via eHealth), perceived trustworthiness and safety of eHealth sources, clinical compatibility and complexity of eHealth, time constraints and eHealth literacy. Moreover, patients and HCPs expressed that eHealth interventions should support CKD self-management by improving the access to reliable and relevant disease related knowledge and optimizing the timeliness and quality of patient and HCPs interactions. Finally, suggestions to adaptation and implementation of the Dutch MD intervention in China were mainly related to improving the intervention functionalities and content of MD such as addressing the complexity of the platform and compatibility with HCPs' workflows. Conclusions: The identified perceptions, attitudes and needs towards eHealth self-management interventions in Chinese settings should be considered by researchers and intervention developers to adapt a tailored eHealth self management intervention for patients with CKD in China. In more detail, future research needs to engage in co creation processes with vulnerable groups during eHealth development and implementation, increase eHealth literacy and credibility of eHealth (information resource), ensure eHealth to be easy to use and well-integrated into HCPs' workflows. Show less
Shen, H.X.; Kleij, R. van der; Boog, P.J.M. van der; Wang, W.J.; Song, X.Y.; Li, Z.Y.; ... ; Chavannes, N. 2022
BackgroundA growing body of evidence supports the potential effectiveness of electronic health (eHealth) self-management interventions in improving disease self-management skills and health... Show moreBackgroundA growing body of evidence supports the potential effectiveness of electronic health (eHealth) self-management interventions in improving disease self-management skills and health outcomes of patients suffering from chronic kidney disease (CKD). However, current research on CKD eHealth self-management interventions has almost exclusively focused on high-income, western countries.ObjectiveTo inform the adaptation of a tailored eHealth self-management intervention for patients with CKD in China based on the Dutch Medical Dashboard (MD) intervention, we examined the perceptions, attitudes and needs of Chinese patients with CKD and health care professionals (HCPs) towards eHealth based (self-management) interventions in general and the Dutch MD intervention in specific.MethodsWe conducted a basic interpretive, cross-sectional qualitative study comprising semi-structured interviews with 11 patients with CKD and 10 HCPs, and 2 focus group discussions with 9 patients with CKD. This study was conducted in the First Affiliated Hospital of Zhengzhou University in China. Data collection continued until data saturation was reached. All data were transcribed verbatim and analyzed using a framework approach.ResultsThree themes emerged: (1) experience with eHealth in CKD (self-management), (2) needs for supporting CKD self-management with the use of eHealth, and (3) adaptation and implementation of the Dutch MD intervention in China. Both patients and HCPs had experience with and solely mentioned eHealth to ‘inform, monitor and track’ as potentially relevant interventions to support CKD self-management, not those to support ‘interaction’ and ‘data utilization’. Factors reported to influence the implementation of CKD eHealth self-management interventions included information barriers (i.e. quality and consistency of the disease-related information obtained via eHealth), perceived trustworthiness and safety of eHealth sources, clinical compatibility and complexity of eHealth, time constraints and eHealth literacy. Moreover, patients and HCPs expressed that eHealth interventions should support CKD self-management by improving the access to reliable and relevant disease related knowledge and optimizing the timeliness and quality of patient and HCPs interactions. Finally, suggestions to adaptation and implementation of the Dutch MD intervention in China were mainly related to improving the intervention functionalities and content of MD such as addressing the complexity of the platform and compatibility with HCPs’ workflows.ConclusionsThe identified perceptions, attitudes and needs towards eHealth self-management interventions in Chinese settings should be considered by researchers and intervention developers to adapt a tailored eHealth self-management intervention for patients with CKD in China. In more detail, future research needs to engage in co-creation processes with vulnerable groups during eHealth development and implementation, increase eHealth literacy and credibility of eHealth (information resource), ensure eHealth to be easy to use and well-integrated into HCPs’ workflows. Show less
Shen, H.X.; Kleij, R. van der; Boog, P.J.M. van der; Wang, W.J.; Song, X.Y.; Li, Z.Y.; ... ; Chavannes, N. 2022
BackgroundA growing body of evidence supports the potential effectiveness of electronic health (eHealth) self-management interventions in improving disease self-management skills and health... Show moreBackgroundA growing body of evidence supports the potential effectiveness of electronic health (eHealth) self-management interventions in improving disease self-management skills and health outcomes of patients suffering from chronic kidney disease (CKD). However, current research on CKD eHealth self-management interventions has almost exclusively focused on high-income, western countries.ObjectiveTo inform the adaptation of a tailored eHealth self-management intervention for patients with CKD in China based on the Dutch Medical Dashboard (MD) intervention, we examined the perceptions, attitudes and needs of Chinese patients with CKD and health care professionals (HCPs) towards eHealth based (self-management) interventions in general and the Dutch MD intervention in specific.MethodsWe conducted a basic interpretive, cross-sectional qualitative study comprising semi-structured interviews with 11 patients with CKD and 10 HCPs, and 2 focus group discussions with 9 patients with CKD. This study was conducted in the First Affiliated Hospital of Zhengzhou University in China. Data collection continued until data saturation was reached. All data were transcribed verbatim and analyzed using a framework approach.ResultsThree themes emerged: (1) experience with eHealth in CKD (self-management), (2) needs for supporting CKD self-management with the use of eHealth, and (3) adaptation and implementation of the Dutch MD intervention in China. Both patients and HCPs had experience with and solely mentioned eHealth to ‘inform, monitor and track’ as potentially relevant interventions to support CKD self-management, not those to support ‘interaction’ and ‘data utilization’. Factors reported to influence the implementation of CKD eHealth self-management interventions included information barriers (i.e. quality and consistency of the disease-related information obtained via eHealth), perceived trustworthiness and safety of eHealth sources, clinical compatibility and complexity of eHealth, time constraints and eHealth literacy. Moreover, patients and HCPs expressed that eHealth interventions should support CKD self-management by improving the access to reliable and relevant disease related knowledge and optimizing the timeliness and quality of patient and HCPs interactions. Finally, suggestions to adaptation and implementation of the Dutch MD intervention in China were mainly related to improving the intervention functionalities and content of MD such as addressing the complexity of the platform and compatibility with HCPs’ workflows.ConclusionsThe identified perceptions, attitudes and needs towards eHealth self-management interventions in Chinese settings should be considered by researchers and intervention developers to adapt a tailored eHealth self-management intervention for patients with CKD in China. In more detail, future research needs to engage in co-creation processes with vulnerable groups during eHealth development and implementation, increase eHealth literacy and credibility of eHealth (information resource), ensure eHealth to be easy to use and well-integrated into HCPs’ workflows. Show less
Objective: To examine the relationship between risk factors for low patient activation and change in patient activation, well-being, and health outcomes in people with type 2 diabetes mellitus ... Show moreObjective: To examine the relationship between risk factors for low patient activation and change in patient activation, well-being, and health outcomes in people with type 2 diabetes mellitus (T2DM). Method: A longitudinal prospective study was conducted with measurements at baseline and 20-week follow-up among 603 people with T2DM participating in a group-based walking intervention. Patient activation and risk factors were assessed using online questionnaires. Health outcomes were assessed in participants' general practices. Results: No association was found between risk factors for activation and change in patient activation. Patient activation significantly increased (t(602) = 2.53, p = 0.012) and was associated with an increase in emotional well-being (beta = 0.22), exercise behavior (beta = 0.17), general diet behavior (beta = 0.20), and a reduction in BMI (beta = -0.28), weight (beta = -0.29), and HbA1c (beta = -0.27). Conclusion: Favorable changes in patient activation, self-management, well-being, and health outcomes occurred during a walking intervention, despite highly prevalent risk factors for low activation and less engagement in self-management. Practice implications: Group-based walking interventions might empower people with T2DM to begin taking a larger role in their self-care and improve (mental) health outcomes. Vulnerable groups of patients (with multiple risk factors for low activation) can change and presumably need this kind of interventions to be able to change. Show less
Solis, E.C.; Carlier, I.V.E.; Wee, N.J.A. van der; Hemert, A.M. van 2021
Background: After regular treatment, patients with persistent depressive disorder (PDD) may remain in specialized psychiatric outpatient care without achieving remission. Lacking other options,... Show moreBackground: After regular treatment, patients with persistent depressive disorder (PDD) may remain in specialized psychiatric outpatient care without achieving remission. Lacking other options, these patients often receive long-term, non-protocolized care as usual (CAU) that does not involve the partner/caregiver of the patient. Although the revised depression treatment guidelines suggest focusing on psychiatric rehabilitation and self-management as the next treatment step for PDD, an evidence-based cost-effective self-management protocol for PDD is lacking. This study investigates the "Patient and Partner Education Program for All Chronic Illnesses" (PPEP4All) as a brief self-management protocol that could lead to lower costs, higher quality of life, and less disease burden in PDD patients and their partners/caregivers.Methods: Presented is the rationale and methods of a multicenter pragmatic randomized controlled trial to evaluate the clinical efficacy and cost-effectiveness of PPEP4All for patients with PDD and their partners/caregivers. In accordance with current recommendations, a mixed methods research approach is used with both quantitative and qualitative data. A total of 178 eligible outpatients with PDD and their partners/caregivers are recruited and randomized to either PPEP4All or CAU. Those assigned to PPEP4All receive nine weekly self-management sessions with a trained PPEP4All therapist. Primary and secondary outcome measurements are at 0, 3, 6, and 12 months.Discussion: This project will result in the implementation of a self-management intervention for patients with PDD, meeting an urgent need in mental healthcare. Using PPEP4All can optimize the quality and efficiency of care for both patients with PDD and their partners/caregivers. Show less
Chronic kidney disease (CKD) poses a major challenge to public health. China, a middle-income country, is the largest country globally with a current population of 1.4 billion. China accounts for... Show moreChronic kidney disease (CKD) poses a major challenge to public health. China, a middle-income country, is the largest country globally with a current population of 1.4 billion. China accounts for around one fifth of the global burden of CKD. Hence, eHealth self-management interventions are a great potential to Chinese populations. An extensively studied CKD self-management eHealth intervention is the Dutch ‘Medical Dashboard (MD)’. It has been demonstrated effective in decreasing the burden of CKD. To aim of this thesis is to inform the adaptation and evaluation of a tailored CKD self-management eHealth intervention in China based on the Dutch MD intervention. Specific characteristics and needs (e.g. facilitators and barriers) in Chinese settings need to be addressed to optimize the implementation of CKD self-management eHealth intervention. Emphasis should be placed on addressing the existing paternalistic patient-HCP relationship, stakeholder involvement in the development and implementation process, adjusting eHealth design features to fit the clinical workflows, and providing the needed support and training. This thesis is a vital step towards the design and implementation of a tailored eHealth solution to improve health outcomes of patients with CKD and address the high burden of CKD in China. Show less
To improve primary diabetes care in the Netherlands, in 2007 a ‘care group’ system is initiated. We first studied the association between adherence to a structured diabetes protocol and patient... Show moreTo improve primary diabetes care in the Netherlands, in 2007 a ‘care group’ system is initiated. We first studied the association between adherence to a structured diabetes protocol and patient outcomes. We then investigated what practices actually require when seeking to adjust care to patient needs. With that aim in mind, we explored the effect of dispensing with protocol and the key conditions for successful implementation of self-management interventions. Finally, we measured patient outcomes with regard to treatment satisfaction, quality of life and monitoring.A structured care protocol has added value for people with diabetes; the proportion of people having recommended monitoring increases sharply. Practices likely undergo an intensive learning process when they join a care group and appear to reach the same as experienced practice within a year. When comparing the HbA1 levels of people with recommended and incomplete monitoring, we found that the HbA1c levels in people with recommended monitoring are significantly circa 2 mmol/mol lower compared to incomplete monitoring. In other words, recommended monitoring is far more than merely an administrative procedure; it actually reflects better real-world HbA1c levels. Differences in HbA1c level between people with recommended versus incomplete monitoring were greater in vulnerable populations, to the extent of approximately 3 mmol/mol, whereas a circa 1 mmol/mol difference was found in the intermediate category. In other words, within a care group setting people in the deprived category derive the most benefit from recommended monitoring.Protocol-free care provided room for reflection concerning ‘tailored care’; varying self-management interventions were chosen Our study revealed three key conditions for successful implementation of self-management interventions. Considering that patient satisfaction and monitoring decreased, this thesis ends with a roadmap consisting of several recommendations to improve and tailor diabetes care in general practice. Show less
van't Land, R.P.; Banga, J.D.; Besselaar, A.M.H.P. van den 2021
Background: The target ranges (TR) for anticoagulation with vitamin K antagonists (VKA) in the Netherlands were changed in 2016 from INR 2.0 & ndash;3.5 (& lsquo;low intensity & rsquo;)... Show moreBackground: The target ranges (TR) for anticoagulation with vitamin K antagonists (VKA) in the Netherlands were changed in 2016 from INR 2.0 & ndash;3.5 (& lsquo;low intensity & rsquo;) and INR 2.5 & ndash;4.0 (& lsquo;high intensity & rsquo;) to INR 2.0 & ndash;3.0 and INR 2.5 & ndash;3.5, respectively.Aim: To assess the effect of the TR change on therapeutic quality control (TQC) in a Dutch regional thrombosis center taking care of approximately 3600 & ndash;5500 patients annually.Methods: TQC of chronically treated patients was assessed as the average time in therapeutic range (TTR). Evaluations were performed for non-self-management (NSM), as well as self-management patients. INR percentiles were assessed from all INR determinations in all patients, i.e. including those of induction episodes and patients treated for a short-term.Results: The number of NSM patients treated chronically decreased gradually, while their average age increased, with a marginal but significant gradual increase in bleeding complications. In the period 2011 & ndash;2015, i.e. before the TR change, there was a gradual increase of the TTR in NSM patients from 77.5% to 88.9% (low intensity) and from 75.3% to 84.1% (high intensity). In the same period, the median INR of all patients in the low and high intensity ranges decreased from 2.9 to 2.7, and from 3.3 to 3.2, respectively. The TTR in self-management patients remained virtually constant. After TR changes from 2016 on, the TTR of all NSM patients in the low and high intensity groups decreased to 77% and 70%, respectively, and median INRs decreased to 2.6 and 3.0, respectively.Conclusions: Introduction of internationally harmonized target ranges in 2016 resulted in further lowering of median INR values in both target ranges. As expected, TTR was reduced slightly. These findings, together with a slight increase in average age and concomitant bleeding complications, suggest that the patients on long-term VKA treatment will require intensified monitoring and treatment. Show less
van't Land, R.P.; Banga, J.D.; Besselaar, A.M.H.P. van den 2021
BackgroundThe target ranges (TR) for anticoagulation with vitamin K antagonists (VKA) in the Netherlands were changed in 2016 from INR 2.0–3.5 (‘low intensity’) and INR 2.5–4.0 (‘high intensity’)... Show moreBackgroundThe target ranges (TR) for anticoagulation with vitamin K antagonists (VKA) in the Netherlands were changed in 2016 from INR 2.0–3.5 (‘low intensity’) and INR 2.5–4.0 (‘high intensity’) to INR 2.0–3.0 and INR 2.5–3.5, respectively.AimTo assess the effect of the TR change on therapeutic quality control (TQC) in a Dutch regional thrombosis center taking care of approximately 3600–5500 patients annually.Methods: TQC of chronically treated patients was assessed as the average time in therapeutic range (TTR). Evaluations were performed for non-self-management (NSM), as well as self-management patients. INR percentiles were assessed from all INR determinations in all patients, i.e. including those of induction episodes and patients treated for a short-term.ResultsThe number of NSM patients treated chronically decreased gradually, while their average age increased, with a marginal but significant gradual increase in bleeding complications. In the period 2011–2015, i.e. before the TR change, there was a gradual increase of the TTR in NSM patients from 77.5% to 88.9% (low intensity) and from 75.3% to 84.1% (high intensity). In the same period, the median INR of all patients in the low and high intensity ranges decreased from 2.9 to 2.7, and from 3.3 to 3.2, respectively. The TTR in self-management patients remained virtually constant. After TR changes from 2016 on, the TTR of all NSM patients in the low and high intensity groups decreased to 77% and 70%, respectively, and median INRs decreased to 2.6 and 3.0, respectively.ConclusionsIntroduction of internationally harmonized target ranges in 2016 resulted in further lowering of median INR values in both target ranges. As expected, TTR was reduced slightly. These findings, together with a slight increase in average age and concomitant bleeding complications, suggest that the patients on long-term VKA treatment will require intensified monitoring and treatment. Show less
Shen, H.X.; Kleij, R. van der; Boog, P.J.M. van der; Song, X.Y.; Wang, W.J.; Zhang, T.T.; ... ; Chavannes, N. 2020
Background: Chronic kidney disease (CKD) is a significant public health concern. In patients with CKD, interventions that support disease self-management have shown to improve health status and... Show moreBackground: Chronic kidney disease (CKD) is a significant public health concern. In patients with CKD, interventions that support disease self-management have shown to improve health status and quality of life. At the moment, the use of electronic health (eHealth) technology in self-management interventions is becoming more and more popular. Evidence suggests that eHealth-based self-management interventions can improve health-related outcomes of patients with CKD. However, knowledge of the implementation and effectiveness of such interventions in general, and in China in specific, is still limited. This study protocol aims to develop and tailor the evidence-based Dutch 'Medical Dashboard' eHealth self-management intervention for patients suffering from CKD in China and evaluate its implementation process and effectiveness.Methods: To develop and tailor a Medical Dashboard intervention for the Chinese context, we will use an Intervention Mapping (IM) approach. A literature review and mixed-method study will first be conducted to examine the needs, beliefs, perceptions of patients with CKD and care providers towards disease (self-management) and eHealth (self-management) interventions (IM step 1). Based on the results of step 1, we will specify outcomes, performance objectives, and determinants, select theory-based methods and practical strategies. Knowledge obtained from prior results and insights from stakeholders will be combined to tailor the core interventions components of the 'Medical Dashboard' self-management intervention to the Chinese context (IM step 2-5). Then, an intervention and implementation plan will be developed. Finally, a 9-month hybrid type 2 trial design will be employed to investigate the effectiveness of the intervention using a cluster randomized controlled trial with two parallel arms, and the implementation integrity (fidelity) and determinants of implementation (IM step 6).Discussion: Our study will result in the delivery of a culturally tailored, standardized eHealth self-management intervention for patients with CKD in China, which has the potential to optimize patients' self-management skills and improve health status and quality of life. Moreover, it will inform future research on the tailoring and translation of evidence-based eHealth self-management interventions in various contexts. Show less
Background: Providing older persons with information about their health status may increase their involvement in their own health and enhance self-management. However, we need a better... Show moreBackground: Providing older persons with information about their health status may increase their involvement in their own health and enhance self-management. However, we need a better understanding of how older persons view their personal results after completing a screening questionnaire on complex health, of their (lack of) motivation and their subsequent action.Methods: In this qualitative study community-dwelling older persons (>= 80 years,n = 13) who completed a screening questionnaire on complex health problems were interviewed regarding their perception of the results, the actions they considered taking and their personal motivations. Data were analysed thematically (qualitative content analyses).Results: Participants expressed interest in feedback, as an objective questionnaire might substantiate their own views regarding their personal health. They were mostly unsurprised by the results and/or had already taken precautions and were therefore not inclined to undertake additional action. They admitted difficulty with and appreciated advice from a professional regarding preparation of an action plan. Unexpected negative results would lead them to discuss matters with family and/or their general practitioner, provided they had a good relationship with their GP.Conclusion: Older people were interested in direct feedback regarding their screening questionnaire results and in subsequent advice on possible additional measures. General practices could consider inviting older persons to complete a screening questionnaire and discuss activities and personal goals. This information could serve to better shape future interventions aimed at increasing self-management amongst older persons. Show less
Khusial, R.J.; Honkoop, P.J.; Usmani, O.; Soares, M.; Simpson, A.; Biddiscombe, M.; ... ; MyAirCoach Study Grp 2020
BACKGROUND: Self-management programs have beneficial effects on asthma control, but their implementation in clinical practice is poor. Mobile health (mHealth) could play an important role in... Show moreBACKGROUND: Self-management programs have beneficial effects on asthma control, but their implementation in clinical practice is poor. Mobile health (mHealth) could play an important role in enhancing self-management.OBJECTIVE: To assess the clinical effectiveness and technology acceptance of myAirCoach-supported self-management on top of usual care in patients with asthma using inhalation medication.METHODS: Patients were recruited in 2 separate studies. The myAirCoach system consisted of an inhaler adapter, an indoor air-quality monitor, a physical activity tracker, a portable spirometer, a fraction exhaled nitric oxide device, and an app. The primary outcome was asthma control; secondary outcomes were exacerbations, quality of life, and technology acceptance. In study 1, 30 participants were randomized to either usual care or myAirCoach support for 3 to 6 months; in study 2, 12 participants were provided with the myAirCoach system in a 3-month before-after study.RESULTS: In study 1, asthma control improved in the intervention group compared with controls (Asthma Control Questionnaire difference, 0.70; P = .006). A total of 6 exacerbations occurred in the intervention group compared with 12 in the control group (hazard ratio, 0.31; P = .06). Asthma-related quality of life improved (mini Asthma-related Quality of Life Questionnaire difference, 0.53; P = .04), but forced expiratory volume in 1 second was unchanged. In study 2, asthma control improved by 0.86 compared with baseline (P = .007) and quality of life by 0.16 (P=.64). Participants reported positive attitudes toward the system.DISCUSSION: Using the myAirCoach support system improves asthma control and quality of life, with a reduction in severe asthma exacerbations. Well-validated mHealth technologies should therefore be further studied. (C) 2020 The Authors. Published by Elsevier Inc. on behalf of the American Academy of Allergy, Asthma & Immunology. This is an open access article under the CC BY-NC-ND license http://creativecommons.org/licenses/by-nc-nd/4.0/). Show less
Background: Post-acute rehabiitation is recommended in the treatment of chronic obstructive pulmonary disease (COPD). It enhances the sense of control by education, which should focus on patient... Show moreBackground: Post-acute rehabiitation is recommended in the treatment of chronic obstructive pulmonary disease (COPD). It enhances the sense of control by education, which should focus on patient information needs. However, it is unknown whether a geriatric rehabilitation programme for older patients with advanced COPD and severely impaired health status (the GR-COPD programme) does fit these patient information needs. Objectives: The study aimed to identify the information needs of patients who were eligible for the GR-COPD programme, and investigated if health-related knowledge improved during rehabilitation. Methods: All patients indicated for the GR-COPD programme were eligible for this study. The information needs were measured with the Lung Information Needs Questionnaire (LINQ). Findings: The 158 patients (mean age 70.8 years; FEV1 %predicted: 35.5) showed relatively high baseline information needs (mean LINQ overall score: 8.6 [SD 3.1]), with the greatest need in the domains 'diet' and 'self-management'. After follow-up, the mean LINQ overall score significantly improved in patients who completed the GR-COPD programme (p=0.001). Conclusion: Patients' knowledge showed a statistically significant improvement in some areas during the GR-COPD programme. Show less
Kaptein, A.A.; Meer, P.B. van der; Florijn, B.W.; Hilt, A.D.; Murray, M.; Schalij, M.J. 2020
Background Understanding representations of disease in various art genres provides insights into how patients and health care providers view the diseases. It can also be used to enhance patient... Show moreBackground Understanding representations of disease in various art genres provides insights into how patients and health care providers view the diseases. It can also be used to enhance patient care and stimulate patient self-management. Methods This paper reviews how cardiovascular diseases are represented in novels, films, and paintings: myocardial infarction, aneurysm, hypertension, stroke, heart transplantation, Marfan's disease, congestive heart failure. Various search systems and definitions were used to help identify sources of representations of different cardiovascular diseases. The representations of the different diseases were considered separately. The Common Sense Model was used a theoretical model to outline illness perceptions and self-management in the various identified novels, films, and paintings. Results Myocardial infarction followed by stroke were the most frequently detailed diseases in all three art genres. This reflects their higher prevalence. Representations ranged from biomedical details through to social and psychological consequences of the diseases. Conclusions Artistic representations of cardiovascular diseases reflect cognitions, emotions, and images of prevalent disease. These representations shape views and behaviour of ill and healthy persons regarding heart diseases. As these representations are amenable to change, they deserve further research, which may be instrumental in improving the quality of life of persons struck by cardiovascular diseases. Changing illness perceptions appears to be a method to improve self-management and thereby quality of life in patients with various cardiovascular diseases. Show less
This dissertation highlights that people with intellectual disabilities (ID) generally have the ability and the desire to manage their affairs more independently, which can positively influence... Show moreThis dissertation highlights that people with intellectual disabilities (ID) generally have the ability and the desire to manage their affairs more independently, which can positively influence their lives. Promoting self-management in people with ID therefore deserves more attention. Whereas previous self-management interventions for people with ID mostly focused on teaching singular practical skills, we aimed to target the promotion of overall self-management. Several barriers are experienced when trying to promote this, such as a lack of time for support staff to guide people with ID, and staff and relatives taking over. What seems necessary is more time and support, next to a clear, tailored, and step-by-step approach. Fostering the transfer of learnt skills to daily life also needs to be considered in interventions, as well as involving the support network of relatives and support staff. Staff need to ensure good communication and coordination between all people involved, adopt a tailored approach, positively encourage people with ID during the learning process, and let them handle things as much as possible themselves. In our evaluations of self-management interventions for people with ID, we concluded that these are generally found to be effective. Show less
People with intellectual disabilities (ID) commonly struggle with managing their affairs, while they consider it important to beindependent. This study aimed to gain insight into the perspectives... Show morePeople with intellectual disabilities (ID) commonly struggle with managing their affairs, while they consider it important to beindependent. This study aimed to gain insight into the perspectives of people with ID, legal representatives, and support staff onpromoting independence in this population. Two focus groups were conducted with people with ID (n= 7), two with legal repre-sentatives (n= 13), and three with support staff (n= 17). Topics included the meaning of independence, the current level andneeds of people with ID regarding their independence, and what they perceived as barriers and requirements when wanting to pro-mote independence in this group. Possible outcomes of a greater independence of people with ID were also discussed. Verbatimtranscripts were analyzed qualitatively with a general inductive approach. According to the respondents, people with ID requiresupport from others, but most want to be more independent. Various barriers are experienced when trying to promote indepen-dence. These concern barriers at the level of support staff (e.g., lack of time), family (e.g., taking over tasks), and of the persons withID themselves (e.g., emotional difficulties). When promoting independence in this population, more support and time seem neces-sary, as well as a clear, step-by-step tailored approach and good communication between all parties involved. Last, several advan-tages (e.g., greater self-worth) and risks (e.g., overestimation by others, greater exposure to hazards) were proposed that couldresult from a greater independence of people with ID. As this study showed that people with ID generally want to become moreindependent. This stresses the need for the development of interventions, which could benefit from thefindings from this study. Show less
Boels, A.M.; Rutten, G.; Zuithoff, N.; Wit, A. de; Vos, R. 2018
