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
There is an increasing number of adults who suffer from cardiovascular diseases (CVD). These patients would benefit from a healthy lifestyle, as this improves the prognosis of CVD. However, even... Show moreThere is an increasing number of adults who suffer from cardiovascular diseases (CVD). These patients would benefit from a healthy lifestyle, as this improves the prognosis of CVD. However, even though improving one’s health and lifestyle is the focus of cardiac rehabilitation, CVD patients need support to also maintain a healthy lifestyle after their rehabilitation has ended. Even though the support of a healthcare professional seems to be an important factor in successful lifestyle change, there are barriers that hinder professionals from providing lifestyle support, such as a lack of time or expertise. Since the involvement of healthcare professionals is also not always possible or desirable, it is important to further investigate possibilities to provide patients with a self-help eHealth intervention. In such self-help eHealth interventions, feedback is automatically provided, making the interference of a healthcare professional no longer needed. However, self-help eHealth interventions can suffer from a low uptake and a low level of adherence. This PhD dissertation therefore focuses on (1) mapping out the needs and wishes of both healthcare professionals and CVD patients with regard to (human-supported and self-help) eHealth lifestyle interventions, and (2) investigating if and how self-help eHealth lifestyle interventions could be optimised. Show less
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
This thesis has demonstrated the use of mobile health devices for up to three months after cardiothoracic surgery. Mobile health devices, as used in this thesis, were found to increase... Show moreThis thesis has demonstrated the use of mobile health devices for up to three months after cardiothoracic surgery. Mobile health devices, as used in this thesis, were found to increase postoperative atrial fibrillation detection, which may also positively impact complications such as ischemic stroke. Moreover, this thesis demonstrated a positive impact of mobile health on both blood pressure and cholesterol level outcomes, which is hypothesized to be related to an increased patient engagement. Potential pitfalls of mobile health are mHealth literacy in both patients and healthcare providers, data integration and data safety. Future researchers are advised to focus on these factors when implementing or improving mobile health interventions. Show less
Hei, S.J. van de; Kim, C.H.; Honkoop, P.J.; Sont, J.K.; Schermer, T.R.J.; MacHale, E.; ... ; J.F.M. van boven 2023
BACKGROUND: Digital inhalers can monitor inhaler usage, support difficult-to-treat asthma management, and inform step-up treatment decisions yet their economic value is unknown, hampering wide... Show moreBACKGROUND: Digital inhalers can monitor inhaler usage, support difficult-to-treat asthma management, and inform step-up treatment decisions yet their economic value is unknown, hampering wide-scale implementation.OBJECTIVE: We aimed to assess the long-term cost-effective-ness of digital inhalerebased medication adherence management in difficult-to-treat asthma.METHODS: A model-based cost-utility analysis was performed. The Markov model structure was determined by biological and clinical understanding of asthma and was further informed by guideline-based assessment of model development. Internal and external validation was performed using the Assessment of the Validation Status of Health-Economic (AdViSHE) tool. The INCA (Inhaler Compliance Assessment) Sun randomized clinical trial data were incorporated into the model to evaluate the cost-effectiveness of digital inhalers. Several long-term clin-ical case scenarios were assessed (reduced number of exacer-bations, increased asthma control, introduction of biosimilars [25% price-cut on biologics]). RESULTS: The long-term modelled cost-effectiveness based on a societal perspective indicated 1-year per-patient costs for digital inhalers and usual care (ie, regular inhalers) of euro7,546 ($7,946) and euro10,752 ($11,322), respectively, reflecting cost savings of euro3,207 ($3,377) for digital inhalers. Using a 10-year interven-tion duration and time horizon resulted in cost savings of euro26,309 ($27,703) for digital inhalers. In the first year, add-on biologic therapies accounted for 69% of the total costs in the usual care group and for 49% in the digital inhaler group. Scenario analyses indicated consistent cost savings ranging from euro2,287 ($2,408) (introduction biosimilars) to euro4,581 ($4,824) (increased control, decreased exacerbations). CONCLUSIONS: In patients with difficult-to-treat asthma, digital inhaler -based interventions can be cost-saving in the long-term by optimizing medication adherence and inhaler technique and reducing add-on biologic prescriptions.(c) 2023 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 license (http:// creativecommons.org/licenses/by/4.0/) Show less
Tailored motivational messages are helpful to motivate people in eHealth applications for increasing physical activity, but it is not sufficiently clear how such messages can be effectively... Show moreTailored motivational messages are helpful to motivate people in eHealth applications for increasing physical activity, but it is not sufficiently clear how such messages can be effectively generated in advance. We, therefore, put forward a theory-driven approach to generating tailored motivational messages for eHealth applications for behavior change, and we examine its feasibility by assessing how motivating the resulting messages are perceived. For this, we designed motivational messages with a specific structure that was based on an adaptation of an existing ontology for tailoring motivational messages in the context of physical activity. To obtain tailored messages, experts in health psychology and coaching successfully wrote messages with this structure for personas in scenarios that differed with regard to the persona's mood, self-efficacy, and progress. Based on an experiment in which 60 participants each rated the perceived motivational impact of six generic and six tailored messages based on scenarios, we found credible support for our hypothesis that messages tailored to mood, self-efficacy, and progress are perceived as more motivating. A thematic analysis of people's free-text responses about what they found motivating and demotivating about motivational messages further supports the use of tailored messages, as well as messages that are encouraging and empathetic, give feedback about people's progress, and mention the benefits of physical activity. To aid future work on motivational messages, we make our motivational messages and corresponding scenarios publicly available. Show less
Aims Lowering low-density lipoprotein (LDL-C) and blood pressure (BP) levels to guideline recommended values reduces the risk of major adverse cardiac events in patients who underwent coronary... Show moreAims Lowering low-density lipoprotein (LDL-C) and blood pressure (BP) levels to guideline recommended values reduces the risk of major adverse cardiac events in patients who underwent coronary artery bypass grafting (CABG). To improve cardiovascular risk management, this study evaluated the effects of mobile health (mHealth) on BP and cholesterol levels in patients after standalone CABG.Methods and results This study is a post hoc analysis of an observational cohort study among 228 adult patients who underwent standalone CABG surgery at a tertiary care hospital in The Netherlands. A total of 117 patients received standard care, and 111 patients underwent an mHealth intervention. This consisted of frequent BP and weight monitoring with regimen adjustment in case of high BP. Primary outcome was difference in systolic BP and LDL-C between baseline and value after three months of follow-up. Mean age in the intervention group was 62.7 years, 98 (88.3%) patients were male. A total of 26 449 mHealth measurements were recorded. At three months, systolic BP decreased by 7.0 mmHg [standard deviation (SD): 15.1] in the intervention group vs. -0.3 mmHg (SD: 17.6; P < 0.00001) in controls; body weight decreased by 1.76 kg (SD: 3.23) in the intervention group vs. -0.31 kg (SD: 2.55; P = 0.002) in controls. Serum LDL-C was significantly lower in the intervention group vs. controls (median: 1.8 vs. 2.0 mmol/L; P = 0.0002).Conclusion This study showed an association between home monitoring after CABG and a reduction in systolic BP, body weight, and serum LDL-C. The causality of the association between the observed weight loss and decreased LDL-C in intervention group patients remains to be investigated. Show less
ObjectiveTo optimize treatment recommendations for eating disorders, it is important to investigate whether some individuals may benefit more (or less) from certain treatments. The current study... Show moreObjectiveTo optimize treatment recommendations for eating disorders, it is important to investigate whether some individuals may benefit more (or less) from certain treatments. The current study explored predictors and moderators of an automated online self-help intervention “Featback” and online support from a recovered expert patient.MethodsData were used from a randomized controlled trial. For a period of 8 weeks, participants aged 16 or older with at least mild eating disorder symptoms were randomized to four conditions: (1) Featback, (2) chat or e-mail support from an expert patient, (3) Featback with expert-patient support, and (4) a waitlist. A mixed-effects partitioning method was used to see if age, educational level, BMI, motivation to change, treatment history, duration of eating disorder, number of binge eating episodes in the past month, eating disorder pathology, self-efficacy, anxiety and depression, social support, or self-esteem predicted or moderated intervention outcomes in terms of eating disorder symptoms (primary outcome), and symptoms of anxiety and depression (secondary outcome).ResultsHigher baseline social support predicted less eating disorder symptoms 8 weeks later, regardless of condition. No variables emerged as moderator for eating disorder symptoms. Participants in the three active conditions who had not received previous eating disorder treatment, experienced larger reductions in anxiety and depression symptoms.DiscussionThe investigated online low-threshold interventions were especially beneficial for treatment-naïve individuals, but only in terms of secondary outcomes, making them well-suited for early intervention. The study results also highlight the importance of a supportive environment for individuals with eating disorder symptoms.Public SignificanceTo optimize treatment recommendations it is important to investigate what works for whom. For an internet-based intervention for eating disorders developed in the Netherlands, individuals who had never received eating disorder treatment seemed to benefit more from the intervention than those who had received eating disorder treatment, because they experienced larger reductions in symptoms of depression and anxiety. Stronger feelings of social support were related to less eating disorder symptoms in the future. Show less
Many Chinese people suffer from chronic diseases like hypertension and chronic lung disease (CLD), leading to a significant disease burden. Self-management intervention (SMI) can help improve... Show moreMany Chinese people suffer from chronic diseases like hypertension and chronic lung disease (CLD), leading to a significant disease burden. Self-management intervention (SMI) can help improve patients’ quality of life and reduce the disease burden. But most research on SMI has been done in high-income countries, while over 599 million Chinese people suffer from chronic diseases. Implementing effective SMI in high–income countries for Chinese people with chronic diseases is possible. However, such SMI might not work well in China because of differences in economics and culture. To meet this end, this thesis aimed to tailor a proven-effective SMI tackling CLD, developed and tested in the Netherlands, to the Chinese context. The tailoring steps included identifying the Chinese context, selecting the SMI and mode of delivery, identifying factors influencing the SMI implementation, and integrating SMI into the Chinese context. The results found that SMI – developed and tested in the Netherlands – could be tailored in China. The tailored SMI could help Chinese people with CLD improve their health outcomes and reduce the disease burden, consequently can optimize resource use locally. Other researchers could use the research experience in this thesis to tailor other SMIs targeting other chronic diseases in other cultures. Show less
For people with chronic kidney disease (CKD), adhering to a range of self-management tasks—such as healthy eating, frequent physical activity, and non-smoking—is crucial. However, changing health... Show moreFor people with chronic kidney disease (CKD), adhering to a range of self-management tasks—such as healthy eating, frequent physical activity, and non-smoking—is crucial. However, changing health behaviors is difficult. To support patients in doing so, an eHealth care pathway was developed and evaluated. The results provide different insights into patients' priorities and care needs. Many individuals with CKD experience problems in self-management, which can be hindered by many different barriers of which a common one is psychological distress. Therefore, personalized interventions are needed with screening and treatment of both psychological distress and suboptimal self-management, tailored to the specific barriers and needs of the individual patient. The E-GOAL eHealth care pathway is an example of such a personalized intervention, combining cognitive behavioral therapy with self-management support. Patients were enthusiastic about the eHealth care pathway. However, in a randomized study, the intervention was not effective in reducing psychological distress compared with regular care only. Patients did experience improvements in areas of functioning and self-management that they prioritized themselves. These mixed results show that interventions could be implemented that are person-tailored, with personalized outcomes that reflect individually meaningful treatment goals and improvements for every patient. Show less
Cardol, C.K.; Middendorp, H. van; Dusseldorp, E.; Boog, P.J.M. van der; Hilbrands, L.B.; Navis, G.; ... ; E GOAL Study Grp 2023
Objective: Psychological distress is common among patients with chronic kidney disease and can interfere with disease self-management. We assessed the effectiveness of the personalized E-GOAL... Show moreObjective: Psychological distress is common among patients with chronic kidney disease and can interfere with disease self-management. We assessed the effectiveness of the personalized E-GOAL electronic health care pathway with screening and cognitive-behavioral therapy including self-management support, aimed to treat psychological distress and facilitate self-management among people with chronic kidney disease not on dialysis (N = 121). Methods: Primary outcome of the open two-arm parallel randomized controlled trial in four Dutch hospitals was psychological distress at posttest directly after the intervention and at 3-month follow-up. Secondary outcomes were physical and mental health-related quality of life, self-efficacy, chronic disease self-management, and personalized outcomes, that is, perceived progress compared with the previous time point on functioning (e.g., mood or social functioning) and self-management (e.g., dietary or medication adherence) outcomes that were prioritized by each individual. Results: Linear mixed-effects analyses showed no significant time-by-group interaction effects for psychological distress, health-related quality of life, self-efficacy, and chronic condition self-management, whereas analyses of covariance showed significantly more perceived progress in the intervention group at posttest on personally prioritized areas of functioning (b = 0.46, 95% confidence interval = 0.07-0.85) and self-management (b = 0.55, 95% confidence interval = 0.16-0.95), with Cohen d values of 0.46 and 0.54 (medium effects), respectively. Effects on personalized outcomes were maintained at follow-up. Conclusions: Compared with regular care only, the electronic health intervention did not reduce psychological distress, whereas personalized outcomes did improve significantly after intervention. Future studies could consider personalized outcomes that reflect individually relevant areas and treatment goals, matching person-tailored treatments. Show less
In the current dissertation the effectiveness and cost-effectiveness of Featback, an internet-based self-help intervention for eating disorders, and online support by individuals with a lived... Show moreIn the current dissertation the effectiveness and cost-effectiveness of Featback, an internet-based self-help intervention for eating disorders, and online support by individuals with a lived experience of an eating disorder were investigated. The findings suggest that low-threshold internet-based interventions for eating disorders, such as Featback, can complement existing treatment options in three ways. First, they have been repeatedly found to be effective in reducing eating disorder symptomatology. Second, such interventions can reach individuals that are currently not reached by other forms of treatment and stimulate them to get professional help. Finally, internet-based interventions are likely to be cost-effective compared to care as usual. Concordantly, implementing highly scalable and easily accessible interventions like Featback likely helps to reduce both the individual and societal burden of eating disorders. Show less
Background: The economic costs of mental disorders for society are huge. Internet-based interventions are often coined as cost-effective alternatives to usual care, but the evidence is mixed... Show moreBackground: The economic costs of mental disorders for society are huge. Internet-based interventions are often coined as cost-effective alternatives to usual care, but the evidence is mixed.Objective: The aim was to review the literature on the cost-effectiveness of internet interventions for mental disorders compared with usual care and to provide an estimate of the monetary benefits of such interventions compared with usual care.Methods: A systematic review and meta-analysis of randomized controlled trials was conducted, which included participants with symptoms of mental disorders; investigated a telephone- or internet-based intervention; included a control condition in the form of treatment as usual, psychological placebo, waiting list control, or bibliotherapy; reported outcomes on both quality of life and costs; and included articles published in English. Electronic databases such as PubMed (including MEDLINE), Embase, Emcare, PsycINFO, Web of Science, and the Cochrane Library were used. Data on risk of bias, quality of the economic evaluation, quality-adjusted life years, and costs were extracted from the included studies, and the incremental net benefit was calculated and pooled.Results: The search yielded 6226 abstracts, and 37 studies with 14,946 participants were included. The quality of economic evaluations of the included studies was rated as moderate, and the risk of bias was high. A random-effects approach was maintained. Analyses suggested internet interventions were slightly more effective than usual care in terms of quality-adjusted life years gain (Hedges g=0.052, 95% CI 0.010-0.094; P=.02) and equally expensive (Hedges g=0.002, 95% CI −0.080 to 0.84; P=.96). The pooled incremental net benefit was US $255 (95% CI US $91 to US $419; P=.002), favoring internet interventions over usual care. The perspective of the economic evaluation and targeted mental disorder moderated the results.Conclusions: The findings indicate that the cost-effectiveness of internet interventions for mental disorders compared with a care-as-usual approach is likely, but generalizability to new studies is poor given the substantial heterogeneity. This is the first study in the field of mental health to pool cost-effectiveness outcomes in an aggregate data meta-analysis. Show less
Weinberg, V.; Haren, E. van; Gombert-Handoko, K.B. 2023
Background: eConsults are increasingly used worldwide to reduce specialist referrals and increase access to medical care. An additional benefit of using an eConsult tool is a reduction of health... Show moreBackground: eConsults are increasingly used worldwide to reduce specialist referrals and increase access to medical care. An additional benefit of using an eConsult tool is a reduction of health care costs while improving the quality of health care and patient participation. Currently, shared decision making is increasingly implemented and preferred by patients. eConsults are also a promising tool to improve access to the hospital pharmacist. Patients often have questions about their medication. When medication is started during a hospital admission or outpatient visit, community pharmacists are not always sufficiently informed to answer patient questions. Direct contact with hospital pharmacists may be more appropriate and efficient. This contact is facilitated through the eConsult feature in the hospital's patient portal. Objective: This study aims to evaluate the prevalence and contents of the eConsults sent by patients to hospital pharmacists.Methods: A first retrospective descriptive study was conducted at the Leiden University Medical Center in the Netherlands. Patients who sent at least one eConsult to a hospital pharmacist between March 2017 and December 2021 were included. Patient characteristics and the number of medications taken were extracted from electronic health records. The content of eConsults was analyzed and grouped into different subjects. Time of sending of the eConsults was analyzed. A comparison was made between the number of eConsults sent to the hospital pharmacy and the number sent to the medical center. Finally, the appropriateness for evaluation by the hospital pharmacist was assessed in all eConsults.Results: During the study period, 983 eConsults (from 808 patients) were sent to the hospital pharmacist. The average patient age was 56 (SD 15.9) years, and 51.4% (415/808) were male; 47.8% (386/808) of the patients used 0 to 4 medications, 33.0% (267/808) used 5 to 9 medications, and 19.2% (155/808) used =10 medications. Of the eConsults, 10.9% (107/983) were excluded due to not being medication-related or not intended for the hospital pharmacist. Patients being treated in 31 medical specialties sent eConsults to the hospital pharmacist. The most common medical specialty was cardiology with 22.5% (197/876) of the eConsults. Most eConsults were sent during office hours (614/876, 70.2%). eConsult subjects were medication verification (372/876, 42.5%), logistics (243/876, 27.7%), therapeutic effect and adverse events (100/876, 11.4%), use of medication (87/876,Conclusions: Introducing eConsults allows patients to ask medication-related questions directly to hospital pharmacists. Our study shows that patients send medication reconciliation-related eConsults most often. Use of the eConsult tool leads to fast, direct, and documented communication between patient and hospital pharmacist. This can reduce medication-related errors, improve patient empowerment, and increase access to the hospital pharmacist. Show less
eHealth is most effective when integrated into conventional health care in a “hybrid” health care model. In order to achieve high-quality hybrid health care, eHealth must benefit patients and must... Show moreeHealth is most effective when integrated into conventional health care in a “hybrid” health care model. In order to achieve high-quality hybrid health care, eHealth must benefit patients and must be effectively integrated and organized within regular health care. This thesis describes the evaluation of eHealth from both a patient perspective and an organizational perspective. Chapters 2 and 3 present patients’ views of an online patient portal. Chapters 4 and 5 describe the factors that affect the organization of high-quality hybrid health care and use these as inputs to develop a tailored quality management model and accompanying self-assessment questionnaire: the Hybrid Health Care Quality Assessment (HHQA) (Chapter 5). Health care organizations can use the model and questionnaire to gain insight into ways of improving the quality of their hybrid care. 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
Aims: Postoperative atrial fibrillation (POAF) is a common complication of cardiac surgery, yet difficult to detect in ambulatory patients. The primary aim of this study is to investigate the... Show moreAims: Postoperative atrial fibrillation (POAF) is a common complication of cardiac surgery, yet difficult to detect in ambulatory patients. The primary aim of this study is to investigate the effect of a mobile health (mHealth) intervention on POAF detection after cardiac surgery. Methods and results: We performed an observational cohort study among 730 adult patients who underwent cardiac surgery at a tertiary care hospital in The Netherlands. Of these patients, 365 patients received standard care and were included as a historical control group, undergoing surgery between December 2017 and September 2018, and 365 patients were prospectively included from November 2018 and November 2020, undergoing an mHealth intervention which consisted of blood pressure, temperature, weight, and electrocardiogram (ECG) monitoring. One physical outpatient follow-up moment was replaced by an electronic visit. All patients were requested to fill out a satisfaction and quality of life questionnaire. Mean age in the intervention group was 62 years, 275 (70.4%) patients were males. A total of 4136 12-lead ECGs were registered. In the intervention group, 61 (16.7%) patients were diagnosed with POAF vs. 25 (6.8%) patients in the control group [adjusted risk ratio (RR) of POAF detection: 2.15; 95% confidence interval (CI): 1.55-3.97]. De novo atrial fibrillation was found in 13 patients using mHealth (6.5%) vs. 4 control group patients (1.8%; adjusted RR 3.94, 95% CI: 1.50-11.27). Conclusion: Scheduled self-measurements with mHealth devices could increase the probability of detecting POAF within 3 months after cardiac surgery. The effect of an increase in POAF detection on clinical outcomes needs to be addressed in future research. Show less
AimsPostoperative atrial fibrillation (POAF) is a common complication of cardiac surgery, yet difficult to detect in ambulatory patients. The primary aim of this study is to investigate the effect... Show moreAimsPostoperative atrial fibrillation (POAF) is a common complication of cardiac surgery, yet difficult to detect in ambulatory patients. The primary aim of this study is to investigate the effect of a mobile health (mHealth) intervention on POAF detection after cardiac surgery.Methods and resultsWe performed an observational cohort study among 730 adult patients who underwent cardiac surgery at a tertiary care hospital in The Netherlands. Of these patients, 365 patients received standard care and were included as a historical control group, undergoing surgery between December 2017 and September 2018, and 365 patients were prospectively included from November 2018 and November 2020, undergoing an mHealth intervention which consisted of blood pressure, temperature, weight, and electrocardiogram (ECG) monitoring. One physical outpatient follow-up moment was replaced by an electronic visit. All patients were requested to fill out a satisfaction and quality of life questionnaire. Mean age in the intervention group was 62 years, 275 (70.4%) patients were males. A total of 4136 12-lead ECGs were registered. In the intervention group, 61 (16.7%) patients were diagnosed with POAF vs. 25 (6.8%) patients in the control group [adjusted risk ratio (RR) of POAF detection: 2.15; 95% confidence interval (CI): 1.55–3.97]. De novo atrial fibrillation was found in 13 patients using mHealth (6.5%) vs. 4 control group patients (1.8%; adjusted RR 3.94, 95% CI: 1.50–11.27).ConclusionScheduled self-measurements with mHealth devices could increase the probability of detecting POAF within 3 months after cardiac surgery. The effect of an increase in POAF detection on clinical outcomes needs to be addressed in future research. Show less
