The decentralization of social care in the Netherlands has had a major impact on the professionals working in this field. This dissertation examines this impact by specifically focusing on the... Show moreThe decentralization of social care in the Netherlands has had a major impact on the professionals working in this field. This dissertation examines this impact by specifically focusing on the cognitive uncertainty experiences of social care professionals. It shows that cognitive uncertainty is a multi-faceted concept that covers different domains of the work and can have multiple sources. Contrary to the frequently expressed view in the literature on bureaucracy, this dissertation shows that rules do not reduce cognitive uncertainty. Leadership of team leaders, in contrast, can reduce cognitive uncertainty experiences of professionals.Moreover, leadership plays a key role in managing cognitive uncertainty. When properly managed, cognitive uncertainty can prove highly valuable as it can spur innovation and thus contribute to achieving the goals set in the decentralization of social care in the Netherlands. Show less
In this thesis the feasibility of tailored follow-up for early-stage breast cancer patients is evaluated. In order to do so, we first determined the risk of locoregional recurrence (LRR) dependent... Show moreIn this thesis the feasibility of tailored follow-up for early-stage breast cancer patients is evaluated. In order to do so, we first determined the risk of locoregional recurrence (LRR) dependent on local treatment in a large cohort of low-risk breast cancer patients, treated with adequate modern systemic therapy. In the second part we evaluated both patients__ and professionals__ needs and preferences for breast cancer follow-up and we reviewed the literature on cost effectiveness of known follow-up schedules. Finally we prospectively examined whether the implementation of a tailored follow-up programme, based on a prognostic index for LRR, is feasible and acceptable to patients and professionals. The results show that in general, implementation of minimised tailored follow-up seems feasible, but professionals tend to more frequent follow-up. Patients accept less intensive follow-up schedules and follow-up by a nurse practitioner. Given the low risk of LRR, tailoring should not only be done based on this risk, but individually, based on the presence of treatment related side effects, either physical or psychosocial. If patients do not experience side effects, annual planned mammography and telephone contact coordinated by a single professional, preferably a specialised nurse, suffice in case of easily accessible information and on demand visits. Show less
Despite the promising findings related to the efficacy of primary health care-based physical activity interventions and recommendations for primary health care professionals to promote physical... Show moreDespite the promising findings related to the efficacy of primary health care-based physical activity interventions and recommendations for primary health care professionals to promote physical activity, the introduction of physical activity interventions in routine daily primary health care practice does not always happen as desired. Specifically, rates of physical activity promotion by primary health care professionals are far from optimal and physical activity interventions are not delivered as intended by the intervention developers. Knowledge of the factors that determine the success or failure of the introduction of innovations in health care is important for the development of strategies to improve the introduction process. As a first step towards the effective introduction of physical activity interventions in primary health care practice, the main aim of this thesis is to investigate what factors influence the introduction of physical activity interventions in primary health care. Show less
