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Carrière ME, Tyack Z, Westerman MJ, Pleat J, Pijpe A, van Zuijlen PPM, de Vet HCW, Mokkink LB. From qualitative data to a measurement instrument: A clarification and elaboration of choices made in the development of the Patient Scale of the Patient and Observer Scar Assessment Scale (POSAS) 3.0. Burns 2023; 49:1541-1556. [PMID: 36914442 DOI: 10.1016/j.burns.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 02/05/2023] [Accepted: 02/19/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE To clarify and elaborate on the choices that were made in the development of the Patient Scale of the Patient and Observer Scar Assessment Scale 3.0 (POSAS 3.0), based upon the rich information obtained from patients during focus groups and pilot tests. METHODS The discussions described in this paper are a reflection of the focus group study and pilot tests that were conducted in order to develop the Patient Scale of the POSAS3.0. The focus groups took place in the Netherlands and Australia and included 45 participants. Pilot tests were performed with 15 participants in Australia, the Netherlands, and the United Kingdom. RESULTS We discussed the selection, wording and merging of 17 included items. Additionally, the reason for exclusion of 23 characteristics are given. CONCLUSION Based upon the unique and rich material of patient input obtained, two versions of the Patient Scale of the POSAS3.0 were developed: the Generic version, and the Linear scar version. The discussions and decisions taken during the development are informative for a good understanding of the POSAS 3.0 and are indispensable as a background for future translations and cross-cultural adaptations.
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Affiliation(s)
- M E Carrière
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Burn center and Department of Plastic, Reconstructive and Hand surgery, Red Cross Hospital, Beverwijk, the Netherlands; Department of Plastic, Reconstructive and Hand surgery, Amsterdam UMC (location VUmc), Amsterdam Movement Sciences, Amsterdam, the Netherlands; Association of Dutch Burn centers, Beverwijk, the Netherlands.
| | - Z Tyack
- Child Health Research Centre, University of Queensland, Brisbane, Australia
| | - M J Westerman
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Division of Life Science, Amsterdam UMC, VU University, Amsterdam, the Netherlands
| | - J Pleat
- Department of Plastic and Reconstructive Surgery, North Bristol NHS Trust, Bristol, United Kingdom
| | - A Pijpe
- Burn center and Department of Plastic, Reconstructive and Hand surgery, Red Cross Hospital, Beverwijk, the Netherlands; Department of Plastic, Reconstructive and Hand surgery, Amsterdam UMC (location VUmc), Amsterdam Movement Sciences, Amsterdam, the Netherlands; Association of Dutch Burn centers, Beverwijk, the Netherlands
| | - P P M van Zuijlen
- Burn center and Department of Plastic, Reconstructive and Hand surgery, Red Cross Hospital, Beverwijk, the Netherlands; Department of Plastic, Reconstructive and Hand surgery, Amsterdam UMC (location VUmc), Amsterdam Movement Sciences, Amsterdam, the Netherlands; Pediatric Surgical Centre, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - H C W de Vet
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - L B Mokkink
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health research institute, Amsterdam, the Netherlands
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En‐nasery ‐ de Heer S, Tromp VNMF, Westerman MJ, Konings I, Beckeringh JJ, Boons CLM, Timmers L, Hugtenburg JG. Patient experiences and views on pharmaceutical care during adjuvant endocrine therapy for breast cancer: A qualitative study. Eur J Cancer Care (Engl) 2022; 31:e13749. [PMID: 36300863 PMCID: PMC9786726 DOI: 10.1111/ecc.13749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 09/24/2022] [Accepted: 10/09/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The use of adjuvant endocrine therapy (AET) after primary treatment of hormone receptor-positive breast cancer reduces the risk of recurrence and mortality. However, non-adherence is still common. Limited consideration has been given to how users deal with AET and the role of pharmaceutical care. Therefore, this study aims to obtain insight into the needs and wishes of women using AET regarding pharmaceutical care and eHealth. METHODS This is a qualitative explorative study comprising semi-structured interviews (n = 16) and a focus group (n = 5) among women who use or used AET after primary early-stage breast cancer (EBC) treatment using a thematic analysis approach. RESULTS Three themes emerged from the interviews and focus group: (1) experiences with AET use, (2) experiences with provided information and (3) needs and wishes regarding pharmaceutical care. Most women were highly motivated to use AET and indicated to have received useful information on AET. However, many expressed a strong need for more elaborate tailored and timely provided information on AET. They acknowledged the accessibility of pharmacists but reported that currently, pharmacists are hardly involved in AET care. Several women considered eHealth useful to obtain counselling and reliable information. CONCLUSION Women need more comprehensive information and follow-up in primary setting after initial cancer treatments. A more elaborate role for the pharmacy and eHealth/mHealth, especially with regard to counselling on side effects and side effect management, could potentially improve pharmaceutical care.
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Affiliation(s)
- Selma En‐nasery ‐ de Heer
- Department of Clinical Pharmacology and PharmacyAmsterdam UMC, Location VUmcAmsterdamThe Netherlands,Amsterdam Public Health Research InstituteAmsterdam UMC, Location VUmcAmsterdamThe Netherlands
| | - Vashti N. M. F. Tromp
- Department of Clinical Pharmacology and PharmacyAmsterdam UMC, Location VUmcAmsterdamThe Netherlands,Amsterdam Public Health Research InstituteAmsterdam UMC, Location VUmcAmsterdamThe Netherlands
| | - Marjan J. Westerman
- Department of Epidemiology and Data ScienceAmsterdam UMC, Location VUmcAmsterdamThe Netherlands
| | - Inge Konings
- Department of Medical Oncology, Cancer Center AmsterdamAmsterdam UMC, Location VUmcAmsterdamThe Netherlands
| | | | - Christel L. M. Boons
- Department of Clinical Pharmacology and PharmacyAmsterdam UMC, Location VUmcAmsterdamThe Netherlands,Amsterdam Public Health Research InstituteAmsterdam UMC, Location VUmcAmsterdamThe Netherlands
| | - Lonneke Timmers
- Department of Clinical Pharmacology and PharmacyAmsterdam UMC, Location VUmcAmsterdamThe Netherlands
| | - Jacqueline G. Hugtenburg
- Department of Clinical Pharmacology and PharmacyAmsterdam UMC, Location VUmcAmsterdamThe Netherlands,Amsterdam Public Health Research InstituteAmsterdam UMC, Location VUmcAmsterdamThe Netherlands
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3
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Luijten JCHBM, Vissers PAJ, Brom L, de Bièvre M, Buijsen J, Rozema T, Mohammad NH, van Duijvendijk P, Kouwenhoven EA, Eshuis WJ, Rosman C, Siersema PD, van Laarhoven HWM, Verhoeven RHA, Nieuwenhuijzen GAP, Westerman MJ. Clinical variation in the organization of clinical pathways in esophagogastric cancer, a mixed method multiple case study. BMC Health Serv Res 2022; 22:527. [PMID: 35449018 PMCID: PMC9022421 DOI: 10.1186/s12913-022-07845-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 03/17/2022] [Indexed: 12/24/2022] Open
Abstract
Background Among esophagogastric cancer patients, the probability of having undergone treatment with curative intent has been shown to vary, depending on the hospital of diagnosis. However, little is known about the factors that contribute to this variation. In this study, we sought to understand the organization of clinical pathways and their association with variation in practice. Methods A mixed-method study using quantitative and qualitative data was conducted. Quantitative data were obtained from the Netherlands Cancer Registry (e.g., outpatient clinic consultations and diagnostic procedures). For qualitative data, thematic content analysis was performed using semi-structured interviews (n = 30), observations of outpatient clinic consultations (n = 26), and multidisciplinary team meetings (MDTM, n = 16) in eight hospitals, to assess clinicians’ perspectives regarding the clinical pathways. Results Quantitative analyses showed that patients more often underwent surgical consultation prior to the MDTM in hospitals associated with a high probability of receiving treatment with curative intent, but more often consulted with a geriatrician in hospitals associated with a low probability of such treatment. The organization of clinical pathways was analyzed quantitatively at three levels: regional, local, and patient levels. At a regional level, hospitals differed in terms of the number of patients discussed during the MDTM. At the local level, the revision of radiological images and restaging after neoadjuvant treatment varied. At the patient level, some hospitals routinely conduct fitness tests, whereas others estimated the patient’s physical fitness during an outpatient clinic consultation. Few clinicians performed a standard geriatric consultation in older patients to assess their mental fitness and frailty. Conclusion Surgical consultation prior to MDTM was more often conducted in hospitals associated with a high probability of receiving treatment with curative intent, whereas a geriatrician was consulted more often in hospitals associated with a low probability of receiving such treatment. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07845-2.
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Affiliation(s)
- J C H B M Luijten
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Godebaldkwartier 419, 3511, DT, Utrecht, The Netherlands.
| | - P A J Vissers
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Godebaldkwartier 419, 3511, DT, Utrecht, The Netherlands.,Department of Surgery, Radboudumc, Nijmegen, The Netherlands
| | - L Brom
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Godebaldkwartier 419, 3511, DT, Utrecht, The Netherlands
| | - M de Bièvre
- Department of Gastroenterology, Viecuri Medical Center, Venlo, The Netherlands
| | - J Buijsen
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - T Rozema
- Department of Radiation Oncology, Verbeten Insitute, Tilburg, The Netherlands
| | - N Haj Mohammad
- Department of Medical Oncology, Utrecht UMC, Utrecht University, Utrecht, The Netherlands
| | | | | | - W J Eshuis
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - C Rosman
- Department of Surgery, Radboudumc, Nijmegen, The Netherlands
| | - P D Siersema
- Department of Gastroenterology, Radboudumc, Nijmegen, The Netherlands
| | - H W M van Laarhoven
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - R H A Verhoeven
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Godebaldkwartier 419, 3511, DT, Utrecht, The Netherlands. .,Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | | | - M J Westerman
- Department of Epidemiology and Datascience, Amsterdam UMC, Amsterdam, The Netherlands
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4
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Bouchareb S, Chrifou R, Bourik Z, Nijpels G, Hassanein M, Westerman MJ, Elders PJM. “I am my own doctor”: A qualitative study of the perspectives and decision-making process of Muslims with diabetes on Ramadan fasting. PLoS One 2022; 17:e0263088. [PMID: 35245315 PMCID: PMC8896728 DOI: 10.1371/journal.pone.0263088] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 01/11/2022] [Indexed: 11/18/2022] Open
Abstract
Background Many Muslims with diabetes choose to fast against medical advice during Ramadan, potentially increasing their risk of acute complications. Patients are often reluctant to disclose fasting to their health care providers, and their needs regarding Ramadan are not met in consultations. For healthcare professionals to provide patient-centred care, it is important to gain more insight into patients’ decision-making process. This study therefore aims to explore how Muslims with diabetes decide whether to fast during Ramadan. Methods A qualitative study was conducted consisting of 15 focus groups with Muslims with diabetes within a constructivist paradigm. Convenience sampling was used. All focus groups were transcribed verbatim and analyzed using Braun and Clarke’s reflexive thematic analysis. Results Four themes were found to be important in the decision on whether to fast: (1) values and beliefs concerning Ramadan, (2) experiences and emotions concerning Ramadan, (3) the perception of illness, and (4) advice from health care professionals, imams and family. Many participants indicated fasting against medical advice and trusting their subjective assessments on whether they could fast. Moreover, three main stages in the decision-making process for eventually refraining from fasting were identified: (1) the stage where positive experiences with fasting dominate, (2) the stage where one encounters challenges but their determination to fast prevails and (3) the stage where one decides to refrain from fasting after experiencing too many physical difficulties with fasting. Conclusions Muslims with diabetes experience autonomy in their decisions on Ramadan fasting. The decision to refrain from fasting often resulted from a difficult and dynamic decision-making process and was often made after participants reached their physical limits. These findings highlight the importance of not only shared decision-making to empower patients to make well-informed decisions on Ramadan fasting but also pre-Ramadan diabetes education to help people with diabetes have a safe Ramadan.
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Affiliation(s)
- Siham Bouchareb
- Department of General Practice, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- * E-mail: (SB); (PE)
| | - Rabab Chrifou
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Department of Public Health and Primary Care, Unit Health Promotion, Ghent University, Ghent, Belgium
| | - Zohra Bourik
- Department of Ethics, Law and Humanities, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Giel Nijpels
- Department of General Practice, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | - Marjan J. Westerman
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Petra J. M. Elders
- Department of General Practice, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- * E-mail: (SB); (PE)
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5
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Luijten JCHBM, Brom L, Vissers PAJ, van de Wouw YAJ, Warmerdam FARM, Heisterkamp J, Mook S, Oulad Hadj J, van Det MJ, Timmermans L, Hulshof MCCM, van Laarhoven HWM, Rosman C, Siersema PD, Westerman MJ, Verhoeven RHA, Nieuwenhuijzen GAP. Treatment decision-making during outpatient clinic visit of patients with esophagogastric cancer. The perspectives of clinicians and patients, a mixed method, multiple case study. Cancer Med 2022; 11:2427-2444. [PMID: 35166037 PMCID: PMC9189462 DOI: 10.1002/cam4.4596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/08/2021] [Accepted: 12/17/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The probability of undergoing treatment with curative intent according to the hospital of diagnosis varies for esophagogastric cancer in the Netherlands. Little is known about the factors contributing to this variation. This study aimed to improve the understanding of the differences between the multidisciplinary team meeting treatment proposal and the treatment that was actually carried out and to qualitatively investigate the differences in treatment decision-making after the multidisciplinary team meeting treatment proposal between hospitals. METHODS To gain an in-depth understanding of treatment decision-making, quantitative data (i.e., multidisciplinary team meeting proposal and treatment that was carried out) were collected from the Netherlands Cancer Registry. Changes in the multidisciplinary team meeting proposal and applied treatment comprised changes in the type of treatment option (i.e., curative or palliative, or no change) and were calculated according to the multivariable multilevel probability of undergoing treatment with curative intent (low, middle, and high). Qualitative data were collected from eight hospitals, including observations of 26 outpatient clinic consultations, 30 in-depth interviews with clinicians, seven focus groups with clinicians, and three focus groups with patients. Clinicians and patients' perspectives were assessed using thematic content analysis. RESULTS The multidisciplinary team meeting proposal and applied treatment were concordant in 97% of the cases. Clinicians' implementation of treatment decision-making in clinical practice varied, which was mentioned by the clinicians to be due to the clinician's personality and values. Differences between clinicians consisted of discussing all treatment options versus only the best fitting treatment option and the extent of discussing the benefits and harms. Most patients aimed to undergo curative treatment regardless of the consequences, since they believed this could prolong their life. CONCLUSION Since changes in the multidisciplinary team meeting-proposed treatment and actual treatment were rarely observed, this study emphasizes the importance of an adequately formulated multidisciplinary team meeting proposal.
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Affiliation(s)
- Josianne C H B M Luijten
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
| | - Linda Brom
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands.,Netherlands Association for Palliative Care (PZNL), Utrecht, The Netherlands
| | - Pauline A J Vissers
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
| | - Yes A J van de Wouw
- Department of Medical Oncology, Viecuri Medical Centre, Venlo, The Netherlands
| | | | - Joos Heisterkamp
- Department of Surgery, Elisabeth Tweesteden Hospital, Tilburg, The Netherlands
| | - Stella Mook
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jamal Oulad Hadj
- Department of Medical Oncology, Gelre Hospital, Apeldoorn, The Netherlands
| | - Marc J van Det
- Department of Surgery, Hospital group Twente, Almelo, The Netherlands
| | - Liesbeth Timmermans
- Department of Primary and Community Care, Radboud university medical center, Nijmegen, The Netherlands.,SPKS Leven met maag- of slokdarmkanker, Utrecht, The Netherlands
| | - Maarten C C M Hulshof
- Department of Radiation Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Hanneke W M van Laarhoven
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Camiel Rosman
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Peter D Siersema
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marjan J Westerman
- Department of Epidemiology and Biostatistics Amsterdam UMC, Amsterdam, The Netherlands
| | - Rob H A Verhoeven
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands.,Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Tettero OM, Westerman MJ, van Stralen MM, van den Beuken M, Monpellier VM, Janssen IM, Steenhuis IH. Barriers to and Facilitators of Participation in Weight Loss Intervention for Patients with Suboptimal Weight Loss after Bariatric Surgery: A Qualitative Study among Patients, Physicians, and Therapists. Obes Facts 2022; 15:674-684. [PMID: 35917803 PMCID: PMC9670013 DOI: 10.1159/000526259] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 06/22/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Not all patients with suboptimal weight loss after bariatric surgery are willing to participate in postoperative behavioral intervention to improve their weight loss. The objective of this study was to explore barriers to and facilitators of participation in postoperative behavioral intervention. METHODS Thirty semi-structured interviews were conducted with patients (18), physicians (6), and therapists (6) (i.e., psychologists, dieticians, or physiotherapists). A thematic analysis approach was used. RESULTS Emotional responses caused by confrontation with suboptimal weight loss hampered patients' deliberation about participation; insufficient exploration of their need for help limited patients' ability to make informed decisions; patients were receptive to their physician's advice when their physician respected their autonomy; using visual weight loss graphs helped to explain suboptimal weight loss to patients; and financial costs and time constraints obstructed participation. CONCLUSIONS To improve adequate intervention participation, healthcare providers should focus on emotion regulation, support patients in exploring their own need for help, and respect patients' autonomy.
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Affiliation(s)
- Onno M. Tettero
- Department of Health Sciences, Vrije Universiteit Amsterdam, and Amsterdam, Public Health Research Institute, Amsterdam, The Netherlands
- Department of Science, Nederlandse Obesitas Kliniek, Huis ter Heide, The Netherlands
- *Onno M. Tettero,
| | - Marjan J. Westerman
- Department of Health Sciences, Vrije Universiteit Amsterdam, and Amsterdam, Public Health Research Institute, Amsterdam, The Netherlands
| | - Maartje M. van Stralen
- Department of Health Sciences, Vrije Universiteit Amsterdam, and Amsterdam, Public Health Research Institute, Amsterdam, The Netherlands
| | - Meike van den Beuken
- Department of Health Sciences, Vrije Universiteit Amsterdam, and Amsterdam, Public Health Research Institute, Amsterdam, The Netherlands
| | - Valerie M. Monpellier
- Department of Science, Nederlandse Obesitas Kliniek, Huis ter Heide, The Netherlands
| | - Ignace M.C. Janssen
- Department of Science, Nederlandse Obesitas Kliniek, Huis ter Heide, The Netherlands
| | - Ingrid H.M. Steenhuis
- Department of Health Sciences, Vrije Universiteit Amsterdam, and Amsterdam, Public Health Research Institute, Amsterdam, The Netherlands
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Evenhuis IJ, Vyth EL, van Nassau F, Veldhuis L, Westerman MJ, Seidell JC, Renders CM. What Do Secondary Schools Need to Create Healthier Canteens? The Development of an Implementation Plan. Front Public Health 2021; 9:683556. [PMID: 34249845 PMCID: PMC8261152 DOI: 10.3389/fpubh.2021.683556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 05/27/2021] [Indexed: 01/22/2023] Open
Abstract
Introduction: The Netherlands Nutrition Centre developed guidelines to improve the availability and accessibility of healthier food products in Dutch canteens. This paper describes the development of an implementation plan to facilitate implementation of Guidelines for Healthier Canteens in Dutch secondary schools. Materials and Methods: In cooperation with stakeholders (i.e., school/caterer managers/employees, school canteen advisors, researchers) and based on theory, we developed an implementation plan in three steps. First, we identified factors that impede/facilitate stakeholders to create a healthier school canteen during 14 interviews. Second, 25 experts discussed and prioritized these identified factors in an expert meeting. Third, we translated these factors into tools to be included in the implementation plan, by making use of behavior change taxonomies and evidence-based implementation strategies. Results: The plan aims to support stakeholders in implementing healthier school canteens and consists of five tools: (1) tailored advice based on an online questionnaire to assess schools' and stakeholders' context and the Canteen Scan (i.e., an online tool to assess the availability and accessibility of food/drink products); (2) communication materials with information and examples; (3) online community for support by sharing experiences/questions; (4) digital newsletter as reminder/support; (5) fact sheet with students' needs/wishes to tailor the canteen. Discussion: This study illustrates how collaboration between science, policy and practice resulted in a tailored implementation plan aimed to support schools to adhere to school canteen policy. This development serves as a good example for researchers, health promotion policymakers, and practitioners how to create an implementation plan that fits the needs of stakeholders.
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Affiliation(s)
- Irma J Evenhuis
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Ellis L Vyth
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Femke van Nassau
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | | | - Marjan J Westerman
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Jacob C Seidell
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Carry M Renders
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
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8
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Eigenhuis E, Waumans RC, Muntingh ADT, Westerman MJ, van Meijel M, Batelaan NM, van Balkom AJLM. Facilitating factors and barriers in help-seeking behaviour in adolescents and young adults with depressive symptoms: A qualitative study. PLoS One 2021; 16:e0247516. [PMID: 33684154 PMCID: PMC7939362 DOI: 10.1371/journal.pone.0247516] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 02/08/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Despite the availability of mental health care, only a minority of depressed adolescents and young adults receive treatment. This study aimed to investigate facilitating factors and barriers in help-seeking behaviour of adolescents and young adults with depressive symptoms, using qualitative research methods. METHODS In-depth, semi-structured interviews with 32 participants with current or previous depressive symptoms aged 16 to 24 years using thematic content analysis. FINDINGS Our sample consisted mainly of adolescents who eventually found their way to professional help. Five main themes in help-seeking by adolescents and young adults were identified: (I) Individual functioning and well-being, (II) Health literacy, (III) Attitudinal aspects, (IV) Surroundings, and (V) Accessibility. Prompts to seek treatment were disease burden and poor academic performance. Health illiteracy negatively influenced treatment-seeking behaviour. Attitudinal aspects either hampered (shame, wanting to handle the problem oneself, negative attitudes towards treatment) or facilitated (positive attitudes towards treatment) help-seeking. Furthermore, adolescents' surroundings (school, family, and peers) appeared to play a critical role in the recognition of depressive symptoms and encouragement to seek help. Barriers regarding accessibility of mental health care were found, whereas direct and easy access to treatment greatly improved mental health care use. CONCLUSION Facilitating factors can play a critical role in the help-seeking process of depressed adolescents and young adults, and may guide efforts to increase access to mental health care of this vulnerable age group. In particular, recognition and encouragement from school personnel and peers and easy access to care providers positively influenced help-seeking in our sample. Health illiteracy and attitudinal aspects appeared to be important barriers to seeking treatment and public/school campaigns aimed at reducing health illiteracy and stigma might be necessary to improve treatment-seeking and health care utilization in this age group.
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Affiliation(s)
- Eline Eigenhuis
- Amsterdam UMC, Department of Psychiatry, Amsterdam Public Health Institute and GGZ inGeest Specialized Mental Health Care, Vrije Universiteit, Amsterdam, The Netherlands
- * E-mail:
| | - Ruth C. Waumans
- Amsterdam UMC, Department of Psychiatry, Amsterdam Public Health Institute and GGZ inGeest Specialized Mental Health Care, Vrije Universiteit, Amsterdam, The Netherlands
| | - Anna D. T. Muntingh
- Amsterdam UMC, Department of Psychiatry, Amsterdam Public Health Institute and GGZ inGeest Specialized Mental Health Care, Vrije Universiteit, Amsterdam, The Netherlands
| | - Marjan J. Westerman
- Department of Epidemiology & Biostatistics, Amsterdam UMC, Location VUmc and Amsterdam Public Health Institute, Amsterdam, The Netherlands
| | - Marlinde van Meijel
- Amsterdam UMC, Department of Psychiatry, Amsterdam Public Health Institute and GGZ inGeest Specialized Mental Health Care, Vrije Universiteit, Amsterdam, The Netherlands
| | - Neeltje M. Batelaan
- Amsterdam UMC, Department of Psychiatry, Amsterdam Public Health Institute and GGZ inGeest Specialized Mental Health Care, Vrije Universiteit, Amsterdam, The Netherlands
| | - Anton J. L. M. van Balkom
- Amsterdam UMC, Department of Psychiatry, Amsterdam Public Health Institute and GGZ inGeest Specialized Mental Health Care, Vrije Universiteit, Amsterdam, The Netherlands
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de Kruif AJT, Westerman MJ, Winkels RM, Koster MS, van der Staaij IM, van den Berg MMGA, de Vries JHM, de Boer MR, Kampman E, Visser M. Exploring changes in dietary intake, physical activity and body weight during chemotherapy in women with breast cancer: A Mixed-Methods Study. J Hum Nutr Diet 2021; 34:550-561. [PMID: 33411940 PMCID: PMC8248384 DOI: 10.1111/jhn.12843] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/03/2020] [Accepted: 10/27/2020] [Indexed: 01/21/2023]
Abstract
Background The present study aimed (i) to assess changes in dietary intake (DI), physical activity (PA) and body weight (BW) in breast cancer patients during chemotherapy; (ii) to describe how women explained, experienced and dealt with these potential changes; and (iii) to eventually develop lifestyle intervention strategies tailored to the women's personal needs during chemotherapy. Methods A longitudinal parallel mixed‐method design was used with quantitative assessment of changes in dietary intake (24‐h recall, Appetite, Hunger, Sensory Perception questionnaire), physical activity (Short Questionnaire to Assess Health‐enhancing physical activity, Multidimensional Fatigue Inventory) and BW (dual‐energy X‐ray absorptiometry), in addition to qualitative interviews with 25 women about these potential changes during chemotherapy. Results Most women who perceived eating less healthily with low energy intake (EI) and being less active before diagnosis continued to do so during chemotherapy, according to quantitative measurements. They struggled to maintain sufficient energy intake. Despite a lower than average reported EI, they unexpectedly gained weight and explained that fatigue made them even more inactive during chemotherapy. Active women usually managed to stay active because exercise was very important to them and made them feel good, although they also suffered from the side‐effects of chemotherapy. They found more ways to deal with taste, smell and appetite problems than women with a lower energy intake. Conclusions The combination of the quantitative and qualitative data provided more insight into the changes in dietary intake, physical activity and BW during chemotherapy. The women's explanations showed why some women remain active and others need support to deal with changes in lifestyle factors such as healthy nutrition and fatigue.
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Affiliation(s)
- Anja JThCM de Kruif
- Department of Health Sciences, Faculty of Science, The Amsterdam Public Health Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Epidemiology and Biostatistics, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - Marjan J Westerman
- Department of Health Sciences, Faculty of Science, The Amsterdam Public Health Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Renate M Winkels
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Marije S Koster
- Department of Health Sciences, Faculty of Science, The Amsterdam Public Health Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Irene M van der Staaij
- Department of Quality Assurance and Process Management, Student & Educational Affairs, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Jeanne H M de Vries
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Michiel R de Boer
- Department of Health Sciences, Faculty of Science, The Amsterdam Public Health Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ellen Kampman
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Marjolein Visser
- Department of Health Sciences, Faculty of Science, The Amsterdam Public Health Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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10
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de Kruif AJT, Chrifou R, Langeslag GL, Sondaal AEC, Franssen MMM, Kampman E, Winkels RM, de Boer MR, Visser M, Westerman MJ. Perceptions of non-Western immigrant women on having breast cancer and their experiences with treatment-related changes in body weight and lifestyle: A qualitative study. PLoS One 2020; 15:e0235662. [PMID: 32634154 PMCID: PMC7340308 DOI: 10.1371/journal.pone.0235662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 06/21/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The number of non-Western immigrants with breast cancer in the Netherlands has increased over the past decades and is expected to triple by 2030. Due to insufficient representation in clinical studies, it is unclear what the specific experiences and needs of these women are. Understanding how culture and religion affect these women's experience of breast cancer and how they deal with chemotherapy and treatment-related changes in body weight and lifestyle is crucial for health care professionals to be able to provide effective support. METHODS A qualitative study was conducted using semi-structured interviews with 28 immigrant women with a history of breast cancer treated with chemotherapy. RESULTS Women often associated breast cancer with taboo, death or bad luck. Religion offered these women guidance, strength and meaning to the disease, but also limited the women to openly talk about their disease. Women perceived lifestyle factors to have little influence on the development and treatment of cancer. After treatment, however, their thinking changed and these lifestyle factors became of paramount importance to them. They realised that they missed out on information about managing their own diet, exercise and body weight and were eager to share their experiences with other women in their culture with newly diagnosed breast cancer. CONCLUSION Women became aware during and after breast cancer treatment that it was difficult for them to actively deal with their illness under the influence of their culture and religion. Based on their own experiences and acquired knowledge, they would like to give advice to newly diagnosed women on how to deal with breast cancer within their own culture and religion. Their recommendations could be used by mosques, churches, support groups and health care professionals, to ensure interventions during breast cancer treatment meet their religious and cultural needs and thus improve their quality of life.
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Affiliation(s)
- Anja JThCM de Kruif
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Epidemiology and Biostatistics, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Rabab Chrifou
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Public and Occupational Health, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Ghislaine L Langeslag
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Annemijn E C Sondaal
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Margret M M Franssen
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ellen Kampman
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
| | - Renate M Winkels
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
| | - Michiel R de Boer
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marjolein Visser
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marjan J Westerman
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Epidemiology and Biostatistics, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
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11
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Agasi-Idenburg CS, Zuilen MKV, Westerman MJ, Punt CJ, Aaronson NK, Stuiver MM. “I am busy surviving” - Views about physical exercise in older adults scheduled for colorectal cancer surgery. J Geriatr Oncol 2020; 11:444-450. [DOI: 10.1016/j.jgo.2019.05.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 04/06/2019] [Accepted: 05/02/2019] [Indexed: 10/26/2022]
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12
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Welbie M, Wittink H, Westerman MJ, Topper I, Snoei J, Devillé WLJM. A Mobile Patient-Reported Outcome Measure App With Talking Touchscreen: Usability Assessment. JMIR Form Res 2019; 3:e11617. [PMID: 31573909 PMCID: PMC6789421 DOI: 10.2196/11617] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 03/01/2019] [Accepted: 03/24/2019] [Indexed: 12/24/2022] Open
Abstract
Background In the past years, a mobile health (mHealth) app called the Dutch Talking Touch Screen Questionnaire (DTTSQ) was developed in The Netherlands. The aim of development was to enable Dutch physical therapy patients to autonomously complete a health-related questionnaire regardless of their level of literacy and digital skills. Objective The aim of this study was to evaluate the usability (defined as the effectiveness, efficiency, and satisfaction) of the prototype of the DTTSQ for Dutch physical therapy patients with diverse levels of experience in using mobile technology. Methods The qualitative Three-Step Test-Interview method, including both think-aloud and retrospective probing techniques, was used to gain insight into the usability of the DTTSQ. A total of 24 physical therapy patients were included. The interview data were analyzed using a thematic content analysis approach aimed at analyzing the accuracy and completeness with which participants completed the questionnaire (effectiveness), the time it took the participants to complete the questionnaire (efficiency), and the extent to which the participants were satisfied with the ease of use of the questionnaire (satisfaction). The problems encountered by the participants in this study were given a severity rating that was used to provide a rough estimate of the need for additional usability efforts. Results All participants within this study were very satisfied with the ease of use of the DTTSQ. Overall, 9 participants stated that the usability of the app exceeded their expectations. The group of 4 average-/high-experienced participants encountered only 1 problem in total, whereas the 11 little-experienced participants encountered an average of 2 problems per person and the 9 inexperienced participants an average of 3 problems per person. A total of 13 different kind of problems were found during this study. Of these problems, 4 need to be addressed before the DTTSQ will be released because they have the potential to negatively influence future usage of the tool. The other 9 problems were less likely to influence future usage of the tool substantially. Conclusions The usability of the DTTSQ needs to be improved before it can be released. No problems were found with satisfaction or efficiency during the usability test. The effectiveness needs to be improved by (1) making it easier to navigate through screens without the possibility of accidentally skipping one, (2) enabling the possibility to insert an answer by tapping on the text underneath a photograph instead of just touching the photograph itself, and (3) making it easier to correct wrong answers. This study shows the importance of including less skilled participants in a usability study when striving for inclusive design and the importance of measuring not just satisfaction but also efficiency and effectiveness during such studies.
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Affiliation(s)
- Marlies Welbie
- Research Group Lifestyle and Health, Research Center Healthy and Sustainable Living, Utrecht University of Applied Sciences, Utrecht, Netherlands
| | - Harriet Wittink
- Research Group Lifestyle and Health, Research Center Healthy and Sustainable Living, Utrecht University of Applied Sciences, Utrecht, Netherlands
| | - Marjan J Westerman
- Institute of Health Sciences, Amsterdam Public Health Research Institute, Department of Methodology and Statistics, VU University, Amsterdam, Netherlands
| | - Ilse Topper
- Research Group Lifestyle and Health, Research Center Healthy and Sustainable Living, Utrecht University of Applied Sciences, Utrecht, Netherlands
| | - Josca Snoei
- Research Group Lifestyle and Health, Research Center Healthy and Sustainable Living, Utrecht University of Applied Sciences, Utrecht, Netherlands
| | - Walter L J M Devillé
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, Netherlands.,Faculty of Social and Behavioral Sciences, University of Amsterdam, Amsterdam, Netherlands.,Dutch Centre of Expertise on Health Disparities (Pharos), Utrecht, Netherlands
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13
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Westerneng M, Diepeveen M, Witteveen AB, Westerman MJ, van der Horst HE, van Baar AL, de Jonge A. Experiences of pregnant women with a third trimester routine ultrasound - a qualitative study. BMC Pregnancy Childbirth 2019; 19:319. [PMID: 31477046 PMCID: PMC6720093 DOI: 10.1186/s12884-019-2470-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 08/21/2019] [Indexed: 11/10/2022] Open
Abstract
Background Studies showed that pregnant women generally value routine ultrasounds in the first two trimesters because these provide reassurance and a chance to see their unborn baby. This, in turn, might help to decrease maternal anxiety levels and increase the bond with the baby. However, it is unclear whether pregnant women hold the same positive views about a third trimester routine ultrasound, which is increasingly being used in the Netherlands as a screening tool to monitor fetal growth. The aim of this study was to explore pregnant women’s experiences with a third trimester routine ultrasound. Methods We held semi-structured interviews with fifteen low-risk pregnant women who received a third trimester routine ultrasound in the context of the Dutch IUGR RIsk Selection (IRIS) study. The IRIS study is a nationwide cluster randomized controlled trial carried out among more than 13,000 women to examine the effectiveness of a third trimester routine ultrasound to monitor fetal growth. For the interviews, participants were purposively selected based on parity, age, ethnicity, and educational level. We performed thematic content analysis using MAXQDA. Results Most pregnant women appreciated a third trimester routine ultrasound because it provided them confirmation that their baby was fine and an extra opportunity to see their baby. At the same time they expressed that they already felt confident about the health of their baby, and did not feel that their bond with their baby had increased after the third trimester ultrasound. Women also reported that they were getting used to routine ultrasounds throughout their pregnancy, and that this increased their need for another one. Conclusions Pregnant women seem to appreciate a third trimester routine ultrasound, but it does not seem to reduce anxiety or to improve bonding with their baby. Women’s appreciation of a third trimester routine ultrasound might arise from getting used to routine ultrasounds throughout pregnancy. We recommend to examine the psychological impact of third trimester routine ultrasounds in future studies. Results should be taken into consideration when balancing the gains, which are as yet not clear, of introducing a third trimester routine ultrasound against unwanted side effects and costs.
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Affiliation(s)
- Myrte Westerneng
- Amsterdam UMC, Vrije Universiteit Amsterdam, Midwifery Science, AVAG, Amsterdam Public Health research institute, P.O. Box 7057, 1007, MB, Amsterdam, The Netherlands.
| | - Mariëlle Diepeveen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Medical Humanities and the Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Anke B Witteveen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Midwifery Science, AVAG, Amsterdam Public Health research institute, P.O. Box 7057, 1007, MB, Amsterdam, The Netherlands
| | - Marjan J Westerman
- Department of Methodology and Statistics, Institute of Health Sciences, Faculty of Earth and Life Sciences, VU University, Amsterdam, The Netherlands
| | - Henriette E van der Horst
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | | | - Ank de Jonge
- Amsterdam UMC, Vrije Universiteit Amsterdam, Midwifery Science, AVAG, Amsterdam Public Health research institute, P.O. Box 7057, 1007, MB, Amsterdam, The Netherlands
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14
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Juurlink TT, Vukadin M, Stringer B, Westerman MJ, Lamers F, Anema JR, Beekman ATF, van Marle HJF. Barriers and facilitators to employment in borderline personality disorder: A qualitative study among patients, mental health practitioners and insurance physicians. PLoS One 2019; 14:e0220233. [PMID: 31335909 PMCID: PMC6650068 DOI: 10.1371/journal.pone.0220233] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 07/11/2019] [Indexed: 12/02/2022] Open
Abstract
Background Borderline personality disorder (BPD) is associated with unemployment and impaired functioning. However, a comprehensive understanding of barriers and facilitators to employment from a multidisciplinary perspective is currently lacking. Therefore, the aim of this qualitative study was to explore barriers and facilitators in gaining and maintaining employment in BPD from the perspectives of patients, mental health practitioners (MHPs) and insurance physicians (IPs). Methods Fifteen semi-structured interviews were conducted in patients with BPD and two focus groups were carried out among MHPs (n = 7) and IPs (n = 6) following a thematic content analysis approach. Results All participants described barriers and facilitators relating to three overall themes: characteristics of BPD, stigma, and support to employment. Barriers to employment mainly related to characteristics of BPD, such as low self-image, difficulty posing personal boundaries, difficulty regulating emotions, and lack of structure. MHPs and IPs additionally mentioned externalization and overestimation of competencies on the part of patients. Enhancing emotion regulation and self-reflection by successful treatment was suggested as a facilitator to enhance employment. Increasing collaboration between mental health and vocational rehabilitation services, and increasing knowledge about BPD, were suggested to increase sustainable employment and decrease stigma. Conclusions The present findings revealed that both facilitators and barriers are important in gaining and maintaining employment in BPD in which diminishing symptoms, examining stigma and increasing support to employment are key. As a next step, supported employment strategies that follow patient preferences and integrate employment and mental health services, should be studied in the context of BPD.
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Affiliation(s)
- Trees T. Juurlink
- Department of Psychiatry, Division of GGZ inGeest Specialized Mental Health Care, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
- * E-mail:
| | - Miljana Vukadin
- Department of Social Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Barbara Stringer
- Centre for Consultation and Expertise (CCE), Utrecht, The Netherlands
| | - Marjan J. Westerman
- Department of Health Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Femke Lamers
- Department of Psychiatry, Division of GGZ inGeest Specialized Mental Health Care, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Johannes R. Anema
- Department of Social Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Aartjan T. F. Beekman
- Department of Psychiatry, Division of GGZ inGeest Specialized Mental Health Care, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Hein J. F. van Marle
- Department of Psychiatry, Division of GGZ inGeest Specialized Mental Health Care, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
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15
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de Kruif JTCM, Visser M, van den Berg MMGA, Derks MJM, de Boer MR, van Laarhoven HWM, de Vries JHM, de Vries YC, Kampman E, Winkels RW, Westerman MJ. A longitudinal mixed methods study on changes in body weight, body composition, and lifestyle in breast cancer patients during chemotherapy and in a comparison group of women without cancer: study protocol. BMC Cancer 2019; 19:7. [PMID: 30611243 PMCID: PMC6321717 DOI: 10.1186/s12885-018-5207-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 12/11/2018] [Indexed: 02/08/2023] Open
Abstract
Background More than 60% of women diagnosed with early stage breast cancer receive (neo)adjuvant chemotherapy. Breast cancer patients receiving chemotherapy often experience symptoms such as nausea, vomiting and loss of appetite that potentially affect body weight and body composition. Changes in body weight and body composition may detrimentally affect their quality of life, and could potentially increase the risk of disease recurrence, cardiovascular disease and diabetes. To date, from existing single method (quantitative or qualitative) studies is not clear whether changes in body weight and body composition in breast cancer patients are treatment related because previous studies have not included a control group of women without breast cancer. Methods We therefore developed the COBRA-study (Change Of Body composition in BReast cancer: All-in Assessment-study) to assess changes in body weight, body composition and related lifestyle factors such as changes in physical activity, dietary intake and other behaviours. Important and unique features of the COBRA-study is that it used I) a “Mixed Methods Design”, in order to quantitatively assess changes in body weight, body composition and lifestyle factors and, to qualitatively assess how perceptions of women may have influenced these measured changes pre-, during and post-chemotherapy, and II) a control group of non-cancer women for comparison. Descriptive statistics on individual quantitative data were combined with results from a thematic analysis on the interviews- and focus group data to understand patients’ experiences before, during and after chemotherapy. Discussion The findings of our mixed methods study, on chemotherapy treated cancer patients and a comparison group, can enable healthcare researchers and professionals to develop tailored intervention schemes to help breast cancer patients prevent or handle the physical and mental changes they experience as a result of their chemotherapy. This will ultimately improve their quality of life and could potentially reduce their risk for other co-morbidity health issues such as cardiovascular disease and diabetes.
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Affiliation(s)
- J Th C M de Kruif
- Department of Health Sciences, Faculty of Science, the Amsterdam Public Health Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - M Visser
- Department of Health Sciences, Faculty of Science, the Amsterdam Public Health Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - M M G A van den Berg
- Division of Human Nutrition and Health, Wageningen University, Wageningen, the Netherlands
| | - M J M Derks
- Division of Human Nutrition and Health, Wageningen University, Wageningen, the Netherlands
| | - M R de Boer
- Department of Health Sciences, Faculty of Science, the Amsterdam Public Health Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - H W M van Laarhoven
- Department of Medical Oncology, Academic Medical Center, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - J H M de Vries
- Division of Human Nutrition and Health, Wageningen University, Wageningen, the Netherlands
| | - Y C de Vries
- Division of Human Nutrition and Health, Wageningen University, Wageningen, the Netherlands
| | - E Kampman
- Division of Human Nutrition and Health, Wageningen University, Wageningen, the Netherlands
| | - R W Winkels
- Division of Human Nutrition and Health, Wageningen University, Wageningen, the Netherlands.,Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - M J Westerman
- Department of Health Sciences, Faculty of Science, the Amsterdam Public Health Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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16
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Hugtenburg JG, En-nasery S, Tromp VN, Westerman MJ, Timmers L, Boons CL, Konings I. Patients’ needs and wishes regarding pharmaceutical care provided by the pharmacist for women treated with adjuvant endocrine therapy for breast cancer. Res Social Adm Pharm 2018. [DOI: 10.1016/j.sapharm.2018.05.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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17
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de Kruif JTCM, Scholtens MB, van der Rijt J, de Boer MR, van den Berg MMGA, de Vries YC, Winkels RM, Visser M, Kampman E, Westerman MJ. Perceptions of Dutch health care professionals on weight gain during chemotherapy in women with breast cancer. Support Care Cancer 2018; 27:601-607. [PMID: 30022349 PMCID: PMC6325997 DOI: 10.1007/s00520-018-4347-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 07/06/2018] [Indexed: 11/29/2022]
Abstract
Purpose Dutch Health care professionals (HCPs) provide little information concerning health risks associated with weight gain during chemotherapy for breast cancer. Women with breast cancer have specified the need for more information on nutrition and physical activity to deal with weight gain. The aims of this study were to assess the perceptions of Dutch HCPs on weight gain during chemotherapy and in addition evaluate whether and what kind of information on dietary intake and physical activity HCPs provide to prevent/treat weight gain during (neo)adjuvant chemotherapy. Methods A qualitative study was conducted using semi-structured interviews with 34 HCPs involved in breast cancer care: general practitioners, oncologists, specialized nurses, and dieticians. Results To date, little information about nutrition, physical activity, and weight gain is given during chemotherapy because it is not part of most HCPs’ training, it is not included in the guidelines and it is not the best time to bring up information in the opinion of HCPs. Weight gain was perceived as just a matter of a few kilos and not an important health issue during treatment. All HCPs felt it is better that women themselves addressed their weight gain after chemotherapy. Conclusion More knowledge about health risks associated with chemotherapy-induced weight gain and how to combat these issues needs to be made readily available to the HCPs and should become part of their training. Existing patient guidelines should include information on how to prevent and/or reduce weight gain through self-management of nutrition intake and physical activity during and post chemotherapy.
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Affiliation(s)
- J Th C M de Kruif
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - M B Scholtens
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - J van der Rijt
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - M R de Boer
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Y C de Vries
- Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands
| | - R M Winkels
- Penn State Cancer Institute, Department of Public Health Sciences, Penn State University, Hershey, PA, USA
| | - M Visser
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - E Kampman
- Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands
| | - M J Westerman
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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18
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Vukadin M, Schaafsma FG, Westerman MJ, Michon HWC, Anema JR. Experiences with the implementation of Individual Placement and Support for people with severe mental illness: a qualitative study among stakeholders. BMC Psychiatry 2018; 18:145. [PMID: 29793455 PMCID: PMC5968490 DOI: 10.1186/s12888-018-1729-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 05/08/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Individual Placement and Support (IPS) is an evidence-based approach to help people with severe mental illness achieve competitive employment. This article provides insight into an organizational and a financial implementation strategy for IPS in the Netherlands by exploring the perceived facilitators and barriers among participating stakeholders. The goal of this multifaceted strategy was to improve IPS implementation by improving the collaboration between all organizations involved, and realising secured IPS funding with a 'pay for performance' element. METHODS A qualitative, explorative study among practitioners (n = 8) and decision makers (n = 7) in mental health care and vocational rehabilitation was performed using semi-structured interviews to collect rich information about the possible facilitators and barriers with regard to the organizational and financial implementation strategy for IPS. RESULTS Important perceived facilitators were the key principles of the IPS model, regular meetings of stakeholders in mental health care and vocational rehabilitation, stakeholders' experienced ownership of IPS and collaboration, the mandate and influence of the decision makers involved and secured IPS funding. Important perceived barriers included the experienced rigidity of the IPS model fidelity scale and lack of independent fidelity reviewers, the temporary and fragmented character of the secured funding, lack of communication between decision makers and practitioners and negative attitudes and beliefs among mental health clinicians. Changes in legislation were experienced as a facilitator as well as a barrier. CONCLUSIONS The results of this study suggest that the collaboration and IPS funding were experienced as improved by applying an organizational and a financial implementation strategy. However, considerable effort is still necessary to overcome the remaining barriers identified and to make the implementation of IPS a success in practice.
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Affiliation(s)
- Miljana Vukadin
- Department of Public and Occupational Health, Amsterdam Public Health research institute, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands. .,Research Center for Insurance Medicine: collaboration between AMC- UMCG - UWV - VUmc, Amsterdam, the Netherlands.
| | - Frederieke G. Schaafsma
- 0000 0004 0435 165Xgrid.16872.3aDepartment of Public and Occupational Health, Amsterdam Public Health research institute, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands ,0000000404654431grid.5650.6Research Center for Insurance Medicine: collaboration between AMC– UMCG – UWV – VUmc, Amsterdam, the Netherlands
| | - Marjan J. Westerman
- 0000 0004 1754 9227grid.12380.38Department of Health Sciences, Vrije Universiteit Amsterdam, De Boelelaan 1105, 1081 HV Amsterdam, the Netherlands
| | - Harry W. C. Michon
- 0000 0001 0835 8259grid.416017.5Trimbos Institute, The Netherlands Institute of Mental Health and Addiction, Da Costakade 45, 3521 VS Utrecht, the Netherlands
| | - Johannes R. Anema
- 0000 0004 0435 165Xgrid.16872.3aDepartment of Public and Occupational Health, Amsterdam Public Health research institute, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands ,0000000404654431grid.5650.6Research Center for Insurance Medicine: collaboration between AMC– UMCG – UWV – VUmc, Amsterdam, the Netherlands
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Terwee CB, Prinsen CAC, Chiarotto A, Westerman MJ, Patrick DL, Alonso J, Bouter LM, de Vet HCW, Mokkink LB. COSMIN methodology for evaluating the content validity of patient-reported outcome measures: a Delphi study. Qual Life Res 2018; 27:1159-1170. [PMID: 29550964 PMCID: PMC5891557 DOI: 10.1007/s11136-018-1829-0] [Citation(s) in RCA: 897] [Impact Index Per Article: 149.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Content validity is the most important measurement property of a patient-reported outcome measure (PROM) and the most challenging to assess. Our aims were to: (1) develop standards for evaluating the quality of PROM development; (2) update the original COSMIN standards for assessing the quality of content validity studies of PROMs; (3) develop criteria for what constitutes good content validity of PROMs, and (4) develop a rating system for summarizing the evidence on a PROM's content validity and grading the quality of the evidence in systematic reviews of PROMs. METHODS An online 4-round Delphi study was performed among 159 experts from 21 countries. Panelists rated the degree to which they (dis)agreed to proposed standards, criteria, and rating issues on 5-point rating scales ('strongly disagree' to 'strongly agree'), and provided arguments for their ratings. RESULTS Discussion focused on sample size requirements, recording and field notes, transcribing cognitive interviews, and data coding. After four rounds, the required 67% consensus was reached on all standards, criteria, and rating issues. After pilot-testing, the steering committee made some final changes. Ten criteria for good content validity were defined regarding item relevance, appropriateness of response options and recall period, comprehensiveness, and comprehensibility of the PROM. DISCUSSION The consensus-based COSMIN methodology for content validity is more detailed, standardized, and transparent than earlier published guidelines, including the previous COSMIN standards. This methodology can contribute to the selection and use of high-quality PROMs in research and clinical practice.
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Affiliation(s)
- C B Terwee
- Department of Epidemiology and Biostatistics and Amsterdam Public Health Research Institute, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
| | - C A C Prinsen
- Department of Epidemiology and Biostatistics and Amsterdam Public Health Research Institute, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - A Chiarotto
- Department of Epidemiology and Biostatistics and Amsterdam Public Health Research Institute, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - M J Westerman
- Department of Health Sciences and Amsterdam Public Health Research Institute, VU University, Amsterdam, The Netherlands
| | - D L Patrick
- Department of Health Services, University of Washington, Seattle, WA, USA
| | - J Alonso
- IMIM (Hospital del Mar Medical Research Institute), Department of Experimental and Health Sciences, Pompeu Fabra University (UPF), Barcelona, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - L M Bouter
- Department of Epidemiology and Biostatistics and Amsterdam Public Health Research Institute, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
- Faculty of Humanities, Department of Philosophy, VU University, Amsterdam, The Netherlands
| | - H C W de Vet
- Department of Epidemiology and Biostatistics and Amsterdam Public Health Research Institute, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - L B Mokkink
- Department of Epidemiology and Biostatistics and Amsterdam Public Health Research Institute, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
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Welbie M, Wittink H, Westerman MJ, Topper I, Snoei J, Devillé WL. Using Plain Language and Adding Communication Technology to an Existing Health-Related Questionnaire to Help Generate Accurate Information: Qualitative Study. J Med Internet Res 2018; 20:e140. [PMID: 29685873 PMCID: PMC5938598 DOI: 10.2196/jmir.7940] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 12/22/2017] [Accepted: 01/31/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Low-educated patients are disadvantaged in using questionnaires within the health care setting because most health-related questionnaires do not take the educational background of patients into account. The Dutch Talking Touch Screen Questionnaire (DTTSQ) was developed in an attempt to meet the needs of low-educated patients by using plain language and adding communication technology to an existing paper-based questionnaire. For physical therapists to use the DTTSQ as part of their intake procedure, it needs to generate accurate information from all of their patients, independent of educational level. OBJECTIVE The aim of this study was to get a first impression of the information that is generated by the DTTSQ. To achieve this goal, response processes of physical therapy patients with diverse levels of education were analyzed. METHODS The qualitative Three-Step Test-Interview method was used to collect observational data on actual response behavior of 24 physical therapy patients with diverse levels of education. The interviews included both think-aloud and retrospective probing techniques. RESULTS Of the 24 respondents, 20 encountered one or more problems during their response process. The use of plain language and information and communication technology (ICT) appeared to have a positive effect on the comprehensibility of the DTTSQ. However, it also had some negative effects on the interpretation, retrieval, judgment, and response selection within the response processes of the participants in this study. No educational group in this research population stood out from the rest in the kind or number of problems that arose. All respondents recognized themselves in the outcomes of the questionnaire. CONCLUSIONS The use of plain language and ICT within the DTTSQ had both positive and negative effects on the response processes of its target population. The results of this study emphasize the importance of earlier recommendations to accompany any adaption of any questionnaire to a new mode of delivery by demonstrating the difference and equivalence between the two different modes and to scientifically evaluate the applicability of the newly developed mode of the questionnaire in its intended setting. This is especially important in a digital era in which the use of plain language within health care is increasingly being advocated.
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Affiliation(s)
- Marlies Welbie
- Research Group Lifestyle and Health, Faculty of Health Care, University of Applied Sciences, Utrecht, Netherlands
| | - Harriet Wittink
- Research Group Lifestyle and Health, Faculty of Health Care, University of Applied Sciences, Utrecht, Netherlands
| | - Marjan J Westerman
- Institute of Health Sciences, Amsterdam Public Health Research Institute, VU University, Amsterdam, Netherlands
| | - Ilse Topper
- Research Group Lifestyle and Health, Faculty of Health Care, University of Applied Sciences, Utrecht, Netherlands
| | - Josca Snoei
- Research Group Lifestyle and Health, Faculty of Health Care, University of Applied Sciences, Utrecht, Netherlands
| | - Walter Ljm Devillé
- Faculty of Social and Behavioral Sciences, University of Amsterdam, Amsterdam, Netherlands.,Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, Netherlands.,National Knowledge and Advisory Centre on Migrants, Refugees and Health (Pharos), Utrecht, Netherlands
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21
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Terwee CB, Prinsen CAC, Chiarotto A, Westerman MJ, Patrick DL, Alonso J, Bouter LM, de Vet HCW, Mokkink LB. COSMIN methodology for evaluating the content validity of patient-reported outcome measures: a Delphi study. Qual Life Res 2018. [PMID: 29550964 DOI: 10.1007/s11136‐018‐1829‐0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Content validity is the most important measurement property of a patient-reported outcome measure (PROM) and the most challenging to assess. Our aims were to: (1) develop standards for evaluating the quality of PROM development; (2) update the original COSMIN standards for assessing the quality of content validity studies of PROMs; (3) develop criteria for what constitutes good content validity of PROMs, and (4) develop a rating system for summarizing the evidence on a PROM's content validity and grading the quality of the evidence in systematic reviews of PROMs. METHODS An online 4-round Delphi study was performed among 159 experts from 21 countries. Panelists rated the degree to which they (dis)agreed to proposed standards, criteria, and rating issues on 5-point rating scales ('strongly disagree' to 'strongly agree'), and provided arguments for their ratings. RESULTS Discussion focused on sample size requirements, recording and field notes, transcribing cognitive interviews, and data coding. After four rounds, the required 67% consensus was reached on all standards, criteria, and rating issues. After pilot-testing, the steering committee made some final changes. Ten criteria for good content validity were defined regarding item relevance, appropriateness of response options and recall period, comprehensiveness, and comprehensibility of the PROM. DISCUSSION The consensus-based COSMIN methodology for content validity is more detailed, standardized, and transparent than earlier published guidelines, including the previous COSMIN standards. This methodology can contribute to the selection and use of high-quality PROMs in research and clinical practice.
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Affiliation(s)
- C B Terwee
- Department of Epidemiology and Biostatistics and Amsterdam Public Health Research Institute, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
| | - C A C Prinsen
- Department of Epidemiology and Biostatistics and Amsterdam Public Health Research Institute, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - A Chiarotto
- Department of Epidemiology and Biostatistics and Amsterdam Public Health Research Institute, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - M J Westerman
- Department of Health Sciences and Amsterdam Public Health Research Institute, VU University, Amsterdam, The Netherlands
| | - D L Patrick
- Department of Health Services, University of Washington, Seattle, WA, USA
| | - J Alonso
- IMIM (Hospital del Mar Medical Research Institute), Department of Experimental and Health Sciences, Pompeu Fabra University (UPF), Barcelona, Spain.,CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - L M Bouter
- Department of Epidemiology and Biostatistics and Amsterdam Public Health Research Institute, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.,Faculty of Humanities, Department of Philosophy, VU University, Amsterdam, The Netherlands
| | - H C W de Vet
- Department of Epidemiology and Biostatistics and Amsterdam Public Health Research Institute, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - L B Mokkink
- Department of Epidemiology and Biostatistics and Amsterdam Public Health Research Institute, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
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Mantziki K, Renders CM, Westerman MJ, Mayer J, Borys JM, Seidell JC. Tools for a systematic appraisal of integrated community-based approaches to prevent childhood obesity. BMC Public Health 2018; 18:189. [PMID: 29378550 PMCID: PMC5789618 DOI: 10.1186/s12889-018-5042-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 01/05/2018] [Indexed: 01/04/2023] Open
Abstract
Background Evaluation and monitoring methods are often unable to identify crucial elements of success or failure of integrated community-wide approaches aiming to tackle childhood overweight and obesity, yet difficult to determine in complex programmes. Therefore, we aimed to systematically appraise strengths and weaknesses of such programmes and to assess the usefulness of the appraisal tools used. Methods To identify strengths and weaknesses of the integrated community-based approaches two tools were used: the Good Practice Appraisal tool for obesity prevention programmes, projects, initiatives and intervention (GPAT), a self-administered questionnaire developed by the WHO; and the OPEN tool, a structured list of questions based on the EPODE theory, to assist face-to-face interviews with the principle programme coordinators. The strengths and weaknesses of these tools were assessed with regard to practicalities, quality of acquired data and the appraisal process, criteria and scoring. Results Several strengths and weaknesses were identified in all the assessed integrated community-based approaches, different for each of them. The GPAT provided information mostly on intervention elements whereas through the OPEN tool information on both the programme and intervention levels were acquired. Conclusion Large variability between integrated community-wide approaches preventing childhood obesity in the European region was identified and therefore each of them has different needs. Both tools used in combination seem to facilitate comprehensive assessment of integrated community-wide approaches in a systematic manner, which is rarely conducted. Nonetheless, the tools should be improved in line to their limitations as recommended in this manuscript. Electronic supplementary material The online version of this article (10.1186/s12889-018-5042-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- K Mantziki
- Department of Health Sciences, VU University of Amsterdam, De Boelelaan 1085, 1081HV, Amsterdam, The Netherlands.
| | - C M Renders
- Department of Health Sciences, VU University of Amsterdam, De Boelelaan 1085, 1081HV, Amsterdam, The Netherlands
| | - M J Westerman
- Department of Health Sciences, VU University of Amsterdam, De Boelelaan 1085, 1081HV, Amsterdam, The Netherlands
| | - J Mayer
- EPODE International Network, 109-111 Rue Royale, 1000, Brussels, Belgium
| | - J M Borys
- EPODE International Network, 109-111 Rue Royale, 1000, Brussels, Belgium
| | - J C Seidell
- Department of Health Sciences, VU University of Amsterdam, De Boelelaan 1085, 1081HV, Amsterdam, The Netherlands
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Hoedjes M, de Kruif A, Mols F, Bours M, Beijer S, Winkels R, Westerman MJ, Seidell JC, Kampman E. An exploration of needs and preferences for dietary support in colorectal cancer survivors: A mixed-methods study. PLoS One 2017; 12:e0189178. [PMID: 29253011 PMCID: PMC5734680 DOI: 10.1371/journal.pone.0189178] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 11/21/2017] [Indexed: 01/01/2023] Open
Abstract
PURPOSE To describe the proportion of colorectal cancer (CRC) survivors who perceive a need for dietary support; to examine which socio-demographic, cancer-related, and health-related characteristics are associated with this need; to explore reasons for (not) needing support; and to explore CRC survivors' specific needs and preferences with regard to lifestyle (i.e., dietary, exercise, and/or weight management) support. METHODS This mixed-methods study comprised a cross-sectional survey among 1774 Dutch CRC survivors and three focus groups (n = 16). To examine associations, logistic regression analyses were conducted. Focus groups were audio-taped, transcribed verbatim, and analyzed using a thematic approach. RESULTS Of 1458 respondents (82%), 1198 (67.5%) were included for analyses. 17.5% reported a need for dietary support. Characteristics associated with this need were: being younger, living without a partner, having a stoma, having diabetes, and being overweight or obese. The main reason for needing support was being unable to initiate and maintain lifestyle changes without support. CRC survivors preferred receiving information soon after diagnosis to make an autonomous, informed decision on improving their lifestyle. They preferred to receive individually-tailored lifestyle support in an autonomy-supportive environment, preferably with involvement of their family and fellow-sufferers. CONCLUSIONS This study has provided knowledge on appropriate support for CRC survivors in need for dietary support to improve health outcomes by promoting adherence to lifestyle and body weight recommendations. Findings can be used to better identify CRC survivors in need for dietary support, and to tailor lifestyle support to their needs and preferences in order to promote uptake, adherence, and effectiveness.
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Affiliation(s)
- Meeke Hoedjes
- Department of Health Sciences and the EMGO+ Institute for Health and Care Research, VU University Amsterdam, Amsterdam, the Netherlands
- Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
- * E-mail:
| | - Anja de Kruif
- Department of Health Sciences and the EMGO+ Institute for Health and Care Research, VU University Amsterdam, Amsterdam, the Netherlands
- Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands
| | - Floortje Mols
- Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - Martijn Bours
- Department of Epidemiology, GROW-School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - Sandra Beijer
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - Renate Winkels
- Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands
| | - Marjan J. Westerman
- Department of Health Sciences and the EMGO+ Institute for Health and Care Research, VU University Amsterdam, Amsterdam, the Netherlands
| | - Jaap C. Seidell
- Department of Health Sciences and the EMGO+ Institute for Health and Care Research, VU University Amsterdam, Amsterdam, the Netherlands
| | - Ellen Kampman
- Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands
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den Boeft M, Huisman D, Morton L, Lucassen P, van der Wouden JC, Westerman MJ, van der Horst HE, Burton CD. Negotiating explanations: doctor-patient communication with patients with medically unexplained symptoms-a qualitative analysis. Fam Pract 2017; 34:107-113. [PMID: 28122926 DOI: 10.1093/fampra/cmw113] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Patients with medically unexplained physical symptoms (MUPS) seek explanations for their symptoms, but often find general practitioners (GPs) unable to deliver these. Different methods of explaining MUPS have been proposed. Little is known about how communication evolves around these explanations. OBJECTIVE To examine the dialogue between GPs and patients related to explanations in a community-based clinic for MUPS. We categorized dialogue types and dialogue outcomes. METHODS Patients were ≥18 years with inclusion criteria for moderate MUPS: ≥2 referrals to specialists, ≥1 functional syndrome/symptoms, ≥10 on the Patient Health Questionnaire-15 and GP's judgement that symptoms were unexplained. We analysed transcripts of 112 audio-recorded consultations (39 patients and 5 GPs) from two studies on the Symptoms Clinic Intervention, a consultation intervention for MUPS in primary care. We used constant comparative analysis to code and classify dialogue types and outcomes. RESULTS We extracted 115 explanation sequences. We identified four dialogue types, differing in the extent to which the GP or patient controlled the dialogue. We categorized eight outcomes of the sequences, ranging from acceptance to rejection by the patient. The most common outcome was holding (conversation suspended in an unresolved state), followed by acceptance. Few explanations were rejected by the patient. Co-created explanations by patient and GP were most likely to be accepted. CONCLUSION We developed a classification of dialogue types and outcomes in relation to explanations offered by GPs for MUPS patients. While it requires further validation, it provides a framework, which can be used for teaching, evaluation of practice and research.
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Affiliation(s)
- Madelon den Boeft
- Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands,
| | - Daniëlle Huisman
- Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - LaKrista Morton
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland
| | - Peter Lucassen
- Department of Primary and Community Care, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands and
| | - Johannes C van der Wouden
- Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Marjan J Westerman
- Department of Methodology and Statistics, Institute of Health Sciences, Faculty of Earth and Life Sciences, VU University, Amsterdam, The Netherlands
| | - Henriëtte E van der Horst
- Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Christopher D Burton
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland
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Baron R, Heesterbeek Q, Manniën J, Hutton EK, Brug J, Westerman MJ. Exploring health education with midwives, as perceived by pregnant women in primary care: A qualitative study in the Netherlands. Midwifery 2017; 46:37-44. [PMID: 28161688 DOI: 10.1016/j.midw.2017.01.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 12/30/2016] [Accepted: 01/19/2017] [Indexed: 01/08/2023]
Abstract
OBJECTIVE to explore the experiences, wishes and needs of pregnant women with respect to health education in primary care with midwives. DESIGN qualitative semi-structured interview study, using thematic analysis and constant comparison. SETTING AND PARTICIPANTS twenty-two pregnant women in midwife-led primary care, varying in socio-demographic characteristics, weeks of pregnancy and region of residence in the Netherlands, were interviewed between April and December 2013. FINDINGS women considered midwives to be the designated health caregivers for providing antenatal health education, and generally appreciated the information they had received from their midwives. Some women, however, believed the amount of verbal health information was insufficient; others that there was too much written information. Many women still had questions and expressed uncertainties regarding various health issues, such as weight gain, alcohol, and physical activity. They perceived their health education to be individualised according to their midwives' assessments of the extent of their knowledge, as well as by the questions they asked themselves. A few were concerned that midwives may make incorrect assumptions about the extent of their knowledge. Women also varied in how comfortable they felt about contacting their midwives for questions between antenatal visits. Women felt that important qualities for midwives underlying health education, were making them feel at ease and building a relationship of trust with them. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE health education was highly appreciated by women in general, suggesting that midwives should err on the side of providing too much verbal information, as opposed to too little. A more pro-active approach with information provision may be of value not only to those with a clear desire for more information, but also to those who are unsure of what information they may be missing. As midwives are the principal health care providers throughout pregnancy,they should ideally emphasise their availability for questions between antenatal visits.
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Affiliation(s)
- Ruth Baron
- Department of Midwifery Science, Midwifery Academy Amsterdam Groningen (AVAG) and the EMGO Institute for Health and Care Research, VU University Medical Centre, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
| | - Querine Heesterbeek
- Department of Midwifery Science, Midwifery Academy Amsterdam Groningen (AVAG) and the EMGO Institute for Health and Care Research, VU University Medical Centre, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Judith Manniën
- Department of Midwifery Science, Midwifery Academy Amsterdam Groningen (AVAG) and the EMGO Institute for Health and Care Research, VU University Medical Centre, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Eileen K Hutton
- Department of Midwifery Science, Midwifery Academy Amsterdam Groningen (AVAG) and the EMGO Institute for Health and Care Research, VU University Medical Centre, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands; Department of Obstetrics and Gynecology, McMaster University, 1280 Main Street West, MDCL 2210, Hamilton, ON, Canada L8S 4K1
| | - Johannes Brug
- Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Centre, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Marjan J Westerman
- Department of Methodology and Statistics, Institute of Health Sciences, Faculty of Earth and Life Sciences, VU University, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
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van Koperen TM, Renders CM, Spierings EJM, Hendriks AM, Westerman MJ, Seidell JC, Schuit AJ. Recommendations and Improvements for the Evaluation of Integrated Community-Wide Interventions Approaches. J Obes 2016; 2016:2385698. [PMID: 28116149 PMCID: PMC5220506 DOI: 10.1155/2016/2385698] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 10/30/2016] [Indexed: 11/23/2022] Open
Abstract
Background. Integrated community-wide intervention approaches (ICIAs) are implemented to prevent childhood obesity. Programme evaluation improves these ICIAs, but professionals involved often struggle with performance. Evaluation tools have been developed to support Dutch professionals involved in ICIAs. It is unclear how useful these tools are to intended users. We therefore researched the facilitators of and barriers to ICIA programme evaluation as perceived by professionals and their experiences of the evaluation tools. Methods. Focus groups and interviews with 33 public health professionals. Data were analysed using a thematic content approach. Findings. Evaluation is hampered by insufficient time, budget, and experience with ICIAs, lack of leadership, and limited advocacy for evaluation. Epidemiologists are regarded as responsible for evaluation but feel incompetent to perform evaluation or advocate its need in a political environment. Managers did not prioritise process evaluations, involvement of stakeholders, and capacity building. The evaluation tools are perceived as valuable but too comprehensive considering limited resources. Conclusion. Evaluating ICIAs is important but most professionals are unfamiliar with it and management does not prioritise process evaluation nor incentivize professionals to evaluate. To optimise programme evaluation, more resources and coaching are required to improve professionals' evaluation capabilities and specifically the use of evaluation.
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Affiliation(s)
- Tessa M. van Koperen
- Department of Health Sciences and the EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, Netherlands
| | - Carry M. Renders
- Department of Health Sciences and the EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, Netherlands
| | - Eline J. M. Spierings
- Department of Health Sciences and the EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, Netherlands
| | - Anna-Marie Hendriks
- Department of Health Promotion, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Marjan J. Westerman
- Department of Health Sciences and the EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, Netherlands
| | - Jacob C. Seidell
- Department of Health Sciences and the EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, Netherlands
| | - Albertine J. Schuit
- Department of Health Sciences and the EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, Netherlands
- National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
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Dikkers MF, Westerman MJ, Rubinstein SM, van Tulder MW, Anema JR. Why Neck Pain Patients Are Not Referred to Manual Therapy: A Qualitative Study among Dutch Primary Care Stakeholders. PLoS One 2016; 11:e0157465. [PMID: 27311067 PMCID: PMC4911043 DOI: 10.1371/journal.pone.0157465] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 05/31/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Treatment of neck pain with manual therapy demonstrated to be more effective and cost-effective than general practitioner (GP) care or physiotherapy in a high quality RCT in the Netherlands in 2002. However, referral to manual therapy for neck pain is still relatively low. This study aims to explore the barriers and facilitators affecting the implementation of manual therapy in neck pain management in primary care. METHODS An explorative study was conducted comprising semi-structured interviews with GPs (n = 13), physiotherapists (n = 10), manual therapists (n = 7) and their patients with neck pain (n = 27), and three focus groups with additional stakeholders (n = 10-12 per group). A thematic analysis approach was used. RESULTS Different barriers and facilitators for referral were found for patients, GPs and physiotherapists on the individual level, but also in the interaction between stakeholders and their context. Individual perceptions such as knowledge and beliefs about manual therapy for neck pain either impeded or facilitated referral. Fear for complications associated with cervical manipulation was an important barrier for patients as well as GPs. For GPs and physiotherapists it was important whether they perceived it was part of their professional role to refer for manual therapy. Existing relations formed referral behavior, and the trust in a particular practitioner was a recurrent theme among GPs and physiotherapist as well as patients. The contextual factor availability of manual therapy played a role for all stakeholders. CONCLUSIONS Barriers and facilitators were found especially in individual perceptions on manual therapy for neck pain (e.g. knowledge and beliefs), the interaction between stakeholders (e.g. collaboration and trust) and the organizational context. Implementation strategies that focus on these different aspects seem to be likely to optimize referral rates and the use of manual therapy in primary care management of neck pain.
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Affiliation(s)
- Marije F. Dikkers
- Department of Health Sciences and EMGO Institute for Health and Care Research, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands
| | - Marjan J. Westerman
- Department of Health Sciences and EMGO Institute for Health and Care Research, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands
| | - Sidney M. Rubinstein
- Department of Health Sciences and EMGO Institute for Health and Care Research, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands
- * E-mail:
| | - Maurits W. van Tulder
- Department of Health Sciences and EMGO Institute for Health and Care Research, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands
| | - Johannes R. Anema
- Department of Public and Occupational Health and EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, Netherlands
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de Kruif AJ, Derks MJ, de Boer MR, Winkels R, Visser M, Kampman E, Westerman MJ. Abstract P1-10-28: Cultural and religious differences during breast cancer treatment between Dutch and non-Western immigrant women. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p1-10-28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Twelve percent of the Dutch population consists of non-Western immigrant women with an incidence of breast cancer that has risen from 2,9% in 2005 to 5% in 2015. For the second generation of these women the incidence of breast cancer is expected to meet the native Dutch population rates soon, partly due to adoption of Western style dietary habits and physical activity. Chemotherapeutic treatment (CT) for breast cancer is associated with increased body fatness and interventions to prevent this increase are currently explored. Whether perceptions on cancer and treatment differ between non-Western immigrant women than for Dutch women needs to be evaluated before these interventions can be set up. This study aimed to explore cultural and religious differences on women's perceptions of the diagnosis of breast cancer and changes in physical activity and eating habits during chemotherapy treatment.
Methods
A longitudinal qualitative multiple case study was conducted. Newly diagnosed women with breast cancer were recruited and purposively selected (n=23, non-immigrant) from six hospitals in the Netherlands. Semi structured interviews were conducted three times (in total 69): before start of CT, halfway and after CT. In addition 38 women (20 non-immigrant and 18 immigrant) were recruited and interviewed after finishing CT. All interviews (n=107, from 61 women) were audiotaped and transcribed verbatim. A thematic content analysis approach was used.
Results
All 43 non-immigrant women, mean age 51,1 yrs. and 18 immigrant women mean age 43,2 yrs., experienced known side effects from CT. Loss of hair and sometimes the breast appeared to be especially for immigrant women a shocking experience and for some even a loss of femininity. Most of the women perceived to have received incomplete and often unclear information from hospitals about weight and CT treatment. Immigrant women participating the Ramadan during treatment encountered resistance from their physicians. Weight gain during period of CT was higher among immigrant women (mean 13,1 kg, 4-28 kg) than among non-immigrant women (mean 2,5 kg, 2-9 kg). Although both groups said to be less physically active and complained about fatigue, non-immigrant women trying to maintain daily structure and were more active with their diet than most immigrants. Immigrant women expressed cancer as a taboo in their culture impeding them to talk openly about their illness, only when side effects of CT such as hair loss were visible they found it inevitable. Cancer was associated with death at time of diagnosis. For most immigrants and a few non-immigrants this was considered a religious ordeal from Allah or God, these women perceived less influence on their behavior during treatment. Most non-religious women perceived breast cancer as bad luck, stress or heredity.
Conclusion
Especially immigrant women experienced little respect for their culture and insufficient information about treatment. Non-immigrants had a need to actively contribute to their treatment while this need was less obvious for immigrants. Probably because they felt not encouraged by their religion and culture.
Citation Format: de Kruif AJ, Derks MJ, de Boer MR, Winkels R, Visser M, Kampman E, Westerman MJ. Cultural and religious differences during breast cancer treatment between Dutch and non-Western immigrant women. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-10-28.
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Affiliation(s)
- AJ de Kruif
- VU University, Amsterdam, Netherlands; Wageningen University & Research Centre, Human Nutrition, Wageningen, Netherlands; VU University Health Sciences & VUmc, Amsterdam, Netherlands; Wageningen University Research Centre & VU University Amsterdam, Wageningen, Netherlands
| | - MJ Derks
- VU University, Amsterdam, Netherlands; Wageningen University & Research Centre, Human Nutrition, Wageningen, Netherlands; VU University Health Sciences & VUmc, Amsterdam, Netherlands; Wageningen University Research Centre & VU University Amsterdam, Wageningen, Netherlands
| | - MR de Boer
- VU University, Amsterdam, Netherlands; Wageningen University & Research Centre, Human Nutrition, Wageningen, Netherlands; VU University Health Sciences & VUmc, Amsterdam, Netherlands; Wageningen University Research Centre & VU University Amsterdam, Wageningen, Netherlands
| | - R Winkels
- VU University, Amsterdam, Netherlands; Wageningen University & Research Centre, Human Nutrition, Wageningen, Netherlands; VU University Health Sciences & VUmc, Amsterdam, Netherlands; Wageningen University Research Centre & VU University Amsterdam, Wageningen, Netherlands
| | - M Visser
- VU University, Amsterdam, Netherlands; Wageningen University & Research Centre, Human Nutrition, Wageningen, Netherlands; VU University Health Sciences & VUmc, Amsterdam, Netherlands; Wageningen University Research Centre & VU University Amsterdam, Wageningen, Netherlands
| | - E Kampman
- VU University, Amsterdam, Netherlands; Wageningen University & Research Centre, Human Nutrition, Wageningen, Netherlands; VU University Health Sciences & VUmc, Amsterdam, Netherlands; Wageningen University Research Centre & VU University Amsterdam, Wageningen, Netherlands
| | - MJ Westerman
- VU University, Amsterdam, Netherlands; Wageningen University & Research Centre, Human Nutrition, Wageningen, Netherlands; VU University Health Sciences & VUmc, Amsterdam, Netherlands; Wageningen University Research Centre & VU University Amsterdam, Wageningen, Netherlands
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Schalkwijk AAH, Bot SDM, de Vries L, Westerman MJ, Nijpels G, Elders PJM. Perspectives of obese children and their parents on lifestyle behavior change: a qualitative study. Int J Behav Nutr Phys Act 2015; 12:102. [PMID: 26283232 PMCID: PMC4539727 DOI: 10.1186/s12966-015-0263-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Accepted: 08/07/2015] [Indexed: 11/14/2022] Open
Abstract
Background In order to improve and optimize future behavioral family lifestyle intervention programs, more information on the perceptions of obese children and their parents of these programs is needed. As such, the aim of this qualitative study is 1) to explore the expectations of obese children and their parents in relation to lifestyle interventions; 2) to identify barriers to making lifestyle changes that parents and children face within their social context (within the family, at school and amongst friends and peers) as well as the things that facilitate these changes and 3) to identify the needs of obese children and their parents in the context of a lifestyle intervention. Methods A qualitative study using semi-structured interviews was conducted. Interviewees were participants in a lifestyle intervention program in the Netherlands. Results Eighteen children (mean age 10 years) and 24 parents were interviewed. The respondents expected to lose weight by being physically active or by eating healthily. Parents struggled with adopting and adhering to new rules and the absence of support of family members. Children struggled with inconsistent parenting and a lack of support from their parents. Bullying experienced at school impeded the children in their ability to make the necessary changes. Support from peers, on the other hand, stimulated their progress. Parents identified the need for the general practitioner to discuss overweight in a non-offensive way and to show an interest in the process of weight loss. Conclusions Participants in a lifestyle behavior intervention program benefit from parental support and help from their (extended) family, peers and friends. They would also profit from the sustained involvement of their general practitioner in assisting in the maintenance of lifestyle behavior changes. Electronic supplementary material The online version of this article (doi:10.1186/s12966-015-0263-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- A A H Schalkwijk
- Department of General Practice & Elderly Care Medicine and the EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - S D M Bot
- Department of General Practice & Elderly Care Medicine and the EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - L de Vries
- Department of General Practice & Elderly Care Medicine and the EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - M J Westerman
- Department of Methodology and Statistics, Institute of Health Sciences and the EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands
| | - G Nijpels
- Department of General Practice & Elderly Care Medicine and the EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - P J M Elders
- Department of General Practice & Elderly Care Medicine and the EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
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30
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van Leeuwen KM, Jansen APD, Muntinga ME, Bosmans JE, Westerman MJ, van Tulder MW, van der Horst HE. Exploration of the content validity and feasibility of the EQ-5D-3L, ICECAP-O and ASCOT in older adults. BMC Health Serv Res 2015; 15:201. [PMID: 25976227 PMCID: PMC4435604 DOI: 10.1186/s12913-015-0862-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 05/05/2015] [Indexed: 11/30/2022] Open
Abstract
Background In economic evaluations of care services for older adults health-related quality of life (QoL) measures such as the EQ-5D are increasingly replaced by the ICECAP-O and ASCOT, which cover a broader scope of QoL than health alone. Little is known about the content validity and feasibility of these measures. The purpose of this study was to explore the content validity and feasibility of the EQ-5D-3L, ICECAP-O and ASCOT in older adults. Methods Ten older adults were purposively sampled using a maximum variation principle. Think-aloud and verbal probing techniques were used to identify response issues encountered during the interpretation of items and the selection of response options. We used constant comparative methods to analyse the data. Results Two types of response issues were identified for various items in all three measures: interpretation issues and positive responses. Issues with the mapping of a response on one of the response options were least often encountered for the EQ-5D-3L items. Older adults considered the items of the ICECAP-O and ASCOT valuable though more abstract than the EQ-5D-3L. Conclusions Researchers who intend to use the EQ-5D, ICECAP-O or ASCOT in economic evaluations of care services for older adults, should be aware of the response issues that occur during the administration of these measures. Older adults perceived none of the measures as providing a comprehensive picture of their QoL. A preference from older adults for one of the measures depends on the extent to which the items reflect current personal concerns in life.
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Affiliation(s)
- Karen M van Leeuwen
- Department of General Practice and Elderly Care Medicine and EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands. .,Department of Health Sciences and EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands.
| | - Aaltje P D Jansen
- Department of General Practice and Elderly Care Medicine and EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - Maaike E Muntinga
- Department of General Practice and Elderly Care Medicine and EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands. .,Department of Medical Humanities and EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - Judith E Bosmans
- Department of Health Sciences and EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands.
| | - Marjan J Westerman
- Department of Health Sciences and EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands.
| | - Maurits W van Tulder
- Department of Health Sciences and EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands.
| | - Henriette E van der Horst
- Department of General Practice and Elderly Care Medicine and EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
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Tonnon SC, Proper KI, van der Ploeg HP, Westerman MJ, Sijbesma E, van der Beek AJ. A qualitative study of the anticipated barriers and facilitators to the implementation of a lifestyle intervention in the Dutch construction industry. BMC Public Health 2014; 14:1317. [PMID: 25539630 PMCID: PMC4326182 DOI: 10.1186/1471-2458-14-1317] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 12/16/2014] [Indexed: 11/22/2022] Open
Abstract
Background Lifestyle interventions have proven effective for lowering a cardiovascular risk profile by improving lifestyle behaviors, blood glucose and blood cholesterol levels. However, implementation of lifestyle interventions is often met with barriers. This qualitative study sought to determine anticipated barriers and facilitators to the nationwide implementation of an effective lifestyle intervention in the construction industry in the Netherlands. Methods Prior to implementation, focus groups were held with 8 lifestyle counselors and semi-structured interviews with 20 employees of the construction industry, 4 occupational physicians, 4 medical assistants, and 1 manager of an occupational health service. The transcripts were coded by two coders and analyzed by constant comparison. Results Hypothetical employee willingness to sign up for the intervention was facilitated by a high level of perceived risk, perceived added value of the intervention, and perceived social support. It was hampered by a preference for independence and perceived interference with their work. All professionals named a lack of time as an anticipated barrier to implementation. Lifestyle counselors suggested several strategies to improve the proficiency of their counseling technique, such as training in small groups and a continuous stream of employee referrals. Occupational physicians thought they would be hampered in screening employees and referring them to a lifestyle counselor by the perception that addressing employee lifestyles was not their task, and by a counter-productive relationship with other stakeholders. The manager addressed financial incentives and a good intervention fit with the current approach of the OHS. Conclusion The findings suggest that employees can be motivated to sign up for a lifestyle intervention by tailoring the implementation strategy to various subgroups within the target group. Occupational physicians can be motivated to refer employees for the intervention by making a referral personally and professionally rewarding. Electronic supplementary material The online version of this article (doi:10.1186/1471-2458-14-1317) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - K I Proper
- Department of Public and Occupational Health, EMGO+ Institute of Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
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32
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de Jonge A, Stuijt R, Eijke I, Westerman MJ. Continuity of care: what matters to women when they are referred from primary to secondary care during labour? a qualitative interview study in the Netherlands. BMC Pregnancy Childbirth 2014; 14:103. [PMID: 24636135 PMCID: PMC3995441 DOI: 10.1186/1471-2393-14-103] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Accepted: 03/11/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Continuity of care during labour is important for women. Women with an intrapartum referral from primary to secondary care look back more negatively on their birh experience compared to those who are not referred. It is not clear which aspects of care contribute to this negative birth experience. This study aimed to explore in-depth the experiences of women who were referred during labour from primary to secondary care with regard to the different aspects of continuity of care. METHODS A qualitative interview study was conducted in the Netherlands among women who were in primary care at the onset of labour and were referred to secondary care before the baby was born. Through purposive sampling 27 women were selected. Of these, nine women planned their birth at home, two in an alongside midwifery unit and 16 in hospital. Thematic analysis was used. RESULTS Continuity of care was a very important issue for women because it contributed to their feeling of safety during labour. Important details were sometimes not handed over between professionals within and between primary and secondary care, in particular about women's personal preferences. In case of referral of care from primary to secondary care, it was important for women that midwives handed over the care in person and stayed until they felt safe with the hospital team. Personal continuity of care, in which case the midwife stayed until the end of labour, was highly appreciated but not always expected.Fear of transportion during or after labour was a reason for women to choose hospital birth but also to opt for home birth. Choice of place of birth emerged as a fluid concept; most women planned their place of birth during pregnancy and were aware that they would spend some time at home and possibly some time in hospital. CONCLUSIONS In case of referral from primary to secondary care during labour, midwives should hand over their care in person and preferrably stay with women throughout labour. Planned place of birth should be regarded as a fluid concept rather than a dichotomous choice.
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Affiliation(s)
- Ank de Jonge
- Department of Midwifery Science, AVAG/EMGO Institute of Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.
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Schook RM, Linssen C, Schramel FM, Festen J, Lammers E, Smit EF, Postmus PE, Westerman MJ. Why do patients and caregivers seek answers from the Internet and online lung specialists? A qualitative study. J Med Internet Res 2014; 16:e37. [PMID: 24496139 PMCID: PMC3936275 DOI: 10.2196/jmir.2842] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 10/23/2013] [Accepted: 01/09/2014] [Indexed: 01/22/2023] Open
Abstract
Background Since its launch in 2003, the Dutch Lung Cancer Information Center’s (DLIC) website has become increasingly popular. The most popular page of the website is the section “Ask the Physician”, where visitors can ask an online lung specialist questions anonymously and receive an answer quickly. Most questions were not only asked by lung cancer patients but also by their informal caregivers. Most questions concerned specific information about lung cancer. Objective Our goal was to explore the reasons why lung cancer patients and caregivers search the Internet for information and ask online lung specialists questions on the DLIC’s interactive page, “Ask the Physician”, rather than consulting with their own specialist. Methods This research consisted of a qualitative study with semistructured telephone interviews about medical information-seeking behavior (eg, information needs, reasons for querying online specialists). The sample comprised 5 lung cancer patients and 20 caregivers who posed a question on the interactive page of the DLIC website. Results Respondents used the Internet and the DLIC website to look for lung cancer–related information (general/specific to their personal situation) and to cope with cancer. They tried to achieve a better understanding of the information given by their own specialist and wanted to be prepared for the treatment trajectory and disease course. This mode of information supply helped them cope and gave them emotional support. The interactive webpage was also used as a second opinion. The absence of face-to-face contact made respondents feel freer to ask for any kind of information. By being able to pose a question instantly and receiving a relatively quick reply from the online specialist to urgent questions, respondents felt an easing of their anxiety as they did not have to wait until the next consultation with their own specialist. Conclusions The DLIC website with its interactive page is a valuable complementary mode of information supply and supportive care for lung cancer patients and caregivers.
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Affiliation(s)
- Romane Milia Schook
- VU University Medical Center, Department of Pulmonary Diseases, Amsterdam, Netherlands.
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Reeuwijk KG, de Wind A, Westerman MJ, Ybema JF, van der Beek AJ, Geuskens GA. 'All those things together made me retire': qualitative study on early retirement among Dutch employees. BMC Public Health 2013; 13:516. [PMID: 23714371 PMCID: PMC3674915 DOI: 10.1186/1471-2458-13-516] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Accepted: 05/22/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Due to the aging of the population and subsequent higher pressure on public finances, there is a need for employees in many European countries to extend their working lives. One way in which this can be achieved is by employees refraining from retiring early. Factors predicting early retirement have been identified in quantitative research, but little is known on why and how these factors influence early retirement. The present qualitative study investigated which non-health related factors influence early retirement, and why and how these factors influence early retirement. METHODS A qualitative study among 30 Dutch employees (60-64 years) who retired early, i.e. before the age of 65, was performed by means of face-to-face interviews. Participants were selected from the cohort Study on Transitions in Employment, Ability and Motivation (STREAM). RESULTS For most employees, a combination of factors played a role in the transition from work to early retirement, and the specific factors involved differed between individuals. Participants reported various factors that pushed towards early retirement ('push factors'), including organizational changes at work, conflicts at work, high work pressure, high physical job demands, and insufficient use of their skills and knowledge by others in the organization. Employees who reported such push factors towards early retirement often felt unable to find another job. Factors attracting towards early retirement ('pull factors') included the wish to do other things outside of work, enjoy life, have more flexibility, spend more time with a spouse or grandchildren, and care for others. In addition, the financial opportunity to retire early played an important role. Factors influenced early retirement via changes in the motivation, ability and opportunity to continue working or retire early. CONCLUSION To support the prolongation of working life, it seems important to improve the fit between the physical and psychosocial job characteristics on the one hand, and the abilities and wishes of the employee on the other hand. Alongside improvements in the work environment that enable and motivate employees to prolong their careers, a continuous dialogue between the employer and employee on the (future) person-job fit and tailored interventions might be helpful.
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Affiliation(s)
| | - Astrid de Wind
- Department of Work, Health & Care, Netherlands Organisation for Applied Scientific Research TNO, Hoofddorp, The Netherlands.
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35
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de Wind A, Geuskens GA, Reeuwijk KG, Westerman MJ, Ybema JF, Burdorf A, Bongers PM, van der Beek AJ. Pathways through which health influences early retirement: a qualitative study. BMC Public Health 2013; 13:292. [PMID: 23551994 PMCID: PMC3621068 DOI: 10.1186/1471-2458-13-292] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Accepted: 03/21/2013] [Indexed: 11/25/2022] Open
Abstract
Background Due to the aeging of the population, there is a societal need for workers to prolong their working lives. In the Netherlands, many employees still leave the workforce before the official retirement age of 65. Previous quantitative research showed that poor self-perceived health is a risk factor of (non-disability) early retirement. However, little is known on how poor health may lead to early retirement, and why poor health leads to early retirement in some employees, but not in others. Therefore, the present qualitative study aims to identify in which ways health influences early retirement. Methods Face-to-face semi-structured interviews were conducted with 30 employees (60–64 years) who retired before the official retirement age of 65. Participants were selected from the Study on Transitions in Employment, Ability and Motivation. The interviews were transcribed verbatim, a summary was made including a timeline, and the interviews were open coded. Results In 15 of the 30 persons, health played a role in early retirement. Both poor and good health influenced early retirement. For poor health, four pathways were identified. First, employees felt unable to work at all due to health problems. Second, health problems resulted in a self-perceived (future) decline in the ability to work, and employees chose to retire early. Third, employees with health problems were afraid of a further decline in health, and chose to retire early. Fourth, employees with poor health retired early because they felt pushed out by their employer, although they themselves did not experience a reduced work ability. A good health influenced early retirement, since persons wanted to enjoy life while their health still allowed to do so. The financial opportunity to retire sometimes triggered the influence of poor health on early retirement, and often triggered the influence of good health. Employees and employers barely discussed opportunities to prolong working life. Conclusions Poor and good health influence early retirement via several different pathways. To prolong working life, a dialogue between employers and employees and tailored work-related interventions may be helpful.
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Affiliation(s)
- Astrid de Wind
- Department of Work, Health & Care, Netherlands Organisation for Applied Scientific Research TNO, Hoofddorp, The Netherlands
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36
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van Alphen A, Westerman MJ, Visschedijk JHM, Hertogh CMPM. [A qualitative study of Falls Efficacy Scale-International/Hips. What do we measure?]. Tijdschr Gerontol Geriatr 2013; 44:3-11. [PMID: 23397435 DOI: 10.1007/s12439-013-0005-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Pilot-testing a new instrument: the Falls Efficacy Scale-International/Hips (FES-I/Hips). This instrument is intended to measure 'Fear of Falling' (FoF). To the current instrument, the Falls Efficacy Scale-International, are four questions added for patients who are rehabilitating in a nursing home. It is pretested and used in the HIPS-study. METHODS Qualitative exploratory study with interviews in a Three Step Test Interview (TSTI) protocol. Respondents (N = 12) were asked to think aloud while completing the questionnaire. RESULTS The instruction how to complete the questionnaire is well understood by patients but was not properly used by them. The questionnaire contains questions with difficult words and questions which are no longer relevant. There are six "two-in-one questions" that cause confusion. CONCLUSION Use of the standard instruction when completing the FES-I/Hips can lead to underreporting of FoF. Adaptation of certain items may improve content validity. Further psychometric studies are recommended to determine whether the proposed adjustments are appropriate.
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Derksen RE, Brink-Melis WJ, Westerman MJ, Dam JJMT, Seidell JC, Visscher TLS. A local consensus process making use of focus groups to enhance the implementation of a national integrated health care standard on obesity care. Fam Pract 2012; 29 Suppl 1:i177-i184. [PMID: 22399550 DOI: 10.1093/fampra/cmr072] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Recent guidelines on obesity management promote integrated care. There is little knowledge about local opportunities and barriers, faced by health care professionals and patients, that affect implementation of an integrated national health care standard in a local setting. Our aim is to understand experiences and expectations of health care professionals and patients as part of the local implementation process. METHODS Eight focus groups and two interviews have been conducted among 24 patients (60+) and 29 professionals from seven different care disciplines. RESULTS Both patients and professionals have identified serious barriers to implement the national standard: older adults do not feel taken seriously and experience lacking support from professionals. Professionals give contradictory advice and recommendations do not match needs of older adults. Professionals actually feel reluctant to discuss weight-related topics due to several reasons: they do not consider obesity being a chronic disease, lack of qualifications to support self-management and perceived lack of awareness and motivation among patients. CONCLUSION Focus groups have proven their value to ascertain the opportunities and barriers older adults and professionals foresee while improving obesity care in order to meet the standards as required in a national guideline. Our research provides an emerging picture of health care professionals and patients having contradictory views and expectations about 'the others' role and their notions on the capability to intervene on patient's weight problems. Without this emerging picture, we would have missed important information on barriers to overcome. The likelihood of successful implementation would then have been small.
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Affiliation(s)
- R E Derksen
- Research Centre for the Prevention of Overweight, VU University Amsterdam/Windesheim University of Applied Sciences Zwolle, Zwolle, The Netherlands.
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Jans SMPJ, van El CG, Houwaart ES, Westerman MJ, Janssens RJPA, Lagro-Janssen ALM, Plass AMC, Cornel MC. A case study of haemoglobinopathy screening in the Netherlands: witnessing the past, lessons for the future. Ethn Health 2012; 17:217-39. [PMID: 21819310 PMCID: PMC3396381 DOI: 10.1080/13557858.2011.604126] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Revised: 07/06/2011] [Indexed: 05/22/2023]
Abstract
OBJECTIVES In 2007 neonatal screening (NNS) was expanded to include screening for sickle cell disease (SCD) and beta-thalassaemia. Up until that year no formal recommendations for haemoglobinopathy (carrier) screening existed in the Netherlands. Although it has been subject to debate in the past, preconceptional and prenatal haemoglobinopathy carrier screening are not part of routine healthcare in the Netherlands. This study aimed to explore the decision-making process of the past: why was the introduction of a screening programme for haemoglobinopathy considered to be untimely, and did ethnicity play a role given the history in other countries surrounding the introduction of haemoglobinopathy screening? DESIGN A witness seminar was organised, inviting key figures to discuss the decision-making process concerning haemoglobinopathy screening in the Netherlands, thereby adding new perspectives on past events. The transcript was content-analysed. RESULTS The subject of haemoglobinopathy screening first appeared in the 1970s. As opposed to a long history of neglect of African-American health in the United States, the heritage of the Second World War influenced the decision-making process in the Netherlands. As a consequence, registration of ethnicity surfaced as an impeding factor. However, overall, official Dutch screening policy was restrained regarding reproductive issues caused by fear of eugenics. In the 1990s haemoglobinopathy screening was found to be 'not opportune' due to low prevalence, lack of knowledge and fear of stigmatisation. Currently the registration of ethnicity remains on the political agenda, but still proves to be a sensitive subject. DISCUSSION Carrier screening in general never appeared high on the policy agenda. Registration of ethnicity remains sensitive caused by the current political climate. Complexities related to carrier screening are a challenge in Dutch healthcare. Whether carrier screening will be considered a valuable complementary strategy in the Netherlands, depends partly on participation of representatives of high-risk groups in policy making.
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Affiliation(s)
- Suze M P J Jans
- Clinical Genetics, Section Community Genetics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
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Brink-Melis WJ, Derksen ERE, Westerman MJ, Renders CM, Seidell JC, Visscher TLS. The local implementation of a chronic disease management model for childhood overweight and obesity. Obes Facts 2012; 5:766-75. [PMID: 23107830 DOI: 10.1159/000345156] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 04/08/2012] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The aim of this study is to determine opportunities and barriers regarding the management of overweight and obese children in daily practice, and to show the value of using focus groups when developing an action plan for childhood overweight management in a local context. METHODS Seven focus groups and four semi-structured interviews were conducted with 29 professionals from nine different care disciplines and 7 parents of overweight and obese children aged 4-19 years. RESULTS After thorough analysis of the focus groups, issues concerning finding the most appropriate care and realising a long-term weight management in daily practice have become clear. Some examples of these issues are: lack of awareness, reluctance to discuss and refer, mutual cooperation, contradictory advice and expectations of treatment and lack of effective support strategies. CONCLUSION Focus groups deliver important information on local issues that are important for the development and implementation of a childhood overweight management action plan. And, besides delivering necessary information, focus groups lead to an increased awareness and willingness to improve childhood overweight management in a local context.
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Affiliation(s)
- Willy J Brink-Melis
- Research Centre for the Prevention of Overweight, VU University Amsterdam/Windesheim University of Applied Sciences, Zwolle, the Netherlands.
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Borgsteede SD, Westerman MJ, Kok IL, Meeuse JC, de Vries TPGM, Hugtenburg JG. Factors related to high and low levels of drug adherence according to patients with type 2 diabetes. Int J Clin Pharm 2011; 33:779-87. [PMID: 21735249 PMCID: PMC3189335 DOI: 10.1007/s11096-011-9534-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Accepted: 06/13/2011] [Indexed: 11/24/2022]
Abstract
Objective Adherence to medication in patients with type 2 diabetes varies widely, yet the factors that influence adherence according to patients are not fully known. The aim of this study is to explore both factors related to high and lower levels of adherence that patients with type 2 diabetes experienced in their medication use. Setting Primary care in the Netherlands. Method Qualitative, semi-structured interviews were performed in 20 patients with type 2 diabetes. Interviews were audio-taped and transcribed verbatim. Transcripts were coded and analysed using content analysis and constant comparison. Main outcome measure experiences and opinions of patients concerning factors related to high and lower levels of adherence. Results Comparable aspects influenced drug adherence in more and less adherent patients. Four aspects that influenced adherence to medication emerged from the interviews: (1) information about the prescribed medication, (2) experience with medication and complications with use, (3) social support for medication behaviour and (4) routines in medication behaviour. Experience with medication and social support for medication behaviour were related to high levels of adherence in some patients, and to lower levels of adherence in others. Complicated medication regimens were mainly related to lower adherence, while social support and routines in medication behaviour were related to higher adherence. Conclusions Routines in medication behaviour were related to higher drug adherence. Patient education should not only address information about the disease and medication, but also more practical issues concerning drug intake. Hence, to improve drug adherence in patients with type 2 diabetes, pharmaceutical care might be aimed at the counselling of patients to organise drug use in their daily schedule.
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Affiliation(s)
- Sander D Borgsteede
- Department of Clinical Pharmacology and Pharmacy, VU University Medical Center, De Boelelaan 1117, 1081HV, Amsterdam, The Netherlands.
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Stol YH, Menko FH, Westerman MJ, Janssens RMJPA. Informing family members about a hereditary predisposition to cancer: attitudes and practices among clinical geneticists. J Med Ethics 2010; 36:391-5. [PMID: 20605992 DOI: 10.1136/jme.2009.033324] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
If a hereditary predisposition to colorectal cancer or breast cancer is diagnosed, most guidelines state that clinical geneticists should request index patients to inform their at-risk relatives about the existence of this condition in their family, thus enabling them to consider presymptomatic genetic testing. Those identified as mutation carriers can undertake strategies to reduce their risk of developing the disease or to facilitate early diagnosis. This procedure of informing relatives through the index patient has been criticised, as it results in relatively few requests for genetic testing, conceivably because a certain number of relatives remain uninformed. This pilot study explored attitudes toward informing family members and relevant practices among clinical geneticists. In general, clinical geneticists consider it to be in the interests of family members to be informed and acknowledge that this goal is not accomplished by current procedures. The reasons given for maintaining present practices despite this include clinical 'mores', uncertainty about the legal right of doctors to inform family members themselves, and, importantly, a lack of resources. We discuss these reasons from an ethical point of view and conclude that they are partly uninformed and inconsistent. If informing relatives is considered to be in their best interests, clinical geneticists should consider informing relatives themselves. In the common situation in which index patients do not object to informing relatives, no legal obstacles prevent geneticists from doing so. An evaluation of these findings among professionals may lead to a more active approach in clinical practice.
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Affiliation(s)
- Yrrah H Stol
- University of Amsterdam/Centre for Society and Genomics, Nijmegen, Amsterdam, The Netherlands.
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van der Berg JD, Roorda J, Westerman MJ. [Reasons not to have your daughter vaccinated against the human papilloma virus in Twente: a questionnaire study]. Ned Tijdschr Geneeskd 2010; 154:A1923. [PMID: 20699020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To gain insight into parents' decision-making process, and their reasons for participation in the human papilloma virus (HPV) vaccination programme in the Twente region, the Netherlands. DESIGN Cross-sectional study by means of a questionnaire. METHODS After the first vaccination round, a questionnaire was sent to the parents of 800 13-year-old girls, born in the year 1996 and living in the Twente region. Data were collected on the socio-demographic characteristics of the parents, their daughters' participation in the HPV vaccination programme (in which 13-15-year-olds were offered the vaccine previously offered only to 12-year-olds), and four determinants derived from the Health Belief Model (HBM): perceived susceptibility, severity, benefits and barriers. RESULTS 371 questionnaires were returned (response rate 46%). 39% of the parents had had their daughters vaccinated. The main reasons for parents to decide not to participate in the vaccination programme were perceived dangers of the vaccine, the risk of minor or major side-effects, and perceived limited efficacy of the vaccine. Religious beliefs also played a limited, but statistically significant, role. Many parents found it difficult to decide whether to let their daughter participate in the vaccination programme. CONCLUSION Follow-up research into participation is recommended, especially once health-education has been improved and media attention is reduced. Future communication about HPV vaccination should take into account the role played by parents in deciding whether or not to participate in the vaccination programme and should concentrate on their concerns about vaccine side-effects and vaccine safety and the perceived efficacy of the new vaccine.
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Westerman MJ, Hak T, Sprangers MAG, Groen HJM, van der Wal G, The AM. Listen to their answers! Response behaviour in the measurement of physical and role functioning. Qual Life Res 2008; 17:549-58. [PMID: 18389384 PMCID: PMC2358935 DOI: 10.1007/s11136-008-9333-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2007] [Accepted: 03/13/2008] [Indexed: 12/02/2022]
Abstract
Background Quality of life (QoL) is considered to be an indispensable outcome measure of curative and palliative treatment. However, QoL research often yields findings that raise questions about what QoL measurement instruments actually assess and how the scores should be interpreted. Objective To investigate how patients interpret and respond to questions on the EORTC-QLQ-C30 over time and to find explanations to account for counterintuitive findings in QoL measurement. Methods Qualitative investigation was made of the response behaviour of small-cell lung cancer patients (n = 23) in the measurement of QoL with the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30). Focus was on physical functioning (PF, items 1 to 5), role functioning (RF, items 6 and 7), global health and QoL rating (GH/QOL, items 29 and 30). Interviews were held at four points: at the start of the chemotherapy, 4 weeks later, at the end, and 6 weeks after the end of chemotherapy. Patients were asked to ‘think aloud’ when filling in the questionnaire. Results Patients used various response strategies when answering questions about problems and limitations in functioning, which impacted the accuracy of the scale. Patients had scores suggesting they were less limited than they actually were by taking the wording of questions literally, by guessing their functioning in activities that they did not perform, and by ignoring or excluding certain activities that they could not perform. Conclusion Terminally ill patients evaluate their functioning in terms of what they perceive to be normal under the circumstances. Their answers can be interpreted in terms of change in the appraisal process (Rapkin and Schwartz 2004; Health and Quality of Life Outcomes, 2, 14). More care should be taken in assessing the quality of a set of questions about physical and role functioning.
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Affiliation(s)
- Marjan J Westerman
- Department of Public and Occupational Health, EMGO Institute, VU University Medical Centre, Amsterdam, The Netherlands.
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Hooftman WE, Westerman MJ, van der Beek AJ, Bongers PM, van Mechelen W. What makes men and women with musculoskeletal complaints decide they are too sick to work? Scand J Work Environ Health 2008; 34:107-12. [PMID: 18470439 DOI: 10.5271/sjweh.1221] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE The objective of this study was to determine what makes men and women with musculoskeletal complaints decide to call in sick for work. METHODS Qualitative, face-to-face interviews were used with employees (16 men and 14 women) who had called in sick due to a musculoskeletal complaint and who expected to be absent from work for at least 2 weeks on sick leave. RESULTS The participants fell into the following two main groups: those who were off sick because of a diagnosed medical condition, such as a fracture, and those who were off sick because of an unidentifiable complaint, such as low-back pain. Employees in the former group called in sick because they were in the hospital or because they reckoned that their condition was too serious to warrant a continuation of work. Employees in the latter group felt hesitant and insecure and found it hard to judge whether absenteeism was justified. They decided either to "play it safe" and stay off work to prevent the complaints from worsening or to seek advice from medical professionals. Their advice did not include explicit instructions to stay at home, but were usually interpreted as such. Finally, women, but not men, were likely to call in sick if they felt that their home situation was being negatively affected by attempts to keep working while suffering physical complaints. CONCLUSIONS The decision to call in sick is not taken lightly. Employees with nonspecific disorders base their decision on several factors, including advice from medical professionals. A factor found only among women was work-home interference.
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Affiliation(s)
- Wendela E Hooftman
- Department of Public and Occupational Health, EMGO Institute, VU University Medical Center, Van der Boechorststraat 7-9, Amsterdam, Netherlands
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Westerman MJ, Hak T, The AM, Echteld MA, Groen HJM, van der Wal G. Change in what matters to palliative patients: eliciting information about adaptation with SEIQoL-DW. Palliat Med 2007; 21:581-6. [PMID: 17942496 DOI: 10.1177/0269216307081938] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study was carried out to investigate the usefulness of the SEIQoL-DW to elicit information about response shifts in palliative patients. The instrument measures individual quality of life and allows respondents to choose, rate and weight important areas of life (cues). We explored patients' reconceptualizations (ie, change in cues) and their value change (ie, change of cues weights). Results of 21 patients showed what mattered to these patients and how they had adjusted to deteriorating health. There is a risk that repeated measurements do not provide all the information that is potentially present and relevant to explore response shifts. But clear instructions to interviewers, such as careful listening, probing self-evident cues such as health and family, and accurate recording of cues on the forms may overcome this risk. Future research is recommended to explore the possibilities of regular assessments to facilitate better adjustment of patients.
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Affiliation(s)
- Marjan J Westerman
- Department of Public and Occupational Health, EMGO Institute, VU University Medical Centre, Amsterdam, The Netherlands.
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Westerman MJ, The AM, Sprangers MAG, Groen HJM, van der Wal G, Hak T. Small-cell lung cancer patients are just 'a little bit' tired: response shift and self-presentation in the measurement of fatigue. Qual Life Res 2007; 16:853-61. [PMID: 17450423 PMCID: PMC1915653 DOI: 10.1007/s11136-007-9178-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2006] [Accepted: 01/16/2007] [Indexed: 01/23/2023]
Abstract
BACKGROUND Response shift has gained increasing attention in the measurement of health-related quality of life (QoL) as it may explain counter-intuitive findings as a result of adaptation to deteriorating health. OBJECTIVE To search for response shift type explanations to account for counter-intuitive findings in QoL measurement. METHODS Qualitative investigation of the response behaviour of small-cell lung cancer (SCLC) patients (n = 23) in the measurement of fatigue with The European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30) question 'were you tired'. Interviews were conducted at four points during 1st line chemotherapy: at the start of chemotherapy, 4 weeks later, at the end of chemotherapy, and 6 weeks later. Patients were asked to 'think aloud' when filling in the questionnaire. RESULTS Fifteen patients showed discrepancies between their answer to the EORTC question 'were you tired' and their level of fatigue spontaneously reported during the interview. These patients chose the response options 'not at all' or 'a little' and explained their answers in various ways. In patients with and without discrepancies, we found indications of recalibration response shift (e.g. using a different comparison standard over time) and of change in perspective (e.g. change towards a more optimistic perspective). Patients in the discrepancy group reported spontaneously how they dealt with diagnosis and treatment, i.e. by adopting protective and assertive behaviour and by fighting the stigma. They distanced themselves from the image of the stereotypical cancer patient and presented themselves as not suffering and accepting fatigue as consequence of treatment. CONCLUSION In addition to response shift, this study suggests that 'self-presentation' might be an important mechanism affecting QoL measurement, particularly during phases when a new equilibrium needs to be found.
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Affiliation(s)
- Marjan J Westerman
- Department of Public and Occupational Health, EMGO Institute, VU University Medical Centre, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
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