Outbreaks of emerging infectious diseases: Risk perception and behaviour of the general public

__Abstract__ This thesis focuses on risk perception and behaviour of the public during the outbreaks of emerging infectious diseases. It consists of studies on Influenza A (H1N1), Q fever and Lyme disease. These studies were conducted among both the general public and specific risk groups in the Netherlands (including parents of young children and patients with a known aortic aneurysm or vascular prosthesis). This thesis describes trends over time and regional/(sub)national differences in risk perception and behaviour of the public during outbreaks of emerging infectious diseases, as well as determinants of preventive behaviour or strong intention to comply with preventive measures. Furthermore, it provides recommendations for optimizing risk communication during future emerging infectious diseases outbreaks

Biosignal and context monitoring: Distributed multimedia applications of body area networks in healthcare

We are investigating the use of Body Area Networks (BANs), wearable sensors and wireless communications for measuring, processing, transmission, interpretation and display of biosignals. The goal is to provide telemonitoring and teletreatment services for patients. The remote health professional can view a multimedia display which includes graphical and numerical representation of patients’ biosignals. Addition of feedback-control enables teletreatment services; teletreatment can be delivered to the patient via multiple modalities including tactile, text, auditory and visual. We describe the health BAN and a generic mobile health service platform and two context aware applications. The epilepsy application illustrates processing and interpretation of multi-source, multimedia BAN data. The chronic pain application illustrates multi-modal feedback and treatment, with patients able to view their own biosignals on their handheld device

Living with my diabetes – introducing eHealth into daily practices of patients with type 2 diabetes mellitus

Objective: Diabetes patients can draw on an increasing number of eHealth apps to support them in the self-management of their disease. While studies so far have focused on patients with type 1 diabetes, we explored how patients with type 2 diabetes mellitus (T2DM) integrate eHealth apps into their practices aimed at managing and coping with the disease, which aspects were considered particularly valuable and which challenges users encountered.Methods: Semi-structured interviews and focus group sessions were conducted to explore how patients cope with T2DM in their daily lives and their attitude towards eHealth. In a further step, four eHealth apps were tested by patients and their expectations and experiences studied by way of qualitative interviews and focus groups.Results: The analysis showed that the study participants valued in particular the possibility to use eHealth apps to sense and gain a better understanding of their own body, to learn about specific responses of their body to nutrition and physical activity,and to support changes in daily routines and lifestyle. Key challenges encountered related to difficulties in interpreting the data, matching the data to other bodily sensations, getting overly occupied with the disease and difficulties in integratingthe apps into personal, family, and care practices.Conclusion: Under certain conditions, eHealth can play an important role for patients in developing a nuanced, personal understanding of their body and coping with T2DM. A prerequisite is that eHealth needs to be fitted into the specific practicesof users, and patients desire a strong role by their care professionals in providing support in interpretation of data

Guideline-based decision support for the mobile patient incorporating data streams from a body sensor network

We present a mobile decision support system (mDSS) which helps patients adhere to best clinical practice by providing pervasive and evidence-based health guidance via their smartphones. Similar to some existing clinical DSSs, the mDSS is designed to execute clinical guidelines, but it operates on streaming data from, e.g., body sensor networks instead of persistent data from clinical databases. Therefore, we adapt the typical guideline-based architecture by basing the mDSS design on existing data stream management systems (DSMSs); during operation, the mDSS instantiates from the guideline knowledge a network of concurrent streaming processes, avoiding the resource implications of traditional database approaches for processing patient data which may arrive at high frequencies via multiple channels. However, unlike typical DSMSs, we distinguish four types of streaming processes to reflect the full disease management process: Monitoring, Analysis, Decision and Effectuation. A prototype of the mDSS has been developed and demonstrated on an Android smartphone

Requirements for a Nutrition Education Demonstrator

[Context and Motivation] Development of innovative ICT-based applications is a complex process involving collaboration of all relevant disciplines. This complexity arises due to differences in terminology, knowledge and often also the ways of working between developers in the disciplines involved. [Question/problem] Advances in each discipline bring a rich design environment of theories, models, methods and techniques. Making a selection from these makes the development of distributed applications very challenging, often requiring a holistic approach to address the needs of the disciplines involved. This paper describes early stage requirements acquisition of a mobile nutrition education demonstrator which supports overweight persons in adopting healthier dietary behaviour. [Principal idea/results] We present a novel way to combine and use known requirements acquisition methods involving a two stage user needs analysis based on scenarios which apply a theory-based model of behavioural change and are onstructed in two phases. The first phase scenarios specify an indicative description reflecting the use of the transtheoretical model of behavioural change. In the second phase, a handshake protocol adds elements of optative system-oriented descriptions to the scenarios such that the intended system can support the indicative description. [Contribution] The holistic and phased approach separates design concerns to which each of the disciplines contributes with their own expertise and domain principles. It preserves the applied domain principles in the design and it bridges gaps in terminology, knowledge and ways of working

Study on public perceptions and protective behaviors regarding Lyme disease among the general public in the Netherlands: Implications for prevention programs

Background: Lyme disease (LD) is the most common tick-borne disease in the United States and in Europe. The aim of this study was to examine knowledge, perceived risk, feelings of anxiety, and behavioral responses of the general public in relation to tick bites and LD in the Netherlands. Methods. From a representative Internet panel a random sample was drawn of 550 panel members aged 18 years and older (8-15 November 2010) who were invited to complete an online questionnaire. Results: Response rate (362/550, 66%). This study demonstrates that knowledge, level of concern, and perceived efficacy are the main determinants of preventive behavior. 35% (n = 125/362) of the respondents reported a good general knowledge of LD. While 95% (n = 344/362) perceived LD as severe or very severe, the minority (n = 130/362, 36%) perceived their risk of LD to be low. Respondents were more likely to check their skin after being outdoors and remove ticks if necessary, than to wear protective clothing and/or use insect repellent skin products. The percentage of respondents taking preventive measures ranged from 6% for using insect repellent skin products, to 37% for wearing protective clothing. History of tick bites, higher levels of knowledge and moderate/high levels of worry were significant predictors of checking the skin. Significant predictors of wearing protective clothing were being unemployed/retired, higher knowledge levels, higher levels of worry about LD and higher levels of perceived efficacy of wearing protective clothing. Conclusions: Prevention programs targeting tick bites and LD should aim at influencing people's perceptions and increasin

Q fever in the Netherlands: Public perceptions and behavioral responses in three different epidemiological regions: A follow-up study

Background: Over the past years, Q fever has become a major public health problem in the Netherlands, with a peak of 2,357 human cases in 2009. In the first instance, Q fever was mainly a local problem of one province with a high density of large dairy goat farms, but in 2009 an alarming incre

MobiHealth: Ambulant Patient Monitoring Over Next Generation Public Wireless Networks

The wide availability of high bandwidth public wireless networks as well as the miniaturisation of medical sensors and network access hardware allows the development of advanced ambulant patient monitoring systems. The MobiHealth project developed a complete system and service that allows the continuous monitoring of vital signals and their transmission to the health care institutes in real time using GPRS and UMTS networks. The MobiHealth system is based on the concept of a Body Area Network (BAN) allowing high personalization of the monitored signals and thus adaptation to different classes of patients. The system and service has been trialed in four European countries and for different patient cases. First results confirm the usefulness of the system and the advantages it offers to patients and medical personnel

Mobile monitoring application to support sustainable behavioural change towards healthy lifestyle

We describe the development of body area networks (BANs) incorporating sensors and other devices to provide intelligent mobile services in healthcare and well-being. The first BAN applications were designed to simply transmit biosignals and display them remotely. Further developments include analysis and interpretation of biosignals in the light of context data. By including feedback loops, BAN telemonitoring was also augmented with teletreatment services. Recent developments include incorporation of clinical decision support by applying techniques from artificial intelligence. These developments represent a movement towards smart healthcare, making health BAN applications more intelligent by incorporating feedback, context awareness, personalization, and decision support.\ud The element of decision support was first introduced into the BAN health and well-being applications in the Food Valley Eating Advisor (FOVEA) project. Obesity and overweight represent a growing threat to health and well-being in modern society. Physical inactivity has been shown to contribute significantly to morbidity and mortality rates, and this is now a global trend bringing huge costs in terms of human suffering and reduction in life expectancy as well as uncontrolled growth in demand on healthcare services. Part of the solution is to foster healthier lifestyle. A major challenge however is that exercise and dietary programs may work for the individual in the short term, but adherence in the medium and long term is difficult to sustain, making weight management a continuing struggle for individuals and a growing problem for society, governments, and health services. Using ICT to support sustainable behavioral change in relation to healthy exercise and diet is the goal of the FOVEA monitoring and feedback application. We strive to design and develop intelligent BAN-based applications that support motivation and adherence in the long term. We present this healthy lifestyle application and report results of an evaluation conducted by surveying professionals in related disciplines