When opinions differ:The development of a reflection tool for youth professionals to support shared decision-making with parents

The importance of shared decision-making (SDM) in youth care is increasingly emphasised. Professional reflection on the decision-making process is an important means to improve the use of SDM in practice. In this study, we report on the development of a reflection tool for youth professionals primarily to use when they hold a different opinion then parents about referral to specialised youth care services. In co-creation with local youth professionals and parent representatives from the South of the Netherlands, the tool was developed and tested in practice. This process was guided by a three-stage cyclical research project. First, reflective group discussions provided an initial understanding of professionals’ needs, interests and experiences. This input then was analysed and documented into a draft tool with reflective questions. Next, this tool was tested on fictive and real life cases and adjusted with input from youth professionals and parents. This process resulted in an online reflection tool covering 16 overarching reflective questions to support youth professionals’ reflection on their shared decision-making in practice. The tool can be used and adapted by others in the field of youth care to improve the process of making shared decisions with parents in complex cases

Onafhankelijk oordeel externe deskundige bij periodieke rapportage ‘De effecten van het kinderopvangbeleid op de ontwikkeling van kinderen’

Deze brief omvat mijn oordeel bij het synthese-onderzoek naar de doeltreffendheid en doelmatigheid van het kinderopvangbeleid in Nederland, specifiek gericht op het beleidsdoel het bevorderen van de ontwikkeling van het kind in de kinderopvang

Systematic review of individual-level, community-level, and healthcare system-level factors contributing to socioeconomic differences in healthcare utilisation in OECD countries with universal health coverage

Objectives Countries with universal health coverage (UHC) strive for equal access for equal needs without users getting into financial distress. However, differences in healthcare utilisation (HCU) between socioeconomic groups have been reported in countries with UHC. This systematic review provides an overview individual-level, community-level, and system-level factors contributing to socioeconomic status-related differences in HCU (SES differences in HCU).Design Systematic review following the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) guidelines. The review protocol was published in advance.Data sources Embase, PubMed, Web of Science, Scopus, Econlit, and PsycInfo were searched on 9 March 2021 and 9 November 2022.Eligibility criteria Studies that quantified the contribution of one or more factors to SES difference in HCU in OECD countries with UHC.Data extraction and synthesis Studies were screened for eligibility by two independent reviewers. Data were extracted using a predeveloped data-extraction form. Risk of bias (ROB) was assessed using a tailored version of Hoy’s ROB-tool. Findings were categorised according to level and a framework describing the pathway of HCU.Results Of the 7172 articles screened, 314 were included in the review. 64% of the studies adjusted for differences in health needs between socioeconomic groups. The contribution of sex (53%), age (48%), financial situation (25%), and education (22%) to SES differences in HCU were studied most frequently. For most factors, mixed results were found regarding the direction of the contribution to SES differences in HCU.Conclusions SES differences in HCU extensively correlated to factors besides health needs, suggesting that equal access for equal needs is not consistently accomplished. The contribution of factors seemed highly context dependent as no unequivocal patterns were found of how they contributed to SES differences in HCU. Most studies examined the contribution of individual-level factors to SES differences in HCU, leaving the influence of healthcare system-level characteristics relatively unexplored

Community-dwelling and recently widowed older adults:Effects of spousal loss on psychological well-being, perceived quality of life, and health-care costs

This study is on the effects of spousal loss among older adults who continue to live independently after bereavement. Little longitudinal studies focus on this group, which is of special interest, since in many countries, care policy and system reform are aimed at increasing independent living among older adults. Using longitudinal data from a Dutch public data repository, we investigate the effects of spousal loss on psychological well-being, perceived quality of life, and (indication of) yearly health-care costs. Of the respondents who had a spouse and were living independently (N = 9,400) at baseline, the majority had not lost their spouse after 12 months (T12, n = 9,150), but 2.7% (n = 250) had lost their spouse and still lived independently. We compared both groups using multivariate regression (ordinary least squares) analyses. The results show that spousal loss significantly lowers scores on psychological well-being and perceived quality of life, but we found no effect on health-care costs

The relative effects of self-reported noise and odour annoyance on psychological distress::Different effects across sociodemographic groups?

In earlier research, both higher levels of noise and odour annoyance have been associated with decreased mental health. Presumably, these perceptions can trigger feelings of threat and stress reactions and in turn evoke psychological distress. There are two important lacunas in the research on this topic: most studies only consider either noise or odour annoyance and not their relative effect on psychological distress and there is scarce evidence about whether different sociodemographic groups experience more psychological distress due to noise and odour annoyance. Starting from the diversity in the available coping resources and in their daily life patterns, we distinguish gender, age and educational level as relevant sociodemographic variables. Using data from the Health Monitor (n = 25236) in Noord-Brabant, we found using Ordinary Least Squares Regression that individuals that reported higher levels of noise and odour annoyance reported higher levels of psychological distress. Furthermore, the effect of noise annoyance was relatively stronger compared to that of odour annoyance. Regarding the interaction effects, we found that younger adults’ psychological distress was more strongly affected by noise annoyance compared to older adults, but not by odour annoyance. The psychological distress of individuals with no or primary education was more strongly affected by both noise and odour annoyance compared those with tertiary education, but not when compared to those who completed lower or higher secondary education. Contrary to our expectations, we did not find different effects between men and women. Though the evidence for the interactions was mixed, classic health inequalities along age and education lines are reinforced when considering the relationship between noise and odour annoyance and psychological distress

From test to rest:Evaluating socioeconomic differences along the COVID-19 care pathway in the Netherlands

IntroductionThe COVID-19 pandemic exacerbated healthcare needs and caused excess mortality, especially among lower socioeconomic groups. This study describes the emergence of socioeconomic differences along the COVID-19 pathway of testing, healthcare use and mortality in the Netherlands.MethodologyThis retrospective observational Dutch population-based study combined individual-level registry data from June 2020 to December 2020 on personal socioeconomic characteristics, COVID-19 administered tests, test results, general practitioner (GP) consultations, hospital admissions, Intensive Care Unit (ICU) admissions and mortality. For each outcome measure, relative differences between income groups were estimated using log-link binomial regression models. Furthermore, regression models explained socioeconomic differences in COVID-19 mortality by differences in ICU/hospital admissions, test administration and test results.ResultsAmong the Dutch population, the lowest income group had a lower test probability (RR = 0.61) and lower risk of testing positive (RR = 0.77) compared to the highest income group. However, among individuals with at least one administered COVID-19 test, the lowest income group had a higher risk of testing positive (RR = 1.40). The likelihood of hospital admissions and ICU admissions were higher for low income groups (RR = 2.11 and RR = 2.46, respectively). The lowest income group had an almost four times higher risk of dying from COVID-19 (RR = 3.85), which could partly be explained by a higher risk of hospitalization and ICU admission, rather than differences in test administration or result.DiscussionOur findings indicated that socioeconomic differences became more pronounced at each step of the care pathway, culminating to a large gap in mortality. This underlines the need for enhancing social security and well-being policies and incorporation of health equity in pandemic preparedness plans

Towards guideline implementation for integrated local health policies:Evaluation of an experimental implementation strategy in regional health services

To enhance implementation of a Guideline for integrated local health policy, a draft implementation strategy (DIS) was developed. It was hypothesized that the DIS would be feasible and effective to enhance the use of a Guideline for integrated local health policy. To examine its feasibility and effectiveness, the DIS was pilot tested simultaneously in two Regional Health Services (RHSs) and compared with the 'care as usual' in two other RHSs that did not receive a predefined strategy for Guideline implementation. The DIS was evaluated in a qualitative way by means of semi-structured individual-and group interviews. We applied the Nutbeam framework for evaluation on: i) program integrity, ii) program reach, iii) program acceptability, and iv) observed change. Comparison of pilot results with the two other RHSs included semi-structured group interviews. Both RHSs conducted implementation largely as planned. The purpose of the Guideline for RHS policy objectives was not discussed at all desired levels. Increased Guideline use was mainly found among health promoters. Comparison with Guideline implementation in the other RHSs revealed information for further evaluation of the DIS. The feasibility and effectiveness of the DIS applied to building blocks which aimed at alignment of goals and ambitions between RHS management and executive disciplines. Possible implications for future application of the DIS are dealt with in the discussion section of this pape

Not Pregnant Now in almost two-thirds of all municipalities in The Netherlands

Het programma Nu Niet Zwanger is gericht op het voorkomen van onbedoelde zwangerschappen bij mensen in kwetsbare omstandigheden. Hulpverleners in het sociaal en medisch domein gaan daartoe tijdens reguliere contactmomenten met hun eigen cliënten (m/v) in gesprek over hun kinderwens. Ze ondersteunen hen bij het maken van een geïnformeerde en vrijwillige keuze, en bieden desgewenst begeleiding bij het kiezen en het realiseren van anticonceptie. Onderzoek laat zien dat de ervaringen van hulpverleners en cliënten met Nu Niet Zwanger positief zijn en leverde ook verbeterpunten op. Begin 2023 wordt het programma in bijna twee derde van de gemeenten in Nederland uitgevoerd en ligt de focus op structurele, landelijke borging.The program Not Pregnant Now aims to prevent unintended pregnancies in vulnerable populations. To this end, care providers start an openconversation during regular social and healthcare visits with their clients about their desire to have children. They support their clients in making an informed and voluntary decision about this and, ifwanted, offer support in choosing and realizing contraception. Research showed that the experiences of the care providers and clients with the program arepositive and also resulted in recommendations for improvement. At the beginning of 2023, the program runs in three quarters of the municipalities in TheNetherlands and the focus is on structural, national maintenance