Healthy aging in complex environments : exploring the benefits of systems thinking for health promotion practice

Background Many different stakeholders and contextual factors influence the success or failure of health promotion activities. Conventional approaches and evaluation designs underlying health promotion interventions, often explicitly take contextual variables out of consideration by controlling them. In doing so, relevant information about why a project was successful or failed to reach success remains invisible and ‘black boxed’. Next to this, in health promotion practice, control over contextual variables often is not possible. Aim Given the complexity of health promotion practice, research approaches often do not fit the realities of practice. As a result, health promotion activities are not always experienced as meaningful by all stakeholders involved. This thesis aims to appreciate the complex environment in which health promotion takes place by applying a systems thinking perspective to healthy aging in order to contribute to more robust strategies and interventions to support the aging population. Methods Systems thinking aims to include a diversity of viewpoints on an issue. Therefore, to be able to answer the research questions, multiple methods were required. A combination of literature review, semi-structured and open interviews, interactive workshops, case study and survey research was used. Different sources for data collection included the aging population, local and national stakeholders, and AGORA project members. Results Part I of this thesis concludes that a systems thinking approach strengthens health promotion by 1) including diverse stakeholder perspectives, 2) explicitly addressing contextual factors, and 3) co-creating solutions with all involved. Following this conclusion, Part II addressed the application of systems thinking at the local level by investigating different stakeholders perspectives on healthy aging. Results show how there is a discrepancy between the way aging individuals experience healthy aging as an integral part of everyday life and the way services and interventions are presented with a focus on isolated health themes. Local healthy aging strategies can benefit by taking into account an assets based approach that better matches aging persons’ perspectives. Next to this, collaboration between local stakeholders can be facilitated when shared issues are made visible and contextual preconditions are taken into account. Since the operationalization of systems thinking in health promotion can benefit from learning experiences with application in practice, findings from Part II were discussed in interactive presentations and workshop formats within participating municipalities. This resulted in the co-creation of a model to facilitate collaboration and the co-creation of an intervention through application of this model. The salutogenic concept Sense of Coherence was identified as a promising concept to operationalize systems approaches in health promotion practice. It was therefore expected that quantitative measurement of SOC could provide useful information for both the development and evaluation of health promotion. The OLQ-13 scale to measure Sense of Coherence was therefore investigated for its psychometric properties. Results indicate difficulties with the use of this scale in aging populations. Deleting two items from the original 13 items, improved the functioning of OLQ. Conclusion The importance of the fact that health issues and possible intervention strategies are perceived differently by involved actors was argued within this thesis. Research is one amongst many stakeholders and a systems thinking approach implies linking all kinds of actors in order to enable co-creation of projects. Consequently, the definition of health risks, health determinants, and possible intervention effects have to be verified in both scientific research and everyday practice. Strategies to improve health are context sensitive, and consequently, certain strategies may not work in some settings whereas they function perfectly well in others. Measurement of successes of interventions should therefore use multi-method evaluations combining the use of quantitative and qualitative approaches to gain insight in the ‘black box’ of why an intervention failed or was successful. If not, alternatives are overlooked and at the same time successes may go unnoticed. </p

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Knowledge management in the care for people with intellectual disabilities during the COVID-19 pandemic

The study aimed to gain insight into knowledge management in the intellectual dis-abilities (ID) care sector during the COVID-19 pandemic. We explored and describedhow knowledge producers, intermediaries, and knowledge users experienced knowl-edge management during this crisis situation, the responses to the specific knowl-edge needs in the ID-care sector, and changes in roles and collaboration during thisperiod. Twenty-five individual in-depth semi-structured interviews were conductedwith knowledge producers, intermediaries, and knowledge users in the Dutch ID-caresector. An inductive thematic analysis was conducted. Three key themes were identi-fied: (1) knowledge needs during the COVID-19 pandemic, (2) experiences withknowledge management, and (3) roles and collaboration in knowledge management.There was an urgent need for specific ID-related knowledge and how to translateavailable evidence for the general population into ID-care settings. In knowledgemanagement, the focus was on knowledge production and exchange, with validationand application receiving less attention. Within stakeholder groups, collaboration andknowledge exchange were intensified by existing or new knowledge infrastructures.Between stakeholder groups, knowledge producers and users created short lines toexchange needs and produce knowledge. This paper provides unique insights intoknowledge management in the Dutch ID-care sector during the COVID-19 pandemic.Implications are discussed to improve future knowledge management processes. Sup-port with knowledge validation and local knowledge infrastructures (complementaryto centralized national knowledge infrastructures) help to assess the reliability andusefulness of knowledge and improve its use in practice during future pandemic-related crisis situations

Exploring views on medical care for people with intellectual disabilities: an international concept mapping study

Contains fulltext : 253060.pdf (Publisher’s version ) (Open Access

A membership categorization analysis of roles, activities and relationships in inclusive research conducted by co-researchers with intellectual disabilities

Contains fulltext : 204050.pdf (publisher's version ) (Open Access

Bidirectional and passive optical field to microwave field quantum converter with high bandwidth

The conversion between microwave photons and optical photons with quantum coherence is important for quantum communication and computation. In this paper, we report a proposal using an ensemble of atoms coupled to microwave and optical resonators. Input photons to one resonator are converted into output photons in the other resonator without active operation. Usually the conversion is only optimized at certain frequency. In our proposal, we find that the efficiency is almost a constant and can be close to 100% in a large interval of frequency, i.e. a high-bandwidth conversion can be realized with our proposal.Comment: 6 pages, 4 figure

Evaluation design for a complex intervention program targeting loneliness in non-institutionalized elderly Dutch people

<p>Abstract</p> <p>Background</p> <p>The aim of this paper is to provide the rationale for an evaluation design for a complex intervention program targeting loneliness among non-institutionalized elderly people in a Dutch community. Complex public health interventions characteristically use the combined approach of intervening on the individual and on the environmental level. It is assumed that the components of a complex intervention interact with and reinforce each other. Furthermore, implementation is highly context-specific and its impact is influenced by external factors. Although the entire community is exposed to the intervention components, each individual is exposed to different components with a different intensity.</p> <p>Methods/Design</p> <p>A logic model of change is used to develop the evaluation design. The model describes what outcomes may logically be expected at different points in time at the individual level. In order to address the complexity of a real-life setting, the evaluation design of the loneliness intervention comprises two types of evaluation studies. The first uses a quasi-experimental pre-test post-test design to evaluate the effectiveness of the overall intervention. A control community comparable to the intervention community was selected, with baseline measurements in 2008 and follow-up measurements scheduled for 2010. This study focuses on changes in the prevalence of loneliness and in the determinants of loneliness within individuals in the general elderly population. Complementarily, the second study is designed to evaluate the individual intervention components and focuses on delivery, reach, acceptance, and short-term outcomes. Different means of project records and surveys among participants are used to collect these data.</p> <p>Discussion</p> <p>Combining these two evaluation strategies has the potential to assess the effectiveness of the overall complex intervention and the contribution of the individual intervention components thereto.</p

How can care settings for people with intellectual disabilities embed health promotion?

Background: People with intellectual disabilities (ID) depend on their environment to live healthily. Asset-based health promotion enhances a settings’ health-promoting capacity starting with identifying protective or promotive factors that sustain health. Method: This inclusive mixed-methods study used group sessions to generate and rank ideas on assets supporting healthy nutrition and physical activity in Dutch intellectual disability care settings. Participants included people with moderate intellectual disabilities and family and care professionals of people with severe/profound intellectual disabilities. Results: Fifty-one participants identified 185 assets in group sessions. They include the following: (i) the social network and ways “people” can support, (ii) assets in/around “places,” and person–environment fit, and (iii) “preconditions”: health care, prevention, budget, and policy. Conclusion: This inclusive research provides a user perspective on assets in the living environment supporting healthy living. This gives insight in contextual factors needed for development and sustainable embedment of health promotion in the systems of intellectual disability support settings