WHAT CONCERNS USERS OF MEDICAL APPS? EXPLORING NON-FUNCTIONAL REQUIREMENTS OF MEDICAL MOBILE APPLICATIONS

The increased use of internet through smartphones and tablets enables the development of new consumer-focused mobile applications (apps) in health care. Concerns including these apps´ safety, usability, privacy, and dependability have been raised. In this paper the authors present the results of a grounded theory-approach to finding what non-functional requirements of medical apps potential users view as most important. A document study and interviews with stakeholders yielded nine non-functional requirements for medical apps: accessibility, certifiability, portability, privacy, safety, security, stability, trustability, and usability. Six of these were evaluated with two groups (differing by age) of potential users through a vignette study. This revealed differences between the age groups regarding the importance each attributed to apps´ usability and certifiability. Furthermore, and contrary to consensus in literature, privacy was considered one of the least important attributes for medical apps by both groups. Trustability, security, and, for the younger group, certifiability, were considered the most important non-functional requirements for medical apps. The implications of these results for developing medical mobile applications are briefly visited

Parents' expected barriers to psychosocial care for children with complex problems

Background and objective: Even though children with complex problems frequently need psychosocial care, two thirds does not receive treatment. Various barriers, particularly expectations of barriers, can hinder effective access of care. Our aim was to assess the practical barriers expected by parents, and the child, family and need factors associated with these expected barriers. Methods: We sent web-based questionnaires to parents of a random sample of children known to have or be at risk of having complex problems (response = 77%). We used backward regression analyses to examine which factors were associated with expected barriers for children using psychosocial care, or no care at all. Results: Seventy-three percent of all parents expected practical barriers. Parents of children using psychosocial care expected more barriers than when using no care at all. For children who used no care, parents of girls expected more barriers (regression coefficient 0.54; 95%—confidence interval 0.16, 0.92) as did families having less social support (−0.30; −0.50, −0.11). When children used psychosocial care, parents expected more barriers when their child was of school-age (0.38; 0.01, 0.75), of non-western origin (vs. native) (0.52; 0.17, 0.88), when parents were older (i.e., 36+ years) (−0.77; −1.12, −0.42), experienced more adverse life events (0.29; 0.13, 0.45) or had less social support (−0.17; −0.34, 0.00). Conclusion: Even when their child is already receiving treatment, parents continue to expect practical barriers to psychosocial care. Psychosocial care services and their gatekeepers should address these concerns. Access to psychosocial care can be improved by removing practical barriers, especially if children already receive psychosocial care, or when parents have a limited network or belong to an ethnic minority.</p

STRIPA: A Rule-Based Decision Support System for Medication Reviews in Primary Care

The chronic use of multiple medicinal drugs is growing, partly because individual patients’ drugs have not been adequately prescribed by primary care physicians. In order to reduce these polypharmacy problems, the Systematic Tool to Reduce Inappropriate Prescribing (STRIP) has been created. To facilitate physicians’ use of the STRIP method, the STRIP Assistant (STRIPA) has been developed. STRIPA is a stand-alone web-based decision support system that advices physicians during the pharmacotherapeutic analysis of patients’ health records. In this paper the application’s architecture and rule engine, and the design decisions relating to the user interface and semantic interoperability, are described. An experimental validation of the prototype by general practitioners and pharmacists showed that users perform significantly better when optimizing medication with STRIPA than without. This leads the authors to believe that one process-oriented decision support system, built around a context-aware rule engine, operated through an intuitive user interface, is able to contribute to improving drug prescription practices

Stakeholder perspectives on payment reform in maternity care in the Netherlands:A Q-methodology study

Based on theoretical notions, there is consensus that alternative payment models to the common fee-for-service model have the potential to improve healthcare quality through increased collaboration and reduced under- and overuse. This is particularly relevant for maternity care in the Netherlands because perinatal mortality rates are relatively high in comparison to other Western countries. Therefore, an experiment with bundled payments for maternity care was initiated in 2017. However, the uptake of this alternative payment model remains low, as also seen in other countries, and fee-for-service models prevail. A deeper understanding of stakeholders’ perspectives on payment reform in maternity care is necessary to inform policy makers about the obstacles to implementing alternative payment models and potential ways forward. We conducted a Q-methodology study to explore perspectives of stakeholders (postpartum care managers, midwives, gynecologists, managers, health insurers) in maternity care in the Netherlands on payment reform. Participants were asked to rank a set of statements relevant to payment reform in maternity care and explain their ranking during an interview. Factor analysis was used to identify patterns in the rankings of statements. We identified three distinct perspectives on payment reform in maternity care. One general perspective, broadly supported within the sector, focusing mainly on outcomes, and two complementary perspectives, one focusing more on equality and one focusing more on collaboration. This study shows there is consensus among stakeholders in maternity care in the Netherlands that payment reform is required. However, stakeholders have different views on the purpose and desired design of the payment reform and set different conditions. Working towards payment reform in co-creation with all involved parties may improve the general attitude towards payment reform, may enhance the level of trust among stakeholders, and may contribute to a higher uptake in practice.</p

Exploring timing and delivery of lifestyle advice following an acute cardiac event hospitalization:The cardiac patient's perspective

Objective: To explore the perspective of cardiac patients regarding the timing and manner of delivering lifestyle advice following an acute cardiac event hospitalization. Methods: Dutch cardiac patients who experienced a cardiac event hospitalization participated in a semi-structured interview (n = 14) or a cross-sectional survey study (n = 119). Results: Our findings indicate that cardiac patients are receptive to lifestyle advice throughout the care trajectory. Advice delivered by a cardiologist had the highest self-reported impact. Furthermore, receiving advice at multiple phases during the care trajectory was associated with a greater intention to change lifestyle (B = 0.37, CI = 0.17 – 0.57). Patients favored clear-cut, feasible, and friendly but confronting advice. Moreover, they stressed the importance of advice being aligned with their identity and beliefs about the causes of their disease. Conclusion: The period following an acute cardiac event provides a unique opportunity to offer tailored and patient-centered lifestyle advice. This “teachable window” for lifestyle change, when used wisely, may improve health outcomes for cardiac patients. Practice Implications: Healthcare professionals should initiate lifestyle advice already during hospitalization and continue during follow-up appointments and cardiac rehabilitation. Advice should be feasible and empathy-based, as well as tailored to the patient's needs, values, and perceptions of the causes of their cardiovascular disease.</p

Self-organizing peer coach groups to increase daily physical activity in community dwelling older adults

Many older adults do not reach the recommended level of physical activity, despite many professional-delivered physical activity interventions. Here we study the implementation of a novel physical activity intervention for older adults that is self-sustainable (no financial support) and self-organizing (participants act as organizers) due to peer coaching. We implemented three groups and evaluated process and effect using participatory observations, questionnaires, six-minute walk tests and body composition measures from October 2016 to September 2018. The intervention was implemented by staff without experience in physical activity interventions. Facilitators were a motivated initiator and a non-professional atmosphere for participants to take ownership. Barriers were the absence of motivated participants to take ownership and insufficient participants to ensure the presence of participants at every exercise session. The groups exercised outside five days a week and were self-organizing after 114, 216 and 263 days. The initial investments were 170_ for sport equipment and 81-187 h. The groups reached 118 members and a retention of 86.4% in two years. The groups continue to exist at the time of writing and are self-sustainable. Quality of life increased 0.4 on a ten-point scale (95%CI 0.1-0.7; p = 0.02) and six-minute walk test results improved with 33 m (95%CI 18-48; p < 0.01) annually. Self-organizing peer coach groups for physical activity are feasible, have positive effects on health and require only a small investment at the start. It is a sustainable and potentially scalable intervention that could be a promising method to help many older adults age healthier

Exploring timing and delivery of lifestyle advice following an acute cardiac event hospitalization:The cardiac patient's perspective

Objective: To explore the perspective of cardiac patients regarding the timing and manner of delivering lifestyle advice following an acute cardiac event hospitalization. Methods: Dutch cardiac patients who experienced a cardiac event hospitalization participated in a semi-structured interview (n = 14) or a cross-sectional survey study (n = 119). Results: Our findings indicate that cardiac patients are receptive to lifestyle advice throughout the care trajectory. Advice delivered by a cardiologist had the highest self-reported impact. Furthermore, receiving advice at multiple phases during the care trajectory was associated with a greater intention to change lifestyle (B = 0.37, CI = 0.17 – 0.57). Patients favored clear-cut, feasible, and friendly but confronting advice. Moreover, they stressed the importance of advice being aligned with their identity and beliefs about the causes of their disease. Conclusion: The period following an acute cardiac event provides a unique opportunity to offer tailored and patient-centered lifestyle advice. This “teachable window” for lifestyle change, when used wisely, may improve health outcomes for cardiac patients. Practice Implications: Healthcare professionals should initiate lifestyle advice already during hospitalization and continue during follow-up appointments and cardiac rehabilitation. Advice should be feasible and empathy-based, as well as tailored to the patient's needs, values, and perceptions of the causes of their cardiovascular disease.</p

Understanding deprescribing of preventive cardiovascular medication: a Q-methodology study in patients

Patients with low cardiovascular disease (CVD) risk potentially use preventive cardiovascular medication unnecessarily. Our aim was to identify various viewpoints and beliefs concerning the preventive CVD management of patients with low CVD risk using preventive cardiovascular medication. Furthermore, we investigated whether certain viewpoints were related to a preference for deprescription or the continuation of preventive cardiovascular medication

Linking a peer coach physical activity intervention for older adults to a primary care referral scheme

Background Physical inactivity has contributed to the current prevalence of many age-related diseases, including type 2 diabetes and cardiovascular disease. Peer coach physical activity intervention are effective in increasing long term physical activity in community dwelling older adults. Linking peer coach physical activity interventions to formal care could therefore be a promising novel method to improve health in inactive older adults to a successful long-term physical activity intervention. Methods We evaluated the effects of linking a peer coach physical activity intervention in Leiden, The Netherlands to primary care through an exercise referral scheme from July 2018 to April 2020. Primary care practices in the neighborhoods of three existing peer coach physical activity groups were invited to refer patients to the exercise groups. Referrals were registered at the primary care practice and participation in the peer coach groups was registered by the peer coaches of the exercise groups. Results During the study, a total of 106 patients were referred to the peer coach groups. 5.7% of patients participated at the peer coach groups and 66.7% remained participating during the 1 year follow up. The number needed to refer for 1 long term participant was 26.5. The mean frequency of participation of the referred participants was 1.2 times a week. Conclusion Linking a peer coach physical activity intervention for older adults to a primary care referral scheme reached only a small fraction of the estimated target population. However, of the people that came to the peer coach intervention a large portion continued to participate during the entire study period. The number needed to refer to engage one older person in long term physical activity was similar to other referral schemes for lifestyle interventions. The potential benefits could be regarded proportional to the small effort needed to refer

The COVID-19 Crisis as a Teachable Moment for Lifestyle Change in Dutch Cardiovascular Disease Patients

Objective: When lifestyle changes are needed, life events or crises such as COVID-19 may function as “teachable moments”. This study aimed to explore whether the pandemic can provoke a teachable moment regarding lifestyle change in cardiovascular disease patients.Method: In this cross-sectional survey study, 830 cardiovascular disease patients reported their intentions to change lifestyle, instigated by the corona crisis, together with risk perception, affective impact, and changed self-concept, based on a “teachable moments” framework.Results: Between 8 and 28% of the sample reported increased intentions to optimize lifestyle behaviors, particularly related to general lifestyle (28%), physical activity (25%), and diet (21%). Multivariate regression analyses revealed that changed self-concept was associated with higher intentions to improve general lifestyle (B = 0.26; CI = 0.19–0.33), physical activity (B = 0.23; CI = 0.16–0.30), and smoking (B = 0.29; CI = 0.01–0.57). In addition, changed self-concept and affective impact were both significantly associated with higher intentions to improve diet (resp. B = 0.29; CI = 0.21–0.36 and B = 0.12; CI = 0.04–0.21) and to limit alcohol consumption (resp. B = 0.22; CI = 0.13–0.30 and B = 0.11; CI = 0.01–0.20). We did not find evidence for an important role of risk perception on behavior change intentions.Conclusion: The COVID-19 crisis evoked a potential teachable moment for lifestyle change in cardiovascular disease patients, driven by a change in a patient's self-concept and to a lesser extent by an affective impact of the COVID-19 crisis. These results suggest an important window of opportunity for healthcare professionals to utilize the pandemic to promote a healthy lifestyle to their patients