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Murugesu L, Fransen MP, Timmermans DR, Pieterse AH, Smets EM, Damman OC. Co-creation of a health literate-sensitive training and conversation aid to support shared decision-making in maternity care. PEC Innov 2024; 4:100278. [PMID: 38596600 PMCID: PMC11002297 DOI: 10.1016/j.pecinn.2024.100278] [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] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 11/17/2023] [Accepted: 03/25/2024] [Indexed: 04/11/2024]
Abstract
Background Maternity care increasingly aims to achieve Shared Decision-making (SDM), yet seemingly not to the benefit of clients with low health literacy (HL). We developed an SDM training for healthcare professionals (HCPs) and a conversation aid to support HL-sensitive SDM in maternity care. Methods The training and conversation aid were based on previous needs assessments and expert consultation, and were developed in co-creation with clients (n = 15) and HCPs (n = 7). Usability, acceptability and comprehension of the conversation aid were tested among new clients (n = 14) and HCPs (n = 6). Acceptability of the training was tested among midwifery students (n = 5). Results In the co-creation sessions, clients reported to expect that their midwife becomes acquainted with their general values, priorities and daily context. Clients also emphasized wanting to be supported in their preferred decisional role. User test interviews showed that clients and HCPs were positive towards using the conversation aid, but also apprehensive about the time it required. The user test of the training showed that more attention was needed for recognizing and adapting information provision to clients' HL level. Conclusion and innovation The newly developed conversation aid and training have potential to support HCPs and clients in HL-sensitive SDM.
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Affiliation(s)
- Laxsini Murugesu
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - Mirjam P. Fransen
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - Danielle R.M. Timmermans
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
- Amsterdam UMC Vrije Universiteit Amsterdam, Public and Occupational Health, Amsterdam, the Netherlands
| | - Arwen H. Pieterse
- Leiden University Medical Center, Biomedical Data Sciences, Leiden, the Netherlands
| | - Ellen M.A. Smets
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
- Amsterdam UMC Location University of Amsterdam, Medical Psychology, Amsterdam, the Netherlands
| | - Olga C. Damman
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
- Amsterdam UMC Vrije Universiteit Amsterdam, Public and Occupational Health, Amsterdam, the Netherlands
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Fransen MP, Damman OC, Bas S, Uiters E, Timmermans DR. Decision-making in breast cancer screening: A qualitative exploration of the match between women's beliefs and screening information in the Netherlands. Patient Educ Couns 2024; 122:108155. [PMID: 38325207 DOI: 10.1016/j.pec.2024.108155] [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] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 01/12/2024] [Accepted: 01/14/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVE Decision-making about breast cancer screening requires balanced and understandable information that takes prior beliefs of screening invitees into account. METHODS In qualitative interviews with 22 Dutch women who were invited for screening for the first time (49-52 years of age, varying health literacy levels), we gained insight in their beliefs on breast cancer and breast cancer screening, and explored how the current screening information matched these beliefs. RESULTS Breast cancer was perceived as an unpredictable, severe, and uncontrollable disease. Women considered screening as self-evident and an important mean to gain some control over breast cancer. Information on benefits of screening was in line with women's prior beliefs and confirmed women's main reasons to participate. Information about false-positive outcomes, overtreatment, and false negative outcomes did not correspond to women's prior beliefs and this information was generally not considered relevant for decision-making. Preferences for additional information merely concerned practical information on the screening procedure. CONCLUSION Complex information on the harms of screening does not match women's beliefs and is not taken into account in their decision-making. PRACTICE IMPLICATIONS Information regarding breast cancer screening could be further aligned to prior beliefs by taking into account values, filling knowledge gaps and correct misconceptions.
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Affiliation(s)
- Mirjam P Fransen
- National Institute for Public Health and the Environment, Centre for Prevention, Lifestyle and Health, Bilthoven, the Netherlands; Amsterdam UMC, Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Amsterdam Public Health Research institute, Quality of Care, Amsterdam, the Netherlands.
| | - Olga C Damman
- Amsterdam Public Health Research institute, Quality of Care, Amsterdam, the Netherlands; Amsterdam UMC, Location Vrije Universiteit Amsterdam, Public and Occupational Health, Van der Boechorststraat 7 1081 Amsterdam, the Netherlands
| | - Sharell Bas
- National Institute for Public Health and the Environment, Centre for Prevention, Lifestyle and Health, Bilthoven, the Netherlands
| | - Ellen Uiters
- National Institute for Public Health and the Environment, Centre for Prevention, Lifestyle and Health, Bilthoven, the Netherlands
| | - Daniëlle Rm Timmermans
- Amsterdam Public Health Research institute, Quality of Care, Amsterdam, the Netherlands; Amsterdam UMC, Location Vrije Universiteit Amsterdam, Public and Occupational Health, Van der Boechorststraat 7 1081 Amsterdam, the Netherlands
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3
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van Strien-Knippenberg IS, Arjangi-Babetti H, Timmermans DRM, Schrauwen L, Fransen MP, Melles M, Damman OC. Communicating the results of risk-based breast cancer screening through visualizations of risk: a participatory design approach. BMC Med Inform Decis Mak 2024; 24:78. [PMID: 38500098 PMCID: PMC10949766 DOI: 10.1186/s12911-024-02483-6] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 03/11/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Risk-based breast cancer (BC) screening raises new questions regarding information provision and risk communication. This study aimed to: 1) investigate women's beliefs and knowledge (i.e., mental models) regarding BC risk and (risk-based) BC screening in view of implications for information development; 2) develop novel informational materials to communicate the screening result in risk-based BC screening, including risk visualizations of both quantitative and qualitative information, from a Human-Centered Design perspective. METHODS Phase 1: Interviews were conducted (n = 15, 40-50 years, 5 lower health literate) on women's beliefs about BC risk and (risk-based) BC screening. Phase 2: In three participatory design sessions, women (n = 4-6 across sessions, 40-50 years, 2-3 lower health literate) made assignments and created and evaluated visualizations of risk information central to the screening result. Prototypes were evaluated in two additional sessions (n = 2, 54-62 years, 0-1 lower health literate). Phase 3: Experts (n = 5) and women (n = 9, 40-74 years) evaluated the resulting materials. Two other experts were consulted throughout the development process to ensure that the content of the information materials was accurate. Interviews were transcribed literally and analysed using qualitative thematic analysis, focusing on implications for information development. Notes, assignments and materials from the participatory design sessions were summarized and main themes were identified. RESULTS Women in both interviews and design sessions were positive about risk-based BC screening, especially because personal risk factors would be taken into account. However, they emphasized that the rationale of risk-based screening and classification into a risk category should be clearly stated and visualized, especially for higher- and lower-risk categories (which may cause anxiety or feelings of unfairness due to a lower screening frequency). Women wanted to know their personal risk, preferably visualized in an icon array, and wanted advice on risk reduction and breast self-examination. However, most risk factors were considered modifiable by women, and the risk factor breast density was not known, implying that information should emphasize that BC risk depends on multiple factors, including breast density. CONCLUSIONS The information materials, including risk visualizations of both quantitative and qualitative information, developed from a Human-Centered Design perspective and a mental model approach, were positively evaluated by the target group.
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Affiliation(s)
- Inge S van Strien-Knippenberg
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands.
| | - Hannah Arjangi-Babetti
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Danielle R M Timmermans
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Laura Schrauwen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Mirjam P Fransen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Marijke Melles
- Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
| | - Olga C Damman
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
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Sponselee HCS, ter Beek L, Renders CM, Kroeze W, Fransen MP, van Asselt KM, Steenhuis IHM. Letting people flourish: defining and suggesting skills for maintaining and improving positive health. Front Public Health 2023; 11:1224470. [PMID: 37900021 PMCID: PMC10602807 DOI: 10.3389/fpubh.2023.1224470] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 09/26/2023] [Indexed: 10/31/2023] Open
Abstract
Background The concept of "positive health" emerged from the need for a holistic and more dynamic perspective on health, emphasising the ability of individuals to adapt and self-manage. The positive health conversation tool helps understand how people score on six positive health dimensions. However, skills within these dimensions to maintain or improve health have not yet been described. This is important for enabling individuals to put health advice into practise. Therefore, this paper aims to define and suggest skills for maintaining and improving positive health. Subsections Suggestions for definitions of skills within the positive health dimensions are described using the functional, interactive, and critical health literacy framework. Additionally, executive functions and life skills were incorporated. Moreover, the environment's role in these individual skills was noted, mentioning organisational health literacy that emphasises organisations' responsibility to provide comprehensible health information to all individuals. We propose that health promotion interventions can incorporate the proposed skills in practical exercises while aligning intervention materials and implementation tools with end-users and implementers. Discussion and conclusion The suggested skills for maintaining and improving positive health are a first step towards a more comprehensive understanding and open to discussion. These skills may also be applied to other practical conversation tools for maintaining or improving health. Increasing positive health through the defined skills may be especially relevant to those with a lower socioeconomic position who also have limited health literacy and thereby may contribute to reducing health inequalities. Taken together, strengthening the defined skills may hopefully contribute to allowing people to flourish in life.
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Affiliation(s)
- Hanne C. S. Sponselee
- Department of Health Sciences, Faculty of Sciences, VU University Amsterdam and Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Lies ter Beek
- Department of Health Sciences, Faculty of Sciences, VU University Amsterdam and Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Carry M. Renders
- Department of Health Sciences, Faculty of Sciences, VU University Amsterdam and Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Willemieke Kroeze
- Department of Health Sciences, Faculty of Sciences, VU University Amsterdam and Amsterdam Public Health Research Institute, Amsterdam, Netherlands
- Care for Nutrition and Health Group, School of Nursing, Christian University of Applied Sciences, Ede, Netherlands
| | - Mirjam P. Fransen
- Department of Health Sciences, Faculty of Sciences, VU University Amsterdam and Amsterdam Public Health Research Institute, Amsterdam, Netherlands
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam, Netherlands
| | - Kristel M. van Asselt
- Department of Health Sciences, Faculty of Sciences, VU University Amsterdam and Amsterdam Public Health Research Institute, Amsterdam, Netherlands
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Ingrid H. M. Steenhuis
- Department of Health Sciences, Faculty of Sciences, VU University Amsterdam and Amsterdam Public Health Research Institute, Amsterdam, Netherlands
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Murugesu L, Damman OC, Timmermans DRM, de Wit S, Nieuwenhuijze M, Smets EMA, Fransen MP. Health literate-sensitive shared decision-making in maternity care: needs for support among maternity care professionals in the Netherlands. BMC Pregnancy Childbirth 2023; 23:594. [PMID: 37605153 PMCID: PMC10440871 DOI: 10.1186/s12884-023-05915-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 08/11/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Shared decision-making (SDM) in maternity care is challenging when clients have insufficient health literacy (HL) skills. This study gained insight in how professionals apply HL-sensitive SDM in Dutch maternity care and their needs for support therein. METHODS Maternity care professionals (n = 30) completed a survey on SDM and the role of HL. Midwives (n = 13) were observed during simulated conversations discussing pain relief options and interviewed afterwards. The client-actors were instructed to portrait specific inadequate HL skills. Observation items focused on adapting communication to HL, and SDM (OPTION-5). RESULTS In the survey, professionals indicated experiencing most challenges when estimating clients' information comprehension. Observations showed that most midwives created choice awareness and informed clients about options, whereas exploring preferences and actual decision-making together with clients were observed less frequently. Their perceived HL-related obstacles and needs for support related to clients' information comprehension. In the interviews, midwives reported putting much effort into explaining available options in maternity care, but also that decisions about pain relief are often postponed until the moment of labour. CONCLUSION Professionals' self-reported needs focus on clients' information comprehension. However, observations indicate that it is not the stage of informing, but rather value clarification and actual decision-making that need improvement in HL-sensitive SDM.
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Affiliation(s)
- Laxsini Murugesu
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Amsterdam, the Netherlands.
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands.
| | - Olga C Damman
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Public and Occupational Health, Amsterdam, the Netherlands
| | - Danielle R M Timmermans
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Public and Occupational Health, Amsterdam, the Netherlands
| | - Sanne de Wit
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Amsterdam, the Netherlands
| | - Marianne Nieuwenhuijze
- Research Centre for Midwifery Science, Zuyd University, Universiteitssingel 60, Maastricht, 6229 ER, the Netherlands
- CAPHRI, Maastricht University, Maastricht, the Netherlands
| | - Ellen M A Smets
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
- Amsterdam UMC Location University of Amsterdam, Medical Psychology, Amsterdam, the Netherlands
| | - Mirjam P Fransen
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
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Blake SN, Hugtenburg JG, van der Vlugt M, Dekker E, Fransen MP. Decision-making on colorectal cancer screening in Curaçao - interviews with the target population. BMC Public Health 2023; 23:1437. [PMID: 37501171 PMCID: PMC10373279 DOI: 10.1186/s12889-023-16335-x] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 07/18/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND During the first year of the population based colorectal cancer (CRC) screening program on Curaçao, about 20% of invitees participated. This study explored the target population's perceptions and awareness on CRC (screening), beliefs on the program provision, their preferences and information needs for informed decision-making. METHODS Semi-structured interviews with 23 individuals, who were not yet invited for CRC screening, were recorded, transcribed, coded and analyzed. RESULTS CRC (screening) was discussed in the context of personal health, where own responsibility and food were important. Cancer was perceived as an unpredictable disease that causes suffering and leads to death and was also associated with fear. Despite being aware of the program, most respondents were not familiar with the screening procedure. Provision of the screening program was regarded positively and as an opportunity to contribute to health improvement. This seemed related to the expressed trust in the Caribbean Prevention Center (program organizer). Respondents preferred to make independent decisions about CRC screening participation. A personal approach, visual aids and media were the preferred sources of information. CONCLUSION The results of our interviews suggest that it may be beneficial to provide information on CRC screening in Curaçao within the context of personal health. While including sensitivity to fears and respect for the autonomy of the target population. Finally, electronic media maybe useful in supporting informed decision-making.
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Affiliation(s)
- Shacara N Blake
- Caribbean Prevention Center (Fundashon Prevenshon), Willemstad, Curaçao.
- Department of Gastroenterology and Hepatology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands.
- Amsterdam Gastroenterology, Endocrinology and Metabolism (AGEM), Amsterdam, the Netherlands.
| | - Jacqueline G Hugtenburg
- Caribbean Prevention Center (Fundashon Prevenshon), Willemstad, Curaçao
- Faculty of Social and Behavioral Sciences, University of Curaçao, Willemstad, Curaçao
- Department of Clinical Pharmacology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Manon van der Vlugt
- Department of Gastroenterology and Hepatology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology, Endocrinology and Metabolism (AGEM), Amsterdam, the Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology, Endocrinology and Metabolism (AGEM), Amsterdam, the Netherlands
| | - Mirjam P Fransen
- Department of Public and Occupational Health, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
- National Institute for Public Health and the Environment, Centre for Nutrition Prevention and Health Services, Bilthoven, the Netherlands
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Pluymen LPM, Yebyo HG, Stegeman I, Fransen MP, Dekker E, Brabers AEM, Leeflang MMG. Perceived Importance of the Benefits and Harms of Colorectal Cancer Screening: A Best-Worst Scaling Study. Value Health 2023; 26:918-924. [PMID: 36646279 DOI: 10.1016/j.jval.2022.12.015] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 12/16/2022] [Accepted: 12/30/2022] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To elicit the relative importance of the benefits and harms of colorectal cancer (CRC) screening among potential screening participants in the Dutch population. METHODS In a consensus meeting with 11 experts, risk reduction of CRC and CRC deaths (benefits) and complications from colonoscopy, stress of receiving positive fecal immunological test (FIT) results, as well as false-positive and false-negative FIT results (harms) were selected as determinant end points to consider during decision making. We conducted an online best-worst scaling survey among adults aged 55 to 75 years from the Dutch Health Care Consumer Panel of The Netherlands Institute for Health Services Research to elicit preference values for these outcomes. The preference values were estimated using conditional logit regression. RESULTS Of 265 participants, 234 (89%) had ever participated in CRC screening. Compared with the stress of receiving a positive FIT result, the outcome perceived most important was the risk of CRC death (odds ratio [OR] 4.5; 95% confidence interval [CI] 3.9-5.1), followed by risk of CRC (OR 4.1; 95% CI 3.6-4.7), a false-negative FIT result (OR 3.1; 95% CI 2.7-3.5), colonoscopy complications (OR 1.6; 95% CI 1.4-1.8), and a false-positive FIT result (OR 1.4; 95% CI 1.3-1.6). The magnitude of these differences in perceived importance varied according to age, educational level, ethnic background, and whether the individual had previously participated in CRC screening. CONCLUSION Dutch men and women eligible for FIT-based CRC screening perceive the benefits of screening to be more important than the harms.
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Affiliation(s)
- Linda P M Pluymen
- Epidemiology and Data Science, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Public Health, Methodology, Amsterdam, The Netherlands.
| | - Henock G Yebyo
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Inge Stegeman
- Epidemiology and Data Science, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Mirjam P Fransen
- Public and Occupational Health, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Quality of Care, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Evelien Dekker
- Gastroenterology and Hepatology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Anne E M Brabers
- Nivel, The Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Mariska M G Leeflang
- Epidemiology and Data Science, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Public Health, Methodology, Amsterdam, The Netherlands
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van der Kamp D, Torensma M, Vader S, Pijpker R, den Broeder L, Fransen MP, Wagemakers A. Exploring experiences with stressors and coping resources among Dutch socioeconomic groups during the COVID-19 pandemic. Health Promot Int 2023; 38:7043187. [PMID: 36795099 PMCID: PMC9933839 DOI: 10.1093/heapro/daac198] [Citation(s) in RCA: 1] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
The COVID-19 crisis impacts populations globally. This impact seems to differ for groups with low- and high-socioeconomic status (SES). We conducted a qualitative study in the Netherlands using a salutogenic perspective to examine experiences with stressors and coping resources during the pandemic among both SES groups to gain insight on how to promote the health and well-being of these groups. We conducted 10 focus group discussions and 20 interviews to explore the experiences, including resources and stressors, of respondents from low- (N = 37) and high-SES (N = 38) groups (25-55 years, Dutch speaking). We analyzed the findings at individual, community, and national levels. The results show that coping depends on government-imposed measures and the way individuals handle these measures; restriction to the home context with positive and negative consequences for work and leisure; psychological negative consequences and resourcefulness; and social effects related to unity (e.g. social cohesion or support) and division (including polarization). Respondents with lower SES expressed more problems with COVID-19 measures and experienced more social impact in their neighborhood than those with higher SES. Where low-SES groups especially mentioned the effects of staying at home on family life, high-SES groups mentioned effects on work life. At last, psychological consequences seem to differ somewhat across SES groups. Recommendations include consistent government-imposed measures and government communication, support for home schooling children, and strengthening the social fabric of neighborhoods.
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Affiliation(s)
- Dani van der Kamp
- Health and Society, Social Sciences Group, Wageningen University & Research, the Netherlands
| | | | | | - Roald Pijpker
- Health and Society, Social Sciences Group, Wageningen University & Research, the Netherlands
| | - Lea den Broeder
- Centre for Health and Society, National Institute for Public Health and the Environment, Bilthoven, the Netherlands,Achieve, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Mirjam P Fransen
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, Wageningen, the Netherlands,Amsterdam UMC, location University of Amsterdam, Department of Public and Occupational Health, Amsterdam, the Netherlands,Amsterdam Public Health Research Institute, Program Quality of Care, Amsterdam, the Netherlands
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Derksen ME, Jaspers MWM, Kunst AE, Fransen MP. Usage of digital, social and goal-setting functionalities to support health behavior change: A mixed methods study among disadvantaged women during or after pregnancy and their healthcare professionals. Int J Med Inform 2023; 170:104981. [PMID: 36603389 DOI: 10.1016/j.ijmedinf.2022.104981] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/26/2022] [Accepted: 12/28/2022] [Indexed: 01/02/2023]
Abstract
OBJECTIVE We aimed to gain insight into how and to what extent social (i.e. private/group chat) and goal-setting (e.g. rewards) functionalities in digital interventions for health behavior change were used by clients and nurses in a preventive care program for disadvantaged women during or after pregnancy, and which factors influenced usage. METHODS We collected quantitative and qualitative data on usage of these functionalities in 'Kindle', a mHealth intervention to prepare for health behavior change. RESULTS We found that nurses (n = 5) and clients (n = 20) scarcely used both functionalities. They sent 862 messages in the social functionality whose security they appreciated, but habitually used WhatsApp likewise. Moreover, nurses were hesitant to let their clients interact in the group chat. Clients formulated 59 personal goals, which they found difficult to do. Nurses rewarded 846 points for clients' progress on goal attainment, but found it hard to determine how many points to reward. Clients and nurses indicated that the functionality made it more fun and easy to discuss clients' personal goals. CONCLUSIONS To conclude, digital, social and goal-setting functionalities were used to a limited extent by nurses and clients, and need optimization before implementation to support disadvantaged groups to change their health behavior.
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Affiliation(s)
- M E Derksen
- Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands.
| | - M W M Jaspers
- Amsterdam UMC, University of Amsterdam, Department of Medical Informatics, Amsterdam Public Health Research Institute, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - A E Kunst
- Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - M P Fransen
- Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
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10
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Murugesu L, Heijmans M, Rademakers J, Fransen MP. Challenges and solutions in communication with patients with low health literacy: Perspectives of healthcare providers. PLoS One 2022; 17:e0267782. [PMID: 35507632 PMCID: PMC9067671 DOI: 10.1371/journal.pone.0267782] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 06/02/2020] [Accepted: 04/16/2022] [Indexed: 11/19/2022] Open
Abstract
Insights in the challenges that healthcare providers encounter in serving low health literate patients is lagging behind. This study explored challenges perceived by healthcare providers and provides strategies in communication with low health literate patients. Primary and secondary healthcare providers (N = 396) filled in an online survey. We assessed the frequency of challenges prior to, during and following a consultation, and which strategies were used and recommended. Survey outcomes were validated in in-depth interviews with healthcare providers (N = 7). Providers (76%) reported one or more challenges that were subscribed to patients’ difficulties in comprehending or applying health-related information, in communicating with professionals, or in taking responsibility for their health. Providers (31%) perceived difficulties in recognizing low health literate patients, and 50% rarely used health literacy specific materials. Providers expressed needs for support to recognize and discuss low health literacy, to adapt communication and to assess patient’s comprehension. Future research should focus on developing strategies for providers to ensure patients’ understanding (e.g. applying teach-back method), to recognize low health literate patients, and to support patients’ in taking responsibility for their health (e.g. motivational interviewing).
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Affiliation(s)
- Laxsini Murugesu
- Nivel, Netherlands Institute for Health Services Research, Utrecht, Netherlands
- Department of Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- * E-mail:
| | - Monique Heijmans
- Nivel, Netherlands Institute for Health Services Research, Utrecht, Netherlands
| | - Jany Rademakers
- Nivel, Netherlands Institute for Health Services Research, Utrecht, Netherlands
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Mirjam P. Fransen
- Department of Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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11
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Derksen ME, Jaspers MW, van Strijp S, Fransen MP. Mobile Health for Smoking Cessation Among Disadvantaged Young Women During and After Pregnancy: User-Centered Design and Usability Study. JMIR Form Res 2021; 5:e24112. [PMID: 34346895 PMCID: PMC8374659 DOI: 10.2196/24112] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/26/2020] [Accepted: 05/31/2021] [Indexed: 01/29/2023] Open
Abstract
Background Smoking prevalence during and after pregnancy remains high among socioeconomically disadvantaged women. Mobile health (mHealth) apps with game and social support elements seem promising to support smoking cessation. Objective This study aims to describe the user-centered design and usability evaluation of Kindle, an mHealth app with game and social support elements, to support disadvantaged young women during and after pregnancy through the first stages of smoking cessation. Methods Disadvantaged women (n=9), members of their social networks (n=4), and nurses supporting these women (n=51) were informants throughout the iterative prototype development of Kindle according to the International Organization for Standardization 9241-11:2018. Specific phases included understanding the context of use through secondary analysis of qualitative interview data (phase 1), establishing the user and organizational requirements (phase 2), production of design solutions (phase 3), and usability inspection of the prototype through a heuristic evaluation (3 experts) along with user testing by a think aloud method (5 disadvantaged women and 5 nurses; phase 4). Usability problems were categorized according to the principles of the Healthcare Information and Management Systems Society. Results Phase 1 resulted in an understanding of the VoorZorg program and the needs of VoorZorg nurses and clients (eg, focus on early stages of change and building new supportive networks to aid clients in smoking cessation). In phase 2, we established requirements (n=22; eg, mHealth app, secure communication between nurses and clients, easy-to-use interfaces, inclusion of game elements, and tailoring at early stages of change in smoking cessation). Phase 3 resulted in a prototype of Kindle, combining the interface for nurses and clients, including the following functionalities: personal goal setting with earning points; secured chat function between nurses and other clients; and tips, diary, and profile creation. The heuristic evaluation and thinking aloud method in phase 4 revealed 78 usability problems in the interfaces. Most usability problems concerned simplicity (eg, unclear clickable button) and naturalness (eg, unclear icon). Conclusions The user-centered design and usability testing of the mHealth app Kindle yielded useful insights. The involvement of end users, specifically socioeconomically disadvantaged women during and after their pregnancy, resulted in a prototype that met their needs and requirements (eg, mHealth app, secure communication between nurses and clients, easy-to-use interfaces, inclusion of game elements, and tailoring to the early stages of change in smoking cessation) to achieve readiness for smoking cessation. Moreover, the usability evaluation by end users and experts revealed unique usability problems for this population. These insights allow for further optimization of Kindle and encourage future studies to engage disadvantaged populations in all phases of mHealth intervention design and usability testing.
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Affiliation(s)
- Marloes E Derksen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Monique Wm Jaspers
- Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Sander van Strijp
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Mirjam P Fransen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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12
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Miranda R, Meeks KAC, Snijder MB, van den Born BJ, Fransen MP, Peters RJ, Stronks K, Agyemang C. Health literacy and hypertension outcomes in a multi-ethnic population: the HELIUS study. Eur J Public Health 2021; 30:545-550. [PMID: 31578555 DOI: 10.1093/eurpub/ckz174] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Hypertension disproportionately affects ethnic minority groups. Although health literacy may play role in these ethnic inequalities, little is known about the extent to which health literacy affects hypertension prevalence, awareness, treatment and control in different ethnic groups. Therefore, we assessed these associations in a multi-ethnic population. METHODS Baseline data from the HELIUS study were used including participants of Dutch (n = 1948), South-Asian Surinamese (n = 2054) and African Surinamese (n = 1932) origin aged 18-70 years, who lived in Amsterdam, the Netherlands, were fluent in Dutch and underwent health literacy assessment through the Rapid Estimate of Adult Literacy in Medicine-Dutch (REALM-D). The REALM-D was categorized either as low (<60 sumscore) or adequate (≥60 sumscore) health literacy. Participants completed questionnaires and underwent physical examination. RESULTS After adjusting for confounding variables, Dutch [odds ratio (OR) 2.02; 95% confidence interval (CI), 1.11-3.64] and African Surinamese (OR 1.36; 1.03-1.79) with low health literacy were more likely than those with adequate health literacy to have hypertension, whereas in South-Asian Surinamese this association was not significant. No significant associations were found between health literacy and hypertension awareness, treatment and control in any of the ethnic groups. CONCLUSION Findings indicate that health literacy is associated with hypertension prevalence in selected ethnic groups, but not with hypertension awareness, treatment and control. Targeting health literacy might be an entry point for tackling ethnic inequalities in hypertension prevalence. To substantially reduce these inequalities, further research is needed to explore other factors and pathways through which health literacy may impact hypertension outcomes in different ethnic groups.
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Affiliation(s)
- R Miranda
- Department of Public Health, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands.,End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | - K A C Meeks
- Department of Public Health, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands.,Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - M B Snijder
- Department of Public Health, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands.,Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, Amsterdam Public Health research institute, University of Amsterdam, Amsterdam, the Netherlands
| | - B J van den Born
- Department of Public Health, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands.,Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - M P Fransen
- Department of Public Health, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - R J Peters
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - K Stronks
- Department of Public Health, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - C Agyemang
- Department of Public Health, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
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13
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Derksen ME, van Strijp S, Kunst AE, Daams JG, Jaspers MWM, Fransen MP. Serious games for smoking prevention and cessation: A systematic review of game elements and game effects. J Am Med Inform Assoc 2021; 27:818-833. [PMID: 32330255 PMCID: PMC7309269 DOI: 10.1093/jamia/ocaa013] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 07/24/2019] [Revised: 01/07/2020] [Accepted: 01/23/2020] [Indexed: 11/13/2022] Open
Abstract
Objective Serious health games might have the potential to prevent tobacco smoking and its health consequences, depending on the inclusion of specific game elements. This review aimed to assess the composition of serious games and their effects on smoking initiation prevention and cessation and behavioral determinants. Materials and Methods We systematically searched MEDLINE, Embase, PsycINFO, and Web of Science for publications that evaluated serious games aimed at changing smoking behavior or behavioral determinants. A taxonomy by King et al was used to classify game elements. Results We identified 15 studies, evaluating 14 unique serious games. All games combined multiple game elements (mean 5.5; range, 3-10). Most frequently used were general and intermittent rewards, theme and genre features, and punishments. Six studies on smoking prevention together assessed 20 determinants and found statistically significant positive effects for 8 determinants (eg, attitude, knowledge, intention). Of 7 studies on smoking cessation, 5 found positive, statistically significant effects on smoking cessation or status. These studies found statistically significant positive effects for 6 of 12 determinants (eg, self-efficacy, attitude, intention). The majority of included studies had poor or fair methodological quality, lacked follow-up measures, and had fixed (as opposed to free, on-demand) play sessions. Conclusions Serious games included multiple types of game elements. The evidence from a number of studies suggests that games may have positive effects on smoking-related outcomes, particularly smoking cessation. However, as most studies had important methodological limitations, stronger designs are needed to demonstrate, quantify, and understand the effects of serious games.
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Affiliation(s)
- M E Derksen
- Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - S van Strijp
- Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - A E Kunst
- Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - J G Daams
- Medical Library, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - M W M Jaspers
- Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - M P Fransen
- Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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14
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Derksen ME, Kunst AE, Murugesu L, Jaspers MWM, Fransen MP. Smoking cessation among disadvantaged young women during and after pregnancy: Exploring the role of social networks. Midwifery 2021; 98:102985. [PMID: 33761432 DOI: 10.1016/j.midw.2021.102985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/29/2020] [Accepted: 03/07/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Smoking prevalence during and after pregnancy remains high among socioeconomically disadvantaged, European women. This research aims to gain insight into the role of social networks on smoking cessation among disadvantaged young women during and after pregnancy. DESIGN Qualitative interview study. SETTING Dutch preventive care program (VoorZorg). PARTICIPANTS Disadvantaged young women during and after pregnancy (n = 17) who participated in a Dutch preventive care program, and members in their social networks (n = 4). METHODS All qualitative interviews were recorded, transcribed, and analyzed by iterative coding processes. FINDINGS Many women were not intrinsically motivated to quit smoking due to, amongst other factors, difficulties in their lives (e.g. domestic violence, psychosocial problems), limited supportive social networks, and a strong dependence on relatives who smoked. Women seemed to be prompted to smoke by smoking cues in their social networks, while distancing from smokers would lead to feelings of social exclusion. When attempting to stop smoking, women experienced little encouragement from their social networks, which instead often undermined their smoking cessation efforts. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE The social networks of disadvantaged young women mostly had a negative role on their smoking cessation efforts. Our results emphasize the need to look at interventions that involve women's social networks, and explore novel opportunities, such as eHealth and mHealth applications so that these women can build supportive new social networks.
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Affiliation(s)
- Marloes E Derksen
- Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands.
| | - Anton E Kunst
- Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands
| | - Laxsini Murugesu
- Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands
| | - Monique W M Jaspers
- Amsterdam UMC, University of Amsterdam, Department of Medical Informatics, Amsterdam Public Health Research Institute, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands
| | - Mirjam P Fransen
- Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands
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15
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Murugesu L, Damman OC, Derksen ME, Timmermans DRM, de Jonge A, Smets EMA, Fransen MP. Women's Participation in Decision-Making in Maternity Care: A Qualitative Exploration of Clients' Health Literacy Skills and Needs for Support. Int J Environ Res Public Health 2021; 18:ijerph18031130. [PMID: 33514070 PMCID: PMC7908258 DOI: 10.3390/ijerph18031130] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 01/22/2021] [Accepted: 01/23/2021] [Indexed: 11/16/2022]
Abstract
Shared decision-making requires adequate functional health literacy (HL) skills from clients to understand information, as well as interactive and critical HL skills to obtain, appraise and apply information about available options. This study aimed to explore women's HL skills and needs for support regarding shared decision-making in maternity care. In-depth interviews were held among women in Dutch maternity care who scored low (n = 10) and high (n = 13) on basic health literacy screening test(s). HL skills and perceived needs for support were identified through thematic analysis. Women appeared to be highly engaged in the decision-making process. They mentioned searching and selecting general information about pregnancy and labor, constructing their preferences based on their own pre-existing knowledge and experiences and by discussions with partners and significant others. However, women with low basic skills and primigravida perceived difficulties in finding reliable information, understanding probabilistic information, constructing preferences based on benefit/harm information and preparing for consultations. Women also emphasized dealing with uncertainties, changing circumstances of pregnancy and labor, and emotions. Maternity care professionals could further support clients by guiding them towards reliable information. To facilitate participation in decision-making, preparing women for consultations (e.g., agenda setting) and supporting them in a timely manner to understand benefit/harm information seem important.
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Affiliation(s)
- Laxsini Murugesu
- Department of Public and Occupational Health, Amsterdam Public Health, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (M.E.D.); (M.P.F.)
- Correspondence: ; Tel.: +31-2056-676-33
| | - Olga C. Damman
- Department of Public and Occupational Health, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands; (O.C.D.); (D.R.M.T.)
| | - Marloes E. Derksen
- Department of Public and Occupational Health, Amsterdam Public Health, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (M.E.D.); (M.P.F.)
| | - Danielle R. M. Timmermans
- Department of Public and Occupational Health, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands; (O.C.D.); (D.R.M.T.)
| | - Ank de Jonge
- Department of Midwifery Science, AVAG, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands;
| | - Ellen M. A. Smets
- Department of Medical Psychology, Amsterdam Public Health, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands;
| | - Mirjam P. Fransen
- Department of Public and Occupational Health, Amsterdam Public Health, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (M.E.D.); (M.P.F.)
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16
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van der Giessen J, Fransen MP, Spreeuwenberg P, Velthuizen M, van Dulmen S, Ausems MGEM. Communication about breast cancer genetic counseling with patients with limited health literacy or a migrant background: evaluation of a training program for healthcare professionals. J Community Genet 2021; 12:91-99. [PMID: 33319336 PMCID: PMC7846648 DOI: 10.1007/s12687-020-00497-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 12/02/2020] [Indexed: 12/24/2022] Open
Abstract
Access to breast cancer genetic counseling is suboptimal for patients with limited health literacy or a migrant background due to ineffective communication and lack of healthcare professionals' recommendation. This study examines the effect of a blended training program (Erfo4all) for healthcare professionals on their awareness, knowledge, and self-efficacy towards communication about genetic counseling with patients with limited health literacy or a migrant background. In total, 59 breast surgeons and specialized nurses from 16 Dutch hospitals completed an online module and group training. Knowledge, self-assessed awareness, and self-efficacy were assessed before the training and 33 participants also completed a posttest questionnaire 6 months after the training program. We also assessed the perceived applicability and relevance of the training program from healthcare professionals' perspectives. We found a significant increase in self-assessed awareness of the prevalence and impact of limited health literacy and in healthcare professionals' self-efficacy to recognize limited health literacy and to communicate effectively with patients with limited health literacy or a migrant background. We did not find an increase in knowledge score. Almost all healthcare professionals reported that they use the techniques learned in the training, such as the teach-back method and plain language, and felt more confident discussing breast cancer genetic counseling. Our results suggest that a blended training program for healthcare professionals has potential to improve their ability to communicate effectively about breast cancer genetic counseling with patients with limited health literacy or a migrant background and offers a promising way to increase the referral rate for these groups of patients.
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Affiliation(s)
- Jeanine van der Giessen
- Division Laboratories, Pharmacy and Biomedical Genetics, Department of Genetics, University Medical Center Utrecht, P. O. Box 85500, 3508, GA, Utrecht, The Netherlands
| | - Mirjam P Fransen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, P. O. Box 22660, 1100, DD, Amsterdam, The Netherlands
| | - Peter Spreeuwenberg
- NIVEL (Netherlands Institute for Health Services Research), P. O Box 1568, 3500, BN, Utrecht, The Netherlands
| | - Mary Velthuizen
- Division Laboratories, Pharmacy and Biomedical Genetics, Department of Genetics, University Medical Center Utrecht, P. O. Box 85500, 3508, GA, Utrecht, The Netherlands
| | - Sandra van Dulmen
- NIVEL (Netherlands Institute for Health Services Research), P. O Box 1568, 3500, BN, Utrecht, The Netherlands
- Radboud Institute for Health Sciences, Department of Primary and Community Care, Radboud University Medical Center, P. O Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Margreet G E M Ausems
- Division Laboratories, Pharmacy and Biomedical Genetics, Department of Genetics, University Medical Center Utrecht, P. O. Box 85500, 3508, GA, Utrecht, The Netherlands.
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17
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Klinkenberg EF, Fransen MP, de Kort WLAM, Huis In 't Veld EMJ, van Weert JCM. Unknown, so also unvalued? Blood donation awareness and attitudes of potential donors of Dutch and African descent. Vox Sang 2020; 116:513-523. [PMID: 33161573 PMCID: PMC8247345 DOI: 10.1111/vox.13029] [Citation(s) in RCA: 3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 10/14/2020] [Accepted: 10/21/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Many Western countries face a shortage of African blood donors, while their specific blood groups are needed to transfuse chronic transfusion patients of similar ethnic background. Blood donation awareness and attitudes greatly impact the decision to become a blood donor, but how they are related and differ across ethnic groups is understudied. This study investigated blood donation awareness and attitudes of individuals of Dutch and African descent in the Netherlands. MATERIALS AND METHODS Survey data of 257 African and 152 Dutch non-donors measuring donation awareness (i.e. being familiar with the Dutch blood bank organization and knowing others who donated blood), cognitive (evaluative judgements) and affective (emotional reactions) attitudes were included. t-Tests, chi-square tests, linear and logistic regressions were conducted to study differences and associations between donation awareness and attitudes. RESULTS African individuals were less often aware of the Dutch blood bank organization (43%; p < 0·05) or others who donated blood (51%; p < 0·05) than Dutch individuals (55% and 68%, respectively). African individuals had lower cognitive donation attitudes compared with Dutch individuals (p < 0·001), but no differences were found for affective attitudes (p = 0·55). High donation awareness was associated with higher cognitive (p < 0·001) and affective (p < 0·05) donation attitudes among African minorities, but not among Dutch individuals. CONCLUSION The lower donation awareness and cognitive attitudes of African minorities should be taken into consideration in donor recruitment. Raising awareness through effective communication strategies might be essential in the donor decision making process of this target group.
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Affiliation(s)
- Elisabeth F Klinkenberg
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands.,Department of Public Health, Amsterdam UMC, Amsterdam Public Health research institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Mirjam P Fransen
- Department of Public Health, Amsterdam UMC, Amsterdam Public Health research institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Wim L A M de Kort
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands.,Department of Public Health, Amsterdam UMC, Amsterdam Public Health research institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Elisabeth M J Huis In 't Veld
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands.,Department of Cognitive Science & Artificial Intelligence, Tilburg University, Tilburg, The Netherlands
| | - Julia C M van Weert
- Amsterdam School of Communication Research / ASCoR, Department of Communication Science, University of Amsterdam, Amsterdam, The Netherlands
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18
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van der Giessen JAM, Ausems MGEM, van Riel E, de Jong A, Fransen MP, van Dulmen S. Development of a plain-language guide for discussing breast cancer genetic counseling and testing with patients with limited health literacy. Support Care Cancer 2020; 29:2895-2905. [PMID: 33001269 PMCID: PMC8062319 DOI: 10.1007/s00520-020-05800-7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/22/2020] [Indexed: 11/23/2022]
Abstract
Purpose Due to limited health literacy and resulting ineffective communication between healthcare professionals and patients, not all eligible patients are offered breast cancer genetic counseling and testing. We aimed to develop a plain-language guide to increase effective communication about genetic counseling and testing with breast cancer patients with limited health literacy. Methods Together with oncological healthcare professionals, we drafted a list of jargon words frequently used during (breast) cancer genetic counseling. In a focus group interview with breast cancer counselees with limited health literacy, who had received genetic counseling before, we reformulated these words in plain language. Low-literate individuals, who are not familiar with breast cancer care or genetic counseling, reflected on the draft of the guide. Completeness, acceptability, and perceived usability were tested in an online questionnaire among healthcare professionals. Results The result is a plain-language guide for genetic counseling and testing with 33 frequently used jargon words and a reformulation of these words in plain language. Acceptability and perceived usefulness of the guide among healthcare professionals (n = 58) were high. Conclusion The plain-language guide provides opportunities to facilitate communication about genetic counseling and testing with patients with limited health literacy and could enhance opportunities for patients to make informed decisions to participate in genetic testing. As the intention from healthcare professionals to use the plain-language guide is high, implementation of the guide in a real-life setting seems promising.
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Affiliation(s)
- J A M van der Giessen
- Division Laboratories, Pharmacy and Biomedical Genetics, Department of Genetics, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - M G E M Ausems
- Division Laboratories, Pharmacy and Biomedical Genetics, Department of Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - E van Riel
- Division Laboratories, Pharmacy and Biomedical Genetics, Department of Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A de Jong
- Reading & Writing Foundation, Den Haag, The Netherlands
| | - M P Fransen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - S van Dulmen
- Research Institute for Health Sciences, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.,Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands.,Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
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19
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Woudstra AJ, Smets EMA, Galenkamp H, Fransen MP. Validation of health literacy domains for informed decision making about colorectal cancer screening using classical test theory and item response theory. Patient Educ Couns 2019; 102:2335-2343. [PMID: 31561933 DOI: 10.1016/j.pec.2019.09.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 01/28/2019] [Revised: 08/14/2019] [Accepted: 09/14/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To construct and validate a computer-based and performance-based instrument to assess health literacy skills for informed decision making in colorectal cancer screening among screening invitees. METHODS An instrument was constructed based on a conceptual framework of health literacy skills in colorectal cancer screening and findings from an expert survey. The instrument was field-tested among individuals with low health literacy (n = 28). Its validity and reliability was assessed using classical test theory and item response theory approaches in an online panel of colorectal cancer screening invitees (n = 696). RESULTS Confirmatory factor analysis confirmed four separate factors: Comprehension, Application, Numeracy and Communication. A fifth domain (Appraisal) demonstrated poor reliability and validity and was omitted in further analyses. Internal consistency (Cronbach's alpha > 0.6 for the four scales) was acceptable and test-retest reliability was moderate. The four factors were measurement invariant for age, sex and educational level. CONCLUSION The computer-based measures were acceptable for self-administration. The constructed multidimensional health literacy instrument showed acceptable measurement properties. PRACTICE IMPLICATIONS Our findings imply that the computer-based instrument can be used for the development of interventions to support informed decision making about colorectal cancer screening among individuals with varying health literacy levels. Further research is needed for optimizing performance-based measurement of the Appraisal and Communication domains.
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Affiliation(s)
- Anke J Woudstra
- Amsterdam UMC, University of Amsterdam, Department of Public Health, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, the Netherlands.
| | - Ellen M A Smets
- Amsterdam UMC, University of Amsterdam, Department of Medical Psychology, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, the Netherlands.
| | - Henrike Galenkamp
- Amsterdam UMC, University of Amsterdam, Department of Public Health, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, the Netherlands.
| | - Mirjam P Fransen
- Amsterdam UMC, University of Amsterdam, Department of Public Health, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, the Netherlands.
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20
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Woudstra AJ, Smets EMA, Verdam MGE, Fransen MP. The Role of Health Literacy in Explaining the Relation between Educational Level and Decision Making about Colorectal Cancer Screening. Int J Environ Res Public Health 2019; 16:ijerph16234644. [PMID: 31766603 PMCID: PMC6926788 DOI: 10.3390/ijerph16234644] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 10/08/2019] [Accepted: 11/15/2019] [Indexed: 02/07/2023]
Abstract
Little is known about why educational inequalities exist in informed decision making in colorectal cancer (CRC) screening. Insight into the role and impact of health literacy is essential for intervention development. This study investigates associations between health literacy and informed decision making in CRC screening and explores to what extent health literacy mediates the association between education and informed decision making in CRC screening. In total, 696 individuals eligible for CRC screening (55–75 years of age) were recruited from online panels and filled in an online questionnaire at T0 (n = 696), T1 (n = 407) and T2 (n = 327). A hypothetical mediation model was tested using structural equation modelling. Outcomes included CRC knowledge, CRC screening knowledge, attitude, injunctive norm, descriptive norm, risk perception, self-efficacy, decisional conflict and decisional certainty. Health literacy domains included Comprehension, Application, Numeracy and Communication. Comprehension, Application and Numeracy, were found to mediate the association between education and knowledge about CRC and CRC screening, injunctive norm, descriptive norm, decisional conflict and decisional certainty. In light of these findings, targeting multiple health literacy domains in decision-support interventions is essential for facilitating informed decision making in CRC screening.
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Affiliation(s)
- Anke J. Woudstra
- Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands;
- Correspondence:
| | - Ellen M. A. Smets
- Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (E.M.A.S.); (M.G.E.V.)
| | - Mathilde G. E. Verdam
- Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (E.M.A.S.); (M.G.E.V.)
- Department of Methodology and Statistics, Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK Leiden, The Netherlands
| | - Mirjam P. Fransen
- Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands;
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21
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Derksen ME, Kunst AE, Jaspers MWM, Fransen MP. Barriers experienced by nurses providing smoking cessation support to disadvantaged, young women during and after pregnancy. Health Soc Care Community 2019; 27:1564-1573. [PMID: 31446634 PMCID: PMC6851702 DOI: 10.1111/hsc.12828] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 07/10/2019] [Accepted: 07/15/2019] [Indexed: 06/10/2023]
Abstract
In Europe, smoking during and after pregnancy is still highly prevalent among socioeconomically disadvantaged women. Nurses caring for these women can play a key role in smoking cessation, but encounter many problems when providing support. This research aims to identify barriers in providing smoking cessation support, experienced by nurses working within a Dutch preventive care programme for disadvantaged young women (VoorZorg), and to understand the underlying reasons of these barriers. Sixteen semi-structured interviews with nurses were performed. All interviews were recorded, transcribed and analysed deductively and inductively. We found that the VoorZorg programme provided nurses with training, resources and time to deliver smoking cessation support. Yet, nurses experienced important barriers, such as unmotivated clients and support methods that do not fit clients' needs. Underlying reasons are competing care demands, unsatisfactory training for cessation support, lack of self-efficacy in attending their clients, and conflicts with own professional attitudes. The results emphasise that nurses' ability to provide smoking cessation support could be improved by proper training in interventions that fit their clients' needs, and by time schedules and task definitions that help them to prioritise smoking cessation support over other matters.
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Affiliation(s)
- Marloes E. Derksen
- Department of Public HealthAmsterdam UMC, University of Amsterdam, Amsterdam Public Health Research InstituteAmsterdamNetherlands
| | - Anton E. Kunst
- Department of Public HealthAmsterdam UMC, University of Amsterdam, Amsterdam Public Health Research InstituteAmsterdamNetherlands
| | - Monique W. M. Jaspers
- Department of Medical InformaticsAmsterdam UMC, University of Amsterdam, Amsterdam Public Health Research InstituteAmsterdamNetherlands
| | - Mirjam P. Fransen
- Department of Public HealthAmsterdam UMC, University of Amsterdam, Amsterdam Public Health Research InstituteAmsterdamNetherlands
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22
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Murugesu L, Hopman ME, Van Voorst SF, Rosman AN, Fransen MP. Systematic Development of Materials for Inviting Low Health-Literate Individuals to Participate in Preconception Counseling. Int J Environ Res Public Health 2019; 16:ijerph16214223. [PMID: 31683516 PMCID: PMC6862136 DOI: 10.3390/ijerph16214223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 10/25/2019] [Accepted: 10/28/2019] [Indexed: 12/30/2022]
Abstract
In this study we aimed to systematically analyze problems in the recruitment of women with low health literacy for preconception counseling and to adapt and evaluate written invitations for this group. In a problem analysis (stage 1) we used structured interviews (n = 72) to assess comprehension of the initial invitations, perception of perinatal risks, attitude and intention to participate in preconception counseling. These outcomes were used to adapt the invitation. The adapted flyer was pretested in interviews (n = 16) (stage 2) and evaluated in structured interviews among a new group of women (n = 67) (stage 3). Differences between women in stages 1 and 3 regarding comprehension, risk perception, attitude and intention to participate in counseling were analyzed by linear regression analysis and chi-square tests. Women in stage 3 (who read the adapted flyer) had a more positive attitude towards participation in preconception counselling and a better understanding of how to apply for a consultation than women in stage 1 (who read the initial invitations). No differences were found in intention to participate in preconception counseling and risk perception. Systematic adaptation of written invitations can improve the recruitment of low health-literate women for preconception counselling. Further research should gain insight into additional strategies to reach and inform this group.
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Affiliation(s)
- Laxsini Murugesu
- Amsterdam Public Health Research Institute, Department of Public Health, University of Amsterdam, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands.
| | - Miriam E Hopman
- Amsterdam Public Health Research Institute, Department of Public Health, University of Amsterdam, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands.
| | - Sabine F Van Voorst
- Department of Obstetrics and Gynaecology, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands.
| | - Ageeth N Rosman
- Department of Obstetrics and Gynaecology, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands.
- Department of Health Care Studies, Rotterdam University of Applied Sciences, 3015 EK Rotterdam, The Netherlands.
| | - Mirjam P Fransen
- Amsterdam Public Health Research Institute, Department of Public Health, University of Amsterdam, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands.
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23
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Woudstra AJ, Smets EMA, Dekker E, Broens THF, Penning J, Smith S, McCaffery K, Fransen MP. Development and pilot-testing of a colorectal cancer screening decision aid for individuals with varying health literacy levels. Patient Educ Couns 2019; 102:1847-1858. [PMID: 31064682 DOI: 10.1016/j.pec.2019.04.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 11/19/2018] [Revised: 02/15/2019] [Accepted: 04/25/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Making an informed decision about colorectal cancer screening requires health literacy. Our aim was to develop and pilot-test a computer-based decision aid to support informed decision making about whether or not to participate in colorectal cancer screening for individuals with varying health literacy levels in the Netherlands. METHODS First, we designed and adapted the decision aid prototype among 25 individuals with low (n = 15) and adequate (n = 10) health literacy. Second, we used a before/after study to assess changes in knowledge, attitude, intention, decisional conflict, deliberation, anxiety and risk perception in an online survey among 81 individuals eligible for colorectal cancer screening with low (n = 35) and adequate (n = 46) health literacy. RESULTS The decision aid was acceptable, comprehensible, reduced decisional conflict, increased deliberation and improved knowledge about colorectal cancer screening, but not about colorectal cancer, among individuals with adequate and low health literacy. Usability was slightly higher for participants with adequate health literacy compared to those with low health literacy. CONCLUSION The decision aid is promising in supporting informed decision making about colorectal cancer screening, also among individuals with lower health literacy. PRACTICE IMPLICATIONS Further refinement of interactive features, such as videos, animations and the values clarification exercise, is needed to increase the usability of the decision aid.
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Affiliation(s)
- Anke J Woudstra
- Amsterdam UMC, University of Amsterdam, Department of Public Health, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, the Netherlands.
| | - Ellen M A Smets
- Amsterdam UMC, University of Amsterdam, Department of Medical Psychology, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, the Netherlands
| | - Evelien Dekker
- Amsterdam UMC, University of Amsterdam, Department of Gastroenterology & Hepatology, Meibergdreef 9, Amsterdam, the Netherlands
| | - Tom H F Broens
- Amsterdam UMC, University of Amsterdam, Department of Medical Informatics, Meibergdreef 9, Amsterdam, the Netherlands
| | - Judith Penning
- Amsterdam UMC, University of Amsterdam, Department of Public Health, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, the Netherlands
| | - Sian Smith
- Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine, Lowy Research Centre, UNSW Sydney, NSW, Australia
| | - Kirsten McCaffery
- Wiser Healthcare, Sydney School of Public health, The University of Sydney, NSW, 2006, Australia; Sydney Health Literacy Lab, Sydney School of Public Health, The University of Sydney, NSW, 2006, Australia
| | - Mirjam P Fransen
- Amsterdam UMC, University of Amsterdam, Department of Public Health, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, the Netherlands
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24
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Klinkenberg EF, Huis in ’t Veld EMJ, de Wit PD, de Kort WLAM, Fransen MP. Barriers and motivators of Ghanaian and African-Surinamese migrants to donate blood. Health Soc Care Community 2019; 27:748-756. [PMID: 30478863 PMCID: PMC7379538 DOI: 10.1111/hsc.12692] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 10/17/2018] [Accepted: 11/05/2018] [Indexed: 05/24/2023]
Abstract
African migrants are underrepresented as blood donors in many Western countries, which can lead to shortages of specific blood types for transfusion. More insight in the reasons for this underrepresentation is required to improve blood donor recruitment and retention strategies. The aim of this qualitative study was to explore barriers and motivators for donating blood among migrants of African background. The research population consisted of first and second generation African-Surinamese (n = 20) and Ghanaian (n = 16) migrants living in the Netherlands. In semi-structured personal interviews performed in 2016 and 2017, their experiences and opinions regarding blood donation, barriers, and motivators to (not) become a blood donor and their suggestions to improve recruitment were explored. Data collection was continued until data saturation was achieved. The interviews revealed that although all participants knew about blood donation in general, only four had previously heard of the Dutch national blood bank organisation. Participants expected that if blood was needed, the blood bank would directly approach them, as in their country of origin. Other main blood donation barriers were fear (e.g., of needles, losing too much blood) and issues related to health and non-eligibility to donate. Main motivators were mainly of altruistic nature (e.g., saving a life) and an increased awareness of the need via personal recruitment appeals. It is concluded that expectations regarding donor recruitment-derived from the country of origin-and unawareness of the need for blood can act as important barriers in blood donation among African migrants. Contrary to studies in the United States and Australia, perceived discrimination and social exclusion did not seem to be a donation deterrent among migrants in the Netherlands. Creating awareness of the need of blood by actively approaching, and informing migrants about the donation procedure in the host country, should be considered by blood banks.
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Affiliation(s)
- Elisabeth F. Klinkenberg
- Donor StudiesSanquin ResearchAmsterdamThe Netherlands
- Department of Public HealthAmsterdam UMC, Amsterdam Public Health Research Institute, University of AmsterdamAmsterdamThe Netherlands
| | - Elisabeth M. J. Huis in ’t Veld
- Donor StudiesSanquin ResearchAmsterdamThe Netherlands
- Department of Medical and Clinical PsychologyTilburg UniversityTilburgThe Netherlands
| | - Puck D. de Wit
- Donor StudiesSanquin ResearchAmsterdamThe Netherlands
- Department of Public HealthAmsterdam UMC, Amsterdam Public Health Research Institute, University of AmsterdamAmsterdamThe Netherlands
| | - Wim L. A. M. de Kort
- Donor StudiesSanquin ResearchAmsterdamThe Netherlands
- Department of Public HealthAmsterdam UMC, Amsterdam Public Health Research Institute, University of AmsterdamAmsterdamThe Netherlands
| | - Mirjam P. Fransen
- Department of Public HealthAmsterdam UMC, Amsterdam Public Health Research Institute, University of AmsterdamAmsterdamThe Netherlands
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25
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Klinkenberg EF, Langi Sasongko PKB, de Kort WLAM, van Weert JCM, Fransen MP, Huis In 't Veld EMJ. The supply chain of migrant blood donors: an organisational interview study. Vox Sang 2019; 114:145-153. [PMID: 30623984 PMCID: PMC6850342 DOI: 10.1111/vox.12748] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 07/06/2018] [Revised: 11/21/2018] [Accepted: 12/14/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND OBJECTIVES Migrant blood donors are underrepresented worldwide resulting in shortages of compatible blood products. Prior studies focused on individual barriers and motivators of potential blood donors, but no studies addressed organisational factors of the blood supply chain. This study explored the perceptions and experiences in recruitment and retention of migrant - and potentially rare-blood donors among staff members within the blood supply chain and identified obstacles and solutions in this chain. MATERIALS AND METHODS The study was conducted at Sanquin, the national blood supply organisation of the Netherlands. Qualitative in-depth interviews were done among key staff members (N = 17). Expert validity was assessed in three feedback meetings. RESULTS Seven staff members believed there is a shortage of migrant blood donors, while five believed there is not. However, there was a consensus that it may become a problem in the future due to demographic changes. The perceived obstacles to recruit and retain migrant donors were difficulties in determining how many migrant donors are needed and recruiting them, excluding potentially rare donors prior to donation, limited use of extended phenotyping and high blood typing and frozen storage costs. The possible solutions to increase blood pool diversity lay in registering donor ethnicity, specialised information provision for donors, reconsidering eligibility criteria and optimising blood typing strategies. CONCLUSION Whilst recruitment of migrant blood donors is perceived by staff as difficult, various organisational policies and guidelines seem to hinder retention. Improvements in the blood supply chain may be achieved by addressing logistics, current procedures and registration of ethnicity.
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Affiliation(s)
- Elisabeth F Klinkenberg
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, the Netherlands.,Department of Public Health, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Wim L A M de Kort
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, the Netherlands.,Department of Public Health, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, the Netherlands
| | - Julia C M van Weert
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam, Amsterdam, the Netherlands
| | - Mirjam P Fransen
- Department of Public Health, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, the Netherlands
| | - Elisabeth M J Huis In 't Veld
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, the Netherlands.,Department of Cognitive Science and Artificial Intelligence, Tilburg University, Tilburg, the Netherlands
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26
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Fransen MP, Hopman ME, Murugesu L, Rosman AN, Smith SK. Preconception counselling for low health literate women: an exploration of determinants in the Netherlands. Reprod Health 2018; 15:192. [PMID: 30470239 PMCID: PMC6251122 DOI: 10.1186/s12978-018-0617-1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 09/30/2018] [Indexed: 11/10/2022] Open
Abstract
Background Women from lower socioeconomic groups tend to be at greater risk of adverse perinatal outcomes, but are less likely to participate in preconception counselling compared to higher socioeconomic groups. This could be partly because of their limited skills to assess, understand and use health related information in ways that promote and maintain good health (health literacy skills). In this study we explored determinants of participation in preconception counselling among women with low health literacy in The Netherlands. Methods Potential determinants of participation in preconception counselling were derived from the literature, and mapped onto a theoretical framework, which was tested for perceived relevance and completeness in an expert review (n = 20). The framework was used to prepare face-to-face interviews with women with low health literacy and a wish to conceive (n = 139). In the interviews we explored preconception counselling awareness, knowledge, considerations, subjective norms, self-efficacy, attitude, and intention. Linear regression analyses were used to test associations with intention to participate in preconception counselling. Results Most women (75%) were unaware of the concept of preconception counselling and the provision of counselling, even if they lived in areas where written invitations had been disseminated. Common considerations for participation were: preparation for pregnancy; perceived lack of information; and problems in a previous pregnancy. Considerations not to participate were mostly related to perceived sufficient knowledge and perceived low risk of perinatal problems. Respondents generally had a positive attitude towards participation in preconception counselling for themselves, and 41% reported that they would participate in preconception counselling. Conclusion Women with low health literacy were generally unaware of the concept and provision of preconception counselling, but seemed to be interested in participation. Further research should investigate how to effectively reach and inform this group about preconception counselling. This knowledge is essential for evidence-based development of interventions to increase the accessibility and understanding of preconception counselling. Electronic supplementary material The online version of this article (10.1186/s12978-018-0617-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mirjam P Fransen
- Amsterdam UMC, University of Amsterdam, Department of Public Health, Public Health Research Institute, Meibergdreef 9, Amsterdam, The Netherlands.
| | - Miriam E Hopman
- Amsterdam UMC, University of Amsterdam, Department of Public Health, Public Health Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
| | - Laxsini Murugesu
- Amsterdam UMC, University of Amsterdam, Department of Public Health, Public Health Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
| | - Ageeth N Rosman
- Rotterdam University of Applied Sciences, School for Healthcare Studies, Department of Master Physician Assistant Midwifery, Rochussenstraat 198, 3015, EK, Rotterdam, The Netherlands
| | - Sian K Smith
- The University of New South Wales, Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine, Lowy Research Centre, Sydney, NSW, 2052, Australia
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27
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Blom IM, Cohen ES, Eshuis LV, Woudstra AJ, Snijder MB, Kunst AE, Fransen MP. Ethnic Differences in Health Literacy Among Young Adults in Amsterdam. Health Lit Res Pract 2018; 2:e192-e204. [PMID: 31294295 PMCID: PMC6608899 DOI: 10.3928/24748307-20180926-01] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 11/03/2017] [Accepted: 05/21/2018] [Indexed: 11/24/2022] Open
Abstract
Background: Ethnic differences in health commence early in life. Ethnic minority young adults have a greater prevalence of unhealthier lifestyles and poorer health outcomes than their peers. Variations in health literacy could contribute to these ethnic inequalities in health but have not yet been investigated in this group. Objective: This study investigated ethnic differences in performance-based and self-reported health literacy in young adults and examined whether these differences are explained by educational level, language difficulties, or cultural distance. Methods: Young adults (age 18–25 years) from Dutch, African Surinamese, South-Asian Surinamese, Ghanaian, Turkish, and Moroccan ethnic backgrounds (N = 2,215) participated in the HELIUS (HEalthy Life in an Urban Setting) study, a cohort study in Amsterdam, the Netherlands. Performance-based health literacy was measured by the Rapid Estimate of Adult Literacy in Medicine in Dutch (REALM-D). Self-reported health literacy was measured by the Chew's Set of Brief Screening Questions (SBSQ). The association between ethnicity and health literacy, and the role of background characteristics was assessed by linear regression analyses. Key Results: Performance-based health literacy was low (REALM-D <60; range, 0–66) among 17% of the participants. After adjustment for educational level, average levels of REALM-D were lower among participants from a Ghanaian, Turkish, and Moroccan background than those from a Dutch background, whereas the two Surinamese groups did not differ from the Dutch group. Additional adjustment for language difficulties and cultural distance did not explain the differences between the five ethnic minority groups. Self-reported health literacy was low (SBSQ <3; range, 0–4) among 3% of the participants. There were no differences in levels of SBSQ between the ethnic minority groups and the Dutch group. Conclusions: We found ethnic differences in performance-based health literacy, which largely remained after adjustment for educational level. Further research is needed to gain insight into how young adults from different ethnic groups appraise and apply health information in various contexts. [HLRP: Health Literacy Research and Practice. 2018;2(4):e192–e204.] Plain Language Summary: We investigated ethnic differences in health literacy among young adults (age 18–25 years) living in the Netherlands. Compared to the Dutch group, some ethnic minority groups scored lower on performance-based health literacy, independent of educational level. Self-reported health literacy did not differ between Dutch and ethnic minority groups.
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Affiliation(s)
| | | | | | | | | | | | - Mirjam P. Fransen
- Address correspondence to Mirjam P. Fransen, PhD, Department of Public Health, Amsterdam University Medical Centres, Amsterdam Public Health Research Institute, Location AMC, Meibergdreef 9 1105 AZ Amsterdam, the Netherlands;
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28
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Woudstra AJ, Timmermans DRM, Uiters E, Dekker E, Smets EMA, Fransen MP. Health literacy skills for informed decision making in colorectal cancer screening: Perceptions of screening invitees and experts. Health Expect 2018; 21:636-646. [PMID: 29266661 PMCID: PMC5980534 DOI: 10.1111/hex.12658] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 11/19/2017] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The process of informed decision making (IDM) requires an adequate level of health literacy. To ensure that all individuals have equal opportunity to make an informed decision in colorectal cancer (CRC) screening, it is essential to gain more insight into which health literacy skills are needed for IDM. Our aims were (i) to explore how individuals make a decision about CRC screening and (ii) to explore which skills are needed for IDM in CRC screening and (iii) to integrate these findings within a conceptual framework. METHODS We conducted 3 focus groups with individuals eligible for CRC screening (n = 22) and 2 focus groups with experts in the field of health literacy, oncology and decision making, including scientific researchers and health-care professionals (n = 17). We used framework analysis to analyse our data. RESULTS We identified and specified ten health literacy skills, which varied from the ability to read and understand CRC screening information to the ability to weigh up pros and cons of screening for personal relevance. The skills were linked to 8 decision-making stages in CRC screening within a conceptual framework. We found differences in perceptions between screening invitees and experts, especially in the perceived importance of CRC screening information for IDM. CONCLUSIONS This study provides insight into the decision-making stages and health literacy skills that are essential for IDM in CRC screening. The proposed conceptual framework can be used to inform the development of context-based measurement of health literacy and interventions to support IDM in cancer screening.
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Affiliation(s)
- Anke J. Woudstra
- Department of Public HealthAcademic Medical CenterAmsterdam Public Health research instituteUniversity of AmsterdamAmsterdamThe Netherlands
| | - Daniëlle R. M. Timmermans
- Department of Public and Occupational Health and the EMGO institute for Health and Care ResearchVU University Medical CenterAmsterdam Public Health research instituteAmsterdamThe Netherlands
- National Institute for Public Health and the Environment (RIVM)BilthovenThe Netherlands
| | - Ellen Uiters
- National Institute for Public Health and the Environment (RIVM)BilthovenThe Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and HepatologyAcademic Medical CentreUniversity of AmsterdamAmsterdamThe Netherlands
| | - Ellen M. A. Smets
- Department of Medical PsychologyAcademic Medical CenterAmsterdam Public Health research instituteUniversity of AmsterdamAmsterdamThe Netherlands
| | - Mirjam P. Fransen
- Department of Public HealthAcademic Medical CenterAmsterdam Public Health research instituteUniversity of AmsterdamAmsterdamThe Netherlands
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29
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Klinkenberg EF, Huis In't Veld EMJ, de Wit PD, van Dongen A, Daams JG, de Kort WLAM, Fransen MP. Blood donation barriers and facilitators of Sub-Saharan African migrants and minorities in Western high-income countries: a systematic review of the literature. Transfus Med 2018; 29 Suppl 1:28-41. [PMID: 29493019 PMCID: PMC7379919 DOI: 10.1111/tme.12517] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 10/31/2017] [Revised: 01/24/2018] [Accepted: 01/27/2018] [Indexed: 12/26/2022]
Abstract
Objectives The present study aimed to gain more insight into, and summarise, blood donation determinants among migrants or minorities of Sub‐Saharan heritage by systematically reviewing the current literature. Background Sub‐Saharan Africans are under‐represented in the blood donor population in Western high‐income countries. This causes a lack of specific blood types for transfusions and prevention of alloimmunisation among Sub‐Saharan African patients. Methods/materials Medline, EMBASE, PsycINFO and BIOSIS were searched for relevant empirical studies that focused on barriers and facilitators of blood donation among Sub‐Saharan Africans in Western countries until 22 June 2017. Of the 679 articles screened by title and abstract, 152 were subsequently screened by full text. Paired reviewers independently assessed the studies based on predefined eligibility and quality criteria. Results Of the 31 included studies, 24 used quantitative and 7 used qualitative research methods. Target cohorts varied from Black African Americans and refugees from Sub‐Sahara Africa to specific Sub‐Saharan migrant groups such as Comorians or Ethiopians. Main recurring barriers for Sub‐Saharan Africans were haemoglobin deferral, fear of needles and pain, social exclusion, lack of awareness, negative attitudes and accessibility problems. Important recurring facilitators for Sub‐Saharan Africans were altruism, free health checks and specific recruitment and awareness‐raising campaigns. Conclusion The findings of this review can be used as a starting point to develop recruitment and retention strategies for Sub‐Saharan African persons. Further research is needed to gain more insight in the role of these determinants in specific contexts as socioeconomic features, personal histories and host country regulations may differ per country.
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Affiliation(s)
- E F Klinkenberg
- Department of Donor Studies, Sanquin Research, Amsterdam, The Netherlands.,Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - E M J Huis In't Veld
- Department of Donor Studies, Sanquin Research, Amsterdam, The Netherlands.,Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - P D de Wit
- Department of Donor Studies, Sanquin Research, Amsterdam, The Netherlands.,Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - A van Dongen
- School of Psychology, University of New South Wales, Sydney, Australia
| | - J G Daams
- Medical Library, Academic Medical Center, Univeristy of Amsterdam, Amsterdam, The Netherlands
| | - W L A M de Kort
- Department of Donor Studies, Sanquin Research, Amsterdam, The Netherlands.,Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - M P Fransen
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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30
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van Schaik TM, Jørstad HT, Twickler TB, Peters RJG, Tijssen JPG, Essink-Bot ML, Fransen MP. Cardiovascular disease risk and secondary prevention of cardiovascular disease among patients with low health literacy. Neth Heart J 2017; 25:446-454. [PMID: 28247247 PMCID: PMC5513995 DOI: 10.1007/s12471-017-0963-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To explore the association between health literacy and the risk of cardiovascular disease (CVD), and to assess the differential effects by health literacy level of a nurse-coordinated secondary prevention program (NCPP) in patients with coronary artery disease (CAD). METHODS Data were collected in two medical centres participating in the RESPONSE trial (Randomised Evaluation of Secondary Prevention by Outpatient Nurse SpEcialists). CVD risk profiles were assessed at baseline and 12-month follow-up using the Systematic Coronary Risk Evaluation (SCORE). Health literacy was assessed by the short Rapid Estimate of Adult Literacy in Medicine (REALM-D) and the Newest Vital Sign (NVS-D); self-reported health literacy was evaluated by the Set of Brief Screening Questions (SBSQ-D). RESULTS Among 201 CAD patients, 18% exhibited reading difficulties, 52% had difficulty understanding and applying written information, and 5% scored low on self-reported health literacy. Patients with low NVS-D scores had a higher CVD risk [mean SCORE 5.2 (SD 4.8) versus 3.3 (SD 4.1), p < 0.01]. Nurse-coordinated care seemed to reduce CVD risk irrespective of health literacy levels without significant differences. CONCLUSION Inadequate health literacy is prevalent in CAD patients in the Netherlands, and is associated with less favourable CVD risk profiles. Where many other forms of CVD prevention fail, nurse-coordinated care seems to be effective among patients with inadequate health literacy.
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Affiliation(s)
- T M van Schaik
- Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.,Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - H T Jørstad
- Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - T B Twickler
- Department of Endocrinology, Diabetology and Metabolic Diseases, University Hospital, Antwerp, Belgium.,Department of Endocrinology, Diabetology and Metabolic Diseases, AZ Monica Hospital, Deurne/Antwerp, Belgium
| | - R J G Peters
- Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - J P G Tijssen
- Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - M L Essink-Bot
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - M P Fransen
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
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Fransen MP, Dekker E, Timmermans DRM, Uiters E, Essink-Bot ML. Accessibility of standardized information of a national colorectal cancer screening program for low health literate screening invitees: A mixed method study. Patient Educ Couns 2017; 100:327-336. [PMID: 27613567 DOI: 10.1016/j.pec.2016.09.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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: 12/23/2015] [Revised: 07/19/2016] [Accepted: 09/05/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To explore the accessibility of standardized printed information materials of the national Dutch colorectal cancer screening program among low health literate screening invitees and to assess the effect of the information on their knowledge about colorectal cancer and the screening program. METHODS Linguistic tools were used to analyze the text and design characteristics. The accessibility, comprehensibility and relevance of the information materials were explored in interviews and in observations (n=25). The effect of the information on knowledge was assessed in an online survey (n=127). RESULTS The materials employed a simple text and design. However, respondents expressed problems with the amount of information, and the difference between screening and diagnostic follow-up. Knowledge significantly increased in 10 out of 16 items after reading the information but remained low for colorectal cancer risk, sensitivity of testing, and the voluntariness of colorectal cancer screening. CONCLUSION Despite intelligible linguistic and design characteristics, screening invitees with low health literacy had problems in accessing, comprehending and applying standard information materials on colorectal cancer screening, and lacked essential knowledge for informed decision-making about participation. PRACTICE IMPLICATIONS To enable equal access to informed decision-making, information strategies need to be adjusted to the skills of low health literate screening invitees.
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Affiliation(s)
- Mirjam P Fransen
- Department of Public Health, Academic Medical Center-University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Academic Medical Center-University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
| | - Daniëlle R M Timmermans
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, PO Box 7057, 1007 MB Amsterdam, The Netherlands; National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA Bilthoven, The Netherlands.
| | - Ellen Uiters
- National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA Bilthoven, The Netherlands.
| | - Marie-Louise Essink-Bot
- Department of Public Health, Academic Medical Center-University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
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Fransen MP, Beune EJAJ, Baim-Lance AM, Bruessing RC, Essink-Bot ML. Diabetes self-management support for patients with low health literacy: Perceptions of patients and providers. J Diabetes 2015; 7:418-25. [PMID: 25042519 DOI: 10.1111/1753-0407.12191] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 05/22/2014] [Accepted: 06/29/2014] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The aim of the present study was to explore perceptions and strategies of health care providers regarding diabetes self-management support for patients with low health literacy (LHL), and to compare their self-management support with the needs of patients with LHL and type 2 diabetes. This study serves as a problem analysis for systematic intervention development to improve diabetes self-management among patients with LHL. METHODS This qualitative study used in-depth interviews with general practitioners (n = 4), nurse practitioners (n = 5), and patients with LHL (n = 31). The results of the interviews with health care providers guided the patient interviews. In addition, we observed 10 general practice consultations. RESULTS Providers described patients with LHL as uninvolved and less motivated patients who do not understand self-management. Their main strategy to improve self-management was to provide standard information on a repeated basis. Patients with LHL seemed to have a different view of diabetes self-management than their providers. Most demonstrated a low awareness of what self-management involves, but did not express needing more information. They reported several practical barriers to self-management, although they seemed reluctant to use the information provided to overcome them. CONCLUSIONS Providing and repeating information does not fit the needs of patients with LHL regarding diabetes self-management support. Health care providers do not seem to have the insight or the tools to systematically support diabetes self-management in this group. Systematic intervention development with a focus on skills-based approaches rather than cognition development may improve diabetes self-management support of patients with LHL.
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Affiliation(s)
- Mirjam P Fransen
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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Fransen MP, Leenaars KEF, Rowlands G, Weiss BD, Maat HP, Essink-Bot ML. International application of health literacy measures: adaptation and validation of the newest vital sign in The Netherlands. Patient Educ Couns 2014; 97:403-409. [PMID: 25224314 DOI: 10.1016/j.pec.2014.08.017] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [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: 04/30/2014] [Revised: 07/16/2014] [Accepted: 08/26/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE The newest vital sign assesses individual reading and numeracy skills. The aim of this study was to create a Dutch version (NVS-D) and to assess its feasibility, reliability, and validity in The Netherlands. METHODS We performed a qualitative study among experts (n=27) and patients (n=30) to develop the NVS-D and to assess its feasibility. For validation, we conducted a quantitative survey (n=329). Reliability was assessed by Cronbach's alpha. Construct validity was examined by analyzing association patterns. Receiver operating characteristic (ROC) curves determined optimal cut-off scores. RESULTS Cronbach's alpha was 0.76. In accordance with a priori hypotheses we found strong associations between NVS-D, general vocabulary, prose literacy and objective health literacy, and weaker associations between NVS-D and subjective health literacy. A score of ≥4 out of 6 best distinguished individuals with adequate versus inadequate health literacy. CONCLUSION The results suggest that the NVS-D is a reliable and valid tool that allows international comparable health literacy research in The Netherlands. PRACTICE IMPLICATIONS The NVS-D can be applied in research on the role of health literacy in health and health care, and the development of interventions. The methods can be applied in cross-cultural adaptation of health literacy measures in other countries.
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Affiliation(s)
- Mirjam P Fransen
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
| | - Karlijn E F Leenaars
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Gillian Rowlands
- Department of Primary Care and Public Health Sciences, King's College London, London, UK; Institut for Folkesundhed, Aarhus Universitet, Aarhus, Denmark
| | - Barry D Weiss
- Department of Family and Community Medicine, University of Arizona College of Medicine, Arizona, USA
| | - Henk Pander Maat
- Department of Languages, Literature and Communication, Utrecht Institute of Linguistics OTS, Utrecht, The Netherlands
| | - Marie-Louise Essink-Bot
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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Pander Maat H, Essink-Bot ML, Leenaars KEF, Fransen MP. A short assessment of health literacy (SAHL) in the Netherlands. BMC Public Health 2014; 14:990. [PMID: 25246170 PMCID: PMC4190424 DOI: 10.1186/1471-2458-14-990] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [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: 06/04/2014] [Accepted: 09/05/2014] [Indexed: 11/25/2022] Open
Abstract
Background An earlier attempt to adapt the REALM (Rapid Estimate of Adult Literacy in Medicine) word recognition test to Dutch was not entirely successful due to ceiling effects. In contrast to REALM, the Short Assessment of Health Literacy (SAHL) assesses both word recognition and comprehension in the health domain. The aim of this study was to design, test and validate a SAHL for Dutch patients (SAHL-D). Methods We pretested 95 health-related terms (n = 127) and selected 33 best performing items for validation in a quantitative survey (n = 329). For each item, a correct recognition (1 point) and comprehension (1 point) contributed to the total score (scale 0–66). Internal consistency was assessed using Cronbach’s alpha. Construct validity was examined by analyzing association patterns of SAHL-D with educational level, objective and subjective health literacy, prose literacy, and vocabulary. Receiver operating characteristic (ROC) curves, with prose literacy as the reference standard, determined optimal cut-off scores. Results Cronbach’s alpha was 0.77 for recognition, 0.79 for comprehension, and 0.86 for the total score. Scores significantly differed substantially by educational level. Association patterns mostly confirmed a priori expectations in direction and strength, thereby supporting the construct validity of the SAHL-D. The optimal cut-off scores for differentiating between adequate and low literacy lie between 52.5 and 55.5. A shorter SAHL-D version presenting 22 terms offers a comparable prediction performance. Conclusion The results provide positive evidence for the reliability and validity of the SAHL-D. The SAHL-D can be applied to analyze the role of health literacy in health and healthcare, and for the development and evaluation of targeted interventions. Electronic supplementary material The online version of this article (doi:10.1186/1471-2458-14-990) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Henk Pander Maat
- Department of Languages, Literature and Communication, Utrecht Institute of Linguistics OTS, Trans 10, 3512, JK Utrecht, The Netherlands.
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Verkissen MN, Ezendam NPM, Fransen MP, Essink-Bot ML, Aarts MJ, Nicolaije KAH, Vos MC, Husson O. The role of health literacy in perceived information provision and satisfaction among women with ovarian tumors: a study from the population-based PROFILES registry. Patient Educ Couns 2014; 95:421-428. [PMID: 24698535 DOI: 10.1016/j.pec.2014.03.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [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: 09/12/2013] [Revised: 02/18/2014] [Accepted: 03/08/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To assess the association of subjective health literacy (HL) and education with perceived information provision and satisfaction. METHODS Women (N=548) diagnosed with an ovarian or borderline ovarian tumor between 2000 and 2010, registered in the Eindhoven Cancer Registry, received a questionnaire including subjective HL, educational level, perceived information provision, and satisfaction with the information received. Multiple linear and logistic regression analyses were performed, controlled for potential confounders. RESULTS Fifty percent of the women responded (N=275). Thirteen percent had low and 41% had medium subjective HL. Women with low HL reported less perceived information provision about medical tests, and were less satisfied with the information received compared to women with high HL. Low educated women reported that they received more information about their disease compared to highly educated women. CONCLUSION Low subjective HL among women with ovarian tumors is associated with less perceived information provision about medical tests and lower information satisfaction, whereas low education is associated with more perceived information provision about the disease. PRACTICE IMPLICATIONS HL should not be overlooked as a contributing factor to patients' perceived information provision and satisfaction. Health care providers may need training about recognizing low HL.
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Affiliation(s)
- Mariëtte N Verkissen
- CoRPS - Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, The Netherlands; Eindhoven Cancer Registry, Comprehensive Cancer Center South (CCCS), Eindhoven Cancer Registry, The Netherlands
| | - Nicole P M Ezendam
- CoRPS - Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, The Netherlands; Eindhoven Cancer Registry, Comprehensive Cancer Center South (CCCS), Eindhoven Cancer Registry, The Netherlands.
| | - Mirjam P Fransen
- Department of Public Health, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Marie-Louise Essink-Bot
- Department of Public Health, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Mieke J Aarts
- Eindhoven Cancer Registry, Comprehensive Cancer Center South (CCCS), Eindhoven Cancer Registry, The Netherlands
| | - Kim A H Nicolaije
- CoRPS - Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, The Netherlands; Eindhoven Cancer Registry, Comprehensive Cancer Center South (CCCS), Eindhoven Cancer Registry, The Netherlands
| | - M Caroline Vos
- Department of Obstetrics and Gynecology, St. Elisabeth Hospital, Tilburg, The Netherlands
| | - Olga Husson
- CoRPS - Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, The Netherlands; Eindhoven Cancer Registry, Comprehensive Cancer Center South (CCCS), Eindhoven Cancer Registry, The Netherlands
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Fransen MP, Rowlands G, Leenaars KEF, Essink-Bot ML. Self-rated literacy level does not explain educational differences in health and disease. Arch Public Health 2014; 72:14. [PMID: 24872884 PMCID: PMC4036107 DOI: 10.1186/2049-3258-72-14] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 09/03/2013] [Accepted: 02/01/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although literacy is increasingly considered to play a role in socioeconomic inequalities in health, its contribution to the explanation of educational differences in health has remained unexplored. The aim of this study was to investigate the contribution of self-rated literacy to educational differences in health. METHODS Data was collected from the Healthy Foundation and Lifestyle Segmentation Dataset (n = 4257). Self-rated literacy was estimated by individuals' self-reported confidence in reading written English. We used logistic regression analyses to assess the association between educational level and health (long term conditions and self-rated health). Self-rated literacy and other potential explanatory variables were separately added to each model. For each added variable we calculated the percentage change in odds ratio to assess the contribution to the explanation of educational differences in health. RESULTS People with lower educational attainment level were more likely to report a long term condition (OR 2.04, CI 1.80-2.32). These educational differences could mostly be explained by age (OR decreased by 27%) and could only minimally be explained by self-rated literacy, as measured by self-rated reading skills (OR decreased by 1%). Literacy could not explain differences in cardiovascular condition or diabetes, and only minimally contributed to mental health problems and depression (OR decreased by 5%). The odds of rating ones own health more negatively was higher for people with a low educational level compared to those with a higher educational level (OR 1.83, CI 1.59-2.010), self-rated literacy decreased the OR by 7%. CONCLUSION Measuring self-rated reading skills does not contribute significantly to the explanation of educational differences in health and disease. Further research should aim for the development of objective generic and specific instruments to measure health literacy skills in the context of health care, disease prevention and health promotion. Such instruments are not only important in the explanation of educational differences in health and disease, but can also be used to identify a group at risk of poorer health through low basic skills, enabling health services and health information to be targeted at those with greater need.
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Affiliation(s)
- Mirjam P Fransen
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Gillian Rowlands
- Department of Primary Care and Public Health Sciences, King’s College London, London, UK
- Institut for Folkesundhed, Aarhus Universitet, Aarhus, Denmark
| | - Karlijn EF Leenaars
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Marie-Louise Essink-Bot
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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Fransen MP, Harris VC, Essink-Bot ML. [Low health literacy in ethnic minority patients: understandable language is the beginning of good healthcare]. Ned Tijdschr Geneeskd 2013; 157:A5581. [PMID: 23548185] [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: 06/02/2023]
Abstract
In order to provide adequate healthcare to ethnic minority patients, healthcare professionals must use professional interpreter services to effectively overcome language barriers. Many ethnic minority patients have low health literacy, i.e. they have difficulty obtaining, understanding and implementing health information. They therefore have a higher risk of poorer health outcomes. Health care professionals need to adapt their communication to patients with low health literacy by checking whether the patient has understood them, avoiding use of medical jargon and tailoring information to the patient's perspective. Various practical strategies have been developed to support health care professionals to communicate effectively with patients with low health literacy. Scientific research is needed to investigate the effectiveness of such strategies in various populations and to systematically develop, implement and evaluate new strategies.
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Affiliation(s)
- Mirjam P Fransen
- Academisch Medisch Centrum-Universiteit van Amsterdam, Afd. Sociale Geneeskunde, Amsterdam, the Netherlands
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Fransen MP, von Wagner C, Essink-Bot ML. Diabetes self-management in patients with low health literacy: ordering findings from literature in a health literacy framework. Patient Educ Couns 2012; 88:44-53. [PMID: 22196986 DOI: 10.1016/j.pec.2011.11.015] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Revised: 11/02/2011] [Accepted: 11/30/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To review studies on the association between health literacy (HL), diabetes self-management and possible mediating variables. METHODS We systematically searched for empirical studies in PubMed. Findings were ordered by a HL framework that outlines routes between HL, sociocognitive determinants and health actions. RESULTS Of the 11 relevant studies, three reported a significant positive association between HL and specific diabetes self-management domains. Ten studies investigated the association between HL and knowledge (n=8), beliefs (n=2), self-efficacy (n=3) and/or social support (n=1). Significant associations were found between HL and knowledge (n=6), self-efficacy (n=1) and social support (n=1). Of the three studies evaluating the effect of these sociocognitive variables on diabetes self-management, only one found proof for a mediating variable (social support) in the pathway between HL and self-management. CONCLUSION There is only limited evidence for a significant association between HL and diabetes self-management, and for the mediating role of sociocognitive variables in this pathway. PRACTICE IMPLICATIONS Longitudinal studies, including HL, diabetes self-management and potential mediators, are needed to substantiate possible associations between these variables. Such research is essential to enable evidence-based development of interventions to increase adequate and sustainable self-management in diabetic patients with low HL.
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Affiliation(s)
- Mirjam P Fransen
- Department of Public Health, Amsterdam Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
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Fransen MP, Schoonen MHMHJD, Mackenbach JP, Steegers EAP, de Koning HJ, Laudy JAM, Galjaard RJ, Looman CWN, Essink-Bot ML, Wildschut HIJ. Ethnic differences in participation in prenatal screening for Down syndrome: a register-based study. Prenat Diagn 2011; 30:988-94. [PMID: 20799374 DOI: 10.1002/pd.2603] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To assess ethnic differences in participation in prenatal screening for Down syndrome in the Netherlands. METHODS Participation in prenatal screening was assessed for the period 1 January 2009 to 1 July 2009 in a defined postal code area in the southwest of the Netherlands. Data on ethnic origin, socio-economic background and age of participants in prenatal screening were obtained from the Medical Diagnostic Centre and the Department of Clinical Genetics. Population data were obtained from Statistics Netherlands. Logistic regression models were used to assess ethnic differences in participation, adjusted for socio-economic and age differences. RESULTS The overall participation in prenatal screening was 3865 out of 15 093 (26%). Participation was 28% among Dutch women, 15% among those from Turkish ethnic origin, 8% among those from North-African origin, 15% among those from Aruban/Antillean origin and 26% among women from Surinamese origin. CONCLUSIONS Compared to Dutch women, those from Turkish, North-African, Aruban/Antillean and other non-Western ethnic origin were less likely to participate in screening. It was unexpected that women from Surinamese origin equally participated. It should be further investigated to what extent participation and non-participation in these various ethnic groups was based on informed decision-making.
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Affiliation(s)
- Mirjam P Fransen
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
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Fransen MP, Van Schaik TM, Twickler TB, Essink-Bot ML. Applicability of internationally available health literacy measures in the Netherlands. J Health Commun 2011; 16 Suppl 3:134-149. [PMID: 21951248 DOI: 10.1080/10810730.2011.604383] [Citation(s) in RCA: 145] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Health literacy measures for use in clinical-epidemiological research have all been developed outside Europe. In the absence of validated Dutch measures, we evaluated the cross-cultural applicability of the Rapid Estimate of Adult Literacy in Medicine (REALM), the Newest Vital Sign (NVS), the Set of Brief Screening Questions (SBSQ), and the measure of Functional Communicative and Critical Health Literacy (FCCHL). Each measure was translated into Dutch following standardized procedures. We assessed feasibility, internal consistency, and construct validity among patients with coronary artery disease (n = 201) and patients with diabetes type 2 (n = 88). Patients expressed most problems in responding to the NVS-D. They were not familiar with the type of food label and had difficulties calculating in portions instead of grams. The FCCHL-D items seemed too theoretical for many patients. Cronbach's alpha was acceptable for all measures. Correlation patterns between the measures were moderately coherent with a priori hypotheses. All translated measures were able to distinguish between high- and low-educated groups of patients, with the NVS-D performing best. Despite reasonable psychometric properties as demonstrated so far, these measures need to be further developed in order to increase applicability for assessing health literacy in clinical-epidemiological research in the Netherlands.
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Affiliation(s)
- M P Fransen
- Department of Public Health, Amsterdam Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
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Fransen MP, Wildschut HI, Mackenbach JP, Steegers EA, Galjaard RJ, Essink-Bot ML. Ethnic and socio-economic differences in uptake of prenatal diagnostic tests for Down's syndrome. Eur J Obstet Gynecol Reprod Biol 2010; 151:158-62. [DOI: 10.1016/j.ejogrb.2010.04.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Revised: 03/19/2010] [Accepted: 04/25/2010] [Indexed: 11/30/2022]
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Fransen MP, Wildschut HIJ, Vogel I, Mackenbach JP, Steegers EAP, Essink-Bot ML. Ethnic differences in considerations whether or not to participate in prenatal screening for Down syndrome. Prenat Diagn 2010; 29:1262-9. [PMID: 19842117 DOI: 10.1002/pd.2391] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate ethnic differences in considerations whether or not to participate in prenatal screening for Down syndrome and to relate these to differences in participation. METHOD The study population consisted of 270 pregnant women from Dutch, Turkish and Surinamese (African and South Asian) ethnic origin, attending midwifery or obstetrical practices in the Netherlands. Women were interviewed after booking for prenatal care. Considerations were assessed by one open-ended question and 18 statements that were derived from focus group interviews. Actual participation was assessed several months later. RESULTS Women from ethnic minorities were less likely to participate in prenatal screening, which could be attributed to differences in age and religious identity. They more often reported acceptance of 'what God gives', low risk of having a child with Down syndrome and costs of screening as considerations not to participate in prenatal screening. They also reported many considerations in favour of participation, which did not differ from those of Dutch women but were less often consistent with actual participation in screening. CONCLUSIONS Women from ethnic minorities should not be stereotyped as being uninterested in prenatal screening, but should be better informed about the consequences of prenatal screening and Down syndrome.
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Affiliation(s)
- Mirjam P Fransen
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
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Fransen MP, Vogel I, Mackenbach J, Steegers E, Essink-Bot ML. Information about prenatal screening for Down syndrome: ethnic differences in knowledge. Patient Educ Couns 2009; 77:279-288. [PMID: 19409748 DOI: 10.1016/j.pec.2009.03.034] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2008] [Revised: 03/16/2009] [Accepted: 03/29/2009] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To evaluate the provision of information about prenatal screening for Down syndrome to women of Dutch, Turkish and Surinamese origins, and to examine the effects of this provision on ethnic differences in knowledge about Down syndrome and prenatal screening. METHODS The study population consisted of 105 Dutch, 100 Turkish and 65 Surinamese pregnant women attending midwifery or obstetrical practices in The Netherlands. Each woman was personally interviewed for 3 weeks (mean) after booking for prenatal care. RESULTS Most women reported to have received oral and/or written information about prenatal screening by their midwife or obstetrician at booking for prenatal care. Turkish and Surinamese women less often read the information than Dutch women, more often reported difficulties in understanding the information, and had less knowledge about Down syndrome, prenatal screening and amniocentesis. Language skills and educational level contributed most to the explanation of these ethnic variations. CONCLUSION Although most Dutch, Turkish and Surinamese women reported to have received information from their midwife or obstetrician, ethnic differences in knowledge about Down syndrome and prenatal screening are substantial. PRACTICE IMPLICATIONS Interventions to improve the provision of information to women from ethnic minority groups should especially be aimed at overcoming language barriers, and targeting information to the women's abilities to comprehend the information about prenatal screening for Down syndrome.
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Affiliation(s)
- Mirjam P Fransen
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
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Fransen MP, Essink-Bot ML, Vogel I, Mackenbach JP, Steegers EAP, Wildschut HIJ. Ethnic differences in informed decision-making about prenatal screening for Down's syndrome. J Epidemiol Community Health 2009; 64:262-8. [PMID: 19692718 DOI: 10.1136/jech.2009.088237] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The aim of this study was to assess ethnic variations in informed decision-making about prenatal screening for Down's syndrome and to examine the contribution of background and decision-making variables. METHODS Pregnant women of Dutch, Turkish and Surinamese origin were recruited between 2006 and 2008 from community midwifery or obstetrical practices in The Netherlands. Each woman was personally interviewed 3 weeks (mean) after booking for prenatal care. Knowledge, attitude and participation in prenatal screening were assessed following the 'Multidimensional Measure of Informed Choice' that has been developed and applied in the UK. RESULTS In total, 71% of the Dutch women were classified as informed decision-makers, compared with 5% of the Turkish and 26% of the Surinamese women. Differences between Surinamese and Dutch women could largely be attributed to differences in educational level and age. Differences between Dutch and Turkish women could mainly be attributed to differences in language skills and gender emancipation. CONCLUSION Women from ethnic minority groups less often made an informed decision whether or not to participate in prenatal screening. Interventions to decrease these ethnic differences should first of all be aimed at overcoming language barriers and increasing comprehension among women with a low education level. To further develop diversity-sensitive strategies for counselling, it should be investigated how women from different ethnic backgrounds value informed decision-making in prenatal screening, what decision-relevant knowledge they need and what they take into account when considering participation in prenatal screening.
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Affiliation(s)
- Mirjam P Fransen
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
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Fransen MP, Essink-Bot ML, Oenema A, Mackenbach JP, Steegers EAP, Wildschut HIJ. Ethnic differences in determinants of participation and non-participation in prenatal screening for Down syndrome: A theoretical framework. Prenat Diagn 2007; 27:938-50. [PMID: 17597492 DOI: 10.1002/pd.1805] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To develop a theoretical framework for analysing ethnic differences in determinants of participation and non-participation in prenatal screening for Down syndrome. METHODS We applied Weinstein's Precaution Adoption Process (PAP) Model to the decision of whether or not to participate in prenatal screening for Down syndrome. The prenatal screening stage model was specified by reviewing the empirical literature and by data from seven focus group interviews with Dutch, Turkish and Surinamese pregnant women in the Netherlands. RESULTS We identified 11 empirical studies on ethnic differences in determinants of participation and non-participation in prenatal screening for Down syndrome. The focus group interviews showed that almost all stages and determinants in the stage model were relevant in women's decision-making process. However, there were ethnic variations in the relevance of determinants, such as beliefs about personal consequences of having a child with Down syndrome or cultural and religious norms. DISCUSSION The prenatal screening stage model can be applied as a framework to describe the decision-making process of pregnant women from different ethnic backgrounds. It provides scope for developing culturally sensitive, tailored methods to guide pregnant women towards informed decision-making on participation or non-participation in prenatal screening for Down syndrome.
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Affiliation(s)
- Mirjam P Fransen
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands.
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Halstead JR, Fransen MP, Eberhart RY, Park AJ, Gilbert HJ, Hazlewood GP. alpha-Galactosidase A from Pseudomonas fluorescens subsp. cellulosa: cloning, high level expression and its role in galactomannan hydrolysis. FEMS Microbiol Lett 2000; 192:197-203. [PMID: 11064195 DOI: 10.1111/j.1574-6968.2000.tb09382.x] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
A library of Pseudomonas fluorescens subsp. cellulosa genomic DNA, constructed in lambda ZAPII, was screened for alpha-D-galactosidase activity. The DNA inserts from six galactosidase-positive clones were rescued into plasmids. Restriction digestion and Southern analysis revealed that each of the plasmids contained a common DNA sequence. The sequence of the Pseudomonas DNA in one of the plasmids revealed a single open reading frame (aga27A) of 1215 bp encoding a protein of M(r) 45900, designated alpha-galactosidase 27A (Aga27A). Aga27A exhibited extensive sequence identity with alpha-galactosidases in glycoside hydrolase 27, and appeared to be a single domain protein. The recombinant alpha-galactosidase was expressed at high levels in Escherichia coli and the biophysical properties and substrate specificity of the enzyme were evaluated. The data showed that Aga27A was a mesophilic neutral acting non-specific alpha-galactosidase. Both P. fluorescens subsp. cellulosa mannanase A (ManA) and Aga27A hydrolyse the polymeric substrate, carob galactomannan. Sequential hydrolysis with AgaA followed by ManA, or ManA followed by AgaA enhanced product release. The positive effects of sequential hydrolysis are discussed.
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Affiliation(s)
- J R Halstead
- Department of Cellular Physiology, The Babraham Institute, Babraham, Cambridge, UK
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Clarke JH, Davidson K, Rixon JE, Halstead JR, Fransen MP, Gilbert HJ, Hazlewood GP. A comparison of enzyme-aided bleaching of softwood paper pulp using combinations of xylanase, mannanase and alpha-galactosidase. Appl Microbiol Biotechnol 2000; 53:661-7. [PMID: 10919323 DOI: 10.1007/s002530000344] [Citation(s) in RCA: 111] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Enzymatic pretreatment of softwood kraft pulp was investigated using xylanase A (XylA) from Neocallimastix patriciarum in combination with mannanase and alpha-galactosidase. Mannanase A (ManA) from Pseudomonas fluorescens subsp. cellulosa and ManA from Clostridium thermocellum, both family 26 glycosyl hydrolases, are structurally diverse and exhibit different pH and temperature optima. Although neither mannanase was effective in pretreating softwood pulp alone, both enzymes were able to enhance the production of reducing sugar and the reduction of single-stage bleached kappa number when used with the xylanase. Sequential incubations with XylA and P. fluorescens ManA produced the largest final kappa number reduction in comparison to control pretreated pulp. The release of galactose from softwood pulp by alpha-galactosidase A (AgaA) from P. fluorescens was enhanced by the presence of ManA from the same microorganism, and a single pretreatment with these enzymes, in combination with XylA. gave the most effective kappa number reduction using a single incubation. Results indicated that mixtures of hemicellulase activities can be chosen to enhance pulp bleachability.
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Affiliation(s)
- J H Clarke
- Department of Cellular Physiology, The Babraham Institute, Cambridge, UK.
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Witjes JA, Fransen MP, van der Meijden AP, Doesburg WH, Debruyne FM. Use of maintenance intravesical bacillus Calmette-Guérin (BCG), with or without intradermal BCG, in patients with recurrent superficial bladder cancer. Long-term follow-up of a randomized phase 2 study. Urol Int 1993; 51:67-72. [PMID: 8351757 DOI: 10.1159/000282516] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
To study maintenance Bacillus Calmette-Guérin (BCG) therapy we treated 49 patients with recurrent superficial bladder cancer pTa and/or carcinoma in situ, failing previous intravesical chemotherapy. They received 20 intravesical instillations in 1 year, with or without 6 intradermal inoculations. Side effects were frequent, causing treatment stop in 14 patients (29%). Drug-induced cystitis was the most frequent side effect, seen in 29 patients (59%). Forty-two patients were evaluable for response. During the first 2 years of the study 14 patients (33%) had one (n = 8) or more (n = 6) recurrences. A total of 18 patients (43%) remained recurrence free with a median follow-up of 47 months. Progression was seen in 2 patients from pTa to pT1, another patient died of metastatic bladder cancer after 47 months. PPD skin test conversion was of no prognostic value. The use of intradermal inoculations caused no significant increase of toxicity and had no effect on efficacy, however, both groups were small. It caused no local side effects. We conclude that maintenance BCG therapy can be useful for patients with recurrent superficial bladder cancer failing previous intravesical chemotherapy.
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Affiliation(s)
- J A Witjes
- Department of Urology, University Hospital Nijmegen, The Netherlands
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