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Women in the Netherlands with non-western migration backgrounds experience domestic violence at the intersection of culture and gender, and visit their general practitioners (GPs) with health concerns related to the violence. Drawing on semi-structured interviews with GPs, this paper illuminates how GPs navigate the process of decision-making around intervention in domestic violence, with particular attention to the role of autonomy. Patient autonomy is a core principle in Dutch general practice. The term refers to the principle that GPs must respect that competent adults can make autonomous decisions about the care they do and do not want, and that GPs must respect patients' views, choices, and ways of life. The interview data shows great variation in how GPs respond in situations of domestic violence against women with non-western migration backgrounds. Deploying 'somatechnics of perception', this paper explores how GPs' perceptions of their patients' autonomy are both the agent and effect of a complex and embodied negotiation of gender, race, culture, ethnicity, medical ethics, and morality. In highlighting how these patients' autonomy is rendered (un)intelligible and (il)legible in contextually specific ways, this paper sheds light on how GPs in the Netherlands can better assist women with non-western migration backgrounds who experience domestic violence. [ABSTRACT FROM AUTHOR]

Background: Given the developmental vulnerability of justice-involved youth, providing a safe environment in secure facilities is a paramount, yet challenging task. Within this complexity, a sound security framework is key. The security framework exists on three dimensions: physical, procedural and relational security. Existing knowledge points at the importance of a shift in focus on physical and procedural security towards relational security as the core of the security framework. At the same time there is a dearth of knowledge on relational security, particularly in the context of youth justice. This paper explores relational security and its working mechanisms in practice. Methods: This paper draws on findings of a comprehensive three-year evaluation of three small-scale, community-embedded facilities that are grounded in relational security. The approach of the evaluation was derived from action research, involving a cyclic process alternating between action, research and critical reflection, while engaging all stakeholders in the research process. The action research cycle involved qualitative research (a total of 63 semi-structured interviews) incorporating the perspective of staff, youth and parents. Results: Relational security is grounded in three distinct, but interrelated, elements – staff's basic attitude, a constructive alliance between staff and youth, staff presence – and promotes a safe and therapeutic environment through several mechanisms. Conclusions: Relational security can be defined in a practical conceptualization; outlining a way of working that guides staff in how to establish a safe and therapeutic environment in secure facilities. This conceptualization finds support in the well-established literature covering the therapeutic alliance and can be substantiated by two aligning theories concerning youth justice strategies: social-ecological theory and self-determination theory. Relational security is not only a way of working, but also a way of being. It encompasses a vision about security and mentality towards justice-involved youth that sees them not merely as 'risks to be managed', but primarly as 'resources to be developed'. [ABSTRACT FROM AUTHOR]

A space, where the client feels safe, is necessary for therapeutic process. Its importance seems to be implicitly understood and agreed upon across different schools of psychotherapy. However, what it means and how it appears in therapy has not been clearly described before. This paper presents the findings from the first author's master thesis, which sought to answer the question 'Why is safe space important in dance therapy, and how do dance therapists define and create it in their practice?'. This phenomenological inquiry originated from a need to translate the experiential phenomenon of safe space into words. It is a first attempt to investigate safe space in depth and to provide a definition of its essence in dance movement therapy. Findings from this research describe working methods and interventions for safe space as well as qualities that therapists can embody to help their clients feel safe. [ABSTRACT FROM AUTHOR]

Introduction: Network platforms are interesting for integrated care governance as they seek solutions for the problem of competition and tensions between networks. In this paper, we analyse how a network platform functions for the actors involved, and how it is used in their work. Methods: We employed a case study in a Dutch urbanised hospital region, and conducted 17 interviews with hospital physicians, directors, and supporting staff who are involved in a network platform called “BeterKeten” (BK). Results: Actors assign different functions and purposes to BK: facilitating and legitimising professional (learning) communities; adapting to a changing policy context; enlarging professionals’ and the networks’ circle of influence; and extending governing possibilities. Network platform’ dynamics and frictions entail changing professional and managerial practices; embedding a BK network in a partner network; and alignment of (conflicting) network platforms. Discussion: Network platforms are a promising strategy to govern, facilitate, and nurture network-building actions to enhance integrated care, offering new ways of working to cope with its multi-level nature. Conclusion: BK is a dynamic actor with steering capacities that enables the coexistence of multiple purposes. Further research could pay attention to how network platforms are able to develop modalities of integrated care governance that suit healthcare system’s networked character. [ABSTRACT FROM AUTHOR]

Background: In the Netherlands, population-based cancer screening programmes (CSPs) are organized aiming at cervical, breast and colorectal cancer. For a CSP to be effective, high participation rates are essential; however, there is an alarming downward trend, including wide regional variation in screening uptake. General practitioner (GP) involvement can have a stimulating effect on screening participation. Current GP involvement is however, limited, varies between the programmes and has changed over time. Unexplored is what GPs think of their role(s) in the CSPs. The aim of this study was therefore to map the perceptions and beliefs of GPs regarding their current and future role in the Dutch CSPs. Methods: A mixed-methods sequential explanatory study was conducted in the Leiden/The Hague area of the Netherlands, between the end of 2021 and 2022. A questionnaire was developed and distributed among 110 GPs. The aggregated results obtained from the questionnaires served as starting points for conducting semi-structured interviews, with purposefully selected GPs. With this sequential approach we aimed to further enhance the understanding of the questionnaire data, and delved into the topics that emerged from the questionnaire responses. Results: In total, 46 GPs completed the online questionnaire (response rate 42%). Subsequent five semi-structured comprehensive interviews were conducted. GPs indicated that they frequently encounter the CSP in their daily practice and consider it important. They also emphasised it is important that GPs remain closely involved with the CSPs in the future. Nevertheless, GPs also repeatedly mentioned that they are not eager to take on more logistical/organizational tasks. They are however willing to empower CSPs in a positive manner. Conclusion: GPs were generally positive about the CSPs and their current role within these programmes. Nevertheless, several options have been proposed to improve the CSPs, especially to increase screening uptake for populations in a socioeconomically disadvantaged position. Since it is of utmost importance to screen those who are most at risk of developing the screening-specific tumours, efforts should be made to achieve this goal. [ABSTRACT FROM AUTHOR]

Background: Unhelpful illness perceptions can be changed by means of interventions and can lead to improved outcomes. However, little is known about illness perceptions in patients with chronic kidney disease (CKD) prior to kidney failure, and no tools exist in nephrology care to identify and support patients with unhelpful illness perceptions. Therefore, this study aims to: (1) identify meaningful and modifiable illness perceptions in patients with CKD prior to kidney failure; and (2) explore needs and requirements for identifying and supporting patients with unhelpful illness perceptions in nephrology care from patients' and healthcare professionals' perspectives. Methods: Individual semi-structured interviews were conducted with purposive heterogeneous samples of Dutch patients with CKD (n = 17) and professionals (n = 10). Transcripts were analysed using a hybrid inductive and deductive approach: identified themes from the thematic analysis were hereafter organized according to Common-Sense Model of Self-Regulation principles. Results: Illness perceptions considered most meaningful are related to the seriousness (illness identity, consequences, emotional response and illness concern) and manageability (illness coherence, personal control and treatment control) of CKD. Over time, patients developed more unhelpful seriousness-related illness perceptions and more helpful manageability-related illness perceptions, caused by: CKD diagnosis, disease progression, healthcare support and approaching kidney replacement therapy. Implementing tools to identify and discuss patients' illness perceptions was considered important, after which support for patients with unhelpful illness perceptions should be offered. Special attention should be paid towards structurally embedding psychosocial educational support for patients and caregivers to deal with CKD-related symptoms, consequences, emotions and concerns about the future. Conclusions: Several meaningful and modifiable illness perceptions do not change for the better by means of nephrology care. This underlines the need to identify and openly discuss illness perceptions and to support patients with unhelpful illness perceptions. Future studies should investigate whether implementing illness perception-based tools will indeed improve outcomes in CKD. [ABSTRACT FROM AUTHOR]

To assess the cultural competence (CC) of GP trainees and GP trainers. Design and setting: A cross-sectional survey study was conducted at the GP Training Institute of Amsterdam UMC. We included 92 GP trainees and 186 GP trainers. We measured the three domains of cultural competency: 1) knowledge, 2) culturally competent attitudes and 3) culturally competent skills. Regression models were used to identify factors associated with levels of CC. Participants rated their self-perceived CC at the beginning and end of the survey, and the correlation between self-perceived and measured CC was assessed. Approximately 94% of the GP trainees and 81% of the GP trainers scored low on knowledge; 45% and 42%, respectively, scored low on culturally competent attitudes. The level of culturally competent skills was moderate (54.3%) or low (48.4%) for most GP trainees and GP trainers. The year of residency and the GP training institute were significantly associated with one or more (sub-)domains of CC in GP trainees. Having >10% migrant patients and experience as a GP trainer were positively associated with one or more (sub-) domains of cultural competence in GP trainers. The correlation between measured and self-perceived CC was positive overall but very weak (Spearman correlation coefficient ranging from −0.1–0.3). The level of cultural competence was low in both groups, especially in the knowledge scores. Cultural competence increased with experience and exposure to an ethnically diverse patient population. Our study highlights the need for cultural competence training in the GP training curricula. General practitioner (GP) trainees find cross-cultural consultations stressful due to a self-perceived lack of cultural competence (CC). The level of CC in general practice is as yet unknown. On average, the level of CC was low for the majority of GP trainees and GP trainers, especially for the scores on knowledge. CC increased with experience and exposure to an ethnically diverse patient population. GP trainees and trainers perceived a lack of covered education on various topics related to the care of migrants. Our study highlights the need for cultural competence training in the GP training curricula. [ABSTRACT FROM AUTHOR]

Introduction: Quality improvement in prehospital emergency medical services (EMS) can only be achieved by high-quality research and critical appraisal of current practices. This study examines current opportunities and barriers in EMS research in the Netherlands. Methods: This mixed-methods consensus study consisted of three phases. The first phase consisted of semi-structured interviews with relevant stakeholders. Thematic analysis of qualitative data derived from these interviews was used to identify main themes, which were subsequently discussed in several online focus groups in the second phase. Output from these discussions was used to shape statements for an online Delphi consensus study among relevant stakeholders in EMS research. Consensus was met if 80% of respondents agreed or disagreed on a particular statement. Results: Forty-nine stakeholders participated in the study; qualitative thematic analysis of the interviews and focus group discussions identified four main themes: (1) data registration and data sharing, (2) laws and regulations, (3) financial aspects and funding, and (4) organization and culture. Qualitative data from the first two phases of the study were used to construct 33 statements for an online Delphi study. Consensus was reached on 21 (64%) statements. Eleven (52%) of these statements pertained to the storage and use of EMS patient data. Conclusion: Barriers for prehospital EMS research in the Netherlands include issues regarding the use of patient data, privacy and legislation, funding and research culture in EMS organizations. Opportunities to increase scientific productivity in EMS research include the development of a national strategy for EMS data and the incorporation of EMS topics in research agendas of national medical professional associations. [ABSTRACT FROM AUTHOR]

Background: Palliative care in primary care and nursing home settings is becoming increasingly important. A multidimensional palliative care approach, provided by a multiprofessional team, is essential to meeting patients' and relatives' values, wishes, and needs. Factors that hamper the provision of palliative care in this context have not yet been fully explored. Objectives: To identify the barriers to providing palliative care for patients at home or in nursing homes as perceived by healthcare professionals. Design: Cross-sectional survey study. Methods: A convenience sample of nurses, doctors, chaplains, and rehabilitation therapists working in primary care and at nursing homes in the Netherlands is used. The primary outcome is barriers, defined as statements with ⩾20% negative response. The survey contained 56 statements on palliative reasoning, communication, and multiprofessional collaboration. Data were analyzed using descriptive statistics. Results: In total, 249 healthcare professionals completed the survey (66% completion rate). The main barriers identified in the provision of palliative care were the use of measurement tools (43%), consultation of an expert (31%), estimation of life expectancy (29%), and documentation in the electronic health record (21% and 37%). In primary care, mainly organizational barriers were identified, whereas in nursing homes, most barriers were related to care content. Chaplains and rehabilitation therapists perceived the most barriers. Conclusion: In primary care and nursing homes, there are barriers to the provision of palliative care. The provision of palliative care depends on the identification of patients with palliative care needs and is influenced by individual healthcare professionals, possibilities for consultation, and the electronic health record. An unambiguous and systematic approach within the multiprofessional team is needed, which should be patient-driven and tailored to the setting. [ABSTRACT FROM AUTHOR]

Aim: To gain insight into the perceived emotional impact of providing palliative care among nursing assistants in Dutch nursing homes, their strategies in coping with this impact and associated needs. Design: Exploratory qualitative study. Methods: In 2022, 17 semistructured interviews with nursing assistants working in Dutch nursing homes were conducted. Participants were recruited via personal networks and social media. Interviews were open‐coded by three independent researchers following the thematic analysis approach. Results: Three themes emerged regarding the elements that contribute to the emotional impact of providing palliative care in nursing homes: impactful situations (e.g. witnessing suffering and sudden deaths), interactions (e.g. close relationship and receiving gratitude) and reflection on provided care (e.g. feeling fulfilment or feeling inadequate in caring). Nursing assistants used different strategies to cope, including emotional processing activities, their attitude towards death and work and gaining experience. Participants experienced a need for more education in palliative care and organized peer group meetings. Conclusion: Elements that play a role in how the emotional impact of providing palliative care is perceived by nursing assistants can have a positive or negative impact. Implications for the Profession and/or Patient Care: Nursing assistants should be better supported in coping with the emotional impact of providing palliative care. Impact: In nursing homes, nursing assistants are most involved in providing daily care to residents and have a signalling role in recognizing the deteriorating conditions of residents. Despite their prominent role, little is known about the emotional impact of providing palliative care among these professionals. This study shows that although nursing assistants already undertake various activities to reduce the emotional impact, employers should be aware of the unmet needs in this area and the responsibility they have in this regard. Reporting Method: The QOREQ checklist was used for reporting. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Introduction: Ignited by the persistent health inequalities many cities and neighbourhoods, the 'Healthy and Happy The Hague' network in the Netherlands wanted to gain insight in how prevention and health promotion could become successful in one deprived neighbourhood, Moerwijk. Methods: The cycle of Look-Think-Act of Participatory Action Research was used in which both citizens and professionals got involved from the start. Besides interviews, field notes were analysed, visualised and discussed in several rounds of focus groups. Results: Thematic analysis yielded seven themes: Healthy Eating and Exercise, Healthy Money, Healthy Mind, Healthy Relationships, Growing up healthy, Healthy Environment and Healthy Collaboration. During sessions around combination of themes, eight initiatives were co-created by citizens and professionals together, improving the feeling of ownership and interconnectedness. Discussion and conclusion: This PAR sheds a light on the mismatch between the system world's solutions for individuals and the living world's needs for solutions for the collective. Findings provides a better insight into the social, political, and cultural mechanisms and processes that influence clustering and interaction of health conditions. PAR is a promising process of citizens and professionals working together is an excellent way to learn about the conditions under which people experience health inequalities, and how to combat these inequalities. [ABSTRACT FROM AUTHOR]

Background: In the Netherlands, general practitioners (GPs) play a key role in provider-initiated HIV testing, but opportunities for timely diagnosis are regularly missed. We implemented an educational intervention to improve HIV testing by GPs from 2015 to 2020, and observed a 7% increase in testing in an evaluation using laboratory data. The objective for the current study was to gain a deeper understanding of whether and how practices and perceptions of GPs' HIV/sexually transmitted infection (STI) testing behaviour changed following the intervention. Methods: We performed a mixed-methods study using questionnaires and semi-structured interviews to assess self-reported changes in HIV/STI testing by participating GPs. Questionnaires were completed by participants at the end of the final educational sessions from 2017 through 2020, and participating GPs were interviewed from January through March 2020. Questionnaire data were analysed descriptively, and open question responses were categorised thematically. Interview data were analysed following thematic analysis methods. Results: In total, 101/103 participants completed questionnaires. Of 65 participants that were included in analyses on the self-reported effect of the programme, forty-seven (72%) reported it had changed their HIV/STI testing, including improved STI consultations, adherence to the STI consultation guideline, more proactive HIV testing, and more extragenital STI testing. Patients' risk factors, patients' requests and costs were most important in selecting STI tests ordered. Eight participants were interviewed and 15 themes on improved testing were identified, including improved HIV risk-assessment, more proactive testing for HIV/STI, more focus on HIV indicator conditions and extragenital STI testing, and tools to address HIV during consultations. However, several persistent barriers for optimal HIV/STI testing by GPs were identified, including HIV-related stigma and low perceived risk. Conclusions: Most GPs reported improved HIV/STI knowledge, attitude and testing, but there was a discrepancy between reported changes in HIV testing and observed increases using laboratory data. Our findings highlight challenges in implementation of effective interventions, and in their evaluation. Lessons learned from this intervention may inform follow-up initiatives to keep GPs actively engaged in HIV testing and care, on our way to zero new HIV infections. [ABSTRACT FROM AUTHOR]

In pluralist societies, stakeholders in healthcare may have different experiences of and moral perspectives on health, well-being, and good care. Increasing cultural, religious, sexual, and gender diversity among both patients and healthcare professionals requires healthcare organizations to address these differences. Addressing diversity, however, comes with inherent moral challenges; for example, regarding how to deal with healthcare disparities between minoritized and majoritized patients or how to accommodate different healthcare needs and values. Diversity statements are an important strategy for healthcare organizations to define their normative ideas with respect to diversity and to establish a point of departure for concrete diversity approaches. We argue that healthcare organizations ought to develop diversity statements in a participatory and inclusive way in order to promote social justice. Furthermore, we maintain that clinical ethicists can support healthcare organizations in developing diversity statements in a more participatory way by fostering reflective dialogues through clinical ethics support. We will use a case example from our own practice to explore what such a developmental process may look like. We will critically reflect on the procedural strengths and challenges as well as on the role of the clinical ethicist in this example. [ABSTRACT FROM AUTHOR]

Patients with a rare cancer often face delays in their diagnostic and treatment trajectory, which may affect their work. In this study, we explored experiences and needs of: 1) patients with a rare cancer regarding return to work (RTW) and work retention, and 2) (health care) professionals (HCPs) regarding work-related support of patients with a rare cancer, throughout their disease trajectory. Semi-structured, in-depth interviews with working-age patients with a rare cancer (n = 16), and HCPs (n = 9) were conducted. During the interviews, a predefined topic list was used. Interviews were transcribed verbatim and analysed by means of thematic analysis. In total, three themes emerged from the interviews: 1) Awareness in patients and HCPs as a first step towards work, 2) Being/becoming an expert is a tough job, and 3) Enhancing employability through early personalized guidance. Patients with a rare cancer are confronted with uncertainties regarding work, due to an overall lack of knowledge and experience with these types of cancer. Raising awareness among patients, HCPs and employers about rare cancer and its implications, and providing timely individualized, supportive occupational care are required to improve rare cancer patients' ability to work. Recognizing and paying attention to the work-related consequences of a rare cancer diagnosis and its treatment is essential to facilitate rare cancer patients' occupational rehabilitation process. Multidisciplinary collaboration and involvement of HCPs specialized in rare cancer are required to provide suitable work-related support. A personalized approach is necessary to adequately address rare cancer patients' RTW and work retention needs. [ABSTRACT FROM AUTHOR]

The use of art (e.g. visualized narratives) in social work may stimulate dialogue between community members about family support in their neighbourhood. The Visualized Narratives on Parenting Interactions in the Neighbourhood (VN‐PIN) were developed in order to foster this dialogue. The aim of this study was to evaluate the implementation of the VN‐PIN in social work practice and to gain insight in mechanisms that stimulate dialogues supported by visualizations. A qualitative process evaluation was conducted to explore the use of the VN‐PIN in various urban settings. We observed meetings (N = 14) where the VN‐PIN was applied and interviewed professionals and community members (N = 81). The results of this study show that the VN‐PIN intervention gives parents a voice and allows them to recognize and reflect on their own parenting behaviour, thereby contributing to mutual exchanges in a supportive community. The conclusion of this study is that the VN‐PIN is a useful intervention that social work professionals can use to foster dialogues about parenting within diverse contexts in super‐diverse neighbourhoods. The intervention fosters a supportive structure to share experiences of various community members. Future research is needed to further evaluate the experiences and satisfaction of community members with the intervention. [ABSTRACT FROM AUTHOR]

Purpose: Many countries have developed hospital-at-home (HAH) models to bring hospital services closer to home. Although some countries already have a long tradition of HAH for adults, paediatric HAH has been developed more recently. Specificities of paediatric care make it difficult to directly extend an adult HAH model to the paediatric population. The objective of this study is to compare the organisation of paediatric HAH in four countries: France, Australia (states of Victoria and New South Wales), the Netherlands and Belgium. Ultimately, lessons can be drawn for further development in the countries analysed and/or for implementation in other countries. Design/methodology/approach: Legal documents and other grey literature were analysed to describe the legal context for the provision of paediatric HAH in the selected countries. In addition, semi-structured in-depth interviews were conducted with key informants from paediatric HAH organisations in these countries, addressing the following topics: historical background, legal framework, functioning of HAH models, workforce, number of services, profile of children, type of care activities, funding, coordination with other providers and quality of care. Results were reviewed by a content expert from the respective country. Findings: Organisational differences were highlighted in terms of coordinating actor (hospital or home nursing care services), decision-making process, range of clinical conditions treated, territorial organisation, qualifications and expertise of the team members, medical expertise, financing, responsibilities, etc. Originality/value: There is no single preferred model for the provision of HAH care for children. There is a large variety in almost all aspects of organisation. There are, however, also some common characteristics across the different models. Notably, paediatric expertise of nurses within the HAH team was considered indispensable in all programmes. [ABSTRACT FROM AUTHOR]

Background: Early mobilisation of critically ill adults has been proven effective and is safe and feasible for critically ill children. However, barriers and perceived benefits of paediatric intensive care unit (PICU) staff involvement in mobilising critically ill children are largely unknown. Aim: To explore the barriers and perceived benefits regarding early mobilisation of critically ill children as perceived by PICU staff. Study design: A cross‐sectional survey study among staff from seven PICUs in the Netherlands has been carried out. Results: Two hundred and fifteen of the 641 health care professionals (33.5%) who were invited to complete a questionnaire responded, of whom 159 (75%) were nurses, 40 (19%) physicians, and 14 (6%) physical therapists. Respondents considered early mobilisation potentially beneficial to shorten the duration of mechanical ventilation (86%), improve wake/sleep rhythm (86%) and shorten the length of stay in the PICU (85%). However, staff were reluctant to mobilise patients on extracorporeal membrane oxygenation (ECMO) (63%), and patients with traumatic brain injury (49%). Perceived barriers to early mobilisation were hemodynamic instability (78%), risk of dislocation of lines/tubes (74%), and level of sedation (62%). In total, 40.3% of PICU nurses stated that physical therapists provided enough support in their PICU, but 84.6% of the physical therapists believed support was sufficient. Conclusion: Participating PICU staff considered early mobilisation as potentially beneficial in improving patient outcomes, although barriers were noted in certain patient groups. Relevance to clinical practice: We identified barriers to early mobilisation which should be addressed in implementation research projects in order to make early mobilisation in critically ill children work. [ABSTRACT FROM AUTHOR]

In the Netherlands, as in many other countries, victims of intentionally committed violent crimes may apply for state compensation if the offender is unknown or unable to pay for the damages of the crime. This state compensation scheme is run by the Dutch Violent Offences Compensation Fund (VOCF). Lawyers who work for this fund need to evaluate applicants' eligibility for state compensation on the basis of two criteria: (1) the plausibility of the applicant's victimization story and (2) the severity of the injury sustained by the applicant. Whether these criteria are fulfilled is largely left to the discretion of the lawyer who evaluates the application. This discretionary power makes the decision-making process prone to biased outcomes. Inspired by previous research, this study investigated whether information from mental health care providers, such as psychiatrists or clinical psychologists, serves as a potential source of bias. Although this type of information may or should sometimes be used to evaluate an applicant's eligibility for compensation, in most cases it should not affect the outcome of this evaluation because of its potential unreliability. A statistical association between availability of information from mental health care providers and adjudication of state compensation is therefore not to be expected. Analyzing 246 applications submitted to the Dutch VOCF between July 1st 2016 and July 1st 2017, this study tested the empirical validity of this expectation. Results indicated that the availability of information of mental health care providers was associated with adjudication of state compensation. This finding was discussed in view of the literature on heuristic thinking and biased decision making and the study's limitations. [ABSTRACT FROM AUTHOR]

Aim: To understand self‐employed long‐term‐care workers' experiences of precariousness, and to unravel how their experiences are shaped at the intersection of gender, class, race, migration and age. Background: In the Netherlands, increasing numbers of nurses and nursing aides in long‐term care (LTC) opt for self‐employment. Societal organizations and policy makers express concerns about this development, as self‐employment is seen as a risk factor for poor health. Self‐employment is not necessarily precarious work but can contribute to the precariousness of specific groups. Knowledge about inequities among self‐employed nurses and nursing aides in long‐term care is lacking. Design: A participatory, qualitative interview study. The research team consisted of four academic researchers and five (un)paid care workers. Methods: Semi‐structured interviews with 23 self‐employed nurses and nursing aides in LTC (2019–2020). Data were analysed from an intersectional perspective. Results: First, we describe that feeling precarious as a hired employee—due to increasing workloads, health risks, poverty and discrimination—shapes care workers' choice for self‐employment. Second, we describe inequities between self‐employed care workers who could (financially) afford to turn to self‐employment as a health strategy and those who felt squeezed out of the organizations due to poverty or discrimination. They more often dealt with precarious work in the context of precarious lives, negatively impacting their health. Third, we describe how negotiating an entrepreneurial identity with a caring identity required material sacrifices and thus contributed to self‐employed care workers' financial precariousness, particularly as women. Conclusion: Our findings indicate that working in LTC is becoming increasingly precarious for all care workers, both for hired and self‐employed, with younger, lower‐paid and racialized women with unpaid caring responsibilities seemingly most at risk for precariousness. Impact Our findings urge policy makers and care organizations to develop gender and diversity‐sensitive policy responses to address these inequities. [ABSTRACT FROM AUTHOR]

Introduction: Client-accessible interdisciplinary health records potentially contribute to integrated care by facilitating collaboration and enhancing clients’ involvement in care. To achieve this, three Dutch organizations providing ‘care for youth’ developed a fully client-accessible electronic patient record (EPR-Youth). Objective: To evaluate the implementation of EPR-Youth and to determine barriers and facilitators. Methods: A mixed methods design combined system data, process observations, questionnaires and focus group interviews. Target groups were parents, adolescents, professionals using EPR-Youth, and implementation stakeholders. Findings: Client-portal acceptability was high among all clients. Client-portal adoption rate was high and differed between age groups and educational levels. Professionals’ doubts about acceptability, appropriateness and fidelity were partly due to lack of system knowledge. Implementation barriers were the complexity of co-creation, lack of clear leadership, and concerns about legal issues. Facilitators were clarifying vision and legal context, setting deadlines, and a pioneering spirit. Conclusion: The early implementation of EPR-Youth, the first Dutch client-accessible interdisciplinary electronic health record in ‘care for youth’ was successful. To enhance adoption among clients, group-specific barriers for portal-use should be determined. Professionals need additional training. Further research is needed to gain insight into client-portal access barriers. To benefit more from co-creation, an organizational change towards situational leadership is necessary. [ABSTRACT FROM AUTHOR]

Background: COVID-19 has greatly affected the delivery of all health care services globally. Antenatal care is one area of care that has been impacted, despite the fact that attending antenatal check-ups is essential for pregnant women and cannot be postponed. Little is known about how exactly ANC provision has changed in the Netherlands, or how the changes have impacted midwives and gynaecologists providing those services. Methods: This study used a qualitative research design to investigate changes in individual and national practice following the onset of the COVID-19 pandemic. The study involved a document analysis of protocols and guidelines for ANC provision to evaluate how those changed following the onset of the COVID-19 pandemic and semi-structured interviews with ANC care providers (i.e., gynaecologists and midwives). Results: Guidance was issued by multiple organizations, during the pandemic, on how to approach the risk of infection in pregnant women, recommending several changes to ANC to protect both pregnant women and ANC providers. Both midwives and gynaecologists reported changes in their practice. With less face-to-face consultations happening, digital technologies became critical in the care of pregnant women. Shorter and fewer visits were reported, with midwifery practices adjusting their guidelines further than hospitals. Challenges, with high workloads and lack of personal protective equipment were discussed. Conclusions: The COVID-19 pandemic has had an immense impact on the health care system. This impact has had both negative and positive effects on the provision of ANC in the Netherlands. It is important to learn from the current COVID-19 pandemic and adapt ANC, as well as health care systems as a whole, to be better prepared for future health crises and ensure continuous provision of good quality care. Plain Language summary: COVID-19 has affected the delivery of healthcare services globally. Antenatal care is one of the healthcare services that has been impacted on a global scale. Little is known about how antenatal care provision has changed in the Netherlands during the pandemic period. Our project focuses on examining the effects of COVID-19 on existing antenatal care protocols, as well as the impacts on antenatal care providers, such as midwives and gynaecologists. This knowledge can be beneficial in adapting antenatal care provision in times of health emergencies, to be better prepared and more resilient. This research uses a qualitative approach to investigate changes in practice following COVID-19 pandemic. It involves 20 antenatal care providers, working in the Netherlands, which took part in semi-structured interviews, and 9 national protocols and guidelines which were analysed. This study indicates that antenatal care changed at different levels in the Netherlands. Many changes show that antenatal care is an essential service, which should not be cut back, but it should be implemented, to be prepared for a future health emergency. [ABSTRACT FROM AUTHOR]

The majority of older adults with dementia living in a nursing home exhibit behavioral and psychological symptoms of dementia (BPSD). This behavior is difficult for residents to cope with. Early recognition of BPSD is important in order to implement personalized integrated treatment, and nursing staff are in the unique position to consistently observe residents' behavior. The aim of this study was to explore nursing staff's experiences observing BPSD of nursing home residents with dementia. A generic qualitative design was chosen. Twelve semi-structured interviews were conducted with nursing staff members until data saturation. Data were analyzed using inductive thematic analysis. Four themes were identified: "group harmony" observations from a group perspective, focused on the disturbance of group harmony; an "intuitive approach", which involves observing unconsciously and without a set method; "reactive intervention", which refers to immediate removal of observed triggers without exploring the causes of behaviors; and "sharing information", which is delayed sharing of observed behavior with other disciplines. The current way in which nursing staff observe BPSD and share observations within the multidisciplinary team explain several existing barriers to achieving high treatment fidelity for BPSD with personalized integrated treatment. Therefore, nursing staff must be educated to structure their daily observations methodologically and interprofessional collaboration improved to share their information in a timely manner. [ABSTRACT FROM AUTHOR]

Since the COVID-19 pandemic started in Europe early 2020, day-to-day practice in care homes has changed considerably. Common elements of music therapy – singing, physical contact, proximity – have become questionable. This study explores the impact of the COVID-19 pandemic on music therapy provision and continuation in Dutch care homes. In December 2020 and January 2021 Dutch music therapists (n = 49) working in elderly care filled out an online survey on their experiences with the COVID-19 pandemic during the first and second wave. Twenty different measures were deployed to adapt and continue music therapy throughout the pandemic. Music therapists were required to deploy social distancing, disinfect hands and instruments, and wear a face mask. Residents from different units were frequently unable to participate in music therapy together. Prevalent adaptations were to provide sessions in a common room (79.6%), in smaller groups (67.4%), for more (individual) residents than usual (65.3%) and to use pre-recorded playlists (65.3%). Music therapists experienced low stress and moderate to high hope, despite the substantial impact of the pandemic on professional and personal musical activities. Music therapy provision in care homes has repeatedly been subject to restrictions throughout the pandemic. By the end of the second wave, music therapy had been resumed in care homes, albeit with a range of preventive measures implemented in daily work routines. The pandemic shed light on adaptability of music therapy as a treatment and demonstrates that employer support is essential to enable music therapy provision. [ABSTRACT FROM AUTHOR]

Introduction: In 24/7 disability care facilities, patient‐reported experience measures (PREMs) are important to help healthcare professionals understand what matters to care users and to improve the quality of care. However, the successful implementation of a PREM is complex. In a Dutch disability care organization, stakeholders cocreated tailored implementation strategies aimed at improving the use and integration of a qualitative PREM. This study gives insights into the uptake and experiences with these cocreated implementation strategies and the perceived impact of the set of strategies. Methods: We performed a prospective process evaluation between February 2020 and February 2021. We collected data in three disability care facilities from 35 care users, 11 professionals, 3 facility managers and 4 organization representatives. Data collection included observations during kick‐offs and learning goal meetings and several attendance checklists. We collected 133 questionnaires (Time 0 and Time 1). We conducted 35 individual semistructured interviews and an online focus group interview. Quantitative data were analysed using descriptive statistics and qualitative data using directed content analysis. Results: The exposure to and adoption of strategies was between 76% and 100%. Participants were positive about tailoring the strategies to each facility. Implementation was hindered by challenges in care users' communication and COVID‐19. The perceived impact referred to an improved understanding of the goal and added value of the PREM and better preparation and execution of the PREM. The impact of the set of strategies was mainly experienced on the micro level. Conclusion: The uptake of the cocreated implementation strategies was acceptable. The participants valued the tailored approach, which enabled them to focus on facility‐specific learning goals. Stakeholder engagement and co‐created strategies may have strengthened the adoption of and experiences with the implementation. Patient or Public Contribution: In this article, we present the process evaluation of implementation strategies for the integrated use of a PREM in disability care. A development group consisting of communication vulnerable care users, trainers and professionals developed the implementation strategies. The disability care organization was responsible for the planning and organization of the implementation process. During the process evaluation the end users, trainers, professionals and managers tailored the implementation strategies to their own settings and needs. Researchers observed this implementation process and interviewed the stakeholders about their experiences and the perceived impact. [ABSTRACT FROM AUTHOR]

The Canadian Occupational Performance Measure (COPM) can be used to support children to clarify their needs themselves. However, for pediatric occupational therapists it is not sufficiently clear how to effectively use the COPM with children from 8 years of age. This study aimed to formulate specific instructions for using the COPM with children themselves, based on the experience of children, parents, and occupational therapists. In addition, professional consensus on the instructions was reached. A multi-stage approach was used to develop the instructions. Triangulation of methods was used to gather knowledge of how the COPM with children themselves is performed in daily practice: interviews with 23 children, questionnaires completed by 30 parents, interviews with 13 therapists, and 10 video recordings of COPM administration. Specific instructions were derived from this knowledge and consensus for these instructions was reached by Delphi method. The data were analyzed and resulted in 40 specific instructions. Consensus of at least 80% amongst 10 occupational therapists, who regularly use the COPM with children, was achieved on each instruction. There is consensus on 40 specific instructions for administering the COPM with children. Following these instructions might help children to formulate their own goals for intervention. [ABSTRACT FROM AUTHOR]

This study reports the findings from a Dutch study, exploring care workers' knowledge and perceptions of the online lives of adolescents with mild or borderline intellectual disabilities. Using an inductive research design 33 semi-structured interviews were conducted with care workers. Three themes were derived from the data: (1) The clients' online world is largely unknown to care workers. (2) The online world is a gateway to an inclusive and connected life. (3) The online world is a dangerous and challenging place. Care workers have limited knowledge of clients' online lives. Care workers show ambivalence about the good and bad of the Internet for their clients. They acknowledge the possibilities of the Internet but mostly perceive it as a place of risk and challenge. Paradoxically, care workers report little experiences of incidents of online risks. Perceptional processes might help explain why this paradox exists. [ABSTRACT FROM AUTHOR]

Introduction: Healthcare professionals (HCPs) are informed about new drug safety issues through Direct Healthcare Professional Communications (DHPCs). The influence of DHPC content on the impact of the communication is unclear.Objectives: The aim of this study was to assess the effect of content elements 'frequency of the safety issue', 'seriousness of the safety issue', 'need to take action', 'life span of drug involved' and 'type of evidence supporting the safety issue' on hospital-based HCPs' preferences and responses towards DHPCs.Methods: A survey study including a conjoint experiment was performed among hospital-based HCPs in the Netherlands. Hypothetical DHPCs varying on the five content elements were constructed. Each respondent received eight out of 16 hypothetical DHPCs and was asked about (1) importance to be informed (fixed-point scale), (2) preferred communication timing (multiple options) and (3) their stated actions (multiple options). Associations were tested using generalized linear mixed models.Results: In total, 178 HCPs participated. DHPCs concerning more frequent or serious safety issues, or requiring action, were associated with a higher perceived importance to be informed and a preference for immediate communication. Periodic communication was preferred for DPHCs concerning less frequent or serious safety issues. The most commonly stated action was to discuss the DHPC with colleagues. Monitoring was common when this was recommended. High frequency and seriousness were associated with more prescribing-related actions.Conclusion: Frequency and seriousness of the safety issue and the recommended action are likely to influence the impact of DHPCs. The timing of communication could be tailored depending on the content, where less urgent safety issues might be communicated periodically. [ABSTRACT FROM AUTHOR]

Background: This study aimed to examine the associations between individual staff and staff team characteristics and quality of life of individuals with intellectual disabilities and challenging behaviours. Method: With multilevel analyses, we examined educational level, experience, attitudes and behaviours of 240 staff members, in relation to their perception of quality of life of 152 individuals with intellectual disabilities and challenging behaviours they cared for. Results: Two individual staff characteristics were related to better quality of life: higher educational and self‐reflection levels. Of the team characteristics, higher educational level, higher self‐efficacy and more friendly behaviour were associated with better quality of life. Unexpectedly, higher staff‐individual ratio was related to lower quality of life. Conclusions: Both individual staff and staff team characteristics are associated with quality of life, indicating the need to take staff team characteristics into account when examining quality of life. [ABSTRACT FROM AUTHOR]

Background: Professional support for people with intellectual disabilities is increasingly provided remotely. This study explores what support staff of the Dutch remote support service DigiContact experience as distinctive aspects of their job as a remote support professional. Method: Semi‐structured interviews were held with 10 DigiContact support workers. The transcripts were analysed through a qualitative content analysis process. Results: Six themes were identified that reflect distinct aspects of the participants' work within the DigiContact remote support context: being encouraged to adopt a solution‐oriented coaching support style; being limited in one's support options; facing considerable diversity; providing support as one team; dealing with unpredictability; and navigating the dynamic within work shifts. Conclusions: The way support is organised and delivered can have substantial implications for support professionals. Working at a service like DigiContact seems to call for specific skills, knowledge, affinities and experience, and for appropriate support and facilitation from organisations. [ABSTRACT FROM AUTHOR]

Patient participation is a highly valued principle. Yet, it remains difficult both to achieve it and to assess its added value, as participation is often started without much clarification of what it means or aims to do. In theory, patients may be invited to participate for reasons of democracy, empowerment, knowledge integration and instrumentalism. By making these rationales explicit in a participatory practice in the Netherlands, we aimed to contribute to the long‐needed 'clarity through specificity' in participation. Apart from the rationales, our analytic framework included dimensions of the participatory process, reflected by questions like 'Who participates?', 'In what?' and 'With how much control?' We used this framework to conduct and analyse semi‐structured interviews (n = 51) with patient participants (20), professionals (14) and researchers (17). We found that the participatory practice included all rationales and that the actual manifestation of an intended rationale very much depended on the design of the dimensions of the participatory process. We conclude that invited participation may gain in clarity by making explicit the rationales for participation. If put at the centre of attention, and made the leading factor in the design of the dimensions of the participatory process, explicit rationales may support the realisation of participation in practice and prevent it from resulting in mere window‐dressing. [ABSTRACT FROM AUTHOR]

Dutch policy stipulates that people with dementia should remain at home for as long as possible. If they need care, they must preferably appeal to family, friends and neighbours. Professional help and nursing homes are deemed last resorts. Therefore, case managers must coproduce their public services increasingly in healthcare triads with both people with dementia (PWDs) and their informal caregivers. Case managers are professionals who provide and coordinate care and support for PWDs and their informal caregivers during the entire trajectory from (suspected) diagnosis until institutionalisation. The literature on coproduction has focused on the bilateral interactions between service providers and users rather than the multilateral collaborative relationships through which many public services are currently delivered, as is the case in dementia care. Little is known about how frontline workers, case managers in this study, handle conflicts in these healthcare triads. Our study addresses this gap in the coproduction literature and explores the action strategies case managers use to handle conflicts. We interviewed 19 Dutch case managers and observed 10 of their home visits between January and May 2017. We focused on the end stage of dementia at home, just before admission to a nursing home, as we assumed that most conflicts occur in that phase. The findings reveal that the case managers use a variety of action strategies to resolve and intervene in these conflicts. Their initial strategies are in line with the ideals underlying coproduction; however, their successive strategies abandon those ideals and are more focused on production or result from their own lack of power. We also found that current reforms create new dilemmas for case managers. Future research should focus on the boundaries of coproducing public services in triadic relationships and the effects of current welfare reforms aimed at coproducing public services in healthcare triads. [ABSTRACT FROM AUTHOR]

Hospital workers in Aruba have been facing an increased demand for healthcare in the unique setting of a Small Island Developing State (SIDS). This study assessed the impact of the first wave of the SARS-CoV-2 pandemic on the mental health of staff at the major hospital in Aruba, examining the differences between employee groups, with the goal of providing recommendations for targeted support and coping strategies in future crises in a small island setting. Patients and methods: In a mixed-method cohort design, Dr. Horacio E. Oduber Hospital staff were asked to complete a 25-item questionnaire about their concerns and worries, organization of work, and general wellbeing; 24% of the hospital staff filled in the questionnaire (mean age 41 ± 11 years, 79% female). Alongside the needs assessment questionnaire, six focus groups were established to explore staff feelings on specific measures taken by hospital management during the COVID-19 crisis. Results: Questionnaire analysis (n = 231) revealed employees' concerns about infecting their relatives and their financial stability. In particular, nurses were significantly more concerned than other staff groups. In the wellbeing section of the questionnaire, items regarding future security scored poorest, alongside increased levels of tiredness and nervousness. Focus groups discussions revealed frustrations of the hospital staff with the foreign staff brought in to help during the crisis and a need for better leadership and communication practices from hospital management. Conclusions: Comprehensive and holistic approaches should be implemented by the hospital management to prevent occupational burnout and demoralized work ethics and further emotional exhaustion. [ABSTRACT FROM AUTHOR]

Background: 'What matters to me' is a five‐category preference elicitation tool to assist clients and professionals in choosing long‐term care. This study aimed to evaluate the use of and experiences with this tool. Methods: A mixed‐method process evaluation was applied. Participants were 71 clients or relatives, and 12 professionals. They were all involved in decision‐making on long‐term care. Data collection comprised online user activity logs (N = 71), questionnaires (N = 38) and interviews (N = 20). Descriptive statistics was used for quantitative data, and a thematic analysis for qualitative data. Results: Sixty‐nine per cent of participants completed one or more categories in an average time of 6.9 (±0.03) minutes. The tool was rated 6.63 (±0.88) of 7 in the Post‐Study System Usability Questionnaire (PSSUQ). Ninety‐five per cent experienced the tool as useful in practice. Suggestions for improvement included a separate version for relatives and a non‐digital version. Although professionals thought the potentially extended consultation time could be problematic, all participants would recommend the tool to others. Conclusion: 'What matters to me' seems useful to assist clients and professionals with preference elicitation in long‐term care. Evaluation of the impact on consultations between clients and professionals by using 'What matters to me' is needed. [ABSTRACT FROM AUTHOR]

Background: Chiropractors commonly provide care to people with low-back pain (LBP). The aim of this survey was to determine the opinions and beliefs of chiropractors regarding the support and management of LBP. We also investigated whether their management is in accordance with the three most commonly recommended approaches to LBP based upon international guidelines (i.e. advice regarding return-to-work, limit bedrest, and stay active). Methods: A web-based survey was sent out in 2013 to collect data from registered Dutch and Belgian chiropractors. In addition to providing a description of their sociodemographic and practice characteristics, chiropractors were asked to complete six patient vignettes representing people with LBP who typically present to a chiropractor. The respondents indicated which intervention(s) they would recommend or undertake. Based upon these vignettes, we were able to determine whether their management approach adhered to clinical guidelines. Generalized mixed models were used to explore guidelines adherence and their relationship to chiropractors' characteristics. Results: In total, 60% (n = 203/340) of the chiropractors who were invited, chose to participate. Chiropractors reported applying a chiropractic adjustment in 90% of all vignettes, while the advice to exercise varied from one-third in the chronic cases to approximately half of those with acute LBP. More than 75% of the chiropractors would initially treat LBP 1–2 times a week. More than 90% of the chiropractors advised against bedrest. Overall, self-reported adherence to clinical guidelines for all six vignettes was [64.5% (CI 58.7–70.0)]. Adherence in the chronic vignettes [73.4% (CI 66.7–79.2)] was better than in the acute vignettes [55.9% (CI 50.5–61.1)]. Importantly, regarding recommended approaches to LBP, chiropractors more consistently followed guidelines regarding advice to limit bedrest [98.5% (CI 97.3–99.1)] than advice to stay active [77.5% (CI 72.3–81.9)] or return-to-work [59.4% (CI 55.2–63.4)]. Finally, Dutch chiropractors were more likely to adhere to the guidelines than Belgian chiropractors. Conclusions: Chiropractic adjustments were the most common self-reported treatment modalities supplemented by exercise in the management of LBP patients. Two-thirds of the chiropractors reported adhering to the guidelines regarding management and advice for LBP patients. Practitioners should improve guideline adherence, particularly for acute LBP cases, and when advising on return-to-work. [ABSTRACT FROM AUTHOR]

Objective The purpose of this study was to explore lived experiences of rehabilitation professionals working in hospitals during the COVID-19 pandemic, including the ethical issues and moral distress that these professionals might have encountered. Methods An interpretative phenomenological study was performed. First-person experiences of rehabilitation professionals (dieticians, occupational therapists, physical therapists, and speech-language therapists) were collected with semi-structured interviews and analyzed with interpretative phenomenological analysis. Results The data of 39 hospital-based rehabilitation professionals revealed 4 themes: a disease with great impact, personal health and safety, staying human in chaotic times, and solidarity and changing roles. Participant experiences show that the virus and COVID-19 measures had a significant impact on the in-hospital working environment due to the massive downscaling of regular care, due to infection prevention measures, and due to unknown risks to rehabilitation professionals' personal health. At the same time, participants experienced a certain freedom, which made room for authentic motives, connection, and solidarity. Participants felt welcomed and appreciated at the COVID-19 wards and intensive care units and were proud that they were able to fulfill their roles. The findings reflect a wide range of situations that were morally complex and led to moral distress. Conclusion To diminish the long-lasting negative impact of the COVID-19 pandemic and moral distress, employers should empathize with the experiences of hospital-based rehabilitation professionals and create conditions for ethical reflection. Our data show that hospital-based rehabilitation professionals value professional autonomy. Creating room for professional autonomy helps them feel needed, connected, and energized. However, the needs of hospital-based rehabilitation professionals may conflict with organizational rules and structures. Impact Hospital-based rehabilitation professionals were involved in situations they considered morally undesirable, and they inevitably faced moral distress during the COVID-19 crisis. This study offers rationale and guidance to employers regarding how to reduce the long-term negative impact of the COVID-19 pandemic on rehabilitation professionals. [ABSTRACT FROM AUTHOR]

Aims: This study aims to evaluate the effectiveness of an innovative postnatal risk assessment (the postnatal Rotterdam Reproductive Risk Reduction checklist: R4U) and corresponding care pathways in Preventive Child Healthcare (PCHC), along with PCHC professional satisfaction. Design: Four PCHC organizations located in three municipalities with a higher adverse perinatal outcome than the national average were selected for participation. The study concerns a historically controlled study design. Methods: The study enrolled participants from September 2016 until December 2017. The historical cohort existed of children born in previous years from 2008 until 2016. The outcome measure was defined as catch-up growth: more than 0.67 standard deviation score weight for height increase in the first 6 months of life. PCHC professional opinion was assessed with a digital survey. Results: After the inclusion period, 1,953 children were included in the intervention cohort and 7,436 children in the historical cohort. Catch-up growth was significantly less common in the intervention cohort; 14.9% versus 19.5% in the historical cohort (p < 0.001). A regression sensitivity analysis, using matching, showed an odds ratio of 0.957 (95% CI 0.938-0.976) for the intervention cohort. In the survey, 74 PCHC physicians and nurses participated; most of them were neutral concerning the benefits of the postnatal R4U. Conclusion: This study shows that the implementation of a novel postnatal risk assessment including in PCHC is feasible and effective. Final efforts to ensure a widespread implementation should be taken. Impact: PCHC offers a unique opportunity to recognize and address risk factors for growth and development in children and to implement care pathways. Effective and widely implemented risk assessments in antenatal and PCHC are scarce. To our knowledge, this kind of evidence-based postnatal risk assessment has not been implemented in PCHC before and seizes the opportunity to prevent catch-up growth and its long-term effects. [ABSTRACT FROM AUTHOR]

To explore the usefulness and feasibility of a comprehensive vocational rehabilitation (C-VR) program and less comprehensive (LC-VR) program for workers on sick leave due to chronic musculoskeletal pain, from the perspective of patients, professionals, and managers. Semi-structured interviews were held with patients, professionals, and managers. Using topic lists, participants were questioned about barriers to and facilitators of the usefulness and feasibility of C-VR and LC-VR. Thirty interviews were conducted with thirteen patients (n = 6 C-VR, n = 7 LC-VR), eight professionals, and nine managers. All interviews were transcribed verbatim. Data were analyzed by systematic text condensation using inductive thematic analysis. Three themes emerged for usefulness ("patient factors," "content," "dosage") and six themes emerged for feasibility ("satisfaction," "intention to continue use," "perceived appropriateness," "positive/negative effects on target participants," "factors affecting implementation ease or difficulty," "adaptations"). The patients reported that both programs were feasible and generally useful. The professionals preferred working with the C-VR, although they disliked the fixed and uniform character of the program. They also mentioned that this program is too extensive for some patients, and that the latter would probably benefit from the LC-VR program. Despite their positive intentions, the managers stated that due to the Dutch healthcare system, implementation of the LC-VR program would be financially unfeasible. The main conclusion of this study is that it is not useful to have one VR program for all patients with CMP and reduced work participation, and that flexible and tailored-based VR are warranted. Both comprehensive and less comprehensive vocational rehabilitation are deemed useful for patients with chronic musculoskeletal pain and reduced work participation. Particular patient factors, for instance information uptake, discipline, willingness to change, duration of complaints, movement anxiety, obstructing thoughts, and willingness to return to work might guide the right program for the right patient. Both comprehensive and less comprehensive vocational rehabilitation are deemed feasible in practice. However, factors such as center logistic (schemes, rooms, professionals available) and country-specific healthcare insurance and sickness compensation systems should foster the implementation of less comprehensive programs. [ABSTRACT FROM AUTHOR]

Background: Childhood obesity can affect physical as well as psychosocial wellbeing. Therefore, childhood obesity care aims to improve all dimensions of health related quality of life (HRQoL). HRQoL can be measured with the generic questionnaire PedsQL4.0 and the weight-specific IWQOL-Kids. In the Netherlands, HRQoL assessment is conducted by the coordinating professional (CP). The aim of this qualitative study was to examine how and when to implement the measurement and discussion of HRQoL using the PedsQL4.0 and IWQOL-Kids within the integrated care for children with obesity in the Netherlands. Semi-structured interviews were conducted with fourteen CPs, in which the following was discussed: a) familiarity and attributions with regard to the assessment of HRQoL; b) wishes and needs with regard to the usage of the questionnaires; c) its practical incorporation. Results: Interviews revealed that most CPs gained insight into the HRQoL by talking with families. One CP used the PedsQL4.0, the remaining CPs were unfamiliar with the two questionnaires. Even though some barriers, for instance a lack of time, might hinder the implementation of the PedsQL4.0 and IWQOL-Kids, all participants think the usage of either one or both questionnaires would have additional value to the support and care for children with obesity. There was no consensus about the questionnaire of preference. Conclusions: When the right preconditions are met, HRQoL questionnaires have the potential to support CPs in improving the care for children with obesity, tailored to each individual child. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives: The aims of this study are as follows: (a) to establish whether a relationship exists between the importance that healthcare professionals attach to ethics in care and their likelihood to report reprehensible conduct committed by colleagues, and (b) to assess whether this relationship is moderated by behavioural control targeted at preventing harm. Method: In this cross‐sectional study, which was based on a convenience sample (n = 155) of nurse practitioners (NPs) and physician assistants (PAs) in the Netherlands, we measured ethics advocacy (EA) as a motivating factor (reflecting the importance that healthcare professionals attach to ethics and care) and "behavioral control targeted at preventing harm" (BCPH) as a facilitating factor. "Reporting reprehensible conduct" (RRC) was measured as a context‐specific indicator of whistleblowing intentions, consisting of two vignettes describing morally questionable behaviour committed by colleagues. Results: The propensity to report reprehensible conduct was a function of the interaction between EA and BCPH. The only group for which EA predicted RRC consisted of individuals with above‐average levels of perceived BCPH. Conclusion: The results suggest that the importance that healthcare professionals attach to ethical aspects in care is not sufficient to ensure that they will report reprehensible conduct. Such importance does not induce reporting behaviour unless the professionals also perceive themselves as having a high level of BCPH. We suggest that these insights could be helpful in training healthcare providers to cope with ethical dilemmas that they are likely to encounter in their work. [ABSTRACT FROM AUTHOR]

Background: Patient reported outcomes (PROs) provide information on a patient's health status coming directly from the patient. Measuring PROs with patient reported outcome measures (PROMs) has gained wide interest in clinical practice for individual patient care, as well as in quality improvement, and for providing transparency of outcomes to stakeholders through public reporting. However, current knowledge of selecting and implementing PROMs for these purposes is scattered, and not readily available for clinicians and quality managers in healthcare organizations. The objective of this study is to develop a framework with tools to support the systematic selection, implementation and evaluation of PROs and PROMs in individual patient care, for quality improvement and public reporting. Methods: We developed the framework in a national project in the Netherlands following a user-centered design. The development process of the framework contained five iterative components: (a) identification of existing tools, (b) identification of user requirements and designing steps for selection and implementation of PROs and PROMs, (c) discussing a prototype of the framework during a national workshop, (d) developing a web version, (e) pre-testing of the framework. A total of 40 users with different perspectives (clinicians, patient representatives, quality managers, purchasers, researchers) have been consulted. Results: The final framework is presented as the PROM-cycle that consists of eight steps in four phases: (1) goal setting, (2) selecting PROs and PROMs, (3) developing and testing of quality indicator(s), (4) implementing and evaluating the PROM(s) and indicator(s). Users emphasized that the first step is the key element in which the why, for whom and setting of the PROM has to be defined. This information is decisive for the following steps. For each step the PROM-cycle provides guidance and tools, with instruments, checklists, methods, handbooks, and standards supporting the process. Conclusion: We developed a framework to support the selection and implementation of PROs and PROMs. Each step provides guidance and tools to support the process. The PROM-cycle and its tools are publicly available and can be used by clinicians, quality managers, patient representatives and other experts involved in using PROMS. Through periodic evaluation and updates, tools will be added for national and international use of the PROM-cycle. [ABSTRACT FROM AUTHOR]

Introduction: Numerous scientific studies have established the necessity of a biopsychosocial (BPS) approach in the treatment of chronic pain, however, the implementation into clinical practice falls short. The aim of this study is to investigate the effectiveness of a BPS pain educational program for primary healthcare providers (PHCP) on changes in knowledge and attitude, and the guideline adherence. Methods: Within an implementation project of the Belgian Federal Government, a BPS pain educational program was developed based on recent scientific research, and barriers and facilitators formulated by an expert panel. 300 PHCP from various disciplines followed the course which contains two e-learning sessions and two one-day face-to-face trainings. Changes in knowledge and attitudes regarding chronic pain were measured using the KNowledge and Attitudes of Pain (KNAP). Guideline adherence was measured with two clinical case vignettes. Participants were measured pre-course, post-course and at a 6-month follow-up. The satisfaction of participants regarding the training and implementation into practice was measured during the course and at the follow-up. Results: A shift towards the biopsychosocial perspective that is in line with clinical guidelines is expected after completing the chronic pain course. Discussion: The pain course developed in the present study might increase the biopsychosocial perspective and guideline adherence of PHCP. Process evaluation: The selection of adequate evaluation tools to assess multidisciplinary groups was challenging. Furthermore, it remains to be established whether the improvements observed in knowledge and attitude questionnaires and the guideline adherence based on clinical vignettes reflect actual change in clinical practice. [ABSTRACT FROM AUTHOR]

Background: Asset-based approaches have become popular in public health. As yet it is not known to what extent health and welfare professionals are able to identify and mobilise individual and community health assets. Therefore, the aim of this study was to understand professional's perceptions of health and health assets.Methods: In a low-SES neighbourhood, 21 health and welfare professionals were interviewed about their definition of health and their perceptions of the residents' health status, assets available in the neighbourhood's environment, and the way residents use these assets. A Nominal Group Technique (NGT) session was conducted for member check. Verbatim transcripts of the semi-structured interviews were coded and analysed using Atlas.ti.Results: The professionals used a broad health concept, emphasizing the social dimension of health as most important. They discussed the poor health of residents, mentioning multiple health problems and unmet health needs. They provided many examples of behaviour that they considered unhealthy, in particular unhealthy diet and lack of exercise. Professionals considered the green physical environment, as well as health and social services, including their own services, as important health enhancing factors, whereas social and economic factors were considered as major barriers for good health. Poor housing and litter in public space were considered as barriers as well. According to the professionals, residents underutilized neighbourhood health assets. They emphasised the impact of poverty on the residents and their health. Moreover, they felt that residents were lacking individual capabilities to lead a healthy life. Although committed to the wellbeing of the residents, some professionals seemed almost discouraged by the (perceived) situation. They looked for practical solutions by developing group-based approaches and supporting residents' self-organisation.Conclusions: Our study shows, firstly, that professionals in the priority district Slotermeer rated the health of the residents as poor and their health behaviour as inadequate. They considered poverty and lack of education as important causes of this situation. Secondly, the professionals tended to talk about barriers in the neighbourhood rather than about neighbourhood health assets. As such, it seems challenging to implement asset-based approaches. However, the professionals, based on their own experiences, did perceive the development of collective approaches as a promising direction for future community health development. [ABSTRACT FROM AUTHOR]

Background: Health workforce projections are important instruments to prevent imbalances in the health workforce. For both the tenability and further development of these projections, it is important to evaluate the accuracy of workforce projections. In the Netherlands, health workforce projections have been done since 2000 to support health workforce planning. What is the accuracy of the techniques of these Dutch general practitioner workforce projections? Methods: We backtested the workforce projection model by comparing the ex-post projected number of general practitioners with the observed number of general practitioners between 1998 and 2011. Averages of historical data were used for all elements except for inflow in training. As the required training inflow is the key result of the workforce planning model, and has actually determined past adjustments of training inflow, the accuracy of the model was backtested using the observed training inflow and not an average of historical data to avoid the interference of past policy decisions. The accuracy of projections with different lengths of projection horizon and base period (on which the projections are based) was tested. Results: The workforce projection model underestimated the number of active Dutch general practitioners in most years. The mean absolute percentage errors range from 1.9% to 14.9%, with the projections being more accurate in more recent years. Furthermore, projections with a shorter projection horizon have a higher accuracy than those with a longer horizon. Unexpectedly, projections with a shorter base period have a higher accuracy than those with a longer base period. Conclusions: According to the results of the present study, forecasting the size of the future workforce did not become more difficult between 1998 and 2011, as we originally expected. Furthermore, the projections with a short projection horizon and a short base period are more accurate than projections with a longer projection horizon and base period. We can carefully conclude that health workforce projections can be made with data based on relatively short base periods, although detailed data are still required to monitor and evaluate the health workforce. [ABSTRACT FROM AUTHOR]

Background: To optimize home care, it is essential to determine how care recipients experience quality of care. Traditionally, quality of care is measured with normative quality indicators such as safety, efficiency, or prevalence rates such as falls. The growing interest for qualitative patient-reported experience measures in home care requires insight into the needs of care receivers, providers, and organizations as key-stakeholders. Each stakeholder has their own needs that are important to communicate and use to conduct thorough comparisons before implementing new experience measures. This study aims to understand the needs of clients, formal/informal caregivers, and managers/policy officers in measuring client's experienced quality of care in home care. Methods: Four focus group interviews and 25 semi-structured interviews with key-stakeholders were conducted and analyzed by means of content analysis. The value-proposition canvas was used as a thematic framework to explore the purpose of experience quality of care measures and related pains and gains. Results: There were two main purposes for measuring experienced quality of care: first improving the primary care process of individual clients and second for learning and improving in home care team. Using experienced quality of care measures for external accountability and transparency on an organizational or national level were considered less relevant. Among others, participants described not having time and no clear procedure for conducting an evaluation as a pain of the current methods used to evaluate perceived quality of home care. As gains they put forward the ability to informally evaluate experiences during care delivery and to openly discuss complaints with a familiar caregiver. Conclusions: This study advocates that home care organizations should be aware of the goal of quality of care measures. They should consider selecting experienced quality of care measures mainly for improving primary care processes of individual clients. The results also underline the relevance of adopting next to quantitative evaluations, more narrative evaluation methods which support communicating openly on care experiences, leading to concrete point-of-improvement. The findings of this study can serve as a guide for both the development or selection of adequate methods, from the perspectives of key-stakeholders, in assessing experienced quality in home care. [ABSTRACT FROM AUTHOR]