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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]

Background: Due to the rising number of acutely hospitalised older people in the coming years, there is increased interest in tailoring care to the individual goals and preferences of patients in order to reach patient‐centred care. Aims: To investigate the goals of older hospitalised patients and the extent to which these goals were reached during hospitalisation. Methods: A single‐centre prospective cohort study was performed in The Netherlands between December 2017 and January 2018. Participants aged 70 years or older were included. In the first 3 days of hospitalisation, a semi‐structured interview was conducted to assess the patient goals regarding the hospital admission. At 1−2 weeks after discharge, patients were asked to what extent the recent hospitalisation had contributed to reaching their goals. Results: One hundred and four patients were included and follow up was completed for 86 patients. The main goals reported at hospital admission were 'remaining alive' (72.1%), 'feeling better' (71.2%) and 'improving condition' (65.4%). Hospitalisation seemed to have a positive contribution to reaching the goals 'remaining alive', 'knowing what is wrong', 'feeling better', 'reducing pain' and 'controlling disease'. Hospitalisation seemed to contribute little to reaching the goals in the categories 'enjoying life', 'independency and freedom', 'improving daily functioning', 'hobbies and work' and 'social functioning'. Conclusions: It is important for healthcare professionals to know the goals of their patients. The majority of these goals were not achieved at hospital discharge. It is important to be aware of this, so sufficient aftercare can be arranged and patients can be prepared. [ABSTRACT FROM AUTHOR]

Currently, Europe is dealing with a large number of asylum seekers. A recent report show that attitudes toward asylum seekers are not that negative in the Netherlands, and yet Dutch citizens living close to asylum seeker centers barely have contact with them. Because contact is vital for a multicultural society, we investigated the facilitators and barriers for Dutch citizens to establish and maintain contact with asylum seekers where they live close together. We conducted semistructured interviews with Dutch people and analyzed them using thematic analysis. We found four themes: Physical possibilities for Contact, Goals for Contact, Social Identities, and Positivity and Openness, and proposed a grounded theory model based on how the themes are related. The findings are discussed in relation to debates on multiculturalism and intergroup tolerance, and can be used to improve the integration policies by local governments, because they present clear conditions and practical information as to how contact can be established and maintained. [ABSTRACT FROM AUTHOR]

Healthy eating can be challenging for type 2 diabetes mellitus (T2DM) patients. The theory of salutogenesis, which focuses on the resources required to organize behavioural changes in everyday life, was used to develop an intervention for healthy eating. The aim was to describe the development, structure and content of this salutogenic intervention. The development consisted of two phases that were based on the operationalization of important key principles of salutogenesis. In Phase 1 (Exploration and synthesis), a systematic review and three qualitative studies were performed to explore important characteristics to enable healthy eating in everyday life. The results were used to develop the draft intervention. In Phase 2 (Validation and adjustment), interviews and workshops were conducted with T2DM patients, healthcare providers and scientists. Based on this, the draft intervention was modified into its final form. The developmental process resulted in a 12-week, group-based intervention that aimed to enable important resources for healthy eating via self-examination, reflection, setting goals and sharing experiences. Attention was also paid to disease information, disease acceptance, food literacy, stress management, self-identity and social support. The group sessions began following an individual intake session, with a booster session held 3 months after the intervention. The researcher's translation of the stakeholders' priorities into an intervention was corrected for and approved by the stakeholders concerned. This comprehensive salutogenic intervention was developed based on practical and scientific evidence. Providing transparency in developmental processes and content is important because it determines the scientific integrity and credibility of an intervention. [ABSTRACT FROM AUTHOR]

Aim: To explore perceptions and preferences of children, parents, and physical therapists regarding the therapeutic alliance in pediatric physical therapy in a rehabilitation setting. Methods: Qualitative phenomenological analysis of interviews with children (n = 10), their parents (n = 10), and physical therapists (n = 10). Results: Three themes were identified: importance of trust in the physical therapist, transparency in sharing information, and negotiation concerning goals and tasks of treatment. Parents considered trust in the therapist's relational skills of greater importance to the therapeutic alliance than the therapist's technical skills. Although the physical therapists showed a strong willingness to meet the needs of children and parents, they seemed unaware of the emotional impact of positional inequality and the differences in roles and tasks of children, parents, and therapists during the treatment. Conclusion: All participants emphasized the importance of the quality of the therapeutic alliance. Nevertheless, positional inequality and differences in roles and tasks appeared to influence negotiation about goals and tasks of treatment. Children and parents are in a dependent relationship with the physical therapist. Physical therapists are challenged to find the right balance between their professional position and input on the one hand, and the emotional needs of child and parents on the other hand. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to focus on the denial of social support to homeless persons and related societal effects of new local governance arrangements. Design/methodology/approach: Analysis of new data and secondary evaluative and comparative data on the policies, administrative structures and management styles of Copenhagen, Glasgow and Amsterdam have brought better understanding of the elements of local governance arrangements that influence the number of homeless persons who are denied access to services and the number of persons sleeping rough who are not eligible for social support. Theoretical explanations for the impact of governance arrangements on these processes and societal effects are considered. Findings: It appears that while the body of research, reports and policy documents on non-eligibility for homelessness services is growing, legal responses at best remain vague, and policies are still in the process of being developed. Modest progress on policy goals, and even more so on policy instruments, leading to less detrimental outcomes, can be explained by centralising and decentralising trends and the relationships between state and society. The latter may also be indicative of how the increased focus on the legal problems of some EU migrants can be explained. Research limitations/implications: The two points in time documented for the case studies are relevant in understanding processes underlying the current circumstances of homeless persons and homeless migrants and offer an interdisciplinary insight into governance and politics, law, and public and health service perspectives. Social implications: Good policy practice, as this paper shows, can lead to a difference in individual lives. Originality/value: Much is unknown about considerations inside government. This paper contributes by combining theoretical and insider perspectives. [ABSTRACT FROM AUTHOR]

Objective: To characterize how rehabilitation goals of older patients change over time and to explore professionals' attitudes toward patient-centered goal-setting and their perspectives on rehabilitation goals. Design: Qualitative interview study. Setting: Three geriatric rehabilitation centers. Subjects: Ten patients (aged ⩾ 80), who had recently received inpatient geriatric rehabilitation, and seven professionals were purposively recruited. Methods: Semi-structured interviews. Patients were interviewed in the third or fourth week after discharge from inpatient rehabilitation, to reflect on their inpatient goals and to investigate long-term goals now that they were at home. A thematic analysis was performed. Results: During inpatient rehabilitation, participants' main goals were regaining independence in self-care activities and going home. Post-discharge, patients were not at their baseline functioning level. Rehabilitation goals appeared to shift over time, and once at home, patients formulated more ambitious rehabilitation goals that were related to regaining full independence and being able to perform activities. Although professionals thought goal-setting together with the patient is important, they also stated that older individuals often are either unable to formulate goals or they set unrealistic ones. In addition, professionals indicated that goals have to be related to discharge criteria, such as performing basic self-care activities, and rehabilitation revolves around getting patients ready for discharge. Conclusion: During inpatient rehabilitation, patient goals are related to going home. After discharge, patients have ambitious goals, related to their premorbid functioning level. Rehabilitation services should distinguish between goals that are important while patients are inpatient and goals that are important after discharge. [ABSTRACT FROM AUTHOR]

Objectives: Effective goal management may potentially prevent or reduce disability in chronic pain. The aim of this study was to gain insight into the nature of goal management in the context of chronic headache (CH). Methods: Interviews with 20 patients were conducted, coded, and analyzed using a combined data-driven and theory-driven approach. The dual process model (DPM) was used as a theoretical framework for this study. Results: Participants used a combination of strategies to regain and maintain a balance between personal goals and resources available for goal pursuit. Furthermore, their retrospective reports indicated a development in strategy use of time. Three goal management phases were identified: (1) a “persistence phase,” characterized by the use of “resource-depleting” assimilative strategies to remain engaged in goals, (2) a “reorientation phase” in accommodative strategies were used to regain balance, and (3) a “balancing phase” in which a combination of “resource-depleting” and “resource-replenishing” assimilative strategies was used to maintain balance. Conclusions: Goal management is a dynamic process that may contribute to the development of, and recovery from, headache-related disability. Rehabilitation services offered to individuals with CH should target this process to promote optimal functioning. Implications for Rehabilitation: Individuals with chronic headache use assimilative and accommodative goal management strategies to be able to pursue personal goals despite the limitations of chronic headache. Before accommodating goals to the limitations of chronic headache, many patients go through a phase of persistence, characterized by the use of resource-depleting assimilative strategies. A reorientation phase, characterized by accommodation of goals to the limitations of chronic headache, allows patients to adopt a more balanced way of pursuing personal goals. [ABSTRACT FROM AUTHOR]

Purpose: To deliver client-centered care, physiotherapists need to identify the patients’ individual treatment goals. However, practical tools for involving patients in goal setting are lacking. The purpose of this study was to improve the frequently used Patient-Specific Complaints instrument in Dutch physiotherapy, and to develop it into a feasible method to improve physiotherapy goal setting. Methods: An iterative user-centered design was conducted in co-creation with the physiotherapists and patients, in three phases. Their needs and preferences were identified by means of group meetings and questionnaires. The new method was tested in several field tests in physiotherapy practices. Results: Four main objectives for improvement were formulated: clear instructions for the administration procedure, targeted use across the physiotherapy process, client-activating communication skills, and a client-centered attitude of the physiotherapist. A theoretical goal-setting framework and elements of shared decision making were integrated into the new-called, Patient-Specific Goal-setting method, together with a practical training course. Conclusions: The user-centered approach resulted in a goal-setting method that is fully integrated in the physiotherapy process. The new goal-setting method contributes to a more structured approach to goal setting and enables patient participation and goal-oriented physiotherapy. Before large-scale implementation, its feasibility in physiotherapy practice needs to be investigated. Implications for rehabilitation: Involving patients and physiotherapists in the development and testing of a goal-setting method, increases the likelihood of its feasibility in practice. The integration of a goal-setting method into the physiotherapy process offers the opportunity to focus more fully on the patient’s goals. Patients should be informed about the aim of every step of the goal-setting process in order to increase their awareness and involvement. Training physiotherapists to use a patient-specific method for goal setting is crucial for a correct application. [ABSTRACT FROM AUTHOR]

This study addresses the question to what extent frontline managers’ people management activities contribute to mission achievement through frontline workers’ behaviors. Drawing on the case of elderly care, we contribute to the literature by: (1) providing a compact measure of mission achievement in elderly care and specifying the requisite employee behaviors; and (2) showing that frontline managers’ people management activities impact on employees’ behaviors, and ultimately on mission achievement. In doing so, we also contribute to more knowledge about elderly care, which is an under-researched sector, and about the role of line managers (instead of top managers) in HRM implementation. [ABSTRACT FROM AUTHOR]

Abstract: Background: To meet the challenge of multimorbidity in decision making, a switch from a disease‐oriented to a goal‐oriented approach could be beneficial for patients and clinicians. More insight about the concept and the implementation of this approach in clinical practice is needed. Objective: This study aimed to develop conceptual descriptions of goal‐oriented care by examining the perspectives of general practitioners (GPs) and clinical geriatricians (CGs), and how the concept relates to collaborative communication and shared decision making with elderly patients with multimorbidity. Method: Qualitative interviews with GPs and CGs were conducted and analyzed using thematic analysis. Results: Clinicians distinguished disease‐ or symptom‐specific goals, functional goals and a new type of goals, which we labelled as fundamental goals. “Fundamental goals” are goals specifying patient's priorities in life, related to their values and core relationships. These fundamental goals can be considered implicitly or explicitly in decision making or can be ignored. Reasons to explicate goals are the potential mismatch between medical standards and patient preferences and the need to know individual patient values in case of multimorbidity, including the management in acute situations. Conclusion: Based on the perspectives of clinicians, we expanded the concept of goal‐oriented care by identifying a three‐level goal hierarchy. This model could facilitate collaborative goal‐setting for patients with multiple long‐term conditions in clinical practice. Future research is needed to refine and validate this model and to provide specific guidance for medical training and practice. [ABSTRACT FROM AUTHOR]

This paper describes the development of a Dutch online programme called Long Live Love+ focusing on positive, coercion-free relationships, contraception use, and the prevention of STIs, using the Intervention Mapping (IM) approach. All six steps of the approach were followed. Step 1 confirmed the need for a sexual health programme targeting young people aged 15 and over enrolled in higher level secondary education. Step 2 resulted in the production of a series of matrices-of-changes, including detailed programme objectives at the behavioural and the psycho-social level. Step 3 involved the selection of relevant methods and applications. Step 4 consisted of programme development, resulting in a sexual health programme with online and offline components, and including interactive exercises. Step 5 focused on adoption and implementation and included the production of a detailed teacher manual. Step 6 involved detailed planning for the process and effect evaluation and included interviews with teachers and focus group discussions with students to evaluate their experiences of the programme. The inclusion of a linkage group – and especially the inclusion of teachers in the development of the programme – turned out to be essential in terms of developing a programme in line with their context and needs. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the study was to develop a whole medical system healthcare program as an alternative for group-oriented guidelines and as a basis for future studies on safety and (cost) effects. Mild to moderately severe depressive disorders were chosen as an illustrative example. Design: Literature surveys, monodisciplinary expert interviews, and multidisciplinary panel discussions were employed to describe the whole medical system, its important elements, and the way the important elements are integrated in daily practice. Results: The treatment of depressive disorders consists of four separate treatment phases in which 10 specific treatment goals are identified. Different disciplines may contribute to each goal. This gives an opportunity for the individualization of care. Within each discipline multiple options per goal are identified which leads to additional possibilities to individualize care. Conclusions: Individualized healthcare for patients with mild to moderately severe depressive disorders can be described in terms of treatment goals and treatment options to allow for personalization. The program may serve as the basis for future measurement of quality, cost effectiveness, and safety of provided care. [ABSTRACT FROM AUTHOR]

BACKGROUND: Play is essential for children's development. Children with severe physical disabilities often experience problems engaging in play. In rehabilitation and special education for children with physical disabilities play-like activities and play for play's sake are important. OBJECTIVE: The current study aimed at examining the possibilities of using the IROMEC robot in rehabilitation and special education for children with severe physical disabilities. METHODS: A mixed methods approach, using individual interviews, two rounds of focus group interviews, a questionnaire and a final session to reach consensus, was used to examine the match between the goals in therapy and special education and the IROMEC robot. RESULTS: The existing play scenarios of IROMEC have the potential to support play for children with severe physical disabilities, especially in the domains of movement functions, learning and applying knowledge, communication/interpersonal interactions and relationships, and play. CONCLUSIONS: The current study helped to build a body of evidence to the possibilities of the IROMEC robot. The results of this study can be used to further develop meaningful robotic play interventions for children with severe physical disabilities. [ABSTRACT FROM AUTHOR]

Very little is known about the personal goals of homeless people and how these relate to their quality of life (QoL). By using survey data on 407 homeless adults upon entry to the social relief system in 2011, we examined the personal goals of homeless adults and the association between their perceived goal-related self-efficacy and their QoL. A hierarchical regression analysis was used to analyse the association between QoL and goal-related self-efficacy, relative to factors contributing to QoL, such as demographic characteristics, socioeconomic resources, health and service use. Results indicate that the majority of homeless adults had at least one personal goal for the coming 6 months and that most goals concerned housing and daily life (94.3%) and finances (83.6%). The QoL of homeless adults appeared to be lower in comparison with general population samples. General goal-related self-efficacy was positively related to QoL ( β = 0.09, P = 0.042), independent of socioeconomic resources (i.e. income and housing), health and service use. The strongest predictors of QoL were psychological distress ( β = −0.45, P < 0.001), income ( β = 0.14, P = 0.002) and being institutionalised ( β = 0.12, P = 0.004). In conclusion, the majority of homeless adults entering the social relief system have personal goals regarding socioeconomic resources and their goal-related self-efficacy is positively related to QoL. It is therefore important to take the personal goals of homeless people as the starting point of integrated service programmes and to promote their goal-related self-efficacy by strength-based interventions. [ABSTRACT FROM AUTHOR]

Process evaluations of newly developed interventions are necessary to identify effective and less effective intervention components. First aim of this study was to identify key components of a psychosocial goal management intervention from the perspective of participants, and second aim was to evaluate the intervention’s fidelity. A mixed-methods approach was applied to 24 interviews with participants post-intervention and 16 audio recordings of random training sessions. Participants experienced three key components: (1) the content, in which specific exercises helped to raise awareness and (intention to) change goal management behaviour, (2) person-focused approach, specifically, the nurse as trainer and personal fit of the approach, and (3) social mechanisms, including facilitating group processes and interpersonal processes. Adherence to the protocol by the trainers was high, while differences were found in the degree to which they were able to apply the intended collaborative approach and psychological communication skills. The applied design provided valuable insights into the processes that took place. Both the effects experienced by participants in relationship to the content, approach and social mechanisms as well as the strengths and weaknesses found with regard to fidelity provide insights that can inform the development and implementation of person-focused interventions. [ABSTRACT FROM AUTHOR]

Background There is a wide gap between knowledge about palliative care and its application in everyday clinical practice, affecting many patients in our ageing population. However, changing health care practice is a complex and challenging process. Therefore, the EU funded IMplementation of quality indicators in PAlliative Care sTudy (IMPACT) project aims to develop optimal implementation strategies to improve the organization of palliative care for people with cancer or with dementia in Europe. Methods and design The organization of palliative care in Europe will be mapped to develop and prepare strategies to improve it, and an overview of barriers and incentives regarding successful organizational changes in palliative care will be undertaken. A pre-test with a set of quality indicators (QIs), developed within the project, will be used to identify aspects of the organization of palliative care requiring change in hospitals, nursing homes, hospices, and primary care in five European countries. Based on the results of the pre-test, each setting will be invited to prioritise and improve aspects of their organization that appeared weak. The improvement objective they choose will be tailored to national and setting-specific barriers. Finally, a post-test with the same QIs will determine the effectiveness of the strategies used. An extensive process analysis will be conducted throughout the entire study. Discussion It is expected that the IMPACT project will provide professionals and policy makers useful tools to facilitate effective implementation of high-quality palliative cancer and dementia care in different settings in Europe. [ABSTRACT FROM AUTHOR]

Introduction Overweight and obesity are associated with an increased risk of morbidity. Mindfulness training could be an effective strategy to optimize lifestyle behaviors related to body weight gain. The aim of this study was to evaluate the effectiveness of a worksite mindfulness-based multi-component intervention on vigorous physical activity in leisure time, sedentary behavior at work, fruit intake and determinants of these behaviors. The control group received information on existing lifestyle behavior- related facilities that were already available at the worksite. Methods In a randomized controlled trial design (n = 257), 129 workers received a mindfulness training, followed by e-coaching, lunch walking routes and fruit. Outcome measures were assessed at baseline and after 6 and 12 months using questionnaires. Physical activity was also measured using accelerometers. Effects were analyzed using linear mixed effect models according to the intention-to-treat principle. Linear regression models (complete case analyses) were used as sensitivity analyses. Results There were no significant differences in lifestyle behaviors and determinants of these behaviors between the intervention and control group after 6 or 12 months. The sensitivity analyses showed effect modification for gender in sedentary behavior at work at 6-month follow-up, although the main analyses did not. Conclusions This study did not show an effect of a worksite mindfulness-based multi-component intervention on lifestyle behaviors and behavioral determinants after 6 and 12 months. The effectiveness of a worksite mindfulness-based multi-component intervention as a health promotion intervention for all workers could not be established. [ABSTRACT FROM AUTHOR]

Introduction: Recent changes in postgraduate medical training curricula usually encompass a shift towards more formative assessment, or assessment for learning. However, though theoretically well suited to postgraduate training, evidence is emerging that engaging in formative assessment in daily clinical practice is complex. Aim: We aimed to explore trainees' and supervisors' perceptions of what factors determine active engagement in formative assessment. Methods: Focus group study with postgraduate trainees and supervisors in obstetrics and gynaecology. Results: Three higher order themes emerged: individual perspectives on feedback, supportiveness of the learning environment and the credibility of feedback and/or feedback giver. Conclusion: Engaging in formative assessment with a genuine impact on learning is complex and quite a challenge to both trainees and supervisors. Individual perspectives on feedback, a supportive learning environment and credibility of feedback are all important in this process. Every one of these should be taken into account when the utility of formative assessment in postgraduate medical training is evaluated. [ABSTRACT FROM AUTHOR]

Background:In pediatrics, the “best interest” standard has become the prevailing standard in decision making even though it proves difficult to apply in practice. Differences in values can lead to different views by families and physicians of what is in the interest of a child. Our aim was to gain insight into the views of parents, children, and physicians in a pediatric oncology setting.Methods: We conducted a qualitative multicenter study, using in-depth semistructured interviews, with 21 children aged 8–18 years undergoing cancer treatment, 26 parents, and 15 pediatric oncologists.Results: At the onset of treatment, parents, children, and physicians had the same views on what is in the interest of the child: survival by following the treatment protocol. In the course of treatment, however, a transition takes place. For families, what constitutes the best interests expands beyond medical considerations, to include the wish to lead a normal life, having control over certain aspects of treatment, and maintaining one's identity (e.g., through religion). These aspects sometimes collide with medical aspects, leading to different professional and familial views about what course of action is appropriate.Conclusions: In order to recognize personal views and avoid conflicts, physicians should explicitly discuss parent and family concerns and opinions in the course of treatment. We present a model of “communicative ethics” to make these issues a subject of discussion. The role of the family in determining what is in the best interest of the child should only be limited when it implies a substantial medical risk of (irreversible) harm to the child. [ABSTRACT FROM PUBLISHER]

Background Solution-focused coaching ( SFC) helps individuals or groups to achieve their preferred outcomes by evoking and co-constructing solutions. SFC has been shown to be helpful for persons with ID as well as for teams coaching people with ID. Nominal Group Technique ( NGT) helps to organize people's thoughts with regard to a single question. This study examines the perceived strengths of and recommendations for SFC for teams coaching people with ID via NGT, as well as the extent to which the NGT results reflect the results of an SFC questionnaire. Methods In total, 54 staff members participated in SFC. Of these, 18 participated in NGT, while 36 completed the SFC questionnaire. The strengths of and recommendations for SFC were obtained via NGT. Interrater agreement was calculated via Cohen's kappa. Results The strengths of SFC include 'exploring hidden successes' and 'focusing on solutions'. It was recommended that 'the results be consolidated in follow-up meetings'. The participants agreed on the content of the strengths and recommendations, but differed in terms of priorities (κ ≤ 0.1). Conclusions NGT is a valuable tool in exploring people's opinions and priorities, but further research is needed to elucidate the perceived priorities of SFC for teams coaching persons with ID. [ABSTRACT FROM AUTHOR]

While active participation is regarded essential in health promotion worldwide, its application proves to be challenging. Notably, participants' experiences are infrequently studied, and it is largely unknown why lay citizens would want to play an active role in promoting the health of the community they belong to. Aiming to produce practical insights to further the application of the participation principle, this qualitative study examined participants' driving motives in a diverse array of health promotion undertakings. Six projects in The Netherlands were used as case studies, including a community-project promoting mental health, peer education against harmful substance use, a health support group, health policy development, physical activity and healthy life style courses. The study involved 24 participants, who played a variety of active roles. Semi-structured interviews were conducted, transcribed verbatim and subjected to content analysis. We found four main motives driving lay citizens in their active participation in health promotion projects: ‘purposeful action’, ‘personal development’, ‘exemplary status’ and ‘service and reciprocity’. The motives reflected crucially distinct personal desires in the participation process, namely to produce tangible results, to experience advancements for oneself, to gain personal recognition as a role model and to have or maintain valued relationships. The implications of the findings are discussed for researchers and professionals in health promotion. [ABSTRACT FROM AUTHOR]

Nationwide health promotion campaigns are an important part of government-funded health promotion efforts. Valid evaluation is important, but difficult because gold standard research designs are not applicable and the allocation of budget and time for evaluation is often very tight. In the Netherlands, Health Promotion Institutes (HPIs) are responsible for these campaigns. We conducted an exploratory study among the HPIs to gain better insight into goals, practices, conditions and perceived barriers regarding evaluation of these campaigns. Data were obtained through personal interviews with representatives of HPIs who had direct management responsibility for the evaluation of their campaigns. The HPIs typically made use of a pre-test–post-test design with single measurements before and after the campaign without a control group. In campaign preparations, HPIs used qualitative research to pre- and pilot-test some campaign materials, but true formative evaluation was rare. Besides, accountability to their sponsors, peers and the population at large, the most important reason to evaluate was to learn for future campaigns. In terms of the RE-AIM framework, evaluation was mostly restricted to Reach and Effects; hardly any evaluation of adoption, implementation or maintenance was reported. Budget and time constraints were reported as the main barriers for more extensive formative and effect evaluation. Evaluation of nationwide campaigns is standard procedure, but the applied research designs are weak, due to lack of time, budget and research methodology expertise. Next to additional budget and a longer-term planning, input from external experts regarding evaluation research designs are needed for evaluation improvement. [ABSTRACT FROM AUTHOR]

Background: In 2010, a shelter programme was established in the Netherlands to provide social and health services for trafficked people. This article describes how service users in this programme conceptualized and experienced their own process of recovery. Methods: In 2012, 14 people of non-Dutch nationality who had been trafficked for the purpose of sexual exploitation were interviewed at all three shelters of the programme. Data analysis followed a grounded theory approach. Results: Participants felt a strong need to turn over a new leaf in life, leaving negative experiences of the past behind and moving towards a life with a job, a family and friends. In contrast with their willingness to work towards realizing that future, they experienced a lack of autonomy and a thwarted sense of agency in redressing their present situation. Together with the ostracized nature of their place in Dutch society this left them 'in limbo': a feeling of standing still, while wanting to move forward. This led participants to find it more difficult to deal with problems related to their pasts and futures. They particularly appreciated Dutch language training, vocational skills training and opportunities for volunteer work. Conclusions: Participants exhibited a strong desire to fulfil the basic psychological needs of competence, relatedness and autonomy, but were thwarted in pursuing these goals. Seemingly against all odds, while faced with several external regulators that limited their agency to change their situation, participants found ways to pursue these goals, through their enthusiasm for activities that helped them get closer to their envisioned futures (language and skills training and volunteer work). Identifying pathways toward attaining their goals allowed them to hope for a better future. That hope and pursuing their goals helped them to cope with the problems of their past and their worries about the future. Therefore, to facilitate service users' recovery in a post-trafficking setting, there is a need to provide them with opportunities to hope for, pursue and attain their personal goals within the structural boundaries of their situation. A future-orientated, strengths-based approach towards service provision and responsive and supportive environments help to do this. [ABSTRACT FROM AUTHOR]

Hope is important for individuals with cancer in palliative care. Health professionals' perspective on hope affects the communication with palliative patients. The aim of this study was to explore how Dutch health professionals deal with palliative patients with cancer who hope for prolongation of life. Focus group discussions (FGD) were conducted. An interpretive description approach was used to understand the interpretation of and reaction to hopefulness in palliative patients with cancer by health professionals. Three FGDs were held, each consisting of five to ten health professionals working with palliative patients recruited in a general Dutch hospital and homecare organisation. The ways in which the participating health professionals interpret hope in palliative individuals with cancer and their behaviour towards these hopeful palliative patients are shaped by their reliance on their own normative ideas. Patients' hopefulness generally violates these norms and is, therefore, considered a problem that requires intervention. Hope that does not correspond with the medical facts is experienced as problematic by Dutch health professionals who therefore believe they should intervene and do something about it. Health professionals are challenged to face and address patients' and families' perceptions of hope, especially when those perceptions might differ from their own as professionals. [ABSTRACT FROM AUTHOR]