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Background: The use of urban green spaces differs by social characteristics, including gender, ethnicity, and socioeconomic position. We examined motives, means and prerequisites to visit green space of marginalised populations with high cardiometabolic risk in the Netherlands, namely women with a Turkish or South Asian Surinamese background residing in disadvantaged neighbourhoods. Methods: We conducted six focus group discussions in two Dutch cities. The study was performed in collaboration with social workers from the local communities with similar ethnic backgrounds as the participants. A thematic analysis was carried out. Results: Sixteen Turkish women and 30 South Asian Surinamese women participated. Motives, means and prerequisites that emerged covered four themes: social, personal, environmental characteristics and undertaking activities. Socializing was an important motive to visit green space. Personal motives mainly consisted of positive effects on mental and physical well-being. Activities undertaken in green space were often a means to socialize or improve well-being. Many environmental factors, including safety, aesthetics, and (sanitary) facilities, influenced motivation to visit green space. Except for environmental characteristics, motives, means and prerequisites largely overlapped between ethnic groups. There were notable interactions between the themes. Conclusion: Motives, means and prerequisites to visit green space of women with a Turkish or South Asian Surinamese background who live in disadvantaged neighborhoods span multiple interacting themes. Future studies examining the relationship between green space and health should consider interactions between motives, means, prerequisites and ethnicity. The possibility of expanding the multifunctionality of green spaces to provide marginalized populations with more equitable access and activities should be further explored. [ABSTRACT FROM AUTHOR]

Previous research highlighted the interpersonal benefits of self‐control in professional contexts: People prefer high self‐control individuals as work or study partners and expect them to perform better than low self‐control individuals. We show that these benefits of self‐control reverse in the artistic domain. Results of one pilot study and five preregistered online experiments (N = 1644) reveal that artists with high (vs. low) self‐control are perceived as less creative. This effect replicates across various artistic domains (visual art, music, poetry, screenwriting), holds for both male and female artists and can be explained by perceptions of lower experiential processing, which is considered indispensable for creativity. However, art created by high (vs. low) self‐control artists is ascribed higher market value due to stronger attributions of productivity. These findings provide novel insights into the social perception of self‐control and contribute to the understudied topic of the downsides of self‐control as well as to the literature on lay theories of creativity. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this explorative, qualitative study is to identify factors that potentially influence the execution of physical fitness training in inpatient orthopedic geriatric rehabilitation (GR), from the perspectives of patients, their relatives and professionals. Materials and methods: In GR wards of skilled nursing facilities in the Netherlands, semi-structured interviews were held with triads of patients, their relatives and responsible nurses, and focus groups with members of the multidisciplinary teams. Verbatim reports were analyzed according to the framework method. Results: We found twelve categories of barriers and facilitators related to characteristics of the patients, their family, staff, training program and organization. Conclusions: The barriers and facilitators found largely correspond with those found for participation in exercise in related settings, but also show important differences. This overview of barriers and facilitators enables multidisciplinary teams to design improvements at the level of the organization and interventions, as well as at the level of the individual training program, tailoring it to the patient's circumstances and needs. Further research should focus on weighing these barriers and facilitators to develop a feasible guidance for daily practice, as well as testing their effect on the adherence to existing physical fitness training guidelines. IMPLICATIONS FOR REHABILITATION: Physical fitness training is important in reaching functional goals in orthopedic geriatric rehabilitation. Practicing outside of therapy can be stimulated by clarity about expectations, proper training equipment and tailored stimulation/assistance. Training volume and intensity should meet the guidelines, but be tailored to the patient. Characteristics of the program, staff and organization need to be considered as they impact the physical fitness training. [ABSTRACT FROM AUTHOR]

The Internet offers an alternative context in which personal experiences with sexual violence can be shared. It has been suggested that victims experience lower barriers to disclosing their stories in a digital environment due to an online disinhibition effect and mainly anonymity. However, little is known about the lived experiences of victims who have shared their experiences online regarding these disinhibiting affordances of the Internet. Twenty-three interviews with victims were conducted to understand the digital affordances involved in the online disclosure of sexual victimization. The results suggest that the Internet offers several opportunities (visibility management, asynchronicity, and connectivity) and constraints (lack of non-verbal communication, disclosing online is irreversible, and Internet as a source of triggers) when disclosing sexual violence victimization online. We learn that disclosures are informed by previous experiences and weighed against digital affordances. Victims use multiple platforms or multiple accounts on the same platform and manipulate anonymity and visibility through the settings of online platforms. The Internet offers a potential for informal online peer support. The results have practical implications for victims, clinicians, and support providers for guiding the disclosure process. Furthermore, a re-evaluation and nuance of the online disinhibition theory is suggested. Suggestions for future research are made. [ABSTRACT FROM AUTHOR]

Objective: Substance use disorders (SUDs) and sex work often co-occur. Possibly, this relationship can be understood by studying personality dimensions and psychological traumas. The aim of this research is to study the role of personality and traumas in sex work and co-occurring SUD. Method: In the present study, focusing on females, drugs use disorder patients not active as sex workers (DUD+/SW−), sex workers not suffering from drug use disorders (DUD−/SW+), sex workers with a drug use disorder (DUD+/SW+) and controls (DUD−/SW−) were compared regarding the personality dimensions Novelty Seeking, Harm Avoidance, and the psychological trauma variable "total level of experienced trauma," and several specific trauma variables. Results: Although Harm Avoidance turned out to be related to DUD, neither Novelty Seeking nor Harm Avoidance could explain the co-occurrence of DUD and sex work. Experienced trauma was more straightforwardly associated with both DUD and sex work. Both DUD and sex work were associated with trauma, with the DUD+/SW+ group showing the highest levels of experienced trauma. Conclusions: Trauma plays an important role in not only DUD and sex work separately, but also in the co-occurrence of DUD and sex work. [ABSTRACT FROM AUTHOR]

Purpose: To identify Capabilities, Opportunities, and Motivational factors influencing movement behaviour throughout the day in people with stroke who are highly sedentary and inactive to enable intervention development. Methods: A qualitative study was conducted using semistructured interviews with people with stroke. The interview guide was based on the Capabilities, Opportunities, and Motivation Behavioural model. Results: Eleven interviews were conducted. Participants reported a lack of knowledge regarding healthy movement behaviour patterns, a lack of insight into their own movement behaviour, and some physical and cognitive limitations to engage in certain physical activities. Several social and environmental elements affecting movement behaviours were mentioned, their impact on movement behaviour varied among participants. Movement behaviour was mostly driven by habits and daily routine, without conscious regulation. Conclusion: Our findings show that people with stroke are unaware of their own movement behaviour or of the consequences of these behaviours on health. Movement behaviour is, for the most part, based on daily routine and personal habits. This indicates the need for a behaviour change intervention. Such interventions will need to include providing information about healthy movement behaviour, feedback on individual's movement behaviour and individualized support, taking into account the social and environmental context and personal capabilities. Implications for Rehabilitation: There is a need to provide insight and feedback regarding individuals' movement behaviour and information about healthy movement behaviour to enable people with stroke who are highly sedentary and inactive to improve their movement behaviour. Movement behaviour is, for the most part, based on daily routine and personal habits. People need individualised support, and personal capabilities, the social and environmental context need to be taken into account to support sustainable movement behaviour change. These findings can be used in clinical practise and to inform intervention development to support movement behaviour change in people after stroke who are highly sedentary and inactive. [ABSTRACT FROM AUTHOR]

Healthcare organizations worldwide face challenges in retaining their healthcare workforce, with individual and organizational factors influencing their intentions to leave. This study conducted eight online co-creation workshops and four Delphi sessions to gain qualitative and in-depth insights into job retention interventions, involving healthcare workers, hospital managers, and policymakers. A thematic analysis was conducted, resulting in multiple interventions that were clustered in four pre-defined themes: professional and personal support, education, financial incentives, and regulatory measures. Professional and personal support interventions included regular interprofessional team meetings, leadership training programs, self-scheduling and sabbaticals, support for administrative and non-clinical work, and the provision of psychological counselling. Educational interventions encompassed facilitating development opportunities, periodic evaluations, onboarding, mentorship programs, and peer support groups. Financial incentives included the provision of competitive salaries, adequate infrastructure, extra benefits, transport possibilities, and permanent employment contracts. Regulatory measures addressed the need for complementary legislation across various levels, fixed healthcare worker-to-patient ratio, and instruments to monitor workload. To optimize retention strategies, healthcare organizations should tailor these interventions to address the unique factors influencing their workforce's intentions to leave within their specific context. The study concludes that combining personal and professional support, educational opportunities, financial incentives, and regulatory measures is necessary because there is no one-size-fits-all solution. [ABSTRACT FROM AUTHOR]

Background: Community nurses (CNs) play an important role in supporting healthy lifestyles, including healthy eating behaviour of patients. However, many CNs do not incorporate healthy eating support in their daily routines to the fullest extent possible. This study aimed to explore (1) the associations between nurse-related behavioural determinants and self-reported healthy eating support practices of Dutch CNs and (2) CNs' need for additional knowledge. Methods: In this cross-sectional survey design, 244 Dutch CNs completed an online, self-administered questionnaire in October-November 2021. The 60 questionnaire items were related to CNs' characteristics, nurse-related determinants, healthy eating support practices (observing problems, having a conversation about patients' dietary behaviour, motivating patients to eat and drink healthier and supporting patients in goal setting) and the need for additional knowledge. The items on determinants and practices used a 5-point Likert scale. Adjusted prevalence ratios (PRadjusted) with 95% confidence intervals (95%CIs) were obtained for the associations between determinants and practices, using adjusted Poisson regression with robust variance estimations. Results: More CNs practiced observing problems (75%) and having a conversation (70%) than did motivating patients (45%) and supporting goal setting (28%) at least often. A more positive attitude (PRadjusted 1.8; 95%CI 1.5–2.2), greater self-efficacy (PRadjusted 1.3; 95%CI 1.1–1.5), greater motivation (PRadjusted 1.5; 95%CI 1.3–1.7) and better abilities (PRadjusted 1.4; 95%CI 1.2–1.6) were associated with a greater prevalence of supporting healthy eating at least often (vs. never to sometimes). Barriers were not associated with healthy eating support (PRadjusted 1.1; 95%CI 1.0-1.2). CNs especially desired more knowledge on diet in relation to cancer, gastrointestinal diseases, severe psychiatric diseases and dementia; methods for motivating patients to start and for supporting patients to sustain healthy eating; and dealing with patient autonomy. Conclusions: This study suggests that nurse-related behavioural determinants such as attitude, self-efficacy, motivation and ability should be addressed to improve CNs' competences in healthy eating support. In addition, based on self-reported need for additional knowledge, it is recommended to pay attention to evidence-based behaviour change techniques, dealing with patient autonomy, and diet in relation to cancer, gastrointestinal diseases, severe psychiatric diseases and dementia. Reporting method: The STROBE Statement was followed for reporting. [ABSTRACT FROM AUTHOR]

Purpose: Language Impairment Testing in Multilingual Settings (LITMUS) instruments were developed to improve the identification of developmental language disorders in multilingual children. The current study investigated the usability and feasibility of the online Dutch version of several of these instruments (LITMUS-NL) according to speech-language pathologists (SLPs), thereby taking the first steps toward implementation in clinical practice. Method: We first conducted a usability study in which 24 SLPs performed the LITMUS-NL tests while using a think-aloud protocol. They subsequently filled out a questionnaire to investigate the degree of usability and added value of LITMUS-NL. After adapting LITMUS-NL based on the results of the usability study, a feasibility study was carried out in which 25 other SLPs each used LITMUS-NL with three multilingual children. Afterward, they completed a feasibility questionnaire and questionnaires about the reactions of the children. Results: In the first study, many usability issues emerged, mainly concerning technical problems, instructions, and test construction. Despite these issues, the SLPs evaluated the degree of usability and added value as positive. The feasibility study revealed a lower degree of usability and, despite the adaptations, feasibility issues in the same categories. Conclusions: By involving the intended users in the process toward implementing a new product, we identified (and solved) many issues that would interfere with successful implementation in daily clinical practice. A systematic, iterative approach toward implementation helps identify what is deemed important by the intended users of a new product and bridges the gap between research and practice. [ABSTRACT FROM AUTHOR]

Purpose: This focus group study aimed to explore experiences and perceptions on post-stroke fatigue guidance in Dutch rehabilitation and follow-up care among people/patients with stroke and health professionals. Methods: Ten persons with stroke and twelve health professionals with different professions within stroke rehabilitation or follow-up care in the Netherlands were purposively sampled and included. Eight online focus group interviews were conducted. We analysed the data using reflexive thematic analysis. Results: Three themes were identified. Guidance in fatigue management did not always match the needs of people/patients with stroke. Professionals were positive about the provided fatigue guidance (e.g. advice on activity pacing), but found it could be better tailored to the situation of people/patients with stroke. Professionals believe the right time for post-stroke fatigue guidance is when people/patients with stroke are motivated to change physical activity behaviour to manage fatigue – mostly several months after stroke – while people/patients with stroke preferred information on post-stroke fatigue well before discharge. Follow-up care and suggestions for improvement described that follow-up support after rehabilitation by a stroke coach is not implemented nationwide, while people/patients with stroke and professionals expressed a need for it. Conclusions: The study findings will help guide improvement of fatigue guidance in stroke rehabilitation programmes and stroke follow-up care aiming to improve physical activity, functioning, participation, and health. IMPLICATIONS FOR REHABILITATION: We recommend fatigue guidance, including peer support, to be accessible to all people after stroke and for health professionals to pay attention to acceptance of the stroke. To improve fatigue guidance, we suggest providing information on post-stroke fatigue to people after stroke and their relatives well before discharge from stroke rehabilitation. Tailored advice on activity pacing during and after stroke rehabilitation is important to fill the current unmet need of people after stroke to manage fatigue and to gradually improve participation, physical activity behaviour and health. We recommend to health professionals working in stroke rehabilitation to tailor the rehabilitation schedule to their patients' energy level and perception of fatigue levels. [ABSTRACT FROM AUTHOR]

Therapists are prone to many occupational hazards, such as compassion fatigue and burnout. Despite much speculation, only a little is known about why therapists choose their profession and what drives them to keep practicing. In a job where the therapist is the main instrument, insight into what makes them tick is paramount to nurture durable therapeutic careers. In this qualitative study, 15 experienced Dutch therapists were interviewed about career choice motivations and how initial—and new—motivations continue to influence them in their daily professional practice. Interview transcripts were subjected to thematic analysis, consensus discussions, and member checks. Ten key career choice motivations emerged, ranging from an empathetic predisposition and interest in humanity to personal experience with symptoms and treatment, inspirational sources, desire for growth, life phase, and coincidental or (partially) subconscious motives. Seven themes that influenced therapists in their daily practice were identified. These included four initial motivations as well as three new themes: a knack for building bridges, going from surviving to thriving, and resilience. The insights gained from this study are a starting point for creating interventions that (re)ignite the spark and improve therapist resilience through regular maintenance, thereby promoting durable careers and mental health among (future) therapists themselves. Public Significance Statement: This Dutch qualitative study revealed 10 career choice motivations of therapists and how their initial—and new—motivations remain influential in their daily professional practice. In a job where many occupational hazards are lurking, such as compassion fatigue and burnout, insight into therapist motivations is paramount. The insights from this study are a starting point for interventions that promote mental health and durable careers among therapists themselves, allowing for the effective and continuous treatment of their patients. [ABSTRACT FROM AUTHOR]

Introduction: While the benefits of integrated care are widely acknowledged, its implementation has proven difficult. Together with other factors, financial factors are known to influence progress towards care integration, but in-depth insight in their influence on the envisioned outcomes of integrated care projects is limited. Methods: We conducted a multiple case study of four integrated care projects in the Netherlands. The projects were purposely sampled to be representative of integrated care in its different forms. A total of 29 semi-structured interviews were held with project members, both medical and non-medical staff. In addition, 141 documents were analyzed, including scientific publications and minutes of meetings. Based on elaborate project descriptions we deduced the synergistic influences of financial and other factors on the outcomes of the projects. Results: Financial factors have an important influence on integrated care projects, though this influence is neither deterministic nor isolated. This is because the likelihood of realizing a positive outcome is affected by the degree to which four key conditions are fulfilled: 1) willingness to change, 2) alignment of interests and uniformity goal, 3) availability of resources to change, and 4) effectiveness of management of external actors. Conclusion: Financial factors have an impact on the outcomes of integrated care projects and must be viewed in synergy with interrelated other factors. Crucial for realizing success in integrated care, a balance must be struck between the level of ambition set in a project and the reality of the prevailing key conditions. [ABSTRACT FROM AUTHOR]

As intimate partner violence (IPV) often remains unknown to police, bystanders can play a crucial role in prevention and further escalation of IPV. However, little is known about what brings them into action by reporting incidents of IPV to authorities. As such, we use statements of bystanders who filed reports about IPV incidents to an official domestic violence agency in the Netherlands (N = 78), to investigate the reasoning and motivations for reporting their suspicions. Results show that the reasons for bystanders to report IPV differ depending on the relational dynamics between partners. In situations perceived as intimate terrorism, involving a hierarchical abusive relationship between a man offender and a woman victim, bystanders primarily reported when previous helping initiatives proved inefficient, and they did so to prevent further harm, often particularly in relation to the woman victim. In situations perceived as situational couple violence, involving a symmetrical abusive relationship, bystanders primarily reported when escalation appeared, and they did so to prevent further harm to involved children. We conclude that bystanders report IPV incidents when the need for help is clear, and their motivation for acting concerns the well-being of victims. Our findings add to the growing body of evidence about real-life bystander intervention in emergencies and highlight the need for understanding intervention as context-specific in order to design effective intervention initiatives. [ABSTRACT FROM AUTHOR]

The development of easily accessible and usable social and cognitive enhancement trainings is becoming a priority to reduce the impact of aging on quality of life. Since most activities of daily living (e.g., making a meal) require problem-solving skills, problem-solving interventions could be used to improve and/or maintain functional abilities in aging to prolong independence. To design an effective problem-solving training and increase older adults' adherence to the training, this study examined older adults' perceptions of their challenges in activities of daily living, their skills and difficulties in using information technology (IT), and their motivations and expectations for participating in a web-based problem-solving training activity. Four focus groups (two in Italy and two in the Netherlands) were conducted with older adults aged between 65 and 84 years, a total of 27 participants. The data were analyzed using the Atlas.ti 8 software for the thematic analysis. The analysis identified five thematic areas: interests and activities, difficulties and concerns, experiences and motivations for training, expertise and resources, suggestions for the design of the new training. The results were used to develop a first prototype of a Shared, Web-based, Intelligent Flexible Thinking Training (SWIFT), adapted to future user needs. The participation of older adults in this design phase was critical to understanding their needs, motivations, and expectations regarding the implementation and use of a cognitive enhancement training. [ABSTRACT FROM AUTHOR]

Background Study: Technology‐supported learning environments, act as significant observational and enabling indicators for evaluating and encouraging the digital revolution of education, are of vital importance in current educational research. Keeping track of the dynamics of technology‐supported learning environment research allows for the enrichment of theoretical studies and a prompt innovation of talent‐training environments. Objectives: The present study carried out a bibliometric analysis of the core collection of WoS database over the last two decades. Method: This study is a bibliometric research. We applied CiteSpace and VOSviewer for co‐occurrence and evolution analysis. In addition, we extracted the fundamental ideas and thoughts through reading and analysis. Results: First, the study found that technology‐supported learning environment research is in a growth phase, with core journals such as Interactive Learning Environments or Computers & Education. The findings show that a core research team comprised of such scholars as Hwang Gwo‐Jen, Lester James C. and Wong Lung‐Hsiang. Key nations of publishing and research strength are from China, the United States, the United Kingdom and the Netherlands. Second, the hot topics in research on technology‐supported learning environments were virtual learning environments, technology‐enabled learning environments and interactive learning environments. Nine study specifics were derived from these three topics such as moulding function, generating scenario, stimulating sensation, effect verification, design idea, research reflection, inquiry and research, virtual community, and mixed environment. Lastly, the frontier evolution offers a pattern of development from enhancing performance to changing mode to incorporating experience. Conclusion: Looking ahead, our research recommendations for the field of technology‐supported learning environments include a multifaceted approach. We should aim to enhance research designs and methodologies, develop contemporary guiding theories and strive for a balanced representation across various educational domains, expanding our scope to encompass all academic disciplines. In terms of practical application, it is imperative to focus on the design and implementation of technology‐supported learning environments from three critical perspectives: "change‐demand," "student‐learning" and "online‐offline." These approaches will collectively ensure that technology‐supported learning environments are both innovative and responsive to the diverse needs of the educational landscape. Lay Description: What is already known about this topic: Technology‐supported learning environments are currently a focal and hot research topic in the field of education.Although numerous studies have been conducted on the learning environment of technical support, there has yet to be a systematic and comprehensive review of the related research. What this paper adds: This study provides a comprehensive review of research on the technology‐supported learning environments over the past two decades.This study primarily presents an overview of research on the technology‐supported learning environments over the past two decades, focusing on main literature, research strength, hot topics and frontier evolution. Implications for practice and/or policy: Researchers need to further advance research on technology‐supported learning environments by enriching research designs and methods, constructing up‐to‐date guiding theories and achieving a balance across different educational domains while extending the reach to all disciplines.Educational practitioners need to pay attention to the design and implementation of technology‐supported learning environments from the three viewpoints of "change‐demand," "student‐learning" and "online‐offline." [ABSTRACT FROM AUTHOR]

Background: Implementing person-centred care (PCC) in nursing homes is challenging due to a gap between theory and practice. Bridging this gap requires suitable education, which focuses on learning how to attune care to the values and preferences of residents and take moral, relational, and situational aspects into account. Staff's stories about the care they provide (i.e. caring stories) may deliver valuable insights for learning about these aspects. However, there is limited research on using staff's narratives for moral learning. Objective: This study aims to provide insight into the perspectives of nursing staff on using their caring stories to learn about PCC. Research design: In this qualitative research, we conducted two rounds of interviews with 17 participants working in nursing homes. We wanted to obtain nursing staff's perceptions of working with their caring stories and the impact on PCC. Ethical considerations: Participation was voluntary, and participants provided written consent. The study protocol is approved by The Institutional Review Board of the Medical Ethical Committee Leiden-Den Haag-Delft. Findings: Working with caring stories enables nursing staff to provide PCC and improves job satisfaction. It increases awareness of what matters to residents, fosters information rich in context and meaning, and enhances voice and vocabulary. Through in-depth team reflections, nursing staff discussed the significant moments for residents, which centralizes the discussions on the moral quality of care. Discussion: Working with caring stories fosters dialogue on PCC and enhances reflection on ethical situations in daily encounters, contributing to the moral development of nursing staff. Putting nursing staff's narratives at the centre of learning suits their daily practice and intrinsic motivation. Therefore, the outcomes of this study are an addition to the existing literature about using narratives in long-term care. Conclusion: Using nursing staff's narratives contributes to PCC and positively impacts nursing staff. We recommend using staff's caring stories as a vehicle for moral learning in the transition to PCC. [ABSTRACT FROM AUTHOR]

Objectives: Based on protection motivation theory, we investigate how indicators of threat perception (perceived severity, perceived vulnerability, and fear arousal) and coping appraisal (hope) are associated with older people's motivation to engage in protective behavior after the outbreak of COVID-19. Methods: We use multivariate regression analyses with a sample of 40,282 individuals from 26 countries participating in the SHARE Corona Survey. Results: We find that 15% of all respondents stayed home completely—mainly the oldest and vulnerable people with prior health risk conditions. On average, older Europeans responded strongly to the recommended protective behavior measures (6 out of 7 measures adopted). Among the threat perception indicators, fear arousal is the main motivator for protective behavior, whereas the coping appraisal indicator hope shows an equally strong association. Discussion: Given the negative health effects of fear, our findings may help evaluate and revise governmental policy responses and communication strategies. [ABSTRACT FROM AUTHOR]

Copyright of TSG: Tijdschrift Voor Gezondheidswetenschappen is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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

Community engagement (CE) has long been endorsed by policy makers and health practitioners. However, uncertainties remain about the workings and outcomes of CE. This study aims to provide in-depth insights into them. In a multiple case study, we investigated three participatory health promotion projects for families in vulnerable situations in the Netherlands. We adopted a realist approach combined with a theory of change (ToC) model. We then analysed the qualitative data for context–mechanism–outcome (CMO) configurations to refine this ToC. Results show that CE can strengthen social networks, empower families, and increase perceived health. However, specific contexts in combination with CE project approaches may or may not trigger positive responses. Participants may feel that they matter when asked to actively contribute to a project, which in turn can enhance their self-confidence. In another context, we found that families were overwhelmed by the responsibilities given to them in the project, leading to feelings of stress and withdrawal from the project. We present a list of CMO configurations and refine the ToC accordingly. Our main conclusion is that flexibility is key when CE is implemented in health promotion. Also, our findings question physical health outcomes as a realistic ambition for CE projects with groups in vulnerable situations. [ABSTRACT FROM AUTHOR]

Purpose: Investing in prevention could be of great benefit to public health. Especially for people with health risks, such as overweight, depressive symptoms, low social-economic status or people who experience loneliness or a sedentary lifestyle. In the Netherlands, different parties are responsible for financing and organising selective and indicated preventive interventions: the government, municipalities and health insurance companies. The aim of this study was two-fold: First, to describe the transition towards a sustainable prevention infrastructure. And second, to gain insight into barriers and facilitators associated with intersectoral collaboration regarding organising prevention for high-risk groups. Design/methodology/approach: A longitudinal qualitative study was conducted among collaborative networks working together to build a prevention infrastructure. During a five-year study period, 86 semi-structured interviews were held. The COM-B model was used for data analysis. Findings: Barriers to intersectoral collaboration are: unknown (cost-)effectiveness, limited incentives to invest in collaboration, lack of clarity about responsibilities, differences in priorities and organisational culture between municipalities and health insurers. Facilitators are commitment, trust, sharing knowledge between parties, meeting regularly within the network and acknowledgement of mutual responsibilities. Also, national policy interventions targeted at the development of regional prevention infrastructures facilitated collaboration. Originality/value: This study shows that collaboration regarding prevention is becoming increasingly common. It can be concluded that the transition towards a sustainable prevention infrastructure has started. The relationship between key stakeholders, like municipalities and health insurers, is generally stronger than it was five years ago. They have a better understanding of each other's interests and expectations. [ABSTRACT FROM AUTHOR]

Introduction Advance care planning (ACP) aims to create conditions for more person-centred care. We aimed to explore variations in person-centred care discussions and treatment-centred care discussions within ACP conversations in the Multidisciplinary Timely Undertaken Advance Care Planning (MUTUAL) intervention and how person-centred care discussions could be encouraged. The MUTUAL intervention consists of the following: (i) timely patient selection, (ii) the patient and healthcare professionals preparing for the conversation, (iii) a scripted ACP conversation in a multidisciplinary setting and (iv) documentation. Methods We conducted a narrative analysis of ACP conversations. A narrative summary template was created and used to analyse 18 audio-recordings. Results We noticed variations in person-centred and treatment-centred focus within the ACP conversations. We identified three important strategies that facilitated person-centred care discussions within ACP conversations. First, healthcare professionals' acceptance that ACP is an individual process. We believe it is important that healthcare professionals recognise and accept where the patient is in his or her individual ACP process; not making decisions right away can also be part of a decisional process. Secondly, exploring the underlying motivation for treatment wishes can give insights into patient's wishes, values and needs. Lastly, healthcare professionals who demonstrated an adaptive, curious and engaged attitude throughout the ACP process achieved more person-centred ACP conversations. This coincided with elaborating on the patient's emotions, fears and worries. Conclusion Person-centred and treatment-centred focus varied within the ACP conversations in the MUTUAL intervention. Certain strategies by healthcare professionals facilitated a more person-centred focus. [ABSTRACT FROM AUTHOR]

Copyright of TSG: Tijdschrift Voor Gezondheidswetenschappen is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Helicopter emergency medical services (HEMS) personnel provide on-scene trauma care to patients with high mortality risk. Work in the HEMS setting is characterized by frequent exposure to critical incidents and other stressors. The aim of this study was to further our understanding of the factors underlying HEMS personnel wellbeing to inform organizations regarding workplace interventions that can be implemented to support employees. We conducted 16 semi-structured interviews with HEMS personnel from a university hospital in The Netherlands. Interview topics included work context, personal characteristics, coping, work engagement, and psychosocial support. To analyze the data, we used a generic qualitative research approach inspired by grounded theory, including open, axial, and selective coding. The analysis revealed ten categories that provide insight into factors underlying the wellbeing of HEMS personnel and their work context: team and collaboration, coping, procedures, informal peer support, organizational support and follow-up care, drives and motivations, attitudes, other stressors, potentially traumatic events, and emotional impact. Various factors are important to their wellbeing, such as working together with colleagues and social support. Participants reported that HEMS work can have an emotional impact on wellbeing, yet they use multiple strategies to cope with various stressors. The perceived need for organizational support and follow-up care is low among participants. This study identifies factors and strategies that support the wellbeing of HEMS personnel. It also provides insight into the HEMS work culture and help-seeking behavior in this population. Findings from this study may benefit employers by shedding much-needed light on factors that HEMS personnel feel affect wellbeing. [ABSTRACT FROM AUTHOR]

This article provides insight into the motivation of young women to join the armed forces and to choose a career in the military. This insight explains why women are still underrepresented in the Netherlands armed forces and can optimize future recruitment programs. An online Dutch questionnaire was completed by 148 women (out of a total of 483 respondents). We analyzed the data of these young women in comparison to the men in this sample to better interpret the descriptive findings. Three research questions focus on whether young Dutch women are interested in the armed forces, how they perceive the Netherlands armed forces, and what their motivation is for choosing a career in the military. Women are very enthusiastic and interested in the armed forces. They know what they want, but they are not aware of the military's efforts to be an inclusive organization. Society's stereotypical thinking about the role of women and the image of the military may have led women to assume that the military environment is not such a good fit after all. Descriptive and injunctive norms, intrinsic motivating work aspects and the self-efficacy of young women appear to be important aspects in the motivation of young women and should be taken into consideration when designing new recruitment and communication strategies and promoting inclusiveness. Women also need more information about the different types of flexible contracts and career paths available within the armed forces. Female role models are important to inform, empower and win over women. The Netherlands armed forces should invest in the recruitment process and anticipate the interest, perception and motivation of young Dutch women to encourage them to apply and reduce stereotypical thinking. [ABSTRACT FROM AUTHOR]

This article addresses what motivations volunteers have for volunteering for refugees and whether these motivations differ from or complement motivations to volunteer in general, such as included in the widely used measurement instrument, the Volunteer Function Inventory (VFI). We organized eight focus groups with volunteers for refugees (N = 44) and interviewed five involved coordinators, all working in one city in the Netherlands. Results show that humanitarian concerns and social justice were highly relevant for people's motivations, next to volunteering to obtain or improve knowledge and skills. We find support for the earlier suggested extension of the VFI with the social justice motivation. Next, the current study expands existing analysis on volunteer motivations by identifying four areas that require further attention: (1) volunteers for refugees seek a meaningful role in life; (2) are motivated by the pragmatism of this volunteer work; (3) have emotional reasons; and (4) are motivated by media exposure. [ABSTRACT FROM AUTHOR]

Aim: To explore motivation, organisational climate, work engagement and related factors within the practice environment of nurse practitioners. Background: Motivation in the workplace, organisational climate and work engagement are important to motivate nurse practitioners and prevent early exit. However, little is known about related factors. Design: A cross‐sectional design using a digital survey with multiple‐choice and open‐ended questions. Data were collected from 1 November 2019 to 30 March 2020. Methods: The survey contained demographic and job‐related data, instruments on motivation in the workplace, organisational climate and work engagement. Three open‐ended questions were added to invite respondents to tell about their next career step, (dis)satisfaction with salary and additional comments. Quantitative data were not normally distributed (Kolmogorov–Smirnov test). Kruskal Wallis tests and Mann–Whitney U tests were used to test the relationship between independent and dependent variables. Answers on the open‐ended questions were coded and categorised in themes. The STROBE checklist was followed. Results: In total 586 questionnaires were completed. The majority of the respondents were female (85%), and their mean age was 47 years (range 26–66 years). Aged 45 or over, more work experience, working in nursing homes, experiencing more autonomy, collaboration with other nurse practitioners, a firmly anchored position, satisfaction with salary and developmental opportunities contributed positively to the practice environment. Answers on the open‐ended questions supported the quantitative results. Conclusions: Work motivation, organisational climate and work engagement are positively related to a large variety of personal and work‐related factors. Therefore, policymakers and professional organisations should be aware of the impact of these influencing factors to enhance an inspiring work environment. Relevance to Clinical Practice: Awareness of factors that influence nurse practitioners' practice environment can be used as a tool to screen and improve the present work environment. [ABSTRACT FROM AUTHOR]

In a time of blurring lines between online content, early adolescents' (12–15 years old) lack of critical engagement with news is problematic. Therefore, we need more effective interventions to empower their news literacy. Interventions should go beyond only informing on the news production process and focus on individual's news literacy application in everyday life. This study tests an intervention based on (news) media literacy and motivational theory, inspired by the needs and preferences of early adolescents themselves, to stimulate news literacy elements (news literacy self-efficacy, value for media literacy, motivation, and social norms) and news literacy application (news consumption, news analysis, and news evaluation). The intervention consists of three lessons in which early adolescents (N = 258) learn about the news production process, combined with a learning-by-doing approach: writing and checking news articles. Based on a between-subjects waitlist experiment, the intervention was effective in increasing participants' news literacy self-efficacy, but not (yet) in stimulating other news literacy elements and news literacy application. Nevertheless, this experiment offers valuable insights on the development of news literacy interventions. Prior State of Knowledge: Early adolescents encounter lots of (online) news daily. However, they have great difficulty with deciding on its trustworthiness, accuracy, and relevance. There is a need for educational interventions that stimulate their everyday critical engagement with news: their news literacy application. Novel Contributions: The study presents an intervention founded in (news literacy) theory and co-creation. Early adolescents gained self-efficacy through writing and checking news articles, combined with information, and incorporating their social context. However, they did not yet increase in news literacy application. Practical Implications: Using learning-by-doing approaches to stimulate news literacy application can be complex. More attention to testing clear goals in media education, and to other factors that influence early adolescents' learning, such as intervention length, feedback, and the social context, is needed. [ABSTRACT FROM AUTHOR]

Shared understanding among collaborators is a key element of delivering successful interprofessional care and a main challenge for professional education concerns nurturing such understanding among students. We assessed how nursing students perceived different levels of shared understanding in their collaborations with others in clinical internships. We analyse the collaborative networks of interns to examine whether individual factors (attitudes, perceptions of collaborative cultures, and motivation) or relational factors among collaborators (task-interdependence, cooperation frequency, and interprofessional and hierarchical roles) affect shared understanding among 150 Dutch nursing interns and their collaborators (n = 865). Theoretically, we stress the importance of focusing on collaborative relations in interprofessional care settings. Multilevel models distinguish two levels in explaining the variation in shared understanding, nesting collaborative relationships within individuals. Results indicate merely 37.4% of found variation of shared understanding could be attributed to individual-level factors (variation between interns), while 62.6% of variation is found within interns, showing that shared understanding differs substantially between the collaborations one intern engages in. Multilevel models reveal that task-interdependence strongly predicts shared understanding in inter- and intraprofessional collaborations. We conclude that focusing on collaborative relations is essential to foster shared understanding in vocational internship programmes, and that health care organisations should pay explicit attention to task-interdependence in interns' collaborations. [ABSTRACT FROM AUTHOR]

The complex emotional work of nurses calls for more recognition of emotional labour and the incorporation of emotional labour in nursing education. Based on participant observation and semistructured interviews, we describe the experiences of student nurses in two nursing homes for elderly people with dementia in the Netherlands. We analyse their interactions using Goffman's dramaturgical view on the front and backstage behaviour and the distinction between surface acting and deep acting. The study reveals the complexity of emotional labour, as nurses swiftly adapt their communication styles and behavioural strategies between settings, patients, and even between moments within one interaction sequence, which shows that the theoretical binaries fail to fully capture their skills. Although student nurses take pride in their emotionally taxing work, the societal undervaluation of the nursing profession negatively impacts their self‐image and ambitions. More explicit recognition of these complexities would enhance their self‐appreciation. This calls for a professional 'backstage area' that allows nurses to articulate and strengthen their emotional labour skills. Educational institutions should provide this backstage for nurses‐in‐training to strengthen these skills as part of the professional skill set. [ABSTRACT FROM AUTHOR]

Contributions to public goods, such as nature areas, are often made by private actors, as well as governmental agencies. Typically, the motivation of citizens to voluntarily contribute depends on how the distribution of such tasks has evolved between public and private actors, and wider contextual factors. Therefore, it is unclear whether decreased public spending on nature areas affects private funding. We conduct an economic experiment in The Hague Forest in the Netherlands and ask citizens to perform a task that generates funding for the forest. In the treatment condition, we describe the ongoing policy changes, which implies less state funding and greater dependency on private actors. We find that highlighting a greater need for private funding reduces individual contributions significantly, which is mostly due to a drop in motivation of frequent visitors. Overall, our study suggests that decreasing public spending may have unexpected repercussions on citizens' motivation to contribute. [ABSTRACT FROM AUTHOR]

This study assessed implementation of the Computer-based Instrument for Low-motor Language Testing (C-BiLLT). The C-BiLLT is an accessible language comprehension assessment tool originally developed for children with cerebral palsy and complex communication needs. The purpose of the current study was to understand the clinical contexts in which the C-BiLLT is used in the Netherlands, Belgium, and Norway and assess barriers and facilitators to implementation. An online survey was distributed to rehabilitation clinicians working in the Netherlands, Dutch-speaking parts of Belgium, and Norway. A total of 90 clinicians reported their training in and use of the C-BiLLT; assessed its acceptability, appropriateness, and feasibility; and commented on perceived barriers as well as advantages of the tool. Acceptability, appropriateness, and feasibility were all rated highly. The C-BiLLT was used with various populations and age groups but most often with children who were younger than 12 years of age, and those with cerebral palsy. The main implementation facilitator was clinicians' motivation; the main barriers were related to resources and complexity of cases. Findings suggest implementation of new assessment tools is an ongoing process that should be monitored following initial training, in order to understand clinical contexts in which the tools are being used. [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]

Previous studies have demonstrated the common occurrence of constituency focus in parliamentary questions, which is most often attributed to electoral incentives. If an electoral system makes use of a single nationwide district, however, these district‐oriented electoral incentives do not apply. MPs may still substantively represent a geographical region, because they are motivated to stand up for a specific region for other reasons. This article explores the extent to which Dutch MPs pay attention in parliamentary questions and debates to specific regions. We find that those with stronger ties to a region, and especially MPs who reside in a region, are more likely to mention it in parliamentary questions and speeches. In addition, we find that this effect is stronger for provinces where regional attachment among residents is relatively stronger. [ABSTRACT FROM AUTHOR]

Background: To address issues related to suboptimal insight in outcomes, fragmentation, and increasing costs, stakeholders are experimenting with value-based payment (VBP) models, aiming to facilitate high-value integrated care. However, insight in how, why and under what circumstances such models can be successful is limited. Drawing upon realist evaluation principles, this study identifies context factors and associated mechanisms influencing the introduction of VBP in stroke care. Methods: Existing knowledge on context-mechanism relations impacting the introduction of VBP programs (in real-world settings) was summarized from literature. These relations were then tested, refined, and expanded based on a case study comprising interviews with representatives from organizations involved in the introduction of a VBP model for integrated stroke care in Rotterdam, the Netherlands. Results: Facilitating factors were pre-existing trust-based relations, shared dissatisfaction with the status quo, regulatory compatibility and simplicity of the payment contract, gradual introduction of down-side risk for providers, and involvement of a trusted third party for data management. Yet to be addressed barriers included friction between short- and long-term goals within and among organizations, unwillingness to forgo professional and organizational autonomy, discontinuity in resources, and limited access to real-time data for improving care delivery processes. Conclusions: Successful payment and delivery system reform require long-term commitment from all stakeholders stretching beyond the mere introduction of new models. Careful consideration of creating the 'right' contextual circumstances remains crucially important, which includes willingness among all involved providers to bear shared financial and clinical responsibility for the entire care chain, regardless of where care is provided. [ABSTRACT FROM AUTHOR]

We empirically test an integral model for healthcare and child support benefits take-up using a probability sample of the Dutch population (N = 905). To examine how different psychological factors, in conjunction, explain take-up, we apply model averaging with Akaike's Information Criterion (AICC). For both types of benefits, people's perceptions of eligibility best explain take-up. For healthcare benefits, take-up also relates to perceptions of need. Exploratory analyses suggest that for healthcare benefits but not for child support benefits, executive functions, self-efficacy, fear of reclaims, financial stress, and welfare stigma explain perceived eligibility. We find no support for knowledge, support, and administrative burden as explanatory factors in take-up. We discuss the results in relation to the Capability Opportunity Motivation Behaviour (COM-B) model for developing behavioural change interventions. [ABSTRACT FROM AUTHOR]

Findings caution for the strategic management of job insecurity in today's workplaces to increase employee performance. Instead, organizations are advised to either directly prevent perceived job insecurity and/or to foster autonomous work motivation in employees in a way that the negative consequences of job insecurity on employee performance are mitigated. Objective: To gain insight into the complex relationship between job insecurity and in-role and extra-role performance. Autonomous work motivation is investigated as a mediator in this relationship. The quality of the employee-supervisor relationship (LMX) is investigated as a moderator between job insecurity and autonomous work motivation. Methods: Cross-sectional data were collected by online surveys among 206 Dutch and Belgian employees. Multiple regression analyses were performed to test the hypotheses. Results: Job insecurity was negatively associated with both in-role and extra-role performance. Autonomous work motivation mediated the negative relationship between job insecurity and in-role and extra-role performance. LMX did not moderate the negative relationship between job insecurity and autonomous work motivation. Conclusions: Organizations need to prevent job insecurity and limit the negative consequences of job insecurity for sustaining employees' autonomous work motivation and job performance. [ABSTRACT FROM AUTHOR]

Objectives: To develop a patient's attitude questionnaire regarding prevention in oral health for use internationally. Methods: Using a mixed methods approach, a questionnaire was developed and refined as part of ADVOCATE (Added Value for Oral Care) study, involving partners in six countries: Netherlands, Hungary, Denmark, Ireland, Germany, and the UK. A literature review explored the history of oral healthcare delivery systems to develop a template for each of the six ADVOCATE countries. A systematic review identified the perceived barriers and facilitators to preventive oral healthcare and underpinned a topic guide and established the patient questionnaire domains. Focus groups in each ADVOCATE country developed the first version of the questionnaire. Patient and Public Involvement and Engagement (PPIE) in each ADVOCATE country tested the questionnaire and led to further refinement. The questionnaire was produced in five languages. Content validity and reproducibility used principal component analysis (PCA) and exploratory factor analysis (EFA) refined the questionnaire. Results: The literature review aided an understanding of each country's oral healthcare system, and the findings from the 25 studies identified in the systematic review found the main barriers/facilitators to preventive oral healthcare were cost, knowledge (preventive treatments and advice), and a patient awareness and adherence to preventive advice/treatments. Interviews and focus groups with 148 participants in the ADVOCATE study identified receiving the appropriate level of care/feeling valued, cost, level of motivation/priority, not feeling informed, knowledge, and skill mix as the main barriers/facilitators. Fifty‐three PPIE members refined the questionnaire. The pilot questionnaire was tested with 160 participants. Non‐essential or highly correlated variables were then removed, leaving 38 items, covering 6 domains (cost, advice received, advice wanted, message delivery, motivation, knowledge, and responsibility) within the questionnaire. A second pilot test‐run was undertaken with 185 participants. The test‐re‐test reliability demonstrated strong consistency of responses between the two time points (kappa range 0.3–0.7, most p <.0011), which culminated with a final version of the Patient Attitudes to Prevention in Oral Health Questionnaire (PAPOH) questionnaire. Conclusions: This mixed‐methods approach enabled the development of a multi‐language attitudinal questionnaire for use with patients (PAPOH) to compare attitudes to oral disease prevention internationally. [ABSTRACT FROM AUTHOR]

Despite the many benefits of club-organized sports participation for children, sports participation is lower among children from low-income families than among those from middle- or high-income families. Social safety experienced by parents from low-income families is an important facilitator for parents to request financial support for their children's sports participation. Therefore, the first aim of this study was to better understand parental social (un)safety in the context of acquiring financial support for children's sports participation and how to create a safe social environment for low-income parents to request and receive this financial support. The second aim was to describe the co-creation process, which was organized to contribute to social safety solutions. To reach these goals, we applied a participatory action research method in the form of four co-creation sessions with professionals and an expert-by-experience, as well as a group interview with parents from low-income families. The data analysis included a thematic analysis of the qualitative data. The results showed that from the perspective of parents, social safety encompassed various aspects such as understandable information, procedures based on trust, and efficient referral processes. Sport clubs were identified as the primary source of information for parents. Regarding the co-creation process, the study found that stakeholders tended to overestimate parental social safety levels. Although the stakeholders enjoyed and learned from the sessions, differences in prior knowledge and a lack of a shared perspective on the purpose of the sessions made it challenging to collaboratively create solutions. The study's recommendations include strategies for increasing parental social safety and facilitating more effective co-creation processes. The findings of this study can be used to inform the development of interventions that contribute to a social environment in which parents from low-income families feel safe to request and receive financial support for their children's sports participation. [ABSTRACT FROM AUTHOR]

Background: Quality of the educational environment affects trainee performance and well-being in postgraduate healthcare education. In pharmacy practice the quality of the educational environment has not been extensively studied. Self-determination Theory can assist in understanding the underlying mechanisms. Objectives: In this study, the quality of the educational environment and its relationship with satisfaction and frustration of trainees' basic psychological needs and motivation were investigated in a Dutch community pharmacy postgraduate education programme. Methods: In a cross-sectional study, pharmacists specializing to become community pharmacists completed the Scan of Postgraduate Educational Environment Domains (SPEED), the Basic Psychological Need Satisfaction and Frustration Scale for the Work Domain, and the Academic Motivation Scale. Confirmatory factor analysis followed by path analysis was used to analyse the relationships between the variables. Results: Out of 232 trainees, 205 responded (88%). Most trainees (82%) were positive about the quality of the educational environment. The resulting path model displayed a moderate to good fit. The perceived quality of the educational environment had a moderate positive association with basic psychological needs satisfaction (Factor loading = 0.40) and a similar negative association with basic psychological needs frustration (Factor loading = -0.47). Basic psychological needs frustration had a moderate association with an increased sense of internal and external pressures also known as controlled motivation (Factor loading = 0.31). Intrinsic motivation was not affected by the perceived quality of the educational environment. Conclusions: The educational environment was perceived as positive in most community pharmacies. However, having a less positive or a negative perception was associated with reduced satisfaction and increased frustration of trainees' basic needs for autonomy, compentence and relatedness. Moreover, basic psychological needs frustration was associated with an increased perception of controlled motivation. We recommend supporting supervisors in creating a positive educational environment in pharmacy practice, thereby reducing the risk of basic psychological needs frustration and increased controlled motivation amongst trainees. [ABSTRACT FROM AUTHOR]

Home-based cardiac rehabilitation (CR) is an attractive alternative for frail older patients who are unable to participate in hospital-based CR. Yet, the feasibility of home-based CR provided by primary care physiotherapists (PTs) to these patients remains uncertain. To investigate physiotherapists' (PTs) clinical experience with a guideline-centered, home-based CR protocol for frail older patients. A qualitative study examined the home-based CR protocol of a randomized controlled trial. Observations and interviews of the CR-trained primary care PTs providing home-based CR were conducted until data saturation. Two researchers separately coded the findings according to the theoretical framework of Gurses. The enrolled PTs (n = 8) had a median age of 45 years (IQR 27–57), and a median work experience of 20 years (IQR 5–33). Three principal themes were identified that influence protocol-adherence by PTs and the feasibility of protocol-implementation: 1) feasibility of exercise testing and the exercise program; 2) patients' motivation and PTs' motivational techniques; and 3) interdisciplinary collaboration with other healthcare providers in monitoring patients' risks. Home-based CR for frail patients seems feasible for PTs. Recommendations on the optimal intensity, use of home-based exercise tests and measurement tools, and interventions to optimize self-regulation are needed to facilitate home-based CR. [ABSTRACT FROM AUTHOR]

Aims: Cognitive and motivational processes are thought to underlie cannabis use disorder (CUD), but research assessing how cognitive processes [e.g. interference control (IC)] interact with implicit [e.g. attentional bias (AB)] and explicit motivation (i.e. craving) is lacking. We assessed the presence of AB in cannabis users with varying use severity and tested models of moderation, mediation and moderated mediation to assess how AB, craving and IC interact in their association with measures of cannabis use. Design: A cross‐sectional study design was used. Setting and participants: Eight studies performed by our laboratory in the Netherlands including never‐sporadic, occasional (≤ 1/month) and regular cannabis users (≥ 2/week), and individuals in treatment for CUD were combined (n = 560; 71% male). Measurements Studies included a classic Stroop task (IC), a cannabis Stroop task (AB) and measures of session‐induced and average session craving. Both heaviness of cannabis use (grams/week) and severity of use related problems were included. Findings Only those in treatment for CUD showed an AB to cannabis (P = 0.019) and group differences were only observed when comparing CUD with never‐sporadic users (P = 0.007). In occasional and regular users, IC was negatively associated with heaviness (β = 0.015, P < 0.001), but not severity of use. Average session craving (exploratory), but not session‐induced craving (confirmatory), mediated this association between AB and heaviness (β = 0.050, P = 0.011) as well as severity of use (β = 0.083, P = 0.009); higher AB was associated with heavier use and more severe problems through increased craving. Conclusions: Attentional bias only appears to be present in cannabis users with the most severe problems and craving appears to mediate the association between attentional bias and both heaviness and severity of use in occasional and regular users. The association of interference control with heaviness but not severity of use may point to subacute intoxication effects of cannabis use on interference control. [ABSTRACT FROM AUTHOR]

People with a negative body image may be more likely to recall negative memories of their body, but also be motivated to avoid retrieving specific memories to prevent triggering aversive emotions (e.g., disgust). Such inclination to retain at a global level of memory recall may hamper the correction of their negative body image. In previous research using Autobiographical Memory Tests (AMTs) with minimal instructions, we failed to find an overgeneral memory bias specific to individuals with a negative body image but observed low specificity overall in response to body cue words. In the present study (N = 153), we included the traditional AMT next to a minimal instructions AMT and explored the idea that sensory reliving may be relevant to avoidance by assessing sensory reliving ratings next to memory specificity. A negative body image was associated with more negative body memories. In both AMTs, the findings failed to support our prediction that a more negative body image would be associated with lower specificity or sensory reliving. The findings are consistent with the view that autobiographical memories might be an important factor in defining one's body image, yet cast doubt on the relevance of avoidant retrieval of body-related memories in non-clinical samples. [ABSTRACT FROM AUTHOR]

Context: Applicant perceptions of selection methods can affect motivation, performance and withdrawal and may therefore be of relevance in the context of widening access. However, it is unknown how applicant subgroups perceive different selection methods. Objectives: Using organisational justice theory, the present multi‐site study examined applicant perceptions of various selection methods, rationales behind perceptions and subgroup differences. Methods: Applicants to five Dutch undergraduate health professions programmes (N = 704) completed an online survey including demographics and a questionnaire on applicant perceptions applied to 11 commonly used selection methods. Applicants rated general favourability and justice dimensions (7‐point Likert scale) and could add comments for each method. Results: Descriptive statistics revealed a preference for selection methods on which applicants feel more 'in control': General favourability ratings were highest for curriculum‐sampling tests (mean [M] = 5.32) and skills tests (M = 5.13), while weighted lottery (M = 3.05) and unweighted lottery (M = 2.97) were perceived least favourable. Additionally, applicants preferred to distinguish themselves on methods that assess attributes beyond cognitive abilities. Qualitative content analysis of comments revealed several conflicting preferences, including a desire for multiple selection methods versus concerns of experiencing too much stress. Results from a linear mixed model of general favourability indicated some small subgroup differences in perceptions (based on gender, migration background, prior education and parental education), but practical meaning of these differences was negligible. Nevertheless, concerns were expressed that certain selection methods can hinder equitable admission due to inequal access to resources. Conclusions: Our findings illustrate that applicants desire to demonstrate a variety of attributes on a combination of selection tools, but also observe that this can result in multiple drawbacks. The present study can help programmes in deciding which selection methods to include, which more negatively perceived methods should be better justified to applicants, and how to adapt methods to meet applicants' needs. The authors report that applicants to undergraduate health professions education prefer selection methods that provide a sense of control and allow the demonstration of more than just academic ability. [ABSTRACT FROM AUTHOR]

Research efforts evaluating the role of altruistic motivations behind health policy support are usually based on direct preference elicitation procedures, which may be biased. We propose an indirect measurement approach to approximate self-protection–related and altruistic motivations underlying preferences for public health policies. Our new approach relies on associations between on the one hand decision makers' perceived health risk for themselves and for close relatives and on the other hand their observed preferences for health policies that reduce such risks. The approach allows to make a rough distinction between health-related self-protection and local altruistic motives behind preferences for health policies. We illustrate our approach using data obtained from a discrete choice experiment in the context of policies to relax coronavirus-related lockdown measures in The Netherlands. Our results show that the approach is able to uncover that (1) people who think they have a high chance of experiencing health risks from a COVID-19 infection are more willing to accept a societal or personal sacrifice, (2) people with a higher health risk perception for their relatives have a higher willingness to accept sacrifices than people with a higher health risk perception for themselves, and (3) people who perceive that they have a high risk of dying of COVID-19 have a higher willingness to accept sacrifices than those anticipating less severe consequences of COVID-19. Our method offers a useful proxy metric to distinguish health-related self-protection and local altruism as drivers of citizens' responses to healthcare policies. • Directly asking about selfish or altruistic motivations behind support for healthcare policies is known to generate unreliable results. • We propose a metric that may serve as an indirect proxy measurement, by associating risk perceptions with policy support. • The method is tested and illustrated in the context of COVID-19 policies. • We find that both self-protection and local altruism play a role in driving acceptance of COVID-19 policies. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to gain insight in motivators and demotivators of the Dutch neurosurgical residents and neurosurgeons. Methods: A mixed method study was conducted. A survey was sent by the Dutch Neurosurgical Society to all Dutch neurosurgeons and residents in the framework of the yearly national quality conference. The focus groups were held during the Dutch national training days for neurosurgical residents. Baseline statistics were made of all survey data. Focus group recordings were transcribed verbatim and open coded in a constant comparative manner. Results: The survey yielded a response rate of 47.3% of neurosurgeons and 72.5% of residents. 42.5% of residents participated in the focus groups. Overall, motivators according to residents and neurosurgeons were divided between autonomous and controlled motivation. For residents, the motivators to become a neurosurgeon were mostly patient-centered. Neurosurgeons had the same general motivators as residents. Around one-third of neurosurgeons considered ending their career as a neurosurgeon. Among residents, 9.5% considered quitting residency. Neurosurgeons and residents indicated that no time for their family life, increased administrative burden and non-patient-related tasks were reasons to consider leaving the profession. Also, less perceived respect from patients and society was a reason to consider ending their career as a neurosurgeon. Conclusion: Neurosurgeons and residents in neurosurgery are mostly motivated by intrinsic motivators. Factors such as administrative burden, less perceived respect from patients and society, and increase in non-patient-related tasks are large demotivators for both neurosurgeons and residents. [ABSTRACT FROM AUTHOR]

Simple Summary: Patients with erythrodermic cutaneous T-cell lymphoma often experience severe symptoms. This study provides an insight into the impact of the disease, mogamulizumab treatment, and essential patient-reported outcomes. The data on patients' expectation, quality of life, and treatment satisfaction can especially be used in the counseling of future patients. Background: Erythrodermic cutaneous T-cell lymphoma (E-CTCL) is associated with a poor prognosis and severe symptoms. Objective: To establish insights into the quality of life (QoL), expectations, and treatment satisfaction of E-CTCL patients receiving mogamulizumab. Methods: Outcomes of this prospective cohort study conducted between September 2020 and August 2021 at the Leiden University Medical Center included the dermatology-specific QoL (Skindex-29), health-related QoL (RAND-12), degree of itch, pain, and fatigue (Visual Analogue Scale), patient's expectations, and treatment satisfaction (Client Satisfaction Questionnaire-8 (CSQ-8)), measured at baseline and after six months. Results: 13 patients with E-CTCL were included. Most patients anticipated a positive treatment effect on symptoms. Five patients (46%) improved one or more clinical categories regarding the symptoms domain, six (55%) regarding emotions, four (36%) regarding functioning, and four (36%) regarding the overall Skindex-29 score compared to baseline. The Mental Component Score clinically improved from 31 (IQR 29–51) at baseline to 38 (IQR 25–51). The median VAS itch improved significantly from baseline (8 (IQR 7–10) vs. 3 (IQR 1–8), p = 0.024). Most patients (n = 7) were "very satisfied" with their treatment. Limitations: There was a limited number of patients due to the rarity of the disease. Conclusion: In general, mogamulizumab has a favorable effect on biochemical- and dermatology-specific QoL and physical functioning in some patients, with high treatment satisfaction. Itch especially improved over time in most patients. The treatment satisfaction was generally high. Mogamulizumab seems to be an effective treatment that improves the QoL in patients with E-CTCL. [ABSTRACT FROM AUTHOR]

Objective: Existing studies on shared decision-making (SDM) have hardly taken into consideration that patients could have independently developed expectations prior to their consultation with a healthcare provider, nor have studies explored how such expectations affect SDM. Therefore, we explore how pre-consultation expectations affect SDM in patients with low back pain.Methods: We performed a qualitative study through telephone interviews with 10 patients and seven care professionals (physicians, nurse, physician assistants) and 63 in-person observations of patient-physician consultations in an outpatient clinic in the Netherlands. Transcripts were analyzed through an open coding process.Results: A discrepancy existed between what patients expected and what care professionals could offer. Professionals perceived they had to undertake additional efforts to address patients' 'unrealistic' expectations while attempting SDM. Patients, in turn, were often dissatisfied with the outcomes of the SDM encounter, as they believed their own expectations were not reflected in the final decision.Conclusion: Unaddressed pre-consultation expectations form a barrier to constructive SDM encounters.Practical Implications: Patients' pre-consultation expectations need to be explored during the SDM encounter. To achieve decisions that are truly shared by care professionals and patients, patients' pre-consultation expectations should be better incorporated into SDM models and education. [ABSTRACT FROM AUTHOR]

During acute hospital admission, patients often experience loss of functional status. A low level of physical activity is associated with higher levels of loss of functional status. Stimulating physical activity to maintain functional status is considered essential nursing care. Function Focused Care is a promising approach stimulating physical activity. In a previous study, Function Focused Care in Hospital was deemed feasible. To determine the effectiveness of Function Focused Care in Hospital compared with usual care on the functional status of hospitalized stroke and geriatric patients. A multicenter stepped wedge cluster trial. A neurological and a geriatric ward of an academic hospital and a general hospital in the Netherlands participated in this study; each was considered a cluster in the trial. The primary outcome was patients' functional status over time, measured with the Barthel Index and Elderly Mobility Scale. Secondary outcomes were the patients' length of stay, fear of falling, self-efficacy, motivation, resilience, and outcome expectations for functional and exercise activities. Data was collected at hospital admission (baseline), day of discharge, and three and six months after discharge via patient files and questionnaires and analyzed with generalized linear mixed models. In total, we included 892 patients, of which 427 received Function Focused Care in Hospital and 465 received usual care. Although we did not find significant differences in the Barthel Index and Elderly Mobility Scale at discharge or follow-up, we found a significant decrease in the mean length of stay (− 3.3 days, 95 % CI − 5.3 to − 1.1) in favor of the Function Focused Care in Hospital group. In addition, in the Function Focused Care in Hospital group, a larger proportion of patients were discharged to home compared to the control group (38.2 % vs. 29.0 %, p = 0.017), who were discharged more often to a care facility. The length of hospital stay was substantially decreased, and discharge to home was more common in the group receiving Function Focused Care in Hospital with equal levels of independence in Activities of Daily Living and mobility in both groups upon discharge. Although significant differences in the Barthel Index and Elderly Mobility Scale were not found, we observed that neurological and geriatric patients were discharged significantly earlier compared to the control group. https://onderzoekmetmensen.nl/en/trial/24287 (date of first recruitment: 05-02-2016). Tweetable abstract : Patients receiving Function Focused Care in Hospital were discharged from the hospital 3.3 days earlier and discharged home more often than the group of patients receiving care as usual. @umcutrecht @hogeschoolutrecht. [ABSTRACT FROM AUTHOR]

Involvement of families in physiotherapy-related tasks of critically ill patients could be beneficial for both patients and their family. Before designing an intervention regarding family participation in the physiotherapy-related care of critically ill patients, there is a need to investigate the opinions of critically ill patients, their family and staff members in detail. Exploring the perceptions of critically ill patients, their family and staff members regarding family participation in physiotherapy-related tasks of critically ill patients and the future intervention. A multicenter study with a qualitative design is presented. Semistructured interviews were conducted with critically ill patients, family and intensive care staff members, until theoretical saturation was reached. The conventional content method was used for data analyses. Altogether 18 interviews were conducted between May 2019 and February 2020. In total, 22 participants were interviewed: four patients, five family members, and 13 ICU staff members. Six themes emerged: 1) prerequisites for family participation (e.g., permission and capability); 2) timing and interactive aspects of engaging family (e.g., communication); 3) eligibility of patients and family (e.g., first-degree relatives and spouses, and long stay patients); 4) suitability of physiotherapy-related tasks for family (e.g., passive, active and breathing exercises); 5) expected effects (e.g., physical recovery and psychological wellbeing); and 6) barriers and facilitators, which may affect the feasibility (e.g., safety, privacy, and responsibility). Patients, family members and staff members supported the idea of increased family participation in physiotherapy-related tasks and suggested components of an intervention. These findings are necessary to further design and investigate family participation in physiotherapy-related tasks. [ABSTRACT FROM AUTHOR]