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Person-centred care requires improved documentation of nursing home resident wellbeing, e.g. by nursing staff proxy assessments. Previous studies mainly focused on proxy self-report agreement of quality of life of people with dementia, using lengthy questionnaires. This is the first study to investigate how well nursing staff assess residents’ wellbeing after training, using a single-question assessment method of happiness and engagement. We conducted a cross-sectional mixed-method study, including proxy assessments from 49 nursing staff, and self-reports from 49 nursing home residents without dementia (mean age 85). We explored agreement between colleagues, and between proxy assessments and self-reports, and potential nursing staff characteristics associated to this (age, experience, hours worked per week). Brief written motivations were evaluated on nursing staffs’ understanding of the happiness and engagement concepts. The results showed low agreement between colleagues, and low agreement between proxy assessments and self-reports. Nursing staff assessed happiness and engagement substantially higher than residents’ self-reports. Hours worked per week was related to happiness proxy assessments, but none of the included nursing staff characteristics were related to proxy self-report agreement. Nursing staff interpreted the concepts in diverse ways. Overestimating resident wellbeing when using this single-assessment method may undermine subsequent efforts to improve wellbeing. We could not identify which nursing staff could best provide wellbeing assessments. For now, proxy wellbeing assessments should always be combined with regular self-reports whenever possible.

Introduction: Whereas the treatment for breast cancer is highly personalized, surveillance remains one-size-fits-all: annual imaging and physical examination for at least five years after treatment. The INFLUENCE-nomogram is a prognostic model to estimate the five-year risk for locoregional recurrences (LRRs) and second primary tumors (SPs) after breast cancer. These risks can help identify patients for which less intensive post-treatment surveillance is sufficient. However, health care professionals (HCPs) seem hesitant about less intensive surveillance for women with a low risk for recurrences. Therefore, the aim of this study was to explore benefits, barriers and preconditions for less intensive post-treatment surveillance for women at low risk for recurrences after breast cancer as perceived by HCPs.Methods: We conducted semi-structured interviews with 21 HCPs that provide breast cancer care in seven Dutch teaching hospitals (Santeon hospital group). Analysis was performed using the framework analysis method, which is a combination between inductive and deductive approaches.Results: HCPs were predominantly positive about less intensive surveillance for women with a low risk for recurrences. Most mentioned perceived advantages were a lower burden for patients and the healthcare system, cost reduction for patients and society, and that patients can be reminded less of being a patient and can continue their lives. Perceived disadvantages were the possibility of missing early recurrences, fear and insecurity among patients and less opportunities to monitor and address needs for aftercare. Mentioned preconditions were clearly defined surveillance schedules based on risk categories, easy access to HCPs in case of worries, and information provision and communication for patients and HCPs containing evidence on surveillance schedules based on risk categories. According to the HCPs, information provision should be improved on the aims, options for (duration, frequency, imaging modalities), and advantages and disadvantages of post-treatment surveillance. Shared decision making, between the patient and HCP on the organization of post-treatment surveillance in breast cancer, was also mentioned in this context.Conclusion: HCPs are open to less intensive surveillance for women with a low risk for recurrences. Certain preconditions should, however, be fulfilled first such as better information provision and the development of risk-based surveillance schedules based on risks for recurrences. Citation Format: Jet W. Ankersmid, Constance H.C. Drossaert, Cornelia F. van Uden-Kraan, Luc J.A. Strobbe, Sabine Siesling. Health care professionals’ perspectives on less intensive post-treatment surveillance after breast cancer for women with low risks for recurrences [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-11-31.

Purpose To evaluate the effectiveness of two versions (personal or automated feedback) of a psychological Web-based self-help intervention targeting partners of cancer patients. The intervention was based on acceptance and commitment therapy (ACT) and self-compassion training. Participants’ adherence and their satisfaction were also studied. Methods Two hundred three partners of patients with heterogeneous entities of cancer were randomized into three conditions: personal feedback (PF) (n = 67), automated feedback (AF) (n = 70), or waiting list (WL) control (n = 66). Participants completed measures at baseline (T0) and post-intervention (T1; 3 months after baseline) to assess psychological distress (HADS; primary outcome), positive mental health, caregiver strain, general health (secondary outcomes), posttraumatic growth, resilience, self-compassion, psychological flexibility, sense of mastery, and relational communication style (process measures). Participants in the two experimental conditions also completed these measures at follow-up (T2; 6 months after baseline). Results There was no significant difference in change in psychological distress, positive mental health, caregiver strain and general health from T0 to T1 for either of the experimental conditions compared with the WL-condition. However, when compared to a WL-condition, the PF-condition was effective in increasing psychological flexibility (effect size d = 0.49) and resilience (d = 0.12) and decreasing overprotection (d = 0.25), and the AF-condition was effective in reducing overprotection (d = 0.36) and improving protective buffering (d = 0.36). At follow-up, the PF-condition was more effective than the AF-condition for improving mental health (d = 0.36), psychological flexibility (d = 0.60), mastery (d = 0.48), and protective buffering (d = 0.24). Participants positively appreciated the intervention and 69% participants were adherent. Conclusion This study demonstrates that a Web-based intervention based on ACT and self-compassion training with automated or personal feedback does not seem to improve psychological distress; however, it may have the potential to support partners of cancer patients to cope with the difficult situation they are facing. The condition with personal feedback seemed to be more beneficial.

Person-centered care (PCC) interventions have the potential to improve resident well-being in nursing homes, but can be difficult to implement. This study investigates perceived facilitators and barriers reported by nursing staff to using a PCC intervention consisting of three components: assessment of resident well-being, planning of well-being support, and behavioral changes in care to support resident well-being. Our explorative mixed method study combined interviews (n = 11) with a longitudinal survey (n = 132) to examine which determinants were most prevalent and predictive for intention to use the intervention and actual implementation 3 months later (n = 63). Results showed that perceived barriers and facilitators were dependent on the components of the intervention. Assessment of resident well-being required a stable nursing home context and a detailed implementation plan, while planning of well-being support was impeded by knowledge. Behavioral changes in nursing care required easy integration in daily caring tasks and social support. (C) 2020 The Author(s). Published by Elsevier Inc.

BACKGROUND Psychosocial eHealth interventions for people with cancer are promising in reducing distress, however their results in terms of effects and rates of adherence are quite mixed. To overcome this, developing interventions with a solid evidence base is recommended, while still ensuring adaptation to user wishes and needs. Since most models of eHealth development are based on examining user experiences only (bottom-up requirements), it is not clear how theory and evidence (top-down requirements) may best be integrated into this process. OBJECTIVE To investigate the integration of top-down and bottom-up requirements in the co-design of eHealth applications, by building on a case study of the development of a mobile self-compassion intervention for newly diagnosed cancer patients. METHODS Four co-design tasks were formulated at the start of the project and adjusted and evaluated throughout: 1) explore bottom-up experiences, 2) reassess top-down content, 3) incorporate bottom-up and top-down into concrete features and design, 4) synergize bottom-up and top-down into intervention context. These tasks were executed iteratively during a series of co-design sessions over the course of 2 years, in which 15 patients and 7 nurses (recruited via 2 hospitals) participated. Based on these sessions, a list of requirements, a final intervention design and an evaluation of the co-design tasks was yielded. RESULTS The final list of requirements included intervention content (e.g. main topics of Compassionate Mind Training such as psycho-education about three emotion systems, main issues that patients encounter post-diagnosis such as regulating information consumption), navigation, visual design, implementation strategies and persuasive elements. The final intervention ‘Compas-Y’ is a mobile self-compassion training that consists of six training modules and several supportive functionalities such as a mood tracker and persuasive elements such as push notifications. The four co-design tasks helped to overcome challenges in the development process such as dealing with conflicting top-down and bottom-up requirements, and enabled the integration of all main requirements into the design. CONCLUSIONS Our study addresses the necessary integration of top-down and bottom-up requirements into eHealth development, by examining a preliminary model of four co-design tasks. Broader considerations regarding designing a mobile intervention based on traditional intervention formats and merging the scientific disciplines of psychology and design research are discussed.

Background For patients with cancer, being well informed by their oncologist about treatment options and the implications thereof is highly relevant. Communication skills training (CST) programs have shown to be effective in improving clinicians’ communication skills, yet CSTs are time-consuming, inconvenient to schedule, and costly. Online education enables new ways of accessible learning in a safe and personalised environment. Aim and methods We describe the design of a digital CST-tool for information provision skills that meets oncologists’ learning needs. We used the CeHRes Roadmap for user-centred design as a guiding framework. Phase 1 (Contextual Inquiry) involved consultation of the literature and a focus group interview study to uncover the learning needs and training preferences of clinicians’ regarding a digital training for the skill of information-provision. In phase 2 (Value Specification), two multidisciplinary expert panels specified the learning content and format of a digital training. Phase 3 (Design) encompassed an iterative development process, including two user group assessment sessions and 5 individual user sessions in which prototypes were tested. All sessions were recorded and independently analyzed by two researchers. Results Based on literature and consultation of the users in the inquiry phase of the development process, and on expert opinion in the value specification phase, relevant (sub) skills and user requirements were defined to consider for the digital training format. It was decided to develop a conventional e-learning and a chatbot. Personalization and interactivity were integrated in the prototypes by including features that allow for e.g., choosing text, video or animation; to upload video-recorded consultations to receive peer-feedback; and to consult a communication expert. Results revealed that, overall, participants expressed a willingness to use a digital training tool to acquire information-provision skills. Individual user testing (including junior clinicians), indicated a preference for the chatbot over the e-learning. Conclusion We offer a description of extensive development work which was conducted in collaboration with multiple health care professionals to iteratively develop two innovative prototypes of digital tools that would appropriately engage oncologists in learning effective information giving skills. The resulting prototypes were well appreciated and thus provide a solid basis for further development and testing.

Objective: Self-criticism is a self-condemning and self-compassion a supportive style of self-to-self relating. These concepts have increasingly been studied in people with cancer, but mainly with quantitative studies. This study is the first to explore how adult cancer patients experience self-criticism and self-compassion in the context of their illness.Design: A multimethod qualitative study design was used, combining individual and group semi-structured interviews. Participants were 26 people with cancer who familiarized themselves with the topic by doing various self-compassion exercises for 2 weeks prior to the interview. Individual and group interviews were analyzed together using thematic analysis.Results: Four themes regarding self-criticism were identified: (1) being harsh or strict with yourself, (2) feeling guilty or angry, (3) feeling useless or like a burden, (4) feeling ashamed and not wanting to show weakness. Six themes regarding self-compassion were identified: (1) being mild to yourself, (2) guarding your boundaries, (3) accepting the illness and limitations, (4) maintaining a positive perspective, (5) connecting to others, and (6) taking responsibility for your health.Conclusion: Our findings offer insights into practical and daily life experiences of self-criticism and self-compassion of people with cancer, which can aid the further development of theory, scales and interventions.

The job demands-resources (JD-R) model has hardly been studied in volunteer organizations and there is a scarcity of studies evaluating self-compassion as a personal resource within the JD-R model. The present study addresses these gaps in current knowledge, first by examining the applicability of the JD-R model in a crisis line volunteer organization. Second, self-compassion is examined, both in terms of its moderating role on the exhaustion process as well as its role on the motivation process. Structural equation modelling was used for the analyses. The influence on the organizational outcome ‘compassion towards others’ was examined using a multiple regression analysis. The results showed that the JD-R model has an acceptable fit on this sample and supports the central assumption that exhaustion and motivation are two independent but related processes. This study provides evidence that self-compassion is a valuable addition to the JD-R model, as it has an indirect effect on both processes, and increases the explained variance in compassion towards others by 7% through the exhaustion process and by 3% through the motivational process. These findings point to the importance of focusing on self-compassion in training and supervision in volunteer organizations.

Background:Crisis line services, run by volunteers, offer a listening ear 24/7 to people who cannot or do not want to use professional help. Although previous studies have identified various potential stressors crisis line volunteers face, as yet a comprehensive assessment is lacking with regards to the frequency and perceived stressfulness of work- and organization-related demands, and their relationship with distress and a volunteer's intention to leave.Objective:To identify the frequency and impact of particular stressful situations (demands). In addition, to examine the extent to which these demands are associated with volunteers' demographics, distress and intention to leave the crisis line service.Method:In a cross-sectional study among 543 volunteers of a Dutch crisis line service the participants filled out a questionnaire about their experience of a large number of work- and organization-related demands and their perceived stressfulness. To calculate the impact of demands, the occurrence and stressfulness were multiplied. In addition, work-related distress, intention to leave the crisis line service as well as a number of demographics and work-related characteristics were assessed.Results:Work-related demands with the highest impact on volunteers were calls from people with psychiatric problems and suicidal intentions. “Having no time for a break” was the organization-related demand with the highest impact on volunteers. Eighteen percentage of the volunteers scored moderate or high on distress and 4% had the intention to leave the crisis line service within 1 year. Most work- and organization-related demands were positively associated with volunteers' distress and intention to leave the organization. Being older, being male and spending more hours per week volunteering were significantly, positively correlated with work-related demands. The total explained variance for distress was 16% and for intention to leave 13%.Conclusion:Although most crisis line volunteers experienced low impact from work- and organization-related demands, these demands were significantly related to experienced distress and the intention to leave crisis line service. For volunteers with moderate to high distress it can be useful to implement interventions aimed at increasing personal resources to help them deal with the challenges of the work at the crisis line.

Objective Follow-up after breast cancer can be divided into surveillance and aftercare. It remains unclear how follow-up can ideally be organised from the perspective of health care professionals (HCPs). The aim of this study was to gain insight in the organisation of follow-up in seven Dutch teaching hospitals and to identify best practices and opportunities for improvement of breast cancer (all stages) follow-up as proposed by HCPs. Methods Semi-structured in-depth group interviews were performed, one in each of the participating hospitals, with in total 16 HCPs and 2 patient advocates. To describe the organisation of follow-up, transcripts were analysed using a deductive approach. Best practices and opportunities were derived using an inductive approach. Results Variation was found in the organisation of aftercare, especially in timing, frequency, and disciplines of involved HCPs. Less variation was observed for surveillance, which was guided by the national guideline. Best practices focused on case management and adequate collaboration between HCPs of different disciplines. Mentioned opportunities were improving the structured monitoring of patients' needs and a comprehensive guideline for organisation and content of aftercare. Conclusions Variation in follow-up existed between hospitals. Shared decision-making (SDM) about surveillance is desirable to ensure that surveillance matches the patient needs, preferences, and personal risk for recurrences.

There is growing evidence that positive psychology interventions (PPIs) are effective in enhancing mental well-being and reducing depressive symptoms. However, there is a knowledge gap regarding the motives of people to seek such PPIs. This study qualitatively identifies help-seeking motives and quantitatively examines which motives relate to client satisfaction, adherence and an impact on mental well-being, anxiety and depressive symptoms. We analyzed 123 introductory emails of people with suboptimal levels of mental well-being who assigned to a comprehensive 9-week PPI with email support, of which its efficacy was investigated in a randomized controlled trial. Results showed that 49% mentioned mainly suffering-related motives (i.e. distress and stressful events/circumstances) and 51% mentioned mainly growth-related motives (i.e. mental well-being and developing resources). Hardly any motive was significantly related to beneficial outcomes, albeit developing resources and suffering were positively—though weak—correlated with adherence. The present study indicates that this PPI was effective for a broad audience, namely for those with suffering-related and with growth-related motives. This finding underscores the great relevance of PPIs to reach people who might be at risk for future mental disorders who otherwise do not seek help.

Objective. Compassion-based interventions show promise in enhancing well-being and reducing distress, however little is known about their applications for people with long-term physical conditions. The current study investigates compassion-based interventions for this population: what are their differing elements (content, structure, tailoring, use of technology), feasibility and acceptability, effects and experienced benefits? Methods. A mixed-methods systematic review was conducted. Four bibliographic databases were searched without time or study design restrictions. Meta-synthesis was used to integrate quantitative results of effects, and qualitative results of experienced benefits. Results. Twenty studies met the inclusion criteria, of which most targeted people with cancer or persistent pain. Interventions were either comprehensive with 6-12 face-to-face sessions, or brief based on a single compassion exercise. Participants highly rated feasibility and accessibility. Amongst a plethora of outcomes, reductions in depression and anxiety were the most common findings. Our qualitative synthesis yielded participants’ perceived benefits of (1) acceptance of the condition; (2) improved emotion regulation skills; (3) reduced feelings of isolation. Little overlap was found between quantitative and qualitative outcomes. Conclusion. While the field is still in its infancy, this review highlights the potential benefits of compassion-based interventions for people with long-term physical conditions and discusses recommendations for further intervention research and development.

In the co-design process, both evidence-based (top-down) and experience-based (bottom-up) input are important, especially in the healthcare context. While the risk of conflict is present, integration of both types of input can lead to synergetic design that encompasses the benefits of both worlds. By building on a case study in which we worked with cancer patients and oncology nurses to co-design an eHealth intervention focused on training self-compassion, this paper contributes to existing literature by exploring practical strategies to merge top-down and bottom-up input in the co-design process. The resulting strategies are: selecting (satisfy one need but not the other), combining (keeping multiple options in the design), integrating (designing a new and coherent functionality that serves both needs) and reframing (redefine perspectives in a way that dissolves the conflict). These bidirectional strategies can enable full co-creation, and further research could investigate their utility in other co-design spaces.

Crisis line services, operated by volunteers, have been proven to be effective in decreasing psychological pain and preventing suicidality. Although working at the crisis line may be rewarding, for some the confrontation with highly complex topics (i.e., suicidality, abuse, and loneliness) in combination with inappropriate calls (i.e., sexually abusive calls), may lead to distress or vicarious trauma. The aim of this paper is to systematically review the studies that have examined mental wellbeing of crisis line volunteers and the factors associated with it. Thirteen published empirical studies on the topic were found. These showed that crisis line volunteers are at increased risk of declined mental wellbeing. However, a wide range of operationalizations were used and most studies did not use validated instruments. On the other hand, studies showed that many volunteers experience satisfaction and gratification from their work. This review gives insight into some of the work-related, organization-related, and volunteer-related factors that may be associated with the decrease of mental wellbeing. More high quality, comprehensive, and quantitative research using validated instruments is urgently needed to assess the impact of the work on mental wellbeing and the relative impact of influencing factors.

__Background:__ Surgery holds high risk for iatrogenic patient harm. Correct and sufficient communication and information during the surgical process is a root solution for preventing patient harm. Information technology may substantially contribute to engaging patients in this process. Objective: To explore the feasibility of a digital patient-led checklist for cataract surgery, we evaluated the experiences of patients and nurses who have used this novel tool with a focus on use, appreciation, and impact. __Methods:__ A multidisciplinary team, including cataract surgeons, nurses, pharmacists and administrative representatives developed a 19-item digital patient-led checklist for cataract patients who underwent surgery in an ambulatory setting. This “EYEpad” checklist was distributed to patients and their companions during their hospital visit via an application on a tablet. It contained necessary information the patient should have received before or during the surgical preparation (8 items), before anesthesia (2 items), and before discharge (9 items). Patients and their companions were invited to actively indicate the information they received, or information discussed with them, by ticking on the EYEpad. Our qualitative research design included semi-structured individual interviews with 17 patients and a focus group involving 6 nurses. The transcripts were analyzed by 2 independent coders using both deductive and inductive coding. __Results:__ All but one of the 17 patients used the EYEpad, occasionally assisted by his or her companion (usually the partner). In several cases, the checklist was completed by the companion. Most patients felt positively about the usability of the EYEpad. Yet, for most of the patients, it was not clear why they received the checklist. Only 4 of them indicated that they understood that the EYEpad was used to determine if there were sufficient and correct information discussed or checked by the nurses. Although most nurses agreed the EYEpad was easy to use and could be a useful tool for improving patient engagement for improving safety, they felt that not all elderly patients were willing or capable of using it and it interfered with the existing surgical process. They also anticipated the need to spend more time explaining the purpose and use of the EYEpad. __Conclusions:__ Our results showed that a digital patient-led checklist is a potentially valid way to increase patient participation in safety improvement efforts, even among elderly patients. It also illustrates the crucial role nurses play in the implementation and diffusion of technological innovations. Increased patient participation will only improve safety when both healthcare workers and patients feel empowered to share responsibility and balance their power.

Purpose: The purpose of the study is to identify demographic, clinical, lifestyle-related, and social-cognitive correlates of physical activity (PA) intention and behavior in head and neck cancer (HNC) survivors using the theory of planned behavior (TPB). Methods: Data from two cross-sectional studies on correlates of PA in HNC survivors were pooled. Both studies used self-reports to assess PA and social-cognitive correlates. Potential correlates were collected via self-report or medical records. Univariable and multivariable multilevel linear mixed-effects models were built to identify correlates of PA intention and PA behavior (Z scores). Structural equation model analyses were conducted to study the full TPB model in one analysis, taking into account relevant covariates. Results: In total, 416 HNC survivors were surveyed. Their mean (SD) age was 66.6 (9.4) years; 64% were men, and 78% were diagnosed with laryngeal cancer. The structural equation model showed that PA intention was significantly higher in HNC survivors with a history of exercising, who had a more positive attitude, subjective norm, and perceived behavioral control. Patients with higher PA intention, higher PBC, a lower age, and without unintentional weight loss or comorbidities had higher PA behavior. The model explained 22.9% of the variance in PA intention and 16.1% of the variance in PA behavior. Conclusions: Despite significant pathways of the TPB model, the large proportion variance in PA intention and behavior remaining unexplained suggests the need for better PA behavior (change) models to guide the development of PA promotion programs, particularly for the elderly. Such programs should be tailored to comorbidities and nutritional status.

The efficacy of several multicomponent positive psychology interventions (PPIs) have been demonstrated, but little is known about its possible mechanisms of change. We examined (1) the efficacy of an email guided self-help PPI on six core well-being processes (positive emotion, use of strengths, optimism, self-compassion, resilience and positive relations) and (2) the mediating role of these processes on mental well-being, anxiety and depressive symptoms. Adults ≥ 18 years were recruited in the general population and randomized into the intervention (n = 137) or wait-list control group (n = 138). Repeated measures analyses showed that the intervention group improved significantly more than the control group on all six processes. Improvement (t0–t1) on each process statistically mediated improvement (t0–t2) on mental well-being, anxiety and depressive symptoms. Simple-mediation analyses revealed small to moderate effect sizes. Multiple-mediation analyses revealed most pronounced results for positive relations and self-compassion, suggesting that these processes might be key mechanisms in promoting well-being.

Unemployment is associated with a diminished mental health. Interventions to improve mental health for the unemployed exist. However, there is no clear overview with respect to the content and effectiveness of these interventions. A systematic search was conducted and, included studies that targeted unemployed adults, described an intervention and reported mental health as an outcome measure. After screening, 24 studies remained, which contained 21 different interventions. These interventions could be classified into three categories: occupational skills training interventions, psychological interventions and combined interventions. The majority of the studies reported significant short-term effects on mental health, but in most cases evidence of sustained effects was lacking or not assessed. There is promising evidence that interventions combining occupational skills and resilience training are effective in promoting mental health. However, there is a need for high-quality research on the intervention effects on the mental health of the (long-term) unemployed.

Background:Although physicians are responsible for writing the antipsychotic prescriptions for patients with dementia, the initiative is often taken by nurses or nursing assistants. To reduce antipsychotics uses, one needs to understand the reasons for nurses and nursing assistants to request them. This study gives an overview of the influencing factors for this request based on the Theory of Planned Behavior in which attitude, beliefs, and behavioral control is thought to influence the intention to request, which in turn affects the behavior to request for a prescription.Methods:Eighty-one nurses and nursing assistants of one Dutch nursing home organization completed an online survey.Results:Nurses and nursing assistants frequently agreed on items related to the positive effects of antipsychotics for the resident and for the staff. Nurses and nursing assistants with a lower job satisfaction were more likely to call for antipsychotics. Having more positive beliefs about treatment effects and feel of being more in control toward asking for antipsychotics were positively associated with intention to call. All variables explained 59% of the variance of intention. The current position (nurse/nursing assistant) was associated with actual behavior to call. The explained variance was 25%.Conclusions:Policy-makers should focus on the nurses’ and nursing assistants’ belief in positive effects of antipsychotics for the resident, which is not in line with available evidence. Nurses and nursing assistants should be educated about the limited effectiveness of antipsychotics.

Background Nursing staff in nursing homes is at risk for stress-related problems. Positive psychology interventions have been shown to effectively improve well-being and decrease depressive symptoms, and may be beneficial for nursing staff. However, controlled studies with nursing staff are missing. Objectives and design This is the first study to test the effectiveness and acceptability of an online multi-component positive psychology intervention in nursing home staff. This study used a cluster-randomized controlled design, with an intervention group and a control group, and measurements at baseline (T0) and following the training period (T1). We hypothesized that the intervention would improve general well-being, job satisfaction and work engagement, especially for people with low initial well-being, satisfaction or engagement. Furthermore, we explored the acceptability of such an intervention for nursing home staff. Settings and Participants All nursing staff of the units for physically frail older adults of four Dutch nursing homes belonging to one care organization were invited to participate in this study. A sample of 128 nursing staff completed T0, and 107 nursing staff completed T1, mostly licensed practical nurses with a mean age of 42 years. Methods The 8-week online intervention concerned information and evidence-based exercises of six topics of Positive Psychology, which were completed individually at home. General well-being, job satisfaction and work engagement were measured, and participants evaluated the intervention. Results No time by group interaction effect was found on general well-being nor on work engagement, but there was a small effect on job satisfaction. No moderation effects of baseline outcome measures were found. The evaluation of the intervention varied: a majority positively valued the intervention, in particular the topics “positive emotions” and “strengths”, but most agreed that there was too much text and too many exercises. Conclusions The online multi-component positive psychology intervention had only very limited effectiveness, as the decrease in job satisfaction in the control group may reflect a regression to the mean. The high baseline levels of well-being and engagement, intervention content, obligatory character of the intervention, and individuality are discussed as possible reasons for these results. Opportunities lie in creating a concise, work focused positive psychology intervention for nursing staff, including some form of autonomy support.

Background There is growing interest in measuring the eudaimonic perspective of mental well-being (social and psychological well-being) alongside existing measures of the hedonic perspective of mental well-being (subjective well-being). The Flourishing Scale (FS) assesses core aspects of social-psychological functioning and is now widely used in research in practice. However, the reliability and validity of eudaimonic measures such as the FS has not yet been tested in people with low or moderate levels of well-being. This group is at risk for developing mental disorders and, therefore, an important target group for public mental health. Methods We extensively evaluated the psychometric properties of the 8-item FS in a sample of adults with low or moderate levels of well-being in The Netherlands (N = 275) using confirmatory factor analysis (CFA), item response theory analysis and a multitrait matrix. Results The unidimensional structure of the scale was confirmed with CFA and an adequate fit to the Rasch model. However, our sample showed positive skewness of the scale, but lacked measurement precision at the higher end of the social-psychological continuum. In general, the multitrait matrix demonstrated the convergent validity of the scale, with strong to weak correlations between the FS and (1) overall well-being, (2) social and psychological well-being (3) positive eudaimonic states, (4) hedonic states, (5) psychopathology and (6) personality traits. Nevertheless, relatively low correlations were found, specifically in comparison with the Mental Health Continuum-Short Form (MHC-SF). Conclusions The FS seems a reliable and valid instrument for measuring social-psychological functioning in adults with suboptimal well-being, but its use in intervention studies and clinical practice might be debatable. Therefore, the FS seems most suitable to include in epidemiological studies alongside existing hedonic measures to more fully capture mental well-being. Future research should examine the temporal stability of the FS and the consequences of the positive skewness and limited external validity of the scale found in the current study.

Background Mental well-being could be promoted and protected by positive psychology (PP) based interventions. Such interventions may be appealing for people at risk of anxiety and depressive disorders, but health-economic evaluations are scarce. The aim was to examine the cost-effectiveness of a PP intervention. Methods Participants with suboptimal levels of mental well-being were randomly assigned to an email guided PP-intervention (n = 137) or a wait-list control group (n = 138) with access to usual care (UC). At baseline and 6 months follow-up, data were collected on health care costs. Outcomes of interest were flourishing mental health and treatment response on anxiety and depressive symptoms. Results Bootstrapped mean incremental cost-effectiveness ratios were €2359 ($2899) for flourishing, €2959 ($3637) for anxiety and €2578 ($3168) for depression, suggesting appreciable health gains for low additional costs. At a willingness to pay ceiling of €10,000 ($12,290) for a treatment response, the probability that the intervention is deemed cost-effective ranged between 90 and 93%. Conclusions The guided PP intervention appears to be a promising strategy as seen from both a public health and a health-economic perspective, especially when there is some willingness to pay. When the PP-intervention is scaled up, then outcome monitoring is recommended to better guarantee the longer term cost-effectiveness of the intervention. Trial registration The Netherlands National Trial Register NTR4297. Registered on 29 November 2013. The NTR is part of the WHO Primary Registries.

Informal caregivers of patients with Amyotrophic Lateral Sclerosis (ALS) or Progressive Muscular Atrophy (PMA) face stressful demands due to severe impairments and prospect of early death of the patients they care for. Caregivers often experience feelings of psychological distress and caregiver burden, but supportive interventions are lacking. The objective of this study is to investigate the effectiveness of a psychosocial support program aimed at enhancing feelings of control over caregiving tasks and reducing psychological distress. This support program is based on an existing program for adult partners of people with cancer and is adapted to meet the needs of ALS caregivers. This study is a randomized controlled trial using a wait-list control design. One hundred and forty caregiver-patient dyads, recruited from a nationwide database and through the website of the Dutch ALS Center, will be either randomized to a support program or a wait-list control group. The blended intervention is based on Acceptance and Commitment Therapy and consists of 1 face-to-face contact, 6 online guided modules and 1 telephone contact. The intervention can be worked through in 8 weeks. The effectiveness and the participants’ satisfaction with the intervention will be evaluated using a mixed method design. Caregivers and patients will be asked to fill in questionnaires on 4 occasions during the study: baseline, 3 months, 6 months and 9 months. The main study outcome is the psychological distress of the caregiver assessed with the Hospital Anxiety and Depression Scale. Secondary outcomes are caregiver burden, caregiver quality of life, quality of life of the patient and psychological distress of the patient. Group differences in primary and secondary outcomes at 6 months will be compared with linear mixed model analysis. In a subgroup of caregivers we will explore experiences with the support program through semi-structured interviews. Usage of the online modules will be logged. The study will provide insights into the effectiveness of a blended psychosocial support program on psychological distress of caregivers of patients with ALS or PMA, as well as into indirect relations with patients’ wellbeing. Netherlands Trial Registry NTR5734 , registered 28 March 2016.

This study examined partners of cancer patients intention to use a web-based psychological intervention, their preferences regarding its preconditions, functionalities and topics, and factors related to their intention. One hundred and sixty-eight partners completed a questionnaire about these aspects. Forty-eight percent of the partners would (maybe) make use of a web-based intervention. Partners who intended to participate were significantly younger, used the Internet more often, and perceived more caregiver strain. Most partners preferred an intervention that takes less than 1 hour/week, lasts five weeks or more, and contains information and peer support. Half of the partners would like to receive online guidance.

Background Detrimental effects of women’s negative feelings during pregnancy have been extensively examined and documented, but research on the influence of positive feelings and protective factors on their prenatal mental health is scarce. Evidence from the positive psychology field has shown that practicing some brief positive exercises, called positive psychology interventions, can maximize well-being by increasing positive emotions, engagement, and meaning. Aim The aim of this study is to examine the effect of a positive psychology web-based intervention on indices of women’s prenatal well-being. Methods Specifically, a case series design was adopted, and data from six women are presented. Participants were involved in a 5-week online positive psychology intervention that includes a set of positive psychology interventions specifically adapted for pregnant women. Measures of women’s mental well-being, depression, pregnancy-related anxiety, life satisfaction, and social support were measured at pre- and post-intervention. Compliance with the intervention and exercise preferences were assessed at post-test. Single-item related well-being measures were assessed weekly. Findings and discussion The findings of this case series study indicate potential effects of the intervention on supporting mental well-being and decreasing depressive symptomatology in these pregnant women. Furthermore, this study provides some suggestions for developing future online-based positive interventions addressed to pregnant women. However, these findings are preliminary, and future studies are needed in order to assess the effects of the intervention in a wider population of pregnant women.

Objectives To explore what considerations patients have when deciding about disease-modifying anti-rheumatic drugs (DMARDs) and what information patients need to participate in the decision-making process. Methods In-depth face-to-face interviews were conducted with 32 inflammatory arthritis patients who recently consulted their rheumatologist and discussed initiating DMARDs. Results Beliefs in the necessity of DMARDs, either for relief of symptoms or prevention of future joint damage, were reasons to initiate DMARDs. Furthermore, trust in the rheumatologist and the healthcare system was important in this respect. Patients expressed many concerns about initiating DMARDS. These related to the perceived aggressive and harmful nature of DMARDs, potential (or unknown) side effects, influence on fertility and pregnancy, combination with other medicines, time to benefit and manner of administration. Participants also worried about the future: about long term medication use and the feeling of dependency, and, -if this medicine proved to be ineffective-, about the risks of future treatments and running out of options. To decrease this uncertainty, participants wanted to be informed about multiple treatment options, both current and future. They did not only want clinical information, but also information on how the medications could affect their daily lives. Conclusion Health education should inform patients about multiple treatment options, for the current time being as well as for the future. It should enable patients to compare treatments with regards to both clinical aspects as well as possible consequences for their daily lives. This article is protected by copyright. All rights reserved

The aim of this study is to gain insight into arthritis patients' motives for (not) wanting to be involved in medical decision-making (MDM) and the factors that hinder or promote patient involvement. In-depth semi-structured interviews were conducted with 29 patients suffering from Rheumatoid Arthritis (RA). Many patients perceived the questions about involvement in MDM as difficult, mostly because they were unaware of having a choice. Shared decision-making (SDM) was generally preferred, but the preferred level of involvement varied between and within individuals. Preference regarding involvement may vary according to the type of treatment and the severity of the complaints. A considerable group of respondents would have liked more participation than they had experienced in the past. Perceived barriers could be divided into doctor-related (e.g. a paternalistic attitude), patient-related (e.g. lack of knowledge) and context-related (e.g. too little time to decide) factors. This study demonstrates the complexity of predicting patients' preferences regarding involvement in MDM: most RA patients prefer SDM, but their preference may vary according to the situation they are in and the extent to which they experience barriers in getting more involved. Unawareness of having a choice is still a major barrier for patient participation. The attending physician seems to have an important role as facilitator in enhancing patient participation by raising awareness and offering options, but implementing SDM is a shared responsibility; all parties need to be involved and educated.

Background There is growing evidence that fostering mental well-being and flourishing might effectively prevent mental disorders. In this study, we examined whether a 9-week comprehensive positive self-help intervention with email support (TL-E) was effective in enhancing well-being and flourishing and decreasing anxiety and depressive symptoms in a non-clinical sample. Methods A total of 275 participants with low or moderate well-being (mean age = 48 years, 86% female) were randomly assigned to a TL-E (n = 137) or wait-list control group (WL; n = 138). Participants completed online self-reporting questionnaires at baseline and at 3, 6 and 12 months. Results Repeated measure analyses revealed significant more improvement on mental well-being (F = 42.00, p ≤ 0.001, d = 0.66, 95% CI = 0.42–0.90), anxiety (F = 21.65, p ≤ 0.001, d = 0.63, 95% CI = 0.39–0.87) and depression (F = 13.62, p ≤ 0.001, d = 0.43, 95% CI = 0.19–0.67) in the TL-E group versus the WL group. The proportion of flourishing in the TL-E group increased from 7 to 30% after 3 months (NNT = 5.46) and to 34% after 6 months (NNT = 5.25). All within group effects were maintained up to 12 months. We found no meaningful dose-response relationship for adherence, nor a clear moderator pattern. Limitations It is unknown whether results were influenced by the email support that accompanied the self-help intervention since TL-E was only compared to a wait-list condition. The generalizability of the findings is limited by the self-selected sample of mainly higher-educated women. Conclusion A guided positive self-help intervention might be considered as a new mental health promotion strategy because it has the potential to improve well-being up to the status of flourishing mental health, and to decrease anxiety and depressive symptomatology., Highlights • We evaluated a comprehensive self-help positive psychology intervention with email support. • The intervention appeared to be effective in promoting flourishing. • Anxiety and depressive symptoms reduced more compared to a wait-list group. • Adherence and client satisfaction were high, drop-out was low. • Offering a multicomponent positive psychology intervention seems a worthwhile public mental health strategy.

Background A main element of patient-centred care, Patient Decision Aids (PtDAs) facilitate shared decision-making (SDM). A recent update of the International Patient Decision Aids Standards (IPDAS) emphasised patient involvement during PtDA development, but omitted a methodology for doing so. This article reports on the value of user-centred design (UCD) methods for the development of a PtDA that aims to support inflammatory arthritis patients in their choice between disease modifying anti-rheumatic drugs (DMARDs). Methods The IPDAS development process model in combination with UCD methods were applied. The process was overseen by an eight-member multidisciplinary steering group. Patients and health professionals were iteratively consulted. Qualitative in-depth interviews combined with rapid prototyping were conducted with patients to assess their needs for specific functionality, content and design of the PtDA. Group meetings with health professionals were organized to assess patients’ needs and to determine how the PtDA should be integrated into patient pathways. The current literature was reviewed to determine the clinical evidence to include in the PtDA. To evaluate usability among patients, they were observed using the PtDA while thinking aloud and then interviewed. Results The combination of patient interviews with rapid prototyping revealed that patients wanted to compare multiple DMARDs both for their clinical aspects and implications for daily life. Health professionals mainly wanted to refer patients to a reliable, easily adjustable source of information about DMARDs. A web-based PtDA was constructed consisting of four parts: 1) general information about SDM, inflammatory arthritis and DMARDs; 2) an application to compare particular DMARDs; 3) value clarification exercises; and 4) a printed summary of patients’ notes, preferences, worries and questions that they could bring to discuss with their rheumatologist. Conclusions The study demonstrated that UCD methods can be of great value for the development of PtDAs. The early, iterative involvement of patients and health professionals was helpful in developing a novel user-friendly PtDA that allowed patients to choose between DMARDs. The PtDA fits the values of all stakeholders and easily integrates with the patient pathway and daily workflow of health professionals. This collaborative designed PtDA may improve SDM and patient participation in arthritis care. Electronic supplementary material The online version of this article (doi:10.1186/s12911-017-0433-5) contains supplementary material, which is available to authorized users.

Background: Partners of cancer patients are the cornerstone of supportive cancer care. They assume different roles and responsibilities that optimally support the patient. Such support is highly demanding, and many partners report (mental) health problems. However, many of them do not use professional supportive care themselves. Offering a Web-based self-help intervention based on Acceptance and Commitment Therapy (ACT) and self-compassion could be an important resource to support this group. This qualitative study aimed to examine user-experiences with a Web-based self-help intervention based on ACT and self-compassion among partners of cancer patients. Methods: Individual in-depth interviews, about partners’ appreciation of the intervention and lessons learned, were conducted with 14 partners of cancer patients who used the Web-based self-help intervention. Interviews were audio-recorded, transcribed verbatim and analyzed by three independent coders both deductively and inductively. Results: In general, partners appreciated the intervention, however, they also expressed ambivalent feelings towards peer support, the content of the feedback of their counselor, and the ‘tunneled’ structure of the intervention. The majority of the partners reported being more self-compassionate accepting that they experienced negative thoughts and feelings, they reported that they learned to increase the distance between their thoughts and themselves, they indicated being more aware of their personal values, and they thought that they were better able to commit to those values. They also reported other (non-specific) helpful processes such as insight and acknowledgement, positivity, the possibility to tell their story, time for themselves, and feeling closer and more connected with their partner (the patient). Conclusions: Partners of cancer patients indicated to appreciate the Web-based self-help intervention based on ACT and self-compassion. They felt that the intervention helped them to cope with negative emotions, thoughts, and one’s suffering; to practice self-kindness; and to clarify values based on difficult recent experiences. In addition, they felt that the intervention supported them to obtain insight and acknowledgement, positivity, to tell their story, make time for themselves, and feeling closer and more connected with the patient. We think that a Web-based psychological intervention based on ACT and self-compassion may be a valuable contribution in supporting partners of cancer patients.

Background: With the digitization of health care and the wide availability of Web-based applications, a broad set of skills is essential to properly use such facilities; these skills are called digital health literacy or eHealth literacy. Current instruments to measure digital health literacy focus only on information gathering (Health 1.0 skills) and do not pay attention to interactivity on the Web (Health 2.0). To measure the complete spectrum of Health 1.0 and Health 2.0 skills, including actual competencies, we developed a new instrument. The Digital Health Literacy Instrument (DHLI) measures operational skills, navigation skills, information searching, evaluating reliability, determining relevance, adding self-generated content, and protecting privacy. Objective: Our objective was to study the distributional properties, reliability, content validity, and construct validity of the DHLI’s self-report scale (21 items) and to explore the feasibility of an additional set of performance-based items (7 items). Methods: We used a paper-and-pencil survey among a sample of the general Dutch population, stratified by age, sex, and educational level (T1; N=200). The survey consisted of the DHLI, sociodemographics, Internet use, health status, health literacy and the eHealth Literacy Scale (eHEALS). After 2 weeks, we asked participants to complete the DHLI again (T2; n=67). Cronbach alpha and intraclass correlation analysis between T1 and T2 were used to investigate reliability. Principal component analysis was performed to determine content validity. Correlation analyses were used to determine the construct validity. Results: Respondents (107 female and 93 male) ranged in age from 18 to 84 years (mean 46.4, SD 19.0); 23.0% (46/200) had a lower educational level. Internal consistencies of the total scale (alpha=.87) and the subscales (alpha range .70-.89) were satisfactory, except for protecting privacy (alpha=.57). Distributional properties showed an approximately normal distribution. Test-retest analysis was satisfactory overall (total scale intraclass correlation coefficient=.77; subscale intraclass correlation coefficient range .49-.81). The performance-based items did not together form a single construct (alpha=.47) and should be interpreted individually. Results showed that more complex skills were reflected in a lower number of correct responses. Principal component analysis confirmed the theoretical structure of the self-report scale (76% explained variance). Correlations were as expected, showing significant relations with age (ρ=–.41, P

Increased breast cancer incidence and better survival have raised the number of patients requiring follow-up care. Despite guidelines, there is controversy about appropriate breast cancer follow-up. Therefore, semi-structured interviews were conducted in two hospitals with 23 patients and 18 health professionals (HPs) in order to explore opinions and preferences about the purpose, the duration and frequency of breast cancer follow-up and which examinations should be done, by whom. The transcripts were inductively analysed and coded into pre-identified themes. Patients were followed more intensively than guidelines recommend. HPs mentioned three major reasons; patient preferences, each discipline wanting to observe the patient, and financial incentives. For patients and HPs the most important purpose of follow-up was early detection of new malignancies. A highly valued aspect of follow-up mentioned by HPs was the psychosocial support, which was rarely mentioned by patients. Patient's expectations about the benefits of follow-up and additional examinations were sometimes unrealistic. Patients and HPs were positive about nurse practitioner-led follow-up, but less positive about general practitioner-led follow-up. Important barriers to current guideline adherence were revealed and should be taken into account by implementing new individualised guidelines. Furthermore, patients should be better informed about the benefits of follow-up to prevent unrealistic expectations.

Purpose: Yoga is a "mind-body" exercise, a combination of physical poses with breathing and meditation, and may have beneficial effects on physical and psychosocial symptoms. We aimed to explore cancer patients' motives for practicing yoga, experiences of practicing yoga, and perceived physical and psychosocial outcomes. Methods: Participants (n = 45) following yoga classes for cancer patients were asked to participate in focus group interviews, of whom 29 participated. The focus groups (n = 5) were audio taped with prior consent and transcribed verbatim. Data were analyzed by two coders and independently coded into key issues and themes. Results: Mean age of the participants was 53.8 (SD 10.8) years, of whom 25 were women, and 18 were diagnosed with breast cancer. Motives for participation in yoga were relaxation, the will to be physically active, the wish to pay more attention to one's body, coping with psychosocial symptoms, contributing to their cancer rehabilitation process, and combing physical and mental processes. Main physical and psychosocial experiences of yoga mentioned by patients were regaining body awareness, raising attention to the inner self, learning how to relax, enjoyment, and finding recognition and understanding. Increased physical fitness and function, mental strength and resilience, increased coping, being more relaxed, and happiness were frequently mentioned experiences of patients. Conclusions: Patients with different types of cancer perceived several benefits on physical and psychosocial outcomes by practicing yoga. Therefore, yoga can be a valuable form of supportive care for cancer patients. © 2013 Springer-Verlag Berlin Heidelberg.

Technology enables patients home access to their electronic medical record (EMR), via a patient portal. This study aims to analyse (dis)advantages, preconditions and suitable content for this service, according to rheumatology health professionals. A two-phase policy Delphi study was conducted. First, interviews were performed with nurses/nurse practitioners (n = 9) and rheumatologists (n = 13). Subsequently, collected responses were quantified, using a questionnaire among the interviewees. The following advantages of patient home access to the EMR were reported: (1) enhancement of patient participation in treatment, (2) increased knowledge and self-management, (3) improved patient–provider interaction, (4) increased patient safety, and (5) better communication with others. Foreseen disadvantages of the service included: (1) problems with interpretation of data, (2) extra workload, (3) a change in consultation content, and (4) disturbing the patient–provider interaction. Also, the following preconditions emerged from the data: (1) optimal security, (2) no extra record, but a patient-accessible section, (3) no access to clinical notes, and (4) a lag time on the release of lab data. Most respondents reported that data on diagnosis, medication, treatment plan and consultations could be released to patients. On releasing more complex data, such as bodily examinations, lab results and radiological images the opinions differed considerably. Providing patients home access to their medical record might be a valuable next step into patient empowerment and in service towards the patient, provided that security is optimal and content and presentation of data are carefully considered.

Developing motivational technology to support long-term behavior change is a challenge. A solution is to incorporate insights from behavior change theory and design technology to tailor to individual users. We carried out two studies to investigate whether the processes of change, from the Transtheoretical Model, can be effectively represented by motivational text messages. We crowdsourced peer-designed text messages and coded them into categories based on the processes of change. We evaluated whether people perceived messages tailored to their stage of change as motivating. We found that crowdsourcing is an effective method to design motivational messages. Our results indicate that different messages are perceived as motivating depending on the stage of behavior change a person is in. However, while motivational messages related to later stages of change were perceived as motivational for those stages, the motivational messages related to earlier stages of change were not. This indicates that a person’s stage of change may not be the (only) key factor that determines behavior change. More individual factors need to be considered to design effective motivational technology.

Internet technology in which social media play a central role offers new opportunities for health communication. The Center for Media & Health (CMH) in the Netherlands in collaboration with the University of Twente developed a methodology called Mark My Words (MMW) to detect and monitor interpersonal conversations on social media. The MMW methodology is based on the concept of “markers” and on data analysis via text mining techniques. MMW is applied in an innovative web-based entertainment-education series called SndBites. This article describes the design of this new research methodology and shares the methodological advantages and challenges.

Objective: While most existing health literacy (HL) measures focus primarily on reading comprehension, the functional, communicative and critical HL scales from Ishikawa et al. [19] aim to measure a broader HL spectrum. The objective of this study was to evaluate the validity of the Dutch translation of this instrument. Methods: Two survey studies (n = 79 and n = 209) and one cognitive interview study (n = 18) were performed among samples of breast cancer patients and patients with rheumatic diseases. Results: Analyses showed the scales measured three distinct factors and convergent validity was satisfactory for communicative and critical HL. Nevertheless, the comprehension of the items and the suitability of the response options raised some problems. Conclusion: The HL scales seem promising to measure a broad definition of HL. By revising some of the items and response options as proposed in this article, the scale will become more understandable for people with low HL skills, which might increase the content validity and the distributional properties of the scale. Practice implications: The scale should be revised and revalidated. An improved version should be used in practice to gain insight into HL levels of patients. This will help to develop suitable education programs for people with low HL skills.

Objectives: To explore patients’ perceptions regarding prospective telerehabilitation services and the factors that facilitate or impede patients’ intentions to use these services. - Design: Using semi-structured interviews, patients reflected on the pros and cons of various scenarios of prospective telerehabilitation services. Patients’ arguments were first arranged according to the Unified Theory of Acceptance and Use of Technology (UTAUT). Next, using inductive analysis, the data for each UTAUT component were analysed and arranged into subthemes. - Setting and participants: Twenty-five chronic pain patients were selected from a rehabilitation centre in the Netherlands. - Results: Overall, participants considered telerehabilitation helpful as a complementary or follow-up treatment, rather than an autonomous treatment. Arguments mainly related to the UTAUT constructs of ‘performance expectancy’ and ‘facilitating conditions’. Patients valued the benefits such as reduced transportation barriers, flexible exercise hours and the possibility to better integrate skills into daily life. However, many patients feared a loss of treatment motivation and expressed concerns about both reduced fellow sufferer contact and reduced face-to-face therapist contact. Few arguments related to ‘social norms’ and ‘effort expectancy’. - Conclusions: The effect of telerehabilitation on healthcare strongly depends on patients’ willingness to use. Our study showed that chronic pain patients valued the benefits of telerehabilitation but hesitate to use it as an autonomous treatment. Therefore, future initiatives should maintain traditional care to some degree and focus on patients’ attitudes as well. Either by giving information to increase patients’ confidence in telerehabilitation or by addressing reported drawbacks into the future design of these services. Further quantitative studies are needed to explore patients’ intentions to use telerehabilitation.

The objective of this study is to explore the experiences and attitudes of rheumatologists and oncologists with regard to their patients' health-related Internet use. In addition, we explored how often physicians referred their patients to health-related Internet sites. We sent a questionnaire to all the rheumatologists and oncologists in the Netherlands. The questionnaire included questions concerning demographics, experiences with patients' health-related Internet use, referral behavior, and attitudes to the consequences of patients' health-related Internet use (for patients themselves, the physician-patient relationship and the health care). The response rate was 46% (N=238). Of these respondents, 134 practiced as a rheumatologist and 104 as an oncologist. Almost all physicians encountered their patients raising information from the Internet during a consultation. They were not, however, confronted with their patients' health-related Internet use on a daily basis. Physicians had a moderately positive attitude towards the consequences of patients' health-related Internet use, the physician-patient relationship and the health care. Oncologists were significantly less positive than rheumatologists about the consequences of health-related Internet use. Most of the physicians had never (32%) or only sometimes (42%) referred a patient to a health-related Internet site. Most physicians (53%) found it difficult to stay up-to-date with reliable Internet sites for patients. Physicians are moderately positive about their patients' health-related Internet use but only seldom refer them to relevant sites. Offering an up-to-date site with accredited websites for patients might help physicians refer their patients.

This study examined the construct validity of the Dutch Life Orientation Test-Revised (LOT-R) in two samples; one sample of patients with psychiatric disorders (n=157) and one sample of patients with rheumatoid arthritis (RA, n=83). Confirmatory factor analyses showed that the LOT-R was not sufficiently unidimensional and could be better explained by two underlying factors consisting of positively and negatively worded items, respectively. This two-factor solution fitted the data significantly better than the onefactor solution in both groups, but satisfied all criteria for good model fit in the psychiatric patient sample only. One-factor models allowing correlated error terms between the positively or negatively worded items performed equally better than the original one-factor solution in both groups, indicating that the two factors may be the result of the specific wording of the items. However, the two factors were differentially associated with other relevant psychological constructs and correlation patterns differed substantially between both populations, indicating possible conceptual differences between optimism and pessimism. Overall, the findings suggest that the positively and negatively worded items of the Dutch LOT-R do not reflect a true unidimensional construct, but two underlying factors which may reflect a complex combination of methodological artefact and substantive differences. Therefore, researchers using the Dutch LOT-R are encouraged to not only rely on total scale scores, but to use additional sub-scores for optimism and pessimism to better examine possible relationships and effects in optimism research.

Decision aids (DAs) may be helpful in improving patients' participation in medical decision-making. We investigated the potential for web-based DAs in a rehabilitation population. Two self-administered DAs focused on the treatment of acquired ankle-foot impairment in stroke and the treatment of arm-hand function in cervical spinal cord injury (SCI). Data collection comprised a telephone interview and a self-reported paper questionnaire. Of the patients who agreed to participate, 39 stroke patients (44%) and 38 patients with SCI (78%) returned a questionnaire. More than 75% of patients expressed a need for more information about the treatment of disease-related impairment. The DAs were highly appreciated by both patient groups. Nearly all patients expressed a positive attitude towards the use of the web-based DAs in general practice. The DAs had a positive effect on the knowledge about the treatment alternatives in the stroke patients ( P = 0.001), although not in the patients with SCI. The DAs reduced patients' conflict about treatment ( P < 0.05). The effect of the DAs on patients' desired role in decision-making was limited. Web-based aids are feasible in the rehabilitation population with access to a computer and can improve the knowledge gaps in patients.

We studied the success and success factors of online support groups (OSGs) for patients, and the motives and goals of people who start such groups. We interviewed 23 webmasters of OSGs for patients with breast cancer, fibromyalgia and arthritis. The majority were women ( n = 20) and most were patients ( n = 21). Analysis of the interviews revealed that webmasters had altruistic and intrinsic motives for initiating an online support group. They defined success as the fulfilment of the goals they had in mind when they initiated their groups. To be able to make a group successful, decisions about its organization and management need to be coherent with these goals. Most webmasters stressed that promoting the group, keeping it alive and moderating the messages were vital success factors during the evolution stage. Management of the OSGs took up much of the webmasters' time and energy. On average webmasters were occupied with the group for 10–15 hours a week. Our study provides an overview of the pros and cons of differing decisions that have to be made when initiating an OSG.

Het aantal patiënten dat met thuisbeademing wordt behandeld is de afgelopen jaren fors toegenomen, en zal de komende jaren vermoedelijk verder stijgen. Er is nog maar weinig bekend over de gevolgen van thuisbeademing voor patiënt en gezin, zeker waar het beademing bij kinderen betreft. Met het huidige onderzoek is getracht hierin een eerste inzicht te verkrijgen. Vijftien kinderen met thuisbeademing werden in aanwezigheid van hun ouder(s) geïnterviewd aan de hand van een semigestructureerd interviewschema. Acht kinderen hadden tracheostomale beademing, zeven kinderen werden niet-invasief beademd. De meeste patiënten en hun ouders gaven aan dat het moment dat beademing actueel werd als een volslagen verrassing kwam, zelfs als hier tevoren over was gesproken. Het opstarten van de thuisbeademing was een ingrijpende gebeurtenis, maar uiteindelijk werd het onderdeel van de dagelijkse routine. Door de meeste kinderen werd door de beademing een duidelijke vooruitgang in conditie en welbevinden bemerkt. Als belangrijkste beperking werd genoemd de invloed die thuisbeademing heeft op het sociaal functioneren van het gezin. Als belangrijkste verbeterpunten werden genoemd de voorlichting over nietinvasieve beademing en de inspraak in de zorg tijdens instellen op de afdeling intensive care.

The aim of this study was to explore the percentage of Dutch patients using the Internet to search for information about their illness. In addition, we studied patients' usage of health-related Internet applications, such as online patient support groups. The final objective of this study was to explore which demographic, health and psychological characteristics are related to patients' health-related Internet use. In order to answer these research questions we sent a written questionnaire to a representative sample of patients with breast cancer, rheumatoid arthritis and fibromyalgia. The overall total response rate was 69% (N = 679). In total, 52% of the patients used the Internet to search for information about their illness. However, only 15% of the respondents had ever read along with an online patient support group. An even smaller proportion of the patients (4%) had send postings to such a group. Online communication with health professionals was not commonly practiced. A younger age, a higher education and employment appeared to be the only significant predictors of patients' health-related Internet use. Patients' health-related Internet use could not be predicted by health and psychological characteristics. Although, about half of the patients made use of the Internet for health-related reasons, mostly their health-related Internet use was restricted to seeking information about their illness.

People in stressful circumstances, such as serious health conditions, often turn to support groups. With the increase in the availability and popularity of the Internet, the possibility has arisen to join support groups online. Various authors have raised potential disadvantages of these groups, such as the lack of control of the quality of the information that is exchanged and the concern that the exchange within the group might include socially inappropriate remarks. In this study we explored to what extent these potential disadvantages actually occur. In addition, we explored who uses Dutch online support groups and what is exchanged by the participants. By means of ''content analysis'' we analyzed a random sample of 1500 messages from publicly available online support groups for patients with breast cancer, arthritis and fibromyalgia. It appeared that the online support groups under study were mainly used by female patients. A major part of the postings contained ''off topic'' remarks. Popular health related topics were ''restrictions in daily life'' and ''regular medication''. Only in a minor proportion of the postings, potential disadvantages were present. Therefore this study suggests that online support groups are a viable option for support.

OBJECTIVE: To evaluate the frequency of use and relevance of health-related Internet (HRI) sites and online peer support groups and their association with demographic, disease-related and psychosocial variables in young people with JIA. METHODS: In a cross-sectional study, 176 young people (10-27 years of age) with JIA were asked to complete a questionnaire. The frequency of using HRI sites (regarding information, medication use and aspects of JIA relating to social life), online peer contact and perceived relevance of HRI sites and online peer communication were determined. Associations with demographic variables, disease activity, medication, emotional behaviour and coping were also examined. RESULTS: Seventy-one per cent of the 142 respondents had used the Internet to search for general information on JIA, but specific topics, such as medication, were searched for less often. Twenty-five per cent of respondents had visited a forum or had contacted peers online. The perceived relevance of HRI sites and online peer contact was rated low (median 2.0 and 1.0, respectively; scale 0-10). Apart from female gender (P < 0.01), none of the demographic and disease-related factors were associated with HRI site use. Coping styles, confrontation and reassuring thoughts were associated with increased HRI site use, but only in males. Internalizing and externalizing problem behaviour were not significantly associated. CONCLUSION: The frequency of HRI site use among young people with JIA was less than expected and was considered of low relevance. HRI sites in their present form cannot replace traditional information as an additional source to increase knowledge.

BackgroundPositive psychology interventions have been found to enhance well-being and decrease clinical symptomatology. However, it is still unknown how flourishing can also be increased. Although multicomponent interventions seem to be necessary for this purpose, different formats can be used. A cost-effective approach could be a positive psychology-based self-help book with tailored email support to reach large target groups and to prevent dropout. ObjectiveThis study will evaluate the efficacy of a comprehensive multicomponent self-help intervention with or without email support on well-being and flourishing, and will seek to determine the working mechanisms underlying the intervention. MethodsIn this 3-armed, parallel, randomized controlled trial, 396 participants with low or moderate levels of well-being and without clinical symptomatology will be randomly assigned to (1) a self-help book condition with weekly email support, (2) a self-help book condition without email support but with a weekly information email, or (3) a waiting list control condition. Online measurements will be assessed at baseline, at post-test (3 months after baseline), and at 6 and 12 months after baseline. ResultsThe primary outcomes are well-being and flourishing (ie, high levels of well-being). Secondary outcomes are the well-being components included in the intervention: positive emotion, use of strengths, optimism, self-compassion, resilience, and positive relations. Other measures include depressive and anxiety symptoms, personality traits, direct medical and non-medical costs, life-events, and client satisfaction. ConclusionsThis study will add knowledge to the efficacy and cost-effectiveness of a multicomponent positive psychology intervention. We will also explore who can benefit most from this intervention. If the intervention is found to be effective, our results will be especially relevant for public mental health services, governments, and primary care. Trial RegistrationThe Netherlands Trial Register NTR4297; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4297 (Archived by WebCite at http://webcitation.org/6Uwb5SUUM).