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Doelstelling Leefstijlaanpassingen zijn belangrijk in de behandeling van diabetes type 2 (DT2). Begin 2022 is gestart met de tweejarige gecombineerde leefstijlinterventie (GLI) Coaching op Leefstijl (CooL) in ZGT om mensen met DT2 te begeleiden naar een betere leefstijl. eHealth kan een ondersteunende rol hebben in dit traject. Echter, er is nog weinig bekend over het gebruik van eHealth in combinatie met een GLI. Sinds januari 2022 kunnen patiënten met DT2 deelnemen aan het CooL-programma en gebruiken zij de eerste zes maanden daarnaast de Diameter (CooL+Diameter). De Diameter is een app die ondersteunt bij dagelijkse leefstijlmonitoring (glucose, voeding en beweging) en digitaal coacht als aanvulling op het CooL-programma. Het doel van deze studie was om de haalbaarheid en effecten van dit nieuwe zorgconcept in de ziekenhuissetting te exploreren vanuit het perspectief van de patiënt en de betrokken zorgverleners. Methode Deze studie heeft een mixed-method prospectief longitudinaal design. Allereerst zijn semigestructureerde interviews met 5 patiënten en 8 zorgprofessionals gehouden drie maanden na de start van de interventie. Daarnaast werden glucoseregulatie (o.a. Time in Range, Hba1c), lichaamssamenstelling (o.a. BMI), beweging, voedingsinname en kwaliteit van leven gemeten op baseline, drie en zes maanden van 5 patiënten na start van de interventies. Resultaten De eerste resultaten laten een hoofdzakelijk positief beeld zien ten aanzien van de haalbaarheid. Patiënten en professionals zagen voornamelijk meerwaarde in het monitoren van glucosewaarden en leefstijl en het bespreken van deze metingen met de leefstijlcoach. Het grootste punt van kritiek was dat de coaching elementen in de Diameter nog onvoldoende aansluiten bij de inhoud van het CooL-programma. De analyse van de kwantitatieve data volgt in juli 2022. Conclusie De eerste bevindingen geven concrete aangrijpingspunten voor het verbeteren van zowel de interventies, de integratie van beide interventies als de implementatie in de ziekenhuissetting. Naar verwachting zijn de resultaten van CooL+Diameter ten aanzien van de eerste effecten op patiëntuitkomsten in oktober bekend en kunnen op de wetenschapsdag conclusies over dit onderzoeksdeel gepresenteerd worden.

Background: In primary care, lifestyle changes are the cornerstone of treatment for people with Type 2 Diabetes (T2D), as a healthy lifestyle can contribute to the reversion or remission of T2D. eHealth applications that support lifestyle changes can be of added value in supporting healthcare. The Diameter app offers lifestyle support through monitoring and coaching of physical activity, nutrition and blood glucose. This study explored the perspectives of people with T2D and healthcare professionals regarding the implementation of the Diameter in primary care. Methods: A qualitative design was used to explore motivations, facilitators and barriers to implement the Diameter in primary care from the perspective of people with T2D and healthcare professionals. From April 21 to June 8 2021, 18 semi-structured interviews were conducted based on the Consolidated Framework for Implementation Research (CFIR). All interviews were audio-recorded, transcribed verbatim, and coded applying inductive thematic analysis. Results: Eight main themes with accompanying sub codes emerged. Motives for using the Diameter were found in the provision of insight for the patient and healthcare professional, the diversity of the patient population, and the implementation setting. The main motivation for implementing the Diameter was the insight that it can provide into the relationship between lifestyle and glucose levels for people with newly diagnosed or poorly controlled diabetes. Facilitators for implementing the Diameter were related to the adoption of the Diameter in the region and the potential to improve efficient working. Important barriers converged around the characteristics of the patient population, interoperability with IT systems, and reimbursement from the health insurer. Discussion: People with T2D and a diverse group of healthcare professionals both see the potential added value of the Diameter in primary diabetes care, provided that the main conditions and barriers for use and implementation are taken into account.

Doelstelling Leefstijlaanpassingen zijn essentieel voor patiënten met diabetes type 2 (DT2) en eHealth interventies kunnen hier effectief in ondersteunen. Echter, deze interventies zijn vaak niet toegankelijk voor DT2-patiënten met beperkte gezondheidsvaardigheden. Deze patiënten hebben moeite om informatie over leefstijl te begrijpen en beoordelen. Veel eHealth interventies zijn niet afgestemd op de behoeften van deze doelgroep. Om mensen met DT2 en beperkte gezondheidsvaardigheden beter te kunnen begeleiden is in dit onderzoek een device ontwikkeld en geëvalueerd dat als aanvulling op een eHealth interventie gebruikt kan worden. Methode Het Creative Technology Design Process diende als leidraad voor het ontwerpproces waarbij gebruik werd gemaakt van divergerende en convergerende ontwikkelfasen op basis van expert opinies en literatuur. Het prototype werd geëvalueerd op begrijpelijkheid en gebruiksvriendelijkheid onder mensen met beperkte gezondheidsvaardigheden en een zorgprofessional met kennis van de doelgroep door middel van think-aloud sessies. Resultaten Het device is een “box” uitgerust met speakers en vier lades waarin kaarten liggen met uitdagingen op het gebied van beweging en voeding, informatie over een gezonde leefstijl en quizvragen. Iedere kaart bevat een illustratie en een korte tekst met het doel van de kaart. De kaart kan op een platform op het device worden gelegd waardoor een karakter met DT2 aanvullende auditieve informatie geeft. Tevens kan iedere kaart gescand worden met de mobiele telefoon waardoor een animatie met instructies, informatie of quizvragen over leefstijl getoond wordt waarin het karakter met DT2 terugkomt. De zorgprofessional was zeer positief door het interactieve karakter van het device. De doelgroep was enthousiast over het concept, vonden het device er aantrekkelijk uitzien en makkelijk in gebruik. Een belangrijk verbeterpunt is het instellen van herinneringen voor het pakken van een nieuwe kaart. Conclusie In het device zijn verschillende essentiële elementen voor informatieoverdracht aan mensen met beperkte gezondheidsvaardigheden gecombineerd. Naar aanleiding van de evaluatiestudie zal het prototype verder worden ontwikkeld.

Engagement in electronic health (eHealth) and mobile health (mHealth) behavior change interventions is thought to be important for intervention effectiveness, though what constitutes engagement and how it enhances efficacy has been somewhat unclear in the literature. Recently published detailed definitions and conceptual models of engagement have helped to build consensus around a definition of engagement and improve our understanding of how engagement may influence effectiveness. This work has helped to establish a clearer research agenda. However, to test the hypotheses generated by the conceptual modules, we need to know how to measure engagement in a valid and reliable way. The aim of this viewpoint is to provide an overview of engagement measurement options that can be employed in eHealth and mHealth behavior change intervention evaluations, discuss methodological considerations, and provide direction for future research. To identify measures, we used snowball sampling, starting from systematic reviews of engagement research as well as those utilized in studies known to the authors. A wide range of methods to measure engagement were identified, including qualitative measures, self-report questionnaires, ecological momentary assessments, system usage data, sensor data, social media data, and psychophysiological measures. Each measurement method is appraised and examples are provided to illustrate possible use in eHealth and mHealth behavior change research. Recommendations for future research are provided, based on the limitations of current methods and the heavy reliance on system usage data as the sole assessment of engagement. The validation and adoption of a wider range of engagement measurements and their thoughtful application to the study of engagement are encouraged.

Physical inactivity is an increasingly serious global health problem, which implies a strong need for effective and engaging interventions. Smartphone technology offers new possibilities to address physical activity promotion. For app-based interventions to have an impact, both the effectiveness and user appreciation of the app are important. In this paper, we explore the user appreciation of the Active2Gether intervention, which offers personalized coaching to increase physical activity levels in daily life. The results are compared to the evaluation of a simplified version of the Active2Gether app (in which no coaching messages are sent) and the Fitbit app. Overall, the results reveal that users of a physical activity app appreciate a coaching feature to be included (on top of self-monitoring functionalities), but are also critical of how it is implemented (in terms of the number and content of the messages). The results also show that it is important to find a balance in the number of messages sent: too many messages seem to be perceived as annoying, but on the other hand, such system-initiated user interaction seems to reduce dropout.

The present white paper presents five principles that can guide the design and implementation of effective and appropriate approaches to e-coaching and discusses both their scientific underpinnings and their (potential) applications. The paper crystallises insights that have emerged in recent and ongoing research developed in the Healthy Lifestyle Solutions programme, which is co-ordinated by the Technology Foundation STW and jointly funded by Philips Research and NWO’s National Initiative for Brain and Cognition (NIHC). Those research projects are focused on the areas of diet, exercise, sleep, and stress, but their applications are even wider.

The present white paper presents five principles that can guide the design and implementation of effective and appropriate approaches to e-coaching and discusses both their scientific underpinnings and their (potential) applications. The paper crystallises insights that have emerged in recent and ongoing research developed in the Healthy Lifestyle Solutions programme, which is co-ordinated by the Technology Foundation STW and jointly funded by Philips Research and NWO’s National Initiative for Brain and Cognition (NIHC). Those research projects are focused on the areas of diet, exercise, sleep, and stress, but their applications are even wider.

International audience; Engagement in electronic health (eHealth) and mobile health (mHealth) behavior change interventions is thought to be important for intervention effectiveness, though what constitutes engagement and how it enhances efficacy has been somewhat unclear in the literature. Recently published detailed definitions and conceptual models of engagement have helped to build consensus around a definition of engagement and improve our understanding of how engagement may influence effectiveness. This work has helped to establish a clearer research agenda. However, to test the hypotheses generated by the conceptual modules, we need to know how to measure engagement in a valid and reliable way. The aim of this viewpoint is to provide an overview of engagement measurement options that can be employed in eHealth and mHealth behavior change intervention evaluations, discuss methodological considerations, and provide direction for future research. To identify measures, we used snowball sampling, starting from systematic reviews of engagement research as well as those utilized in studies known to the authors. A wide range of methods to measure engagement were identified, including qualitative measures, self-report questionnaires, ecological momentary assessments, system usage data, sensor data, social media data, and psychophysiological measures. Each measurement method is appraised and examples are provided to illustrate possible use in eHealth and mHealth behavior change research. Recommendations for future research are provided, based on the limitations of current methods and the heavy reliance on system usage data as the sole assessment of engagement. The validation and adoption of a wider range of engagement measurements and their thoughtful application to the study of engagement are encouraged.

Background: Electronic health (eHealth) and mobile health (mHealth) approaches to address low physical activity levels, sedentary behavior, and unhealthy diets have received significant research attention. However, attempts to systematically map the entirety of the research field are lacking. This gap can be filled with a bibliometric study, where publication-specific data such as citations, journals, authors, and keywords are used to provide a systematic overview of a specific field. Such analyses will help researchers better position their work. Objective: The objective of this review was to use bibliometric data to provide an overview of the eHealth and mHealth research field related to physical activity, sedentary behavior, and diet Methods: The Web of Science (WoS) Core Collection was searched to retrieve all existing and highly cited (as defined by WoS) physical activity, sedentary behavior, and diet related eHealth and mHealth research papers published in English between January 1, 2000 and December 31, 2016. Retrieved titles were screened for eligibility, using the abstract and full-text where needed. We described publication trends over time, which included journals, authors, and countries of eligible papers, as well as their keywords and subject categories. Citations of eligible papers were compared with those expected based on published data. Additionally, we described highly-cited papers of the field (ie, top ranked 1%). Results: The search identified 4805 hits, of which 1712 (including 42 highly-cited papers) were included in the analyses. Publication output increased on an average of 26% per year since 2000, with 49.00% (839/1712) of papers being published between 2014 and 2016. Overall and throughout the years, eHealth and mHealth papers related to physical activity, sedentary behavior, and diet received more citations than expected compared with papers in the same WoS subject categories. The Journal of Medical Internet Research published most papers in the field (9.58%, 164/1712). Most papers originated from high-income countries (96.90%, 1659/1717), in particular the United States (48.83%, 836/1712). Most papers were trials and studied physical activity. Beginning in 2013, research on Generation 2 technologies (eg, smartphones, wearables) sharply increased, while research on Generation 1 (eg, text messages) technologies increased at a reduced pace. Reviews accounted for 20 of the 42 highly-cited papers (n=19 systematic reviews). Social media, smartphone apps, and wearable activity trackers used to encourage physical activity, less sedentary behavior, and/or healthy eating were the focus of 14 highly-cited papers. Conclusions: This study highlighted the rapid growth of the eHealth and mHealth physical activity, sedentary behavior, and diet research field, emphasized the sizeable contribution of research from high-income countries, and pointed to the increased research interest in Generation 2 technologies. It is expected that the field will grow and diversify further and that reviews and research on most recent technologies will continue to strongly impact the field. Refereed/Peer-reviewed