Crossroads of well-being and compliance: a qualitative cohort study of visitor restriction policy during the COVID-19 pandemic, the Netherlands, May 2020-December 2021.

BACKGROUND: In this qualitative study we observed in-depth the impact of the visiting restriction policy (VRP, i.e. number of visitors allowed at home) on well-being and compliance during the COVID-19 pandemic to regulate infection rates. METHODS: A cohort of 15 interviewees was followed throughout the COVID-19 pandemic in the Netherlands in 12 interview rounds (May 2020-December 2021). Every round semi-structured telephone interviews were conducted by a team of 8 researchers. In total 176 interviews were conducted. RESULTS: This study showed that four categories can be identified when observing the impact of the VRP on well-being and compliance. For Resilient-Followers reasons for compliance were risk perception, following government rules, and for some having a small social circle. Because they accepted the situation, well-being was hardly affected. Resilient-Rulebreakers made their own risk assessment of people they met. Their well-being was hardly affected, because they experienced social rest and interpreted the measure in their own way. Suffering-Followers complied, because of risk perception, following government rules, and working in healthcare. However, the VRP had substantial impact on well-being, because social structures were disrupted. Suffering-Rulebreakers gave their own interpretation to the VRP, trying to find a balance between compliance and well-being. We observed that the categories were quite stable over time. CONCLUSIONS: The VRP appeared to be a measure with substantial impact on well-being for some, mostly because social structures were disrupted. The measure showed fluctuating compliance, in which feasibility and frequent changes in the VRP played a role. Well-being seemed related to the number of visitors that was allowed; a restriction of four visitors was feasible, while one visitor resulted in a negative breaking-point in resilience, which had an impact on compliance, even among the most compliant. Taken together, this study provides valuable insights into the implications of and compliance to a VRP during different phases of the COVID-19 pandemic, which may contribute to policymaking during future pandemics.

Moderators of the Effectiveness of UPcomplish on Office Workers' Sedentary Behaviour, Quality of Life, and Psychosocial Determinants: A Stepped Wedge Design.

BACKGROUND: In the earlier developed and evaluated 12-week UPcomplish intervention, the aim was to reduce sedentary behaviour (SB) among office workers and increase their quality of life (QoL). In the current study, we explored moderators of effectiveness. METHOD: We applied a stepped wedge design with five intervention groups starting with time lags of seven weeks (n = 142, 96 females). Participants wore the VitaBit to continuously measure SB and received surveys about QoL and psychosocial determinants at the beginning, middle, and end of the intervention. We regressed baseline participant characteristics and behaviours onto intra-individual improvements (centred around calendar week means) in determinants, SB, performance objectives, and QoL. RESULTS: Those scoring high in baseline intention, task performance, stress, vitality, and emotional well-being improved less in these variables. Baseline stress (ß = - 0.05 [SE = 0.01; 95% CI = - 0.08, - 0.02; pcorrected = .02]) and emotional well-being (ß = 0.02 [SE = 0.01; 95% CI = 0.01, 0.03; pcorrected = .02]) were associated with improvement in contextual performance. Baseline attitude (ß = - 12.92 [SE = 3.93; 95% CI = - 20.80, - 5.04; pcorrected = .02]) and perceived behavioural control (PBC; ß = - 9.27 [SE = 3.04; 95% CI = - 15.37, - 3.16; pcorrected = .03]) were negatively associated with improvements in emotional well-being. Post hoc analyses with a sub-group scoring lower in determinants revealed that improvement in PBC was positively associated with SB registration. CONCLUSION: Participants scoring low in baseline determinants might profit from UPcomplish via an increase in PBC. In combination with changes within organizations (e.g. the implementation of standing desks), UPcomplish might potentially reduce SB. TRIAL REGISTRATION: NL7503 - registered 1 February 2019.

Investigating the Role of Goals and Motivation on Waste Separation Behavior Through the Lens of the Theory of Reasoned Goal Pursuit.

Nowadays the prediction and change of waste-related behaviors represent a key topic for scholars and policy makers. The theoretical mainstays applied to waste separation behavior, such as the Theory of Planned Behavior (TPB), the Norm Activation Model and the Value Belief Norm, do not include the construct of goal in their formulation. Other goal-focused theories, such as the Goal Systems Theory (GST), lack applications on separation behavior. Recently, Ajzen and Kruglanski (2019) have proposed the Theory of Reasoned Goal Pursuit (TRGP) which combines TPB and GST. Considering TRGP has the potential to offer further insights on human behavior and, to our knowledge, there is no application of TRGP to recycling behavior yet, this paper analyses waste separation behavior of households in Maastricht and Zwolle (The Netherlands) under the lens of TRGP. Although waste separation behavior represents a kind of habitual behavior, this paper highlights the influence of goals and motivation on intention to separate waste. Furthermore, it offers some indications to promote behavior change and some suggestions for future research directions.

Just-in-Time, but Still Planned: Lessons Learned From Speeding up the Development and Implementation of an Intervention to Promote COVID-19 Vaccination in University Students.

The process of developing a behavior change intervention can cover a long time period. However, in times of need, this development process has to be more efficient and without losing the scientific rigor. In this article, we describe the just-in-time, planned development of an online intervention in the field of higher education, promoting COVID-19 vaccination among university students, just before they were eligible for being vaccinated. We demonstrate how intervention development can happen fast but with sufficient empirical and theoretical support. In the developmental process, Intervention Mapping (IM) helped with decision-making in every step. We learned that the whole process is primarily depending on the trust of those in charge in the quality of the program developers. Moreover, it is about applying theory, not about theory-testing. As there was no COVID-19-related evidence available, evidence from related fields helped as did theoretical knowledge about change processes, next to having easy access to the target population and important stakeholders for informed qualitative and quantitative research. This project was executed under unavoidable time pressure. IM helped us with systematically developing an intervention, just-in-time to positively affect vaccine acceptance among university students.

Sexual health counselling by Dutch HIV care providers: A cross-sectional survey among physicians and nurses in the Netherlands.

To improve sexual health among people living with HIV, sexual health should be addressed during consultations in routine HIV care. The aim of the present study was to investigate to what extent Sexual Health Counselling (SHC) is incorporated into routine Dutch HIV care and to explore differences between physicians and nurses in their practices and views regarding SHC. A cross-sectional survey was conducted among all HIV physicians (N=110) and HIV nurses (N=82) in the Netherlands. A questionnaire assessed socio-demographic characteristics, current SHC practice, topics addressed, and factors associated with engaging in SHC. The response rate was 53.6% (N=59) among physicians and 60.0% (N=40) among nurses. SHC was performed by 26.1% of physicians and 83.9% of nurses (Χ² (1) = 27.68, p<.001). The most frequently reported barrier for SHC was the presence of a third party, endorsed by 50.9% of physicians and 60.4% of nurses. Nurses were more likely to address issues related to sexual wellbeing, while physicians mainly discussed medical topics. While, both HIV physicians and nursed felt responsible for providing SHC, nurses were more likely to address SHC that physicians. There is scope for improving SHC for PLHIV through a multidisciplinary approach based on clear guidelines for physicians and nurses.

Attachment Orientation Moderates the Sexual and Relational Implications of Sexual Desire Discrepancies.

We examined the degree and direction of sexual desire discrepancies (SDD) between partners and how this relates to sexual function, sexual satisfaction, relationship satisfaction in 100 Saudi Arabian couples, taking into account both partners' attachment orientation. Men and women reported better outcomes when they matched on higher levels of sexual desire. In case of a mismatch, women reported higher sexual satisfaction when their partner's level of sexual desire was higher than their own. Attachment anxiety and avoidance moderated the associations between SDD and the outcome variables. This study offers unique information on SDD in couples with strong gender role expectations and cultural restrictions regarding sexuality. Therapeutic interventions should be directed at understanding the attachment meaning of sexual desire.

The Effects of UPcomplish on Office Workers' Sedentary Behaviour, Quality of Life and Psychosocial Determinants: A Stepped-Wedge Design.

BACKGROUND: Sedentary behaviour (SB) affects cardiometabolic health and quality of life (QoL). We examine the effects of UPcomplish, a 12-week data-driven intervention, on SB, QoL and psychosocial determinants among office workers. METHODS: Participants were recruited via judgement sampling. Five groups starting with time-lags of 7 weeks (n = 142, 96 females) received 14 feedback messages (FBMs) which were tailored to SB patterns, goals and hurdles. Participants received questionnaires at the beginning, middle and end of the intervention and wore an accelerometer measuring SB, operationalized as proportions (compositional data approach, CoDA) and summed squared sitting bouts (SSSB). We used linear mixed-effects models with random intercepts for weeks (between-subjects) and individuals (within-subjects). RESULTS: UPcomplish did not reduce SB. Within-subjects compared to baseline, FBM #3 (ßCoDA = 0.24, p < .001, 95% CI [0.15, 0.33]; ßSSSB = 20.83, p < .001, 95% CI [13.90, 27.28]) and #4 (ßCoDA = 0.20, p < .001, 95% CI [0.11, 0.29]; ßSSSB = 24.80, p < .001, 95% CI [15.84, 33.76]) increased SB. QoL was unaffected. Perceived susceptibility was lower after FBMs #6 to #8 (ßbetween = - 0.66, p = .04, 95% CI [- 1.03, - 0.30]; ßwithin = - 0.75, p = .02, 95% CI [- 1.18, - 0.32]). Within-subjects, intentions to sit less were higher after FBMs #1 to #5 (1.14, p = .02, 95% CI [0.61, 1.66]). Improvements in determinants and in SB were not associated, nor were improvements in SB and in QoL. CONCLUSIONS: Compared to VitaBit only, UPcomplish was not beneficial. Environmental restructuring might be superior, but detailed analyses of moderators of effectiveness are needed.

Recycling behaviour: Mapping knowledge domain through bibliometrics and text mining.

In recent years, the research on human behaviour in relation to waste management has increased at an exponential rate. At the same time, the expanding academic literature on this topic makes it more difficult to understand the main areas of interest, the leading institutions and authors, the possible interconnections among different disciplines, and the gaps. This paper maps knowledge domain on recycling behaviour through bibliometric analysis and text mining in order to identify current trends, research networks and hot topics. 2061 articles between 1975 and 2020 from three different databases are examined with an interdisciplinary approach. The findings reveal that 60% of papers have been published between 2015 and 2020, and this topic is of global interest. Leading countries are mainly located in Europe, North America and Commonwealth; however, China and Malaysia are also assuming a driving role. Bibliometrics and text mining provide the intellectual configuration of the knowledge on recycling behaviour; co-word analysis individuates conceptual sub-domains in food waste, determinants of recycling behaviour, waste management system, waste electrical and electronic equipment (WEEE), higher-level education, plastic bags, and local government. Overall, waste management and related human behaviour represent a universal challenge requiring a structured and interdisciplinary approach at all levels (individual, institutions, industry, academia). Lastly, this paper offers some suggestions for future research such as smart city design, sensor network system, consumer responsibilisation, the adoption of a more comprehensive view of the areas of investigation through the holistic analysis of all stakeholders.

Social Emotional Learning and the promotion of equal personal relationships among adolescents in Panama: a study protocol.

Adolescents in Panama face multiple barriers that affect their health, such as high rates of teenage pregnancy, increased human immunodeficiency virus (HIV) infections and sexual violence. Equal relationships between women and men are likely to reduce such risks. Here, we suggest that the school-based enhancement of Social and Emotional Learning core competencies-awareness of self and others, positive attitudes and values, responsible decision-making, and social interaction skills-could foster positive changes in behaviors between boys and girls, specifically through a focus on equal roles, equal rights in relationships and nonviolent problem solving. This paper, using the Intervention Mapping Protocol, describes the process of development of, and planning surrounding the implementation and evaluation of the program 'Me and My new World', a Social Emotional Learning intervention for middle school students (12-15 years old) in Panama. Program development was based on a needs assessment (Araúz Ledezma et al. (2020) Behavioural and environmental influences on adolescent decision making in personal relationships: a qualitative multi-stakeholder exploration in Panama. Health Education Research, 35, 1-14.) and a literature review of theory- and evidence-based Social and Emotional Learning (SEL)-programs. Intervention outcomes, performance objectives and change objectives of the intervention were identified. The practical applications of different theory-based methods allowed for contextual considerations that could potentially influence the expected behavioral outcomes of the intervention. Teachers were the implementers of the program, and during development, implementation, and evaluation, the roles, opinions, and teaching methods of all stakeholders were recognized. We conclude that Intervention Mapping allows for the analysis of multiple factors influencing the development and implementation of Social Emotional Learning programs promoting equal relationships among adolescents in a developing country, with a special consideration of culture, educational systems, and policies, from a capability development perspective.

Review and gap analysis: molecular pathways leading to fetal alcohol spectrum disorders.

Alcohol exposure during pregnancy affects the development of the fetus in various ways and may lead to Fetal Alcohol Spectrum Disorders (FASD). FASD is one of the leading preventable forms of neurodevelopmental disorders. In the light of prevention and early intervention, knowledge on how ethanol exposure induces fetal damage is urgently needed. Besides direct ethanol and acetaldehyde toxicity, alcohol increases oxidative stress, and subsequent general effects (e.g., epigenetic imprinting, gene expression, and metabolite levels). The current review provides an overview of the existing knowledge about specific downstream pathways for FASD that affects e.g., the SHH pathway, cholesterol homeostasis, neurotransmitter signaling, and effects on the cytoskeleton. Available human data vary greatly, while animal studies with controlled ethanol exposition are only to a certain limit transferable to humans. The main deficits in knowledge about FASD are the lack of pathophysiological understanding and dose-response relationships, together with the lack of reliable biomarkers for either FASD detection or estimation of susceptibility. In addition to single outcome experiments, omics data should be generated to overcome this problem. Therefore, for future studies we recommend holistic data driven analysis, which allows integrative analyses over multiple levels of genetic variation, transcriptomics and metabolomics data to investigate the whole image of FASD development and to provide insight in potential drug targets for intervention.

Attachment Insecurity and Sexual and Relational Experiences in Saudi Arabian Women: The Role of Perceived Partner Responsiveness and Sexual Assertiveness.

BACKGROUND: Attachment and intimacy play an important role in shaping sexual and relational experiences. Yet, their interrelation has rarely been investigated in the context of sexual problems and never been tested in Saudi Arabian women. AIM: The present study examined the interrelations of attachment orientation and sexual function, distress, satisfaction, and relational satisfaction in a sample of Saudi Arabian women and explored whether this link can be explained by 2 important aspects of (sexual) intimacy, namely perceived partner responsiveness (PPR) and sexual assertiveness. METHOD: This is a cross-sectional, observational study in a sample of 50 heterosexual women with sexual problems and 50 control women without problems, who completed an Arabic version of questionnaires on attachment orientation, sexual assertiveness, PPR, relationship satisfaction, sexual satisfaction, sexual distress, and sexual function. RESULTS: We found that both attachment anxiety and sexual refusal showed a significant association with the level of sexual function, sexual distress, and sexual satisfaction (P < .01) in the clinical group. No mediating effects of sexual refusal were found. In the control group, sexual function, sexual distress, and sexual satisfaction were predicted by attachment avoidance (P < .01). Level of sexual function was also predicted by sexual initiation (P < .05). PPR fully mediated the association between attachment anxiety and relational satisfaction in the clinical group (P < .01), while in the control group the link between attachment avoidance and relational satisfaction was only partially mediated by PPR (P < .01). STRENGTHS & LIMITATIONS: This study offers unique information on relational and sexual functioning in a culture in which sexual expression and intimate behavior are restricted, particularly in women. CLINICAL IMPLICATIONS: Perceiving the partner as being more responsive is an important target of intervention to increase satisfaction with the relationship. CONCLUSIONS: Our results suggest that attachment anxiety and low sexual assertiveness, as indicated by lower tendencies to refuse sex when not desired, play a significant role in predicting negative sexual experiences in women who cope with sexual difficulties. Attaky A, Kok G, Dewitte M. Attachment Insecurity and Sexual and Relational Experiences in Saudi Arabian Women: The Role of Perceived Partner Responsiveness and Sexual Assertiveness. J Sex Med 2020;17:1383-1394.

Behavioural and environmental influences on adolescent decision making in personal relationships: a qualitative multi-stakeholder exploration in Panama.

Adolescents in Panama face multiple challenges to their sexual health, rights and well-being such as high rates of teenage pregnancy (∼30% of all pregnancies), increased HIV infections and sexual violence. In the absence of sufficient evidence-based data and an ongoing debate in Panamanian society about how to approach adolescents' health problems, the aim of this qualitative study was to explore the perceptions and attitudes of different societal actors, namely governmental employees, NGO employees, academics, members from religious groups, teachers and parents. We conducted in-depth interviews (N = 34) which focused on the behavioural and environmental factors considered to influence adolescents' decision making with regard to love, friendships and family relations. Furthermore, we explored how these stakeholders viewed the role of the education system, and the potential of including social-emotional learning (SEL) in the curriculum to provide skills and capacities, which could encourage adolescents to make better decisions and improve their well-being, in general but also in the context of sexual behaviours. Analysis revealed five central themes, i.e. perceptions towards gender roles and equality, adolescents' love (sexual) relationships, capacity needs regarding prevention of risk behaviours and the role of education, comprehensive sexuality education in schools and the potentiality of SEL in the education system. The findings of the study can enhance understanding on the views of stakeholders regarding the factors influencing adolescents' decision making, as well as regarding the possibilities of introducing SEL in the Panamanian educational curriculum.

Preventing adolescent sexual harassment: evaluating the planning process in two school-based interventions using the Intervention Mapping framework.

BACKGROUND: The development of school-based programs for preventing adolescent sexual harassment often lacks an evidence-based approach and use of proper theories. Appropriate stakeholders are often not involved in the development process. To help improve this process, we used the Intervention Mapping framework to retrospectively evaluate the development of two school-based programs, Benzies & Batchies and Boys, each of which was intended to prevent sexual harassment among adolescent students of a lower educational level in the Netherlands. The two interventions were among the first school-based programs targeting sexual harassment, and were implemented in Dutch secondary schools. METHODS: As well as doing desk research into the context and content of the interventions, we used semi-structured focused interviews with the initial developers to gather their opinions on and experiences with the development process, whereby the topics were based on the six steps of the IM framework. To better suit the needs of the respondents, we had adapted the language of our topics and had used open-ended questions The data we had gathered from the desk research and face-to-face consultations were checked against a planning tool that was based on 19 tasks within the six steps of IM. RESULTS: Although both programs had been developed in practice and lacked a thorough theoretical foundation, the methods and materials used represented aspects of behavior-change theories. The developers of Benzies & Batchies completed slightly more planning criteria within the six steps of the planning process, and used more change methods than the developers of Boys did. CONCLUSIONS: We recommend that parents should also be involved in the development of sex and relationship education programs, and should be allowed to participate in the program itself. To meet the needs of intervention developers, greater insight is needed into the importance of the individual steps in the Intervention Mapping framework. In our view, the development of practice-based interventions will improve if future intervention developers combine evidence-based theories with their practice-based experience. This will increase the success and effectiveness of their interventions.

Explaining the determinants of hookah consumption among women in southern Iran: a qualitative study.

BACKGROUND: The prevalence of hookah consumption has been on the increase in Iran over the past two decades. This rate is higher among women than men in the south of Iran than other geographical areas. The purpose of this study was to explain the determinants of hookah consumption among indigenous women of Bandar Abbas city, southern Iran. METHODS: This is the first qualitative study with the conventional content analysis approach that has examined the factors affecting the consumption of hookah at all ecological levels in 2018-2019. Participants, with a maximum variation in terms of age, education, occupation, hookah consumption and geographical areas of the city, were selected purposefully to take part in a semi-structured interview. The data were recorded, typed and analyzed according to the framework of the ecological model of health promotion at five levels (intrapersonal, interpersonal, organizational, social and political). The interview continued until data saturation. MAXQDA software version 10 was used for data management. RESULTS: Interviews were conducted with 56 participants (21 female hookah smokers, 15 female ex- smokers, and 20 experienced experts). A total of eight main categories were extracted from the data including; positive attitude towards hookah consumption, psychosocial needs, sensory charms of hookah, individual factors, family factors, cultural-environmental backgrounds, social-political backgrounds, and economic challenges. CONCLUSIONS: The results indicated the extensive influence of internal and external factors on the consumption of hookah. In order to successfully reduce the consumption of hookah, it is essential to consider intrapersonal, interpersonal, organizational, social and political factors.

Eligibility and willingness to donate blood in men who have (had) sex with men.

BACKGROUND: Several countries have changed, or are reevaluating, their blood donor policies for men who have had sex with men (MSM). Changing policies has consequences for donor recruitment and the donor pool. In this study, we investigated whether MSM are eligible and willing to donate blood. STUDY DESIGN AND METHODS: Members of a research panel (n = 4422) in the Netherlands were invited to participate in an online survey. We asked questions about male-to-male sex and risk behavior that are also asked during the predonation screening of a blood donor. Furthermore, we asked questions about willingness to donate. RESULTS: The total response rate was 60% (n = 2654). Of MSM nondonors (n = 230), 32.2% would be eligible to donate under a 12-month deferral policy, according to their reported risk history and last male-to-male sex. In other scenarios, 42.6% (4-month deferral), 38.7% (6-month deferral), and 18.7% (5-year deferral) would be eligible to donate. When not taking their last male-to-male sex into account (n = 203), 47.8% of MSM reported a moderate or high willingness to donate. CONCLUSION: A 12-month deferral after last male-to-male sex is a commonly used criterion by blood services. Approximately one-third of the MSM in our study would be eligible to donate under this deferral policy. Higher proportions of MSM would be eligible to donate in shorter deferral scenarios. Almost half of MSM are willing to donate blood. Targeting MSM by donor recruitment campaigns could therefore prove fruitful.

Interventions developed with the Intervention Mapping protocol in the field of cancer: A systematic review.

OBJECTIVES: The Intervention Mapping (IM) protocol provides a structured framework to develop, implement, and evaluate complex interventions. The main objective of this review was to identify and describe the content of the interventions developed in the field of cancer with the IM protocol. Secondary objectives were to assess their fidelity to the IM protocol and to review their theoretical frameworks. METHODS: Medline, Web of Science, PsycINFO, PASCAL, FRANCIS, and BDSP databases were searched. All titles and abstracts were reviewed. A standardized extraction form was developed. All included studies were reviewed by 2 reviewers blinded to each other. RESULTS: Sixteen studies were identified, and these reported 15 interventions. The objectives were to increase cancer screening participation (n = 7), early consultation (n = 1), and aftercare/quality of life among cancer survivors (n = 7). Six reported a complete participatory planning group, and 7 described a complete logic model of the problem. Ten studies described a complete logic model of change. The main theoretical frameworks used were the theory of planned behaviour (n = 8), the transtheoretical model (n = 6), the health belief model (n = 6), and the social cognitive theory (n = 6). The environment was rarely integrated in the interventions (n = 4). Five interventions were reported as effective. CONCLUSIONS: Culturally relevant interventions were developed with the IM protocol that were effective to increase cancer screening and reduce social disparities, particularly when they were developed through a participative approach and integrated the environment. Stakeholders' involvement and the role of the environment were heterogeneously integrated in the interventions.

Effect Evaluation of a Web-Based Coaching Intervention to Support Implementation of Sex Education Among Secondary School Teachers: Randomized Controlled Trial.

BACKGROUND: The quality of implementation is important to ensure the effectiveness of behavioral change interventions in practice. Implementing such programs with completeness and adherence is not an automatic process and may require additional support. In school settings, the support teachers receive during implementation is often limited and appears to fall short when attempting to preserve completeness and adherence in program delivery. With the aim to improve completeness and adherence of teachers' delivery of a sexual health promoting intervention ("Long Live Love" [LLL]) in secondary education, a Web-based e-coach was developed ("lesgevenindeliefde.nl"or"teachinglove.nl"). The effectiveness of the e-coach, as part of a broader implementation strategy, in influencing teachers' implementation was evaluated. OBJECTIVE: This study aimed to report on the effect evaluation to determine the effect of the Web-based e-coach on teacher implementation of a school-based sex education program called LLL and on its determinants. METHODS: A cluster randomized controlled trial (e-coaching vs waiting list control) was conducted with a baseline assessment (T0) and follow-up (T1) 2 weeks after completing the LLL program. A total of 43 schools with 83 teachers participated in the study. In the follow-up, 38 schools participated, 23 in the e-coaching condition with 41 teachers and 15 in the control condition with 26 teachers. Multilevel regression analysis was used to evaluate the effect of the e-coaching website on implementation behavior, namely, completeness and adherence to LLL implementation, and on its determinants. RESULTS: The e-coaching intervention was not found to have an effect on teachers' implementation behavior; teachers assigned to the experimental e-coaching website did not score higher on completeness (P=.60) or adherence (P=.67) as compared with teachers in the control condition. When comparing the 30 teachers who made actual use of the e-coaching website with the 37 teachers who did not, no significant differences were found either (P≥.54). In addition, there was no effect of e-coaching on the determinants of teacher implementation behavior (t67-75≤0.69; P≥.22). CONCLUSIONS: E-coaching was not found to be effective in enhancing completeness of and adherence to LLL by teachers. The lack of effect may be attributed to the intervention content, the limited use, or the study design itself. The e-coaching intervention may not have adequately addressed adherence and completeness of LLL to bring about behavioral change. Furthermore, the e-coaching intervention was not or insufficiently used by teachers. A possible biased sample of motivated, able teachers may have agreed to participate in the study, and a possible "ceiling effect" may have been present because of the high implementation grade. This, however, does not imply that Web-based coaching in itself is an ineffective strategy to promote adherence and completeness of program implementation. A process evaluation is required as follow-up. TRIAL REGISTRATION: International Standard Randomised Controlled Trial Number ISRCTN11754581; http://www.isrctn.com/ISRCTN11754581 (Archived by WebCite at http://www.webcitation.org/70C5TUOOh).

Effect and Process Evaluation of e-Powered Parents, a Web-Based Support Program for Parents of Children With a Chronic Kidney Disease: Feasibility Randomized Controlled Trial.

BACKGROUND: Parents of children with chronic kidney disease (CKD) experience high levels of stress in the daily management of their child's illness. Parents need continuously available support and information, yet online support programs are lacking. e-Powered Parents was developed to fill this gap; it is an online program consisting of (1) medical information, (2) an interactive part, and (3) four training modules (stress management, setting limits, communication, and coping). Prior to a large-scale evaluation, we conducted a feasibility study that consisted of an effect study and a process evaluation. OBJECTIVE: The objectives of our study were to (1) identify the outcome measures that are most likely to capture the potential benefit, (2) evaluate the potential effectiveness and effect size, and (3) evaluate recruitment, reach, the dose received, and context. METHODS: We conducted a feasibility study with a two-armed, wait-list randomized controlled trial (RCT). Prior to baseline, parents (n=146) were randomly allocated to group 1 or group 2. After completing the baseline questionnaire, parents in group 1 were given access to e-Powered Parents, while those in group 2 received usual care. At the 6-month follow-up (T1), all parents received a questionnaire and parents in group 2 were given access to e-Powered Parents as well. After 1.5 years, through an extra measurement (T2), we evaluated the effect of long-term exposure. Outcomes were the child's quality of life (Child Vulnerability Scale), parental stress (Pediatric Inventory for Parents) and fatigue (Multidimensional Fatigue Inventory), self-efficacy in communication with health care professionals (Perceived Efficacy in Patient-Physician Interactions, PEPPI-5), and parental perceptions of family management (Family Management Measure). Floor and ceiling effects and percentage of parents showing no change in scores were calculated. We used linear mixed models to evaluate the potential effectiveness and effect sizes using the intention-to-treat and per-protocol analyses. In the process evaluation, we evaluated recruitment, reach, the dose received, and context using a questionnaire sent to the parents, log-in data, and a focus group interview with health care professionals. RESULTS: At T1 (n=86) and T2 (n=51), no significant effects were found on any of the five outcomes. The PEPPI-5 showed ceiling effects and high percentages of parents showing no change between the measurement times. The information and interactive part of the intervention were used by 84% (57/68) of the parents in group 1 and 49% (32/65) of the parents in group 2. The information pages were visited most often. Overall, 64% (85/133) of the parents logged in to the training platform and 31% (26/85) actually used the training modules. CONCLUSIONS: We did not observe any significant effect on any of the outcomes. This could possibly be explained by the minimal use of the intervention and by parents' heterogeneity. For continued participation, we recommend a tailored intervention and further studies to find out whether and how online programs could be used to support parents in the management of their child's CKD. TRIAL REGISTRATION: Netherlands Trial Registry NTR4808; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4808 (Archived by WebCite at http://www.webcitation.org/719rCicvW).

Long Live Love+: evaluation of the implementation of an online school-based sexuality education program in the Netherlands.

Schools are a common setting for adolescents to receive health education, but implementation of these programs with high levels of completeness and fidelity is not self-evident. Programs that are only partially implemented (completeness) or not implemented as instructed (fidelity) are unlikely to be effective. Therefore, it is important to identify which determinants affect completeness and fidelity of program implementation. As part of the launch of Long Live Love+ (LLL+), an online school-based sexuality education program for adolescents aged 15-17, we performed a process evaluation among teachers and students to measure the levels of completeness and fidelity, identify factors influencing teachers' implementation, and to evaluate the students' response. Sixteen Biology teachers from nine secondary schools throughout the Netherlands who implemented LLL+ were interviewed and 60 students participated in 13 focus group discussions. Results showed that teachers' completeness ranged between 22-100% (M = 75%). Fidelity was high, but many teachers added elements. Teachers and students enjoyed LLL+, particularly the diversity in the exercises and its interactive character. The most important factors that influenced implementation were time and organizational constraints, lack of awareness on the impact of completeness and fidelity, and student response. These factors should be taken into account when developing school-based prevention programs.

From intention to STI prevention: An online questionnaire on barriers and facilitators for discussing sexual risk behaviour among HIV nurses.

AIMS: We aimed to elucidate facilitators and barriers that HIV nurses experience in discussing sexual risk behaviour with HIV-positive men who have sex with men, using variables from a previous qualitative study and the theory of planned behaviour. BACKGROUND: HIV-positive men who have sex with men are frequently diagnosed with sexually transmitted infections, which can be reduced if HIV nurses discuss sexual risk behaviour. DESIGN: An online questionnaire was disseminated in April 2015 among all HIV nurses in the Netherlands. METHODS: We assessed variables, such as attitudes, shame, ability, knowledge and time concerns. A regression analysis was conducted with "intention to discuss sexual risk behaviour" as an outcome variable. RESULTS: The questionnaire was completed by 60 of 79 HIV nurses. Overall, participants reported high intentions to discuss sexual risk behaviour, and 38% of the variance was explained by attitude, sexual preference, knowing ways to introduce the topic and experiencing enough time or viewing it as a priority. In addition, high intenders significantly differed from low intenders in "experienced shame," "relation with patients," "non-verbal communication," "subjective norm" and "knowledge." CONCLUSION: Improving sexual health in HIV care translates into improving opportunities and the facilitating factors in initiating the discussion of sexual risk behaviour rather than removing barriers HIV nurses experience. Interventions should mainly focus on improving the HIV nurses' perceived ability to initiate the topic of sexual risk behaviour and to utilize the jargon and terminology that is commonly used among men who have sex with men.