Professionals' perspectives on interventions to reduce problematic alcohol use in older adults: a realist evaluation of working elements.

OBJECTIVES: This study set out to understand how (which elements), in what context and why (which mechanisms) interventions are successful in reducing (problematic) alcohol use among older adults, from the perspective of professionals providing these interventions. DESIGN: Guided by a realist evaluation approach, an existing initial programme theory (IPT) on working elements in alcohol interventions was evaluated by conducting semistructured interviews with professionals. SETTING AND PARTICIPANTS: These professionals (N=20) provide interventions across several contexts: with or without practitioner involvement; in-person or not and in an individual or group setting. Data were coded and links between contexts, elements, mechanisms and outcomes were sought for to confirm, refute or refine the IPT. RESULTS: From the perspective of professionals, there are several general working elements in interventions for older adults: (1) pointing out risks and consequences of drinking behaviour; (2) paying attention to abstinence; (3) promoting contact with peers; (4) providing personalised content and (5) providing support. We also found context-specific working elements: (1) providing personalised conversations and motivational interviewing with practitioners; (2) ensuring safety, trust and a sense of connection and a location nearby home or a location that people are familiar with in person and (3) sharing experiences and tips in group interventions. Furthermore, the mechanisms awareness and accessible and low threshold participation were important contributors to positive intervention outcomes. CONCLUSION: In addition to the IPT, our findings emphasise the need for social contact and support, personalised content, and strong relationships (both between client and practitioner, and client and peers) in interventions for older adults.

The dimensionality of vaccination intentions: One strain or multiple strains?

OBJECTIVE: People likely have different attitudes toward different vaccines (e.g., they may hold a positive attitude toward the measles, mumps, and rubella-vaccine while simultaneously hold a neutral attitude toward the flu shot). To examine the dimensionality of vaccination intentions, we measured vaccination intentions toward 16 different diseases. We hypothesized that people differentiate between child-directed vaccination intentions and self-directed vaccination intentions. Furthermore, we hypothesized that some commonly studied factors (e.g., trust in authorities and fear of needles) might have different associations with the two subtypes of vaccination intentions. METHOD: We used data from a nationally representative sample of the Netherlands collected in 2021. We used exploratory (N = 865) and confirmatory factor analysis (N = 865) to evaluate the dimensionality hypothesis and used linear hypothesis tests (N = 1,779) to test whether the commonly studied factors had different associations with the different subtypes of vaccination intentions. RESULTS: The analysis showed two distinct factors of vaccination intentions: intentions toward childhood diseases and intentions toward nonchildhood diseases. Additionally, spiritual beliefs, trust in authorities, and belief in conspiracy theories had stronger associations with nonchildhood diseases than with childhood diseases. Fear of needles, prosocial personality, and religious orthodox beliefs did not have different associations with both types of vaccination intentions. CONCLUSIONS: These findings suggest that vaccination intentions is a multidimensional construct and that interventions may benefit from being tailored to the factors relevant for each specific type of vaccine. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The contribution of Dutch municipalities to stimulate smoke-free outdoor sports clubs: a qualitative study.

Local governments may play a key role in making outdoor sports clubs smoke free. This study aims to assess the activities, motives, challenges and strategies of Dutch municipalities regarding stimulating outdoor sports clubs to become smoke free. Semi-structured interviews were conducted with 19 policy officers of different municipalities in the Netherlands. The included municipalities varied in terms of region, population size and degree of urbanization. Data were analyzed using content analysis. Municipalities stimulated sports clubs to become smoke free by providing information and support and, to a lesser extent, by using financial incentives. Motives of municipalities varied from facilitating a healthy living environment for youth, responding to denormalization of smoking and aligning with goals formulated in national prevention policy. Policy officers faced several challenges, including limited capacity and funds, a reluctance to interfere with sports clubs and little support within the municipal organization. These challenges were addressed by employing various strategies such as embedding smoke-free sports in a broader preventive policy, setting a good example by creating outdoor smoke-free areas around municipal buildings, and collaborating with stakeholders in the municipality to join forces in realizing smoke-free sports clubs. Municipalities demonstrated evident motivation to contribute to a smoke-free sports environment. Currently, most municipalities fulfil an informative and supportive role, while some municipalities still explore their role and position in relation to supporting sports clubs to become smoke free. Other municipalities have established, according to them, effective strategies.

Outdoor smoke-free policies at sports clubs across Europe: Current status, recent evidence, and future challenges.

OBJECTIVE: This commentary emphasizes the importance of implementing outdoor smoke-free policies at sports clubs, particularly highlighting their limited adoption across Europe. The primary aim was to assess the progress made in the Netherlands, explore the strategies employed, and outline future challenges. METHODS: Our methodology involved an examination of national regulations and the voluntary adoption of smoke-free policies at sports clubs throughout Europe. We also assessed the adoption and implementation of these policies using recent evidence, leading to the identification of impending challenges in their implementation across Europe. RESULTS: While only a few European countries currently have national legislation prohibiting outdoor smoking at sports clubs, voluntary initiatives promoting such policies have emerged in various nations. Experiences from the Netherlands have demonstrated the feasibility of implementing outdoor smoke-free policies at sports clubs. To expand these policies across Europe, five key challenges need to be addressed: 1) encouraging smoke-free policies at sports clubs that are less inclined to adopt them, 2) ensuring consistent compliance and enforcement of outdoor smoke-free policies, 3) preventing smoking just outside the sports club, 4) garnering support from various stakeholders to ensure widespread adoption of smoke-free sports clubs, and 5) establishing monitoring and evaluation mechanisms for policy implementation. CONCLUSION: The Dutch experiences serve as a testimony to the feasibility of outdoor smoke-free policies at sports clubs. By addressing the remaining challenges, we can create healthier sports environments for children and take substantial steps towards realizing a smoke-free Europe.

Dutch experiences in new partnerships between science and practice in health promotion: toward a fourth-generation university.

For a long time already, attempts have been made to bridge the gap between research and practice. In this respect, society demands that universities should have a bigger social impact. University and society/societal organizations should work together (co-create) during the entire research process, from the articulation of the research question until the implementation of the results. There is controversy about the question whether it is possible for universities to work together with practice and at the same time to retain the academic quality standards. First, this article deals with the question what characteristics are important for universities in order to be able to work together with practice. In this respect, the Dutch scientist Steinbuch came up with a tantalizing idea arguing that universities may take a next step and develop into 'fourth generation universities'. Second, it is described how a process of co-creation between university and the health promotion practice has been developed, bottom up, at Tranzo, Scientific Center for Care and Wellbeing, Tilburg University, the Netherlands. The ideas developed by Steinbuch and the results of the bottom up processes in Tilburg are combined. Consequences of the Tilburg experiences for the characteristics of a fourth-generation university are discussed as well as consequences for the role of universities in society.

How sports clubs decide to adopt an outdoor smoke-free policy: a qualitative study applying the Garbage Can Model.

BACKGROUND: Outdoor smoke-free policies (SFPs) at sports clubs can contribute to protecting people from second-hand smoke (SHS). However, in absence of national legislation, it is uncertain whether and how sports clubs decide to adopt an SFP. The aim of this study was to explore the decision-making process at sports clubs in relation to the adoption of an outdoor SFP. METHODS: Semi-structured interviews were held with key stakeholders at 20 Dutch sports clubs (in field hockey, football, tennis, or korfball) with an outdoor SFP. Thematic analysis was applied, and themes were defined in line with the four streams of the Garbage Can Model (GCM). RESULTS: We identified four motivating factors for sports clubs to start the decision-making process: 1) SHS as a problem, 2) intolerance of smoking behavior, 3) advantages of an outdoor SFP, and 4) external pressure to become smoke-free. The decision-making process involved a variety of participants, but the board, influential club members, and smokers usually played major roles. Decisions were discussed during both formal and informal choice opportunities, but only made during formal choice opportunities. With regard to solutions, sports clubs adopted a partial or total outdoor SFP. In addition, sports clubs followed different strategies with regard to the decision-making process, which we classified along two dimensions: 1) autocratic vs. democratic and 2) fast vs. slow. CONCLUSION: A number of factors motivated sports clubs to start the decision-making process. These factors were mainly linked to a strong non-smoking norm. Decision-making involved different participants, with a key role for the board, influential club members, and smokers. Governments and other external organizations may contribute to SFP adoption at sports clubs in several ways. They may advise clubs on strategies of decision-making and how to involve smokers in this process.

Parents' and Children's Experiences with a Coordinating Professional in Integrated Care for Childhood Overweight and Obesity-A Novel Dutch Approach.

BACKGROUND: In the new integrated program of care for childhood overweight and obesity (ICCO), a Youth Health Care (YHC) nurse has the role of a coordinating professional. After a broad assessment of strengths and weaknesses in the family setting, this coordinating professional makes a plan of action with the child and parents and involves other professionals when needed. The aim of this study was to explore the experiences of parents and children with the coordinating professional in the ICCO. MATERIAL & METHODS: Semi-structured interviews were conducted with eight families. Interview data were analyzed using content analysis. In addition, descriptive data on involved professionals and referrals was collected with an online questionnaire in 38 families. RESULTS: In total, eight families (8 mothers, 2 fathers, four boys and three girls aged 10-12 yrs) were interviewed and 38 children and parents filled in (three consecutive) online questionnaires. FINDINGS: The main themes related to the experiences of parents and children with the CP: parents and children felt supported and understood by the coordinating professional. They appreciated the broad perspective and personal approach. Contacts with the coordinating professional were not always frequent. Major points of improvement concerned the intensity of the follow-up and collaboration. Only few parents experienced collaboration between the coordinating professional and other professionals in the ICCO. CONCLUSIONS: Parents and children appreciated the personal approach of the Youth Health Care nurse as a CP. The role of the coordinating professional, however, appears not fully implemented yet. Strengthening the promising role of the coordinating professional in the ICCO is recommended.

Impeding and facilitating factors for the implementation of alcohol interventions in hospitals: a qualitative and exploratory study among Dutch healthcare professionals.

BACKGROUND: Non-moderated alcohol use is more prevalent among hospitalized patients compared to the general population. However, many hospitals fail to find and intervene with people with alcohol problems. We aimed to conduct an exploration of impeding and facilitating factors experienced by healthcare professionals in implementation of alcohol interventions in Dutch general hospitals. In addition, we explored the alcohol interventions used in the selected hospitals and involved stakeholders. METHODS: Through a qualitative study, semi-structured telephone interviews were conducted with twenty healthcare professionals working in or in collaboration with six different general hospitals. RESULTS: Healthcare professionals indicated impeding and facilitating factors in the areas of motivation, knowledge and skills, patient characteristics, protocol, internal and external collaboration/support, resources, role suitability and societal support. Five different categories of approaches to identify and intervene with non-moderated alcohol use and 18 involved stakeholders from both inside and outside the hospital were found. CONCLUSIONS: Implementation of alcohol interventions for patients in Dutch general hospitals still seems to be in its infancy. Respondents emphasized the importance of one clear protocol on how to tackle alcohol problems within their hospital, repeated training on alcohol-related knowledge and skills, (clinical) "champions" that support healthcare professionals and developing and maintaining collaborations with stakeholders within and outside the hospital.

Survey of intention among public health nurses in providing solution-focused parenting support.

OBJECTIVE: Parenting support has shifted from a problem-focused to a strengths-based solution-focused approach. This study surveyed public health nurses to explain their intention to provide solution-focused parenting support in their practice. DESIGN: The design of this study was cross-sectional. SAMPLE: The initial sample included 781 public health nurses who were employed with various youth healthcare organizations in the Netherlands. MEASUREMENTS: Based on the Theory of Planned Behavior, a questionnaire was developed and administered to measure (a) behavioral, normative, and control beliefs, (b) attitudes, subjective norm, and perceived behavioral control, and (c) intention. The data were subjected to structural equation modeling. RESULTS: A total of 449 (57.5%) public health nurses completed questionnaires. Associations as indicated by the Theory of Planned Behavior were confirmed with the exception of that between perceived behavioral control and intention. Statistically significant paths and correlations were added. The final model accounted for 53% of the variance in the intention to perform solution-focused parenting support. CONCLUSIONS: In this study, public health nurses strongly intended to provide solution-focused parenting support, thus indicating their acceptance of the approach. Their intention was predominantly associated with subjective norm.

Falls prevention at GP practices: a description of daily practice.

BACKGROUND: General practitioners (GPs) can be considered the designated professionals to identify high fall risk and to guide older people to fall preventive care. Currently it is not exactly known how GPs treat this risk. This study aims to investigate GPs' daily practice regarding fall preventive care for frail older patients. METHODS: Sixty-five GPs from 32 Dutch practices participated in this study for a period of 12 months. When a GP entered specific International Classification of Primary Care-codes related to frailty and/or high fall risk in their Electronic Health Records, a pop-up appeared asking "Is this patient frail?". If the GP confirmed this, the GP completed a short questionnaire about patient's fall history and fear of falling (FOF), and the fall preventive care provided. RESULTS: The GPs completed questionnaires regarding 1394 frail older patients aged ≥75. Of 20% of these patients, the GPs did not know whether they had experienced a fall or not. The GPs did not know whether a FOF existed in even more patients (29%). Of the patients with a fall history and/or a FOF (N = 726), 37% (N = 271) received fall preventive care. Two main reasons for not offering fall preventive care to these patients were: I) the patient finds treatment too intensive or too much of a hassle (37%), and II) the GP identified a high fall risk but the patient did not acknowledge this (14%). When patients were treated for high fall risk, the GP and the physiotherapist were the most frequently involved health care providers. The involved health care providers most often treated mobility limitations, cardiovascular risk factors, and FOF. CONCLUSIONS: The results from this study show that GPs were frequently not aware of their frail patient's fall history and/or FOF and that the majority of the frail older patients with a fall history and/or FOF did not receive fall preventive care. Developing systematic screening strategies for the primary care setting enhancing the identification of high fall risk and the provision of fall preventive care may improve patients' quality of life and reduce health care costs.

Practical and validated tool to assess falls risk in the primary care setting: a systematic review.

OBJECTIVE: Although several falls risk assessment tools are available, it is unclear which have been validated and which would be most suitable for primary care practices. This systematic review aims to identify the most suitable falls risk assessment tool for the primary care setting (ie, requires limited time, no expensive equipment and no additional space) and that has good predictive performance in the assessment of falls risk among older people living independently. DESIGN: A systematic review based on prospective studies. METHODS: An extensive search was conducted in the following databases: PubMed, Embase, CINAHL, Cochrane and PsycINFO. Tools were excluded if they required expensive and/or advanced software that is not usually available in primary care units and if they had not been validated in at least three different studies. Of 2492 articles published between January 2000 and July 2020, 27 were included. RESULTS: Six falls risk assessment tools were identified: Timed Up and Go (TUG) test, Gait Speed test, Berg Balance Scale, Performance Oriented Mobility Assessment, Functional Reach test and falls history. Most articles reported area under the curve (AUC) values ranging from 0.5 to 0.7 for these tools. Sensitivity and specificity varied substantially across studies (eg, TUG, sensitivity:10%-83.3%, specificity:28.4%-96.6%). CONCLUSIONS: Given that none of the falls risk assessment tools had sufficient predictive performance (AUC <0.7), other ways of assessing high falls risk among independently living older people in primary care should be investigated. For now, the most suitable way to assess falls risk in the primary care setting appears to involve asking patients about their falls history. Compared with the other five tools, the falls history requires the least amount of time, no expensive equipment, no training and no spatial adjustments. The clinical judgement of healthcare professionals continues to be most important, as it enables the identification of high falls risk even for patients with no falls history. TRIAL REGISTRAION NUMBER: The Netherlands Trial Register, NL7917; Pre-results.

Adolescents' beliefs, attitudes and social norms with regard to smoking and sports: a qualitative study.

OBJECTIVES: The aim of this study is to explore the beliefs, attitudes and social norms of Dutch adolescents with regard to smoking and sports. In addition, we examine whether there are differences between adolescents at sports clubs with versus without an outdoor smoke-free policy (SFP). DESIGN: Qualitative design in the form of focus group interviews. SETTING: Focus group interviews (n=27) were conducted at 16 sports clubs in the Netherlands. Soccer, tennis, field hockey and korfball clubs were included. Focus group discussions were transcribed verbatim and analysed thematically using MAXQDA. PARTICIPANTS: 180 adolescents aged 13-18 years old were included in the study. All participants signed an informed consent form. For participants younger than 16 years, parental consent was required. RESULTS: With respect to smoking in relation to sports, participants had mostly negative beliefs (ie, smoking has a negative effect on health and sports performance), attitudes (ie, sports and smoking are activities that do not fit together; at sports clubs smoking is not appropriate), and social norms (ie, it is not normal to smoke at sports clubs). The same beliefs, attitudes and social norms were expressed by participants at both sports clubs with and without an outdoor SFP. However, argumentation against smoking was more detailed and more consistent among participants at sports clubs with an outdoor SFP. CONCLUSION: Adolescents have negative beliefs, attitudes and social norms with regard to smoking in relationship to sports. Outdoor SFP at sports clubs might reinforce these negative associations. These findings point to the potential importance of sports in the prevention of adolescent smoking.

Adolescents' support for an outdoor smoke-free policy at sports clubs in the Netherlands.

INTRODUCTION: Outdoor smoke-free policies (SFPs) at sports clubs may contribute to the prevention of smoking among adolescents. Adolescents' support for such policy is important to its success. The aim of this study is to explore adolescents' perceptions with regard to an outdoor SFP at sports clubs in the Netherlands. METHODS: Focus group discussions (n=27) were held with 180 participants (aged 13-18 years) at 16 sports clubs. Thematic analysis was used to analyze the data. RESULTS: Participants generally supported an outdoor SFP at sports clubs. Five reasons for this support were reported: 1) children should not be exposed to smoking, 2) smoking and sports (clubs) do not fit together, 3) secondhand smoke is undesirable, 4) an outdoor SFP may enhance a sports club's image, and 5) an outdoor SFP contributes to the prevention of smoking. Some participants voiced considerations against an outdoor SFP, arguing amongst others, that smokers need to be taken into account, and that problems may occur with compliance and enforcement. Support for an outdoor SFP was stronger among participants at clubs with an outdoor SFP than among those without such policy. CONCLUSIONS: This study shows that adolescents generally support an outdoor smoke-free policy at sports clubs. After implementation, the outdoor SFP was generally experienced as a normal practice. These results could encourage sports clubs without an outdoor SFP to become smoke-free as well.

Smoke-Free Sports in The Netherlands: Why Most Sports Clubs Have Not Adopted an Outdoor Smoke-Free Policy.

Background: Outdoor smoke-free policies (SFPs) at sports clubs represent an important new area of tobacco control, as many people, including youth, spend a large portion of their free time participating in sports. Nevertheless, the majority of sports clubs worldwide still have not adopted an outdoor SFP. The aim of this study is to explore the perceptions of key stakeholders at different Dutch sports clubs concerning the adoption of an outdoor SFP. Methods: Semi-structured interviews were held with 41 key stakeholders at seven Dutch sports clubs (in field hockey, football, tennis, or korfball) without an outdoor SFP. A thematic approach was used to analyze the data. Results: The majority of respondents reported considerations that were favorable towards adoption of an outdoor SFP, including expected support from club members, changing social norms with regard to smoking, and few members who smoke. Most of all, respondents valued the protection of children from the harmful effects of smoking. However, they also foresaw a number of problems in case of adoption, including impaired social functioning of the sports club, problems with compliance and enforcement, conflict with smokers' interest, and low priority in club management. Conclusions: Although stakeholders at sports clubs recognize the intrinsic value of an outdoor SFP, they foresee practical problems that are inherent to sports clubs. Adoption could be enhanced by articulating the importance of protecting children from the harmful effects of smoking, referring to 'success stories' at sports clubs that are already smoke-free, and actively involving smokers in the adoption process.

Lifestyle coaches as a central professional in the health care network? Dynamic changes over time using a network analysis.

BACKGROUND: Overweight and obesity are problems that are increasing globally in both children as well as adults, and may be prevented by adopting a healthier lifestyle. Lifestyle coaches counsel overweight and obese children (and their parents) as well as adults in initiating and maintaining healthier lifestyle behaviours. It is currently unclear whether this novel professional in the Dutch health care system functions as a linchpin in networks that evolve around lifestyle-related health problems. The aim of the present study is to investigate the formation and development of networks of lifestyle coaches and their positions within these networks. METHODS: In this longitudinal study, key professionals and professionals within relevant organisations in the Coaching on Lifestyle (CooL) care networks were asked to fill in three online questionnaires. Respondents were asked to indicate whether they collaborated with each of the specified professionals in the context of CooL. The overall network structures and the central role of the lifestyle coaches were examined by using network analysis. RESULTS: The results showed that the networks in three out of four regions were relatively centralised, but that none of the networks were dense, and that the professionals seemed to collaborate less with others over time. Half of the lifestyle coaches had a high number of collaborations and a central position within their networks, which also increased over time. In half of the regions, the lifestyle coaches had increased their role as consultants, while their role as gatekeeper and liaison decreased over time. In most regions, the sector of lifestyle coaches had a central position in their networks in just one measurement. Other central sectors were the local sports organisation, public health services, youth health care and the municipal government. CONCLUSIONS: Overall, we cannot conclude that more central and denser networks were formed during the study period. In addition, the lifestyle coaches were not often positioned as a central sector within these networks. Entrepreneurial, network and brokering competences are required for lifestyle coaches to build up denser networks. TRIAL REGISTRATION: NTR6208 ; date registered: 13-01-2017; retrospectively registered; Netherlands Trial Register.

Implementation of an outdoor smoke-free policy at sports clubs: Critical situations and determinants influencing implementation.

BACKGROUND: Outdoor smoke-free policies (SFPs) at sports clubs have significant potential to reduce adolescent smoking. However, the realization of this potential may be strongly dependent on how these policies are implemented in practice. The aim of this study is to explore the perceptions of key stakeholders at different sports clubs in the Netherlands concerning how outdoor SFPs are implemented in practice and which determinants influence implementation. METHODS: Semi-structured interviews were held with 46 key stakeholders at eight Dutch sports clubs (i.e., field hockey, soccer, tennis, korfball) with an outdoor SFP. A thematic approach was used for the analysis of the transcripts. RESULTS: Overall, respondents perceived the implementation of an outdoor SFP at sports clubs as feasible. The SFP is often enforced, people who smoke react positively when they are approached, the SFP has led to less (visible) smoking at the venue, and a nonsmoking norm is reinforced. However, we identified three 'critical situations' in which implementation is less than optimal: 1) when children are not present at the sports club, 2) when alcohol is involved, and 3) when people who smoke relocate to the entrance of the sports club. Several determinants influenced implementation in those critical situations: 1) determinants related to individual smokers and club members (i.e., support, communication towards people who smoke), 2) determinants related to the SFP itself (i.e., clarity of the policy), 3) determinants related to the sports club (i.e., communication of the policy, characteristics of the sports club), and 4) determinants related to the wider community (i.e., change of social norm with regard to smoking, support from local and national organizations). CONCLUSION: Implementation of an outdoor SFP at sports clubs is feasible because there is a high level of support and experiences are mainly positive. Nevertheless, some situations present challenges to compliance and enforcement. We identified a number of determinants that may facilitate implementation of an outdoor SFP at sports clubs.

The implementation of the coaching on lifestyle (CooL) intervention: lessons learnt.

BACKGROUND: Combined lifestyle interventions (CLIs) are designed to help people who are overweight or obese maintain a healthy new lifestyle. The CooL intervention is a CLI in the Netherlands, in which lifestyle coaches counsel adults and children (and/or their parents) who are obese or at high risk of obesity to achieve a sustained healthier lifestyle. The intervention consists of coaching on lifestyle in group and individual sessions, addressing the topics of physical activity, dietary behaviours, sleep, stress management and behavioural change. The aim of this study was to evaluate the implementation process of the Coaching on Lifestyle (CooL) intervention and its facilitating and impeding factors. METHODS: Mixed methods were used in this action-oriented study. Both quantitative (number of referrals, attendance lists of participants and questionnaires) and qualitative (group and individual interviews, observations, minutes and open questions) data were collected among participants, lifestyle coaches, project group members and other stakeholders. The Consolidated Framework for Implementation Research was used to analyse the data. RESULTS: CooL was evaluated by stakeholders and participants as an accessible and useful programme, because of its design and content and the lifestyle coaches' approach. However, stakeholders indicated that the lifestyle coaches need to become more familiar in the health care network and public sectors in the Netherlands. Lifestyle coaching is a novel profession and the added value of the lifestyle coach is not always acknowledged by all health care providers. Lifestyle coaches play a crucial role in ensuring the impact of CooL by actively networking, using clear communication materials and creating stakeholders' support and understanding. CONCLUSION: The implementation process needs to be strengthened in terms of creating support for and providing clear information about lifestyle coaching. The CooL intervention was implemented in multiple regions, thanks to the efforts of many stakeholders. Lifestyle coaches should engage in networking activities and entrepreneurship to boost the implementation process. It takes considerable time for a lifestyle coach to become fully incorporated in primary care. TRIAL REGISTRATION: NTR6208 ; date registered: 13-01-2017; retrospectively registered; Netherlands Trial Register.

The evaluation of an integrated network approach of preventive care for children with overweight and obesity; study protocol for an implementation and effectiveness study.

BACKGROUND: Children with overweight often do not receive appropriate integrated care. An innovative integrated network approach of preventive care for overweight children aged 4-12 years old has been developed and implemented in four neighbourhoods of 's-Hertogenbosch, The Netherlands. This new approach focusses on self-management of the family and is based on the principles of stepped and matched care. Youth health care (YHC) nurses support the families in their new role as central care providers. The aim of this study is to evaluate the implementation and effectiveness of this network approach. METHODS: The implementation of the new approach (reach, functioning of the central care provider, network functioning and patient satisfaction) is assessed by interviews and checklists with professionals and parents of 4-12 year old overweight or obese children. To evaluate effectiveness, we aim to compare 120 overweight or obese children in 's-Hertogenbosch with 60 overweight or obese children outside 's-Hertogenbosch during one year of YHC involvement. Quality of life, psychosocial problems of the child and parental empowerment are the main outcomes of the effectiveness study. Outcomes are measured with digital questionnaires at inclusion, at three months and one year after inclusion. BMI measurements and referrals are distracted from medical files. DISCUSSION: Integrated care for overweight and obese children is high on the agenda of many municipalities in The Netherlands. The new approach is expected to have beneficial effects for overweight children, their parents and professionals. With the results of this study, we can optimize the support for overweight and obese children and their parents. The first results are expected to be available in 2019. TRIAL REGISTRATION: This study is registered in the Dutch Trial Register on 10 November 2017 (NTR number NTR6813). https://www.trialregister.nl/trial/6596 Word count: 281 (max 350).

Chronically ill patients' preferences for a financial incentive in a lifestyle intervention. Results of a discrete choice experiment.

BACKGROUND: The preferences of diabetes type 2 patients and cardiovascular disease patients for a financial incentive added to a specified combined lifestyle intervention were investigated. METHODS: A discrete choice experiment questionnaire was filled out by 290 diabetes type 2 patients (response rate 29.9%). Panel-mixed-logit models were used to estimate the preferences for a financial incentive. Potential uptake rates of different financial incentives and relative importance scores of the included attributes were estimated. Included attributes and levels were: form of the incentive (cash money and different types of vouchers), value of the incentive (ranging from 15 to 100 euros), moment the incentive is received (start, halfway, after finishing the intervention) and prerequisite for receiving the incentive (registration, attendance or results at group or individual level). RESULTS: Prerequisites for receiving the financial incentive were the most important attribute, according to the respondents. Potential uptake rates for different financial incentives ranged between 37.9% and 58.8%. The latter uptake rate was associated with a financial incentive consisting of cash money with a value of €100 that is handed out after completing the lifestyle program with the prerequisite that the participant attended at least 75% of the scheduled meetings. CONCLUSIONS: The potential uptake of the different financial incentives varied between 37.9% and 58.8%. The value of the incentive does not significantly influence the potential uptake. However, the potential uptake and associated potential effect of the financial incentive is influenced by the type of financial incentive. The preferred type of incentive is €100 in cash money, awarded after completing the lifestyle program if the participant attended at least 75% of the scheduled meetings.

Development of measurable indicators to enhance public health evidence-informed policy-making.

BACKGROUND: Ensuring health policies are informed by evidence still remains a challenge despite efforts devoted to this aim. Several tools and approaches aimed at fostering evidence-informed policy-making (EIPM) have been developed, yet there is a lack of availability of indicators specifically devoted to assess and support EIPM. The present study aims to overcome this by building a set of measurable indicators for EIPM intended to infer if and to what extent health-related policies are, or are expected to be, evidence-informed for the purposes of policy planning as well as formative and summative evaluations. METHODS: The indicators for EIPM were developed and validated at international level by means of a two-round internet-based Delphi study conducted within the European project 'REsearch into POlicy to enhance Physical Activity' (REPOPA). A total of 82 researchers and policy-makers from the six European countries (Denmark, Finland, Italy, the Netherlands, Romania, the United Kingdom) involved in the project and international organisations were asked to evaluate the relevance and feasibility of an initial set of 23 indicators developed by REPOPA researchers on the basis of literature and knowledge gathered from the previous phases of the project, and to propose new indicators. RESULTS: The first Delphi round led to the validation of 14 initial indicators and to the development of 8 additional indicators based on panellists' suggestions; the second round led to the validation of a further 11 indicators, including 6 proposed by panellists, and to the rejection of 6 indicators. A total of 25 indicators were validated, covering EIPM issues related to human resources, documentation, participation and monitoring, and stressing different levels of knowledge exchange and involvement of researchers and other stakeholders in policy development and evaluation. CONCLUSION: The study overcame the lack of availability of indicators to assess if and to what extent policies are realised in an evidence-informed manner thanks to the active contribution of researchers and policy-makers. These indicators are intended to become a shared resource usable by policy-makers, researchers and other stakeholders, with a crucial impact on fostering the development of policies informed by evidence.