To what extent do decision aids for prenatal screening and diagnosis address involvement of partners in decision-making? - An environmental scan.

OBJECTIVE: Numerous decision aids (DAs) have been developed to inform pregnant people about prenatal screening as the decision whether or not to accept the prenatal screening offer may be difficult. Currently, little is known about the role of the decisional partner of the pregnant people in this decision-making process and to what extent DAs involve and engage the partner. METHODS: A broad search was conducted to identify publicly available DAs in English and/or Dutch regarding prenatal screening and diagnosis. These DAs were analysed on aspects of partner involvement. RESULTS: Ten of the 19 identified DAs (52.6%) contained at least one aspect of partner involvement. Several DAs acknowledged that both partners should be involved in the decision (n = 7). The content that was least likely to contain aspects of partner involvement in the DA was value clarification content (n = 2) and only one DA contained content with plural addressing. CONCLUSION: Just over half of the included DAs included some aspect(s) of partner involvement. PRACTICAL IMPLICATIONS: More research is needed to determine to what extent, and how, the partner should be involved in the decision-making process as expectant people consider the input of their partner as important.

A web-based program to improve treatment adherence in patients with type 2 diabetes: Development and study protocol.

BACKGROUND: Many patients with type 2 diabetes mellitus (T2DM) sub-optimally adhere to core treatment recommendations, such as healthy diets, sufficient physical activity and pharmacological support. This paper describes the development of the web-based computer-tailored program My Diabetes Profile (MDP), incorporating identified success factors of web-based interventions, and the protocol for testing the effectiveness of this program in a randomized multicentre trial. METHODS: Formative research - including the input of a program committee, qualitative and quantitative studies with patients and health professionals and a literature search - yielded input for the development of the MDP program. MDP provides video and text tailored advice, based on determinants and salient beliefs derived from the I-Change Model, on decreasing unhealthy snack intake, increasing physical activity, and improving adherence to both oral blood glucose lowering drugs and self-administered insulin therapy. Patients with T2DM recruited by practice nurses and diabetes nurses across the Netherlands fill in online questionnaires at baseline and six-months follow-up. Participants are randomized on patient level to the intervention group (access to the MDP program) or control group (receiving care as usual). DISCUSSION: The formative research using co-creation principles proved essential in the development of the MDP program and involved various disciplines in T2DM management including target group representatives. Co-creation revealed clearly that patients needed short and attractive messages. Consequently, a mix of video and short text messages were chosen for the ultimate program format. Pilot testing was useful to further shape the program to needs of patients and professionals. TRIAL REGISTRATION: Dutch Trial Register NTR6840; Archived program website: http://www.webcitation.org/6xXz01S7X.

Exploring beliefs on diabetes treatment adherence among Dutch type 2 diabetes patients and healthcare providers.

OBJECTIVE: Despite well-known beneficial effects, adherence to core elements of diabetes treatment is suboptimal. This study, conducted in the Netherlands, aimed to explore if and how treatment adherence success factors are applied in diabetes consultations, and to explore salient personal beliefs about type 2 diabetes treatment including both healthy lifestyle adaptations and pharmacotherapy. METHODS: A qualitative study using semi-structured interviews among nine Dutch healthcare providers predominantly involved in diabetes management and 19 Dutch type 2 diabetes patients. Data was systematically analysed through deductive coding analysis using Nvivo. RESULTS: Most patients visited their consultations unprepared. Patients did not or vaguely experience goal-setting in consultations, whereas healthcare providers indicated to set treatment goals. Shared-decision making was applied, however patients were rather passive collaborators as mostly healthcare providers were in charge of making treatment decisions. Despite suboptimal treatment adherence, many advantages and few disadvantages of treatment strategies were reported. Adherence self-efficacy was lower in situations outside daily routine. CONCLUSION: Treatment adherence success factors are not optimally applied, and in particular treatment adherence self-efficacy could be improved. PRACTICE IMPLICATIONS: The application of treatment adherence success factors in consultations could be improved, and personal beliefs should be addressed to improve treatment adherence and optimize counselling.

Understanding Dutch practice nurses' adherence to evidence-based smoking cessation guidelines and their needs for web-based adherence support: results from semistructured interviews.

OBJECTIVES: Practice nurses in general practices suboptimally adhere to smoking cessation guidelines. Since the effectiveness of their smoking cessation support is greatest when full adherence to these guidelines is achieved, interventions need to be developed to improve practice nurses' guideline adherence, for example, by tailoring their content to adherence determinants. However, the sociocognitive determinants explaining adherence have not yet been investigated. Therefore, this qualitative needs assessment aimed to explore practice nurses' current counselling practices, as well as their sociocognitive beliefs related to their smoking cessation guideline adherence and their needs regarding web-based adherence support. SETTING: Primary care; general practices in the Netherlands. PARTICIPANTS: 19 practice nurses, actively involved in smoking cessation counselling. METHODS: Semistructured individual interviews, based on the I-Change Model and the Diffusion of Innovations Theory, were conducted from May to September 2014. Data were systematically analysed using the Framework Method and considered reliable (κ 0.77; % agreement 99%). RESULTS: Respondents felt able to be empathic and collaborative during smoking cessation consultations. They also reported psychological (eg, low self-efficacy to increase patient motivation and arranging adequate follow-up consultations) and practical barriers (eg, outdated information on quit support compensation and a perceived lack of high-quality trainings for practice nurses) to smoking cessation guideline adherence. Most respondents were interested in web-based adherence support to overcome these barriers. CONCLUSIONS: Sociocognitive determinants influence practice nurses' smoking cessation guideline adherence. To improve their adherence, web-based tailored adherence support can provide practice nurses with personally relevant feedback tailored to individually perceived barriers to smoking cessation guideline adherence. More specifically, low self-efficacy levels can be increased by peer modelling (eg, presenting narratives of colleagues) and up-to-date information can be presented online, enabling practice nurses to use it during patient consultations, resulting in more effective communication with their smoking patients. TRIAL REGISTRATION NUMBER: NTR4436; Pre-results.

Web-based computer-tailoring for practice nurses aimed to improve smoking cessation guideline adherence: A study protocol for a randomized controlled effectiveness trial.

BACKGROUND: Dutch practice nurses sub-optimally adhere to evidence-based smoking cessation guidelines. Web-based computer-tailoring could be effective in improving their guideline adherence. Therefore, this paper aims to describe the development of a web-based computer-tailored program and the design of a randomized controlled trial testing its (cost-)effectiveness. METHODS: Theoretically grounded in the I-Change Model and Self-Determination Theory, and based on the results of a qualitative needs assessment among practice nurses, a web-based computer-tailored program was developed including three modules with tailored advice, an online forum, modules with up-to-date information about smoking cessation, Frequently Asked Questions (FAQs) and project information, and a counseling checklist. The program's effects are assessed by comparing an intervention group (access to all modules) with a control group (access to FAQs, project information and counseling checklist only). Smoking cessation guideline adherence and behavioral predictors (i.e. intention, knowledge, attitude, self-efficacy, social influence, action and coping planning) are measured at baseline and at 6- and 12-month follow-up. Additionally, the program's indirect effects on smokers' quit rates and the number of quit attempts are assessed after 6 and 12months. DISCUSSION: This paper describes the development of a web-based computer-tailored adherence support program for practice nurses and the study design of a randomized controlled trial testing its (cost-)effectiveness. This program potentially contributes to improving the quality of smoking cessation care in Dutch general practices. If proven effective, the program could be adapted for use by other healthcare professionals, increasing the public health benefits of improved smoking cessation counseling for smokers.

Results of the PAS Study: A Randomized Controlled Trial Evaluating the Effectiveness of a Web-Based Multiple Tailored Smoking Cessation Program Combined With Tailored Counseling by Practice Nurses.

This study investigated the effects of Web-based multiple computer tailoring and counseling by a practice nurse (MTC) compared with computer tailoring without counseling (MT) and usual care (UC) on smoking cessation rates, via a randomized controlled trial with 414 Dutch adult smokers, recruited by 91 practice nurses from May 2009 to June 2010. Logistic multilevel regression analyses were conducted with 24-hour point prevalence, 7-day point prevalence, and prolonged abstinence after 6 and 12 months as dependent variables and experimental condition as the independent variable. After 6 and 12 months, 38% and 56% of respondents were followed up, respectively. At both follow-ups, no main effects of the interventions could be identified when comparing them with care as usual and with each other-neither in analyses using available data nor in analyses using a negative scenario in which respondents lost to follow-up were considered to still be smoking. A Web-based multiple computer-tailored smoking cessation program combined with a single face-to-face counseling session by a practice nurse may not be more effective than this computer-tailored program alone or than usual smoking cessation care in the general practice setting. Yet before concluding that the addition of counseling to Web-based computer tailoring cannot be successful, more research needs to be conducted to identify the optimal number of counseling sessions to be combined with the Web-based program and to how to best attune the two modalities.

Potential reach of effective smoking prevention programmes in vocational schools: determinants of school directors' intention to adopt these programmes.

OBJECTIVES: Investigating the current, intended and potential reach of two effective smoking prevention programs in Dutch vocational schools and identifying determinants of school directors' intention to adopt these programs. STUDY DESIGN: Cross-sectional survey. METHODS: Two questionnaires were developed based on the Diffusion of Innovation theory and the I-Change model, focussing on either the 'Healthy School and Stimulants program' (HSS program) or the 'Out-of-school Computer Tailoring program' (CT program). The questionnaires were distributed amongst all Dutch vocational school directors (n = 452) of which 34% completed the questionnaire. RESULTS: The potential reach of the HSS program was 29% whereas the potential reach of the CT program was 5%. Regression analyses revealed that being female, perceiving a higher percentage of smoking students in school, having a personality more open towards change, perceiving a low need for a smoking prevention program, fewer disadvantages of the program, a higher level of self-efficacy towards adopting the program and a more positive social norm towards adopting a smoking prevention program from other school directors resulted in a positive intention towards adopting either program. CONCLUSIONS: The present study showed that the reach of effective smoking prevention programs is fairly low. School-based smoking prevention efforts are likely to improve if schools choose to use programs that are proven to be effective, which can be encouraged by adapting existing and newly designed programs to school directors' characteristics and providing easy access to reliable information regarding available programs.

Psychosocial determinants of cigarette smoking among university students in Jordan.

The objectives of this study were to describe the prevalence of cigarette use and water pipe smoking in Jordanian university students and to analyze differences in determinants between cigarette smokers and non-smokers. A cross-sectional questionnaire was administered to a random sample of 400 students (18-24 years, 51% males). Smokers were compared with non-smokers on several smoking-related determinants. Data were analyzed using descriptive statistics, t-test, χ 2 test and binary logistic regression analysis. The prevalence rates of cigarette use and water pipe smoking were 25.9% and 23.3%, respectively. Cigarette smokers differed significantly from non-smokers on almost all of the assessed determinants. The I-Change model explained 85% of the total variance of cigarette-smoking behavior. Cigarette smoking was determined by being male and older, having more depressive symptoms, having less Muslim identity, being more emancipated, perceiving more pros of smoking, having more modeling from peers and having lower self-efficacy. The popularity of cigarette use and water pipe smoking among Jordanian students necessitates health promotion interventions that motivate students not to engage in smoking behaviors by clearly outlining the outcomes of smoking and the healthier alternatives, how to cope with social influences and difficult situations in order to increase self-efficacy.

Does a typical contemplator exist? Three clusters of smokers in contemplation.

The aim of this study is to test whether subtypes exist among smokers in contemplation. Data from 194 adult smokers that participated in a randomized controlled trial testing the effectiveness of a computer-tailored smoking cessation program in Dutch general practices were used for secondary analysis. Cluster analysis was conducted based on baseline scores on pros and cons of quitting and self-efficacy to quit. Clusters were cross-sectionally compared for demographic variables and smoking characteristics with analyses of variance (ANOVA) and Chi-square tests. Logistic and multinomial regression analyses were used for longitudinal comparison for smoking behavior and stage of change at 6 months follow-up. Three clusters were identified: Early, Progressing and Disengaged Contemplators. Clusters differed significantly on all clustering variables (P < 0.001). Disengaged smokers were significantly less addicted than Early Contemplators. Cluster membership was not predictive of outcome measures. No subtype was identified representing the Classic Contemplator, scoring high on both pros and cons of quitting and low on self-efficacy, as found in previous studies among US samples. The predictive validity of the clusters found was limited.