End-user involvement in developing and field testing an online contraceptive decision aid.

OBJECTIVES: Decision aids in the field of healthcare contribute to informed decision making. To increase the usefulness and effectiveness of decision aids, it is important to involve end-users in the development of these tools. This article reports on the development of an online contraceptive decision aid. METHODS: An exploratory, qualitative study was conducted in the Netherlands between 2014 and 2016. The development process of the decision aid consisted of six steps and included a needs assessment and field test. Interviews were conducted with 17 female students. RESULTS: The needs assessment provided information on the preferred content and structure of a contraceptive decision aid and guided the development of the online contraceptive decision aid prototype. Participants had an overall positive impression of the decision aid prototype during the field test. Minor revisions were made based on participants' feedback. Participants expected that the decision aid would positively contribute to decision making by increasing knowledge and awareness regarding the available contraceptive methods and their features and attributes, and by opening up to other options than the known methods. CONCLUSION: The developed contraceptive decision aid can contribute to better informed decision making and consultation preparation. Involving end-users in development seems valuable to adapt decision aids to specific needs and to identify in what way a decision aid influences decision making.

Better informed is better decided: Addressing the risks of delaying childbearing for female higher educational students.

Objective Delayed childbearing has gradually started to become the norm for higher educational students, with possible increased future fertility risks and psychological distress as a consequence. What do female students expect from their general practitioners (GP) and other health care providers (HCPs) with regard to delaying childbearing? We also looked into indicators that can be used by HCPs to detect female university students who have issues regarding delayed childbearing. Methods Cross sectional study: A total of 398 female students (mean age 21.83; SD = 2.4) from at least three different universities completed the questionnaire (distributed through the Internet and at a students' health service). Potential predictors for having an issue regarding delayed childbearing were assessed with multivariate logistic regression. Results Thirteen percent of 398 female students experienced being childless as more or less problematic. Forty-nine percent thinks having children deserves more attention and 33% of the students expect attention from their GP regarding a possible desire to have children during contraceptive consultations. Four factors demonstrated significant associations with having an issue concerning delayed childbearing: age (these issues also occur in younger students), worrying about fertility, not opting for an abortion if pregnant and dissatisfaction with current contraceptive use. Conclusion HCPs should discuss delayed childbearing with female students, addressing both the decrease of fertility after a certain age (30), the limited range of fertility methods, and the possible negative physical and psychological consequences of postponement. These elements could be included into programmes of sexual and reproductive health training and into pre-conception care and pre-conception education.

The use of conversation analysis to study social accessibility of an online support group on eating disorders.

We conducted a conversation analysis of 21 threads initiated by newcomers of an online support group (OSG) on eating disorders, to examine the discursive process of entering such a group. The analysis revealed three important issues. First, many newcomers articulate that the step to join the group is extremely difficult. Second, a presentation of the self in terms of a diagnosis works as a legitimization for joining the forum. The data suggest that participants who do not fulfil the conditions for such a legitimization do not join the forum. Third, the option of acquiring a serious symptom as a solution to the legitimization problem is offered by one of the regular members. Hence, the newcomers' discourse reveals issues relevant to the accessibility for undiagnosed sufferers. We discuss these findings theoretically as a phenomenon of self-presentation in relation to community norms. The analysis generates the hypothesis that newcomers are confronted with implicit norms regarding membership legitimacy that they should obey in their self-presentation, although they may not be ready yet to actually do so. OSGs should find strategies to facilitate various possibilities for newcomers to present themselves to the group while becoming a member.

Palliative and terminal care at home as portrayed in Dutch newspapers in 2009 compared to 2000.

BACKGROUND: Terminal care at home is receiving increased attention from the Dutch media, which is relevant for primary care providers. OBJECTIVES: To explore the portrayal of terminal care at home in newspapers in the Netherlands in 2000 and in 2009. METHOD: We performed a systematic analysis of documents retrieved from the LexisNexis Academic NL database. We compared data regarding the 'point of reference' (or 'frame') and the 'moral judgments' in articles appearing in the first six months of 2009 to the same period in 2000. RESULTS: In the year 2000, the framing of articles in regional newspapers appeared to be predominantly consumer-oriented (66%) and in national newspapers predominantly contextual (63%). The moral judgment in the regional articles was predominantly positive (66%), in the national newspapers predominantly negative (58%). In 2009, articles in regional and national newspapers were categorized mainly as consumer-oriented (73% and 55%, respectively), and new themes appeared, i.e. self care and medical topics. For moral judgment, again regional articles were mainly positive (76%) and national articles were mainly negative (39%) and neutral (31%). CONCLUSION: Regarding the theme 'terminal care at home' as published in Dutch newspapers in 2009 as compared to 2000, the diversity of the framing was more prominent and over all moral judgments were more positive, particularly in regional newspapers. Health care providers should realize that the portrayal of palliative and terminal care at home may differ depending on the type of newspaper--regional or national.

Context guides illness-identity: a qualitative analysis of Dutch university students' non-help-seeking behavior.

The purpose of this article is to develop a context-based and identity-centered perspective on help-seeking. Recent approaches have indicated the inability of conventional models of help-seeking to account for the non-utilization of health care services in situations for which services, resources and information are adequately provided. We address this non-utilization from a perspective that explores the interactions between notions of health, illness, and identity formation, especially in highly transitional situations in which people are confused about their identity and sense of belonging. More specifically, we explore the non-utilization of health care services by Dutch university students. The results of 36 in-depth interviews show that the help-seeking behaviors of university students are closely associated with questions about identity, forms of agency, and styles of self-presentation, and are deeply influenced by the uncertain social and cultural context in which students are inserted. For example, being a 'normal' student was often regarded as more important than solving health problems, and stress was repeatedly portrayed as a constant and inevitable condition of everyday student life, giving a common language to express the burdens of the shared student experience. Some students even romanticized health problems. Eventually students with serious health problems avoided accessing health services.

From Goya to Afghanistan--an essay on the ratio and ethics of medical war pictures.

For centuries pictures of the dead and wounded have been part and parcel of war communications. Often the intentions were clear, ranging from medical instructions to anti-war protests. The public's response could coincide with or diverge from the publisher's intention. Following the invention of photography in the nineteenth century, and the subsequent claim of realism, the veracity of medical war images became more complex. Analysing and understanding such photographs have become an ethical obligation with democratic implications. We performed a multidisciplinary analysis of War Surgery (2008), a book containing harsh, full-colour photographs of mutilated soldiers from the Iraq and Afghanistan wars. Our analysis shows that, within the medical context, this book is a major step forward in medical war communication and documentation. In the military context the book can be conceived as an attempt to put matters right given the enormous sacrifice some individuals have suffered. For the public, the relationship between the 'reality' and 'truth' of such photographs is ambiguous, because only looking at the photographs without reading the medical context is limiting. If the observer is not familiar with medical practice, it is difficult for him to fully assess, signify and acknowledge the value and relevance of this book. We therefore assert the importance of the role of professionals and those in the humanities in particular in educating the public and initiating debate.

The public and the Internet: multifaceted drives for seeking health information.

The aim of this study was to gain insight into people's drives, or motives, for seeking health information on the Internet. A systematic literature review, restricted to handbooks and reviews, was conducted by searching the databases of various disciplines. Each drive was translated into the context of health information. Five drives were retrieved from the fields of psychology, mass communication, library and information science, and medical science: drives regarding the retrieval of knowledge, social contact or support, tempering uncertainty, entertainment, and self-actualization. Based on these results, three hypotheses were generated for future research: (1) drives are interconnected and may be present simultaneously in the process of seeking information; (2) they not only serve as antecedents for the need for information, but are present throughout the entire information-seeking process; (3) they are subject to change throughout the information-seeking process. Various drives play a role in the health information-seeking process.

Classifying health questions asked by the public using the ICPC-2 classification and a taxonomy of generic clinical questions: an empirical exploration of the feasibility.

In case of an overload of information, structure is needed to make the content of the information accessible and the information flow well-ordered. If we wish to gain insight into the health information needs of the public, a specific research tool is needed. The aim of this study was to investigate the feasibility of using two professional classification structures for medical information to classify health questions asked by the public: one classification for the subject of the question, the International Classification of Primary Care (ICPC-2), and one classification for the nature and type of the question, the Taxonomy for Generic Clinical Questions (TGCQ). Health questions asked during online consultations with health care providers were retrieved (452 subjects for coding) and were given two codes: one code according to the ICPC-2 and one according to the TGCQ. The problems encountered during coding were recorded and analyzed. Nine different clusters of problems arose during classification with the ICPC-2, including issues regarding specificity, lay versus professional terminology, a combination of diverse complaints not complying with a clinical syndrome, and preclinical issues. Nine types of problems were encountered during the classification with the TGCQ: questions about preclinical issues, preventive procedures, name finding, health promotion, where to go for a diagnostic test or therapy, justification of the choice of a test or treatment, and common knowledge. The results of this study are promising, and further investigation of the validity, reliability, and use of these two classification systems to classify health questions asked by the public is desirable. The problems that were encountered should be solved before these professional systems can be used to classify the health information needs of the general public.

Consumption of tobacco, alcohol and recreational drugs in university students in Belgium and the Netherlands: the role of living situation.

UNLABELLED: Studying at university/college is associated with consumption of tobacco, alcohol and recreational drugs. This lifestyle may be associated with moving outside parental control. The aim of this study was to investigate differences between students living with their parents and students living alone or with peers regarding substance use in Belgium (Antwerp) and The Netherlands (Amsterdam). METHOD: The results of two separate surveys, one in Amsterdam (8,258 students) and one in Antwerp (27,210 students) were compared. Both questionnaires contained items about consumption of tobacco, alcohol and recreational drugs, and whether students considered their consumption as a problem and relevant confounders. Students living with their parents were compared with students living alone or with peers, using multivariate logistic regression analyses, separate for Antwerp and Amsterdam. RESULTS: Consumption of tobacco was associated with living with peers. Similar patterns were shown for consumption of alcohol and recreational drugs. Living with peers rather than living with family or alone was a determinant of problematic substance use as well. Patterns were similar for both universities in two different countries. CONCLUSIONS: Students living alone or with peers in Amsterdam and Antwerp may be at risk for problems concerning their consumption of recreational drugs. These findings may have implications for targeted prevention programs.

Problem perception in Dutch university students using tobacco, alcohol and drugs.

When communicating about health behaviour with students, insight is needed in perceptions students have about their (un)healthy behaviour. We aimed to investigate associations between problem perception and perceived health, academic functioning in students using tobacco, alcohol or drugs. Students who were enrolled fulltime in Medicine, Economics, Occupational Therapy, History, Psychology or Information Studies in Amsterdam, the Netherlands (n = 8258), were invited for an internet-based questionnaire about perceived health, social support, study delay, and problem perception regarding tobacco, alcohol and drug use in October 2005 (response: 44%). Students using tobacco, alcohol and drugs with and without problem perception and non-users were compared (logistic regression). Problem perception in students using tobacco, alcohol or drugs was associated with worse health outcomes.

[Give attention to war in medical education]. / Schenk aandacht aan oorlog in het medisch onderwijs.

Medical consequences of war are prominent in the media. The United Nations and the World Medical Association have called for medical curricula to permanently include consideration of human rights, in particular human rights in war time. Information on the medical consequences of war and weapon systems is valuable knowledge. Courses on this subject are popular amongst medical students, a considerable number of whom are willing to spend a period working for organisations as the Red Cross, Doctors without Borders or the Military Health Service. In spite of this, none of the Dutch medical faculties has given the subject a permanent place in its curriculum. Gathering knowledge on the medical consequences of war depends completely on the efforts of individuals.

Development of a student health questionnaire: the necessity of a symbiosis of science and practice.

RATIONALE, AIMS AND OBJECTIVES: University students report more health complaints than their working peers, but do not appear to seek help for these problems. This stresses the importance of early detection. The aim of this study was to obtain information on indicators of health associated with academic functioning to develop a preliminary health surveillance questionnaire. In addition, we aimed to gain insight in the additional value of adding experience-based information from the priority population, and individuals in their direct environment, to the knowledge gained from the scientific literature. METHOD: First, a review of literature on indicators of health associated with academic functioning was conducted. Next, interviews were held with students (n = 11) and two groups of significant others with professional experience in student health care: general practitioners (n = 9) and practice assistants (n = 8). RESULTS AND CONCLUSIONS: A health surveillance questionnaire to detect students with health problems associated with academic functioning should consist of questions on social support, general health, physical health, psychological health, study-related issues and health, help-seeking behaviour and life events in the past. Experiences from practice should be integrated when developing a questionnaire.

Perceived health profiles of Dutch university students living with their parents, alone or with peers.

Students report a lower health status compared with working peers. This discrepancy may be the result of differences in their living situation, such as student housing. The aim of this study was to compare students who were living with their parents with students who were not living with their parents but rather with peers, alone, or with a partner using logistic regression analyses. We hypothesized that students who were living with their parents would report better health outcomes than students who were living with peers or alone or with a partner. A group of 8,258 students studying at the University of Amsterdam, the Netherlands were invited to complete an internet-distributed questionnaire, consisting of questions about general health, fatigue, psychological health, support, study-related issues, study-related problem solving, time pressure, perceived study delay and program study delay, and living situation. Students who are living with their parents reported a lower health status compared with students living with peers or alone/with a partner. Students living with their parents were less often using tobacco, alcohol, or drugs compared with the other two groups. Our hypothesis is not supported by the results of the present study. Students living alone or with a partner and students who are living with peers reported a better general health status than students living with their parents.

Beliefs about the causes of health complaints: a study in primary care.

In public and interpersonal health communication, a need exists to explore the nature of lay beliefs about health complaints to achieve effective communication. Beliefs of patients visiting their family physician/general practitioner (GP) may give insight into this matter. The aim of this study was to investigate the spectrum of causes attributed to different categories of health complaints presented at the GP office. Before visiting their GP, 2,253 individuals completed a questionnaire about their health complaint and the cause they attributed to this complaint. The spectrum of causes attributed to all health complaints was compared between distinct categories of health complaints. Sixty-two percent of the GP patients attributed at least 1 cause to health complaints they presented at the GP office. Thirty-eight percent of GP patients did not attribute a cause to the health complaint they presented at the GP office. Patient beliefs differed across distinct health problems. Lay beliefs seemed to differ from basic notions of illness because patients attributed different causes to different health complaints. These differences in beliefs, when patients choose to share them with their GP, may serve as a starting point for the communication between the patients and the GP to achieve an effective communication. A need seems to emerge to discriminate between lay beliefs regarding the nature of specific illnesses and those regarding basic notions. GPs are therefore advised to attend to, or at least ask for, their patients' views specifically.

Health-related profiles of study delay in university students in The Netherlands.

Compared with their working peers, students report more health complaints. A worse self-rated health status could hinder students to function optimally within the high demands of studying at university. On the other hand, it can be expected that worse academic functioning may have a negative influence on existing health problems or even initiate health problems. The aim of this study was to investigate associations between indicators of health and study delay in university students in the Netherlands. A group of 5,859 students was invited to complete a questionnaire, consisting of questions about general health, fatigue, psychological health, support, study-related issues, study-related problem solving, time pressure, perceived study delay and program study delay. Three study delay profiles were calculated--program delay without perceived delay (A), perceived delay without program delay (B), and perceived and program delay (C) with no study delay as reference. The response rate was 51%. Profile A was associated with unfavorable outcomes in support, study-related issues, and study-related problem solving. Profiles B and C presented unfavorable outcomes in all dimensions. Perceived study delay appeared to be a more important determinant of unfavorable outcomes than program delay. The group with perceived delay without program delay closely resembled the group with perceived and program delay. This group may be at risk for future program-study delay.

How do primary care physicians seek answers to clinical questions? A literature review.

OBJECTIVES: The authors investigated the extent to which changes occurred between 1992 and 2005 in the ways that primary care physicians seek answers to clinical problems. What search strategies are used? How much time is spent on them? How do primary care physicians evaluate various search activities and information sources? Can a clinical librarian be useful to a primary care physician? METHODS: Twenty-one original research papers and three literature reviews were examined. No systematic reviews were identified. RESULTS: Primary care physicians seek answers to only a limited number of questions about which they first consult colleagues and paper sources. This practice has basically not changed over the years despite the enormous increase in and better accessibility to electronic information sources. One of the major obstacles is the time it takes to search for information. Other difficulties primary care physicians experience are related to formulating an appropriate search question, finding an optimal search strategy, and interpreting the evidence found. Some studies have been done on the supporting role of a clinical librarian in general practice. However, the effects on professional behavior of the primary care physician and on patient outcome have not been studied. A small group of primary care physicians prefer this support to developing their own search skills. DISCUSSION: Primary care physicians have several options for finding quick answers: building a question-and-answer database, consulting filtered information sources, or using an intermediary such as a clinical librarian.

Cancer health communication in the Netherlands 1910-1950: paternalistic control or popularization of knowledge?

From the First World War onwards anti-cancer organizations in Europe attempted to spread the message of "Do Not Delay": cancer is curable, if and when early diagnosed. This article reports on a systematic study of sources on cancer health education from the medical and public domains in the Netherlands between 1910 and 1950. Dutch cancer specialists were not at all enthusiastic about spreading too much knowledge about various aspects (genetic, environmental etc.) among laymen, fearing cancerophobia among the public, and preferred to channel information and guidelines through intermediate health professionals. Cancer health education campaigns, doing away with this paternalistic attitude, only started on a comparable scale to other countries in the 1950s, possibly because of the pressure of fund-raising. Before that time compliance of patients with public health policies was orchestrated by the intervention of intermediate civil bodies, such as home nursing services. Health policies in the Netherlands were characterized by indirect strategies involving different actors.

[Medical communication about the management of depression, anxiety and sleeplessness in the Dutch women's magazine 'Margriet' between 1950 and 1960]. / Margriet weet raad op nervositeit. Medische betekenistoekenning aan 'levensmoeilijkheden' in het vrouwenblad Margriet 1950 tot 1960.

The reporting of health and medicine in the media played an important role in the way people perceived, defined and coped with everyday health problems in the second half of the twentieth century. It was and still is predominantly a supply-market which is dominated by the medical approach; creating a medical aura of progress and the self-evidence of a cure. Although the medical approach figured also prominently in women's magazines, the reporting of illness and health is far more a product of supply and demand with a lively interaction between readers and the editorial office by the means of topic-related letter columns. As such women's magazines not only offer a gender-specific but also a more balanced source for acquiring a better understanding of how public definitions and perceptions of illness and health changed over time. In this article we will focus on the communication about the management of health problems related to depression, anxiety and sleeplessness in the prototypical Dutch women's magazine 'Margriet' between 1950 and 1960. Our guiding research question has been: how do notions about depression, anxiety and and about responsive health behaviour, of which psychotropic drug use is a part, change over time in the reporting of health problems in Margriet? This question is of particular interest to learn more about the historical dynamics of the culture- and gender-specific public interplay between patients and doctors in terms of conceptualising the aforementioned health problems and defining medical coping strategies. Among other things we show that although there was hardly any mention of any 'functional division of labour' between mind and body in 1950, the mind-body dichotomy started to play an important role in the way health problems were perceived in 1960.