Exploring colorectal cancer survivors' perspectives on improving care delivery and the role of e-health technology: a qualitative study.

PURPOSE: The purpose of this study was to gather insights from colorectal cancer (CRC) survivors on how to improve care for CRC survivors and how e-health technology could be utilized to improve CRC care delivery. METHODS: Three semi-structured focus groups were held with sixteen CRC survivors. To initiate the discussion, an online registration form and two vignettes were used. The data was analyzed using the framework method. RESULTS: Based on survivors' experiences, five themes were identified as opportunities for improving CRC care delivery. These themes include better recognition of complaints and faster referrals, more information as part of the care delivery, more guidance and monitoring of health outcomes, more collaboration between practitioners, and more attention for partners and relatives. In addition, survivors expressed opportunities for using e-health to facilitate information provision, improve communication, and monitor survivors' health conditions. CONCLUSION: Several suggestions for improvement of CRC care delivery were identified. These often translated into possibilities for e-health to support or improve CRC care delivery. The ideas of survivors align with the vast array of existing e-health resources that can be utilized to enhance CRC care delivery. Therefore, the next step involves addressing the implementation gap between the needs of stakeholders, such as CRC survivors and healthcare providers, and the e-health tools currently available in clinical practice.

Improving the colorectal cancer care pathway via e-health: a qualitative study among Dutch healthcare providers and managers.

PURPOSE: This study aims to identify improvement opportunities within the colorectal cancer (CRC) care pathway using e-health and to examine how these opportunities would contribute to the Quadruple Aim. METHODS: In total, 17 semi-structured interviews were held (i.e., nine healthcare providers and eight managers involved in Dutch CRC care). The Quadruple Aim was used as a conceptual framework to gather and systematically structure the data. A directed content analysis approach was employed to code and analyze the data. RESULTS: Interviewees believe the available e-health technology could be better exploited in CRC care. Twelve different improvement opportunities were identified to enhance the CRC care pathway. Some opportunities could be applied in one specific phase of the pathway (e.g., digital applications to support patients in the prehabilitation program to enhance the program's effects). Others could be deployed in multiple phases or extended outside the hospital care setting (e.g., digital consultation hours to increase care accessibility). Some opportunities could be easily implemented (e.g., digital communication to facilitate treatment preparation), whereas others require structural, systemic changes (e.g., increasing efficiency in patient data exchanges among healthcare professionals). CONCLUSION: This study provides insights into how e-health could add value to CRC care and contribute to the Quadruple Aim. It shows that e-health has the potential to contribute to the challenges in cancer care. To take the next step forward, the perspectives of other stakeholders must be examined, the identified opportunities should be prioritized, and the requirements for successful implementation should be mapped out.

A Health Game Targeting Children's Implicit Attitudes and Snack Choices.

Objective: The present study investigated whether a health game can be used to affect children's implicit attitudes toward food (IAsTF) and subsequent snack choices. Materials and Methods: The health game used was based on an evaluative conditioning paradigm. The experiment followed a between-subjects design with two conditions (health game vs. control), N = 79 (12.42 years ±1.64, body mass index: 25.06 ± 7.40). IAsTF were assessed at baseline and postintervention using an implicit association test (IAT). Baseline IAT scores were used to categorize IAsTF as healthy (favoring fruits) versus unhealthy IAsTF (favoring chocolates). In addition, three digital snack choices were recorded. Results: No main effect of condition on posttest IAsTF was found. However, baseline IAsTF moderated the effect of condition on posttest IAsTF; participants with less healthy baseline IAsTF playing the health game had healthier posttest IAsTF compared to those playing the control game. Regarding the snack choices, participants playing the health game favored fruit over chocolate in one of the snack choices. Baseline IAsTF did not moderate the effect of condition on snack choices. Conclusion: Tentative support was found that health games can be used to improve IAsTF, in particular among participants with less healthy ones at baseline.

Investigating the impact of a health game on implicit attitudes towards food and food choice behaviour of young adults.

Improving diets by stimulating fruit and vegetable consumption might be beneficial, in particular when they substitute energy-dense products. The aim of present study was to investigate whether a health game can be used to positively affect healthy implicit attitudes (IAs) towards food and subsequent food choice behaviour of young adults. A 2 (Time: baseline vs. post-test) x 2 (Condition: health game vs. control game) x 2 (Baseline IAs: healthy IAs vs. less healthy IAs) mixed-subjects design was used with 125 participants (age: M = 20.17, SD = 1.88). IAs towards food were assessed at baseline and post-test using an Implicit Association Test (IAT). Additionally, food choice behaviour was assessed after game play. At baseline, the majority of participants had healthy IAs (i.e., favouring fruit over chocolate snacks). At post-test, significantly less healthy IAs were observed in the control condition, while this reduction was not significant in the health game condition. Regarding food choice behaviour, participants with healthy baseline IAs were more likely to select fruit in the health game condition than participants with healthy baseline IAs in the control game condition. However, participants with less healthy baseline IAs were less likely to select fruit in the health game condition than in the control condition. We found tentative support that health games can be used to influence IAs towards food and positively affect food choice behaviour. However, this influence was only observed for those with healthy baseline IAs. The current version of the health game would primarily benefit those already healthy and could negatively affect those that need the intervention most, so modifications are recommendable.

User Statistics for an Online Health Game Targeted at Children.

OBJECTIVE: Given that many households in western countries nowadays have home access to the Internet, developing health-promoting online interventions has the potential to reach large audiences. Studies assessing usage data of online health interventions are important and relevant but, as of yet, scarce. The present study reviewed usage data from Monkey Do, an existing online health game developed specifically for children from 4 to 8 years old. In addition, the effect of advertising on usage was examined. MATERIALS AND METHODS: In an observational study, a web-based analysis program was used to examine usage data of all visits to the online health game for the first 31 months following the launch. We reported descriptives for usage data. We analyzed the relationship between advertising and usage with a Mann-Whitney U test, and used a Pearson's chi-square test to investigate the association between advertising and the number of first-time visitors. RESULTS: In the period of data analysis, there were 224,859 sessions. Around 34% of the visitors played the game more than once. Compared with first-time visitors, the average session time of returning visitors was doubled. The game was most frequently accessed via search engine query, on a desktop computer (compared to mobile devices). Advertising was found to be positively related to the number of sessions and the number of first-time visitors. CONCLUSIONS: Placing a game online can reach a large audience, but it is important to also consider how to stimulate retention. Furthermore, repeated advertisement for an online game appears to be necessary to maintain visitors over time.

Postoperative pain: knowledge and beliefs of patients and nurses.

AIMS AND OBJECTIVES: To describe patients' and nurses' knowledge and beliefs regarding pain management. Moreover, to explore the effect of information and education on patients' and nurses' knowledge and beliefs regarding pain management. BACKGROUND: In the treatment of postoperative pain, patients' and nurses' inadequate knowledge and erroneous beliefs may hamper the appropriate use of analgesics. DESIGN: A randomised controlled trial and a cross-sectional study. METHODS: In 2013, half of 760 preoperative patients were allocated to the intervention group and received written information about the complications of postoperative pain. The knowledge and beliefs of 1184 nurses were studied in 2014 in a cross-sectional study. All data were collected with the same questionnaires. RESULTS: In the intervention group, patients' knowledge level was significant higher than in the control group, while no differences were found in beliefs. Nurses had higher knowledge and more positive beliefs towards pain management compared with both patient groups. Nurses with additional pain education scored better than nurses without additional pain education. Nurses were also asked what percentage of pain scores matched their impression of the patient's pain, and the mean was found to be 63%. CONCLUSIONS: Written information was effective for increasing patients' knowledge. However, it was not effective for changing beliefs about analgesics and patients and nurses had erroneous beliefs about analgesics. RELEVANCE TO CLINICAL PRACTICE: It is necessary to continue to inform patients and nurses about the need for analgesics after surgery. Such education could also emphasise that a discrepancy between a patient's reported pain score and the nurse's own assessment of the patient's pain should prompt a discussion with the patient about his/her pain.

The influences of task repetition, napping, time of day, and instruction on the Sustained Attention to Response Task.

INTRODUCTION: The Sustained Attention to Response Task (SART) helps to quantify vigilance impairments.Previous studies, in which five SART sessions on one day were administered, demonstrated worse performance during the first session than during the others. The present study comprises two experiments to identify a cause of this phenomenon. METHOD: Experiment 1, counting eighty healthy participants, assessed effects of repetition,napping, and time of day on SART performance through a between-groups design. The SART was performed twice in the morning or twice in the afternoon; half of the participants took a 20-minute nap before the second SART. A strong correlation between error count and reaction time (RT) suggested effects of test instruction. Participants gave equal weight to speed and accuracy in Experiment 1; therefore, results of 20 participants were compared to those of 20 additional participants who were told to prefer accuracy (Experiment 2). RESULTS: The average SART error count in Experiment 1 was 10.1; the median RT was 280 ms. Neither repetition nor napping influenced error count or RT. Time of day did not influence error count, but RT was significantly longer for morning than for afternoon SARTs. The additional participants in Experiment 2 had a 49% lower error count and a 14% higher RT than the participants in Experiment 1. Error counts reduced by 50% from the first to the second session of Experiment 2, irrespective of napping or time of day. CONCLUSIONS: Preferring accuracy over speed was associated with a significantly lower error count. The data suggest that a worse performance in the first SART session only occurs when instructing participants to prefer accuracy, which is caused by repetition, not by napping or time of day. NOTE: We advise that participants are instructed to prefer accuracy over speed when performing the SART and that a full practice session is included.