Identification of the Most Suitable Mobile Apps to Support Dietary Approaches to Stop Hypertension (DASH) Diet Self-Management: Systematic Search of App Stores and Content Analysis.

Smartphone apps might provide an opportunity to support the Dietary Approaches to Stop Hypertension (DASH) diet, a healthy diet designed to help lower blood pressure. This study evaluated DASH diet self-management apps based on their quality, likely effectiveness, and data privacy/security to identify the most suitable app(s). A systematic search and content analysis were conducted of all DASH diet apps available in Google Play and the Apple App Store in the UK in November 2022. Apps were included if they provided DASH diet tracking. A previous systematic literature review found some commercial apps not found in the app store search, and these were also included in this review. Three reviewers used the App Quality Evaluation Tool (AQEL) to assess each app's quality across seven domains: knowledge acquisition, skill development, behaviour change, purpose, functionality, and appropriateness for adults with hypertension. Domains with a score of 8 or higher were considered high-quality. Two reviewers assessed the apps' data privacy and security and then coded Behaviour change techniques (BCTs) linked to the Theoretical Domain Framework (TDF) underpinning the likely effectiveness of the apps. Seven DASH diet apps were assessed, showing the limited availability of apps supporting DASH diet self-management. The AQEL assessment showed that three apps scored higher than eight in most of the AQEL domains. Nineteen BCTs were used across the apps, linked to nine TDF action mechanisms that may support DASH diet self-management behaviours. Four apps met standards for privacy and security. All seven apps with self-monitoring functionality had sufficient theoretical basis to demonstrate likely effectiveness. However, most had significant quality and data security shortcomings. Only two apps, NOOM and DASH To TEN, were found to have both adequate quality and security and were thus deemed suitable to support DASH diet self-management.

Challenges, experience and coping of health professionals in delivering healthcare in an urban slum in India during the first 40 days of COVID-19 crisis: a mixed method study.

OBJECTIVES: To describe the initial dilemmas, mental stress, adaptive measures implemented and how the healthcare team collectively coped while providing healthcare services in a large slum in India, during the COVID-19 pandemic. SETTING: Community Health Division, Bangalore Baptist Hospital, Bangalore. STUDY DESIGN: We used mixed methods research with a quantitative (QUAN) paradigm nested in the primary qualitative (QUAL) design. QUAL methods included ethnography research methods, in-depth interviews and focus group discussions. PARTICIPANTS: A healthcare team of doctors, nurses, paramedical and support staff. Out of 87 staff, 42 participated in the QUAL methods and 64 participated in the QUAN survey. RESULTS: Being cognizant of the extreme vulnerability of the slums, the health team struggled with conflicting thoughts of self-preservation and their moral obligation to the marginalised section of society. Majority (75%) of the staff experienced fear at some point in time. Distracting themselves with hobbies (20.3%) and spending more time with family (39.1%) were cited as a means of emotional regulation by the participants in the QUAN survey. In the QUAL interviews, fear of death, the guilt of disease transmission to their loved ones, anxiety about probable violence and stigma in the slums and exhaustion emerged as the major themes causing stress among healthcare professionals. With positive cognitive reappraisal, the health team collectively designed and implemented adaptive interventions to ensure continuity of care. They dealt with the new demands by positive reframing, peer support, distancing, information seeking, response efficacy, self-efficacy, existential goal pursuit, value adherence and religious coping. CONCLUSION: The novel threat of the COVID-19 pandemic threw insurmountable challenges potentiating disastrous consequences; slums becoming a threat to themselves, threat to the health providers and a threat for all. Perhaps, a lesson we could learn from this pandemic is to incorporate 'slum health' within universal healthcare.

Roles, Strengths and Challenges of Using Robots in Interventions for Children with Autism Spectrum Disorder (ASD).

The aim of this research was to study roles, strengths and challenges of robot-mediated interventions using robot KASPAR for children with autism spectrum disorder (ASD). Twelve focus group sessions were organized in which 70 ASD care and/or education professionals participated. Six roles for KASPAR were identified: provoker, reinforcer, trainer, mediator, prompter, and diagnostic information provider. Strengths of KASPAR are related to personalisation possibilities, its playfulness, the action-reaction principle, its neutral expression, consistent and repetitive application of actions, possibilities to vary behaviour in a controlled manner and having an extra hand. Challenges of working with KASPAR were: limited reaction possibilities, possibility of children being scared of KASPAR, difficulties with generalisation or transfer and finally potential dependence on KASPAR.

Dark clouds in co-creation, and their silver linings practical challenges we faced in a participatory project in a resource-constrained community in India, and how we overcame (some of) them.

BACKGROUND: While any type of field-based research is challenging, building action-oriented, participatory research in resource-constrained settings can be even more so. OBJECTIVE: In this article, we aim to examine and provide insights into some of the practical challenges that were faced during the course of a participatory project based in two non-notified slums in Bangalore, India, aiming to build solutions to indoor air pollution from cooking on traditional cook stoves. METHODS: The article draws upon experiences of the authors as field researchers engaged in a community-based project that adopted an exploratory, iterative design to its planning and implementation, which involved community visits, semi-structured interviews, prioritization workshops, community forums, photo voice activities, chulha-building sessions and cooking trials. RESULTS: The main obstacles to field work were linked to fostering open, continued dialogue with the community, aimed at bridging the gap between the 'scientific' and the 'local' worlds. Language and cultural barriers led to a reliance on interpreters, which affected both the quality of the interaction as well as the relationship between the researchers and the community that was built out of that interaction. The transience in housing and location of members of the community also led to difficulties in following up on incomplete information. Furthermore, facilitating meaningful participation from the people within the context of restricted resources, differing priorities, and socio-cultural diversity was particularly challenging. These were further compounded by the constraints of time and finances brought on by the embeddedness of the project within institutional frameworks and conventional research requirements of a fixed, pre-planned and externally determined focus, timeline, activities and benchmarks for the project. CONCLUSIONS: This article calls for revisiting of scientific conventions and funding prerequisites, in order to create spaces that support flexible, emergent and adaptive field-based research projects which can respond effectively to the needs and priorities of the community.

Understanding the use of email consultation in primary care using a retrospective observational study with data of Dutch electronic health records.

OBJECTIVES: It is unclear why the use of email consultation is not more widespread in Dutch general practice, particularly because, since 2006, its costs can be reimbursed. To encourage further implementation, it is needed to understand the current use of email consultations. This study aims to understand the use of email consultation by different patient groups, compared with other general practice (GP) consultations. SETTING: For this retrospective observational study, we used Dutch routine electronic health record data obtained from NIVEL Primary Care Database for the years 2010 and 2014. PARTICIPANTS: 200 general practices were included in 2010 (734 122 registered patients) and 434 in 2014 (1 630 386 registered patients). PRIMARY OUTCOME MEASURES: The number and percentage of email consultations and patient characteristics (age, gender, neighbourhood socioeconomic status and diagnoses) of email consultation users were investigated and compared with those who had a telephone or face-to-face consultation. General practice characteristics were also taken into account. RESULTS: 32.0% of the Dutch general practices had at least one email consultation in 2010, rising to 52.8% in 2014. In 2014, only 0.7% of the GP consultations were by email (the others comprised home visits, telephone and face-to-face consultations). Its use highly varied among general practices. Most email consultations were done for psychological (14.7%); endocrine, metabolic and nutritional (10.9%); and circulatory (10.7%) problems. These diagnosis categories appeared less frequently in telephone and face-to-face consultations. Patients who had an email consultation were older than patients who had a telephone or face-to-face consultation. In contrast, patients with diabetes who had an email consultation were younger. CONCLUSION: Even though email consultation was done in half the general practices in the Netherlands in 2014, the actual use of it is extremely low. Patients who had an email consultation differ from those who had a telephone or face-to-face consultation. In addition, the use of email consultation by patients is dependent on its provision by GPs.

Facilitating aging in place: A qualitative study of practical problems preventing people with dementia from living at home.

Although the majority of people with dementia wish to age in place, they are particularly susceptible to nursing home admission. Nurses can play an important role in detecting practical problems people with dementia and their informal caregivers are facing and in advising them on various ways to manage these problems at home. Six focus group interviews (n = 43) with formal and informal caregivers and experts in the field of assistive technology were conducted to gain insight into the most important practical problems preventing people with dementia from living at home. Problems within three domains were consistently described as most important: informal caregiver/social network-related problems (e.g. high load of care responsibility), safety-related problems (e.g. fall risk, wandering), and decreased self-reliance (e.g. problems regarding self-care, lack of day structure). To facilitate aging in place and/or to delay institutionalization, nurses in community-based dementia care should focus on assessing problems within those three domains and offer potential solutions.

Robot ZORA in rehabilitation and special education for children with severe physical disabilities: a pilot study.

The aim of this study was to explore the potential of ZORA robot-based interventions in rehabilitation and special education for children with severe physical disabilities. A two-centre explorative pilot study was carried out over a 2.5-month period involving children with severe physical disabilities with a developmental age ranging from 2 to 8 years. Children participated in six sessions with the ZORA robot in individual or in group sessions. Qualitative and quantitative methods were used to collect data on aspects of feasibility, usability, barriers and facilitators for the child as well as for the therapist and to obtain an indication of the effects on playfulness and the achievement of goals. In total, 17 children and seven professionals participated in the study. The results of this study show a positive contribution of ZORA in achieving therapy and educational goals. Moreover, sessions with ZORA were indicated as playful. Three main domains were indicated to be the most promising for the application of ZORA: movement skills, communication skills and cognitive skills. Furthermore, ZORA can contribute towards eliciting motivation, concentration, taking initiative and improving attention span of the children. On the basis of the results of the study, it can be concluded that ZORA has potential in therapy and education for children with severe physical disabilities. More research is needed to gain insight into how ZORA can be applied best in rehabilitation and special education.

Acceptance and usability of a home-based monitoring tool of health indicators in children of people with dementia: a Proof of Principle (POP) study.

BACKGROUND: Large-scale cohort studies are needed to confirm the relation between dementia and its possible risk factors. The inclusion of people with dementia in research is a challenge, however, children of people with dementia are at risk and are highly motivated to participate in dementia research. For technologies to support home-based data collection during large-scale studies, participants should be able and willing to use technology for a longer period of time. OBJECTIVE: This study investigated acceptance and usability of iVitality, a research platform for home-based monitoring of dementia health indicators, in 151 children of people with dementia and investigated which frequency of measurements is acceptable for them. METHODS: Participants were randomized to fortnightly or monthly measurements. At baseline and after 3 months, participants completed an online questionnaire regarding the acceptance (Technology Acceptance Model; 38 items) and usability (Post-Study System Usability Questionnaire; 24 items) of iVitality. Items were rated from 1 (I totally disagree) to 7 (I totally agree). Participants were also invited to take part in an online focus group (OFG) after 3 months of follow-up. Descriptive statistics and both two-sample/independent and paired t-tests were used to analyze the online questionnaires and a directed content analysis was used to analyze the OFGs. RESULTS: Children of people with dementia accept iVitality after long-term use and evaluate iVitality as a user-friendly, useful, and trusted technology, despite some suggestions for improvement. Overall, mean scores on acceptance and usability were higher than 5 (I somewhat agree), although the acceptance subscales "social influence" and "time" were rated somewhat lower. No significant differences in acceptance and usability were found between both protocol groups. Over time, "affect" significantly increased among participants measuring blood pressure fortnightly. CONCLUSION: iVitality has the potential to be used in large-scale studies for home-based monitoring of health indicators related to the development of dementia.

How to Implement Robots in Interventions for Children with Autism? A Co-creation Study Involving People with Autism, Parents and Professionals.

The aim of this study was to gain insight into how robots can be practically implemented into current education and therapy interventions for children with autism spectrum disorder (ASD). This qualitative study included focus groups and co-creation sessions. 73 Participants (professionals and adults with ASD) took part in 13 focus groups to elicit requirements for robot assisted interventions. Additionally, 22 participants (professionals, parents of children with ASD and adults with ASD) generated ideas for interventions using robot KASPAR in three co-creation sessions. This study resulted in: an overview of requirements concerning the robot, end-user, environment and practical implementation; a template to systematically describe robot interventions in general and for KASPAR in particular; and finally new interventions.

Co-creative development of an eHealth nursing intervention: Self-management support for outpatients with cancer pain.

INTRODUCTION: Co-creative methods, having an iterative character and including different perspectives, allow for the development of complex nursing interventions. Information about the development process is essential in providing justification for the ultimate intervention and crucial in interpreting the outcomes of subsequent evaluations. This paper describes a co-creative method directed towards the development of an eHealth intervention delivered by registered nurses to support self-management in outpatients with cancer pain. METHODS: Intervention development was divided into three consecutive phases (exploration of context, specification of content, organisation of care). In each phase, researchers and technicians addressed five iterative steps: research, ideas, prototyping, evaluation, and documentation. Health professionals and patients were consulted during research and evaluation steps. RESULTS: Collaboration of researchers, health professionals, patients and technicians was positive and valuable in optimising outcomes. The intervention includes a mobile application for patients and a web application for nurses. Patients are requested to monitor pain, adverse effects and medication intake, while being provided with graphical feedback, education and contact possibilities. Nurses monitor data, advise patients, and collaborate with the treating physician. CONCLUSION: Integration of patient self-management and professional care by means of eHealth key into well-known barriers and seem promising in improving cancer pain follow-up. Nurses are able to make substantial contributions because of their expertise, focus on daily living, and their bridging function between patients and health professionals in different care settings. Insights from the intervention development as well as the intervention content give thought for applications in different patients and care settings.

Low-smoke chulha in Indian slums: study protocol for a randomised controlled trial.

BACKGROUND: Biomass fuel is used as a primary cooking source by more than half of the world's population, contributing to a high burden of disease. Although cleaner fuels are available, some households continue using solid fuels because of financial constraints and absence of infrastructure, especially in non-notified slums. The present study documents a randomised controlled study investigating the efficacy of improved cookstove on the personal exposure to air pollution and the respiratory health of women and children in an Indian slum. The improved cookstove was based on co-creation of a low-smoke chulha with local communities in order to support adaption and sustained uptake. METHODS: The study will be conducted in a non-notified slum called Ashrayanagar in Bangalore, India. The study design will be a 1:1 randomised controlled intervention trial, including 250 households. The intervention group will receive an improved cookstove (low-smoke chulha) and the control group will continue using either the traditional cookstove (chulha) or a combination of the traditional stove and the kerosene/diesel stove. Follow-up time is 1 year. Outcomes include change in lung function (FEV1/FVC), incidence of pneumonia, change in personal PM2.5 and CO exposure, incidence of respiratory symptoms (cough, phlegm, wheeze and shortness of breath), prevalence of other related symptoms (headache and burning eyes), change in behaviour and adoption of the stove. Ethical clearance was obtained from the Institutional Ethics Committee of the Indian Institute of Public Health Hyderabad- Bengaluru Campus. DISCUSSION: The findings from this study aim to provide insight into the effects of improved cookstoves in urban slums. Results can give evidence for the decrease of indoor air pollution and the improvement of respiratory health for children and women. TRIAL REGISTRATION: The trial was registered with clinicaltrials.gov on 21 June 2016 with the identifier NCT02821650 ; A Study to Test the Impact of an Improved Chulha on the Respiratory Health of Women and Children in Indian Slums.

Self-monitoring of health data by patients with a chronic disease: does disease controllability matter?

BACKGROUND: There is a growing emphasis on self-monitoring applications that allow patients to measure their own physical health parameters. A prerequisite for achieving positive effects is patients' willingness to self-monitor. The controllability of disease types, patients' perceived self-efficacy and health problems could play an essential role in this. The purpose of this study is to investigate the relationship between patients' willingness to self-monitor and a range of disease and patient specific variables including controllability of disease type, patients' perceived self-efficacy and health problems. METHODS: Data regarding 627 participants with 17 chronic somatic disease types from a Dutch panel of people with chronic diseases have been used for this cross-sectional study. Perceived self-efficacy was assessed using the general self-efficacy scale, perceived health problems using the Physical Health Composite Score (PCS). Participants indicated their willingness to self-monitor. An expert panel assessed for 17 chronic disease types the extent to which patients can independently keep their disease in control. Logistic regression analyses were conducted. RESULTS: Patients' willingness to self-monitor differs greatly among disease types: patients with diabetes (71.0%), asthma (59.6%) and hypertension (59.1%) were most willing to self-monitor. In contrast, patients with rheumatism (40.0%), migraine (41.2%) and other neurological disorders (42.9%) were less willing to self-monitor. It seems that there might be a relationship between disease controllability scores and patients' willingness to self-monitor. No evidence is found of a relationship between general self-efficacy and PCS scores, and patients' willingness to self-monitor. CONCLUSIONS: This study provides the first evidence that patients' willingness to self-monitor might be associated with disease controllability. Further research should investigate this association more deeply and should focus on how disease controllability influences willingness to self-monitor. In addition, since willingness to self-monitor differed greatly among patient groups, it should be taken into account that not all patient groups are willing to self-monitor.

The role of the physical environment in conversations between people who are communication vulnerable and health-care professionals: a scoping review.

PURPOSE: The role of the physical environment in communication between health-care professionals and persons with communication problems is a neglected area. This study provides an overview of factors in the physical environment that play a role in communication during conversations between people who are communication vulnerable and health-care professionals. METHOD: A scoping review was conducted using the methodological framework of Arksey and O'Malley. The PubMed, PsycINFO, CINAHL and Cochrane Library databases were screened, and a descriptive and thematic analysis was completed. RESULTS: Sixteen publications were included. Six factors in the physical environment play a role in conversations between people who are communication vulnerable and health-care professionals: (1) lighting, (2) acoustic environment, (3) humidity and temperature, (4) setting and furniture placement, (5) written information, and (6) availability of augmentative and alternative communication (AAC) tools. These factors indicated barriers and strategies related to the quality of these conversations. CONCLUSIONS: Relatively small and simple strategies to adjust the physical environment (such as adequate lighting, quiet environment, providing pen and paper) can support people who are communication vulnerable to be more involved in conversations. It is recommended that health-care professionals have an overall awareness of the potential influence of environmental elements on conversations. Implications for rehabilitation The physical environment is an important feature in the success or disturbance of communication. Small adjustments to the physical environment in rehabilitation can contribute to a communication-friendly environment for conversations with people who are communication vulnerable. Professionals should consider adjustments with regard to the following factors in the physical environment during conversations with people who are communication vulnerable: lighting, acoustic environment, humidity and temperature, setting and furniture placement, written information, and availability of AAC (augmentative and alternative communication tools).

Can the IROMEC robot support play in children with severe physical disabilities? A pilot study.

The aim of this study was to explore the application of the IROMEC (Interactive social RObotic Mediators as Companions) robot to support play for children with severe physical disabilities in rehabilitation and special education. Within a 2-month pilot study, physically disabled children with a developmental age between 2 and 8 years participated in sessions with the robot. A combination of qualitative and quantitative outcome measures was used to collect data on aspects of feasibility, usability, barriers for the child as well as the therapist and an indication of the effects on playfulness and the achievement of therapeutic and educational goals. A total of 11 children participated in this study (four boys, seven girls). Individually Prioritized Problem Assessment scores indicated a positive effect of the IROMEC robot on the achievement of goals for the children. Professionals did observe meaningful application possibilities, but the lacking adaptability, expandability and technical stability of the robot platform make application in daily care practice impossible. The application of a robot like IROMEC for children with severe physical disabilities seems to be positive and worthwhile, but usability and feasibility aspects are crucial for success.

Feasibility of a mobile and web-based intervention to support self-management in outpatients with cancer pain.

PURPOSE: Cancer pain is a prevalent and distressing symptom. To enhance self-management in outpatients, a multi-component intervention was developed, integrating patient self-management and professional care through healthcare technology. This article describes feasibility of the intervention in everyday practice. METHOD: Patients with moderate to severe cancer pain (n = 11) and registered nurses specialized in pain and palliative care (n = 3) participated in a four-week study. The intervention involved daily monitoring, graphical feedback, education, and advice by means of a mobile application for patients and a web application for nurses. Learnability, usability and desirability were measured in patients with a 20-item questionnaire (1-5 scale), higher scores indicating better feasibility. Patients' adherence was based on completion rates from server logs. Single semi-structured interviews with patients and a focus group interview with nurses provided insight into experiences. RESULTS: Questionnaire findings confirmed learnability (4.8), usability (4.8) and desirability (4.6) of the application for patients. Average completion rates were 76.8% for pain monitoring, 50.4% for medication monitoring and 100% for education sessions. Interviews revealed that patients were pleased with the simplicity of the mobile application and appreciated different components. Nurses agreed upon the added value and were mostly positive about the possibilities of the web application. Patients and nurses provided ideas for improvements relating to the content and technical performance of the intervention. CONCLUSIONS: Study results demonstrate feasibility of the intervention in everyday practice. Provided that content-related and technical adjustments are made, the intervention enables patients with cancer pain to practice self-management and nurses to remotely support these patients.

Expectations and needs of patients with a chronic disease toward self-management and eHealth for self-management purposes.

BACKGROUND: Self-management is considered as an essential component of chronic care by primary care professionals. eHealth is expected to play an important role in supporting patients in their self-management. For effective implementation of eHealth it is important to investigate patients' expectations and needs regarding self-management and eHealth. The objectives of this study are to investigate expectations and needs of people with a chronic condition regarding self-management and eHealth for self-management purposes, their willingness to use eHealth, and possible differences between patient groups regarding these topics. METHODS: Five focus groups with people with diabetes (n = 14), COPD (n = 9), and a cardiovascular condition (n = 7) were conducted in this qualitative research. Separate focus groups were organized based on patients' chronic condition. The following themes were discussed: 1) the impact of the chronic disease on patients' daily life; 2) their opinions and needs regarding self-management; and 3) their expectations and needs regarding, and willingness to use, eHealth for self-management purposes. A conventional content analysis approach was used for coding. RESULTS: Patient groups seem to differ in expectations and needs regarding self-management and eHealth for self-management purposes. People with diabetes reported most needs and benefits regarding self-management and were most willing to use eHealth, followed by the COPD group. People with a cardiovascular condition mentioned having fewer needs for self-management support, because their disease had little impact on their life. In all patient groups it was reported that the patient, not the care professional, should choose whether or not to use eHealth. Moreover, participants reported that eHealth should not replace, but complement personal care. Many participants reported expecting feelings of anxiety by doing measurement themselves and uncertainty about follow-up of deviant data of measurements. In addition, many participants worried about the implementation of eHealth being a consequence of budget cuts in care. CONCLUSION: This study suggests that aspects of eHealth, and the way in which it should be implemented, should be tailored to the patient. Patients' expected benefits of using eHealth to support self-management and their perceived controllability over their disease seem to play an important role in patients' willingness to use eHealth for self-management purposes.

Mapping Robots to Therapy and Educational Objectives for Children with Autism Spectrum Disorder.

The aim of this study was to increase knowledge on therapy and educational objectives professionals work on with children with autism spectrum disorder (ASD) and to identify corresponding state of the art robots. Focus group sessions (n = 9) with ASD professionals (n = 53) from nine organisations were carried out to create an objectives overview, followed by a systematic literature study to identify state of the art robots matching these objectives. Professionals identified many ASD objectives (n = 74) in 9 different domains. State of the art robots addressed 24 of these objectives in 8 domains. Robots can potentially be applied to a large scope of objectives for children with ASD. This objectives overview functions as a base to guide development of robot interventions for these children.

Robots and ICT to support play in children with severe physical disabilities: a systematic review.

PURPOSE: Play is an essential part of children's lives. Children with physical disabilities experience difficulties in play, especially those with severe physical disabilities. With the progress of innovative technology, the possibilities to support play are increasing. The purpose of this literature study is to gain insight into the aims, control options and commercial availability of information and communication technology (ICT) and robots to support play (especially play for the sake of play) in children with severe physical disabilities. METHODS: A systematic literature search in the databases PubMed, CINAHL, IEEE and ERIC was carried out. Titles and abstracts were assessed independently by three reviewers. In addition, studies were selected using Google Scholar, conference proceedings and reference lists. RESULTS: Three main groups of technology for play could be distinguished: robots (n = 8), virtual reality systems (n = 15) and computer systems (n = 4). Besides, ICT and robots developed for specific therapy or educational goals using play-like activities, five of the in total 27 technologies in this study described the aim of "play for play's sake". CONCLUSIONS: Many ICT systems and robots to support play in children with physical disabilities were found. Numerous technologies use play-like activities to achieve therapeutic or educational goals. Robots especially are used for "play for play's sake". Implications for Rehabilitation This study gives insight into the aims, control options and commercial availability for application of robots and ICT to support play in children with severe physical disabilities. This overview can be used in both the fields of rehabilitation and special education to search for new innovative intervention options and it can stimulate them to use these innovative play materials. Especially robots may have great potential in supporting "play for play's sake".

Internet Services for Communicating With the General Practice: Barely Noticed and Used by Patients.

BACKGROUND: The Netherlands is one of the frontrunners of eHealth in Europe. Many general practices offer Internet services, which can be used by patients to communicate with their general practice. In promoting and implementing such services, it is important to gain insight into patients' actual use and intention toward using. OBJECTIVE: The objective of the study is to investigate the actual use and intention toward using Internet services to communicate with the general practice by the general practice population. The secondary objective is to study the factors and characteristics that influence their intention to use such services. METHODS: There were 1500 members of the Dutch Health Care Consumer Panel, age over 18 years, that were invited to participate in this cross-sectional study. People who had contacted their general practitioner at least once in the past year were included. Participants were asked to fill out a questionnaire about the following services: Internet appointment planning, asking questions on the Internet, email reminders about appointments, Internet prescription refill requests, Internet access to medical data, and Internet video consultation. Participants indicated whether they had used these services in the past year, they would like to use them, and whether they thought their general practice had these services. For the first two services, participants rated items based on the unified theory of acceptance and use of technology complemented with additional constructs. These items were divided into six subscales: effort expectancy, performance expectancy, trust, attitude, facilitating conditions, and social influence. RESULTS: There were 546 participants that were included in the analyses out of 593 who met the inclusion criteria. The participants had a mean age of 53 years (SD 15.4), 43.6% (n=238) were male, and 66.8% (n=365) had at least one chronic illness. Actual use of the services varied between 0% (n=0, video consultation) and 10.4% (n=57, requesting prescription refill by Internet). The proportion of participants with a positive intention to use the service varied between 14.7% (n=80, video consultation) and 48.7% (n=266, Internet access to medical data). For each service, approximately half indicated that they did not know whether the service was available. Univariate logistic regression analyses revealed that all the constructs as well as age, level of education, and Internet usage had a significant association with intention toward using Internet appointment planning and asking questions by Internet. CONCLUSIONS: Internet communication services to contact the general practice are not yet frequently used by this population. Although a substantial number of persons have a positive intention toward using such services, not all people who receive primary care seem willing to use them. The lack of awareness of the availability and functionality of such services might play an important role.

Daily activity patterns of people provided with a dynamic arm support.

Dynamic arm supports are provided to support activities of daily living in people with limited upper extremity function. A cross-sectional study was performed in the Netherlands involving people who were provided with a dynamic arm support in 2012-2013. An adapted version of the Life-Habits questionnaire was used to assess daily activity patterns. Twenty-three subjects filled in the questionnaire. Tasks people perform themselves in daily life include tasks as eating, drinking, and communication tasks. Participants vary in the need for assistance in order to perform certain tasks. This individual character of daily activity performance is important to bear in mind during the provision of dynamic arm supports. More complex tasks in the field of personal care and household are often performed by caregivers. These are regarded a challenge for the field of assistive technology and/or robotics.