Background Prehabilitation offers patients the opportunity to actively participate in their perioperative care by preparing themselves for their upcoming surgery. Experiencing barriers may lead to non-participation, which can result in a reduced functional capacity, delayed post-operative recovery and higher healthcare costs. Insight in the barriers and facilitators to participation in prehabilitation can inform further development and implementation of prehabilitation. The aim of this review was to identify patient-experienced barriers and facilitators for participation in prehabilitation. Methods For this mixed methods systematic review, articles were searched in PubMed, EMBASE and CINAHL. Articles were eligible for inclusion if they contained data on patient-reported barriers and facilitators to participation in prehabilitation in adults undergoing major surgery. Following database search, and title and abstract screening, full text articles were screened for eligibility and quality was assessed using the Mixed Method Appraisal Tool. Relevant data from the included studies were extracted, coded and categorized into themes, using an inductive approach. Based on these themes, the Capability, Opportunity, Motivation, Behaviour (COM-B) model was chosen to classify the identified themes. Results Three quantitative, 14 qualitative and 6 mixed methods studies, published between 2007 and 2022, were included in this review. A multitude of factors were identified across the different COM-B components. Barriers included lack of knowledge of the benefits of prehabilitation and not prioritizing prehabilitation over other commitments (psychological capability), physical symptoms and comorbidities (physical capability), lack of time and limited financial capacity (physical opportunity), lack of social support (social opportunity), anxiety and stress (automatic motivation) and previous experiences and feeling too fit for prehabilitation (reflective motivation). Facilitators included knowledge of the benefits of prehabilitation (psychological capability), having access to resources (physical opportunity), social support and encouragement by a health care professional (social support), feeling a sense of control (automatic motivation) and beliefs in own abilities (reflective motivation). Conclusions A large number of barriers and facilitators, influencing participation in prehabilitation, were found across all six COM-B components. To reach all patients and to tailor prehabilitation to the patient’s needs and preferences, it is important to take into account patients’ capability, opportunity and motivation.
BackgroundE-mental health holds promise for people with severe mental illness, but has a limited evidence base. This study explored the effect of e-health added to face-to-face delivery of the Illness Management and Recovery Programme (e-IMR).MethodIn this multi-centre exploratory cluster randomized controlled trial, seven clusters (n = 60; 41 in intervention group and 19 in control group) were randomly assigned to e-IMR + IMR or IMR only. Outcomes of illness management, self-management, recovery, symptoms, quality of life, and general health were measured at baseline (T0), halfway (T1), and at twelve months (T2). The data were analysed using mixed model for repeated measurements in four models: in 1) we included fixed main effects for time trend and group, in 2) we controlled for confounding effects, in 3) we controlled for interaction effects, and in 4) we performed sub-group analyses within the intervention group.ResultsNotwithstanding low activity on e-IMR, significant effects were present in model 1 analyses for self-management (p = .01) and recovery (p = .02) at T1, and for general health perception (p = .02) at T2, all in favour of the intervention group. In model 2, the confounding covariate gender explained the effects at T1 and T2, except for self-management. In model 3, the interacting covariate non-completer explained the effects for self-management (p = .03) at T1. In model 4, the sub-group analyses of e-IMR-users versus non-users showed no differences in effect.ConclusionBecause of confounding and interaction modifications, effectiveness of e-IMR cannot be concluded. Low use of e-health precludes definite conclusions on its potential efficacy. Low use of e-IMR calls for a thorough process evaluation of the intervention.
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Op vrijdag 14 mei 2004 heeft de Haagse Hogeschool/TH Rijswijk een internationaal symposium over 'Leiderschap en Diversiteit' georganiseerd. Het symposium handelde over de dynamiek van gender, nationale cultuur en etniciteit in moderne organisaties. Door de diversiteit van medewerkers, klanten en afzetmarkten worden nieuwe eisen gesteld aan de leidinggevende en is de bedrijfscultuur blijvend veranderd. Veel bedrijfsactiviteiten strekken zich uit tot buiten de landsgrenzen. Leidinggeven in of in samenwerking met bijvoorbeeld vestigingen in Zuid-Amerika of Aziatische landen vergt een andere leiderschapsstijl. Kennis van elkaars achtergronden, ofwel transcultureel inzicht, is nodig om optimaal te kunnen samenwerken. Internationaal gerenommeerde sprekers zijn ingegaan op: leiderschap in de Arabische wereld. leiderschap, gender en etniciteit. leiderschap en culturele dynamiek in organisaties. leiderschap en nationaliteit. Na de inleidingen van de gastsprekers werd in vier werkgroepen over deze thema's verder met de gastsprekers van gedachten gewisseld. Het symposium werd afgesloten met een gezamenlijke forumdiscussie en een borrel. Dit verslag is tevens het startsein voor verdere studie over het thema leiderschap en diversiteit binnen het HRM lectoraat. De leden van de HRM Kenniskring gaan verder onderzoek doen en hun kennis over dit thema overdragen in de dagelijkse onderwijspraktijk aan de Haagse Hogeschool/TH Rijswijk.
