Background: A user-centered design approach for eHealth interventions improves their effectiveness in stroke rehabilitation. Nevertheless, insight into requirements of end-users (patients/informal caregivers and/or health professionals) for eRehabilitation is lacking. The aim of this study was to identify end-user requirements for a comprehensive eHealth program in stroke rehabilitation. Methods: Eight focus groups were conducted to identify user requirements; six with patients/informal caregivers and two with health professionals involved in stroke rehabilitation (rehabilitation physicians, physiotherapists, occupational therapists, psychologists, team coordinators, speech therapist). The focus groups were audiotaped and transcribed in full. Direct content analysis was used to identify the end-user requirements for stroke eHealth interventions concerning three categories: accessibility, usability and content. Results: In total, 45 requirements for the accessibility, usability and content of a stroke eRehabilitation program emerged from the focus groups. Most requirements concerned content (27 requirements), followed by usability (12 requirements) and accessibility (6 requirements). Patients/informal caregivers and health professionals each identified 37 requirements, respectively, with 29 of them overlapping. Conclusions: Requirements between stroke patients/informal caregivers and health professionals differed on several aspects. Therefore, involving the perspectives of all end users in the design process of stroke eRehabilitation programs is needed to achieve a user-centered design.
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It is of utmost importance to collect organic waste from households as a separate waste stream. If collected separately, it could be used optimally to produce compost and biogas, it would not pollute fractions of materials that can be recovered from residual waste streams and it would not deteriorate the quality of some materials in residual waste (e.g. paper). In rural areas with separate organic waste collection systems, large quantities of organic waste are recovered. However, in the larger cities, only a small fraction of organic waste is recovered. In general, citizens dot not have space to store organic waste without nuisances of smell and/or flies. As this has been the cause of low organic waste collection rates, collection schemes have been cut, which created a further negative impact. Hence, additional efforts are required. There are some options to improve the organic waste recovery within the current system. Collection schemes might be improved, waste containers might be adapted to better suit the needs, and additional underground organic waste containers might be installed in residential neighbourhoods. There are persistent stories that separate organic waste collection makes no sense as the collectors just mix all municipal solid waste after collection, and incinerate it. Such stories might be fuelled by the practice that batches of contaminated organic waste are indeed incinerated. Trust in the system is important. Food waste is often regarded as unrein. Users might hate to store food waste in their kitchen that could attract insects, or the household pets. Hence, there is a challenge for socio-psychological research. This might also be supported by technology, e.g. organic waste storage devices and measures to improve waste separation in apartment buildings, such as separate chutes for waste fractions. Several cities have experimented with systems that collect organic wastes by the sewage system. By using a grinder, kitchen waste can be flushed into the sewage system, which in general produces biogas by the fermentation of sewage sludge. This is only a good option if the sewage is separated from the city drainage system, otherwise it might create water pollution. Another option might be to use grinders, that store the organic waste in a tank. This tank could be emptied regularly by a collection truck. Clearly, the preferred option depends on local conditions and culture. Besides, the density of the area, the type of sewage system and its biogas production, and the facilities that are already in place for organic waste collection are important parameters. In the paper, we will discuss the costs and benefits of future organic waste options and by discussing The Hague as an example.
OBJECTIVE: to gain insight into what older adults after hip fracture perceive as most beneficial to their recovery to everyday life.DESIGN: qualitative research approach.SETTING: six skilled nursing facilities.PARTICIPANTS: 19 older community dwelling older adults (aged 65-94), who had recently received geriatric rehabilitation after hip fracture.METHODS: semi-structured interviews were conducted with 19 older adults after hip fracture. Coding techniques based on constructivist grounded theory were applied.RESULTS: four categories were derived from the data: 'restrictions for everyday life', 'recovery process', 'resources for recovery' and 'performing everyday activities'. Physical and psychological restrictions are consequences of hip fracture that older adults have struggled to address during recovery. Three different resources were found to be beneficial for recovery; 'supporting and coaching', 'myself' and 'technological support'. These resources influenced the recovery process. Having successful experiences during recovery led to doing everyday activities in the same manner as before; unsuccessful experiences led to ceasing certain activities altogether.CONCLUSION: participants highlight their own role ('myself') as essential for recovery. Additionally, coaching provides emotional support, which boosts self-confidence in performing everyday activities. Furthermore, technology can encourage older adults to become more active and being engaged in the recovery process. The findings suggest that more attention should be paid to follow-up interventions after discharge from inpatient rehabilitation to support older adults in finding new routines in their everyday activities.A conceptual model is presented and provides an understanding of the participants' experiences and perspectives concerning their process of recovery after hip fracture to everyday life.
