Planning of transport through inland shipping is complex, highly dynamic and very specific. Existing software support is focusing on road transport planning and/or is merely a visual representation of shipments to be manually assigned to particular vessels. As a result inland shipment planning is time-consuming and highly relies on the personal skills of the planner. In this paper we present a business rules based model that aims to further support inland shipping organizations in their shipment planning by identifying the characteristics and constraints that are of interest and the related explicated business rules. The model is derived from transport-related literature, explorative expert interviews and transport management software vendors. The usability and applicability of the model is subsequently successfully empirically tested using identified performance measures through a case study at a major European inland shipping broker
DOCUMENT
In Nederland verleent ongeveer een derde van de volwassen bevolking onbetaalde zorg. Het verlenen van mantelzorg kan in normale tijden zeer belastend zijn, maar de impact van een volksgezondheidscrisis op mantelzorgers is grotendeels onbekend. Deze studie richt zich op de vraag hoe de belasting van mantelzorgers veranderde na de COVID-19 pandemie en welke kenmerken verband hielden met deze veranderingen. We gebruiken zelfgerapporteerde gegevens van een steekproef van 965 mantelzorgers uit Nederland na 3 maanden pandemie om te onderzoeken hoe de objectieve belasting (d.w.z. uren besteed aan mantelzorg) en de subjectieve belasting waren veranderd, en wat hun zorggerelateerde kwaliteit van leven (CarerQol) was. We vonden dat de subjectieve belasting gemiddeld licht was toegenomen (van 4,75 naar 5,04 op een schaal van 0-10). Uit onze analyse bleek echter dat sommige zorgverleners er meer last van hadden dan anderen. De zwaarst getroffen zorgverleners waren vrouwen, met een laag inkomen, een betere lichamelijke gezondheid, een verminderde psychische gezondheid, zorgtaken voor kinderen, een langere duur van de zorg en zorgverleners die zorgden voor iemand met een verminderde lichamelijke en psychische gezondheid. Gemiddeld bleef de tijd die aan zorg werd besteed gelijk (een mediaan van 15 uur per week), maar bepaalde groepen zorgverleners ervoeren wel een verandering, namelijk degenen die zorg verleenden aan mensen in een instelling en aan mensen met een betere psychologische gezondheid vóór de pandemie. Bovendien hadden zorgverleners die veranderingen in objectieve belasting ervoeren niet dezelfde kenmerken als degenen die veranderingen in ervaren belasting en kwaliteit van leven ervoeren. Dit laat zien dat de gevolgen van een volksgezondheidscrisis voor zorgverleners niet kunnen worden gevangen door alleen te kijken naar objectieve of subjectieve belastingsmaten of kwaliteit van leven. Beleid voor langdurige zorg dat erop gericht is zorgverleners te ondersteunen om vol te houden tijdens een toekomstige crisis, moet gericht zijn op zorgverleners met een verhoogd risico op subjectieve belasting en een lagere CarerQol, zoals vrouwen, mensen met een laag inkomen en mensen met zorgtaken. Dergelijk beleid moet er rekening mee houden dat een vermindering van de objectieve belasting niet noodzakelijk leidt tot een vermindering van de subjectieve belasting voor alle zorgverleners.
MULTIFILE
In a rapidly evolving world, the need for innovative approaches to societal challenges is more critical than ever. As partners of the Network Applied Design Research (NADR), we believe that applied design research can be a promising approach for addressing complex issues in many domains, such as health-care, digital media, and urban sustainability. But what makes applied design research such a power-ful force for societal change? And how can designers move beyond mere problem-solving to create lasting impact? To discuss this, NADR applies an annual knowledge cycle where researchers submit contributions that are mutually reflected upon. The contributions you can read in these preceedings are the result of such a knowledge-sharing process. The twenty-one contributions are divided into four themes, each addressing a different dimension of the issue at hand. Contributions in part 1 – Connecting System Levels - emphasise the relationship between small-scale interventions and large-scale change. Contributions in part 2 - Theory of Change - examine how change processes actually take place. Contributions in part 3 - Balancing Different Worldviews - address the unique perspective that each stakeholder involved contributes. And contributions in part 4 - Beyond Solutionism - discuss whether it is at all possible to develop ready-made ‘solutions’ to the complex challenges we are facing.
DOCUMENT
Background: Self-management of exacerbations in COPD patients is important to reduce exacerbation impact. There is a need for more comprehensive and individualized interventions to improve exacerbation-related selfmanagement behavior. The use of mobile health (mHealth) could help to achieve a wide variety of behavioral goals. Understanding of patients and health care providers perspectives towards using mHealth in promoting selfmanagement will greatly enhance the development of solutions with optimal usability and feasibility. Therefore, the aim of this study was to explore perceptions of COPD patients and their health care providers towards using mHealth for self-management of exacerbations. Methods: A qualitative study using focus group interviews with COPD patients (n = 13) and health care providers (HCPs) (n = 6) was performed to explore perceptions towards using mHealth to support exacerbation-related selfmanagement. Data were analyzed by a thematic analysis. Results: COPD patients and HCPs perceived mostly similar benefits and barriers of using mHealth for exacerbationrelated self-management. These perceived benefits and barriers seem to be important drivers in the willingness to use mHealth. Both patients and HCPs strengthen the need for a multi-component and tailored mHealth intervention that improves patients’ exacerbation-related self-management by determining their health status and providing adequate information, decision support and feedback on self-management behavior. Most importantly, patients and HCPs considered an mHealth intervention as support to improve self-management and emphasized that it should never replace patients’ own feelings nor undermine their own decisions. In addition, the intervention should be complementary to regular contact with HCPs, as personal contact with a HCP was considered to be very important. To optimize engagement with mHealth, patients should have a positive attitude toward using mHealth and an mHealth intervention should be attractive, rewarding and safe. Conclusions: This study provided insight into perceptions of COPD patients and their HCPs towards using mHealth for self-management of exacerbations. This study points out that future mHealth interventions should focus on developing self-management skills over time by providing adequate information, decision support and feedback on self-management behavior and that mHealth should complement regular care. To optimize engagement, mHealth interventions should be attractive, rewarding, safe and tailored to the patient needs.
DOCUMENT
Background: Adequate self-management skills are of great importance for patients with chronic obstructive pulmonary disease (COPD) to reduce the impact of COPD exacerbations. Using mobile health (mHealth) to support exacerbation-related self-management could be promising in engaging patients in their own health and changing health behaviors. However, there is limited knowledge on how to design mHealth interventions that are effective, meet the needs of end users, and are perceived as useful. By following an iterative user-centered design (UCD) process, an evidence-driven and usable mHealth intervention was developed to enhance exacerbation-related self-management in patients with COPD. Objective: This study aimed to describe in detail the full UCD and development process of an evidence-driven and usable mHealth intervention to enhance exacerbation-related self-management in patients with COPD. Methods: The UCD process consisted of four iterative phases: (1) background analysis and design conceptualization, (2) alpha usability testing, (3) iterative software development, and (4) field usability testing. Patients with COPD, health care providers, COPD experts, designers, software developers, and a behavioral scientist were involved throughout the design and development process. The intervention was developed using the behavior change wheel (BCW), a theoretically based approach for designing behavior change interventions, and logic modeling was used to map out the potential working mechanism of the intervention. Furthermore, the principles of design thinking were used for the creative design of the intervention. Qualitative and quantitative research methods were used throughout the design and development process. Results: The background analysis and design conceptualization phase resulted in final guiding principles for the intervention, a logic model to underpin the working mechanism of the intervention, and design requirements. Usability requirements were obtained from the usability testing phases. The iterative software development resulted in an evidence-driven and usable mHealth intervention—Copilot, a mobile app consisting of a symptom-monitoring module, and a personalized COPD action plan. Conclusions: By following a UCD process, an mHealth intervention was developed that meets the needs and preferences of patients with COPD, is likely to be used by patients with COPD, and has a high potential to be effective in reducing exacerbation impact. This extensive report of the intervention development process contributes to more transparency in the development of complex interventions in health care and can be used by researchers and designers as guidance for the development of future mHealth interventions.
DOCUMENT
Background: There is an emergence of mobile health (mHealth) interventions to support self-management in patients with chronic obstructive pulmonary disease (COPD). Recently, an evidence-driven mHealth intervention has been developed to support patients with COPD in exacerbation-related self-management: the Copilot app. Health care providers (HCPs) are important stakeholders as they are the ones who have to provide the app to patients, personalize the app, and review the app. It is, therefore, important to investigate at an early stage whether the app is feasible in the daily practice of the HCPs. Objective: The aim of this study is to evaluate the perceived feasibility of the Copilot app in the daily practice of HCPs. Methods: A multimethods design was used to investigate how HCPs experience working with the app and how they perceive the feasibility of the app in their daily practice. The feasibility areas described by Bowen et al were used for guidance. HCPs were observed while performing tasks in the app and asked to think aloud. The System Usability Scale was used to investigate the usability of the app, and semistructured interviews were conducted to explore the feasibility of the app. The study was conducted in primary, secondary, and tertiary care settings in the Netherlands from February 2019 to September 2019. Results: In total, 14 HCPs participated in this study—8 nurses, 5 physicians, and 1 physician assistant. The HCPs found the app acceptable to use. The expected key benefits of the app were an increased insight into patient symptoms, more structured patient conversations, and more tailored self-management support. The app especially fits within the available time and workflow of nurses. The use of the app will be influenced by the autonomy of the professional, the focus of the organization on eHealth, costs associated with the app, and compatibility with the current systems used. Most HCPs expressed that there are conditions that must be met to be able to use the app. The app can be integrated into the existing care paths of primary, secondary, and tertiary health care settings. Individual organizational factors must be taken into account when integrating the app into daily practice. Conclusions: This early-stage feasibility study shows that the Copilot app is feasible to use in the daily practice of HCPs and can be integrated into primary, secondary, and tertiary health care settings in the Netherlands. The app was considered to best fit the role of the nurses. The app will be less feasible for those organizations in which many conditions need to be met to use the app. This study provides a new approach to evaluate the perceived feasibility of mHealth interventions at an early stage and provides valuable insights for further feasibility testing.
DOCUMENT
