Vaker sporten. Minder alcohol drinken. Stoppen met roken. Nu echt op tijd naar bed. Dat leefstijlverandering lastig kan zijn, weten we allemaal. Maar voor sommigen lijkt het welhaast onmogelijk. Leefstijlverandering kost energie en aandacht. Wat als je daar helemaal geen ruimte voor hebt, omdat je wordt afgeleid door belangrijkere zaken, zoals de zorg voor een ziek familielid of doordat je de huur weer niet kunt betalen? Waar moet je het in zo’n situatie vandaan halen om gezonder te gaan leven? Vooral onder mensen met een lage sociaaleconomische status (SES) komt zo’n situatie regelmatig voor. Welke bijdrage zou de eerstelijnsgeneeskunde hieraan kunnen leveren? De oplossing is gecompliceerd en de weg ernaartoe is vaak frustrerend, vooral omdat gezondheidscommunicatie alleen kan werken als het in nevenschikking met andere instrumenten wordt gecombineerd. Het antirookbeleid is een mooi voorbeeld waar veel is bereikt door een combinatie van instrumenten.
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Resilience to adverse events is increasingly recognized as important for human health. Socio-economic status (SES) is also frequently identified as a predictor of resilience. However, it is not well-understood how people define resilience in their everyday lives, and whether individuals have different experiences of resilience based on their SES. This study sought to fill these gaps, in the context of the COVID-19 pandemic and pandemic mitigation policies in the Netherlands.We interviewed high (n = 38) and low (n = 37) SES participants about their understanding and experiences of resilience during this period. Participants took part in individual interviews and focus groups in September 2021. Transcripts were analyzed thematically.A key theme was coping with adversity, in line with commonly-used definitions of resilience. However, we found that resilience was often defined more broadly. Resilience also encompassed aspects of self-reflection and improvement, and faith in oneself, the community and the nation. There were also key differences by SES background: elaborate and optimistic definitions and experiences of resilience were more often described by high SES individuals. For instance, high SES participants more frequently defined resilience as growing and improving. In contrast, low SES participants more commonly experienced resilience as enduring until better times arrived.Having a higher SES seemed to support resilience during the COVID-19 pandemic. This indicates that adverse events may exacerbate pre-existing financial and material difficulties among low SES individuals. This finding underscores the importance of addressing financial precarity prior to adverse events.
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Specific approaches are needed to reach and support people with a lower socioeconomic position (SEP) to achieve healthier eating behaviours. There is a growing body of evidence suggesting that digital health tools exhibit potential to address these needs because of its specific features that enable application of various behaviour change techniques (BCTs). The aim of this scoping review is to identify the BCTs that are used in diet-related digital interventions targeted at people with a low SEP, and which of these BCTs coincide with improved eating behaviour. The systematic search was performed in 3 databases, using terms related to e/m-health, diet quality and socioeconomic position. A total of 17 full text papers were included. The average number of BCTs per intervention was 6.9 (ranged 3–15). BCTs from the cluster ‘Goals and planning’ were applied most often (25x), followed by the clusters ‘Shaping knowledge’ (18x) and ‘Natural consequences’ (18x). Other frequently applied BCT clusters were ‘Feedback and monitoring’ (15x) and ‘Comparison of behaviour’ (13x). Whereas some BCTs were frequently applied, such as goal setting, others were rarely used, such as social support. Most studies (n = 13) observed a positive effect of the intervention on eating behaviour (e.g. having breakfast) in the low SEP group, but this was not clearly associated with the number or type of applied BCTs. In conclusion, more intervention studies focused on people with a low SEP are needed to draw firm conclusions as to which BCTs are effective in improving their diet quality. Also, further research should investigate combinations of BCTs, the intervention design and context, and the use of multicomponent approaches. We encourage intervention developers and researchers to describe interventions more thoroughly, following the systematics of a behaviour change taxonomy, and to select BCTs knowingly.
Vulnerable pregnant women are an important and complex theme in daily practice of birth care professionals. Vulnerability is an important risk factor for maternal and perinatal mortality and morbidity. Providing care for these women is often complex. First, because it is not always easy to identify vulnerability. Secondly, vulnerable women more often cancel their appointments with midwives and finally, many professionals are involved while they do not always know each other. Even though professionals are aware of the risks of vulnerability for future mothers and their (unborn) children and the complexity of care for these women, there is no international definition for ‘vulnerable pregnancies’. Therefore, we start this project with defining a mutual definition of vulnerability during pregnancy. In current projects of Rotterdam University of Applied Sciences (RUAS) we define a vulnerable pregnant woman as: a pregnant woman facing psychopathology, psychosocial problems, and/or substance abuse combined with lack of individual and/or social resources (low socioeconomic status, low educational level, limited social network). In the Netherlands, care for vulnerable pregnant women is fragmented and therefore it is unclear for birth care professionals which interventions are available and effective. Therefore, Dutch midwives are convinced that exchanging knowledge and best practices concerning vulnerable pregnancies between midwifery practices throughout Europe could enhance their knowledge and provide midwives (SMB partners in this project) with tools to improve care for vulnerable pregnant women. The aim of this project is to exchange knowledge and best practices concerning vulnerable pregnancies between midwifery practices in several European countries, in order to improve knowledge and skills of midwives. As a result, guidelines will be developed in order to exchange selected best practices which enable midwives to implement this knowledge in their own context. This contributes to improving care for vulnerable pregnant women throughout Europe.
