Background Total laryngectomy with or without adjuvant (chemo)radiation often induces speech, swallowing and neck and shoulder problems. Speech, swallowing and shoulder exercises may prevent or diminish these problems. The aim of the present paper is to describe the study, which is designed to investigate the effectiveness and cost-utility of a guided self-help exercise program built into the application “In Tune without Cords” among patients treated with total laryngectomy. Methods/design Patients, up to 5 years earlier treated with total laryngectomy with or without (chemo)radiation will be recruited for participation in this study. Patients willing to participate will be randomized to the intervention or control group (1:1). Patients in the intervention group will be provided access to a guided self-help exercise program and a self-care education program built into the application “In Tune without Cords”. Patients in the control group will only be provided access to the self-care education program. The primary outcome is the difference in swallowing quality (SWAL-QOL) between the intervention and control group. Secondary outcome measures address speech problems (SHI), shoulder disability (SDQ), quality of life (EORTC QLQ-C30, QLQ-H&N35 and EQ-5D), direct and indirect costs (adjusted iMCQ and iPCQ measures) and self-management (PAM). Patients will be asked to complete these outcome measures at baseline, immediately after the intervention or control period (i.e. at 3 months follow-up) and at 6 months follow-up. Discussion This randomized controlled trial will provide knowledge on the effectiveness of a guided self-help exercise program for patients treated with total laryngectomy. In addition, information on the value for money of such an exercise program will be provided. If this guided self-help program is (cost)effective for patients treated with total laryngectomy, the next step will be to implement this exercise program in current clinical practice.
DOCUMENT
Rationale: In this study, we aimed to explore how dietitians’ history-taking questions function during dietary counseling of clients with malnutrition (risk). Fruitful functioning of history-taking questions during the problem identification phase is crucial for dietitians to develop a client-centered dietary treatment plan.Methods: Using discursive psychology, we analyzed the problem identification phase of recorded dietitian-client conversations of 7 dietitians and 17 clients. Discursive psychology is a qualitative, inductive methodology that is used to analyze real-life conversations. Discursive psychology focuses on how descriptions in talk (including wording, intonation, pauses, non-verbal behavior) accomplish actions such as presenting oneself in a particular way.Results: Our analysis shows how, in response to dietitians’ history-taking questions, clients repeatedly demonstrate that they have already made some effort to self-help. Typically, these history-taking questions presume some biopsychosocial factor as the cause of the dietary problems discussed. In response, clients show they already started to eat extra, closely monitored their body weight, and tried to eat despite having no appetite. In addition, clients account for the absence of efforts by claiming various kinds of inability, such as facing difficulties in preparing food for oneself or by questioning whether their underlying medical condition caused the diet-related problem in the first place.Conclusion: This study shows that history-taking questions not only elicit answers with factual information but also evoke clients’ self-presentations. Responses from dietitians show little attention to the relevance of these self-presentations,while clients treat self-help as a normative requirement to demonstrate they have done everything they can before they sought professional help. To optimize the problem identification phase, we suggest that in addition to conversationaltechniques dietitians could increase their attention to clients’ actions performed.
DOCUMENT
The theoretical framework of this dissertation is based on Amartya Sen’s capability approach (Chapter 2). In the early 1980s, development economist Amartya Sen developed the capability framework as a broad normative framework for the evaluation and assessment of individual well-being and social arrangements mainly in countries in the Global South (Sen, 1999, 2009). I chose the capability approach was chosen because of its strong focus on the notion of freedom as the capability to live the life each individual is aiming for. The freedom to choose a particular lifestyle is an intrinsic part of Sen’s notions of agency and well-being (Sen, 1999). After elaborating on notions of agency and well-being in detail, I turn to the role of financial self-help groups and how their members are influenced by social structures. This chapter concludes by operationalizing the theoretical framework into three capabilities (C1–C3) that serve as sensitizing concepts throughout the dissertation. These capabilities focus on the potential impact CAF groups have on members’ abilities to develop social networks (C1), to control their financial household management (C2), and to adopt an enterprising attitude (C3). Chapter 3 discusses my research methodology. I describe how the three capabilities (C1–C3) were applied as sensitizing concepts in the set-up of this particular action research (Blumer, 1954). I also explain in more detail how, by using sensitizing concepts, I combined an inductive research approach with a deductive angle. Then, I elaborate on the fundamental elements of this action research project: the implementation of the CAF groups as well as the collection and analysis of the empirical data. Finally, I reflect on how I designed and carried out this action research, with a special focus on the interaction between researcher and CAF members as research participants. A more detailed background description of the Dutch financial landscape is provided in Chapter 4. The chapter focuses on two particular financial self-help groups: ROSCAs among Ethiopians and Ghanaians living in the Netherlands. Compared to the formal banking system dominating the current financial landscape, these financial self-help groups claim effectivity instead of efficiency in the operation and management of their respective groups. By exploring developments in the current financial landscape, this chapter argues that distinguishing different kinds of resilience creates possibilities for analysing the different roles of financial arrangements and institutions for the financial landscape. Thus, this explorative study on ROSCAs questions the dominance of the financial side of the coin that has resulted from the efficiency-driven institutions of the financial sector. Chapter 5 presents each CAF group in more detail. The reader gets to know the different members of each CAF group and their motivations to join. Financial performance is assessed according to members’ savings and loan behaviour during the period of their participation. The quantitative data is analysed on how much the members of a respective CAF group saved and how much they borrowed from the group’s fund during the entire period of the research. These insights help the reader to better understand the differences and similarities between the five CAF groups. Chapter 6 discusses the empirical findings from the first three CAF groups. This chapter explores whether and how participation in a CAF group improves individuals’ well-being with regard to expanding their social networks, improving their financial household management, and strengthening their entrepreneurial positions. It also shows how participating in CAF groups at the grassroots level contributes to the well- Balancing the social and financial sides of the coin26being of vulnerable people in the Netherlands. Finally, the chapter reconsiders Sen’s notion of freedom for the particular context of overconsumption, inequality, and overindebtedness. In applying Sen’s capability approach, I realized that the approach has a “blind spot” regarding individuals’ possible impacts on the structures within and around them. By adding notions of Giddens’s structuration theory to the core concepts of the capability approach, I rendered the capability approach more sensitive to how CAF-group members may interact with their surrounding structures (Chapter 7). The relation between individuals and surrounding societal structures is extensively discussed in what is often referred to as the agency-structure debate (Ritzer, 2003). This debate is based on differing views about whether and to what extent individuals have a free will and can act according to their preferences, values, and personal feelings, or to what extent they are the “product” of their surrounding social structures. By expanding the capability approach with the notions of internal structures, on the one hand, and more proximate and more distant societal structures, on the other (Stones, 2008), I detail not only how individual agents are influenced by their surrounding structures, but how they might also have – however small and modest – an impact on those structures themselves. As a result, this chapter not only provides answers to how CAF-group participation affects individual members’ access to social networks, their financial household management, and their entrepreneurial positioning, but it also enabled me to investigate how and why individuals join a CAF group to take part in a so-called countermovement. Thus, I also consider how CAF members could possibly play a role in their surrounding social structures, like the existing financial landscape and the emerging participation society in the Netherlands.One way in which a CAF group can play a role in the surrounding structures is to become a community of practice. Wenger (1998) describes a community of practice as a group of people who share a certain domain of interest that distinguishes them from others. In a community of practice, it is crucial to learn from each other by engaging in joint activities and discussions. To discuss whether and how some of the CAF groups studied here turned into a community of practice, I apply the criteria of a common goal, trust, democratic leadership, and accumulation of knowledge in Chapter 8. The application of these criteria to the functioning of the CAF groups also provides more insight into how members interacted which each other in the different CAF groups. I will show how two of the five CAF groups indeed turned into communities of practice. Chapter 9 concludes this dissertation by linking the empirical findings on the individual level (Chapters 6 and 7) with those on the group level (Chapter 8). I follow this with a general discussion of the main contribution to theory development made by the Balancing the social and financial sides of the coin27expansion of Sen’s capability approach with Giddens’s structuration theory. Then, I discuss the role of CAF groups in enabling individual participants to balance the social and financial sides of the coin. Finally, I conclude this dissertation by showing how CAF groups have the potential to empower their members to meet the expectations of the participation society and the challenges of the contemporary financial landscape. I also provide recommendations for how engaged scholars doing action research can be reflective about the way they interact with their research participants and for how practitioners can set up CAF groups in the field. In the Epilogue, I tell the story of Cash2Grow. Based on the experiences and findings of my research, I co-founded the Cash2Grow foundation to promote savings groups in the Netherlands as a tool for financial and social empowerment. By developing improved savings-group methodologies and financial education tools, the foundation aims to train staff and volunteers from different types of (welfare) organizations to establish savings groups among their target populations. At the moment, we are also collaborating with similar organizations in Spain, Italy, Germany, and Poland to learn more from each other in a project subsidized by the EU.
DOCUMENT
Abstract: Background: Chronic obstructive pulmonary disease (COPD) and asthma have a high prevalence and disease burden. Blended self-management interventions, which combine eHealth with face-to-face interventions, can help reduce the disease burden. Objective: This systematic review and meta-analysis aims to examine the effectiveness of blended self-management interventions on health-related effectiveness and process outcomes for people with COPD or asthma. Methods: PubMed, Web of Science, COCHRANE Library, Emcare, and Embase were searched in December 2018 and updated in November 2020. Study quality was assessed using the Cochrane risk of bias (ROB) 2 tool and the Grading of Recommendations, Assessment, Development, and Evaluation. Results: A total of 15 COPD and 7 asthma randomized controlled trials were included in this study. The meta-analysis of COPD studies found that the blended intervention showed a small improvement in exercise capacity (standardized mean difference [SMD] 0.48; 95% CI 0.10-0.85) and a significant improvement in the quality of life (QoL; SMD 0.81; 95% CI 0.11-1.51). Blended intervention also reduced the admission rate (relative ratio [RR] 0.61; 95% CI 0.38-0.97). In the COPD systematic review, regarding the exacerbation frequency, both studies found that the intervention reduced exacerbation frequency (RR 0.38; 95% CI 0.26-0.56). A large effect was found on BMI (d=0.81; 95% CI 0.25-1.34); however, the effect was inconclusive because only 1 study was included. Regarding medication adherence, 2 of 3 studies found a moderate effect (d=0.73; 95% CI 0.50-0.96), and 1 study reported a mixed effect. Regarding self-management ability, 1 study reported a large effect (d=1.15; 95% CI 0.66-1.62), and no effect was reported in that study. No effect was found on other process outcomes. The meta-analysis of asthma studies found that blended intervention had a small improvement in lung function (SMD 0.40; 95% CI 0.18-0.62) and QoL (SMD 0.36; 95% CI 0.21-0.50) and a moderate improvement in asthma control (SMD 0.67; 95% CI 0.40-0.93). A large effect was found on BMI (d=1.42; 95% CI 0.28-2.42) and exercise capacity (d=1.50; 95% CI 0.35-2.50); however, 1 study was included per outcome. There was no effect on other outcomes. Furthermore, the majority of the 22 studies showed some concerns about the ROB, and the quality of evidence varied. Conclusions: In patients with COPD, the blended self-management interventions had mixed effects on health-related outcomes, with the strongest evidence found for exercise capacity, QoL, and admission rate. Furthermore, the review suggested that the interventions resulted in small effects on lung function and QoL and a moderate effect on asthma control in patients with asthma. There is some evidence for the effectiveness of blended self-management interventions for patients with COPD and asthma; however, more research is needed. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42019119894; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=119894
DOCUMENT
Summary Self-managed shelters claim that participants who have been homeless, are better able to run a shelter than regular providers. Little research has investigated self-managed shelters. In this paper we described the experiences of participants and peer workers with empowerment processes in Je Eigen Stek (Your own place, JES), a self-managed shelter, based on an eight year qualitative responsive evaluation. FindingsWe distinguish three clusters of individual experiences: 1) enthusiastic, 2) moderate to critical, and 3) negative, respectively associated with decreasing engagement with social life in and management of JES. Those not engaged can still benefit materially and from the freedom of choice JES offers, which is generally appreciated. Empowerment provides a useful framework and JES in turn offers new insights into the dialectical nature of empowerment. Empowerment consists of freedom of choice and capacity development and neither should be emphasized over the other. The emphasis in JES is on freedom of choice, which does not automatically lead to developing capacities. Social workers try to balance both aspects of empowerment.Applications Our analysis shows how offering freedom of choice can contribute to empowerment, although social workers need to be aware that participants might opt not to work on capacity development.
DOCUMENT
Purpose: Adolescents are the least likely to seek help for their mental health problems. School may be an important route to improve early recognition of adolescents with mental health problems in need for support, but little is known about the barriers to school support.Materials and methods: Data were collected in a longitudinal cohort study of Dutch adolescents (age 12–16) in secondary school (n = 956). We assessed the relation between level of psychosocial problems at the beginning of the school year (T1) and the support used in school at the end of that school year (T2), whether the willingness to talk to others (measured at T1) mediates this relation, and whether stigma towards help-seeking (T1) moderates this mediation.Results: Adolescents with more psychosocial problems were more likely to use support in school and were less willing to talk to others about their problems, but the willingness to talk to others was not a mediator. Stigma moderated the relationship between psychosocial problems and willingness to talk to others.Conclusions: Most adolescents with psychosocial problems get support in Dutch secondary school regardless of their willingness to talk to others about their problems. However, perceiving stigma towards help-seeking makes it less likely for someone to talk about their problems.
DOCUMENT
Presentation at eHealth consultation northern Netherlands, organized by Rob Giel Research Centre (UMCG), held in October 2013.Presentation on obesity issues and use of online Dialectical Behavioral Therapy to launch a research proposal.
DOCUMENT
Which components are essential for developing the online version of the DBT intervention to be an effective equivalent of the existing face-to-face DBT?Presentation, held during the Symposium Emotional Eating, 14th European Congress of Psychology in Milan, Italy, 7-10 July 2015.
DOCUMENT
Which components are essential for developing the online version of the DBT intervention to be an effective equivalent of the existing face-to-face DBT?Presentation, held during the New Year Conference KCO-January 2014.
DOCUMENT
More people voted in 2024 than any other year in human history, while often relying on the internet for political information. This combination resulted in critical challenges for democracy. To address these concerns, we designed an exhibition that applied interactive experiences to help visitors understand the impact of digitization on democracy. This late-breaking work addresses the research questions: 1) What do participants, exposed to playful interventions, think about these topics? and 2) How do people estimate their skills and knowledge about countering misinformation? We collected data in 5 countries through showcases held within weeks of relevant 2024 elections. During visits, participants completed a survey detailing their experiences and emotional responses. Participants expressed high levels of self-confidence regarding the detection of misinformation and spotting AI-generated content. This paper contributes to addressing digital literacy needs by fostering engaging interactions with AI and politically relevant issues surrounding campaigning and misinformation.
MULTIFILE
