Volgens René Butter is het concept van de zogeheten 'mixed methods' een vruchtbare manier om het praktijkgerichte onderzoek naar een hoger plan te tillen. 'Zo kun je rijke, conceptueel geladen informatie optimaal combineren met meer geformatteerde en gestructureerde informatie'.
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Aim: To evaluate healthcare professionals' performance and treatment fidelity in the Cardiac Care Bridge (CCB) nurse-coordinated transitional care intervention in older cardiac patients to understand and interpret the study results. Design: A mixed-methods process evaluation based on the Medical Research Council Process Evaluation framework. Methods: Quantitative data on intervention key elements were collected from 153 logbooks of all intervention patients. Qualitative data were collected using semi-structured interviews with 19 CCB professionals (cardiac nurses, community nurses and primary care physical therapists), from June 2017 until October 2018. Qualitative data-analysis is based on thematic analysis and integrated with quantitative key element outcomes. The analysis was blinded to trial outcomes. Fidelity was defined as the level of intervention adherence. Results: The overall intervention fidelity was 67%, ranging from severely low fidelity in the consultation of in-hospital geriatric teams (17%) to maximum fidelity in the comprehensive geriatric assessment (100%). Main themes of influence in the intervention performance that emerged from the interviews are interdisciplinary collaboration, organizational preconditions, confidence in the programme, time management and patient characteristics. In addition to practical issues, the patient's frailty status and limited motivation were barriers to the intervention. Conclusion: Although involved healthcare professionals expressed their confidence in the intervention, the fidelity rate was suboptimal. This could have influenced the non-significant effect of the CCB intervention on the primary composite outcome of readmission and mortality 6 months after randomization. Feasibility of intervention key elements should be reconsidered in relation to experienced barriers and the population. Impact: In addition to insight in effectiveness, insight in intervention fidelity and performance is necessary to understand the mechanism of impact. This study demonstrates that the suboptimal fidelity was subject to a complex interplay of organizational, professionals' and patients' issues. The results support intervention redesign and inform future development of transitional care interventions in older cardiac patients.
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Background:An eHealth tool that coaches employees through the process of reflection has the potential to support employees with moderate levels of stress to increase their capacity for resilience. Most eHealth tools that include self-tracking summarize the collected data for the users. However, users need to gain a deeper understanding of the data and decide upon the next step to take through self-reflection.Objective:In this study, we aimed to examine the perceived effectiveness of the guidance offered by an automated e-Coach during employees’ self-reflection process in gaining insights into their situation and on their perceived stress and resilience capacities and the usefulness of the design elements of the e-Coach during this process.Methods:Of the 28 participants, 14 (50%) completed the 6-week BringBalance program that allowed participants to perform reflection via four phases: identification, strategy generation, experimentation, and evaluation. Data collection consisted of log data, ecological momentary assessment (EMA) questionnaires for reflection provided by the e-Coach, in-depth interviews, and a pre- and posttest survey (including the Brief Resilience Scale and the Perceived Stress Scale). The posttest survey also asked about the utility of the elements of the e-Coach for reflection. A mixed methods approach was followed.Results:Pre- and posttest scores on perceived stress and resilience were not much different among completers (no statistical test performed). The automated e-Coach did enable users to gain an understanding of factors that influenced their stress levels and capacity for resilience (identification phase) and to learn the principles of useful strategies to improve their capacity for resilience (strategy generation phase). Design elements of the e-Coach reduced the reflection process into smaller steps to re-evaluate situations and helped them to observe a trend (identification phase). However, users experienced difficulties integrating the chosen strategies into their daily life (experimentation phase). Moreover, the identified events related to stress and resilience were too specific through the guidance offered by the e-Coach (identification phase), and the events did not recur, which consequently left users unable to sufficiently practice (strategy generation phase), experiment (experimentation phase), and evaluate (evaluation phase) the techniques during meaningful events.Conclusions:Participants were able to perform self-reflection under the guidance of the automated e-Coach, which often led toward gaining new insights. To improve the reflection process, more guidance should be offered by the e-Coach that would aid employees to identify events that recur in daily life. Future research could study the effects of the suggested improvements on the quality of reflection via an automated e-Coach.
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Due to societal developments, like the introduction of the ‘civil society’, policy stimulating longer living at home and the separation of housing and care, the housing situation of older citizens is a relevant and pressing issue for housing-, governance- and care organizations. The current situation of living with care already benefits from technological advancement. The wide application of technology especially in care homes brings the emergence of a new source of information that becomes invaluable in order to understand how the smart urban environment affects the health of older people. The goal of this proposal is to develop an approach for designing smart neighborhoods, in order to assist and engage older adults living there. This approach will be applied to a neighborhood in Aalst-Waalre which will be developed into a living lab. The research will involve: (1) Insight into social-spatial factors underlying a smart neighborhood; (2) Identifying governance and organizational context; (3) Identifying needs and preferences of the (future) inhabitant; (4) Matching needs & preferences to potential socio-techno-spatial solutions. A mixed methods approach fusing quantitative and qualitative methods towards understanding the impacts of smart environment will be investigated. After 12 months, employing several concepts of urban computing, such as pattern recognition and predictive modelling , using the focus groups from the different organizations as well as primary end-users, and exploring how physiological data can be embedded in data-driven strategies for the enhancement of active ageing in this neighborhood will result in design solutions and strategies for a more care-friendly neighborhood.
Adolescenten brengen steeds meer vrije tijd door met het spelen van games en bevinden zich mede daardoor in een hybride leefwereld. Deze relatief nieuwe wereld brengt nieuwe uitdagingen mee rondom identiteitsontwikkeling en psychosociaal welzijn; voor gamende adolescenten zelf, maar ook hun (professionele) opvoeders. Wij onderzoeken de relatie tussen gamen, identiteitsontwikkeling en psychosociaal welzijn en de rol die (professionele) opvoeders hierin hebben.Doel Op dit moment ontbreekt kennis over de relatie tussen gamen, identiteitsontwikkeling en psychosociaal welzijn van adolescenten en is het onder andere lastig om handvatten voor (professionele) opvoeders te ontwikkelen. Handvatten kunnen helpen om beter aan te sluiten bij de leefwereld en behoeftes van gamende adolescenten. De resultaten van dit onderzoek kunnen bijdragen aan een positieve (sociale) identiteitsontwikkeling van gamende adolescenten in een hybride wereld. Resultaten Het promotieonderzoek gaat verschillende wetenschappelijke publicaties opleveren. We vertalen onze resultaten samen met professionals, opvoeders en adolescenten naar praktische handvatten voor (professionele) opvoeders. De betrokken praktijkpartners en opleidingen geven deze wetenschappelijk onderbouwde inzichten en handvatten een passende plaats in hun curricula en werkwijzen. Looptijd 01 september 2022 - 01 september 2026 Aanpak Dit promotieonderzoek heeft een praktijkgericht, mixed-methods design. Voor de kwantitatieve analyse maken we gebruik van longitudinale data van het Digital Youth project van Universiteit Utrecht. De kwalitatieve data wordt verzameld door symbolic netnography (een digitale variant van etnografisch onderzoek), interviews en participerende observaties met adolescenten en (professionele) opvoeders. In samenspraak met adolescenten en (professionele) opvoeders worden deze inzichten vertaald naar praktische handvatten.
Adolescenten brengen steeds meer vrije tijd door met het spelen van games en bevinden zich mede daardoor in een hybride leefwereld. Deze relatief nieuwe wereld brengt nieuwe uitdagingen mee rondom identiteitsontwikkeling en psychosociaal welzijn; voor gamende adolescenten zelf, maar ook hun (professionele) opvoeders. Wij onderzoeken de relatie tussen gamen, identiteitsontwikkeling en psychosociaal welzijn en de rol die (professionele) opvoeders hierin hebben.
