Background: The built environment is increasingly recognized as a determinant for health and health behaviors. Existing evidence regarding the relationship between environment and health (behaviors) is varying in significance and magnitude, and more high-quality longitudinal studies are needed. The aim of this study was to evaluate the effects of a major urban redesign project on physical activity (PA), sedentary behavior (SB), active transport (AT), health-related quality of life (HRQOL), social activities (SA) and meaningfulness, at 29–39 months after opening of the reconstructed area. Methods: PA and AT were measured using accelerometers and GPS loggers. HRQOL and sociodemographic characteristics were assessed using questionnaires. In total, 241 participants provided valid data at baseline and follow-up. We distinguished three groups, based on proximity to the intervention area: maximal exposure group, minimal exposure group and no exposure group. Results: Both the maximal and minimal exposure groups showed significantly different trends regarding transportbased PA levels compared to the no exposure group. In the exposure groups SB decreased, while it increased in the no exposure group. Also, transport-based light intensity PA remained stable in the exposure groups, while it significantly decreased in the no exposure group. No intervention effects were found for total daily PA levels. Scores on SA and meaningfulness increased in the maximal exposure group and decreased in the minimal and no exposure group, but changes were not statistically significant. Conclusion: The results of this study emphasize the potential of the built environment in changing SB and highlights the relevance of longer-term follow-up measurements to explore the full potential of urban redesign projects.
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Inaugural address of Frederike Praasterink, Professor Future Food Systems 22 February 2018. Three important principles contribute to the transformation of food systems: - Redesign food systems from ‘less bad’ to ‘net positive’ - Reconnect consumers, producers, youth - Revalue food through true cost accounting and new business models
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Post-war urban neighbourhoods in industrialised countries have been shown to negatively affect the lifestyles of their residents due to their design. This study aims at developing an empirical procedure to select locations to be redesigned and the determinants of health at stake in these locations, with involvement of residents’ perspectives as core issue. We addressed a post-war neighbourhood in the city of Groningen, the Netherlands. We collected data from three perspectives: spatial analyses by urban designers, interviews with experts in local health and social care (n = 11) and online questionnaires filled in by residents (n = 99). These data provided input for the selection of locations to be redesigned by a multidisciplinary team (n = 16). The procedure yielded the following types of locations (and determinants): An area adjacent to a central shopping mall (social interaction, traffic safety, physical activity), a park (experiencing green, physical activity, social safety, social interaction) and a block of low-rise row houses around a public square (social safety, social interaction, traffic safety). We developed an empirical procedure for the selection of locations and determinants to be addressed, with addressing residents’ perspectives. This procedure is potentially applicable to similar neighbourhoods internationally.
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The objective is to develop the redesign of patient clinics by a living lab consisting of a multidisciplinary group of designers (interior design, facility design, organization design) and art students in participation with end-users and health care professionals at a Dutch university hospital.
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Despite increased healthcare extramuralisation, related to increased elderly patients living at home, most nursing students still see the hospital as career favourite. This is problematic, because of the widespread labour-market shortages in community care in many Western countries. At the Amsterdam University of Applied Sciences, the bachelor nursing programme was redesigned to stimulate students’ interest in community-care. The effect of this ‘community-oriented’ curriculum on students’ perceptions and placement preferences was then investigated. To measure both, the Scale on Community Care Perceptions (SCOPE) was used. The intervention group (170 students graduating in 2018), followed the new curriculum and was compared to a historic control group (477 students) that followed the older, more ‘hospital-oriented’ curriculum (three cohorts graduating 2015-2017). Both groups were compared on placement preferences, and multiple regression was used to investigate the effect of the curriculum-redesign on their perceptions of community care.The redesign consisted of an integrative approach based on the influence of lecturers, placement experiences, and the introduction of new educational elements in the curriculum. Goal was to broaden students’ views, showing that nursing is more than hospital care. While the curriculum was scrutinised on how patient cases were presented, more than 60 of the 110 cases were located in the hospital, compared to four in community care. Thus, this aspect of the ‘hidden curriculum’ was adjusted. Five new themes related to community nursing were integrated in the ‘generalist’ programme in years 1 and 2, namely: (1) fostering patient self-management, (2) shared decision-making, (3) collaboration with the patients’ social system, (4) healthcare technology, and (5) care allocation. A community care week was organised in year 2, in which all students visited a community nursing team. In the last two years of study, a ‘paved way’ to community care was created in the form of an interesting minor programme ‘Complex Community care’ in year 3, a well-organised 30-week placement in year 4, and a concluding case study from their own practice [Figure 1].[Figure 1]Figure 1. Curriculum-redesign to stimulate interest in community care.A comparison between the historic control and intervention group on perceptions of communitycare and placement preferences, measured with SCOPE, showed no significant positive results in both outcomes. The model in the regression analysis, predicting students' perceptions from the type of curriculum (historic/intervention), showed no statistically significant result, F(1,635) = .021, p = .884, and a low explained variance R2 = .001. A preference for a placement in community care decreased from 9.2% in the historic control group to 8.2% in the intervention group. However, the regression analysis revealed that two variables, in contrast with the curriculum, had a significant influence, to wit ‘belonging to a church/religious group’ and ‘working/has been working in community care’.Though described in the literature as the only effective way, this study showed that curriculum-redesign was not effective, despite its holistic approach. A combination of factors might explain this result. Other pathways in the curriculum may have strongly competed. Disappointing experiences during placements, leading to ‘bad-mouthing between peers, may also be a reason. Finally, highly publicised workforce problems leading to shortages of higher-educated role models may have played a role.As in this study, the effect of the curriculum as a whole is measured, more research is needed on the effect of separate more powerful curriculum interventions, for example the theme-week in year 2. A well thought-out large-scale strategy that mostly appeals to young people aiming to promote positive perceptions of community care could be a valuable supplement.
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Background: A paradigm shift in health care from illness to wellbeing requires new assessment technologies and intervention strategies. Self-monitoring tools based on the Experience Sampling Method (ESM) might provide a solution. They enable patients to monitor both vulnerability and resilience in daily life. Although ESM solutions are extensively used in research, a translation from science into daily clinical practice is needed. Objective: To investigate the redesign process of an existing platform for ESM data collection for detailed functional analysis and disease management used by psychological assistants to the general practitioner (PAGPs) in family medicine. Methods: The experience-sampling platform was reconceptualized according to the design thinking framework in three phases. PAGPs were closely involved in co-creation sessions. In the ‘understand’ phase, knowledge about end-users’ characteristics and current eHealth use was collected (nominal group technique – 2 sessions with N = 15). In the ‘explore’ phase, the key needs concerning the platform content and functionalities were evaluated and prioritized (empathy mapping – 1 session with N = 5, moderated user testing – 1 session with N = 4). In the ‘materialize’ phase, the adjusted version of the platform was tested in daily clinical practice (4 months with N = 4). The whole process was extensively logged, analyzed using content analysis, and discussed with an interprofessional project group. Results: In the ‘understand’ phase, PAGPs emphasized the variability in symptoms reported by patients. Therefore, moment-to-moment assessment of mood and behavior in a daily life context could be valuable. In the ‘explore’ phase, (motivational) functionalities, technological performance and instructions turned out to be important user requirements and could be improved. In the ‘materialize’ phase, PAGPs encountered barriers to implement the experience-sampling platform. They were insufficiently facilitated by the regional primary care group and general practitioners. Conclusion: The redesign process in co-creation yielded meaningful insights into the needs, desires and daily routines in family medicine. Severe barriers were encountered related to the use and uptake of the experience-sampling platform in settings where health care professionals lack the time, knowledge and skills. Future research should focus on the applicability of this platform in family medicine and incorporate patient experiences.
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BackgroundThere is a shift from inpatient to home-based geriatric rehabilitation (HBGR), and potential benefits are demonstrated. Previously, a theoretical HBGR model, version 1.0, has been developed, outlining its essential components. However, clear guidance on the practical design and organisation of HBGR in everyday practice is still lacking. Therefore, determining the optimal design for this complex intervention is essential for its successful implementation in daily practice. The objective of this study is to redesign the theoretical HBGR trajectory and assess its feasibility, acceptability, and usability from both patient and professional perspectives.MethodsA redesign and feasibility study based on the MRC framework was conducted in a Dutch skilled nursing facility using the MRC framework in co-creation with eleven healthcare professionals and four patient representatives. The HBGR trajectory 1.0, comprises four building blocks (structure, process, environment, and outcomes) based on the Post-Acute-Care rehabilitation quality framework. Version 1.0 was redesigned during the development phase and subsequently pilot-tested in daily practice during the feasibility phase. Adjustments were made based on semi-structured interviews with ten patients and (interim) evaluations.ResultsThe HBGR trajectory 1.0 has been redesigned into version 2.0. It contains eleven elements: individualised goal setting, providing HBGR is the default unless otherwise indicated, an information letter, blended eHealth, mapping the patient’s living environment, stimulation support from informal caregivers, collaboration with community care nursing, rehabilitation coordination, central planning, therapy at home, and online multidisciplinary evaluation. Version 2.0 was enthusiastically endorsed by patients, patient representatives, and professionals, who found it feasible, acceptable, and usable in daily practice.ConclusionThe HBGR trajectory 1.0 was adapted, tested, and finally redesigned into version 2.0. The study revealed that involving patients, their representatives, and healthcare professionals was critical to garnering support and facilitating implementation. Key developments align with global trends and include the successful integration of eHealth with traditional treatment methods, enhanced collaboration and knowledge sharing among community care nurses, and increased involvement of informal caregivers in rehabilitation. This redesigned HBGR trajectory is ready for evaluation and implementation in follow-up effectiveness research.
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This project studies whether a redesigned baccalaureate nursing curriculum in a University of Applied Sciences in the Netherlands can stimulate positive interest for the field of community care. In many Western countries, healthcare is changing from institutional care delivery to caring for patients in their own homes. Problematic is that most nursing students orientate on a career in the hospital and they do not see community care as an attractive option, due to a limited and often mistaken view of the field. Their career choices lead to increasing shortages in the labour market, which in many Western countries is a societal problem urgently needing attention. Providing students with a curriculum with more elements of community nursing could help them build a more positive perception of the field, leading to more students choosing this area as a career.The curriculum-redesign was based on quantitative and qualitative research about first-year students’ perceptions, placement preferences and underlying assumptions on the field. First, a cross-sectional multicentre survey study (n = 1058) was conducted using the SCOPE (Scale on COmmunity care PErceptions) questionnaire. The findings confirm the hospital’s popularity, with community care being perceived as a ‘low-status-field’ with many elderly patients and few challenges. Students’ perceptions of community care appear to be at odds with things they consider important for their placement (i.e., opportunities for advancement and enjoyable relationships with patients).To better understand the factors underlying the perceptions, a focus group study with first-year students at the start of their programme (n = 16) was performed.This led to formulation of eight redesign themes, namely:(1) variety and diversity,(2) challenges,(3) improving people's health,(4) collaboration,(5) role models,(6) patient- or environment-based perceptions,(7) self-efficacy, and(8) immediate vicinity.First-year students have clear ideas about what they see as important in a placement, but their perceptions do not always appear to be realistic.To remedy these misperceptions, recommendations for curriculum redesign strategies were formulated. Curriculum designers can more prominently highlight the complexity of community nursing in the theory part of the curriculum. As many students strive for challenges, in-depth knowledge about community nursing can be presented about aspects that students lacking experience in the field are not aware of (e.g., working in an interprofessional network). In the courses, patient cases can be presented that do not fit the stereotypical views of community care commonly held. Also, as role models are influential, it is important that students collaborate with mentors in the field with an appropriate level of education, who can act as a source of inspiration, but who also create a structured and supporting learning environment. Finally, it is useful to organise meetings where political developments and labour market issues in healthcare are discussed. This can potentially increase awareness of these topics and contribute to well-informed career decisions. These strategies can potentially foster a more optimistic and realistic career outlook on the community care field.
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Abstract Background There is a shift from inpatient to home-based geriatric rehabilitation (HBGR), and potential benefits are demonstrated. Previously, a theoretical HBGR model, version 1.0, has been developed, outlining its essential components. However, clear guidance on the practical design and organisation of HBGR in everyday practice is still lacking. Therefore, determining the optimal design for this complex intervention is essential for its successful implementation in daily practice. The objective of this study is to redesign the theoretical HBGR trajectory and assess its feasibility, acceptability, and usability from both patient and professional perspectives. Methods A redesign and feasibility study based on the MRC framework was conducted in a Dutch skilled nursing facility using the MRC framework in co-creation with eleven healthcare professionals and four patient representatives. The HBGR trajectory 1.0, comprises four building blocks (structure, process, environment, and outcomes) based on the Post-Acute-Care rehabilitation quality framework. Version 1.0 was redesigned during the development phase and subsequently pilot-tested in daily practice during the feasibility phase. Adjustments were made based on semistructured interviews with ten patients and (interim) evaluations. Results The HBGR trajectory 1.0 has been redesigned into version 2.0. It contains eleven elements: individualised goal setting, providing HBGR is the default unless otherwise indicated, an information letter, blended eHealth, mapping the patient’s living environment, stimulation support from informal caregivers, collaboration with community care nursing, rehabilitation coordination, central planning, therapy at home, and online multidisciplinary evaluation. Version 2.0 was enthusiastically endorsed by patients, patient representatives, and professionals, who found it feasible, acceptable, and usable in daily practice. Conclusion The HBGR trajectory 1.0 was adapted, tested, and finally redesigned into version 2.0. The study revealed that involving patients, their representatives, and healthcare professionals was critical to garnering support and facilitating implementation. Key developments align with global trends and include the successful integration of eHealth with traditional treatment methods, enhanced collaboration and knowledge sharing among community care nurses, and increased involvement of informal caregivers in rehabilitation. This redesigned HBGR trajectory is ready for evaluation and implementation in follow-up effectiveness research.
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Community care is becoming increasingly important. In the Netherlands, the percentage of people over the age of 65 is expected to increase to 22% by 2025, leading to more elderly patients, often with long-term and complex health problems (multimorbidity). Because many of these patients continue to live at home until a very old age, nurses are increasingly working outside of institutions. The 17 Dutch Bachelor nursing programmes responded to this development with a new national education profile 'Bachelor Nursing 2020 (BN2020)’ with more elements of community care. However, despite the increase in extramural care, the Dutch labour market has a shortage of community nurses with higher professional education qualifications, partly because most nursing students focus on the general hospital setting as the environment for their future career. Whether this is based on a perception of community care that deters making this choice has never been systematically investigated. It is also unclear whether a more community-oriented curriculum will better equip students for working in community care. In response to these issues, the nursing programme at the Amsterdam University of Applied Sciences (AUAS) redesigned its curriculum to include more elements of community care. Three perspectives were chosen for the redesign: (1) the influence of lecturers as role models, (2) positive placement experiences, and (3) five new ‘community-based’ themes in education. These new themes are as follows: patient self-management, shared decision-making, collaboration with the patients’ social system, healthcare technology, and allocation of care. The redesign also includes a ‘paved way’ into community care in the form of a coherent and attractive programme for interested students.This thesis describes whether and how the curriculum-redesign within higher professional education in nursing can be effective in terms of (1) stimulating a positive perception of community care and (2) realising a form of community care in line with the new themes in BN2020. In other words, that students will base choices in their actions/nursing interventions on these new themes in the education profile.
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