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Article ; Online: "I am my own doctor": A qualitative study of the perspectives and decision-making process of Muslims with diabetes on Ramadan fasting.

Bouchareb, Siham / Chrifou, Rabab / Bourik, Zohra / Nijpels, Giel / Hassanein, Mohamed / Westerman, Marjan J / Elders, Petra J M

PloS one

2022 Volume 17, Issue 3, Page(s) e0263088

Abstract: Background: Many Muslims with diabetes choose to fast against medical advice during Ramadan, potentially increasing their risk of acute complications. Patients are often reluctant to disclose fasting to their health care providers, and their needs ... ...

Abstract	Background: Many Muslims with diabetes choose to fast against medical advice during Ramadan, potentially increasing their risk of acute complications. Patients are often reluctant to disclose fasting to their health care providers, and their needs regarding Ramadan are not met in consultations. For healthcare professionals to provide patient-centred care, it is important to gain more insight into patients' decision-making process. This study therefore aims to explore how Muslims with diabetes decide whether to fast during Ramadan. Methods: A qualitative study was conducted consisting of 15 focus groups with Muslims with diabetes within a constructivist paradigm. Convenience sampling was used. All focus groups were transcribed verbatim and analyzed using Braun and Clarke's reflexive thematic analysis. Results: Four themes were found to be important in the decision on whether to fast: (1) values and beliefs concerning Ramadan, (2) experiences and emotions concerning Ramadan, (3) the perception of illness, and (4) advice from health care professionals, imams and family. Many participants indicated fasting against medical advice and trusting their subjective assessments on whether they could fast. Moreover, three main stages in the decision-making process for eventually refraining from fasting were identified: (1) the stage where positive experiences with fasting dominate, (2) the stage where one encounters challenges but their determination to fast prevails and (3) the stage where one decides to refrain from fasting after experiencing too many physical difficulties with fasting. Conclusions: Muslims with diabetes experience autonomy in their decisions on Ramadan fasting. The decision to refrain from fasting often resulted from a difficult and dynamic decision-making process and was often made after participants reached their physical limits. These findings highlight the importance of not only shared decision-making to empower patients to make well-informed decisions on Ramadan fasting but also pre-Ramadan diabetes education to help people with diabetes have a safe Ramadan.
MeSH term(s)	Diabetes Mellitus ; Fasting ; Health Education ; Humans ; Islam ; Qualitative Research
Language	English
Publishing date	2022-03-04
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0263088
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Article ; Online: Facilitating factors and barriers in help-seeking behaviour in adolescents and young adults with depressive symptoms: A qualitative study.

Eigenhuis, Eline / Waumans, Ruth C / Muntingh, Anna D T / Westerman, Marjan J / van Meijel, Marlinde / Batelaan, Neeltje M / van Balkom, Anton J L M

PloS one

2021 Volume 16, Issue 3, Page(s) e0247516

Abstract: Objective: Despite the availability of mental health care, only a minority of depressed adolescents and young adults receive treatment. This study aimed to investigate facilitating factors and barriers in help-seeking behaviour of adolescents and young ... ...

Abstract	Objective: Despite the availability of mental health care, only a minority of depressed adolescents and young adults receive treatment. This study aimed to investigate facilitating factors and barriers in help-seeking behaviour of adolescents and young adults with depressive symptoms, using qualitative research methods. Methods: In-depth, semi-structured interviews with 32 participants with current or previous depressive symptoms aged 16 to 24 years using thematic content analysis. Findings: Our sample consisted mainly of adolescents who eventually found their way to professional help. Five main themes in help-seeking by adolescents and young adults were identified: (I) Individual functioning and well-being, (II) Health literacy, (III) Attitudinal aspects, (IV) Surroundings, and (V) Accessibility. Prompts to seek treatment were disease burden and poor academic performance. Health illiteracy negatively influenced treatment-seeking behaviour. Attitudinal aspects either hampered (shame, wanting to handle the problem oneself, negative attitudes towards treatment) or facilitated (positive attitudes towards treatment) help-seeking. Furthermore, adolescents' surroundings (school, family, and peers) appeared to play a critical role in the recognition of depressive symptoms and encouragement to seek help. Barriers regarding accessibility of mental health care were found, whereas direct and easy access to treatment greatly improved mental health care use. Conclusion: Facilitating factors can play a critical role in the help-seeking process of depressed adolescents and young adults, and may guide efforts to increase access to mental health care of this vulnerable age group. In particular, recognition and encouragement from school personnel and peers and easy access to care providers positively influenced help-seeking in our sample. Health illiteracy and attitudinal aspects appeared to be important barriers to seeking treatment and public/school campaigns aimed at reducing health illiteracy and stigma might be necessary to improve treatment-seeking and health care utilization in this age group.
MeSH term(s)	Adolescent ; Adolescent Health ; Depression/psychology ; Female ; Health Literacy ; Health Services Accessibility ; Help-Seeking Behavior ; Humans ; Male ; Mental Health ; Mental Health Services ; Patient Acceptance of Health Care/psychology ; Qualitative Research ; Shame ; Young Adult
Language	English
Publishing date	2021-03-08
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	1932-6203
ISSN (online)	1932-6203
DOI	10.1371/journal.pone.0247516
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Article ; Online: What Do Secondary Schools Need to Create Healthier Canteens? The Development of an Implementation Plan.

Evenhuis, Irma J / Vyth, Ellis L / van Nassau, Femke / Veldhuis, Lydian / Westerman, Marjan J / Seidell, Jacob C / Renders, Carry M

Frontiers in public health

2021 Volume 9, Page(s) 683556

Abstract: Introduction: ...

Abstract	Introduction:
MeSH term(s)	Diet, Healthy ; Food Services ; Humans ; Netherlands ; Nutrition Policy ; Schools
Language	English
Publishing date	2021-06-23
Publishing country	Switzerland
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2711781-9
ISSN	2296-2565 ; 2296-2565
ISSN (online)	2296-2565
ISSN	2296-2565
DOI	10.3389/fpubh.2021.683556
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Article ; Online: A Mobile Patient-Reported Outcome Measure App With Talking Touchscreen: Usability Assessment.

Welbie, Marlies / Wittink, Harriet / Westerman, Marjan J / Topper, Ilse / Snoei, Josca / Devillé, Walter L J M

JMIR formative research

2019 Volume 3, Issue 3, Page(s) e11617

Abstract: Background: In the past years, a mobile health (mHealth) app called the Dutch Talking Touch Screen Questionnaire (DTTSQ) was developed in The Netherlands. The aim of development was to enable Dutch physical therapy patients to autonomously complete a ... ...

Abstract	Background: In the past years, a mobile health (mHealth) app called the Dutch Talking Touch Screen Questionnaire (DTTSQ) was developed in The Netherlands. The aim of development was to enable Dutch physical therapy patients to autonomously complete a health-related questionnaire regardless of their level of literacy and digital skills. Objective: The aim of this study was to evaluate the usability (defined as the effectiveness, efficiency, and satisfaction) of the prototype of the DTTSQ for Dutch physical therapy patients with diverse levels of experience in using mobile technology. Methods: The qualitative Three-Step Test-Interview method, including both think-aloud and retrospective probing techniques, was used to gain insight into the usability of the DTTSQ. A total of 24 physical therapy patients were included. The interview data were analyzed using a thematic content analysis approach aimed at analyzing the accuracy and completeness with which participants completed the questionnaire (effectiveness), the time it took the participants to complete the questionnaire (efficiency), and the extent to which the participants were satisfied with the ease of use of the questionnaire (satisfaction). The problems encountered by the participants in this study were given a severity rating that was used to provide a rough estimate of the need for additional usability efforts. Results: All participants within this study were very satisfied with the ease of use of the DTTSQ. Overall, 9 participants stated that the usability of the app exceeded their expectations. The group of 4 average-/high-experienced participants encountered only 1 problem in total, whereas the 11 little-experienced participants encountered an average of 2 problems per person and the 9 inexperienced participants an average of 3 problems per person. A total of 13 different kind of problems were found during this study. Of these problems, 4 need to be addressed before the DTTSQ will be released because they have the potential to negatively influence future usage of the tool. The other 9 problems were less likely to influence future usage of the tool substantially. Conclusions: The usability of the DTTSQ needs to be improved before it can be released. No problems were found with satisfaction or efficiency during the usability test. The effectiveness needs to be improved by (1) making it easier to navigate through screens without the possibility of accidentally skipping one, (2) enabling the possibility to insert an answer by tapping on the text underneath a photograph instead of just touching the photograph itself, and (3) making it easier to correct wrong answers. This study shows the importance of including less skilled participants in a usability study when striving for inclusive design and the importance of measuring not just satisfaction but also efficiency and effectiveness during such studies.
Language	English
Publishing date	2019-09-27
Publishing country	Canada
Document type	Journal Article
ISSN	2561-326X
ISSN (online)	2561-326X
DOI	10.2196/11617
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Article ; Online: Barriers to and Facilitators of Participation in Weight Loss Intervention for Patients with Suboptimal Weight Loss after Bariatric Surgery: A Qualitative Study among Patients, Physicians, and Therapists.

Tettero, Onno M / Westerman, Marjan J / van Stralen, Maartje M / van den Beuken, Meike / Monpellier, Valerie M / Janssen, Ignace M C / Steenhuis, Ingrid H M

Obesity facts

2022 Volume 15, Issue 5, Page(s) 674–684

Abstract: Introduction: Not all patients with suboptimal weight loss after bariatric surgery are willing to participate in postoperative behavioral intervention to improve their weight loss. The objective of this study was to explore barriers to and facilitators ... ...

Abstract	Introduction: Not all patients with suboptimal weight loss after bariatric surgery are willing to participate in postoperative behavioral intervention to improve their weight loss. The objective of this study was to explore barriers to and facilitators of participation in postoperative behavioral intervention. Methods: Thirty semi-structured interviews were conducted with patients (18), physicians (6), and therapists (6) (i.e., psychologists, dieticians, or physiotherapists). A thematic analysis approach was used. Results: Emotional responses caused by confrontation with suboptimal weight loss hampered patients' deliberation about participation; insufficient exploration of their need for help limited patients' ability to make informed decisions; patients were receptive to their physician's advice when their physician respected their autonomy; using visual weight loss graphs helped to explain suboptimal weight loss to patients; and financial costs and time constraints obstructed participation. Conclusions: To improve adequate intervention participation, healthcare providers should focus on emotion regulation, support patients in exploring their own need for help, and respect patients' autonomy.
MeSH term(s)	Humans ; Weight Loss/physiology ; Bariatric Surgery/psychology ; Qualitative Research ; Physicians ; Postoperative Period
Language	English
Publishing date	2022-08-02
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2417831-7
ISSN	1662-4033 ; 1662-4025
ISSN (online)	1662-4033
ISSN	1662-4025
DOI	10.1159/000526259
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Article ; Online: Patient experiences and views on pharmaceutical care during adjuvant endocrine therapy for breast cancer: A qualitative study.

En-Nasery-de Heer, Selma / Tromp, Vashti N M F / Westerman, Marjan J / Konings, Inge / Beckeringh, Jan Jacob / Boons, Christel L M / Timmers, Lonneke / Hugtenburg, Jacqueline G

European journal of cancer care

2022 Volume 31, Issue 6, Page(s) e13749

Abstract: Objective: The use of adjuvant endocrine therapy (AET) after primary treatment of hormone receptor-positive breast cancer reduces the risk of recurrence and mortality. However, non-adherence is still common. Limited consideration has been given to how ... ...

Abstract	Objective: The use of adjuvant endocrine therapy (AET) after primary treatment of hormone receptor-positive breast cancer reduces the risk of recurrence and mortality. However, non-adherence is still common. Limited consideration has been given to how users deal with AET and the role of pharmaceutical care. Therefore, this study aims to obtain insight into the needs and wishes of women using AET regarding pharmaceutical care and eHealth. Methods: This is a qualitative explorative study comprising semi-structured interviews (n = 16) and a focus group (n = 5) among women who use or used AET after primary early-stage breast cancer (EBC) treatment using a thematic analysis approach. Results: Three themes emerged from the interviews and focus group: (1) experiences with AET use, (2) experiences with provided information and (3) needs and wishes regarding pharmaceutical care. Most women were highly motivated to use AET and indicated to have received useful information on AET. However, many expressed a strong need for more elaborate tailored and timely provided information on AET. They acknowledged the accessibility of pharmacists but reported that currently, pharmacists are hardly involved in AET care. Several women considered eHealth useful to obtain counselling and reliable information. Conclusion: Women need more comprehensive information and follow-up in primary setting after initial cancer treatments. A more elaborate role for the pharmacy and eHealth/mHealth, especially with regard to counselling on side effects and side effect management, could potentially improve pharmaceutical care.
MeSH term(s)	Female ; Humans ; Breast Neoplasms/drug therapy ; Chemotherapy, Adjuvant ; beta-Aminoethyl Isothiourea/therapeutic use ; Medication Adherence ; Pharmaceutical Services ; Patient Outcome Assessment ; Antineoplastic Agents, Hormonal/therapeutic use
Chemical Substances	beta-Aminoethyl Isothiourea (151-16-6) ; Antineoplastic Agents, Hormonal
Language	English
Publishing date	2022-10-27
Publishing country	England
Document type	Journal Article
ZDB-ID	1303114-4
ISSN	1365-2354 ; 0961-5423 ; 1360-5801
ISSN (online)	1365-2354
ISSN	0961-5423 ; 1360-5801
DOI	10.1111/ecc.13749
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Article ; Online: Using Plain Language and Adding Communication Technology to an Existing Health-Related Questionnaire to Help Generate Accurate Information: Qualitative Study.

Welbie, Marlies / Wittink, Harriet / Westerman, Marjan J / Topper, Ilse / Snoei, Josca / Devillé, Walter Ljm

Journal of medical Internet research

2018 Volume 20, Issue 4, Page(s) e140

Abstract: Background: Low-educated patients are disadvantaged in using questionnaires within the health care setting because most health-related questionnaires do not take the educational background of patients into account. The Dutch Talking Touch Screen ... ...

Abstract	Background: Low-educated patients are disadvantaged in using questionnaires within the health care setting because most health-related questionnaires do not take the educational background of patients into account. The Dutch Talking Touch Screen Questionnaire (DTTSQ) was developed in an attempt to meet the needs of low-educated patients by using plain language and adding communication technology to an existing paper-based questionnaire. For physical therapists to use the DTTSQ as part of their intake procedure, it needs to generate accurate information from all of their patients, independent of educational level. Objective: The aim of this study was to get a first impression of the information that is generated by the DTTSQ. To achieve this goal, response processes of physical therapy patients with diverse levels of education were analyzed. Methods: The qualitative Three-Step Test-Interview method was used to collect observational data on actual response behavior of 24 physical therapy patients with diverse levels of education. The interviews included both think-aloud and retrospective probing techniques. Results: Of the 24 respondents, 20 encountered one or more problems during their response process. The use of plain language and information and communication technology (ICT) appeared to have a positive effect on the comprehensibility of the DTTSQ. However, it also had some negative effects on the interpretation, retrieval, judgment, and response selection within the response processes of the participants in this study. No educational group in this research population stood out from the rest in the kind or number of problems that arose. All respondents recognized themselves in the outcomes of the questionnaire. Conclusions: The use of plain language and ICT within the DTTSQ had both positive and negative effects on the response processes of its target population. The results of this study emphasize the importance of earlier recommendations to accompany any adaption of any questionnaire to a new mode of delivery by demonstrating the difference and equivalence between the two different modes and to scientifically evaluate the applicability of the newly developed mode of the questionnaire in its intended setting. This is especially important in a digital era in which the use of plain language within health care is increasingly being advocated.
MeSH term(s)	Adolescent ; Adult ; Aged ; Communication ; Female ; Humans ; Information Technology/standards ; Language ; Male ; Middle Aged ; Qualitative Research ; Retrospective Studies ; Surveys and Questionnaires ; Young Adult
Language	English
Publishing date	2018-04-23
Publishing country	Canada
Document type	Journal Article
ZDB-ID	2028830-X
ISSN	1438-8871 ; 1439-4456
ISSN (online)	1438-8871
ISSN	1439-4456
DOI	10.2196/jmir.7940
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Article ; Online: Experiences with the implementation of Individual Placement and Support for people with severe mental illness: a qualitative study among stakeholders.

Vukadin, Miljana / Schaafsma, Frederieke G / Westerman, Marjan J / Michon, Harry W C / Anema, Johannes R

BMC psychiatry

2018 Volume 18, Issue 1, Page(s) 145

Abstract: Background: Individual Placement and Support (IPS) is an evidence-based approach to help people with severe mental illness achieve competitive employment. This article provides insight into an organizational and a financial implementation strategy for ... ...

Abstract	Background: Individual Placement and Support (IPS) is an evidence-based approach to help people with severe mental illness achieve competitive employment. This article provides insight into an organizational and a financial implementation strategy for IPS in the Netherlands by exploring the perceived facilitators and barriers among participating stakeholders. The goal of this multifaceted strategy was to improve IPS implementation by improving the collaboration between all organizations involved, and realising secured IPS funding with a 'pay for performance' element. Methods: A qualitative, explorative study among practitioners (n = 8) and decision makers (n = 7) in mental health care and vocational rehabilitation was performed using semi-structured interviews to collect rich information about the possible facilitators and barriers with regard to the organizational and financial implementation strategy for IPS. Results: Important perceived facilitators were the key principles of the IPS model, regular meetings of stakeholders in mental health care and vocational rehabilitation, stakeholders' experienced ownership of IPS and collaboration, the mandate and influence of the decision makers involved and secured IPS funding. Important perceived barriers included the experienced rigidity of the IPS model fidelity scale and lack of independent fidelity reviewers, the temporary and fragmented character of the secured funding, lack of communication between decision makers and practitioners and negative attitudes and beliefs among mental health clinicians. Changes in legislation were experienced as a facilitator as well as a barrier. Conclusions: The results of this study suggest that the collaboration and IPS funding were experienced as improved by applying an organizational and a financial implementation strategy. However, considerable effort is still necessary to overcome the remaining barriers identified and to make the implementation of IPS a success in practice.
MeSH term(s)	Communication Barriers ; Employment, Supported/organization & administration ; Humans ; Interdisciplinary Communication ; Mental Disorders/psychology ; Mental Disorders/rehabilitation ; Motivation ; Netherlands ; Qualitative Research ; Quality Improvement ; Rehabilitation, Vocational/economics ; Rehabilitation, Vocational/methods ; Reimbursement, Incentive ; Stakeholder Participation
Language	English
Publishing date	2018-05-24
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	1471-244X
ISSN (online)	1471-244X
DOI	10.1186/s12888-018-1729-4
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Article ; Online: Experiences of pregnant women with a third trimester routine ultrasound - a qualitative study.

Westerneng, Myrte / Diepeveen, Mariëlle / Witteveen, Anke B / Westerman, Marjan J / van der Horst, Henriette E / van Baar, Anneloes L / de Jonge, Ank

BMC pregnancy and childbirth

2019 Volume 19, Issue 1, Page(s) 319

Abstract: Background: Studies showed that pregnant women generally value routine ultrasounds in the first two trimesters because these provide reassurance and a chance to see their unborn baby. This, in turn, might help to decrease maternal anxiety levels and ... ...

Abstract	Background: Studies showed that pregnant women generally value routine ultrasounds in the first two trimesters because these provide reassurance and a chance to see their unborn baby. This, in turn, might help to decrease maternal anxiety levels and increase the bond with the baby. However, it is unclear whether pregnant women hold the same positive views about a third trimester routine ultrasound, which is increasingly being used in the Netherlands as a screening tool to monitor fetal growth. The aim of this study was to explore pregnant women's experiences with a third trimester routine ultrasound. Methods: We held semi-structured interviews with fifteen low-risk pregnant women who received a third trimester routine ultrasound in the context of the Dutch IUGR RIsk Selection (IRIS) study. The IRIS study is a nationwide cluster randomized controlled trial carried out among more than 13,000 women to examine the effectiveness of a third trimester routine ultrasound to monitor fetal growth. For the interviews, participants were purposively selected based on parity, age, ethnicity, and educational level. We performed thematic content analysis using MAXQDA. Results: Most pregnant women appreciated a third trimester routine ultrasound because it provided them confirmation that their baby was fine and an extra opportunity to see their baby. At the same time they expressed that they already felt confident about the health of their baby, and did not feel that their bond with their baby had increased after the third trimester ultrasound. Women also reported that they were getting used to routine ultrasounds throughout their pregnancy, and that this increased their need for another one. Conclusions: Pregnant women seem to appreciate a third trimester routine ultrasound, but it does not seem to reduce anxiety or to improve bonding with their baby. Women's appreciation of a third trimester routine ultrasound might arise from getting used to routine ultrasounds throughout pregnancy. We recommend to examine the psychological impact of third trimester routine ultrasounds in future studies. Results should be taken into consideration when balancing the gains, which are as yet not clear, of introducing a third trimester routine ultrasound against unwanted side effects and costs.
MeSH term(s)	Adult ; Anxiety/psychology ; Attitude to Health ; Female ; Humans ; Maternal-Fetal Relations/psychology ; Netherlands ; Object Attachment ; Pregnancy ; Pregnancy Trimester, Third/psychology ; Qualitative Research ; Ultrasonography, Prenatal/psychology
Language	English
Publishing date	2019-09-02
Publishing country	England
Document type	Journal Article
ISSN	1471-2393
ISSN (online)	1471-2393
DOI	10.1186/s12884-019-2470-9
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Article ; Online: Combined Protein-Rich Diet With Resistance Exercise Intervention to Counteract Sarcopenia: A Qualitative Study on Drivers and Barriers of Compliance.

Herrema, Annemarthe L / Westerman, Marjan J / van Dongen, Ellen J I / Kudla, Urszula / Veltkamp, Martijn

Journal of aging and physical activity

2017 Volume 26, Issue 1, Page(s) 106–113

Abstract: Interventions combining protein-rich diets with resistance exercises seem a promising avenue in helping to prevent sarcopenia. However, compliance to health interventions is generally low. The aim of the present study was to provide qualitative insights ... ...

Abstract	Interventions combining protein-rich diets with resistance exercises seem a promising avenue in helping to prevent sarcopenia. However, compliance to health interventions is generally low. The aim of the present study was to provide qualitative insights into the drivers and barriers that older adults experience when trying to comply with a combined dietary and physical exercise intervention. Semi-structured interviews with 18 older adults participating in such an intervention were conducted and analyzed using thematic content analysis. Most frequently reported drivers to comply with the diet were a fit with existing habits, knowledge on the health benefits, and product properties (taste, convenience, package). Drivers for physical exercises were existing habits, social contacts, customized support, and experienced physical improvement. It is suggested that customized support is important to successfully implement exercise-protein interventions amongst older adults, especially regarding participants' habits, product preferences, and social environment.
MeSH term(s)	Aged ; Aged, 80 and over ; Combined Modality Therapy ; Dietary Proteins/administration & dosage ; Feeding Behavior/psychology ; Female ; Health Knowledge, Attitudes, Practice ; Humans ; Male ; Patient Compliance/psychology ; Personal Satisfaction ; Resistance Training ; Sarcopenia/therapy ; Social Support
Chemical Substances	Dietary Proteins
Language	English
Publishing date	2017-12-09
Publishing country	United States
Document type	Clinical Trial ; Journal Article
ISSN	1543-267X
ISSN (online)	1543-267X
DOI	10.1123/japa.2017-0126
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