Gaby Ronda

A Short Dutch Questionnaire to Measure Fruit and Vegetable Intake: Relative Validity Among Adults and Adolescents

A short food frequency questionnaire (FFQ) to assess fruit and vegetable (F&V) intake was validated. Forty-nine adults and fifty-one adolescents (12–18 years old) completed the FFQ at home, and subsequently kept diet records for seven successive days. Mean daily intake of F&V was overestimated by the FFQ as compared to the 7-day diet records. for adults, spearman correlations of at least 0.5 were observed between the two methods for intake of total fruit and intake of citrus fruit. For adolescents, acceptable spearman correlations (0.53–0.64) were observed between the two methods for total F&V intake, total fruit intake and consumption of fruit juice. Low correlations (0.22–0.35) between the FFQ and the diet records were found for vegetable intake. Relatively large percentages (22–37%) of respondents were incorrectly classified by the short FFQ as eating according to the Dutch recommendations for fruit and vegetable intake. Based on the results of the present study as well as an overview of the results of 34 earlier validation studies of F&V FFQs, it is concluded that the available FFQs have only limited capability to make valid assessment of F&V intake levels. In spite of the practical advantages of the short FFQ tested in the present study and the :similar validity scores as compared with other often used F&V FFQs, it needs further revision, especially to be used for valid measurement of vegetable intake as well as total F&V intake among adults.

Involving patients in cardiovascular risk management with nurse-led clinics: a cluster randomized controlled trial

Background: Preventive guidelines on cardiovascular risk management recommend lifestyle changes. Support for lifestyle changes may be a useful task for practice nurses, but the effect of such interventions in primary prevention is not clear. We examined the effect of involving patients in nurse-led cardiovascular risk management on lifestyle adherence and cardiovascular risk. Methods: We performed a cluster randomized controlled trial in 25 practices that included 615 patients. The intervention consisted of nurse-led cardiovascular risk management, including risk assessment, risk communication, a decision aid and adapted motivational interviewing. The control group received a minimal nurse-led intervention. The self-reported outcome measures at one year were smoking, alcohol use, diet and physical activity. Nurses assessed 10-year cardiovascular mortality risk after one year. Results: There were no significant differences between the intervention groups. The effect of the intervention on the consumption of vegetables and physical activity was small, and some differences were only significant for subgroups. The effects of the intervention on the intake of fat, fruit and alcohol and smoking were not significant. We found no effect between the groups for cardiovascular 10-year risk. Interpretation: Nurse-led risk communication, use of a decision aid and adapted motivational interviewing did not lead to relevant differences between the groups in terms of lifestyle changes or cardiovascular risk, despite significant within-group differences.

Use of diagnostic self-tests on body materials among Internet users in the Netherlands: prevalence and correlates of use

BackgroundA range of self-tests on body materials has become available to the general public, but the extent of their use has hardly been studied. This study examined how many people use diagnostic self-tests on body materials such as blood or urine, as well as the type of tests that are used, and factors associated with their use.MethodsCross-sectional survey. Participants were recruited from an existing Dutch Internet panel of 12,529 persons, and information was collected by means of a structured Internet-based questionnaire. Multiple logistic regression analyses were used to assess correlates of self-test use.ResultsResponse to the survey was 63%. Sixteen percent of the respondents said they had ever used at least one self-test, with a mean of 2.1 tests per self-tester. The most frequently reported self-tests were those for diabetes and cholesterol. Self-testers generally reported lower health status and had a higher BMI than non-testers. On the other hand, they were more likely to engage in health-related behaviour such as the use of dietary supplements and homeopathic medicine.ConclusionSelf-testing proved to be relatively prevalent among Dutch Internet users. We therefore think that it is essential to develop appropriate information for consumers, health care providers and policymakers, about the pros and cons of self-testing and specific self-tests. More test-specific research is needed.

To test or not to test: a cross-sectional survey of the psychosocial determinants of self-testing for cholesterol, glucose, and HIV.

BackgroundAlthough self-tests are increasingly available and widely used, it is not clear whether their use is beneficial to the users, and little is known concerning the determinants of self-test use. The aim of this study was to identify the determinants of self-test use for cholesterol, glucose, and HIV, and to examine whether these are similar across these tests. Self-testing was defined as using in-vitro tests on body materials, initiated by consumers with the aim of diagnosing a particular disorder, condition, or risk factor for disease.MethodsA cross-sectional Internet survey was conducted among 513 self-testers and 600 non-testers, assessing possible determinants of self-test use. The structured questionnaire was based on the Health Belief Model, Theory of Planned Behavior, and Protection Motivation Theory. Data were analyzed by means of logistic regression.ResultsThe results revealed that perceived benefits and self-efficacy were significantly associated with self-testing for all three conditions. Other psychosocial determinants, e.g. gender, cues to action, perceived barriers, subjective norm, and moral obligation, seemed to be more test-specific.ConclusionsPsychosocial determinants of self-testing are not identical for all tests and therefore information about self-testing needs to be tailored to a specific test. The general public should not only be informed about advantages of self-test use but also about the disadvantages. Designers of information about self-testing should address all aspects related to self-testing to stimulate informed decision making which, in turn, will result in more effective self-test use.

Motivation and experiences of self-testers regarding tests for cardiovascular risk factors.

Background  In recent years, self‐tests have become increasingly available to the general public, though their value is still being debated. Because these tests are available, consumers should have access to clear information about self‐testing. Examining experiences of self‐testers could contribute to the development of consumer information.

Professional's Attitudes Do Not Influence Screening and Brief Interventions Rates for Hazardous and Harmful Drinkers: Results from ODHIN Study

AIMS To determine the relation between existing levels of alcohol screening and brief intervention rates in five European jurisdictions and role security and therapeutic commitment by the participating primary healthcare professionals. METHODS Health care professionals consisting of, 409 GPs, 282 nurses and 55 other staff including psychologists, social workers and nurse aids from 120 primary health care centres participated in a cross-sectional 4-week survey. The participants registered all screening and brief intervention activities as part of their normal routine. The participants also completed the Shortened Alcohol and Alcohol Problems Perception Questionnaire (SAAPPQ), which measure role security and therapeutic commitment. RESULTS The only significant but small relationship was found between role security and screening rate in a multilevel logistic regression analysis adjusted for occupation of the provider, number of eligible patients and the random effects of jurisdictions and primary health care units (PHCU). No significant relationship was found between role security and brief intervention rate nor between therapeutic commitment and screening rate/brief intervention rate. The proportion of patients screened varied across jurisdictions between 2 and 10%. CONCLUSION The findings show that the studied factors (role security and therapeutic commitment) are not of great importance for alcohol screening and BI rates. Given the fact that screening and brief intervention implementation rate has not changed much in the last decade in spite of increased policy emphasis, training initiatives and more research being published, this raises a question about what else is needed to enhance implementation.

Quality and use of consumer information provided with home test kits: room for improvement

Diagnostic self‐tests (tests on body materials that are initiated by consumers with the aim of diagnosing a disorder or risk factor) are becoming increasingly available. Although the pros and cons of self‐testing are currently not clear, it is an existing phenomenon that is likely to gain further popularity.

The Dutch heart health community intervention “Hartslag Limburg”: evaluation design and baseline data

Hartslag Limburg, a cardiovascular diseases (CVD) prevention programme, integrates a community strategy and a high‐risk strategy. The present paper presents the evaluation design for, and baseline data from, the community intervention. The conceptual framework of the community intervention and its evaluation study were based on programme planning and evaluation models. Within this framework, community organization principles and methods and health education theories and methods were applied. Pre‐test/post‐test control group designs were used to study changes at the individual and the organizational level. The baseline results confirm the need to carry out a comprehensive CVD prevention community project, and the appropriateness of the conceptual model that is used for the development of interventions.

Diagnostische zelftests: gebruik en betrouwbaarheid

SamenvattingIckenroth MHP, Ronda G, Dinant GJ, Van der Weijden T. Diagnostische zelftests: gebruik en betrouwbaarheid. Huisarts Wet 2015;58(2):74-6. Tegenwoordig kunnen consumenten zonder tussenkomst van een arts tests op verschillende aandoeningen uitvoeren of aanvragen. Er zijn diagnostische zelftests op lichaamsmateriaal verkrijgbaar voor 24 verschillende ziekten en risicofactoren. Van de Nederlandse volwassenen die in 2011 een online vragenlijst invulden, zei 15% ooit een dergelijke zelftest te hebben gedaan. Zelftests passen in de trend naar meer verantwoordelijkheid voor de eigen gezondheid en betere toegang tot gezondheidsinformatie, maar ze hebben ook nadelen, met name vanwege de kans op een fout-positieve of fout-negatieve uitslag. De wetgever stelt geen strenge eisen en wetenschappelijke validatie heeft nog nauwelijks plaatsgevonden, zodat van de meeste tests onduidelijk is hoe betrouwbaar ze zijn.Zelftesters geven aan dat ze het prettig vinden dat ze zelf verantwoordelijkheid kunnen nemen voor hun gezondheid. Een negatieve uitslag geeft geruststelling, een afwijkend resultaat levert een valide reden om naar de dokter te gaan. Een geïnformeerde keuze voor al dan niet zelftesten kan worden gefaciliteerd met een (online) keuzehulp, maar het effect is niet groot, vooral als de uitleg ingewikkelder wordt. Het is belangrijk dat de kwaliteit van zelftests beter wordt gecontroleerd en dat consumenten toegang houden tot onafhankelijke informatie.AbstractIckenroth MHP, Ronda G, Dinant GJ, Van der Weijden T. Self-tests: use and reliability. Huisarts Wet 2015;58(2):74-6. Consumers can test themselves for a broad range of conditions, without the involvement of a doctor or other health professional. Self-tests using body materials are available for 24 different diseases and risk factors. In a 2011 Internet survey, 15% of adult Dutch respondents said that they had used a self-test. Self-testing is consistent with the trend to greater patient autonomy and accessibility to medical information, but has disadvantages, mainly because of the chance of false positive or false negative results. There are no strict legal requirements for these tests and few have been scientifically validated, so it is not known how accurate or reliable most of these tests are. Consumers like being able to take responsibility for their health – a negative result gives reassurance and a positive result provides a valid reason to visit the doctor. An online decision aid can help consumers make an informed choice about self-testing, although the effect is small, especially when information or explanations become complex. It is important that consumers have access to objective information on self-testing, and that there is better monitoring of the quality of available self-tests.

Educating Consumers in Self-Testing: The Development of an Online Decision Aid.

Context and objective: Diagnostic self-tests have become available worldwide. The most frequently performed self-tests in the Netherlands are tests to detect high cholesterol and diabetes. Since these tests can be performed without professional guidance, potential consumers need to receive independent information on the pros and cons of self-testing. The aim of this study was to develop a decision aid (DA) on cholesterol and glucose self-testing to encourage informed choice and to meet consumers’ needs and expectations. Methods: A DA was developed based on previous research and medical practice guidelines. The first prototype was assessed for content by means of semi-structured interviews with experts (n = 13), followed by usability tests with users (n = 10), leading to improvements to the DA in an iterative process. Results: Comments of the experts were grouped into four categories: general comments, textual remarks, technical errors and lay-out. User comments were mainly consistent with the experts’ opinions. Important considerations that were identified concerned the safety of providing this information without direct professional counselling, whether a ranking of available tests should be provided and how strong a warning about self-testing should be. Conclusion: Important considerations on how to inform consumers about self-testing were discussed, and led to important changes in the DA. Future research will have to assess the actual use of the DA once it is accessible to the general public, as well as its effects on knowledge and attitude towards self-testing.