Ever since the General Surgeons report on the harmful effects of tobacco in 1964, tobacco control has had major successes and many countries now aim to reach a smoke-free generation. Despite these successes, smoking related mortality remains an important contributor to socio-economic differences, and the peak of smoking attributable mortality has not been reached yet. To further improve tobacco control and contribute to reaching a smoke-free generation, this thesis discusses two strategies. In pat 1 we investigate extending smoke-free policies beyond smoke-free public places and workplaces. Public support is tremendous, not only in the Netherlands but worldwide and not only among smokers, but among non-smokers as well. Especially places with children are low-hanging fruit to implement smoke-free zones. In part 2 we investigated strategies to improve smoking cessation programs through personalization. External circumstances such as poverty related stress might influence (health) behavior, and a stronger focus to alleviate money-related issues may benefit health interventions. Health behavior is also influenced by personal characteristics, which was the focus in the PERSIST trial. Using personalized incentives we tried to improve sustained smoking cessation among health care employees. Combining a personalized advice with the option to deviate from it seems to be an effective strategy, however recruitment was challenging and future research might benefit from more collaboration between researchers and potential participants. Combining the knowledge gained from part 1 and 2, we concluded that by simultaneously targeting the system and aiding the individual, a smoke-free generation should be in reach.
Injuries are a significant global health concern, contributing to 9% of annual deaths worldwide. Despite advancements in trauma care, survivors grapple with both short and long-term challenges, including physical and mental health issues. This thesis investigates patient outcomes (part I) and costs (part II) post-injury. Part I focuses on assessing outcomes in injury patients and traumatic brain injury patients, highlighting the prevalence of physical and mental health issues and their impact on quality of life, healthcare usage, and return to work. Part II delves into the economic burdens of injuries, revealing variations in healthcare and productivity costs influenced by factors such as injury severity, age, and gender. The research underscores the importance of long-term care planning to mitigate costs and support comprehensive recovery, emphasizing the need for tailored interventions addressing both physical and mental well-being.
The main aim of this thesis is to study individual and family-related factors that are relevant for indicators of child health (i.e. dental caries, weight status), health-related quality of life (HRQoL), and lifestyle behaviours. The following conclusions can be drawn from the studies presented in this thesis. Unhealthy lifestyle behaviours (i.e. skipping breakfast, more social media platforms used, and spending more time on social media) have a negative impact on children’s health outcomes and HRQoL. Multiple individual and family-related factors (i.e. sex, ethnic background, socioeconomic status of a family, and family structure) may affect children’s HRQoL at younger age. Additionally, multiple family-related factors (i.e. family structure and socioeconomic status of a family) independent associated with children’s social media use at younger age. The findings in our study also support the assumption that interventions with multiple levels of influence (e.g. public policy, individual, interpersonal, or organizational) may contribute to policies to address oral health inequalities. The findings presented can support the development of evidence-based preventive interventions, practice guidelines and policies to promote child health and well-being.
In her PhD thesis, Doris van der Smissen describes the development, evaluation and implementation of the web-based advance care planning program ‘Verken uw wensen voor zorg en behandeling’ (English translation: ‘Explore your preferences for treatment and care’). The program was developed and implemented together with patients, relatives and patient organizations.
Advance care planning (ACP) supports the conversation about future treatment and care so that care can be provided in line with people’s preferences. Web-based programs can support people in the first steps of ACP, such as preparing discussions about treatment and care with their relatives and healthcare professionals.
The web-based ACP program supports people in thinking about, discussing and recording of treatment and care preferences. The program contains information, videos and questions. Users can print their answers to the questions. Interviews and the before-and-after evaluation study showed that people found the program user-friendly, understandable and useful. The program supported people with chronic disease in reflecting on preferences for treatment and care and helped them to feel more ready for ACP.
Link to the web-based ACP program: https://www.thuisarts.nl/keuzehulp/verken-uw-wensen-voor-zorg-en-behandeling
Link to PhD thesis: https://www.publicatie-online.nl/publicaties/doris-van-der-smissen, password: 169086
If you are interested to attend the PhD defense, please send an email to promotie.dorisvandersmissen@gmail.com
Mental disorders pose an extremely high burden to society, both in terms of their direct effects on health but also societal welfare losses. This burden is distributed unequally and strongly impacts groups of low socioeconomic status (SES). Also unequal is the access and utilization of mental health services, which should be concentrated among those who most need treatment. This thesis aimed to produce evidence to guide mental health policy in reducing inequalities in mental health care and outcomes.
The objective was achieved by addressing two different knowledge gaps. The first research question, descriptive by nature, aimed to complement the existing knowledge about inequalities in the mental health field, which covers disparities in mental health status and access to mental health care but extremely limited in describing inequalities during mental health treatment and patient outcomes. The second research question focused on identifying mental health related interventions, programs and policies that impact the existing inequalities. To address this question, I have relied on quasi-experimental methods to causally evaluate interventions linked to key policy levers in granting access to mental health support: coverage, eligibility, and availability. I have conducted the evaluations applying an equity lens by measuring differential effects by socioeconomic status or focusing on interventions that impact vulnerable groups.
If you are not able to attend the defense in person, you can access the livestream via: https://www.youtube.com/watch?v=NeVyFldZExo
Healthy ageing is a global priority as people worldwide are living longer. With longer lifespans, older adults are at increased risk of chronic conditions. Service provision based on disease-specific guidelines can be inappropriate for people with multiple health conditions; care can become duplicative and inefficient due to poor coordination. Person-centred integrated care is seen as a promising approach to delivering care that is proactive, coordinated and centred around people’s needs. In addition, digital health technology has the potential to involve patients better in their care process and could, therefore, support person-centred integrated care.
The research described in this thesis provides insights into the determinants of health outcomes that matter to older adults (Part 1), stakeholder perspectives regarding person-centred integrated care supported by digital health technology (Part 2), and how to design and evaluate appropriate person-centred integrated care (Part 3).
A diverse healthcare workforce is important to increase and equalize access to high quality healthcare for the whole population. There are concerns, however, that diversity amongst health professionals is already harmed in an early stage: during the selection of prospective students. Therefore, this dissertation provides insights into how selection tools, preparatory activities and applicant acceptance can play a role in shaping student diversity in health professions education. In addition, this dissertation offers recommendations to improve the design of selection procedures in order to ensure or even enhance student diversity.
Prof. dr. Andrea Woltman will give her Inaugural lecture entitled “Fostering Flourishing” (Floreren (stimu)leren) in honor of her appointment as Professor Innovation of Health Professions Education on Friday the 27th of September 2024 at 4:00 pm. The lecture will be given in Dutch.
There will be a reception afterwards.
The inaugural lecture can also be viewed via a livestream : https://eur.cloud.panopto.eu/Panopto/Pages/Viewer.aspx?id=f0d05f94-2dd7-4719-8218-b1a40087ac42