Marieke Spreeuwenberg

Objectives: To evaluate MyRA, a web-based self-monitoring application for RA, on patient empowerment, usability and perceived usefulness. Methods: MyRA was co-developed with patients and used at their own discretion during a 4-month prospective study with patient questionnaires at T0 (baseline), T1 (2 months) and T2 (4 months). The primary outcome was patient empowerment (Patient Activation Measure-13; 0–100). Secondary outcomes included frequency of use, usability (System Usability Scale; 0–100) and perceived usefulness (study specific questions). Descriptive statistics and repeated measures ANOVA were applied with post-hoc subgroup analysis based on frequency of use [subgroup A (infrequent users): 1–7 times; subgroup B (frequent users): ≥8 times]. Results: Among 548 registered patients [90.1% female, mean age 51.8 (s.d. 11.9) years, mean disease duration 10.2 (s.d. 10.1) years], 54 patients never used the application (9.9%), 405 patients were infrequent users (73.9%) and 89 patients were frequent users (16.2%). In the total user group, no statistical difference was found for patient empowerment after 4 months (T0: 55.8, T2: 54.4, P = 0.09). However, subgroup B showed a statistically significant, though not clinically meaningful, decrease (T0: 56.2, T2 53.6, P = 0.04). Subgroup B reported higher usability scores compared with subgroup A (75.9 vs 62.9, P < 0.001) and was more outspoken in perceived usefulness. Conclusion: Despite major patient involvement throughout development, self-monitoring via MyRA did not increase patient empowerment. The study had a considerable decline in application engagement over time, with only a small subgroup of frequent users. These users showed more positive attitudes regarding usability and perceived usefulness of MyRA.

Background: Atherosclerotic cardiovascular disease poses a heavy burden on the population’s health and health care costs. Identifying apparently healthy individuals at risk of developing cardiovascular diseases using clinical prediction models raises awareness, facilitates shared decision-making, and supports tailored management of disease prevention. In the CARRIER project, a personalized cardiovascular risk management (CVRM) eCoach approach is cocreated, in which identified individuals receive education, guidance, and monitoring to prevent atherosclerotic cardiovascular disease through existing interventions. In this approach, an artificial intelligence–driven clinical prediction model calculates the 10-year risk for atherosclerotic cardiovascular disease, which supports informed decision-making. Objective: This study aims to assess the effectiveness of our CVRM eCoach approach through a 10-year risk calculation of atherosclerotic cardiovascular disease, including risk factors contributing to this risk. Methods: This pretest-posttest interventional study provides the CVRM eCoach approach for 6 months to 100 apparently healthy individuals eligible for CVRM. The CVRM eCoach approach is a multicomponent eHealth solution, including a clinical prediction under intervention model that not only calculates the 10-year risk of cardiovascular disease through conventional risk factors (smoking, blood pressure, and lipid profile) and individual characteristics (age, gender, socioeconomic status, physical activity, and diet) but also calculates how the risk changes after hypothetical lifestyle or medical interventions. The CVRM eCoach approach includes features that encourage behavior change. Most of these features include goal setting, decision cards to help decide on an intervention, intervention monitoring, remote communication, and education, all accessible from one dashboard. A practice nurse or physician consults the individuals after risk calculation with the clinical prediction model and uses behavior change features, such as the decision cards, to support shared decision-making. Data are primarily collected via the eCoach, after which the 10-year risk for atherosclerotic cardiovascular disease and its components are analyzed using paired-sample analyses. Results: Recruitment began in March 2024 and will continue until 100 participants have been recruited, which is expected in 2025. Conclusions: We anticipate that our CVRM eCoach approach will be valuable in the primary prevention setting. During the crucial initial first months of habit formation, factors such as education, regular check-ups via the eCoach, and clear risk communication could support individuals in sustaining their medical or lifestyle interventions. We hypothesize that there will be a slight to moderate reduction in the 10-year risk of atherosclerotic cardiovascular disease, which over time will lead to significant health improvements on a larger scale. Trial Registration: CCMO NL84584.096.23; https://onderzoekmetmensen.nl/nl/trial/56578

Background: The health care sector faces increasing pressure, with demand outpacing supply and multiple challenges in accessibility, affordability, and quality. The current organization of health care systems is unsustainable—exacerbated by labor shortages and escalating expenditures in Europe, particularly the Netherlands. To address these issues, hospitals are increasingly adopting digital transformation strategies. This digital transformation involves the systematic implementation of digital technologies and processes. To achieve high-quality hybrid care, hospitals must integrate digital health care seamlessly into existing workflows. However, there is no definitive strategy for implementing these transformations. Objective: This study examines how Dutch hospitals organize their digital transformation, the strategies they employ, and the best practices they follow, to provide evidence-based recommendations for hospitals embarking on similar initiatives. Methods: A qualitative multicase study was conducted using purposive sampling. A total of 11 Dutch hospitals were invited, and 8 participated. Professionals—project or program managers of digital care, or advisors in policy, management, strategy, or related positions—from these hospitals took part in semistructured interviews. Topics included digital transformation strategies, organizational structures, barriers and facilitators, and lessons learned. All interviews were recorded, transcribed verbatim, and analyzed using directed content analysis. Results: Although hospitals organize their digital transformation in different ways and with different teams or departments, they encounter similar facilitators and barriers. Inspired by the Consolidated Framework for Implementation Research, the ExpandNet Scaling Up framework, and the Hybrid Health Care Quality Assessment, these factors were grouped into the following categories: the structure of the digital program, cultural factors within the organization, financial factors (internal or external), political factors (internal or external), patient needs, resources and skills, and technical factors. Conclusions: Despite variations in implementation, hospitals share key challenges and enablers in digital transformation. Common factors—such as organizational culture, financial resources, and technical infrastructure—may serve as foundational elements for effective digital transformation in hospital care.

Objective: Despite promising outcomes from pilot initiatives, the transition to widespread adoption and upscaling of eHealth solutions in the hospital context remains challenging. This study aims to explore the barriers and facilitators influencing the implementation of eCoaches from the perspective of professionals. Methods: A qualitative research design was employed, involving individual semi-structured interviews with management and healthcare professionals ( n = 10) who were involved with an eCoach either for heart failure (HF) or inflammatory bowel disease (IBD). Both eCoaches supported remote monitoring, advisory, educational, and interactive care activities. Interview topics were guided by the Consolidated Framework for Implementation Research (CFIR), including the original five domains and the added domain Patients′ needs and Resources. Data were analyzed thematically. Results: Barriers and facilitators were identified across all CFIR domains: eCoach design and licensing costs (Intervention Characteristics); financial compensation (Outer Setting); integration into care pathways, Information and Communication Technology (ICT) infrastructure, team dynamics, and task reallocation (Inner Setting); intrinsic motivation, beliefs, and competencies of professionals (Characteristics of Individuals); patient resources and digital literacy (Patients’ Needs and Resources); and availability of evidence and management information (Process of Implementation). Conclusion: This study underscores the complex nature of implementing eCoaches within the hospital setting, where barriers and facilitators span multiple interrelated domains. To overcome “pilotitis” and achieve the sustainable integration of blended care for patients with chronic conditions, comprehensive implementation strategies that concurrently address all relevant domains are essential. By illuminating the experiences of healthcare professionals, this study offers actionable insights to guide the design, implementation, and upscaling of eCoaches and related eHealth technologies.

Objective: To develop a web-based self-monitoring tool including motivational elements to improve empowerment of patients with rheumatoid arthritis (RA).Methods: Following a design-thinking approach, the development included 3 iterative, cocreative phases involving different stakeholders. In the empathize and define phase, 2 focus groups gave insight into patients' wishes and needs regarding self-monitoring with an application. During the ideation phase, 2 cocreation sessions were organized to establish the content of the application and consider motivational elements. For the prototyping and testing phase, usability was assessed through both formative (heuristics evaluation) and summative (system usability scale [SUS] 0-100; ≥ 68 was considered good to excellent) evaluations.Results: The focus group meetings resulted in a shortlist of what to monitor (physical function, quality of life, pain, fatigue, mental well-being, and social participation) and preferences on how to monitor (single-item questions, 0-10 scale, use as needed). The cocreation sessions revealed preference for empathetic dialogues with an avatar for self-monitoring. Setting goals, adding notes, sharing results, and receiving tips could further increase motivation for use. Initial experiences regarding heuristics of the tool were generally positive and confirmed by a mean SUS score of 84.4 (SD 11.6). Points for improvement included simplifying login procedures, adding notifications, and adjusting the avatar's tone of voice.Conclusion: A web-based self-monitoring application (MyRA) was developed, with an avatar that asks patients through dialogues to score 6 domains, with graphical displays, diary functionality, and practical tips. Further studies are needed to confirm its usability and effectiveness in empowering patients.

BACKGROUND Atherosclerotic cardiovascular disease poses a heavy burden on the population’s health and health care costs. Identifying apparently healthy individuals at risk of developing cardiovascular diseases using clinical prediction models raises awareness, facilitates shared decision-making, and supports tailored management of disease prevention. In the CARRIER project, a personalized cardiovascular risk management (CVRM) eCoach approach is cocreated, in which identified individuals receive education, guidance, and monitoring to prevent atherosclerotic cardiovascular disease through existing interventions. In this approach, an artificial intelligence–driven clinical prediction model calculates the 10-year risk for atherosclerotic cardiovascular disease, which supports informed decision-making. OBJECTIVE This study aims to assess the effectiveness of our CVRM eCoach approach through a 10-year risk calculation of atherosclerotic cardiovascular disease, including risk factors contributing to this risk. METHODS This pretest-posttest interventional study provides the CVRM eCoach approach for 6 months to 100 apparently healthy individuals eligible for CVRM. The CVRM eCoach approach is a multicomponent eHealth solution, including a clinical prediction under intervention model that not only calculates the 10-year risk of cardiovascular disease through conventional risk factors (smoking, blood pressure, and lipid profile) and individual characteristics (age, gender, socioeconomic status, physical activity, and diet) but also calculates how the risk changes after hypothetical lifestyle or medical interventions. The CVRM eCoach approach includes features that encourage behavior change. Most of these features include goal setting, decision cards to help decide on an intervention, intervention monitoring, remote communication, and education, all accessible from one dashboard. A practice nurse or physician consults the individuals after risk calculation with the clinical prediction model and uses behavior change features, such as the decision cards, to support shared decision-making. Data are primarily collected via the eCoach, after which the 10-year risk for atherosclerotic cardiovascular disease and its components are analyzed using paired-sample analyses. RESULTS Recruitment began in March 2024 and will continue until 100 participants have been recruited, which is expected in 2025. CONCLUSIONS We anticipate that our CVRM eCoach approach will be valuable in the primary prevention setting. During the crucial initial first months of habit formation, factors such as education, regular check-ups via the eCoach, and clear risk communication could support individuals in sustaining their medical or lifestyle interventions. We hypothesize that there will be a slight to moderate reduction in the 10-year risk of atherosclerotic cardiovascular disease, which over time will lead to significant health improvements on a larger scale. CLINICALTRIAL CCMO NL84584.096.23; https://onderzoekmetmensen.nl/nl/trial/56578

BACKGROUND The health care sector faces increasing pressure, with demand outpacing supply and multiple challenges in accessibility, affordability, and quality. The current organization of health care systems is unsustainable—exacerbated by labor shortages and escalating expenditures in Europe, particularly the Netherlands. To address these issues, hospitals are increasingly adopting digital transformation strategies. This digital transformation involves the systematic implementation of digital technologies and processes. To achieve high-quality hybrid care, hospitals must integrate digital health care seamlessly into existing workflows. However, there is no definitive strategy for implementing these transformations. OBJECTIVE This study examines how Dutch hospitals organize their digital transformation, the strategies they employ, and the best practices they follow, to provide evidence-based recommendations for hospitals embarking on similar initiatives. METHODS A qualitative multicase study was conducted using purposive sampling. A total of 11 Dutch hospitals were invited, and 8 participated. Professionals—project or program managers of digital care, or advisors in policy, management, strategy, or related positions—from these hospitals took part in semistructured interviews. Topics included digital transformation strategies, organizational structures, barriers and facilitators, and lessons learned. All interviews were recorded, transcribed verbatim, and analyzed using directed content analysis. RESULTS Although hospitals organize their digital transformation in different ways and with different teams or departments, they encounter similar facilitators and barriers. Inspired by the Consolidated Framework for Implementation Research, the ExpandNet Scaling Up framework, and the Hybrid Health Care Quality Assessment, these factors were grouped into the following categories: the structure of the digital program, cultural factors within the organization, financial factors (internal or external), political factors (internal or external), patient needs, resources and skills, and technical factors. CONCLUSIONS Despite variations in implementation, hospitals share key challenges and enablers in digital transformation. Common factors—such as organizational culture, financial resources, and technical infrastructure—may serve as foundational elements for effective digital transformation in hospital care.

Background: Collaboration with diverse stakeholders in eHealth research is fundamental yet complex. Stakeholders from various disciplines do not “speak the same language” and have different levels of power and interest, resulting in contrasting objectives, priorities, and expectations. An approach to constructive communication and collaboration is necessary to overcome this complex dynamic. Cocreation, known in the field of eHealth most often to involve end users, may also be suitable for facilitating stakeholder engagement and alignment. Objective: This paper provides insights into the application of cocreation, specifically in the early phases of research that focus on involving and aligning relevant stakeholders from different academic and professional backgrounds. Methods: The case for this study was a group discussion with members of a multidisciplinary consortium that works on developing a personalized eHealth intervention for atherosclerotic cardiovascular disease. Using stakeholder mapping, health and medicine experts, big data scientists, software developers, and an innovation manager (N=8) were invited to participate. The discussion was based on a user scenario and structured according to the Six Thinking Hats of de Bono, representing 6 different types of thinking. The discussion was recorded, transcribed verbatim, and analyzed thematically with the use of ATLAS.ti software. Results: First, informative and intuitive thinking served the preparatory purpose of familiarization with the project details and other participants. Second, positive and critical thinking constituted the body of the discussion and resulted in an in-depth conversation. Third, creative and organizational thinking were action oriented and focused on solutions and planning to safeguard future progress. The participants repeatedly reflected on various intervention-related themes, ranging from intervention content to technical functionalities and from legal requirements to implementation in practice. Moreover, project-related matters were discussed, including stakeholder management and time and budget constraints. Conclusions: This paper demonstrates how cocreation can be of value for multidisciplinary stakeholder engagement and alignment. Based on stakeholder mapping (with whom to discuss), a dream user scenario (what to discuss), and the Six Thinking Hats of de Bono (how to discuss), the participants shared information, discussed differences, searched for solutions, and moved toward a collective approach regarding intervention development. The lessons learned may further improve the understanding of how cocreation can contribute to multidisciplinary collaboration.

BACKGROUND Collaboration with diverse stakeholders in eHealth research is fundamental yet complex. Stakeholders from various disciplines do not “speak the same language” and have different levels of power and interest, resulting in contrasting objectives, priorities, and expectations. An approach to constructive communication and collaboration is necessary to overcome this complex dynamic. Cocreation, known in the field of eHealth most often to involve end users, may also be suitable for facilitating stakeholder engagement and alignment. OBJECTIVE This paper provides insights into the application of cocreation, specifically in the early phases of research that focus on involving and aligning relevant stakeholders from different academic and professional backgrounds. METHODS The case for this study was a group discussion with members of a multidisciplinary consortium that works on developing a personalized eHealth intervention for atherosclerotic cardiovascular disease. Using stakeholder mapping, health and medicine experts, big data scientists, software developers, and an innovation manager (N=8) were invited to participate. The discussion was based on a user scenario and structured according to the Six Thinking Hats of de Bono, representing 6 different types of thinking. The discussion was recorded, transcribed verbatim, and analyzed thematically with the use of ATLAS.ti software. RESULTS First, informative and intuitive thinking served the preparatory purpose of familiarization with the project details and other participants. Second, positive and critical thinking constituted the body of the discussion and resulted in an in-depth conversation. Third, creative and organizational thinking were action oriented and focused on solutions and planning to safeguard future progress. The participants repeatedly reflected on various intervention-related themes, ranging from intervention content to technical functionalities and from legal requirements to implementation in practice. Moreover, project-related matters were discussed, including stakeholder management and time and budget constraints. CONCLUSIONS This paper demonstrates how cocreation can be of value for multidisciplinary stakeholder engagement and alignment. Based on stakeholder mapping (with whom to discuss), a dream user scenario (what to discuss), and the Six Thinking Hats of de Bono (how to discuss), the participants shared information, discussed differences, searched for solutions, and moved toward a collective approach regarding intervention development. The lessons learned may further improve the understanding of how cocreation can contribute to multidisciplinary collaboration.

Digital health is a promising tool to support people with an elevated risk for atherosclerotic cardiovascular disease (ASCVD) and patients with an established disease to improve cardiovascular outcomes. Many digital health initiatives have been developed and employed. However, barriers to their large-scale implementation have remained. This paper focuses on these barriers and presents solutions as proposed by the Dutch CARRIER (ie, Coronary ARtery disease: Risk estimations and Interventions for prevention and EaRly detection) consortium. We will focus in 4 sections on the following: (1) the development process of an eHealth solution that will include design thinking and cocreation with relevant stakeholders; (2) the modeling approach for two clinical prediction models (CPMs) to identify people at risk of developing ASCVD and to guide interventions; (3) description of a federated data infrastructure to train the CPMs and to provide the eHealth solution with relevant data; and (4) discussion of an ethical and legal framework for responsible data handling in health care. The Dutch CARRIER consortium consists of a collaboration between experts in the fields of eHealth development, ASCVD, public health, big data, as well as ethics and law. The consortium focuses on reducing the burden of ASCVD. We believe the future of health care is data driven and supported by digital health. Therefore, we hope that our research will not only facilitate CARRIER consortium but may also facilitate other future health care initiatives.