Ilse Mesters

Purpose: Physical activity during pregnancy is associated with reduced risk of obstetric complications and improved maternal wellbeing, yet many pregnant women do not meet recommended activity levels. Low-impact and accessible exercise modalities, such as stationary aquabiking, may help overcome common barriers. This study examined psychosocial determinants of pregnant women’s intention to participate in aquabiking, guided by the Theory of Planned Behavior, to inform prenatal physical activity promotion. Material and methods: A cross-sectional survey was conducted among 145 pregnant women, assessing intentions, sociodemographic and pregnancy-related characteristics, and Theory of Planned Behavior determinants. Results: Overall, 75.8% of participants reported positive intentions to engage in aquabiking during pregnancy. Positive behavioral beliefs, and supportive subjective norms were significant psychosocial determinants of intention. Higher parity, higher education and more pregnancy complications were relevant external factors associated with a more positive intention. Conclusion: These findings suggest substantial interest in aquabiking as a prenatal physical activity option. Integrating innovative, water-based exercise modalities into antenatal care and community health programs may support broader and more inclusive engagement in physical activity during pregnancy.

Background: Combining effective eHealth programs with face-to-face consultations in general practice may help general practitioners care for survivors of cancer. Objective: This study protocol describes a 2-armed randomized controlled trial to evaluate the cost-effectiveness of a blended intervention integrating the Cancer Aftercare Guide in general practice centers (GPCs). Methods: A parallel-group design will compare an intervention group with a waiting list control group. Participants will be nested within GPCs and randomization will occur at the GPC level. The participants in the intervention group will receive a blended care intervention. In contrast, the participants in the waiting list control group will receive care as usual for the duration of this study and will receive the online intervention afterward. All participants will be asked to complete an online questionnaire at baseline, 6 months, and 12 months after baseline, measuring self-reported adherence to lifestyle recommendations, psychosocial well-being, and quality of life. A process evaluation and cost evaluation are also included in this study. The effects will be evaluated based on differences in residual change scores between intervention and control group participants, using multilevel linear regression analyses. Moreover, effect analyses will be supplemented with Bayes factor analyses. Finally, an economic evaluation will be conducted from a societal perspective and will include medical costs, productivity costs, and costs of the blended care intervention. Results: This study was funded in July 2020. Data collection started in August 2022 and is likely to be completed by April 2025. As of December 2024, a total of 127 participants have been included in this study, recruited across 26 GPCs in the Netherlands. Data analysis will commence once data collection is completed. Data analysis is estimated to start in the spring of 2025. The results will likely be published in 2026. Conclusions: The results will provide insight into the effectiveness of blended care and may be relevant to cancer aftercare, general practice, and the field of eHealth implementation in general. Potential challenges lie in recruitment due to the strain on the health care system since the COVID-19 pandemic. Trial Registration: ISRCTN ISRCTN12451453; https://www.isrctn.com/ISRCTN12451453 International Registered Report Identifier (IRRID): DERR1-10.2196/64662

BACKGROUND: Hormonal receptor (HR) positive breast tumors are common. Adjuvant hormonal therapy (AHT) with tamoxifen or Aromatase Inhibitors (AIs) is beneficial depending on the stage of the tumor. Despite the fact that AHT has been shown to improve survival and recurrence, Dutch adherence rates, which were mostly dependent on Tamoxifen prescriptions until 2006, plummeted from 80% after one year to 50% after five years. Nonadherence with AHT reduces its effectiveness. This research presents more recent adherence statistics (from 2006 to 2016), on a larger sample (7,996 vs 1,451), as well as factors that influence AHT adherence. In addition to tamoxifen data, AIs are now included. OBJECTIVE: As low use of adjuvant endocrine therapy is a potentially important and modifiable risk factor for poor outcome, it is important to monitor the rate as an indicator of women’s burden of disease and the direction of adherence trends. METHODS: The Netherlands Cancer Registry (NCR) was used to find women with early-stage breast cancer who started AHT within a year of surgery and were linked to the PHARMO Database Network (n = 8,679). The Kaplan-Meier approach was used to measure AHT adherence five years after treatment was started, with a 60-day gap between refills as our primary outcome. Furthermore, the Medication Possession Rate (MPR) was determined using a cutoff of ≥80%. Analysis was performed on influential factors of adherence. RESULTS: The proportion of persistent women declined over time to reach 46.6% at the end of the fifth year and 53.3% of the women had a MPR ≥80% during the fifth year. Older and being diagnosed in 2006-2010 were associated with AHT adherence. CONCLUSION: Dutch 5-year AHT adherence appears to remain poor. Improving AHT adherence in HR+ breast cancer survivors is a critical medical need.

Background: Although several COVID-19 vaccines are available, the current challenge is achieving high vaccine uptake. We aimed to explore university students’ intention to get vaccinated and select the most relevant determinants/beliefs to facilitate informed decision making around COVID-19 vaccine uptake. Methods: A cross-sectional online survey with students (N = 434) from Maastricht University was conducted in March 2021. The most relevant determinants/beliefs of students’ COVID-19 vaccine intention (i.e., determinants linked to vaccination intention, and with enough potential for change) were visualized using CIBER plots. Results: Students’ intention to get the COVID-19 vaccine was high (80%). Concerns about safety and side effects of the vaccine and trust in government, quality control, and the pharmaceutical industry were identified as the most relevant determinants of vaccine intention. Other determinants were risk perception, attitude, perceived norm, and self-efficacy beliefs. Conclusion: Our study identified several determinants of COVID-19 vaccine intention (e.g., safety, trust, risk perception, etc.) and helped to select the most relevant determinants/beliefs to target in an intervention to maximize COVID-19 vaccination uptake. Concerns and trust related to the COVID-19 vaccine are the most important targets for future interventions. Other determinants that were already positive (i.e., risk perception, attitudes, perceived norms, and self-efficacy) could be further confirmed.

Background: In theory, Motivational Interviewing (MI) fidelity should be associated with client outcomes. Nevertheless, this fidelity-effectiveness association is rarely investigated. This study evaluated the extent to which Telephone Motivational Interviewing (TMI) fidelity is associated with change in self-reported physical activity (PA), fruit intake, and vegetable consumption. Method: Adults in primary care (45–70 years) participated in a study that compared the effect of tailor print communication, telephone motivational interviewing (TMI), and a combination of the two on PA, fruit intake, and vegetable consumption. MI fidelity was assessed using the behavioral coding method “Motivational Interviewing Treatment Integrity Code (MITI)” in 409 randomly selected audio-recorded sessions, representing 232 participants of the TMI group. The associations between MI fidelity scores and the behavioral changes from baseline to 47-week follow-up were examined using backward multiple linear regression analyses (adjusted for covariates). Results: A significant and positive association between the percentage of MI adherent responses and improvements in PA and fruit consumption was found with respectively a small and medium effect size. The global rating “Spirit” (which resembles an all-at-once appraisal of the interviewer’s MI competence) was significantly, but inversely associated with progress in vegetable intake with a medium effect size. Conclusion: The finding that relatively lower MI competency was associated with higher vegetable consumption went against our expectations. Findings suggest that practicing MI-consistent skills was beneficial in promoting PA and fruit consumption, but moderated vegetable intake. This study contributes to the scientific confidence that TMI enables change in PA and fruit intake.

PurposeHormonal receptor (HR) positive breast tumors are common. Adjuvant hormonal therapy (AHT) with Tamoxifen or Aromatase Inhibitors (AIs) is beneficial depending on the stage of the tumor. Despite the fact that AHT has been shown to improve survival and recurrence, Dutch adherence rates, which were mostly dependent on Tamoxifen prescriptions until 2006, plummeted from 80% after one year to 50% after five years. Nonadherence with AHT reduces its effectiveness. This research presents more recent adherence statistics (from 2006 to 2016) as well as factors that influence AHT adherence. In addition to Tamoxifen data, AIs are now included in prescriptions.MethodsThe Netherlands Cancer Registry (NCR) was used to find women with early-stage breast cancer who started AHT within a year of surgery and were linked to the PHARMO Database Network. The Kaplan-Meier approach was used to measure AHT adherence five years after treatment was started, with a 60-day gap between refills as our primary outcome. Furthermore, the Medication Possession Rate (MPR) was determined using a cutoff of 50%. Subgroup analysis was performed on influential factors of adherence.Results The 5-year adherence rate was 46.6% when gaps of 60 days between refills were allowed. Based on MPR 80 %, the five-year adherence rate was 53.3%. Age, ≥ 70 years (HR (95% CI) 1.20 (1.10 – 1.30), 50-69 years (HR (95 % CI) 1.09 (1.02 – 1.17) vs < 49 years), and year of diagnosis, 2011-2016 (HR (95 percent CI) 2.39 (2.24-2.56) vs 2006-2010) were also linked with adherence continuance.ConclusionDutch 5-year AHT adherence has remained poor.

Halfway through 2021 in the midst of a public health crisis, a new academic year was fast approaching. Dutch universities were preparing to reopen their campuses to students and personnel in a safe manner. As the vaccination uptake was increasing and societies were slowly reopening, inviting students and personnel to campus became the next step to “the new normal”. To absorb this change seamlessly, it was considered important to investigate personnel’s beliefs about returning to campus and their perceptions of a safe working environment. An online survey was conducted among personnel (N = 1965) of Maastricht University, the Netherlands. University personnel’s beliefs about a safe return to campus were assessed. The data were collected between 11 June and 28 June 2021. This study showed that, while most personnel (94.7%) were already vaccinated or willing to do so, not all personnel did feel safe to return to campus in September 2021. Over half of the respondents (58%) thought that the university is a safe place to return to work when the new academic year starts. However, the remainder of personnel felt unsafe or were uncertain for various reasons such as meeting in large groups or becoming infected. Moreover, when returning to campus, employees stated that they would require some time to reacclimate to their former work culture. The group who felt relatively more unsafe indicated that returning in September was too risky and that they worried about being infected. They wanted the safety guidelines to still be in force. On the other hand, the “safe” group stated safely returning to be “certainly possible” and trusted that others would still stick to the prevention guidelines. The findings led to practical recommendations for the University Board as they were preparing for organizing research and teaching for the upcoming academic year in the context of the COVID-19 pandemic. A brief intervention was developed: a webinar in which the data were linked to the board’s plans for safe returning. This study demonstrates that university boards may use research among personnel to develop adequate measures promoting safety and feelings of safety among personnel in similar future situations.

Purpose To summarise what is currently known about the psychosocial morbidity, experiences, and needs of people with cancer and their informal caregivers, who live in rural or regional areas of developed countries. Methods Eligible studies dating from August 2010 until May 2021 were identified through several online databases, including MEDLINE, EMBASE, PsychINFO, and RURAL (Rural and Remote Health Database). Results were reported according to the PRISMA guidelines and the protocol was registered on PROSPERO (CRD42020171764). Results Sixty-five studies were included in this review, including 20 qualitative studies, 41 quantitative studies, and 4 mixed methods studies. Qualitative research demonstrated that many unique psychosocial needs of rural people remain unmet, particularly relating to finances, travel, and accessing care. However, most (9/19) quantitative studies that compared rural and urban groups reported no significant differences in psychosocial needs, morbidity, or quality of life (QOL). Five quantitative studies reported poorer psychosocial outcomes (social and emotional functioning) in urban cancer survivors, while three highlighted poorer outcomes (physical functioning, role functioning, and self-reported mental health outcomes) in the rural group. Conclusion Recent research shows that rural people affected by cancer have unique unmet psychosocial needs relating to rurality. However, there was little evidence that rural cancer survivors report greater unmet needs than their urban counterparts. This contrasts to the findings from a 2011 systematic review that found rural survivors consistently reported worse psychosocial outcomes. More population-based research is needed to establish whether uniquely rural unmet needs are due to general or cancer-specific factors.