Jochen Bergs

Background: Advancements in mobile technology have paved the way for innovative interventions aimed at promoting physical activity (PA). Objective: The main objective of this feasibility study was to assess the feasibility, usability, and acceptability of the More In Action (MIA) app, designed to promote PA among older adults. MIA offers 7 features: personalized tips, PA literacy, guided peer workouts, a community calendar, a personal activity diary, a progression monitor, and a chatbot. Methods: Our study used a mixed methods approach to evaluate the MIA app’s acceptability, feasibility, and usability. First, a think-aloud method was used to provide immediate feedback during initial app use. Participants then integrated the app into their daily activities for 5 weeks. Behavioral patterns such as user session duration, feature use frequency, and navigation paths were analyzed, focusing on engagement metrics and user interactions. User satisfaction was assessed using the System Usability Scale, Net Promoter Score, and Customer Satisfaction Score. Qualitative data from focus groups conducted after the 5-week intervention helped gather insights into user experiences. Participants were recruited using a combination of web-based and offline strategies, including social media outreach, newspaper advertisements, and presentations at older adult organizations and local community services. Our target group consisted of native Dutch-speaking older adults aged >65 years who were not affected by severe illnesses. Initial assessments and focus groups were conducted in person, whereas the intervention itself was web based. Results: The study involved 30 participants with an average age of 70.3 (SD 4.8) years, of whom 57% (17/30) were female. The app received positive ratings, with a System Usability Scale score of 77.4 and a Customer Satisfaction Score of 86.6%. Analysis showed general satisfaction with the app’s workout videos, which were used in 585 sessions with a median duration of 14 (IQR 0-34) minutes per day. The Net Promoter Score was 33.34, indicating a good level of customer loyalty. Qualitative feedback highlighted the need for improvements in navigation, content relevance, and social engagement features, with suggestions for better calendar visibility, workout customization, and enhanced social features. Overall, the app demonstrated high usability and satisfaction, with near-daily engagement from participants. Conclusions: The MIA app shows significant potential for promoting PA among older adults, evidenced by its high usability and satisfaction scores. Participants engaged with the app nearly daily, particularly appreciating the workout videos and educational content. Future enhancements should focus on better calendar visibility, workout customization, and integrating social networking features to foster community and support. In addition, incorporating wearable device integration and predictive analytics could provide real-time health data, optimizing activity recommendations and health monitoring. These enhancements will ensure that the app remains user-friendly, relevant, and sustainable, promoting sustained PA and healthy behaviors among older adults. Trial Registration: ClinicalTrials.gov NCT05650515; https://clinicaltrials.gov/study/NCT05650515

BACKGROUND Advancements in mobile technology have paved the way for innovative interventions aimed at promoting physical activity (PA). OBJECTIVE The main objective of this feasibility study was to assess the feasibility, usability, and acceptability of the More In Action (MIA) app, designed to promote PA among older adults. MIA offers 7 features: personalized tips, PA literacy, guided peer workouts, a community calendar, a personal activity diary, a progression monitor, and a chatbot. METHODS Our study used a mixed methods approach to evaluate the MIA app’s acceptability, feasibility, and usability. First, a think-aloud method was used to provide immediate feedback during initial app use. Participants then integrated the app into their daily activities for 5 weeks. Behavioral patterns such as user session duration, feature use frequency, and navigation paths were analyzed, focusing on engagement metrics and user interactions. User satisfaction was assessed using the System Usability Scale, Net Promoter Score, and Customer Satisfaction Score. Qualitative data from focus groups conducted after the 5-week intervention helped gather insights into user experiences. Participants were recruited using a combination of web-based and offline strategies, including social media outreach, newspaper advertisements, and presentations at older adult organizations and local community services. Our target group consisted of native Dutch-speaking older adults aged >65 years who were not affected by severe illnesses. Initial assessments and focus groups were conducted in person, whereas the intervention itself was web based. RESULTS The study involved 30 participants with an average age of 70.3 (SD 4.8) years, of whom 57% (17/30) were female. The app received positive ratings, with a System Usability Scale score of 77.4 and a Customer Satisfaction Score of 86.6%. Analysis showed general satisfaction with the app’s workout videos, which were used in 585 sessions with a median duration of 14 (IQR 0-34) minutes per day. The Net Promoter Score was 33.34, indicating a good level of customer loyalty. Qualitative feedback highlighted the need for improvements in navigation, content relevance, and social engagement features, with suggestions for better calendar visibility, workout customization, and enhanced social features. Overall, the app demonstrated high usability and satisfaction, with near-daily engagement from participants. CONCLUSIONS The MIA app shows significant potential for promoting PA among older adults, evidenced by its high usability and satisfaction scores. Participants engaged with the app nearly daily, particularly appreciating the workout videos and educational content. Future enhancements should focus on better calendar visibility, workout customization, and integrating social networking features to foster community and support. In addition, incorporating wearable device integration and predictive analytics could provide real-time health data, optimizing activity recommendations and health monitoring. These enhancements will ensure that the app remains user-friendly, relevant, and sustainable, promoting sustained PA and healthy behaviors among older adults. CLINICALTRIAL ClinicalTrials.gov NCT05650515; https://clinicaltrials.gov/study/NCT05650515

Process mining leverages process execution data to better understand and improve operational processes. In hospitals, data from the Electronic Health Records (EHR) system that supports their daily operations is often used as input data for process mining. As limitations of EHR data in terms of data quality have also been highlighted in literature, it remains an open question how well EHR data reflects how work actually gets done in a care process. Against this background, this paper reports on the outcomes of an observation study at a Belgian hospital. In particular, the activities that nurses perform have been observed, as well as their data registration behavior. From the findings, it follows that EHR data will provide a highly fragmented and inaccurate view of how nursing work gets done. This constitutes a basis for reflection upon the extent to which EHR data is a truthful basis for process mining.

Response to Letter in regards to How to Support the Referral Towards Group Antenatal Care in Belgian Primary Healthcare Organization: A Qualitative Study [Letter]

Introduction: Group Antenatal Care (GANC) is an alternative for traditional antenatal care. Despite the model is well accepted among participants and is associated with positive effects on pregnancy outcomes, recruitment of participants can be an ongoing challenge, depending on the structure and financing of the wider health system. This is especially the case for primary care organizations offering GANC, which depend on other health care providers to refer potential participants. The main objective of this study is to understand what determinants are at play for health care providers to refer to GANC facilitators in primary care organizations. Accordingly, we make recommendations for strategies in order to increase the influx of women in GANC. Methods: Qualitative findings were obtained from 31 interviews with healthcare providers responsible for the referral of women to the GANC facilitators working in primary care organizations, GANC facilitators and stakeholders indirectly involved in the referral. The domains of the Consolidated Framework for Implementation Research (CFIR) and the Theoretical Domains Framework (TDF) helped to develop interview questions and raise awareness of important elements during interviews and thematic analyses. Results: The findings show that before health care providers decide to refer women, they undergo a complex process that is influenced by characteristics of the potential referrer, GANC facilitator, woman, professional relationship between the potential referrer and the GANC facilitator, organization and broader context. Discussion: Based on these findings and current literature, we recommend that the GANC team implements strategies that anticipate relevant determinants: identify and select potential referrers based on their likelihood to refer, select champions, invest in communication, concretise the collaboration, provide practical tools, involve in policymaking.

Background: Identifying gaps along the human immunodeficiency virus (HIV) continuum of care is essential in reaching viral suppression. Objective: The aim of this study aims to identify sociodemographic and clinical factors influencing HIV diagnosis, linkage to care, antiretroviral therapy (ART) initiation and retention, and viral suppression in Suriname. Method: Adults, over 15 years, enrolled as HIV positive in the national surveillance system from 2010 to 2015, were included. Multiple regression looking into sociodemographic and clinical factors was executed. Indicators evaluated were ‘knowing HIV status’, people initiating ART, 1-year ART retention, and viral suppression with ART. Results: There were 2939 registered adults registered. Based on yearly average, of the 52% (95% confidence interval (CI), 52–53%) of estimated people living with HIV, 4950 knew their HIV status; 63% (95% CI, 62–64%) of these diagnosed initiated ART; and 81% (95% CI, 22–32%) of those on ART were virally suppressed. If tested positive at a non-voluntary counseling testing (VCT) site, better linkage to care (adjusted odds ratio (aOR), 1.6; 95% CI, 1.2–2.1) is seen. Although better linked to care (aOR, 1.5; 95% CI, 1.2–1.8), no difference was noted in viral suppression (aOR, 0.8; 95% CI, 0.6–1.0) for men compared to women. Men initiate treatment at a more advanced stage of disease (CD4 ≤ 200) than women (47.4% versus 31.4%), leading to higher mortality rates. People from the interior were less likely linked to care (aOR, 0.6; 95% CI, 0.4–0.8) than those from urban regions but did not display significant differences in treatment initiation. Conclusion: In each step, the continuum shows a significant drop. Innovative interventions with a particular focus on men and people living in the interior are needed. Also, a more proactive system of linking people in care, especially at VCT sites, is needed.

Background: The World Health Organization (WHO) Patient Safety Curriculum Guide defines learning objectives for patient safety. Current implementation in healthcare education is insufficient. Possible explanations may be obsolescence and/or a shift in needs. We investigated whether overarching topics and specific learning objectives of the WHO Patient Safety Curriculum Guide are still up-to-date, their attributed importance, and their perceived difficulty to achieve. Methods: Experts on patient safety and medical education from 3 European countries were asked to suggest learning objectives concerning patient safety using group concept mapping. Following 3 successive steps, experts rated ideas by importance and difficulty to achieve. Correlation analyses investigated the relationship between those. Overarching topics of the learning goals (clusters) were identified with multivariate analysis. Results: A total of 119 statements about intended learning objectives on patient safety were generated, of which 86 remained for sorting and rating. Based on multivariate analyses, 10 overarching topics (clusters) emerged. Both the learning objectives and the overarching topics showed high correspondence with the WHO Patient Safety Curriculum Guide. Strong correlations emerged between importance and difficulty ratings for learning objectives and overarching topics. Conclusions: The WHO Patient Safety Curriculum Guide’s learning goals are still relevant and up-to-date. Remarkably, learning objectives categorized as highly important are also perceived as difficult to achieve. In summary, the insufficient implementation in medical curricula cannot be attributed to the content of the learning goals. The future focus should be on how the WHO learning goals can be implemented in existing curricular courses.

Background and importance: Cardiac arrhythmia, specifically paroxysmal supraventricular tachycardia (SVT), accounts for a substantial proportion of emergency medical services resources utilisation. Reconversion requires increasing the atrioventricular node’s refractoriness, which can be achieved by vagal manoeuvres, pharmacological agents or electrical cardioversion. There are multiple variants of vagal manoeuvres, including the Valsalva manoeuvre (VM). While the effectiveness of the standard VM has already been systematically reviewed, there has been no such analysis for the modified VM. Objective(s): Compare the effectiveness of the modified VM versus the standard VM in restoring the normal sinus rhythm in adult patients with supraventricular tachycardia. Design: Systematic review with meta-analysis of published randomised controlled trials. Outcome measures: The primary outcome was the reconversion to a sinus rhythm. Secondary outcomes included: medication use, adverse events, length of stay in the emergency department and hospital admission. Main results: Five randomised controlled trials were included, with a combined total of 1181 participants. The meta-analysis demonstrated a significantly higher success rate for reconversion to sinus rhythm when using the modified VM compared to the standard VM in patients with an SVT (odds ratio = 4.36; 95% confidence interval, 3.30–5.76; P < 0.001). More adverse events were reported in the modified VM group, although this difference is NS (risk ratio = 1.48; 95% confidence interval, 0.91–2.42; P = 0.11). The available evidence suggests that medication use was lower in the modified VM group than the standard VM group. However, medication use could not be generalised across the different studies. None of the included studies showed a significant difference in length of stay in the emergency department. Only one study reported on hospital admission, with no significant difference between the two groups. Conclusions: The available evidence is highly suggestive to support the use of the modified VM compared to the standard VM in the treatment of adult patients with SVT. Meta-analysis showed a higher success rate, required less medication use, and resulted in an equal number of adverse events. However, these results cannot be regarded as definitive in the absence of higher-quality studies.