Roland Dingemans Friele

Introduction: People with a low socio-economic position (SEP) are disproportionally affected by both chronic diseases and with reduced access to, use of, and perceived benefits from e-health. People with one or more chronic diseases are likely to experience a greater burden of disease and have more frequent interactions with the healthcare system and e-health. This study provides insights in whether socio-economic differences in e-health use exist in a Dutch population of people with one or more chronic diseases. Methods: In 2023 a questionnaire was sent out to 2,113 members of a Dutch panel consisting of people with one or more chronic diseases. Participants were asked about the use of five e-health applications and their inclination to use e-health. E-health applications included: websites, apps, wearables, patient portal and digital communication. Educational attainment was used as a proxy for SEP. Results were stratified by level of educational attainment. Results: The response rate was 1,543/2,113, 73%, the final study sample was 1,517. Results show that participants with a lower educational attainment used significantly less websites (OR 4.78, 95% CI, 3.50-6.53), apps (OR 2.88, 95% CI, 2.00-4.16), wearables (OR 2.12, 95% CI, 1.52-2.95) and patient portals (OR 3.24, 95% CI, 2.38-4.41) compared to higher educational attainment groups. Participants with a high educational attainment were more likely to be inclined (RRR 2.21, 95% CI 1,48-3,31) and less likely to be uncertain about e-health use (RRR 0.56, 95% CI 0,39-0.81) compared to participants with a low educational attainment. Conclusion: Differences in e-health use and positive inclination towards e-health use also exist between socio-economic groups in a population of people with a chronic disease. These findings show that current practice and implementation of e-health for people with chronic disease does not serve all patients equally, demanding more attention towards inclusive organization of e-health.

Background: There is worldwide recognition of the potential increase of digital health inequity due to the increased digitalization of health care systems. Digital health skill development may prevent disparities in eHealth access and use. In the Dutch context, the public library has started to facilitate support in digital health skill development by offering public eHealth courses. Understanding the motivations of people to seek support may help to further develop this type of public service. Objective: This is a qualitative study on the motivations of citizens participating in an eHealth course offered by public libraries. The study aimed to explore why citizens were motivated to seek nonformal support for eHealth use. Methods: A total of 20 semistructured interviews with participants who participated in an eHealth course were conducted in 7 public libraries across the Netherlands. The interviews were conducted between April and June 2022. Purposive sampling took place in the public library during the eHealth course. The interviews covered participants’ motivations, attitudes, and experiences with eHealth use and their motivations to seek help with eHealth use. Interviews were audio-recorded and transcribed. Themes were identified via a comprehensive thematic data analysis. Results: The participants were 51 to 82 years of age (average 73.5, SD 6.6 y) and 14 (70%) participants were female. Three motivational themes were identified: (1) adapting to an increasingly digital society, (2) sense of urgency facilitated by prior experience in health care, and (3) a need for self-reliance and autonomy. Additionally, participants expressed a general desire for social contact and lifelong learning. A lack of adequate informal support by friends and family for digital skills and positive experiences with formal support from public libraries stimulated the participants to seek formal support for eHealth use. Conclusions: We show that the participants had a feeling of urgency that sparked their motivation to seek nonformal support in the public library. Motivations to participate in the eHealth course stemmed from the need to adapt to the digital society, being a patient or a caregiver, or the need or wish to be independent from others. Participants of the study were mainly older female adults who had native language abilities, up-to-date digital devices, and time. It is likely that other populations experience similar feelings of urgency but have other support needs. Future research should explore the needs and attitudes of nonusers and other users of digital health toward seeking support in eHealth access and use.

Background: There is a growing concern that digital health care may exacerbate existing health disparities. Digital health care or eHealth encompasses the digital apps that are used in health care. Differences in access, use, and perceived benefits of digital technology among socioeconomic groups are commonly referred to as the digital divide. Current research shows that people in lower socioeconomic positions (SEPs) use eHealth less frequently. Objective: This study aims to (1) investigate the association between SEP and eHealth access to, use of, and perceived benefit within the adult Dutch population and (2) evaluate disparities in eHealth access, use, and perceived benefit through three socioeconomic variables—education, standardized income, and the socioeconomic status of the neighborhood. Methods: A secondary analysis was conducted on data from the Nivel Dutch Health Care Consumer Panel (response rate 57%, 849/1500), to assess access to, use of, and perceived benefits from eHealth. These data were collected to monitor eHealth developments in the Netherlands. eHealth was examined through two concepts: (1) eHealth in general and (2) websites, apps, and wearables. Results were stratified into 9 SEP populations based on 3 indicators—education, standardized income, and socioeconomic status level of the neighborhood. Logistic regression analyses were performed to evaluate whether the outcomes varied significantly across different SEP groups. Age was included as a covariate to control for confounding. Results: This study confirms the association between eHealth and SEP and shows that low SEP respondents have less access (odds ratio [OR] 5.72, 95% CI 3.06-10.72) and use (OR 4.96, 95% CI 2.66-9.24) of eHealth compared to medium or high SEP respondents. Differences were most profound when stratifying for levels of education. Conclusions: The access to and use of eHealth has a socioeconomic gradient and emphasizes that SEP indicators cannot be used interchangeably to assess eHealth access and use. The results underline the importance of activities and policies aimed at improving eHealth accessibility and usage among low SEP groups to mitigate disparities in health between different socioeconomic groups.

Globally, ex-post legislative evaluations are becoming increasingly important for understanding how laws function in practice and identifying their limitations and their effects upon stakeholders. This study delves into the impact of ex-post legislative evaluations within the Dutch healthcare system. Building upon insights from previous literature, we aim to refine existing ideas within the field through empirical data. Utilising the realist evaluation method, we examine three distinct case studies followed by a cross-case analysis. Our research underscores that the impact of these evaluations extends beyond policy and politics to the broader societal arena. Our findings also point towards opportunities for strengthening the impact of ex-post legislative evaluations within this broader societal arena. Specifically, we identify strategic phases within the evaluation process through which we aim to maximise impact. Finally, the study emphasises the importance of context awareness, the strategic utilisation of research quality as well as interactional factors for enhancing impact.

Background: The involvement of patients or next of kin (P/N) after a serious adverse event (SAE) is evolving. Beyond providing mandatory information, there is growing recognition of the need to incorporate their interests. This study explores practical manifestations of P/N involvement and identifies significant considerations for hospitals. Methods: The data collection involved various qualitative research methods: 7 focus groups with 56 professionals from 37 hospitals, an interview with 2 representatives from the Dutch Association of Hospitals, and an interactive reflection seminar with over 60 participants from 34 hospitals. Before the focus groups, a brief questionnaire was sent out to survey participants’ practices regarding into SAE investigations. After the study, another questionnaire was distributed to gather suggestions for future improvements and to identify their lessons learned. Thematic analysis was applied to the gathered data to identify key themes. Results: Hospitals are increasingly acknowledging the interests and perspectives of P/N, recognizing their potential contributions to organizational learning and improvement. P/N involvement following SAEs includes active participation in different stages of the investigation process, not just passive information dissemination. Important factors influencing involvement are the provision of (emotional) support, identification of needs, and transparency of the SAE investigation. Conclusions: This study enhances understanding of evolving practices surrounding P/N involvement in the context of SAEs in Dutch hospitals. The findings highlight the importance of promoting meaningful involvement, recognizing the significance of P/N experiences, and fostering a culture of transparency and collaboration. By examining the dynamics of involvement, this research aims to inform policy development and facilitate the implementation of patient-centered approaches to post-SAE care.

BACKGROUND Digitalization of health care services drives people to seek support in utilizing e-health. In the Dutch context, support is offered by public libraries through an e-health course. There is limited insight into the motivation of citizens to seek formal support in e-health use. OBJECTIVE This is a qualitative study on motivations of citizens participating in an e-health course offered by public libraries. The aim of the study was to explore why citizens were motivated to seek formal support for e-health use, and whether this varied between participants with different educational backgrounds. METHODS Twenty interviews with participants in an e-health course were conducted in seven public libraries across the Netherlands. The interviews were conducted between April and June 2022. The interviews covered participants’ motivations, attitudes, and experiences with e-health use and their motivations to seek help for e-health use. A comprehensive thematic data analysis was conducted. RESULTS The participants were aged 51 to 82 years of age (average 73.5 years of age) and 14 (70%) participants were female. Three motivational themes were identified: 1) adapting to an increasingly digital society, 2) sense of urgency facilitated by prior experience in health care, and 3) a need for self-reliance and autonomy. The second theme was observed more often among participants with a low educational background. Additionally, participants expressed a general desire for social contact and lifelong learning. A lack of adequate informal support by friends and family for digital skills and positive experiences with formal support by public libraries stimulated the participants to seek formal support for e-health use. CONCLUSIONS This study indicates that participants seeking formal support for e-health use in public libraries were mainly older adults, driven by their prior health care experience and by a desire to independently engage in a digital society. Persons with a lower educational background were more often motivated by the former. Future research should explore the needs and attitudes of non-users of digital health towards the development of digital health skills.

This article explores the factors that influence the impact of ex-post legislative evaluations and suggests that these factors can be divided into three main categories: context, research quality, and interaction. Contextual factors, including the evaluation’s initiation, it’s place in the legislative process, the varied functions given by stakeholders, and the level of political or social attention, are beyond researchers’ control. However, researchers can influence research quality and interaction with stakeholders, such as the evaluations’ commissioner, as well as the society at large, thereby increasing the likelihood of achieving impactful results. They should engage with the evaluation context to improve impact, but must also maintain independence while being influenced by the context. These findings are in line with the much broader literature on the impact of policy and programme evaluations which pays less attention to the policy instrument legislation. Therefore, both disciplines have an interest in a better exchange of knowledge.

Background: Recent studies on the impact of ex-post legislative evaluations show that there are different types of impact and different factors that can influence it. These include the context of a legislative evaluation, research quality, and interactions between researchers and other actors within the evaluation process. However, thorough empirical research in this area is lacking. This warrants empirical research into the factors that influence the impact of ex-post legislative evaluations, so these insights can be used to increase the likelihood of ex-post legislative evaluations having an impact. Methods and analysis: In this protocol, we report on the realist evaluation methodology that will be used to evaluate the impact of three ex-post legislative evaluations in the Dutch healthcare sector. The mixed methods realist evaluation approach will facilitate this theory-driven, qualitative research. The study will consist of the following three steps: (1) Initial programme theory development, (2) theory validation, and (3) theory refinement. Knowledge from two scoping reviews conducted previously, and two subsequent expert meetings will form the basis for developing the initial programme theory. During this study, three case studies will be conducted, in which three individual ex-post legislative evaluations will be examined. Specific methods for data collection will include: documentary review, observation, structured questionnaires and focus group discussions with purposefully identified key stakeholders. Using the framework approach, the data will be analysed thematically in a within-case analysis followed by a cross-case analysis. Discussion: This protocol provides insight into how the study will be conducted. As this study uses multiple qualitative research methods to answer one question, this protocol supports refining data collection procedures. Careful consideration of the approach beforehand can minimise pitfalls, reduce publication bias and improve reproducibility. The protocol therefore specifies how the research question will be answered in detail, and this provides solid guidance for the research process.

BACKGROUND There is a growing concern that digital health care may exacerbate existing health disparities. Digital health care or eHealth encompasses the digital apps that are used in health care. Differences in access, use, and perceived benefits of digital technology among socioeconomic groups are commonly referred to as the digital divide. Current research shows that people in lower socioeconomic positions (SEPs) use eHealth less frequently. OBJECTIVE This study aims to (1) investigate the association between SEP and eHealth access to, use of, and perceived benefit within the adult Dutch population and (2) evaluate disparities in eHealth access, use, and perceived benefit through three socioeconomic variables—education, standardized income, and the socioeconomic status of the neighborhood. METHODS A secondary analysis was conducted on data from the Nivel Dutch Health Care Consumer Panel (response rate 57%, 849/1500, to assess access to, use of, and perceived benefits from eHealth. These data were collected to monitor eHealth developments in the Netherlands. eHealth was examined through two concepts: (1) eHealth in general and (2) websites, apps, and wearables. Results were stratified into 9 SEP populations based on 3 indicators—education, standardized income, and socioeconomic status level of the neighborhood. Logistic regression analyses were performed to evaluate whether the outcomes varied significantly across different SEP groups. Age was included as a covariate to control for confounding. RESULTS This study confirms the association between eHealth and SEP and shows that low SEP respondents have less access (odds ratio [OR] 5.72, 95% CI 3.06-10.72) and use (OR 4.96, 95% CI 2.66-9.24) of eHealth compared to medium or high SEP respondents. Differences were most profound when stratifying for levels of education. CONCLUSIONS The access to and use of eHealth has a socioeconomic gradient and emphasizes that SEP indicators cannot be used interchangeably to assess eHealth access and use. The results underline the importance of activities and policies aimed at improving eHealth accessibility and usage among low SEP groups to mitigate disparities in health between different socioeconomic groups.

In various countries, laws are increasingly being evaluated by examining the effects in practice once a law enters into force. No systematic overview currently exists on the impact of these ex-post legislative evaluations. Therefore, this scoping review systematically examines the various types of impact of ex-post legislative evaluations. The studies we looked at demonstrate different types of impact that can be divided into the following seven categories: knowledge and understanding; confirmation of well-functioning legislation; legislative revision; influence on the legislative process; influence on the policy process; influence in the political sphere; and influence on society. The various types of impact are sometimes interrelated and can exist in various degrees. At the national and European levels, legislative revision and the tactical use of evaluation results in the political sphere, are the two most often mentioned categories. In contrast, the impact on society category is rarely mentioned.