Biomedical subjects

J Brug

Publications and source records attributed to J Brug.

At least 37 records · Page 2Linked to original sources

PubMed2004

The positive effect on determinants of physical activity of a tailored, general practice-based physical activity intervention.

PACE (Physician-based Assessment and Counseling for Exercise) is an individualized theory-based minimal intervention strategy aimed at the enhancement of regular physical activity. The aim of this study was to evaluate the effectiveness of a PACE intervention applied by general practitioners (GPs) on potential determinants of physical activity. A randomized controlled trial was conducted in 29 general practices with the following inclusion criteria for patients: aged between 18 and 70 years, diagnosed with hypertension, hypercholesterolemia and/or non-insulin-dependent diabetes mellitus, and not in maintenance stage for regular physical activity. The intervention consisted of two visits with the GP and two telephone booster calls by a physical activity counselor. Determinants of physical activity were assessed with questionnaires at baseline, and at 8-week (short), 6-month (medium) and 1-year (long) follow-up. A significant positive effect was observed on self-efficacy, and on the use of cognitive and behavioral processes of change, at both short- and medium-term follow-up. The intervention respondents also perceived fewer barriers for regular physical activity at short-term and used behavioral processes of change more at long-term follow-up. No intervention effect was observed for perceived benefits of physical activity. In conclusion, this GP-based PACE intervention resulted in positive changes in potential determinants of physical activity.

Adolescent↗

PubMed2004

The impact and evaluation of two school-based interventions on intention to register an organ donation preference.

The present paper describes the impact and evaluation of two intervention components-a video with group discussion and an interactive computer-tailored program-in order to encourage adolescents to register their organ donation preference. Studies were conducted in school during regular school hours. The video with group discussion in class had a positive impact on the intention to register an organ donation preference as well as on the intention to register as a posthumous organ donor. The computer-tailored program had no surplus value when compared to reading an extensive brochure with general information on organ donation. However, participants appreciated the tailored information more than the brochure. It may be that having provided general information before exposure to the tailored program, the tailored intervention will be more effective. This needs to be tested in a further experiment.

Adolescent↗

PubMed2004

Process evaluation of a school-based education program about organ donation and registration, and the intention for continuance.

This paper describes the process evaluation of an organ donation education program for high school students aged 15-18 years of which the effectiveness was established. The program consisted of three components: a video with group discussion, an interactive computer-tailored program and a registration training session. A cross-sectional survey was conducted among 50 teachers who had recently worked with the program. The results show that all teachers reported to have implemented at least two of the three intervention components, while a majority of teachers reported to have implemented all components. Teachers' attitudes toward the program were generally positive. They reported that the opinions of students and colleagues in their own department were most influential in their decision to provide the education program. Furthermore, teachers were very confident about their ability to apply the different parts of the education program. The educational quality of the program was evaluated as moderately positive and almost all teachers had the intention to use the program again in the future. Because of the positive evaluations and intentions for future implementation by teachers, and justified by its previously established effectiveness, the education program should be considered for large-scale dissemination among high schools in The Netherlands.

Adolescent↗

PubMed2004

Explaining fruit and vegetable consumption: the theory of planned behaviour and misconception of personal intake levels.

The influence of individuals' misconceptions in assessing fruit and vegetable consumption on the ability of the theory of planned behaviour to explain variance in the consumption of these foods was studied. Dutch women (mean age 41, n=159) completed a questionnaire assessing the theory's constructs with regard to the daily consumption of at least two pieces of fruit and 200 gram of vegetables. Consumption was assessed using a self-rated measure and more objectively with a food-frequency questionnaire. Both measures were combined to classify participants according to the accuracy of their self-assessed intake levels ('realists' vs. 'overestimators'). The model explained variation in objective fruit and vegetable intake much better among realists (R2 = 45% for fruits and 39% for vegetables) than among overestimators (R2 = 18% and 5%, respectively). Perceived behavioural control was the strongest predictor of intentions and behaviour. When plasma vitamin C and carotenoid concentrations were used as objective indicators for fruit and vegetable intake, the explanatory value of the model was lower, but again more variance was explained among realists than among overestimators. We conclude that awareness of personal behaviour should be taken into account when applying the theory of planned behaviour to explain dietary behaviours as well as to design health education interventions.

Adult↗

PubMed2003

Why do diabetic patients not attend appointments with their dietitian?

PURPOSE: Determining the prevalence of and possible reasons for nonattendance of diabetic nutritional care clinics. METHODS: Data were collected by means of a telephone survey and a review of patient records among 293 (166 attendees and 127 nonattendees) patients undergoing outpatient treatment at a university hospital. The t-tests, chi-square tests and logistic regression analysis were used to identify potential determinants of nonattendance. The theoretical framework was primarily based on the Health Belief Model. RESULTS: In univariate analysis, nonattendance at the clinic was associated with a number of factors such as not visiting other care givers, risk perceptions, body-mass index, self-rated health, health locus of control, satisfaction with the dietitian, feelings of obligation to attend, and beliefs about the effectiveness of the treatment. In multivariate analysis only health locus of control and obligation to attend the visit were significant predictors of attendance. A significant number of respondents further reported that they perceived their visits to the dietitian to be of little use. CONCLUSION: One in three diabetic patients undergoing outpatient treatment skipped one or more visits to their dietitian. Patient education to improve attendance should focus primarily on convincing patients that they can contribute to their own health, and may stress the obligation the patients have when making an appointment with the dietitian.

Adolescent↗

PubMed2001

Predictors of organ donation registration among Dutch adolescents.

BACKGROUND: In 1998, a new organ donor registration scheme was implemented in the Netherlands in order to increase the number of potential donors and to facilitate decisions and procedures concerning organ donation. However, registration rate and registration choices failed to meet the expectations. METHODS: A cross-sectional survey among a random sample of 1,731 Dutch adolescents of 18 and 19 years was conducted to study potential determinants of organ donor registration choices. RESULTS: Almost one fifth of the adolescents indicated that they did not return their organ donation registration form. Among subjects who registered, 57% were willing to donate their organs or tissues posthumously. More positive social influences, fewer negative outcome beliefs, and a low level of organ donation anxiety were significant predictors of returning a completed registration form and registration as an organ donor. In addition, religion was a significant predictor of returning a completed registration form, and positive outcome beliefs contributed to the prediction of registration as an organ donor. CONCLUSIONS: The results give clear suggestions for tailoring organ donation registration interventions to specific characteristics, beliefs, and misconceptions of adolescents. The results also suggest that it is important to encourage adolescents to discuss issues related to organ donation with their parents and friends in order to increase donor registration.

Adolescent↗

PubMed2001

Determinants of the intention of Dutch adolescents to register as organ donors.

This article identifies relevant predictors of willingness among Dutch adolescents to register as posthumous organ and tissue donors. A cross-sectional survey was conducted among 1836 Dutch adolescents between 16 and 18 years of age who had not yet been approached for registration. Sixty-seven percent of the participants indicated that they were willing to register as organ donors. In order of greatest association, negative outcome beliefs, anxiety, social outcome expectations, involvement with organ donation issues, positive outcome beliefs, knowledge about organ donation registration, past behaviour, and sex were significant predictors of the willingness to register as organ donor. Religion and level of education had a significant bi-variate correlation with intention, but were not significant predictors after controlling for other variables. The results give clear suggestions for tailoring organ donation registration interventions to specific characteristics, beliefs and misconceptions of adolescents.

Adolescent↗

PubMed2001

A checklist to improve patient education in a cardiology outpatient setting.

A randomised controlled trial with process evaluation was conducted (n=103) to study the use and impact of a Frequently Asked Questions checklist as a means to prepare coronary outpatients for a regular visit to their cardiologist. It was hypothesised that use of the checklist would result in better patient-doctor communication, lower state anxiety and higher knowledge scores among patients, resulting in greater patient satisfaction. The patients in the experimental group (n=53) received the checklist, with written instructions in addition to a brochure from the Dutch Heart Foundation, at home to prepare for their visit. The control patients only received the brochure. State anxiety immediately before the visit was significantly lower among experimental patients. No significant differences in patient satisfaction or knowledge were found. Using the checklist did not result in longer patient-doctor consultations. Experimental patients regarded the checklist as a useful tool to prepare for their visits to the clinic. We conclude that the checklist may be a useful tool for cardiac patients to prepare for their visits to their cardiologist.

Analysis of Variance↗

PubMed2001

The relative validity of a short Dutch questionnaire as a means to categorize adults and adolescents to total and saturated fat intake.

BACKGROUND: To assess the relative validity of a short food frequency questionnaire, the Fat list, to be used in (the evaluation of) nutrition education programmes. METHODS: Forty-five adults and 50 adolescents (12-18 years old) completed the Fat list at home, and subsequently kept diet records for seven subsequent days. RESULTS: Pearson correlations of about 0.7 for adults and 0.6 for adolescents were observed between fat scores derived from the Fat list and total and saturated fat intake in grams estimated by the 7-day diet records. Correlations varied among subpopulations based on sex, age, education, household size and responsibility for cooking and shopping. Lower correlations were especially found for female adolescents and older adolescents (16-18 years old). Pearson correlations between the Fat list and percentages energy from fat were low for both adults and adolescents. Gross misclassification, defined as disagreement between the two fat consumption assessments beyond an adjacent tertile, was less than 6% for all but the female adolescents. CONCLUSIONS: The Fat list can be used in adult and male adolescent populations to classify subjects in broad categories of total and saturated fat intake in grams and to assess differences in absolute and saturated fat intake between groups as a result of nutrition education programmes.

Adolescent↗

PubMed2001

Framing of nutrition education messages in persuading consumers of the advantages of a healthy diet.

BACKGROUND: Educational dietary messages can stress either the positive consequences of performing a recommended dietary behaviour (positive frame) or the negative consequences of not performing a recommended dietary behaviour (negative frame). From studies on other health behaviours, there is evidence that positive frames have a stronger impact in encouraging preventive behaviours than negative frames. The main hypothesis of the present study was therefore that positively framed messages on eating a low-fat diet and eating enough fruit and vegetables (F & V) are more persuasive than negatively framed messages. METHODS: In a 2 (Frame: positive vs. negative) x 2 (Dietary behaviour: fat vs. F & V) design, 152 adult respondents randomly received one of four messages. Subsequently, they completed a questionnaire measuring cognitive attitude, affective attitude and intention to change the dietary behaviours. RESULTS: No significant differences in attitudes and intentions were found between the positive frame conditions and the negative frame conditions. CONCLUSIONS: Based on the current study no advice can be given yet to dietitians and other nutrition educators about whether they should emphasize the positive consequences of a dietary change or the negative consequences of not making the dietary change.

Adult↗

PubMed2001

Stages of change, psychological factors and awareness of physical activity levels in The Netherlands.

The purpose of this study was to investigate physical activity levels, stages of change, awareness, and differences in psychological factors relating to physical activity in an adult Dutch population, in order to identify specific objectives for physical activity promotion. Physical activity levels, self-rated physical activity, stages of change, awareness, attitudes, social influences and self-efficacy relating to physical activity were assessed among a random sample of 2608 adults using structured questionnaires. Almost 60% of the respondents did not meet the recommended target for physical activity to promote health. Half of these respondents were in the pre-contemplation stage, and >60% were overestimating their physical activity level. Furthermore, respondents who were not aware of their inadequate physical activity level had a less positive intention to increase their level of physical activity than those who rated their own physical activity level as low. Respondents in the pre-contemplation and maintenance stages had a less positive attitude, perceived less social support and had lower self-efficacy expectations towards increasing physical activity than those in the contemplation, preparation and action stages. The results suggest that interventions aimed at increasing physical activity in the studied population should be aimed at increasing awareness of personal activity levels and should be stage-matched.

Adolescent↗

PubMed2001

Evoked fear and effects of appeals on attitudes to performing breast self-examination: an information-processing perspective.

The effect of fear arousal on attitude toward participating in early detection activities [i.e. breast self-examination (BSE)] was studied from an information-processing perspective. It was hypothesized that fear arousal motivates respondents to more argument-based processing of fear-relevant persuasive information. Respondents first read information about breast cancer in which fear was manipulated. After measuring fear arousal, respondents read a persuasive message about performing BSE. Analyses with reported fear, but not manipulated fear, found support for the hypothesis. Respondents who reported mild fear of breast cancer based their attitude toward BSE more on the arguments provided than respondents who reported low fear of breast cancer. This finding suggests that the use of fear arousal may be an efficient tool in health education practice. However, alternative interpretations are provided, in addition to the suggestion to be careful with using fear arousal in health education messages.

Adult↗

PubMed2001

Web-based tailored nutrition education: results of a randomized controlled trial.

There is ample evidence that printed, computer-tailored nutrition education is a more effective tool for motivating people to change to healthier diets than general nutrition education. New technology is now providing more advanced ways of delivering tailored messages, e.g. via the World Wide Web (WWW). Before disseminating a tailored intervention via the web, it is important to investigate the potential of web-based tailored nutrition education. The present study investigated the immediate impact of web-based computer-tailored nutrition education on personal awareness and intentions related to intake of fat, fruit and vegetables. A randomized controlled trial, with a pre-test-post-test control group design was conducted. Significant differences in awareness and intention to change were found between the intervention and control group at post-test. The tailored intervention was appreciated better, was rated as more personally relevant, and had more subjective impact on opinion and intentions to change than the general nutrition information. Computer literacy had no effect on these ratings. The results indicate that interactive, web-based computer-tailored nutrition education can lead to changes in determinants of behavior. Future research should be aimed at longer-term (behavioral) effects and the practicability of distributing tailored interventions via the WWW.

Adult↗

PubMed2000

Differences in use and impact of computer-tailored dietary fat-feedback according to stage of change and education.

Computer-tailored written nutrition education has been found to be more effective in motivating people to reduce their consumption of fat than traditional written information. The present study aimed to test whether this innovative nutrition education intervention is also suitable for people with low motivation to change and low education among a self-selected sample of 699 adults. Computer-tailored feedback proved to be more effective in motivating precontemplators to proceed towards fat reduction than general information. Higher appreciation and use of the computer-tailored fat-feedback was found among respondents in contemplation than in other stages. No difference in impact of computer-tailored fat-feedback on fat intake was found between educational groups. Respondents with low education were more positive about how interesting and how personally relevant the tailored letters were. It was concluded that printed computer-tailored fat-feedback can be applied successfully to motivate precontemplators and people with low education to (consider to) reduce their fat intake.

Adult↗

PubMed2000

Tailoring dietary feedback to reduce fat intake: an intervention at the family level.

In this study, we wished to investigate whether the use of tailored nutrition education letters addressed to each family member simultaneously at home could serve as a valuable strategy for nutrition education. Family quartets (both parents and two adolescents, all healthy individuals) were chosen to be the units of intervention. The first aim of our study was to investigate the impact of tailored versus standardized nutrition education on fat intake and on psychosocial determinants of fat intake in families, using a randomized dietary feedback study. Our second aim was to study the differential effect of the tailored nutrition education on different family members. Analyses were conducted among 18 experimental families (n = 72) and 17 control families (n = 68). The tailored intervention was more effective than the nontailored intervention in reducing total and saturated fat intake when all the family members were included (F = 4.0, P < 0.05 and F = 5.9, P < 0.05). However, follow-up analyses revealed that only mothers benefit from the tailored intervention (F = 6.4, P < 0.05 and F = 10.2, P < 0.005). For fathers and adolescents, both interventions resulted in a significant decrease in fat scores. Furthermore, tailored feedback resulted in stronger awareness of personal fat intake and awareness of fat intake of family members. Tailored advice has the potential to communicate the personal need to change. As differences in fat reduction between family members receiving general or tailored nutrition education letters were smaller than expected, future research will have to prove that family-based tailored interventions are more effective than standardized interventions and interventions focusing on a single person. It also needs to be clarified why mothers in particular benefit from tailored feedback.

Adolescent↗

PubMed1999

Computer-tailored interventions motivating people to adopt health promoting behaviours: introduction to a new approach.

This issue of Patient Education and Counseling discusses the development, application and effectiveness of computer-tailored interventions. Computer-tailored interventions are a relatively new health education approach. The interventions are characterised by the fact that the content of the materials is adapted, with the aid of computers, to the specific characteristics of a particular person. The use of computers also facilitates addressing large segments of the population, who can now receive materials that are not general but highly individualized. This thematic issue features papers dealing with a wide range of topics. These articles describe the application of behavioural change theories to this new approach, the advantages of computer-tailored interventions over more general mass media approaches, their effectiveness and future directions for research on computer-tailored interventions. This editorial paper introduces computerised tailoring and provides a brief overview of its elements and applications as well as of the papers in this issue, and summarises the main conclusions and suggestions for future research on computer-tailored interventions.

Attitude to Health↗

PubMed1999

The application and impact of computer-generated personalized nutrition education: a review of the literature.

Computer-tailored nutrition education may be more effective than general nutrition education because messages are tailored to individual behavior, needs and beliefs of subjects. Therefore, the messages are likely to be of more personal relevance and may have stronger motivational effects. Computer-generated nutrition education has been studied for different dietary behaviors, in different target populations, and in different settings. In recent years, eight studies have been published that assessed the impact of comprehensive computer-generated nutrition interventions that were based on behavior change theory. In this article, the process of providing people with computer-tailored nutrition education is described and the studies on the impact of computer-tailored nutrition education are reviewed. The results point to the conclusion that computer-tailored nutrition education is more likely to be read, remembered, and experienced as personally relevant compared to standard materials. Furthermore, computer-tailored nutrition education also appears to have a greater impact in motivating people to change their diet, their fat intake in particular, although at present no definite conclusions can be drawn.

Attitude to Health↗

PubMed1999

Dutch research into the development and impact of computer-tailored nutrition education.

OBJECTIVE: The aim of the present paper is to describe the essential elements of computer-tailored nutrition education and to study the impact of written computer-tailored nutrition education in comparison to general written nutrition advice. DESIGN: The impact of computer-tailored nutrition education was studied in three randomised trials as compared to general nutrition education. The data of the three studies were taken together and re-analysed. SUBJECTS: Random samples of employees at two work sites and a self-selected sample of the Dutch adult population. The total number of subjects was 1309. Response rates were between 45% in one of the work sites and 88% in the self-selected sample. INTERVENTIONS: Subjects in the experimental condition received computer-tailored nutrition education. With computer-tailoring, expert individualised nutrition education can be realised through an automated process for relatively large target groups with relatively low costs per person. MAIN OUTCOME MEASURES: The impact on changes in fat intake were studied. The use and appreciation of the intervention was also assessed. RESULTS: Subjects who received computer-tailored advice had a lower mean fat score at post-test, adjusted for baseline intake levels. Subjects who received tailored advice were more likely to have read and discussed the nutrition advice. CONCLUSION: The results point to the conclusion that printed computer-tailored nutrition education is superior to general written nutrition education.

Adult↗