Background: Inaccurate self-report of portion sizes is a major cause of measurement error in dietary assessment. To reduce this error, different portion size estimation aids (PSEAs) have been developed, including food images (image based, IB-PSE) and textual descriptions of portion sizes (text-based, TB-PSE). We assessed the accuracy of portion size estimation by IB-PSE and TB-PSE.Methods: True intake of one lunch was ascertained in forty participants. Selfreported portion sizes were assessed after 2 and 24 hours by means of TB-PSE and IB-PSE, in random order. Wilcoxon's tests were used to compare mean true intakes to reported intakes. Moreover, proportions of reported portion sizes within 10% and 25% of true intake were assessed. An adapted Bland-Altman approach was used to assess agreement between true and reported portion sizes. Analyses were conducted for all foods and drinks combined and for predetermined food types.Results: No significant differences were observed between reported portion sizes at 2 and 24 hours after lunch. Combining median relative errors of all foods items resulted in an overall 0% error rate for TB-PSE and 6% error rate for IB-PSE. Comparing reported portion sizes within 10% (31% vs. 13%) and 25% (50% vs. 35%) of the true intake showed a better performance for TB-PSE compared to IP-PSE, respectively. Bland-Altman plots indicated a higher agreement between reported and true intake for TB-PSE compared to IB-PSE. Conclusions:Although the use of TB-PSE still results in measurement error, our results suggest a more accurate dietary intake assessment with TB-PSE than IB-PSE.
Due to the COVID-19 pandemic, a sudden shift was warranted from face-to-face to digital interviewing. This shift is in line with the existing trend of digitalization. However, limited literature is available on how to conduct focus group interviews online successfully. This research note provides practical guidelines, tips, and considerations for setting up and conducting online synchronous focus groups for eight relevant factors: preparation, the number of participants, the duration, a break, the usability of the online platform, the interaction between participants and researchers, support and roles of the research team, and privacy considerations. These guidelines were formulated based on the available literature and our own positive hands-on experiences. We consider online focus groups to be an excellent option when taking into account the considerations related to the eight factors.
Introduction:We investigated the main effects of shift work and sleep duration on cancer incidence, and effect modification of the shift work-cancer incidence association by sleep duration. Methods: Shift work and sleep duration were assessed among 21,804 participants from Alberta`s Tomorrow Project. Incident cases of breast, prostate, colorectal and lung cancers were identified through registry linkage. Results: Having worked ≥6 years of rotating shift work (HR = 1.59, 95 % CI = 1.07, 2.37; P = 0.02) and having ever worked night shifts were associated with an increased risk of lung cancer (HR=1.71, 95 % CI=1.18, 2.47; P = 0.01), whereas having ever worked night shifts was associated with a reduced risk of prostate cancer in the latency-adjusted model only (HR=0.70, 95 % CI=0.51, 0.98; P = 0.04). No associations were found between shift work or sleep duration on the risks of breast and colorectal cancers. Some evidence of effect modification by sleep duration for the rotating shift work-lung cancer incidence association was noted (P = 0.06), with stratified analyses revealing borderline increased risk of lung cancer in participants with ≥6 years of rotating shift work and <7 h of sleep/day (HR=2.27, 95 % CI=0.95, 5.41; P = 0.07), and an increased risk of lung cancer in participants with 0.1−5.9 years of rotating shift work and >9 h of sleep/day (HR=2.99, 95 % CI=1.12, 7.97; P = 0.03). No additional evidence of effect modification by sleep duration for shift work and cancer incidence was noted. Discussion: A consistent association between shift work employment and lung cancer risk was noted in this Canadian sample. Furthermore, some evidence of effect modification of the rotating shift work-lung cancer risk association by sleep duration was noted.
Lessons learned from a digital health budget as an innovative way to improve population health: an evaluation study
Introduction:The pressure on general practitioners (GPs) is rising due to an ageing population and an increasing prevalence of chronic diseases. The use of eHealth is suggested to increase the accessibility of healthcare, with the additional potential of lowering costs. 'Flexdoctors' is a concept for general practices that incorporates eHealth in the organizational aspects of the practice. Flexdoctors uses digital communication and remote healthcare delivery. Via a web application, patients can schedule their appointments, send e-consults, chat with a GP, reorder medication for chronic conditions and view their patient files. First contact (i.e., triage) and telephone consults are with the GP.Objective & Methods: This study aimed to provide insight into patient and healthcare professional experiences. The primary study outcomes were acceptability, the implementation process, suggestions for improvement, and facilitators and barriers for future implementation.A mixed-methods design was used. Online questionnaires and focus groups were used to identify patient perspectives, and in-depth interviews with healthcare professionals identified their perspectives. Participants were from three general practices that implemented this concept over a half year ago. Overall acceptability in patients was assessed on a 5-point Likert scale and satisfaction with the Client Satisfaction Questionnaire-8. All primary outcomes were qualitatively assessed in patients and healthcare professionals.
Background eHealth has the potential to improve health outcomes. However, this potential is largely untapped. Individuals face an overload of apps and have difficulties choosing suitable apps for themselves. In the FitKnip experiment, individuals were given access to a health app platform, where they could purchase reliable preselected health apps with a personal budget of €100 (US $107.35). By conducting a prospective study, we aimed to scientifically evaluate the FitKnip experiment as an innovative way to improve population health. Objective The aim of the experiment was to scientifically evaluate the FitKnip experiment as an innovative way to improve population health. More specifically, we conducted an in-depth qualitative evaluation of the concept and acceptability of FitKnip, its perceived impact on health empowerment, as well as the roles of stakeholders for the future implementation of a health app platform through focus group interviews. Methods This study followed a phenomenological research design and included 7 focus group interviews with end users and 1 with stakeholders, held between July and December 2020. End users were recruited through various institutions in the Netherlands, for example, insurance companies and local governments. All focus groups were semistructured using interview guides and were held via videoconferencing due to the COVID-19 pandemic measures. Each participant received access to a health app platform where they were enabled to purchase reliable, preselected health apps with a budget of €100 (US $107.35). The budget was valid for the entire research period. The health app platform offered 38 apps. A third party, a health care coalition, selected the apps to be included in FitKnip. The analyses were conducted according to the principles of the Framework Method. Results A priori formulated themes were concept, acceptability, health empowerment, and outcomes, and the roles of stakeholders for the future implementation of a health app platform. Both end users (n=31) and stakeholders (n=5) were enthusiastic about the concept of a health app platform. End users indicated missing apps regarding physical health and lifestyle and needing more guidance toward suitable apps. End users saw health empowerment as a precondition to using a health app platform and achieving health outcomes depending on the purchased mobile apps. End users and stakeholders identified potential providers and financing parties of FitKnip. Stakeholders recommended the establishment of a reputable national or international quality guidelines or certification for health and wellbeing apps, that can demonstrate the quality and reliability of mobile health applications. Conclusions This study showed the need for a personalized and flexible platform. Next to this, a deeper understanding of the roles of stakeholders in such initiatives is needed especially on financing and reimbursement of health promotion and digital health services. A personalized, flexible health app platform is a promising initiative to support individuals in their health.
BACKGROUND eHealth has the potential to improve health outcomes. However, this potential is largely untapped. Individuals face an overload of apps and have difficulties choosing suitable apps for themselves. In the FitKnip experiment, individuals were given access to a health app platform, where they could purchase reliable preselected health apps with a personal budget of 100 euros. OBJECTIVE The aim of this study was to scientifically evaluate the health app platform as an innovative way to improve population health on concept, feasibility, acceptability, perceived impact on health, and health empowerment. METHODS This study included seven focus group interviews with end-users and one with stakeholders. All focus groups were semi-structured using interview guides. The analyses were conducted according to the principles of the Framework Method. Identified themes were concept, acceptability, health empowerment and outcomes, and future implementation. RESULTS Both end-users and stakeholders were enthusiastic about the concept of a health app platform. End-users indicated missing apps regarding physical health and lifestyle and needing more guidance towards suitable apps. End-users and stakeholders identified potential providers of FitKnip. Stakeholders suggested a trusted National quality mark to show FitKnip and the provided apps are safe. CONCLUSIONS This study showed the need for a personalized and flexible platform. Next to this, a deeper understanding of the roles of stakeholders in such initiatives is needed especially on financing and reimbursement of health promotion and digital health services. A health app platform is a promising innovative initiative to enhance public health. CLINICALTRIAL The FitKnip study was declared to not fall within the scope of the Dutch Medical Research Involving Human Subjects Act by the medical ethics committee of Leiden, Den Haag, Delft (N19.0878).
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