Introduction One of the challenges faced by hospitals during the coronavirus disease 2019 (COVID-19) pandemic is resource shortages in intensive care units (ICUs). In times of scarcity, patient prioritization based on non-medical considerations might be necessary. Objective The aim of this study was to pilot test a survey to elicit public opinions on the relative importance of non-medical considerations in priority setting when admitting patients to the ICU in times of crisis. Methods A discrete-choice experiment was used to collect social preferences for priority setting when admitting patients to the ICU during the COVID-19 pandemic. The six attributes were patient age, profession, guardianship, risk-conscious behavior on a societal level, health-conscious behavior, and expected ICU length of stay. The data were analyzed using a mixed multinomial logit model. Interactions between the age and profession of the respondents and the age and profession of the patient profiles were considered. Results The mean (± standard deviation) age of respondents was 35.9 ± 14.5 years. In all, 70% of respondents indicated that medical and/or non-medical considerations should play a role in prioritizing patients for the ICU, whereas 15% agreed with a "first come, first served" strategy and the remaining 15% had no opinion. Respondents deemed risk-conscious behavior on a societal level to be the most important non-medical factor that should be used to prioritize patients in phase three of the framework, garnering an attribute importance (AI) of 31.2%, followed by patient age (AI 16.3%) and health-conscious behavior (AI 16.0%). ICU length of stay had the lowest impact on patient prioritization for ICU admittance (AI 10.9%). Younger and older respondents attached more importance to age than respondents in the middle age group and indicated a stronger preference to prioritize patients in their own age group (p = 0.042). ConclusionThe results of our study demonstrate the relative importance members of the public attach to responsible societal behavior during the COVID-19 pandemic. In the next phase of the study, we will elicit the perspectives of a representative sample of the Dutch population. Changes to the task design and attribute operationalization could improve the external validity of the study findings, and optimization of the experimental design will improve the internal validity of the study.
The lack of adoption of eMental Health technologies by people with severe mental illness (SMI) might be explained by a mismatch between technology design and users' skills, context and preferences. Co-design can optimize this fit, but populations labelled as 'vulnerable' are often excluded or misrepresented. The goal of this study is to gain insight into best-practices for co-design with people with SMI. A qualitative, multi-method approach was used, consisting of a systematic scoping review of 21 included studies, 25 co-design expert surveys and six participant interviews. The results delivered 23 best-practices divided into four overarching aspects of co-design, namely: (1) activities to carry out before the start of a co-design study; (2) fruitful collaboration of the co-design team; (3) bespoke approach within co-design to accommodate the skills and abilities of SMI participants; and (4) mitigation of challenges surrounding power balance. The bestpractices may help researchers and designers offer the SMI population a more specialized approach for co-design, which can cause the innovative output of eMH projects to be more effective and better adopted. Throughout the co-design process, more attention should be paid to the personal and clinical benefits of participation for the participants themselves.
Background. Ever since 2020, traveling has become complex, and increasingly so as the COVID-19 pandemic continues. To reopen Europe safely, a consensus of travel measures has been agreed between countries to enable movement between countries with as few restrictions as possible. However, communication of these travel measures and requirements for entry are not always clear and easily available. The aim of this study was to assess the availability, accessibility, and harmonization of current travel information available in Europe. Methods. We performed a systematic documental analysis of online publicly available information and synthesized travel entry requirements for all countries in the European Union and Schengen Area (N= 31). For each country we assessed entry requirements, actions after entry, how risk was assessed, and how accessible the information was. Results. We found varying measures implemented across Europe for entry and a range of exemptions and restrictions, some of which were consistent between countries. Information was not always easy to find taking on average 10 clicks to locate. Twenty-one countries required pre-travel forms to be completed. Forty apps were in use, eleven serving as digital certification checkers. All countries required some form of COVID-19 certification for entry with some exemptions (e.g. children). Nineteen percent (n=6) of countries used the ECDC risk assessment system; 80% (n=25) defined their own. Forty-eight percent (n=15) of countries used a traffic light system with 2 to 5 risk classifications. Conclusion. A comprehensive set of measures has been developed to enable continued safe travel in Europe. However further refinements and coordination is needed to align travel measures throughout the EU to minimize confusion and maximize adherence to requested measures. We recommend that, along with developing travel measures based on a common set of rules, a standard approach is taken to communicate what these measures are.
BACKGROUND Lack of physical activity (PA) is a common issue with detrimental consequences for the health of people with severe mental illness (SMI). Existing PA interventions show suboptimal effects because they require substantial cognitive skills, including goal setting and writing, while cognitive deficits are common in this population. To bolster the effectiveness of PA interventions, self-control training (SCT), in which users practice the ability to override unwanted thoughts and behaviors, can be used as an addition. Recent research has demonstrated initial effectiveness of a mobile self-control training app, but this has not been studied in psychiatric clinical practice. OBJECTIVE The aim of this study is to evaluate to what extent adding a mobile self-control app designed for and with people with SMI to an existing PA intervention increases physical activity and self-control levels. METHODS A mixed-methods approach incorporating two single-case experimental designs (SCED) and qualitative interviews is used to evaluate and optimize SCT. 12 participants with SMI will be recruited from two organizations that offer inpatient care to people with SMI. In each experiment 6 inpatients will be included. SCED I is a concurrent multiple-baseline design across participants, which explores initial effectiveness and optimal intervention duration. Using accelerometry and experience sampling questionnaires, participants’ physical activity and self-control will be monitored for at least 5 days of baseline. This is followed by sequential introduction of Google Fit, a PA intervention for 7 days, and the addition of SCIPP: the Self Control Intervention aPP, used for 28 days. SCED II is an introduction/withdrawal design, in which optimized self-control training will be introduced and withdrawn to validate findings from SCED I. In both experiments, daily average of total activity counts per hour and state level of self-control will serve as the primary and secondary outcome measures. Data will be analyzed using visual analysis and piecewise linear regression models. RESULTS The study has been designated as not subject to the Dutch Medical Research Involving Human Subjects Act by the Medical Research Ethical Committee Oost Nederland and has been approved by the University of Twente Ethical Committee Behavioral, Management and Social Sciences. Recruitment for the study has started January 2022 and we expect to publish the results early 2023. CONCLUSIONS The mobile self-control training app is expected to be feasible and effective. It is self-paced, scalable, and can increase patient motivation, making it a suitable intervention to target people with SMI. SCED is a relatively novel yet very promising method for gaining insight into if and how mobile apps work, which can handle heterogenous samples and makes it possible to involve the diverse population of people with SMI without having to include a large number of participants. CLINICALTRIAL Central Committee on Research involving Human Subjects (CCMO Toetsingonline) NL79450.091.21.
Background Lack of physical activity is a common issue with detrimental consequences for the health of people with severe mental illness (SMI). Existing physical activity interventions show suboptimal effects as they require substantial cognitive skills, including goal setting and writing, whereas cognitive deficits are common in this population. To bolster the effectiveness of physical activity interventions, self-control training (SCT), in which users practice the ability to override unwanted thoughts and behaviors, can be used in addition. Recent research has demonstrated the initial effectiveness of a mobile SCT app, but this has not been studied in psychiatric clinical practice. Objective This study aims to evaluate to what extent adding a mobile SCT app designed for and with people with SMI to a mobile lifestyle intervention aimed at increasing physical activity increases physical activity and self-control levels. Methods A mixed methods approach incorporating 2 single-case experimental designs (SCEDs) and qualitative interviews was used to evaluate and optimize SCT. Overall, 12 participants with SMI will be recruited from 2 organizations offering outpatient and inpatient care to people with SMI. Each experiment will include 6 patients. SCED I is a concurrent multiple-baseline design across participants that explores initial effectiveness and optimal intervention duration. Using accelerometry and experience sampling questionnaires, participants’ physical activity and self-control will be monitored for ≥5 days from baseline, followed by the sequential introduction of Google Fit, the physical activity intervention, for 7 days and the addition of SCIPP: Self-Control Intervention App for 28 days. SCED II is an introduction/withdrawal design in which optimized SCT will be introduced and withdrawn to validate the findings from SCED I. In both experiments, the daily average of total activity counts per hour and the state level of self-control will serve as the primary and secondary outcome measures. Data will be analyzed using visual analysis and piecewise linear regression models. Results The study was designated as not subject to the Dutch Medical Research Involving Human Subjects Act by the Medical Research Ethical Committee Oost-Nederland and approved by the Ethics Committee/domain Humanities and Social Sciences of the Faculty of Behavioural, Management, and Social Sciences at the University of Twente. Participant recruitment started in January 2022, and we expect to publish the results in early 2023. Conclusions The mobile SCT app is expected to be feasible and effective. It is self-paced and scalable and can increase patient motivation, making it a suitable intervention for people with SMI. SCED is a relatively novel yet promising method for gaining insights into whether and how mobile apps work that can handle heterogeneous samples and makes it possible to involve a diverse population with SMI without having to include a large number of participants. International Registered Report Identifier (IRRID) PRR1-10.2196/37727
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