eHealth program to empower patients in returning to normal activities and work after gynecological surgery: intervention mapping as a useful method for development

Antonie Vonk Noordegraaf, Judith A F Huirne, Carina A Pittens, Willem van Mechelen, Jacqueline E W Broerse, Hans A M Brölmann, Johannes R Anema, Antonie Vonk Noordegraaf, Judith A F Huirne, Carina A Pittens, Willem van Mechelen, Jacqueline E W Broerse, Hans A M Brölmann, Johannes R Anema

Abstract

Background: Full recovery after gynecological surgery takes much longer than expected regardless of surgical technique or the level of invasiveness. After discharge, detailed convalescence recommendations are not provided to patients typically, and postoperative care is fragmented, poorly coordinated, and given only on demand. For patients, this contributes to irrational beliefs and avoidance of resumption of activities and can result in a prolonged sick leave.

Objective: To develop an eHealth intervention that empowers gynecological patients during the perioperative period to obtain timely return to work (RTW) and prevent work disability.

Methods: The intervention mapping (IM) protocol was used to develop the eHealth intervention. A literature search about behavioral and environmental conditions of prolonged sick leave and delayed RTW in patients was performed. Patients' needs, attitudes, and beliefs regarding postoperative recovery and resumption of work were identified through focus group discussions. Additionally, a literature search was performed to obtain determinants, methods, and strategies for the development of a suitable interactive eHealth intervention to empower patients to return to normal activities after gynecological surgery, including work. Finally, the eHealth intervention was evaluated by focus group participants, medical doctors, and eHealth specialists through questionnaires.

Results: Twenty-one patients participated in the focus group discussions. Sufficient, uniform, and tailored information regarding surgical procedures, complications, and resumption of activities and work were considered most essential. Knowing who to contact in case of mental or physical complaints, and counseling and tools for work reintegration were also considered important. Finally, opportunities to exchange experiences with other patients were a major issue. Considering the determinants of the Attitude-Social influence-self-Efficacy (ASE) model, various strategies based on a combination of theory and evidence were used, resulting in an eHealth intervention with different interactive functionalities including tailored convalescence recommendations and a video to communicate the most common pitfalls during the perioperative period to patients and employers. Fifteen patients in the focus groups, 11 physicians, and 3 eHealth specialists suggested points for improvement to optimize the usability of the eHealth intervention and judged it an approachable, appropriate, and attractive eHealth intervention to empower gynecological patients.

Conclusions: The IM protocol was a useful method to develop an eHealth intervention based on both theory and evidence. All patients and stakeholders judged the eHealth intervention to be a promising tool to empower gynecological patients during the perioperative period and to help them to return to normal activities and work.

Conflict of interest statement

None declared.

Figures

Figure 1
Figure 1
Intervention mapping process.

References

    1. Clayton M, Verow P. A retrospective study of return to work following surgery. Occup Med (Lond) 2007 Oct;57(7):525–31. doi: 10.1093/occmed/kqm082. 57/7/525
    1. Johansen P, Al-Khafagi SK, Thøstesen LM, Lauszus FF, Rasmussen KL. [Analysis of need for sick leave after hysterectomy] Ugeskr Laeger. 2008 Apr 21;170(17):1465–8.VP05070064
    1. Kikuchi I, Takeuchi H, Shimanuki H, Kitade M, Kumakiri J, Kuroda K, Kobayashi Y, Takeda S. Questionnaire analysis of recovery of activities of daily living after laparoscopic surgery. J Minim Invasive Gynecol. 2008 Jan;15(1):16–9. doi: 10.1016/j.jmig.2007.08.606.S1553-4650(07)00970-3
    1. Brölmann HA, Vonk Noordegraaf A, Bruinvels DJ, de Vet RH, Dirksz AA, Huirne JA. Can prolonged sick leave after gynecologic surgery be predicted? An observational study in The Netherlands. Surg Endosc. 2009 Oct;23(10):2237–41. doi: 10.1007/s00464-008-0287-0.
    1. Department of Health . Choosing Health: Making Healthy Choices Easier. London: National Health Service (NHS); 2004.
    1. van Oostrom SH, Driessen MT, de Vet HC, Franche RL, Schonstein E, Loisel P, van Mechelen W, Anema JR. Workplace interventions for preventing work disability. Cochrane Database Syst Rev. 2009;(2):CD006955. doi: 10.1002/14651858.CD006955.pub2.
    1. Commissie Psychische Arbeidsongeschiktheid Aanpak verzuim om psychische redenen. Leidraad. 2001 Nov 01;
    1. Waddell G, Burton AK. Is Work Good for Your Health and Well-being? London: The Stationery Office (TSO); 2006.
    1. Henderson M, Glozier N, Holland Elliott K. Long term sickness absence. BMJ. 2005 Apr 9;330(7495):802–3. doi: 10.1136/bmj.330.7495.802.330/7495/802
    1. Bisgaard T, Klarskov B, Rosenberg J, Kehlet H. Factors determining convalescence after uncomplicated laparoscopic cholecystectomy. Arch Surg. 2001 Aug;136(8):917–21.soa0237
    1. Warren L, Ladapo JA, Borah BJ, Gunnarsson CL. Open abdominal versus laparoscopic and vaginal hysterectomy: analysis of a large United States payer measuring quality and cost of care. J Minim Invasive Gynecol. 2009 Sep;16(5):581–8. doi: 10.1016/j.jmig.2009.06.018.S1553-4650(09)00339-2
    1. Thiel JA, Kamencic H. Assessment of costs associated with outpatient total laparoscopic hysterectom. J Obstet Gynaecol Can. 2006 Sep;28(9):794–8.
    1. Everett TR, Crawford RA. Laparoscopic assisted vaginal hysterectomy and bilateral salpingo-oophorectomy as a day surgery procedure: a promising option. J Obstet Gynaecol. 2010;30(7):697–700. doi: 10.3109/01443615.2010.504866.
    1. Dirksz AA, Bruinvels DJ, de Vet HCW, Brolmann HA. Werkhervatting na gynaecologische ingrepen. Scriptie. 2008
    1. Löfgren A, Hagberg J, Alexanderson K. What physicians want to learn about sickness certification: analyses of questionnaire data from 4019 physicians. BMC Public Health. 2010;10:61. doi: 10.1186/1471-2458-10-61. 1471-2458-10-61
    1. Weevers HJ, van der Beek AJ, Anema JR, van der Wal G, van Mechelen W. Work-related disease in general practice: a systematic review. Fam Pract. 2005 Apr;22(2):197–204. doi: 10.1093/fampra/cmh727. cmh727
    1. Dasinger LK, Krause N, Thompson PJ, Brand RJ, Rudolph L. Doctor proactive communication, return-to-work recommendation, and duration of disability after a workers' compensation low back injury. J Occup Environ Med. 2001 Jun;43(6):515–25.
    1. Shulman AG, Amid PK, Lichtenstein IL. Returning to work after herniorrhaphy. BMJ. 1994 Jul 23;309(6949):216–7.
    1. Lewin SA, Skea ZC, Entwistle V, Zwarenstein M, Dick J. Interventions for providers to promote a patient-centred approach in clinical consultations. Cochrane Database Syst Rev. 2001;(4):CD003267. doi: 10.1002/14651858.CD003267.CD003267
    1. Cheraghi-Sohi S, Bower P. Can the feedback of patient assessments, brief training, or their combination, improve the interpersonal skills of primary care physicians? A systematic review. BMC Health Serv Res. 2008;8:179. doi: 10.1186/1472-6963-8-179. 1472-6963-8-179
    1. Kinnersley P, Edwards A, Hood K, Ryan R, Prout H, Cadbury N, MacBeth F, Butow P, Butler C. Interventions before consultations to help patients address their information needs by encouraging question asking: systematic review. BMJ. 2008;337:a485.
    1. Haywood K, Marshall S, Fitzpatrick R. Patient participation in the consultation process: a structured review of intervention strategies. Patient Educ Couns. 2006 Oct;63(1-2):12–23. doi: 10.1016/j.pec.2005.10.005.S0738-3991(05)00314-9
    1. Bruegel RB. Patient empowerment--a trend that matters. J AHIMA. 1998 Sep;69(8):30–3; quiz 35.
    1. Aujoulat I, d'Hoore W, Deccache A. Patient empowerment in theory and practice: polysemy or cacophony? Patient Educ Couns. 2007 Apr;66(1):13–20. doi: 10.1016/j.pec.2006.09.008.S0738-3991(06)00324-7
    1. Samoocha D, Bruinvels DJ, Elbers NA, Anema JR, van der Beek AJ. Effectiveness of web-based interventions on patient empowerment: a systematic review and meta-analysis. J Med Internet Res. 2010;12(2):e23. doi: 10.2196/jmir.1286. v12i2e23
    1. Cross M. How the internet is changing health care. BMJ. 2008;337:a883.
    1. Randeree E. Exploring technology impacts of Healthcare 2.0 initiatives. Telemed J E Health. 2009 Apr;15(3):255–60. doi: 10.1089/tmj.2008.0093.
    1. de Jong T, Heinrich J, Blatter BM, Anema JR, van der Beek AJ. The feasibility of a web-based counselling program for occupational physicians and employees on sick leave due to back or neck pain. BMC Med Inform Decis Mak. 2009;9:46. doi: 10.1186/1472-6947-9-46. 1472-6947-9-46
    1. Forkner-Dunn J. Internet-based patient self-care: the next generation of health care delivery. J Med Internet Res. 2003 Apr;5(2):e8. doi: 10.2196/jmir.5.2.e8.
    1. Hartmann CW, Sciamanna CN, Blanch DC, Mui S, Lawless H, Manocchia M, Rosen RK, Pietropaoli A. A website to improve asthma care by suggesting patient questions for physicians: qualitative analysis of user experiences. J Med Internet Res. 2007;9(1):e3. doi: 10.2196/jmir.9.1.e3. v9i1e3
    1. Gerber BS, Eiser AR. The patient physician relationship in the Internet age: future prospects and the research agenda. J Med Internet Res. 2001 Apr;3(2):E15. doi: 10.2196/jmir.3.2.e15.
    1. Brug J, Campbell M, van Assema P. The application and impact of computer-generated personalized nutrition education: a review of the literature. Patient Educ Couns. 1999 Feb;36(2):145–56.S0738-3991(98)00131-1
    1. Kroeze W, Werkman A, Brug J. A systematic review of randomized trials on the effectiveness of computer-tailored education on physical activity and dietary behaviors. Ann Behav Med. 2006 Jun;31(3):205–23. doi: 10.1207/s15324796abm3103_2.
    1. Lustria ML, Cortese J, Noar SM, Glueckauf RL. Computer-tailored health interventions delivered over the Web: review and analysis of key components. Patient Educ Couns. 2009 Feb;74(2):156–73. doi: 10.1016/j.pec.2008.08.023.S0738-3991(08)00469-2
    1. Krebs P, Prochaska JO, Rossi JS. A meta-analysis of computer-tailored interventions for health behavior change. Prev Med. 2010 Sep;51(3-4):214–21. doi: 10.1016/j.ypmed.2010.06.004.S0091-7435(10)00231-8
    1. Neville LM, Milat AJ, O'Hara B. Computer-tailored weight reduction interventions targeting adults: a narrative systematic review. Health Promot J Austr. 2009 Apr;20(1):48–57.
    1. Miniwatts Marketing Group Internet World Stats. 2010. [2012-05-29]. Usage and Population Statistics .
    1. Griffiths F, Lindenmeyer A, Powell J, Lowe P, Thorogood M. Why are health care interventions delivered over the internet? A systematic review of the published literature. J Med Internet Res. 2006;8(2):e10. doi: 10.2196/jmir.8.2.e10. v8i2e10
    1. Alpay LL, Henkemans OB, Otten W, Rövekamp TA, Dumay AC. E-health applications and services for patient empowerment: directions for best practices in The Netherlands. Telemed J E Health. 2010 Sep;16(7):787–91. doi: 10.1089/tmj.2009.0156.
    1. Vitacca M, Mazzù M, Scalvini S. Socio-technical and organizational challenges to wider e-Health implementation. Chron Respir Dis. 2009;6(2):91–7. doi: 10.1177/1479972309102805.6/2/91
    1. Bartholomew LK, Parcel GS, Kok G. Intervention mapping: a process for developing theory- and evidence-based health education programs. Health Educ Behav. 1998 Oct;25(5):545–63.
    1. Bartholomew LK, Parcel GS, Kok G, Gottlieb NH. Planning Health Promotion Programs: An Intervention Mapping Approach. San Francisco, CA: Jossey-Bass; 2006.
    1. Kok G, van Essen GA, Wicker S, Llupià A, Mena G, Correia R, Ruiter RA. Planning for influenza vaccination in health care workers: an Intervention Mapping approach. Vaccine. 2011 Nov 3;29(47):8512–9. doi: 10.1016/j.vaccine.2011.09.008.S0264-410X(11)01414-9
    1. Samoocha D, Bruinvels DJ, Anema JR, Steenbeek R, van der Beek AJ. Empowerment of disability benefit claimants through an interactive website: design of a randomized controlled trial. BMC Med Inform Decis Mak. 2009;9:23. doi: 10.1186/1472-6947-9-23. 1472-6947-9-23
    1. Albada A, van Dulmen S, Otten R, Bensing JM, Ausems MG. Development of E-info gene(ca): a website providing computer-tailored information and question prompt prior to breast cancer genetic counseling. J Genet Couns. 2009 Aug;18(4):326–38. doi: 10.1007/s10897-009-9221-4.
    1. Prins RG, van Empelen P, Beenackers MA, Brug J, Oenema A. Systematic Development of the YouRAction program, a computer-tailored physical activity promotion intervention for Dutch adolescents, targeting personal motivations and environmental opportunities. BMC Public Health. 2010;10:474. doi: 10.1186/1471-2458-10-474. 1471-2458-10-474
    1. van Oostrom SH, Anema JR, Terluin B, Venema A, de Vet HC, van Mechelen W. Development of a workplace intervention for sick-listed employees with stress-related mental disorders: Intervention Mapping as a useful tool. BMC Health Serv Res. 2007;7:127. doi: 10.1186/1472-6963-7-127. 1472-6963-7-127
    1. Vermeulen SJ, Anema JR, Schellart AJ, van Mechelen W, van der Beek AJ. Intervention mapping for development of a participatory return-to-work intervention for temporary agency workers and unemployed workers sick-listed due to musculoskeletal disorders. BMC Public Health. 2009;9:216. doi: 10.1186/1471-2458-9-216. 1471-2458-9-216
    1. Kristensen TS. Intervention studies in occupational epidemiology. Occup Environ Med. 2005 Mar;62(3):205–10. doi: 10.1136/oem.2004.016097. 62/3/205
    1. Green LW, Kreuter MW. Health Program Planning: An Educational and Ecological Approach. 4th edition. New York: McGraw Hill Professional; 2005.
    1. Stichting Informatie Gezondheidszorg Landelijke Medische Registratie LMR - Verrichtingen. Prismant. 2009
    1. Centraal Bureau voor de Statistiek Women with paid work. Statline databank. 2009
    1. Morgan D. Focus Groups as Qualitative Research. Thousand Oaks, CA: Sage; 1997.
    1. Barbour RS, Kitzinger J. Developing Focus Group Research: Politics Theory and Practice. London: Sage; 1999.
    1. Scientific Software Development . ATLAS.ti version 6.2. Berlin: Scientific Software Development; 2010.
    1. van Achterberg T, Huisman-de Waal GG, Ketelaar NA, Oostendorp RA, Jacobs JE, Wollersheim HC. How to promote healthy behaviours in patients? An overview of evidence for behaviour change techniques. Health Promot Int. 2011 Jun;26(2):148–62. doi: 10.1093/heapro/daq050. daq050
    1. Ritterband LM, Thorndike FP, Cox DJ, Kovatchev BP, Gonder-Frederick LA. A behavior change model for internet interventions. Ann Behav Med. 2009 Aug;38(1):18–27. doi: 10.1007/s12160-009-9133-4.
    1. Møller C, Ottesen M, Kehlet H, Ottesen BS. [Convalescence recommendations after hysterectomy. A study of opinions among Danish physicians] Ugeskr Laeger. 2001 Dec 10;163(50):7043–7.
    1. Clayton M, Verow P. Advice given to patients about return to work and driving following surgery. Occup Med (Lond) 2007 Oct;57(7):488–91. doi: 10.1093/occmed/kqm063. 57/7/488
    1. Shaw L, Segal R, Polatajko H, Harburn K. Understanding return to work behaviours: promoting the importance of individual perceptions in the study of return to work. Disabil Rehabil. 2002 Mar 10;24(4):185–95.
    1. Rosenberger PH, Jokl P, Ickovics J. Psychosocial factors and surgical outcomes: an evidence-based literature review. J Am Acad Orthop Surg. 2006 Jul;14(7):397–405.14/7/397
    1. Celestin J, Edwards RR, Jamison RN. Pretreatment psychosocial variables as predictors of outcomes following lumbar surgery and spinal cord stimulation: a systematic review and literature synthesis. Pain Med. 2009 May;10(4):639–53. doi: 10.1111/j.1526-4637.2009.00632.x.PME632
    1. Shehmar M, Gupta JK. The influence of psychological factors on recovery from hysterectomy. J R Soc Med. 2010 Feb;103(2):56–9. doi: 10.1258/jrsm.2009.090198.103/2/56
    1. Brouwer S, Krol B, Reneman MF, Bültmann U, Franche RL, van der Klink JJ, Groothoff JW. Behavioral determinants as predictors of return to work after long-term sickness absence: an application of the theory of planned behavior. J Occup Rehabil. 2009 Jun;19(2):166–74. doi: 10.1007/s10926-009-9172-5.
    1. Oyeflaten I, Hysing M, Eriksen HR. Prognostic factors associated with return to work following multidisciplinary vocational rehabilitation. J Rehabil Med. 2008 Jul;40(7):548–54. doi: 10.2340/16501977-0202.
    1. Svajger A, Winding K. Perceptions of possibilities of returning to work with chronic musculoskeletal disorders. Work. 2009;32(4):443–54. doi: 10.3233/WOR-2009-0855.678V56RW6L3H346T
    1. Lambeek LC, van Mechelen W, Knol DL, Loisel P, Anema JR. Randomised controlled trial of integrated care to reduce disability from chronic low back pain in working and private life. BMJ. 2010;340:c1035.
    1. Spelten ER, Sprangers MA, Verbeek JH. Factors reported to influence the return to work of cancer survivors: a literature review. Psychooncology. 2002 Mar;11(2):124–31.10.1002/pon.585
    1. de Vries H, Dijkstra M, Kuhlman P. Self-efficacy: The third factor besides attitude and subjective norm as a predictor of behavioural intentions. Health Educ Res. 1988;3:273–282.
    1. de Vries H. Gezondheidsvoorlichting en gedragsverandering [Health Education and Behavioral Change] Assen: Van Gorcum; 1993. Determinanten van gedrag; pp. 109–132.
    1. Ajzen I. Action-Control: From Cognition to Behaviour. Heidelberg: Springer; 1985. From intentions to action: a theory of planned behaviour; pp. 11–39.
    1. Schaalma H, Kok G. Decoding health education interventions: the times are a-changin'. Psychol Health. 2009 Jan;24(1):5–9. doi: 10.1080/08870440903126348.904931725
    1. Vonk Noordegraaf A, Huirne JAF, Van Mechelen W, Brolmann HAM, Anema JR. Ikherstel. [2012-05-29].
    1. Vonk Noordegraaf A, Huirne JA, Brölmann HA, van Mechelen W, Anema JR. Multidisciplinary convalescence recommendations after gynaecological surgery: a modified Delphi method among experts. BJOG. 2011 Dec;118(13):1557–67. doi: 10.1111/j.1471-0528.2011.03091.x.
    1. Vonk Noordegraaf A, Huirne JA, Brölmann HA, Emanuel MH, van Kesteren PJ, Kleiverda G, Lips JP, Mozes A, Thurkow AL, van Mechelen W, Anema JR. Effectiveness of a multidisciplinary care program on recovery and return to work of patients after gynaecological surgery; design of a randomized controlled trial. BMC Health Serv Res. 2012;12:29. doi: 10.1186/1472-6963-12-29. 1472-6963-12-29
    1. Schmid AA, Andersen J, Kent T, Williams LS, Damush TM. Using intervention mapping to develop and adapt a secondary stroke prevention program in Veterans Health Administration medical centers. Implement Sci. 2010;5:97. doi: 10.1186/1748-5908-5-97. 1748-5908-5-97
    1. Wantland DJ, Portillo CJ, Holzemer WL, Slaughter R, McGhee EM. The effectiveness of Web-based vs. non-Web-based interventions: a meta-analysis of behavioral change outcomes. J Med Internet Res. 2004 Nov 10;6(4):e40. doi: 10.2196/jmir.6.4.e40. v6e40
    1. Quintiliani LM, Campbell MK, Bowling JM, Steck S, Haines PS, DeVellis BM. Results of a randomized trial testing messages tailored to participant-selected topics among female college students: physical activity outcomes. J Phys Act Health. 2010 Jul;7(4):517–26.
    1. van de Bovenkamp HM, Trappenburg MJ, Grit KJ. Patient participation in collective healthcare decision making: the Dutch model. Health Expect. 2010 Mar;13(1):73–85. doi: 10.1111/j.1369-7625.2009.00567.x.HEX567
    1. Williamson C. The patient movement as an emancipation movement. Health Expect. 2008 Jun;11(2):102–12. doi: 10.1111/j.1369-7625.2007.00475.x.HEX475
    1. Jones KR, Burney RE, Peterson M, Christy B. Return to work after inguinal hernia repair. Surgery. 2001 Feb;129(2):128–35.S0039606001676529
    1. Callesen T, Klarskov B, Bech K, Kehlet H. Short convalescence after inguinal herniorrhaphy with standardised recommendations: duration and reasons for delayed return to work. Eur J Surg. 1999 Mar;165(3):236–41. doi: 10.1080/110241599750007108.
    1. Ottesen M, Sørensen M, Kehlet H, Ottesen B. Short convalescence after vaginal prolapse surgery. Acta Obstet Gynecol Scand. 2003 Apr;82(4):359–66.147
    1. Bay-Nielsen M, Thomsen H, Andersen FH, Bendix JH, Sørensen OK, Skovgaard N, Kehlet H. Convalescence after inguinal herniorrhaphy. Br J Surg. 2004 Mar;91(3):362–7. doi: 10.1002/bjs.4437.

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