Staff Publications

Staff Publications

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    'Staff publications' is the digital repository of Wageningen University & Research

    'Staff publications' contains references to publications authored by Wageningen University staff from 1976 onward.

    Publications authored by the staff of the Research Institutes are available from 1995 onwards.

    Full text documents are added when available. The database is updated daily and currently holds about 240,000 items, of which 72,000 in open access.

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The Impact of Social and Financial Education on Savings Attitudes and Behavior Among Primary School Children in Uganda
Supanantaroek, Suthinee ; Lensink, Robert ; Hansen, Nina - \ 2017
Evaluation Review 41 (2017)6. - ISSN 0193-841X - p. 511 - 541.
attitudes - children - financial literacy - intervention - saving and spending - social and financial education - training
Background: Saving plays a crucial role in the process of economic growth. However, one main reason why poor people often do not save is that they lack financial knowledge. Improving the savings culture of children through financial education is a promising way to develop savings attitudes and behavior early in life. Objectives: This study is one of the first that examines the effects of social and financial education training and a children’s club developed by Aflatoun on savings attitudes and behavior among primary school children in Uganda, besides Berry, Karlan, and Pradhan. Research design: A randomized phase in approach was used by randomizing the order in which schools implemented the program (school-level randomization). The treatment group consisted of students in schools where the program was implemented, while in the control group the program was not yet implemented. The program lasted 3 months including 16 hours. We compared posttreatment variables for the treatment and control group. Subjects: Study participants included 1,746 students, of which 936 students were from 22 schools that were randomly assigned to receive the program between May and July 2011; the remaining 810 students attended 22 schools that did not implement the program during the study period. Measures: Indicators for children’s savings attitudes and behavior were key outcomes. Results: The intervention increased awareness of money, money recording, and savings attitudes. It also provides some evidence—although less robust—that the intervention increased actual savings. Conclusions: A short financial literacy and social training can improve savings attitudes and behavior of children considerably.
Making interventions work on the farm : Unravelling the gap between technology-oriented potato interventions and livelihood building in Southern Ethiopia
Tadesse, Yenenesh - \ 2017
Wageningen University. Promotor(en): Paul Struik, co-promotor(en): Conny Almekinders; Rogier Schulte. - Wageningen : Wageningen University - ISBN 9789463436847 - 120
potatoes - crop production - crop physiology - technology - intervention - livelihood strategies - livelihoods - ethiopia - east africa - aardappelen - gewasproductie - gewasfysiologie - technologie - interventie - strategieën voor levensonderhoud - middelen van bestaan - ethiopië - oost-afrika

Poor adoption of modern technologies in sub-Saharan Africa is one of the major factors that limit food production and thereby threaten food security of smallholder farmers. This is despite the potential and emerging success stories of new technologies in increasing productivity of smallholder agriculture. Explanations for low uptake of technologies are diverse. Some studies associated it with characteristics of the farmers and their farm; others attributed it to poor access to information about a particular technology, while some others recognize the importance of technology attributes. Farmers’ adoption decision is shaped socially and the farming practices are changing, not only because of the technical changes introduced, but also because of changes in social circumstances among smallholders. All these possible reasons did, however, miss largely important insights on how local complexities influence adoption. The research presented in this thesis analyses the social dynamics of technology-oriented interventions. More specifically, the study assessed the influence of technology introduction strategies, social networks and social differentiation on the adoption, dissemination and effects of potato technologies. As a case, it used interventions introducing improved potato technologies in Chencha, Southern Ethiopia. The field work combined individual and group in-depth interviews, household surveys and field observation for data collection.

Results show that the efforts to introduce technologies for improved potato production to progressive farmers with the assumption that farmers will eventually adopt, once they become familiar with the technology is a distant prospect. Some of the production practices - agronomic field and storage practices - failed to spread to poor farmers as expected, while the majority of agronomic practices fitted well with wealthy farmers. This resulted in diverse outcomes and strategies for livelihood improvement at household level. Access to the technologies and the necessary resources and diverse needs for technology were important factors in explaining variation in adoption and effects of technology across wealth categories. Tracing the seed diffusion through farmers’ networks showed that not all households had equal access to improved seed potatoes, mainly because of social barriers formed by differences in wealth, gender and religion, and because the type of personal relationship (relatives, neighbours, friends and acquaintance) between seed providers and seed recipients affected farmer to farmer seed sharing. In addition, the set-up of farmer-group based seed production demands resources and faces contextual challenges, which could be addressed through a long-term approach that engages continually in diagnosis and responding to the emerging social as well as material challenges. Development practitioners, however, took organizing group initiatives as a one-time process of design and start-up activity. Thus, clean seed potato production and dissemination through farmers’ organizations could not be sustainable. In conclusion, the present study has indicated that through providing special attention to the social dynamics researchers can arrive at better understanding of constraints affecting technology adoption. This implies effective interventions for a range of farm contexts involve not only finding technical solutions but also integrated understanding of farmers’ production conditions and existing social dynamics.

Targeting persons with low socioeconomic status of different ethnic origins with lifestyle interventions : opportunities and effectiveness
Bukman, A.J. - \ 2016
Wageningen University. Promotor(en): Edith Feskens, co-promotor(en): Reint-Jan Renes. - Wageningen : Wageningen University - ISBN 9789462577022 - 169 p.
socioeconomic status - lifestyle - ethnic groups - intervention - cardiovascular diseases - type 2 diabetes - diabetes - obesity - dutch - turkish - glucose tolerance - morocco - physical activity - prevention - sociaal-economische positie - levensstijl - etnische groepen - interventie - hart- en vaatziekten - diabetes type 2 - suikerziekte - obesitas - nederlands - turks - glucosetolerantie - marokko - lichamelijke activiteit - preventie

Lifestyle intervention studies have shown that the development of cardiometabolic diseases can be partly prevented or postponed by the combination of a healthy diet and physical activity. Cardiometabolic diseases and their risk factors are particularly prevalent among individuals with low socioeconomic status and some ethnic minorities, and therefore these groups especially may benefit from participating in lifestyle interventions. Although individuals with low socioeconomic status and ethnic minorities could potentially benefit from lifestyle interventions, it seems that these groups are often not successfully reached for such interventions. Moreover, when they do participate in these interventions, they seem more likely to quit. The overall aim of this thesis was therefore to study opportunities for, and the effectiveness of, lifestyle interventions to reduce the risk of cardiometabolic diseases, targeting individuals with low socioeconomic status of different ethnic origins. To this end, this thesis reports two studies that identified opportunities for adapting lifestyle interventions to the target group’s needs, one study describing the process of adapting an effective lifestyle intervention (SLIM) into a new lifestyle intervention targeting individuals with low SES of different ethnic origins (MetSLIM) and two studies that determined the effectiveness of lifestyle interventions among the target group.

The aim of the study described in chapter 2 was to identify opportunities for adapting lifestyle interventions in such a way as to be more appealing for individuals with low socioeconomic status. The study provided insight into perspectives of groups with different socioeconomic positions regarding their current eating and physical activity behaviour; triggers for lifestyle change; and preferred ways to support lifestyle change. Data were gathered in semi-structured focus group interviews with adults with low socioeconomic status (four groups) and with adults with high socioeconomic status (five groups). In general, three key topics were identified, namely: current lifestyle is logical for participants given their personal situation; lifestyle change is prompted by feedback from their body; and support for lifestyle change should include individually tailored advice and could profit from involving others. The perceptions of the participants with low socioeconomic status were generally comparable to the perceptions shared by the participants with high socioeconomic status. Some perceptions were, however, especially mentioned in the low socioeconomic status groups. Participants with low socioeconomic status indicated that their current eating behaviour was sometimes affected by cost concerns. They seemed to be especially motivated to change their lifestyle when they experienced health complaints but were rather hesitant to change their lifestyle for preventive purposes. Regarding support for lifestyle change, participants with low socioeconomic status preferred to receive advice in a group rather than on their own. For physical activities, groups should preferably consist of persons of the same age, gender or physical condition.

The aim of the study described in chapter 3 was to identify how Turkish and Moroccan adults living in the Netherlands, aged 45 years and older, could be reached to participate in health checks for cardiometabolic diseases and follow-up (lifestyle) advice. In this study, questionnaire data were combined with interview data. This was done in order to use the narratives from the interviews to get a better understanding of the numbers that resulted from the questionnaire data. It turned out that both ethnic groups preferred an invitation from their general practitioner (GP) for a health check and preferred to fill out the health check questionnaire at the GP’s office or at home, on paper. They preferred to receive advice at individual level in relation to personal matters via either a physician or a specialised healthcare professional. Sixty-one percent of the Turkish respondents preferred to receive information in their native language, compared to 37% of the Moroccan respondents. Several participants mentioned a low proficiency in the local language as an explanation for their preference to fill out the health check questionnaire at home, to receive advice from an ethnicity-matched professional and to receive information in their native language. The results of this study suggested that the GP would be a promising contact to reach adults of Turkish and Moroccan origin for health checks or (lifestyle) advice. Furthermore, the findings suggested that it would be necessary to provide information in individuals’ native language to overcome language barriers and that (lifestyle) advice should be tailored towards the needs of the targeted individuals.

The insights gained into the needs and preferences of the target group – as described in chapter 2 and chapter 3 – were taken into account in the design of the MetSLIM intervention study. The MetSLIM study targeted individuals with low socioeconomic status of Dutch, Turkish and Moroccan origin. The MetSLIM study protocol was based on the SLIM study protocol. The SLIM study showed the beneficial effects of nutrition advice and physical activity promotion on the prevention type 2 diabetes, but drop-out was relatively high among low SES participants. Chapter 4 provides a detailed description of the development from the SLIM study protocol to the MetSLIM study protocol. Furthermore, this chapter gives insight into the obstacles encountered in developing the MetSLIM study to target individuals with low socioeconomic status of different ethnic origins. The new elements regarding the lifestyle intervention programme were: 1) additional group meetings about price concerns and social occasions with regard to a healthy diet; 2) ethnicity-matched dieticians; 3) gender-matched sports instructors; 4) all activities in the participants’ own neighbourhood; and 5) activities for women and men separately. The new elements regarding the study design, in order to study the effectiveness of the MetSLIM intervention programme, included: 1) from an university stetting to a community setting; 2) from a randomised controlled trial to a quasi-experimental study; 3) waist circumference – as a visible cardiometabolic risk factor – as main study outcome; 4) recruitment via GPs and in community centres; 5) translated study materials and ethnicity-matched research assistants involved in measuring; and 6) fewer measurements and measurements that could take place at different locations. Adaptations to the original SLIM study protocol were considered necessary in order to overcome practical barriers that hinder the target group’s participation; to suit the target group’s (cultural) needs; and to make it feasible to perform the study in a local (community) setting.

MetSLIM was not the only study set up based on the SLIM study. The SLIMMER study translated SLIM from a university setting to a real-world setting. The intervention was implemented in the public health and primary healthcare setting involving local GPs, practice nurses, dieticians, physiotherapists and sports clubs. The SLIMMER study did not target individuals with low socioeconomic status in particular; however, 52% of the study participants did have a low socioeconomic status, as determined by highest completed educational level. Chapter 5 describes how we explored the role of socioeconomic status in willingness to participate, programme attendance, programme acceptability, adherence to lifestyle guidelines, drop-out and effectiveness in the SLIMMER diabetes prevention intervention. The SLIMMER study was a randomised controlled trial, targeting 40- to 70-year-old adults at increased risk of type 2 diabetes, carried out in Apeldoorn and Doetinchem. The intervention group participated in a 10-month lifestyle programme: weekly training sessions were guided by a physiotherapist, and dietary advice was given by a dietician during 5–8 individual consultations and one group session. Measurements were carried out at baseline, after 12 months and six months after the active intervention period ended. The study showed that participation, attendance, acceptability, adherence, drop-out and effect of the SLIMMER study were mostly not affected by socioeconomic status. The SLIMMER study was able to reach the low socioeconomic status group as effectively as the higher socioeconomic status group, resulting in at least similar health benefits. The SLIMMER sample size was too small to study differences within the low socioeconomic status group, e.g. comparing the low vs. the least educated or comparing ethnic groups. Only 10% of the 316 SLIMMER participants had the lowest educational levels (no education or primary education) and only 11% had a foreign background.

The aim of the study described in chapter 6 was to measure the effectiveness of the MetSLIM intervention on waist circumference and other cardiometabolic risk factors, lifestyle and quality of life among 30- to 70-year-old adults with an elevated waist-to-height ratio. In the MetSLIM study, 220 individuals participated, of whom 40% had no education or only primary education and of whom 64% had a foreign background. MetSLIM had a quasi-experimental design with measurements at baseline and after 12 months. Participants were recruited in deprived neighbourhoods of Arnhem and Eindhoven via either their GP or in community centres. The intervention group participated in a 12-month lifestyle programme: an introductory group meeting was guided by the researcher, weekly physical activity lessons were guided by a sports instructor and dietary advice was given by an ethnicity-matched dietician (in total four hours of individual consultations and three group sessions). The study showed that the MetSLIM lifestyle intervention was effective in reducing waist circumference, other measures of obesity, total and LDL cholesterol, and quality of life. MetSLIM had a drop-out of 31%, which was higher than at 12 months in the SLIM study (10%) and SLIMMER study (13%), but comparable to drop-out in similar studies among ethnic minorities or low socioeconomic status populations.

Finally, in chapter 7, the main results of this thesis are described, followed by a discussion of methodological considerations, public health implications, suggestions for future research and the general conclusion. The adaptation process from SLIM to MetSLIM is discussed, including a reflection on the decision to use SLIM as a starting point and the decision to target three different ethnic groups at the same time. Moreover, difficulties in defining and selecting persons with low socioeconomic status and specific ethnic groups within research are addressed. As SLIMMER and MetSLIM proved that low socioeconomic status populations can be reached, and that their health can be improved when they participate in lifestyle interventions, it is suggested that further implementation should be considered. Insight should be gained into the ‘black box’ of lifestyle interventions; i.e. we should get to know what works for whom. Planned future research includes a process and economic evaluation of MetSLIM.

This thesis has shown that intensive combined lifestyle interventions can be effective in low socioeconomic status populations and identified possible adaptations to make lifestyle interventions more suitable for individuals with low socioeconomic status of Dutch, Turkish and Moroccan origin. The question is not whether a lifestyle intervention can be effective, but how diverse groups can be reached and benefit from it. For this purpose, further insight into the success of different adaptations for different target groups should be obtained to reveal the effective elements to reach, inspire and retain different low socioeconomic status populations and ethnic minorities with lifestyle interventions.

Towards a set of design principles for developing oral presentation competence: A synthesis of research in higher education
Ginkel, S.O. van; Gulikers, J.T.M. ; Biemans, H.J.A. ; Mulder, M. - \ 2015
Educational Research Review 14 (2015). - ISSN 1747-938X - p. 62 - 80.
presentation skills - communication competence - feedback - students - impact - intervention - apprehension - performance - reflection - anxiety
Developing oral presentation competence is an essential objective in higher education. However, a comprehensive picture of effective learning environment characteristics for encouraging oral presentation performance is lacking hitherto. This review identifies and classifies relevant studies with the aim of deducing a set of design principles with underlying conceptual and empirical argumentations for developing this competence. Fifty-two publications from the last 20 years were selected through a systematic search in four scientific databases. Subsequently, all studies were categorized with respect to student characteristics, learning environment characteristics, learning processes and outcomes. The synthesis of these studies resulted in the formulation of seven design principles, addressing the instruction, learning and assessment sides of the learning environment. These design principles include the following learning environment characteristics: learning objectives, learning task, behaviour modelling, opportunity to practice, intensity and timing of feedback, peer assessment and self-assessment. Finally, an agenda for future research is discussed.
The perceived impact of the National Health Service on personalised nutrition service delivery among the UK public
Fallaize, R. ; Macready, A.L. ; Butler, L.T. ; Ellis, J.A. ; Berezowska, A. ; Fischer, A.R.H. ; Walsh, M.C. ; Gallagher, C. ; Stewart-Knox, B.J. ; Kuznesof, S. ; Frewer, L.J. ; Gibney, M.J. ; Lovegrove, J.A. - \ 2015
The British journal of nutrition 113 (2015)8. - ISSN 0007-1145 - p. 1271 - 1279.
nutrigenomics - communication - disease - information - consumer - medicine - intervention - acceptance - knowledge - attitudes
Personalised nutrition (PN) has the potential to reduce disease risk and optimise health and performance. Although previous research has shown good acceptance of the concept of PN in the UK, preferences regarding the delivery of a PN service (e.g. online v. face-to-face) are not fully understood. It is anticipated that the presence of a free at point of delivery healthcare system, the National Health Service (NHS), in the UK may have an impact on end-user preferences for deliverances. To determine this, supplementary analysis of qualitative data obtained from focus group discussions on PN service delivery, collected as part of the Food4Me project in the UK and Ireland, was undertaken. Irish data provided comparative analysis of a healthcare system that is not provided free of charge at the point of delivery to the entire population. Analyses were conducted using the ‘framework approach’ described by Rabiee (Focus-group interview and data analysis. Proc Nutr Soc 63, 655-660). There was a preference for services to be led by the government and delivered face-to-face, which was perceived to increase trust and transparency, and add value. Both countries associated paying for nutritional advice with increased commitment and motivation to follow guidelines. Contrary to Ireland, however, and despite the perceived benefit of paying, UK discussants still expected PN services to be delivered free of charge by the NHS. Consideration of this unique challenge of free healthcare that is embedded in the NHS culture will be crucial when introducing PN to the UK.
Contesting control : land and forest in the struggle for Loita Maasai self-government in Kenya
Kronenburg García, A.J.N. - \ 2015
Wageningen University. Promotor(en): Han van Dijk, co-promotor(en): S.W.J. Luning. - Wageningen : Wageningen University - ISBN 9789462572720 - 311
landgebruik - autonomie - plattelandsgemeenschappen - grondrechten - bosbezit - bosbeheer - governance - leiderschap - pachtstelsel - regering - staat - interventie - kenya - land use - autonomy - rural communities - land rights - forest ownership - forest administration - leadership - tenure systems - government - state - intervention


Contesting Control: Land and Forest in the Struggle for Loita Maasai Self-government in Kenya

Angela Kronenburg García

Contesting Control is about the Loita Maasai in Kenya who, faced with increasing outside interventions and pressure from neighbouring communities, the state and other agencies, have been struggling to maintain access and control over the land they inhabit and the forest they use. They have been on the losing side in territorial struggles with neighbouring Purko Maasai and (non-Maasai) Sonjo. However, with regard to the state, NGOs and environmental organizations, the Loita have successfully navigated policies and projects and retained access and control of their land and forest. Interventions have, nevertheless, changed the way people engage with the land and forest and with each other on these issues. This study investigates the (in)direct effects of interventions and how they have articulated with existing relations, practices, processes and struggles in Loita. It considers the state-led land adjudication programme of the 1960s that sought to convert Kenya’s pastoral lands into privately owned group ranches, the attempt by Narok County Council to turn the Naimina Enkiyio Forest into a nature reserve for tourism in the 1990s, and a forest co-management project carried out by IUCN in the early 2000s. This volume captures the process of property-in-the-making and socio-political change among the Loita Maasai as they struggle for autonomy and self-government.

Quality of weight-loss counseling by Dutch practice nurses in primary care: an observational study
Dillen, S. van; Noordman, J. ; Dulmen, S. van; Hiddink, G.J. - \ 2015
European Journal of Clinical Nutrition 69 (2015). - ISSN 0954-3007 - p. 73 - 78.
nutrition communication styles - physical-activity - general-practice - guidance practices - health-care - intervention - obesity - life - barriers - consultations
Background/objective:To assess the quality of weight-loss counseling provided by Dutch primary care practice nurses (PNs) to overweight and obese patients including both PNs' compliance with the Five A's Model for behavioral counseling in primary care, and the use of different communication styles. In addition, relationships between PN/patient characteristics (including Five A's) and communication styles will be examined.Subjects/methods:In this observational study, 100 videotaped real-life consultations, collected in 2010/2011, were viewed using an observational checklist. Selection of consultations was based on PNs' registration of patient's complaint. The quality of weight-loss counseling was assessed by the Five A's Model (sequence of evidence-based practice behaviors that are effective for helping patients to change health behaviors) and by PNs' communication styles. Moreover, several PN and patient characteristics were registered. Descriptive statistics and logistic regression analysis were conducted with significance set at P
Vitamin D and mortality: meta-analysis of individual participant data from a large consortium of cohort studies from Europe and the United States
Schottker, B. ; Jorde, R. ; Peasey, A. ; Thorand, B. ; Jansen, E.H.J.M. ; Groot, C.P.G.M. de; Streppel, M.T. ; Feskens, E.J.M. ; Kampman, E. - \ 2014
BMJ: British Medical Journal 348 (2014). - ISSN 0959-8138 - 15 p.
serum 25-hydroxyvitamin d - all-cause mortality - monica/kora augsburg - cardiovascular-disease - general-population - older-adults - risk - cancer - intervention - epidemiology
Objective - To investigate the association between serum 25-hydroxyvitamin D concentrations (25(OH)D) and mortality in a large consortium of cohort studies paying particular attention to potential age, sex, season, and country differences. Design - Meta-analysis of individual participant data of eight prospective cohort studies from Europe and the US. Setting - General population. Participants - 26 018 men and women aged 50-79 years
Maintenance of a healthy trajectory of the intestinal microbiome during aging: A dietary approach
Candela, M. ; Biagi, E. ; Brigidi, P. ; O'Toole, P.W. ; Vos, W.M. de - \ 2014
Mechanisms of Ageing and Development 136-137 (2014). - ISSN 0047-6374 - p. 70 - 75.
gut microbiota - fecal microbiota - immune-system - elderly-patients - human longevity - age - disease - immunosenescence - intervention - enterotypes
Sharing an intense transgenomic metabolism with the host, the intestinal microbiota is an essential factor for several aspects of the human physiology. However, several age-related factors, such as changes diet, lifestyle, inflammation and frailty, force the deterioration of this intestinal microbiota-host mutualistic interaction, compromising the possibility to reach longevity. In this scenario, the NU-AGE project involves the development of dietary interventions specifically tailored to the maintenance of a healthy trajectory of the intestinal microbiome, counteracting all processes connected to the pathophysiology of the human aging
The role of psychological flexibility in the demands-exhaustion-performance relationship
Onwezen, M.C. ; Veldhoven, M.J.P.M. van; Biron, M. - \ 2014
European Journal of Work and Organizational Psychology 23 (2014)2. - ISSN 1359-432X - p. 163 - 176.
job demands - emotional labor - work performance - resources model - burnout - acceptance - impact - diary - intervention - consequences
Employees in the service sector deal with a variety of emotional job demands due to interactions with clients. Emotional job demands often result in heightened levels of emotional exhaustion and decreased levels of performance. The current study aims to explore whether the adaptive behavioural pattern of psychological flexibility diminishes the negative impacts of emotional job demands on emotional exhaustion and subsequent performance. Data were collected from 116 nonprofit service workers, using self-report questionnaires (i.e., baseline) and diaries (i.e., follow-up). The results suggest that psychological flexibility is negatively associated with emotional exhaustion and positively associated with performance. In addition, psychological flexibility is found to attenuate the negative effects of emotional job demands on emotional exhaustion and performance. Finally, the results reveal that the attenuating role of psychological flexibility diminishes if employees are already exhausted. The results support the importance of personal resources, like psychological flexibility, in buffering the negative effects of emotional job demands on emotional exhaustion and performance. However, employees no longer benefit from high levels of psychological flexibility when facing high levels of exhaustion due to excessive emotional job demands.
An innovative team-based stop smoking competition among Maori and Pacific Island smokers: rationale and method for the study and its evaluation
Glover, M. ; Bosman, A. ; Wagemakers, A. ; Kira, A. ; Paton, C. ; Cowie, N. - \ 2013
BMC Public Health 13 (2013). - ISSN 1471-2458 - 15 p.
international quit - social support - win contest - new-zealand - cessation - intervention - community - campaign - population - efficacy
Maori and Pacific Island people have significantly higher smoking rates compared to the rest of the New Zealand population. The main aim of this paper is to describe how knowledge of Indigenous people’s practices and principles can be combined with proven effective smoking cessation support into a cessation intervention appropriate for Indigenous people.
Healthy Ageing: prevention of loneliness among elderly people : evaluation of a complex intervention in public health practice
Honigh - de Vlaming, R. - \ 2013
Wageningen University. Promotor(en): Lisette de Groot; Pieter van 't Veer, co-promotor(en): Annemien Haveman-Nies. - S.l. : s.n. - ISBN 9789461735041 - 214
ouderen - verouderen - levensomstandigheden - sociale integratie - sociologie - interventie - volksgezondheid - nederland - elderly - aging - living conditions - social integration - sociology - intervention - public health - netherlands

Concerns about the ageing population and formal responsibilities of local governments to promote social cohesion and to enhance participation of vulnerable groups in society placed loneliness prevention high on the local policy agenda of Dutch municipalities in the past decade. The study described in this thesis was part of the Healthy Ageing programme of the Academic Collaborative Centre AGORA and aimed to contribute to more effective, evidence-based and problem-oriented approaches to healthy ageing at the local level.

The general aim of this thesis was to evaluate the effectiveness of a local intervention project – called Healthy Ageing – targeting loneliness among non-institutionalised elderly people. Healthy Ageing consisted of five intervention components, namely, a mass media campaign, information meetings, psychosocial group courses, social activities organised by neighbours, Neighbours Connected, and training of intermediaries.

First, the influence of socio-demographic and health characteristics on changes in loneliness over time and municipal differences in the prevalence of loneliness were investigated. Data were gathered from 9,641 persons who participated in the Elderly Health Survey of the community health service, GGD Noord- en Oost- Gelderland (former GGD Gelre-IJssel), in 2005 or 2010. Second, the overall-effect of Healthy Ageing on the initial outcome loneliness literacy, intermediate outcome social support, and ultimate outcome loneliness was evaluated using a quasi-experimental pre-test post-test design, including an intervention and control community. Baseline and follow-up measurements, in 2008 and 2010 respectively, were available for 858 non-institutionalized elderly people. The Loneliness Literacy Scale was developed within the context of this thesis and was pre-tested in a separate study among 303 elderly persons who also participated in the quasi-experimental study. Finally, delivery, reach, and acceptance of the individual intervention components was studied in several satellite studies. Data were collected by different means, e.g. project records and surveys among participants. Furthermore, the acceptability of the mass media communication materials, information meetings, and psychosocial courses of Healthy Ageing was studied by in-depth interviews with 14 clients of the meal delivery service in the intervention community.

Overall and across municipalities, average loneliness scores did not significantly differ between 2005 and 2010. However, among the subgroup with mobility disabilities, loneliness was significantly higher in 2010. Furthermore, mobility disabilities and marital status were the most important factors explaining differences between municipalities. With regard to the evaluation of Healthy Ageing, the satellite studies showed that the reach and intensity of the intervention components were modest. Furthermore, from the interviews it appeared that the mass media communication materials were not successful in attracting attention because interviewees did not expect health information from these communication channels, the perceived personal relevance of the message was low, and the presentation was not attractive. Moreover, the content of the intervention components was not well received because the objectives and intervention components did not connect well with the priority group’s daily life. In addition, it appeared from the quasi-experimental study that 39% of the study participants from the intervention community was familiar with Healthy Ageing at follow-up. Overall, the intervention group scored more favourably on the loneliness literacy subscales, motivation (4.4%), perceived social support (8.2%), and subjective norm (11.5%) than the control group. However, no overall effects were observed for the intermediate and ultimate outcomes, total social support and loneliness after two years.

Given the modest overall intervention exposure, the effect of Healthy Ageing on the loneliness literacy subscale, motivation, is plausible, whereas on the subscales, perceived social support and subjective norm, probable, and on the subscale, self-efficacy, unlikely. Furthermore, whether the initial effects will carry forward to the intermediate and ultimate outcomes needs to be confirmed. The modest effects of Healthy Ageing can partly be explained by the challenges on organisational level which delayed and suppressed project implementation. Furthermore, the project might have benefited from a more systematic approach in order to ensure better alignment between the intervention components and formulated objectives. Finally, target group differentiation is highly recommended. This evaluation of Healthy Ageing illustrates how researchers can cope with the evaluation challenges of complex interventions which cannot be fully controlled. In turn, this provides valuable lessons for the development of intervention programmes and evaluation designs in public health practice.

Effectiveness of flavour nutrient learning and mere exposure as mechanisms to increase toddler's intake and preference for green vegetables
Wild, V.W.T. de; Graaf, C. de; Jager, G. - \ 2013
Appetite 64 (2013). - ISSN 0195-6663 - p. 89 - 96.
childrens food preferences - high dietary-fat - european countries - young-children - pro children - acceptance - fruit - infants - rats - intervention
Children’s consumption of vegetables is still below recommendations. Since preference is the most important predictor of children’s intake and most children dislike vegetables, new strategies are needed to increase their preferences for vegetables. Flavour nutrient learning (FNL) could be an effective mechanism to change preferences. Forty healthy toddlers were included in a randomized intervention study. During an intervention period of 7 weeks, they consumed vegetable soups (endive and spinach) twice per week. Half of the group received a high-energy variant of one soup (e.g. HE spinach) and a low energy variant of the other (LE endive), whereas for the other half the order was reversed (HE endive, LE spinach). Primary outcome measures were preference and ad libitum consumption (with a maximum of 200 g) of both vegetable products (LE), measured before, shortly after the intervention period, and 2 and 6 months following conditioning to assess longer-term effects. After completion of the intervention period, 28 children (14 girls and 14 boys, age 35 months; SD ± 8.3) met criteria for FNL to occur, and were included in further data analysis. Results showed a significant increase (~58 g) in ad libitum intake for both vegetable soups (stable over time), but irrespective of the energy content. This indicates a robust effect of mere exposure on intake, but no FNL. For preference, however, results showed a significant shift in liking for the vegetable soup consistently paired with high energy, supporting FNL.
Determinants of antiretroviral therapy adherence in northern Tanzania: a comprehensive picture from the patient perspective
Lyimo, R.A. ; Bruin, M. de; Boogaard, J. van den; Hospers, H.J. ; Ven, A. van der; Mushi, D. - \ 2012
BMC Public Health 12 (2012). - ISSN 1471-2458 - 8 p.
hiv-infected patients - treatment outcomes - planned behavior - drug-resistance - haart-adherence - intervention - metaanalysis - support - impact - trials
Background - To design effective, tailored interventions to support antiretroviral therapy (ART) adherence, a thorough understanding of the barriers and facilitators of ART adherence is required. Factors at the individual and interpersonal level, ART treatment characteristics and health care factors have been proposed as important adherence determinants. Methods - To identify the most relevant determinants of adherence in northern Tanzania, in-depth interviews were carried out with 61 treatment-experienced patients from four different clinics. The interviews were ad-verbatim transcribed and recurrent themes were coded. Results - Coding results showed that the majority of patients had basic understanding of adherence, but also revealed misconceptions about taking medication after alcohol use. Adherence motivating beliefs were the perception of improved health and the desire to live like others, as well as the desire to be a good parent. A de-motivating belief was that stopping ART after being prayed for was an act of faith. Facilitators of adherence were support from friends and family, and assistance of home based care (HBC) providers. Important barriers to ART adherence were the use of alcohol, unavailability of food, stigma and disclosure concerns, and the clinics dispensing too few pills. Strategies recommended by the patients to improve adherence included better Care and Treatment Centre (CTC) services, recruitment of patients to become Home Based Care ( HBC) providers, and addressing the problem of stigma through education. Conclusion - This study underscores the importance of designing tailored, patient-centered adherence interventions to address challenges at the patient, family, community and health care level.
A systematic review of hand hygiene improvement strategies: a behavioural approach
Huis, A. ; Achterberg, T. van; Bruin, M. de; Grol, R. ; Schoonhoven, L. ; Hulscher, M. - \ 2012
Implementation Science 7 (2012). - ISSN 1748-5908
intensive-care-unit - hospital-acquired infections - nosocomial infections - handwashing practices - emergency-department - improving compliance - glove use - intervention - program - prevalence
Background: Many strategies have been designed and evaluated to address the problem of low hand hygiene (HH) compliance. Which of these strategies are most effective and how they work is still unclear. Here we describe frequently used improvement strategies and related determinants of behaviour change that prompt good HH behaviour to provide a better overview of the choice and content of such strategies. Methods: Systematic searches of experimental and quasi-experimental research on HH improvement strategies were conducted in Medline, Embase, CINAHL, and Cochrane databases from January 2000 to November 2009. First, we extracted the study characteristics using the EPOC Data Collection Checklist, including study objectives, setting, study design, target population, outcome measures, description of the intervention, analysis, and results. Second, we used the Taxonomy of Behavioural Change Techniques to identify targeted determinants. Results: We reviewed 41 studies. The most frequently addressed determinants were knowledge, awareness, action control, and facilitation of behaviour. Fewer studies addressed social influence, attitude, self-efficacy, and intention. Thirteen studies used a controlled design to measure the effects of HH improvement strategies on HH behaviour. The effectiveness of the strategies varied substantially, but most controlled studies showed positive results. The median effect size of these strategies increased from 17.6 (relative difference) addressing one determinant to 49.5 for the studies that addressed five determinants. Conclusions: By focussing on determinants of behaviour change, we found hidden and valuable components in HH improvement strategies. Addressing only determinants such as knowledge, awareness, action control, and facilitation is not enough to change HH behaviour. Addressing combinations of different determinants showed better results. This indicates that we should be more creative in the application of alternative improvement activities addressing determinants such as social influence, attitude, self-efficacy, or intention.
Phenotyping the effect of diet on non-alcoholic fatty liver disease
Wit, N.J.W. de; Afman, L.A. ; Mensink, M.R. ; Muller, M.R. - \ 2012
Journal of Hepatology 57 (2012)6. - ISSN 0168-8278 - p. 1370 - 1373.
biomarker discovery - hepatic steatosis - steatohepatitis - progression - intervention - consumption - metabolism - expression - adiposity - mice
Non-alcoholic fatty liver disease (NAFLD) is associated with the growing incidence of metabolic syndrome. Diet is an important contributor to the pathogenesis of NAFLD. In this review, we focused on recent publications reporting on the effect of macro- and micronutrients on development and progression of NAFLD. In general, saturated fat and fructose seem to stimulate hepatic lipid accumulation and progression into NASH, whereas unsaturated fat, choline, antioxidants, and high-protein diets rich in isoflavones seem to have a more preventive effect. Knowledge of the underlying mechanisms by which diet affects NAFLD is expanding, not in the least due to innovative techniques, such as genomics tools that provide detailed comprehensive information on a large high-throughput scale. Although most nutrients seem to interfere with the balance between hepatic de novo lipogenesis (endogenous synthesis of fatty acids) and lipid oxidation (burning fat for energy), there are also indications that diet can trigger or prevent hepatic lipid accumulation by influencing the interaction between liver, gut, and adipose tissue. This review now gives a current detailed overview of diet-mediated mechanisms underlying NAFLD development and progression and summarizes recent results of genomics (transcriptomics, proteomics and metabolomics) studies that contribute to improved staging, monitoring and understanding of NAFLD pathophysiology
Ervaringsleren op de boerderij : beschrijving van de interventies bij Topaze, BJ Brabant en Juzt
Hassink, J. - \ 2012
Wageningen : Plant Research International Wageningen UR, Business Unit Agrosystems (Rapport / Plant Research International 471) - 24
zorgboerderijen - jeugdzorg - gedragsproblemen - persoonlijke ontwikkeling - antisociaal gedrag - geestelijke gezondheid - interventie - social care farms - child welfare - behaviour problems - personal development - antisocial behaviour - mental health - intervention
De interventie Ervaringsleren op de boerderij is bedoeld voor jongeren met ernstige problemen in de persoonlijke ontwikkeling. Ze vertonen internaliserend en externaliserend probleemgedrag. De jongeren hebben een gebrek aan inzicht in de problematiek. Op het gebied van het gezin zien we dat ouders hun grip verliezen op de jongeren. Ouders voelen zich onmachtig en de communicatie tussen ouders en jongeren is inadequaat.
A lipidomic analysis approach to evaluate the response to cholesterol-lowering food intake
Szymanska, E. ; Dorsten, F.A. van; Troost, J. ; Paliukhovich, I. ; Velzen, E.J.J. van; Hendriks, M.M.W.B. ; Trautwein, E.A. ; Duynhoven, J.P.M. van; Vreeken, R.J. ; Smilde, A.K. - \ 2012
Metabolomics 8 (2012)5. - ISSN 1573-3882 - p. 894 - 906.
coronary-artery-disease - plant sterols - mass-spectrometry - risk-factor - plasma - sphingomyelin - profiles - intervention - inflammation - metabolism
Plant sterols (PS) are well known to reduce serum levels of total cholesterol and LDL-cholesterol. Lipidomics potentially provides detailed information on a wide range of individual serum lipid metabolites, which may further add to our understanding of the biological effects of PS. In this study, lipidomics analysis was applied to serum samples from a placebo-controlled, parallel human intervention study (n = 97) of 4-week consumption of two PS-enriched, yoghurt drinks differing in fat content (based on 0.1% vs. 1.5% dairy fat). A comprehensive data analysis strategy was developed and implemented to assess and compare effects of two different PS-treatments and placebo treatment. The combination of univariate and multivariate data analysis approaches allowed to show significant effects of PS intake on the serum lipidome, and helped to distinguish them from fat content and non-specific effects. The PS-enriched 0.1% dairy fat yoghurt drink had a stronger impact on the lipidome than the 1.5% dairy fat yoghurt drink, despite similar LDL-cholesterol lowering effects. The PS-enriched 0.1% dairy fat yoghurt drink reduced levels of several sphingomyelins which correlated well with the reduction in LDL-cholesterol and can be explained by co-localization of sphingomyelins and cholesterol on the surface of LDL lipoprotein. Statistically significant reductions in serum levels of two lysophosphatidylcholines (LPC(16:1), LPC(20:1)) and cholesteryl arachidonate may suggest reduced inflammation and atherogenic potential. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s11306-011-0384-2) contains supplementary material, which is available to authorized users.
Er is geen enkel werkzaam principe dat altijd werkt. Een eerste verkenning van het begrip werkzame principes
Wartna, J. ; Vaandrager, L. ; Wagemakers, A. ; Koelen, M. - \ 2012
Wageningen : Wageningen University - 31
gezondheidsbevordering - levensstijl - interventie - gezondheidsbescherming - health promotion - lifestyle - intervention - health protection
Sinds 2008 onderhoudt RIVM Centrum Gezond Leven (CGL) het met een interventie database (I-database). In deze I-database zijn leefstijlinterventies opgenomen die geclassificeerd zijn als ‘theoretische goed onderbouwd’, als ‘waarschijnlijk effectief’ of als ‘bewezen effectief’. In de databank Effectieve Jeugdinterventies staan jeugdinterventies die op dezelfde manier geclassificeerd zijn evenals op de web portal het Nederlands Centrum Jeugdgezondheid. Professionals kunnen een interventie indienen en ter beoordeling voorleggen aan de Erkenningscommissie Interventies. Werkzame principes zijn gekoppeld aan de doelen van een interventie en gaan over principes die het effect van een interventie tot stand brengen. Het is echter nog onduidelijk wat er precies bedoeld wordt met 'werkzame principes' en wat dit vervolgens betekent voor het erkenningstraject. De leerstoelgroep Gezondheid en Maatschappij is daarom gevraagd een beperkt literatuuronderzoek te doen en een aantal interviews uit te voeren met personen uit de praktijk van gezondheidsbevordering en de jeugdgezondheidszorg (december 2011- februari 2012). Doel van dit onderzoek is om meer helderheid te krijgen over het begrip werkzame principes zodat er een besluit kan worden genomen of het expliciteren van werkzame principes waardevol is voor het erkenningstraject.
Risky encounters : institutions and interventions in response to recurrent disasters and conflict
Heijmans, A. - \ 2012
Wageningen University. Promotor(en): Thea Hilhorst. - S.l. : s.n. - ISBN 9789461732675 - 308
instellingen - interventie - risicofactoren - risico - plaatselijke bevolking - rampen - politieke conflicten - risicovermindering - sociale participatie - afghanistan - indonesië - filippijnen - ontwikkelingslanden - institutions - intervention - risk factors - risk - local population - disasters - political conflicts - risk reduction - social participation - indonesia - philippines - developing countries

The thesis focuses on local level responses to recurrent small disasters and conflict in Afghanistan, Indonesia and the Philippines. It critically reflects on Community-Based Disaster Risk Reduction (CBDRR) approaches to understand the gap between CBDRR policy and actual outcomes. It considers the multi-level institutions through with meaning and implementation of CBDRR policy are negotiated and transformed, from the conceptual policy design stage until the arena where decisions on risk solutions and resource allocation are made. Disasters and conflict are both understood as the product of a cumulative set of institutional arrangements and policy decisions over a long period of time. Vice versa, disasters and conflict affect institutional arrangements and re-order power relations. Interventions like CBDRR are not isolated, distinct entities, but are very much embedded in a context of particular institutional arrangements, which constrain or enable local actors to advance their risk-solutions. Through CBDRR interventions actors defend and mobilize around CBDRR practices that are meaningful to them, or resist institutions and practices that carry meanings they find disagreeable. This results in the manifold manifestations of CBDRR practices and outcomes. The research concludes that there is no such thing as the CBDRR approach. Instead, there are different processes through which local NGOs, civil society organizations, funding agencies and government agencies arrive at a specific framing of local realities and their responses in the context they live and work. These are related to their histories, current state - civil society relationships, and their mandate on how they legitimize their interventions. These actors either underscore the politics of their interventions or rather de-politicize them. From the experiences of this research it is plausible to conclude that when one ignores to view CBDRR interventions in a political and institutional manner, the out­comes of the interventions are likely to reproduce the status quo and are not supporting the vulnerable populations. The implication for humanitarian aid agencies is to include an institutional and political analysis in risk and vulnerability assessments to explain people’ vulnerability. This is crucial for strategizing actions and to engage in the political arena of disaster risk reduction with the aim to create safe and resilient communities. Rather than simply aiming for isolated village-level project objectives, CBDRR interventions have to think ahead of results to be achieved at district and even national level.

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