Artevelde University of Applied Sciences

This chapter examines the evolution and governance of global public goods (GPGs), tracing their conceptual development from traditional commoning practices to contemporary challenges. It distinguishes between common good and common goods while analysing the transformation from rural to urban governance structures. The discussion identifies four fundamental governance gaps—jurisdictional, knowledge, participation, and incentive—and explores how Political Corporate Social Responsibility has emerged as a response to these challenges. The analysis considers how traditional practices and modern business engagement must adapt to address global governance issues whilst maintaining principles of justice, equality, and inclusiveness.

This chapter examines the critical relationship between communication and global public goods (GPGs) through the lens of sustainable development. It develops an epistemic framework that emphasises how communication enables both knowledge creation and participation in GPG governance. The text distinguishes between global common goods (analysed from a legal perspective) and global public goods (examined from a management approach), positioning them as essential elements in addressing contemporary global challenges.

Introduction: Goal oriented care (GOC) and its readiness for implementation has been described in scientific literature, but research on GOC implementation in primary care organisations is limited. This study aims to capture the experiences of primary care organisations in implementing GOC in their context. Method: A qualitative study, with data triangulation, was conducted. Primary care organisations that experimented with the implementation of GOC in their context were followed. Data were analysed using inductive thematic analysis. Results: Seven themes supporting GOC implementation were identified. Project leaders from the primary care organisations experienced that related concepts can serve as a foundation for initiating the implementation of GOC. The implementation process is an iterative and reflective process, with resistance viewed as an integral part of the process, offering opportunities for reflection. Collaborating with partners, especially the active participation of patients, was seen as a facilitator. Furthermore, having a clear vision for GOC is necessary. Projects invested in adapting tools and processes to align with GOC and provided relevant training. Discussion and conclusion: The findings led to recommendations that can guide the implementation of future GOC projects. Effective implementation extends beyond the development and adaptation of tools; it requires translating theoretical concepts into practical application and creating a shared vision on GOC.

This study examined how construction noise levels and associated annoyance evolved over 4 years during the rehabilitation work of a metropolitan highway interchange. A total of 1409 participants, grouped by their proximity to the construction sites, completed a socio-acoustic survey on their personal situation and noise perception. Noise levels were monitored using 18 autonomous stations near the construction sites. Findings showed that a significant portion of participants experienced annoyance due to construction noise, though annoyance levels decreased significantly over time in both groups. Interestingly, those living closer to the construction sites reported a faster decline in overall construction noise annoyance and annoyance from other aspects of the work undertaken. Regression models indicated that construction noise levels explained only a small portion of annoyance variance. Key contributing factors included annoyance from other construction nuisances, noise perception in the bedroom, and perceived safety. This study provides valuable insights for future development of policy concerning noise on construction sites. Specifically, the results suggest that taking into account identified socio-demographic, psychosocial, and contextual variables, as well as the individuals' perception of noise levels and construction-related nuisances, could help to reduce construction noise annoyance, ultimately improving the quality of life for nearby residents.

Background People with intellectual disabilities in Flanders (Belgium) often rely on their direct support professionals (DSPs) to engage in meaningful activities. While structured approaches exist to guide engagement, limited insight is available into the specific support DSPs need in practice. Methods A descriptive qualitative study was conducted using in‐depth interviews with 13 DSPs. Thematic analysis was performed using NVivo 12. Results Five themes emerged: (1) Basic assumptions regarding meaningful activities, (2) Relationship between people with intellectual disabilities and DSPs as a prerequisite for enabling meaningful activities, (3) Facilitating factors in enabling meaningful activities, (4) Areas of tension in enabling meaningful activities, and (5) Barriers to enabling meaningful activities. Conclusions DSPs recognise the importance of meaningful activities but face significant challenges in practice. Addressing these challenges requires training and support tailored to their specific needs and the realities of their daily work, ensuring they are better equipped to foster engagement in meaningful activities.

Between 2020 and 2050, the world’s population aged 80 years and over will triple, drastically increasing the prevalence of frailty and associated healthcare costs. Multimodal exercise programmes have proven to be an ideal countermeasure for frailty, but the current Flemish standard of care does not include them. The purpose of this study is to investigate the effect of the home-based exercise programme for frail community-dwelling older adults (>70 years), ACTIVE-AGE@home, on frailty-associated outcomes, when delivered by professionals or volunteers, as well as its cost-effectiveness. A pragmatic randomised controlled trial will be conducted. Participants will be randomised into three parallel groups using permuted block randomisation. There will be two intervention groups: in one group, the intervention is delivered by professionals with a bachelor or masters’ degree in physiotherapy, occupational therapy and/or physical education, and in the other by trained volunteers. Both groups will be compared with a control group receiving usual care. Participants (n=195) are community-dwelling physically frail older adults (>70 years), as defined by Fried et al. (2001). The intervention is a 24 week programme that consists of three 1 hour visits per week and contains aerobic, strength, balance, flexibility, coordination and dual tasking exercises, accompanied by goal-setting and motivational interviewing. The Timed Chair Stand (TCS) test is the primary outcome. Functional ability, cognition, loneliness, self-management, health-related quality of life, healthcare utilisation and meaningful activities will be measured in all groups at 0, 24 and 48 weeks. Time and expenses invested by professionals or volunteers will be kept in diaries for trial and model-based cost-effectiveness analyses, expressed in incremental cost per QALY (quality-adjusted life year). The model will be designed to associate the frailty at the end of follow-up with further expected healthcare expenses beyond the duration of the trial. Statistical analysis will be blinded to group allocation, and outcome assessors will be blinded to the maximal extent possible. Ethics and dissemination Ethics approval has been obtained from the Medical Ethics Committee of UZ Brussel (O.G. 016), Peer reflection group Biomedical Ethics, Laarbeeklaan 101, 1090 Brussels. Results will be disseminated in publications and other relevant platforms. This study was registered at Clinicaltrials.gov on 6 July 2023 and posted on 14 July 2023 after National Library of Medicine quality control review. Registration details: NCT05946109 Trial registration number NCT05946109 .

Background Goal-oriented care is prominent in primary care settings due to the rising number of people living with (multiple) chronic conditions. Before goal-oriented care can be fully implemented, a better understanding about the concept of goals needs to be gained. This study aimed to elicit in-depth knowledge through the narratives of people with (multiple) chronic conditions regarding their view on goal setting. Method In a qualitative research design within a phenomenological–hermeneutical paradigm, 15 in-depth interviews were performed with people living with (multiple) chronic conditions (mean age 65; 38–81) based on a homogeneous sampling strategy. Results This study revealed that goal setting starts from talking about everyday activities embedded in a real-life context. A well-defined goal should consist of the context, the life narrative of the patient, the engagement towards a particular goal, the reason why this goal is important in terms of underlying values, the emotions going along the activity, and the relevance for the patient. This leads to CLEVER goals. Conclusion These findings prompt a reconsideration of traditional goal setting in healthcare, which typically adheres to SMART. Based on the participants’ experiences, goals should be defined as CLEVER first before they can be transposed into SMART goals.

Background and Objectives Most studies examining combined cognitive and physical activity are conducted in laboratory settings. This randomized controlled trial (RCT) examines the effects of a real-life cognitively enriched walking program on cognitive functioning and moderate-to-vigorous physical activity (MVPA) in adults aged ≥65 years. Research Design and Methods A three-arm RCT was conducted, comparing the cognitively enriched walking program (WALK+, doing cognitive tasks while walking) with a walking program without enrichment (WALK-only) and a passive control condition (CONT). Both WALK+ and WALK-only had a duration of six months, with two outdoors, supervised group-based sessions/week (60-90 minutes/session). Cognitive functioning (short- and long-term memory, executive functioning and processing speed) and MVPA were measured at baseline, three, six and 12 months using the Cambridge Neuropsychological Test Automated Battery (CANTAB) and ActiGraph GT3X+ accelerometers respectively. Results A total of 148 community-dwelling adults (median age: 69 years, range: 65-85; 72% (n=107) female) were included. Comparing WALK+ to WALK-only and CONT, and WALK-only to CONT, there were no significant intervention effects on cognitive functioning at three, six or 12 months. MVPA decreased with 13 minutes/day in WALK+ between baseline and 12 months, whilst it increased between baseline and six months with 12 minutes/day in WALK-only and between three and six months with 16 minutes/day in CONT. Discussion and Implications The WALK+ program did not lead to statistically significant benefits for cognitive functioning or MVPA compared to WALK-only or CONT. Future studies should explore for whom combined interventions may work and determine the optimal dosage.

Due to the rising number of long‐term mental health conditions, there has been a shift in therapeutic focus from curing these conditions, to living a meaningful life with them. Self‐management is described as the ability to live with the emotional, life role and medical consequences of long‐term conditions such as schizophrenia. However, the perspective of people with schizophrenia on self‐management in current literature is missing. A lack of understanding of strategies used by people with schizophrenia to self‐manage, could adversely affect the use of self‐management interventions. Therefore, this study aims to identify how people with schizophrenia manage their daily life. Semi‐structured interviews ( n = 9) were conducted in a qualitative descriptive design. The study is reported by using the COREQ checklist. All participants, recruited through purposive sampling, have been stabilised after a schizophrenic episode and have been reintegrated into their community. The data were analysed through thematic analysis. Self‐management for people with schizophrenia is an individualised process that revolves around performing day‐to‐day activities according to the participant's wishes. In addition, participants tried to prevent relapse by self‐managing daily life. Personal‐, social‐ and schizophrenia‐related factors were seen as barriers and/or facilitators in their self‐management. These barriers and/or facilitators were self‐managed using daily activities. Current self‐management interventions for this population often aim at improving medication adherence. Self‐management interventions facilitated by health care professionals should (i) focus more on supporting patients in finding their daily structure through meaningful activities and (ii) be mindful of the duality contained within self‐management of people with stabilised schizophrenia.

Background Video review is a feasible, commonly used learning tool, but current literature lacks a comprehensive review of its impact on learning in postgraduate medical education. This systematic review aims at examining the learning effect of video review of resident performance in clinical practice during postgraduate medical education. Methods A systematic literature search was conducted from May 2023 to July 2023 with an update on 12/12/2023. Databases of MEDLINE (Pubmed), Web of Science, Embase and ERIC (through Webquest) were searched. Eligible articles had to describe the learning effects of video review in clinical practice in postgraduate medical education. The videos had to be actively recorded in a setting where a camera was not normally used for standard patient care. The investigated effect needed to be classified at least as a Kirkpatrick level 2. We iteratively developed a standardized data extraction form to extract study characteristics. The methodological quality of the individual studies was assessed using the Medical Education Research Quality Instrument. Results Out of 9323 records after deduplication, 11 studies were included. The designs were randomised controlled trials (n = 4) and single-group pre-test post-tests trials (n = 7). The studies had outcomes related to knowledge and skills (n = 5), resident behaviours (n = 5) and patient outcome (n = 1). All studies reported outcomes regarding learning effect. Conclusions Video review appears to have a positive impact on residents’ learning outcomes in postgraduate medical education. However, it is mostly not tailored to the specific learning needs of residents, and there is a lack of information regarding its optimal integration with other learning methods and within distinct clinical contexts. The heterogeneity observed among the included studies makes it challenging to formulate clear recommendations in the use of video.

Background The policy shift towards person-centred integrated primary care systems drives interest in primary care across higher education programs. In Flanders, the Primary Care Academy (PCA) is established to support this policy shift. The PCA focusses on the concepts of goal-oriented care, self-management, and interprofessional collaboration to support the shift towards integrated care and to integrate them in curricula in order to strengthen and develop a futureproof health system. Therefore, the aim of this study is if and how lecturers implement these concepts in the curriculum and what they need for a successful implementation. Methods A sequential explanatory mixed method study design was used combining quantitative and qualitative data. A cross-sectional survey was sent to 276 Flemish health care education programs. Qualitative data was collected through focus groups in which lecturers participated. Results The results showed that 89% of the higher education programs address goal-oriented care, self-management, and interprofessional collaboration with regard to primary care. Further analysis of courses within the programs reveals that the concept of self-management is covered in only 58%, while goal-oriented care (73%) and interprofessional collaboration (80%) appear more frequently. The level at which the themes are addressed in the courses are often limited to an introduction. The focus groups revealed that primary care is present in education programs, however lecturers are limited aware where primary care is integrated in their own and other programs. Lectures expressed a need for more collaboration between research, education and practice in developing educational content. When new concepts are introduced, lecturers want them to be translated into educational content, learning objectives and competencies. Conclusions The study shows that the concepts of goal-oriented care, self-management, and interprofessional collaboration are present in higher education programs to a varying degree. Lecturers are eager to implement these new primary concepts but they lack collaboration between education, research and practice. Lecturers indicate the need for a competence profile for primary care professionals as common framework to guide curriculum development. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-024-02670-4.

Increasing evidence shows how distress following sexual violence might spill over to victims’ romantic relationship functioning. However, studies investigating the reverse spillover between relationship functioning and psychological distress following sexual violence are lacking. The current study therefore aimed to investigate the bidirectional association between victims’ psychological distress (posttraumatic stress, depression, anxiety and stress) and emotional and sexual intimacy using a three-wave yearly survey study of a community sample of sexual violence victims (N = 274, 89% women, 3% men and 8% trans persons, Mage = 32 years, SD = 10.7). Results show evidence for spillover effects for posttraumatic stress and stress on emotional intimacy and for anxiety on sexual intimacy. In addition, reverse spillover effects for emotional intimacy were found on all indicators of psychological distress and for sexual intimacy on depression and anxiety. These results suggest that victims’ individual and relational functioning is bidirectionally associated. In addition, results suggest that targeting intimacy levels within romantic relationships might improve victims’ individual functioning and vice versa. Future research that includes dyadic assessment could enhance our understanding of the bidirectional associations between individual functioning and couple functioning following sexual violence.

Introduction and context The social and healthcare system faces numerous challenges, with primary care playing a key role in achieving universal and equitable health coverage. However, the primary care field often struggles with limited research capacity, activity, and funding. The Primary Care Academy To address these gaps, the Primary Care Academy (PCA) - a large-scale, innovative, interdisciplinary research and networking organization, encompassing then organization in the primary care field, was established and funded in 2019 by the Fund Dr. Daniel De Coninck, a charity foundation, managed by the King Baudouin Foundation, attempted to fil this gap. Objectives The aim of this study was identifying lessons learned on the implementation and achievements of a large-scale, innovative research and network organization, specifically the PCA. Method This study evaluates the PCA’s development process, focusing on its key achievements and critical elements by using a mixed-method data collection approach. After 5 years of rigorous collaboration, several lessons can be drawn regarding accomplishments and process flow, particularly in terms of a shared and clear vision, governance, leadership, and organizational culture. Discussion and conclusion These lessons can inform future adaptations in the continuation of the PCA and serve as a guide for other caritative large-scale innovative initiatives.

Aims This study aims to report on the development and validation of the Attitude of Nursing staff towards Oral healthcare for Care‐dependent Older adults (ANOCO) questionnaire. Methods The development of the ANOCO questionnaire was performed in three stages between 2008 and 2019. In a first stage, domains related to oral healthcare attitudes were identified. Next, relevant statements per domain were formulated by a Delphi panel in two rounds, resulting in a questionnaire with 32 statements. In a final phase, this questionnaire was subjected to psychometric analysis, including an evaluation of the construct validity, an internal consistency analysis (Cronbachs alpha) and a principal component analysis. Results The questionnaire could significantly distinguish between known groups (dentists, nurses' aides, nursing students and nurses). Regarding internal consistency, Cronbach's alpha was 0.863 in the first sample ( n = 361) and 0.843 in the second sample ( n = 1051). Based on principal component analysis, 22 statements were retained. Four components with an eigenvalue of more than 1 explained 45% of the total variance. Conclusion The ANOCO‐22 questionnaire consists of 22 statements and is a valid tool to assess the changes or differences in the attitude of nursing staff towards oral healthcare for care‐dependent older adults.

Soundscape is an important environmental factor that influences people's behaviour and well-being. People with dementia can benefit from a personalized soundscape to improve the behavioural and psychological syndrome of dementia. This paper is based on a single-blind, repeated-measure pilot randomized clinical trial of soundscape augmentation on the treatment effect of people with severe dementia. Participants were randomized to a personalized soundscape intervention delivered in their room in the morning and evening or treatment-as-usual, with two baseline weeks and four weekly post-randomization assessments of the primary and secondary behavioural outcomes. A linear mixed effects model showed that the soundscape intervention was possible and acceptable. There were improvements in the Neuropsychiatric Inventory (resistance to care) and a significant reduction in aggression in the soundscape group. This study is the first pilot randomized controlled trial of a soundscape intervention for older adults with dementia to improve the behavioural and psychological syndrome of dementia. In this pilot study, soundscape augmentation was a feasible and effective non-pharmacological approach to reducing resistance and improving participants' behaviour. Further studies with larger samples are recommended to confirm our findings. Longitudinal studies are necessary to investigate the long-term effect of an augmented sonic environment on people with dementia.

Background Nursing homes face a critical need for competent healthcare professionals to deliver high-quality care. Focusing on clinical leadership is crucial for equipping healthcare professionals with the skills necessary to manage complex care needs, collaborate effectively within multidisciplinary teams, and improve care quality in nursing homes. Developing clinical leadership fosters professional growth and enhances healthcare professionals’ ability to tackle the challenges unique to the nursing home environment. However, the concept of clinical leadership in nursing homes remains poorly defined and investigated. This study aimed to explore and define influencing factors for the development of clinical leadership within healthcare professionals in nursing homes. Methods A qualitative study was conducted in Flanders, Belgium, using semi-structured focus group interviews (n = 5) with healthcare professionals (n = 41), including nurse assistants, licensed practical nurses, registered nurses, occupational therapists, recreational therapists, psychologists, and gerontologists. Interviews were audio-taped, transcribed, analysed and interpretated by using a thematic analysis based on descriptive phenomenology. Results Clinical leadership development within healthcare professionals’ hinges on four pivotal themes: (1) Cultivating an empowering working environment that fosters open feedback, encourages peer learning, and champions a stimulating learning climate. (2) Nurturing a supportive leadership style in formal leaders that exemplifies role modeling, accessibility, and a coaching approach. (3) Elevating well-developed professional identity through targeted training, experience, and a talent-oriented work approach. (4) Fostering team dynamics marked by commitment, collaboration, support, and trust. Conclusions The study’s findings on the influencing factors for clinical leadership development should be actively applied in nursing homes and guide the creation of targeted training programs and leadership development initiatives. Awareness of these factors are crucial to optimise and to support the development and implementation of clinical leadership in nursing homes in an attempt to reduce the workforce shortages.

Interprofessional communication is crucial for patient care, yet there is a dearth of comprehensive assessment tools essential to train and assess healthcare students. While the Interprofessional Educational Collaborative framework (IPEC) outlines eight sub-competencies, it lacks detailed behavioral indicators. This study aimed to create a repository of interprofessional communication behaviors to complement the IPEC sub-competencies. From 12,448 articles, 55 were selected and thematically analyzed with NVivo18®. We identified 230 interprofessional communication behaviors, organized into 10 themes and 61 sub-themes, aligning with the IPEC sub-competencies. This comprehensive repository could be foundational for developing interprofessional communication assessment tools in healthcare education and aiding healthcare institutions in improving interprofessional communication practices. ARTICLE HISTORY

Stuttering is a speech disorder in which the flow of speech is disrupted by involuntary repetitions of sounds, syllables, words or phrases, stretched sounds or silent pauses in which the person is unable to produce sounds and sound transitions. Treatment success is the highest if stuttering is treated before the age of 6 years, before it develops into “persistent” stuttering. Stuttering treatment programs that focus directly on the speech of the child, like the Lidcombe Program, have shown to be effective in this age group. Mini-KIDS is also a treatment that focuses directly on the speech of the child. It is possible that capturing the increased brain plasticity at this age in combination with creating optimal conditions for recovery underlie these treatments’ success rate. A treatment focusing on the cognitions, emotions and behaviour of the child, the social cognitive behaviour treatment (SCBT), is also frequently delivered in Belgium. In this study we want to compare, and collect data on the effectiveness, of these three treatment programs: Mini-KIDS, SCBT and the Lidcombe Program (protocol registered under number NCT05185726). 249 children will be allocated to one of three treatment groups. Stuttering specialists will treat the child (and guide the parents) with Mini-KIDS, the SCBT or the Lidcombe Program. They will be trained to deliver the programs meticulously. At 18 months after randomisation, the speech fluency of the child and the attitude of the child and parent(s) towards speech will be measured. It is expected that the three programs will achieve the same (near) zero levels of stuttering in nearly all children and a positive attitude towards speech at 18 months after the start of treatment. The amount of treatment hours to reach the (near) zero levels of stuttering will be compared between the different programmes. For families as well as for the health system this could generate important information.

Increasing evidence shows that survivors of sexual violence frequently expe- rience relationship difficulties following their victimization. Little is known regarding how couples which formed post-assault cope with the impact of the prior assault. Hence, the aim of the current study was to gain insight into post-assault formed couples’ experiences in coping with the impact of sexual violence. To this end, an interview study was conducted with five female survivors and their male partners who began their romantic relation- ship post-assault. A dyadic phenomenological interview analysis revealed that sexual victimization is a dyadic stressor but is not always considered as such by the couple. In addition, disclosure is described as a potential bond- ing experience. Flexibility and creativity from both partners are required as they adapt to the post-assault impact. In addition, meaningful communica- tion and considering the perspective of one’s partner seemed to be key to dyadically cope successfully. The current study also identified challenges couples had to manage, including caregiver burden and role confusion. Results suggest that interventions supporting couples in their continuous efforts toward mutual understanding can foster trust and growth.