Danielle R M Timmermans

Amsterdam University Medical Center | VUmc · Department of Public and Occupational Health

Background The introduction and wide application of non-invasive prenatal testing (NIPT) has triggered further evolution of routines in the practice of prenatal diagnosis. ‘Routinization’ of prenatal diagnosis however has been associated with hampered informed choice and eugenic attitudes or outcomes. It is viewed, at least in some countries, with...

Background: Patient decision aids (PDAs) have shown to be effective in facilitating shared decision-making (SDM) in maternity care. However, many PDAs are difficult to use for clients because of high cognitive demand. Objective: This study aimed to explore how current digital PDAs support clients’ health literacy skills (understanding, appraising,...

Background Shared decision-making (SDM) in maternity care is challenging when clients have insufficient health literacy (HL) skills. This study gained insight in how professionals apply HL-sensitive SDM in Dutch maternity care and their needs for support therein. Methods Maternity care professionals (n = 30) completed a survey on SDM and the role...

Background: Intrinsic values and priorities influence decision-making and are, therefore, important to consider explicitly in intervention development. Although health is generally considered an important value, individuals often make unhealthy choices, indicating a values disconnect. Study aim: To investigate how becoming aware of a disconnect...

In the Netherlands, intensive livestock farming is a recurrent topic of societal debate with stakeholders having quite different perspectives on the benefits and harms. In particular, stakeholders appear to have different perceptions on the risks to human and animal health. This paper reports a quantitative analysis of a survey on the perceptions o...

Background: Pregnant women should be able to make autonomous and meaningful decisions about prenatal screening for fetal abnormalities. It remains largely unclear which circumstances facilitate or hinder such a decision-making process. Objective: To investigate what conditions Dutch pregnant women and professional experts consider important for...

To (1) explore how women visually attend to a hospital report card (HRC), (2) explore whether visual attention of younger and older women (patients and non-patients) differs. Eye-tracking study with a short survey. Participants ( N = 37) were provided with a hypothetical realistic HRC. Total dwell times and fixation counts were measured while parti...

Currently, there is a societal debate in the Netherlands about the future of intensive livestock farming and the current risks for human health and the environment. These risks could be described as systemic risks, which call for a deliberative approach to risk governance, including risk communication. However, stakeholders often have different per...

Een preventieve maatregel die kan bijdragen aan het reduceren en/of voorkomen van stressgerelateerde aan-doeningen bij zorgmedewerkers is risicocommunicatie. Risicocommunicatie gaat over oorzaken, gevolgen en preventieve maatregelen van gezondheidsrisico's en heeft drie doelen: informeren, geïnformeerde besluit-vorming stimuleren en motiveren tot a...

This entry provides an introduction to the communication of statistical health messages to the lay public. Statistical health messages are defined in this entry as “messages about numbers of individuals, events or items in the context of health and healthcare.” The lay public is mostly confronted with these messages in probability form, through the...

Communicating personalized, risk-based breast cancer screening information is challenging. In co-creation with women, information needs were assessed and information prototypes and visualizations were developed. Explaining risk-based screening with underlying risk factors should be done through unambiguous information with a cordial/personal tone,...

Informed decision-making (IDM) is considered an important ethical and legal requirement for population-based screening. Governments offering such screening have a duty to enable invitees to make informed decisions regarding participation. Various views exist on how to define and measure IDM in different screening programmes. In this paper we first...

Purposes Healthcare workers are at risk of stress-related disorders. Risk communication can be an effective preventive health measure for some health risks, but is not yet common in the prevention of stress-related disorders in an occupational healthcare setting. The overall aim is to examine whether risk communication was part of interventions aim...

Workers do not always showcase adequate knowledge on potential long-term health effects and other properties of particulate matter (PM), which may lead to a decreased tendency to work safely in a high-PM environment. To empower workers to work more safely in environments with high PM exposure, we developed an educational folder tethered to their in...

Risk communication is often seen as summarizing the results of epidemiological research in layman's terms, assuming that this information is sufficient for citizens to make choices. However, many people struggle to understand and make sense of the numbers in which risks are expressed. People also generally do not have an epidemiological view of the...

Background With increasing knowledge on the adverse health effects of certain constituents of PM (particulate matter), such as silica, metals, insoluble ions, and black carbon, PM has been under the attention of work safety experts. Previously, we investigated the perceptions of blue-collar workers in highly exposed areas of work. Subsequently, we...

Background Promoting active (i.e., conscious, autonomous, informed, and value-congruent) choices may improve the effectiveness of physical activity interventions. This web-based four-arm experimental study investigated the effect of promoting an active versus passive choice regarding physical activity on behavioural and psychological outcomes (e.g....

Background From 2015 to 2018, the Netherlands faced an outbreak of invasive meningococcal disease (IMD) caused by serogroup W. To counter the rise in infections, the government introduced a catch-up menACWY vaccination campaign for teenagers in 2018 and 2019. The outbreak situation induced substantial media attention and a run on menACWY vaccines o...

Background Office workers spend a significant part of their workday sitting. Interventions that aim to reduce sedentary behaviour and increase physical activity might be more effective if greater attention is paid to individual perspectives that influence behavioural choices, including beliefs and values. This study aimed to gain insight into offic...

Background Hospital report cards (HRCs) are usually presented in a textual and factual format, likely hampering information processing. Objective This study aimed to investigate the effects of audiovisual and narrative information in HRCs on user responses, and to test differences between older and younger women. Design A 2 (modality [textual vs....

Women’s views on responsible motherhood influence decision-making regarding participation in prenatal screening. Previous studies showed that the probabilistic nature of the first-trimester combined test and the potential requirement for subsequent invasive diagnostics serve as legitimate reasons for women to exclude prenatal screening from their m...

Due to the favorable test characteristics of the non-invasive prenatal test (NIPT) in the screening of fetal aneuploidy, there has been a strong and growing demand for implementation. In the Netherlands, NIPT is offered within a governmentally supported screening program as a first-tier screening test for all pregnant women (TRIDENT-2 study). Howev...

Background To counter the rise in invasive meningococcal disease (IMD) serogroup W, the Netherlands introduced a menACWY catch-up vaccination campaign for teenagers in 2018 and 2019. Teenagers and parents who have questions or who seek advice from a professional about vaccinations are likely to consult a youth healthcare professional or their gener...

Background Office workers spend a significant part of their workday in a sedentary position. Interventions that aim to reduce sedentary behaviour and increase physical activity insufficiently take into account individual perspectives – including beliefs and values – that influence behavioural choices. This study aimed to gain an in-depth understand...

This study aims to increase insights into the potential role of the media in the amplification and attenuation of modern risks in society, by studying the dynamics and contents of the newspaper coverage about the potential health risk posed by rubber granulate in the Netherlands. We thematically analysed 153 national newspaper articles about the ri...

Zorg van goede kwaliteit kan worden beschreven in vier domeinen. Ten eerste: effectiviteit of doeltreffendheid, gebaseerd op wetenschappelijk bewijs. Ten tweede: patiëntveiligheid, opdat de zorg geen schade aan de patiënt veroorzaakt. Ten derde: patiëntgerichtheid, ondersteund door gedeelde besluitvorming en gebruik van door de patiënt gerapporteer...

Background: Shared decision making requires evidence to be conveyed to the patient in a way they can easily understand and compare. Patient decision aids facilitate this process. This article reviews the current evidence for how to present numerical probabilities within patient decision aids. Methods: Following the 2013 review method, we assembl...

Background: Decision aid developers have to convey complex task-specific numeric information in a way that minimizes bias and promotes understanding of the options available within a particular decision. Whereas our companion paper summarizes fundamental issues, this article focuses on more complex, task-specific aspects of presenting numeric info...

Shared decision-making requires adequate functional health literacy (HL) skills from clients to understand information, as well as interactive and critical HL skills to obtain, appraise and apply information about available options. This study aimed to explore women’s HL skills and needs for support regarding shared decision-making in maternity car...

A key component of outbreak control is monitoring public perceptions and public response. To determine public perceptions and public responses during the first 3 months of the coronavirus disease (COVID-19) outbreak in the Netherlands, we conducted 6 repeated surveys of ≈3,000 persons. Generalized estimating equations analyses revealed changes over...

Background Particulate matter (PM) exposure is an important health risk, both in daily life and in the workplace. It causes respiratory and cardiovascular diseases and results in 800,000 premature deaths per year worldwide. In earlier research, we assessed workers’ information needs regarding workplace PM exposure, the properties and effects of PM,...

In the Netherlands, until recently, public messages in case of a large chemical fire, routinely contained phrases such as: ‘no hazardous materials have been detected in the smoke’, ‘there is no danger to public health’, and ‘people are recommended to stay indoors and close doors and windows’. Such messages not only fail to adequately inform people...

Audiovisual and narrative information are often used in online decision aids. However, few studies have tested whether these strategies are more effective compared to other types of information. We tested the effect of these strategies on satisfaction with the information, recall and informed decision-making in a 2 (Modality: audiovisual vs. textua...

Background: Risk information in patient decision aids (PDAs) is often difficult for older patients to process. Providing audiovisual and narrative information may enhance the understanding and use of health-related information. We studied the effects on patients' information processing and use of audiovisual and narrative information of an early-s...

Background. Particulate matter (PM) exposure is an important health risk, both in daily life and in the workplace. It causes respiratory and cardiovascular diseases and results in 800,000 premature deaths per year worldwide. In earlier research, we assessed workers’ information needs regarding workplace PM exposure, the properties and effects of PM...

Background. Particulate matter (PM) exposure is an important health risk, both in daily life and in the workplace. It causes respiratory and cardiovascular diseases and results in 800,000 premature deaths per year worldwide. In earlier research, we assessed workers’ information needs regarding workplace PM exposure, the properties and effects of PM...

Background. Particulate matter (PM) exposure is an important health risk, both in daily life and in the workplace. It causes respiratory and cardiovascular diseases and results in 800,000 premature deaths per year worldwide. In earlier research, we assessed workers’ information needs regarding workplace PM exposure, the properties and effects of PM...

Background. Particulate matter (PM) exposure is an important health risk, both in daily life and in the workplace. It causes respiratory and cardiovascular diseases and results in 800,000 premature deaths per year worldwide. In earlier research, we assessed workers’ information needs regarding workplace PM exposure, the properties and effects of PM...

To control the rise in Neisseria meningitidis strain W infections, during 2018–2019, the Netherlands launched a catch-up meningococcal conjugate (MenACWY) vaccination campaign for teenagers (13–18 years of age). Applying a mental models approach, we surveyed teenagers and their parents about their knowledge and beliefs about meningococcal disease,...

Introduction It is increasingly considered important that people make an autonomous and informed decision concerning colorectal cancer (CRC) screening. However, the realisation of autonomy within the concept of informed decision-making might be interpreted too narrowly. Additionally, relatively little is known about what the eligible population bel...

Electromagnetic fields, or EMF, are ubiquitous in our daily life. Extremely low frequency magnetic fields (ELF MF) are generated by any device using electric current. Especially in workplace situations involving MRI scanners, welding equipment, induction heaters, and power plants, they are known for potentially high field strengths. These high fiel...

Background: Choice architecture interventions, which subtly change the environment in which individuals make decisions, can be used to promote behavior change. This systematic review aimed to summarize studies on micro-environmental choice architecture interventions that encouraged physical activity or discouraged sedentary behavior in adults, and...

Individualizing the risks of cardiovascular disease and the expected effects of preventive medication can contribute to better shared decisions between patients and doctors. Calculated risks, however, do not always align with the patient's own experience or intuition. Maybe it's time for even more individualization by taking patients' personal expe...

Background: Our study examined the use of decision-making styles, as identified by Scott and Bruce (1995) (i.e. differentiating between a rational, intuitive, dependent, avoidant and spontaneous decision-making style), within the context of colorectal cancer (CRC) screening participation. In the field of cancer screening, informed decision-making...

Purpose: Counselees' preferences are considered important for the choice of risk communication format and for improving patient-centered care. We here report on counselees' preferences for how risks are presented in familial breast cancer counseling and the impact of this preferred format on their understanding of risk. Patients and methods: As...

For some chemical substances in food, scientific uncertainty prevents definitive statements about the presence of risk for human health. In this qualitative study, we explored the public’s understanding and risk appraisal of these substances. During semi-structured interviews, participants from the public were presented with inconclusive risk infor...

Particulate matter (PM) exposure, amongst others caused by emissions and industrial processes, is an important source of respiratory and cardiovascular diseases. There are situations in which blue-collar workers in roadwork companies are at risk. This study investigated perceptions of risk and mitigation of employees in roadwork (construction and m...

Background The recent emphasis on value‐based health care (VBHC) is thought to provide new opportunities for shared decision‐making (SDM) in the Netherlands, especially when using patient‐reported outcome measures (PROMs) in routine medical encounters. It is still largely unclear about how PROMs could be linked to SDM and what we expect from clinic...

In toxicological health risk assessment, epistemic uncertainties (e.g. about an agent's intrinsic properties or toxicity) often remain, preventing definitive statements about whether a chemical carries a risk. In this study, we analyzed public appraisals of uncertain risks of food additives and contaminants. We identified three major characteristic...

Background The Netherlands experiences an unprecedented increase in meningococcal W infections. A national catch-up menACWY vaccination campaign started in October 2018, covering birth cohorts 2001-2005. To understand menACWY vaccination decisions, our study reports on perceptions of risks and their influence on menACWY vaccination intentions durin...

Making good decisions prospectively is difficult, especially when there is the perception that the stakes are high. There is often uncertainty regarding prognosis and emotions prevail both between a couple and in the interactions with their healthcare professional team. This is the case when parents have to decide about fetal therapy for congenital...

The presence of intensive livestock farms in close vicinity to residential areas in the Netherlands is a complex problem characterised by knowledge uncertainty about the effects on residential health, overlapping value-driven concerns and stakeholder diversity. In order to address concerns about the health effects and effectively manage the debate...

Background: In cervical screening programs, women typically receive information leaflets to support their decision about participation. However, these leaflets are often based on what experts consider important benefits and harms of screening and not what women themselves consider important to know. Objective: To identify which benefits and harms w...

This paper reports on the perceptions of risk related to practicing sports on fields containing rubber granulate infill, and preferences for mitigation measures, among people with and without offspring exposed to rubber granulate. Two repeated surveys were conducted among members of the general population and parents of children aged under 18, in t...

Objective Previous studies have shown that having promotion-oriented goals (e.g. wanting to become healthy) or prevention-oriented goals (e.g. wanting to avoid getting ill) can affect people’s health-related decisions and behaviour by emphasising aspects and information that seem relevant in light of what they want to achieve. However, this issue h...

Factor analysis and correlation matrix. (DOCX)

Associations between sex, education and birth year, people’s goal-orientation, people’s focus on advantages or disadvantages, and CRC screening participation and (multiple linear and logistic regression analyses). (DOCX)

Questionnaire (in English and Dutch). (DOCX)

Considerations regarding CRC screening participation (descriptive statistics). (DOCX)

In environmental health science, the concept ‘uncertain risk’ refers to situations in which epistemic uncertainties prevent definitive statements about the presence or existence of risk. The concept is difficult for risk communication and may easily lead to miscommunications and misunderstanding. This research investigated how the concept of uncert...

Title: Perceptions of uncertain risks of societal groups Aim: To foster effective risk communication in case of uncertain environmental health risks. Keywords: • Risk communication • Risk perception • Environmental health • Inconclusive risk information In order to foster effective risk communication in case of uncertain environmental heal...

Background Colorectal cancer (CRC) screening is widely recommended. Earlier research showed that the general public are positive about CRC screening, as too the eligible CRC screening population. Among the eligible CRC screening population this positive perception has been shown to be associated with their perceptions of cancer, preventive health s...

Introduction: Studies found that higher risk appraisal of radiofrequency electromagnetic fields is associated with reporting more non-specific symptoms such as headache and back pain. There is limited data available on the longitudinal nature of such associations and what aspects of risk appraisal and characteristics of subjects are relevant. Obj...

Objective: Situational factors of prenatal screening have changed in recent decades. To explore the effect of a changing context on women's decision making, differences and similarities in the decision-making process of pregnant women regarding prenatal screening for fetal aneuploidy between two periods in time were studied. Design: A qualitativ...

Background: Psychosocial research has shown that perceived exposure can influence symptom reporting, regardless of actual exposure. The impact of this phenomenon on the interpretation of results from epidemiological research on environmental determinants of symptoms is unclear. Objective: Our aim was to compare associations between modeled expos...

Large fires involving hazardous materials are often characterized by failing crisis communication. In this study, we compared opinions of experts regarding the risks of major fires to lay beliefs using a mental models approach. Amongst lay people this revealed relevant knowledge gaps and beliefs in opposition to those held by experts. While, expert...