Inge Merkelbach’s research while affiliated with Erasmus University Rotterdam and other places

Background There are concerns about access to remote care for patients from low-income neighborhoods, as their first point of contact in Dutch health care is the general practitioner (GP). Now that general practice professionals have returned to the pre-pandemic ways of health care delivery, this paper looks back at experiences with remote care during COVID-19. It investigates experiences of both patients and general practice professionals with the approachability and appropriateness of remote care, and their satisfaction. Methods In this qualitative study, interviews were conducted with 78 patients and 18 GPs, 7 nurse practitioners and 6 mental health professionals from general practices in low-income neighborhoods. Interviews took place by phone or in person in the native language of participants. Results Patients from low-income neighborhoods generally found remote care to be approachable, especially telephone consultation. In contrast, video calling was rarely used. Most patients thought remote care was possible for minor ailments but still wanted to see the doctor face-to-face regularly. Patients were generally satisfied with remote care at the time, but this did not necessarily reflect their willingness to continue using it in the future. Moreover, there was lack in consensus among general practice professionals on the appropriateness of remote care for certain physical and mental complaints. Nurse practitioners and mental health professionals had a negative attitude toward remote care. Conclusions Integrating remote care in general practices in low-income neighborhoods is not only important in times of crisis, but also for the future where care is becoming increasingly digitalized. To achieve full integration of remote care in general practices, it is important to take opinions and barriers of patients and providers into account. It is also recommended to create guidelines for reaching consensus on the cases in which remote care can be appropriately used. Key messages • Take opinions and barriers regarding remote care of GP patients and providers into account. • Create guidelines to reach consensus on the appropriate use of remote care for GP patients’ health problems.

Aim To explore how patients and general practice professionals in low-income neighborhoods experienced the increase of remote care during COVID-19. Background As the GP (general practitioner) is the first point of contact in Dutch health care, there are concerns about access to remote care for patients from low-income neighborhoods. Now that general practice professionals have returned to the pre-pandemic ways of healthcare delivery, this paper looks back at experiences with remote care during COVID-19. It investigates experiences of both patients and general practice professionals with the approachability and appropriateness of remote care and their satisfaction. Methods In this qualitative study, 78 patients and 18 GPs, 7 nurse practitioners and 6 mental health professionals were interviewed. Interviews were held on the phone and face-to-face in the native language of the participants. Findings Remote care, especially telephone consultation, was generally well-approachable for patients from low-income neighborhoods. Contrarily, video calling was rarely used. This was partly because patients did not know how to use it. The majority of patients thought remote care was possible for minor ailments but would also still like to see the doctor face-to-face regularly. Patients were generally satisfied with remote care at the time, but this did not necessarily reflect their willingness to continue using it in the future. Moreover, there was lack in consensus among general practice professionals on the appropriateness of remote care for certain physical and mental complaints. Nurse practitioners and mental health professionals had a negative attitude toward remote care. In conclusion, it is important to take the opinions and barriers of patients and care providers into account and to increase patient-centered care elements and care provider satisfaction in remote care. Integrating remote care is not only important in times of crisis but also for future care that is becoming increasingly digitalized.

Psychosocial characteristics of children with autism were collected before the COVID-19 pandemic and compared with data collected during the pandemic. The results show a surprising improvement, especially from T0 to T1. Girls and children attending special education showed increased difficulties over time, while older children showed fewer difficulties. While there was a general decrease in difficulties, we observed stability in the subdomain of emotional problems. Hyperactivity, behavioral problems, and peer issues decreased. Moreover, we noticed increased prosocial behavior during the pandemic. Attending special education was associated with increased peer-related problems over time, while a higher age predicted fewer behavioral problems and increased prosocial behavior over time. All in all, the COVID-19 pandemic may have temporarily improved the environment for autistic children in the Netherlands.

Studies on the impact of the COVID-19 pandemic on autistic children’s psychosocial outcomes have shown mixed results. In the current study we aimed to gain a better insight into the effect of the COVID-19 pandemic by comparing psychosocial outcomes collected pre-pandemic with data collected during the pandemic. We used the Strengths and Difficulties Questionnaire (SDQ) to examine change over time in psychosocial outcomes of autistic children from pre-pandemic (T0) to lockdown I (T1) and lockdown II (T2) in the Netherlands. We expected a deterioration in psychosocial outcomes. There were 224 participants in T0 and T1, of which 141 also participated in T2. The results showed a surprising improvement in psychosocial outcomes from T0 to T1. Special education and female gender were associated with increased difficulties over time, while higher age was associated with decreased difficulties. At the subdomain level we found that emotional problems remained stable, while hyperactivity, conduct problems, and peer problems decreased, and prosocial behavior increased. Attending special education predicted increased peer problems over time, while higher age predicted both decreased conduct problems and increased prosocial behavior over time. The COVID-19 pandemic may have temporarily improved the fit between the psychosocial needs and the environment for children with autism in the Netherlands.

Background Smokers with a low socioeconomic position (SEP) often experience heightened stress due to increased exposure to daily hassles and multiple environmental, social, and smoking-specific stressors. In turn, these stressors may deplete mental bandwidth and trigger unhealthy behavioral responses, such as smoking. This study aimed to evaluate the effectiveness of an integrated multicomponent intervention developed to concurrently target stress- and smoking-related behaviors among socioeconomically disadvantaged smokers. Methods A 3-group randomized controlled trial was conducted between February 2018 and July 2019. Adult low-SEP smokers experiencing stress complaints were recruited from disadvantaged neighborhoods in Rotterdam. Groups of participants were randomly assigned to a stress management course (SM, n = 62), stress management with a buddy component (SMb, n = 66) or a waitlist (n = 90). The SM and SMb groups received psychoeducation topics linked to cognitive and behavioral technique activities. SMb additionally provided emotional and instrumental support. The waitlist group received the intervention after the study. Groups were randomized using a computer-generated random allocation. Participants were blinded to the study hypotheses, while the research team was unblinded to allocation. Primary outcomes were assessed at baseline (T0), at week four of the intervention (T1) and at 12 weeks (T2), and included total stress scores, nicotine dependence scores, self-reported and expired carbon monoxide (eCO)-validated smoking abstinence at T1 and T2. The analyses were intention-to-treat and adjusted for covariates measured at baseline. Intervention effectiveness was examined using mixed-effects models. Results Of 209 participants (mean age, 47.1 (SD = 11.3, range 21–78 years), 176 completed the intervention (retention rate 84%). A significant reduction in stress levels was found in the SM at one month and in the SMb at three months compared to the waitlist. At one month and three months, nicotine dependence scores were significantly lower in the SM and SMb groups than in the waitlist group. No significant changes were observed in expired carbon monoxide levels. Conclusions These findings show that a multicomponent intervention aimed at relieving stress complaints may be a solution to improve smoking-related outcomes among socioeconomically disadvantaged smokers. These findings have implications and merit further evaluation. Trial registration: www.clinicaltrials.gov; identifier: NCT03553979; date of registration: 01/01/2018

Behavioral insights teams (BITs) employ behavioral experts and policy professionals to collaboratively improve public policy. Most evaluations of BITs focus on the interventions that BITs develop, but not the functioning of BITs. Here, we report the first comprehensive evaluation of a BIT, the Behavioral Insights Group Rotterdam. We investigate how its resources were used, for what activities, with what outputs, and to which effects. Using quantitative and qualitative methods, we derive nine propositions to describe and improve the integration of behavioral insights into public policy and administration.

Samenvatting We hebben onderzocht wat de bereidheid van ouders is om hun kinderen van 5 tot 11 jaar te laten vaccineren tegen corona en factoren die hieraan bijdragen. Op boostervaccinatielocaties in Rotterdam is aan ouders (N = 214, 57,8 % vrouw) een vragenlijst uitgedeeld met open en gesloten vragen. De vragenlijst was onderverdeeld in drie categorieën: achtergrondvariabelen van de deelnemer (ouder), achtergrondvariabelen van zijn/haar kinderen, en determinanten van vaccinatiebereidheid en informatiebehoeften. De resultaten laten zien dat 43,0 % van de ouders bereid was hun kinderen te vaccineren. Ouders hadden een ambivalente attitude ten aanzien van vaccineren, en schatten de kans op corona bij kinderen relatief hoog en de ernst van corona bij kinderen relatief laag in. De visie op schadelijkheid van het vaccin was ambivalent. Attitude was de sterkste voorspeller van vaccinatie-intentie en medieerde de effecten van kans, ernst en schadelijkheid. Veel ouders zouden de beslissing met de partner, maar ook met het kind nemen. In de open vragen gaven ze als redenen om het kind wel te vaccineren vooral dat ze het kind of anderen wilden beschermen. Redenen om het kind niet te vaccineren waren vooral zorgen over bijwerkingen en twijfel over de meerwaarde van het vaccineren van kinderen. De beschouwing beschrijft communicatie- en interventiemogelijkheden om vaccinatiebereidheid te bevorderen.

Background Worldwide the Covid-19 pandemic resulted in drastic behavioral measures and lockdowns. Vaccination is widely regarded as the true and only global exit strategy; however, a high vaccination coverage is needed to contain the spread of the virus. Vaccination rates among young people are currently lacking. We therefore studied the experienced motivations and barriers regarding vaccination in young people with the use of the health belief model. Methods We conducted a correlational study, based on a convenience sample. At the vaccination location, directly after vaccination, 194participants(16–30 years) who decided to get vaccinated at a pop-up location several weeks after receiving a formal invitation, filled out a questionnaire regarding their attitudes towards vaccination based on concepts defined in the health belief model. We used these concepts to predict vaccination hesitancy. Results Younger participants and participants with lower educational levels report higher levels of hesitancy regarding vaccination (low education level = 38.9%, high education level = 25.4%). Perceived severity (Mhesitancy = .23, Mno hesitancy = .37) and susceptibility (Mhesitancy = .38, Mno hesitancy = .69) were not associated with hesitancy. Health related and idealistic benefits of vaccination were negatively associated with experienced hesitancy (Mhesitancy = .68, Mno hesitancy = -.37), while individualistic and practical benefits were not associated with hesitancy (Mhesitancy = -.09, Mno hesitancy = .05). Practical barriers were not associated with hesitancy (Mhesitancy = .05, Mno hesitancy = -.01), while fear related barriers were strongly associated with hesitancy (Mhesitancy = -.60, Mno hesitancy = .29). Conclusions Health related, and idealistic beliefs are negatively associated with experienced hesitancy about vaccination, while fear related barriers is positively associated with experienced hesitancy. Future interventions should focus on these considerations, since they can facilitate or stand in the way of vaccination in young people who are doubting vaccination, while not principally opposed to it.

Objectives Remote consultations were common in general practice during the COVID-19 pandemic. This approach may have affected access to GP care for people with low socio-economic status: this group has a high prevalence of chronic conditions and a higher mortality rate due to COVID-19. This study explores the association of sociodemographic and health factors with the decision to contact a GP practice, and care utilisation, among patients in low-income neighbourhoods in the Netherlands. Design Cross-sectional survey study. Setting General practice in low-income neighbourhoods in the Netherlands. Participants Patients from low-income neighbourhoods were selected from fourteen general practices on the basis of ethnic background, chronic disease or health literacy. Participants were stratified according to categories of these background characteristics to obtain equal numbers per category. A total of 213 surveys were retained for analysis. Main outcome measures Need for GP contact, decision to contact a GP practice, and GP service utilisation. Results Forty-five percent ( N = 88) of the participants experienced health problems for which they wished to consult their GP at the start of the outbreak of COVID-19. A majority of them (81%) had contact with a GP service. The need to contact the GP was significantly associated with financial difficulties (OR 2.20 CI (1.10 to 4.39)). An interaction effect was found of health literacy with concerns about COVID-19 with in respondents with low health literacy a significant association between concerns about COVID-19 and a need for a GP appointment (OR 5.33 CI (2.09 to 13.59)) and absence of a significant association in the higher health literacy group (OR 1.14 CI (0.51 to 2.56)) . Moreover, 56% ( N = 74) of the participants received remote care at least one time during the first wave of COVID-19. Female participants used remote care more often (OR 3.22 CI (1.57 to 6.59)) and participants aged 50 and over used remote care less often (OR 0.46 CI (0.21 to 0.97)). Conclusion Many patients in low-income neighbourhoods were able to consult a GP, often remotely. However from the equity perspective, access to GP care should be safeguarded for patients with health problems, financial difficulties and low health literacy because of their greater need to consult a GP during times of crisis.