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Background: Organ donation registration rates remain low, especially among people with lower educational levels. An interactive educational intervention was developed to prepare lower-educated students in the Netherlands for making a well-informed decision about organ donation. This article reports on the effects of this intervention on the intention to register (i.e., the primary outcome in the study at hand) and beliefs regarding organ donation., Materials and Methods: The effectiveness was investigated in a post-test-only cluster randomized controlled trial, in which the intervention was offered to the experimental group and after measurement also to the control group. Randomization to the experimental and control groups took place at a class level. Teachers of schools for Intermediate Vocational Education who taught a course on Citizenship delivered three intervention elements (i.e., video fragments and discussion, quizzes with tailored feedback and exercise filling out a registration form) to their students during two 50-min lessons., Results: A total of 1170 students participated in the trial and filled out a questionnaire (45 experimental and 43 control classes). Compared to the control group, students in the experimental group had higher odds of having positive registration intentions (OR = 1.81; 95%CI [1.10-2.96]), their perceived knowledge was higher (B = 0.62; 95%CI [0.23-1.01]) and they had higher intentions to talk to family members (B = 0.68; 95%CI [0.28-1.08]) and friends (B = 0.36; 95%CI [0.07-0.66]) about organ donation. There were no effects on the choice students intended to register (OR = 1.08; 95%CI [0.67-1.73])., Conclusions: Providing education in a classroom setting is an effective tool in increasing registration intentions. Despite uncertainties about the effects on actual registration behavior, a larger-scale dissemination of this intervention is recommended. Providing clear information and opening the discussion about organ donation is an important and promising first step towards higher registration rates., Trial Registration: The Dutch Trial Register, ID: NTR6771. Registered on 24 October 2017. https://www.trialregister.nl/trial/6557.

Background: Registration rates are low for organ donation among lower educated adolescents in The Netherlands. This could be improved by preparing them for making a decision regarding donation when they become 18 years old. To do so, more insight is needed into their beliefs about organ donation and registration., Methods: A cross-sectional quantitative study was conducted among students in intermediate vocational education schools. Data were gathered my means of self-administrated questionnaires. The outcome measurements included current registration status, being an organ donor, intention to register, and intention to become a donor. Correlation coefficients were used to assess the strength of associations between beliefs and each of the 4 outcome measurements., Results: A total of 405 participants (mean age, 18.86 years) were included, of whom 26.6% had already registered a decision. Most beliefs showed a significant correlation with one or more of the outcomes. In general, the correlations were of small to medium size and participants scored around the middle of the scales on the beliefs., Conclusion: Means and correlations need to be combined to gain insight into the importance of certain beliefs for future interventions. However, it is plausible that, in addition to these explicit beliefs, implicit factors play a role in registration behavior. This could be explored in future research. Results could support intervention development for increasing registration rates., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: The gap between the supply and demand of organ donors is substantial, causing patients to suffer from long waiting times. Moreover, the lack of registrations places a burden on family members and medical professionals when an unregistered individual dies. This article describes a cluster randomized controlled trial (CRCT) study to assess the effectiveness and quality of implementation of a web-based program aimed at encouraging lower-educated adolescents to register a well-informed choice about organ donation, regardless of it being as a donor or not., Methods/design: The program will be delivered by teachers at schools for Intermediate Vocational Education in the Netherlands. The effectiveness will be assessed in a CRCT design with post-test only using self-administered questionnaires for the primary outcome (i.e. intention to register). Classes will be matched to improve equivalence of groups. From each pair of matched classes, one class will be randomly assigned to the experimental condition, and the other assigned to the control condition. Students in the control groups will fill in the questionnaire before receiving the program, while the experimental groups will do this afterwards. A post-test design prevents the risk of testing bias. The required sample size is 14 schools, with 10 classes per school and 13 unregistered students per class. The questionnaire assesses demographics, behavioural determinants (attitude, self-efficacy, knowledge and social outcomes), intention to register (as a donor) and registration status. Six months after delivery, registration status will be assessed again. Additionally, a process evaluation will be conducted to evaluate the quality of implementation using both qualitative (i.e. semi-structured interviews) and quantitative (i.e. logbooks, questionnaires, Google Analytics to track user behaviour at the website) methods., Discussion: Findings of the study can help to further improve the program and serve as a basis for a solid dissemination plan. Moreover, the study will provide insight into (change in) determinants of registration and donorship and the translation of research into practice of school-based health promotion interventions, which can serve as an example for others., Trial Registration: The Dutch Trial Register, NTR6771 . Registered on 24 October 2017. This is version 2 of the protocol (5 November 2017).

Objective: The high energy intake from energy-dense foods among children in developed countries is undesirable. Improving food parenting practices has the potential to lower snack intakes among children. To inform the development of interventions, we aimed to predict food parenting practice patterns around snacking (i.e. 'high covert control and rewarding', 'low covert control and non-rewarding', 'high involvement and supportive' and 'low involvement and indulgent')., Design: A cross-sectional survey was conducted. To predict the patterns of food parenting practices, multinomial logistic regression analyses were run with 888 parents. Predictors included predisposing factors (i.e. parents' and children's demographics and BMI, parents' personality, general parenting, and parenting practices used by their own parents) and parents' cognitions (i.e. perceived behaviour of other parents, subjective norms, attitudes, self-efficacy and outcome expectations)., Setting: The Netherlands (October-November 2014)., Subjects: Dutch parents of children aged 4-12 years old., Results: After backward elimination, nineteen factors had a statistically significant contribution to the model (Nagelkerke R 2=0·63). Overall, self-efficacy and outcome expectations were among the strongest explanatory factors. Considering the predisposing factors only, the general parenting factor nurturance most strongly predicted the food parenting clusters. Nurturance particularly distinguished highly involved parents from parents employing a pattern of low involvement., Conclusions: Parental cognitions and nurturance are important factors to explain the use of food parenting practices around snacking. The results suggest that intervention developers should attempt to increase self-efficacy and educate parents about what constitute effective and ineffective parenting practices. Promoting nurturance might be a prerequisite to achieve prolonged change.

Evaluation research concerning the impact of sexual and reproductive health (SRH) education in sub-Saharan Africa is scarce. This study obtained more insight into the knowledge, attitudes and behavioural intentions of students concerning SRH in Bolgatanga municipality in northern Ghana, and studied the effects of an SRH programme for this group. This quasi-experimental study used a pre-post-intervention design, with an SRH programme as intervention. A questionnaire was filled in by 312 students before, and by 272 students after the SRH programme. The results showed that before the programme, students answered half of the knowledge questions correctly, they thought positively about deciding for themselves whether to have a relationship and whether to have sex, and their intentions towards SRH behaviour, such as condom use were positive. The SRH intervention led to a small but significant increase in the students' knowledge. It was also found that the attitude of the students aged 18-20 significantly improved. Finally, it was found that female students aged 18-20 were more positive towards changing their behaviour after following the SRH programme. It can be concluded that the impact of the SRH programme in general was positive. Significant effects were found for gender and age.

Background: Over the past decade, the National Action program Diabetes (NAD) was implemented in the Netherlands. Its aim was to introduce the Care Standard (CS) for diabetes by means of a specific implementation plan and piloting in several regions. This study aimed to provide insight into the implementation of the NAD as, coupled with the introduction of the CS, it may function as an example for similar approaches in other countries., Methods: A series of quantitative studies (participants 2010: N = 1726, participants 2013: N = 1370 & participants pilot regions 2013: N = 168) and qualitative studies (participants 2010: N = 18 and participants 2013: N = 4) was conducted among health care professionals (HCPs). In addition, two quantitative studies were conducted among type 1 and 2 patients (participants 2010: N = 573; participants 2013: N = 5056)., Results: Overall, positive changes in diabetes care were detected in the period 2010 - 2013. In 2013 significantly more HCPs were familiar with the CS (43.7 versus 37.6 %) and more HCPs perceived themselves to be working largely or completely in accordance with the CS (89.2 versus 79.0 %) than in 2010. A comparison of the results in specific pilot regions with the rest of the country revealed that HCPs in these regions scored significantly more positively on implementation and appreciation of the CS. This positive trend was reflected by the high levels of reported patient satisfaction and involvement in treatment. HCPs who were in possession of the CS had significantly better scores on the implementation of several elements of the CS than HCPs who were not in possession of the CS., Conclusion: The CS has become more prominent and embedded in daily health care practice. In retrospect the CS has provided momentum for the realization of various processes relating to the wider implementation of standards to improve the care for people with other chronic diseases in the Netherlands. Experiences with the NAD and CS underline the need to move towards an integrated multidisciplinary approach of diabetes care worldwide.

Objective: The aim of this study was to assess the associations between type 2 diabetes patients' mastery and perceived autonomy support and their self-management skills and health-related quality of life (HRQOL)., Methods: A cross-sectional questionnaire survey was conducted among 3352 patients with type 2 diabetes. Key variables were assessed with validated questionnaires., Results: Patients' mastery and perceived autonomy support correlated positively with their self-management skills (r=0.34, p<0.001; r=0.37, p<0.001) and HRQOL (r=0.37, p<0.001; r=0.15, p<0.001). In the linear regression analysis, mastery and perceived autonomy support were positive correlates of self-management (β=0.23; p<0.001; β=0.25; p<0.001). Patients with more physical or psychological complications had significantly lower scores on mastery, perceived autonomy support, self-management and HRQOL., Conclusion: Our results indicate the importance of mastery in relation to diabetes patients' perceived autonomy support, self-management skills and HRQOL., Practice Implications: Since a greater sense of mastery is likely to increase patients' autonomous motivation to cope with their disease, interventions can aim to influence patients' motivational regulation. In addition, we confirmed the need for autonomy support to improve patients' self-management skills. Professionals can be trained to be autonomy-supportive, which relates to person-centered approaches such as motivational interviewing (MI)., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Background: In this article, the test implementation of a school-oriented drug prevention program "Study without Drugs" is discussed. The aims of this study were to determine the results of the process evaluation and to determine whether the proposed school-oriented drug prevention program during a pilot project was effective for the participating pupils., Methods: Sixty second-grade pupils at a junior high school in Paramaribo, Suriname participated in the test implementation. They were divided into two classes. For the process evaluation the students completed a structured questionnaire focusing on content and teaching method after every lesson. Lessons were qualified with a score from 0-10. The process was also evaluated by the teachers through structured interviews. Attention was paid to reach, dose delivered, dose received, fidelity, connection, achieved effects/observed behaviors, areas for improvement, and lesson strengths. The effect evaluation was conducted by using the General Liniair Model (repeated measure). The research (-design) was a pre-experimental design with pre-and post-test., Results: No class or sex differences were detected among the pupils with regard to the assessment of content, methodology, and qualification of the lessons. Post-testing showed that participating pupils obtained an increased knowledge of drugs, their drug-resisting skills were enhanced, and behavior determinants (attitude, subjective norm, self-efficacy, and intention) became more negative towards drugs., Conclusions: From the results of the test implementation can be cautiously concluded that the program "Study without Drugs" may yield positive results when applied in schools). Thus, this pilot program can be considered a step towards the development and implementation of an evidence-based school-oriented program for pupils in Suriname.

Background: 'An ounce of prevention is worth a pound of cure' is a common saying, and indeed, most health economic studies conclude that people are more willing to pay for preventive measures than for treatment activities. This may be because most health economic studies ask respondents to compare preventive measures with treatment, and thus prompt respondents to consider other uses of resources. However, psychological theorizing suggests that, when methods do not challenge subjects to consider other uses of resources, curative treatment is favored over prevention. Could it be that while prevention is praised, cure is preferred?, Methods: In two experimental studies, we investigated, from a psychological perspective and using a between-subjects design, whether prevention or treatment is preferred and why. In both studies, participants first read a lung cancer prevention or treatment intervention scenario that varied on the prevention-treatment dimension, but that were the same on factors like 'costs per saved life' and kind of disease. Then participants completed a survey measuring appreciation (general and monetary) as well as a number of potential mediating variables., Results: Both studies clearly demonstrated that, when the design was between-subjects, participants had greater (general and monetary) appreciation for treatment interventions than for preventive interventions with perceived urgency of the intervention quite consistently mediating this effect. Differences in appreciation of treatment over preventive treatment were shown to be .59 (Study 1) and .45 (Study 2) on a 5-point scale. Furthermore, participants thought that health insurance should compensate more for the treatment than for preventive measures, differences of 16% (Study 1), and 22% (Study 2). When participants were asked to directly compare both interventions on the basis of a short description, they preferred the preventive intervention., Conclusion: It appears that people claim to prefer prevention when they are asked to consider other use of resources, but otherwise they prefer treatment. This preference is related to perceived urgency. The preference for treatment may be related to the prevention-treatment dimension itself, but also to variations on other dimensions that are inherently linked to prevention and treatment (like different efficacy rates and costs per treatment).

Background: The Netherlands can be regarded as unique in the use of the Netherlands Diabetes Federation (NDF) Care Standard (CS) for diabetes. The need to understand the barriers obstructing optimal health care, the dissemination and implementation of health care innovations into daily practice and the extent to which health care professionals actually adhere to guidelines has been emphasized repeatedly. Therefore, the aim of the present study was to suggest ways to optimize the implementation of the CS by examining the perceptions of Dutch health care professionals regarding the CS and the barriers to using it., Methods: A cross-sectional questionnaire survey was conducted among health care professionals (N = 1547) in 2010., Results: A total of 39.6% (N = 1323) of the participating health care professionals possessed the CS. Only 15.5% of the professionals who were to some extent familiar with the CS (N = 1100) described themselves as working in complete accordance with the CS. The majority (83.9%) thought the CS contributed greatly to ensuring the quality of care; the judgment on the feasibility of working in accordance with the CS was positive (mean = 3.9 on a 5-point Likert scale). However, professionals tended to perceive the guidelines issued by the own professional association as the norm for high quality diabetes care, rather than the CS. The main barrier to using the CS was the lack of effective lifestyle interventions (or access to them) to provide care for people with diabetes or those at increased risk for the disorder., Conclusions: A limited percentage of health care professionals were found to posses the CS. It is questionable whether possession of the CS is a prerequisite for delivering high quality care. Overall, professionals were largely positive about the CS, although only a minority indicated they were working in complete accordance with it. Professionals and professional organizations should be further educated about the content of the CS and especially its added value with respect to the guidelines for their own professional group, in terms of the multidisciplinary approach to diabetes care. Furthermore, attention should be given to the most important perceived barriers, to facilitate adherence to the CS.

Objective: The objective in this study was to evaluate a web-based type 2 diabetes self-management education programme aimed at improving knowledge, encouraging active patient participation and providing supportive self-management tools., Methods: (1) An effect evaluation was conducted using a randomized controlled trial with a pre-test and post-test design (n=99) and a knowledge questionnaire. (2) A user evaluation was conducted using an online questionnaire (n=564) and one-on-one interviews (n=11) to examine the perceived quality, use of functionalities and use of the programme as a supportive tool in education., Results: The effect evaluation showed a significant intervention effect (p<0.01) on knowledge. The user evaluation showed high satisfaction with the programme's content, credibility and user-friendliness. However, functionalities and self-management tools were used by less than half of the participants., Conclusion: The programme can improve knowledge, but it is not fully used as intended. A more optimal use of the programme is necessary for higher efficacy., Practice Implications: The use of mostly spoken text instead of written text was highly appreciated and could be used more often for educational websites. Furthermore, health care practitioners need support in implementing new educational programmes during consultations., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Genetic health messages are increasingly prevalent in our society. The materialist framework of laypeople's genetic knowledge may provide a good basis for understanding the effects of such messages on preventive behavior and related health cognitions. This study provides an empirical test of the predictions of this framework. We presented 929 participants who were aware or unaware of the existence of genetic risk factors for salt sensitivity with either a genetic health message or a general health message about salt sensitivity. Baseline, immediate follow-up, 1-month follow-up, and 6-month follow-up questionnaires assessed risk perception, intention, and salt consumption. Compared with the general health message, previously unaware participants reported lower susceptibility to, and lower severity of, salt sensitivity and lower intentions to restrict salt intake immediately after reading the genetic health message, but not at the 1- and 6-month follow-ups. No such effects were observed for previously aware participants. In addition, the authors observed no effect of health message type on self-reported salt consumption. The authors' findings support the validity of the materialist framework for understanding laypeople's knowledge of genetics. On the basis of the results, several implications were deduced for public education of genetics.

Objectives: Although health messages communicating the role of genetics in health and disease development are increasingly prevalent in our society, no research has examined whether the general public perceives such messages as believable or personally relevant. We examined whether the general public accepted genetic health messages and viewed them personally relevant in promoting their preventive behaviour., Design: Experimental pre-test-post-test measurement design was employed to contrast the information acceptance and perceived personal relevance of the genetic health message with a general health message., Methods: We presented a randomly selected group of Dutch participants (N=1,319) with either a health message about the genetic risk factors for salt sensitivity or with a general health message about salt sensitivity without reference to genetic risk factors. Risk perception and intention to restrict salt intake was assessed before and after participants read the messages while information acceptance and perceived personal relevance was only assessed post-test., Results: Although we observed no effects of health message type on information processing, previously aware participants perceived the genetic health message as less personally relevant compared to the general health message. This difference in personal relevance resulted in lower estimates of susceptibility and a lower intention to engage in preventive behaviour among previously unaware participants., Conclusions: Genetic health messages in the mass media may not be effective in promoting (intentions to engage in) preventive behaviour due to their low perceived personal relevance by the public. Hence, identifying strategies to increase personal relevance for genetic education is needed.

Background: The Internet is an attractive medium for delivering individualized, computer-tailored behavior change interventions to large numbers of people. However, the actual numbers of people reached seem to fall behind the high expectations. Insight into factors that determine use of and exposure to these Internet interventions is important to be able to increase the reach and improve exposure., Objective: The aim was to identify potentially important factors that determine whether adults visit an Internet-delivered behavior change intervention, extend their visit, and revisit the intervention., Methods: A systematic, three-round Delphi study was conducted among national and international experts from Internet intervention research and practice, e-marketing/e-commerce, Web design, and technical website development. In the first round, 30 experts completed a structured, open-ended online questionnaire assessing factors that were, in their opinion, important for a first visit, an extended visit, a revisit and for effective promotion strategies. Based on the responses in this first questionnaire, a closed-ended online questionnaire was developed for use in the second round. A total of 233 experts were invited to complete this questionnaire. Median and interquartile deviation (IQD) scores were computed to calculate agreement and consensus on the importance of the factors. The factors for which no consensus was obtained (IQD > 1) were included in the third-round questionnaire. Factors with a median score of six or higher and with an IQD

The present article describes the application of a theory-based framework to understand current public knowledge of genetic risk factors of multifactorial diseases. The main innovative aspect is the application of E. M. Rogers' knowledge framework which distinguishes three types of knowledge: "awareness knowledge," "how-to knowledge," and "principles knowledge." We argue that distinguishing these types of knowledge allows for a more sophisticated overview of the general public. To illustrate the application of Rogers' framework, we performed a literature review of current public knowledge of genetic risk factors of multifactorial genetic diseases. Relevant articles were identified by searching the Pubmed, Web of Science, Embase, CINAHL, ERIC, and PsycINFO databases from January 1990 until January 2007 and by performing reference list and author searches. Although this review showed that current public knowledge is limited, it also showed that the knowledge framework may be a useful tool for assessing different types of public knowledge and pinpointing flaws or caveats in public knowledge with more precision and subsequently develop public health campaigns to remedy such flaws. Implications for genetic education are discussed.

Background: Underdiagnosis of inherited high cholesterol (IHC) may be reduced if at-risk populations are aware of IHC existence and actively seek diagnosis. This study describes correlates of the public's IHC awareness., Methods: Telephone interviews were conducted with 4117 Dutch adults., Results: Half of the respondents were aware of IHC; however, their knowledge was superficial. Awareness was weakly predicted by family history of cardiovascular diseases (CVD), and not by own CVD status. Awareness was associated with higher health-related knowledge and experiences with cholesterol testing., Conclusions: Professionals should help the public to relate their own and family CVD history to IHC.

This study addresses which specific values play a role in predicting participants' attitudes toward genetically modified food (GMF) and organically grown food (OGF). The first central question is whether the attitudes towards GMF and OGF are influenced by specific values and beliefs. The second central question is whether the attitudes towards GMF and OGF are related to each other, and whether the specific values underlying these two attitudes are also related to each other. A total of 100 participants responded to the Schwartz Value Survey and two questionnaires about GMF and organically grown food. When respondents scored high on the value power (dominance, submission), they rated GMF positively and OGF more negatively. Respondents who rated the value universalism (welfare for all people and protection of nature) high, rated OGF as positive. Furthermore, the relationship between attitudes and values was mediated by beliefs. These findings imply a meaningful relationship between specific values, beliefs, and these food-related attitudes, and suggest that values might play a role in explaining attitudes toward GMF and OGF products.