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Ultrasound screening for developmental dysplasia of the hip (DDH) is an innovation in preventive child health care in the Netherlands. Parental participation in the screening will be essential for the success of implementation of the screening. The aim of the current study was to investigate whether psychosocial factors (attitude, subjective norm, self-efficacy, perceived susceptibility, perceived severity, perceived effectiveness) predicted parental participation in the screening. A cross-sectional survey was conducted. Using a questionnaire, several background variables (organization, sociodemographic variables, and knowledge) and psychosocial variables were collected. Blockwise logistic regression was used to analyze the relations. A total of 703 questionnaires of participating parents (response 61.7%) and 393 questionnaires of nonparticipating parents were received (response 37.2%). When controlling for the background variables, attitude, subjective norm, self-efficacy, perceived susceptibility, and perceived effectiveness predicted parental participation in the screening (p< .05). Perceived severity of the dysplasia did not predict participation (p >.05). Psychosocial determinants influenced parental participation in the ultrasound screening for DDH. Emphasizing the positive aspects of the screening, highlighting the effectiveness, removing practical barriers, and being conscious of the influential role of child health care professionals on decision making are areas to focus on when organizing the ultrasound screening for DDH. Health care policy decision makers and child health care professionals should consider these determinants in order to stimulate parental participation

Doel: Rechtstreeks verwijzen door de jeugdarts naar de tweede lijn lijkt zinvol bij verdenking op heupdysplasie. Screening op heupdysplasie vindt plaats door lichamelijk onderzoek en de identificatie van risicofactoren. Echografische screening blijkt medisch en economisch gezien te leiden tot betere uitkomsten. Als onderdeel van een studie naar de haalbaarheid van implementatie van echografische screening in Nederland is onderzocht hoe ouders het verwijstraject beoordelen afhankelijk van de manier waarop zij naar de orthopaedisch chirurg zijn verwezen - rechtstreeks of via de huisarts - bij verdenking op heupdysplasie. Methode: Een vragenlijst is ontwikkeld om de ervaring van ouders die verwezen zijn te meten. In totaal is de vragenlijst gestuurd naar 355 ouders van kinderen die verwezen zijn tussen januari 2008 en november 2008. Resultaten: De respons op de vragenlijst was 46,5%. Ouders waren meer tevreden wanneer zij door de jeugdarts rechtstreeks waren verwezen dan wanneer dat via de huisarts plaatsvond. De tijd tussen de verwijzing en de eerste afspraak bij de orthopaedisch chirurg was korter als kinderen rechtstreeks werden verwezen. Tot slot waren ouders meer tevreden als zij het verwijstraject als niet stressvol ervoeren en als het traject soepel verliep. Conclusie: Gebaseerd op de perceptie van ouders, geeft dit onderzoek een eerste indicatie dat, met inachtneming van een aantal belangrijke randvoorwaarden, rechtstreeks verwijzen in het geval van heupdysplasie wenselijk is.

Background: Blending online modules into face-to-face therapy offers perspectives to enhance patient self-management and to increase the (cost-)effectiveness of therapy, while still providing the support patients need. The aim of this study was to outline optimal usage of blended care for depression, according to patients and therapists. Methods: A Delphi method was used to find consensus on suitable blended protocols (content, sequence and ratio). Phase 1 was an explorative phase, conducted in two rounds of online questionnaires, in which patients' and therapists' preferences and opinions about online psychotherapy were surveyed. In phase 2, data from phase 1 was used in face-to-face interviews with therapists to investigate how blended therapy protocols could be set up and what essential preconditions would be. Results: Twelve therapists and nine patients completed the surveys. Blended therapy was positively perceived among all respondents, especially to enhance the self-management of patients. According to most respondents, practical therapy components (assignments, diaries and psycho-education) may be provided via online modules, while process-related components (introduction, evaluation and discussing thoughts and feelings), should be supported face-to-face. The preferred blend of online and face-to-face sessions differs between therapists and patients; most therapists prefer 75% face-to-face sessions, most patients 50 to 60%. The interviews showed that tailoring treatment to individual patients is essential in secondary mental health care, due to the complexity of their problems. The amount and ratio of online modules needs to be adjusted according to the patient's problems, skills and characteristics. Therapists themselves should also develop skills to integrate online and face-to-face sessions. Conclusions: Blending online and face-to-face sessions in an integrated depression therapy is viewed as a positive innovation by patients and therapists. Following a standard blended protocol, however, would be difficult in secondary mental health care. A database of online modules could provide flexibility to tailor treatment to individual patients, which asks motivation and skills of both patients and therapists. Further research is necessary to determine the (cost-)effectiveness of blended care, but this study provides starting points and preconditions to blend online and face-to-face sessions and create a treatment combining the best of both worlds.

Prior research has shown ultrasound (US) screening for developmental dysplasia of the hip (DDH) in preventive child health care to be more effective than the current screening method. In the present study, 3-month-old infants were screened for DDH with US. The objective of this study was to examine parental satisfaction with the screening and determinants that affect satisfaction. Parental satisfaction was measured using a questionnaire. Independent variables included socio-demographic determinants, structure, process and outcome-related determinants and the meeting of expectations. Satisfaction with the screening was high. Parents who perceived the screener as competent, had enough time to ask questions, perceived the proceeding as fluent, perceived a low burden on their infant and whose expectations were met, were more likely to be satisfied. Satisfaction was influenced by process-related factors and not by factors related to the structure and the outcome of the screening. Good information provision before the screening and communication during the screening are means by which parental satisfaction can be influenced positively.

The use of ultrasound (US) screening for developmental dysplasia of the hip (DDH) is an innovation in preventive child health care in the Netherlands. What is not known is whether parents will accept this screening method and will actually participate in it. It is widely known that health behaviors can be influenced by the framing of information. The objective of this study was to examine the influence of a gain- versus loss-framed brochure on parental participation in US screening for DDH. In total, 4150 parents of infants born between August 2007 and December 2008 received either a gain-framed or a loss-framed brochure. Parents could participate in the screening when their infant was 3 months old. The participation rate in the US screening was 74.3%. In contrast to the predictions of prospect theory, the results indicated that parents who had received the gain-framed message were more likely to participate in the screening compared to parents who had received the loss-framed message. This effect may be explained by the low risk perception of parents and by the possibility that the screening was perceived as a health-affirming behavior rather than an illness-detecting behavior. To increase participation rates, it is recommended that parents be informed about the positive aspects of partaking in screening for DDH.

Early diagnosis and treatment of developmental dysplasia of the hip (DDH) is essential to allow for the normal development of the hip. In the Netherlands, the current screening for DDH consists of physical examination and identification of risk factors. In previous studies, ultrasound screening was demonstrated to be more (cost)effective compared to the current screening. However, clinical and economic outcomes can be relatively uncertain since they may not reflect the value of the innovation once implemented in a ‘real‐world’ health care setting. The next step was therefore to investigate ultrasound screening for DDH as part of the preventive child health care program by means of a pilot implementation. This thesis aimed to study determinants related to the implementation of the screening and, particularly, determinants associated with parental participation in and satisfaction with the screening. Prior to the pilot implementation, a focus group study was conducted to identify enhancing factors, impeding factors and preconditions related to several innovation determinants (innovation, user, organization, socio‐political context). The results, such as preferences regarding parental information provision and the training program, could be used in formulating the implementation strategy. The second study identified psychosocial determinants related to parental screening participation. A positive attitude, a high subjective norm, a high self‐efficacy, a low perceived susceptibility and a high perceived effectiveness, were positively related to participation. The third study examined the influence of a gainversus loss‐framed message on parental participation. Parents who received a gain‐framed brochure were more likely to participate. The fourth study examined determinants related to parental satisfaction with the screening. General satisfaction with the screening was high and mostly affected by processrelated factors. The fifth study explored the evaluation of parents regarding a referral to the orthopedic surgeon. Parents preferred to be directly referred instead of indirectly via the general practitioner. Based on the outcomes of the separate studies, effective implementation strategies were formulated, related to the organization of the screening, the communication with parents and the screening process. These strategies can support health care policy decision‐makers with national implementation of ultrasound screening for DDH, so as to facilitate optimal likelihood of implementation.