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. 2019 Feb 6;21(2):e9938.
doi: 10.2196/jmir.9938.

Electronic Health Program to Empower Patients in Returning to Normal Activities After General Surgical and Gynecological Procedures: Intervention Mapping as a Useful Method for Further Development

Chantal M den Bakker  1   2 , Frederieke G Schaafsma  1 , Eva van der Meij  1   3 , Wilhelmus Jhj Meijerink  4 , Baukje van den Heuvel  4 , Astrid H Baan  5 , Paul Hp Davids  6 , Petrus C Scholten  7 , Suzan van der Meij  8 , W Marchien van Baal  9 , Annette D van Dalsen  10 , Daniel J Lips  11 , Jan Willem van der Steeg  12 , Wouter Kg Leclercq  13 , Peggy Maj Geomini  14 , Esther Cj Consten  15 , Steven E Schraffordt Koops  16 , Steve Mm de Castro  17 , Paul Jm van Kesteren  18 , Huib A Cense  19 , Hein Bac Stockmann  20 , A Dorien Ten Cate  21 , Hendrik J Bonjer  2 , Judith Af Huirne  3 , Johannes R Anema  1
Affiliations

Electronic Health Program to Empower Patients in Returning to Normal Activities After General Surgical and Gynecological Procedures: Intervention Mapping as a Useful Method for Further Development

Chantal M den Bakker et al. J Med Internet Res. .

Abstract

Background: Support for guiding and monitoring postoperative recovery and resumption of activities is usually not provided to patients after discharge from the hospital. Therefore, a perioperative electronic health (eHealth) intervention ("ikherstel" intervention or "I recover" intervention) was developed to empower gynecological patients during the perioperative period. This eHealth intervention requires a need for further development for patients who will undergo various types of general surgical and gynecological procedures.

Objective: This study aimed to further develop the "ikherstel" eHealth intervention using Intervention Mapping (IM) to fit a broader patient population.

Methods: The IM protocol was used to guide further development of the "ikherstel" intervention. First, patients' needs were identified using (1) the information of a process evaluation of the earlier performed "ikherstel" study, (2) a review of the literature, (3) a survey study, and (4) focus group discussions (FGDs) among stakeholders. Next, program outcomes and change objectives were defined. Third, behavior change theories and practical tools were selected for the intervention program. Finally, an implementation and evaluation plan was developed.

Results: The outcome for an eHealth intervention tool for patients recovering from abdominal general surgical and gynecological procedures was redefined as "achieving earlier recovery including return to normal activities and work." The Attitude-Social Influence-Self-Efficacy model was used as a theoretical framework to transform personal and external determinants into change objectives of personal behavior. The knowledge gathered by needs assessment and using the theoretical framework in the preparatory steps of the IM protocol resulted in additional tools. A mobile app, an activity tracker, and an electronic consultation (eConsult) will be incorporated in the further developed eHealth intervention. This intervention will be evaluated in a multicenter, single-blinded randomized controlled trial with 18 departments in 11 participating hospitals in the Netherlands.

Conclusions: The intervention is extended to patients undergoing general surgical procedures and for malignant indications. New intervention tools such as a mobile app, an activity tracker, and an eConsult were developed.

Trial registration: Netherlands Trial Registry NTR5686; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5686.

Keywords: colectomy; eHealth; hysterectomy; intervention mapping; patient reported outcome measures; return to normal activities; return to work.

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Conflict of interest statement

Conflicts of Interest: WJHJM, BvdH, AHB, PHPD, PCS, SvdM, WMvB, ADvD, DJL, JWvdS, WKGL, PMAJG, ECJC, SESK, SMMdC, PJMvK, HAC, HBACS, and ADtC have no conflicts of interest. CMdB, FGS, EvdM, JAFH, HJB, and JRA are the developers of the care program under study. JRA and JAFH intend to set up a spin-off company concerning the implementation of a mobile app concerning the “ikherstel” intervention in the Netherlands. JAFH received grants from ZonMw-NWO, and Samsung during the conduct of the study and received a fee from Olympus, outside the submitted work. HJB received personal fees from Olympus, Stryker, Medtronic, and Applied Medical, outside the submitted work. JRA holds a chair in Insurance Medicine paid by the Dutch Social Security Agency, is a stockholder of Evalua, and received grants from ZonMw-NWO, Instituut Gak, UWV, SZW, VWS, Pfizer, Achmea, and CVZ/Zorg Instituut outside the submitted work.

Figures

Figure 1
Figure 1
Intervention mapping steps.
See this image and copyright information in PMC

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