東華大學圖書館 |

Nutritional Telemonitoring for Community-Dwelling Older Adults: Feasibility and Effectiveness /

Record Type:	Electronic resources : Monograph/item
Title/Author:	Nutritional Telemonitoring for Community-Dwelling Older Adults: Feasibility and Effectiveness // Marije N van Doorn-van Atten.
Author:	van Doorn-van Atten, Marije N.,
Description:	1 electronic resource (201 pages)
Notes:	Source: Dissertations Abstracts International, Volume: 83-02, Section: B.
Contained By:	Dissertations Abstracts International83-02B.
Subject:	Health care expenditures. -
Online resource:	https://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=28232865
ISBN:	9798728222019

Nutritional Telemonitoring for Community-Dwelling Older Adults: Feasibility and Effectiveness /
van Doorn-van Atten, Marije N.,

Nutritional Telemonitoring for Community-Dwelling Older Adults: Feasibility and Effectiveness /Marije N van Doorn-van Atten. - 1 electronic resource (201 pages)

Source: Dissertations Abstracts International, Volume: 83-02, Section: B.

An optimal nutritional status contributes to healthy ageing. Conversely, ageing poses a nutritional risk as physiological, psychological, and social changes that may come with ageing influence appetite, food intake, and nutritional status. Undernutrition can be defined as "a state resulting from lack of intake or uptake of nutrition that leads to altered body composition (decreased fat free mass) and body cell mass leading to diminished physical and mental function and impaired clinical outcome from disease". Although undernutrition is mostly prevalent among older adults living in long-term care facilities, in absolute numbers undernutrition is mostly encountered among older adults living in the community: 11 to 35% of community-dwelling older adults are affected. Undernutrition has unfavourable consequences for health, functioning, and quality of life. Therefore, prevention and early detection of nutritional risks are key for healthy ageing. Among many possible strategies and solutions that range from screening, prevention, and treatment, eHealth may be meaningful in signalling or preventing undernutrition at an early stage. The aim of this research was to provide insight into the feasibility and the effectiveness of a nutritional telemonitoring intervention for community-dwelling older adults. Chapters 2-6 present the results of this research and are summarised below.The intervention consisted of self-measurements of nutritional outcomes and physical activity, nutrition education, and follow-up by a nurse. For this purpose, participants received measurement instruments (weighing scale, pedometer), and obtained an additional television channel and optionally a tablet computer to view their measurement results. The television channel was also used to display short messages concerning healthy eating and physical activity. Nurses received the results of the self-measurements and provided proper follow-up in case of nutritional risk. Although the intervention was practice-based, several theoretical strategies could be distinguished that underpinned the intervention, with the most important ones being self-monitoring, goalsetting, and feedback (Chapter 2).This intervention was tested during a three-month pilot study (n=20) (Chapter 3). This study showed that the intervention could be implemented as intended by researchers and health care professionals. However, participants' acceptance was low (only 50% was satisfied) and Summary 177 drop-out was high (n=9). Participants perceived the usability of the television channel as poor and needed more help than anticipated with the self-measurements. Based on these experiences, the intervention material was further developed with, among others, an improved television channel. The intervention was also made less intensive to further improve the fit with the target population.Consequently, the intervention was evaluated during a six-month effect study (Chapter 4). Participants were allocated to the intervention group (n=97) or to the control group (n=107), based on municipality. Effect measurements were conducted at baseline, after 4.5 months, and at the end of the intervention and included measurements of diet quality, appetite, body weight, nutritional status, physical functioning, and quality of life. Participants at risk of undernutrition significantly improved their nutritional status (β (T1)=2.55, 95% CI (1.41, 3.68), β (T2)=1.77, 95% CI (0.60, 2.94)). Furthermore, intervention group participants increased scores for compliance with Dutch guidelines for the intake of vegetables (β=1.27, 95% CI (0.49, 2.05)), fruit (β=1.24, 95% CI (0.60, 1.88)), dietary fibre (β=1.13, 95% CI (0.70, 1.57)), protein (β=1.20, 95% CI (0.15, 2.24)), and physical activity (β=2.13, 95% CI (0.98, 3.29)). No effects on appetite, body weight, physical functioning, and quality of life were found.Equally important as evaluating effectiveness, is investigating the feasibility and acceptability of an intervention. Therefore, a process evaluation was conducted in which a mixed method approach was used to study the process indicators reach, fidelity, dose, and acceptability (Chapter 5). A study of the reach of the intervention revealed that 80% of the participants completed the intervention and that participants who dropped out were older, had a worse cognitive and physical functioning, and were more care-dependent. With regard to fidelity, the intervention was implemented as intended. With regard to dose, participants' adherence to self-measurements of weight was better than adherence to self-measurements via questionnaires, for which half of the participants needed help. Concerning acceptability, the intervention was well received by participants (satisfaction score 4.1 on a scale from 1-5), but satisfaction rates of nurses were lower with an average score of 3.5 (scale 1-5). Two constructs of acceptability predicted the intention to use the intervention: performance expectancy (β=0.40, 95% CI 0.13,0.67) and social influence (β=0.17, 95% CI 0.00,0.34). None of the process indicators were associated with intervention outcomes.Besides studying process and effect outcomes, testing the theoretical framework of an intervention deepens understanding of how an intervention achieves its effects, thereby contributing to future intervention development. For this purpose, measurements were conducted of compliance to the behaviour change techniques self-monitoring and goalsetting, and of the behavioural determinants perceived behavioural control, attitude, and knowledge. Mediation analyses were used to study the mechanisms of impact (Chapter 6). The intervention increased self-monitoring and improved knowledge and perceived behavioural control for physical activity. Increased self-monitoring mediated the intervention's effect on diet quality, fruit intake, and saturated fatty acids intake. Improved knowledge mediated the effect on protein intake. Nevertheless, the role of the hypothesised mediators was limited.Concluding, our multi-component nutritional eHealth intervention led to improved diet quality and physical activity levels, and improved nutritional status in older adults with risk of undernutrition. The intervention was feasible to implement and was accepted by participants. This suggests that eHealth plays a valuable role in nutrition screening, prevention, and treatment of nutritional issues in community-dwelling older adults. Nevertheless, some issues need to be addressed to facilitate sustainable and scalable implementation, such as usability, perceived benefits of the intervention, and acceptability by health care professionals. Future research can address these issues by employing usercentred design and a collaborative approach involving all relevant stakeholders from research, practice, policy, and business. Directions for future research include unravelling mechanisms of impact, identifying groups of older adults that benefit most from nutritional eHealth interventions, improving accessibility of eHealth for vulnerable groups, establishing long-term effects on functioning and quality of life, and assessing economic impact.

English

ISBN: 9798728222019Subjects--Topical Terms:

3433801
Health care expenditures.

Nutritional Telemonitoring for Community-Dwelling Older Adults: Feasibility and Effectiveness /
LDR:17120nmm a22004333i 4500 001 2433584
005 20250903054127.5
006 m o d
007 cr|nu||||||||
008 261011s2019 miu||||||m |||||||eng d
020 $a 9798728222019
035 $a (MiAaPQD)AAI28232865
035 $a (MiAaPQD)Wageningen550220
035 $a AAI28232865
040 $a MiAaPQD $b eng $c MiAaPQD $e rda
100 1 $a van Doorn-van Atten, Marije N., $e author. $3 3823264
245 1 0 $a Nutritional Telemonitoring for Community-Dwelling Older Adults: Feasibility and Effectiveness / $c Marije N van Doorn-van Atten.
264 1 $a Ann Arbor : $b ProQuest Dissertations & Theses, $c 2019
300 $a 1 electronic resource (201 pages)
336 $a text $b txt $2 rdacontent
337 $a computer $b c $2 rdamedia
338 $a online resource $b cr $2 rdacarrier
500 $a Source: Dissertations Abstracts International, Volume: 83-02, Section: B.
500 $a Advisors: de Groot, C. P.G.M.; Haveman-Nies, A.; de Vries, J. H.M. Committee members: Witteman, B. J.M. ; Mathers, J. C. ; Visser, M. ; Peppelenbos, H. W. .
502 $b Ph.D. $c Wageningen University and Research $d 2019.
520 $a An optimal nutritional status contributes to healthy ageing. Conversely, ageing poses a nutritional risk as physiological, psychological, and social changes that may come with ageing influence appetite, food intake, and nutritional status. Undernutrition can be defined as "a state resulting from lack of intake or uptake of nutrition that leads to altered body composition (decreased fat free mass) and body cell mass leading to diminished physical and mental function and impaired clinical outcome from disease". Although undernutrition is mostly prevalent among older adults living in long-term care facilities, in absolute numbers undernutrition is mostly encountered among older adults living in the community: 11 to 35% of community-dwelling older adults are affected. Undernutrition has unfavourable consequences for health, functioning, and quality of life. Therefore, prevention and early detection of nutritional risks are key for healthy ageing. Among many possible strategies and solutions that range from screening, prevention, and treatment, eHealth may be meaningful in signalling or preventing undernutrition at an early stage. The aim of this research was to provide insight into the feasibility and the effectiveness of a nutritional telemonitoring intervention for community-dwelling older adults. Chapters 2-6 present the results of this research and are summarised below.The intervention consisted of self-measurements of nutritional outcomes and physical activity, nutrition education, and follow-up by a nurse. For this purpose, participants received measurement instruments (weighing scale, pedometer), and obtained an additional television channel and optionally a tablet computer to view their measurement results. The television channel was also used to display short messages concerning healthy eating and physical activity. Nurses received the results of the self-measurements and provided proper follow-up in case of nutritional risk. Although the intervention was practice-based, several theoretical strategies could be distinguished that underpinned the intervention, with the most important ones being self-monitoring, goalsetting, and feedback (Chapter 2).This intervention was tested during a three-month pilot study (n=20) (Chapter 3). This study showed that the intervention could be implemented as intended by researchers and health care professionals. However, participants' acceptance was low (only 50% was satisfied) and Summary 177 drop-out was high (n=9). Participants perceived the usability of the television channel as poor and needed more help than anticipated with the self-measurements. Based on these experiences, the intervention material was further developed with, among others, an improved television channel. The intervention was also made less intensive to further improve the fit with the target population.Consequently, the intervention was evaluated during a six-month effect study (Chapter 4). Participants were allocated to the intervention group (n=97) or to the control group (n=107), based on municipality. Effect measurements were conducted at baseline, after 4.5 months, and at the end of the intervention and included measurements of diet quality, appetite, body weight, nutritional status, physical functioning, and quality of life. Participants at risk of undernutrition significantly improved their nutritional status (β (T1)=2.55, 95% CI (1.41, 3.68), β (T2)=1.77, 95% CI (0.60, 2.94)). Furthermore, intervention group participants increased scores for compliance with Dutch guidelines for the intake of vegetables (β=1.27, 95% CI (0.49, 2.05)), fruit (β=1.24, 95% CI (0.60, 1.88)), dietary fibre (β=1.13, 95% CI (0.70, 1.57)), protein (β=1.20, 95% CI (0.15, 2.24)), and physical activity (β=2.13, 95% CI (0.98, 3.29)). No effects on appetite, body weight, physical functioning, and quality of life were found.Equally important as evaluating effectiveness, is investigating the feasibility and acceptability of an intervention. Therefore, a process evaluation was conducted in which a mixed method approach was used to study the process indicators reach, fidelity, dose, and acceptability (Chapter 5). A study of the reach of the intervention revealed that 80% of the participants completed the intervention and that participants who dropped out were older, had a worse cognitive and physical functioning, and were more care-dependent. With regard to fidelity, the intervention was implemented as intended. With regard to dose, participants' adherence to self-measurements of weight was better than adherence to self-measurements via questionnaires, for which half of the participants needed help. Concerning acceptability, the intervention was well received by participants (satisfaction score 4.1 on a scale from 1-5), but satisfaction rates of nurses were lower with an average score of 3.5 (scale 1-5). Two constructs of acceptability predicted the intention to use the intervention: performance expectancy (β=0.40, 95% CI 0.13,0.67) and social influence (β=0.17, 95% CI 0.00,0.34). None of the process indicators were associated with intervention outcomes.Besides studying process and effect outcomes, testing the theoretical framework of an intervention deepens understanding of how an intervention achieves its effects, thereby contributing to future intervention development. For this purpose, measurements were conducted of compliance to the behaviour change techniques self-monitoring and goalsetting, and of the behavioural determinants perceived behavioural control, attitude, and knowledge. Mediation analyses were used to study the mechanisms of impact (Chapter 6). The intervention increased self-monitoring and improved knowledge and perceived behavioural control for physical activity. Increased self-monitoring mediated the intervention's effect on diet quality, fruit intake, and saturated fatty acids intake. Improved knowledge mediated the effect on protein intake. Nevertheless, the role of the hypothesised mediators was limited.Concluding, our multi-component nutritional eHealth intervention led to improved diet quality and physical activity levels, and improved nutritional status in older adults with risk of undernutrition. The intervention was feasible to implement and was accepted by participants. This suggests that eHealth plays a valuable role in nutrition screening, prevention, and treatment of nutritional issues in community-dwelling older adults. Nevertheless, some issues need to be addressed to facilitate sustainable and scalable implementation, such as usability, perceived benefits of the intervention, and acceptability by health care professionals. Future research can address these issues by employing usercentred design and a collaborative approach involving all relevant stakeholders from research, practice, policy, and business. Directions for future research include unravelling mechanisms of impact, identifying groups of older adults that benefit most from nutritional eHealth interventions, improving accessibility of eHealth for vulnerable groups, establishing long-term effects on functioning and quality of life, and assessing economic impact.
520 $a Een optimale voedingsstatus draagt bij aan gezond ouder worden. Tegelijkertijd kan het verouderingsproces van invloed zijn op de voedingsstatus. Lichamelijke, psychologische en sociale veranderingen kunnen de eetlust, de voedingsinname en de voedingsstatus negatief beinvloeden. Ondervoeding kan omschreven worden als "een toestand waarbij sprake is van een tekort aan inname of opname van voeding dat leidt tot een veranderde lichaamssamenstelling, met nadelige effecten op lichamelijk en mentaal functioneren en klinische resultaten". Ondervoeding komt procentueel gezien het meest voor bij ouderen in woonzorgcentra, maar in absolute aantallen is het probleem het grootst onder ouderen die thuis wonen: geschat wordt dat 11 tot 35% van de ouderen die thuis wonen ondervoed zijn. Ondervoeding heeft nadelige effecten op de gezondheid, het functioneren en de kwaliteit van leven. Daarom is preventie en een vroegtijdige signalering van groot belang voor gezond ouder worden. Hiervoor zijn veel strategieen en mogelijkheden op het gebied van screening, preventie en behandeling. EHealth zou een mogelijkheid zijn voor het voorkomen of vroegtijdig signaleren van ondervoeding. Het doel van dit onderzoek was het verkrijgen van inzicht in de uitvoerbaarheid en effectiviteit van een telemonitoringsinterventie (de 'Eet & Beweegmonitor') rondom voeding bij thuiswonende ouderen. De hoofdstukken 2-6 beschrijven de resultaten van dit onderzoek en zijn hieronder samengevat.De interventie bestond uit de volgende onderdelen: 1) zelfmetingen van gewicht, eetlust, voedingsstatus, kwaliteit van de voeding en lichamelijke activiteit, 2) voedingseducatie en 3) follow-up door een verpleegkundige. Hiervoor kregen deelnemers een weegschaal, een stappenteller, een extra televisiekanaal en optioneel een tablet. Op het televisiekanaal en de tablet konden deelnemers hun resultaten van de zelfmetingen bekijken. Op het televisiekanaal ontvingen deelnemers ook korte berichten over voeding en beweging. Verpleegkundigen ontvingen de resultaten van de zelfmetingen en gaven passende followup in geval van risico op ondervoeding. Alhoewel deze interventie in de praktijk is ontwikkeld, kunnen er verschillende gedragsveranderingstechnieken worden onderscheiden die ten grondslag liggen aan de interventie. Daarvan zijn de belangrijkste zelfmonitoring, doelen stellen en feedback (Hoofdstuk 2).Deze interventie werd getest tijdens een drie maanden durende pilotstudie met 20 deelnemers (Hoofdstuk 3). Deze studie liet zien dat de interventie kon worden uitgevoerd zoals dat was bedoeld door onderzoekers en zorgprofessionals. De acceptatie onder deelnemers was echter laag (maar 50% was tevreden) en 9 van de 20 deelnemers stopten voortijdig met hun deelname. Deelnemers vonden de gebruiksvriendelijkheid van het televisiekanaal onvoldoende en hadden meer hulp nodig met de zelfmetingen dan vooraf gedacht. Op basis van deze ervaringen en inzichten werd het interventiemateriaal verder ontwikkeld met onder andere een gebruiksvriendelijker televisiekanaal. De interventie werd ook minder intensief gemaakt om beter aan te sluiten bij de doelgroep.Vervolgens werd de interventie geevalueerd tijdens een zes maanden durende effectstudie (Hoofdstuk 4). Deelnemers werden verdeeld over een interventiegroep (97 deelnemers) en een controlegroep (107 deelnemers), gebaseerd op de gemeente waar ze woonden. Effectmetingen werden uitgevoerd bij de start van de studie, na 4,5 maanden en aan het eind van de studie. Dit waren metingen van de kwaliteit van de voeding, eetlust, lichaamsgewicht, voedingsstatus, lichamelijk functioneren en kwaliteit van leven. Deelnemers met risico op ondervoeding verbeterden hun voedingsstatus significant (β (T1)=2,55, 95% CI (1,41, 3,68), β (T2)=1,77, 95% CI (0,60, 2,94)). Verder verbeterden deelnemers in de interventiegroep hun scores voor naleving van de Nederlandse richtlijnen voor de inname van groenten (β=1,27, 95% CI (0,49, 2,05)), fruit (β=1,24, 95% CI (0,60, 1,88)), voedingsvezel (β=1,13, 95% CI (0,70, 1,57)), eiwit (β=1,20, 95% CI (0,15, 2,24)) en lichamelijke activiteit (β=2,13, 95% CI (0,98, 3,29)). Er werden geen effecten gevonden op eetlust, lichaamsgewicht, lichamelijk functioneren en kwaliteit van leven.Even belangrijk als het onderzoeken van de effectiviteit is het onderzoeken van de uitvoerbaarheid en acceptatie van een interventie. Daarom werd er een procesevaluatie gedaan waarbij zowel kwantitatieve als kwalitatieve methoden werden gebruikt. De procesindicatoren 'reach' (bereik), 'fidelity' (mate waarin een interventie is uitgevoerd zoals bedoeld), 'dose' (dosis) en 'acceptability' (acceptatie) werden bestudeerd (Hoofdstuk 5). Wat betreft het bereik van de interventie heeft 80% van de deelnemers de interventie afgemaakt. Deelnemers die voortijdig stopten waren ouder, hadden een slechter cognitief en lichamelijk functioneren en hadden meer zorg nodig. Wat betreft 'fidelity' was de interventie uitgevoerd zoals bedoeld. Wat betreft 'dose' voldeden deelnemers beter aan de zelfmetingen van gewicht dan zelfmetingen via vragenlijsten over voedingsstatus, eetlust en kwaliteit van de voeding, waarvoor de helft van de deelnemers hulp nodig had. Wat betreft acceptatie werd de interventie goed ontvangen door deelnemers (tevredenheidsscore 4,1 op een schaal van 1-5), maar tevredenheidsscores van verpleegkundigen waren lager met een gemiddelde van 3,5 op een schaal van 1-5. Twee constructen van acceptatie voorspelden de intentie van deelnemers om met de interventie mee te doen: 'performance expectancy' (mate waarin men gelooft dat de technologie zal leiden tot gezond gedrag of gezondheid) (β=0,40, 95% CI 0,13, 0,67) en 'social influence' (mate waarin belangrijke anderen geloven dat men de technologie moet gebruiken) (β=0,17, 95% CI 0,00, 0,34). Geen van de procesindicatoren was geassocieerd met de effecten van de interventie.Naast het bestuderen van het proces en de effecten is het onderzoeken van het theoretische kader van een interventie belangrijk om beter te begrijpen hoe een interventie werkt. Dit kan bijdragen aan het verder ontwikkelen van interventies. Voor dit doel werd gemeten in hoeverre de deelnemers zelfmetingen deden en doelen stelden. Ook werd een aantal gedragsdeterminanten gemeten, waaronder 'perceived behavioural control' (de mate waarin iemand verwacht controle te hebben over gedrag), houding en kennis. Impactmechanismen werden bestudeerd door middel van mediatie analyses (Hoofdstuk 6). De interventie leidde tot meer zelfmetingen, meer kennis, en meer ervaren controle over de mate waarin men lichamelijk actief is. Meer zelfmetingen medieerden het effect van de interventie op de totale score voor de kwaliteit van de voeding en scores voor de inname van fruit en verzadigd vet. Meer kennis medieerde het effect van de interventie op de score voor eiwit inname. Ondanks deze gevonden mediatie effecten was de rol van de veronderstelde mediatoren beperkt.Concluderend, deze telemonitoringsinterventie rondom voeding bij thuiswonende ouderen heeft geleid tot een betere kwaliteit van de voeding en meer beweging, en een verbeterde voedingsstatus bij deelnemers met risico op ondervoeding. De interventie kon worden uitgevoerd zoals bedoeld en werd geaccepteerd door de deelnemers. Dit suggereert dat eHealth een waardevolle rol kan spelen in screening, preventie en behandeling van ondervoeding bij thuiswonende ouderen. Toch blijven er aspecten die aandacht vragen voordat dit soort interventies op grotere schaal en voor langere tijd kunnen worden ingezet. Hieronder vallen gebruiksvriendelijkheid, het waargenomen nut van de interventie door de doelgroep en acceptatie door zorgprofessionals. Toekomstig onderzoek kan inspelen op deze aspecten door de eindgebruiker centraal te stellen bij de ontwikkeling van de technologie en door een multidisciplinaire aanpak waarbij alle relevante stakeholders vanuit de wetenschap, praktijk, beleid en bedrijfsleven betrokken zijn. Aanbevelingen voor toekomstig onderzoek zijn onder andere het bestuderen van mechanismen van impact, het identificeren van groepen ouderen die het meeste baat hebben bij dit soort interventies, het verbeteren van de toegankelijkheid van eHealth interventies voor kwetsbare groepen, het behalen van effect op functioneren en kwaliteit van leven en het onderzoeken van kosteneffectiviteit.
546 $a English
590 $a School code: 2157
650 4 $a Health care expenditures. $3 3433801
650 4 $a Dietary supplements. $3 535759
650 4 $a Older people. $3 761975
650 4 $a Body mass index. $3 3562858
650 4 $a Mortality. $3 533218
650 4 $a Public health. $3 534748
650 4 $a Gerontology. $3 533633
650 4 $a Nutrition. $3 517777
690 $a 0769
690 $a 0573
690 $a 0570
690 $a 0351
710 2 $a Wageningen University and Research. $e degree granting institution. $3 3815267
720 1 $a de Groot, C. P.G.M. $e degree supervisor.
720 1 $a Haveman-Nies, A. $e degree supervisor.
720 1 $a de Vries, J. H.M. $e degree supervisor.
773 0 $t Dissertations Abstracts International $g 83-02B.
790 $a 2157
791 $a Ph.D.
792 $a 2019
856 4 0 $u https://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=28232865