Inhoudsopgave
Introduction lecture 31-10-2022 ..................................................................................................................... 3
Chronic diseases and lifestyle factors................................................................................................................. 3
Levels of influence over human behavior: socio-ecological model ..................................................................... 3
Defining Health Promotion and Disease Prevention .......................................................................................... 3
Types of prevention ............................................................................................................................................ 4
Intervention levels, and tools or instruments ..................................................................................................... 4
Lecture 2: Upstream determinants of lifestyle behaviours and chronic disease risk ........................................ 5
What are upstream determinants? .................................................................................................................... 5
ANGELO-framework ........................................................................................................................................... 5
Challenges in upstream research ....................................................................................................................... 6
(Evaluation of) behavioural theories .................................................................................................................. 6
Lecture 3: Hearing impairment in adults ......................................................................................................... 8
Describe some determinants and consequences of hearing impairment........................................................... 8
Describe primary, secondary, and tertiary prevention of hearing impairment .................................................. 8
Understand the relevance of applying health behaviour change models when designing and implementing
interventions .................................................................................................................................................... 10
Understand how to design and perform a cluster RCT by evaluating an intervention: SUPR study ................ 12
Summary .......................................................................................................................................................... 13
Lecture 4: Community action (research): a transdisciplinary approach to health promotion ......................... 14
Introduction...................................................................................................................................................... 14
Background of community approach ............................................................................................................... 15
Community what is it? ..................................................................................................................................... 15
Community approaches ................................................................................................................................... 16
Community participation ................................................................................................................................. 16
Social network approach .................................................................................................................................. 17
Intersectoral collaboration ............................................................................................................................... 17
Challenges in community action ...................................................................................................................... 17
Lecture 5: Quality of life ............................................................................................................................... 19
Understand the QoL concept and its domains ................................................................................................. 19
Able to deal with the many terms .................................................................................................................... 19
Why and how to measure QoL ......................................................................................................................... 20
Types of QoL instruments ................................................................................................................................. 21
Able to distinguish health & QoL outcomes ..................................................................................................... 23
Lecture 6: Evaluation .................................................................................................................................... 24
, Understand and describe the concept of evaluation........................................................................................ 24
To name the main elements of an evaluation plan .......................................................................................... 24
Distinguish different types of evaluation ......................................................................................................... 24
Distinguish and name basic evaluation questions ........................................................................................... 26
Describe and use the RE-AIM framework ......................................................................................................... 26
GRADE .............................................................................................................................................................. 27
Quality of evidence........................................................................................................................................... 27
Lecture 7: Power calculation and analyzing RCT data .................................................................................... 29
Sample size calculations ................................................................................................................................... 29
For continuous variables .................................................................................................................................. 29
Dichotomous outcomes.................................................................................................................................... 31
Evidence based medicine ................................................................................................................................. 32
Conclusion ........................................................................................................................................................ 32
The analysis of RCT data .................................................................................................................................. 32
One follow-up measurement............................................................................................................................ 32
More than one follow-up measurement .......................................................................................................... 34
Lecture 8: Vitamin G – the importance of green space for our health ........................................................... 37
Describe and understand why green space could be important in disease prevention and health promotion
programs .......................................................................................................................................................... 37
Describe and understand underlying theories and mechanisms which explain the relation between green
space and health .............................................................................................................................................. 37
Apply knowledge on the relation between green space and health in disease prevention and health
promotion programs ........................................................................................................................................ 39
Lecture 9: Implementation ........................................................................................................................... 40
Lecture 10: Economic evaluation .................................................................................................................. 44
Why conduct economic evaluations? ............................................................................................................... 44
Types of economic evaluations ........................................................................................................................ 44
Steps of an economic evaluation...................................................................................................................... 44
Example Vital@Work ....................................................................................................................................... 47
Lecture 11: Ethics of medical research .......................................................................................................... 48
Unethical experiments ..................................................................................................................................... 48
2 examples from the past............................................................................................................................ 48
And from the present .................................................................................................................................. 48
Responsibilities of METC’s/ REC’s ..................................................................................................................... 50
The ethical and legal ‘pillars’............................................................................................................................ 51
Acceptability (aanvaardbaarheid van het onderzoek) ................................................................................ 51
Protection of the subject/ informed consent .............................................................................................. 52
Incompetent research objects – wilsonbekwaamheid ..................................................................................... 52
Challenges for the future.................................................................................................................................. 53
,Introduction lecture 31-10-2022
Chronic diseases and lifestyle factors
Many chronic diseases are influenced by lifestyle factors
- Lifestyle factors: BRAVVO-acronyme
o Bewegen – Physical activity
o Roken - smoking
o Alcohol
o Voeding - Nutrition
o Veilige seks – Safe sex
o Ontspannen/stress - stress
- Risk factor: when unhealthy behavioral choices are made
o PA à low levels of PA become a risk factor for chronic disease
o Smoking à >10 cigarettes a day
o Alcohol à >7 units a day
Levels of influence over human behavior: socio-ecological model
Different levels of influence on human behavior
Defining Health Promotion and Disease Prevention
Health Promotion = Maintaining people’s current health
status. And ideally shifting towards better health.
Disease Promotion = Preventing people getting a
disease. And prevent a shift towards the seriousness of a
disease.
Examples – HP vs DP
- Smoking reduction with the aim of maintaining an optimal respiratory and CV-
system à HP
- Smoking reduction with the aim to reduce the chance of getting lung cancer à DP
Relation between HP and DP
- Many lifestyle factors focus initially on Health Promotion
o E.g., increasing PA, lowering fat intake, reducing smoking
, - And then have an effect on Disease Prevention
o E.g., preventing obesity or cancer
Types of prevention
- Primary prevention = to prevent (development) disease and illness.
To promote a healthy lifestyle.
- Secondary prevention = early detection of a disease/ screening of
disease e.g., cancer screening
- Tertiary prevention = prevent/ reduce the seriousness or
complications of diseases.
- Palliative care = end of life care, to relieve the pain of the patient, mostly for
terminally ill people.
Prevention can be target at different population levels
- Universal
o Designed to reach entire population, without regard to individual risk factors
and intends to reach a very large audience.
- Selective
o Targets subgroups of general population that are determined to be at risk.
Subgroups may be distinguished by traits such as age, gender, family history,
economic status, etc.
- Indicated
o Involves a screening process and aims to identify individuals who exhibit early
signs of a disease and other problem behaviors.
Intervention levels, and tools or instruments
- Eliminate, restrict, disincentive e.g., legislature/ law, sanctions
- Incentive, shift, enable e.g., pricing, nudging, facilities
- Enable, educate e.g., education, training
Real-life setting
- HPDP requires multifactorial interventions in the complexity of real-life settings.
- Individual move from setting to setting and constantly making lifestyle choices
influenced on different levels (intra, interpersonal, institutional, community, policy).
Consequently, interventions are often aimed at a specific setting.
- Definition of a setting: physical and recognizable structure with predefined
geographical boundaries.
Introduction lecture 31-10-2022 ..................................................................................................................... 3
Chronic diseases and lifestyle factors................................................................................................................. 3
Levels of influence over human behavior: socio-ecological model ..................................................................... 3
Defining Health Promotion and Disease Prevention .......................................................................................... 3
Types of prevention ............................................................................................................................................ 4
Intervention levels, and tools or instruments ..................................................................................................... 4
Lecture 2: Upstream determinants of lifestyle behaviours and chronic disease risk ........................................ 5
What are upstream determinants? .................................................................................................................... 5
ANGELO-framework ........................................................................................................................................... 5
Challenges in upstream research ....................................................................................................................... 6
(Evaluation of) behavioural theories .................................................................................................................. 6
Lecture 3: Hearing impairment in adults ......................................................................................................... 8
Describe some determinants and consequences of hearing impairment........................................................... 8
Describe primary, secondary, and tertiary prevention of hearing impairment .................................................. 8
Understand the relevance of applying health behaviour change models when designing and implementing
interventions .................................................................................................................................................... 10
Understand how to design and perform a cluster RCT by evaluating an intervention: SUPR study ................ 12
Summary .......................................................................................................................................................... 13
Lecture 4: Community action (research): a transdisciplinary approach to health promotion ......................... 14
Introduction...................................................................................................................................................... 14
Background of community approach ............................................................................................................... 15
Community what is it? ..................................................................................................................................... 15
Community approaches ................................................................................................................................... 16
Community participation ................................................................................................................................. 16
Social network approach .................................................................................................................................. 17
Intersectoral collaboration ............................................................................................................................... 17
Challenges in community action ...................................................................................................................... 17
Lecture 5: Quality of life ............................................................................................................................... 19
Understand the QoL concept and its domains ................................................................................................. 19
Able to deal with the many terms .................................................................................................................... 19
Why and how to measure QoL ......................................................................................................................... 20
Types of QoL instruments ................................................................................................................................. 21
Able to distinguish health & QoL outcomes ..................................................................................................... 23
Lecture 6: Evaluation .................................................................................................................................... 24
, Understand and describe the concept of evaluation........................................................................................ 24
To name the main elements of an evaluation plan .......................................................................................... 24
Distinguish different types of evaluation ......................................................................................................... 24
Distinguish and name basic evaluation questions ........................................................................................... 26
Describe and use the RE-AIM framework ......................................................................................................... 26
GRADE .............................................................................................................................................................. 27
Quality of evidence........................................................................................................................................... 27
Lecture 7: Power calculation and analyzing RCT data .................................................................................... 29
Sample size calculations ................................................................................................................................... 29
For continuous variables .................................................................................................................................. 29
Dichotomous outcomes.................................................................................................................................... 31
Evidence based medicine ................................................................................................................................. 32
Conclusion ........................................................................................................................................................ 32
The analysis of RCT data .................................................................................................................................. 32
One follow-up measurement............................................................................................................................ 32
More than one follow-up measurement .......................................................................................................... 34
Lecture 8: Vitamin G – the importance of green space for our health ........................................................... 37
Describe and understand why green space could be important in disease prevention and health promotion
programs .......................................................................................................................................................... 37
Describe and understand underlying theories and mechanisms which explain the relation between green
space and health .............................................................................................................................................. 37
Apply knowledge on the relation between green space and health in disease prevention and health
promotion programs ........................................................................................................................................ 39
Lecture 9: Implementation ........................................................................................................................... 40
Lecture 10: Economic evaluation .................................................................................................................. 44
Why conduct economic evaluations? ............................................................................................................... 44
Types of economic evaluations ........................................................................................................................ 44
Steps of an economic evaluation...................................................................................................................... 44
Example Vital@Work ....................................................................................................................................... 47
Lecture 11: Ethics of medical research .......................................................................................................... 48
Unethical experiments ..................................................................................................................................... 48
2 examples from the past............................................................................................................................ 48
And from the present .................................................................................................................................. 48
Responsibilities of METC’s/ REC’s ..................................................................................................................... 50
The ethical and legal ‘pillars’............................................................................................................................ 51
Acceptability (aanvaardbaarheid van het onderzoek) ................................................................................ 51
Protection of the subject/ informed consent .............................................................................................. 52
Incompetent research objects – wilsonbekwaamheid ..................................................................................... 52
Challenges for the future.................................................................................................................................. 53
,Introduction lecture 31-10-2022
Chronic diseases and lifestyle factors
Many chronic diseases are influenced by lifestyle factors
- Lifestyle factors: BRAVVO-acronyme
o Bewegen – Physical activity
o Roken - smoking
o Alcohol
o Voeding - Nutrition
o Veilige seks – Safe sex
o Ontspannen/stress - stress
- Risk factor: when unhealthy behavioral choices are made
o PA à low levels of PA become a risk factor for chronic disease
o Smoking à >10 cigarettes a day
o Alcohol à >7 units a day
Levels of influence over human behavior: socio-ecological model
Different levels of influence on human behavior
Defining Health Promotion and Disease Prevention
Health Promotion = Maintaining people’s current health
status. And ideally shifting towards better health.
Disease Promotion = Preventing people getting a
disease. And prevent a shift towards the seriousness of a
disease.
Examples – HP vs DP
- Smoking reduction with the aim of maintaining an optimal respiratory and CV-
system à HP
- Smoking reduction with the aim to reduce the chance of getting lung cancer à DP
Relation between HP and DP
- Many lifestyle factors focus initially on Health Promotion
o E.g., increasing PA, lowering fat intake, reducing smoking
, - And then have an effect on Disease Prevention
o E.g., preventing obesity or cancer
Types of prevention
- Primary prevention = to prevent (development) disease and illness.
To promote a healthy lifestyle.
- Secondary prevention = early detection of a disease/ screening of
disease e.g., cancer screening
- Tertiary prevention = prevent/ reduce the seriousness or
complications of diseases.
- Palliative care = end of life care, to relieve the pain of the patient, mostly for
terminally ill people.
Prevention can be target at different population levels
- Universal
o Designed to reach entire population, without regard to individual risk factors
and intends to reach a very large audience.
- Selective
o Targets subgroups of general population that are determined to be at risk.
Subgroups may be distinguished by traits such as age, gender, family history,
economic status, etc.
- Indicated
o Involves a screening process and aims to identify individuals who exhibit early
signs of a disease and other problem behaviors.
Intervention levels, and tools or instruments
- Eliminate, restrict, disincentive e.g., legislature/ law, sanctions
- Incentive, shift, enable e.g., pricing, nudging, facilities
- Enable, educate e.g., education, training
Real-life setting
- HPDP requires multifactorial interventions in the complexity of real-life settings.
- Individual move from setting to setting and constantly making lifestyle choices
influenced on different levels (intra, interpersonal, institutional, community, policy).
Consequently, interventions are often aimed at a specific setting.
- Definition of a setting: physical and recognizable structure with predefined
geographical boundaries.
