• Accessibility of standardized information of a national colorectal cancer screening program for low health literate screening invitees: A mixed method study.

      Fransen, Mirjam P; Dekker, Evelien; Timmermans, Daniëlle R M; Uiters, Ellen; Essink-Bot, Marie-Louise (2017-02)
      To explore the accessibility of standardized printed information materials of the national Dutch colorectal cancer screening program among low health literate screening invitees and to assess the effect of the information on their knowledge about colorectal cancer and the screening program.
    • Autonomous and informed decision-making: The case of colorectal cancer screening.

      Douma, Linda N; Uiters, Ellen; Verweij, Marcel F; Timmermans, Danielle R M (2020-01-01)
    • Community participation in Health Impact Assessment. A scoping review of the literature

      Den Broeder, Lea; Uiters, Ellen; ten Have, Wim; Wagemakers, Annemarie; Schuit, Albertine Jantine (2017-09)
    • Decision-making styles in the context of colorectal cancer screening.

      Douma, Linda N; Uiters, Ellen; Timmermans, Danielle R M (2020-02-03)
    • Do people with a different goal-orientation or specific focus make different decisions about colorectal cancer-screening participation?

      Douma, Linda N; Uiters, Ellen; Timmermans, Danielle R M (2019-01-01)
      Previous studies have shown that having promotion-oriented goals (e.g. wanting to become healthy) or prevention-oriented goals (e.g. wanting to avoid getting ill) can affect people's health-related decisions and behaviour by emphasising aspects and information that seem relevant in light of what they want to achieve. However, this issue has not yet been researched regarding colorectal cancer (CRC) screening. With our study, we aimed to examine the relationship between people's goal-orientation or focus on advantages or disadvantages and their CRC screening participation, as this could provide insights for supporting people in making this complex decision. An online survey was carried out among a sample of first-time CRC screening invitees (1282 respondents, response rate 49%). We assessed people's goal-orientation (i.e. promotion-orientation and prevention-orientation), focus on the advantages or disadvantages of CRC screening, screening participation and main considerations (e.g. cancer is a serious illness) concerning their screening decision. Generally, CRC screening participants scored higher on both promotion-orientation and prevention-orientation than non-participants. Both CRC screening participation and non-participation were not associated with a dominant goal-orientation. CRC screening participants did show a dominant focus on the advantages of CRC screening. Mediation analysis showed support for our premise that the relationship between people's goal-orientation or focus on advantages or disadvantages and their screening participation could be (partially) mediated by people's main considerations concerning CRC screening. CRC screening participants and non-participants differed in their goal-orientation and focus on advantages or disadvantages. CRC screening participation appears to be associated with a focus on the advantages of CRC screening, which could impede the making of an informed decision. CRC screening non-participation appears not to be associated with any clear goal-orientation or focus, or we have not yet managed to capture this, which could be either beneficial or problematic for making an informed decision.
    • Educational differences in acute infectious diseases in the Netherlands: results from a nationwide health survey.

      de Gier, Brechje; Houben-van Herten, Marieke; Uiters, Ellen; Hahné, Susan J M (2020-04-01)
    • Health expenditure of employees versus self-employed individuals; a 5 year study.

      Herber, Gerrie-Cor; Schipper, Maarten; Koopmanschap, Marc; Proper, Karin; van der Lucht, Fons; Boshuizen, Hendriek; Polder, Johan; Uiters, Ellen (2020-08-27)
    • Health literacy among older adults is associated with their 10-years' cognitive functioning and decline - the Doetinchem Cohort Study.

      Geboers, Bas; Uiters, Ellen; Reijneveld, Sijmen A; Jansen, Carel J M; Almansa, Josué; Nooyens, Astrid C J; Verschuren, W M Monique; de Winter, Andrea F; Picavet, H Susan J (2018-03-20)
      Many older adults have low levels of health literacy which affects their ability to participate optimally in healthcare. It is unclear how cognitive decline contributes to health literacy. To study this, longitudinal data are needed. The aim of this study was therefore to assess the associations of cognitive functioning and 10-years' cognitive decline with health literacy in older adults.
    • Health literacy skills for informed decision making in colorectal cancer screening: Perceptions of screening invitees and experts.

      Woudstra, Anke J; Timmermans, Daniëlle R M; Uiters, Ellen; Dekker, Evelien; Smets, Ellen M A; Fransen, Mirjam P (2017-12-20)
      The process of informed decision making (IDM) requires an adequate level of health literacy. To ensure that all individuals have equal opportunity to make an informed decision in colorectal cancer (CRC) screening, it is essential to gain more insight into which health literacy skills are needed for IDM. Our aims were (i) to explore how individuals make a decision about CRC screening and (ii) to explore which skills are needed for IDM in CRC screening and (iii) to integrate these findings within a conceptual framework.
    • Healthcare utilisation and expenditure of overweight and non-overweight children.

      Wijga, Alet H; Mohnen, Sigrid M; Vonk, Judith M; Uiters, Ellen (2018-06-11)
      Quantification of the burden of overweight on the healthcare system is becoming increasingly urgent for health policy, but accurate estimates are hard to obtain.
    • Local professionals' perceptions of health assets in a low-SES Dutch neighbourhood: a qualitative study.

      Den Broeder, Lea; Uiters, Ellen; Hofland, Aafke; Wagemakers, Annemarie; Schuit, Albertine Jantine (2017-07-12)
      Asset-based approaches have become popular in public health. As yet it is not known to what extent health and welfare professionals are able to identify and mobilise individual and community health assets. Therefore, the aim of this study was to understand professional's perceptions of health and health assets.
    • Single transitions and persistence of unemployment are associated with poor health outcomes.

      Herber, Gerrie-Cor; Ruijsbroek, Annemarie; Koopmanschap, Marc; Proper, Karin; van der Lucht, Fons; Boshuizen, Hendriek; Polder, Johan; Uiters, Ellen (2019-06-13)
    • Socioeconomic differences in healthcare expenditure and utilization in The Netherlands.

      Loef, Bette; Meulman, Iris; Herber, Gerrie-Cor M; Kommer, Geert Jan; Koopmanschap, Marc A; Kunst, Anton E; Polder, Johan J; Wong, Albert; Uiters, Ellen (2021-07-03)
    • What benefits and harms are important for a decision about cervical screening? A study of the perspective of different subgroups of women.

      van der Meij, Amber E; Damman, Olga C; Uiters, Ellen; Timmermans, Danielle Rm (2019-01-01)
      Background: In cervical screening programs, women typically receive information leaflets to support their decision about participation. However, these leaflets are often based on what experts consider important benefits and harms of screening and not what women themselves consider important to know. Objective: To identify which benefits and harms women consider important for making a decision about cervical screening. Design: Cross-sectional study. Setting and participants: Women from the Dutch target group of cervical screening (N=248; 30-60 years), recruited through an online access panel. Main variables studied: Perceived importance of different benefits and harms of cervical screening, assessed through two rating items ("How important is the information about [this harm/benefit] for your decision?" and "For me it is a [benefit/harm] that participating in the screening program leads to [the benefit/harm]"), and one ranking item ("Rank the information according to their importance for your own choice"). Results: Women overall considered the benefits of cervical screening more important than the harms or disadvantages. The most important harm according to women was the chance of false positive results (M=4.88; SD=1.75). Differences between those with lower and higher numeracy/health literacy were found regarding several aspects, e.g. for the chance of false positive results, the chance of false negative results, the chance of overtreatment. Discussion and conclusion: The results suggest that leaflets could include more explicit information about false positive results.
    • Why are the public so positive about colorectal cancer screening?

      Douma, Linda N; Uiters, Ellen; Timmermans, Danielle R M (2018-10-30)
      Colorectal cancer (CRC) screening is widely recommended. Earlier research showed that the general public are positive about CRC screening, as too the eligible CRC screening population. Among the eligible CRC screening population this positive perception has been shown to be associated with their perceptions of cancer, preventive health screening and their own health. It is unclear whether these concepts are also associated with the positive perception of the general public. Knowing this can provide insight into the context in which public perception concerning CRC screening is established. The aim of our study was to examine which main perceptions are associated with the public perception concerning CRC screening. An online survey was carried out in a Dutch population sample (adults 18+) among 1679 respondents (response rate was 56%). We assessed the public's perceptions concerning cancer, preventive health screening, own health, and the government, and examined their possible association with public opinion concerning CRC screening. The public's positive attitude towards CRC screening is associated with the public's positive attitude towards preventive health screening in general, their perceived seriousness of cancer, their belief of health being important, and their trust in the government regarding national screening programmes. Trust in the government and perceptions regarding the seriousness of cancer, preventive health screening and the importance of one's health seem to be important factors influencing how the public view CRC screening. The public are likely to process information about CRC screening in such a way that it confirms their existing beliefs of cancer being serious and preventive screening being positive. This makes it likely that they will notice information about the possible benefits of CRC screening more than information about its possible downsides, which would also contribute to the positive perception of CRC screening.