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 (Preprint)

Abstract

Funding: This study is carried out with funding of ZonMw (projectnumber 837002409), an organization for health research and development in the Netherlands. A B S T R A C TBackground: Guiding and monitoring postoperative recovery and resumption of activities are usually not provided to patients after discharge from the hospital. Therefore a perioperative 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: To further develop the 'ikherstel' eHealth intervention to fit a broader patient population.Methods: The Intervention Mapping protocol was used to guide further development of the 'ikherstel'-intervention. Firstly, patients' needs were identified using i) the information of a process evaluation of the earlier performed 'ikherstel'-study; ii) a review of the literature; iii) a survey study; and iv) focus group discussions among stakeholders. Next, program and change-objectives were defined. Thirdly, 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 effective 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 in the needs assessment and using the theoretical framework in the preparatory steps of the Intervention Mapping protocol resulted in additional tools. A mobile application, an activity tracker and an 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. I N T R O D U C T I O NThe length of in-hospital stay after general surgical and gynecological procedures decreased significantly due to a growing trend in day care surgery, introduction of minimal invasive techniques and Enhanced Recovery after Surgery programs (ERAS) [1][2][3]. Due to this shortening of in-hospital stay, perioperative in-hospital care has been reduced and the greater part of the recovery period takes place at home [4][5]. As a result, guiding and monitoring resumption of normal activities (RNA) including return to work (RTW), and long term recovery is now transferred to primary care [6].However, frequently no or conflicting advice is given resulting in patients being unsure whom to contact for support in case of complaints. Patients often lack the knowledge themselves to determine how and when to resume ac...