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, Frederieke G. Schaafsma, Eva van der Meij, Wilhelmus Jhj Meijerink, Baukje van den Heuvel, Astrid H. Baan, Paul Hp Davids, Petrus C. Scholten, Suzan van der Meij, W. Marchien van Baal, Annette D. van Dalsen, Daniel J. Lips, Jan Willem van der Steeg, Wouter Kg Leclercq, Peggy Maj Geomini, Esther Cj Consten, Steven E. Schraffordt Koops, Steve Mm de Castro, Paul Jm van Kesteren, Huib A. CenseHein Bac Stockmann, A. Dorien ten Cate, Hendrik J. Bonjer, Judith Af Huirne, Johannes R. Anema

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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.
Original languageEnglish
Article numbere9938
Pages (from-to)e9938
JournalJournal of Medical Internet Research
Issue number2
Publication statusPublished - 1 Feb 2019


  • Colectomy
  • EHealth
  • Hysterectomy
  • Intervention mapping
  • Patient reported outcome measures
  • Return to normal activities
  • Return to work

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