Determinants and mechanism from the earliest moment in life and health during the lifecourse? Gezonde Voeding & Gezonde Leefstijl
Prepregnancy =Preconception Pregnancy Birth 1 10 20 40 80 years Developmental Origins of Health and Disease Preconceptie & zwangerschapsperiode zijn window of opportunity voor gedragsverandering van huidige en toekomstige generaties
Evidence-based leefstijlinterventies = gedragsverandering Prochaska & Diclemente s transtheoretical model: readiness to behavioral change Bandura s social cognitive theory: self-efficacy Fogg: motivation, ability and triggers ASE Model: attitude, social influences and self-efficacy
Preconception clinic tailored on nutrition and lifestyle couples contemplating pregnancy 2 consultations < 3 months personal screening (questionnaires, anthropometrics, laboratory) personal advises (intervention) 2007-2012: 3,500 couples 30% reduction in lifestyle risk factors Hammiche et al, Hum Reprod 2011 >65% enhanced pregnancy chance Twigt et al, Hum Reprod 2012
Pimp the recipe Kiezen Kopen Eten Bereiden Liesbeth Luijendijk, 2015, Food & Biobased research, WageningenUR
Websites 6 billion mobile phones 2.3 billion smart phones wellness, prevention, self-management patient- centered & healthcare professional centered 430 pregnancy apps for pregnancy Tripp et al., Women Birth 2014;27:64-7
ehealth care solutions 6 billion mobile phones 2.3 billion smart phones wellness, prevention, self-management patient- centered & healthcare professional centered 430 pregnancy apps for pregnancy Benefits Barriers At any time and place Effectiveness? Anonymously Cost effectiveness? Personalised Reimbursement Continuous coaching Biomarkers, anthropometrics Cheap I Interoperability Tripp et al., Women Birth 2014;27:64-7
Smarter Pregnancy Platform 3.0 CE1 Personal lifestyle coaching Couples and health care professionals www.slimmerzwanger.nl www.slimmerzwanger.nl/nl/demo-en.php www.slimmerzwanger.nl/onderzoek Multifunctional device independent platform: Folic acid, vegetables, fruits, smoking, alcohol Modules for safe medication use (IVF, CVD..) hospital appointments, physical exercise Vitamine D 3 recipes/week, vouchers folic acid, pregnancy test
Survey results 2012-2013 Compliance and usability 60 50 40 30 20 10 0 % Screening Coaching General 1 (disagree) 2 3 4 5 (agree) Preconception & antenatal clinic 86% participation 6% no smartphone 8% other reasons Survey 65% compliance 26 weeks coaching 49-74% positive usability
Survey results 2012-2013 Disagree (%) Agree (%) 0 1 2 3 I have more attention for my nutrition 0 14 25 61 I have more attention for my lifestyle 0 15 23 62 Slimmer Zwanger supports me very much 0 27 39 34 I will not take a subscription when I have to pay 0 6 18 77 I like that the program is also for my partner 0 3 51 46
Survey results 2012-2013 (Cost) efficacy Efficacy: Fruit, vegetables: 20-38% Folic acid supplement use: 60-71% Smoking, alcohol: 13-22% Pregnancy chance: 19% (14-23%) Cost-efficacy with assumption of 30% effectiveness 3,0% absolute reduction of subfertility 13.317 per woman 3,4% absolute reduction Big3-outcome 10.693 per baby
Implementation of ehealth and mhealth from the earliest moment during the lifecourse
Kopen, bereiden, eten Monitoring Persoonlijk profiel Gezondheid, gezin, religie, voorkeuren Gepersonaliseerde voeding Communicatie Liesbeth Luijendijk, 2015, Food & Biobased research, WageningenUR
Meer onderzoek naar ehealth en mhealth en gedrag Personalisatie en motivatie Voedingswaarde data voedings producten Meten voedingsinname Betrouwbaarheid: 100% en Up-to-date, Digitalisering & Privacy 19 Liesbeth Luijendijk, 2015, Food & Biobased research, WageningenUR
Health Lifestyle Social media Environment Occupation Income Parents Marketing Behavior Gen Health practitioner Biomarkers DNA Lifestyle Midwife Gynecologist Geneticists Stakeholders Consumption Behavior Public Child Health Lifestyle Behavior health Education Health professional Health data Biomarkers DNA Lifestyle Anthropometrics