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There is worldwide recognition of the potential increase of digital health inequity due to the increased digitalization of health care systems. Digital health skill development may prevent disparities in eHealth access and use. In the Dutch context, the public library has started to facilitate support in digital health skill development by offering public eHealth courses. Understanding the motivations of people to seek support may help to further develop this type of public service. This is a qualitative study on the motivations of citizens participating in an eHealth course offered by public libraries. The study aimed to explore why citizens were motivated to seek nonformal support for eHealth use. A total of 20 semistructured interviews with participants who participated in an eHealth course were conducted in 7 public libraries across the Netherlands. The interviews were conducted between April and June 2022. Purposive sampling took place in the public library during the eHealth course. The interviews covered participants' motivations, attitudes, and experiences with eHealth use and their motivations to seek help with eHealth use. Interviews were audio-recorded and transcribed. Themes were identified via a comprehensive thematic data analysis. The participants were 51 to 82 years of age (average 73.5, SD 6.6 y) and 14 (70%) participants were female. Three motivational themes were identified: (1) adapting to an increasingly digital society, (2) sense of urgency facilitated by prior experience in health care, and (3) a need for self-reliance and autonomy. Additionally, participants expressed a general desire for social contact and lifelong learning. A lack of adequate informal support by friends and family for digital skills and positive experiences with formal support from public libraries stimulated the participants to seek formal support for eHealth use. We show that the participants had a feeling of urgency that sparked their motivation to seek nonformal support in the public library. Motivations to participate in the eHealth course stemmed from the need to adapt to the digital society, being a patient or a caregiver, or the need or wish to be independent from others. Participants of the study were mainly older female adults who had native language abilities, up-to-date digital devices, and time. It is likely that other populations experience similar feelings of urgency but have other support needs. Future research should explore the needs and attitudes of nonusers and other users of digital health toward seeking support in eHealth access and use.

The digitalization of healthcare poses a risk of exacerbating health inequalities. Dutch public libraries offer freely accessible e-health courses given by trainers. However, there is limited knowledge on whether these libraries successfully reach and support those in need. This study aimed to explore trainers' perspectives on the challenges, successes, and potential improvements in digital health skill education in a library setting. Trainers of the e-health course were interviewed. Topics included: the role of the library in digital health skills education, the successes and challenges in reaching groups with a low socioeconomic position, the perceived impact of the digital health skills education, and strategies for future improvement in digital health skills education. A deductive analysis based upon the interview guide topics was performed. A second inductive analysis was applied to identify underlying patterns. Coding was done independently and cross-checked. Codebooks and themes were determined in discussion with authors. Three themes emerged. 1) Trainers' services, skills and expertise: Trainers identified older adults, youth, people with low (digital) literacy, the unemployed, and people from non-native cultural backgrounds as the groups most in need of support. Trainers felt equipped to address these groups' needs. 2) The libraries' reach: improving engagement, perceived accessibility, and clients' barriers: Despite trainers' efforts to adjust the course to the target groups' level of commitment, digital and literacy levels, and logistics, the digital health course predominantly engages older adults. Experienced barriers in reach: limited perceived accessibility of the public library and clients' personal barriers. 3) Collaborations with healthcare, welfare and community organizations: Trainers emphasized that collaborations could enhance the diversity and number of participants. Current partnerships provided: reach to target groups, teaching locations, and referral of clients. Trainers in public libraries recognize a various target groups that need support in digital health skill development. The study identified three challenges: accessibility of the digital health course, reach of the public library, and clients' personal barriers. Public libraries have potential to support their target groups but need strategies to improve their engagement and reach. Collaborations with healthcare, welfare, and community organizations are essential to improve their reach to those most in need of support.

Introduction: To guarantee a health system that remains accessible for all, reaches high standards of quality and does not stretch the limits of financial budgets, it is important to collaborate across domains and take on an integrated and incremental approach. Over the years different stakeholders across the Dutch health system engaged in the first steps to transform towards a sustainable health system. With a new Dutch integrated healthcare agreement signed in 2022 by the national representatives of health, care and patient organizations, this study aimed to reflect on past experiences in the process of health systems transformation, and formulate lessons learned for further development.  Methods and Analysis: A qualitative study was conducted to reflect on the activities, experiences and outcomes linked to a national program focused on health system transformation. Interviews were held with national and regional representatives of patients and clients (organizations), municipalities, health insurers, health care organizations, health and care professionals, policy makers, (regional) program managers and other key players in the health sector (n=31). The semi-structured interviews were transcribed and deductively coded. The interviewees reflected on their ambition and experiences by scoring their expectation versus outcome. Insights were gained on persistent challenges and facilitating factors. After thematic analysis, the lessons learned were shared with the participants during a collective session (n=26). The aim of this session was to validate the lessons learned and to discuss potential solutions together. Preliminary Results: Participants are positive about the increasing collaboration and shared enthusiasm for the transition in the past years. However, there are concerns about the speed of change and structural assurance. It remains a challenge to reach concrete agreements and have a holistic view across the domains. It appeared that trust and equality between partners can only evolve if there is awareness of the differences in interests and needs. Furthermore, our results show the complexity of the transformation process as needs can vary on different levels (national, regional and local) and from different perspectives. Examples are the search for a balance between trust and control on national and regional level, the need of different actors to be equally valued in decision making (and not only consulted), and connecting the systemic world with the needs of citizens, clients and patients. In order to grow sustainable relationships, stimulate active participation and connect the system with citizens, clients and patients, time and financial resources to experiment appeared to be essential. Lessons learned and Next steps: As the transformation of health systems is an ongoing, iterative and long term process, developments will be monitored in the coming years. According to our insights, more connection and balance is needed between the different perspectives, goals and levels of action. A recommendation on the short term is to focus on equal input from all involved partners, especially health care professionals, citizens, clients and patients. With the start of a new national integrated healthcare agreement, we argue for the importance of an incremental approach and collaborative learning to pursue this transformation.

Background: There are people who access primary health care services who experience multiple-problems in different living areas (e.g. financial, housing, unemployment, alcohol or drugs) and also lack a social support network. These issues are related to wider determinants of health. Supporting people with multiple-problems is a major challenge for general practitioners, as these people might not need medical help (first), but require help from other sectors. Social prescribing (SP) is a holistic, person-centered community-based approach to address clients’ wider health needs. This approach creates a bridge between medical and non-medical sectors. Clients in vulnerable neighborhoods more often experience multiple problems at the same time. Therefore implementing SP in vulnerable neighborhoods differs from implementation in non-vulnerable neighborhoods. We applied the method of participatory action research to co-create and realize a plan together with relevant stakeholders. The goal was to better respond to the wider support needs of people with multi-problems. This research methodology starts with exploring the different perspectives of health and care professionals and clients on the design and implementation of SP in a vulnerable neighborhood. Methods: For this study, interviews were conducted with an divers group of professionals from different sectors, clients and experts-by-experience who received care and support in the past and are currently working as volunteers to help people with multi-problems. We used guiding principles for successful implementation of social prescribing and a methodological framework of system exploration in data collection and analysis. Results:Results of the system exploration provide valuable insights into the experiences of professionals and client in the current situation and what is needed towards the desired situation of improved support for people with multi-problems. For example, one experience is that in the current situation addressing wider health needs is not yet the norm, the current offer of care is not always aligned with  wider health needs and there is insufficient cohesion in providing care and support. To create the desired situation a case manager, customization of supporting wider health needs of client, and structural collaboration between sectors are needed. Discussion: Internationally, SP has gained increasing attention, and many countries are implementing SP. However, there is little attention for social prescribing in vulnerable neighborhoods. We will reflect on how guiding principles for successful implementation of SP relate to the experiences and perspectives on how to better support people with multi-problems through SP in an vulnerable neighborhood. Conclusion: This study provides insight into different perspectives on improving the support for people with multi-problems through SP in a vulnerable neighborhood. These insights are useful when implementing SP in the context of an vulnerable neighborhood for people with multi-problems. Lessons learned: The insights of the experiences and perspectives gives the opportunity to start with a action plan to better support people with multi-problems through SP in an vulnerable neighborhood. Suggestions for future research: This study only describes the first phase of action research: system exploration. Future research should focus on cocreating an action plan together with the involved stakeholders and on monitoring and evaluating this action plan.  

Samenvatting Digitalisering en technologische innovaties spelen een steeds prominentere rol in de gezondheidszorg. Het gebruik van digitale technologieën in de gezondheidszorg, ook wel bekend als e‑health of digitale zorg, heeft de potentie om de toegankelijkheid, efficiëntie en kwaliteit van zorg te verbeteren. Om de potentie van e‑health te kunnen realiseren, is het essentieel dat technologieën voor zo veel mogelijk inwoners toegankelijk zijn. Recente nationale gegevens van de E‑healthmonitor van 2023 laten zien dat hier nog verbetering mogelijk is.