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ObjectivesLifestyle changes—such as adopting healthy nutrition and increasing physical activity—are essential for alleviating symptoms in patients with knee osteoarthritis (OA) and overweight, with weight loss being a key outcome of these changes. Since 2019, healthcare professionals (HCPs) in the Netherlands have been able to refer these patients to a reimbursed combined lifestyle intervention (CLI). This study aims to identify determinants affecting CLI implementation for individuals with knee OA and overweight from both patient and HCP perspectives.DesignSemistructured interviews were conducted in a qualitative study with 23 individuals with knee OA and overweight and 16 HCPs (general practitioners (GPs) and lifestyle coaches). Interviews were transcribed verbatim and coded independently by two researchers using the updated Consolidated Framework for Implementation Research (CFIR).SettingPrimary care, including GPs and lifestyle coaches from the Greater Rotterdam region in the Netherlands.Participants23 individuals with knee OA and overweight and 16 HCPs (GPs and lifestyle coaches).ResultsDeterminants were explored within four CFIR domains: innovation, outer setting, inner setting and individuals. Key facilitators included recognition of the programme’s potential, strong social support and positive participant–coach relationships. Major barriers involved the absence of an exercise component, financial constraints limiting its inclusion, scepticism among GPs about care quality, limited expertise of lifestyle coaches addressing OA-specific needs and difficulties adapting the programme to participants’ diverse knowledge levels and health literacy.ConclusionsTo improve the implementation of the CLI for patients with knee OA, it is essential to incorporate a tailored exercise component, strengthen lifestyle coaches’ expertise, address financial barriers and build trust among GPs through education and clear communication of programme outcomes. Tailoring the CLI to better meet participant needs is crucial to ensure its long-term effectiveness and sustainability as a treatment for individuals with knee OA and overweight.Trial registeration numberNetherlands Trial Registry (NL9355).

Worldwide the Covid-19 pandemic resulted in drastic behavioral measures and lockdowns. Vaccination is widely regarded as the true and only global exit strategy; however, a high vaccination coverage is needed to contain the spread of the virus. Vaccination rates among young people are currently lacking. We therefore studied the experienced motivations and barriers regarding vaccination in young people with the use of the health belief model. We conducted a correlational study, based on a convenience sample. At the vaccination location, directly after vaccination, 194participants(16-30 years) who decided to get vaccinated at a pop-up location several weeks after receiving a formal invitation, filled out a questionnaire regarding their attitudes towards vaccination based on concepts defined in the health belief model. We used these concepts to predict vaccination hesitancy. Younger participants and participants with lower educational levels report higher levels of hesitancy regarding vaccination (low education level = 38.9%, high education level = 25.4%). Perceived severity (Mhesitancy = .23, Mno hesitancy = .37) and susceptibility (Mhesitancy = .38, Mno hesitancy = .69) were not associated with hesitancy. Health related and idealistic benefits of vaccination were negatively associated with experienced hesitancy (Mhesitancy = .68, Mno hesitancy = -.37), while individualistic and practical benefits were not associated with hesitancy (Mhesitancy = -.09, Mno hesitancy = .05). Practical barriers were not associated with hesitancy (Mhesitancy = .05, Mno hesitancy = -.01), while fear related barriers were strongly associated with hesitancy (Mhesitancy = -.60, Mno hesitancy = .29). Health related, and idealistic beliefs are negatively associated with experienced hesitancy about vaccination, while fear related barriers is positively associated with experienced hesitancy. Future interventions should focus on these considerations, since they can facilitate or stand in the way of vaccination in young people who are doubting vaccination, while not principally opposed to it.

In a digital early literacy intervention RCT, children born late preterm fell behind peers when in a control condition, but outperformed them when assigned to the intervention. Results did however not replicate previous findings. Replication is often complicated by resource quality. Gold Standard measures are generally time-intensive and costly, while they closely align with, and are more sensitive to changes in, early literacy and language performance. A planned missing data approach, leaving these gold standard measures incomplete, might aid in addressing the origin(s) of non-replication. Participants after consent were 695 p Dutch primary school pupils of normal and late preterm birth. The high-quality measures, in additional to simpler but complete measures, were intentionally administered to a random subsample of children. Five definitions of gold standard alignment were evaluated. Two out of five gold standard levels improved precision compared to the original results. The lowest gold standard level did not lead to improvement: precision was actually diminished. In two gold standard definitions, an alphabetical factor and a writing-only factor the model estimates were comparable to the original results. Only the most precise definition of the gold standard level replicated the original results. Gold standard measures could only be used to improve model efficiency in RCT-designs under sufficiently high convergent validity.

Background Examining the correlates of adolescent’s physical activity (PA) and how they may differ according to the intersection of gender and family socioeconomic status (SES) can support the development of tailored interventions to more effectively promote adolescents’ PA. This study explored how the associations between psychosocial, behavioural and environmental factors and adolescent’s PA differed according to gender and family SES. Methods This study used data from the Dutch Youth Health Survey 2015. Adolescents ( n  = 9068) aged 12–19 were included in the study. The associations between psychosocial, behavioural, and environmental factors and PA (days per week engaging in at least one hour of PA) were examined with multilevel linear regression analysis. Potential interactions between these correlates, gender and family SES were explored. Results On average, adolescents engaged in at least one hour of PA for 4,2 days per week. Poor self-perceived health, low peer social support, and a weak connection with the environment were all associated with lower PA in adolescents. Daily smoking, cannabis use, risk of problematic gaming and social media use, as well as lack of daily consumption of fruit, vegetables, water and breakfast were associated with lower PA, whereas binge drinking was not. Interactions revealed that poor self-perceived health was associated with lower PA in adolescents from moderate- and high-SES families, but not in low-SES adolescents, whereas cannabis use was only associated with lower PA amongst low-SES adolescents. Low peer social support was associated with lower PA across all groups, but it was most strongly associated with lower PA amongst male adolescents from low-SES families than in other subgroups. Amongst low-SES males, low peer social support was associated with a 1.47 reduction in days engaging in sufficient PA, compared with a 0.69 reduction for high-SES males. Conclusions This study identified several psychosocial, behavioural and environmental factors that can be targeted to potentially increase adolescent’s PA. We also found that correlates of PA differed according to the intersection of gender and family SES. Our findings suggest that PA interventions should be tailored according to gender and SES to address the specific needs, barriers and facilitators of different subgroups.

Studies on the impact of the COVID-19 pandemic on autistic children’s psychosocial outcomes have shown mixed results. In the current study we aimed to gain a better insight into the effect of the COVID-19 pandemic by comparing psychosocial outcomes collected pre-pandemic with data collected during the pandemic. We used the Strengths and Difficulties Questionnaire (SDQ) to examine change over time in psychosocial outcomes of autistic children from pre-pandemic (T0) to lockdown I (T1) and lockdown II (T2) in the Netherlands. We expected a deterioration in psychosocial outcomes. There were 224 participants in T0 and T1, of which 141 also participated in T2. The results showed a surprising improvement in psychosocial outcomes from T0 to T1. Special education and female gender were associated with increased difficulties over time, while higher age was associated with decreased difficulties. At the subdomain level we found that emotional problems remained stable, while hyperactivity, conduct problems, and peer problems decreased, and prosocial behavior increased. Attending special education predicted increased peer problems over time, while higher age predicted both decreased conduct problems and increased prosocial behavior over time. The COVID-19 pandemic may have temporarily improved the fit between the psychosocial needs and the environment for children with autism in the Netherlands.

Fostering a sense of belonging and a positive atmosphere in tertiary education impacts student motivation and persistence, with campus environments playing a crucial role. Littering can disrupt this experience, making it important to address. This study used a quantitative approach to examine the effects of social norm interventions on littering at a Dutch university campus. Conducted in two buildings, the experiment included daily litter measurements. One building received a social norm intervention using persuasive communication, while the other served as a control. Litter levels were measured at baseline, post-intervention and seven months later, analyzed using logistic regression. Trashcan presence was noted. Littering decreased significantly in the treatment building (63% vs. 23% post-intervention, 28% follow-up). The treatment effect was significant at post and follow-up measurements, showing short- and long-term behavior change. Trashcan proximity affected the intervention at follow-up. Social factors play a key role in reducing littering. Future research should explore the dynamics with physical disposal opportunities further. Encouraging Cleaner Habits on a University Campus Feeling like you belong and enjoying a positive atmosphere on campus can boost students’ motivation and success in university. However, littering can disrupt this environment, making it important to find ways to reduce it. This study explored whether social norms (unspoken rules about how people behave) could encourage students to litter less on a university campus in the Netherlands. The research focused on two campus buildings. In one building, signs with persuasive messages about keeping the area clean were placed as part of the intervention. The other building did not receive these signs and was used for comparison. Researchers counted litter every day in both buildings before the intervention, immediately after, and seven months later. They also noted where trashcans were located to see if proximity made a difference. The results showed that littering dropped significantly in the building with the signs. Before the intervention, 63% of the spaces had litter. This dropped to 23% immediately after the intervention and stayed low at 28% seven months later. The changes were less noticeable in the building without signs. The study also found that trashcans placed closer to where people walk made it easier for the intervention to succeed over time. These findings highlight that social norms can be a powerful tool for encouraging cleaner behaviors on campus. However, combining these strategies with practical solutions, like placing trashcans in convenient locations, can make them even more effective. Future research could explore how to balance these social and physical factors to create cleaner and more welcoming university spaces.

Pre- and post-term children show increased autism risk. Little is known about gestational age (GA) prevalence among autistic children, and their respective autism phenotype. We compared prevalence of pre-, full- and post-term birth between a population-derived sample of N = 606 (137 females, 22.61%) autistic children and adolescents (mean age = 14.01, SD = 3.63, range 3–24) from the Netherlands Autism Register, and matched controls from the Dutch birth register. Autism phenotype and comorbid symptoms were assessed with the AQ-short and SDQ questionnaires. Using logistic regression, we found higher prevalence of pre- and post-term birth among autistic individuals but no phenotypical differences across GA groups. Autism risk was particularly elevated for post-term children, highlighting the need for closer investigation of autism on the whole GA range.

Lighting illegal fireworks inside soccer stadiums is a worldwide and persistent problem. Despite rules and regulations as well as rigorous enforcement, the use of illegal fireworks in football stadium is increasing rather than decreasing. Little is yet known about the causes and predictors of this behavior, preventing the development of effective interventions or communication strategies. We therefore conducted a qualitative study, using semistructured interviews with both supporters of a large Dutch soccer club who participated in lighting fireworks, and with professionals who dealt with illegal fireworks in daily practice. Semi-structures interviews were based on hooliganism literature as well as the COM-B model. We concluded that hooliganism and lighting illegal are distinctly different phenomena, although they share some underlying constructs. From a behavioral perspective, using the COM-B model as a framework, reflective motivation was identified as the strongest facilitator of lighting fireworks, which appeared to be an important part of supporter life and shared culture. Quick interventions that target automatic behavior, such as nudges, will probably thus not be successful in changing this behavior. Supporters suggest compromise between supporters and professionals as preferred future direction. Reported feelings of stigmatization by and feeling unappreciated by professionals, could interfere with successful implementation of this direction. Professionals however contradict negative to have judgements of supporters. Building a bridge between supporters and professionals should be a first step towards a solution.

Background Worldwide the Covid-19 pandemic resulted in drastic behavioral measures and lockdowns. Vaccination is widely regarded as the true and only global exit strategy; however, a high vaccination coverage is needed to contain the spread of the virus. Vaccination rates among young people are currently lacking. We therefore studied the experienced motivations and barriers regarding vaccination in young people with the use of the health belief model. Methods We conducted a correlational study, based on a convenience sample. At the vaccination location, directly after vaccination, 194participants(16–30 years) who decided to get vaccinated at a pop-up location several weeks after receiving a formal invitation, filled out a questionnaire regarding their attitudes towards vaccination based on concepts defined in the health belief model. We used these concepts to predict vaccination hesitancy. Results Younger participants and participants with lower educational levels report higher levels of hesitancy regarding vaccination (low education level = 38.9%, high education level = 25.4%). Perceived severity (Mhesitancy = .23, Mno hesitancy = .37) and susceptibility (Mhesitancy = .38, Mno hesitancy = .69) were not associated with hesitancy. Health related and idealistic benefits of vaccination were negatively associated with experienced hesitancy (Mhesitancy = .68, Mno hesitancy = -.37), while individualistic and practical benefits were not associated with hesitancy (Mhesitancy = -.09, Mno hesitancy = .05). Practical barriers were not associated with hesitancy (Mhesitancy = .05, Mno hesitancy = -.01), while fear related barriers were strongly associated with hesitancy (Mhesitancy = -.60, Mno hesitancy = .29). Conclusions Health related, and idealistic beliefs are negatively associated with experienced hesitancy about vaccination, while fear related barriers is positively associated with experienced hesitancy. Future interventions should focus on these considerations, since they can facilitate or stand in the way of vaccination in young people who are doubting vaccination, while not principally opposed to it.

Debtors were stimulated to contact their creditors to negotiate a repayment plan. Contacting creditors was important because debtors were unlikely to repay the debt immediately and upon contacting, debtors could agree on a repayment plan to repay the debt in the long run. Using insights from scarcity theory and nudging techniques, a standard debt repayment letter was adapted and both letters were compared. Experimental results ( N = 3,330) provide support for the use of nudging techniques as more debtors agreed on a repayment plan and response rates increased. The results underline the importance of stimulating debtors to contact their creditors.