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Determinants and mechanism from the earliest moment in life and health during the lifecourse? Gezonde Voeding & Gezonde Leefstijl
Determinants and mechanism from the earliest moment in life and health during the lifecourse?
Gezonde Voeding
&
Gezonde Leefstijl
Pregnancy Birth 1 10 20 40 80 years Prepregnancy
=Preconception
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
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
Preconception clinic tailored on nutrition and lifestyle
Kiezen Kopen
Eten Bereiden
Pimp the recipe
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
Benefits Barriers
At any time and place Effectiveness?
Anonymously Cost effectiveness?
Personalised Reimbursement
Continuous coaching Biomarkers, anthropometrics
Cheap I Interoperability
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
Tripp et al., Women Birth 2014;27:64-7
Smarter Pregnancy Platform 3.0 CE1 Personal lifestyle coaching
Couples and health care professionals
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
www.slimmerzwanger.nl www.slimmerzwanger.nl/nl/demo-en.php www.slimmerzwanger.nl/onderzoek
Preconception & antenatal clinic 86% participation 6% no smartphone 8% other reasons Survey 65% compliance 26 weeks coaching 49-74% positive usability
0
10
20
30
40
50
60
Screening Coaching General
%
1 (disagree)
2
3
4
5 (agree)
Survey results 2012-2013
Compliance and usability
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
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
Survey results 2012-2013
(Cost) efficacy
Implementation of eHealth and mHealth from the earliest moment during the lifecourse
Persoonlijk profiel
Gezondheid, gezin,
religie, voorkeuren
Monitoring
Communicatie Gepersonaliseerde voeding
Kopen, bereiden, eten
Liesbeth Luijendijk, 2015, Food & Biobased research, WageningenUR
19
Meten voedingsinname
Digitalisering & Privacy
Meer onderzoek naar eHealth en mHealth en gedrag
Personalisatie
en
motivatie Voedingswaarde data
voedings producten
Betrouwbaarheid:
100% en Up-to-date,
Liesbeth Luijendijk, 2015, Food & Biobased research, WageningenUR
Health
professional
Stakeholders
Gen
practitioner
Midwife
Gynecologist
Geneticists
Public
health
Education
Social media
Marketing Parents
Health
Lifestyle
Environment
Occupation
Income
Consumption
Behavior
Child
Health
Lifestyle
Behavior
Anthropometrics
Health data
Biomarkers
DNA
Lifestyle
Health
Biomarkers
DNA
Lifestyle
Behavior
