title: eHealth program to empower patients in returning to normal activities and work after gynecological surgery: intervention mapping as a useful method for development.
abstract: BACKGROUND
  Full recovery after gynecological surgery takes much longer than expected regardless of surgical technique or the level of invasiveness. After discharge, detailed convalescence recommendations are not provided to patients typically, and postoperative care is fragmented, poorly coordinated, and given only on demand. For patients, this contributes to irrational beliefs and avoidance of resumption of activities and can result in a prolonged sick leave.
  
  
  OBJECTIVE
  To develop an eHealth intervention that empowers gynecological patients during the perioperative period to obtain timely return to work (RTW) and prevent work disability.
  
  
  METHODS
  The intervention mapping (IM) protocol was used to develop the eHealth intervention. A literature search about behavioral and environmental conditions of prolonged sick leave and delayed RTW in patients was performed. Patients' needs, attitudes, and beliefs regarding postoperative recovery and resumption of work were identified through focus group discussions. Additionally, a literature search was performed to obtain determinants, methods, and strategies for the development of a suitable interactive eHealth intervention to empower patients to return to normal activities after gynecological surgery, including work. Finally, the eHealth intervention was evaluated by focus group participants, medical doctors, and eHealth specialists through questionnaires.
  
  
  RESULTS
  Twenty-one patients participated in the focus group discussions. Sufficient, uniform, and tailored information regarding surgical procedures, complications, and resumption of activities and work were considered most essential. Knowing who to contact in case of mental or physical complaints, and counseling and tools for work reintegration were also considered important. Finally, opportunities to exchange experiences with other patients were a major issue. Considering the determinants of the Attitude-Social influence-self-Efficacy (ASE) model, various strategies based on a combination of theory and evidence were used, resulting in an eHealth intervention with different interactive functionalities including tailored convalescence recommendations and a video to communicate the most common pitfalls during the perioperative period to patients and employers. Fifteen patients in the focus groups, 11 physicians, and 3 eHealth specialists suggested points for improvement to optimize the usability of the eHealth intervention and judged it an approachable, appropriate, and attractive eHealth intervention to empower gynecological patients.
  
  
  CONCLUSIONS
  The IM protocol was a useful method to develop an eHealth intervention based on both theory and evidence. All patients and stakeholders judged the eHealth intervention to be a promising tool to empower gynecological patients during the perioperative period and to help them to return to normal activities and work.
authors.affiliation: VU University Medical Center, Department of Obstetrics and Gynaecology, Amsterdam, Netherlands. t.vonknoordegraaf@vumc.nl
authors.forename: Antonie
authors.initials: A
authors.lastname: Vonk Noordegraaf
authors.forename: Judith A F
authors.initials: JA
authors.lastname: Huirne
authors.forename: Carina A
authors.initials: CA
authors.lastname: Pittens
authors.forename: Willem
authors.initials: W
authors.lastname: van Mechelen
authors.forename: Jacqueline E W
authors.initials: JE
authors.lastname: Broerse
authors.forename: Hans A M
authors.initials: HA
authors.lastname: Brölmann
authors.forename: Johannes R
authors.initials: JR
authors.lastname: Anema
mesh_terms: D004651:Employment; D005260:Female; D017144:Focus Groups; D013509:Gynecologic Surgical Procedures; D006801:Humans; D020407:Internet; D011209:Power, Psychological; D020377:Self Efficacy; D018582:Sick Leave