Universiteit Leiden

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Research project

We all BENEFIT: The Ecosystem for Healthy Living

The modification of risk factors and related health behaviors lies at the very core of adequate cardiovascular risk management, yet evidence shows that the majority of people with cardiovascular disease (CVD) fail to achieve a healthy lifestyle in the long term. The main objective of this project is to ensure that by 2022, the BENEFIT program forms an attractive, effective, and accessible supplement to rehabilitation that will help CVD patients to maintain a healthy lifestyle.

Andrea Evers
The Dutch Heart Foundation
ZonMw ZonMw
Medical delta




Background/Scientific relevance/Aims for current research

The BENEFIT program aims to provide long-term support to patients with cardiovascular disease (CVD) in their own home with a healthy lifestyle. Core of the BENEFIT program is access to an advanced eHealth platform with Personal Health Portal consisting of functionality for daily goal monitoring, access to (evidence-based) lifestyle interventions, personal coaching and a reward program aimed at stimulating a wide range of health behaviours and therapy adherence. This integrated healthy living program makes it possible to tailor lifestyle interventions to the needs and preferences of end users, encouraging engagement and active use. The program also promotes self-management of a healthy lifestyle by encouraging patients to measure health indicators (such as blood pressure) themselves at home.

The BENEFIT project is divided into six research projects:

1. Lifestyle change at the level of the individual

Extensive research supports the importance of the relationship between healthcare professional and patient in individual lifestyle programs for improving physical and mental outcomes across a range of emotional, psychiatric, and somatic conditions. The aim of this project is to evaluate different forms of automated and personal coaching regarding lifestyle behaviour maintenance, and study whether and how a coach-patient relationship within automated self-help interventions affect adherence and effectiveness. This research will fuel the agile development, rollout, and evaluation of a digital platform with automated and personal coaching, and enable tailoring of the platform to preferences of different user groups.

Supervisors Leiden University: prof. dr. Andrea Evers,  dr. Thomas Reijnders

Supervisor LUMC: prof. dr. Douwe Atsma
PhD candidate: Talia Cohen Rodrigues

2. Lifestyle change at the environmental level

Reward-based reinforcement is a much-researched learning theory strategy to promote behaviour change. Its effectiveness was originally proven in the treatment of substance abuse disorders. Since then, incentive-based interventions have been successfully applied to other areas of behaviour change, ranging from smoking cessation and physical exercise to counselling attendance and medication adherence Deposit contracts, a form of financial incentive in which participants deposit their own money, are an inexpensive variant with possibly beneficial effects on behaviour by utilizing the power of loss aversion. This project focuses on investigating the acceptability and effectiveness of deposit contract financial incentives for health behaviour change. The ultimate aim is to incorporate the resulting insights in the BENEFIT reward program.

Supervisors Leiden University: prof. dr. Andrea Evers, dr. Thomas Reijnders

Supervisor Máxima MC: dr. Hareld Kemps
PhD candidate: David de Buisonjé

3. Implementation science

Combined, our implementation partners are treating hundreds of thousands of people with a (high risk of) developing cardiovascular disease. A major strength of our consortium is that both primary, secondary, and public healthcare partners have joined forces. This project focuses on investigating conditions for sustainable implementation of the BENEFIT program within primary and secondary care as well as mechanisms behind sustainable referral of people with (high risk of) cardiovascular disease to the BENEFIT program. Important tasks include identifying determinants for dissemination and upscaling of the program, identifying conditions for continuity of secondary and primary prevention care, development of tailored implementation strategies, and process evaluation of the multi-centre implementation.

Supervisors Leiden University: prof. dr. Andrea Evers, dr. Veronica Janssen, dr. Rosalie van der Vaart

Supervisor AMC-UvA: prof. dr. Wilma Scholte op Reimer
PhD candidate: Renée IJzerman

4. eHealth for people with a low socioeconomic status (SES)

Current eHealth lifestyle interventions are often less suitable for people with a low socioeconomic status (SES). However, no clear and scientifically substantiated guidelines currently support professionals (i.e. health professionals or researchers) in developing eHealth interventions to meet the needs, preferences, and skills of people with low SES. This project is funded by Medical Delta and we are investigating how we can develop guidelines for eHealth to help professionals (including researchers, policymakers and developers) to make eHealth lifestyle interventions suitable for this low SES-group.  This project employs a top-down approach (studies focused on professionals).

Supervisors Leiden University: prof. dr. Andrea Evers, dr. Thomas Reijnders

Supervisor LUMC: prof. dr. Niels Chavannes

PhD candidate: Isra Al-Dhahir

5. Value-based development

The CeHRes-Roadmap for user-centered and stakeholder-driven development and evaluation of eHealth interventions is used as a guiding framework for the development and refinement of elements of the BENEFIT eHealth platform and reward system. The CeHRes-Roadmap is an evidence-based method that reflects a participatory design process, in which representative stakeholders (e.g. patients, patient organizations, primary care practices, hospitals, rehabilitation centres, health insurers, business partners) participate in all stages of development and evaluation of the BENEFIT program. This project focuses on co-creation and evaluation with stakeholders and end-users, business modelling, and strategic acquisitions. Furthermore, real-time use of the digital platform will be evaluated (process analysis).

Supervisors Leiden University: prof. dr. Andrea Evers, dr. Linda Breeman 
Supervisors University of Twente: prof. dr. Lisette van Gemert-Pijnen, dr. Jobke Wentzel, and Britt Bente

6. Designing for behaviour change maintenance

Rehabilitation after a myocardial infarction (MI) requires patients to change their behaviour. Nowadays, the use of telemonitoring via smart technology (eHealth) becomes more and more part of cardiovascular care as it has the potential to support patients in obtaining and maintaining a healthy lifestyle. One such eHealth intervention is The Box, which facilitates patients to use self-monitoring devices at home and continuously share these data with the hospital to help monitor patients’ health and lifestyle. Currently, this intervention is generic for all MI patients. However, tailoring The Box to the specific needs of individual patients seems promising to enhance adherence and better support a healthy lifestyle maintenance. Therefore, the aim of this project is to develop personalized, dynamic, eHealth modules for The Box by means of co-creative research-through-design methods. Eventually, an evaluation study will be conducted to evaluate the six-month behavioural maintenance effect of The Box.  

Supervisors Leiden University: prof. dr. Andrea Evers, dr. Veronica Janssen, dr. Thomas Reijnders

Supervisor LUMC: prof. dr. Douwe Atsma

Supervisor TU Delft: dr. Valentijn Visch

PhD Candidate: Laura Schrauwen

This research program is part of the Research Group Psychoneurobiology of Health and Disease (www.andreaevers.nl) and is conducted in collaboration with the co-executors Vital10, CardioVitaal and the LUMC. Both public and private partners contribute to the BENEFIT consortium, which includes many significant players in healthcare, academia and industry in the Netherlands.

Do you want to learn more about the BENEFIT program and get to follow the latest news and publications in the field? Click here for the BENEFIT website.

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