Govert Veldhuijzen

174 Chapter 9 VR glasses during colonoscopy without compromising the technical success of the procedure. Secondary outcomes were patient comfort, pain and anxiety before, during and after the procedure, using validated patient questionnaires. Patients’ comments were collected through a qualitative interview. We included 19 patients, of which 10 used VR glasses. All patients accepted VR glasses without lengthening procedural time. No disadvantages of the VR glasses were reported in terms of communication or changing of position of the patient. We found that patient comfort, pain, anxiety and satisfaction in relation to the procedure were similar in both groups. Patients described a pleasant distracting effect using VR glasses. We concluded therefore that VR glasses during colonoscopy were well accepted by patients and did not compromise endoscopic technical success. Future studies are justified to evaluate the possible substitution of sedation with VR. Patients reported that the VR experience was pleasant and distracting, facilitating recruitment for these trials. Developing tools for evaluating eHealth applications in endoscopy In this thesis, we used several outcome measurement tools provided by earlier research. However, for some patient outcome measures, there was no standard available. In case of patient satisfaction, there was a validated English tool - the gastrointestinal endoscopy satisfaction questionnaire (GESQ) - described in literature. 6 For use in clinical practice as well as future trials, we set out to see if this tool could be validated in Dutch. In chapter 8 we described this validation process for the GESQ that assessed patient satisfaction in endoscopy. The original GESQ was translated in Dutch according to the World Health Organization (WHO) linguistic validation guidelines. First, internal validation of the Dutch GESQ (D-GESQ) was established by application of the think-aloud method and subsequent expert panel analysis. Next, the D-GESQ was embedded in the CBE platform in our unit, with a 30-day interval after endoscopy. Adult patients, who were informed via CBE and had undergone endoscopy, were included. Exclusion criteria were conscious sedation, limited Dutch language skills, no e-mail address available, dementia and visual impairment. For statistical analysis, several psychometric analyses of the questionnaire were performed to identify the underlying dimensions and assessed the questionnaire for reliability and validity. In total, 227 of 1065 patients completed the D-GESQ, yielding a response rate of 21.3%. Men comprised 52.6% (N=129) of patients. Mean age was 62.7 ±11.54 years. In total 180 patients (79.3%) had previously undergone endoscopy, with 157 (87.2%) of them twice or more. The exploratory factor analysis showed that the 21 questions could best be clustered into five clusters instead of four in the original GESQ. The D-GESQ had an overall Cronbach α of 0.88, confirming the high internal validity of the tool. We concluded that the Dutch version of the GESQ showed high internal validity and