Flávia Martinelli Pelegrino

Cross-cultural adaptation and psychometric properties of the Brazilian–Portuguese version of the Duke Anticoagulation Satisfaction Scale

AIM The aim of this study was to evaluate the internal reliability and validity of the Brazilian-Portuguese version of Duke Anticoagulation Satisfaction Scale (DASS) among cardiovascular patients. BACKGROUND Oral anticoagulation is widely used to prevent and treat thromboembolic events in several conditions, especially in cardiovascular diseases; however, this therapy can induce dissatisfaction and reduce the quality of life. DESIGN Methodological and cross-sectional research design. METHODS The cultural adaptation of the DASS included the translation and back-translation, discussions with healthcare professionals and patients to ensure conceptual equivalence, semantic evaluation and instrument pretest. The Brazilian-Portuguese version of the DASS was tested among subjects followed in a university hospital anticoagulation outpatient clinic. The psychometric properties were assessed by construct validity (convergent, known groups and dimensionality) and internal consistency/reliability (Cronbachs alpha). RESULTS A total of 180 subjects under oral anticoagulation formed the baseline validation population. DASS total score and SF-36 domain correlations were moderate for General health (r=-0.47, p<0.01), Vitality (r=-0.44, p<0.01) and Mental health (r=-0.42, p<0.01) (convergent). Age and length on oral anticoagulation therapy (in years) were weakly correlated with total DASS score and most of the subscales, except Limitation (r=-0.375, p<0.01) (Known groups). The Cronbachs alpha coefficient was 0.79 for the total scale, and it ranged from 0.76 (hassles and burdens)-0.46 (psychological impact) among the domains, confirming the internal consistency reliability. CONCLUSIONS The Brazilian-Portuguese version of the DASS has shown levels of reliability and validity comparable with the original English version. RELEVANCE TO CLINICAL PRACTICE Healthcare practitioners and researchers need internationally validated measurement tools to compare outcomes of interventions in clinical management and research tools in oral anticoagulation therapy.

Adaptation and validation of an oral anticoagulation measurement of treatment adherence instrument

This methodological study adapted and analyzed the psychometric properties of the Measurement of Treatment Adherence (MTA) instrument for Brazilian users of oral anticoagulation therapy. Its final version was tested with 178 individuals. The average of answers for all questions ranged from 4.6 to 5.8 and 97.2% of the individuals were considered adherent. Moderate correlations were obtained between the adherence measure and the Mental health and Vitality domains of the SF-36. Cronbachs alpha was 0.60 and the ceiling effect occurred in answers to all items. These results indicate weak evidence of the validity, reliability and responsiveness of the MTA-adapted version for users of oral anticoagulant therapy.Este e um estudo metodologico que teve como objetivos adaptar e analisar as propriedades psicometricas do instrumento medida de adesao aos tratamentos (MAT) como medida de adesao a terapeutica de anticoagulacao oral (ACO). A versao final foi testada em 178 sujeitos. As medias das respostas aos itens do MAT variaram de 4,6 a 5,8, sendo que 97,2% foram considerados aderentes. Correlacoes moderadas foram obtidas entre a medida de adesao e os dominios saude mental e vitalidade, do SF-36. O alfa de Cronbach obtido foi 0,60 e constatou-se a presenca de efeito maximo nas respostas de todos os itens. Esses resultados indicam fracas evidencias da validade, confiabilidade e responsividade da versao adaptada do MAT para usuarios de anticoagulantes orais.

Adaptação e validação de uma medida de adesão à terapia de anticoagulação oral

This methodological study adapted and analyzed the psychometric properties of the Measurement of Treatment Adherence (MTA) instrument for Brazilian users of oral anticoagulation therapy. Its final version was tested with 178 individuals. The average of answers for all questions ranged from 4.6 to 5.8 and 97.2% of the individuals were considered adherent. Moderate correlations were obtained between the adherence measure and the Mental health and Vitality domains of the SF-36. Cronbachs alpha was 0.60 and the ceiling effect occurred in answers to all items. These results indicate weak evidence of the validity, reliability and responsiveness of the MTA-adapted version for users of oral anticoagulant therapy.Este e um estudo metodologico que teve como objetivos adaptar e analisar as propriedades psicometricas do instrumento medida de adesao aos tratamentos (MAT) como medida de adesao a terapeutica de anticoagulacao oral (ACO). A versao final foi testada em 178 sujeitos. As medias das respostas aos itens do MAT variaram de 4,6 a 5,8, sendo que 97,2% foram considerados aderentes. Correlacoes moderadas foram obtidas entre a medida de adesao e os dominios saude mental e vitalidade, do SF-36. O alfa de Cronbach obtido foi 0,60 e constatou-se a presenca de efeito maximo nas respostas de todos os itens. Esses resultados indicam fracas evidencias da validade, confiabilidade e responsividade da versao adaptada do MAT para usuarios de anticoagulantes orais.

Health related quality of life of patients undergoing oral anticoagulation therapy.

Se trata de un estudio descriptivo, de tipo corte transversal, que tuvo como objetivo analizar la calidad de vida relacionada a la salud (CVRS) y su relacion con sexo, edad, tiempo e indicacion de uso de anticoagulantes orales. Fueron entrevistados 178 pacientes y la CVRS fue evaluada por los ocho dominios del SF-36. Fue utilizada estadistica descriptiva, las pruebas: t Student, ANOVA y Tukey, para comparacion de los promedios entre los grupos. La indicacion para el uso fue predominantemente la protesis cardiaca metalica (50%) y la warfarina el anticoagulante mas prescrito (83,3%). Los promedios de los dominios del SF-36 variaron de 82 (Aspectos sociales) a 54,8 (Aspectos fisicos). Mujeres, ancianos, y pacientes con diagnostico de fibrilacion atrial y con menos de un ano de uso del medicamento, presentaron peor evaluacion de la CVRS. Los resultados obtenidos pueden orientar acciones de enfermeria, en la medida en que indican posibles asociaciones entre la CVRS y las variables sociodemograficas y clinicas de los pacientes.This is a descriptive cross-sectional study, which aimed to analyze the health related quality of life (HRQoL) and its relationship with gender, age, duration and indication for the use of oral anticoagulants. A total of 178 patients were interviewed and the HRQoL was assessed through eight domains of the SF-36. The descriptive statistics used were, the Students t, ANOVA and Tukeys tests for the comparison of the means between the groups. The indication for use was predominantly the metallic prosthetic heart valve (50%) with warfarin the most widely prescribed anticoagulant (83.3%). The means of the domains of the SF-36 ranged from 82 (Social aspects) to 54.8 (Physical aspects). Women, elderly, patients diagnosed with atrial fibrillation and with less than one year of medication use, presented a worse HRQoL evaluation. The results obtained can guide nursing actions, in that they indicate possible associations between the HRQoL and the sociodemographic and clinical variables of the patients.

Perfil sócio demográfico e clínico de pacientes em uso de anticoagulantes orais

Este estudo teve como objetivo investigar o perfil socio-demografico, clinico e laboratorial de individuos em seguimento ambulatorial devido ao uso de anticoagulantes orais. O estudo foi descritivo, transversal, realizado no ambulatorio de anticoagulacao oral de um hospital terciario do interior do estado de Sao Paulo. Os dados foram coletados por entrevistas e consultas aos prontuarios dos pacientes. Participaram 180 sujeitos, a maioria do sexo feminino (65,6%), com idade media de 55 anos, em uso de varfarina (83,3%) ha mais de 6,9 anos, devido a presenca de protese cardiaca metalica (50%). Os resultados obtidos fornecem subsidios para os enfermeiros planejarem a assistencia aos usuarios de anticoagulacao oral com vistas a diminuicao de possiveis complicacoes relacionadas a terapia e ao aumento da adesao ao tratamento.

Qualidade de vida relacionada à saúde de pacientes em uso de anticoagulação oral

Se trata de un estudio descriptivo, de tipo corte transversal, que tuvo como objetivo analizar la calidad de vida relacionada a la salud (CVRS) y su relacion con sexo, edad, tiempo e indicacion de uso de anticoagulantes orales. Fueron entrevistados 178 pacientes y la CVRS fue evaluada por los ocho dominios del SF-36. Fue utilizada estadistica descriptiva, las pruebas: t Student, ANOVA y Tukey, para comparacion de los promedios entre los grupos. La indicacion para el uso fue predominantemente la protesis cardiaca metalica (50%) y la warfarina el anticoagulante mas prescrito (83,3%). Los promedios de los dominios del SF-36 variaron de 82 (Aspectos sociales) a 54,8 (Aspectos fisicos). Mujeres, ancianos, y pacientes con diagnostico de fibrilacion atrial y con menos de un ano de uso del medicamento, presentaron peor evaluacion de la CVRS. Los resultados obtenidos pueden orientar acciones de enfermeria, en la medida en que indican posibles asociaciones entre la CVRS y las variables sociodemograficas y clinicas de los pacientes.This is a descriptive cross-sectional study, which aimed to analyze the health related quality of life (HRQoL) and its relationship with gender, age, duration and indication for the use of oral anticoagulants. A total of 178 patients were interviewed and the HRQoL was assessed through eight domains of the SF-36. The descriptive statistics used were, the Students t, ANOVA and Tukeys tests for the comparison of the means between the groups. The indication for use was predominantly the metallic prosthetic heart valve (50%) with warfarin the most widely prescribed anticoagulant (83.3%). The means of the domains of the SF-36 ranged from 82 (Social aspects) to 54.8 (Physical aspects). Women, elderly, patients diagnosed with atrial fibrillation and with less than one year of medication use, presented a worse HRQoL evaluation. The results obtained can guide nursing actions, in that they indicate possible associations between the HRQoL and the sociodemographic and clinical variables of the patients.

Calidad de vida relacionada a la salud de pacientes que usan anticoagulación oral

Se trata de un estudio descriptivo, de tipo corte transversal, que tuvo como objetivo analizar la calidad de vida relacionada a la salud (CVRS) y su relacion con sexo, edad, tiempo e indicacion de uso de anticoagulantes orales. Fueron entrevistados 178 pacientes y la CVRS fue evaluada por los ocho dominios del SF-36. Fue utilizada estadistica descriptiva, las pruebas: t Student, ANOVA y Tukey, para comparacion de los promedios entre los grupos. La indicacion para el uso fue predominantemente la protesis cardiaca metalica (50%) y la warfarina el anticoagulante mas prescrito (83,3%). Los promedios de los dominios del SF-36 variaron de 82 (Aspectos sociales) a 54,8 (Aspectos fisicos). Mujeres, ancianos, y pacientes con diagnostico de fibrilacion atrial y con menos de un ano de uso del medicamento, presentaron peor evaluacion de la CVRS. Los resultados obtenidos pueden orientar acciones de enfermeria, en la medida en que indican posibles asociaciones entre la CVRS y las variables sociodemograficas y clinicas de los pacientes.This is a descriptive cross-sectional study, which aimed to analyze the health related quality of life (HRQoL) and its relationship with gender, age, duration and indication for the use of oral anticoagulants. A total of 178 patients were interviewed and the HRQoL was assessed through eight domains of the SF-36. The descriptive statistics used were, the Students t, ANOVA and Tukeys tests for the comparison of the means between the groups. The indication for use was predominantly the metallic prosthetic heart valve (50%) with warfarin the most widely prescribed anticoagulant (83.3%). The means of the domains of the SF-36 ranged from 82 (Social aspects) to 54.8 (Physical aspects). Women, elderly, patients diagnosed with atrial fibrillation and with less than one year of medication use, presented a worse HRQoL evaluation. The results obtained can guide nursing actions, in that they indicate possible associations between the HRQoL and the sociodemographic and clinical variables of the patients.

Educational protocol for patients on oral anticoagulant therapy: construction and validation

This is a report of experience on the construction and validation of an educational protocol for patients on oral anticoagulation therapy. Based on Banduras Social Cognitive Theory, three phases were identified to construct the educational protocol. The literature review on oral anticoagulants was used to prepare the content of each phase of the protocol. As a result, verbal and written orientation in the phases of attention and retention were developed. In the reproduction and motivation phase, support through contact by telephone was provided. And finally, an improvement in the evaluation of the outcomes related to oral anticoagulant is expected in the performance phase. Once the educational protocol was defined, we proceeded with the face and content validity process, which allowed adaptations to the final version of the educational protocol constructed. DEESCRIPTORS: Anticoagulans. Health education. Protocols.

Protocolo educativo para pacientes en uso de anticoagulante oral: construcción y validación

This is a report of experience on the construction and validation of an educational protocol for patients on oral anticoagulation therapy. Based on Banduras Social Cognitive Theory, three phases were identified to construct the educational protocol. The literature review on oral anticoagulants was used to prepare the content of each phase of the protocol. As a result, verbal and written orientation in the phases of attention and retention were developed. In the reproduction and motivation phase, support through contact by telephone was provided. And finally, an improvement in the evaluation of the outcomes related to oral anticoagulant is expected in the performance phase. Once the educational protocol was defined, we proceeded with the face and content validity process, which allowed adaptations to the final version of the educational protocol constructed. DEESCRIPTORS: Anticoagulans. Health education. Protocols.

PROTOCOLO EDUCATIVO PARA PACIENTES EM USO DE ANTICOAGULANTE ORAL: CONSTRUÇÃO E VALIDAÇÃO 1

This is a report of experience on the construction and validation of an educational protocol for patients on oral anticoagulation therapy. Based on Banduras Social Cognitive Theory, three phases were identified to construct the educational protocol. The literature review on oral anticoagulants was used to prepare the content of each phase of the protocol. As a result, verbal and written orientation in the phases of attention and retention were developed. In the reproduction and motivation phase, support through contact by telephone was provided. And finally, an improvement in the evaluation of the outcomes related to oral anticoagulant is expected in the performance phase. Once the educational protocol was defined, we proceeded with the face and content validity process, which allowed adaptations to the final version of the educational protocol constructed. DEESCRIPTORS: Anticoagulans. Health education. Protocols.