Heloisa de Carvalho Torres

Avaliação estratégica de educação em grupo e individual no programa educativo em diabetes

OBJECTIVE To compare the effectiveness of individual and group strategies in a diabetes education program. METHODS A total of 104 type-2 diabetes outpatients enrolled in an education program of a teaching hospital in Belo Horizonte, Southeastern Brazil, were randomly selected and assigned to two different education strategies: group education (54 subjects) and individual education (50 subjects). Group education comprised three monthly sessions, which involved play and interactive dynamics. In parallel, a second group received individual education. Subjects were follow up for six months during 2006 and they were evaluated using specific questionnaires: knowledge of diabetes, psychological attitudes, change in behavior, quality of life. Clinical evaluation was performed at baseline, three and six months of intervention. RESULTS Mean age was 60.6 years. The results of group and individual education were similar in the assessment tests of attitude, change of behavior and quality of life. A reduction in HbA1c levels was seen in both groups, but a statistically significant difference (p=0.012) was found only in the group education. CONCLUSIONS Both strategies of diabetes education were effective, however, group education was more effective than individual education for blood glucose control.OBJETIVO: Comparar a efetividade de estrategias, em grupo e individual, de programa educativo em diabetes. METODOS: Cento e quatro pacientes com diabetes tipo 2, atendidos no ambulatorio e com seguimento em programa educativo de hospital de Belo Horizonte (MG), foram aleatoriamente recrutados e alocados em dois grupos: educacao em grupo (n=54) e individual (n=50). A educacao em grupo consistia de tres encontros mensais, nos quais eram desenvolvidas dinâmicas ludicas e interativas. Simultaneamente, o outro grupo era acompanhado individualmente. O acompanhamento ocorreu por seis meses durante o ano de 2006, sendo avaliados por questionarios especificos: conhecimentos em diabetes, atitudes psicologicas, mudanca de comportamento, qualidade de vida. Foi realizada avaliacao clinica no tempo inicial, depois de tres e seis meses da intervencao. RESULTADOS: A media de idade dos pacientes era de 60,6 anos. Os resultados da educacao em grupo e individual foram semelhantes no teste de atitudes, mudanca de comportamento e qualidade de vida. Observou-se reducao nos niveis de HbA1c nos dois grupos, entretanto apenas no de educacao em grupo a diferenca apresentou significância estatistica (p= 0,012). CONCLUSOES: As duas estrategias do programa educativo em diabetes foram efetivas, porem a educacao em grupo apresentou melhores resultados de controle glicemico do que a individual.

Adesão à dieta e ao exercício físico das pessoas com diabetes mellitus

This cross-sectional and quantitative study aimed to evaluate adherence among people with type-2 Diabetes Mellitus to self-care, regarding diet and physical exercises, as well as the relationship to socio-demographic and clinical characteristics. The sample consisted of 162 type-2 Diabetes Mellitus patients under outpatient clinic follow-up. Data was collected using the Brazilian version of the Summary of Diabetes Self-care Activities Questionnaire and patient files. Low adherence to self-care was evidenced in the studied sample. For p<0.05, correlation was inversely proportional to patient educational level, suggesting that the higher the educational level, the lower the adherence. There was no statistically significant correlation between adherence to self-care and gender, age, marital status, monthly per capita income, time of diagnosis, type of medication in treatment, and/or presence of complications/ co-morbidities. Results corroborate findings in literature that socio-demographic and clinical variables may not predict adherence to treatment among people with Diabetes Mellitus.. DESCRIPTORS: Diabetes mellitus. Patient compliance. Nursing. ADHERENCIA A LA DIETA Y A LOS EJERCICIOS FISICOS DE LAS PERSONAS CON DIABETES MELLITUS RESUMEN: Estudio transversal de enfoque cuantitativo que tuvo como objetivo evaluar la adherencia de las personas con Diabetes Mellitus tipo 2 al autocuidado, con respecto a la dieta y a los ejercicios fisicos, asi como la relacion con caracteristicas sociodemograficas y clinicas. La muestra consistio de 162 personas con Diabetes Mellitus tipo 2, en consulta externa de seguimiento. Para la recoleccion de datos se utilizo la version brasilena del instrumento Summary of Diabetes Self-care Activities Questionnaire y consulta a los archivos de los participantes. Fue encontrada baja adherencia al autocuidado. Para p<0,05, la correlacion fue inversamente proporcional a la escolaridad, lo que sugiere menor adherencia para mayor escolaridad. No se encontraron correlaciones estadisticamente significantes entre la adherencia al autocuidado y sexo, edad, estado civil, ingreso per capita mensual, tiempo de diagnostico, tipo de tratamiento con medicamentos y presencia de complicaciones/comorbilidades. Los resultados corroboran la literatura, en la cual variables sociodemograficas y clinicas pueden no predecir la adhesion al tratamiento de personas con Diabetes Mellitus. DESCRIPTORES: Diabetes mellitus. Cooperacion del paciente. Enfermeria.Estudio transversal de enfoque cuantitativo que tuvo como objetivo evaluar la adherencia de las personas con Diabetes Mellitus tipo 2 al autocuidado, con respecto a la dieta y a los ejercicios fisicos, asi como la relacion con caracteristicas sociodemograficas y clinicas. La muestra consistio de 162 personas con Diabetes Mellitus tipo 2, en consulta externa de seguimiento. Para la recoleccion de datos se utilizo la version brasilena del instrumento Summary of Diabetes Self-care Activities Questionnaire y consulta a los archivos de los participantes. Fue encontrada baja adherencia al autocuidado. Para p<0,05, la correlacion fue inversamente proporcional a la escolaridad, lo que sugiere menor adherencia para mayor escolaridad. No se encontraron correlaciones estadisticamente significantes entre la adherencia al autocuidado y sexo, edad, estado civil, ingreso per capita mensual, tiempo de diagnostico, tipo de tratamiento con medicamentos y presencia de complicaciones/comorbilidades. Los resultados corroboran la literatura, en la cual variables sociodemograficas y clinicas pueden no predecir la adhesion al tratamiento de personas con Diabetes Mellitus.

Validação dos questionários de conhecimento (DKN-A) e atitude (ATT-19) de Diabetes Mellitus

OBJETIVO: Apresentar a adaptacao transcultural dos instrumentos Diabetes Knowledge Scale e Attitudes Questionnaires, especificos para avaliacao do conhecimento e atitudes de pacientes com Diabetes Mellitus. METODOS: Os instrumentos foram submetidos as seguintes etapas: apresentacao, traducao, back-translation, avaliacao das equivalencias semântica e idiomatica, cultural e conceitual, e pre-teste. Os questionarios foram aplicados em duas oportunidades, com intervalos de um mes, em uma amostra de 61 pacientes com Diabetes Tipo 2 cadastrados num hospital universitario. Utilizou-se um desenho de estudo de confiabilidade teste-reteste das respostas, que foram analisadas e estimadas pelo Coeficiente de Kappa. RESULTADOS: Os achados sugerem adequacao do processo de adaptacao cultural dos instrumentos para a lingua portuguesa. Na analise de confiabilidade, o coeficiente de Kappa alcancou nivel de concordância de moderada a forte (0,44 a 0,69) em grande parte das questoes. CONCLUSOES: Os instrumentos mostraram ser de facil compreensao pelos sujeitos do estudo e confiaveis e validos para uso na avaliacao de programas educativos em Diabetes Mellitus na realidade brasileira.

A proposta da educação permanente em saúde na atualização da equipe de saúde em diabetes mellitus

O objetivo do estudo foi relatar a experiencia da Educacao Permanente em Saude na atualizacao da equipe de saude de uma Unidade Basica de Saude para a atencao integral e humanizada as pessoas com diabetes tipo 2. A metodologia de escolha para a capacitacao das equipes de saude foi a Educacao em Permanente em Saude, por meio de oficinas educativas em diabetes com enfoque na problematizacao do processo educativo e profissional. Buscou-se, assim, construir um programa de educacao em diabetes visando a modificar e a reori-entar a pratica da equipe de saude. A Educacao Permanente contribuiu para a integracao dos individuos, fortificou o comprometimento profissional e desenvolveu a consciencia de grupo. A experiencia de inserir o ensino no cotidiano das equipes de saude favoreceu o progresso da integracao entre universidade, servico e comunidade, favorecendo o planejamento e organizacao do programa educativo, valorizando a interdisciplinaridade.The objective of the study was to report the experience of Continuing Health Education to update the health team of a Health Center about comprehensive and humanized care to individuals with type 2 diabetes. The methodology used to train the health teams was Continuing Health Education by means of educational workshops in diabetes focused on the problem-posing of the professional and educational process. Hence, it was sought to design a program for education in diabetes with a view to changing and reorienting the practice of the health team. Continuing Education helped to integrate the individuals, strengthened the professional commitment and developed the group awareness. The experience of including education in the everyday activities of the health teams helped to improve the integration among university, service and community, thus favoring the process of planning and organizing the educational program, valuing interdisciplinarity.

O processo de elaboração de cartilhas para orientação do autocuidado no programa educativo em Diabetes

This study aimed at describing the experience of creating guidebooks on self-care, performed with individuals with diabetes of the Teaching Hospital, by professors and undergraduate students of the Nursing School at Universidade Federal de Minas Gerais. Problems and issues related to self-care and diabetes were raised in the healthcare workshops held with professors and students. Based on Freires methodology, meetings were held with individuals with diabetes according to directives for the construction of the guidebooks that included the selection of content, style and format of the material. The creativity present in the images during the topic discussions made the meetings into a rich moment of exchange, where the participants could express ideas, values, beliefs and life histories. The messages were well-planned, comprehensible and attractive, and the individuals considered them effective in helping them in the educational activities and diabetes self-care.

Intervenção educativa para o autocuidado de indíviduos com diabetes mellitus

OBJECTIVE: To assess the knowledge, attitudes and practices of self-care in individuals with diabetes mellitus (DM) in a specialized health service in Belo Horizonte - MG, Brazil. METHODS: The research was a case study with a qualitative approach. Data were collected by conducting focus groups with the participation of 12 individuals with diabetes and who attended three sessions of the educational program developed in this health service. RESULTS: Data were analyzed using thematic analysis, which allowed the identification of the following categories: experiences; feelings; practical education for self-care associated with food and physical activity; perceived barriers to the pursuit of a healthy lifestyle; and expectations. CONCLUSION: The results of the study showed the importance of education and health communication guided the dialogical relations and appreciation of popular knowledge, by reorienting the educational practices for self care, in order to establish strategies for prevention and disease control.OBJETIVO: Analizar conocimientos, actitudes y practicas del autocuidado de individuos con Diabetes mellitus (DM) en un servicio especializado de salud de Belo Horizonte - MG, Brasil. METODOS: Investigacion de tipo estudio de caso con abordaje cualitativo. Los datos fueron recolectados por medio de la realizacion de grupos focales con la participacion de 12 individuos con DM y que asistieron a tres sesiones del programa educativo desarrollado en ese servicio de salud. RESULTADOS: Los datos, analizados segun el enfoque del analisis tematico, posibilitaron la identificacion de las siguientes categorias: Experiencias; Sentimientos; Practica educativa para el autocuidado, asociada a la alimentacion y a la actividad fisica; Barreras percibidas para la busqueda de un estilo de vida saludable; y Expectativas. CONCLUSION: Los resultados del estudio mostraron la importancia de la educacion y de la comunicacion en salud basadas en las relaciones dialogicas y en la valorizacion del saber popular, al reorientar las practicas educativas para el autocuidado, de forma a estabelecer estrategias de prevencion y control de la enfermedad.

Evaluation of group and individual strategies in a diabetes education program

OBJECTIVE To compare the effectiveness of individual and group strategies in a diabetes education program. METHODS A total of 104 type-2 diabetes outpatients enrolled in an education program of a teaching hospital in Belo Horizonte, Southeastern Brazil, were randomly selected and assigned to two different education strategies: group education (54 subjects) and individual education (50 subjects). Group education comprised three monthly sessions, which involved play and interactive dynamics. In parallel, a second group received individual education. Subjects were follow up for six months during 2006 and they were evaluated using specific questionnaires: knowledge of diabetes, psychological attitudes, change in behavior, quality of life. Clinical evaluation was performed at baseline, three and six months of intervention. RESULTS Mean age was 60.6 years. The results of group and individual education were similar in the assessment tests of attitude, change of behavior and quality of life. A reduction in HbA1c levels was seen in both groups, but a statistically significant difference (p=0.012) was found only in the group education. CONCLUSIONS Both strategies of diabetes education were effective, however, group education was more effective than individual education for blood glucose control.OBJETIVO: Comparar a efetividade de estrategias, em grupo e individual, de programa educativo em diabetes. METODOS: Cento e quatro pacientes com diabetes tipo 2, atendidos no ambulatorio e com seguimento em programa educativo de hospital de Belo Horizonte (MG), foram aleatoriamente recrutados e alocados em dois grupos: educacao em grupo (n=54) e individual (n=50). A educacao em grupo consistia de tres encontros mensais, nos quais eram desenvolvidas dinâmicas ludicas e interativas. Simultaneamente, o outro grupo era acompanhado individualmente. O acompanhamento ocorreu por seis meses durante o ano de 2006, sendo avaliados por questionarios especificos: conhecimentos em diabetes, atitudes psicologicas, mudanca de comportamento, qualidade de vida. Foi realizada avaliacao clinica no tempo inicial, depois de tres e seis meses da intervencao. RESULTADOS: A media de idade dos pacientes era de 60,6 anos. Os resultados da educacao em grupo e individual foram semelhantes no teste de atitudes, mudanca de comportamento e qualidade de vida. Observou-se reducao nos niveis de HbA1c nos dois grupos, entretanto apenas no de educacao em grupo a diferenca apresentou significância estatistica (p= 0,012). CONCLUSOES: As duas estrategias do programa educativo em diabetes foram efetivas, porem a educacao em grupo apresentou melhores resultados de controle glicemico do que a individual.

Avaliação das ações educativas na promoção do autogerenciamento dos cuidados em diabetes mellitus tipo 2

The objective of this is study to evaluate the educational practices in promoting the self-management of diabetes mellitus. Subjects were twenty-six individuals with type 2 diabetes, who participated in the educational program at a teaching hospital in Belo Horizonte, Minas Gerais. The subjects were followed for four months in 2008. The educational group practices consisted of three monthly meetings, in which recreational and interactive dynamics were performed, and individual sessions were held using dialogic education. The evaluation was performed using a specific questionnaire: self-care and clinical exams in the beginning and four months after the intervention. The mean age of the subjects was 60.9 ±8.4 years; the mean time of disease was 8.7±6.7 years; most (55.6% or 27 individuals) had incomplete primary education and a family income between 1 and 3 minimum salaries. Satisfactory results were found in the self-care test. It was also observed that HbA1c levels dropped down and the educational practices improved self-care and self-management of the disease.The objective of this is study to evaluate the educational practices in promoting the self-management of diabetes mellitus. Subjects were twenty-six individuals with type 2 diabetes, who participated in the educational program at a teaching hospital in Belo Horizonte, Minas Gerais. The subjects were followed for four months in 2008. The educational group practices consisted of three monthly meetings, in which recreational and interactive dynamics were performed, and individual sessions were held using dialogic education. The evaluation was performed using a specific questionnaire: self-care and clinical exams in the beginning and four months after the intervention. The mean age of the subjects was 60.9 ±8.4 years; the mean time of disease was 8.7±6.7 years; most (55.6% or 27 individuals) had incomplete primary education and a family income between 1 and 3 minimum salaries. Satisfactory results were found in the self-care test. It was also observed that HbA1c levels dropped down and the educational practices improved self-care and self-management of the disease.

Home visit: an educational health strategy for self-care in diabetes

OBJECTIVE: To understand the home visit as an educational health care strategy to orient the self-care practices of patients with type 2 diabetes mellitus.METHODS: A qualitative study using 25 home visits to patients with diabetes mellitus, who did not attend the diabetes education program offered by the basic health care unit. Data were organized and categorized by content analysis.RESULTS: Four thematic categories emerged: feelings; knowledge about the disease; adherence to meal plan and physical activity; and barriers to self-care.CONCLUSION: Home visit is an important strategy for health care education to orient patients with type 2 diabetes on self-care practices.

Práticas educativas em diabetes mellitus: compreendendo as competências dos profissionais da saúde

The aim of this study was to understand the skills of health professionals in the educational practices in type 2 diabetes in primary care. A total of ten health professionals included in basic Belo Horizonte-MG, Brazil, participated in interviews and focus groups. The findings were organized from the identification of the following categories: importance of educational practices, knowledge, skills, and attitudes. This study shows the importance of reorienting the skills of health professionals in diabetes education practices, through training, continuing education and strengthening teamwork. DESCRIPTORS: Competency-based education. Health personnel. Diabetes. Health communication.O objetivo desse estudo foi compreender as competencias necessarias aos profissionais de saude nas praticas educativas em Diabetes tipo 2 na Atencao Primaria. Um total de dez profissionais de saude inseridos em Unidades Basicas de Belo Horizonte-MG, participaram de entrevistas e grupos focais. Os achados foram organizados a partir da identificacao das seguintes categorias: importância das praticas educativas; conhecimentos; habilidades; e atitudes. Este estudo mostra a importância de se reorientar as competencias dos profissionais de saude nas praticas educativas em diabetes, por meio de capacitacao, de educacao permanente e do fortalecimento do trabalho em equipe.