Maria Cecília Bueno Jayme Gallani

Social structure, social cognition, and physical activity: a test of four models.

OBJECTIVE This study investigated the combined influence of social structural factors (e.g. income) and cognitions in predicting changes in physical activity. Four models were tested: (a) direct effects (social structural factors influence behaviour controlling for cognitions), (b) mediation (cognitions mediate social structural influence), (c) moderation (social structural factors moderate cognition-behaviour relations), and (d) mediated moderation (cognitions mediate the moderating effects of social structural position). DESIGN Baseline and 3-month follow-up surveys. METHODS A random sample of 1,483 adults completed self-report measures of physical activity at baseline and 3-month follow-up. Measures of age, gender, education, income, material and social deprivation, intention, perceived behavioural control (PBC), and intention stability also were taken. RESULTS Apart from age, social structural factors exhibited very small or marginal effects on behaviour change, and only education moderated the intention-behaviour relation. In contrast, the magnitude of direct effects of the social cognition variables was comparatively large and intention stability mediated the moderating effect of education. CONCLUSIONS Stable intentions and PBC are the key predictors of changes in physical activity. Consequently, our findings would suggest the value of focusing on cognitions rather than social structural variables when modelling the determinants of physical activity.

A adesão ao tratamento na hipertensão arterial: análise da produção científica

O estudo teve como objetivo avaliar a producao cientifica publicada entre 1991 e 1995, para identificar como o assunto adesao ao tratamento anti-hipertensivo vem sendo abordado. Foram analisados 107 artigos cientificos. Os resultados mostraram que a adesao foi abordada da seguinte maneira: 68% relacionaram ao paciente, 63% ao tratamento farmacologico, 62% a aspectos gerais, 39% ao tratamento nao farmacologico, 34% a fatores institucionais, e 8% relativos a, doenca. A adesao ao tratamento anti-hipertensivo tem sido um desafio no controle da hipertensao arterial e conhecer como este assunto esta sendo enfocado na literatura pode contribuir para aumentar adesao ao tratamento na hipertensao arterial.

Development and reliability of an instrument to measure psychosocial determinants of salt consumption among hypertensive patients

This study aimed to present the content validity and reliability analyses of an instrument to study the determinant factors of salt consumption among hypertensive subjects, based on an extension of the Theory of Planned Behavior. Content validity was assessed by 3 experts and a pre-test was carried out with 5 subjects. The final tool, comprising 3 different behaviors related to salt consumption and corresponding psychosocial variables, was applied to 32 subjects for internal consistency and temporal stability (15-day interval) analysis. Cronbachs alpha coefficients > 0.70 and significant intra-class correlation coefficients were observed for most variables, indicating the temporal stability of the measured concepts. The developed instrument exhibited evidence of both content validity and reliability.This study aimed to present the content validity and reliability analyses of an instrument to study the determinant factors of salt consumption among hypertensive subjects, based on an extension of the Theory of Planned Behavior. Content validity was assessed by 3 experts and a pre-test was carried out with 5 subjects. The final tool, comprising 3 different behaviors related to salt consumption and corresponding psychosocial variables, was applied to 32 subjects for internal consistency and temporal stability (15-day interval) analysis. Cronbachs alpha coefficients >; 0.70 and significant intra-class correlation coefficients were observed for most variables, indicating the temporal stability of the measured concepts. The developed instrument exhibited evidence of both content validity and reliability.

Adesão de pacientes com AIDS ao tratamento com antiretrovirais: dificuldades relatadas e proposição de medidas atenuantes em um hospital escola

This study aimed at identifying the incidence of drug intake errors and the main therapy-related difficulties among AIDS patients as well as at proposing measures to increase patients’ adherence to treatment. Sixty-one patients with AIDS assisted by the University Hospital of Sao Paulo State University at Campinas were interviewed. The most frequent errors concerned the combinations of drugs and the length of fasting. The difficulties reported were adverse effects and the variety of drugs. Based on these data the authors proposed the use of an illustrated guide for drug-related information. It is hoped that individualized guidance can contribute to minimize errors concerning adherence to therapy. (authors)

Effect of implementation intentions to change behaviour: moderation by intention stability.

The aim of this study was to assess the effects of implementation intentions on leisure-time physical activity, taking into account the stability of intention. At baseline (T0), 349 participants completed a psychosocial questionnaire and were randomly assigned to implementation intention or control condition. Three months after baseline assessment (T1), participants in the experimental group were asked to plan where, when, and how they would exercise. Leisure-time physical activity was assessed 3 mo. later (i.e., at 6-mo. follow-up; T2). The intervention had no significant effect on physical activity at 6-mo. follow-up. However, a significant interaction of group and intention stability was observed, with the effect of the intervention on behaviour statistically significant only among those with unstable intention. Intention stability thus moderated the effect of the intervention, i.e., the intervention was more successful among individuals who needed support to change (unstable intenders).

Clinical and psycossocial features of heart failure patients admitted for clinical decompensation

This study had the purpose to identify the sociodemographic and clinical profiles, history of hospitalizations due to Heart Failure (HF) and follow-ups (regular appointments, drug treatment, facilities and difficulties for follow-up) of patients admitted for clinical decompensation. Interviews were held with 61 patients, with average age of 58.1 (± 15.9) years, 3.5 (± 4.4) years of education and individual income of 1.3 (± 2.4) times the minimum wage. Most subjects were in functional classes III or IV of the New York Heart Association, having signs and symptoms of the congestive form of HF as the most frequent cause of hospitalization. Of all subjects, 75.4% reported clinical follow-ups, although they tended to be irregular. The use of drug therapy occurred in lower ratios than that recommended in the literature. The findings must help to identify patients with higher risk of HC decompensation, and, as such, design and implement specific interventions aiming at reducing re-admittances due to HF.This study had the purpose to identify the sociodemographic and clinical profiles, history of hospitalizations due to Heart Failure (HF) and follow-ups (regular appointments, drug treatment, facilities and difficulties for follow-up) of patients admitted for clinical decompensation. Interviews were held with 61 patients, with average age of 58.1 (+/- 15.9) years, 3.5 (+/- 4.4) years of education and individual income of 1.3 (+/- 2.4) times the minimum wage. Most subjects were in functional classes III or IV of the New York Heart Association, having signs and symptoms of the congestive form of HF as the most frequent cause of hospitalization. Of all subjects, 75.4% reported clinical follow-ups, although they tended to be irregular. The use of drug therapy occurred in lower ratios than that recommended in the literature. The findings must help to identify patients with higher risk of HC decompensation, and, as such, design and implement specific interventions aiming at reducing re-admittances due to HF.

A randomized controlled trial of the effectiveness of planning strategies in the adherence to medication for coronary artery disease.

AIM To examine the effect of action and coping planning strategies in the adherence to medication among outpatients with coronary artery disease. BACKGROUND Action and coping planning strategies are based on implementation intention, which requires self-regulation by the individual, to prioritize intentionally planned responses over learned or habitual ones, from daily routines to stressful situations. DESIGN Randomized controlled trial. METHODS Participants (n = 115) were randomized into intervention (use of action and coping planning strategies, n = 59) or control (usual care, n = 56) groups. The study was conducted between June 2010-May 2011 in two in-person visits: baseline and 2-month follow-up. Participants in the intervention group received telephone reinforcement between baseline and 2-month follow-up. Adherence to medication for cardioprotection and symptoms relief was evaluated by proportion of adherence, global measure of adherence evaluation and Morisky Self-Reported Measure of Medication Adherence Scale at both baseline and 2-month follow-up. FINDINGS When using the measure of global measure of adherence, participants in the intervention group reported adherence to therapy more often than controls (odds ratio = 5.3), but no statistically significant change was observed in the other two outcome measures. CONCLUSION This study has shown that individuals who use action and coping planning report higher adherence to drug treatment, when measured by the global adherence evaluation. Further studies with longer follow-ups are needed to assess if the effect of planning strategies has long-term duration.

Relationship Between Beliefs Regarding a Low Salt Diet in Chronic Renal Failure Patients on Dialysis

OBJECTIVE The aim of this study was to investigate the relationship between beliefs regarding a low salt diet and the nutritional behavior of sodium consumption as well their relation with sociodemographic and clinical variables among chronic renal failure (CRF) patients on dialysis. DESIGN AND METHODS This cross-sectional study enrolled a sample of 117 patients who answered the Brazilian version of the Beliefs about Dietary Compliance Scale (BDCS), the sodium frequency food questionnaire, and the use of discretionary salt/day. RESULTS The average of total salt consumption was 10.6 g/day (±6.3) and it was positively correlated with the interdialytic weight gain (r = 0.20 P = .032) and negatively correlated with the education level (r = -0.19 P = .044). The Benefits beliefs were discriminatory of the higher and lower salt consumers, and proportionally related to monthly income (r = 0.22 P = .017). The Barriers beliefs were positively correlated only to time on dialysis (r = 0.25 P = .008). Subjects with lower schooling and those of older age tended to consume more discretionary salt (r = -0.27, P = .005; r = 0.23, P = .016, respectively); however, they reported a lower consumption of foods with high salt content (r = 0.25 P = .006; r = -0.27 P = .004). CONCLUSIONS Educational interventions aimed at reducing salt consumption for this group must include interventions targeted at different behaviors related to overall salt consumption, the specificities of age, and level of schooling of the patients.

Características clínicas e psicossociais do paciente com insuficiência cardíaca que interna por descompensação clínica

This study had the purpose to identify the sociodemographic and clinical profiles, history of hospitalizations due to Heart Failure (HF) and follow-ups (regular appointments, drug treatment, facilities and difficulties for follow-up) of patients admitted for clinical decompensation. Interviews were held with 61 patients, with average age of 58.1 (± 15.9) years, 3.5 (± 4.4) years of education and individual income of 1.3 (± 2.4) times the minimum wage. Most subjects were in functional classes III or IV of the New York Heart Association, having signs and symptoms of the congestive form of HF as the most frequent cause of hospitalization. Of all subjects, 75.4% reported clinical follow-ups, although they tended to be irregular. The use of drug therapy occurred in lower ratios than that recommended in the literature. The findings must help to identify patients with higher risk of HC decompensation, and, as such, design and implement specific interventions aiming at reducing re-admittances due to HF.This study had the purpose to identify the sociodemographic and clinical profiles, history of hospitalizations due to Heart Failure (HF) and follow-ups (regular appointments, drug treatment, facilities and difficulties for follow-up) of patients admitted for clinical decompensation. Interviews were held with 61 patients, with average age of 58.1 (+/- 15.9) years, 3.5 (+/- 4.4) years of education and individual income of 1.3 (+/- 2.4) times the minimum wage. Most subjects were in functional classes III or IV of the New York Heart Association, having signs and symptoms of the congestive form of HF as the most frequent cause of hospitalization. Of all subjects, 75.4% reported clinical follow-ups, although they tended to be irregular. The use of drug therapy occurred in lower ratios than that recommended in the literature. The findings must help to identify patients with higher risk of HC decompensation, and, as such, design and implement specific interventions aiming at reducing re-admittances due to HF.

Behavioural determinants of salt consumption among hypertensive individuals

BACKGROUND High salt consumption among populations remains a challenge for health professionals dealing with prevention and control of hypertension. The present study aimed to identify the psychosocial predictors of salt consumption among hypertensive individuals, based on an extended version of the Theory of Planned Behaviour (TPB). Three salt consumption behaviours were studied: Behaviour 1- using <4 g of salt per day during cooking; Behaviour 2- avoiding adding salt/table salt use to the prepared foods; and Behaviour 3- avoiding the consumption of foods with high salt content. METHODS At baseline (n = 108), TPB and additional variables (self-efficacy, habit, past behaviour, hedonic determinant, self-perceived diet quality) were measured. At 2-month follow-up (n = 95), the three behaviours were assessed. Behaviour and intention were sequentially regressed on the study variables, using polytomous logistic regression and hierarchical linear regression with rank transformation, respectively. RESULTS Behaviour 1 was predicted by intention [odds ratio (OR) = 6.23; 95% confidence interval (CI) = 1.81-21.52], whereas self-efficacy and habit predicted intention. Behaviour 2 exhibited high score mean and low variation and was predicted by self-perceived diet quality (OR = 2.56; 95% CI = 1.03-6.36). Behaviour 3 was predicted by the hedonic determinant (OR = 1.42; 95% CI = 1.01-1.98). CONCLUSIONS The results indicate that salt-related behaviours are explained by a variety of determinants. Among these determinants, special consideration should be given to motivational and hedonic aspects.