Susanne Brandstetter

A systematic review on empowerment for healthy nutrition in health promotion

OBJECTIVE The present review aimed to identify and synthesize studies that used an empowerment approach within the field of healthy nutrition. DESIGN A systematic review was conducted. Studies were identified by database searching (PubMed, PsycINFO, Web of Science and Psyndex). Searching, selecting and reporting were done according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) Statement. SETTING Health promotion including the subject of healthy nutrition. SUBJECTS Individuals from non-clinical populations. RESULTS A total of 1226 studies were screened for eligibility, eight studies were finally included. Three studies used the empowerment approach within a qualitative research paradigm and five studies within (quasi-) experimental intervention studies. Heterogeneity in settings, samples and evaluation methods was high. Most studies referred to the key message of empowerment, i.e. taking control over ones own life. However, the ways in which this key message was implemented in the interventions differed considerably. CONCLUSIONS The number of studies included was very low. Furthermore, most studies had some limitations in terms of reporting how the empowerment approach was actually applied. The empowerment approach still seems to be unfamiliar within the field of healthy nutrition.

Depression moderates the associations between beliefs about medicines and medication adherence in patients with rheumatoid arthritis: Cross-sectional study:

The ‘necessity–concerns framework’ postulates that patients’ adherence behaviour is influenced by beliefs about the necessity and the concerns patients have regarding their prescribed medicines. We hypothesized that depression moderates the associations between beliefs about medicines and medication adherence among people with rheumatoid arthritis. Using multivariate logistic regression, we observed that people experiencing more depressive symptoms showed stronger associations between necessity beliefs and adherence as well as attenuated associations between concerns and adherence, respectively, in a cross-sectional sample (N = 361). Thus, depression moderates the associations postulated in the ‘necessity–concerns framework’ in a differential way in people with rheumatoid arthritis.

Determinants of quality of life and return to work following acute respiratory distress syndrome — a systematic review

BACKGROUND Acute respiratory distress syndrome (ARDS) in adults is a consequence of lung damage caused by either pulmonary or extrapulmonary disease. Survivors often suffer from an impaired health-related quality of life (HRQoL), mental and physical impairments, and persistent inability to work. METHODS In this systematic review of the literature, we consider the determinants of HRQoL and return to work (RtW). 24 observational studies showing a statistical association between one or more determinants and HRQoL or RtW were included. Because of the heterogeneity of these studies, no statistical aggregation of the individual effect estimates was carried out; instead, the results are summarized descriptively. RESULTS Psychopathological manifestations, in particular, are associated with impaired quality of life. In contrast, many care- and disease-related determinants had only small, non-significant effects on HRQoL and RtW. The onesecond capacity was found in all studies to be positively associated with the HRQoL. ARDS induced by sepsis seems to be a risk factor for a lower HRQoL in comparison to ARDS of other causes. A synthesis of the evidence is impeded both by the high level of heterogeneity of studies and by the high risk of selection bias in all studies. CONCLUSION The identification of determinants of impaired quality of life after ARDS is essential for the assessment of clinically relevant interventions. In multiple studies, major significant effects were only observed when determinants the content of which was closely related to the scales of the HRQoL instruments were measured at the same time as the HRQoL.

Depression and inflammatory arthritis are associated in both Western and Non-Western countries: Findings from the World Health Survey 2002.

OBJECTIVES Epidemiological studies have linked arthritis to depression. However, it remains unclear to what degree the association between arthritis and depression extends to low income countries and whether it can be replicated for inflammatory arthritis (IA). We aimed to address these knowledge gaps based on a large multi-national sample. METHODS Cross-sectional data was drawn from the 2002 World Health Survey. IA was defined as reports of either a diagnosis or treatment of arthritis and morning stiffness for >30min. Self-reported depression was defined as positive if participants reported its prior diagnosis or treatment or if they were classified as suffering from a major depressive episode by a seven-item screening instrument. Multivariable logistic regression analysis was used to estimate odds ratios (ORs) and 95% confidence intervals (CI) for the entire sample and stratified by sex and continent. RESULTS The odds of IA was 2.6-fold increased in those with depression compared to those without (OR=2.64, 95% CI 2.18-3.21) in the entire sample. This association was observed in both men (OR=3.06, 95% CI 2.19-4.27) and women (OR=2.50, 95% CI 1.95-3.21). Similar associations were found on the continent level, but were generally stronger for the Americas and Asia compared to Africa and Europe. CONCLUSIONS Although our definition of IA was limited by the use of self-reported morning stiffness, this study suggests that there is a positive association between inflammatory arthritis and depression in Western and Non-Western countries, suggesting that this relationship represents a universal phenomenon.

'The lesser of two evils…' - views of persons with rheumatoid arthritis on medication adherence: a qualitative study.

Objective: This study aimed to explore medication adherence among adherent and non-adherent persons suffering from rheumatoid arthritis (RA). A special focus was put on the reasons accounting for successful medication adherence and on potential barriers or facilitating factors. Design: A qualitative study with semi-structured interviews was conducted. Eighteen participants were recruited through stratified purposive sampling according to their medication adherence level. Interviews were analysed by interpretative phenomenological analysis. Results: Medication adherence behaviour was described on a continuum ranging from non-adherent to adherent. Participants’ current adherence level was represented as a result of inner negotiations between a variety of influential factors and the successful application of a range of strategies. The influential factors were: experiences with medication, outcome expectations, knowledge of therapeutic options, the traits ‘openness’ and ‘conscientiousness’, belief in medical progress, characteristics of the medication, level of trust in one’s physician, and perceived autonomy. Facilitating strategies were: establishing routines, using social support and the deliberate suppression of information about potential adverse events. Conclusion: The experience of and the reasons for medication (non-)adherence from the perspective of people with RA were explored comprehensively. Participants’ ongoing negotiations between adherence and non-adherence emerged as a key finding with implications for health service providers.

Differences in medication adherence are associated with beliefs about medicines in asthma and COPD

Abstract Adherence to medication is crucial for achieving treatment control in chronic obstructive lung diseases. This study refers to the “necessity-concerns framework” and examines the associations between beliefs about medicines and self-reported medication adherence in people with chronic obstructive lung disease. 402 patients (196 with asthma, 206 with COPD) participated in the study and completed a questionnaire comprising the “Beliefs about Medicines-Questionnaire” (BMQ) and the “Medication Adherence Report Scale” (MARS). Multivariable logistic regression analyses with the BMQ-subscales as explanatory and the dichotomized MARS-score as dependent variable were computed for the asthma and the COPD sample, respectively, and adjusted for potentially confounding variables. 19% of asthma patients and 34% of COPD patients were completely adherent to their prescribed medication. While specific beliefs about the necessity of medicines were positively associated with medication adherence both in patients with asthma and with COPD, general beliefs about harm and overuse of medicines by doctors were negatively associated with medication adherence only among patients with asthma. The findings of this study suggest that patients’ specific beliefs about the necessity of medicines represent an important modifiable target for improving patient–doctor consultations when prescribing medicines.

Folgen kritischer Erkrankung und mögliche Interventionen

Surviving critical illness is often associated with persistent physical and mental morbidity, which cannot be reduced to late sequelae of the primary underlying diseases. A frequent combination of physical, mental and cognitive deficits is referred to as post-intensive care syndrome (PICS). This article illuminates the epidemiology of these impairments and discusses post-intensive care interventions aiming at prevention and recovery.

Pain, social support and depressive symptoms in patients with rheumatoid arthritis: testing the stress-buffering hypothesis

This study investigated as to how social support influences health among people with rheumatoid arthritis (RA). We refer to the stress-buffering hypothesis of social support which suggests that the negative consequences of stressors on health outcomes can be buffered by social support. In this study, pain represents a stressor and depressive symptoms represent negative health outcomes. It was hypothesized that higher levels of social support should attenuate the association between pain and depression in RA. A cross-sectional study was conducted in 361 patients with RA. They completed questionnaires on social support, depression and perceived pain. Linear regression analysis was applied, with pain as the main explanatory variable, depression as a dependent variable, and an interaction term “social support × pain”. Both pain and social support showed significant associations with depression, with more severe pain and lower social support going along with a higher depression score. However, the interaction term “social support × pain” was not significant, indicating that social support did not attenuate the association between pain and depression. Social support was inversely associated with the experience of depressive symptoms among people suffering from RA. However, it had no buffering effect in attenuating the postulated association between the stressor “pain” and the negative health outcomes assessed as depressive symptoms. The stress-buffering hypothesis of social support was not supported by data from this study among people suffering from RA.

Factors associated with generic health-related quality of life (HRQOL) in patients with chronic obstructive pulmonary disease (COPD): a cross-sectional study

Background Health-related quality of life (HRQOL) is impaired in chronic obstructive pulmonary disease (COPD) patients, but determining factors for HRQOL are still not unequivocal. This study measures HRQOL among patients with COPD and aims to determine factors associated with HRQOL. Methods Data for cross-sectional analyses were obtained from the baseline of a cohort study. The study population includes adult COPD patients (disease duration ≥3 months), recruited from primary and secondary care settings in Germany, without acute psychiatric/neurologic disease (exception: affective/ anxiety disorders). HRQOL was assessed using the Short-Form 12 (SF-12) Health Survey Questionnaire, comprising a physical and mental component. Independent variables encompass socio-demographic, disease-specific, treatment-related and psychological factors. Multivariable linear regression analyses were conducted. Results In total, 206 COPD patients (60.7% male; mean age: 65.3 years) took part in the study. In multivariable analysis, the physical component score showed a significant negative association with the COPD Assessment Test (CAT) (P<0.001) and a higher total number of prescribed medications (P=0.001). A higher forced expiratory volume in 1 second (FEV1) value in percent predicted was significantly related to the physical component score in a positive manner (P=0.006). The mental component score was significantly associated with elevated patient-reported symptoms of anxiety (P=0.002) or depression (P<0.001), measured by the hospital anxiety and depression scale (HADS) in a negative way. Like for the physical component score (P<0.001), a worse CAT score was significantly associated with a lower mental component score (P=0.033). Conclusions Focusing on patient reported outcomes and screening for depression and anxiety with potential successive treatment might be promising approaches to improve HRQOL in patients with COPD.

Evaluation of Empowerment in Health Promotion Interventions: A Systematic Review:

Although empowerment is one of the core principles of the World Health Organization’s approach to health promotion, there are no standards, best practice recommendations, or guidelines for evaluating empowerment within interventions. For the development of effective empowerment promoting interventions, adequate study designs, methods, and indicators for assessing empowerment are essential. In order to better understand which evaluation procedures have been used so far, and which advantages and disadvantages are connected to them, we systematically reviewed empowerment-based health promotion interventions. We included 26 studies, which use a broad variety of quantitative, qualitative, and mixed-methods designs and various data collection methods; qualitative and mixed-methods designs predominated. The quantitative measurement instruments are heterogeneous: Mainly self-designed or modified scales are applied. All studies consider indicators reflecting individual competencies and motivations, whereas indicators capturing the organizational and political components of empowerment are less common. Involving target group members in the development of evaluation procedures and combining different data sources are mentioned as specific steps to improve the quality of data collection. Given the flexible and context-dependent nature of empowerment approaches, the development of a “gold standard” for its evaluation seems unrealistic. However, the analyzed studies can be used to deduce recommendations that may help to conduct high-quality evaluations of empowerment, for example, mixed-methods designs, participation of target groups, and reflective loops within the research team.