Evaluating the effectiveness of an empowerment program for self-care in type 2 diabetes: a cluster randomized trial.

BACKGROUND: The prevalence of type 2 diabetes mellitus is increasing substantially worldwide, leading to serious economic effects, complications and deaths. This study evaluated the effectiveness of an empowerment program providing support for psychosocial, behavioral, and clinical aspects of diabetes to help Brazilian users of public health services obtain metabolic control of this condition. METHODS: In this cluster randomized trial, participants aged 30-80 diagnosed with type 2 diabetes were recruited from ten Brazilian public health units in 2014 and 2015. Five units were randomly assigned to receive the empowerment program based on a behavior change protocol, and five continued to receive only conventional treatment. The primary outcome was the biochemical and anthropometric parameters, and the secondary outcomes were self-care, attitude, knowledge and empowerment related to diabetes. The effect of the experiment was defined as the percentage variation between the values at the initial and final periods. To evaluate this effect and to compare it in the two groups, tests were used for paired and independent samples, respectively. RESULTS: There were 238 participants: 127 and 111 in the intervention and control group, respectively. For glycated hemoglobin, the mean effect in the control and intervention groups was 3.93 and -5.13, respectively (p < 0.001). Levels of glycated hemoglobin and other metabolic indicators, as well as the most part of the secondary outcomes showed a significant difference in the experimental group compared to the control group. CONCLUSIONS: The empowerment program improved metabolic control of type 2 diabetes in Brazilian users. TRIAL REGISTRATION: NCT02132338 - April 22, 2014.

Adherence to self-care practices and empowerment of people with diabetes mellitus: a randomized clinical trial. / Adesão e empoderamento de usuários com diabetes mellitus para práticas de autocuidado: ensaio clínico randomizado.

OBJECTIVE: To evaluate adherence to self-care and glycemic control and empowerment of people with diabetes mellitus in group education. METHOD: Cluster-randomized clinical trial, with participants with type 2 diabetes mellitus. All people in the sample were linked to Family Health Strategy Units from Divinópolis, state of Minas Gerais, Brazil, during 2014 and 2015. Data regarding adherence to self-care practices, empowerment and glycated hemoglobin were collected for comparison of groups in the baseline and of intergroup results before and after interventions. The chosen level of significance was 0.05. RESULTS: The sample had 183 people, with 72 in the intervention group and 111 in the control group. A statistically significant decrease (< 0.001) in the value of glycated hemoglobin and an increase in the scores of adherence to self-care and empowerment scales were found for participants in the intervention group (< 0.001). CONCLUSION: Group education caused an increase in the scores of the scales of adherence to self-care practices and empowerment, in addition to an improvement in glycemic levels, as shown by glycated hemoglobin results. Brazilian Registry of Clinical Trials: RBR-92j38t.

[Relationship between the users' contact time in educational programs on diabetes mellitus and self-care skills and knowledge]. / Associação do tempo de contato no programa educativo em diabetes mellitus no conhecimento e habilidades de autocuidado.

OBJECTIVE: Check the relationship between the users' contact time in educational programs and self-care and knowledge variables in diabetes mellitus. METHOD: A longitudinal study with a quantitative approach with the participation, in the initial phase, of 263 users linked to Basic Health Units in Belo Horizonte, Brazil during the years 2012 and 2013. The data were collected with respect to the total contact time of the users' participation in the educational program as regards knowledge and self-care in acquired diabetes mellitus. The data were analyzed using the Student t-test for comparison of means, considering a 0.05 significance level. RESULTS: The final sample included 151 users. The analysis showed that the improvement in self-care scores was statistically higher during an educational intervention of eight hours or more (p-value <0.05). In relation to the scores for knowledge, there was a statistically significant improvement at the end of the educational program. It was not possible to identify a value for the contact time from which there was an increase in mean scores for the ability of knowledge. CONCLUSION: To improve the effectiveness of the promotion of skills related to knowledge and self-care in diabetes mellitus, it is necessary to consider the contact time as a relevant factor of the educational program.

Terminology subset for the International Classification of Nursing Practice in Diabetes Mellitus.

OBJECTIVE: to describe the process of developing a terminological subset for the International Classification of Nursing Practice in Diabetes Mellitus, based on Horta's Basic Human Needs Theory and Bandura's Social Cognitive Theory. METHOD: a methodological study based on the identification in the literature of 313 statements of nursing diagnoses pertinent to diabetes care, selected and validated by a consensus of nurses from different states of Brazil, specialists in diabetes, using the nominal group technique. RESULTS: 156 nursing diagnosis/result statements were selected, of which 111 (71.15%) related to psychobiological needs, 42 (26.92%) to psychosocial needs and three (1.92%) to psychospiritual needs. A total of 433 nursing interventions were developed. The diagnostic statements were validated on the basis of a consensus among the experts, with an average content validity index of 0.89: 0.87 for psychobiological needs, 0.93 for psychosocial needs, and 0.77 for psychospiritual needs. CONCLUSION: the study validated the terminological subset for the International Classification of Nursing Practice in Diabetes, favoring clinical reasoning, the qualification of the Nursing Process, and the improvement of self-care practices in diabetes. It has made it possible to use nursing's own language based on a globally recognized classification. (1) Provision of the guiding document for nursing practice in diabetes. (2) Methodological innovation in the development of ICNP® subsets. (3) Advances in knowledge of the basic human needs of people with diabetes. (4) The potential of standardized language for coding and monitoring data. (5) Improving clinical reasoning during nursing consultations.

Translation, cross-cultural adaptation and validation of the sickle cell self-efficacy scale (SCSES).

OBJECTIVE: To translate, cross-culturally adapt and validate the Sickle Cell Self-Efficacy Scale for application in the Brazilian cultural context. METHODS: This is a methodological study performed in 6 steps: 1- Forward translation; 2- Translation synthesis; 3- Back-translation; 4- Assessment by expert committee, with computation of the Content Validity Index (CVI); 5- Cultural adequacy (pre-test); 6- Reproducibility. A pre-test was performed with the participation of 10 adolescents/young adults with sickle cell disease through a telephone call and their responses were recorded on a form in a web platform. The instrument validation step was carried out with 55 adolescents/young adults with sickle cell disease, 43 of them having participated in the retest. The analysis of internal consistency and reproducibility was calculated using the Cronbach's alpha coefficient and the Intraclass Correlation Coefficient (ICC), in the R statistical programming environment. RESULTS: The translated instrument had good acceptance among the experts, reaching an average CVI of 1.0. In assessing reliability, the scale showed acceptable internal consistency, with a Cronbach's alpha of 0.84. In the agreement analysis, the ICC was 0.923 (95% CI: 0.857 to 0.958), which indicates good temporal reproducibility. CONCLUSIONS: Following the process of translation, cross-cultural adaptation and validation, we obtained the Brazilian version of the Sickle Cell Self-Efficacy Scale, considered valid and reliable to be applied to adolescents and young adults with sickle cell disease in Brazil.

[Evaluation of the behavioral program in type 2 diabetes mellitus: a randomized clinical trial]. / Avaliação do programa comportamental em diabetes mellitus tipo 2: ensaio clínico randomizado.

The scope of this article was to evaluate the effect of the behavioral group education program and telephone intervention in modifying psychological attitudes, enhancing empowerment, and self-care practices aimed at improving clinical control in type 2 diabetes mellitus. It involved a randomized cluster clinical trial, carried out with 199 people with diabetes. In order to perform intragroup comparisons (final and initial phases) and between groups with respect to the indices of the psychological attitude, empowerment, self-care and glycated hemoglobin level variables, the Generalizing Estimating Equation (GEE) approach was used. In all analyses, a 5% significance level and 95% confidence interval were used. When compared to the CG, the IG showed a significant reduction in the mean values of glycated hemoglobin (95%CI: -1.49 to -0.45), a statistically significant increase in the change in psychological attitude scores (95%CI: 9.70 to 15.40), on the empowerment scale (95%CI: 0.81 to 2.72) and adherence to self-care practices (95%CI: 1.44 to 2.10) at the end of the study. The behavioral program proved to be capable of modifying psychological attitudes, improving empowerment, self-care practices and clinical control.

O objetivo deste artigo é avaliar o efeito do programa comportamental educação em grupo e intervenção telefônica na modificação das atitudes psicológicas, melhora do empoderamento e das práticas de autocuidado visando à melhora do controle clínico em diabetes mellitus tipo 2. Trata-se de um ensaio clínico com cluster randomizado, realizado em 199 pessoas com diabetes. Para realizar as comparações intragrupos (tempos final e inicial) e entre grupos quanto aos valores das variáveis atitudes psicológicas, empoderamento, autocuidado e medidas da hemoglobina glicada, foi utilizada a abordagem das Generalizing Estimating Equations (GEE). Em todas as análises, utilizou-se um nível de significância de 5% e intervalos de 95% de confiança. Quando comparado ao GC, o GI apresentou uma redução significativa nos valores médios de hemoglobina glicada (IC95%: -1,49 a - 0,45), aumento estatisticamente significativo na modificação dos escores de atitudes psicológicas (IC95%: 9,70 a 15,40), na escala do empoderamento (IC95%: 0,81 a 2,72) e na adesão às práticas de autocuidado (IC95%: 1,44 a 2,10) ao final do estudo. O programa comportamental se mostrou capaz de modificar as atitudes psicológicas, melhorar o empoderamento, as práticas de autocuidado e o controle clínico.

Construction and Validation of a Protocol Targeting Patients on Oral Anticoagulation with Warfarin. / Construção e Validação do Protocolo EmpoderACO Direcionado a Pacientes em Anticoagulação Oral com Varfarina.

BACKGROUND: Warfarin is an oral anticoagulant that is very useful in preventing thromboembolism, though it is considered a drug with a high risk of causing adverse events. Considering the practical challenges in controlling oral anticoagulation, the patients on warfarin could benefit from educational strategies aimed at behavioral changes, active participation in self-care, and adherence to drug therapy. OBJECTIVE: The aim was to construct and validate the EmpoderACO protocol for behavioral changes in warfarin patients. METHODS: The methodological steps were: definition of concepts and domains of self-care, identification of objectives, construction and selection of items, assessment of content validity, and pre-test in the target population. RESULTS: Relevance, adequacy, clarity, and internal reliability of the instrument's items were assessed by a multidisciplinary judges committee (JC) through the E-surv web platform, obtaining an average agreement of ≥0.91. The understanding of the instrument measured by the target population revealed adequate clarity with a coefficient average of 0.96. CONCLUSION: EmpoderACO can aid in qualifying the communication process between medical professionals and patients, as well as in improving adherence to both treatment and clinical outcomes, and can be replicated in healthcare settings.

FUNDAMENTO: A varfarina é um anticoagulante oral útil para prevenção de tromboembolismo, embora seja considerado fármaco de alto risco de causar eventos adversos. Considerando os desafios práticos no controle da anticoagulação oral, os pacientes poderiam se beneficiar de estratégias educacionais que visem mudança de comportamento, participação ativa no autocuidado e adesão à farmacoterapia. OBJETIVO: Construir e validar o protocolo EmpoderACO para mudança de comportamento em pacientes em uso de varfarina. MÉTODOS: As etapas metodológicas foram: definição de conceitos e domínios do autocuidado, identificação dos objetivos, construção e seleção dos itens, avaliação da validade de conteúdo e pré-teste na população alvo. RESULTADOS: Relevância, adequação, clareza e confiabilidade interna dos itens do instrumento foram avaliadas por comitê de juízes multiprofissional pela plataforma web E-surv, obtendo-se média de concordância ≥0,91. A compreensão do instrumento pela população-alvo teve clareza adequada com média de 0,96. CONCLUSÃO: O EmpoderACO poderá contribuir para qualificar o processo de comunicação entre profissionais e pacientes, melhorar a adesão ao tratamento e os resultados clínicos, podendo ser replicado nos serviços de saúde.

[Evaluation of the educational practices in promoting self-management in type 2 diabetes mellitus]. / 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.

Evaluation of group education strategies and telephone intervention for type 2 diabetes. / Avaliação das estratégias de educação em grupo e intervenção telefônica para o diabetes tipo 2.

OBJECTIVE: To evaluate group education strategies and telephone intervention regarding the variables empowerment, self-care practices, and glycemic control of people with diabetes. METHOD: Clinical trial with eight randomized clusters, conducted between 2015 and 2016, with 208 users with type 2 diabetes mellitus allocated for group education, telephone intervention, or control group. Sociodemographic data, glycated hemoglobin, empowerment, and self-care practices were collected. RESULTS: The user mean age was of 63.5 years (SD = 8.9 years), with the participation of 124 women, which amounts to 59.6% of these users. The strategies led to a statistically significant reduction in the levels of glycated hemoglobin (p < 0.001). The telephone intervention was also observed to present statistically significant results regarding self-care practices (p < 0.001) and empowerment in diabetes (p < 0.001) when compared to group education. CONCLUSION: The telephone intervention presented statistically significant results for empowerment and practices of self-care when compared to group education. Brazilian Registry of Clinical Trials (Registro Brasileiro de Ensaios Clínicos): RBR-7gb4wm.

[Elaboration for nursing consultation: focus on the treatment with insulin]. / Protocolo para consulta de enfermagem: assistência a pacientes com diabetes mellitus tipo 2 em insulinoterapia.

This article describes the experience in making a protocol for nursing consultations in order to subsidize the assistance provided for diabetic patients attended in Hospital das Clínicas State University of Campinas, São Paulo, Brazil, at the stage of beginning their insulin therapy. The development of the protocol was divided into two working stages. On the first stage, a literature research was carried out to survey the scientific production related to the orientations and nursing care, by the introduction of insulin therapy. The second stage was the building of the protocol proposal based on the achieved results. The conception process allowed the acknowledgment of both nursing consultations and systematization of care as a valuable tools to identify the problems individually, besides planning, carrying out, and assessing the assistance and health service plan continually, bringing about the improvement of care and the standardization of documents and records.

Terminology subset for the International Classification of Nursing Practice in Diabetes Mellitus / Subconjunto terminológico para la Clasificación Internacional para la Práctica de Enfermería en Diabetes Mellitus / Subconjunto terminológico para la Clasificación Internacional para la Práctica de Enfermería en Diabetes Mellitus

Objective: to describe the process of developing a terminological subset for the International Classification of Nursing Practice in Diabetes Mellitus, based on Horta's Basic Human Needs Theory and Bandura's Social Cognitive Theory. Method: a methodological study based on the identification in the literature of 313 statements of nursing diagnoses pertinent to diabetes care, selected and validated by a consensus of nurses from different states of Brazil, specialists in diabetes, using the nominal group technique. Results: 156 nursing diagnosis/result statements were selected, of which 111 (71.15%) related to psychobiological needs, 42 (26.92%) to psychosocial needs and three (1.92%) to psychospiritual needs. A total of 433 nursing interventions were developed. The diagnostic statements were validated on the basis of a consensus among the experts, with an average content validity index of 0.89: 0.87 for psychobiological needs, 0.93 for psychosocial needs, and 0.77 for psychospiritual needs. Conclusion: the study validated the terminological subset for the International Classification of Nursing Practice in Diabetes, favoring clinical reasoning, the qualification of the Nursing Process, and the improvement of self-care practices in diabetes. It has made it possible to use nursing's own language based on a globally recognized classification.

Objetivo: describir el proceso de elaboración de un subconjunto terminológico para la Clasificación Internacional para la Práctica de Enfermería en Diabetes Mellitus , basado en la Teoría de las Necesidades Humanas Básicas de Horta y en la Teoría Social Cognitiva de Bandura. Método: estudio metodológico realizado a partir de la identificación en la literatura de 313 enunciados de diagnósticos de Enfermería pertinentes al cuidado en diabetes, seleccionados y validados por consenso de enfermeras especializadas en diabetes, provenientes de diferentes estados de Brasil, utilizando la técnica de grupo nominal. Resultados: fueron seleccionados 156 enunciados diagnósticos/resultados de Enfermería, así relacionados: 111 (71,15%) con las necesidades psicobiológicas; 42 (26,92%) con las psicosociales y tres (1,92%) con las psicoespirituales. Fueron construidas 433 intervenciones de Enfermería. Los enunciados diagnósticos fueron validados a partir del consenso entre las especialistas con índice de validez de contenido medio de 0,89; siendo: 0,87 para las necesidades psicobiológicas; 0,93 para las psicosociales y 0,77 para las psicoespirituales. Conclusión: el estudio validó los enunciados del subconjunto terminológico para la Clasificación Internacional para la Práctica de Enfermería en diabetes, favoreciendo el raciocinio clínico, la calificación del Proceso de Enfermería y la mejora de las prácticas de autocuidado en diabetes. También, posibilitó la utilización de lenguaje propio de la Enfermería basado en una clasificación reconocida mundialmente.

Objetivo: descrever o processo de elaboração de um subconjunto terminológico para a Classificação Internacional para a Prática de Enfermagem em Diabetes Mellitus , baseado na Teoria das Necessidades Humanas Básicas de Horta e na Teoria Social Cognitiva de Bandura. Método: estudo metodológico realizado a partir da identificação na literatura de 313 enunciados de diagnósticos de Enfermagem pertinentes ao cuidado em diabetes, selecionados e validados por consenso de enfermeiras especialistas em diabetes, provenientes de diferentes estados do Brasil, utilizando a técnica de grupo nominal. Resultados: foram selecionados 156 enunciados diagnósticos/resultados de Enfermagem, sendo relacionados: 111 (71,15%) às necessidades psicobiológicas; 42 (26,92%) às psicossociais e três (1,92%) às psicoespirituais. Foram construídas 433 intervenções de Enfermagem. Os enunciados diagnósticos foram validados a partir do consenso entre os especialistas com índice de validade de conteúdo médio de 0,89, sendo: 0,87 para as necessidades psicobiológicas; 0,93 para as psicossociais e 0,77 para as psicoespirituais. Conclusão: o estudo validou os enunciados do subconjunto terminológico para a Classificação Internacional para a Prática de Enfermagem em diabetes, favorecendo o raciocínio clínico, a qualificação do Processo de Enfermagem e a melhoria das práticas de autocuidado em diabetes. Possibilitou a utilização de linguagem própria da Enfermagem com base em uma classificação reconhecida mundialmente.

Translation and cross-cultural adaptation of the Behavior Change Protocol for educational practices in Diabetes Mellitus. / Tradução e adaptação cultural do Behavior Change Protocol para as práticas educativas em Diabetes Mellitus.

OBJECTIVE: to translate and cross-culturally adapt the Behavior Change Protocol for educational practices in Diabetes Mellitus. METHOD: methodological study aimed at cross-cultural adaptation, comprising the steps of translation, back-translation, assessment by an expert committee and pre-testing of the instrument on a sample of 30 healthcare service users with type 2 Diabetes Mellitus. RESULTS: the instrument was assessed based on criteria pertaining semantic, idiomatic, conceptual and cultural equivalence between the original instrument and the translated version, its mean Content Validity Index being 0.85. CONCLUSION: results showed content validity indicating the instrument's successful cross-cultural adaptation to the Brazilian culture for use in educational practices targeting self-care in type 2 DM.

Development and validation of an instrument to assess Brazilian healthcare professional providers' knowledge on sickle cell disease.

OBJECTIVE: To develop and validate DFConhecimento, an instrument to assess Brazilian healthcare professional providers' knowledge on sickle cell disease. METHOD: Study carried out in four stages: (1) instrument development; (2) content validation by an Expert Committee; (3) cultural adequacy check at pre-test; (4) instrument reliability analysis by healthcare professional providers supported by Intraclass Correlation Coefficient calculation. The data for content validation and reliability analyses were collected through the web tool eSurv and analyzed within the statistical software and environment R. RESULTS: The instrument, consisting of 13 multiple-choice questions, showed acceptability, with an average Content Validity Index of 0.88. The reliability analysis showed moderate agreement (0.67) indicating that test-retest reproducibility is acceptable. CONCLUSION: The instrument DFConhecimento showed reliability and internal consistency, proving suitable for measuring Brazilian healthcare professional providers' acquisition of knowledge on sickle cell disease.

Knowledge of professional healthcare providers about sickle cell disease: Impact of a distance education course.

OBJECTIVE: To assess the impact of the distance education course "Sickle Cell Disease: Primary Health Care Line" on knowledge acquisition of professional healthcare providers. METHODS: A cross-sectional study was conducted with a quantitative approach at the Educational and Support Center for Hemoglobinopathies (Cehmob-MG), state of Minas Gerais, Brazil, in 2016. One hundred and fifty-three out of 300 professional healthcare providers were invited to participate in the proposed distance course. Of the participating professional healthcare providers, 72 (47%) successfully concluded the course (Group A), whereas 81 (53%) did not complete their course assignments and did not meet the minimum requirements for regular attendance (Group B). Knowledge acquisition was assessed with the Knowledge of Sickle Cell Disease Instrument, DFConhecimento, applied using the web tool eSurv. Univariate analysis by Poisson regression was employed to assess the influence of sociodemographic variables on the DFConhecimento score and to select variables to compose the initial multivariate regression model (p-value<0.20). The analysis was performed in the statistical programming environment R. RESULTS: The average score was 9.76 for Group A and 6.54 for Group B. The two groups were considered statistically different (p-value<0.05) for all items with the proportion of correct items being greater in Group A. Professional healthcare providers who concluded the course had a significantly higher DFConhecimento score (45%) when compared to those who did not successfully conclude the course. CONCLUSION: Participation in a distance education course on sickle cell disease had a positive impact on the acquisition of knowledge about the disease by professional healthcare providers.

Barriers experienced in self-care practice by young people with sickle cell disease.

OBJECTIVE: To identify barriers to the self-care practice of young people with sickle cell disease. METHOD: This qualitative study was conducted with 17 individuals with sickle cell disease aged between 13 and 24 years in Belo Horizonte, MG, Brazil in March and April 2017. An interview investigated the barriers to self-care practice and the feelings associated with sickle cell disease. Data were transcribed and analyzed according to Bardin's perspective using the following steps: (1) pre-analysis, (2) exploration of the material, and (3) treatment of the results (inference and interpretation). RESULTS: Five thematic categories emerged: (1) feelings: anger, sadness, and fear; (2) bullying and stigmatization: challenges regarding walking, speaking, or behaving, as well as patient labels; (3) cognitive factors: doubts related to medication, hydration, heredity and maternity; (4) medication compliance: fear of the side effects suffered and anger triggered by the obligation to use the medication; (5) family issues: complaints of not earning the mothers' trust to live independently. CONCLUSION: The barriers to self-care in young people with sickle cell disease indicate difficulties related to emotional, behavioral, and environmental aspects. Understanding these factors will favor a better adaptation of youths to the context of sickle cell disease.

Translation, cultural adaptation and validation of the Diabetes Attitudes Scale - third version into Brazilian Portuguese.

OBJECTIVE: to perform the translation, adaptation and validation of the Diabetes Attitudes Scale - third version instrument into Brazilian Portuguese. METHODS: methodological study carried out in six stages: initial translation, synthesis of the initial translation, back-translation, evaluation of the translated version by the Committee of Judges (27 Linguists and 29 health professionals), pre-test and validation. The pre-test and validation (test-retest) steps included 22 and 120 health professionals, respectively. The Content Validity Index, the analyses of internal consistency and reproducibility were performed using the R statistical program. RESULTS: in the content validation, the instrument presented good acceptance among the Judges with a mean Content Validity Index of 0.94. The scale presented acceptable internal consistency (Cronbach's alpha = 0.60), while the correlation of the total score at the test and retest moments was considered high (Polychoric Correlation Coefficient = 0.86). The Intra-class Correlation Coefficient, for the total score, presented a value of 0.65. CONCLUSION: the Brazilian version of the instrument (Escala de Atitudes dos Profissionais em relação ao Diabetes Mellitus) was considered valid and reliable for application by health professionals in Brazil.

Evaluation of the effects of a diabetes educational program: a randomized clinical trial.

OBJECTIVE: Evaluate the effectiveness of a diabetes mellitus educational program in primary health care. METHODS: This cluster randomized trial was conducted in a sample of 470 people with type 2 diabetes mellitus from eight health units, randomly assigned to two groups: intervention (n = 231) and control (n = 239). The intervention group participated in the educational program composed of three strategies: group education, home visit, and telephone intervention. Simultaneously, the control group was monitored individually. Group monitoring took place over nine months in the year 2012. Clinical evaluations were performed at the initial time (T0), three (T3), six (T6) and nine (T9) months after the beginning of the intervention. RESULTS: After nine months of follow-up, 341 users remained in the study, 171 in the control group and 170 in the intervention group. The average age of users was 60.6 years. In both groups, statistically significant differences were observed in mean HbA1c levels over the follow-up time (p < 0.05). However, the mean HbA1c level at T3, T6 and T9 times were significantly lower among the people in the intervention group (p < 0.05). CONCLUSIONS: The educational program model developed was effective to improve the glycemic control of the intervention group participants.

Translation, cross-cultural adaptation and validation of the sickle cell self-efficacy scale (SCSES)

ABSTRACT Objective: To translate, cross-culturally adapt and validate the Sickle Cell Self-Efficacy Scale for application in the Brazilian cultural context. Methods: This is a methodological study performed in 6 steps: 1- Forward translation; 2- Translation synthesis; 3- Back-translation; 4- Assessment by expert committee, with computation of the Content Validity Index (CVI); 5- Cultural adequacy (pre-test); 6- Reproducibility. A pre-test was performed with the participation of 10 adolescents/young adults with sickle cell disease through a telephone call and their responses were recorded on a form in a web platform. The instrument validation step was carried out with 55 adolescents/young adults with sickle cell disease, 43 of them having participated in the retest. The analysis of internal consistency and reproducibility was calculated using the Cronbach's alpha coefficient and the Intraclass Correlation Coefficient (ICC), in the R statistical programming environment. Results: The translated instrument had good acceptance among the experts, reaching an average CVI of 1.0. In assessing reliability, the scale showed acceptable internal consistency, with a Cronbach's alpha of 0.84. In the agreement analysis, the ICC was 0.923 (95% CI: 0.857 to 0.958), which indicates good temporal reproducibility. Conclusions: Following the process of translation, cross-cultural adaptation and validation, we obtained the Brazilian version of the Sickle Cell Self-Efficacy Scale, considered valid and reliable to be applied to adolescents and young adults with sickle cell disease in Brazil.

Atitudes dos profissionais da saúde em relação ao cuidado em diabetes tipo 2 na atenção primária / Actitudes de los profesionales de la salud hacia elcuidado a la diabetes tipo 2 en la atención primaria / Attitudes of health professionals towards type 2 diabetes care in primary care

RESUMO Objetivo: analisar as atitudes de profissionais que atuam na Atenção Primária à Saúde em relação ao cuidado de pessoas com diabetes mellitus tipo 2 (DM2). Método: estudo transversal realizado com 56 profissionais da atenção primária à saúde em Divinópolis, município do centro-oeste mineiro. As atitudes dos profissionais foram medidas por meio do instrumento Escala de Atitudes dos profissionais em relação ao diabetes Mellitus (EAP-DM) aplicado via plataforma web e-Surv. Os dados foram coletados entre maio e julho de 2019. Para análise, utilizaram-se os testes Mann Whitney e de Kruskal Wallis. Resultados: dos 56 profissionais, 36 (64,3%) possuíam menos de 10 anos de atuação na atenção primária e 40 (71,4%) concluíram especialização na área de atuação. Os participantes apresentaram atitudes positivas em relação ao diabetes, com pontuação média de 4,37 (DP: 0.22), variando entre 3,76 e 4,85. Médicos e psicólogos demonstraram atitudes menos favoráveis em relação aos cuidados em DM2, quando comparados aos enfermeiros e fisioterapeutas (valor de p <0,05). Conclusão: todos os profissionais apresentaram atitudes positivas e o nível destas atitudes variou conforme categoria profissional.

RESUMEN Objetivo: analizar las actitudes de profesionales que actúan en la Atención Primaria de Salud con relación al cuidado de personas con diabetes mellitus tipo 2 (DM2). Método: estudio transversal realizado con 56 profesionales de la atención primaria a la salud en Divinópolis, municipio del centro-oeste del Estado de Minas Gerais-Brasil. Las actitudes de los profesionales fueron medidas a través del instrumento Escala de Actitudes de los profesionales respecto al diabetes Mellitus (EAP-DM) aplicado vía plataforma web e-Surv. Los datos fueron recogidos entre mayo y julio de 2019. Para el análisis, se utilizaron las pruebas Mann Whitney y de Kruskal Wallis. Resultados: de los 56 profesionales, 36 (64,3%) poseían menos de 10 años de actuación en la atención primaria y 40 (71,4%) concluyeron especialización en el área de actuación. Los participantes presentaron actitudes positivas con relación a la diabetes, con puntuación media de 4,37 (DP: 0.22), variando entre 3,76 y 4,85. Médicos y psicólogos demostraron actitudes menos favorables hacia los cuidados en DM2, cuando comparados a los enfermeros y fisioterapeutas (valor de p <0,05). Conclusión: todos los profesionales presentaron actitudes positivas y el nivel de estas actitudes varió según categoría profesional.

ABSTRACT Objective: to analyze the attitudes of professionals working in Primary Health Care in relation to the care of people with type 2 diabetes mellitus (T2DM). Method: cross-sectional study conducted with 56 primary health care professionals in Divinópolis, a city in the center-west of Minas Gerais. The attitudes of professionals were measured through the instrument Scale of Attitudes of professionals in relation to diabetes Mellitus (EAP-DM) applied via e-Surv web platform. Data were collected between May and July 2019. For analysis, the Mann Whitney and Kruskal Wallis tests were used. Results: of the 56 professionals, 36 (64.3%) had less than 10 years of experience in primary care and 40 (71.4%) completed specialization in the area of activity. Participants showed positive attitudes towards diabetes, with a mean score of 4.37 (SD: 0.22), ranging from 3.76 to 4.85. Physicians and psychologists showed less favorable attitudes towards T2DM care when compared to nurses and physical therapists (p-value <0.05). Conclusion: all professionals showed positive attitudes and the level of these attitudes varied according to professional category.

Qualidade de vida do cuidador familiar de paciente em hemodiálise / Calidad de vida de cuidadores familiares de pacientes en hemodiálisis / Quality of life of family caregivers of patients under hemodialysis

Resumo Objetivo Analisar a qualidade de vida do cuidador familiar do paciente em hemodiálise e a existência de associação com suas características clínicas e sociodemográficas. Métodos Estudo transversal, realizado com 75 cuidadores familiares em dois centros de diálise. A qualidade de vida do cuidador foi medida por meio do instrumento World Health Organization Quality of Life - BREF, e sua associação com as características sociodemográficas foi avaliada pelo teste de Kruskal-Wallis (nível de significância igual a 5%). Resultados A maioria dos cuidadores familiares era mulher (84%), cônjuge (41,3%), filho (38,7%), do lar (38,7%) e possuía renda familiar de um a três salários mínimos (85,4%). A variável trabalhar fora de casa teve influência positiva na qualidade de vida geral (p=0,014), nos domínios psicológicos (p=0,009) e nas relações sociais (p≤0,001). Ser do sexo masculino (p=0,016), não ter doenças (p=0,002) e não usar medicamentos (p=0,007) interferiram positivamente no domínio físico. A ausência de ajuda financeira de outras pessoas e/ou familiares influenciou de forma negativa nos domínios das relações sociais (p=0,050) e meio ambiente (p=0,001). Conclusão O cuidador familiar do sexo masculino, ou que trabalha fora de casa ou recebe ajuda financeira de outras pessoas e/ou familiares apresentaram melhores níveis de qualidade de vida. Em contrapartida, as condições clínicas tais como fazer uso de algum medicamento ou ter doenças influenciaram de forma negativa nos níveis de qualidade de vida.

Resumen Objetivo Analizar la calidad de vida de los cuidadores familiares de pacientes en hemodiálisis y la existencia de asociación con las características demográficas y clínicas. Métodos Estudio transversal, realizado con 75 cuidadores familiares en dos centros de diálisis. La calidad de vida de los cuidadores fue medida a través del instrumento World Health Organization Quality of Life - BREF, y su relación con las características sociodemográficas fue evaluada mediante la prueba de Kruskal-Wallis (nivel de significación igual a 5 %). Resultados La mayoría de los cuidadores familiares era mujer (84 %), cónyuge (41,3 %), hijo (38,7 %), del hogar (38,7 %) y poseía ingresos familiares de uno a tres salarios mínimos (85,4 %). La variable trabajar fuera de casa tuvo influencia positiva en la calidad de vida general (p=0,014), en los dominios psicológicos (p=0,009) y en las relaciones sociales (p≤0,001). Ser de sexo masculino (p=0,016), no tener enfermedades (p=0,002) y no usar medicamentos (p=0,007) interfirieron positivamente en el dominio físico. La ausencia de ayuda financiera de otras personas o familiares influyó de manera negativa en los dominios de las relaciones sociales (p=0,050) y del medio ambiente (p=0,001). Conclusión Los cuidadores familiares de sexo masculino, o que trabajan fuera de casa o reciben ayuda financiera de otras personas o familiares presentaron mejores niveles de calidad de vida. En contraste, las condiciones clínicas, tales como hacer uso de algún medicamento o padecer enfermedades, influyeron de forma negativa en los niveles de calidad de vida.

Abstract Objective To analyze the quality of life of family caregivers of patients under hemodialysis and the existence of an association with their sociodemographic and clinics characteristics. Methods This is a cross-sectional study conducted with 75 family caregivers in two hemodialysis centers. Caregivers' quality of life was measured using the World Health Organization Quality of Life - BREF instrument, and its association with sociodemographic characteristics was assessed using the Kruskal-Wallis test (significance level equal to 5%). Results Most family caregivers were women (84%), spouses (41.3%), children (38.7%), housewives (38.7%) and had a family income of one to three minimum wages (85.4 %). The variable working outside the home had a positive influence on overall quality of life (p=0.014), psychological domains (p=0.009) and social relationships (p≤0.001). Being male (p=0.016), not having diseases (p=0.002) and not using medications (p=0.007) positively interfered with the physical domain. The absence of financial help from other people and/or family members had a negative influence on the social relationships (p=0.050) and environment (p=0.001) domains. Conclusion Male family caregivers, or those who work outside the home or receive financial help from other people and/or family members had better quality of life levels. On the other hand, clinical conditions such as using a drug or having diseases have negatively influenced quality of life levels.