Effects of a comprehensive structured patient education intervention on disease-related knowledge and behaviour change among people living with type 2 diabetes in the Philippines.

Introduction: Addressing the ongoing needs of individuals with diabetes, particularly in low- and middle-income countries like the Philippines, requires a focus on regular follow-ups with healthcare teams, adherence to healthy behaviors, and effective patient education to prevent long-term complications. The aim of this study was to ascertain the impact of a comprehensive educational program for those living with diabetes in the Philippines. Methods: In a prospective study, a convenience sample of patients living with diabetes attending a cardiac rehabilitation or an outpatient diabetes clinic in the Philippines received a 12-week education intervention. Participants completed surveys at pre- and post-intervention assessing disease-related knowledge, health literacy, dietary habits, and tobacco use. Physical activity was measured by steps taken per day using wearable devices and by self-report of minutes of moderate or vigorous-intensity exercise per week. Satisfaction with the educational materials was also evaluated by a survey composed of Likert-type scale and open-ended questions. Descriptive statistics, paired t-tests or chi-square were used for data analysis. Results: Overall, 184 individuals living with diabetes type 2 (mean age = 54.4 ± 12.4, 32% female) completed both assessments. There was significant improvement in disease-related knowledge (p < 0.001), daily steps measured by a wearable device and self-reported minutes of moderate/vigorous-intensity exercise (p < 0.001), and the number of fruit and vegetable servings consumed per day (p = 0.001). No significant changes were observed in health literacy levels. One participant stopped using tobacco at post-education. Educational materials were highly satisfactory to participants. Lack of time, family responsibilities, and poor internet access were the main barriers to learning reported by participants. Suggestions to improve the education provided included assessment of information needs at the start of the education, having short summaries about the topics, follow-ups post-intervention, and inviting family members to sessions. Discussion: Results of this study demonstrated the positive effects a comprehensive structured patient education intervention on disease-related knowledge and behaviour changes among people living with type 2 diabetes in the Philippines.

Translation, cultural adaptation and psychometric validation of the Arabic short version of the coronary artery disease education questionnaire (CADE-Q SV) in Saudi Arabia.

Objective: To translate, culturally adapt, and psychometrically validate the Arabic Coronary Artery Disease Education Questionnaire Short Version (CADE-Q SV). Methods: The CADE-Q SV was translated to Arabic by two independent translators, followed by back-translation. Then, an expert panel of 10 healthcare providers and 10 patients reviewed the survey and provided input for content validity (CV) and clarity of items. For the psychometric analysis, 202 cardiac patients from Saudi Arabia completed the questionnaire, of which factor structure, internal consistency, construct, and criterion validity were assessed. Results: Items were translated, and CV was confirmed. Items were rated based on relevance and understandability. The scale was finalized after changes in 5 items. Confirmatory factor analysis revealed 5 factors, all internally consistent: medical condition, risk factors, exercise, nutrition, and psychosocial health. Overall alpha was 0.84. Construct validity was established by significant associations between scores and occupation, educational level, family income, having a diagnosis of acute coronary syndrome or valve disorders and with a history of valve repair or replacement a coronary artery bypass graft procedure. Scores were significantly higher for those that participated in cardiac rehabilitation, confirming criterion validity. Conclusions: Results from this study confirm the validity and reliability of the CADE-Q SV in Arabic-speaking patients. Innovation: The CADE-Q SV can be used as a knowledge measurement to support clinical work and development of education intervention for Arabic patients.

Information needs of women with breast cancer participating in cardiovascular rehabilitation: A mixed-methods study.

OBJECTIVE: To determine the information needs of women with a history of breast cancer attending a cardiovascular rehabilitation (CR) program. METHODS: A mixed-methods approach was used, including a cross-sectional online survey using an adapted version of the Toronto Information Needs Questionnaire Breast Cancer (TINQ-BC) and 7 virtual focus group sessions (n = 20). RESULTS: Overall, 50 responses were received. The TINQ-BC mean was 4.2 ± 0.5/5, with 34/42 items scoring higher than 4 (very important). The highest information needs were related to knowing if cancer is in their bodies or has come back, ways to prevent treatment side effects, and how the illness may affect their future. Participants identified their preferences for education delivery as discussion with peers/healthcare providers and lectures. The focus groups revealed six overarching themes: need for peer support, to make connections, and build relationships; comfort with and utility of technology; desire to learn about specific educational topics; preferences for education sessions; value of education; and value of exercise. CONCLUSIONS: These findings provided insight into the information needs of women with a history of breast cancer who participate in CR. PRACTICAL IMPLICATION: The care of these patients should be personalized based on these needs to support their adherence to the program.

Exercise and Lifestyle Education program for Brazilians living with prediabetes and diabetes: A pilot randomized trial.

AIMS: To test the Diabetes College Brazil Study feasibility, the acceptability of study interventions and their preliminary effectiveness, and describe the study protocol modifications due to the COVID-19 pandemic. METHODS: Single-center, double-blinded pilot randomized trial with two parallel groups, Exercise and Lifestyle Education (ExLE; 12-week exercise and educational interventions) and Exercise (Ex; 12-week exercise intervention only) involving patients with prediabetes or diabetes. Feasibility (eligibility, recruitment, retention, completeness of variables measures and participation rates), acceptability (satisfaction), and preliminary effectiveness of interventions (variables: functional capacity, physical activity (PA), exercise self-efficacy, diabetes knowledge, health literacy, adherence to Mediterranean food pattern, glycated hemoglobin (HbA1c), anthropometric measures, cardiac autonomic control, depression, and quality of life (QofL)). RESULTS: Eligibility, recruitment, retention, participation in exercise sessions, and education classes rates were 17%, 93%,82%, 76%, and 71%, respectively. Missing data in the post-intervention assessment (PA, HbA1c, cardiac autonomic control, anthropometric measures, depression, and QofL) were mainly related to research procedure modifications. The interventions were highly acceptable, and most variables improved farther in the ExLE, with moderate effect sizes for PA, diabetes knowledge, health literacy, cardiac autonomic control, and QofL. CONCLUSIONS: The Diabetes College Brazil Study is feasible, and the ExLE may benefit Brazilians living with prediabetes and diabetes.

Patient education program for Brazilians living with diabetes and prediabetes: findings from a development study.

BACKGROUND: Globally, the incidence of diabetes is increasing and strategies to reach a comprehensive approach of care are needed, including education in self-management. This is particularly true in low and middle-income countries where the number of people living with diabetes is higher than in the high-income ones. This article describes the development of a structured patient education program for Brazilians living with diabetes or prediabetes. METHODS: These steps were undertaken: 1) a 4-phase needs assessment (literature search of local diabetes guidelines, environmental scan, evaluation of information needs of patients identified by diabetes experts, and patient focus groups); and, 2) the translation and cultural adaptation of the patient guide (preparation, translation, back-translation, back-translation review, harmonization, and proofreading). RESULTS: Four of the seven guidelines identified include educational aspects of diabetes management. No structured education program was reported from the environmental scan. Regarding the information needs, 15 diabetes experts identified their patients' needs, who referred that they have high information needs for topics related to their health condition. Finally, results from six patient focus groups were clustered into six themes (self-management, physical activity, eating habits, diabetes medication, psychosocial being, and sleep), all embedded into the new education program. Constructive theory, adult learning principles, and the Health Action Process Approach model were used in program development and will be used in delivery. The developed program consists of 18 educational sessions strategically mapped and sequenced to support the program learning outcomes and a patient guide with 17 chapters organized into five sections, matched with weekly lectures. CONCLUSIONS: This program is a sequential and theoretical strategic intervention that can reach programs in Brazil to support diabetes and prediabetes patient education.

Translation, cross-cultural adaptation, and psychometric properties of the Brazilian Portuguese version of the DiAbeTes Education Questionnaire (DATE-Q).

BACKGROUND: The DiAbeTes Education Questionnaire (DATE-Q) is a self-administered tool developed to evaluate disease-related knowledge and to assess knowledge of five core components of rehabilitation programs: physical exercise, diet, psychosocial well-being, disease self-management, and complications. OBJECTIVE: To translate and cross-culturally adapt into Brazilian Portuguese, and to test the psychometric properties of the DATE-Q for its use in Brazil. METHODS: The process of translation and cross-cultural adaptation consisted of five steps: translation into Brazilian Portuguese, synthesis of translation, back translation, expert committee, and pilot test of pre-final version. The pre-final version was applied to a sample of 30 patients with diabetes. Psychometric properties (internal consistency, reliability, construct validity, and ceiling and floor effects) of the final version of the Brazilian Portuguese version of the DATE-Q were tested in a sample of 200 adults with diabetes. RESULTS: There was no conceptual divergence between the original and the translated versions. Ten (50%) items of the DATE-Q were culturally adapted. Internal consistency (Cronbach's alpha coefficient = 0.6), reliability (intraclass correlation coefficient = 0.5), and construct validity (correlation between Diabetes Knowledge Scales and DATE-Q total scores: ρ = 0.7; P < 0.001) were confirmed. Ceiling or floor effects were not identified. The highest scoring item was about healthy eating. The average time for completion of the DATE-Q was 5 min and 51 s, and the completion rate was 100% for all items. CONCLUSION: The Brazilian Portuguese version of the DATE-Q showed adequate psychometric properties, and results suggested that the tool can be used to assess disease-related knowledge in adults with diabetes in Brazil.

Effectiveness of an Education Intervention Among Cardiac Rehabilitation Patients in Canada: A Multi-Site Study.

BACKGROUND: Although patient education is considered a core component of cardiac rehabilitation (CR) programs, to our knowledge, no educational program designed for CR has been standardized in Canada. This absence of standardization may be due to a lack of reliable resources to educate these patients. The objective of this study was to assess the effectiveness of an education intervention in improving knowledge and health behaviours among CR patients in 3 sites in Canada. METHODS: CR patients were exposed to an evidence- and theoretically based comprehensive education intervention. Patients completed surveys assessing knowledge, physical activity, food intake, self-efficacy, and health literacy. All outcomes were assessed pre- and post-CR. Paired t tests were used to investigate variable changes between pre- and post-CR, Pearson correlation coefficients were used to determine the association between knowledge and behaviours, and linear regression models were computed to investigate differences in overall post-CR knowledge based on participant characteristics. RESULTS: A total of 252 patients consented to participate, of whom 158 (63.0%) completed post-CR assessments. There was a significant improvement in patients' overall knowledge pre- to post-CR, as well as in exercise, food intake, and self-efficacy (P < 0.05). Results showed a significant positive correlation between post-CR knowledge and food intake (r = 0.203; P = 0.01), self-efficacy (r = 0.201; P = 0.01), and health literacy (r = 0.241; P = 0.002). Education level (unstandardized beta = -2.511; P = 0.04) and pre-CR knowledge (unstandardized beta = 0.433; P < 0.001) were influential in changing post-CR knowledge. CONCLUSION: In this first-ever multi-site study focusing on patient education for CR patients in Canada, the benefits of an education intervention have been supported.

CONTEXTE: Bien que l'éducation du patient soit considérée comme un élément essentiel des programmes de réadaptation cardiaque (RC), il n'existe, à notre connaissance, aucun programme éducatif standardisé en RC au Canada. Cette absence de standardisation peut être attribuable à un manque de ressources fiables en matière d'éducation des patients. Cette étude visait à évaluer l'efficacité réelle d'une intervention éducative au regard de l'amélioration des connaissances et des comportements touchant la santé chez des patients en RC dans trois établissements au Canada. MÉTHODOLOGIE: Une intervention éducative globale fondée sur des données probantes et théoriques a été menée auprès de patients en RC. Les patients ont répondu à des questionnaires d'évaluation des connaissances, de l'activité physique, de l'apport alimentaire, de l'autoefficacité et de la littératie en matière de santé. Tous les résultats ont été évalués avant et après la RC. Des tests t pour échantillons appariés ont été utilisés pour étudier les changements touchant les variables évaluées avant et après la RC, des coefficients de corrélation de Pearson ont servi à déterminer l'association entre les connaissances et les comportements, et des modèles de régression linéaire ont été calculés pour étudier les différences dans les connaissances globales après la RC en fonction des caractéristiques des participants. RÉSULTATS: Au total, 252 patients ont accepté de participer; de ce nombre, 158 (63,0 %) ont pris part aux évaluations postérieures à la RC. Les connaissances globales des patients se sont améliorées de façon significative d'avant à après la RC, tout comme l'activité physique, l'apport alimentaire et l'autoefficacité (p < 0,05). Les résultats ont montré une corrélation positive significative entre les connaissances et l'apport alimentaire (r = 0,203; p = 0,01), l'autoefficacité (r = 0,201; p = 0,01) et la littératie en matière de santé (r = 0,241; p = 0,002) après la RC. Le niveau d'éducation (B = -2,511; p = 0,04) et les connaissances avant la RC (B = 0,433; p < 0,001) ont influé sur les changements touchant les connaissances après la RC. CONCLUSION: Cette toute première étude multicentrique axée sur l'éducation des patients en RC au Canada a permis de confirmer les avantages d'une intervention éducative.

Comprehensive Cardiac Rehabilitation Effectiveness in a Middle-Income Setting: A RANDOMIZED CONTROLLED TRIAL.

PURPOSE: The impact of comprehensive cardiac rehabilitation (CCR) in Latin America is not well known. Herein, the pre-specified tertiary outcomes of a cardiac rehabilitation (CR) trial are reported: disease-related knowledge, depressive symptoms, and heart-health behaviors (exercise, diet, and smoking). METHODS: This was a single-blinded, single-center (Brazil) randomized trial with three parallel arms: CCR (exercise + education) versus exercise-only CR versus wait-list control. Eligible patients were randomized in blocks of four with 1:1:1 concealed allocation. The CR program was 6 mo long. Participants randomized to exercise-only CR received 36 exercise classes; the CCR group also received 24 educational sessions, including a workbook. All outcomes were assessed at pre-test and 6-mo later (blinded). Analysis of covariance was performed by intention-to-treat (ITT) and per-protocol (PP). RESULTS: A total of 115 (89%) patients were randomized; 93 (81%) were retained. There were significant improvements in knowledge with CCR (ITT [51.2 ± 11.9 pre and 60.8 ± 13.2 post] and PP; P < .01), with significantly greater knowledge with CCR versus control (ITT mean difference [MD] = 9.5, 95% CI, 2.3-16.8) and CCR vs exercise-only CR at post-test (ITT MD = 6.8, 95% CI, 0.3-14.0). There were also significant improvements in self-reported exercise with CCR (ITT [13.7 ± 15.8 pre and 32.1 ± 2 5.7 post] and PP; P < .001), with significantly greater exercise with CCR versus control at post-test (ITT MD = 7.6, 95% CI, 3.8-11.4). Also, there were significant improvements in diet with CCR (PP: 3.4 ± 7.5 pre and 8.0 ± 7.0 post; P < .05). CONCLUSIONS: In this first-ever randomized trial of CR for coronary artery disease in Latin America, the benefits of CCR have been supported.

Effectiveness of an education intervention associated with an exercise program in improving disease-related knowledge and health behaviours among diabetes patients.

OBJECTIVE: to assess the effectiveness of an education intervention associated with an exercise program in improving knowledge and health behaviours among diabetes patients. METHODS: Diabetes and prediabetes patients were exposed to an evidence- and theoretically-based comprehensive education intervention over 24 weeks. Patients completed surveys assessing knowledge, physical activity, food intake, self-efficacy, and health literacy. Functional capacity was measured by oxygen uptake. All outcomes were assessed pre- and post-CR. Satisfaction about the education provided was assessed at post-CR. Paired t-tests, Pearson correlation coefficients, and linear regression models were computed to investigate the effectiveness of this intervention. RESULTS: 84 patients consented to participate, of which 47(56.0%) completed post-CR assessments. There was a significant improvement in patients' overall knowledge pre- to post-CR, as well as in physical activity, food intake, self-efficacy, and health literacy (p < 0.05). Peak VO2 has clinically significant improved. Results showed a low significant positive correlation was between post-CR knowledge and food intake(r = 0.297;p = 0.04). Linear regression analysis revealed that age(B=-0.051; p = 0.01) was influential in changing post-CR knowledge. CONCLUSION: The benefits of an education intervention designed for diabetes and prediabetes patients associated with an exercise program have been supported. PRACTICE IMPLICATIONS: This work shows one effective education strategy taken in place that can be replicated in different settings.

Vietnamese version of the coronary artery disease education questionnaire-Short version: Translation, adaptation and validation.

WHAT IS KNOWN AND OBJECTIVE: Coronary artery disease (CAD) is the leading cause of mortality worldwide. Patient education is an essential part of cardiac patients' care targeting self-management behaviour to reduce risk factors and subsequent events. There has been no Vietnamese questionnaire to assess patient's knowledge about CAD; therefore, the purpose of this study was to translate, cross-culturally adapt and validate the Coronary Artery Disease Education Questionnaire-Short Version (CADE-Q SV) for use in Vietnam. METHODS: Translation and cross-cultural adaption of the tool were carried out in five stages: (a) two independent translations from English into Vietnamese were produced; (b) these two translations were then synthesized; (c) two translators blinded to the outcome measurements independently created separate back translations into English; (d) nine experts reached consensus on all items of the Vietnamese version of the CADE-Q SV; and (e) a pilot study was conducted on 35 patients with acute coronary syndrome (ACS). The validity and reliability of the questionnaires were then evaluated in 117 Vietnamese patients with ACS. The internal consistency and test-retest reliability were assessed by Cronbach's alpha and Cohen's kappa coefficient, respectively. Construct validity was determined by examining the relationship between knowledge scores and patient characteristics. RESULTS: The Vietnamese version of CADE-Q SV was created, including 20 items divided into two domains: medical and psychological condition, and nutrition and exercise. There was good equivalence between the original and the Vietnamese versions in all four areas: semantic, idiomatic, experiential and conceptual equivalence. Cronbach's alpha coefficients were acceptable for the questionnaire as a whole (0.78) and for the two domains: medical and psychological condition (0.71) and nutrition and exercise (0.52). All Cohen's kappa coefficients confirmed test-retest reliability (Kappa > 0.600; P < .001). Construct validity was confirmed by a significant correlation of knowledge scores with education level (P = .004). WHAT IS NEW AND CONCLUSION: The Vietnamese version of CADE-Q SV can be considered a valid and reliable questionnaire to evaluate patient's knowledge of CAD. Further studies could investigate the influence of knowledge scores on adherence to medications and clinical outcomes of patients with CAD.

Sistemas de saúde e percepção de barreiras para admissão e aderência em programas de reabilitação cardíaca: estudo comparativo / Health systems and perception of barriers to admission and adherence in cardiac rehabilitation programs: a comparative study

Além da elevada prevalência de doenças cardiovasculares (DCV), iniquidades regionais no acesso aos serviços de saúde e subutilização de programas de reabilitação cardíaca (PRC) ainda são marcantes no cenário brasileiro. Objetivo: Esse estudo visou descrever e comparar barreiras para uso de PRC em usuários de diferentes sistemas de saúde e níveis de atendimento em um estado brasileiro. Métodos: Participantes de PRC e pacientes elegíveis de enfermarias e ambulatórios foram pareados pelos sistemas de saúde que utilizavam e responderam a Escala de Barreiras para Reabilitação Cardíaca (EBRC). Os testes U de Mann-Withney e Kruskal Wallis foram usados para comparar barreiras entre os sistemas de saúde e entre níveis de atendimento, respectivamente. Resultados: Cento e quarenta (87%) pacientes participaram do estudo. A média total dos itens da escala foi 1,98±0,48 e diferiu apenas entre participantes de PRC e pacientes internados (p<0,05). Algumas barreiras de acesso, necessidades percebidas e comorbidades/estado funcional foram maiores no sistema público do que no privado (p<0,05). A falta de conhecimento sobre PRC (3.75±1.66) e a falta de referência médica (2.32±1.53) destacaram-se no domínio necessidades percebidas, que teve o maior escore médio da amostra (2.31±0.71). Conclusões: Barreiras de acesso e necessidades percebidas foram maiores para usuários de serviços públicos. Viagens e trabalho foram barreiras maiores para participantes de PRC, enquanto para pacientes internados e ambulatoriais as maiores barreiras foram necessidades percebidas. Logo, a disseminação de PRC e estratégias para referência de elegíveis devem ser estimuladas em ambos os sistemas de saúde e níveis de atendimento.

In addition to the high prevalence of cardiovascular disease (CVD), regional iniquities in access to health services and underutilization of cardiac rehabilitation programs (CRP) are still significant in the Brazilian scenario. Objective:This study aimed to describe and compare barriers to the use of CRP in users of different health systems and levels of care in a Brazilian state. Methods: CRP participants and eligible inpatients and outpatients were matched by the health systems they used and responded to the Cardiac Rehabilitation Barriers Scale (CRBS). Mann-Whitney U and Kruskal Wallis tests were used to compare barriers in health systems and levels of care, respectively. Results: One hundred and forty (87%) adults with heart disease participated in the study. The total mean score of barriers on the scale was 1.98 ± 0.48 and only differed between CRP participants and inpatients (p<0.05). Some access barriers, perceived needs and comorbidities/functional status were higher in the public services than in the private services (p <0.05). Lack of knowledge about CRP (3.75 ± 1.66) and lack of medical referral (2.32 ± 1.53) were the major barriers in the perceived needs domain, which had the highest average score in the sample (2.31 ± 0.71). Conclusions: Access barriers and perceived needs were greater among users of public services. Travel and work were greater barriers for CRP participants, while for inpatients and outpatients the largest were perceived needs. Therefore, the dissemination of CRP and implementation of strategies for eligible referral should be encouraged in both health systems and levels of care.

The Effects of Cardiac Rehabilitation on Mortality and Morbidity in Women: A META-ANALYSIS ATTEMPT.

PURPOSE: Cardiac rehabilitation (CR) is associated with significant reductions in mortality and morbidity, but few women are included in trials. Therefore, a meta-analysis of the effects of CR in women is warranted. METHODS: Randomized controlled trials from recent systematic reviews that included women attending comprehensive CR and reporting the outcomes of mortality and morbidity (hospitalization, myocardial infarction, bypass surgery, percutaneous coronary intervention) were considered for inclusion. An updated search of the literature was performed from the end date of the last search, based on the Cochrane strategy. Authors were contacted to provide results on women where none were reported. RESULTS: On the basis of 2 recent systematic reviews, 80 trials were identified. Fifty (62.5%) were excluded, most commonly due to lack of inclusion of women (n = 18; 22.5%). One trial was identified through the search update. Of 31 potential trials meeting inclusion criteria, 1 reported results on women and many were old, and hence data by sex were no longer available. Ultimately, data for women were available in 2 trials. Therefore, it was deemed inappropriate to undertake this meta-analysis. CONCLUSIONS: This review corroborates the dearth of data on CR in women despite the fact that cardiovascular disease is the leading cause of death in women. Given the totality of evidence, including reductions in mortality and morbidity in nonrandomized studies, and evidence of benefit for other important outcomes such as functional capacity and quality of life, women should continue to be referred to CR.

Validation of the Brazilian-Portuguese Version of a Short Questionnaire to Assess Knowledge in Cardiovascular Disease Patients (CADE-Q SV) / Validação da Versão Brasileira do Questionário Curto para Avaliar Conhecimento de Pacientes com Doenças Cardiovasculares (CADE-Q SV)

Abstract Background: Patient education is an essential part of cardiovascular patients' care targeting self-management behavior to reduce risk factors and subsequent events. Herein, a short and reliable tool to assess patients' knowledge in Brazil is warranted. Objectives: To translate, culturally-adapt and psychometrically validate the Portuguese version of the Coronary Artery Disease Education Questionnaire Short Version (CADE-Q SV). Methods: The Portuguese CADE-Q SV - translated and culturally-adapted - was reviewed by five bilingual experts in cardiovascular disease. This version was then pre-tested in 21 patients, and clarity of items was checked using a Likert-type scale ranging from 1 = not clear to 10 = very clear. It was then psychometrically tested in 200 cardiovascular patients (41%women; mean age = 58.4 ± 11.6 years old). The internal consistency was assessed using Kuder-Richardson-20 (KR-20) and Cronbach's alpha, test-retest reliability through intraclass correlation coefficient (ICC), factor structure using confirmatory factor analysis, and construct validity regarding educational level, family income, and time of diagnosis. Results: All questions were considered clear by patients (clarity range:7.8-9.6). KR-20 was 0.70. All ICC values were > 0.70. Factor analysis revealed 6 factors, all internally consistent. Construct validity was supported by significant differences in total scores by educational level and family income (p < 0.001). The overall mean was 13.08 ± 2.61. The area with the highest knowledge was risk factors and the lowest was psychosocial risk. Conclusions: The Portuguese CADE-SV was demonstrated to have good validity and reliability. This tool can be applicable in clinical and research settings, assessing cardiovascular patients' knowledge as part of an education programming.

Resumo Fundamento: A educação é parte essencial do atendimento dos pacientes cardiovasculares, visando ao autocuidado, para reduzir os fatores de risco. Assim, uma ferramenta curta e confiável para avaliar o conhecimento dos pacientes no Brasil é necessária. Objetivo: Traduzir, adaptar culturalmente e validar psicometricamente a versão em português do Coronary Artery Disease Education Questionnaire Short Version (CADE-Q SV). Métodos: CADE-Q SV português foi revisado por cinco especialistas em doenças cardiovasculares bilíngues e testado em 21 pacientes, avaliando clareza dos itens por uma escala tipo Likert variando de 1 = não clara a 10 = muito clara. Foi testada psicometricamente em 200 pacientes cardiovasculares (41% mulheres; média de idade = 58,4 ± 11,6 anos). Consistência interna foi avaliada usando o Kuder-Richardson-20 (KR-20) e o alfa de Cronbach; teste-reteste de confiabilidade por meio do coeficiente de correlação intraclasse (ICC); estrutura de fatores usando análise fatorial; e validade de construto em relação ao nível educacional, renda familiar e tempo de diagnóstico. Resultados: Todas as perguntas foram consideradas claras pelos pacientes (faixa de clareza: 7,8-9,6). O KR-20 foi de 0,70. Todos os valores ICC foram > 0,70. A análise dos fatores revelou 6 fatores, todos consistentes. A validade do construto foi sustentada por diferenças significativas nas pontuações totais por nível educacional e renda familiar (p < 0,001). A média geral foi de 13,08 ± 2,61. A área com maior conhecimento foi fatores de risco e menor risco psicossocial. Conclusão: O CADE-SV português demonstrou ter boa validade e confiabilidade; podendo ser aplicado em contextos clínicos e de pesquisa, avaliando o conhecimento dos pacientes com doença cardiovascular.

Availability and characteristics of cardiac rehabilitation programs in one Brazilian state: a cross-sectional study.

BACKGROUND: Cardiac rehabilitation (CR) is a recommended model of care for cardiovascular diseases; however, is not widely available and is underutilized, especially in low- and middle-income countries. OBJECTIVES: To identify the CR programs available in one Brazilian state (Minas Gerais; MG) and describe their characteristics by funding type. METHODS: In this multi-center descriptive study, CR programs were identified in four MG regions and 41 CR coordinators were sent a survey to report the characteristics of their programs, including CR components described in guidelines and barriers to patients' participation. Descriptive and comparative analysis between public and private programs were carried out. RESULTS: Forty-one CR programs were identified, only 21.9% public. Nineteen completed the survey. The majority of CR programs offered initial assessment and physical training. Components of comprehensive CR programs that were rarely offered included treatment of tobacco dependence, psychological support and lipid control. Physical therapists were present in all CR programs. The six-minute walk test was used in most programs to assess functional capacity. Programs were located intra-hospital only in public hospitals. Phase 2 (initial outpatient) and phase 4 (maintenance) were offered significantly more in private programs when compared to public ones. The main barrier for CR participation was the lack of referral. CONCLUSIONS: The availability of CR programs in MG state is low, especially public programs. Most programs do not offer all core components of CR.

Development and Psychometric Validation of HIPER-Q to Assess Knowledge of Hypertensive Patients in Cardiac Rehabilitation / Construção e Validação Psicométrica do HIPER-Q para Avaliar o Conhecimento de Pacientes Hipertensos em Reabilitação Cardíaca

Abstract Background: The absence of instruments capable of measuring the level of knowledge of hypertensive patients in cardiac rehabilitation programs about their disease reflects the lack of specific recommendations for these patients. Objective: To develop and validate a questionnaire to evaluate the knowledge of hypertensive patients in cardiac rehabilitation programs about their disease. Methods: A total of 184 hypertensive patients (mean age 60.5 ± 10 years, 66.8% men) were evaluated. Reproducibility was assessed by calculation of the intraclass correlation coefficient using the test-retest method. Internal consistency was assessed by the Cronbach's alpha and the construct validity by the exploratory factorial analysis. Results: The final version of the instrument had 17 questions organized in areas considered important for patient education. The instrument proposed showed a clarity index of 8.7 (0.25). The intraclass correlation coefficient was 0.804 and the Cronbach's correlation coefficient was 0.648. Factor analysis revealed five factors associated with knowledge areas. Regarding the criterion validity, patients with higher education level and higher family income showed greater knowledge about hypertension. Conclusion: The instrument has a satisfactory clarity index and adequate validity, and can be used to evaluate the knowledge of hypertensive participants in cardiac rehabilitation programs.

Resumo Fundamento: A ausência de instrumentos capazes de mensurar o nível de conhecimento de pacientes hipertensos em programas de reabilitação cardíaca sobre sua doença reflete a carência de recomendações específicas para esses pacientes. Objetivo: Construir e validar um questionário para avaliar o conhecimento de hipertensos em programas de reabilitação cardíaca sobre sua doença. Métodos: foram avaliados 184 hipertensos, com média de idade de 60,5±10 anos, 66,8% homens. A reprodutibilidade foi avaliada pelo cálculo do coeficiente de correlação intraclasse, utilizando-se as situações do método de teste-reteste. A consistência interna foi avaliada pelo alfa de Cronbach, e a validade do construto pela análise fatorial exploratória. Resultados: A versão final do instrumento apresentou 17 questões dispostas em áreas de importância para a educação do paciente. O instrumento proposto apresentou um índice de clareza de 8,7 (0,25). O valor do coeficiente de correlação intraclasse foi de 0,804 e do alfa de Cronbach 0,648. A análise fatorial revelou cinco fatores associados às áreas de conhecimento. No que diz respeito à validade de critério, os pacientes com maior escolaridade e maior renda familiar apresentaram maior conhecimento sobre a hipertensão. Conclusão: O instrumento possui índice de clareza satisfatório e validade adequada, podendo ser utilizado para avaliar o conhecimento de hipertensos participantes de programas de reabilitação cardíaca.

Health literacy and coronary artery disease: A systematic review.

OBJECTIVE: Identify health literacy (HL) screening instruments available to CAD patients; describe the prevalence of low HL; explore the predictors of low HL; and, identify the association between HL, health behaviors, and outcomes among these patients. METHODS: A literature search of electronic databases was conducted for published articles from database inception to February 2017. Eligible articles included the assessment of HL in CAD patients. Health behaviors and outcomes included diet, exercise, smoking, medication use, hospital readmission, knowledge, health-related quality of life (HRQoL), and psychosocial indicators. RESULTS: Overall, ten articles were included, of which two were RCTs, and seven were considered "good" quality. The most used screening instruments were REALM and TOFHLA. The average prevalence of low HL was 30.5%. Low HL participants were more likely to be older, male, from a non-white ethnic group, have many CVD comorbidities, lower educational level, disadvantaged socioeconomic position, and less likely to be employed. Low HL was consistently associated with hospital readmissions, low HRQoL, higher anxiety and lower social support. CONCLUSION: The literature on HL in CAD patients is very limited. PRACTICE IMPLICATIONS: Healthcare providers should start adopting strategies that can potentially mitigate the impact of low HL in the care of CAD patients.

Validation of the portuguese version of the tampa scale for kinesiophobia heart (TSK-SV heart) / Validação da versão em português da escala de tampa para cinesiofobia cardíaca (TSK-SV cardíaca) / Validación de la versión en portugués de la escala de tampa para kinesiofobia cardiaca (TSK-SV cardiaca)

ABSTRACT Introduction: It has been shown that kinesiophobia has a negative influence on the outcomes of cardiac rehabilitation and consequently is important for the clinical setting. Objective: The objective of this study was to translate, culturally adapt, and psychometrically validate the Tampa Scale for Kinesiophobia Heart (TSK-SV Heart) to Brazilian Portuguese. Methods: The Portuguese version was tested in 300 patients in cardiac rehabilitation. Test-retest reliability was assessed by intraclass correlation coefficient, internal consistency by Cronbach's alpha, and criterion validity was assessed with respect to patients' education, income, duration of cardiac rehabilitation, and sex. Results: After intraclass correlation coefficient analysis, one item was excluded. All four areas were considered internally consistent (α >0.7). Significant differences between mean total scores and income (p<0.01) supported the criterion validity. Two hundred sixty-nine (89.6%) patients had a high level of kinesiophobia (scores > 37). Conclusions: The Brazilian Portuguese version of TSK-SV Heart demonstrated sufficient reliability, consistency and validity, supporting its use in future studies.

RESUMO Introdução: Demonstrou-se que a cinesiofobia tem influência negativa sobre os resultados da reabilitação cardíaca e, consequentemente, é importante no contexto clínico. Objetivo: O objetivo deste estudo foi traduzir, fazer a adaptação cultural e validar em termos psicométricos a Escala de Tampa para Cinesiofobia Cardíaca (TSK-SV Cardíaca) para o português do Brasil. Métodos: A versão em português foi testada em 300 pacientes em reabilitação cardíaca. A confiabilidade teste-reteste foi avaliada pelo coeficiente de correlação intraclasse, a consistência interna pelo alfa de Cronbach, e a validade de critério foi avaliada no que diz respeito a educação dos pacientes, renda, duração da reabilitação cardíaca e sexo. Resultados: Após análise do coeficiente de correlação intraclasse, um item foi excluído. Todas as quatro áreas foram consideradas internamente consistentes (α > 0,7). As diferenças significativas entre os escores totais médios e de renda (p < 0,01) apoiaram a validade de critério. Duzentos e sessenta e nove (89,6%) pacientes apresentavam um alto nível de cinesiofobia (escore > 37). Conclusões: A versão em português do Brasil da TSK-SV Cardíaca demonstrou ter confiabilidade, consistência e validade suficientes, apoiando a sua utilização em estudos futuros.

RESUMEN Introducción: Se ha demostrado que la kinesiofobia tiene una influencia negativa sobre el resultado de la reha-bilitación cardiaca y, por consiguiente, es importante en el contexto clínico. Objetivo: El objetivo de este estudio fue traducir, hacer la adaptación cultural y la validación en términos psicométricos de la Escala de Tampa para Kinesio-fobia Cardiaca (TSK-SV Cardiaca) al portugués de Brasil. Métodos: La versión portuguesa se probó en 300 pacientes en rehabilitación cardiaca. Se evaluó la fiabilidad test-retest por el coeficiente de correlación intraclase, la consistencia interna mediante el alfa de Cronbach, y la validez de criterio con respecto a la educación, el ingreso, la duración de la rehabilitación cardiaca y el sexo de los pacientes. Resultados: Después del análisis de coeficientes de correlación intraclase, un elemento ha sido eliminado. Las cuatro áreas se consideraron internamente consistentes (α > 0,7). Las diferencias significativas entre las puntuaciones totales medias y el ingreso (p < 0,01) apoyaron la validez del criterio. Doscientos sesenta y nueve (89,6%) pacientes tenían un alto nivel de kinesiofobia (puntuación > 37). Conclusiones: La versión en portugués de Brasil de la TSK-SV Cardiaca ha demostrado suficiente fiabilidad, consistencia y validez, apoyando su uso en futuros estudios.

Development, pilot testing and psychometric validation of a short version of the coronary artery disease education questionnaire: The CADE-Q SV.

OBJECTIVE: To develop, pilot test and psychometrically validate a shorter version of the coronary artery disease education questionnaire (CADE-Q), called CADE-Q SV. METHODS: Based on previous versions of the CADE-Q, cardiac rehabilitation (CR) experts developed 20 items divided into 5 knowledge domains to comprise the first version of the CADE-Q SV. To establish content validity, they were reviewed by an expert panel (N=12). Refined items were pilot-tested in 20 patients, in which clarity was provided. A final version was generated and psychometrically-tested in 132CR patients. Test-retest reliability was assessed via the intraclass correlation coefficient (ICC), the internal consistency using Cronbach's alpha, and criterion validity with regard to patients' education and duration in CR. RESULTS: All ICC coefficients meet the minimum recommended standard. All domains were considered internally consistent (α>0.7). Criterion validity was supported by significant differences in mean scores by educational level (p<0.01) and duration in CR (p<0.05). Knowledge about exercise and nutrition was higher than knowledge about medical condition. CONCLUSION: The CADE-Q SV was demonstrated to have good reliability and validity. PRACTICE IMPLICATIONS: This is a short, quick and appropriate tool for application in clinical and research settings, assessing patients' knowledge during CR and as part of education programming.

Treinamento aeróbio intenso promove redução da pressão arterial em hipertensos / Intense aerobic training promotes reduction of blood pressure in hypertensive / Entrenamiento aeróbico intenso promueve reducción de la presión arterial en hipertensos

INTRODUÇÃO: O treinamento físico promove importantes respostas adaptativas no organismo que diminuem a morbidade e a mortalidade em hipertensos. Entretanto, são poucos os estudos que avaliaram a resposta pressórica do treinamento aeróbio de diferentes intensidades em hipertensos. Objetivo: Analisar os efeitos do treinamento físico aeróbio intenso com relação ao treinamento físico moderado sobre a pressão arterial ambulatorial em hipertensos.MÉTODOS: Participaram do estudo 32 hipertensos (48 ± 9 anos) randomizados como: grupo de treinamento aeróbio de intensidade moderada (IM), intensidade de 60-65% da frequência cardíaca de reserva, 40 minutos, três sessões por semana (n=12); exercício aeróbio de alta intensidade (AI), intensidade de 80% a 85% da frequência cardíaca de reserva (n=12), com a duração ajustada para atingir o mesmo gasto energético que a IM e um grupo controle (GC) sem exercícios (n=10). Nos três grupos foram avaliadas variáveis da monitorização ambulatorial da pressão arterial de 24 horas (MAPA) antes e após as oito semanas de intervenção.RESULTADOS: Após a intervenção a pressão arterial sistólica (PAS) da vigília reduziu 10,1 mmHg (p=0,024) em AI e 9,7 mmHg (p=0,035) em IM e a pressão arterial diastólica (PAD) da vigília reduziu 12,3 mmHg (p=0,002) em AI e 8,4 mmHg (p<0,001) em IM. A PAS do sono reduziu 9,5 mmHg (p=0,004) apenas em AI e 9,8 mmHg (p=0,005) em IM. A PAD do sono reduziu 8,2 mmHg (p=0,006) em AI e 4,8 mmHg (p<0,007) em IM. As cargas pressóricas sistólicas e diastólicas da vigília e do sono reduziram-se significativamente apenas em AI.CONCLUSÃO: Treinamento físico aeróbio moderado e intenso com duração equalizada pelo gasto calórico tem efeito hipotensor semelhante em hipertensos. A carga pressórica reduziu apenas na AI, sendo assim intensidade-dependente.

INTRODUCTION: Physical training promotes important adaptive responses in the body that decrease morbidity and mortality in hypertensive patients. However, few studies have evaluated the blood pressure response of aerobic training of different intensities in hypertensive patients. Objective: To analyze the effects of intense physical training versus moderate physical training on ambulatory blood pressure in hypertensive patients.METHODS: The study included 32 hypertensive patients (aged 48±9 years) randomized as group of aerobic training of moderate intensity (MI), intensity of 60-65% of the heart rate reserve, 40 minutes, three sessions per week (n=12 ); high-intensity aerobic exercise (HI), intensity of 80-85% of the heart rate reserve (n=12), with the duration adjusted to achieve the same energy expenditure that MI, and a control group (CG) without exercise (n=10). In all three groups the variables ambulatory 24h blood pressure (ABPM) were assessed before and after the eight-week intervention.RESULTS: After the intervention, awake systolic blood pressure (SBP) decreased 10.1mmHg (p=0.024) in HI and 9.7mmHg (p=0.035) in MI and awake diastolic blood pressure (DBP) decreased 12.3mmHg (p=0.002) in HI and 8.4mmHg (p<0.001) in MI. The sleeping SBP reduced 9.5mmHg (p = 0.004) only in AI and 9.8mmHg (p=0.005) in MI. The sleeping DBP reduced 8.2mmHg (p=0.006) in AI and 4.8mmHg (p<0.007) in MI. Systolic and diastolic BP loads of wakefulness and sleep were significantly reduced only in HI.CONCLUSION: Moderate and intense aerobic exercise training with a duration equalized by caloric expenditure has similar hypotensive effects in hypertensive patients. The pressure load decreased only in HI, thus being intensity-dependent.

INTRODUCCIÓN: El entrenamiento físico promueve importantes respuestas adaptativas en el organismo que disminuyen la morbimortalidad en hipertensos. Sin embargo, son pocos los estudios que evaluaron la respuesta presórica del entrenamiento aeróbico de diferentes intensidades en hipertensos. Objetivo: Analizar los efectos del entrenamiento físico aeróbico intenso versus el entrenamiento físico moderado sobre la presión arterial ambulatoria en hipertensos.MÉTODOS: Participaron en el estudio 32 hipertensos (48±9 años) separados de forma aleatoria como: grupo de entrenamiento aeróbico de intensidad moderada (IM), intensidad de 60-65% de la frecuencia cardíaca de reserva, 40 minutos, tres sesiones por semana (n=12); ejercicio aeróbico de alta intensidad (AI), intensidad de 80-85% de la frecuencia cardíaca de reserva (n=12), con la duración ajustada para alcanzar el mismo gasto energético que el IM y un grupo control (GC) sin ejercicios (n = 10). En los tres grupos fueron evaluadas variables de la monitorización ambulatoria de la presión arterial de 24 horas (MAPA) antes y después de las ocho semanas de intervención.RESULTADOS: Después de la intervención la presión arterial sistólica (PAS) de la vigilia se redujo a 10,1 mmHg (p=0,024) en AI y 9,7 mmHg (p=0,035) en IM y la presión arterial diastólica (PAD) de la vigilia se redujo a 12,3 mmHg (p=0,002) en AI y 8,4 mmHg (p<0,001) en IM. La PAS del sueño se redujo a 9,5 mmHg (p=0,004) sólo en AI y 9,8 mmHg (p=0,005) en IM. La PAD del sueño se redujo a 8,2 mmHg (p=0,006) en AI y 4,8 mmHg (p<0,007) en IM. Las cargas presóricas sistólicas y diastólicas de la vigilia y del sueño se redujeron significativamente sólo en AI.CONCLUSIÓN: En entrenamiento físico aeróbico moderado e intenso con duración ecualizada por el gasto calórico tiene efecto hipotensor semejante en hipertensos. La carga presórica se redujo sólo en el AI, siendo así intensidad dependiente.