Impact of a Theory-Based Intervention to Promote Medication Adherence in Patients With a History of Myocardial Infarction.

BACKGROUND: Patient discontinuation of cardioprotective medications after a cardiac ischemic event commonly occurs early after hospital discharge. Theory-based interventions could be effective in promoting better patient self-regulation of health-related behaviors and positive intentions to adhere to the recommended medical regimen. OBJECTIVE: The aim of this study was to evaluate the potential efficacy and feasibility of a theory-based intervention to promote adherence to cardioprotective medications. METHODS: In this mixed-methods quasi-experimental study with 3 time points, we recruited 45 participants with a positive intention to adhere and a history of myocardial infarction. They were recruited in primary care units in Brazil. Data collection occurred in 2 waves (Tb and T60). The intervention consisted of developing action and coping plans, delivered in a 30-minute face-to-face session, with face-to-face reinforcement at a 30-day interval. Quantitative data were submitted to descriptive, Wilcoxon, and McNemar analyses; qualitative data were submitted to content analysis. RESULTS: An increase in the proportion of patients adhering to medications at the end of follow-up was found (T60 - Tb, +60.0%; P < .001). In addition, a significant reduction was found for blood pressure (T60 - Tb, -8.6 mm Hg; P < .001), heart rate (T60 - Tb, -6.6 bpm; P < .001), and low-density lipoprotein (T60 - Tb, -6.2 mg/dL; P < .05). Qualitative results revealed that the intervention was feasible, with an attrition rate of zero. The intervention was found to be easy to apply to patients' daily lives, and there was adequate time for implementation. CONCLUSIONS: Our data confirm the potential efficacy of a theory-based intervention on the promotion of adherence to cardioprotective medications and on the related clinical end points, as well as its feasibility in the clinical context (Universal Trial Number: U1111-1189-9967).

What methods have been used to estimate salt intake? A systematic review.

The relationship between salt intake and cardiovascular diseases is a contemporary scientific controversy, which has been attributed to the limits of the measures of salt intake used in the studies. Thus, this article sought to systematically review the literature on the methods used to estimate salt intake in different study designs. Of the 124 articles, 60.5% used only biochemical measures, 26.6% only self-report measures and 12.9% reported the combined use of both methods. The 24-hour urinary sodium excretion was the predominant biochemical method (79.1%) and the Food Frequency Questionnaire was the predominant self-report measure (36.4%). Interventional studies used mostly 24-hour urinary sodium excretion; while longitudinal studies used self-report measures. The question guiding the study and its design, as well as constraints related to costs, sample size and feasibility seems to influence the choice of the type of measurement.

Dietary sources of salt intake in adults and older people: a population-based study in a Brazilian town.

OBJECTIVE: To assess salt intake and its dietary sources using biochemical and self-report methods and to characterize salt intake according to sociodemographic and disease-related variables in a sample of the Brazilian population. DESIGN: Population-based cross-sectional survey. SETTING: Salt intake was assessed by biochemical (24 h urinary Na excretion) and self-report methods (sodium FFQ, 24 h dietary recall, seasoned-salt questionnaire, discretionary-salt questionnaire and total reported salt intake).ParticipantsAdults and older people (n 517) aged 20-80 years, living in Artur Nogueira, São Paulo, Brazil. RESULTS: Mean salt intake based on 24 h urinary Na excretion and total reported salt intake was 10·5 and 11·0 g/d, respectively; both measures were significantly correlated. Discretionary salt and seasoned salt were the most important sources of salt intake (68·2 %). Men in the study consumed more salt than women as estimated by 24 h urinary Na excretion (11·7 v. 9·6 g salt/d; P<0·0001). Participants known to be hypertensive added more salt to their meals but consumed less salty ultra-processed foods. Waist circumference in both sexes and BMI were positively correlated with salt intake estimated by 24 h urinary Na excretion. In addition, regression analysis revealed that being a young male or having a high waist circumference was a predictor of higher salt intake. CONCLUSIONS: Salt intake in this population was well above the recommended amount. The main source of salt intake came from salt added during cooking. Salt intake varied according to sex and waist circumference.

[Factors associated with beliefs about adherence to non-pharmacological treatment of patients with heart failure]. / Fatores associados às crenças sobre adesão ao tratamento não medicamentoso de pacientes com insuficiência cardíaca.

This study aimed at assessing beliefs about the benefits and barriers to adherence to daily self-monitoring of weight/edema in patients with heart failure, and the influence of demographic and clinical variables on those beliefs. 105 patients were interviewed. The mean of the subscales Benefits and Barriers were 20.2 (± 5.7) and 30.1 (±7.1), respectively. Patients perceived that adherence to daily self-monitoring of weight/edema could keep them healthy, improve their quality of life and decrease the chances of readmission. Approximately half of patients (46.7%) reported forgetting this measure. Those who controlled weight once a month were more likely to have barriers to adherence (OR= 6.6; IC 95% 1.9-13.8; p=0.01), showing this measure to be the main factor related to perceived barriers. Education in health can contribute with the development of strategies aimed at lowering barriers and increasing benefits of this control.

Validity, sensitivity and specificity of a measure of medication adherence instrument among patients taking oral anticoagulants.

Although self-report instruments are currently considered a valuable tool for measuring adherence, due to their low cost and ease of implementation, there are still important factors that impact measurement accuracy, such as social desirability and memory bias. Thus, the Global Assessment of Medication Adherence Instrument (GEMA) was developed to provide an accurate measure of this construct. The aim of this study was to evaluate the properties of the measurement of the Global Evaluation of Medication Adherence Instrument (GEMA) among patients with chronic diseases. A methodological study was conducted in the public hospital of the state of São Paulo, Brazil. The adherence to anticoagulants as well as the international normalized ratio (INR) was assessed on 127 patients. Besides GEMA, two other instruments were used to assess adherence: the Morisky Medication Adherence Scale-8 (MMAS-8) and the Measurement of Adhesion to Treatments (MAT). The GEMA presented a satisfactory level of specificity (0.76) to identify adherents among those with a stable INR, low sensitivity (0.43) for the identification of non-adherents among those with an unstable INR, and a Positive Predictive Value of 0.70. Positive and weak to moderate correlations were observed between the proportion of doses assessed with GEMA and the scores on the MMAS-8 (r = .26 and r = .22, respectively) and the MAT (r = .22 and r = .30, respectively). The GEMA presented good practicality, acceptability, and evidence of specificity regarding the stability of the INR. The validity of the construct was partially supported by the relationship with self-reported measures of adherence.

[Characterization of nursing diagnoses of patients in a cardiology unit]. / Caracterização dos diagnósticos de enfermagem de pacientes internados em uma unidade de cardiologia.

This retrospective, descriptive-exploratory study aimed to formulate the most frequent nursing diagnoses (ND) among inpatients with ischemic heart disease and its association with sociodemographic and clinical data. Data collection was carried out by an instrument based on defining characteristics and risk factors (Taxonomy II, North American Nursing Diagnosis Association International) and submitted to descriptive and inferential analyses to test the association between ND and demographic and clinical data. Seventy-seven ND were formulated, and 18 ND were above 75 percentile. From those ND, 15 were associated to at least one sociodemographic or clinical variable as gender, age, marital status, professional activity and associated clinical condition.

A Mobile Phone App Intervention to Promote Healthy Salt Intake Among Adults: Protocol for a Randomized Controlled Study.

BACKGROUND: There is sound evidence associating high salt intake and a greater risk of cardiovascular and noncardiovascular diseases. High salt intake has been observed in several populations worldwide. Therefore, promoting healthier salt consumption has been encouraged as a low-cost strategy to reduce this risk factor. However, these strategies need to be sound, built on theoretical and methodological bases, and consider the target population's context. OBJECTIVE: This protocol aims to describe a mobile phone app intervention to promote healthy salt intake among adults. METHODS: This is an experimental and longitudinal study protocol conducted in three modules. Module 1 refers to the planning of the intervention based on the Behaviour Change Wheel framework. Module 2 is the development of the mobile phone app intervention based on the date of module 1. In module 3, the intervention will be evaluated using a randomized controlled study, with three steps of data collection in a 2-month follow-up in a sample of 86 adults (43 participants for each group: the control group and intervention group) recruited from the primary health care centers of a Brazilian town. The discretionary salt intake questionnaire will assess salt consumption, the app usability will be assessed using the System Usability Scale, and psychosocial variables (habit, intention, and self-efficacy) will also be measured. RESULTS: Recruitment began in October 2021, and the follow-up will end in August 2022. The results of this study are expected to be published in 2023. CONCLUSIONS: Results from this study will help people to control salt intake when cooking at home, will stimulate self-care, will work as an alternative or supportive method in the relationship between health care professionals and patients, and will contribute to implementing the app intervention to promote healthy salt intake on a large scale. TRIAL REGISTRATION: The Brazilian Clinical Trials Registry RBR-4s8qyyq; https://ensaiosclinicos.gov.br/rg/RBR-4s8qyyq. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/37853.

Cultural adaptation and reliability analysis of the Modified Dyspnea Index for the Brazilian culture.

This study aims to present the cross-cultural adaptation process of the Modified Dyspnea Index to the Brazilian culture and to investigate its content validity and reliability. This process included the steps of translation, back translation and review by two experts to assess semantic, conceptual, idiomatic, cultural and metabolic equivalence. The Index of Content Validity was used to evaluate the extent of inter-observer agreement. A Guide to implement the Modified Dyspnea Index was developed and validated. Two different professionals assessed the reliability of the Brazilian version of the Modified Dyspnea Index, according to the inter-observer equivalence criterion, with 31 patients, indicating a Kappa coefficient=0.960 (p<0.001). In conclusion, the Brazilian version of MDI presented evidence of interobserver equivalence when applied by different health professionals in the population of cardiac patients.

[Development of an instrument to measure psychosocial determinants of physical activity behavior among coronary heart disease patients]. / Desenvolvimento de instrumento para medida dos fatores psicossociais determinantes do comportamento de atividade física em coronariopatas.

The aim of this study was to report the development and the analysis of content validity and reliability of the Psychosocial Determinants of Physical Activity among Coronary Heart Disease Patients Questionnaire, based on an extension of the Theory of Planned Behavior. In the content validity step, three experts evaluated the instrument which was, afterwards, pre-tested with five subjects in order to obtain a conceptually appropriate and easily understood instrument. Fifty-one patients participated in the evaluation of internal consistency of the reviewed instrument. Cronbach's alpha coefficients above 0.75 were observed for the constructs: Intention, Attitude, Subjective Norm, Self-efficacy and Habit. The new instrument demonstrated acceptable evidence of content validity and reliability.

[Stressors at the intensive care unit: the Brazilian version of The Environmental Stressor Questionnaire]. / Estressores em Unidade de Terapia Intensiva: versão brasileira do The Environmental Stressor Questionnaire.

The objective of the present study was to perform the cultural adaptation of The Environmental Stressor Questionnaire-ESQ for the Brazilian Portuguese, as well as to verify its reliability and validity. In order to ensure the equivalence between the original instrument and the Brazilian version, all methodological steps recommended in the literature regarding cultural adaptation were followed. The Brazilian version of the ESQ was applied to 106 ICU patients in two hospitals (public and private) in the interior of São Paulo State. Reliability was evaluated in relation to internal consistency and stability (test e retest) and the convergent validity was determined by the correlation between ESQ and generic questions about ICU stress. Reliability was satisfactory with Cronbach's Alfa = 0.94 and stability (ICC = 0.861; IC 95% 0.723; 0.933). ESQ total score displayed strong correlation with the generic questions about stress (r = 0.70; p < 0.0001), thus confirming the convergent validity. The conclusion was that the ESQ adapted for Brazilian culture is a reliable instrument for evaluation of stressors in the ICU.

[Physical activity behavior among coronary outpatients according to socio-demographic and clinical profile]. / Comportamento de atividade física de cardiopatas isquêmicos segundo perfil sociodemográfico e clínico.

Behavior and motivation for physical activity (PA) were assessed among 144 coronary heart disease outpatients according to the sociodemographic and clinical profile. The sample was predominantly male (63.9%), with 59.4(± 8.8) years, with low levels of monthly income and schooling. Behavior and Habitual PA measures revealed sedentary lifestyle with high motivation for future PA. Women, patients with history of angina and non-smokers reported lower levels of behavior and motivation. Higher age, lower income, lower number of associated conditions, less time since last coronary syndrome and higher values of BMI were associated to lower levels of PA. The findings suggest that the pattern of PA and motivation vary among CHD outpatients according to sociodemographic and clinical profile, information that should be considered in educational interventions.

Psychometric properties of MacNew Heart Disease Health-related Quality of Life Questionnaire: Brazilian version.

AIM: . This paper is a report of a study to test the psychometric properties of the Brazilian Version of the MacNew Heart Disease Health-related Quality of Life Questionnaire. BACKGROUND: Evidence of acceptable psychometric properties of the original MacNew questionnaire has been reported. However, the psychometric performance of the Brazilian version has not been extensively studied. METHOD: Between November 2004 and June 2005, 159 patients with myocardial infarction completed the Brazilian version of the instrument. Reliability was determined with Cronbach's alpha coefficient; convergent validity with Pearson's correlation between the Brazilian MacNew questionnaire and the SF-36; and the 'known-group' approach was used to test discriminant validity. Ceiling and floor effects and practicality were analyzed. FINDINGS: It took an average of 8.9 minutes to complete the instrument. A ceiling effect was detected in the subscales and global scores, with no floor effect. Cronbach's alpha coefficient ranged from 0.87 to 0.92. Scores on similar domains of the SF-36 and the MacNew questionnaire were correlated (r = 0.66; 0.78 and 0.53 for the physical, emotional, and social domains). Correlation between the dissimilar SF-36 mental health and MacNew physical domains was lower at 0.45; correlation between the dissimilar SF-36 physical functioning and MacNew emotional domain was 0.64. Individuals without regional ventricular dysfunction or symptoms had statistically significantly higher scores than those with regional ventricular dysfunction or symptoms. CONCLUSION: The Brazilian version of the MacNew questionnaire has acceptable levels of validity, reliability and practicality. Further studies are advisable to confirm its divergent validity and to test its responsiveness.

Integrative review: behavioral interventions for physical activity practice.

This study aimed to carry out an integrative literature review on the effectiveness of interventions in physical activity (PA) practice in the general population. The search was carried out in articles indexed in online databases: Scopus, CINAHL and Medline. Studies in English or Brazilian Portuguese were included, with evidence levels 2 or 3, published between 2004 and 2008. The final sample consisted of 14 studies. In 57.1% of the studies, interventions were effective for behavior change to practice PA. The diversity of target populations, assessment instruments and intervention designs makes it difficult to compare results and build evidence on the effectiveness of interventions for PA promotion.

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

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

[Clinical and psycosocial features of heart failure patients admitted for clinical decompensation]. / Características clínicas e psicossoclais do paciente com insuficiência cardíaca que interna por descompensação clínica.

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

Creation and content validity of 5r-medsafe: assessing adherence to the safe drug administration "five rights" / Elaboración y validez de contenido del instrumento 5r-medsafe: evaluación de la adhesión a los "cinco correctos" de la administración segura de medicamentos / Construção e validade de conteúdo do 5r-medsafe: avaliação da adesão aos cinco certos da administração segura de medicamentos

ABSTRACT Objective: to present the creation and content validity stages of a questionnaire to assess the determinants of adherence to the safe drug administration five "rights" "x", based on the Theory of Planned Behavior integrative model. Method: a methodological study to create and validate a self-reported measuring instrument for psychosocial variables. It took place in two public university teaching hospitals: one located in the South and the other in the Southeast of Brazil. Results: the results were organized according to each stage of the 5R-MEDSAFE content validation process. Conclusion: the results obtained in this creation and content validation study of the 5R-MEDSAFE indicated that the tool presented diverse content validity evidence. Its application can be useful in different contexts as a way of assessing adherence to these behaviors among Nursing workers. This will make it possible to identify which elements of the behaviors are amenable to intervention, as well as to implement the most appropriate intervention, according to the Theory of Planned Behavior constructs.

RESUMEN Objetivo: presentar las etapas de creación y validez de contenido correspondientes a un cuestionario para evaluar los determinantes del nivel de adhesión a los "Cinco correctos" de la administración segura de medicamentos - "5R-MEDSAFE", sobre la base del modelo integrador de la Teoría del Comportamiento Planificado. Método: estudio metodológico para crear y validar un instrumento de medición autoinformado de variables psicosociales. Se desarrolló en dos hospitales-escuela universitarios y públicos: uno situado en la región Sur y el otro en la región Sudeste de Brasil. Resultados: los resultados se organizaron conforme a cada etapa de la validación de contenido de 5R-MEDSAFE. Conclusión: los resultados obtenidos en este estudio de creación y validación del contenido del instrumento 5R-MEDSAFE indicaron que la herramienta presentó diversa evidencia de validez de contenido. Su aplicación puede resultar útil en diferentes contextos como una forma de evaluar el nivel de adhesión a estas conductas entre trabajadores de Enfermería. Eso permitirá identificar los elementos de los comportamiento que son pasibles de intervención, al igual que implementar la intervención más adecuada, conforme a los constructos de la Teoría del Comportamiento Planificado.

RESUMO Objetivo: apresentar as etapas de construção e validade de conteúdo de um questionário para avaliação dos determinantes da adesão aos cinco certos da administração segura de medicamentos - 5R-MEDSAFE, baseado no modelo integrador da Teoria do Comportamento Planejado. Método: estudo metodológico de construção e validação de instrumento de medida autorrelatada de variáveis psicossociais. Desenvolveu-se em dois hospitais-escola universitários, públicos, um localizado na região Sul e outro na região Sudeste do Brasil. Resultados: os resultados foram organizados conforme cada etapa da validação de conteúdo do 5R-MEDSAFE. Conclusão: os resultados obtidos neste estudo de construção e validação de conteúdo do instrumento 5R-MEDSAFE indicaram que o instrumento apresentou evidências de validade de conteúdo. Sua aplicação pode ser útil em contextos distintos como forma de avaliar a adesão a esse comportamento entre trabalhadores de enfermagem. Isso permitirá identificar qual elemento do comportamento é passível de intervenção, bem como implementar a intervenção mais adequada, conforme os construtos da Teoria do Comportamento Planejado.

Nurses' attitudinal and normative beliefs concerning hemodynamic assessment by pulmonary artery catheterization.

The objective of this study was to identify, by using the Theory of Reasoned Action/Theory of Planned Behavior, the attitude and normative beliefs that influence the behavioral intention of the nurse to perform a hemodynamic assessment using the pulmonary artery catheterization. Data were collected through semi-structured interviews involving 23 nurses from three hospitals in the city of Campinas, São Paulo. The data were analyzed according to a qualitative methodology. Among the Attitude Beliefs, affective beliefs and those related to the advantages and disadvantages of performing the behavior stand out. Among the Normative Beliefs social referents were identified for the behavior, as well as the behavior-stimulating factors and the factors that discourage the performance of the behavior.

[Beliefs that influence adolescents in organ donations]. / Crenças que influenciam adolescentes na doaçao de órgãos.

This study was aimed at investigating knowledge, behavior and normative beliefs of students concerning transplant and organs donations, based on the Theory of Reasoned Action (TRA), in two public schools of the city of São Paulo. The sample was comprised of 94 students who answered a questionnaire, whose answers were submitted to statistical analysis. The results showed that the group had little knowledge about organ donation because 45.8% were not familiar with the concept of encephalic death, 37.2% do not know when death occurs and 70.3% do not know when a person becomes a potential organ donor. Eight positive and five negative beliefs about organ donations were detected. The conclusion is that it is necessary to develop studies and to implement education programs to clarify the population about this topic.

Hypertensive patients and risk factors related to physical activity and nutrition.

The aim of this study was to identify the cardiovascular risk factors related to physical activity and/or nutrition of hypertensive patients (n = 99) seen at a public health care center of a large city in the southeastern part of Brazil. These factors included, diabetes mellitus (36.4% of patients, more frequent in women), dyslipidemia (38.4%, with no gender differences) and overweight/obesity (83.1% with Body Mass Index (BMI) higher than 24.9 Kg/m2, more frequent in women). The mean BMI was 29.2 Kg/m2 (+/- 5.5); significantly higher among women. All these factors are related to the dysmetabolic syndrome and the risk can be prevented or controlled with interventions involving physical activity and nutrition.

Satisfaction with medication in coronary disease treatment: psychometrics of the Treatment Satisfaction Questionnaire for Medication.

OBJECTIVE: to psychometrically test the Brazilian version of the Treatment Satisfaction Questionnaire for Medication - TSQM (version 1.4), regarding ceiling and floor effect, practicability, acceptability, reliability and validity. METHODS: participants with coronary heart disease (n=190) were recruited from an outpatient cardiology clinic at a university hospital in Southeastern Brazil and interviewed to evaluate their satisfaction with medication using the TSQM (version 1.4) and adherence using the Morisky Self-Reported Measure of Medication Adherence Scale and proportion of adherence. The Ceiling and Floor effect were analyzed considering the 15% worst and best possible TSQM scores; Practicability was assessed by time spent during TSQM interviews; Acceptability by proportion of unanswered items and participants who answered all items; Reliability through the Cronbach's alpha coefficient and Validity through the convergent construct validity between the TSQM and the adherence measures. RESULTS: TSQM was easily applied. Ceiling effect was found in the side effects domain and floor effect in the side effects and global satisfaction domains. Evidence of reliability was close to satisfied in all domains. The convergent construct validity was partially supported. CONCLUSIONS: the Brazilian TSQM presents evidence of acceptability and practicability, although its validity was weakly supported and adequate internal consistency was observed for one domain.