ABSTRACT
O presente trabalho tem por objetivo cartografar as potencialidades do encontro entre a estratégia da Gestão Autônoma da Medicação (GAM) com a perspectiva ético-política da Redução de Danos, a partir da experiência de um grupo GAM no Centro de Atenção Psicossocial para Álcool e Outras Drogas (Caps-Ad) da cidade de Garanhuns-PE. Nos valemos de diários de campo produzidos durante o grupo e, depois, em retorno ao campo para atualização da experiência. Os diários auxiliaram na composição de narrativas de análise com foco nas práticas de cuidado de si e nos efeitos do grupo nas trajetórias dos atores envolvidos e do serviço. Conclui-se que a estratégia GAM enriquece e amplia o paradigma da Redução de Danos, potencializando o cuidado integral aos que usam drogas e gerando efeitos de autonomia e emancipação nas trajetórias de cuidado e vida. (AU)
The present work aims to map the potential of the clash between the Autonomous Medication Management (GAM) strategy with the ethical-political perspective of Harm Reduction, based on the experience of a GAM group at the Psychosocial Care Center for Alcoholand Others Drugs (Caps-Ad) in the city of Garanhuns-PE. We made use of field diaries produced during the group and, later, back in the field to update the experience. The diaries helped in the composition of analysis narratives focusing on Self-Care practices and on the effects of the group on the trajectories of the actors involved and on the service. It is concluded that the GAM strategy enriches and expands the Harm Reduction paradigm, enhancing comprehensive care for drug users and generating effects of autonomy and emancipation in care and life trajectories. (AU)
El presente trabajo tiene como objetivo mapear el potencial del encuentro entre la estrategia de Gestión Autónoma de Medicamentos (GAM) con la perspectiva ético-política de Reducción de Daños, a partir de la experiencia de un grupo GAM del Centro de Atención Psicosocial de Alcohol y Otras Drogas (Caps-Ad) en la ciudad de Garanhuns-PE. Hicimos uso de diarios de campo elaborados durante el grupo y, posteriormente, de vuelta en el campo para actualizar la experiencia. Los diarios ayudaron en la composición de narrativas de análisis centradas en las prácticas de autocuidado y en los efectos del grupo en las trayectorias de los actores involucrados y el servicio. Se concluye que la estrategia GAM enriquece y amplía el paradigma de Reducción de Daños, potenciando la atención integral a los usuarios de drogas y generando efectos de autonomía y emancipación en el cuidado y en las trayectorias de vida. (AU)
Subject(s)
Humans , Self Care , Personal Autonomy , Harm Reduction , Drug Users/psychology , Mental Health Services , Patient Participation/psychologyABSTRACT
OBJECTIVE: To evaluate the factors associated with the intention to participate in COVID-19 vaccine clinical trials in the Peruvian population. METHODS: Cross-sectional study and secondary analysis of a database that involved Peruvian population during September 2020. The Poisson regression model was used to estimate the associated factors. RESULTS: Data from 3231 individuals were analyzed, 44.1% of whom intended to participate in COVID-19 vaccine clinical trials. Factors associated with the outcome were being male (RPa: 1.25; 95% CI: 1.15-1.35), being from the highlands region (RPa: 1.18; 95% CI: 1.09-1.28) or jungle (RPa: 1.30; 95% CI: 1.15-1.47), having a relative that is a healthcare professional (PRa: 1.16; 95% CI: 1.06-1.28), using a medical source of information (PRa: 1.28; 95% CI: 1.17-1.41), and trusting in the possible effectiveness of vaccines (PRa: 1.40; 95% CI: 1.29-1.51). The main reason for not participating in the trial was the possibility of developing side effects (69.80%). CONCLUSION: There is an urgent need to generate a perception of safety in COVID-19 vaccine clinical trials, to increase the population's intention to participate in these studies, and to provide evidence-based information about the vaccine.
Subject(s)
COVID-19 Vaccines , Clinical Trials as Topic , Intention , Patient Participation , COVID-19/epidemiology , COVID-19/prevention & control , Cross-Sectional Studies , Female , Humans , Male , Patient Participation/psychology , Peru/epidemiologyABSTRACT
Introduction: Vaccine efficacy testing requires engagement of willing volunteers with high disease incidence. We evaluated factors associated with willingness to participate in potential future HIV vaccine trials in Maputo, Mozambique. Methods: Adults aged 18-35 years without HIV and who reported at least two sexual partners in the 3 months prior to screening were enrolled into a 24-month observational study. They were asked at screening and exit if they would be willing to participate in a theoretical HIV vaccine study. Bivariate and multivariate logistic regression analyses were done between willingness to participate, demographic, sexual behavior, and motivational factors for screening visit data. Logistic regression with generalized estimating equations (GEE) was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for factors potentially associated with willingness to participate for data from both visits. Results: A total of 577 participants without HIV were eligible, including 275 (48%) women. The mean age was 22.2 (SD ± 3.9) years. At screening 529 (92%) expressed willingness to participate and the proportion remained stable at 378 (88%) of the 430 participants retained through the exit visit (p = 0.209). Helping the country (n = 556) and fear of needles (n = 26) were the top motive and barrier for willingness to participate, respectively. Results from the GEE binary logistic regression (screening visit and exit visit) showed that wanting to learn how to avoid risk behaviors (aOR 3.33, 95% CI: 1.61-6.86) and feeling protected against HIV infection (aOR 2.24, 95% CI: 1.07-4.7) were associated with willingness to participate in HIV vaccine studies. Conclusion: The majority of our study population in Mozambique expressed willingness to participate in a theoretical HIV vaccine trial. Participation in a HIV vaccine trial was seen as a way to contribute to the fight against HIV but was associated with some unrealistic expectations such as protection against HIV. This reinforces the need for continuous mobilization and awareness of potential participants to HIV vaccine trial.
Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Clinical Trials as Topic/psychology , AIDS Vaccines/therapeutic use , Patient Participation/psychology , Phobic Disorders , Sexual Behavior , Sexual Partners , HIV Infections/prevention & control , Health Knowledge, Attitudes, Practice , Motivation , MozambiqueABSTRACT
Introduction: Vaccine efficacy testing requires engagement of willing volunteers with high disease incidence. We evaluated factors associated with willingness to participate in potential future HIV vaccine trials in Maputo, Mozambique. Methods: Adults aged 18-35 years without HIV and who reported at least two sexual partners in the 3 months prior to screening were enrolled into a 24-month observational study. They were asked at screening and exit if they would be willing to participate in a theoretical HIV vaccine study. Bivariate and multivariate logistic regression analyses were done between willingness to participate, demographic, sexual behavior, and motivational factors for screening visit data. Logistic regression with generalized estimating equations (GEE) was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for factors potentially associated with willingness to participate for data from both visits. Results: A total of 577 participants without HIV were eligible, including 275 (48%) women. The mean age was 22.2 (SD ± 3.9) years. At screening 529 (92%) expressed willingness to participate and the proportion remained stable at 378 (88%) of the 430 participants retained through the exit visit (p = 0.209). Helping the country (n = 556) and fear of needles (n = 26) were the top motive and barrier for willingness to participate, respectively. Results from the GEE binary logistic regression (screening visit and exit visit) showed that wanting to learn how to avoid risk behaviors (aOR 3.33, 95% CI: 1.61-6.86) and feeling protected against HIV infection (aOR 2.24, 95% CI: 1.07-4.7) were associated with willingness to participate in HIV vaccine studies. Conclusion: The majority of our study population in Mozambique expressed willingness to participate in a theoretical HIV vaccine trial. Participation in a HIV vaccine trial was seen as a way to contribute to the fight against HIV but was associated with some unrealistic expectations such as protection against HIV. This reinforces the need for continuous mobilization and awareness of potential participants to HIV vaccine trial.
Subject(s)
Humans , Male , Female , Adolescent , Young Adult , Clinical Trials as Topic/psychology , Patient Participation , Patient Participation/psychology , Phobic Disorders , Sexual Behavior , Sexual Partners , HIV Infections/prevention & control , Health Knowledge, Attitudes, Practice , AIDS Vaccines/therapeutic use , Motivation , MozambiqueABSTRACT
INTRODUCTION: Introduction: the Chilean Ministry of Health implements the Vida Sana (VS) program with the objective of reducing risk factors for chronic diseases in overweight/obese (OW/OB) individuals, aged 2-64. Objective: to determine the effectiveness of VS in OW/OB women (20-44 yrs) in terms of their engagement in the recommended activities. These consist of participating in a minimum number each of three core activities (psychologist consultations, lifestyle workshops, and physical activity sessions) during 6 months, to obtain a 5 % weight loss and improved physical fitness (PF). Methods: a retrospective study involving secondary analyses of the 2017 VS database (n = 5,179 OW/OB women). We determined effectiveness by: a) comparing changes in weight and PF in participants who achieved one or both outcomes, using t-tests and tests of proportions, and b) assessing the probability of achieving the program´s goal, according to participation in 1, 2, or 3 core activities, individually and jointly, using the OR (95 % CI) and trend analysis. Results: around 32 %, 88 %, and 29 % of women achieved 5 % weight loss, improved PF, and both, respectively. The high percentage of women who improved PF was due to a permissive criterion. Although 20 % of women attained the program´s goal with 0 engagement, among participants, the ORs (95 % CI) for achieving the program´s goal when engaging in 1, 2, or 3 core activities were 1.55 (CI 1.2-2.03), 2.34 (1.76-3.11), and 3.5 (2.21-5.53), respectively. Conclusion: effectiveness parallels degree of engagement in the recommended activities of VS. A characterization of a program´s participation rate is crucial for improving its effectiveness.
INTRODUCCIÓN: Introducción: el objetivo del programa chileno Vida Sana (VS) es reducir los factores de riesgo de enfermedades crónicas en personas de 2-64 años con sobrepeso/obesidad (SP/OB). Objetivo: determinar la efectividad del programa VS en mujeres SP/OB (20-44 años) a través de su participación en cada una de las actividades recomendadas (consultas con psicólogo, talleres y actividad física) durante 6 meses, para lograr perder un 5 % de peso y mejorar la condición física (CF). Métodos: estudio retrospectivo con análisis secundario de la base de datos VS de 2017 (n = 5179 mujeres SP/OB). Se determinó la efectividad: a) comparando los cambios en el peso y la CF de las participantes que lograron uno o ambos resultados, usando el test de la "t" y el de proporciones; b) evaluando la probabilidad de lograr el objetivo de acuerdo con la participación en 1, 2 o 3 actividades, de manera individual y conjunta, calculando los OR (IC 95 %) y el análisis de tendencias. Resultados: el 32 %, 88 % y 29 % de las mujeres perdieron un 5 % de peso, mejoraron la CF o consiguieron ambas cosas, respectivamente. El alto porcentaje que mejoró la CF se debió a un criterio permisivo. Aunque el 20 % de las mujeres lograron el objetivo del programa con una participación "0", los OR (IC del 95 %) de lograr el objetivo al participar en 1, 2 o 3 de las actividades fueron de 1,55 (IC: 1,2-2,03), 2,34 (IC: 1,76-3,11) y 3,5 (IC: 2,21-5,53), respectivamente. Conclusión: la efectividad del programa VS se asocia directamente con el grado de participación en las actividades. Caracterizar la participación de un programa es clave para mejorar su efectividad.
Subject(s)
Obesity/therapy , Overweight/therapy , Patient Participation/psychology , Adult , Body Mass Index , Chile/epidemiology , Female , Humans , Male , Middle Aged , Obesity/psychology , Overweight/psychology , Patient Participation/statistics & numerical data , Program Evaluation/standards , Program Evaluation/statistics & numerical data , Retrospective Studies , Risk Factors , Treatment Adherence and Compliance/psychology , Treatment Adherence and Compliance/statistics & numerical dataABSTRACT
OBJECTIVE: Reflect, in the light of the Health Belief Model, on the adoption of behavioral measures in the context of COVID-19. METHODS: Theoretical-reflective essay, based on the Health Belief Model, to reflect on adherence to preventive behaviors in the pandemic of COVID-19. RESULTS: Adherence to preventive behaviors is strongly influenced by socioeconomic, territorial, political and individual factors in the face of critical health situations. In addition, the spread of false news modulates the thinking and execution of behavioral actions in the population. FINAL CONSIDERATIONS: It is necessary to understand the importance of health communication processes and the use of tools aimed at responsible human behavior and engaged in the adoption of a preventive posture.
Subject(s)
Attitude to Health , COVID-19/prevention & control , COVID-19/psychology , Guideline Adherence/statistics & numerical data , Health Behavior , Pandemics/prevention & control , Patient Participation/psychology , Adult , Aged , Aged, 80 and over , Brazil , Female , Humans , Male , Middle Aged , SARS-CoV-2 , Surveys and QuestionnairesABSTRACT
INTRODUCTION: It has been said that mental illnesses are characterised by poor decision making; there is some neuroscientific evidence of specific alterations in performance in decision making tests, but little is known about how patients make choices about their own treatments. METHODS: Focus groups with patients from two psychiatric clinics, with discourse analysis. RESULTS: Five deductive categories (tools, capacity, therapeutic relationship, method and family and network), plus one additional category from the analysis (stigma), and 35 inductive (posterior) categories were considered. The categories are analysed and the findings presented. CONCLUSIONS: Patients express a need for greater participation in decisions about their treatment, and a more symmetrical psychiatrist-patient relationship, involving families. Decisions may be changed due to stigma, barriers to treatment access, and previous experiences.
Subject(s)
Decision Making , Mental Disorders/psychology , Patient Participation/psychology , Adult , Colombia , Female , Focus Groups , Health Services Accessibility , Humans , Male , Mental Disorders/therapy , Patient Participation/methods , Physician-Patient Relations , Professional-Family Relations , Psychiatry , Qualitative Research , Social StigmaABSTRACT
BACKGROUND: Heart failure with reduced ejection fraction (HFrEF) benefits from initiation and intensification of multiple pharmacotherapies. Unfortunately, there are major gaps in the routine use of these drugs. Without novel approaches to improve prescribing, the cumulative benefits of HFrEF treatment will be largely unrealized. Direct-to-consumer marketing and shared decision making reflect a culture where patients are increasingly involved in treatment choices, creating opportunities for prescribing interventions that engage patients. HYPOTHESIS: Encouraging patients to engage providers in HFrEF prescribing decisions will improve the use of guideline-directed medical therapies. DESIGN: The Electronically delivered, Patient-activation tool for Intensification of Chronic medications for Heart Failure with reduced ejection fraction (EPIC-HF) trial randomizes patients with HFrEF to usual care versus patient-activation tools-a 3-minute video and 1-page checklist-delivered prior to cardiology clinic visits that encourage patients to work collaboratively with their clinicians to intensify HFrEF prescribing. The study assesses the effectiveness of the EPIC-HF intervention to improve guideline-directed medical therapy in the month after its delivery while using an implementation design to also understand the reach, adoption, implementation, and maintenance of this approach within the context of real-world care delivery. Study enrollment was completed in January 2020, with a total 305 patients. Baseline data revealed significant opportunities, with <1% of patients on optimal HFrEF medical therapy. SUMMARY: The EPIC-HF trial assesses the implementation, effectiveness, and safety of patient engagement in HFrEF prescribing decisions. If successful, the tool can be easily disseminated and may inform similar interventions for other chronic conditions.
Subject(s)
Decision Making, Shared , Heart Failure , Patient Participation , Practice Patterns, Physicians' , Stroke Volume , Adult , Female , Health Services Misuse , Heart Failure/drug therapy , Heart Failure/physiopathology , Heart Failure/psychology , Humans , Internet-Based Intervention , Male , Patient Participation/methods , Patient Participation/psychology , Physician-Patient Relations , Quality Improvement , Randomized Controlled Trials as Topic , Ventricular Dysfunction, Left/diagnosisABSTRACT
INTRODUCCIÓN: La cantidad de pacientes asmáticos que asisten al sistema público de salud es cada vez mayor, no obstante, la tasa de adherencia al tratamiento es muy baja, siendo los adolescentes quienes presentan mayor porcentaje de abandono al tratamiento, inasistencia a sus controles y gran conflicto decisional (CD). El OBJETIVO de este estudio fue evaluar el efecto de la aplicación de consejerías sobre el CD en relación al tratamiento del asma y el nivel de control de su enfermedad. MATERIALES Y MÉTODOS: Estudio pre-experimental que reclutó a 32 niños asmáticos entre 10 a 14 años de edad del policlínico respiratorio infantil del hospital Carlos Van Buren de Valparaíso. Solo 15 niños estuvieron dispuestos a participar en el estudio quienes completaron la totalidad de las sesiones de consejería. Para determinar el grado de CD de su patología, se aplicó la Escala de Conflicto Decisional de Ottawa; y para el nivel del control del asma, se usó la Escala Global Initiative for Asthma (GINA). RESULTADOS: La edad media del grupo de niños fue de 12,06 ± 1,16 años. Finalizada la intervención, el nivel de control de asma se mantuvo y la media del CD disminuyó de 34,05 ± 4,59 a 18,02 ± 3,01 puntos (p < 0,05; t de Student para muestras pareadas). Un 73,3% de los pacientes disminuyó su nivel de conflicto decisional. CONCLUSIÓN: Las consejerías de apoyo decisional demostraron tener efectos positivos en la población estudiada.
INTRODUCTION: The number of asthmatic patients attending the public health system is increasing. However, the rate of adherence to treatment is very low. Adolescents have the largest percentage of abandonment to treatment, lack of control and a great decisional conflict (DC). The OBJECTIVE of this study was to evaluate the effect of the application of counseling on the DC in relation to asthma treatment and the level of control of their disease. MATERIALS AND METHODS: Pre-experimental study that recruited 32 asthmatic children from 10 to 14 years-old, from the children's respiratory outpatients clinic of Carlos Van Buren hospital in Valparaíso, Chile. Only 15 children were willing to participate in the study and completed all of the counseling sessions. To determine the degree of DC of its pathology, the Ottawa Decision Conflict Scale was applied; and for the Asthma Control level, the Global Initiative for Asthma Scale (GINA) was used. RESULTS: Mean children age was 12.06 ± 1.16 years-old. After the intervention, the level of Asthma Control was maintained and the mean of the DC decrease from 34.05 ± 4.59 to 18.02 ± 3.01 points (p < 0.05; paired Student's t-test). 73.3% of the patients lowered their level of decisional conflict. CONCLUSION: The counseling of decision support proved to have positive effects on the population studied.
Subject(s)
Humans , Male , Female , Child , Adolescent , Asthma/psychology , Conflict, Psychological , Counseling/methods , Decision Making , Outpatients , Patient Participation/psychology , Asthma/therapy , Treatment Adherence and ComplianceABSTRACT
OBJECTIVES: to conceive a theoretical-reflective discussion about participatory diagnosis as a methodological option in participatory research. METHODS: this is a reflection study, based on an experience that used participatory diagnosis as a research strategy in a socially vulnerable community. It was intended to implicate social groups in the search for identification and solution to the problems. RESULTS: the use of participatory diagnosis has provided significant results regarding the importance given by participants to community empowerment in the fight for health, quality of life and social empowerment. FINAL CONSIDERATIONS: participatory research and its relationship to participatory diagnosis favors the understanding of social issues, including health conditions, education and effective participation in problem solving.
Subject(s)
Diagnostic Screening Programs/standards , Patient Participation/psychology , Community-Based Participatory Research , Diagnostic Screening Programs/statistics & numerical data , Humans , Interviews as Topic/methods , Patient Participation/methods , Patient Participation/statistics & numerical data , Qualitative ResearchABSTRACT
OBJECTIVE: to evaluate functional performance and technical quality of user embracement software with pediatric risk classification. METHOD: descriptive exploratory study developed based on the quality requirements set forth in ISO/IEC 25010. The evaluated characteristics were: functional adequacy, reliability, usability, performance efficiency, compatibility, safety, maintainability and portability. Eight specialists from the area of informatics and 13 from nursing participated in the evaluation. The characteristics were considered adequate when they reached more than 70% of indication as very and/or completely appropriate in the evaluations of each group of specialists. RESULTS: The results obtained from the evaluation of informatics and nursing specialists were: functional adequacy (100.0%, 96.2%), reliability (82.6%, 88.5%), usability (84.9%; 98.7%), performance efficiency (93.4%; 96.2%), compatibility (85.0%, 98.1%), safety (91.7%, 100.0%), and, yet, maintainability (95.0%) and portability (87.5%) evaluated by the first ones. CONCLUSION: the software was considered adequate regarding technical quality and functional performance.
Subject(s)
Patient Participation/psychology , Risk Assessment/standards , Humans , Patient Participation/methods , Reproducibility of Results , Risk Assessment/methods , Risk Assessment/statistics & numerical data , Software DesignABSTRACT
ABSTRACT Objective: to evaluate functional performance and technical quality of user embracement software with pediatric risk classification. Method: descriptive exploratory study developed based on the quality requirements set forth in ISO/IEC 25010. The evaluated characteristics were: functional adequacy, reliability, usability, performance efficiency, compatibility, safety, maintainability and portability. Eight specialists from the area of informatics and 13 from nursing participated in the evaluation. The characteristics were considered adequate when they reached more than 70% of indication as very and/or completely appropriate in the evaluations of each group of specialists. Results: The results obtained from the evaluation of informatics and nursing specialists were: functional adequacy (100.0%, 96.2%), reliability (82.6%, 88.5%), usability (84.9%; 98.7%), performance efficiency (93.4%; 96.2%), compatibility (85.0%, 98.1%), safety (91.7%, 100.0%), and, yet, maintainability (95.0%) and portability (87.5%) evaluated by the first ones. Conclusion: the software was considered adequate regarding technical quality and functional performance.
RESUMEN Objetivo: evaluar el desempeño funcional y la calidad técnica del software para el acogimiento con clasificación de riesgo en pediatría. Método: estudio exploratorio descriptivo, fundamentado en los requisitos de calidad dispuestos en la norma ISO/IEC 25.010. Las siguientes características fueron evaluadas: adecuación funcional, confiabilidad, facilidad de uso, eficiencia del desempeño, compatibilidad, seguridad, manutención y portabilidad. En la evaluación participaron 8 expertos en el área de informática y 13 en enfermería. Se consideradon adecuadas las características cuando habían alcanzado más del 70,0% de indicación como "muy y/o completamente apropiadas" en las evaluaciones de cada grupo de expertos. Resultados: Los resultados obtenidos a partir de la evaluación de los expertos en informática y en enfermería fueron respectivamente: adecuación funcional (100,0%; 96,2%); confiabilidad (82,6%; 88,5%); facilidad de uso (84,9%; 98,7%); eficiencia del desempeño (93,4%; 96,2%); compatibilidad (85,0%; 98,1%); seguridad (91,7%; 100,0%); y también manutención (95,0%) y portabilidad (87,5%) evaluados por los primeros. Conclusión: se observó que el software es adecuado en relación con la calidad técnica y el rendimiento funcional.
RESUMO Objetivo: avaliar desempenho funcional e qualidade técnica de software para acolhimento com classificação de risco em pediatria. Método: estudo exploratório descritivo desenvolvido com base nos quesitos de qualidade dispostos na norma ISO/IEC 25010. As características avaliadas foram: adequação funcional, confiabilidade, usabilidade, eficiência de desempenho, compatibilidade, segurança, manutenibilidade e portabilidade. Participaram da avaliação oito especialistas da área de informática e 13 de enfermagem. As características foram consideradas adequadas quando atingiram mais de 70,0% de indicação como muito e/ou completamente apropriadas nas avaliações de cada grupo de especialistas. Resultados: Os resultados obtidos a partir da avaliação dos especialistas de informática e de enfermagem foram respectivamente: adequação funcional (100,0%; 96,2%), confiabilidade (82,6%; 88,5%), usabilidade (84,9%; 98,7%), eficiência de desempenho (93,4%; 96,2%), compatibilidade (85,0%; 98,1%), segurança (91,7%; 100,0%), e, ainda, manutenibilidade (95,0%) e portabilidade (87,5%) avaliados pelos primeiros. Conclusão: o software foi considerado adequado em relação à qualidade técnica e ao desempenho funcional.
Subject(s)
Humans , Patient Participation/psychology , Risk Assessment/standards , Patient Participation/methods , Software Design , Reproducibility of Results , Risk Assessment/statistics & numerical data , Risk Assessment/methodsSubject(s)
Humans , Female , Mammography/trends , Decision Support Techniques , Early Detection of Cancer/trends , Patient Participation/psychology , Patient Participation/trends , Breast Neoplasms/diagnostic imaging , Review Literature as Topic , Mammography/psychology , Randomized Controlled Trials as Topic/methods , Decision Making , Early Detection of Cancer/psychology , Systematic Reviews as TopicABSTRACT
ABSTRACT Objective: To carry out a review of the literature on adolescents' participation in decision making for their own health. Data sources: Review in the Scientific Electronic Library Online (SciELO), Latin American and Caribbean Health Sciences Literature (LILACS) and PubMed databases. We consider scientific articles and books between 1966 and 2017. Keywords: adolescence, autonomy, bioethics and adolescence, autonomy, ethics, in variants in the English, Portuguese and Spanish languages. Inclusion criteria: scientific articles, books and theses on clinical decision making by the adolescent patient. Exclusion criteria: case reports and articles that did not address the issue. Among 1,590 abstracts, 78 were read in full and 32 were used in this manuscript. Data synthesis: The age at which the individual is able to make decisions is a matter of debate in the literature. The development of a cognitive and psychosocial system is a time-consuming process and the integration of psychological, neuropsychological and neurobiological research in adolescence is fundamental. The ability to mature reflection is not determined by chronological age; in theory, a mature child is able to consent or refuse treatment. Decision-making requires careful and reflective analysis of the main associated factors, and the approach of this problem must occur through the recognition of the maturity and autonomy that exists in the adolescents. To do so, it is necessary to "deliberate" with them. Conclusions: International guidelines recommend that adolescents participate in discussions about their illness, treatment and decision-making. However, there is no universally accepted consensus on how to assess the decision-making ability of these patients. Despite this, when possible, the adolescent should be included in a serious, honest, respectful and sincere process of deliberation.
RESUMO Objetivo: Realizar uma revisão da literatura sobre a participação do adolescente na tomada de decisão sobre a sua saúde. Fonte de dados: Revisão nos bancos Scientific Electronic Library Online (SciELO), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e PubMed. Consideramos artigos científicos e livros entre 1966 e 2017. Palavras-chave: adolescência, autonomia, bioética e adolescência, autonomia, ética, em línguas inglesa, portuguesa e espanhola. Critérios de inclusão: artigos científicos, livros e dissertações que contemplassem a tomada de decisão clínica pelo paciente adolescente. Critérios de exclusão: relatos de caso e artigos que não abordavam a questão norteada nesta pesquisa. Do total de 1.590 resumos, 78 foram lidos na íntegra, e 36, utilizados neste manuscrito. Síntese dos dados: A idade em que o indivíduo é capaz para tomar decisões é motivo de debate na literatura. O desenvolvimento de um sistema cognitivo e psicossocial é um processo demorado, e faz-se fundamental a integração da investigação psicológica, neuropsicológica e neurobiológica na adolescência. A capacidade de reflexão madura não é determinada pela idade cronológica; em teoria, um menor maduro seria capaz de consentir ou recusar um tratamento. A tomada de decisão exige análise cuidadosa e reflexiva dos principais fatores associados, e a abordagem desse problema deve ocorrer por meio do reconhecimento da maturidade e da autonomia que existe no adolescente. Para tanto, é necessário "deliberar" com ele. Conclusões: Diretrizes internacionais recomendam que os adolescentes participem de discussões sobre sua doença, tratamento e tomada de decisão, entretanto não há nenhum consenso universalmente aceito sobre como avaliar a capacidade de decisão desses pacientes. Apesar disso, quando possível, o adolescente deve ser incluído em um processo sério, honesto, respeitoso e sincero de deliberação.
Subject(s)
Humans , Adolescent , Patient Participation/methods , Patient Participation/psychology , Professional-Patient Relations/ethics , Adolescent Health Services/ethics , Adolescent Development , Informed Consent By Minors/psychology , Informed Consent By Minors/ethics , Clinical Decision-Making/methods , Clinical Decision-Making/ethics , Personal AutonomyABSTRACT
RATIONALE: Familial Hypercholesterolemia (FH) is a genetic condition that predisposes patients to substantially increased risk of early-onset atherosclerotic cardiovascular disease. FH risks can be minimized through regular participation in three self-management. BEHAVIORS: physical activity, healthy eating, and taking cholesterol lowering medication. OBJECTIVE: The present study tested the effectiveness of an integrated social cognition model in predicting intention to participate in the self-management behaviors in FH patients from seven countries. METHOD: Consecutive patients in FH clinics from Australia, Hong Kong, Brazil, Malaysia, Taiwan, China, and UK (total Nâ¯=â¯726) completed measures of social cognitive beliefs about illness from the common sense model of self-regulation, beliefs about behaviors from the theory of planned behavior, and past behavior for the three self-management behaviors. RESULTS: Structural equation models indicated that beliefs about behaviors from the theory of planned behavior, namely, attitudes, subjective norms, and perceived behavioral control, were consistent predictors of intention across samples and behaviors. By comparison, effects of beliefs about illness from the common sense model were smaller and trivial in size. Beliefs partially mediated past behavior effects on intention, although indirect effects of past behavior on intention were larger for physical activity relative to taking medication and healthy eating. Model constructs did not fully account for past behavior effects on intentions. Variability in the strength of the beliefs about behaviors was observed across samples and behaviors. CONCLUSION: Current findings outline the importance of beliefs about behaviors as predictors of FH self-management behaviors. Variability in the relative contribution of the beliefs across samples and behaviors highlights the imperative of identifying sample- and behavior-specific correlates of FH self-management behaviors.
Subject(s)
Health Knowledge, Attitudes, Practice , Hyperlipoproteinemia Type II/psychology , Intention , Patient Participation/psychology , Self-Management/psychology , Australia , Brazil , China , Cross-Sectional Studies , Female , Hong Kong , Humans , Hyperlipoproteinemia Type II/complications , Hyperlipoproteinemia Type II/therapy , Malaysia , Male , Patient Participation/methods , Patient Participation/statistics & numerical data , Self-Management/methods , Self-Management/statistics & numerical data , Surveys and Questionnaires , Taiwan , United KingdomABSTRACT
We apply mixed methods to explore how a conditional cash transfer (CCT) may influence intimate partner violence (IPV). Qualitative interviews with female beneficiaries of Bolsa Familia, Brazil's CCT program, and service providers suggest positive, negative, and null associations between CCTs and IPV are all plausible. These associations result from a combination of economic and psychological motivations. We also use quantitative methods to examine if the expansion of Bolsa Familia between 2004 and 2009 affects the female homicide rate and marital separations. Using municipal level data in a difference-in-differences analysis, we find null associations between Bolsa Familia and female homicides. When we examine the impact on marriages and separations, indicative of a change in the reservation utility of women within the household, we find no impact on marriages but Bolsa Familia is associated with an increase in separations, and, to a greater extent, separations of couples with children. These results suggest Bolsa Familia impacts women's agency within the family, but not to the extent that it reduces the most extreme form of IPV.
Subject(s)
Intimate Partner Violence/psychology , Patient Participation/psychology , Poverty/statistics & numerical data , Adolescent , Adult , Brazil , Female , Humans , Income/statistics & numerical data , Interviews as Topic/methods , Intimate Partner Violence/statistics & numerical data , Middle Aged , Patient Participation/statistics & numerical data , Qualitative ResearchABSTRACT
OBJECTIVE: To carry out a review of the literature on adolescents' participation in decision making for their own health. DATA SOURCES: Review in the Scientific Electronic Library Online (SciELO), Latin American and Caribbean Health Sciences Literature (LILACS) and PubMed databases. We consider scientific articles and books between 1966 and 2017. Keywords: adolescence, autonomy, bioethics and adolescence, autonomy, ethics, in variants in the English, Portuguese and Spanish languages. Inclusion criteria: scientific articles, books and theses on clinical decision making by the adolescent patient. Exclusion criteria: case reports and articles that did not address the issue. Among 1,590 abstracts, 78 were read in full and 32 were used in this manuscript. DATA SYNTHESIS: The age at which the individual is able to make decisions is a matter of debate in the literature. The development of a cognitive and psychosocial system is a time-consuming process and the integration of psychological, neuropsychological and neurobiological research in adolescence is fundamental. The ability to mature reflection is not determined by chronological age; in theory, a mature child is able to consent or refuse treatment. Decision-making requires careful and reflective analysis of the main associated factors, and the approach of this problem must occur through the recognition of the maturity and autonomy that exists in the adolescents. To do so, it is necessary to "deliberate" with them. CONCLUSIONS: International guidelines recommend that adolescents participate in discussions about their illness, treatment and decision-making. However, there is no universally accepted consensus on how to assess the decision-making ability of these patients. Despite this, when possible, the adolescent should be included in a serious, honest, respectful and sincere process of deliberation.
Subject(s)
Adolescent Development , Adolescent Health Services , Clinical Decision-Making , Informed Consent By Minors , Patient Participation , Professional-Patient Relations , Adolescent , Adolescent Health Services/ethics , Clinical Decision-Making/ethics , Clinical Decision-Making/methods , Humans , Informed Consent By Minors/ethics , Informed Consent By Minors/psychology , Patient Participation/methods , Patient Participation/psychology , Personal Autonomy , Professional-Patient Relations/ethicsABSTRACT
BACKGROUND AND PURPOSE: To assess the psychometric properties of the PAM13 Brazilian-Portuguese (PAM13-B) among outpatients with chronic diseases. METHODS: 513 adults participated, diagnosed with a chronic disease for more than 6 months, under outpatient monitoring. Reliability was tested using internal consistency and test-retest reliability. Construct validity was verified through different techniques (correlation between activation and self-esteem measures, anxiety, depression and health status), known-groups validity and dimensionality by means of confirmatory factor analysis. Significance was set at 0.05. RESULTS: The PAM13-B presented appropriate results for internal consistency (α = 0.83) and test-retest reliability (intraclass correlation coefficient [ICC] = 0.81). A moderate correlation was found between activation and self-esteem only (r = 0.43, p < 0.001). The one-dimensional structure was not confirmed in the sample analyzed. CONCLUSIONS: In the study sample, the version PAM13-B demonstrated its reliability and validity, but with a two-factor structure.
Subject(s)
Chronic Disease/psychology , Patient Participation/psychology , Patient Participation/statistics & numerical data , Psychometrics/statistics & numerical data , Psychometrics/standards , Surveys and Questionnaires/statistics & numerical data , Surveys and Questionnaires/standards , Adult , Aged , Aged, 80 and over , Brazil , Factor Analysis, Statistical , Female , Humans , Male , Middle Aged , Reproducibility of ResultsABSTRACT
OBJECTIVE: This qualitative study examines surgical consultation as a social process and assesses its alignment with assumptions of the shared decision-making (SDM) model. SUMMARY OF BACKGROUND DATA: SDM stresses the importance of patient preferences and rigorous discussion of therapeutic risks/benefits based on these preferences. However, empirical studies have highlighted discrepancies between SDM and realities of surgical decision making. Qualitative research can inform understanding of the decision-making process and allow for granular assessment of the nature and causes of these discrepancies. METHODS: We observed consultations between 3 general surgeons and 45 patients considering undergoing 1 of 2 preference-sensitive elective operations: (1) hernia repair, or (2) cholecystectomy. These patients and surgeons also participated in semi-structured interviews. RESULTS: By the time of the consultation, patients and surgeons were predisposed toward certain decisions by preceding events occurring elsewhere. During the visit, surgeons had differential ability to arbitrate surgical intervention and construct the severity of patients' conditions. These upstream dynamics frequently displaced the centrality of the risk/benefit-based consent discussion. CONCLUSION: The influence of events preceding consultation suggests that decision-making models should account for broader spatiotemporal spans. Given surgeons' authority to define patients' conditions and control service provision, SDM may be premised on an overestimation of patients' power to alter the course of decision making once in a specialist's office. Considering the subordinate role of the risk/benefit discussion in many surgical decisions, it will be important to study if and how the social process of decision making is altered by SDM-oriented decision aids that foreground this discussion.
Subject(s)
Decision Making, Shared , General Surgery , Patient Participation/psychology , Physician-Patient Relations , Referral and Consultation , Social Behavior , Surgeons/psychology , Adult , Aged , Cholecystectomy/methods , Cholecystectomy/psychology , Elective Surgical Procedures/methods , Elective Surgical Procedures/psychology , Female , Herniorrhaphy/methods , Herniorrhaphy/psychology , Humans , Informed Consent/psychology , Interviews as Topic , Male , Middle Aged , Models, Theoretical , Patient Preference , Qualitative ResearchABSTRACT
Este artigo abordou os efeitos de uma pesquisa da estratégia da Gestão Autônoma da Medicação em usuárias(os) da saúde mental que passam a ocupar o lugar de palestrantes em ambientes acadêmicos no interior do RS. Por objetivo geral pretendeu analisar como se constituíram esses investimentos e visibilidades no saber das(os) usuárias(os) para frequentarem essas universidades. Também intentou-se descrever as relações de saber e poder e os limites da prática de autonomia nas salas de aula. Por uma abordagem de inspiração foucaultiana, mapeouse o campo estratégico produzido pela pesquisa e os enunciados 'saber no corpo' e 'autonomia' pela experiência de seis participações dessas pessoas como palestrantes. Discute-se a produção de um corpo que encontra outras possibilidades além da relação com o medicamento e a loucura, assim como um processo de autonomia temporária no jogo de forças da ação de uns sobre os outros.
Este artículo abordó los efectos de una investigación de la estrategia de la Gestión Autónoma de la Medicación en usuarias(os) de la salud mental que pasan a ocupar el lugar de oradores en ambientes académicos en una ciudad interiorana del RS, Brasil. Por objetivo general pretendió analizar cómo se constituyeron esas inversiones y visibilidades en el saber de las usuarias(os) para frecuentar esas universidades. También se intentó describir las relaciones de saber y poder y los límites de la práctica de autonomía en las aulas. Por un enfoque de inspiración foucaultiana, se mapeó el campo estratégico producido por la investigación y los enunciados 'saber en el cuerpo' y 'autonomía' por la experiencia de seis participaciones de esas personas como oradores. Se discute la producción de un cuerpo que encuentra otras posibilidades además de la relación con el medicamento y la locura, así como un proceso de autonomía temporal en el juego de fuerzas de la acción de unos sobre otros.
This apper deals with the effects of a research on the strategy of Autonomous Medication Management in mental health users who are now taking the place of lecturers in academic settings in the countrtyside of the district of RS, Brazil. The purpose of the general objective was to analyze how these investments and visibilities were constituted in the knowledge of the users to attend these universities. We also attempted to describe the relations of knowledge and power and the limits of the practice of autonomy in classrooms. Through a Foucauldian-inspired approach, the strategic field produced by the research and the statements 'knowing in the body' and 'autonomy' were mapped by the experience of six participation of these people as lecturers. It discusses the production of a body that finds other possibilities beyond the relation with medicine and madness, as well as a process of temporary autonomy in the role of forces of the action of one on the other.