Validación de un cuestionario para medir factores psicosociales asociados al seguimiento farmacoterapéutico en farmacéuticos españoles / Validation of a questionnaire for measuring psychosocial factors associated with pharmaceutical care in Spanish community pharmacists

Seguimiento Farmacoterapéutico (SFT) es la práctica profesional en la que el farmacéutico se responsabiliza de las necesidades del paciente relacionadas con medicamentos. Objetivo: validar un cuestionario para medir los determinantes psicosociales ASE (actitud, influencia social y autoeficacia) del SFT y el estadio de cambio según Prochaska y DiClemente, en farmacéuticos de oficina de farmacia. Método: encuesta postal a 482 farmacéuticos asturianos (test) y reenvío (retest). La validez se estimó en 134 farmacéuticos que contestaron al test. La estabilidad, en los 85 que respondieron a test y retest. Del análisis factorial exploratorio (validez de constructo) se obtuvieron 4 factores y 104 ítems. Estos factores tuvieron fiabilidad elevada (a de Cronbach entre 0,87 y 0,96). Validez discriminante: Comparando grupos en estadios de cambio extremos hubo diferencias significativas en actitud, motivaciones y autoeficacia. La repetibilidad fue alta y el cuestionario parece suficientemente válido y fiable

Pharmacotherapy follow-up (PTF) is the professional practice in which the pharmacist takes charge of the needs of the patients related to their drugs. Objective: To validate a questionnaire to measure the ASE psychosocial determinants (attitude, social influence, self-efficacy) of PTF and the Prochaska & DiClemente’s stage of change in Spanish community pharmacists. Method: Postal survey to 482 Asturian community pharmacists (test and retest). Validity was estimated in 134 pharmacists answering the test. Stability was estimated in 85 pharmacists answering the test and retest. Exploratory factorial analysis was used to investigate construct validity and produced 4 factors and 104 items. Those factors had high reliability (Cronbach’s a between 0,87 and 0,96). Discriminant validity: Pharmacists in extreme stages of change showed significant differences of attitude, motivation and self-efficacy. Repeatability was good and the questionnaire appears valid and reliable

Categorización de los factores psicosociales del seguimiento farmacoterapéutico en el modelo A.S.E., en farmacéuticos de oficina de farmacia / Categorisation of psychosocial factors in pharmacotherapeutic follow-up in the A.S.E. model, in pharmaceutical office pharmacists

La provisión de seguimiento farmacoteropéutico personalizado (SFP) por el farmacéutico comunitario es una conducta compleja, que puede estudiarse aplicando modelos teóricos conductuales, como el Modelo A.S.E. y el de Proceso de Cambio, de Prochaska y DiClemente. Según el Modelo A.S.E. los determinantes psicosociales de cualquier conducta humana son actitud, influencia social y autoeficacia.Sustituir el modelo tradicional de ejercicio profesional, por otro teóricamente más eficaz orientado al paciente, exige conocer la actitud de los farmacéuticos hacia ese cambio; qué personas o estamentos profesionales serían idóneos para influir positivamente sobre ellos, en qué medida los profesionales se sienten capacitados para adoptar el nuevo modelo; cuáles son Ias barreras a eliminar y qué actuaciones de la administración sanitaria, de Ias organizaciones profesionales, etc. podrían facilitarles la tarea.Como no existe instrumento adecuado para medir variables tan complejas como Ias del modelo A.S.E. en el SFP, nuestro objetivo fue categorizar los determinantes de la conducta "proveer SFP", entre los farmacéuticos comunitarios, y elaborar un cuestionario para medirlos y establecer el estadio de cambio de esa conducta. Realizamos una investigación cualitativa mediante grupos focales con 25 farmacéuticos de oficina asturianos, obteniendo las categorías de Ias variables que integrarán el cuestionario definitivo. Las categorías de las variables de actitud revelan ventajas para pacientes, sistema de salud y profesión y desventajas para el trabajo en la farmacia. Las de la influencia social se relacionan con sistema de salud, profesión y pacientes. Las de la autoeficacia reflejan la necesidad de promoción institucional del nuevo modelo (AU)

The delivery of Pharmaceutical Care (PhC) by community pharmacists is a complex behaviour that may be studied using theoretical behavioural models like the A.S.E. and Prochaska & DiClemente's models. According to the A.S.E. model theory, psychosocial determinants of human behaviour are attitude, social influence and self-efficacy. To facilitate moving from traditional pharmaceutical practice to the PhC model, which is more efficient and patient oriented, it is necessary to know. the attitude of community pharmacists about PhC; what people and professionals could positively influence them to practice PhC; if pharmacists feel able themselves to practice PhC; what principal barriers should be removed and what interventions of health authorities, professional organisations etc. could facilitate the new professional model. It doesn't exist a suitable instrument to measure the 'PhC behaviour' and its complex determinants according to the A.S.E. model. For this reason, our objective was to categorize the 'PhC behaviour' determinants among community pharmacists and to elaborate a culturally adapted questionnaire to measure these determinants and to establish the Stages of Change related to such behaviour. We carry out a qualitative investigation using focal groups and involving 25 community pharmacists. We obtained the categories of the variables that will form the final questionnaire. The categories of the variables of attitude display advantages for patients, health system and pharmaceutical profession and disadvantages for the work in the pharmacy. Those of social influence are related to health system, profession and patients. Those of self-efficacy reveal the need of institutional actions favouring the PhC practice (AU)

Categorización de factores psicosociales asociados al cumplimiento farmacológico antihipertensivo / Categorization of psychosocial factors associated with adherence to antihypertensive drugs

Este estudio intenta categorizar los determinantes del cumplimiento farmacológico antihipertensivo en el modelo psicosocial A.S.E. (actitud, influencia social y autoeficacia). Es un estudio cualitativo, realizado mediante entrevista semiestructurada y grabada, con 44 pacientes (25 cumplidores y 19 incumplidores). Dos investigadores independientes realizaron un análisis temático de las respuestas, siguiendo el método de Burnand. El método se valió mediante el Índice de Kappa. La información de los pacientes sugiere que los programas educativos deberían resaltar las ventajas del tratamiento, enseñar las habilidades que mejoran la adherencia, prever las dificultades y efectos secundarios, y enseñar a soslayarlos o manejarlos. Dichos programas deberían ser impartidos por sanitarios convencidos de la eficacia del tratamiento, buenos comunicadores y dispuestos a compartir responsabilidad con el paciente y a integrar en el programa a las personas influyentes de su entorno próximo. La información obtenida es útil para la ecuación a medida y para el diseño de cuestionarios cuantitativos (AU)

This qualitative study tries to categorize the determinants of adherence to antihypertensive drugs in the A.S.E. model (attitude, social influence and self-efficacy). Data were obtained from the information of 44 patients (25 compliant and 19 noncompliant), by means of a semi-structured, recorded interview. Two independent investigators carried out a thematic analysis of the answers, following Burnard’s method. The method was validated using the Kappa Index. The information from the patients suggests that educational programs should emphasize the advantages of treatment, teach the skills that improve adherence, foresee the barriers and secondary effects, and teach avoiding or managing them. These programs should be developed by health workers convinced of the effectiveness of the treatment, who are good communicators and willing to share responsibility with patients and to integrate in the program significant people in their personal environment. The information obtained is useful for tailor made education and to elaborate quantitative questionnaires (AU)

[Evaluation of the implementation of the FAPACAN programme to prevent cancer behavioral risk in primary care users in the North of Spain]. / Evaluación de la implementación del programa FAPACAN para prevenir el riesgo conductual de cáncer en usuarios de atención primaria del norte de España.

BACKGROUND: The evaluation of the process is an essential condition to correctly measure the impact of educational interventions on behaviour, its psychosocial determinants and the state of change, in the context of health promotion. The aim was to evaluate the quality of the implementation of the FAPACAN Programme, designed to prevent behavioural risk of cancer in Primary Care, and to improve its psychosocial determinants in the A.S.E. Model and the state of change according to Prochaska and DiClemente Theory. METHODS: The quality of implementation was measured by means of a visit to the health centre, by filling in a checklist 'in situ', and a phone survey with the patient. Centralisation and association measures were found (Pearson and Spearman's coefficient). A multiple regression model was obtained with the score made by the patient (range of 0 to 8) and the covariables: gender, age, level of education, locality and family history of cancer. RESULTS: The quality scores obtained oscillate between 72% and 81% of optimum quality. Significant differences were found owing to the administrator (better with fewer years of exercise) and the patient (better with higher level of study). CONCLUSIONS: In general, the quality of implementation was more than sufficient, in spite of the poor provision by the health system.