Design and Content Validation using Expert Opinions of an Instrument Assessing the Lifestyle of Adults: The 'PONTE A 100' Questionnaire.

Lifestyle, a major determinant of health status, comprises a number of habits and behaviours that form a part of daily life. People with healthy lifestyles have a better quality of life, suffer less disease, and have a longer life expectancy. This work reports the design and content validation of a questionnaire-the 'PONTE A 100' questionnaire-assessing the lifestyle of adults. This collects information across five dimensions-'Eating Habits', 'Physical Activity', 'Smoking and use of Alcohol and other Drugs', 'Emotional Wellbeing', and 'Safety and Non-intentional Injuries'-via the answering of a total 33 items. Psychometric validation of the instrument's content was obtained via expert opinions. This was performed by two rounds of assessment and involved 34 experts representing different health science disciplines (mean experience, 27.4 ± 9.4 years). At the end of each round, adjustments were made according to their recommendations. Agreement between the experts was examined using the Aiken V test. A final V value of 0.95 (95% CI, 0.90-1.00) was obtained for the questionnaire as a whole, highlighting the validity of its content. The questionnaire would therefore appear to be an appropriate instrument for assessing the lifestyle of adults.

Participación ciudadana en la adaptación de la Guía NICE sobre participación comunitaria: aprendizajes y claves de futuro / Citizen involvement in the adaptation of the NICE Guideline on community involvement: lessons learnt and keys for the future

El estudio multicéntrico AdaptaGPS surge con el objeto de traducir y adaptar al contexto español las recomendaciones de la Guía NICE NG44 Community engagement: improving health and wellbeing and reducing health inequalities.Parte del proceso de adaptación contó con el asesoramiento de 11 proyectos de participación en salud del Estado español que valoraron la comprensibilidad y adaptabilidad de las recomendaciones a nuestro contexto. Un grupo de ciudadanía fue consultado en cada uno de los proyectos, lo cual ha supuesto un hecho novedoso, ya que hasta el momento la contribución de la ciudadanía en la elaboración o adaptación de guías de salud se había centrado principalmente en participar en la creación de versiones ciudadanas. Este paso innovador coincide con un interés cada vez más nutrido en incluir la participación ciudadana en la investigación.Las aportaciones realizadas por los grupos de la ciudadanía de los proyectos consultados en el proceso AdaptaGPS han supuesto una oportunidad para aproximarnos al modo en que la población movilizada concibe la participación, las barreras que observa y las propuestas de mejora que expresa, así como ejemplos de cómo en la práctica incorporan las recomendaciones. (AU)

Risk-Taking Attitudes of Patients who Seek Health Care: An Exploratory Approach through Lottery Games. / La valoración de la actitud ante el riesgo en personas que demandan cuidados en salud: una aproximación mediante juegos de loterías utilizando generalized estimating equations.

BACKGROUND: The characterization of the risk-taking attitude of individuals may be useful for planning health care interventions. It has been attempted to study expressions of risk-taking attitude and evaluate characteristics of a standard lottery game in a population that seeks health care to elicit these attitudes. METHODS: Multicentric cross-sectional study. Demographic and socioeconomic characteristics, quality of life (EuroQol-5D), and health risk behaviors were collected from 662 users of 23 health centers selected by random sampling. Risk-taking attitude was evaluated by means of a self-evaluation scale and two lottery games, (L1 and L2; L2 included the possibility of economic losses). Generalized estimating equations (GEE) explicative models were used to evaluate the variability of risk-taking attitude. RESULTS: Nineteen percent out of interviewed people (CI95%: 15.6-22.6%) expressed a high risk appetite, but only 10.0% (CI95% 7.0 to 13.0) were classified as risk-seeking by L2. It was found association between increased risk appetite and having a better perception of health status (0.110, CI95%: 0,007-0,212) or a higher income (0.010, CI95%: 0.017- 0.123) or smoking status (0.059, CI95%: 0.004- 0.114). Being Spanish was associated with lower risk appetite (-0.105, CI95%: -0.005 --0.205), as being over 65 (-0.031, CI95%:- 0.061- -0.001) or a woman (-0.038, CI95%:-0.064- -0.012). The intraclass correlation coefficient for self-evaluation scale was 0.511 (95% CI: 0.372 to 0.629), 0.571 (95% CI: 0.441 to 0.678) for L1 and 0.349 (95% CI: 0.186-0.493) to L2. CONCLUSIONS: People who seek health care express certain inclination to risk, but this feature is attenuated when methodologies involving losses are used. Risk appetite seems greater in young people, males, people with better health, or more income, and in immigrants. Lottery games such as the proposed ones are a simple and useful tool to estimate individuals' inclination to risk.

OBJETIVO: La caracterización de la actitud ante el riesgo puede ser útil en la planificación de las intervenciones sanitarias. El objetivo fue estudiar la actitud ante el riesgo de una población que demanda cuidados de salud y evaluar la capacidad de un juego de loterías para evidenciar dicha actitud. METODOS: Estudio multicéntrico transversal. Se recogieron características demográficas, socioeconómicas, de calidad de vida y conductas de riesgo en salud de 662 personas usuarias de 23 centros de salud seleccionadas mediante muestreo aleatorio. La actitud ante el riesgo se evaluó mediante una escala subjetiva y mediante dos juegos de azar (L1 y L2; L2 incluía la posibilidad de pérdidas económicas). Se realizaron modelos explicativos para valorar la variabilidad de la propensión al riesgo utilizando Generalized Estimating Equations (GEE). RESULTADOS: El 19,1% (IC95%:15,6-22,6%) de los sujetos expresaron una propensión al riesgo alta, el 10,0% (IC95%:7,0-13,0) fueron clasificados como propensos al riesgo con L2. Se encontró asociación entre una mayor propensión al riesgo y tener mejor percepción del estado de salud (0,110; IC95%:0,007- 0,212) o mayor renta (0,010; IC95%: 0,017- 0,123) o ser fumador (0,059; IC95%: 0,004-0,114). Ser español se relacionaba con menor propensión al riesgo (-0,105; IC95%: -0,205- -0,005), al igual que ser mayor de 65 años (-0,031; IC95%:-0,061- -0,001) o ser mujer (-0,038, IC95%:-0,064- -0,012). El coeficiente de correlación intraclase para la escala subjetiva fue 0,511 (IC95%:0,372-0,629), 0,571 (IC95%:0,441-0,678) para L1 y 0,349 (IC95%:0,186-0,493) para L2. CONCLUSIONES: Las personas que demandan cuidados de salud presentan con frecuencia propensión al riesgo, la cual se atenúa cuando se caracteriza mediante metodologías que implican pérdidas. La propensión al riesgo parece mayor en personas jóvenes, varones, con mejor estado de salud, con mayor renta y en inmigrantes.

La valoración de la actitud ante el riesgo en personas que demandan cuidados en salud: una aproximación mediante juegos de loterías utilizando Generalized Estimating Equations / Risk-taking attitudes of people who seek health care: an exploratory approach through lottery games using Generalized Estimating Equations

Fundamento: La caracterización de la actitud ante el riesgo puede ser útil en la planificación de las intervenciones sanitarias. El objetivo fue estudiar la actitud ante el riesgo de una población que demanda cuidados de salud y evaluar la capacidad de un juego de loterías para evidenciar dicha actitud. Métodos: Estudio multicéntrico transversal. Se recogieron características demográficas, socioeconómicas, de calidad de vida y conductas de riesgo en salud de 662 personas usuarias de 23 centros de salud seleccionadas mediante muestreo aleatorio. La actitud ante el riesgo se evaluó mediante una escala subjetiva y mediante dos juegos de azar (L1 y L2; L2 incluía la posibilidad de pérdidas económicas). Se realizaron modelos explicativos para valorar la variabilidad de la propensión al riesgo utilizando Generalized Estimating Equations (GEE). Resultados: El 19,1% (IC95%:15,6-22,6%) de los sujetos expresaron una propensión al riesgo alta, el 10,0% (IC95%:7,0-13,0) fueron clasificados como propensos al riesgo con L2. Se encontró asociación entre una mayor propensión al riesgo y tener mejor percepción del estado de salud (0,110; IC95%:0,007- 0,212) o mayor renta (0,010; IC95%: 0,017- 0,123) o ser fumador (0,059; IC95%: 0,004-0,114). Ser español se relacionaba con menor propensión al riesgo (-0,105; IC95%: -0,205- -0,005), al igual que ser mayor de 65 años (-0,031; IC95%:-0,061- -0,001) o ser mujer (-0,038, IC95%:-0,064- -0,012). El coeficiente de correlación intraclase para la escala subjetiva fue 0,511 (IC95%:0,372-0,629), 0,571 (IC95%:0,441-0,678) para L1 y 0,349 (IC95%:0,186-0,493) para L2. Conclusiones: Las personas que demandan cuidados de salud presentan con frecuencia propensión al riesgo, la cual se atenúa cuando se caracteriza mediante metodologías que implican pérdidas. La propensión al riesgo parece mayor en personas jóvenes, varones, con mejor estado de salud, con mayor renta y en inmigrantes (AU)

Background: The characterization of the risk-taking attitude of individuals may be useful for planning health care interventions. It has been attempted to study expressions of risk-taking attitude and evaluate characteristics of a standard lottery game in a population that seeks health care to elicit these attitudes. Methods: Multicentric cross-sectional study. Demographic and socioeconomic characteristics, quality of life (EuroQol-5D), and health risk behaviors were collected from 662 users of 23 health centers selected by random sampling. Risk-taking attitude was evaluated by means of a self-evaluation scale and two lotteries games, (L1 and L2; L2 included the possibility of economic losses). Generalized estimating equations (GEE) explicative models were used to evaluate the variability of risk-taking attitude. Results: Nineteen percent out of interviewed people (CI95%: 15.6-22.6%) expressed a high risk appetite, but only 10.0% (CI95% 7.0 to 13.0) were classified as risk-seeking by L2. It was found association between increased risk appetite and having a better perception of health status (0.110, CI95%: 0,007-0,212) or a higher income (0.010, CI95%: 0.017- 0.123) or smoking status (0.059, CI95%: 0.004- 0.114). Being Spanish was associated with lower risk appetite (-0.105, CI95%: -0.005 --0.205), as being over 65 (-0.031, CI95%:- 0.061- -0.001) or a woman (-0.038, CI95%:-0.064- -0.012). The intraclass correlation coefficient for self-evaluation scale was 0.511 (95% CI: 0.372 to 0.629), 0.571 (95% CI: 0.441 to 0.678) for L1 and 0.349 (95% CI: 0.186-0.493) to L2. Conclusions: People who seek health care express certain inclination to risk, but this feature is attenuated when methodologies involving losses are used. Risk appetite seems greater in young people, males, people with better health, or more income, and in immigrants. Lottery games such as the proposed ones are a simple and useful tool to estimate individuals’ inclination to risk (AU)

Economic valuation of health care services in public health systems: a study about Willingness to Pay (WTP) for nursing consultations.

BACKGROUND: Identifying the economic value assigned by users to a particular health service is of principal interest in planning the service. The aim of this study was to evaluate the perception of economic value of nursing consultation in primary care (PC) by its users. METHODS AND RESULTS: Economic study using contingent valuation methodology. A total of 662 users of nursing consultation from 23 health centers were included. Data on demographic and socioeconomic characteristics, health needs, pattern of usage, and satisfaction with provided service were compiled. The validity of the response was evaluated by an explanatory mixed-effects multilevel model in order to assess the factors associated with the response according to the welfare theory. Response reliability was also evaluated. Subjects included in the study indicated an average Willingness to Pay (WTP) of €14.4 (CI 95%: €13.2-15.5; median €10) and an average Willingness to Accept [Compensation] (WTA) of €20.9 (CI 95%: €19.6-22.2; median €20). Average area income, personal income, consultation duration, home visit, and education level correlated with greater WTP. Women and older subjects showed lower WTP. Fixed parameters explained 8.41% of the residual variability, and response clustering in different health centers explained 4-6% of the total variability. The influence of income on WTP was different in each center. The responses for WTP and WTA in a subgroup of subjects were consistent when reassessed after 2 weeks (intraclass correlation coefficients 0.952 and 0.893, respectively). CONCLUSIONS: The economic value of nursing services provided within PC in a public health system is clearly perceived by its user. The perception of this value is influenced by socioeconomic and demographic characteristics of the subjects and their environment, and by the unique characteristics of the evaluated service. The method of contingent valuation is useful for making explicit this perception of value of health services.

A study of the user's perception of economic value in nursing visits to primary care by the method of contingent valuation.

BACKGROUND: The identification of the attribution of economic value that users of a health system assign to a health service could be useful in planning these services. The method of contingent valuation can provide information about the user's perception of value in monetary terms, and therefore comparable between services of a very different nature. This study attempts to extract the economic value that the subject, user of primary care nursing services in a public health system, attributes to this service by the method of contingent valuation, based on the perspectives of Willingness to Pay (WTP) and Willingness to Accept [Compensation] (WTA). METHODS/DESIGN: This is an economic study with a transversal design. The contingent valuation method will be used to estimate the user's willingness to pay (WTP) for the care received from the primary care nurse and the willingness to accept [compensation] (WTA), were this service eliminated. A survey that meets the requisites of the contingent valuation method will be constructed and pilot-tested. Subsequently, 600 interviews will be performed with subjects chosen by systematic randomized sampling from among those who visit nursing at twenty health centers with different socioeconomic characteristics in the Community of Madrid. The characteristics of the subject and of the care received that can explain the variations in WTP, WTA and in the WTP/WTA ratio expressed will be studied. A theoretical validation of contingent valuation will be performed constructing two explanatory multivariate mixed models in which the dependent variable will be WTP, and the WTP/WTA relationship, respectively. DISCUSSION: The identification of the attribution of economic value to a health service that does not have a direct price at the time of use, such as a visit to primary care nursing, and the definition of a profile of "loss aversion" in reference to the service evaluated, can be relevant elements in planning, enabling incorporating patient preferences to health policy decision-making.

Differences between willingness to pay and willingness to accept for visits by a family physician: a contingent valuation study.

BACKGROUND: The economic value attributed by users of health services in public health systems can be useful in planning and evaluation. This value can differ from the perspectives of Willingness to Pay (WTP) and Willingness to Accept [Compensation] (WTA).Our objective was to study the perceptions of the patient about the service provided by the family physician by means of the WTA/WTP ratio. METHODS: An economic evaluation study by the Contingent Valuation Method was designed. Interviews were conducted with 451 subjects at six health centres (four urban and two rural) in areas with different socioeconomic characteristics. A payment card was used to measure the WTP and WTA. Other characteristics of the subject or service that could influence these responses were collected. An explicative model was constructed to study the WTA/WTP relationship. RESULTS: Four hundred and four subjects (89.6%) expressed a WTP and WTA different from zero. The WTA/WTP quotient showed a median of 1.55 (interquartile range 1-3.08) and a mean of 3.30 (IC 95%: 2.84-3.75). The WTA/WTP ratio increases with age and in low-income areas. It decreases in professional groups with more specialized activities, with growing family income, and in the chronically ill. Other characteristics related to the perception of state of health, accessibility to the service, satisfaction, or perception of risk were not explicative. CONCLUSIONS: Subjects who were older and had a less favourable socioeconomic situation expressed a higher WTA/WTP ratio when valuing the visit to the family physician. These characteristics could identify a profile of "aversion to loss" with respect to this service.

Perception of the economic value of primary care services: a Willingness to Pay study.

OBJECTIVE: Identify the economic value the user attributes to the visit to the family physician, in a setting of a National Health System, by the Willingness to Pay (WTP) expressed. METHODS: Economic evaluation study, by the contingent valuation method. Questions were asked about WTP using a payment card format. Interviews were conducted with 451 subjects, in areas with different socioeconomic characteristics. An ordered probit was used to evaluate model's validity. RESULTS: Median WTP expressed was euro18 (interquartile range euro8-28), not including "zero-answers" of thirty-four subjects (7.5%). This value represents 2% of average adjusted family incomes. Patients with higher incomes or with chronic illnesses presented a probability of 5-14 percentage points of expressing a high WTP. For every point of increase of patient satisfaction, the probability of presenting a WTP in the lowest range decreases 7.0 percentage points. Subjects with a low education level and those older than 65 expressed a lower WTP. Accessibility, risk perception, nationality and having private insurance were not related to the WTP expressed. CONCLUSIONS: Users of primary care have a clear perception of the economic value of care received from the family physician, even in a framework of providing services financed by taxes and without cost at the moment of use. This value increases in subjects with higher incomes, with greater need for care, or more satisfied.

Eficacia de un taller de habilidades de afrontamiento en pacientes diabéticos / Efficacy of a practical intervention for diabetic patients on coping abilities

Objetivos: determinar la eficacia de un taller de habilidades de afrontamiento frente a un taller de Educación para la Salud (EpS) tradicional en personas diabéticas; asimismo se quería determinar cuáles eran las habilidades de afrontamiento más utilizadas por los pacientes de cada taller. Material y métodos: estudio experimental, abierto y aleatorizado en dos grupos, de dos años de duración, sobre población con diabetes mellitus tipo 2 (DM2) de Atención Primaria de Madrid. Las variables dependientes fueron: específicas relacionadas con el autocuidado, el Índice de Masa Corporal (IMC), la Hemoglobina Glicosilada (HbA1c), los modos de afrontamiento adoptados por los pacientes (Lazarus y Folkman) y el nivel de ansiedad (STAI). Se midieron todas las variables dependientes al inicio del estudio (mes 0), y al final del mismo (mes 12). Resultados: se obtuvieron 78 sujetos para el grupo TET y 69 sujetos en el grupo THA. Con respecto al cambio intragrupo producido en las variables de autocuidado mejoraron todas significativamente tras la intervención y en ambos grupos, excepto en adherencia al tratamiento; consumo de tabaco y apoto social/familiar; al final del estudio no se objetivaron diferencias estadísticamente significativas entre ambos grupos. La habilidad de afrontamiento más utilizada al incio y al final del estudio fue la búsqueda de apoyo social, en ambos grupos. Los valores de HbA1c y el nivel de ansiedad se redujeron significativamente a nivel intragrupo, no entre ambos grupos al final del estudio. Conclusiones: la EpS se demuestra una herramienta eficaz en la mejora de los autocuidados en las personas diabéticas. La inclusión en los pro yectos educativos de habilidades de afrontamiento como: planificación y resolución de problemas, autocontrol y búsqueda de apoyo social, podrían mejorar los autocuidados

Objectives: the primary objective was to determine efficacy of an intervention on Health Education offered to diabetic patients. The secondary objective was to determine which techniques the patients used most frequently to deal with their condition. Material and methods: experimental, open randomised study of two groups on a population of type 2 diabetes mellitus in a primary care setting in Madrid. Dependent variables were: specifically related to self-care, Body Mass Index (BMI); glycosilated haemoglobin (HbA1c); the ways in which patients coped with their condition (Lazarus y Folkman) and their level of anxiety (STAI). All dependent variables were measured at the start of the study (month 0) and at the end of the study (month 12). Results: 78 subjects were recruited for “traditional health education intervention” (group B) and 69 for “practical intervention on coping abilities” (group A). As regards the intergroup change that took place in the self-care variables, these variables improved significantly after the intervention in both groups, except for “Compliance with treatment, smoking, and social/familial support”. There were no statistically significant differences between both groups. The most frequently used coping ability at the beginning and at the end of the study was the search for social support, in both groups. HbA1c values and level of anxiety went down significantly at intergroup level, not between both groups at the end of the study. Conclusions: the “practical intervention on coping abilities” is an effective tool for improving self –care in diabetic subjects. Inclusion of coping abilities such as planning and problem resolution, self-control and search for social support in educational interventions could greatly improve self-care

[Organisational issues in implementing clinical trials in primary care]. / Aspectos organizativos de los ensayos clínicos en atención primaria.

OBJECTIVE: To identify health professionals concerns on the organisational issues of a randomised clinical trial. DESIGN: A qualitative cross-sectional, descriptive study. SETTING: Primary Care Area 11, Madrid, Spain. PARTICIPANTS: Twenty-four doctors and nurses from 4 primary care teams. METHOD: Three planning meetings with researchers. Design of an anonymous self-administered questionnaire to collect researchers' perceptions on design, method, and organisation during the implementation of a clinical trial. RESULTS: The prestige of being involved in a multi-centre nationwide project, the training sessions offered, a primary care research topic, a working team model of doctor and nurse, and the support provided by team from the 11th Area, were the main organisational incentives. Lack of time, increased clinic workload, and methodological difficulties are discouraging issues. 79.2% (19/24) of the researchers returned the questionnaire. 94.7% (18/19) considered themselves highly motivated. 84.2% (16/19) of researchers, the time required to complete recruitment was reasonable. The 57.9% (13/19) spent 20-25 minutes collecting data at the interview. Cooperation between doctors and nurses had been effective for 68.4% (13/19) of researchers. 89.4% (17/18) considered that support from the Area 11 organisers was useful. CONCLUSIONS: Organisational barriers for implementation are: complexity of data collection at the recruitment interview, design and methodological issues too unrealistic for a primary care setting, and lack of time and extra workload at consultations. The factors that make organisation easier are: having a high level of motivation, sharing workload with other professionals, and support provided by organisers of the trial.

Reflexiones sobre «lo comunitario» en nuestro sistema sanitario / Reflections on our health service

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Aspectos organizativos de los ensayos clínicos en atención primaria / Organisational issues in implementing clinical trials in primary care

Objetivo. Conocer la opinión de los investigadores respecto a la organización de un ensayo clínico. Diseño. Estudio cualitativo, descriptivo y transversal. Emplazamiento. Área 11 de Madrid. Atención primaria. Participantes. Participaron 24 médicos y enfermeras de 4 equipos de atención primaria. Métodos. Se realizaron 3 reuniones de planificación con los investigadores. Se utilizó un cuestionario anónimo autoadministrado respecto al diseño, la metodología y la organización del ensayo. Resultados. Poder participar en un proyecto multicéntrico nacional, las sesiones formativas ofertadas, un tema de investigación propio de atención primaria, el modelo de trabajo investigador médico-enfermera y el apoyo recibido por la Organización del ensayo son factores organizativos motivadores. El escaso tiempo disponible, una elevada presión asistencial en las consultas y las dificultades metodológicas son aspectos desmotivadores. El 79,2% (19/24) de los profesionales contesta el cuestionario. El 94,7% (18/19) considera que ha estado muy motivado. El 84,2% (16/19) cree que el tiempo de selección es bastante apropiado. Un 57,9% (13/19) invierte 20-25 min en la entrevista. Para un 68,4% (13/19), la colaboración entre médicos y enfermeras ha sido efectiva. Un 89,4% (17/18) estima que el apoyo de la Organización del Área 11 ha sido muy útil. Conclusiones. Las dificultades organizativas son: complejidad de la entrevista de selección, factores metodológicos y del diseño que distan de la realidad de atención primaria, falta de tiempo y elevada presión asistencial. Los factores organizativos facilitadores son: tener un alto grado de motivación, poder repartir las cargas de trabajo con otros profesionales y recibir apoyo organizativo

Objective. To identify health professionals concerns on the organisational issues of a randomised clinical trial. Design. A qualitative cross-sectional, descriptive study. Setting. Primary Care Area 11, Madrid, Spain. Participants. Tweenty-four doctors and nurses from 4 primary care teams. Method. Three planning meetings with researchers. Design of an anonymous self-administered questionnaire to collect researchers' perceptions on design, method, and organisation during the implementation of a clinical trial. Results. The prestige of being involved in a multi-centre nationwide project, the training sessions offered, a primary care research topic, a working team model of doctor and nurse, and the support provided by team from the 11th Area, were the main organisational incentives. Lack of time, increased clinic workload, and methodological difficulties are discouraging issues. 79.2% (19/24) of the researchers returned the questionnaire. 94.7% (18/19) considered themselves highly motivated. 84.2% (16/19) of researchers, the time required to complete recruitment was reasonable. The 57.9% (13/19) spent 20-25 minutes collecting data at the interview. Cooperation between doctors and nurses had been effective for 68.4% (13/19) of researchers. 89.4% (17/18) considered that support from the Area 11 organisers was useful. Conclusions. Organisational barriers for implementation are: complexity of data collection at the recruitment interview, design and methodological issues too unrealistic for a primary care setting, and lack of time and extra workload at consultations. The factors that make organisation easier are: having a high level of motivation, sharing workload with other professionals, and support provided by organisers of the trial

Factores que afectan al reclutamiento de un ensayo clínico en atención primaria / Factors that affect recruitment for a clinical trial in primary care

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