Modelos teóricos de promoción de la salud en la práctica habitual en atención primaria de salud

Exploring personal aptitudes and personality traits that, together with social determinants, shape health behaviors and conduct: a thematic analysis based on the Capability, Opportunity, Motivation and Behavior (COM-B) change system

Introduction

Effective implementation of strategies to promote health and prevent noncommunicable illnesses requires a profound understanding of the interaction between the individual and society. This study brings to health research the consideration of psychosocial factors that influence the maintenance and change of health behaviors and conduct. From a primary care perspective, it is crucial to propose a biopsychosocial approach for the development of health promotion and self-care programs that embrace personal aptitudes as a relevant individual aspect.

Objectives

To explore experiences related to personal aptitudes and personality traits that influence health behaviors and conduct, taking into account the social determinants of health, through a thematic analysis based on the capability-opportunity-motivation and behavior (COM-B) system.

Methods and analysis

This qualitative research is carried out from a descriptive phenomenological perspective, based on 17 focus groups in which 156 people participated. Inductive and deductive analysis techniques were used following Lincoln and Guba's criteria of methodological rigor. In addition to 7 different triangulations of analysts, 6 main categories were identified based on the COM-B system: psychological capacity, physical capacity, physical opportunity, social opportunity, reflective motivation, and automatic motivation. The importance of considering these factors to promote healthy behaviors was stressed.

Discussion

This study examined how personal experiences related personal aptitudes and personality traits influence health behaviors and conduct in Spain. It was found that personality traits such as health literacy, self-efficacy, activation, and self-determination can influence the adoption of healthy behaviors. Likewise, the need for control, overthinking, and ambivalence made it impossible. Furthermore, social determinants of health and interpersonal relationships also play an important role.

Trial registration

ClinicalTrials.gov, NCT04386135. Registered on April 30, 2020.

Attitude towards health promotion in university students. Construction and validation of a scale

OBJECTIVE

To construct and validate a questionnaire about the attitude of university students toward health promotion.

METHOD

A cross-sectional study. A questionnaire of 14 questions was designed and administered to 1486 first-year undergraduates. The principal axes factoring method with oblique rotation was applied and a confirmatory factor analysis was carried out. Reliability was calculated through internal consistency with Cronbach's alpha and item-total correlation for the global scale and its subscales.

RESULTS

A 14-item scale was constructed, with two dimensions. Its Cronbach's alpha was 0.872, and 0.852, and 0.718 for its subscales. The adjustment values of the confirmatory factor analysis were adequate.

CONCLUSIONS

The attitude towards health promotion scale has shown to have adequate psychometric properties. It is an instrument that will help to detect referents and health assets for future interventions.

Role of personal aptitudes as determinants of incident morbidity, lifestyles, quality of life, use of the health services and mortality (DESVELA cohort): qualitative study protocol for a prospective cohort study in a hybrid analysis

Introduction

Maintaining or acquiring healthier health-oriented behaviours and promoting physical and mental health amongst the Spanish population is a significant challenge for Primary Health Care. Although the role of personal aptitudes (characteristics of each individual) in influencing health behaviours is not yet clear, these factors, in conjunction with social determinants such as gender and social class, can create axes of social inequity that affect individuals' opportunities to engage in health-oriented behaviours. Additionally, lack of access to health-related resources and opportunities can further exacerbate the issue for individuals with healthy personal aptitudes. Therefore, it is crucial to investigate the relationship between personal aptitudes and health behaviours, as well as their impact on health equity.

Objectives

This paper outlines the development, design and rationale of a descriptive qualitative study that explores in a novel way the views and experiences on the relationship between personal aptitudes (activation, health literacy and personality traits) and their perception of health, health-oriented behaviours, quality of life and current health status.

Method and analysis

This qualitative research is carried out from a phenomenological perspective. Participants will be between 35 and 74 years of age, will be recruited in Primary Health Care Centres throughout Spain from a more extensive study called DESVELA Cohort. Theoretical sampling will be carried out. Data will be collected through video and audio recording of 16 focus groups in total, which are planned to be held in 8 different Autonomous Communities, and finally transcribed for a triangulated thematic analysis supported by the Atlas-ti program.

Discussion

We consider it essential to understand the interaction between health-related behaviours as predictors of lifestyles in the population, so this study will delve into a subset of issues related to personality traits, activation and health literacy.Clinical trial registration: ClinicalTrials.gov, identifier NCT04386135.

Self-Efficacy of the Community Health Agent, Importance of Motivation and Empowerment

INTRODUCTION

The community health agent plays an essential role as a link between the community and health institutions; the effectiveness of their work is crucial in promoting health, prevention, and detection of diseases. Motivation and empowerment could affect the performance of the community agent in carrying out his work.

OBJECTIVE

To determine if work motivation and empowerment are factors associated with the self-efficacy of the community health agent.

METHODOLOGY

Observational and cross-sectional study. The study included community health agents in the Non-Governmental Organization ADRA in Imbabura and Pichincha, Ecuador. The sample selected by the census method corresponds to 300 agents. The instruments were the Motivation at Work Scale (R-MAWS), the Psychological Empowerment Scale, and the Professional Self-efficacy Questionnaire (AU10). Descriptive statistical analyses were performed using dispersion and summary measures-a comparative analysis with chi-square. The inferential analysis was done through logistic regression where the B coefficient and the odds ratio (OR) with 95% confidence intervals (CI) were evaluated, P < .05. The theoretical and adjusted model of the structural model allowed us to corroborate the association of the variables.

RESULTS

Motivation had a positive effect on self-efficacy (OR = 10.091, CI [5.509-18.485], P < .05), empowerment had a minimal effect (OR = 0.664, CI [0.363-1.214], P > .05), which is not significant to predict the perception of self-efficacy.

CONCLUSION

This study suggests that to improve the self-efficacy of the work of community health agents, it is necessary to intervene through strategies that keep them motivated in the exercise of their mediation work between the community and health institutions. Likewise, empowering them would contribute to self-efficacy and thus help in the fulfillment of the functions of health agents.

Improving Initial Medication Adherence to cardiovascular disease and diabetes treatments in primary care: Pilot trial of a complex intervention

Introduction

The Initial Medication Adherence (IMA) intervention is a multidisciplinary and shared decision-making intervention to improve initial medication adherence addressed to patients in need of new treatments for cardiovascular diseases and diabetes in primary care (PC). This pilot study aims to evaluate the feasibility and acceptability of the IMA intervention and the feasibility of a cluster-RCT to assess the effectiveness and cost-effectiveness of the intervention.

Methods

A 3-month pilot trial with an embedded process evaluation was conducted in five PC centers in Catalonia (Spain). Electronic health data were descriptively analyzed to test the availability and quality of records of the trial outcomes (initiation, implementation, clinical parameters and use of services). Recruitment and retention rates of professionals were analyzed. Twenty-nine semi-structured interviews with professionals (general practitioners, nurses, and community pharmacists) and patients were conducted to assess the feasibility and acceptability of the intervention. Three discussion groups with a total of fifteen patients were performed to review and redesign the intervention decision aids. Qualitative data were thematically analyzed.

Results

A total of 901 new treatments were prescribed to 604 patients. The proportion of missing data in the electronic health records was up to 30% for use of services and around 70% for clinical parameters 5 months before and after a new prescription. Primary and secondary outcomes were within plausible ranges and outliers were barely detected. The IMA intervention and its implementation strategy were considered feasible and acceptable by pilot-study participants. Low recruitment and retention rates, understanding of shared decision-making by professionals, and format and content of decision aids were the main barriers to the feasibility of the IMA intervention.

Discussion

Involving patients in the decision-making process is crucial to achieving better clinical outcomes. The IMA intervention is feasible and showed good acceptability among professionals and patients. However, we identified barriers and facilitators to implementing the intervention and adapting it to a context affected by the COVID-19 pandemic that should be considered before launching a cluster-RCT. This pilot study identified opportunities for refining the intervention and improving the design of the definitive cluster-RCT to evaluate its effectiveness and cost-effectiveness.

Clinical trial registration

ClinicalTrials.gov, identifier NCT05094986.

[Design and validation of an instrument about quality of the advance care planning for professionals]

OBJECTIVE

To develop a questionnaire aimed to measure the quality of the advance care planning process in healthcare professionals and to assess its psychometric quality.

METHOD

Instrumental questionnaire validation study.

SCOPE

primary care centers and outpatients clinics from general hospitals in Ferrol, Ourense, Monforte-Lugo and Health Area V of the Health Service of Asturias.

PARTICIPANTS

physicians and nurses. Phases: (1) design of the first version of the questionnaire using the Delphi technique; (2) construction of the second version of 21 items, after judges' agreement and Kendall's W test; (3) pilot study: internal consistency using Cronbach's alpha and omega coefficient, retest-test by Pearson's correlation coefficient; (4) validation: Barlett's spherity test and Kaiser-Meyer-Olkin measurement, exploratory factor analysis with varimax rotation and study of the dimensions of the questionnaire (number, CCI and correlation), internal consistency using Cronbach's alpha.

RESULTS

Pilot study with 28 professionals. Reliability ɷ=0.917, α=0.841, and test-retest correlation coefficient of 0.785 (95% confidence interval: 0.587-0.894; p<0.001). Validation of the questionnaire (21 items) in 204 professionals. Ítem analysis and exploratory factor analysis (Barlett's test [χ²=1298,789] and KMO=0.808; p<0.001) yielded a five-factor model explaining 64.377% of the total variance, with 18 items grouped into 5 dimensions (information, preferences, behavioral intention, training and communication). Cronbach's alpha of the global questionnaire was 0.841.

CONCLUSIONS

The ProPAD-pro questionnaire has showed to be a valid and reliable instrument to assess the quality of the advance care planning process.

La salud pública en Colombia (1991-2021). Promoción de la salud y prevención: una revisión

Objetivo Este artículo se propone realizar un balance de la promoción de la salud durante el desempeño del sistema de salud, a partir de la reforma constitucional de 1991. Métodos Se parte de una revisión temática, en bases de datos de PubMed, SciELO, Google Scholar, a través de los términos y operadores booleanos (“promoción de la salud” or “prevención”) and (“Colombia”), en los últimos 10 años (2011-2021); y la legislación sobre promoción de la salud de los últimos 30 años en Colombia, seleccionando la más relevante. Discusión Se analiza la trayectoria regulatoria de la salud pública, derivada de la Ley 100 de 1993, destacando la confusión que entre promoción y prevención se dio en el sistema. Se discuten varias fases de desarrollo de la salud pública en este período, con grandes falencias en la primera década de la reforma, mejorando después del 2005, pero sin lograr su cometido, dadas las contradicciones con el modelo de mercado que rige el sistema. No se logran desarrollar los niveles colectivos y comunitarios de la promoción de la salud, como tampoco la perspectiva estratégica de la atención primaria en salud (APS). Conclusión La promoción de la salud y la prevención no lograron ser desarrolladas de manera cabal en Colombia, a pesar del entorno internacional proclive a su implementación mediante la atención primaria en salud. Muchos de los postulados teóricos de la legislación se han quedado en la retórica y pendientes de aplicación, muy a pesar del amplio marco regulatorio que se dio en estos treinta años.

Cost-effectiveness analysis of a multiple health behaviour change intervention in people aged between 45 and 75 years: a cluster randomized controlled trial in primary care (EIRA study)

BACKGROUND

Multiple health behaviour change (MHBC) interventions that promote healthy lifestyles may be an efficient approach in the prevention or treatment of chronic diseases in primary care. This study aims to evaluate the cost-utility and cost-effectiveness of the health promotion EIRA intervention in terms of MHBC and cardiovascular reduction.

METHODS

An economic evaluation alongside a 12-month cluster-randomised (1:1) controlled trial conducted between 2017 and 2018 in 25 primary healthcare centres from seven Spanish regions. The study took societal and healthcare provider perspectives. Patients included were between 45 and 75 years old and had any two of these three behaviours: smoking, insufficient physical activity or low adherence to Mediterranean dietary pattern. Intervention duration was 12 months and combined three action levels (individual, group and community). MHBC, defined as a change in at least two health risk behaviours, and cardiovascular risk (expressed in % points) were the outcomes used to calculate incremental cost-effectiveness ratios (ICER). Quality-adjusted life-years (QALYs) were estimated and used to calculate incremental cost-utility ratios (ICUR). Missing data was imputed and bootstrapping with 1000 replications was used to handle uncertainty in the modelling results.

RESULTS

The study included 3062 participants. Intervention costs were €295 higher than usual care costs. Five per-cent additional patients in the intervention group did a MHBC compared to usual care patients. Differences in QALYS or cardiovascular risk between-group were close to 0 (- 0.01 and 0.04 respectively). The ICER was €5598 per extra health behaviour change in one patient and €6926 per one-point reduction in cardiovascular risk from a societal perspective. The cost-utility analysis showed that the intervention increased costs and has no effect, in terms of QALYs, compared to usual care from a societal perspective. Cost-utility planes showed high uncertainty surrounding the ICUR. Sensitivity analysis showed results in line with the main analysis.

CONCLUSION

The efficiency of EIRA intervention cannot be fully established and its recommendation should be conditioned by results on medium-long term effects.

TRIAL REGISTRATION

Clinicaltrials.gov NCT03136211 . Registered 02 May 2017 - Retrospectively registered.