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Jácome C, Brito D, João C, Lopes F, Santos J, Amorim L, Barbosa MJ, Pardal M, Teixeira P, Bernardo F, Fonseca JA, Correia-de-Sousa J. EPI-ASTHMA study protocol: a population-based multicentre stepwise study on the prevalence and characterisation of patients with asthma according to disease severity in Portugal. BMJ Open 2022; 12:e064538. [PMID: 36123070 PMCID: PMC9486331 DOI: 10.1136/bmjopen-2022-064538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION In Portugal as in other countries, data on the epidemiology of asthma are mainly grounded in questionnaire studies. Additionally, the detailed characterisation of asthma in terms of disease severity, control and phenotypes remain scarce. Studies assessing the prevalence of asthma and its subgroups using accurate methods are needed. This study aims to determine the prevalence of asthma, difficult-to-treat asthma and severe asthma, and to evaluate sociodemographic and clinical characteristics of those patients, in mainland Portugal. METHODS AND ANALYSIS A population-based nationwide study with a multicentre stepwise approach will be conducted between 2021 and 2023 in 38 primary care centres of the Portuguese National Health Service. The stepwise approach will comprise four stages: Stage 0-telephone call invitation to adult subjects (≥18 years) randomly selected (n~15 000); stage 1-telephone screening interview assessing the participants' respiratory symptoms (n~7500); stage 2-diagnostic visit, including physical examination, diagnostic tests (eg, spirometry, fraction of exhaled nitric oxide, blood eosinophil count) and patient-reported outcome measures for diagnostic confirmation of those identified with possible asthma at stage 1 (n~1800); stage 3-further evaluation of patients with asthma and of patients with difficult-to-treat asthma and severe asthma, after 3 months (n~460). At stage 3, data will be collected from a review of the patient's electronic health records, a follow-up telephone call and the CARATm (Caracteristicas Auto-reportadas de Asma em Tecnologias Móveis) app database. The prevalence of asthma, difficult-to-treat asthma and severe asthma will be determined as the percentage of patients with asthma confirmed from the overall population (stage 1). For the analysis of factors associated with asthma, difficult-to-treat asthma and severe asthma, logistic regression models will be explored. ETHICS AND DISSEMINATION Ethical approvals for the study were obtained from the ethics committee of the local health unit of Matosinhos, Porto (38/CES/JAS), Alto Minho (38/2021/CES) and the regional health administration of Lisbon-Vale do Tejo (035/CES/INV/2021). Results will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT05169619.
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Affiliation(s)
- Cristina Jácome
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Dinis Brito
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- Sete Fontes, Family Health Unit, Braga, Portugal
| | - Catarina João
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
| | | | - Janete Santos
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
| | | | - Maria João Barbosa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- Gualtar Family Health Unit, Braga, Portugal
| | | | - Pedro Teixeira
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- Digital Medicine Center P5, Braga, Portugal
| | | | - Joao A Fonseca
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
- MEDIDA, Porto, Portugal
- Allergy Unit, Hospital and Institute CUF, Porto, Portugal
| | - Jaime Correia-de-Sousa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
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Vieira RJ, Sousa-Pinto B, Cardoso-Fernandes A, Jácome C, Portela D, Amaral R, Sá-Sousa A, Pereira AM, Bousquet J, Fonseca JA. Control of Allergic Rhinitis and Asthma Test: A systematic review of measurement properties and COSMIN analysis. Clin Transl Allergy 2022; 12:e12194. [PMID: 36178185 PMCID: PMC9510765 DOI: 10.1002/clt2.12194] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/17/2022] [Accepted: 08/29/2022] [Indexed: 11/09/2022] Open
Abstract
The Control of Allergic Rhinitis and Asthma Test (CARAT) is a patient-reported outcome measurement (PROM) assessing the control of asthma and allergic rhinitis (AR) at a 4 week interval. This systematic review aimed to evaluate the measurement properties of CARAT. Following PRISMA and COSMIN guidelines, we searched five bibliographic databases and retrieved studies concerning the development, assessment of properties, validation, and/or cultural adaption of CARAT. The studies' methodological quality, the quality of measurement properties, and the overall quality of evidence were assessed. We performed meta-analysis of CARAT measurement properties. We included 16 studies. Control of Allergic Rhinitis and Asthma Test displayed sufficient content validity and very good consistency (meta-analytical Cronbach alpha = 0.83; 95% CI = 0.80-0.86;I2 = 62.6%). Control of allergic rhinitis and Asthma Test meta-analytical intraclass correlation coefficient was 0.91 (95% CI = 0.64-0.98;I2 = 93.7%). It presented good construct validity, especially for correlations with Patient-reported outcome measures assessing asthma (absolute Spearman correlation coefficients range = 0.67-0.73; moderate quality of evidence), and good responsiveness. Its minimal important difference is 3.5. Overall, CARAT has good internal consistency, reliability, construct validity and responsiveness, despite the heterogeneous quality of evidence. Control of Allergic Rhinitis and Asthma Test can be used to assess the control of asthma and AR. As first of its kind, this meta-analysis of CARAT measurement properties sets a stronger level of evidence for asthma and/or AR control questionnaires.
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Affiliation(s)
- Rafael José Vieira
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine of the University of Porto, Porto, Portugal.,Centre for Health Technology and Services Research, Health Research Network (CINTESIS@RISE), Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Bernardo Sousa-Pinto
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine of the University of Porto, Porto, Portugal.,Centre for Health Technology and Services Research, Health Research Network (CINTESIS@RISE), Faculty of Medicine of the University of Porto, Porto, Portugal
| | - António Cardoso-Fernandes
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine of the University of Porto, Porto, Portugal.,Centre for Health Technology and Services Research, Health Research Network (CINTESIS@RISE), Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Cristina Jácome
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine of the University of Porto, Porto, Portugal.,Centre for Health Technology and Services Research, Health Research Network (CINTESIS@RISE), Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Diana Portela
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine of the University of Porto, Porto, Portugal.,Centre for Health Technology and Services Research, Health Research Network (CINTESIS@RISE), Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Rita Amaral
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine of the University of Porto, Porto, Portugal.,Centre for Health Technology and Services Research, Health Research Network (CINTESIS@RISE), Faculty of Medicine of the University of Porto, Porto, Portugal.,School of Health, Polytechnic of Porto, Porto, Portugal.,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Ana Sá-Sousa
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine of the University of Porto, Porto, Portugal.,Centre for Health Technology and Services Research, Health Research Network (CINTESIS@RISE), Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Ana Margarida Pereira
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine of the University of Porto, Porto, Portugal.,Allergy Unit, CUF Porto Hospital & Institute, Porto, Portugal
| | - Jean Bousquet
- Institute for Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany.,University Hospital, Montpellier, France.,ARIA, Montpellier, France
| | - João Almeida Fonseca
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine of the University of Porto, Porto, Portugal.,Centre for Health Technology and Services Research, Health Research Network (CINTESIS@RISE), Faculty of Medicine of the University of Porto, Porto, Portugal.,Allergy Unit, CUF Porto Hospital & Institute, Porto, Portugal
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Correia-DE-Sousa J, Vicente C, Brito D, Tsiligianni I, Kocks JW, Román-Rodriguez M, Baxter N, Maricoto T, Williams S. Managing asthma in primary healthcare. Minerva Med 2021; 112:582-604. [PMID: 34814633 DOI: 10.23736/s0026-4806.21.07277-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Asthma brings considerable challenges for family doctors because of its variety of shapes, different levels of severity, a wide age range, and the fact that in the last decades clinicians are able to offer much better treatment options with a better level of disease control and a higher quality of life. The objectives of the current review article are to provide an up-to-date review by primary care respiratory leaders from different countries of the most significant challenges regarding asthma diagnosis and management, the importance of team work and the problems in recognizing and dealing with difficult-to-manage and severe asthma in primary care. The article provides a short review of the main challenges faced by family physicians and other primary health care professionals in supporting their patients in the management of asthma, such as asthma diagnosis, promoting access to spirometry, the importance of a multiprofessional team for the management of asthma, how to organize an asthma review, the promotion of patient autonomy and shared decision-making, improving the use of inhalers, the importance of the personalized asthma action plan, dealing with difficult-to-manage and severe asthma in primary care and choosing when, where and how to refer patients with severe asthma. The article also discusses the development of an integrated approach to asthma care in the community and the promotion of Asthma Right Care.
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Affiliation(s)
- Jaime Correia-DE-Sousa
- ICVS/3B's Associate Laboratory, Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal -
| | | | - Dinis Brito
- ICVS/3B's Associate Laboratory, Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,.7 Fontes Family Health Unit, ACES Cávado I - ARS Norte, Braga, Portugal
| | - Ioanna Tsiligianni
- International Primary Care Respiratory Group, Edinburgh, UK.,Health Planning Unit, Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Janwillem W Kocks
- International Primary Care Respiratory Group, Edinburgh, UK.,General Practitioners Research Institute, Groningen, the Netherlands.,GRIAC Research Institute, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.,Observational and Pragmatic Research Institute, Singapore, Singapore
| | - Miguel Román-Rodriguez
- Primary Care Respiratory Research Unit, Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
| | - Noel Baxter
- International Primary Care Respiratory Group, Edinburgh, UK
| | - Tiago Maricoto
- Aveiro-Aradas Family Health Unit, Aveiro Health Center, Aveiro, Portugal.,Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal
| | - Siân Williams
- International Primary Care Respiratory Group, Edinburgh, UK
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Romão M, Godinho AR, Teixeira PM, Mendes Z, Bernardo F, Teixeira Rodrigues A, Correia de Sousa J. Characteristics of Reliever Inhaler Users and Asthma Control: A Cross-Sectional Multicenter Study in Portuguese Community Pharmacies. J Asthma Allergy 2021; 14:943-954. [PMID: 34354362 PMCID: PMC8331120 DOI: 10.2147/jaa.s315678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/24/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE SABA overuse might indicate poorly managed or uncontrolled asthma and be responsible for poor health outcomes. The aim of this study integrated in new fourth multi-design SABINA+ pillar was to characterize the population using short-acting β2-agonists for asthma and examine the patterns of its use among community pharmacy customers in Portugal, as well as identify characteristics associated with disease control and explore potential differences between GINA treatment steps. PATIENTS AND METHODS This cross-sectional multicenter study was conducted in Portuguese community pharmacies between 29 May 2018 and 15 August 2018. Participants were adults (age ≥18 years) self-reporting asthma diagnosis recruited in the context of a short-acting β2-agonist dispense. A two-part questionnaire (pharmacist interview and self-administered) was used to collect information about sociodemographic characteristics, comorbidities, reliever inhaler use, healthcare resource consumption and self-reported disease control (assessed by the Control of Allergic Rhinitis and Asthma Test - CARAT®). Descriptive statistics was done to characterize the study sample. After categorizing patients according to GINA steps, based on their therapeutic regimen, we performed an exploratory subgroup analysis to evaluate if there were any differences between such groups in terms of the variables collected. A logistic regression was used to identify the potential determinants of overall disease control. RESULTS Around 50.8% of patients were male, and the average age was 52 years old. Half of the patients never smoked, and 51.9% were employed. More than half of the patients report inhaler overreliance - purchasing more than 1 pack in 3 months (65.0%) or using the inhaler on more than 8 days over the previous 4 weeks (50.2%). Of the total number of patients in the study, 79.1% had poorly controlled asthma symptoms, and 78.7% had overall poorly controlled respiratory symptoms. We found statistically significant differences between GINA treatment steps in all sociodemographic characteristics (sex, mean age, education level, employment status); maximum number of SABA uses in 24h, CARAT score (total an asthma sub-score); history of exacerbations requiring ED visits or treatment with OCS for at least 3 days in the previous 12 months. Logistic regression revealed that patients reporting SABA use in more than 8 days in the previous 4 weeks and patients with at least 1 exacerbation requiring treatment with OCS for at least 3 days in the previous 12 months have greater odds of poor disease control [adjusted OR (95% CI): 2.6 (1.3-5.2) and 3.0 (1.3-6.6)]. CONCLUSION Based on the results of this study, it can be inferred that the asthma population using SABA is largely uncontrolled and uses reliever inhalers excessively.
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Affiliation(s)
- Mariana Romão
- Centre for Health Evaluation & Research/Infosaude – National Association of Pharmacies (CEFAR/IS-ANF), Lisbon, Portugal
| | - Ana Rita Godinho
- Centre for Health Evaluation & Research/Infosaude – National Association of Pharmacies (CEFAR/IS-ANF), Lisbon, Portugal
| | - Pedro M Teixeira
- Life and Health Sciences Research Institute (ICVS)/3B’s-PT Government Associate Laboratory, University of Minho, Braga, Portugal
| | - Zilda Mendes
- Centre for Health Evaluation & Research/Infosaude – National Association of Pharmacies (CEFAR/IS-ANF), Lisbon, Portugal
| | | | - António Teixeira Rodrigues
- Centre for Health Evaluation & Research/Infosaude – National Association of Pharmacies (CEFAR/IS-ANF), Lisbon, Portugal
| | - Jaime Correia de Sousa
- Life and Health Sciences Research Institute (ICVS)/3B’s-PT Government Associate Laboratory, University of Minho, Braga, Portugal
- Horizonte Family Health Unit, ULS Matosinhos, Matosinhos, Portugal
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Alansari D, Mirza TA. Assessment of Asthma Control Among Asthmatic Patients at Primary Healthcare Centers in Makkah, Saudi Arabia. Cureus 2020; 12:e11103. [PMID: 33240699 PMCID: PMC7682510 DOI: 10.7759/cureus.11103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction Asthma is the most common respiratory disease worldwide. In Saudi Arabia, asthma is considered as a major public health concern and has a negative impact in the life of patients, their families, and the community, including lost days of work, absence from school, and poor quality of life, which can eventually lead to frequent emergency department visits, hospitalizations, and sometimes, to death. Thus, the objectives of this study were to evaluate asthma control status among asthmatic patients in primary health care centers (PHCCs) in Makkah, Saudi Arabia and to identify factors associated with poor asthma control. Methods This was a cross-sectional study conducted from March to May 2016 in selected PHCCs in Makkah, Saudi Arabia. Data was collected from five PHCCs which were selected using a stratified random sample technique from a total of 47 PHCCs to represent the different geographic regions of the city. The 167 asthmatic patients, aged four years and above, presented during the study period were included. Each respondent completed two tools: the first is a self-administrated questionnaire and the second is the asthma control test. Statistical analyses were performed with SPSS version 21 software (IBM Corp, Armonk, USA). Qualitative variables were analyzed with the Chi-square test or Fisher's exact test as appropriate. Results Around one-third (34.1%) of all asthmatic patients were categorized as having uncontrolled asthma and about one-quarter (24.6%) were partially controlled asthma. Dust (91.6%), exposure to incense, detergent and essence (86.8%), common cold (82%) and cold weather (79.6%) were the factors that trigger or exacerbate asthma attacks. Physical activity/exercise and cold weather were the commonest factors that significantly exacerbate asthma attacks particularly among children and were mostly uncontrolled. More than one-third (36.5%) of the asthmatic patients in the PHCCs were cared for by general practitioners. Conclusion Poor asthma control was observed in a high proportion of asthmatic children, adolescents and adults in the Makkah region and they were mostly from non-specialized PHCCs. The poor asthma control among the respondents affects their quality of sleep ( i.e., frequent awakening at night), recurrent absences from work and school, increased hospitalizations, emergency and unscheduled visits to the hospital.
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Affiliation(s)
- Dalia Alansari
- Family and Community Medicine, King Abdulaziz Medical City, Ministry of National Guard Health Affairs-Western Region, Jeddah, SAU
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Barbosa JP, Ferreira-Magalhães M, Sá-Sousa A, Azevedo LF, Fonseca JA. Cost of asthma in Portuguese adults: A population-based, cost-of-illness study. REVISTA PORTUGUESA DE PNEUMOLOGIA 2017; 23:323-330. [PMID: 28807558 DOI: 10.1016/j.rppnen.2017.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 07/01/2017] [Accepted: 07/06/2017] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION Asthma is one of the most frequent chronic diseases, putting a considerable economic burden on societies and individuals. We aimed to estimate the total cost of adult asthma in Portugal, as well as the extent to which direct and indirect costs are influenced by the level of asthma control. METHODS A nationwide, prevalence-based, cost-of-illness study using a bottom-up approach to calculate direct and indirect costs of asthma was conducted, using participant data from the Portuguese National Asthma Survey (INAsma). Direct (healthcare service usage, diagnostic tests and treatment) and indirect (absenteeism and transportation) costs were measured. Decision analytic modelling was used to perform multivariate deterministic sensitivity analysis. RESULTS On average, each adult costs 708.16€ (95%CI: 594.62-839.30) a year, with direct costs representing 93% (658.46€; 95%CI: 548.99-791.29) and indirect costs representing 7% (49.70€; 95%CI: 32.08-71.56). This amounts to a grand total of 386,197,211.25€ (95%CI: 324,279,674.31-457,716,500.18), with direct costs being 359,093,559.82€ (95%CI: 299,391,930.03-431,533,081.07). Asthma direct costs are 2.04% of the total Portuguese healthcare expense in 2010. The major cost domains were acute care usage (30.7%) and treatment (37.4%). Asthma control was significantly associated with higher costs throughout several domains, most notably in acute medical care. CONCLUSIONS Asthma in adults poses a significant economic burden on the Portuguese healthcare system, accounting for over 2% of the total healthcare expenditure in Portugal in 2010. It is important to note that a considerable portion of this burden might be eased by improving asthma control in patients, as uncontrolled patients' costs are more than double those of controlled asthma patients.
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Affiliation(s)
- J P Barbosa
- MEDCIDS: Department of Community Medicine, Information and Decision in Health (MEDCIDS), Faculdade de Medicina, Universidade do Porto, Portugal.
| | - M Ferreira-Magalhães
- MEDCIDS: Department of Community Medicine, Information and Decision in Health (MEDCIDS), Faculdade de Medicina, Universidade do Porto, Portugal; Center for Health Technology and Services Research (CINTESIS), Centro de Investigação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal; Department of Pediatrics, Centro Hospitalar de São João, Porto, Portugal
| | - A Sá-Sousa
- MEDCIDS: Department of Community Medicine, Information and Decision in Health (MEDCIDS), Faculdade de Medicina, Universidade do Porto, Portugal; Center for Health Technology and Services Research (CINTESIS), Centro de Investigação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - L F Azevedo
- MEDCIDS: Department of Community Medicine, Information and Decision in Health (MEDCIDS), Faculdade de Medicina, Universidade do Porto, Portugal; Center for Health Technology and Services Research (CINTESIS), Centro de Investigação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - J A Fonseca
- MEDCIDS: Department of Community Medicine, Information and Decision in Health (MEDCIDS), Faculdade de Medicina, Universidade do Porto, Portugal; Center for Health Technology and Services Research (CINTESIS), Centro de Investigação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
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Remelhe M, Teixeira PM, Lopes I, Silva L, Correia de Sousa J. The modified patient enablement instrument: a Portuguese cross-cultural adaptation, validity and reliability study. NPJ Prim Care Respir Med 2017; 27:16087. [PMID: 28079863 PMCID: PMC5228497 DOI: 10.1038/npjpcrm.2016.87] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 10/31/2016] [Accepted: 10/31/2016] [Indexed: 11/16/2022] Open
Abstract
Enabling patients with asthma to obtain the knowledge, confidence and skills they need in order to assume a major role in the management of their disease is cost effective. It should be an integral part of any plan for long-term control of asthma. The modified Patient Enablement Instrument (mPEI) is an easily administered questionnaire that was adapted in the United Kingdom to measure patient enablement in asthma, but its applicability in Portugal is not known. Validity and reliability of questionnaires should be tested before use in settings different from those of the original version. The purpose of this study was to test the applicability of the mPEI to Portuguese asthma patients after translation and cross-cultural adaptation, and to verify the structural validity, internal consistency and reproducibility of the instrument. The mPEI was translated to Portuguese and back translated to English. Its content validity was assessed by a debriefing interview with 10 asthma patients. The translated instrument was then administered to a random sample of 142 patients with persistent asthma. Structural validity and internal consistency were assessed. For reproducibility analysis, 86 patients completed the instrument again 7 days later. Item-scale correlations and exploratory factor analysis were used to assess structural validity. Cronbach’s alpha was used to test internal consistency, and the intra-class correlation coefficient was used for the analysis of reproducibility. All items of the Portuguese version of the mPEI were found to be equivalent to the original English version. There were strong item-scale correlations that confirmed construct validity, with a one component structure and good internal consistency (Cronbach’s alpha >0.8) as well as high test–retest reliability (ICC=0.85). The mPEI showed sound psychometric properties for the evaluation of enablement in patients with asthma making it a reliable instrument for use in research and clinical practice in Portugal. Further studies are needed to confirm its responsiveness.
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Affiliation(s)
- Mafalda Remelhe
- School of Health Sciences, University of Minho, Braga, Portugal
| | - Pedro M Teixeira
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal
| | | | - Luís Silva
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal.,Horizonte Family Health Unit, Porto, Portugal
| | - Jaime Correia de Sousa
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal.,Horizonte Family Health Unit, Porto, Portugal
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