RESUMO

Background: An understanding of the factors that influence cardiovascular (CVD) risk among young Black men is critically needed to promote cardiovascular health earlier in the life course and prevent poor outcomes later in life. Purpose: To explore how individual (eg, depression, racial discrimination) and environmental factors (eg, neighborhood resources) are associated with CVD risk factors among young Black men. Methods: We conducted a convergent mixed methods study (qualitative/quantitative, QUAL+quant) with Black men aged 18 to 30 years (N = 21; 3 focus groups). Participants completed a self-administered electronic survey immediately prior to the focus groups. Results: Participants (M age = 23) reported: two or more CVD risk factors (75%; eg, high blood pressure); racial discrimination (32%); and depressive symptoms in the past 2 weeks (50%). Five themes emerged: 1) emergence and navigation of Black manhood stressors; 2) high expectations despite limited available resources; 3) heart disease socialization: explicit and vicarious experiences; 4) managing health care needs against fear, avoidance and toughing it out; and 5) camaraderie and social support can motivate or deter. The integrated qualitative and quantitative analyses highlight race, gender, and class intersectionality factors that are relevant to what it means to be young, Black, male and of lower socioeconomic status in the United States. Conclusion: Our findings help to identify modifiable, culturally specific and contextually relevant factors that relate to CVD risk factors among young Black men. Such work is crucial to inform interventions, primary prevention efforts, policies, and social-structural changes to thwart the development of CVD and advanced disease stages.

Assuntos

RESUMO

AIM: The Self-Care Self-Efficacy Scale (SCSES) was newly developed as a self-report measure for self-care self-efficacy for chronic illness. This study investigated its measurement equivalence (ME) in different cultural groups, including United States, China (Hong Kong), Italy, and Brazil. DESIGN: A multi-national study for cross-cultural validation of the Scale. METHODS: From January 2015 - December 2018, investigators recruited 957 patients (United State: 200; Hong Kong: 300; Italy: 285; and Brazil: 142) with chronic illness from inpatient and outpatient settings. The SCSES was administered and clinical and demographic data were collected from participants. Based on the Meredith framework, multi-group confirmatory factor analysis evaluated the configural, metric, scalar, and strict invariance of the scale across the four populations through a series of nested models, with evaluation of reliability and coherence of the factor solution. RESULTS: The mean ages of the groups ranged from 65-77 years, 56.4% was male. The Cronbach's alpha coefficients of the single-factor SCSES were 0.93, 0.89, 0.92, and 0.90 for the United States, China (Hong Kong), Italy, and Brazil, respectively. Three of the four levels of ME were partially or totally supported. The highest level achieved was partial scalar invariance level (χ2 [52] = 313.4, p < 0.001; RMSEA = 0.067; 95% CI = 0.056-0.077; CFI = 0.966; TLI = 0.960, SRMR = 0.080). CONCLUSION: Patients from the four countries shared the same philosophical orientation towards scale items, although some of the items contributed differently to represent the concept and participants shared the same schemata for score interpretation. IMPACT: Self-efficacy is important in producing effective and sustainable self-care behavioural changes. Cultural ideation shapes the ways individuals interpret and report their self-care self-efficacy. The study findings support cross-cultural and cross-national utility of the SCSES for research on self-care across United States, China (Hong Kong), Italy, and Brazil.

Assuntos

RESUMO

BACKGROUND: Caregivers can contribute enormously to the self-care of patients with heart failure (HF). The Caregiver Contribution to Self-care of Heart Failure Index (CC-SCHFI) measures these contributions across 3 scales: self-care maintenance, which evaluates caregiver contributions to symptom monitoring and treatment adherence; self-care management, which evaluates caregiver contributions in dealing with symptoms; and caregiver confidence, which assesses caregiver self-efficacy in managing all contributions to self-care. Although the CC-SCHFI has been used in several investigations, only 1 study has evaluated its psychometric characteristics. OBJECTIVE: The aim of this study was to evaluate the psychometric properties of the CC-SCHFI in Brazil. METHODS: A cross-sectional design was used in this study. Confirmatory factor analysis was used to assess construct validity, and factor score determinacy coefficients were computed to evaluate internal consistency reliability. RESULTS: The sample comprised 99 caregivers of patients with HF. Most were women (73%), with a mean age of 48 ± 14 years; 57% were patients' spouses. Confirmatory factor analysis confirmed the original factor structure of the instrument, with supportive fit indices for all 3 scales (comparative fit index, 0.95-1.00; root-mean-square error of approximation, 0.00-0.057). Reliability estimates were adequate for each CC-SCHFI scale (0.77-0.96). CONCLUSIONS: The CC-SCHFI is a valid and reliable scale to measure caregiver contributions to self-care maintenance, caregiver contributions to self-care management, and caregiver confidence in HF.

Assuntos

RESUMO

BACKGROUND: Lifestyle changes and treatment adherence still constitute a challenge to healthcare providers involved in the care of persons with hypertension. The lack of validated instruments measuring the ability of hypertensive patients to manage their disease has slowed research progress in this area. The Self-care of Hypertension Inventory, originally developed in the United States, consists of 23 items divided across 3 scales: Self-care Maintenance, Self-care Management, and Self-care Confidence. These scales measure how well patients with hypertension adhere to treatment and manage elevated blood pressure, as well as their confidence in their ability to perform self-care. A rigorous cross-cultural adaptation and validation process is required before this instrument can be used in other countries. OBJECTIVE: The aims of this study were to translate the Self-care of Hypertension Inventory into Brazilian Portuguese with cross-cultural adaptation and to evaluate interobserver reliability and temporal stability. METHODS: This methodological study involved forward translation, synthesis of forward translations, back-translation, synthesis of back-translations, expert committee review, and pretesting. Interobserver agreement and the temporal stability of the scales were assessed. RESULTS: The expert committee proposed semantic and cultural modifications to some items and the addition of guidance statements to facilitate administration of the scale. Interobserver analysis demonstrated substantial agreement. Analysis of temporal stability showed near-perfect agreement. CONCLUSIONS: Cross-cultural adaptation of the Self-care of Hypertension Inventory successfully produced a Portuguese-language version of the instrument for further evaluation of psychometric properties. Once that step is completed, the scale can be used in Brazil.

Assuntos

RESUMO

Antecedentes: el tratamiento de la IC es complejo por los múltiples fármacos a utilizar y las medidas no farmacológicas requeridas, por ello es importante que el paciente implemente su autocuidado adecuadamente. Autocuidado es el proceso de toma de decisiones del paciente con elección de comportamientos que mantienen la estabilidad fisiológica y la respuesta a los síntomas cuando ocurren y existen instrumentos para su evaluación. El Self Care of Heart Failure Index 6.2 (SCHFI 6.2), desarrollado en Estados Unidos, ayuda a los profesionales de la salud a identificar la adhesión (o no adhesión) al autocuidado, auxiliando en el redimensionamiento de orientaciones y conductas, pero para su utilización es necesario una adaptación transcultural. Objetivo: adaptar y validar el SCHFI 6.2 para pacientes uruguayos con IC. Material y método: estudio metodológico desarrollado en cuatro fases: traducción de la versión original (inglés) al español por dos traductores oficiales uruguayos; síntesis de las dos traducciones; retrotraducción y evaluación por la autora original; evaluación por el comité de expertos. Se invitó a ocho expertos en IC para evaluar cada ítem del cuestionario, en relación con la equivalencia semántica, idiomática, experimental y conceptual, a través de una escala Likert de cuatro puntos. Los datos fueron tabulados por Microsoft Excel 2013 y evaluados a través del índice de validez de contenido (IVC). El estudio se realizó entre los meses de julio y setiembre de 2017, con la aprobación del comité de ética. Resultados: de los 53 puntos evaluados, cinco presentaron IVC por debajo de 0,75, fueron reformulados y reenviados al comité de expertos para nueva evaluación, obteniéndose la versión final del SCHFI 6.2 español / Uruguay. Conclusiones: los instrumentos para evaluar el autocuidado son herramientas importantes y de bajo costo para el seguimiento de pacientes con IC. Se pretende dar seguimiento al estudio a través de la validación clínica y, con ello, poner a disposición la escala para uso de los profesionales de salud uruguayos, lo que podrá auxiliar en el direccionamiento de las orientaciones a estos pacientes.

RESUMO

Objective. To adapt and evaluate the psychometric properties of the Brazilian version of the SCHFI v 6.2. Methods. With the approval of the original author, we conducted a complete cross-cultural adaptation of the instrument (translation, synthesis, back translation, synthesis of back translation, expert committee review, and pretesting). The adapted version was named Brazilian version of the self-care of heart failure index v 6.2. The psychometric properties assessed were face validity and content validity (by expert committee review), construct validity (convergent validity and confirmatory factor analysis), and reliability. Results. Face validity and content validity were indicative of semantic, idiomatic, experimental, and conceptual equivalence. Convergent validity was demonstrated by a significant though moderate correlation (r = -0.51) on comparison with equivalent question scores of the previously validated Brazilian European heart failure self-care behavior scale. Confirmatory factor analysis supported the original three-factor model as having the best fit, although similar results were obtained for inadequate fit indices. The reliability of the instrument, as expressed by Cronbach's alpha, was 0.40, 0.82, and 0.93 for the self-care maintenance, self-care management, and self-care confidence scales, respectively. Conclusion. The SCHFI v 6.2 was successfully adapted for use in Brazil. Nevertheless, further studies should be carried out to improve its psychometric properties.

RESUMO

OBJECTIVE: Clinicians worldwide seek to educate and support heart failure patients to engage in self-care. We aimed to describe self-care behaviors of patients from 15 countries across three continents. METHODS: Data on self-care were pooled from 5964 heart failure patients from the United States, Europe, Australasia and South America. Data on self-care were collected with the Self-care of Heart Failure Index or the European Heart Failure Self-care Behavior Scale. RESULTS: In all the samples, most patients reported taking their medications as prescribed but exercise and weight monitoring were low. In 14 of the 22 samples, more than 50% of the patients reported low exercise levels. In 16 samples, less than half of the patients weighed themselves regularly, with large differences among the countries. Self-care with regard to receiving an annual flu shot and following a low sodium diet varied most across the countries. CONCLUSION: Self-care behaviors are sub-optimal in heart failure patients and need to be improved worldwide. PRACTICE IMPLICATIONS: Interventions that focus on specific self-care behaviors may be more effective than general educational programs. Changes in some health care systems and national policies are needed to support patients with heart failure to increase their self-care behavior.

Assuntos

RESUMO

BACKGROUND: Heart failure (HF) self-care is poor in developed countries like the United States, but little is known about self-care in developing countries. METHODS AND RESULTS: A total of 2082 adults from 2 developed (United States and Australia) and 2 developing countries (Thailand and Mexico) were studied in a descriptive, comparative study. Self-care was measured using the Self-Care of HF Index, which provided scores on self-care maintenance, management, and confidence. Data were analyzed using regression analysis after demographic (age, gender, education), clinical (functional status, experience with the diagnosis, comorbid conditions), and setting of enrollment (hospital or clinic) differences were controlled. When adequate self-care was defined as a standardized score >or=70%, self-care was inadequate in most scales in most groups. Self-care maintenance was highest in the Australian sample and lowest in the Thai sample (P < .001). Self-care management was highest in the US sample and lowest in the Thai sample (P < .001). Self-care confidence was highest in the Mexican sample and lowest in the Thai sample (P < .001). Determinants differed for the three types of self-care (eg, experience with HF was associated only with self-care maintenance). CONCLUSION: Interventions aimed at improving self-care are greatly needed in both the developed and the developing countries studied.

Assuntos

RESUMO

Reporte de la fuerza de Trabajo sobre Guías de Práctica del Colegio Americano de Cardiología ACC y la Asociación Americana del Corazón AHA (Comité de actualización de las Guías para la evaluación cardiovascular preoperatoria para cirugía no cardiaca). Desarrollado en colaboración con la American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society of Cardiovascular Angiography and Interventions, Society for Cardiovascular Medicine and Biology. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) Developed in Collaboration With the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society for Vascular Medicine and Biology. Notas: Este documento fue aprobado por la Fundación Comité del Colegio Americano de Cardiología (ACC) en Marzo de 2006 y por el Consejo Asesor y Consultor de Ciencias de la Asociación Americana de Corazón (AHA) en febrero de 2006. Cuando cite este documento el Colegio Americano de Cardiología requiere el siguiente formato de citación: Fleisher LA, Beckman JA, Brown KA, Calkins H, Chaikof E, Fleischmann KE, Freeman WK, Froehlich JB, Kasper EK, Kersten JR, Riegel B, Robb JF. ACC/AHA 2006 Guideline Update on Perioperative Cardiovascular...

Assuntos

RESUMO

BACKGROUND: Disease management is effective in the general population, but it has not been tested prospectively in a sample of solely Hispanics with heart failure (HF). We tested the effectiveness of telephone case management in decreasing hospitalizations and improving health-related quality of life (HRQL) and depression in Hispanics of Mexican origin with HF. METHODS AND RESULTS: Hospitalized Hispanics with chronic HF (n = 134) were enrolled and randomized to intervention (n = 69) or usual care (n = 65). The sample was elderly (72 +/- 11 years), New York Heart Association class III/IV (81.3%), and poorly educated (78.4% less than high school education). Most (55%) were unacculturated into US society. Bilingual/bicultural Mexican-American registered nurses provided 6 months of standardized telephone case management. Data on hospitalizations were collected from automated systems at 1, 3, and 6 months after the index hospital discharge. Health-related quality of life and depression were measured by self-report at enrollment, 3, and 6 months. Intention to treat analysis was used. No significant group differences were found in HF hospitalizations, the primary outcome variable (usual care: 0.49 +/- 0.81 [CI 0.25-0.73]; intervention: 0.55 +/- 1.1 [CI 0.32-0.78] at 6 months). No significant group differences were found in HF readmission rate, HF days in the hospital, HF cost of care, all-cause hospitalizations or cost, mortality, HRQL, or depression. CONCLUSION: These results have important implications because of the current widespread enthusiasm for disease management. Although disease management is effective in the mainstream HF patient population, in Hispanics this ill, elderly, and poorly educated, a different approach may be needed.

Assuntos

RESUMO

BACKGROUND: Measuring health status is challenging in Mexican Americans and other diverse groups, because most health measurement instruments were developed and tested in English. Thus, it is difficult to determine whether measured health disparities are the result of actual differences or due to measurement error resulting from translation or conceptual differences. OBJECTIVES: The purpose of this study was to test the metric equivalence of the United States (US) Spanish Short-Form-36 Health Survey (SF-36) in a group of elderly Mexican Americans. In addition, the SF-36 scores of elderly Mexican American women in our sample were compared with normed scores for the SF-36 scales in the general population of elderly US women. METHOD: Health status was measured by the US Spanish SF-36 in telephone surveys conducted entirely in Spanish. The sample (N = 65) was elderly (mean age 75.3) and primarily female (78%). Most had less than 7 years of education and an annual income below $10,000. RESULTS: Missing data were negligible, and did not indicate difficulty with particular items. The item response values were well distributed and item response means were generally similar within a scale. Most item correlations were higher with the item's hypothesized scale than with other scales, though some items in the Mental Health, Vitality, and Social Functioning scales were highly correlated with other scales. Internal consistency reliability (Cronbach alpha) was.80 or above on all scales except Social Functioning (.69). SF-36 scale scores were lower in elderly Mexican American women than in elderly women in the general US population. DISCUSSION: The US Spanish SF-36 was a generally satisfactory measure of health status in a sample of elderly Mexican Americans with little formal education. The performance of some items in the Mental Health, Vitality, and Social Functioning scales warrants further research.

Assuntos