Browsing by Author "Fonseca, Helena"
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- Análise do impacto da e-terapia enquanto estratégia de promoção de saúde em adolescentes obesosPublication . Sousa, Pedro Miguel Lopes; Gaspar, Pedro; Fonseca, HelenaA obesidade na adolescência atingiu proporções epidémicas, sendo urgente encontrar estratégias efetivas de prevenção e tratamento, e recursos apropriados que induzam a mudança no individuo, família e comunidade. Um estudo nacional revelou uma prevalência de excesso de peso de 31% na população infanto-juvenil, salientando a urgência da intervenção precoce. Além da prevenção é fundamental apostar no tratamento efetivo dos jovens que apresentam peso excessivo, porque a obesidade adolescente: a) tem um impacto signi cativo na saúde física e psicossocial; b) é um fator de risco para a obesidade e mortalidade na idade adulta; e d) é uma ameaça major para o aumento sustentado da esperança de vida. Este estudo parte da premissa que proporcionar um melhor tratamento requer: a) contacto mais extenso e frequente com a equipa de tratamento e b) utilização de outros canais de comunicação e de tecnologias mais interativas com os adolescentes e suas famílias. Os componentes nucleares dos programas de tratamento (alimentação, exercício e estratégias comportamentais) não têm conseguido obter a adesão pretendida. A solução poderá passar por estratégias mais interativas e dinâmicas, sobretudo para crianças e adolescentes. Neste contexto convém destacar o papel da e-saúde na prevenção e redução da obesidade pediátrica, em virtude da ubiquidade da tecnologia na vida dos jovens. Este projeto explora as potencialidades da e-terapia assente no modelo de gestão de caso, no âmbito da mudança cognitivo-comportamental em adolescentes obesos,promovendo o envolvimento familiar no processo terapêutico. Consideramos que a inclusão das Tecnologias da Informação e Comunicação (TIC) permite otimizar os recursos e maximizar o impacto, em complementaridade com as abordagens convencionais, o que se tem revelado vantajoso e efetivo em diversos estudos internacionais, mas que ainda não foi testado no contexto nacional. O objetivo principal deste projeto consiste no desenvolvimento, implementação e avaliação de um programa de tratamento de obesidade na adolescência, baseado na e-terapia e assente na metodologia de gestão de caso. Este projeto visa promover competências de gestão do peso, conhecimentos de saúde, adoção de estilos de vida saudáveis através do contacto aumentado e interativo entre adolescente, família e equipa clínica, com re exos na adesão terapêutica e qualidade de vida. A população em estudo será constituída pelos adolescentes com um IMC superior ou igual ao percentil 95, idade entre os 12-18 anos e acesso à internet pelo menos 1 vez por semana, que frequentem a Consulta de Obesidade Pediátrica do HSM (critérios de inclusão). Constituirão critérios de exclusão a presença de dé ces cognitivos graves, incapacidade de comunicação por escrito e gravidez. Serão necessários três estudos distintos mas complementares: E1-diagnóstico de situação, E2-avaliação da usabilidade da plataforma; E3-avaliação da efetividade. De salientar a importância do estudo 3 para os objetivos delineados, um ensaio clínico com grupo de controlo (tratamento standard) e grupo experimental que terá acesso adicional ao programa de intervenção e-terapêutico (Next.Step). A plataforma e-terapêutica inclui valências como: auto-monitorização (peso, estilo de vida, adesão terapêutica, qualidade de vida), recursos educativos (vídeos, folhetos, histórias, manuais, dietas, links, sugestões), módulos interativos (Resolução de problemas, Quizzes, jogos didáticos, concursos), ferramentas de suporte (Deinição de objetivos pessoais, percurso evolutivo, mensagens personalizadas) e suporte social (Fóruns de discussão e chats com colegas e com proossionais de saúde). Os benefícios principais serão: redução do z-score do IMC e aumento da adesão terapêutica, qualidade de vida (relacionada com o peso) e pelo de estilo de vida saudável. A avaliação positiva da efetividade irá fomentar a inclusão das TIC no tratamento, perspetivando-se uma redução dos custos a médio/longo prazo, redução dos índices de abandono do tratamento e melhoria da satisfação dos clientes face aos cuidados
- Association between treatment adherence and quality of life among overweight adolescentsPublication . Sousa, Pedro Miguel Lopes; Gaspar, Pedro; Fonseca, Helena; Gaspar, FilomenaOverweight is an extra burden for adolescent development and can trigger severe physical and psychosocial problems. This cross-sectional correlational study aimed to analyze the association between treatment adherence and obesity-related quality of life among overweight adolescents. The sample consisted of 94 adolescents attending a specialized Pediatric Obesity Clinic in Portugal, 48.94% of whom were boys and 51.06% girls, with a median age of 14.17 years (SD = 1.51). A positive correlation was found between obesity-related quality of life and adherence to weight control. The influence of parents and caregivers on the adherence to weight control is significantly associated with increased physical comfort, better social life and family relations. These results highlight the importance of behavioral change and adherence to weight control as pillars of a better quality of life among overweight adolescents. Obesity management programs need to focus on multiple criteria of treatment effectiveness, such as obesity-related quality of life.
- Controlled trial of an Internet-based intervention for overweight teens (Next.Step): effectiveness analysisPublication . Sousa, Pedro Miguel Lopes; Fonseca, Helena; Gaspar, Pedro; Gaspar, FilomenaAdolescent obesity is a major health problem. The need for effective adolescent weight management programs is of high clinical and public health relevance. This study evaluates the effectiveness of an e-therapeutic platform (Next.Step), aiming to promote weight management skills and the adoption of health-promoting lifestyles. This nonrandomized clinical trial with control group uses a sample of 94 adolescents who attended a paediatric obesity clinic. The experimental group was invited to access the platform Next.Step during 24 weeks, in addition to the standard treatment program. The control group followed the standard treatment protocol and joined a waiting list. Overall, the outcomes of the e-therapeutic program were not substantially better than those obtained with a traditional kind of intervention despite the intervention being associated with an improved health responsibility score (d = 0.51; p = 0.014). Several predictors of the Next.Step effectiveness were found. Conclusion: Although the e-therapeutic program led to a significant increase in health responsibility, inconclusive results were found regarding the program effectiveness compared to the standard multidisciplinary intervention. The lack of significant differences between groups may be due to the reduced rates of program adherence and the high dropout rate.
- Cross-sectional study showed psychosocial variables, gender and family involvement played an important role in an adolescent weight management programmePublication . Prioste, Ana; Fonseca, Helena; Sousa, Pedro Miguel Lopes; Gaspar, Pedro; Machado, Maria do CéuAim: This study aimed to investigate the psychosocial gains perceived by overweightadolescents attending a 12-week weight management programme and to analyse gender-specific differences. Methods: A quantitative cross-sectional study was conducted with a sample of 70overweight adolescents aged between 12 and 18 (52.9% girls), evaluated at baseline andat week 12 using anthropometric measurements and self-reported questionnaires. Weanalysed gender-specific differences related to body self-esteem, social life, relationshipswith their family, physical comfort, health responsibility, perceived benefits of theintervention, self-efficacy and adherence. We further investigated whether the variables atweek 12 would predict changes in their body mass index. Results: While weight had a greater impact on the body self-esteem of girls, both atbaseline and week 12, boys reported higher self-efficacy and adherence as well as agreater perception of the benefits of the intervention at week 12. The body mass indexchange was positively associated with body self-esteem, relationships within the family andself-efficacy and adherence. Conclusion: Gender specifics and the role of psychosocial variables must be taken intoaccount during weight management programmes for adolescents, and it is important toinclude the family throughout the entire process.
- Development and Preliminary Validation of the Adherence to Weight Control QuestionnairePublication . Sousa, Pedro Miguel Lopes; Gaspar, Pedro; Fonseca, HelenaBackground and Purpose: This study tests the psychometric properties of the Adherence to Weight Control Questionnaire, a new screening tool to measure treatment adherence (TAWC) and the risk of nonadherence to weight control (RNAWC) in adolescents. Methods: Participants are 92 adolescents (12–18 years old) from a pediatric obesity clinic. Construct validity were evaluated using a principal axis factoring method with varimax rotation. Reliability and criterion-related validity of both scales were also checked. Results: Both scales presented good reliability values (.770 and .908). Statistical analyses yielded a 1-factor solution for the RNAWC and a 4-factor solution for the TAWC. Criterion-related validity of scales was also checked. Conclusions: Results showed that this theory-driven measure of adherence to weight control has adequate psychometric properties to support both research and the clinical practice.
- Effectiveness analysis of an internet-based intervention for overweight adolescents: next steps for researchers and cliniciansPublication . Fonseca, Helena; Prioste, Ana; Sousa, Pedro Miguel Lopes; Gaspar, Pedro; Machado, Maria do CéuBackgrounds The development of effective strategies for the management of overweight in adolescence is a well recognized need. The current study investigates the effectiveness of an e-therapeutic platform (Next.Step) which aims to promote weight management skills and the adoption of health-promoting behaviours among overweight adolescents. Methods We conducted a randomized clinical trial with a sample of 80 adolescents. The control group followed the standard intervention. The experimental group was invited to access the platform during 12 weeks in addition to the standard intervention. Results Although there was no change in the primary outcomes (body mass index and percentage of fat mass), the results suggest that the program is associated with an improvement in the ‘positive perspective of life’ and ‘benefits perceived from the intervention’, which have been identified as relevant factors for an effective weight management. Conclusions Our findings provide little support for the effectiveness of internet-based weight management programs as an add-on to the standard intervention.
- Health promoting behaviors in adolescence: validation of the Portuguese version of the Adolescent Lifestyle ProfilePublication . Sousa, Pedro Miguel Lopes; Gaspar, Pedro; Fonseca, Helena; Hendricks, Constance; Murdaugh, CarolynObjective Reliable and valid instruments are essential for understanding health-promoting behaviors in adolescents. This study analyzed the psychometric properties of the Portuguese version of the Adolescent Lifestyle Profile (ALP). Methods A linguistic and cultural translation of the ALP was conducted with 236 adolescents from two different settings: a community (n = 141) and a clinical setting (n = 95). Internal consistency reliability and confirmatory factor analysis were performed. Results Results showed an adequate fit to data, yielding a 36-item, seven-factor structure (CMIN/DF = 1.667, CFI = 0.807, GFI = 0.822, RMR = 0.051, RMSEA = 0.053, PNFI = 0.575, PCFI = 0.731). The ALP presented a high internal consistency (α = 0.866), with the subscales presenting moderate reliability values (from 0.492 to 0.747). The highest values were in Interpersonal Relations (3.059 ± 0.523) and Positive Life Perspective (2.985 ± 0.588). Some gender differences were found. Findings showed that adolescents from the clinic reported an overall healthier lifestyle than those from the community setting (2.598 ± 0.379 vs. 2.504 ± 0.346; t = 1.976, p = 0.049). Conclusion The ALP Portuguese version is a psychometrically reliable, valid, and useful measurement instrument for assessing health-promoting lifestyles in adolescence. The ALP is cross-culturally validated and can decisively contribute to a better understanding of adolescent health promotion needs. Additional research is needed to evaluate the instrument's predictive validity, as well as its clinical relevance for practice and research.
- Internet-based intervention programme for obese adolescents and their families (Next.Step): research protocol of a controlled trialPublication . Sousa, Pedro Miguel Lopes; Fonseca, Helena; Gaspar, Pedro; Gaspar, FilomenaAim This paper describes the design and rationale of a controlled trial that aims to determine the effectiveness of an intervention programme in which the internet is used. Background Adolescent obesity is a major health problem, there being urgency to find effective interventions that induce behavioural change. The inclusion of the internet in the intervention may improve adolescents' adherence to the weight management programme and lead to adoption of healthier lifestyles. Design A clinical trial with a control group (non‐randomized). Methods Participants are adolescents with appointments at a paediatric obesity clinic (Portugal). Sample size was calculated according to the power analysis. The experimental group will follow the standard treatment protocol and receive free access to the e‐therapeutic platform. The control group will follow the standard treatment protocol and join a waiting list. Intervention length will be 36 weeks (24 weeks of direct intervention with a follow‐up for 12 weeks). This study was approved by the Ethical Committee for Health (Lisbon, Portugal) in January 2012 and funded by the Foundation for Science and Technology (Portugal) in December 2012. Discussion The results of this research will promote reflection on new approaches directed to treat adolescent obesity and on the promotion of healthy behaviours. We expect to gather empirical evidence of the intervention programme effectiveness. The expectations lie on the population health gains, empowerment in decision‐making and adoption of healthier lifestyles.
- Lifestyle and treatment adherence among overweight adolescentsPublication . Sousa, Pedro Miguel Lopes; Gaspar, Pedro; Fonseca, Helena; Gaspar, FilomenaThis study evaluated the influence of overweight adolescents' lifestyle on the adherence to weight control, and identifies their predictors. Participants were 94 adolescents, aged 12-18 years, attending a Paediatric Obesity Clinic. Lifestyle was assessed using the "Adolescent Lifestyle Profile" and treatment adherence through the "Therapeutic Adherence to Weight Control Questionnaire." Adherence to weight control was associated with various lifestyle domains. Several predictors were identified for lifestyle and adherence to weight control among overweight adolescents. A broad array of inter-correlations and predictors were identified and should be taken into account when designing adolescent weight control interventions.
- Pathways between BMI and adherence to weight management in adolescencePublication . Prioste, Ana; Fonseca, Helena; Pereira, Cícero R.; Sousa, Pedro Miguel Lopes; Gaspar, Pedro; Machado, Maria do CéuBackground: In order to understand the mechanisms involved in how overweight adolescents adhere to weight management and perceive its benefits, a few variables have been identified, namely, body mass index (BMI), body self-esteem (BSE) and positive perspective of life (PPL). Methods: In a sample of 112 adolescents, we investigated whether BMI would predict adolescents’ self-efficacy/adherence (SEA) to weight management and perception of its benefits. A structural equation modeling approach was chosen. We hypothesized that perceived quality of life (PQL) would mediate the relationships between BMI and SEA and between BMI and perception of benefits (PB). Results: The results suggested that BMI is not directly associated with SEA and PB. However, PQL was identified as a mediator between BMI and SEA and PB. Conclusion: These findings bring important implications for understanding overweight adolescents’ adherence to weight management. There is evidence that adolescents’ adherence to weight management and PB are not predicted by their BMI. However, it has been shown that PQL mediates this process. For a long time, health professionals have been too focused on BMI. Time has come to be more focused on quality of life and how to improve it.