The role of individual and group level variables in healthcare profissionals' hand hygiene compliance: a multi-level perspective

Literature shows that non-compliance with hand hygiene increases hospital-acquired infections and research in this area is far from synthesized. This work aims to conciliate the contributions of the Theory of Planned Behavior (TPB), the Precede-Proceed model and the safety climate approach to analyse (1) this problematic during the education of future healthcare professionals; (2) hand hygiene as arising from micro-systems (e.g. care-delivery teams); (3) the specificities of compliance between different categories of professionals; and (4) the importance of work experience in constraining intention to comply. We also intend to analyse the impact of the moral norm and the vulnerability perception. The former as a behavioural intention predictor will be tested as an inhibitor of compliance; the latter, will be used as a multi-level moderator to explore its role in the relationship between team safety climate and compliance. Furthermore, we will also analyse self-reported and observed compliance. We present five studies whose results indicate that (1) TPB behavioural intention predictors function as significant mediators in transferring the impact of team safety climate to intention; (2) social influence is an important predictor enhancing the relevance of role models; (3) professionals present multi-faceted moral prerogatives that inhibit compliance, particularly physicians and medical students; 4) reported compliance appears to be an adequate way to measure hand hygiene due to its consistency with observed compliance. In the end, predisposing, enabling and reinforcing variables are presented to link the empirical evidence of this work with its practical dimension by defining measures to design future interventions.A literatura demonstra que a não adesão à higiene das mãos aumenta as infecções hospitalares, contudo a investigação nesta área permanece dispersa. Este trabalho pretende conciliar os contributos da Teoria da Acção Planeada (TAP), modelo Precede-Proceed e abordagem de clima de segurança para analisar esta problemática (1) durante a formação de futuros profissionais de saúde; (2) a higiene das mãos como um comportamento que emerge de micro-sistemas (e.g. equipas de trabalho); (3) as especificidades entre diferentes categorias de profissionais; e (4) o impacto da experiência de trabalho na intenção de aderir. Pretende-se ainda aferir o papel da norma moral enquanto preditora da intenção, sendo testada como inibidora da adesão; e da percepção de vulnerabilidade como moderadora numa relação multinível para explorar o seu papel entre o clima de segurança de equipa e a adesão. Para além disso, iremos também avaliar a adesão reportada e observada. Serão apresentados cinco estudos cujos resultados indicam que (1) os preditores da intenção da TAP funcionam como mediadores transferindo o impacto do clima de segurança de equipa para a intenção; (2) a influência social é um preditor importante reforçando o papel dos “role models”; (3) os profissionais apresentam prerrogativas morais multi-facetadas que inibem a adesão, particularmente os médicos e estudantes de medicina; (4) a adesão reportada parece ser uma medida adequada para avaliar este comportamento devido à sua consistência com a adesão observada. No final, as variáveis que predispõem, facilitam e reforçam a adesão serão apresentadas relacionando a evidência empírica deste trabalho com a sua dimensão prática pela apresentação de medidas de intervenção

The role of behaviour‐change theory in sleep interventions with emerging adults (aged 18–29 years): a systematic review and meta‐analysis

CICPSI Investigation and Development Unit of Faculdade de Psicologia, Universidade de Lisboa, Grant/Award Number: FPUL/BI/2020/12Previous systematic reviews and meta-analysis of sleep interventions with young adults have not reached consensus on what contributes to their efficacy. Behaviourchange theories may influence the efficacy of interventions; hence, the aim of this research was to investigate the role of such theories in sleep interventions with this population. Six electronic databases and reference lists were searched (April–May 2021) for published sleep behaviour-change interventions with emerging adults (aged 18–29 years) that used control groups. A selection of 20 studies fulfilled the inclusion criteria, but only six were based on behaviour-change theories. Meta-analysis was run with eight studies, as the others had a high risk of bias or did not present the necessary data to calculate Hedges’ g. The estimation of a random effects model for the studies showed a small effect in the sleep quality of the participants in the experimental group (g = 0.26; 95% confidence interval 0.42 to 0.09), with low levels of heterogeneity (I 2 = 21%), and a small 95% prediction interval ( 0.59 to 0.08). Although we could not examine theory or any other moderators of the effect, a qualitative analysis of the behaviour-change techniques present in the interventions leads us to hypothesise that there is not a direct link between behaviour-change techniques and the success of the intervention. Other characteristics of the interventions may be linked to their variable levels of efficacy and should be investigated in the future, as for now there are no answers as to what the key is for successful sleep interventions.info:eu-repo/semantics/publishedVersio

Parenting and child mental health during the COVID-19 pandemic:An online study with Portuguese and British Families

COVID-19 and the subsequent public health response created many additional stresses for families. We examined parental behaviour during the COVID-19 pandemic in two European Countries and explored the association between parents’ behaviour and children’s anxiety and quality of life. Caregivers of children and adolescents (N = 442; 86.7% mothers) between 6 and 16 years old (M = 10, SD = 2.85) participated in an online cross-sectional survey in Portugal and the United Kingdom. Results show that higher children’s anxiety and lower quality of life were associated with higher levels of unrealistic parental demands, lower parental self-care, and higher parental emotional dysregulation. Encouragement of children’s emotion expression and management of exposure to COVID-19 information was negatively associated with children’s anxiety. Promotion of routines, support of children’s emotion modulation and promotion of children’s healthy lifestyles were positively associated with children’s quality of life. The predictors differed according to country and age group. These results highlight the importance of specific parenting behaviours on children’s mental health during COVID-19. The need to moderate unrealistic demands and attend to parental self-care to reduce parental emotional dysregulation is important.Parentalidad y salud mental infantil durante la pandemia de COVID-19: Un estudio online con familias Portuguesas y Británicas. COVID-19 y la subsiguiente respuesta de salud pública crearon muchas tensiones adicionales para las familias. Examinamos el comportamiento de los padres durante la pandemia de COVID-19 en dos países europeos y exploramos la asociación entre el comportamiento de los padres y la ansiedad y la calidad de vida del niño. Cuidadores de niños y adolescentes (N = 442; 86.7% madres) entre 6 y 16 años (M = 10, DT = 2,85) participaran en una online encuesta en Portugal y en el Reino Unido. En los resultados se observa que la mayor ansiedad y una menor calidad de vida de los niños se asociaron con niveles más altos de demandas parentales poco realistas, menor autocuidado y mayor desregulación emocional de los padres. El estímulo a la expresión de las emociones de los niños y el manejo de la exposición a la información de COVID-19 se asoció negativamente con la ansiedad de los niños. La promoción de rutinas, el apoyo a la modulación de las emociones de los niños y la promoción de estilos de vida saludables de los niños se asociaron positivamente con la calidad de vida de los niños. Los predictores difirieron según el país y el grupo de edad. Estos resultados resaltan la importancia de comportamientos parentales específicos en la salud mental de los niños durante el COVID-19. La necesidad de moderar las demandas poco realistas y prestar atención al autocuidado de los padres para reducir la desregulación emocional de los padres es important

Validation and invariance across age and gender for the Melbourne Decision-Making Questionnaire in a sample of Portuguese adults

The personal pattern of coping with the stress associated with making decisions characterizes the way an individual makes choices and judgments. The Melbourne Decision Making Questionnaire (MDMQ) analyses these personal patterns and has been used across various cultures in order to assess four main strategies: vigilance, buck-passing, procrastination, and hypervigilance. We sought to adapt and validate a Portuguese version of the MDMQ. Our study was conducted with a sample of 523 Portuguese people aged 18 or older. The questionnaire retained the original four scales, which represent four different decisional patterns, showing good reliability and validity – concurrent as well as predictive – and invariance for gender and age. The coping pattern with the highest mean was vigilance, while procrastination had the lowest mean. In contrast to other studies of the MDMQ, our sample had a more diversified distribution of age. Young adults were less capable than older adults of managing stress when making decisions, due to their higher levels of buck-passing, hypervigilance, and procrastination. Vigilance showed stronger correlations to positive affect, satisfaction with life, and better decisional self-esteem, while the remaining scales were related to negative affect, reduced decisional self-esteem, and lower satisfaction with life. These decision-making styles are chosen depending on time constraints, pressure, or other contextual characteristics. These results suggest that individuals resort to more convenient patterns according to their situation, and that these patterns of decision-making can be trained, developed, and improved.info:eu-repo/semantics/publishedVersio

Parenting and child mental health during the COVID-19 pandemic:An online study with Portuguese and British Families

COVID-19 and the subsequent public health response created many additional stresses for families. We examined parental behaviour during the COV-ID-19 pandemic in two European Countries and explored the association between parents’ behaviour and children’s anxiety and quality of life. Caregivers of children and adolescents (N = 442; 86.7% mothers) between 6 and 16 years old (M = 10, SD = 2.85) participated in an online cross-sectional survey in Portugal and the United Kingdom. Results show that higher children’s anxiety and lower quality of life were associated with higher levels of unrealistic parental demands, lower parental self-care, and higher parental emotional dysregulation. Encouragement of children’s emotion expression and management of exposure to COVID-19 information was negatively associated with children’s anxiety. Promotion of routines, support of children’s emotion modulation and promotion of children’s healthy lifestyles were positively associated with children’s quality of life. The predictors differed according to country and age group. These results highlight the importance of specific parenting behaviours on children’s mental health during COVID-19. The need to moderate unrealistic demands and attend to parental self-care to reduce parental emotional dysregulation is important.</p

Cumulative Risk Exposure and Social Isolation as Correlates of Carer and Child Mental Health During the COVID-19 Pandemic:An Online Study with Families from Various Europeans Countries

This study adopted a cumulative risk approach to examine the relations between various domains of risk factors (i.e., social isolation and home confinement, other pandemic-related risk factors, and pre-existing psychosocial risk factors) and carers’ and children’s mental health during the first wave of the COVID-19 pandemic in Europe. The sample consisted of 1475 carers of 6- to 16-year-old children and adolescents residing in five European countries (Portugal, United Kingdom, Romania, Spain, and The Netherlands) who completed an online survey. The results showed that each of the three domains of adversity accounted for unique variation in carers’ and children’s mental health outcomes. Also, the results indicated that pre-existing psychosocial risk factors moderated the relationship between pandemic-related risk factors and children and carers’ anxiety and between social isolation and confinement and carers’ well-being. Simple slopes analysis suggested a stronger relationship between these domains of adversities and mental health outcomes in already more vulnerable families. It is important to consider the implications of social isolation measures and confinement for families’ mental health, paying special attention to families with pre-existing psychosocial vulnerabilities. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10578-021-01233-3

Illness Perceptions of COVID-19 in Europe: Predictors, Impacts and Temporal Evolution

Objective: Illness perceptions (IP) are important predictors of emotional and behavioral responses in many diseases. The current study aims to investigate the COVID-19-related IP throughout Europe. The specific goals are to understand the temporal development, identify predictors (within demographics and contact with COVID-19) and examine the impacts of IP on perceived stress and preventive behaviors. Methods: This was a time-series-cross-section study of 7,032 participants from 16 European countries using multilevel modeling from April to June 2020. IP were measured with the Brief Illness Perception Questionnaire. Temporal patterns were observed considering the date of participation and the date recoded to account the epidemiological evolution of each country. The outcomes considered were perceived stress and COVID-19 preventive behaviors. Results: There were significant trends, over time, for several IP, suggesting a small decrease in negativity in the perception of COVID-19 in the community. Age, gender, and education level related to some, but not all, IP. Considering the self-regulation model, perceptions consistently predicted general stress and were less consistently related to preventive behaviors. Country showed no effect in the predictive model, suggesting that national differences may have little relevance for IP, in this context. Conclusion: The present study provides a comprehensive picture of COVID-19 IP in Europe in an early stage of the pandemic. The results shed light on the process of IP formation with implications for health-related outcomes and their evolution

Structure, Process, and Mortality Associated with Acute Coronary Syndrome Management in Guatemala’s National Healthcare System: The ACS-GT Registry

Background: Acute coronary syndromes (ACS) include ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevation myocardial infarction (NSTEMI), and unstable angina (UA). The leading cause of mortality in Guatemala is acute myocardial infarction (AMI) and there is no established national policy nor current standard of care. Objective: Describe the factors that influence ACS outcome, evaluating the national healthcare system’s quality of care based on the Donabedian health model. Methods: The ACS-Gt study is an observational, multicentre, and prospective national registry. A total of 109 ACS adult patients admitted at six hospitals from Guatemala’s National Healthcare System were included. These represent six out of the country’s eight geographic regions. Data enrolment took place from February 2020 to January 2021. Data was assessed using chi-square test, Student’s t-test, or Mann-Whitney U test, whichever applied. A p-value < 0.05 was considered statistically significant. Results: One hundred and nine patients met inclusion criteria (80.7% STEMI, 19.3% NSTEMI/UA). The population was predominantly male, (68%) hypertensive (49.5%), and diabetic (45.9%). Fifty-nine percent of STEMI patients received fibrinolysis (alteplase 65.4%) and none for primary Percutaneous Coronary Intervention (pPCI). Reperfusion success rate was 65%, and none were taken to PCI afterwards in the recommended time period (2–24 hours). Prognostic delays in STEMI were significantly prolonged in comparison with European guidelines goals. Optimal in-hospital medical therapy was 8.3%, and in-hospital mortality was 20.4%. Conclusions: There is poor access to ACS pharmacological treatment, low reperfusion rate, and no primary, urgent, or rescue PCI available. No patient fulfilled the recommended time period between successful fibrinolysis and PCI. Resources are limited and inefficiently used