Why and when social support predicts older adults’ pain-related disability

Pain-related social support has been shown to be directly associated with pain-related disability, depending on whether it promotes functional autonomy or dependence. However, previous studies mostly relied on cross-sectional methods, precluding conclusions on the temporal relationship between pain-related social support and disability. Also, research on the behavioral and psychological processes that account for such a relationship is scarce. Therefore, this study aimed at investigating the following longitudinally: (1) direct effects of social support for functional autonomy/dependence on pain-related disability, (2) mediating role of physical functioning, pain-related self-efficacy, and fear, and (3) whether pain duration and pain intensity moderate such mediating processes. A total of 168 older adults (Mage = 78.3; SDage = 8.7) participated in a 3-month prospective design, with 3 moments of measurement, with a 6-week lag between them. Participants completed the Formal Social Support for Autonomy and Dependence in Pain Inventory, the Brief Pain Inventory, the 36-SF Health Survey, behavioral tasks from the Senior Fitness Test, the Pain Self-Efficacy Questionnaire, and the Tampa Scale for Kinesiophobia. Moderated mediation analyses showed that formal social support for functional dependence (T1) predicted an increase in pain-related disability (T3), that was mediated by self-reported physical functioning (T2) and by pain-related self-efficacy (T2) at short to moderate pain duration and at low to moderate pain intensity, but not at higher levels. Findings emphasized that social support for functional dependence is a risk factor for pain-related disability and uncovered the “why” and “when” of this relationship. Implications for the design of social support interventions aiming at promoting older adults' healthy aging despite chronic pain are drawn.info:eu-repo/semantics/acceptedVersio

Buffer or amplifier? Longitudinal effects of social support for functional autonomy/dependence on older adults’ chronic-pain experiences

Objective: This longitudinal study aimed to investigate (a) the moderating role of formal social support for functional autonomy versus dependence on the relationship between pain intensity and pain-related disability among older adults with chronic pain and (b) the mediating role of pain-related self-efficacy and pain-related fear in this moderation. Method: One hundred and seventy older adults (Mage = 78.0; SD = 8.7) with chronic musculoskeletal pain participated in a 3-month prospective study, with 3 measurement moments. Participants filled out the Formal Social Support for Autonomy and Dependence in Pain Inventory, the Portuguese versions of the Brief Pain Inventory, the Pain Self-Efficacy Questionnaire, and the Tampa Scale of Kinesiophobia. Results: Using structural equation modeling, it was found that perceived promotion of autonomy, at Time 1, moderated the relationship between pain intensity (T1) and pain-related disability (T2); this moderation was fully mediated by pain-related self-efficacy (T2). Perceived promotion of dependence was not a significant moderator. Conclusions: These findings highlight the importance of social support for functional autonomy in buffering the impact of pain intensity on older adults’ pain-related disability. Also, they clarify the role of pain-related self-efficacy in this effect. Implications for the development of intervention programs, with formal caregivers, to reduce the impact of chronic pain on older adults’ healthy ageing process, are discussed.info:eu-repo/semantics/acceptedVersio

The relationship between perceived promotion of autonomy/dependence and pain-related disability in older adults with chronic pain: the mediating role of self-reported physical functioning

Chronic pain is prevalent among older adults and is usually associated with high levels of functional disability. Social support for the promotion of functional autonomy and dependence has been associated with pain-related disability and self-reported physical functioning. Nevertheless, these relationships need further inquiry. Our aims were to investigate: (1) the relationship between perceived promotion of autonomy/dependence and pain-related disability and (2) the extent to which self-reported physical functioning mediated these relationships. 118 older adults (Mage = 81.0) with musculoskeletal chronic pain completed the Portuguese versions of the revised formal social support for Autonomy and Dependence in Pain Inventory, the pain severity and interference scales of the Brief Pain Inventory, and the physical functioning scale of the Medical Outcomes Study-Short-Form 36 v2. Higher levels of perceived promotion of autonomy were associated with lower pain-related disability; this relationship was partially mediated by self-reported physical functioning (B = -.767, p < .001 decreasing to B' = -.485, p < .01). Higher perceived promotion of dependence was associated with higher pain-related disability; this effect was also partially accounted for by self-reported physical functioning (B = .889, p < .01 decreasing to B' = .597, p < .05). These results highlight the importance of perceived promotion of autonomy and dependence for managing older adults' experience of chronic pain

(De)humanizing metaphors of people in pain and their association with the perceived quality of nurse-patient relationship

Metaphors are central in communication and sense-making processes in health-related contexts. Yet how the metaphors used by health-care-professionals to make sense of their patients and their relations to them are associated to the perceived valence of their clinical encounters is underexplored. Drawing-upon the ABC Model of Dehumanization, this study investigated how the humanizing or dehumanizing metaphors nurses’ use for making sense of their pain patients are associated with how they perceived their relationships with them. Fifty female nurses undertook individual narrative-episodic interviews about easy/difficult cases in pain care. A content analysis classified the metaphors, identifying eight classes reflecting different types of patients (de)humanization. A multiple correspondence analysis extracted patterns of metaphors and their association with the perceived characteristics of the patient-nurse relationship. It showed how these patterns were not associated with patient sex or socioeconomic status (SES) but were related to the perceived valence of the clinical relationship. By uncovering how patient metaphors guide nurses’ sense-making and potentially modulate interactions in clinical encounters, these findings may contribute to improve quality of pain care.Fundação para a Ciência e Tecnologiainfo:eu-repo/semantics/publishedVersio

Questionário de Crenças de Controlo face à Saúde (QCCS): Processo de desenvolvimento e validação de um instrumento

O presente artigo tem como objectivo a apresentação do processo de desenvolvimento e validação do Questionário de Crenças de Controlo face à Saúde (QCCS). Este é um instrumento que, tendo como raiz conceptual o modelo tridimensional da percepção de controlo de Skinner (1995), visa a avaliação de três tipos de crenças: (1) controlo; (2) estratégia e; (3) capacidade. O QCCS foi aplicado a uma amostra de 91 crianças (Midade=11,92) e 97 adolescentes (Midade=16,86) Portugueses saudáveis. Análises em componentes principais mostraram que o instrumento reflecte, na generalidade, a estrutura tridimensional esperada. Os índices de fidelidade interna da maioria das escalas mostraram-se adequados, particularmente tendo em conta a idade dos participantes. Uma análise do conteúdo dos itens, efectuada por dois juízes independentes, atesta a validade de conteúdo do QCCS. Este instrumento, ao permitir detectar diferenças etárias nas crenças de controlo, previsíveis de um ponto de vista desenvolvimentista, demonstra ainda validade de constructo. Em suma, embora as características psicométricas do QCCS possam ainda ser aperfeiçoadas, este mostra ser um instrumento útil e com qualidades adequadas

Otimismo comparativo e percepções de controle face à saúde na adolescência: existirão diferenças etárias?

O Otimismo Comparativo (OC), a tendência da maioria das pessoas para ver o seu futuro como mais positivo que o futuro dos outros, e a sua relação com a Percepção de Controle estão pouco estudados na adolescência. Os objetivos deste estudo prenderam-se com a análise das diferenças etárias na adolescência: (1) no OC e Percepções Comparativas de Controle (PCC) face a riscos para a saúde e (2) na forma como as Percepções Absolutas e Comparativas de Controle predizem o OC. Noventa e um pré-adolescentes (M = 11,92 anos) e 97 adolescentes (M = 16,86 anos) saudáveis efectuaram julgamentos de risco e controle (Próprio vs. Alvo) para 8 enfermidades. Os participantes mostraram-se comparativamente otimistas, julgando ter maior controle sobre algumas doenças que o alvo. Não existiram diferenças etárias no OC ou nas PCCs. Estas foram o principal preditor do OC, mediando a relação entre este e as Percepções Absolutas de Controle apenas na sub-amostra dos adolescentes.Comparative Optimism (CO) is the tendency for most people to perceive their future as rosier than the future of others. Such optimistic bias and its relationship with Perceived Control have seldom been studied among adolescents. Hence, this study aimed at exploring age differences throughout adolescence in: 1) CO and Comparative Perceived Control (CPC) over health hazards; 2) the way Absolute and Comparative Perceived Control account for CO. Ninety-one pre-adolescents (M = 11.92 years) and 97 adolescents (M = 16.86 years), all considered healthy, were asked for risk and control judgements (Self vs. Target) regarding 8 health hazards. Generally, participants were comparatively optimistic and saw themselves as having more personal control over some hazards than the target. No age differences were found in CO or CPC. The latter was the best predictor of CO for both cohorts. It mediated the relationship between Absolute Perceived Control and CO in the older participants' sample

Being less of a man or less of a woman: perceptions of chronic pain patients’ gender identities

WOS:000275117600015 (Nº de Acesso Web of Science)“Prémio Científico ISCTE-IUL 2011”Living with chronic pain may be a threatening experience to one's own gender identity. Findings suggest that the presence of chronic pain does not allow individuals to achieve the most valued standards of being male or female in our societies. Such contention, however, has not yet been empirically supported. Therefore, our goal was to explore laypeople's and nurses’ perceptions of the man/woman with chronic low-back pain (CLBP) as compared to the typical man/woman, respectively. Three hundred and sixteen laypeople (52.8% women) and 161 nurses (54% women) participated in this study. Half of the participants were presented with a written vignette depicting a man/woman with CLBP, followed by a list of 33 traits of the masculine and feminine stereotypes. Participants evaluated the extent to which each trait fit their image of the man/woman with CLBP. The other half of the participants described the image people in general had of the typical man/woman using the same list of traits. This study consisted on a quasi-experimental design, 2 (character's sex) × 2 (type of character) × 2 (participant's sex) × 2 (health-care training). Results have generally supported our hypotheses. Both laypeople and nurses perceived: (1) the man with CLBP as having less masculinity and more femininity-related traits than the typical man; (2) the woman with CLBP as having less femininity and more masculinity-related traits than the typical woman; and (3) the man and woman with CLBP as more similar to each other than the typical man/woman. Issues on gender identity conflicts in CP patients are discussed

Gender awareness in medicine: adaptation and validation of the Nijmegen Gender Awareness in Medicine Scale to the Portuguese population (N-GAMS)

Health care professionals’ gender awareness has been presented as a mechanism to minimize gender biases in health. The present paper aimed to adapt and validate the Nijmegen Gender Awareness in Medicine Scale (N-GAMS, Verdonk et al. in Sex Roles 58:222–234, 2008. https://doi.org/10.1007/s11199-007-9326-x) to the Portuguese population, also addressing some limitations of its original study, namely by: (1) testing the scale’s three-fold underlying structure and (2) extending the study of its criteria-related validity, by analyzing sex-related differences in medical students’ gender awareness and the associations between gender awareness and empathy and sexism. One thousand and forty-eight medical students (Mage = 22.90; 67.1% women) filled out the Portuguese version of the N-GAMS (N-GAMS.pt) along with measures of Physician Empathy and Sexism. A Parallel Analysis and an Exploratory Factor Analysis suggested the presence of three factors. A Confirmatory Factor Analysis showed a good fit of the hypothesized three-factor structure: (1) gender sensitivity (n = 6 items; α =.713), (2) gender-role ideologies towards patients (n = 7 items; α =.858) and (3) gender-role ideologies towards doctors (n = 5 items; α =.837), with a positive association between the latter two (r =.570; p <.001). The N-GAMS.pt also showed good criteria-related validity. Namely, as hypothesized: (1) more empathic students reported more gender sensitivity and lower endorsement of gender-role ideologies; (2) higher hostile and benevolent sexism were associated to higher endorsement of gender-role ideologies; and (3) higher hostile sexism was associated to lower gender sensitivity. Implications of the N-GAMS for research and interventional purposes are discussed

Classism in pain assessment and management: the mediating role of female patient dehumanization and perceived life hardship

Compared with racism and sexism, classism in pain assessment and management practices (PAMPs) has been less investigated, and its mediating mechanisms are still unknown. Drawing on a social psychological model of dehumanization, this research aimed to test (1) the effect of patient socioeconomic status (SES; a proxy of social class) on PAMPs and (2) whether patient dehumanization and perceived life hardship mediated these effects. Two online experimental studies were conducted, in which patient SES was manipulated (low vs high) within-subjects. One-hundred sixty-two female medical students (study 1) and 105 female nurses (study 2) were presented with vignettes/images depicting 2 cases of women with chronic low-back pain, followed by videos of them performing a pain-inducing movement. Participants reported on patient dehumanization, perceived life hardship, and PAMPs. The low SES patient was perceived as less pain sensitive (medical students alone) but more disabled, credible, and her pain more attributed to psychological causes (by nurses alone). Medical students recommended less nonpharmacological treatments but prescribed slightly stronger medication. Medical students were less willing to provide individualized care to the low SES patient, whereas nurses showed the opposite pattern. Patient mechanistic dehumanization mediated SES effects on pain disability (medical students alone). Perceived life hardship mediated SES effects on pain disability, credibility (nurses alone), and intentions of providing individualized care (nurses alone). These finding bear novel contributions to the fields of pain, health service research, and social psychology and have important implications to the development of more effective future interventions to reduce classism in PAMPs.info:eu-repo/semantics/publishedVersio