Adesão ao tratamento da Hepatite C - o papel das variáveis sociodemográficas e psicológicas: revisão integrativa
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Data
2016-09-06
Autores
Côco, Layla Tatiane [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
Introdução: Adesão ao tratamento refere-se a um comportamento ativo do paciente em relação à doença e ao tratamento compartilhando as decisões com o profissional de saúde. Considera-se a adesão um fenômeno resultante da interação de fatores de diferentes naturezas que afetam diretamente o comportamento do paciente: fatores relacionados ao indivíduo; fatores sociais, econômicos; fatores relacionados ao serviço de saúde e aos profissionais de saúde e ainda os fatores relacionados à doença e ao tratamento. Objetivo: Este estudo propõe-se a realizar uma revisão integrativa da literatura nacional e internacional sobre fatores associados à adesão ao tratamento da Hepatite C, com especial ênfase aos fatores psicológicos e sociais. Método: Foram estabelecidas as várias fases deste estudo, segundo o procedimento proposto: elaboração da pergunta de pesquisa, estabelecimento dos critérios para seleção da amostra, apresentação das características das pesquisas selecionadas, análise dos dados, interpretação dos resultados e a síntese da revisão. Realizou-se busca dos artigos nas bases de dados: Medline, Web of Science, Cinahl, Lilacs, Psycinfo, Scopus e Scielo. Foram incluídos artigos nos idiomas português, inglês e espanhol, publicados entre os anos 2000 a 2016 e excluídos os artigos que não foram considerados pertinentes ao objeto de estudo. Resultados: Obteve-se um corpus com 14 artigos, totalmente estrangeiro, publicado em inglês, nos anos de 2001 a 2015, majoritariamente indexados no Medline, o método quantitativo predominou entre as pesquisas selecionadas (onze artigos) em relação aos qualitativos (três artigos). As variáveis psicológicas pesquisadas em relação à possível associação com a adesão/não adesão ao tratamento de Hepatite C, nos estudos quantitativos, foram: presença de sintomas psicológicos, como ansiedade e depressão, raiva, hostilidade, transtornos psiquiátricos, autoeficácia, ainda foram investigados funcionamento social, problemas interpessoais e comportamentos relacionados à saúde. Esses estudos avaliaram também a possível influência na adesão ao tratamento de características sociodemográficas: idade, ocupação, escolaridade, sexo, etnia, apoio social e ainda o uso de álcool e outras drogas (abstinência e tratamento). Entre estes fatores foi verificada associação significativa entre não adesão e presença de transtornos psiquiátricos, sintomas de depressão, ansiedade fóbica, comportamento hostil, intrusividade, uso regular de substâncias, idade (ser mais jovem), desemprego, não estar em relacionamento estável. Já as variáveis associadas estatisticamente com adesão ao tratamento foram iniciar medicação psiquiátrica durante o tratamento, comportamentos relacionados à saúde (dieta e comportamento alimentar), menor distância do centro de tratamento, genótipo 3, coinfectado HIV e virgens de tratamento. Também foram avaliados três estudos qualitativos em que foram apontadas e discutidas como barreiras e como facilitadores da adesão ao tratamento: percepção e experiências com o tratamento, presença de estigma, apoio social, estratégias de enfrentamento, sistemas de crenças, medo e ansiedade. Conclusões: Conhecer os fatores que podem interferir na adesão ao tratamento da Hepatite C é extremamente importante, seja pela gravidade da doença, pelo aumento de sua incidência, pela complexidade e custo do tratamento que exige adesão completa para se obter RVS, além do impacto pessoal e social dessa doença e de seu tratamento, que faz da Hepatite C um problema de saúde pública. Considera-se que a relevância desta revisão está ainda em apontar a necessidade de se ampliarem as pesquisas sobre o papel das variáveis psicológicas e sociais sobre as características da comunicação com os profissionais de saúde que possam favorecer melhor adesão. Pesquisas com esse intuito, ainda tão ausentes na literatura, poderão contribuir para o desenvolvimento de programas psicoeducativos para que se amplie a adesão aos tratamentos hoje disponíveis.
Introduction: Adherence to treatment refers to an active patient behavior regarding the disease and treatment by sharing decisions with the health professional. Adherence is considered a phenomenon resulting from the interaction of factors of different nature that directly affect patient behavior: factors related to the individual; social and economic factors; factors related to health care and health care professionals and also factors related to the disease and treatment. Objective: This study aims to carry out an integrative review of national and international literature of factors associated with adherence to treatment of hepatitis C, with special emphasis to psychological and social factors. Method: We establish the various stages of this study according to the proposed procedure: the development of the research question, establishment of criteria for sample selection, presentation of the characteristics of the selected research, data analysis, interpretation of results and a summary of the review. A search of articles was conducted in the following databases: Medline, Web of Science, CINAHL, Lilacs, Psycinfo, Scopus and Scielo. Complete articles were included, in Portuguese, English and Spanish, published between 2000 and 2016, and articles considered not relevant to the object of study were excluded. Results: Obtained a corpus with 14 totally foreign articles published in English between 2001-2015, mainly indexed in Medline, the quantitative method predominated among the selected studies (eleven articles) against three articles using the qualitative method. The psychological variables studied in relation to the possible association with adherence/non-adherence to treatment of hepatitis C, in the quantitative study were: presence of psychological symptoms such as anxiety and depression, anger, hostility, psychiatric disorders, and self-efficacy, but social functioning, interpersonal problems, behaviors related to health and quality of life were also investigated. These studies also assessed the possible impact on treatment adherence of sociodemographic characteristics: age, occupation, education, gender, ethnicity, social support and even the use of alcohol and other drugs (abstinence and treatment). Among these factors there was significant association between non-adherence and presence of psychiatric disorders, symptoms of depression, phobic anxiety, hostile behavior, intrusiveness, regular substance use, age (being younger), unemployment, not being in a stable relationship. The variables statistically associated with adherence to treatment were: starting psychiatric medication during treatment, health-related behaviors (diet and eating behavior), shorter distance from the center of treatment, genotype 3, HIV co-infected and treatment first timers. The three qualitative studies were also evaluated and the barriers and facilitators of adherence to treatment were identified and discussed: perception and experiences with treatment, presence of stigma, social support, coping strategies, belief systems, fear and anxiety. Conclusions: Knowing the factors that can interfere with adherence to hepatitis C treatment is extremely important because the severity of the disease, the increase in incidence, the complexity and cost of treatment that requires full adherence to achieve SVR in addition to the personal and social impact of the disease and its treatment, which makes it a public health problem. It is considered that the relevance of this review is still to point out the need to expand research on the role of psychological and social variables on the characteristics of communication with health professionals who can promote better adherence. Research to this end, yet so absent from the literature, may contribute to the development of psychoeducational programs to broaden adherence to currently available treatments.
Introduction: Adherence to treatment refers to an active patient behavior regarding the disease and treatment by sharing decisions with the health professional. Adherence is considered a phenomenon resulting from the interaction of factors of different nature that directly affect patient behavior: factors related to the individual; social and economic factors; factors related to health care and health care professionals and also factors related to the disease and treatment. Objective: This study aims to carry out an integrative review of national and international literature of factors associated with adherence to treatment of hepatitis C, with special emphasis to psychological and social factors. Method: We establish the various stages of this study according to the proposed procedure: the development of the research question, establishment of criteria for sample selection, presentation of the characteristics of the selected research, data analysis, interpretation of results and a summary of the review. A search of articles was conducted in the following databases: Medline, Web of Science, CINAHL, Lilacs, Psycinfo, Scopus and Scielo. Complete articles were included, in Portuguese, English and Spanish, published between 2000 and 2016, and articles considered not relevant to the object of study were excluded. Results: Obtained a corpus with 14 totally foreign articles published in English between 2001-2015, mainly indexed in Medline, the quantitative method predominated among the selected studies (eleven articles) against three articles using the qualitative method. The psychological variables studied in relation to the possible association with adherence/non-adherence to treatment of hepatitis C, in the quantitative study were: presence of psychological symptoms such as anxiety and depression, anger, hostility, psychiatric disorders, and self-efficacy, but social functioning, interpersonal problems, behaviors related to health and quality of life were also investigated. These studies also assessed the possible impact on treatment adherence of sociodemographic characteristics: age, occupation, education, gender, ethnicity, social support and even the use of alcohol and other drugs (abstinence and treatment). Among these factors there was significant association between non-adherence and presence of psychiatric disorders, symptoms of depression, phobic anxiety, hostile behavior, intrusiveness, regular substance use, age (being younger), unemployment, not being in a stable relationship. The variables statistically associated with adherence to treatment were: starting psychiatric medication during treatment, health-related behaviors (diet and eating behavior), shorter distance from the center of treatment, genotype 3, HIV co-infected and treatment first timers. The three qualitative studies were also evaluated and the barriers and facilitators of adherence to treatment were identified and discussed: perception and experiences with treatment, presence of stigma, social support, coping strategies, belief systems, fear and anxiety. Conclusions: Knowing the factors that can interfere with adherence to hepatitis C treatment is extremely important because the severity of the disease, the increase in incidence, the complexity and cost of treatment that requires full adherence to achieve SVR in addition to the personal and social impact of the disease and its treatment, which makes it a public health problem. It is considered that the relevance of this review is still to point out the need to expand research on the role of psychological and social variables on the characteristics of communication with health professionals who can promote better adherence. Research to this end, yet so absent from the literature, may contribute to the development of psychoeducational programs to broaden adherence to currently available treatments.
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Palavras-chave
Adesão do paciente, Hepatite C, Revisão, Aspectos Psicológicos, Indicadores Demográficos, Patient Adherence, Hepatitis C, Review, Psychological Aspects, Demographic Indicators