Fatores intervenientes entre suporte social e autoeficácia em pessoas infectadas pelo HIV / Factors involved between social support and self-efficacy in HIV-infected individuals

Objetivos: Verificar a relação entre a percepção do suporte social recebido e a expectativa de autoeficácia em adultos em tratamento antirretroviral para o HIV. Métodos: Estudo transversal, realizado de janeiro a julho de 2012 no Ambulatório de Doenças Infecciosas do Hospital Universitário de Santa Maria, Rio Grande do Sul, com adultos em tratamento antirretroviral para HIV. Como instrumentos para coleta de dados foram aplicados um questionário com informações sociodemográficas e econômicas, a escala de expectativa de autoeficácia ao tratamento antirretroviral para o HIV e a escala para avaliação do suporte social. Utilizou-se estatística descritiva, correlação de Spearman e regressão logística multivariada. Foi considerado o nível de significância com valores iguais ou menores que 5%. Resultados: Verificou-se correlação entre suporte social emocional e expectativa de autoeficácia. O suporte social total apresenta como fator de risco contagem de linfócitos T CD4+ em até 50 células/µL (odds ratio [OR] 1,17; intervalo de confiança [IC] 95% 1,01-1,37) e como fator de proteção renda inferior a 16.024 reais anuais (OR 0,95; IC 95% 0,91-0,99). A autoeficácia apresentou como fatores de proteção escolaridade entre quatro e sete anos de estudo (OR 0,94; IC 0,89-0,99), renda inferior a 16.024 reais anuais (OR 0,91; IC 0,84-0,98), contagem de linfócitos T CD4+ em até 50 células/µL (OR 0,84; IC 0,77-0,92), carga viral igual ou acima de 501 cópias/mL (OR 0,91; IC 0,87-0,95) e considerar o acompanhamento no serviço de saúde moderado (OR 0,96; IC 0,92-0,99) ou difícil (OR 0,94; IC 0,89-0,99). Conclusões: O suporte social percebido associou-se com a expectativa de autoeficácia. Os dados sugerem que o suporte social e a expectativa de autoeficácia, além de afetar a resposta terapêutica ao tratamento, podem interferir no acompanhamento do serviço de saúde, assim como servir como barreira de proteção para manutenção da adesão ao TARV.

Aims: To investigate the relationships between perceived social support received and expectation of self-efficacy. Methods: Cross-sectional study conducted at the Outpatient Clinic of Infectious Diseases of the Teaching Hospital of Santa Maria, southern Brazil, from January to July 2012 with adults on antiretroviral treatment for HIV. To collect the data, we applied an instrument which included: a sociodemographic and economic questionnaire, a self-efficacy expectation scale for antiretroviral treatment, and the scale for evaluation of social support. We used descriptive statistics, Spearman's correlation, and multivariate logistic regression. Values equal to or less than 5% were considered to be of statistical significance. Results: There was a correlation between emotional social support and expectation of self-efficacy. Total social support presented CD4+ T lymphocyte count up to 50 cells/µL (odds ratio [OR]=1.17; 95% confidence interval [CI]=1.01-1.37) as a risk factor, and an income of less than 8,000 dollars per year (OR=0.95; 95% CI=0.91-0.99) as a protective factor. Four to seven years of schooling (OR=0.94; 95% CI=0.89-0.99), income of less than 8,000 dollars per year (OR=0.91; 95% CI=0.84-0.98), CD4+ T lymphocyte count up to 50 cells/µL (OR=0.84; 95% CI=0.77-0.92), viral load equal to or greater than 501copies/mL (OR=0.91; 95% CI=0.87-0.95), and healthcare follow-up considered moderate (OR=0.96; 95% CI=0.92-0.99) or difficult (OR=0.94; 95% CI=0.89-0.99) were regarded as protective factors for self-efficacy. Conclusions: Perceived social support is associated with expectation of self-efficacy. The data suggest that social support and expectation of self-efficacy, in addition to affecting the therapeutic response to treatment, may interfere with healthcare follow-up and act as a protective factor for sustained adherence to antiretroviral therapy.

Motivational Interviewing (MI) in Behavioural Change

Patients are often advised to adopt healthier behaviours or change unhealthy ones on the basis that what they are doing or not doing is detrimental to their health. Some of these changes may include going on a diet, exercising, stopping cigarette smoking and even relaxing and sleeping more. MI was initially developed by Rollnick and Miller as a strategy for addictive behaviour change, but it has found many applications in helping patients change other health related behaviours. MI was initially defined as a client-oriented, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence. The guiding stance, whilst respecting the patient's autonomy and the patient as the agency of change, maintain controls of the direction and structure of the consultation to evoke the patient's own arguments and strategies for change. The guiding process thus avoids the struggle or "fights" with the patient over changing behaviour and has been likened more to "dancing" with the patient. The four counselling principles in MI are: Develop discrepancy; Express empathy; Roll with resistance; and Support self-efficacy. Facilitating the patient to process and speak more about why and how to change then becomes one of the strategies to motivate change. In MI, this is known as change talk. Once change talk is elicited, the ways the practitioner can respond are: Elicit more (with open questions); Affirm; Reflect; and Summarise. Once the patient decides to change, goal setting becomes the next important process. Needless to say, the goal setting process must be done in collaboration with the patient, with the patient having the final say.

Correlation between Social Support and Self-efficacy for Patients with Breast Cancer during Postoperative Chemotherapy / 中国康复理论与实践

@#Objective To observe the level of social support and self-efficacy of the breast cancer patients with postoperative chemotherapy, and study the relationship between them. Methods 76 patients were investigated with Social Support Rating Scale and Strategies Used by Patients to Promote Health (SUPPH). Results The total and every dimension scores of SUPPH and Social Support decreased in the patients. The total and every dimension scores of Social Support positively correlated with every dimension scores of SUPPH (P<0.01). Conclusion The level of self-efficacy and social support may relate each other.