Methods to assess ambivalence toward food and diet: a scoping review protocol.

OBJECTIVE: This scoping review aims to identify and understand the different tools and methods used in studies in the field of human eating behavior to assess, measure, or classify participants' ambivalence toward food and diet, as well as to identify which tools and methods are most frequently employed. INTRODUCTION: People's attitudes toward food and eating behaviors are often ambivalent (simultaneously positive and negative), making it harder to change eating behaviors in favor of a healthier diet. This highlights the importance of resolving diet-related ambivalence. Identifying and understanding the different methods used in the literature to assess attitudinal ambivalence toward food and diet will provide researchers with a range of options to choose from for future studies. INCLUSION CRITERIA: We will include peer-reviewed studies as well as preprints that assess the ambivalence of human participants toward food and diet, regardless of sex, age, or other sociodemographic factors. We will exclude studies in which the methods used to assess ambivalence are not detailed or cannot be reproduced, as well as studies that assess the ambivalence of participants toward farming and agricultural methods or toward methods of food production and preparation. METHODS: This review will follow the JBI methodology for scoping reviews. Peer-reviewed studies will be retrieved from MEDLINE, PsycINFO, Web of Science, Food Science Source, FSTA, and CINAHL, while preprints will be retrieved from PsyArXiv and MedArXiv. Two independent reviewers will screen the articles. All relevant extracted information will be presented as tables and a descriptive summary of the findings.

Action and coping plans related to the behavior of adherence to oral anti-diabetic medication / Planos de ação e de enfrentamento de obstáculos relacionados ao comportamento de adesão aos antidiabéticos orais

ABSTRACT: Study Design: This mixed-methods study. Objective: To describe action plans related to the behavior of adher-ence to oral antidiabetic medications produced by people with type 2 diabetes mellitus and identify the challenges and coping strategies for the establishment of this behavior. Methods: The study followed-up 44 people with type 2 diabetes mellitus who used oral antidiabetic medications from southeast Brazil. Adults were invited to build action and coping plans based on the Implementation Intention Theory.The plans were quantitative and qualitatively ana-lyzed. Results: Action plans included three major themes: (1) binding oral antidiabetic medication to time markers or the sleep/wake cycle; (2) in specific environments; (3) associated with daily life activities. The motivation for coping with the perceived barriers focused on placing the pills in visible places, asking for help from family mem-bers, establishing a routine and feeding properly. Conclusions: The most effective way to manage satisfactory oral antidiabetic medication adherence seems to be recognizing the perceived barriers by patients. The implementation of specific and individualized action and coping plans to overcome perceived barriers was the stark difference. (AU)

RESUMO: Desenho do estudo: Estudo de método misto. Objetivo: Descrever planos de ação relacionados ao comportamento de adesão aos antidiabéticos orais elaborados por pessoas com diabetes mellitus tipo 2 e identificar as barreiras percebidas e respectivas estratégias de enfrentamento para efetivação desse comportamento. Métodos: O estudo envolveu 44 pessoas com diabetes mellitus tipo 2 que utilizavam antidiabéticos orais na região sudeste do Brasil. Adultos foram convidados a construir os planos de ação e de enfrentamento de obstáculos baseados sobre a Teoria da Ativação da Intenção. Os planos foram analisados quantitativa e qualitativamente. Resultados: Os planos de ação incluíram três temas principais: (1) Associar a tomada dos antidiabéticos orais aos marcadores de tempo ou ao ciclo de sono / vigília; (2) em ambientes específicos; (3) associados às atividades de vida diária. Os planos de enfrentamento das barreiras percebidas centraram-se em colocar os comprimidos em locais visíveis, pedir ajuda aos familiares para evitar esquecimento, estabelecer rotina e alimentar-se adequadamente. Conclusões: A forma mais eficaz de manejar a tomada de antidiabéticos orais de modo satisfatório parece ser o reconhecimento das barreiras percebidas pela própria pessoa. A implementação de ações específicas e individualizadas bem como de planos de enfrentamento para superar as barreiras percebidas foi o diferencial neste estudo. (AU)

Measurement properties and factor analysis of the Diabetic Foot Ulcer Scale-short form (DFS-SF).

The purpose of this paper is to provide measurement properties evaluation and factor analysis of the Brazilian version of the diabetic foot ulcer scale-short form (DFS-SF). This methodological study evaluated the measurement properties of the DFS-SF by ceiling and floor effect reliability, responsiveness, and structural construct validity. The study included 290 people with diabetic foot under regular follow-up in a specialised outpatient clinic in inland São Paulo. Reliability was assessed by internal consistency using Cronbach's alpha and composite reliability. Ceiling and floor effects were assessed by the percentage of participants who scored the 15% worst (floor) and 15% best (ceiling) possible scale results. Validity was tested by correlating the instrument values with the domains of the Brazilian version of the Short Form Health Survey (SF-36). Responsiveness (n = 34) was accessed through the wound area obtained by photography and evaluated by the Image J Features program and the DFS-SF score at two moments, with a 4-week interval between them. The instrument had good evidence of reliability, shown by adequate internal consistency (Cronbach's alpha in domains >0.70) and compound reliability (0.84 > CC > 0.92); and of convergent validity, by significant positive correlations of moderate to strong magnitude with SF-36. Structural construct validity was examined by applying the DFS-SF confirmatory factor analysis, which indicated that the Brazilian version of the instrument is properly fitted to the original dimensional structure. The ceiling and floor effect analysis showed no ceiling or floor effects. Responsiveness was observed in the wound area, but not in the DFS-SF scores in the times. The Brazilian version of the DFS-SF presented evidence of validity and reliability, suggesting that this instrument is a valid tool for assessing the quality of life of people with diabetic foot in the Brazilian population.

Psychosocial determinants of adherence to oral antidiabetic medication among people with type 2 diabetes.

AIMS AND OBJECTIVES: The aim of this study was to identify the psychosocial determinants of adherence to oral antidiabetic medication, according to the Theory of Planned Behaviour (TPB). BACKGROUND: Appropriate adherence to oral antidiabetic medication contributes to long-term glycaemic control. However, glycaemic control is often poor in people with type 2 diabetes, mainly due to the poor adherence to oral antidiabetic agents. DESIGN: Prospective study with 2 waves of data collection, based on STROBE checklist was conducted. One hundred and fifty-seven adults with type 2 diabetes, in chronic use of oral antidiabetic agents, composed the sample. At baseline, self-reported measures of medication adherence (proportion and global evaluation of adherence) and of metabolic control (glycated haemoglobin) of diabetes were obtained. METHODS: The TPB main constructs (attitude, subjective norm and perceived control) and related beliefs were measured. Adherence and metabolic control measurements were obtained in a two-month follow-up (n = 157). RESULTS: Attitude and subjective norm, together, explained 30% of the variability in intention; their underlying belief-based measures (behavioural and normative beliefs) explained 28% of the variability in intention. In addition, intention predicted behaviour at follow-up. However, when added to the prediction model, past behaviour was the only explanatory factor of adherence behaviour. CONCLUSION: Adherence behaviour to oral antidiabetic medication was predicted by intention, which, in turn, was determined by attitude and subjective norm. In order to promote adherence to oral antidiabetic agents, health professionals should include motivational strategies as well as strategies targeted to attitude and subjective norm when designing interventions. RELEVANCE TO CLINICAL PRACTICE: The nonadherence to antidiabetic medication contributes to lack of control of diabetes and ensuing complications. The comprehension of the factors explaining the variability in medication adherence can inform the design of theory-based interventions aimed at promoting this behaviour.

A randomized controlled trial on the effect of behavioral strategies for adherence to oral antidiabetic drugs: study protocol.

BACKGROUND: Non-adherence to oral antidiabetics drugs (OADs) has been a common problem and may contribute to poor glycemic control. AIM: To describe an experimental study protocol that aims at implementing and evaluating the effect of the "action planning and coping planning" interventions on medication adherence to OADs in patients with type 2 diabetes mellitus (T2DM) in follow-up at primary care services. DESIGN: A randomized controlled trial. METHODS: Two groups (intervention and control) will be followed over a period of 105 days. The intervention group will receive a combination of the "action planning" and "coping planning" intervention strategies. There will be in-person meetings and phone calls to reinforce the intervention. The control group will receive the usual care from the health unit. CONCLUSIONS: It is hoped that this study will help health professionals to improve their approach with patients who have T2DM in relation to medication adherence.

Effect of a behavioral intervention of the SALdável program to reduce salt intake among hypertensive women: A randomized controlled pilot study.

BACKGROUND: Excessive salt intake has been directly associated with cardiovascular diseases, especially hypertension, and non-cardiovascular diseases. Despite the current recommendations, salt intake remains high, indicating the need to develop theory-based interventions aimed at reducing this intake. AIM: The purpose of this study was to test the impact of a theory-based intervention - the SALdável Program - to promote the use of less than 4 g of salt/day during cooking. METHODS: This was a two-arm parallel-group randomized study. A total of 92 hypertensive women were randomly assigned to an intervention or control group. The intervention was aimed at motivating participants to reduce salt addition by increasing self-efficacy and counteracting the negative influence of habit. Primary outcomes were the behavioral question of salt addition and total salt addition, secondary outcomes were overall salt intake, provided by 24-hour urinary sodium excretion, and psychosocial variables (intention, self-efficacy, and habit). RESULTS: At three-month follow-up, the intervention group improved significantly more than the control group regarding salt addition measures (p-values between 0.05 and 0.001) and psychosocial variables (all p-values ⩽0.001). The reduction in 24-hour urinary sodium excretion was not significant. CONCLUSION: The findings showed that this theory-based intervention was effective to motivate and change the behavior of hypertensive women regarding daily salt use in cooking meals. This was accomplished by means of improvements in intention and self-efficacy and reduction of the habit of using more than 4 g of salt/day during cooking.

Sodium intake is associated with carotid artery structure alterations and plasma matrix metalloproteinase-9 upregulation in hypertensive adults.

The mechanisms by which dietary sodium modulates cardiovascular risk are not fully understood. This study investigated whether sodium intake is related to carotid structure and hemodynamics and to plasma matrix metalloproteinase (MMP) activity in hypertensive adults. One hundred thirty-four participants were cross-sectionally evaluated by clinical history, anthropometry, carotid ultrasound, and analysis of hemodynamic, inflammatory, and metabolic variables. Daily sodium intake (DSI) was estimated by 24-h recall, discretionary sodium, and a FFQ. In 42 patients, plasma MMP-2 and MMP-9 activities were also analyzed. The mean DSI was 5.52 ± 0.29 g/d. Univariate analysis showed that DSI correlated with common carotid artery systolic and diastolic diameter (r = 0.36 and 0.34; both P < 0.001), peak and mean circumferential tension (r = 0.44 and 0.39; both P < 0.001), Young's Elastic Modulus (r = 0.40; P < 0.001), intima-media thickness (r = 0.19; P < 0.05), and internal carotid artery resistive index (r = 0.20; P < 0.05). Multivariate analyses revealed that only artery diameter, circumferential wall tension, and Young's Elastic Modulus were independently associated with DSI. Conversely, plasma MMP-9 activity was associated with DSI (r = 0.53; P < 0.001) as well as with common carotid systolic diameter (r = 0.33; P < 0.05) and Young's Elastic Modulus (r = 0.38; P < 0.01). In conclusion, sodium intake is associated with carotid alterations in hypertensive adults independently of systemic hemodynamic variables. The present findings also suggest that increased MMP-9 activity might play a role in sodium-induced vascular remodeling.

Relationship between beliefs regarding a low salt diet in chronic renal failure patients on dialysis.

OBJECTIVE: The aim of this study was to investigate the relationship between beliefs regarding a low salt diet and the nutritional behavior of sodium consumption as well their relation with sociodemographic and clinical variables among chronic renal failure (CRF) patients on dialysis. DESIGN AND METHODS: This cross-sectional study enrolled a sample of 117 patients who answered the Brazilian version of the Beliefs about Dietary Compliance Scale (BDCS), the sodium frequency food questionnaire, and the use of discretionary salt/day. RESULTS: The average of total salt consumption was 10.6 g/day (±6.3) and it was positively correlated with the interdialytic weight gain (r = 0.20 P = .032) and negatively correlated with the education level (r = -0.19 P = .044). The Benefits beliefs were discriminatory of the higher and lower salt consumers, and proportionally related to monthly income (r = 0.22 P = .017). The Barriers beliefs were positively correlated only to time on dialysis (r = 0.25 P = .008). Subjects with lower schooling and those of older age tended to consume more discretionary salt (r = -0.27, P = .005; r = 0.23, P = .016, respectively); however, they reported a lower consumption of foods with high salt content (r = 0.25 P = .006; r = -0.27 P = .004). CONCLUSIONS: Educational interventions aimed at reducing salt consumption for this group must include interventions targeted at different behaviors related to overall salt consumption, the specificities of age, and level of schooling of the patients.