Mindfulness, perceived stress, and subjective well-being: a correlational study in primary care health professionals.

BACKGROUND: Primary health care professionals (PHPs) usually report high levels of distress and burnout symptoms related to job strain. Mindfulness, defined as non-judgmental-present-moment awareness, seems to be a moderator in the causal association between life stressors and well-being. This study aimed to verify correlations among self-reported mindfulness, perceived stress (PS), and subjective well-being (SW) in Brazilian PHPs. METHODS: We performed a correlational cross-sectional study in a purposive sample of Brazilian PHPs (physicians, nurses, nursing assistants, and community health workers), working in community-oriented primary care programs (known locally as "Family Health Programs"). We used validated self-reporting instruments: the Mindful Attention Awareness Scale (MAAS), the Perceived Stress Scale (PSS), and the Subjective Well-being Scale (SWS). We performed a multivariate analysis of variance (MANOVA), through regression coefficients (beta) in relation to the professional category (nursing assistant), in addition to the length of time in the same job (under than 6 months) that had indicated the lowest level of PS. RESULTS: Participants (n=450) comprised community health workers (65.8%), nursing assistants (18%), registered nurses (10.0%), and doctors (family physicians) (6.0%); 94% were female and 83.1% had worked in the same position for more than one year. MANOVA regression analysis showed differences across professional categories and length of time in the same job position in relation to mindfulness, PS, and SW. Nurses demonstrated lower levels of mindfulness, higher PS, and SW negative affect, as well as lower SW positive affect. Being at work for 1 year or longer showed a clear association with higher PS and lower SW positive affect, and no significance with mindfulness levels. Pearson's coefficient values indicated strong negative correlations between mindfulness and PS, and medium correlations between mindfulness and SW. CONCLUSION: In this study, there were clear correlations between mindfulness, PS, and SW across different primary care professional categories and time in the same job position, suggesting specific vulnerabilities that should be addressed through the development of staff awareness, stress prevention, and well-being interventions.

Staff commitment to providing tobacco dependence in drug treatment: Reliability, validity, and results of a national survey.

Although most people in treatment for illicit drug use smoke cigarettes, few facilities offer any form of treatment for tobacco dependence. One reason for this may be that drug treatment staff have varying levels of commitment to treat tobacco. We developed and validated a 14-item Tobacco Treatment Commitment Scale (TTCS), using 405 participants in leadership positions in drug treatment facilities. We first conducted a confirmatory factor analysis to evaluate 4 a priori domains suggested by our original set of 38 items-this did not produce a good fit (comparative fit index [CFI] = 0.782, root mean square error of approximation [RMSEA] = 0.067). We then conducted a series of exploratory factor analyses to produce a more precise and reliable scale. The final confirmatory factor analysis indicated a 3-factor solution, produced a good fit (CFI = 0.950, RMSEA = 0.058), and had substantial unified reliability of 0.975. The final TTCS contained 14 items in 3 domains: "Tobacco is less harmful than other drugs," "It's not our job to treat tobacco," and "Tobacco treatment will harm clients." These constructs account for most of the variance in the survey items and emerged as major sentiments driving staff commitment to providing tobacco services. The TTCS can be used to understand the role of staff attitudes in the adoption of tobacco services in this important treatment setting.

Process evaluation of the implementation of a screening and brief intervention program for alcohol risk in primary health care: An experience in Brazil.

INTRODUCTION AND AIMS: Screening and brief intervention (SBI) are considered good prevention strategies for alcohol-related problems in Primary Health Care (PHC). The aim of this study was to evaluate the process of an SBI implementation program for alcohol risk use and evaluate the factors that facilitated or impeded this implementation, in two PHC settings at the Brazilian city of Juiz de Fora. DESIGN AND METHODS: Case 1 public PHC services and case 2 the PHC service of the Military Police. Participants were trained on SBI strategies and supervised during 6 months. The qualitative methodology of action research was used. Data were analysed using thematic analysis. RESULTS: Case 1: 70 participants; facilitating factors: good expectations about the project; simplicity of SBI technique; collaborative way the project was planned. Barriers: lack of time; discomfort in dealing with alcohol issues; focus on alcohol-dependence; unstable political environment; other priorities; difficulties in patients' referral. Case 2: nine participants. Facilitating factors: simplicity of SBI technique; collaborative way the project was planned; importance of alcohol issues; data confidentiality and the voluntary work to do SBI. Barriers: only one health professional in the group; the variability of the institutional support; organisational culture about alcohol use. DISCUSSION AND CONCLUSIONS: The barriers and facilitators were related to two main factors: organisational culture and personal attitudes. The action research provided the opportunity to bridge the gap between research and practice, but it also showed that SBI faces significant challenges before it can be implemented as a routine procedure in PHC settings in Brazil.

Beliefs about alcohol use among university students.

The aim of this study was to analyze and compare standards of consumption and beliefs about alcohol among university students. There were 255 students who participated in this study. Of all the students, 61 were taking up psychology, 106 were taking up medicine, and 88 were taking up business administration. We used a sociodemographic questionnaire, the Inventory of Personal Expectations and Beliefs About Alcohol, and the Alcohol Use Disorders Identification Test (AUDIT) as study instruments. Of the total sample, 83.9% consumed alcohol. There was good correlation between the marks in the inventory and the total score in the AUDIT-R (0.519; p < .01); the more positive the beliefs about alcohol and its effects were, the higher the scores in the AUDIT were. Many beliefs are associated with risk behaviors, and identifying them can contribute to prevention strategies and health promotion. Alcohol abuse and its consequences, especially for young people, are important aspects of public health and justify studies such as this one. Action strategies must be wide-reaching and directed toward cultural change. They must serve to foster discussions and take into account the real implications that alcohol use has for public health.