Behavioural cancer risk factors in women diagnosed with primary breast cancer.

AIMS: To investigate behavioural risk factors and self-efficacy among women diagnosed with breast cancer. BACKGROUND: The appearance of new tumours in breast cancer survivors is influenced by risk behaviours. Knowing their prevalence and women's perceived ability to adopt a healthy lifestyle would allow designing educational interventions aimed at modifying these behaviours. DESIGN: An observational cross-sectional study of women diagnosed with breast cancer. METHODS: The study was carried out in Asturias (Spain). A total of 2407 breast cancer patients diagnosed between 1998-2008 were selected and 492 women agreed to participate. Self-reported data on risk factors self-efficacy were gathered through a telephone interview based on the European Code against Cancer conducted between February-June 2010. RESULTS: A total of 16·1% of women in this study were regular smokers, 5% drank alcohol excessively, 49% were overweight, 54% reported a lower level of physical activity than recommended and 7·5% did not use sun protection. The Total Cancer Behavioural Risk indicator was calculated by adding up the results of all modifiable risks contained in the European Code against Cancer, with an average score of 21·6 in a scale from 0-78 points (0 = null cancer risk, 78 = maximum cancer risk). Self-efficacy levels were very high among our participants. CONCLUSION: The results suggest that there is a need to design programmes to promote a healthy lifestyle among women diagnosed with breast cancer. Nurses have an important role to play in planning and implementing these programmes, using the most efficient educational techniques.

Study protocol of a randomized controlled trial to improve cancer prevention behaviors in adolescents and adults using a web-based intervention supplemented with SMS.

BACKGROUND: The overall number of cancer cases is increasing and, therefore, strengthening cancer prevention has become a priority. The institutions responsible for its control establish guidelines for primary prevention. These include recommendations, such as: not smoking, following a healthy diet, doing daily physical exercise or avoiding overweight. Adolescence is a period of adoption and/or consolidation of health behaviors, and both school- and family-based interventions have proven effective to improve them. Furthermore, online and mobile phone educational interventions are encouraging. Consequently, the main aim of this study is to assess the efficacy of an intervention in which these requirements (school, family, the Internet and SMS) are combined to prevent behavioral cancer risk. METHODS: This protocol describes the design and implementation of a complex online program that includes a randomized controlled trial put into practice in two countries: Spain and Mexico. Adolescents and adults of their environment (relatives and teachers) who voluntarily participate will be randomly assigned to the experimental group or to the control group once they have completed the online pre-test. The experimental group members will have free access to a tailor-made and interactive website (http://www.alertagrumete.com). During the academic year, this website will be periodically updated with different school and leisure activities related to the avoidance of risk behaviors. To encourage participation, the program includes a competition that gives rewards to the winners. SMS are also sent to students to stimulate the adoption of healthy behaviors and as a reminder of participation. Finished the intervention, an online post-test is performed in both groups and the impact on the risk behaviors is therefore assessed. DISCUSSION: The program is pioneer, since it combines many components which have already proven effective in previous researches. Moreover, it aims to compare efficacy in two countries with different socio-economic levels to find out if these approaches are equally effective in countries with a lower income level. However, the vertiginous evolution of the Internet and mobile phones may make this tool less attractive for adolescents, who may prefer social networks and other mobile phone applications which are nowadays massively used by their peers. TRIAL REGISTRATION: ISRCTN27988779.

Psychosocial and behavioural determinants of the implementation of Pharmaceutical Care in Spain.

OBJECTIVE: We aimed to gain greater understanding of the implementation of the Pharmaceutical Care (PhC) initiative in Spain. Our investigation was underpinned by Prochaska and Di Clemente's stages of change model. We also used the A.S.E. (Attitude, Social influence and self-Efficacy) Model to identify the psychosocial determinants of this professional behaviour. SETTING: Spanish community pharmacists. METHOD: A validated questionnaire was sent to all community pharmacists registered on a national database and 1,977 (10.3%) responded. The questionnaire assessed stage of change regarding the implementation of PhC and the psychosocial determinants of this professional behaviour. Data were analyzed using descriptive statistics. Kruskal-Wallis and Mann-Whitney U tests were used to compare psychosocial determinants according to stage of change. The profile of community pharmacists who had implemented PhC was identified through logistic regression analysis. MAIN OUTCOME MEASURES: attitude, social influence, self-efficacy, motivations, needs and stages of change to perform PhC. RESULTS: Some respondents (n = 228; 11.8%) had adopted PhC, and were, thus, in the action or maintenance stage. The mean A.S.E. determinants scores increased significantly by stage i.e. from "precontemplation" to "action": attitude (0.28 vs. 0.99), social influence of people (2.61 vs. 3.07), and self-efficacy (2.74 vs. 3.61). Conversely, most needs were highlighted by precontemplators (3.66 vs. 347.). Variables significantly associated with the probability of implementing PhC were: having undertaken appropriate training (OR: 13.92; CI 95%: 5.37-36.08); self-efficacy (OR: 3.19; CI 95%: 2.38-4.28), having assistant pharmacists (OR: 1.70; CI 95%: 1.02-2.80) and positive attitude (OR: 1.03; CI 95%: 1.01-1.04). The A.S.E. determinants were the best predictors of PhC implementation according to the regression model. CONCLUSION: The implementation of PhC among Spanish community pharmacists appears to be relatively low. Strategies to move pharmacists should be adapted to stage: focussed on emphasizing advantages at initial stages and facilitating training courses, guidelines and communication to professionals at intermediate and advanced stages.