WJCR – Tese de Doutoramento
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Browsing WJCR – Tese de Doutoramento by advisor "Pimenta, Filipa"
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- Me-wel: Menopause and weight loss – development of model, measure, and interventionPublication . Leitão, Mafalda Rodrigues; Pimenta, Filipa; Marôco, J. P.; Pérez-López, FaustinoABSTRACT: Middle-age significantly impacts a woman´s life, primarily due to menopause and its associated changes, such as weight gain, which poses a complex challenge. Understanding the behaviours and beliefs surrounding this phenomenon is crucial. The ME-WEL (MEnopause and WEight Loss) Project aimed to expand knowledge about weight management in middle-age and menopausal transition, employing both qualitative and quantitative methods and comprising three phases entailing eight distinct objectives. In Phase 1 (cross-sectional), quantitative instruments were developed and validated (n=1,921 middle-aged women aged 45-65 years) to assess cognitive/behavioural weight management strategies based on the Oxford Food and Activity Behaviours (OxFAB) Taxonomy (Objective 1) and weight management based on the Health Action Process Approach (HAPA) model (Objective 2). The Three Factor Eating Questionnaire-R21 was also validated (Objective 3). A quantitative study also explored the pandemic´s impact on eating behaviour and psychological symptoms in peri and postmenopausal women (Objective 4). Phase 2 (cross-sectional) used qualitative methods (n=62 postmenopausal women) and highlighted the health beliefs associated with different weight experiences during the menopausal transition (i.e., weight gain or maintenance), based on the Health Belief Model (HBM; Objective 5), the factors contributed to weight gain among women who gained weight during the menopausal transition (Objective 6), and the successful weight management strategies employed by women who maintained a healthy weight during this specific phase (Objective 7). Phase 3 (longitudinal) included the development, implementation, and evaluation of the efficacy of an intervention to promote weight management strategies and subjective well-being among postmenopausal women (BMI≥25kg/m2 ), using a randomised control trial design (nIntervention=13; nControl=14). The intervention drew upon models and taxonomies of behavioural change – HBM, HAPA, Behaviour Change Techniques (BCT), and OxFAB. The ME-WEL findings suggest that i) the HBM is suitable for gaining an in-depth understanding of the weight differences among middleaged women during the menopausal transition, and ii) promoting knowledge and anticipatory strategies regarding menopause and weight management, specifically among premenopausal women, is an important preventive approach (desirably conducted by a multidisciplinary team). Also, iii) strategies like regulation-rule setting or energy compensation can be implemented and maintained over time, and iv) short eHealth group interventions are beneficial to promote weight management (in terms of cognitive and behavioural change) and well-being.
- "Menopause – Representantions, predictors and management of vasomotor symptoms, and impact on the couple’s sexual functions"Publication . Silva, Maria Rita Garoupa Albergaria; Pimenta, FilipaABSTRACT: The experience of menopause, despite being a natural physiological phenomenon and transversal to all women, can facilitate the emergence of vasomotor symptoms (VMS) and is influenced by representations, lifestyles, sociocultural context (among others) and, therefore, idiosyncratic for each woman. As such, the study of menopause representations proved to be relevant through: 1) development of an instrument guided by the Common-Sense Model of Self-Regulation (CSM-SR); 2) assessment of couples at middle-age, as well as the study of predictors of menopause symptoms’ (MS) perceived severity and the application of an intervention intended to modify these predictors and, thus, decrease their perceived severity. Four studies were carried out (3 transversal and descriptive-observational and 1 longitudinal and quasi-experimental) with Portuguese women aged between 45 and 65 years. The status, the representations and MS were variables common in all studies. The MenoSentations-Questionnaire, a culturally validated instrument, was developed to measure representations of menopause in 309 Portuguese women. It was based on the 5 cognitive components of the CSM-SR (identity, consequences, control, duration and cause), demonstrating adequate psychometric qualities. It proved to be useful both for the assessment of (mis)adjusted menopausal beliefs as well as for delineating cognitivebehavioural interventions (CBI) aiming to improve the menopause experience (Chapter 2). Knowing that genitourinary syndrome of menopause (GSM) and VMS (hot flushes and night sweats) are the most prevalent and problematic MS in middle-aged women’s daily life, and that the representations of menopause can determine the GSM’s management and, therefore, impact on women’s and the couple sexual functioning, the middle-aged couples were evaluated. We explored whether 28 Portuguese couples' representations of menopause influenced their sexual functioning, concluding that only men's negative representations impaired in their own sexual functioning (Chapter 3). Subsequently, a structural model was developed to understand the predictors of MS’ perceived severity in 505 Portuguese women (with special emphasis on potentially modifiable behaviours/aspects of diet and lifestyle). It was concluded that women with obesity, iatrogenic menopause, psychological problem, alternative complementary medicine’s users and frequent users of caffeinated beverages experience greater MS’ severity (Chapter 4). These results proved to be relevant to guide the intervention that followed, in the course of this doctoral thesis, for MS’ attenuation. Thus, in order to alleviate the problematic VMS’ experience in Portuguese women, MENOS2 (group CBI, effective in VMS’s reduction in English women) was adapted to the Portuguese language and culture (MENOS-PT), taking also in consideration the results obtained in Chapter 2 and 4. The MENOS-PT was applied and their effectiveness was tested in 8 Portuguese women, evaluating them in 4 times: T0–before MENOS-PT; T1– after the implementation of MENOS-PT; T2–3 months later; T3–6 months later. The results of this pilot study revealed the decrease of problematic VMS’ experience and frequency of hot flushes over time (T0-T3); the frequency of night sweats decreased only between T0- T2. Participants reported improvements in perception and perceived severity of MS, decreased perception of negative consequences (T0-T3) and greater perception of menopause’s control, awareness, and cause (T0-T2). Women showed improvements in quality of life only at T1, with no improvements in the perceived positive consequences of menopause, nor in the quality of sleep at any evaluation moment. This set of studies aimed to contribute to a better understanding of menopause based on a bio-psycho-socio-cultural perspective, namely in the measurement of menopause’s representations, its impact on sexual functioning, the determinants of exacerbation of MS’ severity, as well as on the CBI availability that demonstrated improvements in problematic menopause experiences.