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Características e eficácia reportada das intervenções dirigidas a múltiplos comportamentos de saúde na diabetes mellitus do tipo 2: Revisão sistemática de literatura
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Abstract(s)
Introdução: A Diabetes Mellitus do tipo 2 (DM2) é uma doença crónica que resulta quer de
fatores genéticos quer de comportamentos de risco para a saúde. As intervenções dirigidas a
múltiplos comportamentos de saúde (IMCS), como a prática de atividade física e dieta alimentar de baixas calorias, podem ser uma forma eficaz de controlar os efeitos da diabetes. Contudo,
existe ainda conhecimento limitador sobre a eficácia e características destas intervenções no
contexto da DM2. Objetivos: (i) Identificar as componentes das intervenções; (ii) Descrever a
eficácia reportada das intervenções em pessoas com DM2. Método: Foi conduzida uma revisão
sistemática da literatura em 6 bases de dados eletrónicas (e.g. Web of Science, PubMed). Foram
incluídos estudos randomizados de IMCS com dois ou mais resultados comportamentais em
populações com DM2 e idade igual ou superior a 18 anos, usando qualquer tipo de grupo de
controlo e em língua inglesa. Os estudos foram selecionados de forma independente por dois
investigadores. Foi extraída informação relativa aos detalhes do estudo, características da
amostra, componentes das intervenções (e.g. técnicas de mudança comportamental) e eficácia
reportada para as variáveis de interesse. O risco de viés foi avaliado a partir da ferramenta Risk
of Bias 2 (RoB2). Resultados: Os estudos somaram 6843 participantes com DM2 e a idade
média foi de 57,15 (DP = 4,38). As intervenções variaram entre 12 e 156 semanas, em formato
presencial, digital ou híbrido. Identificaram-se 20 Técnicas de Mudança Comportamental diferentes (e.g. Formulação de Objetivos (comportamentais), Resolução de Problemas). Os estudos apresentaram uma qualidade metodológica fraca. As intervenções focadas no consumo de
bebidas alcoólicas e de tabaco reportaram baixa eficácia, enquanto as focadas em atividade
física e dieta reportaram maior eficácia. Discussão: Os resultados reportados são favoráveis às
IMCS para atividade física e dieta, mas a falta de clareza e de detalhe nas descrições das intervenções e o uso de medidas de auto reporte, sujeitas à subjetividade dos participantes, limitam
os resultados encontrados. Intervenções futuras devem ser descritas de forma mais clara e rigorosa, através, e.g., de ontologias existentes. Recomenda-se que futuras revisões analisem a
eficácia destas intervenções por meio de uma meta-análise.
Background: Type 2 diabetes mellitus (T2D) is a chronic disease related to genetic factors and adverse health behaviors. Multiple health behavior change (MHBC) interventions, i.e., those aiming to change two or more behaviours (e.g., physical activity and diet), can play a key role in this context by improving health results, minimizing public spending, and mitigating the effects of T2D However, a comprehensive summary of these interventions, including their components and efficacy, is still lacking. Objectives: (i) To identify the components of MHBC interventions in individuals with type 2 diabetes; and (ii) To describe the reported efficacy of these MHBC interventions. Methods: A systematic review of the literature was performed in 6 electronic databases (e.g., Web of Science, PubMed). This review included randomized trials of MHBC interventions with two or more behavioral outcomes, using any type of control groups, with samples of adults (i.e., ≥ 18 years old) with type 2 diabetes, and that were published in English. Two researchers independently screened and selected studies for inclusion. Data extraction was conducted for study details, sample characteristics, intervention components (e.g., behavior change techniques, BCTs), and reported efficacy of behavioral outcomes. Risk of bias was assessed using the Risk of Bias 2 tool (RoB2). Results: Sixteen studies were included, which reported interventions targeting physical activity, diet, alcohol consumption, and/or smoking behaviors. In total, 6843 individuals with type 2 diabetes, with a mean age of 57,15 (SD = 4,38) years, participated in the interventions. Intervention length varied between 12 and 78 weeks, and face-to-face, digital and hybrid formats were used. Twenty BCTs were identified (e.g., Goal Setting (behavior) and Problem-Solving). Included studies showed poor methodological quality. Interventions focused on alcohol and tobacco consumption reported low efficacy, whereas physical activity and diet interventions were reported to be more effective. Discussion: The reported results are favorable for MHBC interventions targeting physical activity and diet. However, the lack of clarity and detailed descriptions of the interventions, as well as the use of self-report measures, limit the interpretation of the results found. Future studies should have clearer and more objective descriptions of interventions, e.g., through the use of existing ontologies and taxonomies. It is also recommended that future reviews analyze the effectiveness of interventions through a meta-analysis.
Background: Type 2 diabetes mellitus (T2D) is a chronic disease related to genetic factors and adverse health behaviors. Multiple health behavior change (MHBC) interventions, i.e., those aiming to change two or more behaviours (e.g., physical activity and diet), can play a key role in this context by improving health results, minimizing public spending, and mitigating the effects of T2D However, a comprehensive summary of these interventions, including their components and efficacy, is still lacking. Objectives: (i) To identify the components of MHBC interventions in individuals with type 2 diabetes; and (ii) To describe the reported efficacy of these MHBC interventions. Methods: A systematic review of the literature was performed in 6 electronic databases (e.g., Web of Science, PubMed). This review included randomized trials of MHBC interventions with two or more behavioral outcomes, using any type of control groups, with samples of adults (i.e., ≥ 18 years old) with type 2 diabetes, and that were published in English. Two researchers independently screened and selected studies for inclusion. Data extraction was conducted for study details, sample characteristics, intervention components (e.g., behavior change techniques, BCTs), and reported efficacy of behavioral outcomes. Risk of bias was assessed using the Risk of Bias 2 tool (RoB2). Results: Sixteen studies were included, which reported interventions targeting physical activity, diet, alcohol consumption, and/or smoking behaviors. In total, 6843 individuals with type 2 diabetes, with a mean age of 57,15 (SD = 4,38) years, participated in the interventions. Intervention length varied between 12 and 78 weeks, and face-to-face, digital and hybrid formats were used. Twenty BCTs were identified (e.g., Goal Setting (behavior) and Problem-Solving). Included studies showed poor methodological quality. Interventions focused on alcohol and tobacco consumption reported low efficacy, whereas physical activity and diet interventions were reported to be more effective. Discussion: The reported results are favorable for MHBC interventions targeting physical activity and diet. However, the lack of clarity and detailed descriptions of the interventions, as well as the use of self-report measures, limit the interpretation of the results found. Future studies should have clearer and more objective descriptions of interventions, e.g., through the use of existing ontologies and taxonomies. It is also recommended that future reviews analyze the effectiveness of interventions through a meta-analysis.
Description
Dissertação de Mestrado apresentada no ISPA –
Instituto Universitário para obtenção de
grau de Mestre na especialidade de Psicologia Clínica
Keywords
Intervenções multicomportamentais Comportamentos de saúde Ttécnicas de mudança comportamental Multiple health behavior change interventions Health behavior Behavior change techniques