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Efeito de materiais digitais de educação em dor lombar nas crenças e atitudes sobre esta condição de indivíduos da comunidade: ensaio controlado aleatorizado

Detalhes bibliográficos
Ano de defesa: 2024
Autor(a) principal: Celedonio, Viviane Rocha
Orientador(a): Moraleida, Fabianna Resende de Jesus
Banca de defesa: Não Informado pela instituição
Tipo de documento: Dissertação
Tipo de acesso: Acesso embargado
Idioma: por
Instituição de defesa: Não Informado pela instituição
Programa de Pós-Graduação: Não Informado pela instituição
Departamento: Não Informado pela instituição
País: Não Informado pela instituição
Área do conhecimento CNPq:
Link de acesso: http://repositorio.ufc.br/handle/riufc/76830
Resumo: Considering the great impact of low back pain (LBP) on the individual’s functioning and society's economy, addressing beliefs and attitudes in the community is one of the proposed actions to improve coping with this health condition. In accordance with the biopsychosocial model of pain care, beliefs constitute a modifiable factor that can aid in the pain and disability management, thereby favoring behavioral aspects as the deliberate utilization of health resources and self-management. Education can lead to changes in pain beliefs, and social networks can help disseminate reliable content, confronting misinformation about the topic. To the authors' knowledge, there is a gap in understanding the effect of digital LBP education material on changes in related beliefs and attitudes. This dissertation had the main objective to verify the effect of exposure to a set of evidence-based digital LBP education material on beliefs and attitudes about LBP in the community. All stages of this survey were conducted on electronic environment (REDCap®), with a convenience sample of 448 Brazilians, over 18, with or without LBP. The primary outcome was beliefs and attitudes about LBP (Back Pain Attitudes Questionnaire), and the secondary outcomes were self-efficacy to cope with pain (Pain Self-efficacy Questionnaire), and electronic health literacy (eHealth Literacy Scale). The research resulted in three products. Product 1 made it possible to registrate the randomized controlled trial protocol, describing methodology, statistical planning, and the project development on REDCap®. Product 2 described, on a cross-sectional design, the mean beliefs and attitudes about LBP among Brazilians (-10.8; ±13.9), and compared the means of those with and without LBP. The significant difference, favored the group without LBP. In a multiple regression model, having family income greater than two minimum wages (β standardized=0.42; 0.32; 0.40 related to different categories), being female (β standardized=0.26) and having higher eHealth literacy (β standiardized=0.23) were directly associated with beliefs and attitudes about LBP, while age was inversely associated (β standardized=-0.15). Product 3 demonstrated the trial findings. The digital LBP education material promoted favorable changes in beliefs and attitudes, immediately post-intervention, when compared with a digital education material on general health habits (MD=-7.94; Standard Error=1.84; p<0.001). However, this effect was not sustained after eight weeks (MD=-4.52; Standard Error=1.73; p=0.097). There was no effect of the material to change self-efficacy. Furthermore, the eHealth literacy and self-efficacy were not associated with the changes in beliefs immediately after the intervention. The results of this dissertation are innovative, as there were no data of beliefs and attitudes about LBP from the general Brazilian community, and as this was the first experimental study worldwide to verify the effect of a digital LBP education material for social media in beliefs and attitudes about LBP, encompassing individuals with and without LBP. The findings are limited to immediate effects, but it is possible to consider the implementation of integrated strategies involving the community, researchers, healthcare professionals and policymakers to explore the permanence of the effect and possible behavioral changes that reduce the burden of LBP on society.
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spelling Celedonio, Viviane RochaNunes, Ana Carla LimaMoraleida, Fabianna Resende de Jesus2024-04-24T17:12:57Z2024-04-24T17:12:57Z2024CELEDONIO, Viviane Rocha. Efeito de materiais digitais de educação em dor lombar nas crenças e atitudes sobre esta condição de indivíduos da comunidade: ensaio controlado aleatorizado. 2024. 215 f. Dissertação (Mestrado em Fisioterapia e Funcionalidade) – Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, 2024. Disponível em: http://www.repositorio.ufc.br/handle/riufc/ 76830. Acesso em: 24 abr. 2024.http://repositorio.ufc.br/handle/riufc/76830Considering the great impact of low back pain (LBP) on the individual’s functioning and society's economy, addressing beliefs and attitudes in the community is one of the proposed actions to improve coping with this health condition. In accordance with the biopsychosocial model of pain care, beliefs constitute a modifiable factor that can aid in the pain and disability management, thereby favoring behavioral aspects as the deliberate utilization of health resources and self-management. Education can lead to changes in pain beliefs, and social networks can help disseminate reliable content, confronting misinformation about the topic. To the authors' knowledge, there is a gap in understanding the effect of digital LBP education material on changes in related beliefs and attitudes. This dissertation had the main objective to verify the effect of exposure to a set of evidence-based digital LBP education material on beliefs and attitudes about LBP in the community. All stages of this survey were conducted on electronic environment (REDCap®), with a convenience sample of 448 Brazilians, over 18, with or without LBP. The primary outcome was beliefs and attitudes about LBP (Back Pain Attitudes Questionnaire), and the secondary outcomes were self-efficacy to cope with pain (Pain Self-efficacy Questionnaire), and electronic health literacy (eHealth Literacy Scale). The research resulted in three products. Product 1 made it possible to registrate the randomized controlled trial protocol, describing methodology, statistical planning, and the project development on REDCap®. Product 2 described, on a cross-sectional design, the mean beliefs and attitudes about LBP among Brazilians (-10.8; ±13.9), and compared the means of those with and without LBP. The significant difference, favored the group without LBP. In a multiple regression model, having family income greater than two minimum wages (β standardized=0.42; 0.32; 0.40 related to different categories), being female (β standardized=0.26) and having higher eHealth literacy (β standiardized=0.23) were directly associated with beliefs and attitudes about LBP, while age was inversely associated (β standardized=-0.15). Product 3 demonstrated the trial findings. The digital LBP education material promoted favorable changes in beliefs and attitudes, immediately post-intervention, when compared with a digital education material on general health habits (MD=-7.94; Standard Error=1.84; p<0.001). However, this effect was not sustained after eight weeks (MD=-4.52; Standard Error=1.73; p=0.097). There was no effect of the material to change self-efficacy. Furthermore, the eHealth literacy and self-efficacy were not associated with the changes in beliefs immediately after the intervention. The results of this dissertation are innovative, as there were no data of beliefs and attitudes about LBP from the general Brazilian community, and as this was the first experimental study worldwide to verify the effect of a digital LBP education material for social media in beliefs and attitudes about LBP, encompassing individuals with and without LBP. The findings are limited to immediate effects, but it is possible to consider the implementation of integrated strategies involving the community, researchers, healthcare professionals and policymakers to explore the permanence of the effect and possible behavioral changes that reduce the burden of LBP on society.Considerando o grande impacto da dor lombar (DL) na funcionalidade dos indivíduos e economia da sociedade, abordar crenças e atitudes na comunidade é uma das ações propostas para melhorar o enfrentamento desta condição de saúde. Frente ao modelo biopsicossocial do cuidado em dor, as crenças constituem um aspecto modificável, podendo contribuir para o controle da dor e incapacidade, favorecendo aspectos comportamentais como utilização consciente dos recursos de saúde e autogerenciamento. As mudanças de crenças em dor são resultado de processos educativos, e as redes sociais podem disseminar conteúdo confiável, confrontando a desinformação sobre o tema. De conhecimento dos autores, existe uma lacuna no entendimento do efeito de materiais de educação em DL nas mudanças de crenças e atitudes relacionadas. Esta dissertação teve como objetivo geral verificar o efeito da exposição a um conjunto de materiais digitais de educação em DL, baseado em evidências, nas crenças e atitudes sobre DL na comunidade. Todas as etapas desta survey ocorreram em ambiente eletrônico (REDCap®), com amostra de conveniência de 448 brasileiros, maiores de 18 anos, com ou sem DL. O desfecho principal foram as crenças e atitudes sobre DL (Back Pain Attitudes Questionnaire), e os secundários foram a autoeficácia para lidar com a dor (Pain Self- efficacy Questionnaire), e o letramento em saúde eletrônico (eHealth Literacy Scale). O resultado dessa pesquisa originou três produtos. O produto 1 trouxe o registro do protocolo do ensaio controlado randomizado, descrevendo metodologia, planejamento estatístico, e o desenvolvimento do projeto no REDCap®. O produto 2 descreveu, em um desenho observacional, a média de crenças e atitudes sobre DL entre brasileiros (-10,8; ±13,9), e comparou as médias daqueles com e sem DL. A diferença foi significativa, favorecendo o grupo sem DL. Em um modelo de regressão múltipla, ter renda familiar maior que dois salários mínimos (β padronizado=0,42; 0,32; 0,40 em relação a diferentes categorias), ser do sexo feminino (β padronizado=0,26) e ter maior letramento em saúde eletrônico (β padronizado=0,23) foram diretamente associados com crenças e atitudes sobre DL, enquanto idade demonstrou associação inversa (β padronizado=-0,15). O produto 3 demonstrou resultados do ensaio. O material de educação em DL da intervenção provocou mudanças em crenças e atitudes, logo após a exposição, quando comparado a um material educativo sobre hábitos de saúde geral (Diferença Média=-7,94; Erro Padrão=1,84; p<0,001). Contudo, este efeito não se manteve após oito semanas (Diferença Média=-4,52; Erro Padrão=1,73; p=0,097). O material não foi efetivo nas mudanças de autoeficácia. Além disso, autoeficácia e letramento em saúde eletrônico não mostraram associação com as mudanças de crenças e atitudes logo após a intervenção. Os resultados desta dissertação são inovadores, pois não existiam dados sobre as medidas de crenças na comunidade brasileira, nem estudos com essa caracterização ao nível mundial. Os achados são limitados a efeitos imediatos, mas é possível pensar na implementação de ações integradas entre comunidade, profissionais de saúde, pesquisadores e responsáveis por políticas públicas, para utilização de diferentes estratégias explorando a permanência do efeito e possíveis mudanças comportamentais que diminuam o impacto da DL na sociedade.Efeito de materiais digitais de educação em dor lombar nas crenças e atitudes sobre esta condição de indivíduos da comunidade: ensaio controlado aleatorizadoEffect of digital low back pain education materials on beliefs and attitudes about this condition among individuals in the community: a randomized controlled trialinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesisDor LombarCrençasModelos BiopsicossociaisEnsaio Controlado AleatórioAutoeficáciaLow Back PainBeliefsBiopsychosocial ModelsRamdomized Controlled TrialSelf EfficacyCNPQ::CIENCIAS DA SAUDE::FISIOTERAPIA E TERAPIA OCUPACIONALinfo:eu-repo/semantics/embargoedAccessporreponame:Repositório Institucional da Universidade Federal do Ceará (UFC)instname:Universidade Federal do Ceará (UFC)instacron:UFChttps://orcid.org/0000-0001-8176-5133http://lattes.cnpq.br/8135528553408841https://orcid.org/0000-0002-3797-949Xhttp://lattes.cnpq.br/0487299538828490https://orcid.org/0000-0002-7380-6537http://lattes.cnpq.br/40230014797250282026-03-27ORIGINAL2024_dis_vrceledonio.pdf2024_dis_vrceledonio.pdfProdutos em fase de submissão a revistas científicas com restrições contratuais de ineditismo do conteúdo a ser publicadoapplication/pdf5568727http://repositorio.ufc.br/bitstream/riufc/76830/1/2024_dis_vrceledonio.pdf2794e1f19a01bddac8808d847bb515bfMD51LICENSElicense.txtlicense.txttext/plain; charset=utf-81748http://repositorio.ufc.br/bitstream/riufc/76830/3/license.txt8a4605be74aa9ea9d79846c1fba20a33MD53riufc/768302024-04-24 14:16:05.935oai:repositorio.ufc.br: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Repositório InstitucionalPUBhttp://www.repositorio.ufc.br/ri-oai/requestbu@ufc.br || repositorio@ufc.bropendoar:2024-04-24T17:16:05Repositório Institucional da Universidade Federal do Ceará (UFC) - Universidade Federal do Ceará (UFC)false
dc.title.pt_BR.fl_str_mv Efeito de materiais digitais de educação em dor lombar nas crenças e atitudes sobre esta condição de indivíduos da comunidade: ensaio controlado aleatorizado
dc.title.en.pt_BR.fl_str_mv Effect of digital low back pain education materials on beliefs and attitudes about this condition among individuals in the community: a randomized controlled trial
title Efeito de materiais digitais de educação em dor lombar nas crenças e atitudes sobre esta condição de indivíduos da comunidade: ensaio controlado aleatorizado
spellingShingle Efeito de materiais digitais de educação em dor lombar nas crenças e atitudes sobre esta condição de indivíduos da comunidade: ensaio controlado aleatorizado
Celedonio, Viviane Rocha
CNPQ::CIENCIAS DA SAUDE::FISIOTERAPIA E TERAPIA OCUPACIONAL
Dor Lombar
Crenças
Modelos Biopsicossociais
Ensaio Controlado Aleatório
Autoeficácia
Low Back Pain
Beliefs
Biopsychosocial Models
Ramdomized Controlled Trial
Self Efficacy
title_short Efeito de materiais digitais de educação em dor lombar nas crenças e atitudes sobre esta condição de indivíduos da comunidade: ensaio controlado aleatorizado
title_full Efeito de materiais digitais de educação em dor lombar nas crenças e atitudes sobre esta condição de indivíduos da comunidade: ensaio controlado aleatorizado
title_fullStr Efeito de materiais digitais de educação em dor lombar nas crenças e atitudes sobre esta condição de indivíduos da comunidade: ensaio controlado aleatorizado
title_full_unstemmed Efeito de materiais digitais de educação em dor lombar nas crenças e atitudes sobre esta condição de indivíduos da comunidade: ensaio controlado aleatorizado
title_sort Efeito de materiais digitais de educação em dor lombar nas crenças e atitudes sobre esta condição de indivíduos da comunidade: ensaio controlado aleatorizado
author Celedonio, Viviane Rocha
author_facet Celedonio, Viviane Rocha
author_role author
dc.contributor.co-advisor.none.fl_str_mv Nunes, Ana Carla Lima
dc.contributor.author.fl_str_mv Celedonio, Viviane Rocha
dc.contributor.advisor1.fl_str_mv Moraleida, Fabianna Resende de Jesus
contributor_str_mv Moraleida, Fabianna Resende de Jesus
dc.subject.cnpq.fl_str_mv CNPQ::CIENCIAS DA SAUDE::FISIOTERAPIA E TERAPIA OCUPACIONAL
topic CNPQ::CIENCIAS DA SAUDE::FISIOTERAPIA E TERAPIA OCUPACIONAL
Dor Lombar
Crenças
Modelos Biopsicossociais
Ensaio Controlado Aleatório
Autoeficácia
Low Back Pain
Beliefs
Biopsychosocial Models
Ramdomized Controlled Trial
Self Efficacy
dc.subject.ptbr.pt_BR.fl_str_mv Dor Lombar
Crenças
Modelos Biopsicossociais
Ensaio Controlado Aleatório
Autoeficácia
dc.subject.en.pt_BR.fl_str_mv Low Back Pain
Beliefs
Biopsychosocial Models
Ramdomized Controlled Trial
Self Efficacy
description Considering the great impact of low back pain (LBP) on the individual’s functioning and society's economy, addressing beliefs and attitudes in the community is one of the proposed actions to improve coping with this health condition. In accordance with the biopsychosocial model of pain care, beliefs constitute a modifiable factor that can aid in the pain and disability management, thereby favoring behavioral aspects as the deliberate utilization of health resources and self-management. Education can lead to changes in pain beliefs, and social networks can help disseminate reliable content, confronting misinformation about the topic. To the authors' knowledge, there is a gap in understanding the effect of digital LBP education material on changes in related beliefs and attitudes. This dissertation had the main objective to verify the effect of exposure to a set of evidence-based digital LBP education material on beliefs and attitudes about LBP in the community. All stages of this survey were conducted on electronic environment (REDCap®), with a convenience sample of 448 Brazilians, over 18, with or without LBP. The primary outcome was beliefs and attitudes about LBP (Back Pain Attitudes Questionnaire), and the secondary outcomes were self-efficacy to cope with pain (Pain Self-efficacy Questionnaire), and electronic health literacy (eHealth Literacy Scale). The research resulted in three products. Product 1 made it possible to registrate the randomized controlled trial protocol, describing methodology, statistical planning, and the project development on REDCap®. Product 2 described, on a cross-sectional design, the mean beliefs and attitudes about LBP among Brazilians (-10.8; ±13.9), and compared the means of those with and without LBP. The significant difference, favored the group without LBP. In a multiple regression model, having family income greater than two minimum wages (β standardized=0.42; 0.32; 0.40 related to different categories), being female (β standardized=0.26) and having higher eHealth literacy (β standiardized=0.23) were directly associated with beliefs and attitudes about LBP, while age was inversely associated (β standardized=-0.15). Product 3 demonstrated the trial findings. The digital LBP education material promoted favorable changes in beliefs and attitudes, immediately post-intervention, when compared with a digital education material on general health habits (MD=-7.94; Standard Error=1.84; p<0.001). However, this effect was not sustained after eight weeks (MD=-4.52; Standard Error=1.73; p=0.097). There was no effect of the material to change self-efficacy. Furthermore, the eHealth literacy and self-efficacy were not associated with the changes in beliefs immediately after the intervention. The results of this dissertation are innovative, as there were no data of beliefs and attitudes about LBP from the general Brazilian community, and as this was the first experimental study worldwide to verify the effect of a digital LBP education material for social media in beliefs and attitudes about LBP, encompassing individuals with and without LBP. The findings are limited to immediate effects, but it is possible to consider the implementation of integrated strategies involving the community, researchers, healthcare professionals and policymakers to explore the permanence of the effect and possible behavioral changes that reduce the burden of LBP on society.
publishDate 2024
dc.date.accessioned.fl_str_mv 2024-04-24T17:12:57Z
dc.date.available.fl_str_mv 2024-04-24T17:12:57Z
dc.date.issued.fl_str_mv 2024
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/masterThesis
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dc.identifier.citation.fl_str_mv CELEDONIO, Viviane Rocha. Efeito de materiais digitais de educação em dor lombar nas crenças e atitudes sobre esta condição de indivíduos da comunidade: ensaio controlado aleatorizado. 2024. 215 f. Dissertação (Mestrado em Fisioterapia e Funcionalidade) – Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, 2024. Disponível em: http://www.repositorio.ufc.br/handle/riufc/ 76830. Acesso em: 24 abr. 2024.
dc.identifier.uri.fl_str_mv http://repositorio.ufc.br/handle/riufc/76830
identifier_str_mv CELEDONIO, Viviane Rocha. Efeito de materiais digitais de educação em dor lombar nas crenças e atitudes sobre esta condição de indivíduos da comunidade: ensaio controlado aleatorizado. 2024. 215 f. Dissertação (Mestrado em Fisioterapia e Funcionalidade) – Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, 2024. Disponível em: http://www.repositorio.ufc.br/handle/riufc/ 76830. Acesso em: 24 abr. 2024.
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reponame_str Repositório Institucional da Universidade Federal do Ceará (UFC)
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