Isa Raquel Brito Santos Pereira Felix
Verified @egasmoniz.edu.pt
Egas Moniz School of Health & Sciences
Egas Moniz School of Health & Sciences
Scopus Publications
Scopus Publications
Mara Pereira Guerreiro, João Balsa, Maria Beatriz Carmo, Ana Paula Cláudio, and Isa Brito Félix
Ovid Technologies (Wolters Kluwer Health)
KEY POINTS Applications with virtual humans coupled to information systems for health professionals are a promising avenue to engage people living with chronic diseases and streamline self-management support. Primary healthcare professionals had a positive perspective on the usability of the VASelfCare (virtual assistant to facilitate self-care) mobile application for older people with type 2 diabetes (T2D) and the VASelfCare-connected Web-based dashboard. Overall, findings endorse the further development of the mobile application and connectedWeb-based dashboard to foster the Portuguese integrated care pathway in T2D. D iabetes is a global epidemic; it currently affects approximately 537 million adults worldwide and is expected to rise to 783 million by 2045. Most adults affected by this condition live with type 2 diabetes (T2D), which is highly prevalent in older adults. Diabetes is associated with overwhelming costs for health systems, mainly from treating complications (eg, renal failure and retinopathy). The risk of complications can be reduced by effectively managing glycemia through self-management behaviors, such as medication adherence and physical activity. Digital health interventions, defined as a health service delivered using technology such as mobile applications, can provide self-management support as a complement to nursing consultations; their merits include overcoming the need of frequent face-to-face sessions, convenient access for users, and tailored and attractive content plus the possibility of integrating effective behavior change techniques. Several systematic reviews examined the impact of digital health interventions to support diabetes self-management. A meta-analysis of 13 randomized controlled trials on mobile applications for type 1 diabetes and T2D indicated overall efficacy in reducing glycated hemoglobin (HbA1c), with a mean of 0.44% decrease (95% CI, 0.29%–0.59%). Similarly, a meta-analysis focusing exclusively on persons with T2D (six randomized controlled trials, a total of 1022 participants) found a significant reduction in HbA1c of 0.40% (95% CI, 0.11%–0.69%). One promising area in mobile health is anthropomorphic conversational agents (ACAs). A systematic review on the
Mara Pereira Guerreiro, Isa Brito Félix, and José Camolas
Frontiers Media SA
Afke Kerkstra, Cristina Lavareda Baixinho, Isa Brito Félix, Judith Strawbridge, and Mara Pereira Guerreiro
Springer International Publishing
AbstractThis chapter sets the stage for the remaining book, by introducing the Train4Health project and by explaining how the learning outcomes presented in subsequent chapters have been derived and linked with content of the book. Firstly, the Train4Health interprofessional competency framework to support behaviour change in persons self-managing chronic disease is briefly presented. This European competency framework was the starting point for developing the learning outcomes-based curriculum, which is succinctly addressed in the subsequent section. Finally, practical considerations about the Train4Health curriculum are discussed, including opportunities and challenges for interprofessional education.
Isa Brito Félix and Mara Pereira Guerreiro
Springer International Publishing
AbstractThis chapter outlines a stepwise approach to implementing behaviour change strategies in chronic disease. In the first part of this chapter, examples of determinants of target behaviours discussed in Chapter 3 are listed, based on case studies developed in the Train4Health project and in the literature. This includes barriers or opportunities (facilitators) for diet, physical activity, smoking cessation and medication adherence. Next, a brief description of approaches to assess key determinants is presented. The second part of this chapter begins with an overview of the classification of behaviour change techniques. Then, we offer guidance for the development of an intervention plan, covering how behaviour change techniques can be implemented in practice, considering potential barriers to the target behaviour, the length of the intervention and the modes through which they can be delivered.
Afonso Miguel Cavaco, Carlos Filipe Quitério, Isa Brito Félix, and Mara Pereira Guerreiro
Springer International Publishing
AbstractThis chapter presents critical components of the interaction between the professional and the person, needed to effectively support behaviour change. Most of these components are relational competencies assisted by communication skills. Relational competencies include person-centredness and shared decision-making, contributing to the person’s empowerment, a concept strongly linked with health literacy. Communication skills comprise the basic interchange and optimised linguistic features. Further, coping strategies to deal with negative emotions and psychosocial implications of chronic disease are summarised.This chapter also proposes an integrated approach (ABCD) for first and follow-up encounters in behaviour change interventions. The ABCD approach comprises four stages: setting the stage (A), establishing an information base (B), obtaining a commitment (C) and negotiating an intervention plan (D).
Nuno Pimenta, Isa Brito Félix, Diogo Monteiro, Marta Moreira Marques, and Mara Pereira Guerreiro
Frontiers Media SA
IntroductionAnthropomorphic conversational agents (ACA) are a promising digital tool to support self-management of type 2 diabetes (T2D), albeit little explored. There is a dearth of literature on the detailed content of these interventions, which may limit effectiveness and replication. Our aim is to describe the development of an evidence and theory-based intervention to improve physical activity in older adults with T2D, subsumed in a multi-behavior intervention via a mobile application with an ACA.MethodsOverall decisions on the multi-behavior intervention design, such as the use of standardized behavior change techniques (BCTTv1), guided the development of the physical activity component. Firstly, recommendations on ambulatory activity were used to select the target behavior (walking). Meta-research on effective behavior change techniques (BCTs) was then identified. One meta-analysis linked effective BCTs with the three basic psychological needs of the self-determination theory (SDT). This meta-analysis, taken together with additional evidence on SDT, led to the selection of this theory to inform the design. BCTs were extracted from meta-research; we selected the most appropriate to be operationalized via the conversational agent through multidisciplinary discussions. Rules governing the dialogue flow and BCTs tailoring, taking the form “if some conditions hold then execute some action,” were derived based on the Basic Psychological in Exercise Scale (competence, autonomy, and relatedness scores), in conjunction with published evidence and multidisciplinary discussions.ResultsThirteen BCTs were implemented in the prototype via the ACA (e.g., goal setting behavior 1.1). Six if-then rules were derived and depicted in the dialogue steps through process flow diagrams, which map how the system functions. An example of a rule is “If competence score ≤ 10 then, apply BCT 1.1 with 500 steps increments as options for the daily walking goal; If competence score > 10 then, apply BCT 1.1 with 1,000 steps increments as options for the daily walking goal.”ConclusionEvidence and SDT were translated into a mobile application prototype using an ACA to promote physical activity in older adults with T2D. This approach, which includes 13 BCTs and six if-then rules for their tailoring, may leverage the efforts of others in developing similar interventions.
Maria Bastos, Ana Cláudio, Isa Félix, Mara Guerreiro, Maria Carmo, and João Balsa
SCITEPRESS - Science and Technology Publications
Departing from previous work on the use of well-established behavior change techniques in an mHealth intervention based on a conversational agent (CA), we propose in this contribution a new architecture for the design of behavior change CAs. This novel approach combines the use of an advanced natural language platform (Dialogflow) with the explicit representation, in an ontology, of how behavior change techniques can be operationalized. The integration of these two components is explained, as well as the most challenging aspect of using the advanced features of the platform in a way that allowed the agent to lead the dialogue flow, when needed. A successful proof of concept was built, which can be the basis for the development of advanced conversational agents, combining natural language tools with ontology-based knowledge representation.
Mara Pereira Guerreiro, Isa Brito Félix, João Balsa, Maria Beatriz Carmo, Maria Adriana Henriques, Afonso Cavaco, and Ana Paula Cláudio
IGI Global
This chapter describes the development of a theory-driven and evidence-based digital intervention to facilitate self-care in older adults with Type 2 Diabetes (T2D) and, additionally, its contribution to healthy aging and the individual care plan. T2D is highly prevalent in older adults. Difficulties in adopting and maintaining desirable self-care behaviors is associated with lack of glycemic control and subsequent complications, which significantly burden patients, their families, and the health system. The VASelfCare (Virtual Assistant Self-Care) intervention is a software application that provides an interface with a 3D anthropomorphic virtual assistant targeting three key self-care behaviors: medication-taking, physical activity, and a healthy diet. Other VASelfCare elements are intended for nurses providing diabetes consultations, including a web-based back-office with a patient data dashboard, which streamlines integration of care. The application prototype has been co-produced with older adults with T2D, primary care health professionals, and other stakeholders.
Lucija Gosak, Gregor Štiglic, Leona Cilar Budler, Isa Brito Félix, Katja Braam, Nino Fijačko, Mara Pereira Guerreiro, and Mateja Lorber
MDPI AG
Due to the increased prevalence of chronic diseases, behavior changes are integral to self-management. Healthcare and other professionals are expected to support these behavior changes, and therefore, undergraduate students should receive up-to-date and evidence-based training in this respect. Our work aims to review the outcomes of digital tools in behavior change support education. A secondary aim was to examine existing instruments to assess the effectiveness of these tools. A PIO (population/problem, intervention, outcome) research question led our literature search. The population was limited to students in nursing, sports sciences, and pharmacy; the interventions were limited to digital teaching tools; and the outcomes consisted of knowledge, motivation, and competencies. A systematic literature review was performed in the PubMed, CINAHL, MEDLINE, Web of Science, SAGE, Scopus, and Cochrane Library databases and by backward citation searching. We used PRISMA guidelines 2020 to depict the search process for relevant literature. Two authors evaluated included studies using the Mixed Methods Appraisal Tool (MMAT) independently. Using inclusion and exclusion criteria, we included 15 studies in the final analysis: six quantitative descriptive studies, two randomized studies, six mixed methods studies, and one qualitative study. According to the MMAT, all studies were suitable for further analysis in terms of quality. The studies resorted to various digital tools to improve students’ knowledge of behavior change techniques in individuals with chronic disease, leading to greater self-confidence, better cooperation, and practical experience and skills. The most common limitations that have been perceived for using these tools are time and space constraints.
David de Sousa Loura, Rafael Alves Bernardes, Cristina Lavareda Baixinho, Helga Rafael Henriques, Isa Brito Félix, and Mara Pereira Guerreiro
FapUNIFESP (SciELO)
ABSTRACT Objective: To identify the learning outcomes and skills obtained of undergraduate nursing students involved in research projects. Methods: This was an integrative literature review, based on a research protocol in the CINAHL Complete databases; Cochrane Central Register of Controlled Trials; Cochrane Database of Systematic Reviews; Cochrane Methodology Register; MedicLatina; MEDLINE, Scopus and JBI, including primary and secondary studies, published between 2015 and 2020. Results: A total of five heterogeneous articles were included, which were categorized using Kirkpatrick's (adapted) model. Seventeen learning outcomes acquired through participation in research projects were identified, from the learning of new knowledge and skills to the development of new attitudes and behaviors. Final considerations: The involvement of nursing students in research projects is important to their professional development. Future investment in research on this topic can help cement the potential of this type of student involvement.
Mara Pereira Guerreiro, Judith Strawbridge, Afonso Miguel Cavaco, Isa Brito Félix, Marta Moreira Marques, and Cathal Cadogan
Springer Science and Business Media LLC
Abstract Background Healthcare and other professionals are expected to support behaviour change in people living with chronic disease. However, effective behaviour change interventions are largely absent in routine encounters. The Train4Health project, a European strategic partnership for higher education, sought to address this problem. The primary aim of this study, which is part of an early work package, was to develop an interprofessional competency framework for health and other professions to support behaviour change for the self-management of chronic disease at a European level. A secondary aim was to derive a set of behaviour change techniques (BCTs) from an established taxonomy to link with framework competencies. Methods The study comprised two interlinked parts. Part 1 involved a two-round e-Delphi study with an interprofessional panel of 48 experts across 12 European countries to develop the behaviour change competency framework. Preparatory work included drafting a list of competency statements based on seven existing frameworks. Part 2 involved an expert panel of six behavioural psychologists deriving a set of BCTs to link with framework competencies. Their feedback was based on preparatory work, which focused on seven high priority chronic diseases for self-management, identified through European projects on self-management and identifying five relevant target behaviours from key clinical guidelines. A literature search yielded 29 effective BCTs for the target behaviours in the selected chronic diseases. Results Twenty-seven competency statements, were presented in Round 1 to the Delphi panel. Consensus was achieved for all statements. Based on comments, two statements were removed, one was added, and 14 were modified. All 15 statements subjected to Round 2 were consensus-approved, yielding a total of 12 foundational competencies for behaviour change in self-management of chronic disease and 14 behaviour change competencies. Four behaviour change competencies related to BCTs. Behavioural psychologists’ feedback led to a core set of 21 BCTs deemed applicable to the five target behaviours across the seven chronic diseases. Conclusions A behaviour change competency framework comprising 26 statements for European health and other professionals to support self-management of chronic disease was developed, linked with a core set of 21 BCTs from an established taxonomy.
Isa Brito Félix and Adriana Henriques
Hindawi Limited
AIM
Identify the medication adherence determinants in older adults with multimorbidity and polypharmacy.
MATERIALS AND METHODS
A cross-sectional study was conducted in a non-probabilistic sample of 245 adults ≥65 years recruited in a general medical ward of one teaching hospital. Data were collected during hospital stay using a face-to-face interview based on a set of validated questionnaires, such as the measure treatment adherence, the beliefs about medicines questionnaire-specific and the geriatric depression scale. Descriptive and multiple linear regression analysis were performed.
RESULTS
Participants' mean age was 78.32 (SD: 6.95) years and 50.6% were women. Older adults lived with an average of 7.51 (SD: 1.95) chronic conditions and had a mean of 7.95 (min. 4; max. 18) medications prescribed. The proportion of older adults adherent to medication was 43.7%. Depression ( β = -0.142; p = 0.031), beliefs about treatment necessity ( β = 0.306; p = 0.001) and concerns about the medication ( β = -0.204; p = 0.001) were found as independent determinants of adherence.
CONCLUSION
Self-reported medication non-adherence appears to be common in older adults with multimorbidity and polypharmacy. Depression, necessity and concerns should be considered when assessing medication non-adherence in practice. This study will also contribute to develop an intervention to manage adherence in older people, as part of a doctoral research project.
Mara Pereira Guerreiro, Leonardo Angelini, Helga Rafael Henriques, Mira El Kamali, Cristina Baixinho, João Balsa, Isa Brito Félix, Omar Abou Khaled, Maria Beatriz Carmo, Ana Paula Cláudio,et al.
JMIR Publications Inc.
Background Conversational agents, which we defined as computer programs that are designed to simulate two-way human conversation by using language and are potentially supplemented with nonlanguage modalities, offer promising avenues for health interventions for different populations across the life course. There is a lack of open-access and user-friendly resources for identifying research trends and gaps and pinpointing expertise across international centers. Objective Our aim is to provide an overview of all relevant evidence on conversational agents for health and well-being across the life course. Specifically, our objectives are to identify, categorize, and synthesize—through visual formats and a searchable database—primary studies and reviews in this research field. Methods An evidence map was selected as the type of literature review to be conducted, as it optimally corresponded to our aim. We systematically searched 8 databases (MEDLINE; CINAHL; Web of Science; Scopus; the Cochrane, ACM, IEEE, and Joanna Briggs Institute databases; and Google Scholar). We will perform backward citation searching on all included studies. The first stage of a double-stage screening procedure, which was based on abstracts and titles only, was conducted by using predetermined eligibility criteria for primary studies and reviews. An operational screening procedure was developed for streamlined and consistent screening across the team. Double data extraction will be performed with previously piloted data collection forms. We will appraise systematic reviews by using A Measurement Tool to Assess Systematic Reviews (AMSTAR) 2. Primary studies and reviews will be assessed separately in the analysis. Data will be synthesized through descriptive statistics, bivariate statistics, and subgroup analysis (if appropriate) and through high-level maps such as scatter and bubble charts. The development of the searchable database will be informed by the research questions and data extraction forms. Results As of April 2021, the literature search in the eight databases was concluded, yielding a total of 16,351 records. The first stage of screening, which was based on abstracts and titles only, resulted in the selection of 1282 records of primary studies and 151 records of reviews. These will be subjected to second-stage screening. A glossary with operational definitions for supporting the study selection and data extraction stages was drafted. The anticipated completion date is October 2021. Conclusions Our wider definition of a conversational agent and the broad scope of our evidence map will explicate trends and gaps in this field of research. Additionally, our evidence map and searchable database of studies will help researchers to avoid fragmented research efforts and wasteful redundancies. Finally, as part of the Harnessing the Power of Conversational e-Coaches for Health and Well-being Through Swiss-Portuguese Collaboration project, our work will also inform the development of an international taxonomy on conversational agents for health and well-being, thereby contributing to terminology standardization and categorization. International Registered Report Identifier (IRRID) DERR1-10.2196/26680
David Loura, Ana Eva Arriscado, Afke Kerkstra, Carla Nascimento, Isa Félix, Mara Pereira Guerreiro, and Cristina Baixinho
Ludomedia
Abstract: The paradigm of collaborative health care delivery drove the development of interprofessional competency frameworks (ICFs). The Train4Health project, funded by the Erasmus+ program, aims to improve healthcare students’ competencies in behaviour change support to optimize self-care in chronic diseases. As part of this project, we surveyed the landscape of ICFs in health. Our aim was to characterize ICFs in health and its translation into learning outcomes embedded in academic curricula. An integrative review was conducted between March and September 2020 based on a predefined protocol. The search was performed in EBSCO, B-On, Scopus, Web of Science and Joanna Briggs Institute databases. Four articles were eligible, describing ICFs in different domains in health, such as digital healthcare environment, simulation and genetic healthcare. Generally, ICFs were planned and developed by a committee. Students were involved in all four ICFs. These frameworks supported the development of learning outcomes-based curricula, organized in a tiered or straightforward structure, with different learning outcomes depending on their complexity and specialization level. Despite the overlap in some areas across health professions, we found only four ICFs that can guide collaborative education and are linked to learning outcomes. Pursuing this integrated approach, ideally resorting to structured scientific methods, may facilitate competencies attainment and merits further attention.
David Loura, Rafael Bernardes, Cristina Lavareda Baixinho, Helga Rafael, Isa Félix, and Mara Guerreiro
Ludomedia
Resumo. Introdução: O desenvolvimento da investigação e a emergência de uma prática baseada na evidência são um desafio claro para a educação dos futuros profissionais de saúde, aos quais são requeridas competências de pesquisa, leitura e utilização correta dos resultados da investigação na prática clínica. Objetivos: Identificar o que aprendem os estudantes de enfermagem com o envolvimento em projetos de investigação, durante a licenciatura. Métodos: A revisão integrativa de literatura foi efetuada segundo um protocolo, com definição dos critérios de elegibilidade dos estudos primários, obtidos nas bases de dados dos motores de busca EBSCO, Abstract. Introduction: The development of research and the evidence-based practice paradigm pose a challenge for the education of future health professionals, who are required to have search skills, and be able to appraise and correctly use research results in clinical practice. Objectives: To identify what nursing students learn from being involved in research projects during their undergraduate degree. Methods: This integrative literature review was carried out according to a protocol, defining the eligibility criteria for primary studies, obtained from EBSCO, JBI and Scopus search engines. Results: Students can be involved in all phases of the research process, contributing to their satisfaction with learning, with positive impact on motivation, reflection and integration of knowledge, development of communication skills, scientific writing, time management and critical judgment. Involving these students also benefits the research process. Conclusions: Students’ involvement in research projects contributes to a range of learning opportunities. Our results suggest that classroom education on research should be associated with other strategies for the development of research knowledge, skills and attitudes.
João Balsa, Isa Félix, Ana Paula Cláudio, Maria Beatriz Carmo, Isabel Costa e Silva, Ana Guerreiro, Maria Guedes, Adriana Henriques, and Mara Pereira Guerreiro
Springer Science and Business Media LLC
Mara Pereira Guerreiro, Isa Brito Félix, João Balsa, Maria Beatriz Carmo, Maria Adriana Henriques, Afonso Cavaco, and Ana Paula Cláudio
IGI Global
This chapter describes the development of a theory-driven and evidence-based digital intervention to facilitate self-care in older adults with Type 2 Diabetes (T2D) and, additionally, its contribution to healthy aging and the individual care plan. T2D is highly prevalent in older adults. Difficulties in adopting and maintaining desirable self-care behaviors is associated with lack of glycemic control and subsequent complications, which significantly burden patients, their families, and the health system. The VASelfCare (Virtual Assistant Self-Care) intervention is a software application that provides an interface with a 3D anthropomorphic virtual assistant targeting three key self-care behaviors: medication-taking, physical activity, and a healthy diet. Other VASelfCare elements are intended for nurses providing diabetes consultations, including a web-based back-office with a patient data dashboard, which streamlines integration of care. The application prototype has been co-produced with older adults with T2D, primary care health professionals, and other stakeholders.
João Balsa, Pedro Neves, Isa Félix, Mara Pereira Guerreiro, Pedro Alves, Maria Beatriz Carmo, Diogo Marques, António Dias, Adriana Henriques, and Ana Paula Cláudio
Springer International Publishing
Isa Brito Félix, Mara Pereira Guerreiro, Afonso Cavaco, Ana Paula Cláudio, Anabela Mendes, João Balsa, Maria Beatriz Carmo, Nuno Pimenta, and Adriana Henriques
Frontiers Media SA
Introduction: Improving adherence to antidiabetic medication is crucial, resulting in improved health outcomes, cost reduction, and minimization of waste. A lack of underlying theory in existing interventions may explain the limited success in sustaining behavior change. This paper describes the development of a theory and evidence-based complex intervention to improve adherence to oral antidiabetics in older people via a software prototype with an anthropomorphic virtual assistant. Methods: The Behavior Change Wheel (BCW) was used to develop a theoretical understanding of the change process, corresponding to the first phase of the Medical Research Council Framework for developing and evaluating complex interventions. At the BCW core is a model of human behavior (COM-B), which posits that human behavior (B) results from the interaction between capabilities (C), opportunities (O), and motivation (M). Literature-derived medication adherence determinants were mapped onto COM-B components. Then, intervention functions (IFs) were selected employing the APEASE criteria. Finally, standardized behavior change techniques (BCTs) were chosen based on their suitability and their effectiveness on medication adherence trials. The prototype was developed for android devices; its core was implemented in Unity3D, using a female 3D virtual assistant, named Vitória. Results: Two COM-B components were identified as main targets for behavior change—psychological capability and reflective motivation; these were linked with four IFs—education, persuasion, enablement, and environmental restructuring. Eleven BCTs were, in turn, linked with the IFs. An example of a BCT is “problem solving”; it requires users to pinpoint factors influencing non-adherence and subsequently offers strategies to achieve the desired behavior. BCTs were operationalized into the dialogues with Vitória and into supplementary software features. Vitória communicates with users verbally and non-verbally, expressing emotions. Input options consist of buttons or recording values, such as medication taken. Conclusion: The present approach enabled us to derive the most appropriate BCTs for our intervention. The use of an explicit bundle of BCTs, often overlooked in interventions promoting medication adherence, is expected to maximize effectiveness and facilitates replication. The first prototype is being refined with users and health professionals’ contributions. Future work includes subjecting the prototype to usability tests and a feasibility trial.
Gergely Magyar, João Balsa, Ana Cláudio, Maria Carmo, Pedro Neves, Pedro Alves, Isa Félix, Nuno Pimenta, and Mara Guerreiro
SCITEPRESS - Science and Technology Publications
The global prevalence of diabetes is escalating. Attributable deaths and avoidable health costs related to diabetes represent a substantial burden and threaten the sustainability of contemporary healthcare systems. Information technologies are an encouraging avenue to tackle the challenge of diabetes management. Anthropomorphic virtual assistants designed as relational agents have demonstrated acceptability to older people and may promote long-term engagement. The VASelfCare project aims to develop and test a virtual assistant software prototype to facilitate the self-care of older adults with type 2 diabetes mellitus. The present position paper describes key aspects of the VASelfCare prototype and discusses the potential use of artificial intelligence. Machine learning techniques represent promising approaches to provide a more personalised user experience with the prototype, by means of behaviour adaptation of the virtual assistant to users’ preferences or emotions or to develop chatbots. The effect of these sophisticated approaches on relevant endpoints, such as users’ engagement and motivation, needs to be established in comparison to less responsive options.
Susana Buinhas, Ana Paula Cláudio, Maria Beatriz Carmo, João Balsa, Afonso Cavaco, Anabela Mendes, Isa Félix, Nuno Pimenta, and Mara Pereira Guerreiro
Springer International Publishing