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Association between self-care and hospital readmissions of patients with heart failure
Revista Brasileira de Enfermagem. 2016;69(3):500-506
Abstract
Association between self-care and hospital readmissions of patients with heart failure
Revista Brasileira de Enfermagem. 2016;69(3):500-506
DOI 10.1590/0034-7167.2016690312i
Views0See moreABSTRACT
Objective:
to assess the association between self-care and the number of hospital readmissions of patients with heart failure (ADHF) and test the applicability of two self-care assessment tools. longitudinal study, performed in a cardiology reference hospital in southern Brazil.
Method:
it included 82 patients with a mean age of 61.85±12.33 years, 57.3% male. The mean score of self-care assessment found the scales European Heart Failure Self-care Behavior Scale and Self-care Scale for Patients with Heart Failure was unsatisfactory.
Results:
it was observed an average of 2.57±1.66 rehospitalization last year for decompensated heart failure. There was a correlation between self-care scores with the number of hospital readmissions for decompensated HF. Education and age were associated to self-care of HF patients.
Conclusion:
both scales assess self-care in a relevant way, and correlated their indexes.
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Knowledge management in Portuguese healthcare institutions
Revista Brasileira de Enfermagem. 2016;69(3):492-499
Abstract
Knowledge management in Portuguese healthcare institutions
Revista Brasileira de Enfermagem. 2016;69(3):492-499
DOI 10.1590/0034-7167.2016690311i
Views0See moreABSTRACT
Objective:
to evaluate the perception of healthcare institution collaborators in relation to knowledge management in the institution where they operate and analyze the existence of differences in this perception, based on the institution’s management model.
Method:
a study conducted in a sample consisting of 671 collaborators from 10 Portuguese healthcare institutions with different models of management. In order to assess the knowledge management perception, we used a score designed from and based on items from the scores available in the literature.
Results:
the perception of moderate knowledge management on the healthcare institutions and the statistically significant differences in knowledge management perception were evidenced in each management model.
Conclusion:
management knowledge takes place in healthcare institutions, and the current management model determines the way staff at these institutions manage their knowledge.
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Frailty and quality of life in elderly primary health care users
Revista Brasileira de Enfermagem. 2016;69(3):478-483
Abstract
Frailty and quality of life in elderly primary health care users
Revista Brasileira de Enfermagem. 2016;69(3):478-483
DOI 10.1590/0034-7167.2016690309i
Views1See moreABSTRACT
Objective:
to investigate the association between physical frailty and quality of life in elderly users of primary health care in the capital of the state of Paraná.
Method:
a cross-sectional, quantitative study with 203 elders. Data collected included: physical activity questionnaires, weight loss, fatigue/exhaustion, quality of life, performance of gait speed tests, and handgrip strength.
Results:
of the 203 older adults, 115 were pre-frail, 49 were non-frail, and 39 were frail, with a significant association with functional capacity and quality of life in all groups. The dimensions resulting from physical aspects, pain, and vitality were associated with those that were non-frail.
Conclusion:
in this study, frailty syndrome was inversely proportional to the quality of life, and significantly associated with functional capacity of older adults. Physical frailty is a manageable condition which can be targeted through geriatric nursing interventions.
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Impact of home visits on the functional capacity of patients with venous ulcers
Revista Brasileira de Enfermagem. 2016;69(3):468-477
Abstract
Impact of home visits on the functional capacity of patients with venous ulcers
Revista Brasileira de Enfermagem. 2016;69(3):468-477
DOI 10.1590/0034-7167.2016690308i
Views0See moreABSTRACT
Objective:
to assess the impact of protocol home visits on the functional capacity of adult and elderly patients with venous ulcers, before and after guidance received at home.
Method:
clinical experimental, randomized, nonblinded and controlled study, developed with 32 patients (case and control groups). Fields of research were the Wound Outpatient Care Unit of the Antônio Pedro University Hospital and households of patients treated in the outpatient unit. Data collection occurred from February to June 2014, by means of an assessment tool of the health care unit, the TINETTI index and a script for directions to be provided to study participants who received home visits.
Results:
participants in the case group showed significant and differentiated improvement post-intervention when compared to the control group, which remained stable.
Conclusion:
directions provided in the home context were beneficial to the members of the case group.
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Pressure ulcers in critically ill patients: incidence and associated factors
Revista Brasileira de Enfermagem. 2016;69(3):460-467
Abstract
Pressure ulcers in critically ill patients: incidence and associated factors
Revista Brasileira de Enfermagem. 2016;69(3):460-467
DOI 10.1590/0034-7167.2016690307i
Views0See moreABSTRACT
Objective:
to identify the incidence and describe the associated factors for pressure ulcers in critically ill patients.
Method:
this was a prospective cohort study with 77 patients, using a clinical, metabolic assessment and the associated factors for pressure ulcer, applying the risk scales (Braden and Waterlow) and assigning ulcers to categories.
Results:
an incidence of 22% (95% CI 12.6 – 31.5), with 17 patients with 32 pressure ulcers in the sacral region (47%), and of Class I (72%). The length of stay was greater than ten days (71%), most admissions were surgical (53%) or for congestive heart failure (24%), and were high risk on the Braden Scale (59%).
Conclusion:
the study highlights the high incidence of pressure ulcers, clinical and metabolic characteristics and associated factors, as well as the outcome of death, requiring, therefore, preventive measures.
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Accreditation in a public hospital: perceptions of a multidisciplinary team
Revista Brasileira de Enfermagem. 2016;69(3):451-459
Abstract
Accreditation in a public hospital: perceptions of a multidisciplinary team
Revista Brasileira de Enfermagem. 2016;69(3):451-459
DOI 10.1590/0034-7167.2016690306i
Views1See moreABSTRACT
Objective:
to analyze the perceptions of the multidisciplinary team on Accreditation in a public hospital.
Method:
descriptive, exploratory, qualitative research, performed in May 2014, using recorded individual interviews. In total, 28 employees of a public hospital, Accredited with Excellence, answered the guiding question: “Tell me about the Accreditation system used in this hospital”. The interviews were transcribed and subjected to content analysis.
Results:
of the speeches, three categories emerged: Advantages offered by the Accreditation; Accredited public hospital resembling a private hospital; Pride/satisfaction for acting in an accredited public hospital.
Conclusion:
participants perceived Accreditation as a favorable system for a quality management in the public service because it promotes the development of professional skills and improves cost management, organizational structure, management of assistance and perception of job pride/satisfaction.
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Health status and the return to work after traffic accidents
Revista Brasileira de Enfermagem. 2016;69(3):443-450
Abstract
Health status and the return to work after traffic accidents
Revista Brasileira de Enfermagem. 2016;69(3):443-450
DOI 10.1590/0034-7167.2016690305i
Views0See moreABSTRACT
Objective:
to compare the health status of traffic accident victims, at hospital discharge and after six months, and to analyze the predictive variables of their health status and return to work.
Method:
observational, longitudinal study. Data were collected through interviews and medical records of 102 patients with a mean age of 33 years; with the majority being men and victims of motorcycle accidents. The variables were analyzed by means of validated tools, student’s t-test, multiple linear regression, and logistic regression.
Results:
there was an improvement of perception in the patients’ health status six months after hospital discharge and functional capacity. The individuals who returned to work showed better health-related quality of life evaluation.
Conclusion:
improvement of the perceived health status six months after hospital discharge was found. Factors that influenced the patients’ return to work were not identified.
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ORIGINAL ARTICLE07-29-2024
Primary Health Care in transitional care of people with stroke
Revista Brasileira de Enfermagem. 2024;77(3):e20230468
Abstract
ORIGINAL ARTICLEPrimary Health Care in transitional care of people with stroke
Revista Brasileira de Enfermagem. 2024;77(3):e20230468
DOI 10.1590/0034-7167-2024-0468
Views0ABSTRACT
Objectives:
to understand the role of Primary Health Care teams in caring for people with stroke after hospital discharge.
Methods:
single case study, with integrated units of analysis, with a qualitative approach. Data triangulation occurred through interviews with professionals and family caregivers involved in transition of care, in addition to direct observations in rounds and document analysis. For the analyses, the analytical strategies of theoretical propositions and construction of explanations were used, with the help of ATLAS.ti®.
Results:
the importance of counter-referral, the role of community health workers and the multidisciplinary team, health promotion, secondary prevention, home visits as a visceral attribute and nurses as care managers are evident.
Final Considerations:
the high demand on teams and the Social Determinants of Health interfere with adequate continuity of care. Transitional care programs that enable continuity of care are recommended.
Keywords:Comprehensive Health CareContinuity of Patient CarePrimary Health CareStrokeTransitional CareSee more -
ORIGINAL ARTICLE07-29-2024
Completeness of variables in Hospital-Based Cancer Registries for prostatic malignant neoplasm
Revista Brasileira de Enfermagem. 2024;77(3):e20230467
Abstract
ORIGINAL ARTICLECompleteness of variables in Hospital-Based Cancer Registries for prostatic malignant neoplasm
Revista Brasileira de Enfermagem. 2024;77(3):e20230467
DOI 10.1590/0034-7167-2023-0467
Views0See moreABSTRACT
Objectives:
to analyze the completeness of variables from Hospital-Based Cancer Registries of cases of prostate neoplasm in the Oncology Care Network of a Brazilian state between 2000 and 2020.
Methods:
an ecological time series study, based on secondary data on prostate cancer Hospital-Based Cancer Registries prostate. Data incompleteness was classified as excellent (<5%), good (between 5%-10%), fair (10%-20%), poor (20%-50%) and very poor (>50%), according to the percentage of lack of information.
Results:
there were 13,519 cases of prostate cancer in the Hospital-Based Cancer Registries analyzed. The variables “family history of cancer” (p<0.001), “alcoholism” (p<0.001), “smoking” (p<0.001), “TNM staging” (p<0.001) had a decreasing trend, while “clinical start of treatment” (p<0.001), “origin” (p=0.008) and “occupation” (p<0.001) indicated an increasing trend.
Conclusions:
most Hospital-Based Cancer Registries variables showed excellent completeness, but important variables had high percentages of incompleteness, such as TNM and clinical staging, in addition to alcoholism and smoking.
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ORIGINAL ARTICLE07-29-2024
Disrupted mother-fetus dyad risk in high-risk pregnancies: a Middle-Range Theory
Revista Brasileira de Enfermagem. 2024;77(3):e20230464
Abstract
ORIGINAL ARTICLEDisrupted mother-fetus dyad risk in high-risk pregnancies: a Middle-Range Theory
Revista Brasileira de Enfermagem. 2024;77(3):e20230464
DOI 10.1590/0034-7167-2023-0464
Views0See moreABSTRACT
Objectives:
to develop and evaluate a Middle-Range Theory for the nursing diagnosis “Disrupted Mother-Fetus Dyad Risk” in high-risk pregnancies.
Methods:
this methodological study was conducted in two stages: theory development and evaluation. Dorothea Orem’s General Nursing Model was used as the theoretical-conceptual foundation. Evaluation was conducted using the Delphi method with seven judges, and consensus was achieved when the Content Validity Index of the evaluated items was ≥ 0.80.
Results:
the theory identified 20 elements of the nursing diagnosis “Disrupted Mother-Fetus Dyad Risk” (10 risk factors, 4 at-risk populations, and 6 associated conditions), 14 propositions, and 1 pictogram. After two rounds of evaluation, the theory was considered consistent, with consensus reached for all items, each achieving a Content Validity Index ≥ 0.80.
Conclusions:
the Middle-Range Theory included biopsychosocial factors explaining the nursing phenomenon “Disrupted Mother-Fetus Dyad Risk,” which aids in nurses’ diagnostic reasoning.
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ORIGINAL ARTICLE07-29-2024
Mental health of parents of children and adolescents who require special health care
Revista Brasileira de Enfermagem. 2024;77(3):e20230457
Abstract
ORIGINAL ARTICLEMental health of parents of children and adolescents who require special health care
Revista Brasileira de Enfermagem. 2024;77(3):e20230457
DOI 10.1590/0034-7167-2023-0457
Views0See moreABSTRACT
Objective:
To identify the manifestations presented by parents of children and adolescents who require special health attention that can impact their mental health.
Methods:
exploratory, qualitative research, based on the concept of vulnerability, with data collection carried out through interviews with 18 parents of children and adolescents with special health care needs, hospitalized in the pediatric ward of a hospital in Paraná, between May/2017 and May/ 2018. Data analyzed by inductive thematic analysis.
Results:
parents experienced situations of vulnerability when providing care at home, with repercussions on their mental health, expressed by manifestations of lack of protection, anxiety and depression.
Final considerations:
It is important that health professionals seek to expand actions to promote care and reduce situations that generate threats, insecurities, concerns and damage to the health of parents, which can impact and further weaken care for children and adolescents who need attention especially health.
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REVIEW07-29-2024
Profile of scientific production on nursing technology construction, validity and application: a bibliometric study
Revista Brasileira de Enfermagem. 2024;77(3):e20230452
Abstract
REVIEWProfile of scientific production on nursing technology construction, validity and application: a bibliometric study
Revista Brasileira de Enfermagem. 2024;77(3):e20230452
DOI 10.1590/0034-7167-2023-0452
Views0See moreABSTRACT
Objective:
to analyze the profile of scientific production on nursing technology construction, validity and application.
Methods:
this is a bibliometric study, carried out in six databases, based on the Methodi Ordinatio application, arranged in nine stages. To represent the findings, the VOSviewer® software was used.
Results:
346 studies were identified, obtained from BDENF, CINAHL, EMBASE, LILACS, PubMed/MEDLINE, Scopus and Web of Science. There was a predominance of the English language, and 20% of the authors hold more than 25% of studies. Only two journals account for 25% of studies in the period studied. Twenty-six studies were selected for the InOrdinatio classification. Nursing Process (23%) stood out among the studies. The most produced technology was software (27%), and 50% of works describe construction and validity.
Conclusions:
there is an emphasis on the creation of educational technologies, especially information technology. The data demonstrates opportunities for future research in the area.
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ORIGINAL ARTICLE07-29-2024
Evaluation of software technical quality for collecting data from patients under palliative care
Revista Brasileira de Enfermagem. 2024;77(3):e20230435
Abstract
ORIGINAL ARTICLEEvaluation of software technical quality for collecting data from patients under palliative care
Revista Brasileira de Enfermagem. 2024;77(3):e20230435
DOI 10.1590/0034-7167-2023-0435
Views0See moreABSTRACT
Objectives:
to evaluate software technical quality for collecting data from patients under palliative care.
Methods:
this is methodological technology evaluation research, according to the technical standard International Organization for Standardization/International Electrotechnical Commission 25040-2011, developed from August 2021 to August 2023. Eight nurses and eight information technology professionals participated as judges, who evaluated six quality characteristics and 23 subcharacteristics. Items that reached a percentage of agreement greater than 70% were considered suitable.
Results:
the characteristics evaluated by nurses/information technology professionals received the following percentages of agreement, respectively: functional suitability (94%-84%); reliability (100-70%); usability (89.9-66.8%); performance efficiency (95.8%-86.1%); compatibility (95.8-79.6%); and safety (96%-83.4%).
Conclusions:
the software was considered suitable in quality evaluation to offer support to nurses in collecting patient data under palliative care, with the potential to operationalize the first Nursing Process stage.
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ORIGINAL ARTICLE07-29-2024
Sexual counseling for people with acute coronary syndrome: educational video development
Revista Brasileira de Enfermagem. 2024;77(3):e20230416
Abstract
ORIGINAL ARTICLESexual counseling for people with acute coronary syndrome: educational video development
Revista Brasileira de Enfermagem. 2024;77(3):e20230416
DOI 10.1590/0034-7167-2023-0416
Views0See moreABSTRACT
Objective:
to assess validity evidence of an educational video on safe sexual activity after acute coronary syndrome.
Method:
study in three phases: video development; content validity analysis by 11 experts; and analysis of validity based on response processes by seven people with coronary disease. The content validity ratio (CVR) was calculated with critical values for the second phase of 0.63 and for the third of 1.0.
Results:
the video addressed the importance of resuming sexual activity and positions that consume less energy, clinical warning signs, the importance of adhering to treatment and a welcoming environment for sexual practice. A CVR above the critical value was obtained with a total of 4 minutes and 41 seconds.
Conclusion:
the educational video brings together adequate content validity evidence and can be used as a tool for patients after acute coronary syndrome.
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REVIEW07-29-2024
Utilization of local pressure devices in pain management during injections: scoping review
Revista Brasileira de Enfermagem. 2024;77(3):e20230399
Abstract
REVIEWUtilization of local pressure devices in pain management during injections: scoping review
Revista Brasileira de Enfermagem. 2024;77(3):e20230399
DOI 10.1590/0034-7167-2023-0399
Views0See moreABSTRACT
Objective:
to map scientific evidence regarding the use of local pressure devices in pain relief during injection procedures in patients.
Methods:
scoping review, following the recommendations of the JBI Manual for Evidence Synthesis and PRISMA-ScR, with searches conducted in the PubMed, EMBASE, CINAHL, LILACS, and PsycINFO databases, without temporal restrictions and with a cutoff date of March 2023.
Results:
a total of 1,514 studies were identified, with 20 articles included in the final sample. The ShotBlocker® device was utilized during subcutaneous and intramuscular injections in children and adults, proving beneficial in reducing pain, anxiety, and fear associated with the procedure.
Final considerations:
the ShotBlocker® is a low-cost, easy-to-use device that can enhance nursing clinical practice during painful procedures. However, studies involving the Brazilian Pikluc® device are scarce. Further research involving both local pressure devices is recommended.
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ERRATUM
Revista Brasileira de Enfermagem. 2016;69(1):206-206
Abstract
ERRATUM
Revista Brasileira de Enfermagem. 2016;69(1):206-206
DOI 10.1590/0034-7167.20166901e02
Views0In the article “Conceptions of mid-level nursing professionals facing those with a chemical dependency”, with the number of DOI: 10.1590/0034-7167.2015680610i, published in the journal Revista Brasileira de Enfermagem, v68(6):755-60, page 760 that read:“8. Vargas D, Soares J. Knowledge and attitudes of nurses towards alcohol and related problems: the impact of an educational intervention. Rev Esc […]See more -
ERRATUM
Revista Brasileira de Enfermagem. 2016;69(1):205-205
Abstract
ERRATUM
Revista Brasileira de Enfermagem. 2016;69(1):205-205
DOI 10.1590/0034-7167.20166901e01
Views0In the article “Using the theory of meaningful learning in nursing education”, with the number of DOI: 10.1590/0034-7167.2015680420i, published in the journal Revista Brasileira de Enfermagem, v68(4):626-35, page 627 that read:“Ausubel was descended from Jewish, born in New York in 1918 and died in 1994 at the age of 75. He thought and wrote until […]See more -
Nursing process documentation: rationale and methods of analytical study
Revista Brasileira de Enfermagem. 2016;69(1):197-204
Abstract
Nursing process documentation: rationale and methods of analytical study
Revista Brasileira de Enfermagem. 2016;69(1):197-204
DOI 10.1590/0034-7167.2016690126i
Views0See moreABSTRACT
Objective:
to describe the methods used to analyze the associations between variables of service, nursing and the nursing process documentation in institutions of the Department of Health of the State of São Paulo.
Method:
multilevel analytical study with data obtained in the domains of institution, units of the institution and nursing professionals who work there, using standardized instruments. The analyses had as axis the degree of completeness of the nursing process documentation in units or institutions and their association with variables of nursing personnel, of units and of institutions.
Conclusion:
This study will provide important empirical evidence on the factors involved in the nursing process documentation.
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Qualitative methodologies in health research: interpretive referential of Patricia Benner
Revista Brasileira de Enfermagem. 2016;69(1):192-196
Abstract
Qualitative methodologies in health research: interpretive referential of Patricia Benner
Revista Brasileira de Enfermagem. 2016;69(1):192-196
DOI 10.1590/0034-7167.2016690125i
Views0See moreABSTRACT
Objective:
this article reports on the experience of using the interpretive phenomenological framework of Patricia Benner in a Brazilian context. Benner’s interpretive phenomenology, based on existential and interpretative philosophy, aims to understand human experiences in the particular worlds of research participants. Data were collected through interviews with nine nurses in November and December 2014.
Results:
data analysis process according to Benner’s framework consisted of: transcription, coding, thematic analysis, and search for paradigmatic cases and examples. Therefore, the prior knowledge of the researcher is an important part of the study, consisting in manners of the research conduction.
Conclusion:
The use of this methodological framework entailed a great challenge for the researcher, however, it also enabled a unique opportunity to illuminate important existential phenomena related to the daily lives of research participants.
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Nurses’ performance on primary care in the National Health Service in England
Revista Brasileira de Enfermagem. 2016;69(1):182-191
Abstract
Nurses’ performance on primary care in the National Health Service in England
Revista Brasileira de Enfermagem. 2016;69(1):182-191
DOI 10.1590/0034-7167.2016690124i
Views0See moreABSTRACT
Objective:
To analyze the expansion of nursing roles in primary care in the English National Health Service and the implications for professional practice.
Method:
qualitative research in case study format, held in London, England, in six primary care units. Data were obtained through interviews with nine nurses. After the thematic data analysis, two units emerged: the nurses’ performance characteristics and effects of the expansion of nursing roles.
Results:
expansion of nurses’ roles: consultation, diagnosis and drug therapy, case management and monitoring of chronic conditions. Repercussions: for the user, there was improved access, communication and comprehensive care, increased duration of consultations, resulting in greater adherence; for nurses, there was the expansion of professional skills, knowledge and professional recognition; to the health care system, it resulted in cost savings.
Conclusion:
benefits in expanding nursing roles, were visible, contributing to primary care quality.
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Meleis’ Nursing Theories Evaluation: integrative review
Revista Brasileira de Enfermagem. 2016;69(1):174-181
Abstract
Meleis’ Nursing Theories Evaluation: integrative review
Revista Brasileira de Enfermagem. 2016;69(1):174-181
DOI 10.1590/0034-7167.2016690123i
Views0See moreABSTRACT
Objective:
to analyze the application of the theory evaluation model proposed by Meleis in Brazilian studies.
Method:
integrative review of online articles published from 2002 to 2012 in the databases LILACS and BDENF.
Results:
the 16 selected studies confirmed the use of only three of the five stages proposed for Meleis’ theories analysis: Description of the Theory, Criticism of the Theory and Analysis of the Theory, with a predominance of a single unit of analysis in each.
Conclusion:
the analysis of nursing theories provides support to nurses in the practice, research, education and administration of the different dimensions of care. Meleis’ model figures as very important by contributing to the development of knowledge of nursing discipline, considering that its use as a method allows several reflections on theories in order that they be revalidated to support a more theoretical and practical applicability.
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Clinical indicators of sexual dysfunction in pregnant women: integrative literature review
Revista Brasileira de Enfermagem. 2016;69(1):165-173
Abstract
Clinical indicators of sexual dysfunction in pregnant women: integrative literature review
Revista Brasileira de Enfermagem. 2016;69(1):165-173
DOI 10.1590/0034-7167.2016690122i
Views0ABSTRACT
Objective:
to identify the nursing diagnosis clinical indicators of sexual dysfunction in pregnant women.
Method:
it is an integrative literature review, with research in databases using the keywords “sexual*”, “pregnan*” and “function*”. Studies included had an abstract available for analysis, referring to pregnant women over 18 years old, written in Portuguese, French, Spanish and English, with publication date between 2010 and 2014. Studies that reporting pregnant women with an associated pathology were excluded.
Results:
sexual dysfunction in pregnant women is consistent in the literature. Nine defining characteristics were identified and 16 related factors, some not classified in NANDA International.
Conclusion:
clinical indicators can be added to the nursing diagnosis to favor an accurate diagnosis and effective interventions in the surveillance of pregnancy as a period of healthy sexual experience.
Keywords:Physiological Sexual Dysfunction, Psychogenic Sexual DysfunctionPregnant WomenReviewSexual BehaviorSee more -
Conditions of functional health literacy of an elderly diabetics group
Revista Brasileira de Enfermagem. 2016;69(1):156-164
Abstract
Conditions of functional health literacy of an elderly diabetics group
Revista Brasileira de Enfermagem. 2016;69(1):156-164
DOI 10.1590/0034-7167.2016690121i
Views0See moreABSTRACT
Objective:
to evaluate the conditions of functional health literacy of an elderly diabetics group.
Method:
cross-sectional and descriptive study, with diabetic’s elderly assisted in the SUS (N = 114). The social and health conditions were evaluated as well as functional health literacy by S-TOFHLA test (short version); the simple proportions, average, standard deviation and Pearson’s Chi-square were described by SPSS software (20.0) with α = 5% value.
Results:
the mean age was 67.4 years, 74.0% of the elderly were women, had up to four years of schooling; 29.8% had a long-standing illness, 64.0% reported having high blood pressure, 47.4% smoke or were smokers, 73.7% had low functional health literacy, which was associated with schooling p = 0.001.
Conclusions:
the low functional health literacy could be a self-care conditioning and can be influenced by low schooling because it implies to have skills to understand and make decisions aimed at self-management of health.
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