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RESEARCH01-01-2016
Leads for potentializing groups in Primary Health Care
Revista Brasileira de Enfermagem. 2016;69(5):964-971
Abstract
RESEARCHLeads for potentializing groups in Primary Health Care
Revista Brasileira de Enfermagem. 2016;69(5):964-971
DOI 10.1590/0034-7167-2015-0102
Views0ABSTRACT
Objective:
to analyze the aspects that potentialize groups in Primary Health Care according to their coordinators and participants.
Method:
This is a descriptive study with a qualitative approach, conducted with a health promotion group affiliated with a Family Health Unit. The data were collected by means of focus groups with participants and community workers who were submitted to thematic content analysis.
Results:
the analysis gave rise to three thematic categories: The group is our medicine; Healthy living and learning; and Priceless leadership.
Conclusion:
the leads identified during the study were as follows: group organization involves investment in motivation and leadership by the coordinators; production of grouping and cohesion is a result of participants and coordinators meeting together, interspersed with dialog, things said and left unsaid that the subjects expressed in the group dynamic; the sense of belonging guarantees their placement in the group based on the recognition of their knowledge and affective, social and health needs.
Keywords:Group ProcessesGroup StructureHealth PromotionNursing in Community HealthPrimary Health CareSee more -
RESEARCH01-01-2016
Intimate partner violence in adolescence: an analysis of gender and generation
Revista Brasileira de Enfermagem. 2016;69(5):946-955
Abstract
RESEARCHIntimate partner violence in adolescence: an analysis of gender and generation
Revista Brasileira de Enfermagem. 2016;69(5):946-955
DOI 10.1590/0034-7167-2016-0408
Views0ABSTRACT
Objective:
to analyze the intimate partner violence in adolescence from the perspective of gender and generation.
Method:
Quantitative, descriptive, and exploratory research. 111 adolescents participated in this study, with ages from 15 to 19 years old.
Results:
We found that 91% of participants have perpetrated and 90.1% have undergone at least one of the natures of violence. The intimate partner violence in adolescence constitutes a form of gender violence, and gender constructions have determined the suffered and perpetrated aggressions, possibly also determining the naturalization and legitimization of such aggressions. The inequality of power between generations may determine greater vulnerability of youngsters to the phenomenon.
Conclusion:
The historical and social construction of masculinity and femininity and the power inequalities set by these constructions converge with the power inequality between generations. Thus, gender and generation are determinants of intimate partner violence in adolescence, as well as of the vulnerability of adolescents to this phenomenon.
Keywords:AdolescentAdolescent HealthGender and HealthIntimate Partner ViolenceViolence Against WomenSee more -
RESEARCH01-01-2016
Hospitalization anxiety in children: conceptual analysis
Revista Brasileira de Enfermagem. 2016;69(5):940-945
Abstract
RESEARCHHospitalization anxiety in children: conceptual analysis
Revista Brasileira de Enfermagem. 2016;69(5):940-945
DOI 10.1590/0034-7167-2015-0116
Views0See moreABSTRACT
Objective:
to analyze the concept “hospitalization anxiety in children”, identifying its antecedents, attributes, and consequences, with the objective of clarifying its meaning.
Method:
we used a conceptual analysis model, whose objective is to clarify the meaning of terms.
Results:
we identified the concept antecedents and its attributes, classified as biological and psychological needs, which are essential characteristics of “hospitalization anxiety in children”. This process consequences have also been identified. We proceeded to the analysis of the characteristics with emphasis on the impacts of the hospitalization process on the child and on the family.
Conclusion:
based on the conceptual analysis of the phenomenon, it was possible to identify the antecedents, attributes, and consequences of Hospitalization Anxiety in children. We recommend the continuation of the study validating the essential characteristics presently identified as a way to join knowledge gathered and professional practice.
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RESEARCH01-01-2016
Stroke: patient characteristics and quality of life of caregivers
Revista Brasileira de Enfermagem. 2016;69(5):933-939
Abstract
RESEARCHStroke: patient characteristics and quality of life of caregivers
Revista Brasileira de Enfermagem. 2016;69(5):933-939
DOI 10.1590/0034-7167-2015-0064
Views0See moreABSTRACT
Objective:
to investigate the association between the domains of health-related quality of life of family caregivers and sociodemographic characteristics of individuals with stroke sequelae.
Method:
descriptive, cross-sectional, quantitative research, conducted with 136 family caregivers of individuals with stroke sequelae by means of home interviews from April to June 2013.
Results:
we found that caregivers of individuals aged under 65 years, married, with 10 to 12 years of formal education, presented higher scores, respectively, in the domains ‘Social aspects’, ‘Emotional aspects’, and ‘Mental health’. However, caregivers of patients with higher degree of disability obtained lower score in the ‘Mental Health’ domain.
Conclusion:
the results foster reflection on the need of including the family caregivers of individuals with stroke sequelae in the planning of care provided by health professionals.
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RESEARCH01-01-2016
A quasi-experimental nursing study on pain in comatose patients
Revista Brasileira de Enfermagem. 2016;69(5):927-932
Abstract
RESEARCHA quasi-experimental nursing study on pain in comatose patients
Revista Brasileira de Enfermagem. 2016;69(5):927-932
DOI 10.1590/0034-7167-2015-0121
Views0See moreABSTRACT
Objective:
to verify whether comatose patients feel pain during the bed bath nursing procedure.
Method:
nineteen patients aged 61 ± 17.39 years participated in the study. A quantitative analysis was conducted on the P substance (PS) in the saliva collected before and during a bed bath, using the ELISA method. Program Graph Pad Prisma 6 was used to analyze the data. The verification of normality was made through the Shapiro Wilk test, which determined the choice for the Wilcoxon nonparametric test.
Results:
the study showed a statistically significant increase (∆= 5.62%, p<0.001) in the PS level of the patients studied during the nursing procedure.
Conclusion:
when caring for comatose patients during a bed bath, professionals cause or add painful stimuli; therefore, they feel pain.
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RESEARCH01-01-2016
Quality of nursing care: instrument development and validation
Revista Brasileira de Enfermagem. 2016;69(5):920-926
Abstract
RESEARCHQuality of nursing care: instrument development and validation
Revista Brasileira de Enfermagem. 2016;69(5):920-926
DOI 10.1590/0034-7167-2015-0151
Views0See moreABSTRACT
Objectives:
to describe the development and validation process of a scale to measure the nurses’ perception of the activities that contribute to nursing care quality.
Method:
methodological study based on a literature review, the opinion of experts and the experience of study investigators. An instrument was designed containing six dimensions and 25 items, applied as a questionnaire to 775 nurses from a hospital in northern Portugal, from May to July 2014. The instrument validation used an exploratory factor analysis and an internal consistency assessment of each factor/dimension.
Results:
the factor analysis indicated the need to adjust the original composition of the scale, which then received one more dimension, totaling seven dimensions and the same 25 items, and presented a high internal consistency (Cronbach’s alpha of 0.940).
Conclusion:
the final version of the scale presents adequate psychometric properties, with potential use in future studies.
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EDITORIAL05-13-2024
Qualitative methodology: considerations and singularities regarding the implementation of person-centered interventions
Revista Brasileira de Enfermagem. 2024;77(3):e770301
Abstract
EDITORIALQualitative methodology: considerations and singularities regarding the implementation of person-centered interventions
Revista Brasileira de Enfermagem. 2024;77(3):e770301
DOI 10.1590/0034-7167.2024770301
Views0Qualitative health research allows for an in-depth understanding of how a person experiences different health transitions, their relationship with healthcare professionals and their passage through different clinical practice environments. At the same time, it has the potential to support professionals’ clinical decision-making and to empower citizens in their autonomy and responsibility for the health-disease process, […]See more -
REVIEW05-13-2024
Lean methodology: contributions to improving work processes in health and nursing
Revista Brasileira de Enfermagem. 2024;77(2):e20230322
Abstract
REVIEWLean methodology: contributions to improving work processes in health and nursing
Revista Brasileira de Enfermagem. 2024;77(2):e20230322
DOI 10.1590/0034-7167-2023-0322
Views0ABSTRACT
Objective:
to investigate the contributions of applying the Lean methodology to improve work processes in health and nursing and its impact on associated financial aspects.
Method:
an integrative review, carried out in six databases, whose sample of ten (100.0%) studies was analyzed and summarized descriptively.
Results:
the outcomes obtained were stratified into: benefits/barriers to Lean Healthcare implementation; economic aspects involving Lean Healthcare implementation; and process improvements through Lean Healthcare implementation. The majority of studies (60.0%) were carried out in university hospitals, contexts that need to continually improve the quality of services provided, generally with scarce and limited resources, which support the viability of maintaining the teaching, research and extension tripod.
Conclusion:
three (30.0%) studies highlighted the financial aspects associated with Lean methodology application. The others only mentioned the possibility of financial gains through improving processes and reducing waste.
Keywords:Cost Efficiency AnalysisCost SavingsEfficiencyOrganizationalProcess OptimizationTotal Quality ManagementSee more -
ORIGINAL ARTICLE05-13-2024
Generalized Resistance Deficits in inmates with hypertension: missing resources that limit health
Revista Brasileira de Enfermagem. 2024;77(2):e20230246
Abstract
ORIGINAL ARTICLEGeneralized Resistance Deficits in inmates with hypertension: missing resources that limit health
Revista Brasileira de Enfermagem. 2024;77(2):e20230246
DOI 10.1590/0034-7167-2023-0246
Views0See moreABSTRACT
Objective:
to understand the Generalized Resistance Deficits of people deprived of liberty with hypertension in a Brazilian prison unit.
Method:
qualitative research, anchored in Salutogenesis, carried out with 38 people with hypertension from a Brazilian prison unit, from February to July 2022, with a semi-structured interview with open-ended questions, whose analysis was thematic, explaining the limitations to health in prison.
Results:
13 Generalized Resistance Deficits were reported, mostly related to the prison environment and, to a lesser extent, to the social group and the individual, respectively. Living in prison for people with hypertension implies living with a high number of Generalized Resistance Deficits, accentuating the movement towards the disease pole.
Final considerations:
knowing Generalized Resistance Deficits allows directing health promotion to support the use of available Generalized Resistance Resources and contributes to the expansion of intersectoral policies.
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REVIEW05-13-2024
Preditores de nanismo entre crianças de 0 a 24 meses no Sudeste Asiático: Uma revisão do escopo
Revista Brasileira de Enfermagem. 2024;77(2):e20220625
Abstract
REVIEWPreditores de nanismo entre crianças de 0 a 24 meses no Sudeste Asiático: Uma revisão do escopo
Revista Brasileira de Enfermagem. 2024;77(2):e20220625
DOI 10.1590/0034-7167-2022-0625
Views0See moreRESUMEN
Objetivo:
Identificar indicadores de desnutrición crónica entre niños de 0 a 24 meses en el Sudeste Asiático.
Métodos:
Esta revisión de alcance se centró en artículos con diseño de estudio observacional publicados en inglés, entre los años 2012 y 2023 de cinco bases de datos internacionales. Las principales palabras clave utilizadas fueron: “stunting (Desnutrición crónica)” o “growth disorder (Desorden del crecimiento)”, y “newborn (Recién nacido)”, y “predict (Predecir)”, y “Southeast Asia (Sudeste Asiático)”.
Resultados:
De los 27 artículos seleccionados para el análisis final, se encontraron trece indicadores que influyen en la desnutrición crónica en siete países del Sudeste Asiático. Los trece indicadores incluyen el niño, la madre, el hogar, la alimentación inadequada complementaria, la lactancia materna inadecuada, la atención inadecuada, los alimentos de mala calidad, la seguridad de los alimentos y el agua, la infección, la economía política, la salud y la asistencia sanitaria, el agua, el saneamiento y el medio ambiente, y por último el factor sociocultural.
Conclusión:
Todos estos indicadores pueden provocar desnutrición crónica en niños del Sudeste Asiático. Para poder prevenirlo los prestadores de servicios de salud y otros sectores relacionados, necesitan realizar actividades de promoción y prevención de la salud de acuerdo con los indicadores encontrados en este artículo.
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REVIEW05-13-2024
Stunting predictors among children aged 0-24 months in Southeast Asia: a scoping review
Revista Brasileira de Enfermagem. 2024;77(2):e20220625
Abstract
REVIEWStunting predictors among children aged 0-24 months in Southeast Asia: a scoping review
Revista Brasileira de Enfermagem. 2024;77(2):e20220625
DOI 10.1590/0034-7167-2022-0625
Views0See moreABSTRACT
Objective:
To identify predictors of stunting among children 0-24 months in Southeast Asia.
Methods:
This scoping review focused on articles with observational study design in English published from 2012 to 2023 from five international databases. The primary keyword used were: “stunting” OR “growth disorder” AND “newborn” AND “predict” AND “Southeast Asia”.
Results:
Of the 27 articles selected for the final analysis there are thirteen predictors of stunting in seven Southeast Asia countries. The thirteen predictors include the child, mother, home, inadequate complementary feeding, inadequate breastfeeding, inadequate care, poor quality foods, food and water safety, infection, political economy, health and healthcare, water, sanitation, and environment, and social culture factor.
Conclusion:
All these predictors can lead to stunting in Southeast Asia. To prevent it, health service providers and other related sectors need to carry out health promotion and health prevention according to the predictors found.
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ORIGINAL ARTICLE05-13-2024
Factors associated with Community Health Agents’ knowledge about tuberculosis
Revista Brasileira de Enfermagem. 2024;77(2):e20220520
Abstract
ORIGINAL ARTICLEFactors associated with Community Health Agents’ knowledge about tuberculosis
Revista Brasileira de Enfermagem. 2024;77(2):e20220520
DOI 10.1590/0034-7167-2022-0520
Views0See moreABSTRACT
Objective:
To analyze the factors associated with the knowledge of Community Health Agents (ACS) about tuberculosis.
Methods:
A cross-sectional study was conducted with 110 ACS. A questionnaire was used to assess knowledge about pulmonary tuberculosis (component 1) and the work functions of ACS in the National Tuberculosis Control Program (component 2). The level of knowledge, according to the scores converted into a scale of 0 to 100, was classified as: 0-50% (low), 51-75% (medium), and over 75% (high). Multiple regression was used in the analysis of associated factors.
Results:
The global score (average of the scores of components 1 and 2) median knowledge was 68.6%. Overall knowledge about tuberculosis was positively associated with the length of professional experience, having received training on tuberculosis, and access to the tuberculosis guide/handbook.
Conclusions:
Investments in training and capacity-building strategies for ACS will contribute to increasing these professionals’ knowledge, resulting in greater success in tuberculosis control.
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ORIGINAL ARTICLE05-13-2024
A influência da internet nas escolhas sobre a saúde e o bem-estar dos idosos
Revista Brasileira de Enfermagem. 2024;77(1):e20230321
Abstract
ORIGINAL ARTICLEA influência da internet nas escolhas sobre a saúde e o bem-estar dos idosos
Revista Brasileira de Enfermagem. 2024;77(1):e20230321
DOI 10.1590/0034-7167-2023-0321
Views0See moreRESUMEN
Objetivos:
describir el perfil de los ancianos que acceden a internet para buscar información de salud e identificar los factores que pueden influir en las decisiones de los ancianos sobre su salud a partir de la información recopilada en línea.
Métodos:
391 ancianos respondieron a un cuestionario online sobre hábitos y satisfacción con la información de salud recogida en internet. El procesamiento de datos implicó regresión logística.
Resultados:
la educación superior reduce en un 44% la probabilidad de que un anciano siga las recomendaciones de salud en los sitios web. Sin embargo, las actividades sociales y la salud autopercibida aumentan la posibilidad de seguir las recomendaciones en un 83% y un 71%, respectivamente. La creencia de que internet promueve hábitos saludables aumenta 29,2 veces la probabilidad de que un anciano siga un consejo.
Consideraciones Finales:
conocer el perfil de los ancianos que utilizan internet puede ayudar a los profesionales a formular políticas públicas y construir buenas plataformas de información sobre salud y bienestar.
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ORIGINAL ARTICLE05-13-2024
The influence of the internet on choices about older adults’ health and well-being
Revista Brasileira de Enfermagem. 2024;77(1):e20230321
Abstract
ORIGINAL ARTICLEThe influence of the internet on choices about older adults’ health and well-being
Revista Brasileira de Enfermagem. 2024;77(1):e20230321
DOI 10.1590/0034-7167-2023-0321
Views0See moreABSTRACT
Objectives:
to describe the profile of older adults who access the internet to search for health information and identify the factors that can influence older adults’ decisions about their health based on information collected online.
Methods:
391 older adults answered an online questionnaire regarding habits and satisfaction with information about health collected on the internet. Data processing involved Logistic Regression.
Results:
higher education reduces by 44% the likelihood of an older adult following the health recommendations on internet sites. However, social activities and self-perceived health increase the possibility of following the recommendations by 83% and 71%, respectively. The belief that the internet promotes healthy habits increases by 29.2 times the probability of an older adult following the advice.
Final Considerations:
knowing the profile of older adults who use the Internet can help professionals formulate public policies and build good information platforms on health and well-being.
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ERRATUM01-01-2016
ERRATUM
Revista Brasileira de Enfermagem. 2016;69(1):206-206
Abstract
ERRATUMERRATUM
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 -
ERRATUM01-01-2016
ERRATUM
Revista Brasileira de Enfermagem. 2016;69(1):205-205
Abstract
ERRATUMERRATUM
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 -
EXPERIENCE REPORT01-01-2016
Nursing process documentation: rationale and methods of analytical study
Revista Brasileira de Enfermagem. 2016;69(1):197-204
Abstract
EXPERIENCE REPORTNursing 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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EXPERIENCE REPORT01-01-2016
Qualitative methodologies in health research: interpretive referential of Patricia Benner
Revista Brasileira de Enfermagem. 2016;69(1):192-196
Abstract
EXPERIENCE REPORTQualitative 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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REVIEW01-01-2016
Nurses’ performance on primary care in the National Health Service in England
Revista Brasileira de Enfermagem. 2016;69(1):182-191
Abstract
REVIEWNurses’ 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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REVIEW01-01-2016
Meleis’ Nursing Theories Evaluation: integrative review
Revista Brasileira de Enfermagem. 2016;69(1):174-181
Abstract
REVIEWMeleis’ 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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REVIEW01-01-2016
Clinical indicators of sexual dysfunction in pregnant women: integrative literature review
Revista Brasileira de Enfermagem. 2016;69(1):165-173
Abstract
REVIEWClinical 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 -
RESEARCH01-01-2016
Conditions of functional health literacy of an elderly diabetics group
Revista Brasileira de Enfermagem. 2016;69(1):156-164
Abstract
RESEARCHConditions 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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