Följande kandidatuppsats undersöker hur en elektronisk hälsoapplikation kan utformasför att öka medvetenheten om den personliga dagliga hälsan, fokuserat på huden och atthålla den frisk. Det sker genom att en prototyp har utformats där användaren genombilder samt text får instruktioner för att utföra en självkontroll. Prototypen innehållerockså en bildregistrering där användaren kan ladda upp bilder på en leverfläck ochgenom registreringen kan om leverfläcken utvecklas över tid. Syftet med prototypen äratt undersöka om en elektronisk hälsoapplikation utformad med fokus på återkopplingkan göra det möjligt för en person som inte är utbildad inom ämnet att undersöka sinhud samt se och följa förändring i en leverfläck genom bildanalys. Detta undersöktesgenom två tester. Ett frågeformulär där svarspersonen fick försöka avgöra om enleverfläck var frisk eller inte. Ett användartest där testpersonen fick testa bildanalysen,det som testades var om personen kunde ladda upp en bild samt se skillnad i bildernagenom bildregistreringen.Resultatet visar att majoriteten av enkätsvaren var korrekta svar, närmare bestämt 76,9procent. Personerna kunde identifiera om leverfläcken var frisk eller sjuk med hjälp avinformationen som tilldelades. Resultatet av användartesten visade att personerna kundeladda upp en bild på webbplatsen och sedan förstå bildanalysen. / This bachelor thesis examins how a electronic health application can be made toincrease awareness about personal daily health, with focus on individual skin andkeeping it healthy. This was made by creating a prototype where the user get usefulinformation on how to perform a self examination through text and images. Theprototype also contains functionality that allows the user to upload images of a moleand by an image registration follow possible changes over long periods of time. Thepurpose of the prototype is to investigate if an electronic health application with focuson feedback can make it possible for a person who is not educated in this area to examinthe skin and also discover possible changes over time with the image registration. Twotests were made to examin if this was possible. The first test was an questionnaire wherethe respondet tried to determine if a mole was healthy or not. The second test was a usertest where the test person got to try out the functionality with image registration in theprototype. The person got to upload an image and see the differences through the imageregistration.The results showed that the majority of the collected repsonses from the quetsionnairewas correct, with a percentage of 76,9 correct answers. The respondent could identify ifthe mole was healthy or not through the information that was presented. The results ofthe user test showed that all test persons could perform and understand the functionalityof uploading an image and then analyze the results throgh image registration.

Physiotherapy is a key part of treatment for neurological and musculoskeletal disorders, which affect millions in the U.S. each year. Physical therapy treatments typically consist of an initial diagnostic session during which patients’ impairments are assessed and exercises are prescribed to improve the impaired functions. As part of the treatment program, exercises are often assigned to be performed at home daily. Patients return to the clinic weekly or biweekly for check-up visits during which the physical therapist reassesses their condition and makes further treatment decisions, including readjusting the exercise prescriptions. Most physical therapists work in clinics or hospitals. When patients perform their exercises at home, physical therapists cannot supervise them and lack quantitative exercise data reflecting the patients’ exercise compliance and performance. Without this information, it is difficult for physical therapists to make informed decisions or treatment adjustments. To make informed decisions, physical therapists need to know how often patients exercise, the duration and/or repetitions of each session, exercise metrics such as the average velocities and ranges of motion for each exercise, patients’ symptom levels (e.g. pain or dizziness) before and after exercise, and what mistakes patients make. In this thesis, I evaluate and work towards a solution to this problem. The growing ubiquity of mobile and wearable technology makes possible the development of “virtual rehabilitation assistants.” Using motion sensors such as accelerometers and gyroscopes that are embedded in a wearable device, the “assistant” can mediate between patients at home and physical therapists in the clinic. Its functions are to:  use motion sensors to record home exercise metrics for compliance and performance and report these metrics to physical therapists in real-time or periodically;  allow physical therapists and patients to quantify and see progress on a fine-grain level;  record symptom levels to further help physical therapists gauge the effectiveness of exercise prescriptions;  offer real-time mistake recognition and feedback to the patients during exercises; One contribution of this thesis is an evaluation of the feasibility of this idea in real home settings. Because there has been little research on wearable virtual assistants in patient homes, there are many unanswered questions regarding their use and usefulness: Q1. What patient in-home data could wearable virtual assistants gather to support physical therapy treatments? Q2. Can patient data gathered by virtual assistants be useful to physical therapists? 3 Q3. How is this wearable in-home technology received by patients? I sought to answer these questions by implementing and deploying a prototype called “SenseCap.” SenseCap is a small mobile device worn on a ball cap that monitors patients’ exercise movements and queries them about their symptoms. A technology probe study showed that the virtual assistant could gather important compliance, performance, and symptom data to assist physical therapists’ decision-making, and that this technology would be feasible and acceptable for in-home use by patients. Another contribution of this thesis is the development of a tool to allow physical therapists to create and customize virtual assistants. With current technology, virtual assistants require engineering and programming efforts to design, implement, configure and deploy them. Because most physical therapists do not have access to an engineering team they and their patients would be unable to benefit from this technology. With the goal of making virtual assistants accessible to any physical therapist, I explored the following research questions: Q4. Would a user-friendly rule-specification interface make it easy for physical therapists to specify correct and incorrect exercise movements directly to a computer? What are the limitations of this method of specifying exercise rules? Q5. Is it possible to create a CAD-type authoring tool, based on a usable interface, that physical therapists could use to create their own customized virtual assistant for monitoring and coaching patients? What are the implementation details of such a system and the resulting virtual assistant? Q6. What preferences do PTs have regarding the delivery of coaching feedback for patients? Q7. What is the recognition accuracy of a virtual rehabilitation assistant created by this tool? This dissertation research aims to improve our understanding of the barriers to rehabilitation that occur because of the invisibility of home exercise behavior, to lower these barriers by making it possible for patients to use a widely-available and easily-used wearable device that coaches and monitors them while they perform their exercises, and improve the ability of physical therapists to create an exercise regime for their patients and to learn what patients have done to perform these exercises. In doing so, treatment should be better suited to each patient and more successful.

No description available.

Every healthcare system faces unlimited demands and limited resources, creating a need to make decisions that may limit access to some new, potentially effective technologies. It has become increasingly clearer that such decisions are more than technical ones. They require social value judgements - statements of the publics distributive preferences for healthcare across the population. However, these value judgements largely remain ill-defined. The purpose of this thesis was to explicate distributive preferences of the public to inform funding/coverage decisions on new health technologies. It contains six papers. The first comprises a systematic review of current coverage processes around the world, including value assumptions embedded within them. The second paper presents findings from an expert workshop and key-informant interviews with senior-level healthcare decision-makers in Canada. A technology funding decision-making framework, informed by the results of the first paper and the experiences of these decision-makers, was developed. Their input also highlighted the lack of and need for information on values that reflect those of the Canadian public. The third paper provides a systematic review of empirical studies attempting to explicate distributive preferences of the public. It also includes an analysis of social value arguments found in appeals to negative coverage decisions. From the results of both components, possible approaches to eliciting social values from the public and a list of factors around which distributive preferences may be sought were compiled. Such factors represented characteristics of unique, competing patient populations. Building on findings from the third paper, the fourth paper describes a citizens jury held to explicate distributive preferences for new health technologies in Alberta, Canada. The jury involved a broadly representative sample of the public, who participated in decision simulation exercises involving trade-offs between patient populations characterized by different combinations of factors. A list of preference statements, demonstrating interactions among such factors, emerged. The fifth and sixth papers address methodological issues related to citizens juries, including the comparability of findings from those carried out in the same way but with different samples of the public, and the extent to which they changed the views of individuals who participate in them.

The term telemedicine is broadly defined as the use of information and communication technology to deliver health care at a distance. However, the concept of ‘telemedicine’ still lacks consensus both in the literature and in practice. Generation of telemedicine knowledge and evidence for clinical practice is still controversial within the telemedicine scholarship and among decision-makers as telemedicine objectives remain ill-defined and outcomes vary in time. In Ontario, despite the fast pace of information and communication technology change and the increased interest in its health applications, telemedicine is not a mainstream model of care delivery within the medical system. This study empirically investigates the social construction of telemedicine technologies to understand how telemedicine expectations shaped telemedicine in Ontario (Canada) from 1993 to 2017. Drawing from the Social Construction of Technologies framework (SCOT) and historical narrative analytical techniques, it identifies the shared understandings of what telemedicine is (and is not) and what role telemedicine plays in the health care system. I used grounded theory methodology to develop a narrative theory of how the future of telemedicine in Ontario has been constructed over the last 24 years from national newspaper articles, stakeholder documents, service provider websites, and semi-structured interviews with relevant telemedicine stakeholders. Findings show that the development of telemedicine narratives in Ontario is a multi-storied process of conflicting and overlapping visions and expectations among stakeholders and interests. Telemedicine expectations focus mostly on the process of innovation, the provideroriented approach to telemedicine, and the advantages and risks of adopting consumercontrolled telemedicine in a publicly insured health care system. The telemedicine visions result fragmented among different stakeholders and practices, overall inhibiting telemedicine’s future agenda. These findings intend to help researchers, policy makers, private vendors, and health care providers to create a vision of telemedicine that accommodates competing expectations among the clinical, technical, political, and commercial worlds. / Thesis / Doctor of Science (PhD) / Telemedicine delivers health care at a distance by letting doctors talk to patients or other doctors via video, email, or text messages. However, as simple as this idea is, researchers, physicians, policy-makers, and entrepreneurs have speculative, overlapping, and conflicting views about what it should be. These differing views create ambiguity and often confuse the aims of health policy decision-makers and end-users limiting telemedicine’s development. I intend to clarify telemedicine’s shared and diverging understandings of what telemedicine should be by analyzing how stakeholders in Ontario have told and tell stories about telemedicine’s future over the last three decades. I view stories of the technology’s future as persuasive policy arguments that stakeholders adopt to shape and use telemedicine according to their visions and goals. These findings will help researchers, policy-makers, doctors, and businesspeople understand what telemedicine is (and is not) to help them define policies and guidelines for its adoption and implementation.

Yes / With the expected increase in the numbers of persons with dementia, providing timely, adequate, and affordable care and support is challenging. Assistive and health technologies may be a valuable contribution in dementia care, but new challenges may emerge. The aim of our study was to review the state of the art of technologies for persons with dementia regarding issues on development, usability, effectiveness and cost-effectiveness, deployment, and ethics in 3 fields of application of technologies: (1) support with managing everyday life, (2) support with participating in pleasurable and meaningful activities, and (3) support with dementia health and social care provision. The study also aimed to identify gaps in the evidence and challenges for future research. Methods: Reviews of literature and expert opinions were used in our study. Literature searches were conducted on usability, effectiveness and cost-effectiveness, and ethics using PubMed, Embase, CINAHL, and PsycINFO databases with no time limit. Selection criteria in our selected technology fields were reviews in English for community-dwelling persons with dementia. Regarding deployment issues, searches were done in Health Technology Assessment databases. Results: According to our results, persons with dementia want to be included in the development of technologies; there is little research on the usability of assistive technologies; various benefits are reported but are mainly based on low-quality studies; barriers to deployment of technologies in dementia care were identified, and ethical issues were raised by researchers but often not studied. Many challenges remain such as including the target group more often in development, performing more high-quality studies on usability and effectiveness and cost-effectiveness, creating and having access to high-quality datasets on existing technologies to enable adequate deployment of technologies in dementia care, and ensuring that ethical issues are considered an important topic for researchers to include in their evaluation of assistive technologies. Conclusions: Based on these findings, various actions are recommended for development, usability, effectiveness and cost-effectiveness, deployment, and ethics of assistive and health technologies across Europe. These include avoiding replication of technology development that is unhelpful or ineffective and focusing on how technologies succeed in addressing individual needs of persons with dementia. Furthermore, it is suggested to include these recommendations in national and international calls for funding and assistive technology research programs. Finally, practitioners, policy makers, care insurers, and care providers should work together with technology enterprises and researchers to prepare strategies for the implementation of assistive technologies in different care settings. This may help future generations of persons with dementia to utilize available and affordable technologies and, ultimately, to benefit from them.

Introduction : En psychologie de la santé, les études réalisées pour comprendre les perceptions des technologies par les patients sont peu nombreuses et nécessitent d’être développées. Ce travail a eu pour objectif d’identifier et d’évaluer les déterminants qui composent l’acceptabilité des nouvelles technologies en santé, en associant les développements issus de la psychologie sociale et de la psychologie de la santé.Méthodologie : Pour évaluer l’acceptabilité des technologies de santé, auprès des patients et des professionnels de santé, nous avons réalisé trois études. Nous avons choisi d’utiliser une approche par méthodes multiples (Ajzen, 1991 ; Fisher & Tarquinio, 2006) dans le but d’identifier les différents déterminants prédisant l’intention d’usage des technologies.Objectifs et études : Le premier objectif de notre travail a consisté à choisir le modèle le plus approprié parmi les théories intentionnelles classiques et à identifier les déterminants pouvant le compléter. Les résultats obtenus, à l’aide de la méthodologie qualitative par focus group, révèlent que les déterminants proposés dans le modèle de l’UTAUT (Venkatesh, 2003), complété de déterminants affectifs et interpersonnels, semblent les plus appropriés pour évaluer le processus d’acceptabilité en santé. Dans une seconde étude, nous avons proposé d’adapter le modèle de l’UTAUT en y associant une dimension affective, composée de l’anxiété et de la confiance envers la technologie, puis nous avons testé le pouvoir prédictif de ce modèle auprès de patients et de professionnels de santé. Ce modèle admet des résultats tout à fait satisfaisants pour prédire l’intention d’usage. Chez les patients, les technologies sont initialement appréhendées au travers des composantes émotionnelles et générales (anxiété perçue et attitude) alors que chez les professionnels de santé, expérimentés et familiers, les technologies sont appréhendées au travers des composantes cognitives et spécifiques (utilité et contrôle perçus). Pour améliorer notre modèle, nous avons ensuite exploré dans une troisième étude, deux nouvelles variables correspondant au niveau de confiance envers le médecin et aux connaissances sur la technologie issues de la relation médecin-patient (dimension interpersonnelle).Discussion : La proposition d’un modèle intégratif d’acceptabilité des technologies en santé basé sur le modèle de l’UTAUT, complété par une dimension affective et une dimension interpersonnelle, apparaît être un modèle prometteur pour comprendre les perceptions des usagers face aux technologies. / Introduction: In health psychology, few studies have been conducted to understand patients' perceptions of health technologies and need to be carried out. This work aims to identify and evaluate the determinants that make up the acceptability of new technologies in health, by associating developments from social psychology and health psychology.Methodology: To investigate patient and health professional acceptability of health technologies, we conducted three studies. We chose to use a multiple methods approach (Ajzen, 1991, Fisher & Tarquinio, 2006) in order to identify the different determinants predicting the intention to use technologies.Objectives and studies: The first objective of our work was to select the most suitable models of behavioral intention, and then tailor it by adding pertinent variables. The results, using the qualitative focus group methodology, revealed that the determinants proposed in the UTAUT model (Venkatesh, 2003) supplemented with affective and interpersonal determinants, seemed the most appropriate to evaluate the process of acceptability. In a second study, we proposed adapting the UTAUT model, associating an affective dimension composed of anxiety and trust in technology, and then testing the predictive power of this model with patients and health professionals. This model showed quite satisfactory results in predicting acceptability. In patients, the technologies are initially perceived through emotional and general components (perceived anxiety and attitude) whereas among experienced and familiar health professionals, the technologies are understood through cognitive and specific components (perceived utility and control). To optimize our model we added two new variable of the doctor-patient relationship representing the level of patient’s trust in the doctor and the effectiveness of the explanation of the technology (interpersonal dimension).Discussion: The proposal of an integrative model of acceptability of health technologies based on the UTAUT model, supplemented by an affective dimension and an interpersonal dimension, appears to be a promising model to understand users' perceptions of technologies.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Face à crescente procura por outras modalidades terapêuticas que abordam o ser humano de forma holística e a introdução das mesmas no SUS, torna-se muito importante a avaliação da efetividade e segurança dessas formas de cuidado. A Homeopatia faz parte deste conjunto de terapêuticas e, para sua avaliação, pode existir a necessidade de se valer de múltiplos instrumentos para abarcar os vários aspectos de uma resposta integral ao tratamento. Este trabalho teve como objetivo identificar e elaborar categorias de análises e instrumentos que permitam avaliar e mensurar a efetividade deste tratamento, bem como testá-los, considerando-se as características desta racionalidade. Foram levantados, na literatura nacional e internacional, trabalhos sobre efetividade do tratamento homeopático, em busca da definição do estado da arte mas também dos principais problemas, limitações e possibilidades dessas avaliações tendo em vista seu resultado integral. Finda esta etapa, a pesquisa destinou-se a elaboração, proposição e testagem de uma metodologia considerada mais adequada a avaliar o tratamento homeopático nesta perspectiva. Um estudo observacional foi realizado em serviço público homeopático no município de Juiz de Fora, com tratamento individualizado, no qual foi utilizada uma estratégia de avaliação composta por três componentes: (1) avaliação de qualidade de vida pelo instrumento SF-36; (2) análises em busca de objetivar e quantificar queixas clínicas e outros atributos de natureza subjetiva (sensação de bem-estar, sono, estado cognitivo e memória, vida sexual, sensação de felicidade) por meio da utilização de uma escala visual analógica (EVA), na mensuração da intensidade e de opções fechadas, a exemplo do SF-36, na estimativa da frequência desses aspectos e (3) entrevistas qualitativas por intermédio de questionário semiestruturado, com a finalidade de abordar questões relacionadas a biopatografia e mudança da atitude vital (como pacientes enfrentam os problemas do cotidiano, fatores deflagradores das queixas, como se sentem e como reagem, além de indagar seus projetos de vida e felicidade). A aplicação do questionário SF-36 apresentou algumas dificuldades de compreensão pelos participantes, talvez devido à baixa escolaridade dos entrevistados, mas mostrou-se útil à pesquisa, embora demonstre limitações na avaliação do aspecto integral do resultado da terapêutica analisada. O acompanhamento das queixas clínicas, sensação de bem-estar, sono e estado cognitivo e memória foram captados e mensurados de forma satisfatória tanto pela EVA (intensidade dos sintomas) quanto pelas respostas fechadas para medir a frequência. Situações como as avaliações da biopatografia e da sexualidade foram insuficientes para serem adequadamente avaliadas pelo pesquisador e o paciente somente. A participação do médico assistente poderia contribuir nestes casos. Questões mais abrangentes na avaliação da mudança na atitude vital, como reação diante de fatores desequilibrantes e projeto de vida e felicidade, necessitam de metodologia qualitativa até que se possa avançar nas pesquisas à espera de soluções futuras. A combinação dessas estratégias em estudos controlados, randomizados, com amostras de magnitude satisfatória, preferencialmente em rede e que explicitem as condições nas quais o atendimento homeopático ocorreu e como se chegou a cada prescrição, podem ter utilidade para a avaliação da efetividade da dimensão integral do tratamento homeopático. / Given the increasing demand for other therapeutic modalities that address the human being holistically and their introduction in the SUS, it is very important to evaluate the effectiveness and safety of these forms of care. Homeopathy is part of this group of therapies, and for its assessment, there may be a need to use multiple instruments to cover the various aspects of a integral response to treatment. This study aimed to identify and establish categories of analysis and tools to evaluate and measure the effectiveness of this treatment, and test them, considering the characteristics of this rationality. We searched in national and international literature works on the effectiveness of homeopathic treatment, trying to define the state of the art but also of the main problems, constraints and possibilities of these assessments in view of its full result. Then the research was aimed at drafting, proposing and testing the most appropriate methodology to assess homeopathic treatment in this perspective. An observational study was conducted in a homeopathic public unit in the city of Juiz de Fora, with individualized treatment, adopting an evaluation strategy that comprised three components: (1) assessment of quality of life using the SF-36; (2) analysis seeking to objectify and quantify clinical complaints and other attributes of subjective nature (feeling of well-being, sleep, memory and cognitive status, sexual life, feelings of happiness) by using a visual analogue scale (VAS) to measure the intensity and closed options, such as the SF-36, to estimate the frequency of these aspects; and (3) qualitative interviews through semi-structured questionnaire, in order to address issues related to Biopathography and changes in vital attitude (such as how patients face everyday problems, trigger factors of complaints, how they feel and react, and ask their projects of life and happiness). The application of the SF-36 showed some difficulties in understanding by the participants, perhaps due to low education level of respondents, but was useful for research, although it shows limitations in evaluating the integral aspect of the outcome of therapy examined. The monitoring of clinical symptoms, sense of well-being, sleep and cognitive status and memory were captured and measured adequately by both the VAS (intensity of symptoms) and by the closed responses to measure the frequency. Situations like the assessments of biopathography and sexuality were insufficient to be properly assessed by the investigator and the patient only. The doctor could help in these cases. Wider issues in assessing the change in vital attitude, as reaction to destabilizing factors and design of life and happiness require qualitative methodology to make progress in the polls waiting for future solutions. The combination of these strategies in randomized controlled trials, with samples of satisfactory magnitude, preferably in the network and which clearly define the conditions under which homeopathic care occurred and how one came to each prescription, can be useful for evaluating the effectiveness of integral homeopathic treatment.

Submitted by Maria Creuza Silva (mariakreuza@yahoo.com.br) on 2013-10-03T18:51:28Z No. of bitstreams: 1 Diss MP. Adeanio Almeida 2013.pdf: 761576 bytes, checksum: e6fa6de40f4407eb0e64fad35f261cd6 (MD5) / Approved for entry into archive by Maria Creuza Silva(mariakreuza@yahoo.com.br) on 2013-10-03T18:52:11Z (GMT) No. of bitstreams: 1 Diss MP. Adeanio Almeida 2013.pdf: 761576 bytes, checksum: e6fa6de40f4407eb0e64fad35f261cd6 (MD5) / Made available in DSpace on 2013-10-03T18:52:11Z (GMT). No. of bitstreams: 1 Diss MP. Adeanio Almeida 2013.pdf: 761576 bytes, checksum: e6fa6de40f4407eb0e64fad35f261cd6 (MD5) Previous issue date: 2013 / Na conjuntura atual, é perceptível o descompasso entre os conceitos de humanização e o processo de desenvolvimento tecnológico. A tecnologia, cada vez mais determinante para aumentar a sobrevida humana e diminuição do sofrimento, afasta os profissionais do contato mais próximo com o paciente. Ambientes com alta densidade tecnológica - que apresentam grande concentração de equipamentos e instrumentais médico-hospitalares (tecnologias duras) – trazem consigo desafios ligados à qualificação, modernização e à necessidade de refletir sobre as modificações que possam ocorrer para o cuidado de enfermagem. Neste trabalho interessa discutir este último aspecto, de forma a responder a seguinte questão: como se configura o cuidado de enfermagem, tendo em vista a perspectiva da humanização em saúde, em instituições com realidades distintas em termos de densidade tecnológica? A partir desta questão, o estudo teve como objetivo comparar percepções e práticas do cuidado de enfermagem, sob a perspectiva da humanização em saúde, em dois serviços hospitalares que se distinguem por apresentar, respectivamente a seguinte configuração: baixa e alta densidade tecnológica. Um critério básico para tipificar a densidade tecnológica foi a existência ou não de monitores multiparamétricos na unidade. Trata-se de uma pesquisa qualitativa, baseada no estudo de caso múltiplo, realizado em duas unidades hospitalares: Hospital Antônio Carlos Magalhães, em Inhambupe (BA) e Hospital do Subúrbio, em Salvador (BA). Os sujeitos foram cinquenta e um profissionais de enfermagem que atuam nas unidades assistenciais e de terapia intensiva. A coleta de dados foi realizada através de entrevista semiestruturada e observação direta. Os dados foram analisados e distribuídos em três categorias: percepções de enfermagem acerca do cuidado humanizado; práticas do cuidado e humanização da assistência e fatores que limitam ou que favorecem o cuidado humanizado de enfermagem. Não foram observadas, nos casos estudados, diferença significativa entre as percepções dos enfermeiros (as) e a prática, apenas mudanças de focos da dimensão ou ação do cuidado humanizado. Dentre os fatores limitantes, puderam ser notados o despreparo e insatisfação profissional, rotinas rígidas, sobrecarga de trabalho; tempo excessivo consumido em atividades gerencias e o constante barulho dos equipamentos médico hospitalares. Em contrapartida, fatores como ambientes silenciosos; melhor distribuição do tempo entre as atividades de enfermagem; estabelecimento de protocolos assistenciais; existência de programa de gratificação; adequação de horas de trabalho de enfermagem e, principalmente, programas de educação continuada são apontados como facilitadores da humanização do cuidado. Programas de educação continuada e o estabelecimento de ações gerenciais e institucionais que privilegiem a qualidade da assistência revelam-se essenciais para o incentivo à humanização, vez que o que o fator determinante para que a tecnologia desumanize o cuidado de enfermagem não é a tecnologia por si só, mas principalmente como esta opera nos contextos pessoais, institucionais e gerenciais. / Salvador

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Face à crescente procura por outras modalidades terapêuticas que abordam o ser humano de forma holística e a introdução das mesmas no SUS, torna-se muito importante a avaliação da efetividade e segurança dessas formas de cuidado. A Homeopatia faz parte deste conjunto de terapêuticas e, para sua avaliação, pode existir a necessidade de se valer de múltiplos instrumentos para abarcar os vários aspectos de uma resposta integral ao tratamento. Este trabalho teve como objetivo identificar e elaborar categorias de análises e instrumentos que permitam avaliar e mensurar a efetividade deste tratamento, bem como testá-los, considerando-se as características desta racionalidade. Foram levantados, na literatura nacional e internacional, trabalhos sobre efetividade do tratamento homeopático, em busca da definição do estado da arte mas também dos principais problemas, limitações e possibilidades dessas avaliações tendo em vista seu resultado integral. Finda esta etapa, a pesquisa destinou-se a elaboração, proposição e testagem de uma metodologia considerada mais adequada a avaliar o tratamento homeopático nesta perspectiva. Um estudo observacional foi realizado em serviço público homeopático no município de Juiz de Fora, com tratamento individualizado, no qual foi utilizada uma estratégia de avaliação composta por três componentes: (1) avaliação de qualidade de vida pelo instrumento SF-36; (2) análises em busca de objetivar e quantificar queixas clínicas e outros atributos de natureza subjetiva (sensação de bem-estar, sono, estado cognitivo e memória, vida sexual, sensação de felicidade) por meio da utilização de uma escala visual analógica (EVA), na mensuração da intensidade e de opções fechadas, a exemplo do SF-36, na estimativa da frequência desses aspectos e (3) entrevistas qualitativas por intermédio de questionário semiestruturado, com a finalidade de abordar questões relacionadas a biopatografia e mudança da atitude vital (como pacientes enfrentam os problemas do cotidiano, fatores deflagradores das queixas, como se sentem e como reagem, além de indagar seus projetos de vida e felicidade). A aplicação do questionário SF-36 apresentou algumas dificuldades de compreensão pelos participantes, talvez devido à baixa escolaridade dos entrevistados, mas mostrou-se útil à pesquisa, embora demonstre limitações na avaliação do aspecto integral do resultado da terapêutica analisada. O acompanhamento das queixas clínicas, sensação de bem-estar, sono e estado cognitivo e memória foram captados e mensurados de forma satisfatória tanto pela EVA (intensidade dos sintomas) quanto pelas respostas fechadas para medir a frequência. Situações como as avaliações da biopatografia e da sexualidade foram insuficientes para serem adequadamente avaliadas pelo pesquisador e o paciente somente. A participação do médico assistente poderia contribuir nestes casos. Questões mais abrangentes na avaliação da mudança na atitude vital, como reação diante de fatores desequilibrantes e projeto de vida e felicidade, necessitam de metodologia qualitativa até que se possa avançar nas pesquisas à espera de soluções futuras. A combinação dessas estratégias em estudos controlados, randomizados, com amostras de magnitude satisfatória, preferencialmente em rede e que explicitem as condições nas quais o atendimento homeopático ocorreu e como se chegou a cada prescrição, podem ter utilidade para a avaliação da efetividade da dimensão integral do tratamento homeopático. / Given the increasing demand for other therapeutic modalities that address the human being holistically and their introduction in the SUS, it is very important to evaluate the effectiveness and safety of these forms of care. Homeopathy is part of this group of therapies, and for its assessment, there may be a need to use multiple instruments to cover the various aspects of a integral response to treatment. This study aimed to identify and establish categories of analysis and tools to evaluate and measure the effectiveness of this treatment, and test them, considering the characteristics of this rationality. We searched in national and international literature works on the effectiveness of homeopathic treatment, trying to define the state of the art but also of the main problems, constraints and possibilities of these assessments in view of its full result. Then the research was aimed at drafting, proposing and testing the most appropriate methodology to assess homeopathic treatment in this perspective. An observational study was conducted in a homeopathic public unit in the city of Juiz de Fora, with individualized treatment, adopting an evaluation strategy that comprised three components: (1) assessment of quality of life using the SF-36; (2) analysis seeking to objectify and quantify clinical complaints and other attributes of subjective nature (feeling of well-being, sleep, memory and cognitive status, sexual life, feelings of happiness) by using a visual analogue scale (VAS) to measure the intensity and closed options, such as the SF-36, to estimate the frequency of these aspects; and (3) qualitative interviews through semi-structured questionnaire, in order to address issues related to Biopathography and changes in vital attitude (such as how patients face everyday problems, trigger factors of complaints, how they feel and react, and ask their projects of life and happiness). The application of the SF-36 showed some difficulties in understanding by the participants, perhaps due to low education level of respondents, but was useful for research, although it shows limitations in evaluating the integral aspect of the outcome of therapy examined. The monitoring of clinical symptoms, sense of well-being, sleep and cognitive status and memory were captured and measured adequately by both the VAS (intensity of symptoms) and by the closed responses to measure the frequency. Situations like the assessments of biopathography and sexuality were insufficient to be properly assessed by the investigator and the patient only. The doctor could help in these cases. Wider issues in assessing the change in vital attitude, as reaction to destabilizing factors and design of life and happiness require qualitative methodology to make progress in the polls waiting for future solutions. The combination of these strategies in randomized controlled trials, with samples of satisfactory magnitude, preferably in the network and which clearly define the conditions under which homeopathic care occurred and how one came to each prescription, can be useful for evaluating the effectiveness of integral homeopathic treatment.