BACKGROUND: Practitioners of complementary and alternative medicine (CAM) therapies are an important and growing presence in health care systems worldwide. A central question is whether evidence-based behavior change interventions routinely employed in conventional health care could also be integrated into CAM practice to address public health priorities. Essential for successful integration are intervention approaches deemed acceptable and consistent with practice patterns and treatment approaches of different types of CAM practitioners - that is, they have context validity. Intervention development to ensure context validity was integral to Project CAM Reach (CAMR), a project examining the public health potential of tobacco cessation training for chiropractors, acupuncturists and massage therapists (CAM practitioners). This paper describes formative research conducted to achieve this goal. METHODS: Intervention development, undertaken in three CAM disciplines (chiropractic, acupuncture, massage therapy), consisted of six iterative steps: 1) exploratory key informant interviews; 2) local CAM practitioner community survey; 3) existing tobacco cessation curriculum demonstration with CAM practitioners; 4) adapting/tailoring of existing curriculum; 5) external review of adaptations; 6) delivery of tailored curriculum to CAM practitioners with follow-up curriculum evaluation. RESULTS: CAM practitioners identified barriers and facilitators to addressing tobacco use with patients/clients and saw the relevance and acceptability of the intervention content. The intervention development process was attentive to their real world intervention concerns. Extensive intervention tailoring to the context of each CAM discipline was found unnecessary. Participants and advisors from all CAM disciplines embraced training content, deeming it to have broad relevance and application across the three CAM disciplines. All findings informed the final intervention. CONCLUSIONS: The participatory and iterative formative research process yielded an intervention with context validity in real-world CAM practices as it: 1) is patient/client-centered, emphasizing the practitioner's role in a healing relationship; 2) is responsive to the different contexts of CAM practitioners' work and patient/client relationships; 3) integrates relevant best practices from US Public Health Service Clinical Practice Guidelines on treating tobacco dependence; and 4) is suited to the range of healing philosophies, scopes of practice and practice patterns found in participating CAM practitioners. The full CAMR study to evaluate the impact of the CAMR intervention on CAM practitioners' clinical behavior is underway.

Submitted by Ronildo Prado (ronisp@ufscar.br) on 2016-09-20T14:31:30Z No. of bitstreams: 1 DissBKM.pdf: 1169423 bytes, checksum: 39b613f01adf2eeb7d14a31a1eae9b0d (MD5) / Approved for entry into archive by Ronildo Prado (ronisp@ufscar.br) on 2016-09-20T14:31:57Z (GMT) No. of bitstreams: 1 DissBKM.pdf: 1169423 bytes, checksum: 39b613f01adf2eeb7d14a31a1eae9b0d (MD5) / Approved for entry into archive by Ronildo Prado (ronisp@ufscar.br) on 2016-09-20T14:32:17Z (GMT) No. of bitstreams: 1 DissBKM.pdf: 1169423 bytes, checksum: 39b613f01adf2eeb7d14a31a1eae9b0d (MD5) / Made available in DSpace on 2016-09-20T14:32:26Z (GMT). No. of bitstreams: 1 DissBKM.pdf: 1169423 bytes, checksum: 39b613f01adf2eeb7d14a31a1eae9b0d (MD5) Previous issue date: 2015-02-20 / Não recebi financiamento / Pain disorders are usually related to lower level of general health, quality of life and poores work performance. Brazilian studies show that pain disorders have been described as the second or third leading cause of absence from work. Therefore this replication study was conducted to evaluate a brief intervention program developed by Nash et al (2004) that could be implemented in companies or organizations, which would represent an important advance in dealing with this problem. This study aimed to evaluate the effects of a brief intervention protocol, using behavioral and cognitive-behavioral techniques for administrative employees with chronic pain diagnoses. The impacts were evaluated along three dimensions: 1) self-perception of both pain and work impacts; 2) mental health indicators, including measures of depression, anxiety and stress; and 3) measures of functionality and quality of life. The study included five public service workers, between 36 and 61 years of age. Three women had been diagnosed with Fibromyalgia, one with Migraines and the other with neuritis. Time since diagnosis ranged from 2 to 7 years. The intervention was programmed using a multiple baseline procedure in four phases: 1) Baseline; 2) Module 1 (Psychoeducation about pain processes); 3) Module 2 (Relaxation Techniques); and 3) Module 3 (Stress and coping strategies). During the Initial Evaluations and over the course of the intervention, the following instrumentes were used: General Interview, Inventory of Stress Symptoms for Adults - Lipp (ISSL), Beck Depression and Anxietyies Inventory, FAST and the WHOQOL-BREF Scale. The Individual records showed a correlation between the intensity of pain and effectiveness in working conditions in general (r = 0.86, p <0.001) and for each of the participants. It was possible to observe the effect of the intervention at different times, for all participants. Initially, all participants had health care needs related to stress (four presented scores of resistance and one of almost exhaustion). Two had health care needs related to depression (P4 and P6) and two had process related to anxiety (P2 and P4). One participant (P4) had health care needs on all three measures. With regards to functionality, three respondents reported having difficulty in performing cognitive activities and one of the participants reported having difficulties in both controlling money and managing daily financial routines. The participants had average scores close to 50 points in the four areas assessed by the WHOQOL-BREF. Following the intervention, three of the five subjects had an increase in their total score for quality of life. Four participants also reported less difficulty with functionality, considering all the domains evaluated, with better performance observed in the autonomy domain. The strong points of the protocol were discussed along with challenges in its execution. Further research are needed to. / Os transtornos dolorosos são usualmente relacionados a perdas na saúde em geral, na qualidade de vida e do trabalho; processos dolorosos têm sido descritos como a segunda e terceira causa de afastamento do trabalho, em todo o País. Desta forma, programas de intervenções breves, replicando estudo anterior (Nash et al, 2004) que pudessem ser implementados nas próprias empresas ou organizações, podem representar avanços importantes para lidar com este problema. O presente estudo teve como objetivo avaliar os efeitos de um protocolo de intervenção breve, utilizando técnicas comportamentais e cognitivo-comportamentais, para funcionários administrativos de uma universidade pública, portadores de dor crônica. Foram avaliados impactos em três dimensões: 1) auto percepção da dor e do impacto no trabalho; 2) indicadores de saúde mental, particularmente depressão, ansiedade e estresse; e, 3) indicadores de funcionalidade e qualidade de vida. Participaram do estudo cinco funcionárias públicas, com idade variando entre 36 e 61 anos; três mulheres tinham o diagnóstico de Fibromialgia, uma Enxaqueca e uma Neurite. O tempo desde o diagnóstico variou de 2 a 7 anos. A intervenção foi programada utilizando um procedimento de linha de base múltipla, em quatro fases: 1) Linha de base; 2) Módulo 1 (Psicoeducação sobre dor); 3) Módulo 2 (Técnicas de Relaxamento); e 3) Módulo 3 (Estresse e estratégias de enfrentamento). Para avaliação inicial e ao longo do processo de coleta e intervenção foram utilizados: Roteiro da Entrevista, Inventário de Sintomas de Stress para Adultos de Lipp (ISSL), Inventário Beck de Depressão e de Ansiedade, Escala FAST e Inventário WHOQOL-BREF. Registros individuais mostraram uma relação entre a intensidade da dor e a pouca efetividade nas condições de trabalho em geral (r=0,86, p<0,000) e para cada uma das participantes. Foi possível observar o efeito da introdução da intervenção, em diferentes momentos, para todos os participantes. Na avaliação inicial, todos os participantes apresentaram indicadores de cuidado de saúde em estresse (quatro apresentando escore de resistência e um de quase exaustão). Duas apresentavam indicador de cuidado em depressão (P4 e P6) e duas em ansiedade (P2 e P4). Um participante (P4) apresentava indicador de cuidado em todas as condições. Quanto a funcionalidade três dos participantes relataram ter dificuldade no desempenho de atividades cognitivas e uma das participantes relata ter dificuldades no controle de dinheiro e aspectos financeiros diários. Os participantes apresentaram resultados médios próximos aos 50 pontos nos quatro domínios avaliados pelo WHOQOL-BREF. Ao final, três das cinco participantes apresentaram aumento no indicador total de qualidade de vida. Com exceção de P5 todas as participantes apresentaram menor dificuldade de funcionalidade na média de todos os domínios avaliados, sendo a autonomia o domínio com melhor desempenho. Foram discutidas as vantagens de protocolos como implementado, as dificuldades observadas na sua execução e propostas para estudos posteriores.