ANA FLAVIA PIRES LUCAS D OLIVEIRA
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Medicina Preventiva, Faculdade de Medicina - Docente
LIM/39 - Laboratório de Processamento de Dados Biomédicos, Hospital das Clínicas, Faculdade de Medicina
LIM/39 - Laboratório de Processamento de Dados Biomédicos, Hospital das Clínicas, Faculdade de Medicina
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- Psychometric properties of a condition-specific PROM for the psychosocial consequences of Labelling hypertension by using Rasch analysis(2021) GYURICZA, Janos Valery; CHRISTENSEN, Karl Bang; D'OLIVEIRA, Ana Flavia Pires Lucas; BRODERSEN, JohnBackground A previous qualitative assessment of the psychosocial consequences of labelling hypertension describes the diagnosis of hypertension as a labelling event with potential unintended negative long-term psychosocial consequences (labelling effects). Until now, the benefits of diagnosing hypertension have been far more reported than the harms. To obtain the net result of the preventive interventions for cardiovascular disease, such as diagnosing and treating mild hypertension, assessing benefits and harms in the most comprehensive way possible is necessary, including the psychosocial consequences of labelling. When measuring psychosocial consequences of labelling hypertension, a questionnaire with high content validity and adequate psychometric properties is needed. Objectives The aim of this study was to describe the psychometric parameters of face and content-validated pool of items. Other objectives were also to screen the item pool by using Rasch model analysis and confirmatory factor analysis (CFA) for identifying such items with sufficient fit to the hypothesised models. Methods We surveyed the pool of items as a draft questionnaire to Brazilians recruited via social networks, sending e-mails, WhatsApp (R) messages and posting on Facebook (R). The inclusion criteria were to be older than 18 years old, to be healthy and to have only hypertension. We used Rasch model analysis to screen the item pool, discarding items that did not fit the hypothesised domain. We searched for local dependence and differential item functioning. We used CFA to confirm the derived measurement models and complementarily assessed reliability using Cronbach's coefficient alpha. Results The validation sample consisted of 798 respondents. All 798 respondents completed Part I, whereas 285 (35.7%)-those with hypertension-completed Part II. A condition-specific questionnaire with high content validity and adequate psychometric properties was developed for people labelled with hypertension. This measure is called 'Consequences of Labelling Hypertension Questionnaire' and covers the psychosocial consequences of labelling hypertension in two parts, encompassing a total of 71 items in 15 subscales and 11 single items. Conclusion We developed a tool that can be used in future research involving hypertension, especially in scenarios of screening, prevention, population strategies and in intervention studies. Future use and testing of the questionnaire may still be required.
- Patterns of alcohol use among men receiving treatment for heroin and/or cocaine use in England, Brazil and Spain. A cross-country analysis(2020) RADCLIFFE, Polly; CANFIELD, Martha; D'OLIVEIRA, Ana Flavia Pires Lucas; FINCH, Emily; SEGURA, Lidia; TORRENS, Marta; GILCHRIST, GailIntroduction: Although alcohol is widely used concurrently with illicit drugs, the role of alcohol in recovery from and relapse to drug use is under-researched. This study investigates drinking patterns and factors associated with harmful drinking among men receiving community treatment for heroin and/or cocaine use. Methods: Secondary analysis of 3 cross-sectional studies in England (n = 153), Brazil (n = 149) and Spain (n = 131) was conducted. Sociodemographic, alcohol consumption (AUDIT), substance use, treatment characteristics, and physical health were assessed. Logistic regression determined factors associated with harmful drinking. Results: 41% of men receiving heroin and/or cocaine treatment met criteria for harmful drinking. Of this, 28% were not receiving treatment for alcohol. Factors identified with harmful drinking among those who were not receiving treatment for alcohol use were as follows: homeless, unemployment/receiving benefits, poly drug use, history of injecting drug(s), hepatitis C seropositive, and receiving treatment for heroin use with/without treatment for cocaine use. Participants from England who met criteria for harmful drinking were more likely to report not receiving treatment for alcohol use than those from Brazil and Spain. Discussion: Findings show that harmful drinking is common among men in treatment for drug use and remains neglected by the services.
- Engaging early career researchers in a global health research capacity-strengthening programme: a qualitative study(2023) HAWCROFT, Claire; ROSSI, Evelina; TILOUCHE, Nerissa; D'OLIVEIRA, Ana Flavia; BACCHUS, Loraine J.BackgroundResearch capacity-strengthening is recognized as an important component of global health partnership working, and as such merits monitoring and evaluation. Early career researchers are often the recipients of research capacity-strengthening programmes, but there is limited literature regarding their experience.MethodsWe conducted a qualitative study as part of an internal evaluation of the capacity-strengthening programme of the international HERA (HEalthcare Responding to violence and Abuse) research group. Semi-structured interviews were conducted with group members, and thematic analysis was undertaken.ResultsEighteen group members participated; nine of these were early career researchers, and nine were other research team members, including mid-career and senior researchers. Key themes were identified which related to their engagement with and experience of a research capacity-strengthening programme. We explored formal/planned elements of our programme: mentoring and supervision; training and other opportunities; funding and resources. Participants also discussed informal/unplanned elements which acted as important facilitators and/or barriers to engaging with research capacity-strengthening: English language; open relationships and communication; connection and disconnection; and diversity. The sustainability of the programme was also discussed.ConclusionsOur study gives voice to the early career researcher experience of engaging with a research capacity-strengthening programme in a global health group. We highlight some important elements that have informed adaptations to our programme and may be relevant for consideration by other global health research capacity-strengthening programmes. Our findings contribute to the growing literature and important discussions around research capacity-strengthening and how this relates to the future directions of global health partnership working.
- Remote methods for research on violence against women and children: lessons and challenges from research during the COVID-19 pandemic(2022) BHATIA, Amiya; TURNER, Ellen; AKIM, Aggrey; MIREMBE, Angel; NAKUTI, Janet; PARKES, Jenny; DATZBERGER, Simone; NAGAWA, Rehema; KUNG'U, Mary; BABU, Hellen; KABUTI, Rhoda; KIMANI, Joshua; BEATTIE, Tara S.; D'OLIVEIRA, Ana Flavia; RISHAL, Poonam; NYAKUWA, Robert; BELL, Sadie; BUKULUKI, Paul; CISLAGHI, Beniamino; TANTON, Clare; CONOLLY, Anne; MERCER, Catherine H.; SEELEY, Janet; BACCHUS, Loraine J.; DEVRIES, KarenCollecting data to understand violence against women and children during and after the COVID-19 pandemic is essential to inform violence prevention and response efforts. Although researchers across fields have pivoted to remote rather than in-person data collection, remote research on violence against women, children and young people poses particular challenges. As a group of violence researchers, we reflect on our experiences across eight studies in six countries that we redesigned to include remote data collection methods. We found the following areas were crucial in fulfilling our commitments to participants, researchers, violence prevention and research ethics: (1) designing remote data collection in the context of strong research partnerships; (2) adapting data collection approaches; (3) developing additional safeguarding processes in the context of remote data collection during the pandemic; and (4) providing remote support for researchers. We discuss lessons learnt in each of these areas and across the research design and implementation process, and summarise key considerations for other researchers considering remote data collection on violence.
- Factors associated with the severity of IPV perpetrated by substance using men towards current partner(2019) CANFIELD, Martha; RADCLIFFE, Polly; D'OLIVEIRA, Ana Flavia Pires Lucas; GILCHRIST, GailPurpose The purpose of this paper is to examine frequency and correlates of intimate partner violence (IPV) severity perpetrated by heterosexual men receiving treatment for substance use towards a current partner in the past 12 months. Design/methodology/approach A secondary analysis of a self-reported questionnaire (n=162) completed by men receiving treatment for substance use in England and Brazil was conducted. Types of IPV perpetration (emotional, physical and/or sexual IPV) and frequency of occurrence were assessed. A five level ordinal variable for IPV perpetration severity was created: no IPV, minor; moderate, low severe and high severe. Psychological and cultural correlates of perpetration severity were explored using ordinal logistic regression. Findings Approximately four in ten men reported perpetrating IPV towards their partner in the past 12 months, one in ten reported perpetrating severe IPV (including hitting with something, kicking or beating, choking or burning, threatening with/using a weapon, sexual IPV and frequent emotional IPV) during this period. A number of correlates of perpetration severity were identified: experiencing childhood physical abuse, witnessing IPV in childhood, perpetrating IPV in previous relationships, committing violence towards another man, controlling behaviours, technology-facilitated abuse, depressive symptoms, having a substance using partner, receiving treatment for illicit drug use, hazardous drinking and poly-drug use. Originality/value A strength of this study methodology is the use of a specific 12 months time frame for the perpetration of IPV towards current partner. The categorisation of levels of IPV perpetration based on types and frequency of violence occurrence was an additional valuable contribution of this study.
- Development of an item pool for a questionnaire on the psychosocial consequences of hypertension labelling(2019) GYURICZA, Janos Valery; D'OLIVEIRA, Ana Flavia Pires Lucas; MACHADO, Lucas Bastos Marcondes; BRODERSEN, JohnBackground Hypertension is the most prevalent risk factor for cardiovascular disease globally. Roughly one-third of the adult population has hypertension. However, most people diagnosed with hypertension do not benefit from blood pressure control with pharmacologic interventions: they are overdiagnosed and overtreated and might experience negative psychosocial consequences of being labelled. These consequences are relevant outcomes that need to be assessed and validly measured to identify all benefits and harms related to interventions designed to prevent cardiovascular disease. Objectives To develop a pool of items with high content validity for a draft version of a condition-specific questionnaire to measure the psychosocial consequences of being labelled with mild hypertension. Methods We selected relevant items from existing Consequences of Screening (COS) questionnaires. These items belonged to two groups: COS core items and potential condition-specific items. All items were originally in Danish and were translated into Brazilian Portuguese using the dual-panel method. Individual and group interviews were conducted with people with mild hypertension and low risk for cardiovascular disease, and were designed to test the translated items for face and content validity and were also used to generate new relevant items. Structured individual interviews were conducted to categorise all the items into domains. Results The Brazilian Portuguese dual-panel translation of both groups of items was found to be relevant for adults diagnosed with hypertension. We generated 52 new items to achieve high content validity. The result was a set of 132 items divided into 22 domains in 2 parts. Part I was directed at the general population, whereas part II was directed only at people diagnosed with hypertension and it consisted of 38 items in 8 domains. Twelve items remained as single items. High content validity was achieved with the pool of 132 items divided into 22 domains in 2 parts. Discussion High content validity was achieved for a condition-specific questionnaire measuring the psychosocial consequences of being labelled with mild hypertension. This instrument encompassed 132 items divided into 22 domains in 2 parts. Thereby, a draft of the Consequneces of Hypertension questionnaire (COH) was developed. The psychometric properties of this questionnaire will be discussed in a diferent paper.
- Improving health system readiness to address violence against women and girls: a conceptual framework(2022) COLOMBINI, Manuela; MAYHEW, Susannah H.; GARCIA-MORENO, Claudia; D'OLIVEIRA, Ana Flavia; FEDER, Gene; BACCHUS, Loraine J.Background There is an increasing focus on readiness of health systems to respond to survivors of violence against women (VAW), a global human rights violation damaging women's health. Health system readiness focuses on how prepared healthcare systems and institutions, including providers and potential users, are to adopt changes brought about by the integration of VAW care into services. In VAW research, such assessment is often limited to individual provider readiness or facility-level factors that need to be strengthened, with less attention to health system dimensions. The paper presents a framework for health system readiness assessment to improve quality of care for intimate partner violence (IPV), which was tested in Brazil and Palestinian territories (oPT). Methods Data synthesis of primary data from 43 qualitative interviews with healthcare providers and health managers in Brazil and oPT to explore readiness in health systems. Results The application of the framework showed that it had significant added value in capturing system capabilities - beyond the availability of material and technical capacity - to encompass stakeholder values, confidence, motivation and connection with clients and communities. Our analysis highlighted two missing elements within the initial framework: client and community engagement and gender equality issues. Subsequently, the framework was finalised and organised around three levels of analysis: macro, meso and micro. The micro level highlighted the need to also consider how the system can sustainably involve and interact with clients (women) and communities to ensure and promote readiness for integrating (and participating in) change. Addressing cultural and gender norms around IPV and enhancing support and commitment from health managers was also shown to be necessary for a health system environment that enables the integration of IPV care. Conclusion The proposed framework helps identify a) system capabilities and pre-conditions for system readiness; b) system changes required for delivering quality care for IPV; and c) connections between and across system levels and capabilities.
conferenceObject Prevalence and risk factors for intimate partner violence perpetration by men in substance use treatment in England and Brazil: A cross-cultural comparison(2016) GILCHRIST, G.; RADCLIFFE, P.; D'OLIVEIRA, A. F. P. L.- An evidence-based primary health care intervention to address domestic violence against women in Brazil: a mixed method evaluation(2023) BACCHUS, Loraine J.; D'OLIVEIRA, Ana Flavia Pires Lucas; PEREIRA, Stephanie; SCHRAIBER, Lilia Blima; AGUIAR, Janaina Marques de; GRAGLIA, Cecilia Guida Vieira; BONIN, Renata Granusso; FEDER, Gene; COLOMBINI, ManuelaBackgroundHealth systems have a critical role in a multi-sectoral response to domestic violence against women (DVAW). However, the evidence on interventions is skewed towards high income countries, and evidence based interventions are not easily transferred to low-and middle-income countries (LMIC) where significant social, cultural and economic differences exist. We evaluated feasibility and acceptability of implementation of an intervention (HERA-Healthcare Responding to Violence and Abuse) to improve the response to DVAW in two primary health care clinics (PHC) in Brazil.MethodsThe study design is a mixed method process and outcome evaluation, based on training attendance records, semi-structured interviews (with 13 Primary Health Care (PHC) providers, two clinic directors and two women who disclosed domestic violence), and identification and referral data from the Brazilian Epidemiological Surveillance System (SINAN).ResultsHERA was feasible and acceptable to women and PHC providers, increased providers' readiness to identify DVAW and diversified referrals outside the health system. The training enhanced the confidence and skills of PHC providers to ask directly about violence and respond to women's disclosures using a women centred, gender and human rights perspective. PHC providers felt safe and supported when dealing with DVAW because HERA emphasised clear roles and collective action within the clinical team. A number of challenges affected implementation including: differential managerial support for the Nucleo de Prevencao da Violencia (Violence Prevention Nucleus-NPV) relating to the allocation of resources, monitoring progress and giving feedback; a lack of higher level institutional endorsement prioritising DVAW work; staff turnover; a lack of feedback from external support services to PHC clinics regarding DVAW cases; and inconsistent practices regarding documentation of DVAW.ConclusionTraining should be accompanied by system-wide institutional change including active (as opposed to passive) management support, allocation of resources to support roles within the NPV, locally adapted protocols and guidelines, monitoring progress and feedback. Communication and coordination with external support services and documentation systems are crucial and need improvement. DVAW should be prioritised within leadership and governance structures, for example, by including DVAW work as a specific commissioning goal.