The Psychologist: Practice & Research Journal
SEE TABLE OF CONTENTS OF PPRJ FOR ONLINE SUBMISSIONS, PLEASE CLICK HERE The Psychologist: Practice & Research Journal (PPRJ; ISSN 2184-3317) is the scientific journal of the Professional Association of Portuguese Psychologists (Ordem dos Psicólogos Portugueses). Why publish your article in PPRJ? Ethical principles PPRJ endorses the principles of the Committee on Publication Ethics (COPE). Only original papers are eligible to be submitted to PPRJ. The journal endorses a strict policy against multiple submissions or redundant publications, as well as against plagiarism, citation manipulation, and data falsification or fabrication. High visibility PPRJ is a free-to-publish and open-access journal, allowing maximum visibility of articles to a wide, global audience. Flexibility Exclusive online publication allows publishing large datasets or supplementary materials. It also allows color illustrations and the inclusion of relevant links. Finally, but of major relevance, the exclusive online publication also facilitates the interaction with Reference Management Software such as EndNote, Zotero, Docear, or Mendeley (among others). Impact factor PPRJ is a recently-established journal and, therefore, still does not have an impact factor. Nevertheless, our editorial team is invested in having the journal indexed in the main academic databases and search engines (e.g., PsycINFO, PubMed, SciELO, JSTOR, Scopus, Web of Science, Google Scholar). We are enthusiastic about receiving your contributions as authors of high-quality papers, for continuously promoting the relevance and visibility of PPRJ. Copyright Authors of papers published in PPRJ retain the copyright and are free to reproduce and to disseminate their published work.
Authors of articles published in PPRJ retain the copyright and are free to reproduce and disseminate their published work.
Community participation in health promotion programs in Portugal: development and implementation of the Cascais Local Forum for Health Promotion
Current international and national guidelines on health promotion recommend the collaborative involvement of the communities that will use and benefit from the implementation of policies and interventions in public health. As such, communities should be involved in every step of the process, from setting priorities to dissemination of findings and outcomes that they will use to address health of communal concern. In Portugal, there has been a growing interest in participatory approaches mainly to set priorities that address diverse societal concerns. In the particular case of health promotion, it stills not a widespread approach. This paper aims to describe the development and implementation of the Cascais Local Forum for Health Promotion (FCPS). Cascais FCPS is a local network of public schools, profit and non-profit organizations and private companies from the healthcare sector that share a common purpose: to increase health and well-being of people living in Cascais. To accomplish this main endeavour, Cascais FCPS adopted a community-based participatory research approach and fosters the involvement of citizens throughout the whole process of developing and implementing the Local Strategy for Health Promotion (ELPS 2016-2020). Cascais FCPS also established a partnership with an academic research institution and created the Cascais Observatory for Health Promotion (Cascais OPS). Cascais OPS independently assesses the partnership process and outcomes under the ELPS 2016-2020, among other responsibilities more devoted to research in public health promotion. Several partnership- and methodological-related challenges are anticipated for the upcoming years; as such, Cascais OPS in collaboration with Cascais FCPS have produced a set of recommendations on how to tackle these. In the Portuguese context, Cascais FCPS is an innovative programme in public health promotion at the local level, which despite its young age (formally created in 2016), it has been successful in the accomplishment of its main objectives
Essays, Clinical cases, Innovative Interventions
Copyright (c) 2020 Ana Virgolino, Teresa Silva, Manuela Correia, Ricardo Caldeira, Mónica Fialho, Paula Batista-Santos, Osvaldo Santos
Determinants of effective communication from policymakers and health authorities in the contexts of public health crises
Effective communication from policymakers and health authorities is a critical determinant in public health crisis management, especially during pandemics such as COVID-19. This paper identifies key elements that enhance communication effectiveness: trust, clarity, consistency, cultural sensitivity, and inclusivity. Drawing from the Crisis and Emergency Risk Communication (CERC) model, it outlines a phased communication strategy that evolves with the crisis, ensuring transparency, scientific grounding, and adaptability to emerging evidence. Trust in health messages increases when they are delivered by credible sources – primarily, health professionals and scientists – using accessible language and narratives. Social media's rapid dissemination capacity and the prevalence of misinformation highlight the need for proactive, coordinated, and targeted communication strategies that consider audience-specific literacy and perceptions. The study also emphasizes the importance of strategic collaboration between health authorities and the media, recommending the establishment of dedicated communication support units and training for both journalists and spokespersons. Clear guidelines for message dissemination, tested for clarity and cultural resonance, are essential to encourage adherence to public health behaviors. Ultimately, the paper advocates for a health communication that is transparent, empathetic, empowering, and aligned with community values and social norms, enabling effective population-wide engagement during health crises.
Copyright (c) 2022 Osvaldo Santos, Margarida Gaspar de Matos
Schools' context and COVID-19 | Fact-sheets collection from the Portuguese COVID-19 pandemic Task Force on Behavioral Sciences
Children and adolescents represent a relatively small proportion of total COVID-19 cases, with low rates of severe illness. Transmission in school settings is generally limited, primarily involving staff rather than students. On the other hand, school closures, though minimally effective in reducing mortality, have had severe psychological, developmental, and educational impacts, particularly on vulnerable populations. Educational institutions play a key role in children’s cognitive, emotional, and behavioral development and are central in promoting public health behaviors. This policy brief aims to leverage school environments to mitigate COVID-19 transmission, while safeguarding students’ well-being and educational development. It integrates behavioral science models to support sustained health-promoting behaviors and addresses equity concerns associated with school closures. Key messages are: schools are essential platforms for health education and the promotion of protective behaviors. Applying the COM-B model, this framework advocates for regular updates on local epidemiological conditions, integration of health topics into curricula, and student-led initiatives to reinforce preventive practices. Schools should remain open with enhanced psychological support and targeted interventions, especially for transition-year students. Intergenerational transmission of protective behaviors, reinforced through structured school activities, can foster widespread community health benefits. Active mobility strategies and health literacy initiatives further complement efforts to maintain safe learning environments. The framework underscores the necessity of inclusive, context-specific measures that prioritize mental health, educational continuity, and long-term public health resilience.
Sports events: crowd dynamics and relevance in the context of the COVID-19 pandemic | Fact-sheets collection from the Portuguese COVID-19 pandemic Task Force on Behavioral Sciences
Cultural and sporting events hold significant social value, promoting cognitive, emotional, and interpersonal skills. The COVID-19 pandemic has disrupted these events, necessitating a careful examination of safety conditions for their resumption. This policy brief summarizes evidence on safety predictors in organizing large-scale sporting events, focusing on crowd dynamics and relevance in the context of the pandemic. Emphasis is given to the importance of understanding crowd behavior, noting that violent behavior is an exception rather than the rule. Various factors need to be considered for promoting public health safety in the pandemic context, including the nature of the sport, spatial organization, and socio-demographic characteristics of the audience. Key recommendations include maintaining physical distance, organizing outdoor events, and perceiving crowds as compositions of smaller groups with shared social identities. Clear communication, consistent messaging, and involvement of informed individuals to guide crowd behavior are also crucial. Mega events can be used to promote COVID-19 health behaviors and to enhance collaborative actions among various stakeholders, including government bodies, sports organizations, and the media, to ensure safe sporting events.
Copyright (c) 2022 Osvaldo Santos, Gaspar de Matos Margarida
Adverse childhood experiences of sexual offenders against children and adolescents: an analysis of life-trajectory perceptions based on the bioecological theory
Background: Adverse Childhood Experiences (ACEs) have been reported in research involving sexual offenders against children and adolescents, becoming indispensable for understanding aggressive behaviors later manifested by these individuals. However, few studies address them from an ecological and developmental perspective. Goals: The present study aimed to understand perceptions regarding the occurrence of Adverse Childhood Experiences (ACEs) based on the life-history narratives of sexual offenders against children and adolescents. Methods: A total of 30 interviews were analyzed, conducted with men aged between 27 and 70 years who had been convicted of sexual crimes against children and adolescents in the state of Pará, Brazil. Content analysis was conducted using thematic categories derived from the ACE-IQ instrument. The software Iramuteq was employed to perform correspondence analysis using Descending Hierarchical Classification (DHC). Results: The results indicated retention of 88.81% of the textual corpus (119 text segments), yielding five classes. These classes revealed that the ACE category “Sexual abuse” (Class 5) was perceived as distinct from the others due to its specificity, at times being recognized as abuse and at other times as a sexual relationship. Experiences of bullying and involvement in physical fights (Class 4) were also reported with specific vocabulary, occurring during the transitional phase from childhood to adolescence, in which school and family emerged as weakly interconnected environments. Finally, a correspondence relationship was identified among Class 1 – Parental death and substance abuse by family members; Class 2 – Neglect and parental separation; and Class 3 – Physical abuse and domestic violence. All three were associated with the family context and the difficulties in establishing dyadic relationships with caregivers during the participants’ development. Discussion and conclusion: Investigating ACEs based on the principles of the Bioecological Model of Human Development enables a deeper understanding of the mechanisms that contribute to the emergence of sexually aggressive behaviors. Such knowledge supports the creation of effective strategies for protection and prevention of these behaviors, while also expanding the understanding of the conditions that foster their occurrence.
Copyright (c) 2024 Maira de Maria Pires Ferraz, Lília Iêda Chaves Cavalcante, Milene Maria Xavier Veloso, Samille da Silva de Andrade, Aline Pinheiro Alves
Mental health in primary health care: professionals' perceptions and patients' levels of depression, anxiety and stress
Background: The integration of mental health in primary health care, throughout its various functional units and with effective articulation between primary health care and mental health services, has been considered an essential objective of the legislative documents produced in the last three decades in Portugal, among them the National Health Plan 2011-2016. Goals: This study aimed to inquire health professionals’ perceptions about mental health care provided by public primary health care units, namely their perceptions about the mental health of their patients. It also intended to explore the difficulties perceived by the health professionals in their daily activity about the mental health problems of their patients and about the need of clinical psychologists’ activity in the public primary health care. Methods: This is an observational cross-sectional study with two non-probabilistic samples: health professionals (doctors, nurses and psychologists) and patients from two public health care units. Health professionals were interviewed (individual structured face-to-face interviews) about their perceptions of needs for improving their capacity to provide mental healthcare and about patients’ mental health conditions. Patients responded (by self-administration) to the Depression, Anxiety and Stress Scale (DASS-21), providing a characterization of patients’ stress, anxiety and symptoms of depression. Results: Health professionals in their daily practice often identify in their patients symptoms of stress, anxiety and depression (most particularly in adults),. Several issues were identified as problematic, such as: poor access of the referral system for psychiatric and clinical psychological specialized care, insufficient number of health professionals, particularly of psychologists, and lack of appropriate mental health care specialization. The results also revealed relevant levels of stress, anxiety and depression in primary health care patients (both genders), which seem to increase with age. Discussion: Difficulties identified by health professionals may relate to the centralisation of resources, resistance to change from human resources management, lack of consensus among the various decision groups linked to mental health and, at institutional level, insufficient and inadequate funding. These factors may contribute to a failure in early diagnosis of symptoms of depression, anxiety and stress. It is expected that articulation between primary health services and differentiated health services will improve, with improvement in teamwork among professionals and increase of the quality of life of users, satisfaction with work, from health professionals, and reduction of health costs.
Copyright (c) 2020 Tatiana Varela Madureira, Cristina Quintas Antunes
Bibliotherapy and mental health: literature as a mediator of expressiveness and resilience in the face of global threat narratives and psychological vulnerability
Bibliotherapy is an intervention with both preventive and therapeutic dimensions, transdisciplinary and transdiagnostic in nature. It enables individuals, through listening, reading, or dramatization of texts (individually or in groups) to: communicate and express emotions, enhance self-understanding by valuing their personality and promoting self-esteem, become familiar with external reality and clarify real problems (improving their ability to respond to them), refine orientation toward reality by correcting perceptions of the surrounding world, and foster better adaptation and adjustment to their life context, whether in educational, professional, clinical, or correctional settings. Bibliotherapy encompasses personal, familial, and community domains. Understood as both a science and an art by researchers in the field, the bibliotherapeutic process also offers other benefits, namely: enhancing socialization and preventing isolation, promoting tolerance, respect, and self-acceptance as well as acceptance of others, stimulating critical thinking and higher-level reasoning, providing moments of joy and relaxation, and encouraging reading as a leisure activity. According to Régine Detambel, the main work of the bibliotherapist is to promote well-being and resilience. Through the examination of shared experiences and national and international studies, the application of bibliotherapy offers benefits to mental health for patients, their families, and therapists, making it a valuable addition to a health-professional practice toolkit, as it addresses all life stages and responds to the diversity of global threats and situations of heightened psychological vulnerability.
Copyright (c) 2024 Aida Borges, Tânia Morgado, Carlos Melo, Filipa Maduro, Dulce Carvalho
STOP Procrastination: development and expert evaluation of a new acceptance and compassion-based group intervention
Backgound: Procrastination has been characterized as a deliberate delay of an intended course of action despite anticipating negative consequences. Literature has found associations between psychopathological symptoms and impaired functioning, particularly in academic contexts. Goals: The present work aimed to develop and characterize an experts’ panel evaluation of a new psychotherapeutic group intervention named “STOP Procrastination: Sensitize, Transform, Organize, Produce” based on the combination of traditional cognitive-behavioral therapy and contextual behavioral approaches. Methods: STOP is a 10-session group intervention aimed at helping people reduce their levels of procrastination by fostering more adaptive emotional regulation skills. Results: Results show that experts found STOP highly acceptable, adequate to the target population, and viable for implementation. Discussion: Qualitative suggestions regarding sessions were considered for STOP improvement. With further study, STOP has the potential to help individuals to better manage their procrastination.
Copyright (c) 2025 Andreia Ferreira, Sandra Xavier, Sofia Caetano, Marisa Marques, Joana Martins, António Queirós, Maria João Martins
Assessing functional impairment in university students seeking psychological help: a psychometric study of the Portuguese Work and Social Adjustment Scale
Background: It has been advocated that higher education settings should promote a supportive environment devoted to improving several dimensions of the well-being of their communities. Assessing functional impairment is of utmost importance, particularly in clinical services. Goals: The present study aimed at analyzing factor structure and psychometric properties of the Work and Social Adjustment Scale (WSAS), a 5-item scale developed to assess the patient’s perceived functional impairment resulting from a health problem in five dimensions: work, social leisure activities, private leisure activities, and relationships with others. Methods: A non-probabilistic sample of university students who sought mental health support answered a set of self-report questionnaires, including the WSAS and measures of anxiety, depression, and quality of life. Results: Overall, 207 university students participated in the study (22 years old of mean age; 74,9% female and 69,2% undergraduate). Confirmatory factor analysis indicated an adequate fit to the single-factor structure, and the scale presented very good reliability. Concurrent, convergent, and incremental validity were also found, and the WSAS differentiated groups with different levels of anxiety and depressive symptoms. Discussion: Overall, our results corroborate that WSAS is a brief, reliable, and valid measure, and, therefore, useful in research and clinical settings. Further research is needed, particularly regarding temporal stability, discriminative power between clinical and nonclinical populations, and clinical samples between different diagnoses.
Copyright (c) 2024 Sofia Caetano, Marisa Marques, Ana Carvalhal de Melo, Andreia Ferreira, Sandra Xavier, António Queirós, Maria João Martins
Psychosocial exposome and double precarity as emergent concepts for an old story
Psychosocial exposome is presented as a novel integrative concept, stressing out the relevance of individual unique physical and psychological caracteristics and how these interact with a multitude of global (e.g., pandemics, climate change, war, etc.) and proximal (e.g., family, individuals' health conditions, socio-economic status, etc.) challenges, at different moments of the life cycle. Double precarity (precarious housing and employment) is highlighted as a highly relevant marker of psychosocial exposome due to its close relationship with decision making and mental health. Despite not being a new phenomenon, double precarity has been recently recognized also as a main health-related determinant, especially when considering the Portuguese (and international) economical crises, associated with global threats. Evidence-based science addressing individual and plublic health is crucial for mitigating the negative effects of enduring scenarios of double precarity as a relevant component of the psychosocial exposome.
Copyright (c) 2023 Osvaldo Santos, Isabela Sousa
Scientific Committee V OPP Congress, 2022
Trust in times of pandemics | Fact-sheets collection from the Portuguese COVID-19 pandemic Task Force on Behavioral Sciences
Trust is a multifactorial and dynamic interpersonal (and institutional) facet, highly sensitive to individual, social, political, and economic contexts. It is a crucial determinant for adherence to public health measures, especially when those measures are addressed to a large (or universal) group of citizens in scenarios of uncertainty, such as the COVID-19 pandemic scenario. Indeed, trust in public institutions, experts, and citizens is essential for effective cooperation and coordinated responses to pandemics. This paper discusses the concept of trust as a family of concepts, including trust, distrust, and mistrust. The importance of reciprocity in trust-based relationships is also highlighted, as a more long-lasting effective alternative to a “duty-to-trust” paternalistic and directive approach.
Confidence in public health stakeholders
Copyright (c) 2024 Osvaldo Santos, Margarida Gaspar de Matos
Adjustment and perceived needs of cancer survivors: a qualitative exploratory study in a Portuguese island region
Background: Cancer survivors from rural or isolated areas may experience psychosocial adjustment issues and needs following treatments. The adjustment and the perceived needs of cancer survivors in the Azores have not been investigated. Goals: To explore the adjustment to survivorship and perceived needs of cancer survivors from a Portuguese archipelago region. Methods: Cancer survivors from São Miguel Island (Azores archipelago) took part in this qualitative exploratory study. Three focus groups were carried out, which were transcribed, coded through thematic analysis, and analyzed using NVivo 12. Results: The sample comprised twenty-two cancer survivors. Five main themes emerged: 1) Current adjustment to diagnosis; 2) Barriers to current adjustment; 3) Promoters of current adjustment; 4) Post-diagnostic growth; and 5) Perceived needs and suggestions for improvement. The results revealed that the factors influencing cancer survivors´ adjustment and their perceived needs are similar to those of survivors from other rural or isolated regions. However, some differences were found, such as the perceived trauma related to the follow-up spaced-out period and the displacement to Portugal mainland to perform cancer therapy as a promoter of adjustment in survivorship. Beyond the financial and social concerns, the psychosocial support and continuity of care needs were also expressed by cancer survivors. Discussion: Assessing and monitoring survivors' needs during different stages of the disease could inform health and psychosocial care providers on how to better support cancer survivors from the Azores, preparing them for survivorship. A multidisciplinary approach which recognizes cancer survivors’ difficulties and unmet needs can promote optimal care delivery, improving their adjustment.
Copyright (c) 2023 Marina Sousa, Maria Cristina Canavarro, Joana Cabral, Célia Barreto Carvalho, Helena Moreira
Psychometric properties of the Bergen Facebook Addiction Scale for Portuguese adults
Background: The research about online behavior addiction suggests the importance of improving assessment methods and deepening the knowledge about this phenomenon. Goals: To characterize main psychometric properties of the Bergen Facebook Addiction Scale (BFAS) for Portuguese adults. Methods: This cross-sectional study design involved Portuguese participants who were selected by snowball-convenience sampling. Data were collected through online survey of sociodemographic and BFAS, with invitations distributed by Facebook. Data analysis was performed through descriptive and reliability tests, as well factorial and invariance analysis. Results: The sample was composed of 444 Portuguese people between 18 and 73 years old. Reliability estimate for the one-factor solution was .795, suggesting good internal consistency reliability properties. Confirmatory factor analysis revealed congruence with original unifactorial model of BFAS. Multigroup analysis supported measurement invariance across sex and education level. Discussion: These results suggest reliability and validity. Invariance evidence was also confirmed for the BFAS in a Portuguese sample of Facebook users. These results contribute to the validation process of the Portuguese version of the BFAS, encouraging further studies with different clinical and non-clinical groups.
Copyright (c) 2023 Hugo Rodrigues Fernandes, Helena P. Pereira, Mário Pinto Gonçalves, Eduarda Zenaida Ramião, Helena Isabel Antunes, Fátima Cristina Fernandes, Isabel Cristina Barbosa
Riscos & Desafios (Risk & Challenges) Program in pandemic times: the students’ voice
Background: Preventive interventions are important to delay the onset of high-risk behaviors for young people's health. Regarding emerging adulthood, successful preventive programs are important to avoid high-risk alcohol consumption among university students. Riscos & Desafios (Risk & Challenges) Program is an extracurricular, comprehensive, and multi-component competence enhancement-based preventive intervention designed for students attending the first year of higher education. Goals: This paper aims to give voice to the procedural assessment made by students and to describe the implementation of the Program at the Faculty of Sport of the University of Porto in the second semester of the 2019/2020 school year. This implementation of a previous validated program was innovative twofold, since it has a curriculum infusion format through an optional curricular unit, and because it was developed during the period of lockdown due to COVID-19 pandemic. Methods: This is a mixed-method study that focus on the implementation of the Riscos & Desafios Program during the second semester of 2019/20 academic year. This evaluation of the Riscos & Desafios Program was done with a post-program survey, followed by univariate analysis of frequency. Complementary, an inductive analysis of qualitative data of student’s reflexive reports was carried out, using the QSR-NVIVO 12®. Results: Twenty-three first-year students who participated in the Riscos & Desafios Program constituted the target group of the intervention. Most of the participants were male (n=16) aging between 17 to 21 years. Most attended all the eight sessions and 96% of them participated in seven or more sessions. At the end of the implementation, 23 post-program filled-in questionnaires, and 18 structured reflection reports, were obtained. Most of the students rated the program as very good. Several categories emerged from the thematic analysis of the 18 reports, namely (1) perceived competencies, developed in the program, including the promotion of the social support network, interpersonal and communication skills, problem-solving skills, and their importance, as factors to protect against the development of risk behaviors, (2) personal positive impacts of the program attendance and (3) gains and losses with the transition to online learning format. Discussion: Students’ considerations about the experience with the Riscos & Desafios Program not only reinforced the importance and pertinence of this experience in their life trajectory, but also brought to light its relevance at this pandemic moment.
Copyright (c) 2023 Maria Paula Santos, Gizela Cardoso, Paula Silva, Carla Rocha
Career transition of dancers in Portugal: an exploratory study supporting the need for a program for development and career transition in dance
Background: The subject of career transition for dancers continues to be a challenging issue to tackle. Consequently, dancers are mostly left alone to deal with this crucial transition, one that also determines the quality of their lives after dance. Goals: Main finality of this research study was to understand and offer guidance in the career transition experiences of professional dancers in Portugal and to propose a development and career transition program in dance that allows effective intervention to help dancers in their transition process. Main goal was to characterize how dancers perceive their career transition processes. Methods: The study follows a qualitative approach, with data collection throw semi-structured individual interviews to professional dancers (from both genders) at different moments of career. Thematic analysis was conducted for the complete corpus, with codes emerging from the collected data (no a-priori coding system). Results: Six key themes and a total of 34 sub-themes were identified. Dancers referred to feel unsupported and alone and, consequently, to experience significant psychological challenges when faced with a career transition. Most specifically, without adequate guidance, dancers reported to feel unprepared for their future. None of the interviewed dancers was aware of initiatives available to support dance career transition in Portugal. They were aware, however, of the existence of programs in other countries and expressed a need for such support in Portugal. Discussion: . It can be concluded from the above that this research validates the need for a development and career transition program in the Portuguese dance community, one that aims to soften and/or eradicate the challenges associated with a dancer’s transition from active performer into a dance-related or other career. Collected data support the need for outlining a training and supportive program that provides dancers with tools to enable a healthier and harmonious experience of transitioning beyond performance. Keywords: career transition; career development; dance; dancers; intervention program
Copyright (c) 2023 Fabíola Borges de Castro
Psychologists' health, sleep, and behaviour in the COVID-19 turmoil
Background: The infection caused by SARS-CoV-2 (COVID-19) emerged in China in 2019. Studies carried out during the pandemic period demonstrated an association between this pandemic context and psychological suffering. Psychologists, as health professionals, came to play a leading role in this period. Goals: This study aimed to evaluate the psychologist’s health status, behaviors, attitudes, and habits during the pandemic. Methods: This study included 1100 subjects, with two different samples: general population and psychologists. The sample was obtained through a non-probabilistic sampling process (online data collection). Survey Legend® online platform was used for this purpose. The data collection happened during the first wave of COVID-19, in Portugal. Two types of analytical design were used: an inter-subject design (Mann-Whitney U Test and Chi-Square Test [χ2] were performed), and an intra-subject design (Sign test and the Wilcoxon test were applied). Results: Of the 1100 participants, 128 (11.6%) belong to the group of psychologists, aged between 24 and 82 years (mean age 45.4 ± 11.85). Subjects self-reported several changes occurring between the before-pandemic period and the first wave of the pandemic, revealing a significant increase in the use of television, social networks, cell phones, and games. It was also found a self-perceived overall deterioration in sleep quality, a reduction in smoking, and an increase in alcohol consumption. Discussion: The findings of this study support the need for the adoption of measures, and the development of specific health promotion intervention plans targeted to this professional group, in similar situations in the future.
Copyright (c) 2023 João Peixoto, Maria Augusta Machado, Teresa Paiva, Rute Sousa, Cátia Branquinho, Fábio Guedes, Gina Tomé, Tânia Gaspar, Margarida Gaspar Matos
Promoting relationship-centred care skills and attitudes: study protocol for the development and ef-fectiveness assessment of a training program for health professionals
Background: Patient-centred and relationship-centred care (RCC) are considered crucial for therapeutic success. However, due to time pressure and fatigue, among other constraints, health professionals tend to act based on implicit directive (i.e., more authoritative) attitudes, common to the traditional biomedical approach to care. Despite current agreement on the importance of the relationship established between patients and health professionals, limited understanding exists regarding how to promote health professionals’ implicit attitudes, in line with the concept of RCC. Goals: To develop and evaluate the effectiveness of a sustainable short-term training program to promote awareness and endorsement of attitudes and values aligned with RCC in health professionals. Methods: The development of the training program to promote RCC attitudes will be supported by literature reviews and a Delphi panel to define its structure, format, and contents. The effectiveness assessment of the RCC training program will entail a 2-arms randomized controlled trial, over three moments: at baseline, immediately after the training, and two months afterward. For the effectiveness assessment, implicit and explicit attitudes regarding RCC will be evaluated, considering the sociodemographic and professional characteristics of the participants. An implicit association test (IAT) targeting RCC attitudes will be specifically developed and validated for the Portuguese population to be applied in the effectiveness assessment process. Intention-to-treat and per-protocol statistical analyses will be performed for primary and secondary outcomes, respectively. Discussion: Integrating RCC-related content in health professionals’ education programs may promote attitudes more aligned with RCC and fitting with the participatory healthcare paradigm.
The role of emotions in health-promoting behavior campaigns | Fact-sheets collection from the Portuguese COVID-19 pandemic Task Force on Behavioral Sciences
Behavioral activation requires both cognitive and emotional processes. Fast and automatic decisions are highly dependent of emotional stata and, therefore, emotion activation is widely used in marketing initiatives. Health promotion campaigns traditionally opted by using threatening messages, aiming to raise awareness of health risks and to promote adherence to health behaviors. However, the evidence does not support the hypothesis that using fear-inducing messages promotes systematically the expected health protection behavior. Instead, the use of messages promoting positive emotions associated with the target behavior should be the first choice for health promotion programs. The effect of messages on emotional experiencing should be tested as much as possible (considering most vulnerable groups), before launching large-scale campaigns, as well as its effectiveness on the desired health behavior activation.
Copyright (c) 2023 Ricardo R. Santos, Osvaldo Santos, Margarida Gaspar de Matos
Determinants of adherence to COVID-19 vaccine | Fact-sheets collection from the Portuguese COVID-19 pandemic Task Force on Behavioral Sciences
Adherence to COVID-19 vaccine is determined by several cognitive and emotional determinants. Portuguese population has remarkable trust level on vaccines, also explained by a highly favorable public perception of the quality of healthcare public services. However, the process of development, testing and implementation of COVID-19 vaccines (some of them involving new applied health technology) raises concern in important segments of the population. Effective programs for promotion of adherence to COVID-19 vaccine requires communicating easy-to-understand, solid and credible evidence about the effectiveness of COVID-19 vaccines (at individual and collective levels) and about the safety of these vaccines (at short and long terms). Reducing the number of steps and procedure complexity for accessing the vaccine is also crucial for the adherence to this form of severe COVID-19 prevention.
Promoting the Development of Social Norms for Protecting Against COVID-19 | Fact-sheets collection from the Portuguese COVID-19 pandemic Task Force on Behavioural Sciences
Social norms constitute collective-based expectations about what behaviours are considered proper or acceptable. They inform the decision-making process, discouraging or promoting the activation of behaviours, thus representing a major and strategic public health determinant. Individual and collective protection against COVID-19 is inherently associated with social norms related to behaviours such as maintaining physical distance in public spaces, ensuring air circulation (opening windows) when meeting with other than nuclear relatives (i.e., from the household), or using masks. This paper briefly goes over some of the psychosocial mechanisms associated to the development of social norms.
The use of images in the promotion of health behaviors | Fact-sheets collection from the Portuguese COVID-19 pandemic Task Force on Behavioral Sciences
The use of images is highly frequent in science and health communication, and it is usually considered to be very effective to transmit health messages. Although not so much attention has been paid to measuring the effects of using visual elements in public health communication, images can indeed contribute to increasing effectiveness in promoting adherence to health behaviors. The choice between images that activated negative emotions, such as fear or threat, versus images that induce positive emotions, such as emotions resulting from social support, or rather emotional-neutral images, needs to be grounded in evidence about how emotional arousal may impact health-oriented decisions. This fact sheet was developed to provide easy-to-use scientific pieces of evidence about the use of images for health promotion to stakeholders involved in public health decisions.
Copyright (c) 2022 Ricardo R. Santos, Osvaldo Santos, Margarida Gaspar de Matos
Predictors of physical distance in the context of the COVID-19 pandemic | Fact-sheets collection from the Portuguese COVID-19 pandemic Task Force on Behavioral Sciences
The promotion of physical distancing is a highly effective way of preventing the interpersonal transmission of pathogenic agents, including SARS-CoV-2. However, the protection of physical health through physical distance should not promote social distancing, which is a relevant disrupter of human subjective and psychological well-being. Interpersonal bonds are essential for the promotion and protection of mental health and quality of life. It is, therefore, necessary to identify adequate criteria for the establishment and promotion of adequate, protective, and health-promoting physical distancing.
Copyright (c) 2022 Ana Virgolino, Osvaldo Santos, Margarida Gaspar de Matos
Insights from hospital-based psycho-oncology consultations during the COVID-19 pandemic
Introduction. The work of hospital psychologists aims to address the psychological and social needs of patients and their families through psychological assessment, follow-up, and psychotherapeutic intervention. Goals. To characterize the main complaints presented by adult patients attending clinical psychology and psycho-oncology consultations during the COVID-19 pandemic at a hospital in northern Portugal. Method: Data were collected during a curricular internship through clinical record review. Data source was an electronic clinical registry system used to support psychological consultations, gathering sociodemographic, physical, emotional, psychological, and social information, as well as clinical notes regarding the patient and their family. Results: The sample included 25 patients (mean age = 51.5 years, SD = 12.8), the majority female (n = 20). Ten participants were aged between 50 and 60 years, 13 resided in the municipality of Vila Real, and 16 lived in rural areas. Regarding education, 13 patients had completed primary school, six secondary school, and six higher education. All but one lived with relatives (collateral, ascendant, or descendant). Most were married or in a de facto union (n = 18). Three cases were unrelated to oncological disease. Among oncological cases, 15 involved breast cancer, and 16 patients were undergoing active treatment. Most (n = 16) had undergone surgery within the previous 12 months. Six patients reported physical pain during consultations. The most frequent reasons for referral were anxiety, sadness, and depression, with most referrals originating from medical oncology (n = 16) and psychiatry (n = 5). Additional issues identified included personal and family crises, interpersonal conflict, and experiences of domestic or marital violence. The most frequently used interventions were psychoeducation, emotion identification, cognitive restructuring, and correction of maladaptive beliefs. Discussion: The findings are consistent with the literature on predictors of psychological distress in oncology, including emotional suffering, previous cancer history, self-perceived diagnosis/prognosis, social support, sociodemographic characteristics, and coping strategies. Conclusion: During the pandemic, psycho-oncology consultations were significantly influenced by pandemic-related factors. Many patients faced additional personal and family difficulties, including violence and alcoholism. Psycho-oncology provides a therapeutic context in which psychological phenomena intertwined with personal, family, and social experiences can be better understood and addressed, thereby reducing dysfunction in patients and their families across multiple domains.
COVID-19 and Mental health in School-Aged Children and Young People: Thinking ahead while preparing the return to school and to life “as usual”
From December 2019 onwards, the COVID-19 pandemic brought with it several health, social and economic issues, particularly associated with home confinement measures, lockdown, and fear of being infected or otherwise affected by the virus, or even die. As with everybody else, children and young people are experiencing a new reality. The question is how well, and how long will it take for recovery. Furthermore, what is the likely affective, social, academic and economic cost for this recovery. There are at least four psychosocial scenarios that must be separately analysed: children and young people with previous mental ill health that may be left unattended by health services; those who may have a first episode of mental ill health during home confinement and had no health care; those with psychosocial vulnerabilities that may be left under-monitored and exposed to undermining circumstances, and finally those that have faced a huge change in their routines and may have formed a relatively stable pessimistic outlook that affects their wellbeing. Social isolation and quarantine have precipitated a decrease in wellbeing and an increase in mental health problems and psychosocial vulnerabilities, plus a lowering of general capacity for health, education and social security care. Confined children and young people are separated from their usual social support, deprived of the personal freedom that they are used to, and see a comprehensive change in the usual life routine and lifestyle with an enormous change in physical, social, affective and even digital environments. All children and young people are in need of a monitoring system and of arrangements to promote social participation and engagement, that runs at the same time as their return to school. Mitigating negative mental health effects requires a concerted effort from the general population, policy makers, education and healthcare professionals. Moreover, international health and educational organisations have advised governments that this action would benefit by being proactive: meaning there is an urgent need to get ready immediately – being ready for the “day after”, thinking ahead and being able to put together in the field and on time, an adequate nation-wide, participatory, multidisciplinary, mental health related set of interventions.
Copyright (c) 2021 Margarida Gaspar de Matos, Tony Wainwright
A Structural Model of Relationships between Stressful Life Events and Older Adults’ Loneliness: Religious Orientation as Mediator
Background: Loneliness is an issue, among many, faced by older adults through stressful life events, which may lead them to unbalanced life. Goals: This study aimed to construct a structural model of associations between stressful life events and older adults’ loneliness, with religious orientation functioning as a mediator. Methods: This correlational-descriptive survey involved participants over 60 nursing homes in Hamedan, who were selected by convenience sampling. The tools utilized in this study were the Paykel Life Events Questionnaire, the Allport-Ross Religious Orientation Scale, and the Short Version of the Social and Emotional Loneliness Scale for Adults (SELSA-S). Data analysis was performed through statistical tests of path analysis and Pearson correlation coefficient. Results: The sample is composed of 92 participants (40 females). Results showed that stressful life events and loneliness have significantly positive and negative relationships, respectively, to religious orientation. Moreover, religious orientation played a mediating role in the association pattern between stressful life events and loneliness. Discussion: These results suggest that although stressful events perform an important role in older adults’ loneliness, religious orientation as a mediating variable have a crucial place in reducing the loneliness in the old age.
Are Agatha, Dashiell, and Arthur alive? Assessing the link between hand movements and false intentions
Background: With the ever-increasing political, ideological and social tension which followed 9/11, crime prevention stands as an issue of major relevance. The development of the ability to accurately detect statements of false intent is of great societal and legal value. It could aid intelligence services in preventing crimes (e.g., terrorist threats) and security services in reinforcing their protocols (e.g., airport security checks, parole hearings, and border control). Goals: To examine the associations between hand movements and false intentions in adults. Methods: Using a laboratory-based variation of the ‘Portsmouth design’, 23 students completed a questionnaire about their intentions to travel in the near future. Participants with a planned trip were placed in the truth tellers’ condition (n = 12). Those who did not have a planned trip were placed in the liars’ condition (n = 11). Based on the main theoretical approaches, three hypotheses were proposed. Hypothesis 1 advocated a decrease in the three categories of illustrators (movements interconnected to speech that serve to illustrate what is being verbally said) in liars, as compared to the truth tellers. Hypothesis 2 also suggested a decrease in the category of subtle hand and finger movements in the lying condition, comparatively with the truth condition. Finally, hypothesis 3 proposed a lack of significant differences between liars and truth-tellers in the five categories of self-adaptors (movements in which one part of the body does something to another body part, such as scratching the ear or squeezing the hands). Results: Hypothesis 1 was partially supported. The general and the unilateral categories of illustrators decreased in the case of the liars, as compared to the truth tellers; however, the bilateral category of illustrators slightly increased in the lying condition, in comparison with truth telling. Hypotheses 2 and 3 were fully supported. Discussion: Apart from the slight increase of bilateral illustrators in the case of the liars, all the results are in accordance with the empirical findings on deception research about past events. This similarity is noteworthy, considering the cognitive differences between lies about past events and lies about future events.
The Subjective Experience of Pregnancy and the Expectations of Childbirth on a Medicalized World: a Qualitative Study
Background: To become a mother represents, for many women, a challenging existential process. Women have to deal with countless changes and adaptations, which can be experienced as sources of imbalance but also as moments of personal enrichment. Currently, this process is influenced by the medicalization of pregnancy and childbirth, which may have positive or negative consequences to the individual experiences of pregnancy and childbirth. Goals: This study aimed to deepen the understanding of the experience of pregnancy and expectations regarding childbirth in a group of women, in a context where pregnancy and childbirth are increasingly medicalized processes. Methods: In this qualitative study, we used semi-structured interviews to collect data regarding the experience of pregnancy and regarding expectations about childbirth in a sample of women (n = 37), recruited in health care centres or obstetric clinics by research assistants. The individual interviews took place at their homes. Data resulting from these interviews, focusing on the relationship with the health team, the partner and the unborn baby, and on the moment of childbirth, were analysed using ALCESTE software. Two senior researchers, psychologists, conducted the content analysis. Investigator triangulation was achieved through independent content analysis by each researcher and subsequent discussion and consensual interpretation. Results: Thirty-seven pregnant women were interviewed. Four classes emerged from the analysis: "Expectations about childbirth and baby health", “Significant relational experiences of the past”, "Mother-baby relationship process" and “Health care in pregnancy". Results emphasize the desire of future mothers to have a quick childbirth, without stress and with minimal suffering and anxiety. Despite these worries, women described a positive subjective experience of pregnancy and a feeling of security related to the knowledge they attribute to health professionals. Discussion: “Medicalization” seems to be perceived as positive and securing, with no mention to a sense of disempowerment or loss of control. Therefore, the existence of spaces for sharing disturbing experiences and expectations of childbirth is prophylactic, contributing to the creation of conditions that foster positive expectations and mitigate fears related to childbirth.
Copyright (c) 2020 Rute Brites, Odete Nunes, Monica Pires, João Hipólito
Long-term efficacy of psychotherapy in major depression: protocol of a network meta-analysis
Background: Depression is currently considered the epidemic of the century. In recent decades, research has established that psychotherapy is globally effective for the treatment of depression; however, it remains open which psychotherapeutic treatment is most effective and, particularly, if its efficacy is maintained over the long term. Given the difficulty in performing randomized and controlled clinical trials (RCTs) that simultaneously compare several psychotherapeutic models, meta-analyses aim to provide answers by synthesizing the evidence generated through direct comparisons of treatments. Goals: This protocol describes the meta-analysis study we will perform in order to assess the efficacy and acceptability of long-term results of psychotherapy (i.e., 18-month follow-up or higher) in the treatment of major depression in adults. Methods: Through the use of a recent methodological approach - the network meta-analysis - we will integrate the direct and indirect analysis of evidence from randomized and controlled clinical trials in this domain. We will systematically search seven databases for RCTs of psychotherapy, published since 1994, with evaluation of the efficacy in terms of long-term results for the treatment of depression. All studies with adult participants (18 to 65 years of age) diagnosed with major depression (according to DSM-IV, IV-TR, V or ICD-9, 10) will be eligible and all studies that compare psychotherapy (individual and face-to-face treatment) with a control condition (waiting-list, placebo) will be considered. Data extraction, quality assessment and risk of bias will be carried out independently by three researchers. The primary outcome measure will be the long-term efficacy of treatments (follow-ups of 18 months or above) measured by changes in the overall clinical response and symptoms of depression since post-treatment and follow-ups. The secondary measure will be the acceptability of treatment as measured by the proportion of participants who drop out of follow-up or start another treatment (not psychotherapy). A direct comparison (pairwise meta-analysis) of all studies comparing different psychotherapies will be performed. We will compare relative efficacy and acceptability by indirect comparison, through a bayesian network meta-analysis of random effects to compare different psychological interventions. Further analyses will be conducted if inconsistency and heterogeneity values are found. Discussion: The purpose of this review is to systematize and integrate evidence of long-term maintenance of the results of different psychotherapeutic treatments for major depression, administered individually and face-to-face in RCTs. For this reason, multiple direct and indirect comparisons of treatments (bayesian network) will be made, and the interrelationships between treatments will be estimated in terms of long-term efficacy and acceptability. Even though our scope will be focused on RCTs, we hope that the results obtained can contribute to summarize the present evidence available in terms of long-term results of psychotherapy (i.e., its effectiveness), optimizing the planning of future studies, providing public health guidelines and more informed clinical decisions on the treatment of depression.
Brief assessment of depression: Psychometric properties of the Portuguese version of the Patient Health Questionnaire (PHQ-9)
Background: The lack of knowledge regarding psychometric characteristics of brief scales for assessing the severity of symptoms of depression for the Portuguese population limits the ability of health professionals to signal clinically relevant situations, as well as the implementation of alternative forms of mental health care. The Patient Health Questionnaire (PHQ-9) is a scale whose usefulness in various professional contexts has been amply demonstrated by research. However, some of its psychometric qualities remain unknown for the Portuguese version. Goals: The main objective of this study was to analyse the validity of the factorial structure and the psychometric characteristics of the PHQ-9 in two different clinical Portuguese contexts, namely in primary health care units and in a university clinic, also reflecting the similarities and differences found regarding the factorial structures. Methods: The first study was carried out with 153 patients (83.66% females), with a mean age of 46.10 years (SD = 16.79), from eight health units of primary health care (non-probabilistic sampling). All participants underwent an initial screening for the detection of symptoms of depression and suicidal ideation, within the context of a regular family medicine appointment or nursing visit. Participants who scored positively for one of these symptoms were invited to participate in the study. The PHQ-9 and the Work and Social Adjustment Scale (WSAS) were used and exploratory and semi-confirmatory factor analyses of the PHQ-9 were performed. In the second study, 106 adults (70.78% females) participated in a psychological counselling session at a university clinic, with a mean age of 32.47 years (SD = 11.01), also constituting a non-probabilistic sample. As instruments, the PHQ-9, the Beck-II Depression Inventory and the State-Trait Anxiety Inventory were used, which participants completed before the beginning of the psychological treatment. As in the first study, exploratory and semi-confirmatory factor analyses of the PHQ-9 were conducted. Results: The results of the two studies revealed a factorial structure consisting of three factors. In the first study, the three factors were: (1) depressed mood and anhedonia; (2) self-devaluation and suicidal ideation; and (3) fatigue, psychomotor agitation/retardation, and changes in appetite, sleep problems or difficulty in concentration. In the second study, the three factors that were found were: (1) sleep problems and fatigue; (2) changes in appetite and difficulty in concentration, psychomotor agitation/retardation, and suicidal ideation; and (3) depressed mood, anhedonia, and self-devaluation. The factorial structure found in both studies revealed a good fit. The PHQ-9 also presented good internal consistency, convergent validity and criterion validity in both studies. The cut-off point of 9 emerged as an indicator of major depression. Discussion: The results of this study enhance the use of this scale in different contexts of health care provision in Portugal, since it was possible to determine the cut-off point for the detection of cases with major depression, as well as the criteria for delimiting severity degrees of depression-related symptomatology. Keywords: PHQ-9, Depression, Psychometric qualities, Primary health care, University clinic