Educational intervention improves quality of life for patients with chronic conditions

Model that includes orientation through educational materials, face-to-face care and telephone follow-up is being tested by researchers at the USP Ribeirão Preto School of Nursing

By Karina Toledo, in Raleigh

Agência FAPESP – Thanks to an educational intervention model that includes orientation through educational materials, face-to-face care and telephone follow-up, a group of researchers from the Ribereirão Preto School of Nursing at the University of São Paulo (USP) have been able to improve the health of patients with chronic conditions.

The results of the study, which received a Thematic Project grant from FAPESP, coordinated by Professor Lidia Aparecida Rossi, were presented this past Tuesday (11/12) in Raleigh, North Carolina during FAPESP Week North Carolina.

“As the population ages, the number of people with chronic conditions – caused by disease or physical trauma that requires constant care over long periods of time – is on the increase. That is why adequate follow-up of these individuals has been a growing concern in the field of nursing all over the world,” explained Rossi.

Several diseases may be categorized as chronic conditions, including Parkinson’s disease, Alzheimer’s disease, diabetes and cardiovascular disease. In Ribeirão Preto, individuals with heart disease and victims of severe burns are being monitored by the Rehabilitation Investigation and Quality of Life Group, coordinated by Rossi and Professor Rosana Spadoti Dantas. Also involved in the study is a team from the School of Nursing at the University of Campinas (Unicamp), led by Professor Roberta Cunha Matheus Rodrigues, as well as researchers Marcia Ciol and Jeanne Hoffman, both from the University of Washington.

“Studies by our group that have already been completed showed that certain chronic conditions present quite similar responses such as fear, anxiety, depression, low self-esteem, loss of independence, treatment adherence problems and diminished quality of life,” explained Rossi.

Some of these findings were published in the journals Disability and Rehabilitation (“The life impact of burns: the perspective from burn persons in Brazil during their rehabilitation phase” and “Cultural meaning of quality of life: perspectives of Brazilian burn patients”) and in Revista Brasileira de Saúde Pública (“Heart disease experience of adults undergoing coronary artery bypass grafting surgery”).

Under an already completed FAPESP Thematic Project grant, the researchers adapted and modified several scales – originally proposed for use in other countries – to the Brazilian culture to enable assessment of subjective aspects of individuals with chronic conditions, such as level of anxiety related to pain, body image and quality of life.

“At present, these instruments are being used in our studies as well as by other researchers to measure the results of interventions that seek to increase the level of treatment adherence and patient self-sufficiency which, in this case, represents the ability to perform actions to improve one’s own health,” explained Rossi.


The educational intervention model adopted by Rossi’s group includes frequent encouragement for self-care made by telephone as well as through face-to-face nursing appointments, at which time teaching materials are distributed. These materials contain a simple explanation of the disease or condition as well as the care to be taken by the patient and his or her family.

The impact of the initiative is being assessed in several theses currently underway. The doctoral studies of Flavia Martinelli Pelegrino, whose advisor is Professor Dantas, monitored patients with heart disease who are undergoing treatment with oral anticoagulants.

Compared with the control group, which received standard care from the health institution, the intervention group exhibited a higher degree of satisfaction with the treatment, better quality of life, and fewer symptoms of depression and anxiety.

In the doctoral studies of Laura Bacelar de Araújo Lourenço, whose advisor was Professor Rodrigues, the effect of the educational intervention was tested on a group of patients suffering from coronary artery disease. The results indicate a significant increase – from 32% to 72% – in treatment adherence among those who received encouragement for self-care.

In another project in which Rossi served as advisor, the strategy was tested on patients undergoing angioplasty for insertion of a stent (steel spring used to unclog an artery and allow blood to flow). In the group that received the intervention, there was a significant reduction in the symptoms of anxiety compared with the control group in assessments made six months after the procedure. The study is still underway and patients continue to be monitored.

“The data related to interventions conducted on burn patients are still being analyzed. In this case, in addition to the scales, we utilized instruments to measure skin elasticity and viscosity, which enabled indirect measurement of treatment adherence,” said Rossi.

She went on to say that the group’s next goal is to identify which aspects of the intervention model most contribute towards improving the health of people with chronic conditions as well as providing the best cost-benefit to the health system.

Down syndrome

On the same panel devoted to health sciences held during the second day of FAPESP Week, Professor Marcia Van Riper of the School of Nursing at the University of North Carolina in Chapel Hill, presented the findings of a multi-centric study whose objective is to understand how culture, interaction with the health system, and family factors contribute to the resilience and ability to adapt on the part of families whose members include individuals with Down syndrome.

The study is being conducted in collaboration with researchers from the USP São Paulo School of Nursing as well as the USP Ribeirão Preto School of Nursing along with scientists from the United Kingdom, Ireland, Portugal and Japan.