Parenting, self-regulation and childhood anxiety : A Self-Determination Theory perspective

Le contrôle psychologique parental est un facteur de risque réputé pour les problèmes intériorisés des enfants (p. ex., Affrunti & Ginsburg, 2011; McLeod, Wood & Weisz, 2007). Selon la Théorie de l'auto-détermination, le contrôle psychologique mène aux problèmes intériorisés (Ryan, Deci, Grolnick, & La Guardia, 2006) car il brime le besoin fondamental d'autonomie. En effet, recevoir de la pression afin de penser, se comporter et se sentir d’une certaine façon (Ryan, 1982) semble favoriser une régulation trop rigide et surcontrôlée (Ryan et al., 2006). Suite aux travaux de Soenens et Vansteenkiste (2010), la distinction conceptuelle entre deux formes de contrôle psychologique, soit manifestes (p. ex., les menaces, forcer physiquement) et dissimulées (p. ex., la surprotection, le marchandage), ont été utilisées pour évaluer le style parental (Étude 1) et les pratiques disciplinaires (Étude 2). Le contrôle psychologique parental et le soutien de l'autonomie (Étude 2) ont été mesurés durant la petite enfance puisque (1) les problèmes intériorisés émergent tôt, (2) le développement du sentiment d'autonomie est central au cours de cette période, et (3) attire probablement plus de contrôle psychologique parental. Avec ses deux articles, la présente thèse vise à clarifier la façon dont le contrôle psychologique manifeste et dissimulé est lié au développement précoce de problèmes intériorisés. L'étude 1 est une étude populationnelle examinant l'impact relatif du style parental sur des trajectoires développementales d'anxiété (N = 2 120 enfants; de 2,5 à 8 ans) avec de nombreux facteurs de risque potentiels provenant de l'enfant, de la mère et de la famille, tous mesurés au cours de la petite enfance. Les résultats ont montré qu'en plus de la timidité des enfants, de la dépression maternelle et du dysfonctionnement familial, le contrôle psychologique manifeste (c.-à-d., coercitif) et dissimulé (c.-à-d., la surprotection) augmentent le risque, pour les enfants, de suivre une trajectoire d'anxiété élevée. Une interaction entre la dépression maternelle et le contrôle dissimulé a été trouvée, ce qui indique que la surprotection augmente l'anxiété des enfants seulement lorsque la dépression maternelle est élevée. Enfin, le contrôle dissimulé prédit également l'anxiété telle que rapportée par les enseignants de deuxième année. Le deuxième article est une étude observationnelle qui examine comment l'autorégulation (AR) des bambins est liée au développement précoce des symptômes intériorisés, tout en explorant comment les pratiques disciplinaires parentales (contrôle et soutien de l'autonomie) y sont associées. Les pratiques parentales ont été codifiées lors d'une requête de rangement à 2 ans (contexte "Do", N = 102), tandis que l'AR des bambins a été codifiée à la fois durant la tâche de rangement ("Do") et durant une tâche d'interdiction (ne pas toucher à des jouets attrayants; contexte «Don't » ), à 2 ans puis à 3 ans. Les symptômes d'anxiété / dépression des enfants ont été évalués par leurs parents à 4,5 ans. Les résultats ont révélé que l'AR aux interdictions à 3 ans diminue la probabilité des enfants à manifester des taux élevés de symptômes d'anxiété / dépression. Les analyses ont aussi révélé que le parentage soutenant l'autonomie était lié à l'AR des enfants aux requêtes, un an plus tard. En revanche, le contrôle psychologique manifeste et dissimulé ont eu des effets délétères sur l'AR. Enfin, seul le contrôle dissimulé a augmenté les probabilités de présenter des niveaux plus élevés de problèmes intériorisés et ce, au-delà de l’effet protecteur de l'AR des bambins. Des résultats mitigés sont issus de cette thèse concernant les effets respectifs des deux formes de contrôle sur les problèmes intériorisés, dépendamment de l'informateur (mère c. enseignant) et de la méthodologie (questionnaires c. données observationnelles). Toutefois, le contrôle psychologique dissimulé était lié à ce problème affectif dans les deux études. Enfin, le soutien à l'autonomie s’est révélé être un facteur de protection potentiel et mériterait d'être étudié davantage.

Impact of the ego-dystonic nature of obsessions on treatment outcome in eating disorders

Il s'agit d'une hypothèse largement répandue que l’égo-dystonie et l’égo-syntonie caractérisent les obsessions dans les troubles des conduites alimentaires (TCA) et que ces facteurs sont cliniquement pertinents pour la conceptualisation et le traitement des TCA. Cependant, les résultats empiriques sur ce sujet sont rares. Compte tenu du chevauchement reconnu entre les TCA, notamment l'anorexie et la boulimie (BN), et le trouble obsessionnel-compulsif (TOC) dans la phénoménologie et les caractéristiques psychologiques, un programme de thérapie cognitive basée sur les inférences (TBI) de 24 semaines, démontré efficace dans le traitement des TOC, a été adapté pour traiter les TCA. La recherche sur le TOC suggère que la transformation des pensées intrusives en obsessions est liée à la mesure dans laquelle les pensées intrusives menacent des perceptions fondamentales du soi et de l’identité. Cette thèse a pour objectif d'examiner le lien entre l’égo-dystonie et les TCA. Pour se faire, nous avons exploré le lien entre la nature égo-dystone des obsessions chez les patients souffrant d'un TCA et la peur de l'image de soi. Nous avons également étudié la relation entre la sévérité des symptômes TCA et l’égo-dystonie dans les obsessions. En outre, nous avons investigué les différences dans la présence de pensées égo-dystones et de peur face à son identité entre des sujets non-cliniques et des personnes atteintes d’un TCA. Enfin, nous avons comparé le degré d’égo-dystonie dans les pensées de personnes atteintes d’un TCA à celui dans les pensées d’individus souffrant d’un TOC. L’égo-dystonie dans les pensées a été mesurée par l'Ego Dystonicity Questionnaire (EDQ) et le degré de peur face à l’identité a été mesuré par le Fear of Self Questionnaire (FSQ) d’une part dans un échantillon de femmes souffrant d’un TCA (n = 57) et d’autre part dans un échantillon de participantes non-cliniques (n = 45). Les résultats révèlent que l’égo-dystonie et la peur face à l’identité étaient fortement corrélées à la fois dans l’échantillon clinique et non-clinique. Les scores de l’EDQ n’étaient pas significativement corrélés à la sévérité des symptômes TCA à l'exception de la sous-échelle d’irrationalité de l’EDQ qui était fortement associée à la sévérité des comportements compulsifs compensatoires. Les participantes souffrant d'un TCA avaient des scores significativement plus élevés à l’EDQ et au FSQ que les sujets non-cliniques. Ensuite, une étude de cas décrit l’application du programme de thérapie cognitive TBI pour une femme de 35 ans avec un diagnostic de BN. La pathologie TCA s’est significativement améliorée au cours de la TBI et six mois suivant la thérapie. Cette étude de cas met en évidence l'importance de cibler les idées surévaluées, les doutes et le raisonnement face au soi et à l’identité dans le traitement psychologique pour les TCA. Enfin, l’objectif final de cette thèse était d’examiner les changements au niveau (1) des symptômes TCA, (2) du degré d’égo-syntonie dans les obsessions, et (3) des mesures de peur face à l’identité, de motivation, d’humeur et d’anxiété au cours de la TBI et au suivi post six mois. L’égo-dystonie, la peur face à l’identité, les symptômes TCA et le stade motivationnel ont été mesurés chez 15 femmes souffrant de BN au cours du traitement et six mois après la TBI. Quatre vingt pourcent de l’échantillon, soit 12 des 15 participantes, ont démontré une diminution cliniquement significative des symptômes TCA et 53% ont cessé leurs comportements compensatoires au suivi post six mois. Les retombées cliniques relatives au traitement des TCA sont discutées.

Associations prospectives entre l’exposition à la fumée secondaire résidentielle à l’enfance et les difficultés psychosociales à la préadolescence

Introduction. La fumée secondaire est considérée comme un agent neurotoxique. À ce jour, la littérature traitant des liens entre l’exposition à la fumée secondaire à l’enfance et les comportements antisociaux repose majoritairement sur des devis transversaux ou porte sur la période développementale de l’enfance. Objectif. D’une part, nous souhaitons repousser l’âge auquel les comportements antisociaux sont mesurés en le portant à la préadolescence. De plus, nous souhaitons utiliser des données autorapportées afin d’utiliser une mesure possiblement plus valide des comportements antisociaux. Finalement, nous souhaitons confirmer les résultats longitudinaux précédemment rapportés par les parents ou les enseignants à l’âge de 10 ans. Méthode. Les parents de 1035 enfants ayant participé à l’Étude longitudinale des enfants du Québec ont rapporté si au moins un individu fumait au domicile (entre l’âge d’un an et demi et sept ans). Les variables dépendantes autorévélées (mesurées à douze ans) comprenaient les problèmes de conduite, l’agressivité proactive, l’agressivité réactive, l’indiscipline scolaire et le risque de décrochage. Résultats. Après l’inclusion des variables de contrôle, nous avons observé que l’exposition à la fumée secondaire est prospectivement associée aux problèmes de conduite, l’agressivité proactive, l’agressivité réactive, l’indiscipline scolaire et le risque de décrochage autorévélés. Discussion. Les jeunes exposés à la fumée secondaire à l’enfance rapportent avoir plus de comportements antisociaux. Nos résultats corroborent les recommandations du American Surgeon’s General indiquant qu’aucune exposition à la fumée secondaire ne peut être considérée sécuritaire à l’enfance.

Sexual and relationship intimacy among women with provoked vestibulodynia and their partners : associations with sexual satisfaction, sexual function, and pain self-efficacy

Introduction Provoked vestibulodynia (PVD) is the most frequent subtype of vulvodynia. Women report negative consequences of PVD on their sexual and romantic relationships. Researchers have recently highlighted the importance of examining interpersonal factors such as intimacy, and of including both women and their partners in study designs. Aim The aim of this study was to investigate sexual and relationship intimacy as defined by the Interpersonal Process Model of Intimacy and their associations with sexual satisfaction, sexual function, pain self-efficacy, and pain intensity among women with PVD and their partners. Methods Ninety-one heterosexual women (M age = 27.38, SD = 6.04) diagnosed with PVD and their partners (M age = 29.37, SD = 7.79) completed measures of sexual and relationship intimacy, sexual satisfaction, sexual function, pain self-efficacy, and pain intensity. Main Outcome Measures Dependent measures were the (i) Global Measure of Sexual Satisfaction Scale; (ii) Female Sexual Function Index; (iii) Painful Intercourse Self-Efficacy Scale; and (iv) visual analog scale of pain intensity during intercourse. Results After controlling for women's age, women's greater sexual intimacy (β = 0.49, P < 0.001) was associated with women's greater sexual satisfaction and higher pain self-efficacy (β = 0.39, P = 0.001), beyond the effects of partners’ sexual intimacy. Also, women's greater sexual intimacy (β = 0.24, P = 0.05) and women's greater relationship intimacy (β = 0.54, P = 0.003) were associated with greater women's sexual function, beyond the effects of partners’ sexual and relationship intimacy. Conclusions Women's self-reported sexual and relationship intimacy in the couple relationship may promote higher sexual satisfaction, sexual function, and pain self-efficacy, as well as possibly foster greater sexual well-being among women with PVD. The authors discuss implications for the inclusion of emotional and interpersonal aspects of the couple's dynamic in clinical interventions and future research in PVD.

Do romantic partners' responses to entry dyspareunia affect women's experience of pain? : the roles of catastrophizing and self-efficacy.

Introduction Entry dyspareunia is a sexual health concern which affects about 21% of women in the general population. Characterized by pain provoked during vaginal penetration, introital dyspareunia has been shown by controlled studies to have a negative impact on the psychological well-being, sexual function, sexual satisfaction, and quality of life of afflicted women. Many cognitive and affective variables may influence the experience of pain and associated psychosexual problems. However, the role of the partner's cognitive responses has been studied very little. Aim The aim of the present study was to examine the associations between partners' catastrophizing and their perceptions of women's self-efficacy at managing pain on one side and women's pain intensity, sexual function, and sexual satisfaction on the other. Methods One hundred seventy-nine heterosexual couples (mean age for women = 31, SD = 10.0; mean age for men = 33, SD = 10.6) in which the woman suffered from entry dyspareunia participated in the study. Both partners completed quantitative measures. Women completed the Pain Catastrophizing Scale and the Painful Intercourse Self-Efficacy Scale. Men completed the significant-other versions of these measures. Main Outcome Measures Dependent measures were women's responses to (i) the Pain Numeric Visual Analog Scale; (ii) the Female Sexual Function Index; and (iii) the Global Measure of Sexual Satisfaction scale. Results Controlled for women's pain catastrophizing and self-efficacy, results indicate that higher levels of partner-perceived self-efficacy and lower levels of partner catastrophizing are associated with decreased pain intensity in women with entry dyspareunia, although only partner catastrophizing contributed unique variance. Partner-perceived self-efficacy and catastrophizing were not significantly associated with sexual function or satisfaction in women. Conclusions The findings suggest that partners' cognitive responses may influence the experience of entry dyspareunia for women, pointing toward the importance of considering the partner when treating this sexual health problem.

Teacher self-perceptions of effectiveness: a study in a district of Kenya

Background and purpose: The paper reports a study of the perceptions of teachers in secondary schools in the Gucha district of Kenya of their own effectiveness, the structure of their self-perceptions, variations in self-perceived effectiveness and the relationship between self-perceptions of effectiveness and the examination performance of their students. Design and methods: Data were based on questionnaires completed by 109 English and mathematics teachers from a random sample of 30 schools in the Gucha district of Kenya. Pupil examination results were also collected from the schools. Results: Three dimensions of self-perceived effectiveness emerged from a factor analysis. These were: pedagogic process, personal and affective aspects of teaching and effectiveness with regard to pupil performance. Teachers tended to rate themselves relatively highly with regard to the first two, process-oriented, dimensions but less highly on the third, outcome-oriented, dimension. Self-ratings for pupil outcomes correlated with pupil examination performance at school level. Conclusions: The results show that these teachers can have a sense of themselves as competent classroom performers and educational professionals without necessarily having a strong sense of efficacy with regard to pupil outcomes.

Self-exclusion from health care in women at high risk for postpartum depression

Background A significant proportion of women who are vulnerable to postnatal depression refuse to engage in treatment programmes. Little is known about them, other than some general demographic characteristics. In particular, their access to health care and their own and their infants' health outcomes are uncharted. Methods We conducted a nested cohort case-control study, using data from computerized health systems, and general practitioner (GP) and maternity records, to identify the characteristics, health service contacts, and maternal and infant health outcomes for primiparous antenatal clinic attenders at high risk for postnatal depression who either refused (self-exclusion group) or else agreed (take-up group) to receive additional Health Visiting support in pregnancy and the first 2 months postpartum. Results Women excluding themselves from Health Visitor support were younger and less highly educated than women willing to take up the support. They were less likely to attend midwifery, GP and routine Health Visitor appointments, but were more likely to book in late and to attend accident and emergency department (A&E). Their infants had poorer outcome in terms of gestation, birthweight and breastfeeding. Differences between the groups still obtained when age and education were taken into account for midwifery contacts, A&E attendance and gestation;the difference in the initiation of breast feeding was attenuated, but not wholly explained, by age and education. Conclusion A subgroup of psychologically vulnerable childbearing women are at particular risk for poor access to health care and adverse infant outcome. Barriers to take-up of services need to be understood in order better to deliver care.

Conversations around homework: links to parental mental health, family characteristics and child psychological functioning

Parents are increasingly expected to supplement their children's school-based learning by providing support for children's homework. However, parents' capacities to provide such support may vary and may be limited by the experience of depression. This may have implications for child development. In the course of a prospective, longitudinal study of children of postnatally depressed and healthy mothers, we observed mothers (N = 88) and fathers (N = 78) at home during maths homework interactions with their 8-year-old children. The quality of parental communication was rated and analysed in relation to child functioning. The quality of communication of each of the parents was related to their mental state, social class and IQ. While postnatal depression was not directly related to child development, there was some evidence of the influence of maternal depression occurring in the child's school years. Different aspects of parental communication with the child showed specific associations with different child outcomes, over and above the influence of family characteristics. In particular, child school attainment and IQ were associated with parental strategies to encourage representational thinking and mastery motivation, whereas child behavioural adjustment at school and self-esteem were linked to the degree of parental emotional support and low levels of coercion. Notably, the influence of maternal homework support was more strongly related to child outcome than was paternal support, a pattern reflected in mothers' greater involvement in children's schools and school-related activities. Some parents may need guidance in how to support their children's homework if it is to be of benefit to child functioning.

Health-related quality of life in Huntington’s Disease patients: a comparison of proxy assessment and patient self-rating using the disease-specific Huntington’s Disease health-related quality of life questionnaire (HDQoL)

Huntington’s disease (HD) is a fatal, neurodegenerative disease for which there is no known cure. Proxy evaluation is relevant for HD as its manifestation might limit the ability of persons to report their health-related quality of life (HrQoL). This study explored patient–proxy ratings of HrQoL of persons at different stages of HD, and examined factors that may affect proxy ratings. A total of 105 patient–proxy pairs completed the Huntington’s disease health-related quality of life questionnaire (HDQoL) and other established HrQoL measures (EQ-5D and SF-12v2). Proxy–patient agreement was assessed in terms of absolute level (mean ratings) and intraclass correlation. Proxies’ ratings were at a similar level to patients’ self-ratings on an overall Summary Score and on most of the six Specific Scales of the HDQoL. On the Specific Hopes and Worries Scale, proxies on average rated HrQoL as better than patients’ self-ratings, while on both the Specific Cognitive Scale and Specific Physical and Functional Scale proxies tended to rate HrQoL more poorly than patients themselves. The patient’s disease stage and mental wellbeing (SF-12 Mental Component scale) were the two factors that primarily affected proxy assessment. Proxy scores were strongly correlated with patients’ self-ratings of HrQoL, on the Summary Scale and all Specific Scales. The patient–proxy correlation was lower for patients at moderate stages of HD compared to patients at early and advanced stages. The proxy report version of the HDQoL is a useful complementary tool to self-assessment, and a promising alternative when individual patients with advanced HD are unable to self-report.

Policy making without legislating: the self-regulation of commercial property leasing

The terms of a commercial property lease covers aspects such as rent, alterations to premises and the ability to leave; consequently they have a significant impact on cash flow and the ability of a business to develop. In contrast to the heavily-legislated residential sector, commercial landlords and tenants in the UK are largely free to negotiate the terms of their contract. Yet, since the property crash of 1989/90, successive governments have taken an interest in commercial leasing; in particular there is a desire to see landlords being more flexible. UK Government policy in this area has been pursued through industry self-regulation rather than legislation; since 1995 there have been three industry codes of practice on leasing. These codes are sanctioned by government and monitored by them. Yet, 15 years after the first code was launched, many in the industry see the whole code concept as ineffective and unlikely to ever achieve changes to certain aspects of landlord behaviour. This paper is the first step in considering the lease codes in the wider context of industry self-regulation. The aim of the paper is twofold: First a framework is created using the literature on industry self-regulation from various countries and industries which suggests key criteria to explain the effectiveness (or ineffectiveness) of self-regulation. This is then applied to the UK lease codes based on research carried out by the authors for the UK Government to monitor the success of all three codes. The outcome is a clearer understanding of the possibilities and limitations of using a voluntary solution to achieve policy aims within the property industry.

Self-ratings and observer-ratings of social skill: a manipulation of state social anxiety in anxious and non-anxious children

The role of state and trait anxiety on observer ratings of social skill and negatively biased self-perception of social skill was examined. Participants were aged between 7 and 13 years (mean=9.65; sd=1.77; N=102), 47 had a current anxiety diagnosis and 55 were non-anxious controls. Participants were randomly allocated to a high or low anxiety condition and asked to complete social tasks. Task instructions were adjusted across conditions to manipulate participants’ state anxiety. Observers rated anxious participants as having poorer social skills than non-anxious controls but there was no evidence that anxious participants exhibited a negative self-perception bias, relative to controls. However, as participants’ ratings of state anxiety increased, their perception of their performance became more negatively biased. The results suggest that anxious children may exhibit real impairments in social skill and that high levels of state anxiety can lead to biased judgements of social skills in anxious and non-anxious children.

Protocol for a feasibility study of a self help cognitive behavioural therapy resource for the reduction of dental anxiety in young people

Background Childhood dental anxiety is very common, with 10–20 % of children and young people reporting high levels of dental anxiety. It is distressing and has a negative impact on the quality of life of young people and their parents as well as being associated with poor oral health. Affected individuals may develop a lifelong reliance on general anaesthetic or sedation for necessary dental treatment thus requiring the support of specialist dental services. Children and young people with dental anxiety therefore require additional clinical time and can be costly to treat in the long term. The reduction of dental anxiety through the use of effective psychological techniques is, therefore, of high importance. However, there is a lack of high-quality research investigating the impact of cognitive behavioural therapy (CBT) approaches when applied to young people’s dental anxiety. Methods/design The first part of the study will develop a profile of dentally anxious young people using a prospective questionnaire sent to a consecutive sample of 100 young people referred to the Paediatric Dentistry Department, Charles Clifford Dental Hospital, in Sheffield. The second part will involve interviewing a purposive sample of 15–20 dental team members on their perceptions of a CBT self-help resource for dental anxiety, their opinions on whether they might use such a resource with patients, and their willingness to recruit participants to a future randomised controlled trial (RCT) to evaluate the resource. The third part of the study will investigate the most appropriate outcome measures to include in a trial, the acceptability of the resource, and retention and completion rates of treatment with a sample of 60 dentally anxious young people using the CBT resource. Discussion This study will provide information on the profile of dentally anxious young people who could potentially be helped by a guided self-help CBT resource. It will gain the perceptions of dental care team members of guided self-help CBT for dental anxiety in young people and their willingness to recruit participants to a trial. Acceptability of the resource to participants and retention and completion rates will also be investigated to inform a future RCT.

Self-reported conflict management competence among nursing students on the point of graduating and registered nurses with professional experience

Objective: It has been shown that specific competence is necessary for preventing and managing conflicts in healthcare settings. The aim of this descriptive and correlation study was to investigate and compare the self-reported conflict management competence (CMC) of nursing students who were on the point of graduating (NSPGs), and the CMC of registered nurses (RNs) with professional experience. Methods: The data collection, which consisted of soliciting answers to items measuring CMC in the Nurse Professional Competence (NPC) Scale, was performed as a purposive selection of 11 higher education institutions (HEIs) in Sweden. Three CMC items from the NPC Scale were answered by a total of 569 nursing students who were on the point of graduating and 227 RN registered nurses with professional experience. Results: No significant differences between NSPGs and RNs were found, and both groups showed a similar score pattern, with the lowest score for the item: “How do you perceive your ability to develop the group and strengthen competence in conflict management and problem-solving, based on knowledge of group dynamics?”. RNs with long professional experience (>24 months) rated their overall CMC as significantly better than RNs with short (<24 months) professional experience did (p = .05). NSPGs who had experience of international studies during their nursing education reported higher CMC, compared with those who did not have this experience (p = .03). RNs who reported a high degree of utilisation of CMC during the previous month scored higher regarding self-reported overall CMC (p < .0001). Conclusions: Experience of international studies during nursing education, or long professional experience, resulted in higher self-reported CMC. Hence, the CMC items in the NPC Scale can be suitable for identifying self-reported conflict management competence among NSPGs and RNs

Studying the satisfaction of patients on the outcome of an aesthetic dermatological filler treatment

Background: Many factors contribute to extend productive life in the modern world. Competition makes people worry about physical appearance, mosftly in respect to facial and skin aging. This has motivated new developments in cosmetic dermatology and the need of evaluating patient satisfaction with the new proposed treatments. Poll questionnaire has been used for such evaluation, and the analysis of the electroencephalogram (EEG) mapping obtained while the patient answers the satisfaction questionnaire may render the results less subjective. Objectives: The purpose of this paper is to study the satisfaction of a group of 33 women (mean age, 44.years) treated with hyaluronic acid filling of nasolabial folding or lips, combining the EEG brain mapping and questionnaire techniques. Methods: At the third month of evaluation, two networked personal computers were used for the EEG recording and for presenting the patient with a questionnaire about her well-being feeling; self-evaluation of her face; her satisfaction with the results of the aesthetic treatment; how the family, friends, and people at work evaluated the result of the treatment; and her decision to repeat the treatment and to recommend it to friends and family. Results: Poll results showed that patients were feeling well and were satisfied with the results of the aesthetic treatment. Furthermore, the regression EEG mappings showed patients to be satisfied with their appearance and with the treatment involving similar brain areas. Conclusion: Patients decided to undergo the treatment because they were already considering it (54%) or because they were dissatisfied with their lips or nasolabial folding (52%). The fact that the treatment was free of charge solidified the decision. Patients consider themselves as good-looking and they wanted to preserve such a condition. © 2008 Wiley Periodicals, Inc.

Evaluation of the Capillary Blood Glucose Self-monitoringProgram

OBJECTIVE: to evaluate the structure, process and results of the Capillary Blood Glucose Self-monitoring Program in a Brazilian city. METHOD: epidemiological, cross-sectional study. The methodological framework of Donabedian was used to construct indicators of structure, process and outcome. A random sample (n = 288) of users enrolled and 96 health professionals who worked in the program was studied. Two questionnaires were used that were constructed for this study, one for professionals and one for users, both containing data for the evaluation of structure, process and outcome. Anthropometric measures and laboratory results were collected by consulting the patients' health records. The analysis involved descriptive statistics. RESULTS: most of the professionals were not qualified to work in the program and were not knowledgeable about the set of criteria for patient registration. None of the patients received complete and correct orientations about the program and the percentage with skills to perform conducts autonomously was 10%. As regards the result indicators, 86.4% of the patients and 81.3% of the professionals evaluated the program positively. CONCLUSION: the evaluation indicators designed revealed that one of the main objectives of the program, self-care skills, has not been achieved.