REVIEW ARTICLES

 
Concept analysis of behavior prevention in the context of chronic disease

ABSTRACT: Concept analysis proves important to improving the understanding of a given phenomenon and to supporting professional practice. This study aimed at analyzing the concept of prevention behavior in the context of chronic disease on the basis of the model referred by Walker and Avant in 2005.  In 2011 an integrative review on databases was performed with combinations of descriptors. Online articles addressing the questions made were selected. Thereby, 146 abstracts were read and 25 publications were selected. Elements of the phenomenon were identified as attributes: skill, knowledge, and attitude; antecedents: disease occurrence, identification of risk factors, decision making, and support network; and consequences: individual self-management, mastery of skills, adaptation, and improvement in quality of life. As a result, it was possible to formulate a wider concept of behavior prevention, which, on its turn, can help the health professional in preventive action.

Keywords: Concept formation; behavior; prevention & control; stroke

INTRODUCTION

Sometimes, countless individuals have mistaken understanding with regard to certain common concepts in a professional environment, for example. In this way, research studies and analysis of the concept of specific elements are important, in order to clear and comprehensive understanding of literature.

In this context, we highlight the prevention behavior phenomenon, given the need for modifications to lifestyle of people who experience chronic disease like stroke. Prevention behavior is important for dealing with phenomena of promoting a healthy lifestyle, in order to avoid complications and aggravations, reduce costs and demand at health services^1,2.

So, with the goal of improving the health condition or prevent occurrence of worsening, behavior of prevention focuses on, in general, the management of risk factors³.

Although some of these risk factors are physiological nature, in which stands out the pharmacological action, the risk factors that can be controlled through the modification of habits of the individual call the attention. Mainly knowing that habits are aspects quite susceptible to variation, according to cultural issues, beliefs and values, it should be considered in definition⁴.

Based on the importance of conceptual understanding of the phenomenon, it is considered the chosen technique concept analysis to assist the use of thought and communication, as well as describe particular strategies, especially when the concept is vague or has more than one meaning⁵.

It is necessary concept analysis for the case of careful examination and a descriptive word or phrase and its use in the language, along with explanation of how it is and how it relates to other words or terms in the transmission of actual and possible meanings⁶.

Thus, the objective of this study was to analyze the concept of preventive Behavior in the context of chronic disease and based on the model advocated for conceptual analysis⁶, which was chosen because it is more directed to the nursing classification systems. It is intended, therefore, to seek a more meaningful and consistent understanding possible about the concept, contributing to better understanding of professionals, among which stands out the figure of the nurse health promoter, directly responsible for the ongoing management of modifiable risk factors of chronic patients.

METHODOLOGY

This study is of Integrative Review type, which sought to evaluate the existing literature thoroughly for providing subsidies to the analysis of concept proposal. The study was conducted during the period of September to November 2011.

Given the analysis of concept provide the identification of particular and characteristic attributes of the concept, it is important to use procedures described by a consolidated model as what was used in the study in question⁶. It should be noted that the analysis of concept, according to the authors⁶, refers to the modified and simplified proposal from another more general model and previously proposed⁵.

So, eight recommended steps were followed as sufficient to capture phases and implementation of the essence of the process from concept analysis to reality of nursing taxonomies, comprising: selecting a concept; determination of the goals or purposes of analysis; identification of uses of concept; determination of the attributes that define it; identification of a case model; identification of a limit case, a related case, otherwise, an event invented and a legitimate case; identifying antecedents and consequent; and definition of empirical references⁶. It should be noted that this study did not take place to identify the cases suggested by the authors, following the other steps, that were enough for the preparation of the concept in question.

Thus, for search of evidence about this concept in the literature, an integrative review of literature in databases was done: Publications Medical (PUBMED), Cummulative Index to Nursing and Allied Health Literature (CINAHL), Latin American literature and Caribbean Health Sciences (LILACS)and Cochrane library (CLIB), with three combinations of indexed descriptors: Behavior, Adaptation, psychological and Stroke; Behavior, Prevention & control and Stroke; and lastly Behavior, Behavioral Science and Stroke.

It is mentioned that cerebral vascular accident or stroke is focused because it is a chronic disease that requires significant modifications of individual habits, given the range of physical sequels and limitations imposed by stroke.

In this search were found 146 articles, which were submitted to a reading of the title, as well as the abstract, in order to verify whether they would respond to any of the following questions: what is understood by prevention behavior of the patient or family member after the stroke event? Which elements are characterized as prevention behavior? What factors hinder or affect the behavior?
In addition to the need of the possibility of at least one of the questions referred, it is established the following inclusion criteria: to be published in Portuguese, English or Spanish language and be available in their entirety and electronically. Articles may be repeated were deleted.

Thus, a total of 25 articles was selected, of which 16 were found on base CINAHL1-3,7-19, eight articles were selected from the PUBMED4,20-26  basis and a LILACS27 database, as shown in Figure 1.

It is highlighted that many publications, especially those of the Cochrane database, referred to behavioral aspects of prevention with emphasis on pharmacological mechanisms. Thus, these studies were excluded because they did not meet the objectives of the research.

RESULTS AND DISCUSSION

We analyzed 25 publications that subsidized the identifying attributes, antecedents and consequences as well as definitions about the concept of Preventive Behavior.

Thus, the integrative review conducted, it was possible to identify various aspects of the concept of preventive behavior, compile the data and build a final broader concept than those found, since no studies presented complete concept and often this is implicit and dissolved in the text. Thus, among the 25 works analyzed, 16 had direct information about the definition of the concept, the other articles^{1,3,8,12,13,18,19,22,25}  were the other important aspects to the elaboration of the concept as attributes, antecedents or consequences.

As noted, many definitions are similar in some aspects and complement each other, so that the concept of prevention behavior impounded refers to subjective and intrinsic aspects of the individual. Such aspects are based on the correct identification of risk factors or health modifiable conditions¹⁵, by developing skills and individual competencies^14,15 to provide effective management fators^14,27.  See Figure 2.

It should be noted that the behavior of prevention is understood as a continuous process of transition and reorganization of activities and routine aspects of the person²⁶. Routine aspects can be perceived as an individual's habits, thus, modification or acquisition of new habits also occurs in some definitions found^9,14.

As the definitions found, it was perceived congruence studies to refer to the behavior of prevention, in face of the acquisition or modification of everyday habits, through the acquisition of skill. It should be noted that the development of ability relates to the process of knowledge acquisition that is configured as dynamic and continuous. Such a process is also likely to use health promotion strategies for the effective confrontation of health situations^10,27.  Knowledge is thus related to the development of skills for more effective management of the risk factors experienced by the individual^3,7.

Health situations are translated by risk factors, with focus on that are modifiable and, are related to individual conditions, such as the person's habits. There are also environmental conditions, which in the context of the occurrence of falls, it can be mentioned the conditions on the ground, footwear, lighting, objects scattered on the ground, among others^14,24.

With respect to subjective aspects, it is highlighted the influence of cultural issues involving values and beliefs of the individual, with active effect in the decision-making process. Thus, continuous actions of positive attitudes aimed at preventing certain aspect that can also be stimulated^4,20.

Therefore, it mentions the importance of the provision of guidelines and recommendations of health professionals with regard to correct that preventive measures that should be implemented^14,16. It's worth mentioning the importance of social networks as friends and family, which can encourage and assist in carrying out the activities²¹.

About the attributes, antecedents and consequences Prevention Behavior concept, helps its understanding and it was able to find several aspects involved with the theme, as shown in Figure 3.

Thus, as verified, prevention behavior has interrelated attributes, employed at the same time, which mentioned skill for the management of individual and environmental conditions^{3,4,7,8,23-27}.

The attribute knowledge was then, the most mentioned in the studies examined^{1-3,21-24,13-19}.  There are also other essential attributes to capture the concept phenomenon, as the motivation of the individual who is related to the posture of engagement and previously involved with values and beliefs^4,7,20. The last denote the relationship of cultural issue on incorporation of the behavior²³.

Knowledge was the more attribute found in the studies and stands out to be closely related to the ability that acquired by knowledge of the subject, with a view to the acquisition of sufficient competence to carry out preventive practices.

However, skill, knowledge and competence are also influenced by an individual's motivation to engage in preventive attitudes^1,2,9,13,27,  considering aspects of the beliefs and values of the individual^4,7,20,  since the cultural issue is intrinsically related to the behavior of the individual.

In this context, it mentions the figure of health professionals in the orientation of people as the correct management of risk factors, considering limitations and capacities of the individual^{1,2,7,8,14-19,21,24,25,27}. Moreover, in most of these situations, it is essential that the training of professionals to work with this population, since stroke is one public health problem increasingly common²⁸.

Regarding the antecedents of the concept, it was found that the occurrence of a chronic disease like STROKE, it is often the starting point for the individual to realize the need for changes in certain aspects of life^4,19,26 The patient support network also stands to precede and be important driver of the conceptualized event^{1,2,7,8,14-19,21,24,27}.  In addition, subjective experiences of the person also are configured as antecedents and are responsible for stimulating preventive behavior^9,24.

The antecedent support network can directly influence a person's decision making regarding the prevention behavior^21,24. Thus, stimulate collaborative efforts^12,15, weighing financial resources, since changes in routine habits involve onus^19,23,22.

The subjective experiences are knowledge obtained empirically. In this context, successful experiences influence the individual to believe and trust prevention behavior actions previously experienced and in which benefits were observed.

Through the empowerment acquired the patient experiences significant and positive changes in his lifestyle^{3,7,9,14,20,21,23,24,26}. This process seeks to adapt the person to new aspects imposed by a chronic disease, among which may be mentioned environmental modifications, habits, preferences and needs^{7,9,21,23,24,26}.

With respect to consequences extracted in the search, it has been that after the implementation of preventive behavior, the individual acquires empowerment necessary for the management of the risk factors of the most correct way possible^3,14,20. What happens with the intention of establishing alternatives to prevent health complications for the domain of new skills^20,22,23.

Therefore, it is highlighted, consequences features of the concept phenomenon, such as: Optimizing functional status, with increased autonomy, and improvement in quality of life^26,27.

However, in the context of the patient affected by stroke, it is worth mentioning the phenomenon consequent workload, most commonly experienced by their caregivers who take actions that the patient is unable due to some physical or cognitive sequel^21,23. The consequent workload is commonly found in reality of people who experience stroke event, especially in the context of caregivers of patients. The fact is related to the condition of physical dependence that patients with stroke experience and in which caregivers, mostly relatives, ending by putting many of the activities by the patient, overloading him^21,23.
In light of the above, it was possible to elaborate a concept that considers the evidence presented and discusses the behavior of prevention as a skill or ability of the individual can acquire. This objective ability to engage in certain activities of preventive nature and employs evidence presented as attributes. It should be noted that, in this engagement, emphasizes the use of preventive strategies with a focus on management of modifiable risk factors leading to preventive actions.

In this way, the process of engagement in the modification or acquisition of new habits culminates in the person's adaptation to changes necessary and often imposed by a chronic disease. The adaptive process experienced is, then, important consequent of the concept studied, as well as obtaining a healthy lifestyle. There are seen to be improving the quality of life another consequence of individual who adopts a preventive behavior.

As the foregoing and based on attributes, antecedents and consequences, it is possible the analysis of concepts from other studies, from which proceeds to the construction of more complete and coherent conceptual definition possible.

In order to formulate the following concept of Preventive Behavior: ability to engage in the management of modifiable risk factors through the use of strategies that facilitate the process of adaptation in search of healthier lifestyle.

CONCLUSION

By reading the papers about the prevention behavior phenomenon, it was possible to identify prevention behavior phenomenon definitions. As well as, several attributes, antecedents and consequences the analysis of these definitions were identified and assisted with a view to elaborate a more completed concept.

It was found that such concepts as being partial definitions of the phenomenon and many other articles not mentioned concepts but attributes, antecedents or consequences. From these recent and based on definitions referred it was possible to elaborate a complete and coherent concept.

Thus, it was possible to clarify the constituent elements of the concept approached, verifying the intrinsic relationship of these. Thus, prevention behavior encompasses aspects of knowledge about risk factors, so that it can be identified them when present. Through collaborative efforts which highlight the role of family members and health professionals, the individual can acquire competence and ability to correct management of risk factors. Finally, we seek to achieve a process of adaptation and incorporation of new habits that can lead to better quality of life.

The conceptual formulation may contribute to better understanding of the professionals who, in turn, can act in a more targeted and individualized, given that the performance of these professionals has been identified as an important antecedent to the phenomenon studied.

It is concluded that the identification of attributes, antecedents and consequences is important because it made possible the clarification of a concept, therefore, greater understanding of the progresses elements, as well as subsequent to the event. Such clarification has demonstrated the benefits that the incorporation of preventive behavior may entail.

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