Isa Raquel Brito Santos Pereira Felix

Scopus Publications

RESEARCH ARTICLE Behaviour change support education in chronic disease: An international focus group study with undergraduate students and academic educators in nursing, pharmacy and sport science disciplines
Isa Brito Félix, Carla Nascimento, Patrícia Pereira, Katja Braam, Cathal Cadogan, et al.
Plos One, 2026
Introduction Supporting behaviour change for the self-management of chronic diseases is a key competency for health professionals. Little is known about how undergraduate students and academic educators across disciplines and European contexts perceive current education, identify unmet needs relative to a European competency framework, and view the implementation of novel educational tools. To address this gap, we explored students’ and educators’ perspectives, focusing on unmet needs, views on interprofessional education, preferred modalities for using a MOOC, case studies and a simulation software, and perceived facilitators and barriers to use. Methods Twelve online focus groups were conducted separately with a purposive sample of 39 undergraduate students (seven groups) and 27 academic educators (5 groups). Recruitment spanned national and transnational levels across seven European countries, and included participants from nursing, pharmacy and sport science disciplines within the focus groups. The discussions were recorded, transcribed verbatim, and analysed using thematic analysis. Results Unmet needs in behaviour change support education were identified (e.g., models and theories, behaviour change techniques, work in partnership to prioritise target behaviours), detailing contributing factors and strategies for their development. Another theme was interprofessional behaviour change education, highlighting perceived benefits, barriers, such as limited training of educators, and implementation strategies. The third theme, on educational products, yielded insights on barriers and facilitators of use, as well as implementation within undergraduate programme. Conclusion This study highlights the unmet needs in behaviour change support education, the potential of interprofessional education (IPE) and innovative educational products to address these gaps. Findings suggest the need for integrating behaviour change support education into undergraduate curricula, enhancing interprofessional learning on this topic and leveraging digital tools to better equip future professionals in chronic disease management. Strategies emerging from the data can guide these endeavours.
Barriers and strategies for pain management in non-verbal people with dementia in residential care facilities: protocol for an e-Delphi study
Isa Brito Félix, Catarina Ramos, Rui Guerreiro, Jeffery David Hughes, Kreshnik Hoti, et al.
BMJ Open, 2025
Introduction Pain is a prevalent symptom in people living with dementia. Evidence shows that pain frequently remains unrecognised and untreated in this vulnerable population, leading to avoidable suffering. Effective pain management is hindered by multifactorial barriers at the individual, organisational and policy level. This study aims to achieve expert consensus on the key barriers to pain management in non-verbal people living with dementia and strategies to address these barriers within Portuguese residential care facilities. Methods and analysis An e-Delphi study will be conducted using two rounds of online questionnaires. The Behaviour Change Wheel (BCW) framework guided the development of e-Delphi statements by linking identified determinants (i.e., barriers and facilitators) to intervention functions. Barriers were extracted from the literature reviews and mapped into the capability, opportunity and motivation–behaviour model. Intervention functions were then selected using the BCW linkage matrices and operationalised into practical strategies. A purposive and snowball sampling approach will be used to recruit a heterogeneous panel of experts across national residential care facilities, including nurses, physicians, managers and policymakers with relevant experience in dementia. During the e-Delphi rounds, participants will be invited to rate the relevance of each barrier and associated strategy(ies) on a five-point Likert scale and provide comments or suggestions. Consensus will be defined as ≥75% agreement on each statement. Ethics and dissemination Ethical approval for this study was obtained from the Egas Moniz Ethics Committee (Ref. 1586), and all procedures will comply with the Declaration of Helsinki. Informed consent will be obtained from all participants. The findings will be disseminated through a peer-reviewed publication, scientific events and stakeholder networks, including residential care facilities, to inform future practice and policy in dementia care.
Protocol for a usability and pilot implementation study of a digital medical device to assess pain in non-verbal people with dementia in Portuguese residential care facilities
Mara Pereira Guerreiro, Isa Brito Félix, Morgane Tomé, Kreshnik Hoti, Catarina Ramos, et al.
Digital Health, 2025
Objective People living with moderate to severe dementia (PLWD) are often unable to self-report pain. This matter is of particular concern given that up to 80% experience chronic pain. Mistreated or untreated pain in PLWD is associated with symptoms such as agitation and aggression, and unnecessary use of antipsychotic agents. Further, it can also engender mental burden in formal caregivers. The PainChek® App, a regulatory cleared class I medical device, enables the assessment and monitoring of pain in people who cannot verbalise it, such as those with moderate to severe dementia. To date there are no data on the real-world use of the PainChek® App in Portugal. To address this gap, we report the protocol of a pilot study, which combines usability evaluation and implementation research. Methods Usability evaluation of the PainChek® (Portuguese) App will be guided by the ISO framework, focused on effectiveness, efficiency and user satisfaction. Implementation research will combine qualitative interviews to inform the implementation process, a longitudinal study of formal caregivers’ psychological variables, implementation outcomes, plus qualitative interviews to explore the ‘hows’ and ‘whys’ of implementation. The NASSS framework will be used as an implementation framework, together with the COM-B model and the Theoretical Domains Framework. Results The usability and implementation studies have received ethics approval from the Egas Moniz Ethics Committee, under numbers 1367 and 64/24, respectively. Conclusion This study is expected to inform the scale-up of the PainChek® (Portuguese) App in real-world settings and establish a foundation for a larger effectiveness and implementation study.
Translating the Behaviour Change Technique Taxonomy v.1 to other languages: the approach used in European Portuguese (BCTTv1-PT)
Isa Brito Félix, Carolina C. Silva, Mara Pereira Guerreiro, Helga Rafael Henriques, Susan Michie, et al.
Wellcome Open Research, 2024
Background The Behaviour Change Techniques Taxonomy v1 (BCTTv1) is the most widely used classification of behaviour change techniques (BCTs), contributing to the accurate report and evaluation of behaviour change interventions and accumulation of evidence. This study reports a structured approach to adapt the BCTTv1 into European Portuguese (BCTTv1-PT). Methods A collaborative and iterative approach was used. The translation process encompassed four phases: (1) independent forward translation by two native Portuguese speakers proficient in English, (2) forward translation reconciliation, (3) expert consultation by involving seven experts in behaviour change to collect feedback on the draft version of the taxonomy through a structured online form; and (4) feedback analysis and improvement of the BCTTv1-PT. Results Independent forward translations and a reconciled version of the BCTTv1-PT were produced. All experts agreed with the groupings designation (100%). Recommendations were made to improve BCTs labels, definitions and/or examples in all groupings, except for Feedback and monitoring. Experts disagreed with the translated definitions in 40.9% of the BCTs (38/93), with examples in 21.5% (20/93) and with labels in 11.8% (11/93). Recommendations were made for all instances where there was disagreement (n = 69) and were enacted entirety, yielding the final version (BCTTv1-PT). Conclusions Researchers, educators, students and health and other professionals will be able to standardise terminology and have a common language, contributing to the impact of the BCTTv1-PT. This study presents a systematic and rigorous approach for the adaptation of the BCTTv1 and similar taxonomies, which may guide others.
Usability Evaluation by Primary Care Providers of a Novel Digital Intervention for Type 2 Diabetes Self-Management in Older Adults
Mara Pereira Guerreiro, João Balsa, Maria Beatriz Carmo, Ana Paula Cláudio, Isa Brito Félix
CIN Computers Informatics Nursing, 2023
KEY POINTS Applications with virtual humans coupled to information systems for health professionals are a promising avenue to engage people living with chronic diseases and streamline self-management support. Primary healthcare professionals had a positive perspective on the usability of the VASelfCare (virtual assistant to facilitate self-care) mobile application for older people with type 2 diabetes (T2D) and the VASelfCare-connected Web-based dashboard. Overall, findings endorse the further development of the mobile application and connectedWeb-based dashboard to foster the Portuguese integrated care pathway in T2D. D iabetes is a global epidemic; it currently affects approximately 537 million adults worldwide and is expected to rise to 783 million by 2045. Most adults affected by this condition live with type 2 diabetes (T2D), which is highly prevalent in older adults. Diabetes is associated with overwhelming costs for health systems, mainly from treating complications (eg, renal failure and retinopathy). The risk of complications can be reduced by effectively managing glycemia through self-management behaviors, such as medication adherence and physical activity. Digital health interventions, defined as a health service delivered using technology such as mobile applications, can provide self-management support as a complement to nursing consultations; their merits include overcoming the need of frequent face-to-face sessions, convenient access for users, and tailored and attractive content plus the possibility of integrating effective behavior change techniques. Several systematic reviews examined the impact of digital health interventions to support diabetes self-management. A meta-analysis of 13 randomized controlled trials on mobile applications for type 1 diabetes and T2D indicated overall efficacy in reducing glycated hemoglobin (HbA1c), with a mean of 0.44% decrease (95% CI, 0.29%–0.59%). Similarly, a meta-analysis focusing exclusively on persons with T2D (six randomized controlled trials, a total of 1022 participants) found a significant reduction in HbA1c of 0.40% (95% CI, 0.11%–0.69%). One promising area in mobile health is anthropomorphic conversational agents (ACAs). A systematic review on the
Implementing Behaviour Change Strategies
Isa Brito Félix, Mara Pereira Guerreiro
A Practical Guide on Behaviour Change Support for Self Managing Chronic Disease, 2023
This chapter outlines a stepwise approach to implementing behaviour change strategies in chronic disease. In the first part of this chapter, examples of determinants of target behaviours discussed in Chapter 3 are listed, based on case studies developed in the Train4Health project and in the literature. This includes barriers or opportunities (facilitators) for diet, physical activity, smoking cessation and medication adherence. Next, a brief description of approaches to assess key determinants is presented. The second part of this chapter begins with an overview of the classification of behaviour change techniques. Then, we offer guidance for the development of an intervention plan, covering how behaviour change techniques can be implemented in practice, considering potential barriers to the target behaviour, the length of the intervention and the modes through which they can be delivered.
A Practical Guide on Behaviour Change Support for Self-Managing Chronic Disease
A Practical Guide on Behaviour Change Support for Self Managing Chronic Disease, 2023
Editorial: Digital approaches in the nutritional prevention and management of chronic diseases
Mara Pereira Guerreiro, Isa Brito Félix, José Camolas
Frontiers in Nutrition, 2023
Preface
A Practical Guide on Behaviour Change Support for Self Managing Chronic Disease, 2023
Communication and Person-Centred Behaviour Change
Afonso Miguel Cavaco, Carlos Filipe Quitério, Isa Brito Félix, Mara Pereira Guerreiro
A Practical Guide on Behaviour Change Support for Self Managing Chronic Disease, 2023
This chapter presents critical components of the interaction between the professional and the person, needed to effectively support behaviour change. Most of these components are relational competencies assisted by communication skills. Relational competencies include person-centredness and shared decision-making, contributing to the person’s empowerment, a concept strongly linked with health literacy. Communication skills comprise the basic interchange and optimised linguistic features. Further, coping strategies to deal with negative emotions and psychosocial implications of chronic disease are summarised.This chapter also proposes an integrated approach (ABCD) for first and follow-up encounters in behaviour change interventions. The ABCD approach comprises four stages: setting the stage (A), establishing an information base (B), obtaining a commitment (C) and negotiating an intervention plan (D).
Interprofessional Learning Outcomes-Based Curriculum to Support Behaviour Change in Persons Self-Managing Chronic Disease
Afke Kerkstra, Cristina Lavareda Baixinho, Isa Brito Félix, Judith Strawbridge, Mara Pereira Guerreiro
A Practical Guide on Behaviour Change Support for Self Managing Chronic Disease, 2023
Promoting Physical Activity in Older Adults With Type 2 Diabetes via an Anthropomorphic Conversational Agent: Development of an Evidence and Theory-Based Multi-Behavior Intervention
Nuno Pimenta, Isa Brito Félix, Diogo Monteiro, Marta Moreira Marques, Mara Pereira Guerreiro
Frontiers in Psychology, 2022
Operationalizing Behavior Change Techniques in Conversational Agents
Maria Bastos, Ana Cláudio, Isa Félix, Mara Guerreiro, Maria Carmo, et al.
International Conference on Agents and Artificial Intelligence, 2022
Nursing students’ learning from involvement in research projects: an integrative literature review
David de Sousa Loura, Rafael Alves Bernardes, Cristina Lavareda Baixinho, Helga Rafael Henriques, Isa Brito Félix, et al.
Revista Brasileira De Enfermagem, 2022
Contribution of an Intelligent Virtual Assistant to Healthy Ageing in Adults With Type 2 Diabetes
Mara Pereira Guerreiro, Isa Brito Félix, João Balsa, Maria Beatriz Carmo, Maria Adriana Henriques, et al.
Research Anthology on Supporting Healthy Aging in A Digital Society, 2022
Digital tools in behavior change support education in health and other students: A systematic review
Lucija Gosak, Gregor Štiglic, Leona Cilar Budler, Isa Brito Félix, Katja Braam, et al.
Healthcare Switzerland, 2022
Development of a European competency framework for health and other professionals to support behaviour change in persons self-managing chronic disease
Mara Pereira Guerreiro, Judith Strawbridge, Afonso Miguel Cavaco, Isa Brito Félix, Marta Moreira Marques, et al.
BMC Medical Education, 2021
Medication adherence and related determinants in older people with multimorbidity: A cross-sectional study
Isa Brito Félix, Adriana Henriques
Nursing Forum, 2021
Conversational agents for health and well-being across the life course: Protocol for an evidence map
Mara Pereira Guerreiro, Leonardo Angelini, Helga Rafael Henriques, Mira El Kamali, Cristina Baixinho, et al.
Jmir Research Protocols, 2021
Interprofessional Competency Frameworks in Health to Inform Curricula Development: Integrative Review
David Loura, Ana Eva Arriscado, Afke Kerkstra, Carla Nascimento, Isa Félix, et al.
New Trends in Qualitative Research, 2021
LEARNING IN RESEARCH PROJECTS DURING NURSING UNDERGRADUATE DEGREE: INTEGRATIVE LITERATURE REVIEW
David Loura, Rafael Bernardes, Cristina Lavareda Baixinho, Helga Rafael, Isa Félix, et al.
New Trends in Qualitative Research, 2020
Usability of an Intelligent Virtual Assistant for Promoting Behavior Change and Self-Care in Older People with Type 2 Diabetes
João Balsa, Isa Félix, Ana Paula Cláudio, Maria Beatriz Carmo, Isabel Costa e Silva, et al.
Journal of Medical Systems, 2020
Contribution of an intelligent virtual assistant to healthy ageing in adults with type 2 diabetes
Mara Pereira Guerreiro, Isa Brito Félix, João Balsa, Maria Beatriz Carmo, Maria Adriana Henriques, et al.
Exploring the Role of Icts in Healthy Aging, 2020
Virtual assistant to improve self-care of older people with type 2 diabetes: First prototype
Susana Buinhas, Ana Paula Cláudio, Maria Beatriz Carmo, João Balsa, Afonso Cavaco, et al.
Communications in Computer and Information Science, 2019
Development of a complex intervention to improve adherence to antidiabetic medication in older people using an anthropomorphic virtual assistant software
Isa Brito Félix, Mara Pereira Guerreiro, Afonso Cavaco, Ana Paula Cláudio, Anabela Mendes, et al.
Frontiers in Pharmacology, 2019
Anthropomorphic virtual assistant to support self-care of type 2 diabetes in older people: A perspective on the role of artificial intelligence
Gergely Magyar, João Balsa, Ana Cláudio, Maria Carmo, Pedro Neves, et al.
Visigrapp 2019 Proceedings of the 14th International Joint Conference on Computer Vision Imaging and Computer Graphics Theory and Applications, 2019
Intelligent virtual assistant for promoting behaviour change in older people with T2D
João Balsa, Pedro Neves, Isa Félix, Mara Pereira Guerreiro, Pedro Alves, et al.
Lecture Notes in Computer Science Including Subseries Lecture Notes in Artificial Intelligence and Lecture Notes in Bioinformatics, 2019