{"id":761,"date":"2017-11-22T11:52:03","date_gmt":"2017-11-22T11:52:03","guid":{"rendered":"http:\/\/practicalhealthpsychology.com\/?p=761"},"modified":"2025-11-04T14:43:32","modified_gmt":"2025-11-04T14:43:32","slug":"very-brief-interventions","status":"publish","type":"post","link":"https:\/\/practicalhealthpsychology.com\/cz\/2017\/11\/very-brief-interventions\/","title":{"rendered":"Velmi kr\u00e1tk\u00e9 intervence pro zm\u011bnu chov\u00e1n\u00ed v oblasti zdravotn\u00ed p\u00e9\u010de"},"content":{"rendered":"<p><strong>Stephen Sutton, Univerzita v\u00a0Cambridge, Anglie<\/strong><\/p>\n<p>Velk\u00e9 probl\u00e9my vy\u017eaduj\u00ed velk\u00e1 \u0159e\u0161en\u00ed. Vypo\u0159\u00e1dat se s \u201eVelkou \u010dty\u0159kou\u201c chov\u00e1n\u00ed (fyzick\u00e1 inaktivita, u\u017e\u00edv\u00e1n\u00ed tab\u00e1ku, nadm\u011brn\u00e1 konzumace j\u00eddla a alkoholu) tak, aby to m\u011blo v\u00fdznamn\u00fd vliv na ve\u0159ejn\u00e9 zdrav\u00ed, vy\u017eaduje odstup\u0148ovan\u00e9 intervence, kter\u00e9 mohou oslovit velk\u00fd po\u010det lid\u00ed. Jedn\u00edm ze slibn\u00fdch p\u0159\u00edstup\u016f v\u00a0oblasti zdravotn\u00ed p\u00e9\u010de je pou\u017e\u00edv\u00e1n\u00ed kr\u00e1tk\u00fdch intervenc\u00ed, kter\u00e9 by poskytovali prakti\u010dt\u00ed l\u00e9ka\u0159i. Nap\u0159\u00edklad <a href=\"http:\/\/www.nice.org.uk\/guidance\/ph44\">N\u00e1rodn\u00ed Institut pro p\u00e9\u010di a zdrav\u00ed ve Velk\u00e9 Brit\u00e1nii doporu\u010duje<\/a>, aby neaktivn\u00edm dosp\u011bl\u00fdm pacient\u016fm poskytovali l\u00e9ka\u0159i v prim\u00e1rn\u00ed p\u00e9\u010di kr\u00e1tk\u00e9, na m\u00edru \u0161it\u00e9 rady o fyzick\u00e9 aktivit\u011b a navazovali na n\u011b b\u011bhem\u00a0dal\u0161\u00edch sch\u016fzek.<\/p>\n<p><!--more--><\/p>\n<p>Existuj\u00ed <a href=\"http:\/\/bjsm.bmj.com\/content\/50\/7\/408\">d\u016fkazy o efektivit\u011b<\/a> t\u011bchto kr\u00e1tk\u00fdch intervenc\u00ed, ale probl\u00e9m s\u00a0interpretac\u00ed t\u011bchto zdroj\u016f spo\u010d\u00edv\u00e1 v\u00a0<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/28232098\">odli\u0161n\u00fdch definic\u00edch<\/a> toho, co je \u201estru\u010dn\u00e9 poradenstv\u00ed\u201c a \u201ekr\u00e1tk\u00e1 intervence\u201c. Jedna <a href=\"https:\/\/www.nice.org.uk\/guidance\/ph44\/evidence\/review-of-effectiveness-and-barriers-and-facilitators-pdf-69102685\">p\u0159ehledov\u00e1 studie<\/a> nap\u0159\u00edklad definuje kr\u00e1tk\u00e9 poradenstv\u00ed jako \u201etrvaj\u00edc\u00ed m\u00e9n\u011b ne\u017e 30 minut nebo poskytnut\u00e9 v\u00a0pr\u016fb\u011bhu jednoho sezen\u00ed (p\u0159i\u010dem\u017e sledov\u00e1n\u00ed pr\u016fb\u011bhu pro v\u011bdeckou studii je mo\u017en\u00e9 jen p\u0159i dodate\u010dn\u00e9 sch\u016fzce). Mnoho takov\u00fdch \u201ekr\u00e1tk\u00fdch\u201c intervenc\u00ed trv\u00e1 p\u0159\u00edli\u0161 dlouho na to, aby \u0161ly zahrnout do rutinn\u00edch prohl\u00eddek v\u00a0prim\u00e1rn\u00ed p\u00e9\u010di. V\u00a0na\u0161\u00ed pr\u00e1ci jsme se proto soust\u0159edili na v\u00fdvoj a zhodnocen\u00ed \u201evelmi kr\u00e1tk\u00fdch\u201c intervenc\u00ed, kter\u00e9 definujeme jako jedin\u00e9 sezen\u00ed nep\u0159esahuj\u00edc\u00ed 5 minut, abychom ovlivnili fyzickou inaktivitu. Tyto velmi kr\u00e1tk\u00e9 intervence je mo\u017en\u00e9 pou\u017e\u00edt v\u00a0r\u016fzn\u00fdch syst\u00e9mech zdravotn\u00ed p\u00e9\u010de, nicm\u00e9n\u011b my jsme je vyvinuli pro Program zdravotn\u00edch prohl\u00eddek N\u00e1rodn\u00ed zdravotn\u00ed slu\u017eby (NHS) v\u00a0Anglii. Spo\u010d\u00edvaj\u00ed v\u00a0sezv\u00e1n\u00ed dosp\u011bl\u00fdch ve v\u011bku 40 a\u017e 74 let, kte\u0159\u00ed nejsou sledov\u00e1ni pro \u017e\u00e1dn\u00e9 choroby, k\u00a0preventivn\u00ed prohl\u00eddce c\u00e9v jednou za p\u011bt let. V\u011bt\u0161ina t\u011bchto prohl\u00eddek prob\u00edh\u00e1 v\u00a0prim\u00e1rn\u00ed p\u00e9\u010di a vykon\u00e1vaj\u00ed je zdravotn\u00ed sestry a zdravotni\u010dt\u00ed asistenti. Jsou ide\u00e1ln\u00ed p\u0159\u00edle\u017eitost\u00ed, jak potenci\u00e1ln\u011b poskytnout velmi kr\u00e1tkou intervenci pro zm\u011bnu chov\u00e1n\u00ed milion\u016fm lid\u00ed.<\/p>\n<p>P\u0159i v\u00fdvoji <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25887643\">intervenc\u00ed<\/a> jsme vyu\u017eili iterativn\u00ed p\u0159\u00edstup, kter\u00fd kombinoval v\u011bdeck\u00e9 d\u016fkazy a expert\u00edzy z\u00a0r\u016fzn\u00fdch zdroj\u016f a zahrnoval nap\u0159. systematick\u00e9 p\u0159ehledy, konzultace se z\u00fa\u010dastn\u011bn\u00fdmi stranami, kvalitativn\u00ed studie, odhady n\u00e1klad\u016f a t\u00fdmov\u00e9 diskuze. Obsah velmi kr\u00e1tk\u00fdch intervenc\u00ed jsme specifikovali v\u00a0kontextu <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23512568\">technik zm\u011bny chov\u00e1n\u00ed<\/a>. Nap\u0159\u00edklad na\u0161e <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/27350131\">velmi kr\u00e1tk\u00e1 intervence s vyu\u017eit\u00edm krokom\u011bru<\/a> zahrnovala dev\u011bt r\u016fzn\u00fdch technik zm\u011bny chov\u00e1n\u00ed, v\u010detn\u011b nastavov\u00e1n\u00ed c\u00edl\u016f, pl\u00e1nov\u00e1n\u00ed \u010dinnosti a self-monitoring vlastn\u00edho chov\u00e1n\u00ed. Ty spo\u010d\u00edvaly v tom, \u017ee \u00fa\u010dastn\u00edk v\u00fdzkumu dostal krokom\u011br a tabulku se slovn\u00ed instrukc\u00ed ve smyslu \u201eka\u017ed\u00fd t\u00fdden si m\u016f\u017eete stanovit c\u00edl, nap\u0159\u00edklad 6000 krok\u016f denn\u011b, a pak si denn\u011b m\u016f\u017eete zapisovat, kolik krok\u016f jste u\u0161li, a ov\u011b\u0159it si, zda jste sv\u00e9ho c\u00edle dos\u00e1hli.\u201c Tak\u00e9 jsme vytvo\u0159ili t\u0159\u00edhodinov\u00e9 \u0161kolen\u00ed a manu\u00e1l pro praktick\u00e9 l\u00e9ka\u0159e.<\/p>\n<p>Velmi kr\u00e1tk\u00e9 intervence vych\u00e1zej\u00edc\u00ed z\u00a0konkr\u00e9tn\u00edch technik bychom m\u011bli rozli\u0161ovat od pouh\u00e9ho \u201ed\u00e1v\u00e1n\u00ed rad\u201c. Poradenstv\u00ed zahrnuje obvykle pouze v\u00fdzvy ke zm\u011bn\u011b a informace o \u0161kodlivosti fyzick\u00e9 inaktivity, pop\u0159. o v\u00fdhod\u00e1ch v\u011bt\u0161\u00ed fyzick\u00e9 aktivity. Krom\u011b toho, \u017ee je to d\u016fle\u017eit\u00e9, m\u016f\u017ee b\u00fdt tak\u00e9 u\u017eite\u010dn\u00e9 p\u0159idat techniky jako nap\u0159. kladen\u00ed c\u00edl\u016f a self-monitoring, kter\u00e9 jsou navr\u017eeny tak, aby lidem pom\u00e1haly m\u011bnit chov\u00e1n\u00ed.<\/p>\n<p>Zjistili jsme, \u017ee p\u0159idat velmi kr\u00e1tk\u00e9 intervence do pravideln\u00fdch prohl\u00eddek je realizovateln\u00e9 a nav\u00edc i p\u0159ijateln\u00e9 jak pro l\u00e9ka\u0159e, tak pro pacienty. Na\u0161e po\u010d\u00e1te\u010dn\u00ed zji\u0161t\u011bn\u00ed o \u00fa\u010dinnosti byla pom\u011brn\u011b slibn\u00e1. <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/27716297\">Velmi kr\u00e1tk\u00e1 intervence zalo\u017een\u00e1 na krokom\u011bru<\/a> a objektivn\u011b m\u011b\u0159en\u00e9 fyzick\u00e9 aktivit\u011b prost\u0159ednictv\u00edm akcelerometru m\u011bla 73% \u0161anci na \u00fasp\u011bch (tzn. zv\u00fd\u0161en\u00ed fyzick\u00e9 aktivity oproti stavu p\u0159ed intervenc\u00ed). Kdy\u017e jsme v\u0161ak tuto velmi kr\u00e1tkou intervenci testovali v rozs\u00e1hlej\u0161\u00ed studii (N = 1007), m\u011bla po t\u0159ech m\u011bs\u00edc\u00edch jen mal\u00fd, nev\u00fdznamn\u00fd pozitivn\u00ed vliv na objektivn\u011b m\u011b\u0159enou fyzickou aktivitu. Ekonomick\u00e9 zhodnocen\u00ed nicm\u00e9n\u011b nazna\u010dilo, \u017ee existuje 60% pravd\u011bpodobnost, \u017ee se intervence z\u00a0dlouhodob\u00e9ho hlediska vyplat\u00ed \u2013 alespo\u0148 tedy v\u00a0porovn\u00e1n\u00ed s oby\u010dejn\u00fdmi zdravotn\u00edmi prohl\u00eddkami N\u00e1rodn\u00ed zdravotn\u00ed slu\u017eby. Poskytnut\u00ed velmi kr\u00e1tk\u00e9 intervence tedy m\u016f\u017ee b\u00fdt lep\u0161\u00ed ne\u017e ned\u011blat nic.<\/p>\n<p>Efektivitu velmi kr\u00e1tk\u00fdch intervenci by \u0161lo zlep\u0161it p\u0159id\u00e1n\u00edm dodate\u010dn\u00fdch interven\u010dn\u00edch prvk\u016f. Je v\u0161ak v\u00fdzvou to uskute\u010dnit bez v\u00fdrazn\u00e9ho nav\u00fd\u0161en\u00ed n\u00e1klad\u016f. Jedn\u00edm z\u00a0p\u0159\u00edstup\u016f je kombinace velmi kr\u00e1tk\u00e9 intervence poskytnut\u00e9 tv\u00e1\u0159\u00ed v\u00a0tv\u00e1\u0159 praktick\u00fdm l\u00e9ka\u0159em a \u201edigit\u00e1ln\u00ed\u201c intervence, kter\u00e1 pacientovi poskytne soub\u011b\u017enou podporu p\u0159i zm\u011bn\u011b chov\u00e1n\u00ed. Kombinace t\u011bchto dvou komponent m\u016f\u017ee b\u00fdt efektivn\u011bj\u0161\u00ed ne\u017e ka\u017ed\u00e1 samostatn\u011b. Verzi tohoto interven\u010dn\u00edho modelu jsme pou\u017eili ve sv\u00e9 pr\u00e1ci na <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4309513\">zvy\u0161ov\u00e1n\u00ed po\u010dtu abstinent\u016f mezi ku\u0159\u00e1ky<\/a> v\u00a0prim\u00e1rn\u00ed p\u00e9\u010di, kde digit\u00e1ln\u00ed komponenta spo\u010d\u00edvala v\u00a0devades\u00e1tidenn\u00edm programu na m\u00edru nastaven\u00fdch textov\u00fdch zpr\u00e1v zas\u00edlan\u00fdch na mobiln\u00ed telefon ku\u0159\u00e1ka.<\/p>\n<p><strong>Doporu\u010den\u00ed<\/strong><\/p>\n<ul>\n<li>Existuj\u00ed d\u016fkazy o efektivit\u011b kr\u00e1tk\u00fdch intervenc\u00ed pro zm\u011bnu chov\u00e1n\u00ed, nap\u0159. kou\u0159en\u00ed, fyzick\u00e1 aktivita. Mnoh\u00e9 z\u00a0t\u011bchto intervenc\u00ed jsou v\u0161ak p\u0159\u00edli\u0161 dlouh\u00e9 na to, aby \u0161ly zahrnout do rutinn\u00edch konzultac\u00ed s\u00a0pacienty.<\/li>\n<li>Zva\u017ete m\u00edsto toho pou\u017eit\u00ed velmi kr\u00e1tk\u00fdch intervenc\u00ed, kter\u00e9 nezaberou v\u00edce ne\u017e 5 minut. D\u016fkaz o jejich efektivit\u011b je slab\u0161\u00ed ne\u017e u kr\u00e1tk\u00fdch intervenc\u00ed, ale poskytov\u00e1n\u00ed velmi kr\u00e1tk\u00e9 intervence je pravd\u011bpodobn\u011b lep\u0161\u00ed ne\u017e neintervenovat v\u016fbec.<\/li>\n<li>Sp\u00ed\u0161e ne\u017e pouh\u00e9 poskytnut\u00ed rady rad\u011bji zva\u017ete velmi kr\u00e1tkou intervenci, kter\u00e1 zahrnuje jednu nebo v\u00edce technik zm\u011bny chov\u00e1n\u00ed. M\u016f\u017ee b\u00fdt u\u017eite\u010dn\u00e9 nap\u0159. cht\u00edt po pacientech, aby sledovali sv\u00e9 chov\u00e1n\u00ed nebo si vytvo\u0159ili specifick\u00fd ak\u010dn\u00ed pl\u00e1n seps\u00e1n\u00edm kdy, kde a jak zv\u00fd\u0161\u00ed svou fyzickou aktivitu nebo se vyhnou l\u00e1kav\u00fdm sva\u010dink\u00e1m.<\/li>\n<li>Nasm\u011brovat pacienty na u\u017eite\u010dn\u00e9 zdroje (nap\u0159. mobiln\u00ed aplikace nebo m\u00edstn\u00ed vych\u00e1zkov\u00fd klub) trv\u00e1 chvilku a m\u016f\u017ee zv\u00fd\u0161it efekt intervence. I n\u00e1sledn\u00e1 kontroln\u00ed prohl\u00eddka m\u016f\u017ee b\u00fdt n\u00e1pomocn\u00e1.<\/li>\n<li>Ka\u017ed\u00fd kontakt se po\u010d\u00edt\u00e1. Poka\u017ed\u00e9, kdy\u017e pacienta uvid\u00edte, m\u00e1te potenci\u00e1ln\u00ed p\u0159\u00edle\u017eitost n\u011bco \u0159\u00edci o zm\u011bn\u011b chov\u00e1n\u00ed. Zvyk pou\u017e\u00edvat praktick\u00fdmi l\u00e9ka\u0159i velmi kr\u00e1tk\u00e9 intervence u mnoha pacient\u016f m\u016f\u017ee m\u00edt v\u00fdznamn\u00fd vliv na ve\u0159ejn\u00e9 zdrav\u00ed.<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>By Stephen Sutton, University of Cambridge, England Large-scale problems require large-scale solutions. Tackling the \u2018Big 4\u2019 behaviours (physical inactivity, tobacco use, excessive consumption of food and alcohol) requires scalable interventions that can reach large numbers of people to achieve a [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":778,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_et_pb_use_builder":"","_et_pb_old_content":"","_et_gb_content_width":"","_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"_uf_show_specific_survey":0,"_uf_disable_surveys":false,"footnotes":""},"categories":[13],"tags":[],"class_list":["post-761","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-interventions"],"translation":{"provider":"WPGlobus","version":"3.0.2","language":"cz","enabled_languages":["en","id","my","bg","zh","hr","cz","da","de","es","fr","gr","he","it","ja","kr","lv","lt","hu","nl","no","pl","pt","ro","ru","sk","fi","sv","tr","uk"],"languages":{"en":{"title":true,"content":true,"excerpt":false},"id":{"title":true,"content":true,"excerpt":false},"my":{"title":false,"content":false,"excerpt":false},"bg":{"title":true,"content":true,"excerpt":false},"zh":{"title":true,"content":true,"excerpt":false},"hr":{"title":false,"content":false,"excerpt":false},"cz":{"title":true,"content":true,"excerpt":false},"da":{"title":true,"content":true,"excerpt":false},"de":{"title":true,"content":true,"excerpt":false},"es":{"title":false,"content":false,"excerpt":false},"fr":{"title":true,"content":true,"excerpt":false},"gr":{"title":true,"content":true,"excerpt":false},"he":{"title":true,"content":true,"excerpt":false},"it":{"title":true,"content":true,"excerpt":false},"ja":{"title":false,"content":false,"excerpt":false},"kr":{"title":false,"content":false,"excerpt":false},"lv":{"title":true,"content":true,"excerpt":false},"lt":{"title":true,"content":true,"excerpt":false},"hu":{"title":false,"content":false,"excerpt":false},"nl":{"title":true,"content":true,"excerpt":false},"no":{"title":false,"content":false,"excerpt":false},"pl":{"title":true,"content":true,"excerpt":false},"pt":{"title":true,"content":true,"excerpt":false},"ro":{"title":true,"content":true,"excerpt":false},"ru":{"title":true,"content":true,"excerpt":false},"sk":{"title":false,"content":true,"excerpt":false},"fi":{"title":true,"content":true,"excerpt":false},"sv":{"title":false,"content":false,"excerpt":false},"tr":{"title":false,"content":false,"excerpt":false},"uk":{"title":true,"content":true,"excerpt":false}}},"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/practicalhealthpsychology.com\/cz\/wp-json\/wp\/v2\/posts\/761","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/practicalhealthpsychology.com\/cz\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/practicalhealthpsychology.com\/cz\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/practicalhealthpsychology.com\/cz\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/practicalhealthpsychology.com\/cz\/wp-json\/wp\/v2\/comments?post=761"}],"version-history":[{"count":24,"href":"https:\/\/practicalhealthpsychology.com\/cz\/wp-json\/wp\/v2\/posts\/761\/revisions"}],"predecessor-version":[{"id":4638,"href":"https:\/\/practicalhealthpsychology.com\/cz\/wp-json\/wp\/v2\/posts\/761\/revisions\/4638"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/practicalhealthpsychology.com\/cz\/wp-json\/wp\/v2\/media\/778"}],"wp:attachment":[{"href":"https:\/\/practicalhealthpsychology.com\/cz\/wp-json\/wp\/v2\/media?parent=761"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/practicalhealthpsychology.com\/cz\/wp-json\/wp\/v2\/categories?post=761"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/practicalhealthpsychology.com\/cz\/wp-json\/wp\/v2\/tags?post=761"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}