Comportamentos ineficazes de manutenção da saúde em pacientes transplantados de fígado: revisões sistemáticas e metanálises

Abstract

The objective of this study was to systematically summarize the scientific evidence on the etiological factors and clinical indicators of ineffective health maintenance behaviors in adult liver transplant recipients followed in non-hospital settings. To this end, two independent systematic reviews with meta-analysis were conducted. The first review aimed to identify etiological and risk factors and, consequently, associated conditions and populations at risk related to this phenomenon. The second review was directed toward the identification and evaluation of the diagnostic accuracy of the clinical indicators of ineffective health maintenance behaviors. Both reviews followed international methodological recommendations for systematic reviews and diagnostic test accuracy reviews, with protocols previously registered in PROSPERO. Searches were carried out in eight health-related databases, in addition to gray literature and manual reference tracking, without restrictions on language or publication period. Observational and experimental studies involving liver transplant recipients aged 18 years or older in non-hospital follow-up were included, while studies conducted exclusively in hospital settings, protocols, guidelines, and research involving health professionals or students were excluded. Study selection, methodological quality assessment, and data extraction were performed by two independent reviewers. Data synthesis was carried out through narrative, tabular, and quantitative approaches, with meta-analysis performed only when conceptual homogeneity and availability of compatible data were present. In the etiology and risk review, 39 studies were included, from which 32 factors related to ineffective health maintenance behaviors were identified, 15 of which provided sufficient data for quantitative synthesis. These factors encompassed psychosocial, cognitive, socioeconomic, and clinical-functional dimensions. Factors related to inadequate self-efficacy, insufficient knowledge of basic health practices, substance abuse, insufficient health resources, and psychological distress-especially anxiety and feelings of guilt related to transplantation-were prominent. Associated conditions, such as physical frailty and a greater need for clinical follow-up, were also related to the manifestation of the phenomenon. Other factors, such as inadequate health literacy, insufficient social support, and competing lifestyle preferences, showed inconsistent results among the included studies. In the review of clinical indicators, 24 indicators of ineffective health maintenance behaviors were identified. Among these, 3 indicators provided sufficient data for quantitative synthesis of diagnostic accuracy, particularly those related to alcohol consumption and the absence of active coping behaviors. These indicators demonstrated greater clinical usefulness for confirming the diagnosis when present; however, in isolation, they are not sufficient to exclude the phenomenon.The synthesized evidence demonstrates that ineffective health maintenance behaviors in liver transplant recipients constitute a multifactorial phenomenon, influenced by psychosocial, cognitive, socioeconomic, and clinical-functional determinants. The identification of 32 factors and 24 clinical indicators contributes to greater precision in nursing clinical judgment. Despite the advances, methodological heterogeneity and the scarcity of diagnostic accuracy studies limit the quantitative synthesis of all indicators, indicating the need for further investigations, especially with longitudinal designs, to strengthen the level of evidence and the clinical applicability of this nursing diagnosis.