Differences in fibromyalgia impact on functioning exist and appear to be influenced by numerous factors, including symptomatology severity, as well as the cognitive profile of the individual. The contribution of these elements, however, tends to be explored in a fragmented manner. To address this issue, we tested a comprehensive structural equation model in which associations of cognitive fusion and pain catastrophizing with function limitations are investigated through fibromyalgia symptomatology (i.e., fatigue, pain severity, and depression) in 231 women with fibromyalgia. In the model, cognitive fusion and two catastrophizing components (magnification and helplessness) were associated with poorer functioning indirectly through fibromyalgia symptomatology. Only the rumination component of catastrophizing had a direct association with functional limitations. All fibromyalgia symptoms were linked to increased functional limitations. A parsimonious model with significant associations only obtained an excellent fit (S-B χ2 = 774.191, df = 543, p < 0.001; CFI = 0.943; RMSEA = 0.043; CAIC = −2724.04) and accounted for 50% of the variance of functional limitations. These results suggest that the relationship between psychological cognitive processes, fibromyalgia symptomatology, and functional limitations is complex and support the need for comprehensive models such as the present. The findings are discussed in the context of personalized psychological treatments (i.e., the need to address certain cognitive processes according to the problematic symptomatology or outcome).

The International Union for Health Promotion and Education (IUHPE) European Accreditation System for Health Promotion aims to promote quality assurance in health promotion practice, education and training. The System is designed to be flexible and sensitive to the different contexts for health promotion practice, education and training in Europe, while maintaining robust criteria. These competency-based criteria were developed in the CompHP Project (2009-2012) that developed core competencies, professional standards and an accreditation framework for health promotion practice, education and training in the context of workforce capacity development in Europe.This paper describes how consultations undertaken with the health promotion community informed the structure and processes of the IUHPE Accreditation System. An overview of its development, key functions and the piloting of its implementation, which was co-funded by the European Union in the context of the EU Health Programme, is presented.Feedback from consultations with key health promotion stakeholders in Europe indicated overall support for the development of an accreditation system for health promotion. However, a number of potential barriers to its implementation were noted including: absence of dedicated practitioners and professional bodies in some countries; lack of clarity about professional boundaries; lack of financial resources required to facilitate capacity building; and concerns about the costs, objectivity and transparency of the system. Feedback from the consultations shaped and informed the process of designing an operational accreditation system to ensure that it would be responsive to potential users' needs and concerns.Based on the agreed structures and processes, a web-based application system was developed and managed at IUHPE headquarters. A governance structure was established together with agreed policies and procedures for the System. During the pilot period, applications from 20 health promotion practitioners, two health promotion education programmes and one national accreditation organisation were processed. Feedback from the piloting stage will inform further refinement of the system.While recognising the challenges, the overall positive feedback and the commitment demonstrated by the health promotion community form a constructive platform for the implementation of the IUHPE Accreditation System in Europe and internationally.

Illegal migrants in Europe are, generally, only entitled to emergency care and services for children and pregnant women. In 2002 legal changes in Spain made accessible medical cards and free medical care for illegal migrants in similar terms than the legal migrants or the Spanish population. We interviewed 380 migrants to assess whether there were differences on health services utilization by legal status. We did not find differences in the utilization of health services when ill between legal and illegal migrants. However, a significantly lower utilization of health services was associated with less education (RP = 0.4; 95% CI: 0.2-0.9).

The CompHP Pan-European Accreditation Framework for Health Promotion provides an agreed system to promote quality assurance and competence for health promotion practice and education in Europe. The Framework, which builds on the CompHP Core Competencies and Professionals Standards, outlines the systems and processes for the accreditation of health promotion practitioners and health promotion education and training by accrediting organizations at national and European levels.

BackgroundFibromyalgia patients are often advised to engage in regular low- to moderate-intensity physical exercise. The need of fibromyalgia patients to walk has been stressed in previous research. Behavioral self-regulation theories suggest that a combination of motivational aspects (to develop or strengthen a behavioral intention: Theory of Planned Behavior) and volitional aspects (engagement of intention in behavior: implementation intentions) is more effective than a single intervention. In this paper, we describe a protocol for identifying the motivational processes (using the Theory of Planned Behavior) involved in the practice of walking (phase I) and for studying the efficacy of an intervention that combines motivational and volitional contents to enhance the acquisition and continuation of this exercise behavior (phase II). The paper also shows the characteristics of eligible individuals (women who do not walk) and ineligible populations (women who walk or do not walk because of comorbidity without medical recommendation to walk). Both groups consist of members of any of four patients’ associations in Spain who are between 18 and 70 years of age and meet the London Fibromyalgia Epidemiology Study Screening Questionnaire criteria for fibromyalgia. Furthermore, using this study protocol, we will explore the characteristics of participants (eligible women who agreed to participate in the study) and nonparticipants (eligible women who refused to participate).Methods/designTwo studies will be conducted: Phase I will be a cross-sectional study, and phase II will be a triple-blind, randomized longitudinal study with two treatment groups and one active control group. The questionnaires were sent to a total of 2,227 members of four patients’ associations in Spain. A total of 920 participants with fibromyalgia returned the questionnaires, and 582 were ultimately selected to participate.DiscussionThe first data gathered have allowed us to identify the characteristics of the study population and they support the appropriateness of the inclusion criteria.. When the study is complete, the results will enable us to establish whether this kind of intervention can be used as a self-regulation tool for increasing and maintaining walking as unsupervised physical exercise of low to moderate intensity in fibromyalgia patients.Trial registrationTrial registration number: ISRCTN68584893

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Título: Andar como forma de ejercicio físico en la Fibromialgia: un estudio de identificación de creencias desde la Teoría de la Acción Planeada. Resumen Este estudio corresponde a la primera fase de investigación formativa recomendada en la teoría de la Acción Planeada para desarrollar una intervención. Nuestros objetivos son identificar las creencias modales sobre la realización de una pauta de ejercicio en personas con fibromialgia, probar los ítems para la evaluación directa de los constructos predictivos y explorar sus relaciones con la conducta. Evaluamos a 46 mujeres con fibromialgia. El análisis de contenido mostró un mayor número de consecuencias positivas que negativas asociadas a la ejecución de la pauta de ejercicio (creencias comportamentales); la familia y los amigos son los referentes importantes (creencias normativas) y se detectaron factores facilitadores e inhibidores de la ejecución de la conducta de ejercicio, relacionados con aspectos de la fibromialgia (creencias de control) como el dolor, la fatiga y el estado de ánimo. El índice de consistencia interna más bajo fue el de la escala de norma subjetiva (α= .78). Los resultados confirman el sedentarismo de la muestra (conducta previa: Media=3.67; rango=1-7) aunque también sugieren que estas personas tienen intención de realizar la conducta (Media= 5.67). Las relaciones obtenidas entre los constructos son las esperadas desde la teoría, apoyando la pertinencia de aplicarla en la conducta y población seleccionada. Palabras clave: Andar; creencias; fibromialgia; teoría de la acción planeada; investigación formativa; estudio de identificación.Abstract: This study is the first phase of the formative research recommended in the Theory of Planned Behavior for the development of an intervention. Our aims are to identify modal beliefs about the performance of an exercise pattern in people with fibromyalgia, to test the items designed for direct evaluation of the predictive constructs and to explore their relationships with the behavior. We assessed 46 women with fibromyalgia. Content analysis showed more positive than negative consequences related to the performance of exercise guidelines (behavioral beliefs). Families and friends are the important referents (normative beliefs) and we identified facilitating and inhibiting factors in the performance of exercise behavior related to aspects of fibromyalgia (control beliefs) such as pain, fatigue and emotional state. The subjective norm scale showed the lowest internal consistency (α= .78). The results confirmed the sedentary lifestyle of the participants (previous behavior: Mean=3.67; rank=1-7) although they also suggested that participants intended to perform the behavior (Mean=5.67). The relationships between constructs are coherent with the theory, and support the relevance of applying it to the selected behavior and population.

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