摘要:

Objectives: To explore the judgments of rule‐related behaviour by health care professionals and the general public in the UK, against a background in which clinical guidelines and protocols are proliferating.Design: A questionnaire survey was used in which short scenarios describing medical practice were presented to a sample of health care professionals and members of the general public.Methods: The health care sample consisted of 315 nurses, doctors and midwives from three English National Health Service (NHS) Trusts who volunteered to take part in the study. A stratified sample of members of the general public (N= 350) was recruited via a market research organizatiofn. Three types of behaviour (compliance with a protocol, violation of a protocol, and improvization, where no protocol exists) and three types of outcome for the patient (good, bad, poor) were manipulated within nine scenarios. Respondents were asked to make judgments about (1) the inappropriateness of behaviour (2) likelihood that they would take further action and (3) responsibility for the outcome.Results: Findings suggest that the process of care has a greater effect on judgments of the behaviour of health care professionals than does the outcome of that behaviour. This was equally true of the professional and public samples.Conclusions: The study has both theoretical and practical implications. First, information about a behaviour's relationship to existing rules has a stronger influence than the consequence of the behaviour on attributions of responsibility. Secondly, using clinical protocols as a way of managing risk in the NHS may be counterproductive unless full compliance is achieve

ISSN:1359-107X    

DOI:10.1348/135910702760213661

出版商:Blackwell Publishing Ltd    

年代:2002

数据来源: WILEY

摘要:

Objectives: The objective of the present study was to test the application of the Transtheoretical Model of Change (TTM) in relation to exercise behaviour of 298 Hong Kong Chinese undergraduates.Design and methods: A cross‐sectional design was used. Respondents completed measures of stages of change, self‐efficacy, processes of change, decisional balance, exercise and demographic data.Results: Significant effects for stage of change were found for self‐efficacy, pros, exercise and nine of the 10 processes of change. In general, scores on these variables were found to increase across the stages although posthoc testsrevealed slightly different patterns of significant differences. Cons were not found to differ significantly across stages of change. The relationship between self‐efficacy and processes of change was dependent on stage of change.Conclusions: The results support some of the assumptions of the TTM but raise questions about the predicted relationships between stages of change and processes of change and between self‐efficacy and processes of change at each stage of change. The practical implications of the findings for the development of interventions to improve young people's exercise levels are

ISSN:1359-107X    

DOI:10.1348/135910702760213670

出版商:Blackwell Publishing Ltd    

年代:2002

数据来源: WILEY

摘要:

Objectives: This study aimed to examine how general motives from self‐determination theory (SDT; Deci&Ryan, 1985) influence intentions to engage in physical activity within the Theory of Planned Behaviour (TPB; Ajzen, 1985). It was hypothesized that the general motives will influence intentions only when mediated by the specific cognitions of attitude, subjective norms and perceived behavioural control (PBC) from the TPB.Design: A cross‐sectional study assessing psychological variables from two theoretical perspectives.Method: Self‐report questionnaires were administered to 1088 children aged 12‐14 years. The children's intentions, attitudes, subjective norms and PBC towards participating in physical activity were assessed using a TPB questionnaire. A modified verson of Ryan and Connell's (1989) perceived locus of causality (PLOC) inventory was used to measure controlling and autonomous motives for participating in physical activity.Results: These data were analysed using structural equation modelling. The resulting well‐fitting model demonstrated that attitude and PBC mediated the influence of autonomous motives to perform physical activity on physical activity intentions. The presence of autonomous motives resulted in the effects of the controlling motives being attenuated to zero.Conclusions: The present results indicate that general autonomous motives to participate in physical activity act as sources of information when childen make their judgments regarding their specific attitudes and PBC. Attitudes and PBC are necessary to translate these general motives from SDT into intentions in the TPB. In terms of targets for intervention, practitioners may positively influence intentions by providing a choice of physical activities to foster increased autonomy in

ISSN:1359-107X    

DOI:10.1348/135910702760213689

出版商:Blackwell Publishing Ltd    

年代:2002

数据来源: WILEY

摘要:

Objectives: The present paper reports two studies designed to test the ability of the theory of planned behaviour (TPB) to mediate the effects of age, gender and multidimensional health locus of control (MHLC) on behavioural intentions and behaviour.Design: Two studies are reported. Study 1 (N= 124) employed a cross‐sectional design and examined three self‐reported health‐related behaviours: safe sex (condom use), binge drinking and drink‐driving. Study 2 (N= 201) employed a prospective design and examined actual attendance at health screening.Methods: Respondents completed questionnaires containing measures of MHLC and TPB. The data were analysed using a combination of bivariate correlations and hierarchical multiple regression.Results: Study 1 showed that the TPB was a superior predictor of health‐related behavioural intentions than both demographic variables and MHLC. Study 2 corroborated the findings of Study 1, and showed that TPB variables were useful predictors of actual behaviour, although the TPB failed to fully mediate the effects of gender on screening attendance.Conclusions: Whilst the TPB accounted for significant proportions of the variance in health‐related behavioural intentions and behaviour, it failed to completely mediate the effects of demographic variables. Future work is required to identify social cognitive variables that will fully mediate the effects of d

ISSN:1359-107X    

DOI:10.1348/135910702760213698

出版商:Blackwell Publishing Ltd    

年代:2002

数据来源: WILEY

摘要:

Objective: To examine the influence of an individually derived versus modal subjective norm component of the Theory of Planned Behaviour (TPB) in predicting attendance at breast screening.Design: A prospective, longitudinal design was employed using a postal questionnaire at Time 1 and objective attendance data from screening records at Time 2.Method: Questionnaires were sent to 1000 women from East Kent due to be invited for X‐ray mammography under the UK's National Health Service Breast Screening Programme. The TPB constructs were used to predict attendance, with a focus on subjective norm. Two versions of the questionnaire were distributed: one assessed subjective norm using individually generated normative beliefs (individual condition) and the other provided a list of modal referents (modal condition).Results: The mean number of normative referents in the individual condition was just two, almost all of whom were family members, in contrast to the modal condition where ‘GP’ led the rank table. The results suggest that a more senstive measure of subjective norm is attained using individually derived beliefs. Structural equation modelling revealed that, contrary to theoretical prediction, the effect on attendance of the individually derived subjective norm was not entirely mediated by intention: an independent contribution to attendance was shown. In the modal condition the construct was entirely mediated by intention.Conclusions: For health behaviours that have implications for others as well as self, measuring individually salient normative beliefs may both improve theoretical prediction and yield information of potential value for designing intervention progr

ISSN:1359-107X    

DOI:10.1348/135910702760213706

出版商:Blackwell Publishing Ltd    

年代:2002

数据来源: WILEY

摘要:

Objective: To examine the relationship between pain, coping, and quality of life in adult patients with sickle cell disease (SCD) in the UK, and to assess the influence of these factors on the utilization of health services.Design: This cross‐sectional study involved 96 adult patients with SCD attending hospitals in London.Method: Interview and questionnaire study involving standard measures of pain, health service utilization, coping responses (measured with the Coping Strategies Questionnaire — revised for SCD), and quality of life (measured by the SF36). Data concerning clinical history, complications and haemoglobin levels were also collected.Results: The number and duration of painful sickle cell episodes in the past 12 months varied widely between patients. We found that 49.5% of accident and emergency visits and 45% of hospitalizations were of 10.4% (10) patients. Pain experience accounted for 12.3% of hospital and general practice service use, independently of age, sex, number of SCD complications and haemoglobin levels. Three higher order factors emerged from analysis of the coping strategies questionnaire, reflecting active behavioural and cognitive coping, affecting coping, and passive adherence (e.g. resting, taking fluids). Active coping was positively associated with the number of pain episodes, while passive adherence coping was related to pain intensity. Psychological coping was unrelated to health service utilization. Marked impairment onmany dimensions of quality of life was apparent in the analyses of the SF36. Affective coping was associated with impaired quality of life independently of demographic and clinical variables.Conclusions: It is evident that sickle cell disease involves not only severe recurrent pain, but also other impairments in health‐related quality of life. Psychological coping patterns are relevant both to the experience of pain, and to broader adjustment. Patients may benefit from interventions that enhance the use of appropriate pain coping techniques and other strategies to improve quality of

ISSN:1359-107X    

DOI:10.1348/135910702760213715

出版商:Blackwell Publishing Ltd    

年代:2002

数据来源: WILEY

摘要:

Objectives: In this exploratory study, an in‐depth analysis of accounts of the experiences of people with sickle cell disease (SCD) was undertaken to gain an understanding of the psychosocial impact of the disease. An additional aim of the study was to determine whether these experiences could be conceptualized in terms of quality of life as defined by the World Health Organization (WHOQOL) with the intention of informing psychosocial research.Design: This study utilized a series of non‐directive, patient‐led, focus groups that specifically addressed the ways in which sickle cell disease impacts on life. Participants were recruited from four centres in London and eight focus group discussions (each one hourin length) were held separately for each centre.Method: Altogether 32 hours of focus group materials were tape‐recorded and transcribed verbatim. Data were analysed using a phenomenological approach to identify emerging themes.Results: Six themes were identified: Growing up with SCD; Education; Impact of the unremitting nature of the disease; Employment; Effects on relationships; and Hospitalization.Conclusion: This research has clearly shown that SCD carries a huge psychosocial burden impacting on physical, psychological, social and occupational well‐being as well as levels of independence and environment. These aspects of life are equivalent to the core domains of the multi‐dimensional WHOQOL and consequently we have argued that SCD undermines quality of life in important ways. The paper provides a rich source of qualitative data to complement quantitative findings and provides detailof the complex human processes and experiences consequent on a life‐long chronic illnes

ISSN:1359-107X    

DOI:10.1348/135910702760213724

出版商:Blackwell Publishing Ltd    

年代:2002

数据来源: WILEY

摘要:

Objectives: Four in ten women with breast cancer experience high levels of anxiety or depression, despite advances in oncology treatments. The study investigates the role of psychosocial, disease and treatment characteristics, and appraisal processes to better understand factors contributing to this high psychological morbidity.Design: A postal survey was employed to observe psychological morbidity in women 2 and 6 months after initial diagnosis and treatment of breast cancer. The study was conducted as an adjunct to an Australian multi‐centre feasibility study of an evidence‐based specialist breast nurse (SBN) model of care.Methods: In total, 195 women with a new diagnosis of early or locally advanced breast cancer completed the data collection relating to this study. Psychosocial, disease and treatment information for each woman at diagnosis was recorded in research logs. Women completed the GHQ‐12 questionnaire 2 months after diagnosis, and at 6 months they completed the GHQ‐12 and an appraisal process questionnaire designed by the National Breast Cancer Centre (NBCC). Bivariate and multiple regression analyses were undertaken to build a statistical model to account for GHQ‐12 scores at 6 months.Results: According to the GHQ‐12, 43% of women had a likely affective disorder at either 2 or 6 months after diagnosis. Point prevalence decreased from 2 to 6 months yet remained substantial compared with general population statistics. Psychological functioning in women with breast cancer is related to a woman's psychiatric history, grade of tumour, and her appraisal processes. Most importantly, improvedpsychological functioning from 2 to 6 months after diagnosis is related to a woman having a lower primary appraisal of threat and a greatersecondary appraisal of self‐efficacy in terms of having confidence in her own ability to cope with concerns associated with the illness.Conclusion: Appraisal processes play a significant role in psychological adjustment to breast cancer. Adjustment may be facilitated by ensuring that the treatment team responds to shortfalls in a woman's appraisal of her illness and her perceived ability to cope, especially where a difficult prognos

ISSN:1359-107X    

DOI:10.1348/135910702760213733

出版商:Blackwell Publishing Ltd    

年代:2002

数据来源: WILEY