ISSN:1359-107X    

DOI:10.1111/bjhp.12126

年代:2015

数据来源: WILEY

摘要:

PurposeTo outline some of the challenges of mixed methods research and illustrate how they can be addressed in health psychology research.MethodsThis study critically reflects on the author's previously published mixed methods research and discusses the philosophical and technical challenges of mixed methods, grounding the discussion in a brief review of methodological literature.ResultsMixed methods research is characterized as having philosophical and technical challenges; the former can be addressed by drawing on pragmatism, the latter by considering formal mixed methods research designs proposed in a number of design typologies. There are important differences among the design typologies which provide diverse examples of designs that health psychologists can adapt for their own mixed methods research. There are also similarities; in particular, many typologies explicitly orient to the technical challenges of deciding on the respective timing of qualitative and quantitative methods and the relative emphasis placed on each method. Characteristics, strengths, and limitations of different sequential and concurrent designs are identified by reviewing five mixed methods projects each conducted for a different purpose.ConclusionsAdapting formal mixed methods designs can help health psychologists address the technical challenges of mixed methods research and identify the approach that best fits the research questions and purpose. This does not obfuscate the need to address philosophical challenges of mixing qualitative and quantitative methods.Statement of contributionWhat is already known on this subject?Mixed methods research poses philosophical and technical challenges.Pragmatism in a popular approach to the philosophical challenges while diverse typologies of mixed methods designs can help address the technical challenges.Examples of mixed methods research can be hard to locate when component studies from mixed methods projects are published separately.What does this study add?Critical reflections on the author's previously published mixed methods research illustrate how a range of different mixed methods designs can be adapted and applied to address health psychology research questions.The philosophical and technical challenges of mixed methods research should be considered together and in relation to the broader purpose of the research.

ISSN:1359-107X    

DOI:10.1111/bjhp.12122

年代:2015

数据来源: WILEY

摘要:

PurposeInformal family and community support deriving from social relations can play an important role in protecting mental and physical health in resource‐scarce contexts and may help facilitate health service access and uptake. Yet, to date, there has been surprisingly little empirical research investigating the role of social support as a resource for health inHIV‐affectedSouthernAfrican communities, despite the known importance of social connectedness, high rates of physical and mental health conditions, and existing ‘treatment gaps’.MethodsThis paper brings together and discusses findings of multiple linked analyses, from the first large‐scale explanatory sequential mixed methods research investigating the relationship between social support and health with caregiver populations inHIV‐endemicSouthAfrica.ResultsOverall, findings highlight the protective role of social support for caregiver mental health, the multiple perceived psychological and behavioural mechanisms possibly explaining the relationship between social support and both mental and physical health, and gender differences in the provision, effects, and availability of support.ConclusionsDrawing from these findings and the broader literature, four potential foci for future research inSouthernAfrica are identified and discussed, as are implications for research design and methodologies. These involve achieving a better understanding of the following: The pathways and processes explaining common and differential effects of social support across different population groups; the potential protective role of social support for physical health; and the role of factors such as gender and social and cultural norms in shaping the relationship between social support and health.Statement of contributionWhat is already known on this subject?Mental and physical health are closely related.HIVincreases the risk of mental health conditions.Studies mainly from high‐income countries have shown social relations and support to be protective of health.What does this study add?First mixed methods research of this dimension on social support and health inSouthernAfrica.Highlights importance of social support for mental health among caregivers of children inHIV‐endemicSouthAfrica.Points to biological and psychological pathways explaining the support–health relationsh

ISSN:1359-107X    

DOI:10.1111/bjhp.12127

年代:2015

数据来源: WILEY

摘要:

PurposeTo discuss an example of mixed methods in health psychology, involving separate quantitative and qualitative studies of women's mental health in relation to miscarriage, in which the two methods produced different but complementary results, and to consider ways in which the findings can be integrated.MethodsWe describe two quantitative projects involving statistical analysis of data from 998 young women who had had miscarriages, and 8,083 who had not, across three waves of theAustralianLongitudinalStudy onWomen'sHealth. We also describe a qualitative project involving thematic analysis of interviews with nineAustralian women who had had miscarriages.ResultsThe quantitative analyses indicate that the main differences between young women who do and do not experience miscarriage relate to social disadvantage (and thus likelihood of relatively early pregnancy) and to a lifestyle that makes pregnancy likely: Once these factors are accounted for, there are no differences in mental health. Further, longitudinal modelling demonstrates that women who have had miscarriages show a gradual increase in mental health over time, with the exception of women with prior diagnoses of anxiety, depression, or both. By contrast, qualitative analysis of the interviews indicates that women who have had miscarriages experience deep emotional responses and a long and difficult process of coming to terms with their loss.ConclusionsA contextual model of resilience provides a possible framework for understanding these apparently disparate results. Considering positive mental health as including the ability to deal constructively with negative life events, and consequent emotional distress, offers a model that distinguishes between poor mental health and the processes of coping with major life events. In the context of miscarriage, women's efforts to struggle with difficult emotions, and search for meaning, can be viewed as pathways to resilience rather than to psychological distress.Statement of contributionWhat is already known on this subject?Quantitative research shows that women who miscarry usually experience moderate depression and anxiety, which persists for around 6 months.Qualitative research shows that women who miscarry frequently experience deep grief, which can last for years.What does this study add?We consider ways in which these disparate findings might triangulate.The results suggest a need to distinguish between poor mental health and the experience of loss and grief.Adjusting to miscarriage is often emotionally challenging but not always associated with poor mental health

ISSN:1359-107X    

DOI:10.1111/bjhp.12121

年代:2015

数据来源: WILEY

摘要:

PurposeThis article illustrates the use of mixed methods in the development and evaluation of the Positive Online Weight Reduction (POWeR) programme, an e‐health intervention designed to support sustainable weight loss. The studies outlined also explore how human support might enhance intervention usage and weight loss.MethodsMixed methods were used to develop and evaluatePOWeR. In the development phase, we drew on both quantitative and qualitative findings to plan and gain feedback on the intervention. Next, a feasibility trial, with nested qualitative study, explored what level of human support might lead to the most sustainable weight loss. Finally, a large community‐based trial ofPOWeR, with nested qualitative study, explored whether the addition of brief telephone coaching enhances usage.ResultsFindings suggest thatPOWeRis acceptable and potentially effective. Providing human support enhanced usage in our trials, but was not unproblematic. Interestingly, there were some indications that more basic (brief) human support may produce more sustainable weight loss outcomes than more regular support. Qualitative interviews suggested that more regular support might foster reliance, meaning patients cannot sustain their weight losses when support ends. Qualitative findings in the community trial also suggested explanations for why many people may not take up the opportunity for human support.ConclusionsIntegrating findings from both our qualitative and quantitative studies provided far richer insights than would have been gained using only a single method of inquiry. Further research should investigate the optimum delivery of human support needed to maximize sustainable weight loss in online interventions.Statement of contributionWhat is already known on this subject?There is evidence that human support may increase the effectiveness of e‐health interventions.It is unclear what level of human support might be optimal or how human support improves effectiveness.Triangulation of quantitative and qualitative methods can be used to inform the design and implementation of interventionsWhat does this study add?This paper demonstrates the value of a mixed methods approach when developing and evaluating an intervention.Qualitative methods provided complementary insights into the optimal level of human support.Brief human support is valued by some and may enhance usage and outcomes of an e‐health intervention for wei

ISSN:1359-107X    

DOI:10.1111/bjhp.12125

年代:2015

数据来源: WILEY

摘要:

Background and aimThe roles of self‐efficacy and self‐monitoring as proximal predictors of dental flossing frequency are studied in the context of an oral health intervention.Materials and methodsA study among 287 university students, aged 19 to 26 years, compared an intervention group that received a brief self‐regulatory treatment, with a passive and an active control group. Dental flossing, self‐efficacy, and self‐monitoring were assessed at baseline and 3 weeks later.ResultsThe intervention led to an increase in dental flossing regardless of experimental condition. However, treatment‐specific gains were documented for self‐efficacy and self‐monitoring. Moreover, changes in the latter two served as mediators in a path model, linking the intervention with subsequent dental flossing and yielding significant indirect effects.ConclusionsSelf‐efficacy and self‐monitoring play a mediating role in facilitating dental flossing. Interventions that aim at an improvement in oral self‐care should consider using these constructs.Statement of contributionWhat is already known on this subject?The adoption and maintenance of oral self‐care can be facilitated by a number of social‐cognitive variables.Interventions that include planning, action control, or self‐efficacy components have been shown to improve dental flossing.In one recent study on flossing in adolescent girls, planning intervention effects were mediated by self‐efficacy.What does this study add?Self‐monitoring is associated with better oral self‐care.A 10‐min intervention improves self‐efficacy and self‐monitoring.Self‐efficacy and self‐monitoring operat

ISSN:1359-107X    

DOI:10.1111/bjhp.12091

年代:2015

数据来源: WILEY

摘要:

ObjectiveThis analysis examines whether or not younger caregivers, parents of children with developmental disabilities, differed from controls in terms of cytomegalovirus (CMV) seropositivity andCMV‐specific antibody titre. Secondly, it examined whether any particular socio‐demographics, health behaviours, or psychological/caregiving variables were associated with a higherCMVantibody titre among caregivers.DesignYoung caregivers and age‐ and sex‐matched controls were compared with respect to their reported health behaviour and psychosocial status as well as latent virus control.MethodsOne hundred and seventeen parents of children with developmental disabilities and 52 control parents completed standard measures of health behaviours, socio‐demographics, perceived stress, depression and anxiety, caregiver burden, child problem behaviours. They also provided a blood sample assayed for the presence ofCMV‐specific antibody.ResultsCaregivers were no more likely to beCMVpositive than controls and did not have higher antibody titres againstCMV. In addition, there was no association betweenCMVantibody titre in seropositive caregivers and any of the psychological/caregiving variables. However, higherCMVantibody titres were significantly associated with a higherBMI, lower exercise levels, smoking, and lower fruit and vegetable and fat intake among seropositive caregivers.ConclusionsThese data suggest that in the absence of immunosenescence, the chronic stress of caregiving is not sufficient to compromise the immune response to persistentCMVinfection. However, an indirect mechanism to poorer health in caregivers might be via adoption of disadvantageous health behaviours in response to stress.Statement of contributionWhat is already known on this subject?Older caregivers of spouses with dementia show a poorer immune response against latent viruses when compared to age‐ and sex‐matched controls.Younger parental caregivers of children with developmental disabilities show a poorer antibody response to vaccination.What does this study add?The study showed no association between caregiving stress andCMVantibody titre in young caregivers.There were higherCMVantibody titres in the caregivers who engage in unhea

ISSN:1359-107X    

DOI:10.1111/bjhp.12092

年代:2015

数据来源: WILEY

摘要:

ObjectivesCancer not only affects the patient but also the partner. In fact, couples may react as a unit rather than as individuals while coping with cancer (i.e., dyadic coping). We assessed (1) the relationship between dyadic coping and relationship functioning in couples coping with cancer and (2) whether intervention studies aimed at improving dyadic coping were able to enhance the relationship functioning of these couples. Recommendations for future studies are provided.MethodA systematic search was conducted to identify all eligible papers between January 1990 and September 2012. The databasesPubMed, PsycINFO, the Cochrane Library, andEMBASEwere screened.ResultsMost studies (n = 33) used an appropriate study design, adequate measurements, adequate analytical techniques, and a sufficient number of included participants to answer addressed research questions. However, the definition and assessment of dyadic coping strategies differed, which hampered comparison. Coping styles characterized by open and constructive (cancer‐related) communication, supportive behaviours, positive dyadic coping, and joint problem solving were related to higher relationship functioning, whereas dysfunctional communication patterns (e.g., protective buffering, demand–withdraw communication), unsupportive behaviours, and negative dyadic coping were related to lower relationship functioning. The results of the intervention studies were inconsistent: while some studies reported a beneficial effect on relationship functioning, other studies report no such effect, or only found a positive effect in couples with fewer personal relationship resources.ConclusionsThis review showed that adequate dyadic coping may improve relationship functioning, while dysfunctional dyadic coping may impede relationship functioning. In order to increase the comparability of the reported findings, a more uniformly conceptualized perspective on dyadic coping is needed. A better understanding of the dyadic challenges couples coping with cancer may face and more insight on how to expand the dyadic coping of these coupes might facilitate improvements in the quality of cancer care. Couple‐based intervention studies may increase the couples’ relationship functioning. However, future research is needed to examine more specifically which couples may benefit from such interventions.Statement of contributionWhat is already known on this subject?Dyadic coping may influence the distress experienced by both members of the couple and their relationship functioning. Several reviews already reported on the potential of couple‐based interventions to improve the dyadic coping of couples coping with cancer and on the beneficial effects of this coping on the psychosocial adjustment and relationship functioning of patients and partners (e.g., Badr&Krebs, [Badr, H., 2012]; Martire, Shulz, Helgeson, Small,&Saghafi, [Martire, L. M., 2010]; Reganet al., [Regan, T. W., 2012]). However, even though we now know that couple‐based intervention might be useful, no systematic review has been conducted that focuses specifically on the mechanisms of dyadic coping itself.What does this study add?This review showed the importance of stress communication, supportive behaviours, and positive dyadic coping for the maintenance or enhancement of relationship functioning in couples coping with cancer. In addition, the dyadic intervention studies send an important message that encourages to further examine the potential benefit of such interventions in future. However, more consensus in the conceptualization and assessment of the dyadic coping styles is needed in order to increase the comparability of the rep

ISSN:1359-107X    

DOI:10.1111/bjhp.12094

年代:2015

数据来源: WILEY

摘要:

ObjectivesInitiating and maintaining physical activity presents the individual with challenges of inconvenience, discomfort, and counteractive energy. Addressing these challenges requires an intervention that elicits motivation to engage in this activity, minimizes the direct relationship between unwanted internal experiences and inaction, and is also in itself accessible and convenient. Accordingly, this study investigated the efficacy of a self‐managed Acceptance and Commitment Therapy (ACT) intervention delivered viaDVDand tailored for physical activity initiation.Design and methodsFifty‐nine minimally active community participants were randomly allocated to receive a 12‐week pedometer‐based walking programme, or the same walking programme with the additional provision of theACT DVD. The primary outcome was overall physical activity level (assessed at baseline and post‐intervention), and the secondary outcome was pedometer‐assessed step count (measured at 4‐weekly intervals throughout the intervention period).ResultsParticipants who received theACT DVDachieved a significantly greater increase in physical activity levels post‐intervention, were more likely to achieve the goals specified in the programme, and reported a higher average step count than participants who received the walking programme in isolation.ConclusionsTheACTintervention, delivered viaDVDfor the promotion of physical activity, proved a simple, efficient, and accessible method to encourage positive short‐term increases in an important health‐promoting behaviour.Statement of contributionWhat is already known?ACTinterventions can increase physical activity levels through augmenting initiatory self‐regulatory control.Face‐to‐face delivery presents challenges of accessibility and feasibility for community implementation.There is a need for effective interventions that maximize impact while minimizing inconvenience.What does this study add?Supplementing a walking programme with a self‐managedACT DVDproduced significant increases in physical activity.TheACT DVDis a convenient, accessible, and potentially cost‐effective approach to physical activity initiation.ACTlends itself to implementation as a self‐managed electr

ISSN:1359-107X    

DOI:10.1111/bjhp.12098

年代:2015

数据来源: WILEY

摘要:

ObjectivesBehaviour change technique (BCT)Taxonomy v1 is a hierarchically grouped, consensus‐based taxonomy of 93BCTs for reporting intervention content. To enhance the use and understanding ofBCTs, the aims of the present study were to (1) quantitatively examine the ‘bottom‐up’ hierarchical structure of Taxonomy v1, (2) identify whetherBCTs can be reliably mapped to theoretical domains using a ‘top‐down’ theoretically driven approach, and (3) identify any overlap between the ‘bottom‐up’ and ‘top‐down’ groupings.Methods and designThe ‘bottom‐up’ structure was examined for higher‐order groupings using a dendrogram derived from hierarchical cluster analysis. For the theory‐based ‘top‐down’ structure, 18 experts sortedBCTs into 14 theoretical domains. Discriminant Content Validity was used to identify groupings, and chi‐square tests and Pearson's residuals were used to examine the overlap between groupings.ResultsBehaviour change techniques relating to ‘Reward and Punishment’ and ‘Cues and Cue Responses’ were perceived as markedly different to otherBCTs. Fifty‐nine of theBCTs were reliably allocated to 12 of the 14 theoretical domains; 47 were significant and 12 were of borderline significance. Thirty‐four of 208 ‘bottom‐up’ × ‘top‐down’ pairings showed greater overlap than expected by chance. However, only six combinations achieved satisfactory evidence of similarity.ConclusionsThe moderate overlap between the groupings indicates some tendency to implicitly conceptualizeBCTs in terms of the same theoretical domains. Understanding the nature of the overlap will aid the conceptualization ofBCTs in terms of theory and application. Further research into different methods of developing a hierarchical taxonomic structure ofBCTs for international, interdisciplinary work is now required.Statement of contributionWhat is already known on this subject?Behaviour change interventions are effective in improving health care and health outcomes.The ‘active’ components of these interventions are behaviour change techniques and over 93 have been identified.Taxonomies of behaviour change techniques require structure to enable potential applications.What does this study add?This study identifies groups ofBCTs to aid the recall ofBCTs for intervention coding and design.It compares two methods of grouping – ‘bottom‐up’ and theory‐based ‘top‐down’ – and finds a moderate overlap.Bu

ISSN:1359-107X    

DOI:10.1111/bjhp.12102

年代:2015

数据来源: WILEY