Can safer-sex promotion leaflets change cognitive antecedents of condom use? An experimental evaluation

The role of customer education: a repeated cross-sectional study

Purpose

Customer education is considered as an appropriate communication strategy for promoting green products. This paper aims to elaborate on the characteristics of customer education that are suitable for green products by identifying what messages must be delivered, sources and channels that must be used to achieve the greatest effect. Moreover, this study uses a repeated cross-sectional approach by using the same research model in 2008 and 2019.

Design/methodology/approach

A questionnaire was arranged based on the research model. In 2008, the data were collected at 12 shopping malls in Jakarta. The 2019 data were collected online, using Google forms, from citizens of Jakarta and five nearby cities. Then, the data were processed using structural equation modeling.

Findings

Data analysis of both years shows that education containing messages that are both informational and transformational can increase customers’ perceptions of the benefits and economic accessibility of green products, as well as environmental concerns. This study’s results also indicate that customers’ intentions to buy green products are influenced by their attitudes toward buying. However, the impact of customers’ perceptions of benefit and economic accessibility on their attitudes toward green purchasing varied between 2008 and 2019.

Practical implications

Sustainable consumption can be pursued through customer education once a community’s economic conditions have reached a certain level. This study shows how changes have unfolded in Indonesia in several areas, therefore it should also be necessary to pursue green behavior via policies that are tailored to changes in the community.

Social implications

This study shows how changes have unfolded in Indonesia in several areas, therefore it should also be necessary to pursue green behavior via policies that are tailored to changes in the community.

Originality/value

Investigation of the role of customer education in green products using a repeated cross-sectional study.

Acceptability, safety and perceived impact of providing a fact sheet to young people about cognitive symptoms in depression

AIM

Cognitive deficits are common in young people, aged 15-25, with depression. Nevertheless, these symptoms are not routinely addressed in clinical care. This study examined the acceptability, safety, and reported impact on cognitive knowledge and strategy use, of a newly developed fact sheet (Thinking about Thinking Skills in Depression) for young people with depression.

METHOD

Twenty-three participants, aged 15-25 years old (M = 19.6, SD = 3.2), receiving community-based treatment for a depressive disorder were delivered the fact sheet by their case manager and completed pre- and post-assessments conducted 3 weeks apart. Primary outcomes included: acceptability, safety, subjective distress, knowledge of cognition and use of, and confidence in using, cognitive strategies. Exploratory outcomes included depression symptoms, perceived cognitive difficulties, self-efficacy and self-esteem. Case manager perspectives were obtained using an anonymous online survey.

RESULTS

Participant experiences of the fact sheet were favourable. Most reported that the amount of content provided was appropriate (91%), looked at the fact sheet again after receiving it (83%), and tried at least one strategy (57%). Participants reported significant improvements in their knowledge of cognitive difficulties and a greater use of, and confidence in using, cognitive strategies. Distress did not change following fact sheet delivery, supporting safety. Perceived improvements in depression symptoms and cognitive deficits, but not self-esteem or self-efficacy, were revealed. Case manager perspectives were also positive.

CONCLUSION

Written fact sheet resources are an acceptable, safe and pragmatic method of delivering information about cognitive difficulties to young people with depression.

A tailored intervention to promote uptake of retinal screening among young adults with type 2 diabetes - an intervention mapping approach

BACKGROUND

Young adults (18-39 years) with type 2 diabetes are at risk of early development and rapid progression of diabetic retinopathy, a leading cause of vision loss and blindness in working-age adults. Retinal screening is key to the early detection of diabetic retinopathy, with risk of vision loss significantly reduced by timely treatment thereafter. Despite this, retinal screening rates are low among this at-risk group. The objective of this study was to develop a theoretically-grounded, evidence-based retinal screening promotion leaflet, tailored to young adults with type 2 diabetes.

METHODS

Utilising the six steps of Intervention Mapping, our multidisciplinary planning team conducted a mixed-methods needs assessment (Step 1); identified modifiable behavioural determinants of screening behaviour and constructed a matrix of change objectives (Step 2); designed, reviewed and debriefed leaflet content with stakeholders (Steps 3 and 4); and developed program implementation and evaluation plans (Steps 5 and 6).

RESULTS

Step 1 included in-depth qualitative interviews (N = 10) and an online survey that recruited a nationally-representative sample (N = 227), both informed by literature review. The needs assessment highlighted the crucial roles of knowledge (about diabetic retinopathy and screening), perception of personal risk, awareness of the approval of significant others and engagement with healthcare team, on retinal screening intentions and uptake. In Step 2, we selected five modifiable behavioural determinants to be targeted: knowledge, attitudes, normative beliefs, intention, and behavioural skills. In Steps 3 and 4, the "Who is looking after your eyes?" leaflet was developed, containing persuasive messages targeting each determinant and utilising engaging, cohort-appropriate imagery. In Steps 5 and 6, we planned Statewide implementation and designed a randomised controlled trial to evaluate the leaflet.

CONCLUSIONS

This research provides an example of a systematic, evidence-based approach to the development of a simple health intervention designed to promote uptake of screening in accordance with national guidelines. The methods and findings illustrate how Intervention Mapping can be employed to develop tailored retinal screening promotion materials for specific priority populations. This paper has implications for future program planners and is intended to assist those wishing to use Intervention Mapping to create similar theoretically-driven, tailored resources.

Increasing knowledge about depression in adolescents: effects of an information booklet

PURPOSE

This study evaluates a newly developed information booklet about depression among adolescents. The aim was to examine the enhancement of knowledge through the booklet with the objective of reducing stigma and facilitating awareness of own treatment needs.

METHODS

628 German ninth graders were enrolled in a pre-post-follow-up study using study-specific questionnaires to investigate knowledge enhancement in seven depression-related topics. Exploratively, knowledge enhancement was calculated with respect to education level and gender. Additionally, the students assessed the booklet's layout, content and utility. Knowledge enhancement was analyzed using repeated measures ANOVA for index values of the booklet's topics. The effect size partial eta square (η²) was computed.

RESULTS

The pre-post-follow-up comparison yielded significant knowledge enhancement for all seven index values (p < 0.001). The associated effect sizes were medium to large. The strongest effects were achieved for the categories "Antidepressants" (η² = 0.56), "Symptoms" (η² = 0.45) and "Treatment" (η² = 0.17) of depression as well as for "Suicidality" (η² = 0.36). Although baseline knowledge was high in all students, knowledge enhancement was greater in better educated than in less educated students. Overall assessment of the booklet was good (mean = 2.15 on a rating scale from "very good" (1) to "fail" (6)).

CONCLUSIONS

The information booklet as a low-threshold educational approach can significantly enhance depression-specific knowledge in students. Hence, it helps adolescents to acknowledge their own symptoms and treatment needs as well as to recognize these specific mental health problems in their peers. Thus, the booklet can contribute to the reduction of stigma and treatment barriers in adolescents.

What is the role and authority of gatekeepers in cluster randomized trials in health research?

This article is part of a series of papers examining ethical issues in cluster randomized trials (CRTs) in health research. In the introductory paper in this series, we set out six areas of inquiry that must be addressed if the CRT is to be set on a firm ethical foundation. This paper addresses the sixth of the questions posed, namely, what is the role and authority of gatekeepers in CRTs in health research? ‘Gatekeepers’ are individuals or bodies that represent the interests of cluster members, clusters, or organizations. The need for gatekeepers arose in response to the difficulties in obtaining informed consent because of cluster randomization, cluster-level interventions, and cluster size. In this paper, we call for a more restrictive understanding of the role and authority of gatekeepers.

Previous papers in this series have provided solutions to the challenges posed by informed consent in CRTs without the need to invoke gatekeepers. We considered that consent to randomization is not required when cluster members are approached for consent at the earliest opportunity and before any study interventions or data-collection procedures have started. Further, when cluster-level interventions or cluster size means that obtaining informed consent is not possible, a waiver of consent may be appropriate. In this paper, we suggest that the role of gatekeepers in protecting individual interests in CRTs should be limited. Generally, gatekeepers do not have the authority to provide proxy consent for cluster members. When a municipality or other community has a legitimate political authority that is empowered to make such decisions, cluster permission may be appropriate; however, gatekeepers may usefully protect cluster interests in other ways. Cluster consultation may ensure that the CRT addresses local health needs, and is conducted in accord with local values and customs. Gatekeepers may also play an important role in protecting the interests of organizations, such as hospitals, nursing homes, general practices, and schools. In these settings, permission to access the organization relies on resource implications and adherence to institutional policies.

Can theory-based messages in combination with cognitive prompts promote exercise in classroom settings?

A randomised control trial evaluated the effectiveness of a theory-based persuasive leaflet designed to encourage students to undertake at least one additional physical exercise session a week. Participants were 503 secondary school students attending a school in South-East England. The leaflet was written to target potentially modifiable cognitive antecedents of exercise specified by the Theory of Planned Behaviour. It was separately augmented with two cognitive change techniques, resulting in three intervention conditions, leaflet alone; leaflet plus motivational quiz, and leaflet plus implementation intention prompt, as well as a no-leaflet control condition. Cognitions and behaviour were measured immediately before and 3 weeks after intervention. The results showed that all three-leaflet interventions significantly increased reported exercise, intention to exercise and related cognitions, compared to the control condition, but did not differ in their impact. Mediation analysis showed that intervention effects on exercise were partially mediated by intentions and perceived behavioural control.