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Conner M, Wilding S, Norman P. Does Intention Strength Moderate the Intention-Health Behavior Relationship for Covid-19 Protection Behaviors? Ann Behav Med 2024; 58:92-99. [PMID: 37874734 PMCID: PMC10831218 DOI: 10.1093/abm/kaad062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND AND PURPOSE The present research tests whether intention strength moderates intention-health behavior relations and the extent to which this is accounted for by the moderating effects of intention stability, goal priority, and goal conflict. METHODS In a prospective multi-behavior study, a representative sample of UK adults (N = 503) completed measures of past behavior, intention, intention strength, goal priority, and goal conflict in relation to eight Covid-19 protection behaviors at time 1. Intention and self-reported behavior were assessed at time 2 (2 months later). Intention stability was assessed over 2 months. RESULTS Intention strength was a significant moderator of the intention-behavior relationship (controlling for past behavior). Controlling for the moderating effects of intention stability attenuated the moderating effect of intention strength, while also controlling for the moderating effects of goal priority and goal conflict reduced the moderating effects of intention strength to nonsignificance. CONCLUSIONS The present findings indicate that intention strength is a significant moderator of the intention-health behavior relationship. They also suggest that the moderating effect of intention strength is explained by effects on intention stability, goal priority, and goal conflict. Tests of interventions to manipulate intention strength as a means to strengthen intention stability and intention-behavior relations are warranted.
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Affiliation(s)
- Mark Conner
- School of Psychology, University of Leeds, Leeds, UK
| | - Sarah Wilding
- School of Psychology, University of Leeds, Leeds, UK
| | - Paul Norman
- Department of Psychology, University of Sheffield, Sheffield, UK
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Rogerson O, Wilding S, Prudenzi A, O'Connor DB. Effectiveness of stress management interventions to change cortisol levels: a systematic review and meta-analysis. Psychoneuroendocrinology 2024; 159:106415. [PMID: 37879237 DOI: 10.1016/j.psyneuen.2023.106415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/09/2023] [Indexed: 10/27/2023]
Abstract
Stress has a damaging impact on our mental and physical health, and as a result, there is an on-going demand for effective stress management interventions. However, there are no reviews or meta-analyses synthesising the evidence base of randomised controlled trials testing the effectiveness of psychological interventions on changing cortisol levels (the stress hormone) in non-patient groups. Therefore, the primary aim of this systematic review and meta-analysis was to address this gap. Six databases (Medline, PsychInfo, Embase, CINAHL, Cochrane and Web of Science) were searched (1171 studies identified) with 58 studies (combined N = 3508) included in the meta-analysis. The interventions were coded into one of four categories; mind body therapies, mindfulness, relaxation or talking therapies. A random effects meta-analysis on cortisol as measured in blood, saliva or hair found that stress management interventions outperformed pooled control conditions with a medium positive effect size (g = 0.282). The studies that utilised cortisol awakening measures (g = 0.644) revealed larger effects of stress management interventions than those that measured diurnal cortisol (g = 0.255). Mindfulness and meditation (g = 0. 345) and relaxation (g = 0. 347) interventions were most effective at changing cortisol levels, while mind body therapies (g = 0. 129) and talking therapies (g = 0.107) were shown to have smaller and non-significant effect sizes. Additionally, studies that utilised an active control group (g = 0. 477) over passive control group (g = 0.129) were found to have stronger effects. Length of the intervention, study quality, risk of bias, age and gender did not influence the effectiveness of interventions and there was no evidence of publication bias. Overall, the current findings confirm that stress management interventions can positively influence cortisol levels. Future research should investigate the longer term implications for health and health outcomes.
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Wilding S, O'Connor DB, Conner M. Social Norms in Cervical Cancer Screening. Psychol Rep 2023:332941231219943. [PMID: 38048215 DOI: 10.1177/00332941231219943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
Cancer screening aims to check the body for cancer before symptoms develop. Social norms theory suggests people falsely perceive the attitudes and/or behaviours of similar others to be different from their own and correcting these perceptions can lead to behaviour change. Across two studies, we tested if women underestimate peer levels of cervical screening behaviour and whether a social norms manipulation increases intention to attend cervical cancer screening. In study 1, participants completed a survey on cervical cancer screening norms. In study 2, participants were randomised to receive no norm information, norm information, or norm information plus statement on value of norms in decision making. In study 1, participant estimates of peer level of cervical screening behaviour were significantly lower than nationally reported levels. In study 2, a social norm plus value statement intervention led to stronger intentions to attend screening. This effect was consistent across demographic factors and screening status. Participants significantly underestimate rates of cervical screening behaviour in their peers. A brief, online social norms plus values manipulation increased intentions to attend cervical cancer screening across all groups.
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Affiliation(s)
- Sarah Wilding
- School of Psychology, University of Leeds, Leeds, UK
| | | | - Mark Conner
- School of Psychology, University of Leeds, Leeds, UK
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4
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O'Connor DB, Wilding S, Ferguson E, Cleare S, Wetherall K, McClelland H, Melson AJ, Niedzwiedz C, O'Carroll RE, Platt S, Scowcroft E, Watson B, Zortea T, Robb KA, O'Connor RC. Effects of COVID-19-related worry and rumination on mental health and loneliness during the pandemic: longitudinal analyses of adults in the UK COVID-19 mental health & wellbeing study. J Ment Health 2023; 32:1122-1133. [PMID: 35579054 DOI: 10.1080/09638237.2022.2069716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 02/21/2022] [Accepted: 04/03/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND The lasting effects of the coronavirus disease 2019 pandemic are likely to be significant. AIMS This study tracked worry and rumination levels during the pandemic and investigated whether periods with higher COVID-related worry and rumination were associated with more negative mental health and loneliness. METHODS A quota survey design and a sampling frame that permitted recruitment of a national sample were employed. Findings for waves 1 (March 2020) to 6 (November 2020) are reported (N = 1943). RESULTS Covid-related worry and rumination levels were highest at the beginning of the first lockdown, then declined but increased when the UK returned to lockdown. Worry levels were higher than rumination levels throughout. High levels of COVID-related worry and rumination were associated with a five- and ten-fold increase in clinically meaningful rates of depression and anxiety (respectively) together with lower well-being and higher loneliness. The effects of COVID-related worry on depression and anxiety levels were most marked and clinically meaningful in individuals living with a pre-existing mental health condition. CONCLUSIONS Psychological interventions should include components that specifically target COVID-related worry and rumination. Individuals with pre-existing mental health conditions should be prioritised as we emerge from the current pandemic and in any future public health crises.
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Affiliation(s)
| | - Sarah Wilding
- School of Psychology, University of Leeds, Leeds, England
| | | | - Seonaid Cleare
- Suicidal Behaviour Research Laboratory, Institute of Health & Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Karen Wetherall
- Suicidal Behaviour Research Laboratory, Institute of Health & Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Heather McClelland
- Suicidal Behaviour Research Laboratory, Institute of Health & Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Ambrose J Melson
- Suicidal Behaviour Research Laboratory, Institute of Health & Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Claire Niedzwiedz
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, Scotland
| | | | - Steve Platt
- Usher Institute, University of Edinburgh, Edinburgh, Scotland
| | | | - Billy Watson
- Scottish Association for Mental Health, Glasgow, Scotland
| | - Tiago Zortea
- Suicidal Behaviour Research Laboratory, Institute of Health & Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Kathryn A Robb
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Rory C O'Connor
- Suicidal Behaviour Research Laboratory, Institute of Health & Wellbeing, University of Glasgow, Glasgow, Scotland
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Wilding S, Wighton S, West R, Conner M, O'Connor DB. A randomised controlled trial of volitional and motivational interventions to improve cervical cancer screening uptake. Soc Sci Med 2023; 322:115800. [PMID: 36858020 DOI: 10.1016/j.socscimed.2023.115800] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 01/18/2023] [Accepted: 02/20/2023] [Indexed: 02/25/2023]
Abstract
OBJECTIVE Cervical cancer is the fourth most common cancer to occur in women worldwide. In the UK, the NHS cervical screening programme invites eligible individuals to take part in screening every 3-5 years. At present, around 70% of individuals attend screening when invited. The present study aimed to test the effectiveness of a volitional and a motivational intervention alone and in combination on screening uptake at 16-week follow up. METHODS 14,536 participants were recruited from the list of eligible participants invited for screening in Yorkshire, Humber and the North East regions of England in December 2021. They were randomised to a social norm-based motivational intervention (SNA); implementation intention-based Volitional Help Sheet (VHS); combined intervention (SNA + VHS); or treatment as usual control. The primary outcome was screening uptake measured via patient screening records at 16 weeks. RESULTS Of the 14,466 participants with eligible data for analysis, 5793 (40.0%) attended for cervical cancer screening in the 16 weeks after the intervention mailing. Both age and deprivation influenced screening uptake, with lower uptake in the youngest individuals and those from more deprived areas. Compared to control, there was no evidence of any benefit from the VHS implementation intervention alone (Adj.OR = 0.99, 95% CI 0.90 to 1.10), the SNA motivational intervention alone (Adj.OR = 0.89; 95% CI: 0.80 to 0.99), or the combined intervention (Adj.OR = 0.96, 95% CI 0.86 to 1.06). CONCLUSION The study did not support any benefit of either VHS or SNA interventions alone or in combination on cervical cancer screening uptake. It did demonstrate alarmingly low levels of screening uptake at 16 weeks which were well below the average rate. Future research needs to urgently investigate and understand the barriers to uptake following on from the COVID-19 pandemic.
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Affiliation(s)
- Sarah Wilding
- School of Psychology, University of Leeds, Leeds, UK
| | - Sarah Wighton
- NHS England and NHS Improvement (North East & Yorkshire), UK
| | - Robert West
- Leeds Institute of Health Sciences, University of Leeds, UK
| | - Mark Conner
- School of Psychology, University of Leeds, Leeds, UK.
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Wilding S, O'Connor DB, Ferguson E, Wetherall K, Cleare S, O'Carroll RE, Robb KA, O'Connor RC. Information seeking, mental health and loneliness: Longitudinal analyses of adults in the UK COVID-19 mental health and wellbeing study. Psychiatry Res 2022; 317:114876. [PMID: 36215778 PMCID: PMC9526871 DOI: 10.1016/j.psychres.2022.114876] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 09/23/2022] [Accepted: 09/30/2022] [Indexed: 01/05/2023]
Abstract
Information seeking has generally been seen as an adaptive response to the COVID-19 pandemic. However, it may also result in negative outcomes on mental health. The present study tests whether reporting COVID-related information seeking throughout the pandemic is associated with subsequently poorer mental health outcomes. A quota-based, non-probability-sampling methodology was used to recruit a nationally representative sample. COVID-related information seeking was assessed at six waves along with symptoms of depression, anxiety, mental wellbeing and loneliness (N = 1945). Hierarchical linear modelling was used to assess the relationship between COVID-related information seeking and mental health outcomes. Information seeking was found to reduce over time. Overall, women, older and higher socioeconomic group individuals reported higher levels of information seeking. At waves 1-4 (March-June 2020) the majority of participants reported that they sought information on Covid 1-5 times per day, this decreased to less than once per day in waves 5 and 6 (July-November 2020). Higher levels of information seeking were associated with poorer mental health outcomes, particularly clinically significant levels of anxiety. Use of a non-probability sampling method may have been a study limitation, nevertheless, reducing or managing information seeking behaviour may be one method to reduce anxiety during pandemics and other public health crises.
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Affiliation(s)
- Sarah Wilding
- School of Psychology, University of Leeds, Leeds, United Kingdom
| | - Daryl B. O'Connor
- School of Psychology, University of Leeds, Leeds, United Kingdom,Corresponding author
| | - Eamonn Ferguson
- School of Psychology, University of Nottingham, Nottingham, United Kingdom
| | - Karen Wetherall
- Suicidal Behaviour Research Laboratory, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Seonaid Cleare
- Suicidal Behaviour Research Laboratory, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Ronan E. O'Carroll
- Division of Psychology, University of Stirling, Stirling, United Kingdom
| | - Kathryn A. Robb
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Rory C. O'Connor
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
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Wilding S, Prudenzi A, Conner M, O'Connor DB. Do reasoned action approach variables mediate relationships between demographics and cervical cancer screening intentions or behaviour? An online study of women from the UK. Soc Sci Med 2022; 313:115354. [PMID: 36191387 DOI: 10.1016/j.socscimed.2022.115354] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 08/05/2022] [Accepted: 09/03/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVE In the UK, approximately 3,200 women are diagnosed with cervical cancer each year. Regular screening is one of the best ways to prevent cervical cancer from developing, yet screening rates are declining and vary by sociodemographic variables. The present stratified online study aimed to investigate relationships between sociodemographic factors and screening intentions and past behaviour. Reasoned Action Approach (RAA) variables were assessed as potential mediators. METHODS In total, 500 women living in the UK were recruited via an online research recruitment website to an online cross-sectional survey. Participant recruitment was stratified by age, socioeconomic status and ethnicity to ensure adequate representation of each strata. Participants completed measures on RAA variables (affective attitudes, cognitive attitudes, injunctive norms, descriptive norms, capability, autonomy, and intention) as well as screening past behaviour. RESULTS Among the demographic variables, age, ethnicity and deprivation were significantly related to screening intention. Younger women, those from less deprived areas, along with white women were more likely to report higher intentions to attend screening. Past behaviour was significantly negatively predicted by deprivation only, indicating that individuals from less deprived areas were more likely to be up to date with their screening. Both intention and past behaviour were significantly positively correlated with all RAA variables. Capability and cognitive attitude partially mediated the relationship between age and intention and fully mediated the relationship between ethnicity and intention. Capability fully mediated the relationships between deprivation and intention and between deprivation and past behaviour. CONCLUSION Intentions toward attending cervical cancer screening are related to age, ethnicity, and level of deprivation, with older women and those from areas of greater deprivation and ethnic minority groups reporting lower intentions. Capability (confidence engaging in cervical screening) and cognitive attitudes (how useful/beneficial screening is seen to be) are key variables to target to promote cervical screening attendance and reduce potential inequalities.
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Affiliation(s)
- Sarah Wilding
- School of Psychology, University of Leeds, LS2 9JT, Leeds, UK
| | - Arianna Prudenzi
- School of Psychology, Institute for Mental Health, University of Birmingham, Birmingham, UK
| | - Mark Conner
- School of Psychology, University of Leeds, LS2 9JT, Leeds, UK.
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Conner M, Wilding S, Wright CE, Sheeran P. How Does Self-Control Promote Health Behaviors? A Multi-Behavior Test of Five Potential Pathways. Ann Behav Med 2022; 57:313-322. [PMID: 36206193 PMCID: PMC10094954 DOI: 10.1093/abm/kaac053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Self-control is generally defined as the capacity to override impulses and is a robust predictor of health behaviors. This paper integrates trait, reasoned action, and habit approaches to develop and test a mechanistic account of how self-control influences health actions. PURPOSE We tested five potential pathways from self-control to behavior, termed the valuation, prioritization, habituation, translation, and inhibition routes. METHODS At baseline, participants (N = 663 adults) completed survey measures of reasoned action approach variables and habits in relation to eight health behaviors and the Brief Self-Control Scale. Three months later, participants reported their behavior. Multi-level modeling was used to test pathways across behaviors. RESULTS Supporting the valuation route, affective attitude, cognitive attitude, descriptive norms, and perceived behavioral control mediated the self-control-intention relation, and intentions and perceived behavioral control mediated the relationship between self-control and health behaviors. Self-control also predicted the priority accorded to different considerations during intention formation. Higher self-control was associated with stronger prediction by cognitive attitudes and perceived behavioral control and weaker prediction by habits and injunctive norms. Self-control predicted habit formation, and habits mediated the self-control-behavior relation. Finally, self-control was associated with the improved translation of intentions into health behaviors and with greater inhibition of affective and habitual influences. Findings for the different pathways were not moderated by whether approach (health-protective behaviors) or avoidance responses (health-risk behaviors) were at issue. CONCLUSIONS The present research offers new insights into why self-control promotes health behavior performance, and how deficits in self-control might be offset in future behavior-change interventions.
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Affiliation(s)
- Mark Conner
- School of Psychology, University of Leeds, Leeds, UK
| | - Sarah Wilding
- School of Psychology, University of Leeds, Leeds, UK
| | - Charles E Wright
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Paschal Sheeran
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, USA
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Abstract
Background Preventive behaviors continue to play an important role in reducing the spread of the SARS-CoV-2 virus. Purpose This study aimed to apply the reasoned action approach (RAA) to predict Covid-19 preventive intentions and behavior and to test whether temporal stability moderates relations between RAA constructs and behavior. Methods A representative sample of UK adults (N = 603) completed measures of RAA variables (i.e., experiential attitudes, instrumental attitudes, injunctive norms, descriptive norms, capacity, autonomy and intention) in relation to six Covid-19 preventive behaviors (i.e., wearing face coverings, social distancing, hand sanitizing, avoiding the three Cs [closed spaces, crowded places, and close contacts], cleaning surfaces, and coughing/sneezing etiquette) at baseline (December 2020) and after 1 month. Self-reported behavior was assessed at baseline and after 1 and 2 months. Results The RAA was predictive of Covid-19 preventive intentions at time 1 and time 2; instrumental attitudes, descriptive norms, and capability were the strongest predictors at each time point. The RAA also predicted subsequent behavior across time points with intention, descriptive norms, and capability the strongest/most consistent predictors. Temporal stability moderated a number of RAA–behavior relationships including those for intention, descriptive norms, and capability. In each case, the relationships became stronger as temporal stability increased. Conclusions Health cognitions as outlined in the RAA provide appropriate targets for interventions to promote Covid-19 preventive intentions and behavior. Moreover, given that continued performance of Covid-19 preventive behaviors is crucial for reducing transmission of the SARS-CoV-2 virus, the results highlight the need for consistent messaging from governments and public health organizations to promote positive intentions and maintain preventive behavior.
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Affiliation(s)
- Paul Norman
- Department of Psychology, University of Sheffield, Cathedral Court, 1 Vicar Lane, Sheffield, UK
| | - Sarah Wilding
- School of Psychology, University of Leeds, Leeds, UK
| | - Mark Conner
- School of Psychology, University of Leeds, Leeds, UK
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Conner M, Wilding S, Prestwich A, Hutter R, Hurling R, Harreveld FV, Abraham C, Sheeran P. Goal prioritization and behavior change: Evaluation of an intervention for multiple health behaviors. Psychol Health 2022; 41:356-365. [PMID: 35467903 DOI: 10.1037/hea0001149] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Goal prioritization is a promising strategy for promoting health behavior change. The present research (a) tested whether goal prioritization engenders change in multiple health behaviors, (b) compared the effectiveness of prioritizing one versus two health behavior goals, and (c) assessed whether prioritization compromises the performance of nonprioritized behaviors. METHOD Participants (N = 1,802) were randomly allocated to one of two intervention conditions (prioritize one vs. two behaviors) or two no-prioritization, control conditions. Participants in the intervention conditions self-selected the behavior(s) to prioritize from a given set. Goal priority and behavioral performance were assessed 8 weeks later. RESULTS The prioritization interventions were successful in promoting goal priority and led to significantly greater behavior change compared to both control conditions. Prioritizing two health behavior goals led to increased behavioral performance compared to prioritizing a single goal. Goal prioritization did not lead to a decline in rates of performance of nonprioritized behaviors. CONCLUSIONS The present findings offer new evidence that goal prioritization is effective in promoting health behavior change. Prioritizing health goals engenders behavior change for both one and two focal behaviors and does so without adversely affecting the performance of nonprioritized health behaviors. Further tests of interventions to promote the priority of health goals are warranted. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | | | | | | | - Paschal Sheeran
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill
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Prudenzi A, Graham CD, Flaxman PE, Wilding S, Day F, O’Connor DB. A workplace Acceptance and Commitment Therapy (ACT) intervention for improving healthcare staff psychological distress: A randomised controlled trial. PLoS One 2022; 17:e0266357. [PMID: 35442963 PMCID: PMC9020690 DOI: 10.1371/journal.pone.0266357] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 03/02/2022] [Indexed: 11/20/2022] Open
Abstract
The levels of psychological distress and burnout among healthcare staff are high, with negative implications for patient care. A growing body of evidence indicates that workplace programmes based on Acceptance and Commitment Therapy (ACT) are effective for improving employees' general psychological health. However, there is a paucity of research examining the specific psychological and/or behavioural processes through which workplace ACT programmes transmit their beneficial effects. The aim of this randomised controlled trial was to investigate the outcomes and putative processes of change in a 4-session ACT training programme designed to reduce psychological distress among healthcare staff (n = 98). Ninety-eight employees of a healthcare organisation were randomly allocated to the ACT intervention or to a waiting list control group. Study measures were administered on four occasions (baseline, mid-intervention, post-intervention, and follow-up) over a three-month evaluation period. Results showed that the ACT intervention led to a significant decrease in symptoms of psychological distress and a less pronounced reduction in burnout. These effects were mediated primarily via an improvement in mindfulness skills and values-based behaviour and moderated by participants' initial levels of distress. At four-week post-intervention, 48% of participants who received the ACT intervention showed reliable improvements in psychological distress, with just under half of the aforementioned improvements (46.15%) meeting criteria for clinically significant change. The results advance ACT as an effective stress management intervention for healthcare staff. The findings should be confirmed in a large scale randomised controlled trial with longer follow-up and cost-effectiveness analyses.
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Affiliation(s)
- Arianna Prudenzi
- School of Psychology, University of Leeds, Leeds, United Kingdom
| | - Christopher D. Graham
- School of Psychology, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Paul E. Flaxman
- Department of Psychology, University of London, London, United Kingdom
| | - Sarah Wilding
- School of Psychology, University of Leeds, Leeds, United Kingdom
| | - Fiona Day
- Fiona Day Consulting LTD, Leeds, United Kingdom
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Mason SJ, Downing A, Wilding S, Hounsome L, Wright P, Watson E, Wagland R, Butcher H, Kind P, Selby P, Gavin A, Glaser AW. Stability of health-related quality of life and morbidity burden from 18 months after diagnosis of prostate cancer: results of a UK-wide population-based outcome cohort. Support Care Cancer 2021; 30:3151-3164. [PMID: 34904181 PMCID: PMC8857149 DOI: 10.1007/s00520-021-06650-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 10/25/2021] [Indexed: 11/30/2022]
Abstract
Objective To evaluate the dynamic nature of self-reported health-related quality of life (HRQL) and morbidity burden in men diagnosed with prostate cancer, we performed a follow-up study of the Life After Prostate Cancer Diagnosis (LAPCD) study cohort 12 months after initial survey. Methods The LAPCD study collected information from 35,823 men across the UK who were 18–42 months post-diagnosis of prostate cancer. Men who were still alive 12 months later were resurveyed. Generic HRQL (EQ-5D-5L plus self-assessed health rating) and prostate cancer-specific outcomes (EPIC-26) were assessed. Treatment(s) received was self-reported. Previously defined clinically meaningful differences were used to evaluate changes in outcomes over time. Results A total of 28,450 men across all disease stages completed follow-up surveys (85.8% response). Of the 21,700 included in this study, 89.7% reported no additional treatments since the first survey. This group experienced stable urinary and bowel outcomes, with good function for most men at both time points. On-going poor (but stable) urinary issues were associated with previous surgery. Sexual function scores remained low (mean: 26.8/100). Self-assessed health ratings were stable over time. The largest declines in HRQL and functional outcomes were experienced by men reporting their first active treatment between surveys. Discussion The results suggest stability of HRQL and most specific morbidities by 18–42 months for men who report no further treatment in the subsequent 12 months. This is reassuring for those with good function and HRQL but re-enforces the need for early intervention and support for men who experience poor outcomes. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-021-06650-7.
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Affiliation(s)
- Samantha J Mason
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Amy Downing
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK. .,Leeds Institute for Data Analytics, University of Leeds, Level 11, Worsley Building, Leeds, LS2 9NL, UK.
| | - Sarah Wilding
- School of Psychology, University of Leeds, Leeds, UK
| | | | - Penny Wright
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Eila Watson
- Oxford Institute of Nursing, Midwifery and Allied Health Research, Oxford Brookes University, Oxford, UK
| | - Richard Wagland
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Hugh Butcher
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Paul Kind
- Academic Unit of Health Economics, University of Leeds, Leeds, UK
| | - Peter Selby
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK.,Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Anna Gavin
- Northern Ireland Cancer Registry, Queens University Belfast, Belfast, UK
| | - Adam W Glaser
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK.,Leeds Institute for Data Analytics, University of Leeds, Level 11, Worsley Building, Leeds, LS2 9NL, UK
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Wilding S, O'Connor DB, Conner M. Financial incentives for bowel cancer screening: Results from a mixed methods study in the United Kingdom. Br J Health Psychol 2021; 27:741-755. [PMID: 34747113 DOI: 10.1111/bjhp.12570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/22/2021] [Accepted: 09/22/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The purpose of bowel cancer screening is to test for signs of cancer before symptoms develop. Financial incentives are one potential method to increase participation rates. Few studies have tested incentives in relation to bowel screening in the United Kingdom (UK). The current research explored reactions to different financial incentives to participate in population-level bowel cancer screening in a UK sample. DESIGN An online mixed methods study. Recruitment was via a study recruitment website (https://prolific.ac/). METHODS 499 participants (aged 60-74 years) completed a survey on invitations for population-level bowel cancer screening using different levels of financial incentives. RESULT Respondents were generally positive about the use of financial incentives. A £10 voucher was most frequently selected as the appropriate amount to incentivise screening participation. The current invitation method with no voucher was judged to be most acceptable but suggested to produce the lowest likelihood of others participating. Offering a £10 voucher that the NHS would not be charged for if not used was the second most acceptable invitation method. There were few differences between invitation methods on own perceived likelihood of participation in bowel screening. Offering a £10 voucher was seen as leading to the greatest likelihood of others participating in bowel screening. Findings were largely unaffected by participant demographics. CONCLUSION The use of small financial incentives to increase bowel cancer screening uptake was generally well received. Impacts of incentives on actual bowel screening rates in UK samples need to be established in the light of the current findings.
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Affiliation(s)
| | | | - Mark Conner
- School of Psychology, University of Leeds, UK
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14
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Schüz B, Conner M, Wilding S, Alhawtan R, Prestwich A, Norman P. Do socio-structural factors moderate the effects of health cognitions on COVID-19 protection behaviours? Soc Sci Med 2021; 285:114261. [PMID: 34332252 PMCID: PMC8299154 DOI: 10.1016/j.socscimed.2021.114261] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 07/11/2021] [Accepted: 07/21/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Adherence to protection behaviours remains key to curbing the spread of the SARS-CoV-2 virus that causes COVID-19, but there are substantial differences in individual adherence to recommendations according to socio-structural factors. To better understand such differences, the current research examines whether relationships between health cognitions based on the Reasoned Action Approach (RAA) and eight COVID-19 protection behaviours vary as a function of participant-level socio-structural factors. METHODS Within-person design with behaviours nested within participants in a two-wave online survey (one week delay) conducted during the UK national lockdown in April 2020. A UK representative sample of 477 adults completed baseline measures from the RAA plus perceived susceptibility and past behaviour for eight protection behaviours, and self-reported behaviour one week later. Moderated hierarchical linear models with cross-level interactions were used to test moderation of health cognitions by socio-structural factors (sex, age, ethnicity, deprivation). RESULTS Sex, ethnicity and deprivation moderated the effects of health cognitions on protection intentions and behaviour. For example, the effects of injunctive norms on intentions were stronger in men compared to women. Importantly, intention was a weaker predictor of behaviour in more compared to less deprived groups. In addition, there was evidence that perceived autonomy was a stronger predictor of behaviour in more deprived groups. CONCLUSION Socio-structural variables affect how health cognitions relate to recommended COVID-19 protection behaviours. As a result, behavioural interventions based on social-cognitive theories might be less effective in participants from disadvantaged backgrounds.
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Affiliation(s)
| | | | | | - Rana Alhawtan
- University of Leeds, UK; Princess Nourah bint Abdulrahman University, Saudi Arabia
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15
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Curzen N, Nicholas Z, Stuart B, Wilding S, Hill K, Shambrook J, Eminton Z, Ball D, Barrett C, Johnson L, Nuttall J, Fox K, Connolly D, O'Kane P, Hobson A, Chauhan A, Uren N, Mccann GP, Berry C, Carter J, Roobottom C, Mamas M, Rajani R, Ford I, Douglas P, Hlatky MA. Fractional flow reserve derived from computed tomography coronary angiography in the assessment and management of stable chest pain: the FORECAST randomized trial. Eur Heart J 2021; 42:3844-3852. [PMID: 34269376 PMCID: PMC8648068 DOI: 10.1093/eurheartj/ehab444] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 05/10/2021] [Accepted: 06/25/2021] [Indexed: 11/25/2022] Open
Abstract
Aims Fractional flow reserve (FFRCT) using computed tomography coronary angiography (CTCA) determines both the presence of coronary artery disease and vessel-specific ischaemia. We tested whether an evaluation strategy based on FFRCT would improve economic and clinical outcomes compared with standard care. Methods and results Overall, 1400 patients with stable chest pain in 11 centres were randomized to initial testing with CTCA with selective FFRCT (experimental group) or standard clinical care pathways (standard group). The primary endpoint was total cardiac costs at 9 months. Secondary endpoints were angina status, quality of life, major adverse cardiac and cerebrovascular events, and use of invasive coronary angiography. Randomized groups were similar at baseline. Most patients had an initial CTCA: 439 (63%) in the standard group vs. 674 (96%) in the experimental group, 254 of whom (38%) underwent FFRCT. Mean total cardiac costs were higher by £114 (+8%) in the experimental group, with a 95% confidence interval from −£112 (−8%) to +£337 (+23%), though the difference was not significant (P = 0.10). Major adverse cardiac and cerebrovascular events did not differ significantly (10.2% in the experimental group vs. 10.6% in the standard group) and angina and quality of life improved to a similar degree over follow-up in both randomized groups. Invasive angiography was reduced significantly in the experimental group (19% vs. 25%, P = 0.01). Conclusion A strategy of CTCA with selective FFRCT in patients with stable angina did not differ significantly from standard clinical care pathways in cost or clinical outcomes, but did reduce the use of invasive coronary angiography.
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Affiliation(s)
- N Curzen
- Faculty of Medicine, University of Southampton.,Coronary Research Group, University Hospital Southampton
| | - Z Nicholas
- Coronary Research Group, University Hospital Southampton
| | - B Stuart
- Clinical Trials Unit, University of Southampton
| | - S Wilding
- Clinical Trials Unit, University of Southampton
| | - K Hill
- Clinical Trials Unit, University of Southampton
| | - J Shambrook
- Cardiothoracic Radiology, University Hospital Southampton
| | - Z Eminton
- Clinical Trials Unit, University of Southampton
| | - D Ball
- Clinical Trials Unit, University of Southampton
| | - C Barrett
- Clinical Trials Unit, University of Southampton
| | - L Johnson
- Clinical Trials Unit, University of Southampton
| | - J Nuttall
- Clinical Trials Unit, University of Southampton
| | - K Fox
- Imperial College, London, UK
| | | | - P O'Kane
- Dorset Heart Centre, University Hospitals Dorset, Bournemouth
| | - A Hobson
- Queen Alexandra Hospital, Portsmouth
| | | | - N Uren
- Royal Infirmary, Edinburgh
| | - G P Mccann
- Department of Cardiovascular Sciences, University of Leicester & NIHR Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - C Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow
| | - J Carter
- University Hospital of North Tees, Stockton on Tees
| | | | - M Mamas
- Royal Stoke University Hospital, Stoke-on-Trent
| | - R Rajani
- Guy's & St Thomas' Hospital, London
| | - I Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow
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16
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Wilding S, Kettu V, Thompson W, Howard P, Jeuken LJC, Pownall M, Conner M, Sandoe JAT. Development and randomized controlled trial of an animated film aimed at reducing behaviours for acquiring antibiotics. JAC Antimicrob Resist 2021; 3:dlab083. [PMID: 34223142 PMCID: PMC8251327 DOI: 10.1093/jacamr/dlab083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 05/17/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Antimicrobial resistance (AMR) is a global health crisis but reducing antibiotic use can help. Some antibiotic use is driven by patient demand. OBJECTIVES To develop an intervention to discourage antibiotic-seeking behaviour in adults. METHODS Literature reviewed to identify behaviours for acquiring antibiotics among adults in the community. Behaviour change wheel approach was used to select the target behaviour and behaviour change techniques. An intervention in the form of a short animated film was developed and its potential impact evaluated in a randomized, controlled, online questionnaire study. RESULTS Asking a general medical/dental practitioner for antibiotics was identified as the target behaviour. A short stop-motion animated film was chosen to deliver several behaviour-change techniques. Education and persuasion were delivered around information about the normal microbial flora, its importance for health, the negative effect of antibiotics, and about AMR. 417 UK-based individuals completed the questionnaire; median age 34.5 years, 71% female, 91% white ethnicity. 3.8% of participants viewing the test film intended to ask for antibiotics compared with 7.9% viewing the control film. Test film viewers had significantly higher knowledge scores. At 6 week follow up, knowledge scores remained significantly different, while most attitude and intention scores were not different. CONCLUSIONS Some patients continue to ask for antibiotics. The film increased knowledge and reduced intentions to ask for antibiotics. At 6 weeks, knowledge gains remained but intentions not to ask for antibiotics had waned. Evaluation in the clinical environment, probably at the point of care, is needed to see if antibiotic prescribing can be impacted.
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Affiliation(s)
- Sarah Wilding
- School of Psychology, University of
Leeds, Leeds, UK
| | | | - Wendy Thompson
- Division of Dentistry, University of
Manchester, Manchester, UK
| | - Philip Howard
- School of Healthcare, University of
Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust,
Leeds, UK
| | - Lars J C Jeuken
- School of Biomedical Sciences, University of
Leeds, Leeds, UK
| | | | - Mark Conner
- School of Psychology, University of
Leeds, Leeds, UK
| | - Jonathan A T Sandoe
- Leeds Teaching Hospitals NHS Trust,
Leeds, UK
- Leeds Institute of Medical Research, School of
Medicine, University of Leeds, Leeds, UK
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17
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Abstract
Stress leads to detrimental health outcomes through direct biological and indirect behavioural changes. Stress can lead to disruption to normal eating behaviours, although the strength of these associations is unknown. This is the first meta-analysis to determine the strength of the stress-eating relationship in healthy adults and to explore the impact of potential moderators. Studies included had a clearly defined measure of stress (i.e., any noxious event or episode in one's environment with the exclusion of emotional distress) that was linked to non-disordered eating. Key terms were searched in Medline, PsycInfo and Ovid databases (23,104 studies identified). 54 studies (combined N = 119,820) were retained in the meta-analysis. A small, positive effect size was found for the stress-overall food intake relationship (Hedges' g = 0.114). Stress was associated with increased consumption of unhealthy foods (Hedges' g = 0.116) but decreased consumption of healthy foods (Hedges' g = -0.111). Only one significant moderator (restraint on stress-unhealthy eating) was identified. This meta-analysis identified the magnitude of the effect of stress on eating behaviour outcomes. Significant heterogeneity was observed that was not explained by the moderators examined. Further research on moderators of the stress-eating relationship is required and should distinguish effects for healthy versus unhealthy eating.
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Affiliation(s)
- Deborah Hill
- School of Psychology, University of Leeds, Leeds, LS2 9JT, UK
| | - Mark Conner
- School of Psychology, University of Leeds, Leeds, LS2 9JT, UK
| | - Faye Clancy
- School of Psychology, University of Leeds, Leeds, LS2 9JT, UK
| | - Rachael Moss
- School of Psychology, University of Leeds, Leeds, LS2 9JT, UK
| | - Sarah Wilding
- School of Psychology, University of Leeds, Leeds, LS2 9JT, UK
| | - Matt Bristow
- School of Psychology and Sports Science, Anglia Ruskin University, Cambridge, CB1 1PT, UK
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18
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Conner M, Wilding S, van Harreveld F, Dalege J. Cognitive-Affective Inconsistency and Ambivalence: Impact on the Overall Attitude-Behavior Relationship. Pers Soc Psychol Bull 2021; 47:673-687. [PMID: 32749192 PMCID: PMC7961742 DOI: 10.1177/0146167220945900] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 07/01/2020] [Indexed: 11/15/2022]
Abstract
This research explored whether overall attitude is a stronger predictor of behavior when underlying cognitive-affective inconsistency or ambivalence is low versus high. Across three prospective studies in different behaviors and populations (Study 1: eating a low-fat diet, N = 136 adults, eating five fruit and vegetables per day, N = 135 adults; Study 2: smoking initiation, N = 4,933 adolescents; and Study 3: physical activity, N = 909 adults) we tested cognitive-affective inconsistency and ambivalence individually and simultaneously as moderators of the overall attitude-behavior relationship. Across studies, more similar effects were observed for inconsistency compared with ambivalence (in both individual and simultaneous analyses). Meta-analysis across studies supported this conclusion with both cognitive-affective inconsistency and ambivalence being significant moderators when considered on their own, but only inconsistency being significant when tested simultaneously. The reported studies highlight the importance of cognitive-affective inconsistency as a determinant of the strength of overall attitude.
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19
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Fennell D, Ottensmeier C, Califano R, Hanna G, Ewings S, Hill K, Wilding S, Danson S, Nye M, Steele N, Johnson L, Lord J, Middleton C, Marwood E, Szlosarek P, Chan S, Gaba A, Darlison L, Wells-Jordan P, Richards C, Poile C, Lester J. PS01.11 Nivolumab Versus Placebo in Relapsed Malignant Mesothelioma: The CONFIRM Phase 3 Trial. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.323] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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20
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Watson E, Wilding S, Matheson L, Brett J, McCaughan E, Downing A, Wright P, Cross W, Selby P, Butcher H, Glaser A, Gavin A, Wagland R. Experiences of Support for Sexual Dysfunction in Men With Prostate Cancer: Findings From a U.K.-Wide Mixed Methods Study. J Sex Med 2021; 18:515-525. [PMID: 33642238 DOI: 10.1016/j.jsxm.2020.12.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 12/23/2020] [Accepted: 12/28/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Men with prostate cancer (PCa) often experience sexual dysfunction following diagnosis and treatment, yet little is known about the support they receive to deal with this. AIM To explore men's experiences of support for sexual dysfunction following PCa diagnosis. METHODS This study included a U.K.-wide survey of men 18-42 months post-diagnosis of PCa, identified through cancer registries. The survey measured sexual function and the extent to which men perceived sexual dysfunction to be a problem (Expanded Prostate Cancer Index Composite-26), access to and experience of medications, devices, and specialist services for sexual dysfunction, and included a free-text question for further comments. Analysis focussed on men who reported poor sexual function, which they considered a moderate or big problem. Descriptive statistics explored the characteristics of men offered intervention and those that found this helpful. Free-text responses were analyzed using thematic analysis. OUTCOME The main outcome of this study was to assess access to and experience of medications, devices, and specialist services for sexual dysfunction. RESULTS 39.0% of all survey respondents (13,978/35,823) reported poor sexual function, which they considered a moderate or big problem. 51.7% of these men were not offered any intervention to aid sexual functioning. 71.9% of those offered an intervention reported trying it, of whom 48.7% found the intervention helpful. Men treated with surgery or brachytherapy were most likely to be offered an intervention. Medication was the most commonly offered intervention and 39.3% of those who tried medication found this helpful. Although offered less often, approximately half of the men who tried devices or attended specialist services found the intervention helpful. Free-text responses indicated that barriers to accessing support included inadequate information and support from healthcare professionals, embarrassment, negative views about treatment options, concerns about side effects and safety, and inconsistencies between secondary and primary care. Barriers to continuing use included limited effectiveness of treatments, inadequate ongoing support, and funding constraints. Drivers of sexual recovery included patient proactivity and persistence with trying different treatment options and ongoing support from health professionals. CLINICAL IMPLICATIONS There is an urgent need to ensure that all men are offered, and have equal access to, sexual care support, with referral to specialist services when required. STRENGTHS & LIMITATIONS This study presents data from a large, U.K.-wide, population-based study of men with PCa and includes quantitative and qualitative findings. The possibility of non-response bias should, however, be considered. CONCLUSION There are significant shortcomings in the support offered to U.K. men with sexual dysfunction following diagnosis and treatment for PCa which need to be addressed. Watson E, Wilding S, Matheson L, et al. Experiences of Support for Sexual Dysfunction in Men With Prostate Cancer: Findings From a U.K.-Wide Mixed Methods Study. J Sex Med 2021;18:515-525.
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Affiliation(s)
- Eila Watson
- Oxford Institute of Nursing, Midwifery and Allied Health Research, Oxford Brookes University, Oxford, UK.
| | - Sarah Wilding
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK; Leeds Institute for Data Analytics, University of Leeds, Leeds, UK; School of Psychology, University of Leeds, Leeds, UK
| | - Lauren Matheson
- Oxford Institute of Nursing, Midwifery and Allied Health Research, Oxford Brookes University, Oxford, UK
| | - Jo Brett
- Oxford Institute of Nursing, Midwifery and Allied Health Research, Oxford Brookes University, Oxford, UK
| | - Eilis McCaughan
- Institute of Nursing and Health Research, Ulster University, Coleraine, N.Ireland, UK
| | - Amy Downing
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK; Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
| | - Penny Wright
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | | | - Peter Selby
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Hugh Butcher
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Adam Glaser
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK; Leeds Institute for Data Analytics, University of Leeds, Leeds, UK; Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Anna Gavin
- Northern Ireland Cancer Registry, Centre for Public Health, Queen's University, Belfast, UK
| | - Richard Wagland
- Faculty of Health Sciences, University of Southampton, Southampton, UK
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21
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Norman P, Wilding S, Conner M. Reasoned action approach and compliance with recommended behaviours to prevent the transmission of the SARS-CoV-2 virus in the UK. Br J Health Psychol 2020; 25:1006-1019. [PMID: 33007143 PMCID: PMC7536976 DOI: 10.1111/bjhp.12474] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/01/2020] [Indexed: 12/05/2022]
Abstract
Objectives To examine associations between demographics, people’s beliefs, and compliance with behaviours recommended by the UK government to prevent the transmission of the SARS‐CoV‐2 virus that causes COVID‐19. Design A two‐wave online survey conducted one week apart during the national lockdown (April, 2020). Measures A sample of 477 UK residents completed baseline measures from the reasoned action approach (experiential attitudes, instrumental attitudes, injunctive norms, descriptive norms, capacity, autonomy, and intention) and perceived susceptibility for each of the following recommended behaviours: limiting leaving home, keeping at least 2 m away from other people when outside and when inside shops, not visiting or meeting friends or other family members, and washing hands when returning home. Self‐reported compliance with each of the recommended behaviours was assessed one week later. Results Rates of full compliance with the recommended behaviours ranged from 31% (keeping at least 2 m away from other people when inside shops) to 68% (not visiting or meeting friends or other family members). Capacity was a significant predictor of compliance with each of the five recommended behaviours. Increasing age and intentions were also predictive of compliance with three of the behaviours. Conclusions Interventions to increase compliance with the recommended behaviours to prevent the transmission of the SARS‐CoV‐2 virus, especially those relating to social distancing, need to bolster people’s intentions and perceptions of capacity. This may be achieved through media‐based information campaigns as well as environmental changes to make compliance with such measures easier. Such interventions should particularly target younger adults.
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Affiliation(s)
- Paul Norman
- Department of Psychology, University of Sheffield, UK
| | | | - Mark Conner
- School of Psychology, University of Leeds, UK
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22
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Wilding S, Wighton S, Halligan D, West R, Conner M, O'Connor DB. What factors are most influential in increasing cervical cancer screening attendance? An online study of UK-based women. Health Psychol Behav Med 2020; 8:314-328. [PMID: 34040874 PMCID: PMC8114340 DOI: 10.1080/21642850.2020.1798239] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: Cervical cancer is the fourth most commonly occurring cancer in women worldwide. The UK has one of the highest cervical screening rates in Europe, yet attendance has been decreasing. This study aimed to identify barriers and facilitators to screening attendance and assess the perceived importance of these factors. Methods: 194 women living in the UK were recruited via an online research recruitment website to an online survey. Most participants (N = 128, 66.0%) were currently up-to-date with cervical screening, 66 participants (34.0%) had never been screened, or were overdue for screening. Participants identified barriers and facilitators to cervical screening attendance via free-text responses and were also asked to rate a list of factors as most to least influential over decision making. Results were analysed using thematic content analysis and ratings analysed using multivariable analyses. Results: The most commonly reported barriers were: Pain/discomfort; Embarrassment; and Time. These were also rated as most influential for decision making. The most commonly reported facilitators were: Ease of making appointments; Peace of mind; and Fear of cancer/preventing serious illness. While importance rating of barriers did not differ by previous screening behaviour, ratings of some facilitators significantly differed. Up-to-date women rated believing screening is potentially life-saving and part of personal responsibility as significantly more important than overdue/never screened women. Conclusion: This study confirmed that factors which encourage screening are key to the decision of whether to attend screening. Women suggested several improvements that might make attending easier and improve uptake, including flexibility of screening locations to fit around work hours and childcare arrangements. Psychological facilitators included the peace of mind that screening brings and the belief that cervical cancer screening is potentially life-saving. Public health interventions should target factors which facilitate screening and how these interplay with barriers in order to improve uptake.
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Affiliation(s)
- Sarah Wilding
- School of Psychology, University of Leeds, Leeds, UK
| | - Sarah Wighton
- NHS England and NHS Improvement (North East & Yorkshire), Leeds, UK
| | | | - Robert West
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Mark Conner
- School of Psychology, University of Leeds, Leeds, UK
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23
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Tsipa A, O'Connor DB, Branley-Bell D, Day F, Hall LH, Sykes-Muskett B, Wilding S, Taylor N, Conner M. Promoting colorectal cancer screening: a systematic review and meta-analysis of randomised controlled trials of interventions to increase uptake. Health Psychol Rev 2020; 15:371-394. [PMID: 32401175 DOI: 10.1080/17437199.2020.1760726] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Colorectal cancer (CRC) represents a global public health concern. CRC screening is associated with significant reductions in CRC incidence and mortality, however, uptake is suboptimal. This systematic review and meta-analysis of randomised controlled trials explored the effectiveness of interventions designed to increase screening uptake, plus the impact of various moderators. Data from 102 studies including 1.94 million participants were analysed. Results showed significant benefit of all interventions combined (OR, 1.49, 95% CI: 1.43, 1.56, p < 0.001). The effects were similar in studies using objective versus self-reported uptake measures and lower in studies judged to be at high risk of bias. Moderator analyses indicated significant effects for aspects of behaviour (effects lower for studies on non-endoscopic procedures), and intervention (effects higher for studies conducted in community settings, in healthcare systems that are not free, and that use reminders, health-professional providers, paper materials supplemented with in-person or phone contact, but avoid remote contact). Interventions that included behaviour change techniques targeting social support (unspecified or practical), instructions or demonstration of the behaviour, and that added objects to the environment produced stronger effects. The way in which findings can inform interventions to improve CRC screening uptake is discussed.
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Affiliation(s)
| | | | - Dawn Branley-Bell
- Department of Psychology, Northumbria University, Newcastle upon Tyne, UK
| | - Fiona Day
- NHS Leeds West Clinical Commissioning Group, Leeds, UK
| | - Louise H Hall
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Sarah Wilding
- School of Psychology, University of Leeds, Leeds, UK
| | - Natalie Taylor
- Cancer Council New South Wales, Sydney, NSW, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Mark Conner
- School of Psychology, University of Leeds, Leeds, UK
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24
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Howarth EJ, O'Connor DB, Panagioti M, Hodkinson A, Wilding S, Johnson J. Are stressful life events prospectively associated with increased suicidal ideation and behaviour? A systematic review and meta-analysis. J Affect Disord 2020; 266:731-742. [PMID: 32217256 DOI: 10.1016/j.jad.2020.01.171] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 12/11/2019] [Accepted: 01/28/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Stressful life events are a risk factor for suicidal ideation and behaviour, but the strength and nature of this association is unclear. This review examined the prospective relationship between stressful life events and subsequent suicidal ideation and behaviours. METHODS Five databases were searched from inception to April 2019. Eligible studies included observational, quantitative longitudinal cohort studies with adult or adolescent samples. A random-effects meta-analysis model was used to examine the prospective relationship between stressful life events and subsequent suicidal ideation and behaviours. Sub-group analyses examined moderating factors. RESULTS Eight studies were identified in the systematic review, and seven studies comprising 2,639 participants were included in the meta-analysis. Six studies investigated suicidal ideation and one investigated suicidal behaviours. Stressful life events were associated with a 37% higher odds of subsequently reported suicidal ideation and behaviours combined (Odds Ratio (OR): 1.37, 95% CI: 1.10 to 1.70), and a 45% increased risk for suicidal ideation (OR: 1.45, 95% CI: 1.20 to 1.75). This association was stronger in males, young adults, and studies with shorter term follow-up. LIMITATIONS The analyses indicated statistical heterogeneity was high (I2 = 76. 48, 95% CI: 55.0 to 87.7%) and there was evidence of publication bias. CONCLUSIONS Stressful life events were shown to increase the risk of subsequently reported suicidal ideation and behaviours. These findings suggest that the experience of stressful life events should be incorporated into clinical suicide risk assessments and suicide interventions could include a component on developing resilience and adaptive coping to stressful life events.
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Affiliation(s)
- Emma J Howarth
- Clinical Psychology Training Programme, University of Leeds, Leeds, United Kingdom.
| | - Daryl B O'Connor
- School of Psychology, University of Leeds, Leeds, United Kingdom
| | - Maria Panagioti
- NIHR Greater Manchester Patient Safety Translational Research Centre, NIHR School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, United Kingdom
| | - Alexander Hodkinson
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Sarah Wilding
- School of Psychology, University of Leeds, Leeds, United Kingdom
| | - Judith Johnson
- School of Psychology, University of Leeds, Leeds, United Kingdom; Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, United Kingdom; School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
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Wilding S, Downing A, Selby P, Cross W, Wright P, Watson EK, Wagland R, Kind P, Donnelly DW, Hounsome L, Mottram R, Allen M, Kearney T, Butcher H, Gavin A, Glaser A. Decision regret in men living with and beyond nonmetastatic prostate cancer in the United Kingdom: A population-based patient-reported outcome study. Psychooncology 2020; 29:886-893. [PMID: 32065691 PMCID: PMC7317932 DOI: 10.1002/pon.5362] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 01/28/2020] [Accepted: 02/11/2020] [Indexed: 11/26/2022]
Abstract
Objective Clinical options for managing nonmetastatic prostate cancer (PCa) vary. Each option has side effects associated with it, leading to difficulty in decision‐making. This study aimed to assess the relationship between patient involvement in treatment decision‐making and subsequent decision regret (DR), and quantify the impact of health‐related quality of life (HRQL) outcomes on DR. Methods Men living in the United Kingdom, 18 to 42 months after diagnosis of PCa, were identified from cancer registration data and sent a questionnaire. Measures included the Decision Regret Scale (DRS), Expanded Prostate cancer Index Composite short form (EPIC‐26), EQ‐5D‐5L, and an item on involvement in treatment decision‐making. Multivariable ordinal regression was utilized, with DR categorized as none, mild, or moderate/severe regret. Results A total of 17 193 men with stage I‐III PCa completed the DRS: 36.6% reported no regret, 43.3% mild regret, and 20.0% moderate/severe regret. The odds of reporting DR were greater if men indicated their views were not taken into account odds ratio ([OR] = 6.42, 95% CI: 5.39‐7.64) or were involved “to some extent” in decision‐making (OR = 4.63, 95% CI: 4.27‐5.02), compared with men who were “definitely” involved. After adjustment, including for involvement, men reporting moderate/big problems with urinary, bowel, or sexual function were more likely to experience regret compared with men with no/small problems. Better HRQL scores were associated with lower levels of DR. Conclusions This large‐scale study demonstrates the benefit of patient involvement in treatment decision‐making for nonmetastatic PCa. However, men experiencing side effects and poorer HRQL report greater DR. Promoting engagement in clinical decision‐making represents good practice and may reduce the risk of subsequent regret.
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Affiliation(s)
- Sarah Wilding
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK.,Leeds Institute for Data Analytics, University of Leeds, Leeds, UK.,School of Psychology, University of Leeds, Leeds, UK
| | - Amy Downing
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK.,Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
| | - Peter Selby
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - William Cross
- Leeds Teaching Hospitals NHS Trust, University of Leeds, Leeds, UK
| | - Penny Wright
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Eila K Watson
- Oxford Institute of Nursing, Midwifery and Allied Health Research, Oxford Brookes University, Oxford, UK
| | - Richard Wagland
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Paul Kind
- Academic Unit of Health Economics, University of Leeds, Leeds, UK
| | - David W Donnelly
- Northern Ireland Cancer Registry, Queen's University Belfast, Belfast, UK
| | - Luke Hounsome
- National Cancer Registration and Analysis Service, Public Health England, Bristol, UK
| | - Rebecca Mottram
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK.,Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
| | - Majorie Allen
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK.,Leeds Institute for Data Analytics, University of Leeds, Leeds, UK.,Leeds Teaching Hospitals NHS Trust, University of Leeds, Leeds, UK
| | - Therese Kearney
- Northern Ireland Cancer Registry, Queen's University Belfast, Belfast, UK
| | - Hugh Butcher
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Anna Gavin
- Northern Ireland Cancer Registry, Queen's University Belfast, Belfast, UK
| | - Adam Glaser
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK.,Leeds Institute for Data Analytics, University of Leeds, Leeds, UK.,Leeds Teaching Hospitals NHS Trust, University of Leeds, Leeds, UK
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26
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Donnelly DW, Vis LC, Kearney T, Sharp L, Bennett D, Wilding S, Downing A, Wright P, Watson E, Wagland R, Cross WR, Mason MD, Siesling S, van Manen JG, Glaser AW, Gavin A. Quality of life among symptomatic compared to PSA-detected prostate cancer survivors - results from a UK wide patient-reported outcomes study. BMC Cancer 2019; 19:947. [PMID: 31615476 PMCID: PMC6792209 DOI: 10.1186/s12885-019-6164-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 09/16/2019] [Indexed: 01/01/2023] Open
Abstract
Background Quality of life among prostate cancer survivors varies by socio-demographic factors and treatment type received; however, less in known about differences in functional outcomes by method of presentation. We investigate differences in reported urinary, bowel, sexual and hormone-related problems between symptomatic and PSA-detected prostate cancer survivors. Methods A UK wide cross-sectional postal survey of prostate cancer survivors conducted 18-42 months post-diagnosis. Questions were included on presentation method and treatment. Functional outcome was determined using the EPIC-26 questionnaire. Reported outcomes were compared for symptomatic and PSA-detected survivors using ANOVA and multivariable log-linear regression. Results Thirty-five thousand eight hundred twenty-three men responded (response rate: 60.8%). Of these, 31.3% reported presenting via PSA test and 59.7% symptomatically. In multivariable analysis, symptomatic men reported more difficulty with urinary incontinence (Adjusted mean ratio (AMR): 0.96, 95% CI: 0.96-0.97), urinary irritation (AMR: 0.95, 95% CI: 0.95-0.96), bowel function (AMR: 0.97, 95% CI: 0.97-0.98), sexual function (AMR: 0.90, 95% CI: 0.88-0.92), and vitality/hormonal function (AMR: 0.96, 95% CI: 0.96-0.96) than PSA-detected men. Differences were consistent across respondents of differing age, stage, Gleason score and treatment type. Conclusion Prostate cancer survivors presenting symptomatically report poorer functional outcomes than PSA-detected survivors. Differences were not explained by socio-demographic or clinical factors. Clinicians should be aware that men presenting with symptoms are more likely to report functional difficulties after prostate cancer treatment and may need additional aftercare if these difficulties persist. Method of presentation should be considered as a covariate in patient-reported outcome studies of prostate cancer.
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Affiliation(s)
- David W Donnelly
- Northern Ireland Cancer Registry, Centre for Public Health, Queen's University Belfast, Mulhouse Building, Grosvenor Road, Belfast, BT12 6DP, Northern Ireland, UK.
| | - Linda C Vis
- Northern Ireland Cancer Registry, Centre for Public Health, Queen's University Belfast, Mulhouse Building, Grosvenor Road, Belfast, BT12 6DP, Northern Ireland, UK.,Department of Health Technology & Services Research, University of Twente, Enschede, The Netherlands
| | - Therese Kearney
- Northern Ireland Cancer Registry, Centre for Public Health, Queen's University Belfast, Mulhouse Building, Grosvenor Road, Belfast, BT12 6DP, Northern Ireland, UK
| | - Linda Sharp
- Institute of Health & Society, Newcastle University, Newcastle-upon-Tyne, England
| | - Damien Bennett
- Northern Ireland Cancer Registry, Centre for Public Health, Queen's University Belfast, Mulhouse Building, Grosvenor Road, Belfast, BT12 6DP, Northern Ireland, UK
| | - Sarah Wilding
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, England.,Leeds Institute of Data Analytics, University of Leeds, Leeds, England
| | - Amy Downing
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, England.,Leeds Institute of Data Analytics, University of Leeds, Leeds, England
| | - Penny Wright
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, England
| | - Eila Watson
- Department of Midwifery, Community and Public Health, School of Nursing and Midwifery, Oxford Brookes University, Oxford, England
| | - Richard Wagland
- Faculty of Health Sciences, University of Southampton, Southampton, England
| | - William R Cross
- Department of Urology, St James's University Hospital, Leeds, England
| | - Malcolm D Mason
- Division of Cancer and Genetics, School of Medicine, Cardiff University, Cardiff, Wales
| | - Sabine Siesling
- Department of Health Technology & Services Research, University of Twente, Enschede, The Netherlands.,Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Jeannette G van Manen
- Department of Health Technology & Services Research, University of Twente, Enschede, The Netherlands
| | - Adam W Glaser
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, England.,Leeds Institute of Data Analytics, University of Leeds, Leeds, England
| | - Anna Gavin
- Northern Ireland Cancer Registry, Centre for Public Health, Queen's University Belfast, Mulhouse Building, Grosvenor Road, Belfast, BT12 6DP, Northern Ireland, UK
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27
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Schüz B, Brick C, Wilding S, Conner M. Socioeconomic Status Moderates the Effects of Health Cognitions on Health Behaviors within Participants: Two Multibehavior Studies. Ann Behav Med 2019; 54:36-48. [DOI: 10.1093/abm/kaz023] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Socioeconomic differences in health-related behaviors are a major cause of health inequalities. However, the mechanisms (mediation/moderation) by which socioeconomic status (SES) affects health behavior are a topic of ongoing debate.
Purpose
Current research on SES as moderator of the health cognitions–health behavior relation is inconsistent. Previous studies are limited by diverse operationalizations of SES and health behaviors, demographically narrow samples, and between-person designs addressing within-person processes. This paper presents two studies addressing these shortcomings in a within-person multibehavior framework using hierarchical linear models.
Methods
Two online studies, one cross-sectional and one 4 week longitudinal, assessed 1,005 (Study 1; Amazon MTurk; USA only) and 1,273 participants (Study 2; Prolific; international). Self-reports of multiple SES indicators (education, income, occupation status; ZIP code in Study 1), health cognitions (from the theory of planned behavior), and measures of six health behaviors were taken. Multilevel models with cross-level interactions tested whether the within-person relationships between health cognitions and behaviors differed by between-person SES.
Results
Education significantly moderated intention-behavior and attitude-behavior relationships in both studies, with more educated individuals showing stronger positive relationships. In addition, ZIP-level SES (Study 1) moderated attitude-behavior effects such that these relationships were stronger in participants living in areas with higher SES.
Conclusions
Education appears to be an important resource for the translation of intentions and attitudes into behavior. Other SES indicators showed less consistent effects. This has implications for interventions aiming at increasing intentions to change health behaviors, as some interventions might inadvertently increase health inequalities.
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Affiliation(s)
- Benjamin Schüz
- Institute for Public Health and Nursing, University of Bremen, Bremen, Germany
- School of Medicine, University of Tasmania, Hobart, Australia
| | - Cameron Brick
- Department of Psychology, University of Cambridge, Cambridge, UK
| | | | - Mark Conner
- School of Psychology, University of Leeds, UK
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28
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Matheson L, Wilding S, Wagland R, Nayoan J, Rivas C, Downing A, Wright P, Brett J, Kearney T, Cross W, Glaser A, Gavin A, Watson E. The psychological impact of being on a monitoring pathway for localised prostate cancer: A UK-wide mixed methods study. Psychooncology 2019; 28:1567-1575. [PMID: 31132801 DOI: 10.1002/pon.5133] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 05/16/2019] [Accepted: 05/19/2019] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To address concerns over the psychological impact of being on a monitoring pathway following prostate cancer (PCa) diagnosis, this study compared the psychological status of men on active surveillance (AS) or watchful waiting (WW) with men on active treatment (AT) and explored psychological adjustment in men on AS/WW. METHODS Cross-sectional survey of UK men diagnosed with PCa 18 to 42 months previously (n = 16 726, localised disease at diagnosis) and telephone interviews with 24 men on AS/WW. Psychological outcomes were measured using two validated scales (Short Warwick-Edinburgh Mental Well-being Scale [SWEMWBS] and Kessler Psychological Distress Scale). Univariable and multivariable analyses compared outcomes between men on AS/WW and AT. Thematic analysis of interviews was undertaken, informed by a previously developed theory of adjustment to cancer. RESULTS A total of 3986 (23.8%) respondents were on AS/WW. Overall, psychological outcomes were similar or better in men on AS/WW compared with those receiving AT (SWEMWBS: Poor well-being; 12.3% AS/WW vs 13.9% AT, adjusted OR = 0.86, 95% CI, 0.76-0.97; K6: severe psychological distress; 4.6% vs 5.4%, adjusted OR = 0.90, 95% CI, 0.74-1.08). Interviews indicated that most men on AS/WW had adjusted positively. Men with poorer well-being were less able to accept, reframe positively and normalise their diagnosis, described receiving insufficient information and support, and reported a lack of confidence in their health care professionals. CONCLUSIONS Most men on AS/WW cope well psychologically. Men making treatment decisions should be given this information. Psychological health should be assessed to determine suitability for AS/WW, and at monitoring appointments. A clear action plan and support from health care professionals is important.
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Affiliation(s)
- Lauren Matheson
- Oxford Institute of Nursing, Midwifery and Allied Health Research, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Sarah Wilding
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Richard Wagland
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Johana Nayoan
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Carol Rivas
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Amy Downing
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Penny Wright
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Jo Brett
- Oxford Institute of Nursing, Midwifery and Allied Health Research, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Therese Kearney
- Northern Ireland Cancer Registry, Queen's University Belfast, Belfast, UK
| | | | - Adam Glaser
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK.,Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Anna Gavin
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Eila Watson
- Oxford Institute of Nursing, Midwifery and Allied Health Research, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
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29
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Donnelly DW, Gavin A, Downing A, Hounsome L, Kearney T, McNair E, Allan D, Huws DW, Wright P, Selby PJ, Kind P, Watson E, Wagland R, Wilding S, Butcher H, Mottram R, Allen M, McSorley O, Sharp L, Mason MD, Cross WR, Catto JWF, Glaser AW. Regional Variations in Quality of Survival Among Men with Prostate Cancer Across the United Kingdom. Eur Urol 2019; 76:228-237. [PMID: 31060822 DOI: 10.1016/j.eururo.2019.04.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 04/12/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Prostate cancer incidence, treatment, and survival rates vary throughout the UK, but little is known about regional differences in quality of survival. OBJECTIVE To investigate variations in patient-reported outcomes between UK countries and English Cancer Alliances. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional postal survey of prostate cancer survivors diagnosed 18-42mo previously. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Urinary, bowel, and sexual problems and vitality were patient reported using the Expanded Prostate Cancer Index Composite (EPIC-26) questionnaire. General health was also self-assessed. Regional variations were identified using multivariable log-linear regression. RESULTS AND LIMITATIONS A total of 35823 men responded, 60.8% of those invited. Self-assessed health was significantly lower than the UK average in Wales and Scotland. Respondents reported more urinary incontinence in Scotland, more urinary irritation/obstruction in Scotland and Northern Ireland (NI), poorer bowel function in Scotland and NI, worse sexual function in Scotland, and reduced vitality/hormonal function in Scotland, Wales, and NI. Self-assessed health was poorer than the English average in South Yorkshire and North-East and Cumbria, with more urinary incontinence in North-East and Cumbria and Peninsula, greater sexual problems in West Midlands, and poorer vitality in North-East and Cumbria and West Midlands. Limitations include difficulty identifying clinically significant differences and limited information on pretreatment conditions. CONCLUSIONS Despite adjustment for treatment, and clinical and sociodemographic factors, quality of survival among prostate cancer survivors varied by area of residence. Adoption of best practice from areas performing well could support enhanced survival quality in poorer performing areas, particularly with regard to bowel problems and vitality, where clinically relevant differences were reported. PATIENT SUMMARY We conducted a UK-wide survey of patient's quality of life after treatment for prostate cancer. Outcomes were found to vary depending upon where patients live. Different service providers need to ensure that all prostate cancer patients receive the same follow-up care.
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Affiliation(s)
- David W Donnelly
- Northern Ireland Cancer Registry, Centre for Public Health, Queen's University Belfast, Belfast, UK.
| | - Anna Gavin
- Northern Ireland Cancer Registry, Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Amy Downing
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK; Leeds Institute of Data Analytics, University of Leeds, Leeds, UK
| | - Luke Hounsome
- National Cancer Registration and Analysis Service, Public Health England, Bristol, UK
| | - Therese Kearney
- Northern Ireland Cancer Registry, Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Emma McNair
- Information Services Division, NHS National Services Scotland, Edinburgh, UK
| | - Dawn Allan
- Welsh Cancer Intelligence and Surveillance Unit, Public Health Wales, Cardiff, UK
| | - Dyfed W Huws
- Welsh Cancer Intelligence and Surveillance Unit, Public Health Wales, Cardiff, UK
| | - Penny Wright
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Peter J Selby
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK; Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Paul Kind
- Academic Unit of Health Economics, University of Leeds, Leeds, UK
| | - Eila Watson
- Department of Midwifery, Community and Public Health, School of Nursing and Midwifery, Oxford Brookes University, Oxford, UK
| | - Richard Wagland
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Sarah Wilding
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK; Leeds Institute of Data Analytics, University of Leeds, Leeds, UK
| | - Hugh Butcher
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Rebecca Mottram
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK; Leeds Institute of Data Analytics, University of Leeds, Leeds, UK
| | - Majorie Allen
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK; Leeds Institute of Data Analytics, University of Leeds, Leeds, UK
| | - Oonagh McSorley
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Linda Sharp
- Institute for Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Malcolm D Mason
- Division of Cancer and Genetics, School of Medicine, Cardiff University, Cardiff, UK
| | - William R Cross
- Department of Urology, St James's University Hospital, Leeds, UK
| | - James W F Catto
- Academic Urology Unit, University of Sheffield, Sheffield, UK
| | - Adam W Glaser
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK; Leeds Institute of Data Analytics, University of Leeds, Leeds, UK; Leeds Teaching Hospitals NHS Trust, Leeds, UK
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30
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Wright P, Wilding S, Watson E, Downing A, Selby P, Hounsome L, Wagland R, Brewster DH, Huws D, Butcher H, Mottram R, Kearney T, Allen M, Gavin A, Glaser A. Key factors associated with social distress after prostate cancer: Results from the United Kingdom Life after Prostate Cancer diagnosis study. Cancer Epidemiol 2019; 60:201-207. [PMID: 31071525 DOI: 10.1016/j.canep.2019.04.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 04/16/2019] [Accepted: 04/19/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND More men are living following a prostate cancer (PCa) diagnosis. They may need support to maximize the quality of their survival. Physical and psychological impacts of PCa are widely documented. Less is known about social impacts. We aimed to identify key factors associated with social distress following PCa. METHODS The Life After Prostate Cancer Diagnosis study is a UK national cross-sectional survey of men 18-42 months post diagnosis of PCa. Men (n = 58 930) were invited to participate by their diagnosing cancer centre including 82% of English NHS Trusts (n = 111) and 100% of all Health Boards in Northern Ireland (n = 5), Scotland (n = 14) and Wales (n = 6). Social distress was measured using the Social Difficulties Inventory (SDI-21), 16 item Social Distress scale with men assigned to 'socially distressed'/'not socially distressed' groups, according to published guidelines. Clinical and sociodemographic variables were collected from self-report and cancer registries. RESULTS Response rate 60.8% (n = 35 823) of whom 97% (n = 29 351) completed the Social Distress scale (mean age = 71.2; SD = 7.88). The proportion of 'socially distressed' men was 9.4%. Multivariable logistic regression analysis revealed unemployment versus employment (odds ratio (OR): 11.58 [95% CI 9.16-14.63]) and ≥3 co-morbidities versus none (OR: 5.37 [95% CI 4.61-6.27]) as key associations. Others were Androgen Deprivation Therapy, External Beam Radiotherapy in combination with another treatment, age, prior mental health problems and living in a socio-economically deprived area. CONCLUSION Most men following PCa are socially resilient. A simple checklist could help clinicians identify men at risk of social distress.
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Affiliation(s)
- Penny Wright
- Leeds Institute of Medical Research at St James's, University of Leeds, UK.
| | - Sarah Wilding
- Leeds Institute of Medical Research at St James's, University of Leeds, UK; Leeds Institute of Data Analytics, University of Leeds, UK
| | - Eila Watson
- Faculty of Health and Life Sciences, Oxford Brookes University, UK
| | - Amy Downing
- Leeds Institute of Medical Research at St James's, University of Leeds, UK; Leeds Institute of Data Analytics, University of Leeds, UK
| | - Peter Selby
- Leeds Institute of Medical Research at St James's, University of Leeds, UK
| | - Luke Hounsome
- National Cancer Registration and Analysis Service, Public Health England, UK
| | | | - David H Brewster
- Deanery of Molecular, Genetic and Population Health Sciences, University of Edinburgh, UK
| | - Dyfed Huws
- Welsh Cancer Intelligence and Surveillance Unit, Public Health Wales, UK
| | - Hugh Butcher
- Leeds Institute of Medical Research at St James's, University of Leeds, UK
| | - Rebecca Mottram
- Leeds Institute of Medical Research at St James's, University of Leeds, UK; Leeds Institute of Data Analytics, University of Leeds, UK
| | - Therese Kearney
- Northern Ireland Cancer Registry, Queen's University Belfast, Royal Victoria Hospital, Belfast, UK
| | | | - Anna Gavin
- Northern Ireland Cancer Registry, Queen's University Belfast, Royal Victoria Hospital, Belfast, UK
| | - Adam Glaser
- Leeds Institute of Medical Research at St James's, University of Leeds, UK; Leeds Institute of Data Analytics, University of Leeds, UK; Leeds Teaching Hospitals NHS Trust, UK
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Wagland R, Nayoan J, Matheson L, Rivas C, Brett J, Downing A, Wilding S, Butcher H, Gavin A, Glaser AW, Watson E. 'Very difficult for an ordinary guy': Factors influencing the quality of treatment decision-making amongst men diagnosed with localised and locally advanced prostate cancer: Findings from a UK-wide mixed methods study. Patient Educ Couns 2019; 102:797-803. [PMID: 30527732 DOI: 10.1016/j.pec.2018.12.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 11/19/2018] [Accepted: 12/02/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To explore experiences of treatment decision-making (TDM) amongst men diagnosed with stage 1-3 prostate cancer. METHODS Mixed-methods study incorporating UK-wide cross-sectional postal survey of men 18-42 months post-diagnosis and semi-structured interviews with a subsample (n = 97), including men who received both radical treatments and active surveillance. Interview data was analysed using a Framework approach. RESULTS Within the context of TDM, 'drivers' included men's intra-personal preferences for decision-making responsibility or clinical direction, relative treatment intrusiveness or desire for excision, and work, personal and social life priorities; 'facilitators' were inter-personal mechanisms such as information and communication with clinicians to enact, but also sometimes challenge drivers. Drivers and facilitators can conflict, challenging patient empowerment. Men frequently undertook greater TDM responsibility than desired, without clinical recommendations; others received conflicting recommendations. Information on potential side-effects was often reportedly inadequate. Unchallenged preferences, absence of clinical recommendations and inadequate preparation for side-effects sometimes led to decision regret. CONCLUSIONS Men are not empowered when expected to take more TDM responsibility than desired, when provided with conflicting recommendations, or when their potentially inappropriate preferences are unchallenged. PRACTICE IMPLICATIONS TDM should involve men exercising preferences and priorities in discussion with clinicians. Clinicians should ensure patients do not receive conflicting recommendations.
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Affiliation(s)
- Richard Wagland
- Faculty of Health Sciences, University of Southampton, Southampton, UK.
| | - Johana Nayoan
- Health Psychology Research Group, University College London, UK
| | - Lauren Matheson
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Carol Rivas
- Social Science Research Unit, University College London (UCL), London, UK
| | - Jo Brett
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Amy Downing
- Leeds Institute of Medical Research at St James's, University of Leeds, UK; Leeds Institute of Data Analytics, University of Leeds, Leeds, UK
| | - Sarah Wilding
- Leeds Institute of Medical Research at St James's, University of Leeds, UK; Leeds Institute of Data Analytics, University of Leeds, Leeds, UK
| | - Hugh Butcher
- Yorkshire Cancer Patient Forum, c/o Strategic Clinical Network and Senate, Yorkshire and The Humber, Harrogate, UK
| | - Anna Gavin
- Northern Ireland Cancer Registry, Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Adam W Glaser
- Leeds Institute of Medical Research at St James's, University of Leeds, UK; Leeds Institute of Data Analytics, University of Leeds, Leeds, UK
| | - Eila Watson
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
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32
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Wilding S, Conner M, Prestwich A, Lawton R, Sheeran P. Using the question-behavior effect to change multiple health behaviors: An exploratory randomized controlled trial. J Exp Soc Psychol 2019; 81:53-60. [PMID: 30828108 PMCID: PMC6358049 DOI: 10.1016/j.jesp.2018.07.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Asking questions about a behavior has been found to influence subsequent performance of that behavior, a phenomenon termed the question-behavior effect (QBE). The present study addressed two under-researched questions concerning the QBE: (1) Can the QBE be used to change multiple health behaviors, and (2) does enhancing dissonance during questionnaire completion increase the magnitude of the QBE? Participants (N = 1534) were randomized to one of three conditions (dissonance-enhanced QBE; standard QBE; control) that targeted three health-protective behaviors (eating fruit and vegetables, physical activity, dental flossing) and three health-risk behaviors (alcohol intake, sedentariness, unhealthy snacking). The dissonance-enhanced intervention comprised a message designed to pressurize participants into forming healthful behavioral intentions. Behavior was assessed via self-reports at four-week follow up. Findings showed significant overall effects of the QBE both in increasing performance of health-protective behaviors (p = .001) and in reducing performance of health-risk behaviors (p = .04). Compared to the standard QBE condition, the dissonance-enhanced QBE intervention increased performance of health-protective behaviors (p = .04) and marginally reduced performance of health-risk behaviors (p = .07). The dissonance-enhanced QBE intervention outperformed the control condition in all analyses. This is the first report that a brief QBE intervention influences performance of multiple health behaviors. Findings supported the idea that magnifying dissonance increases the impact of the QBE.
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Affiliation(s)
| | | | | | | | - Paschal Sheeran
- University of North Carolina at Chapel Hill, United States of America
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Downing A, Wright P, Hounsome L, Selby P, Wilding S, Watson E, Wagland R, Kind P, Donnelly DW, Butcher H, Catto JWF, Cross W, Mason M, Sharp L, Weller D, Velikova G, McCaughan E, Mottram R, Allen M, Kearney T, McSorley O, Huws DW, Brewster DH, McNair E, Gavin A, Glaser AW. Quality of life in men living with advanced and localised prostate cancer in the UK: a population-based study. Lancet Oncol 2019; 20:436-447. [PMID: 30713036 DOI: 10.1016/s1470-2045(18)30780-0] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 10/11/2018] [Accepted: 10/12/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Little is known about the health-related quality of life (HRQOL) of men living with advanced prostate cancer. We report population-wide functional outcomes and HRQOL in men with all stages of prostate cancer and identify implications for health-care delivery. METHODS For this population-based study, men in the UK living 18-42 months after diagnosis of prostate cancer were identified through cancer registration data. A postal survey was administered, which contained validated measures to assess functional outcomes (urinary incontinence, urinary irritation and obstruction, bowel, sexual, and vitality and hormonal function), measured with the Expanded Prostate Cancer Index Composite short form (EPIC-26), plus questions about use of interventions for sexual dysfunction) and generic HRQOL (assessed with the 5-level EuroQol five dimensions questionnaire [EQ-5D-5L] measuring mobility, self-care, usual activities, pain or discomfort, and anxiety or depression, plus a rating of self-assessed health). Log-linear and binary logistic regression models were used to compare functional outcomes and HRQOL across diagnostic stages and self-reported treatment groups. Each model included adjustment for age, socioeconomic deprivation, and number of other long-term conditions. FINDINGS 35 823 (60·8%) of 58 930 men responded to the survey. Disease stage was known for 30 733 (85·8%) of 35 823 men; 19 599 (63·8%) had stage I or II, 7209 (23·4%) stage III, and 3925 (12·8%) stage IV disease. Mean adjusted EPIC-26 domain scores were high, indicating good function, except for sexual function, for which scores were much lower. Compared with men who did not receive androgen deprivation therapy, more men who received the therapy reported moderate to big problems with hot flushes (30·7% [95% CI 29·8-31·6] vs 5·4% [5·0-5·8]), low energy (29·4% [95% CI 28·6-30·3] vs 14·7% [14·2-15·3]), and weight gain (22·5%, 21·7-23·3) vs 6·9% [6·5-7·3]). Poor sexual function was common (81·0%; 95% CI 80·6-81·5), regardless of stage, and more than half of men (n=18 782 [55·8%]) were not offered any intervention to help with this condition. Overall, self-assessed health was similar in men with stage I-III disease, and although slightly reduced in those with stage IV cancer, 23·5% of men with metastatic disease reported no problems on any EQ-5D dimension. INTERPRETATION Men diagnosed with advanced disease do not report substantially different HRQOL outcomes to those diagnosed with localised disease, although considerable problems with hormonal function and fatigue are reported in men treated with androgen deprivation therapy. Sexual dysfunction is common and most men are not offered helpful intervention or support. Service improvements around sexual rehabilitation and measures to reduce the effects of androgen deprivation therapy are required. FUNDING The Movember Foundation, in partnership with Prostate Cancer UK.
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Affiliation(s)
- Amy Downing
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK; Leeds Institute for Data Analytics, University of Leeds, Leeds, UK.
| | - Penny Wright
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Luke Hounsome
- National Cancer Registration and Analysis Service, Public Health England, Bristol, UK
| | - Peter Selby
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK; Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Sarah Wilding
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK; Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
| | - Eila Watson
- Department of Midwifery, Community and Public Health, School of Nursing and Midwifery, Oxford Brookes University, Oxford, UK
| | - Richard Wagland
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Paul Kind
- Academic Unit of Health Economics, University of Leeds, Leeds, UK
| | - David W Donnelly
- Northern Ireland Cancer Registry, Queens University Belfast, Belfast, UK
| | - Hugh Butcher
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - James W F Catto
- Academic Urology Unit, University of Sheffield, Sheffield, UK
| | | | - Malcolm Mason
- Division of Cancer and Genetics, School of Medicine, Cardiff University, Cardiff, UK
| | - Linda Sharp
- Institute for Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - David Weller
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Galina Velikova
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Eilis McCaughan
- Institute of Nursing and Health Research, Ulster University, Coleraine, UK
| | - Rebecca Mottram
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK; Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
| | - Majorie Allen
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK; Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
| | - Therese Kearney
- Northern Ireland Cancer Registry, Queens University Belfast, Belfast, UK
| | - Oonagh McSorley
- School of Nursing and Midwifery, Queen's University Belfast, UK
| | - Dyfed W Huws
- Welsh Cancer Intelligence and Surveillance Unit, Public Health Wales, Cardiff, UK
| | - David H Brewster
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Emma McNair
- Information Services Division, NHS National Services Scotland, Edinburgh, UK
| | - Anna Gavin
- Northern Ireland Cancer Registry, Queens University Belfast, Belfast, UK
| | - Adam W Glaser
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK; Leeds Institute for Data Analytics, University of Leeds, Leeds, UK; Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Wilding S, Ziauddeen N, Roderick PJ, Alwan NA. Socioeconomic differences in the incidence of small-for-gestational-age birth and their time trend. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky212.728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S Wilding
- University of Southampton, Southampton, UK
| | | | | | - NA Alwan
- University of Southampton, NIHR Southampton Biomedical Research Centre, Southampton, UK
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Bennett D, Kearney T, Donnelly DW, Downing A, Wright P, Wilding S, Wagland R, Watson E, Glaser A, Gavin A. Factors influencing job loss and early retirement in working men with prostate cancer-findings from the population-based Life After Prostate Cancer Diagnosis (LAPCD) study. J Cancer Surviv 2018; 12:669-678. [PMID: 30058009 PMCID: PMC6153559 DOI: 10.1007/s11764-018-0704-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 07/13/2018] [Indexed: 12/17/2022]
Abstract
Purpose To investigate factors associated with job loss and early retirement in men diagnosed with prostate cancer (PCa) 18–42 months previously. Methods Men ≤ 60 years at diagnosis who completed the Life After Prostate Cancer Diagnosis (LAPCD) survey were identified. Men who moved from employment at diagnosis to unemployment (EtoU) or retirement (EtoR) at survey (18–42 months post-diagnosis) were compared to men remaining in employment (EtoE). Sociodemographic, clinical and patient-reported factors were analysed in univariable and multivariable analysis. Results There were 3218 men (81.4%) in the EtoE, 245 (6.2%) in EtoU and 450 (11.4%) in the EtoR groups. Men with stage IV disease (OR = 4.7 95% CI 3.1–7.0, relative to stage I/II) and reporting moderate/big bowel (OR = 2.5, 95% CI 1.6–3.9) or urinary problems (OR = 2.0, 95% CI 1.4–3.0) had greater odds of becoming unemployed. Other clinical (≥ 1 comorbidities, symptomatic at diagnosis) and sociodemographic (higher deprivation, divorced/separated), living in Scotland or Northern Ireland (NI)) factors were predictors of becoming unemployed. Men who were older, from NI, with stage IV disease and with caring responsibilities had greater odds of retiring early. Self-employed and non-white men had lesser odds of retiring early. Conclusion PCa survivors who retire early following diagnosis do not report worse urinary or bowel problems compared to men remaining in employment. However, we identified clinical and sociodemographic factors which increased unemployment risk in PCa survivors. Implications for Cancer Survivors Targeted support and engagement with PCa survivors at risk of unemployment, including their families and employers, is needed. Electronic supplementary material The online version of this article (10.1007/s11764-018-0704-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Damien Bennett
- Northern Ireland Cancer Registry, Mulhouse Building, Queen's University Belfast, Mulhouse Rd., Belfast, BT12 6DP, Northern Ireland.
| | - Therese Kearney
- Northern Ireland Cancer Registry, Mulhouse Building, Queen's University Belfast, Mulhouse Rd., Belfast, BT12 6DP, Northern Ireland
| | - David W Donnelly
- Northern Ireland Cancer Registry, Mulhouse Building, Queen's University Belfast, Mulhouse Rd., Belfast, BT12 6DP, Northern Ireland
| | - Amy Downing
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, LS2 9JT, UK.,Leeds Institute of Data Analytics, University of Leeds, Leeds, LS2 9JT, UK
| | - Penny Wright
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, LS2 9JT, UK
| | - Sarah Wilding
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, LS2 9JT, UK.,Leeds Institute of Data Analytics, University of Leeds, Leeds, LS2 9JT, UK
| | - Richard Wagland
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Eila Watson
- Faculty Health and Life Sciences, Oxford Brookes University, Oxford, OX3 0BP, UK
| | - Adam Glaser
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, LS2 9JT, UK.,Leeds Institute of Data Analytics, University of Leeds, Leeds, LS2 9JT, UK
| | - Anna Gavin
- Northern Ireland Cancer Registry, Mulhouse Building, Queen's University Belfast, Mulhouse Rd., Belfast, BT12 6DP, Northern Ireland
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Donnelly DW, Donnelly C, Kearney T, Weller D, Sharp L, Downing A, Wilding S, Wright P, Kind P, Catto JWF, Cross WR, Mason MD, McCaughan E, Wagland R, Watson E, Mottram R, Allen M, Butcher H, Hounsome L, Selby P, Huws D, Brewster DH, McNair E, Rivas C, Nayoan J, Horton M, Matheson L, Glaser AW, Gavin A. Urinary, bowel and sexual health in older men from Northern Ireland. BJU Int 2018; 122:845-857. [PMID: 29489050 PMCID: PMC6220963 DOI: 10.1111/bju.14182] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Objectives To provide data on the prevalence of urinary, bowel and sexual dysfunction in Northern Ireland (NI), to act as a baseline for studies of prostate cancer outcomes and to aid service provision within the general population. Subjects and Methods A cross‐sectional postal survey of 10 000 men aged ≥40 years in NI was conducted and age‐matched to the distribution of men living with prostate cancer. The EuroQoL five Dimensions five Levels (EQ‐5D‐5L) and 26‐item Expanded Prostate Cancer Composite (EPIC‐26) instruments were used to enable comparisons with prostate cancer outcome studies. Whilst representative of the prostate cancer survivor population, the age‐distribution of the sample differs from the general population, thus data were generalised to the NI population by excluding those aged 40–59 years and applying survey weights. Results are presented as proportions reporting problems along with mean composite scores, with differences by respondent characteristics assessed using chi‐squared tests, analysis of variance, and multivariable log‐linear regression. Results Amongst men aged ≥60 years, 32.8% reported sexual dysfunction, 9.3% urinary dysfunction, and 6.5% bowel dysfunction. In all, 38.1% reported at least one problem and 2.1% all three. Worse outcome was associated with increasing number of long‐term conditions, low physical activity, and higher body mass index (BMI). Urinary incontinence, urinary irritation/obstruction, and sexual dysfunction increased with age; whilst urinary incontinence, bowel, and sexual dysfunction were more common among the unemployed. Conclusion These data provide an insight into sensitive issues seldom reported by elderly men, which result in poor general health, but could be addressed given adequate service provision. The relationship between these problems, raised BMI and low physical activity offers the prospect of additional health gain by addressing public health issues such as obesity. The results provide essential contemporary population data against which outcomes for those living with prostate cancer can be compared. They will facilitate greater understanding of the true impact of specific treatments such as surgical interventions, pelvic radiation or androgen‐deprivation therapy.
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Affiliation(s)
- David W Donnelly
- Northern Ireland Cancer Registry, Centre for Public Health, Queen's University Belfast, Belfast, UK
| | | | - Therese Kearney
- Northern Ireland Cancer Registry, Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - David Weller
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Linda Sharp
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Amy Downing
- Leeds Institute of Cancer and Pathology/Leeds Institute of Data Analytics, University of Leeds, Leeds, UK
| | - Sarah Wilding
- Leeds Institute of Cancer and Pathology/Leeds Institute of Data Analytics, University of Leeds, Leeds, UK
| | - Penny Wright
- Leeds Institute of Cancer and Pathology/Leeds Institute of Data Analytics, University of Leeds, Leeds, UK
| | - Paul Kind
- Institute of Health Sciences, University of Leeds, Leeds, UK
| | - James W F Catto
- Academic Urology Unit, University of Sheffield, Sheffield, UK
| | - William R Cross
- Department of Urology, St James's University Hospital, Leeds, UK
| | - Malcolm D Mason
- Division of Cancer and Genetics, School of Medicine, Velindre Hospital, Cardiff University, Cardiff, UK
| | - Eilis McCaughan
- Institute of Nursing and Health Research, Ulster University, Coleraine, UK
| | - Richard Wagland
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Eila Watson
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Rebecca Mottram
- Leeds Institute of Cancer and Pathology/Leeds Institute of Data Analytics, University of Leeds, Leeds, UK
| | - Majorie Allen
- Leeds Institute of Cancer and Pathology/Leeds Institute of Data Analytics, University of Leeds, Leeds, UK
| | - Hugh Butcher
- Yorkshire Cancer Patient Forum, c/o Strategic Clinical Network and Senate, Yorkshire and The Humber, Harrogate, UK
| | - Luke Hounsome
- National Cancer Registration and Analysis Service, Public Health England, Bristol, UK
| | - Peter Selby
- Leeds Institute of Cancer and Pathology/Leeds Institute of Data Analytics, University of Leeds, Leeds, UK
| | - Dyfed Huws
- Welsh Cancer Intelligence and Surveillance Unit, Cardiff, UK
| | - David H Brewster
- Information Services Division, NHS National Services Scotland, Edinburgh, UK
| | - Emma McNair
- Information Services Division, NHS National Services Scotland, Edinburgh, UK
| | - Carol Rivas
- Department of Social Science, UCL Institute of Education, University College London, London, UK
| | - Johana Nayoan
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Mike Horton
- Psychometric Laboratory for Health Sciences, Academic Department of Rehabilitation Medicine, University of Leeds, Leeds, UK
| | - Lauren Matheson
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Adam W Glaser
- Leeds Institute of Cancer and Pathology/Leeds Institute of Data Analytics, University of Leeds, Leeds, UK
| | - Anna Gavin
- Northern Ireland Cancer Registry, Centre for Public Health, Queen's University Belfast, Belfast, UK
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Glaser A, Downing A, Wright P, Hounsome L, Kind P, Selby PJ, Wilding S, Donnelly D, Butcher H, Watson E, Richard W, Catto J, Cross W, Mason MD, Sharp L, Velikova G, Mottram R, Allen M, Kearney T, Anna G. Life after prostate cancer diagnosis: One step beyond. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.6_suppl.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
40 Background: Prostate cancer (PCa) outcome studies are frequently restricted to specific disease stage or treatments. Interpretation may be restricted through lack of population control data & selection bias. We report a whole population evaluation of health-related quality of life (HRQL) following diagnosis of PCa compared to a general population (GenPop) cohort. Methods: Cross-sectional postal survey of all men diagnosed with PCa in the UK 18-42 months earlier. Measures of generic HRQL (EQ-5D) and PCa specific outcomes (EPIC-26 & interventions for erectile dysfunction), as defined in ICHOM minimum dataset, were utilized. Comparable GenPop data was collected from men never diagnosed with PCa in Northern Ireland. Results: 35,823 PCa survivors responded (60.8% response rate), median age 71, and 2,995 from the GenPop (30%). Overall HRQL was slightly lower in the PCa men than the GenPop, this difference was significant only in stage 4 disease. Men with PCa were less likely to report problems in individual EQ5D domains than men in the GenPop (62.0% vs. 68.8%). Both populations were most likely to report pain/discomfort, this was lower in PCa men than the GenPop (42.1% vs. 60.8%). Problems increased with age in all domains, with the exception of anxiety/depression. Men generally reported good function on EPIC-26; however PCa survivors reported poorer sexual function (78.9% vs 48%) except in the oldest. Medications/devices/services to aid or improve erections were offered to 45.4%, 26.0% & 16.9% respectively (and considered helpful by 14.7%, 7.5% & 3.2%). Men with PCa reported more problems with urinary leakage (13.1% vs. 7.1%), particularly after surgery. Hormonal symptoms were linked with receiving Androgen Deprivation Therapy and, to a lesser extent, external beam radiation. Conclusions: 18-42 months following diagnosis of PCa significant sexual and urinary morbidity is experienced relative to the GenPop. Specialist support for sexual dysfunction is not always offered. With the exception of men with stage 4 disease, overall HRQL is only mildly reduced. Funding The Life After Prostate Cancer Diagnosis study was funded by the Movember Foundation, in partnership with Prostate Cancer UK, as part of the Prostate Cancer Outcomes programme, grant number BO26/MO.
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Affiliation(s)
| | | | | | | | - Paul Kind
- University of Leeds, Leeds, United Kingdom
| | | | | | | | | | - Eila Watson
- Oxford Brookes University, Oxford, United Kingdom
| | | | - James Catto
- University of Sheffield, Sheffield, United Kingdom
| | - William Cross
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | | | - Linda Sharp
- Newcastle University, Newcastle, United Kingdom
| | - Galina Velikova
- Leeds Institute of Cancer and Pathology/ St James's Institute of Oncology, Leeds, United Kingdom
| | | | | | | | - Gavin Anna
- Queen's University, Belfast, United Kingdom
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Wilding S, Conner M, Sandberg T, Prestwich A, Lawton R, Wood C, Miles E, Godin G, Sheeran P. The question-behaviour effect: A theoretical and methodological review and meta-analysis. European Review of Social Psychology 2016. [DOI: 10.1080/10463283.2016.1245940] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Sarah Wilding
- School of Psychology, University of Leeds, Leeds, UK
| | - Mark Conner
- School of Psychology, University of Leeds, Leeds, UK
| | | | | | | | - Chantelle Wood
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Eleanor Miles
- School of Psychology, University of Sussex, Brighton, UK
| | - Gaston Godin
- Canada Research Chair on Behavior and Health, Laval University, Ville de Quebec City, Canada
| | - Paschal Sheeran
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Dearinger AT, Ingram RC, Pendley RP, Wilding S. Diabetes education: quality improvement interventions through health departments. Am J Prev Med 2013; 45:782-6. [PMID: 24237923 PMCID: PMC4418498 DOI: 10.1016/j.amepre.2013.08.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 07/24/2013] [Accepted: 08/13/2013] [Indexed: 01/08/2023]
Abstract
BACKGROUND As the burden of diabetes continues to overwhelm the public health system, there is increased demand on local health departments (LHDs) to improve public health services. Quality improvement (QI) techniques have been shown to be an effective means to improve the delivery of services by LHDs. PURPOSE To evaluate the extent to which the adoption of organizational QI strategies influences the delivery and outreach of diabetes self-management education (DSME) services provided by LHDs. METHODS A change facilitation model that included QI team development and on-site QI training and facilitation was delivered to six LHDs that provide DSME, during 2010-2011. After training, each LHD developed and implemented a QI project to improve the outreach and delivery of DSME services. Pre- and post-intervention surveys were administered to evaluate the extent of change in DSME outreach and delivery. Data were analyzed in 2011. RESULTS The number of individuals who completed an entire course of DSME increased by >100%, and 14% more diabetics attended DSME on a monthly basis. Half of LHDs reported receiving increased numbers of referrals per month, and 15% more healthcare providers referred diabetic patients to the LHD for DSME. CONCLUSIONS Participation in Community Outreach and Change for Diabetes Management (COACH 4DM) led to improvements in the LHD QI infrastructure, and in the outreach and delivery of services to diabetic patients. The techniques used during COACH 4DM are applicable to a wide variety of contexts and may be an effective tool to improve the delivery of other clinical and community preventive services.
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Affiliation(s)
- Angela T Dearinger
- Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, Kentucky.
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