bluuebunny/crossref_metadata_2025 huggingface dataset:
The influence of perceived control over causes and responses to health threats: A vignette study
Authors: Senior Victoria , Weinman John , Marteau Theresa M.
Published: February 2003

Objectives: To test the hypothesis that a disease caused by controllable, compared with uncontrollable, factors is more likely to result in negative emotions and less likelihood of disclosure to significant others.

Design and methods: A between‐participants design in which students (N=108) imagined they had just been diagnosed with either HIV or hypertension and where the cause for each was described as either controllable or uncontrollable. Anticipated emotional and behavioural responses by self and others were assessed by questionnaire.

Results: When the vignette represented a more controllable cause, participants thought they would have more negative feelings and that they would be less likely to disclose information about the disease to their family oran acquaintance than when the vignette represented a less controllable cause. The type of disease, but not the cause, influenced anticipated responses by others.

Conclusions: Although greater perceived control over future outcomes is often psychologically adaptive, these findings suggest that the perception that the onset of a disease was controllable may be maladaptive, resulting in more negative feelings and a greater reluctance to disclose the diagnosis to others. In the light of the increasing use of medical technologies aimed at primary prevention of disease, together with a cultural shift toward individual responsibility for health, there is a need for greater understanding of how the perceived controllability of the cause of a disease affects subsequent adjustment.
Living with vitiligo: Dealing with difference
Authors: Thompson Andrew R. , Kent Gerry , Smith Jonathan A.
Published: February 2003

Objectives: Individuals with a disfigurement are at risk of experiencing psychological distress, but the level of this distress is only marginally associated with clinical severity. This study examinesthe experience of living with the skin condition vitiligo with a view towards understanding its impact and the ways in which participants deal with this chronic and disfiguring disease.

Design: The qualitative method Interpretative Phenomenological Analysis was used.

Methods: In a semi‐structured interview, seven white female vitiligo sufferers were asked to describe their experiences from the time the vitiligo first became apparent to the time of the interview. They were encouraged to elaborate on their own reactions and how they dealt with the reactions of others.

Results: Initially, participants felt overwhelmed by their illness but over time they developed several strategies in order to ‘contain’ their difference in appearance within manageable limits. The behavioural strategies of avoidance and concealment had several disadvantages, whereas cognitive strategies were less problematic but difficult to sustain consistently. Social support served to facilitate the development of coping methods associated with acceptance of difference. However, maintaining this acceptance was a struggle and the process fragile.

Conclusions: Living with vitiligo was a continuous struggle. The results are consistent with Leventhal's (1970) notion that coping is a problem‐solving process and with Moos and Schaefer's (1984) contention that dealing with a chronic disease involves the development of a variety of strategies in order to regain equilibrium. Further research is needed to examine whether the experiences described here are common to other disfiguring conditions.
Do health promotion messages target cognitive and behavioural correlates of condom use? A content analysis of safer sex promotion leaflets in two countries
Authors: Abraham Charles , Krahé Barbara , Dominic Robert , Fritsche Immo
Published: February 2003

Objective: To categorize and quantify the content of publicly available safer sex promotion leaflets in the UK and Germany and to assess the extent to which this content corresponds to the cognitiveand behavioural correlates of condom use identified by theory‐based research.

Methods: A content analysis using a 45 category coding manual was undertaken. The manual included 20‘correlate‐representative’ categories identifying text promoting the strongest cognitive and behavioural correlates of condom use.

Results: Overall inter‐coder reliability was high. Few content differences were observed between the German and UK samples. Leaflets from both countries highlighted information on how people become infected with HIV and advice to contact health care professionals. Few mentioned delaying or abstaining from sexual intercourse. Only 25% of leaflets included text that referred to more than 10 of the 20 correlate‐representative categories. Moreover, using one standard deviation above the meanas an indication of frequent inclusion, two‐thirds of leafets failed to target frequently more than two of the 20 correlate‐representative categories.

Conclusions: Some safer sex promotion leaflets frequently promote the strongest cognitive and behavioural correlates of condom use. In general, however, the recommendations of researchers investigating psychological correlates of condom use have not shaped the content of safer sex promotion leaflets.
The effect of pre‐operative psychological interventions on post‐operative outcomes in Chinese women having an elective hysterectomy
Authors: Callaghan Patrick , Li Ho Cheung
Published: February 2003

Objective: To test the effect of cognitive interventions with information given pre‐operatively on post‐operative outcomes in Chinese women undergoing elective hysterectomies.

Design: An experimental design. The experimental group (n=48) received cognitive distraction and cognitive reappraisal with information, the control group (n=48) received information only.

Outcome measures: Post‐operative anxiety (Chinese State‐Trait Anxiety Inventory and mean arterial blood pressure), post‐operative requests for analgesia (drug record), post‐operative pain (visual analogue scale) and satisfaction (Chinese Patient Satisfaction Questionnaire).

Results: Cognitive distraction and reappraisal with information produced lower post‐operative anxiety and pain scores and higher levels of satisfaction than information only. Post‐operative analgesic requests did not differ between groups.

Conclusions: Cognitive distraction and reappraisal with information, when used with women undergoing a hysterectomy may have significant clinical benefits.
Illness representation, coping and outcome in irritable bowel syndrome (IBS)
Authors: Rutter Claire L. , Rutter Derek R.
Published: February 2003

Objective: Irritable bowel syndrome has no observable symptom markers and there is little that the medical profession can do to help sufferers. Psychotherapy, antidepressants and drugs aimed at the most problematic symptoms have been shown to have limited efficacy. Inan attempt to help understand the illness better, and to suggest alternative forms of intervention, the study tested whether outcome might be influenced by patients' representation of their illness and by their coping strategies.

Method: All members of the IBS Network (an independent charitable support network based in the UK) were invited to participate via their quarterly newsletter, and 209 completed questionnaires were returned. Participants completed the Illness Perception Questionnaire (IPQ), the COPE, and the Hospital Anxiety and Depression Scale (HADS), and rated their quality of life and their satisfaction with their health.

Results: The reporting of serious consequences was associated with lower quality of life and lower satisfaction with health, and with higher scores for anxiety and depression (p < .001). Weaker control beliefs were related to lower quality of life, lower satisfaction with health, and higher depression scores (p < .01). Lower illness scores were associated with more satisfaction with health (p < .01), but not with quality of life (p > .05). Psychological causal attribution of IBS was positively correlated with anxiety (p < .001) and depression (p < .01). Path analyses based on multiple linear regression demonstrated that (1) the reporting of serious consequences was a strong independent predictor of outcome; (2) coping mediated the link between representation and outcome; and (3) when predicting depression, coping strategies predicted coping independently of representation dimensions.

Conclusions: The findings indicate that the illness representations of IBS sufferers can have significant implications for outcome. Therapeutic interventions based on illness representations may prove useful for treatment.
The Transplant Effects Questionnaire (TxEQ): The development of a questionnaire for assessing the multidimensional outcome of organ transplantation — example of end stage renal disease (ESRD)
Authors: Ziegelmann J. P. , Griva K. , Hankins M. , Harrison M. , Davenport A. , Thompson D. , Newman S. P.
Published: February 2003

Objectives: To develop a questionnaire to assess the responses of transplant recipients to the receipt of an organ, including their self‐care behaviour.

Design: Following a literature review, open‐ended interviews and a focus group, a transplant questionnaire was developed. Two studies (Study 1: N = 231, Study 2: N = 105) were conducted to evaluate its psychometric properties.

Methods: A pool of 51 items was derived from themes identified in published studies and from interviews and a focus group discussion with renal transplant recipients. These were constructed into a questionnaire and were then administered to two renal transplant out‐patients populations. Item responses of study sample 1 were subjected to principal components analysis (PCA) using varimax rotation to examine the structure of responses. In order to investigate the stability of the factor structure found in Study 1, item responses of the second sample were subjected to confirmatory factor analysis (CFA) using structural equation modelling.

Results: PCA indicated six factors that accounted for 64.2% of the variance. With extraneous items omitted, the final questionnaire derived from Study 1 has 24 items clustered around five conceptual coherent factors: worry about transplant (22.1%), guilt regarding donor (11.9%), disclosure (9.58%), medication adherence (8.73%), and responsibility (6.63%). CFA on the final 24‐item version of the TxEQ revealed that the resulting model was a good fit for the Study 2 data (RMSEA = 0.08, pclose = .005).

Conclusions: The TxEQ has potential application as a measure in the area of transplantation research. CFA demonstrated that the factor structure of the TxEQ is consistent across different renal transplant out‐patients populations. Further research is currently in progress to assess other groups of transplant recipients and to examine its relationship to other measures.
Optimism and adaptation to chronic disease: The role of optimism in relation to self‐care options of type 1 diabetes mellitus, rheumatoid arthritis and multiple sclerosis
Authors: Fournier Marijda , de Ridder Denise , Bensing Jozien
Published: February 2003

Objectives: To determine the role of optimistic beliefs in adaptation processes of three chronic diseases different in controllability by self‐care. It was expected that optimism towards the future would relate to adaptation independently of the controllability of disease. Optimism regarding one's coping ability should be beneficial in controllable diseases. Unrealistic optimism was expected to be beneficial in uncontrollable disease.

Design: The cross‐sectional design involved 104 patients with type 1 diabetes, 95 patients with rheumatoid arthritis and 98 patients with multiple sclerosis, recruited via their physician at the out‐patient department of five hospitals.

Method: Confirmatory Factor Analysis (LISREL) was employed to confirm a three‐dimensional approach of optimism: outcome expectancies, efficacy expectancies and unrealistic thinking. Multi‐sample analysis by path modelling was used to examine whether the relationship of the three optimistic beliefs with coping (CISS‐21), depression and anxiety (HADS), and physical functioning (SF‐36) differs with the controllability based on the self‐care options of chronic disease.

Results: These show that when chronic disease must be controlled by self‐care, physical health depends more strongly on positive efficacy expectancies. In contrast, when self‐care options for controlling chronic disease are limited, physical health depends more strongly on positive unrealistic thinking and relates negatively to positive efficacy expectancies. The impact of the three optimistic beliefs on mental health is independent of the controllability by self‐care.

Conclusion: Optimistic beliefs are differently beneficial for physical health dependent on the controllability of chronic disease. Unrealistic beliefs are helpful when patients are confronted with moderately to largely uncontrollable disease where self‐care options are limited, in contrast to positive efficacy expectancies that are helpful when patients deal with largely controllable disease where self‐care is required.
Cholesterol control, medication adherence and illness cognition
Authors: Brewer Noel T. , Chapman Gretchen B. , Brownlee Susan , Leventhal Elaine A.
Published: February 2003

Objective: To examine the relation between illness cognitions and two measures of adherence in patients with hypercholesterolaemia, a disease marked by chronically high cholesterol.

Design: Cross‐sectional. Based on the self‐regulation model (Leventhal, Diefenbach, & Leventhal, 1992), patients' illness cognitions were predicted to be related to cholesterol control and medication adherence. Patients with illness cognitions consonant with an experts' mental model of hypercholesterolaemia were expected to show better control and adherence.

Method: Hypercholesterolaemic patients (N= 169) were recruited at a university‐based general medicine clinic. Patients completed a survey that assessed beliefs about hypercholesterolaemia and medication‐taking behaviour. Cholesterol levels were obtained from patients' medical charts.

Results: Low‐density lipoprotein (LDL) cholesterol control was related to believing that hypercholesterolaemia is a stable, asymptomatic disease with severe coronary consequences, and self‐report of medication adherence was related to believing that the disease has severe coronary consequences (ps < .05). LDL cholesterol differences between groups low and high in various illness beliefs ranged between 0.04 and 0.24 mmol/l (2 and 9 mg/dl) which translated to between 1% and 18% lower LDL cholesterol levels.

Conclusion: The present study shows several relations that have not been previously demonstrated between better LDL cholesterol control and illness cognition, cognitions that were similar to an expert or physician's mental model of hypercholesterolaemia. The magnitude of differences in patient cholesterol levels was small but may be clinically important.
Living with Huntington's disease: Illness perceptions, coping mechanisms, and patients' well‐being
Authors: Helder Desirée I. , Kaptein Ad A. , Van Kempen Godfried M. J. , Weinman John , Van Houwelingen Hans C. , Roos Raymund A. C.
Published: February 2003

Objectives: To describe the illness perceptions and coping mechanisms of patients with Huntington's disease (HD), and to assess their role in the well‐being of these individuals.

Design: A single group, cross‐sectional study.

Methods: In 77 individuals with a clinically confirmed diagnosis of HD, illness perceptions, coping mechanisms, motor and cognitive performance, and well‐being were assessed by means of questionnaire‐guided interviews, and subjected to correlational analyses, t‐tests and two‐stage regression analyses.

Results: HD patients' illness perceptions were characterized by a strong illness identity, combined with beliefs about a long duration of HD, perceived negative consequences for their daily lives, and little hope for cure or improvement of their symptoms. In turn, the coping strategies that HD patients reported adopting to deal with their disease were comparable with those adopted by reference individuals dealing with everyday life stressful situations.Where the well‐being of HD patients is concerned, compared with Dutch community sample, HD patients scored significantly lower on measures of physical well‐being and general health. Both illness perceptions and coping mechanisms were significant predictors of patients' well‐being.

Conclusions: More systematic research within a health psychology framework is justified in order to assess the role of illness perceptions and coping mechanisms in the well‐being of HD patients.
The structure of beliefs about the causes of heart attacks: A network analysis
Authors: French David P. , Marteau Theresa M. , Senior Victoria , Weinman John
Published: February 2003

Objectives: To explore the structure of causal beliefs about heart attack, using network analysis, in particular to determine whether there is a consensual representation and, if so, which putative causes of heart attacks were perceived as being proximal or distal causes and which were perceived to mediate the effects of other causes.

Methods: A total of 107 adult respondents completed questionnaires, indicating the extent to which they perceived each of eight agents as causes of a heart attack, as well as whether they perceived that each of these eight causal agents, in turn, causally affects each of the other seven causal agents.

Results: A consensual representation was produced, indicating how these eight agents were perceived as causally relating to each other, and to heart attack. Three key features were evident. First, the type of work a person does was perceived to be a distal cause of heart attack, operating mainly through stress and high blood pressure. Second, the causal impact of stress on heart attack was not seen as mediated by behaviour, but mediated via blood pressure. Third, the causal impact of genes on heart attack was perceived as unmediated by behaviour or physiological processes.

Conclusions: The general public appears to share a reasonably complex view of how different agents lead to heart attack. This complexity would not be elicited by standard methods, suggesting that the network analysis method may be usefully employed as either a process or an outcome measure in health‐promotion research.
Failing in spousal caregiving: The ‘identity‐relevant stress’ hypothesis to explain sex differences in caregiver distress
Authors: Hagedoorn Mariët , Sanderman Robbert , Buunk Bram P. , Wobbes Theo
Published: February 2003

Objectives: This study examined a possible explanation for the frequently reported finding that female caregivers perceive more psychological distress than do male caregivers. Our ‘identity‐relevant stress’ hypothesis asserts that feelings of incompetence with respect to caregiving are more strongly associated with psychological distress in women than in men. Women who feel competent with respect to caregiving may report levels of distress as low as that of male caregivers.

Design: This study has a cross‐sectional design.

Methods: Psychological distress (CES‐D) was measured in 32 female and 36 male partners of patients suffering from various types of cancer. Furthermore, partners' perceptions of caregiving performance and patients' perceptions of partners' supportive and unsupportive behaviour were assessed.

Results: Only among female partners were self‐efficacy and personal accomplishment regarding caregiving found to be positively linked to distress. Also, in contrast to male partners, female partners reported more distress when they acted less supportively.

Conclusion: The difference in psychological distress between female and male caregivers seems to be carried by a subgroup of partners who feel that they are not doing a very good job at caregiving.
Judgments of the rule‐related behaviour of health care professionals: An experimental study
Authors: Lawton Rebecca , Parker Dianne
Published: February 2003

Objectives: To explore the judgments of rule‐related behaviour by health care professionals and the general public in the UK, against a background in which clinical guidelines and protocols are proliferating.

Design: A questionnaire survey was used in which short scenarios describing medical practice were presented to a sample of health care professionals and members of the general public.

Methods: The health care sample consisted of 315 nurses, doctors and midwives from three English National Health Service (NHS) Trusts who volunteered to take part in the study. A stratified sample of members of the general public (N = 350) was recruited via a market research organizatiofn. Three types of behaviour (compliance with a protocol, violation of a protocol, and improvization, where no protocol exists) and three types of outcome for the patient (good, bad, poor) were manipulated within nine scenarios. Respondents were asked to make judgments about (1) the inappropriateness of behaviour (2) likelihood that they would take further action and (3) responsibility for the outcome.

Results: Findings suggest that the process of care has a greater effect on judgments of the behaviour of health care professionals than does the outcome of that behaviour. This was equally true of the professional and public samples.

Conclusions: The study has both theoretical and practical implications. First, information about a behaviour's relationship to existing rules has a stronger influence than the consequence of the behaviour on attributions of responsibility. Secondly, using clinical protocols as a way of managing risk in the NHS may be counterproductive unless full compliance is achieved.
Applying the Transtheoretical Model of Change to exercise in young Chinese people
Authors: Callaghan Patrick , Eves Frank F. , Norman Paul , Chang Anne M. , Lung Cheung Yuk
Published: February 2003

Objectives: The objective of the present study was to test the application of the Transtheoretical Model of Change (TTM) in relation to exercise behaviour of 298 Hong Kong Chinese undergraduates.

Design and methods: A cross‐sectional design was used. Respondents completed measures of stages of change, self‐efficacy, processes of change, decisional balance, exercise and demographic data.

Results: Significant effects for stage of change were found for self‐efficacy, pros, exercise and nine of the 10 processes of change. In general, scores on these variables were found to increase across the stages although post hoc tests revealed slightly different patterns of significant differences. Cons were not found to differ significantly across stages of change. The relationship between self‐efficacy and processes of change was dependent on stage of change.

Conclusions: The results support some of the assumptions of the TTM but raise questions about the predicted relationships between stages of change and processes of change and between self‐efficacy and processes of change at each stage of change. The practical implications of the findings for the development of interventions to improve young people's exercise levels are discussed.
The influence of autonomous and controlling motives on physical activity intentions within the Theory of Planned Behaviour
Authors: Hagger Martin S. , Chatzisarantis Nikos L. D. , Biddle Stuart J. H.
Published: February 2003

Objectives: This study aimed to examine how general motives from self‐determination theory (SDT; Deci & Ryan, 1985) influence intentions to engage in physical activity within the Theory of Planned Behaviour (TPB; Ajzen, 1985). It was hypothesized that the general motives will influence intentions only when mediated by the specific cognitions of attitude, subjective norms and perceived behavioural control (PBC) from the TPB.

Design: A cross‐sectional study assessing psychological variables from two theoretical perspectives.

Method: Self‐report questionnaires were administered to 1088 children aged 12‐14 years. The children's intentions, attitudes, subjective norms and PBC towards participating in physical activity were assessed using a TPB questionnaire. A modified verson of Ryan and Connell's (1989) perceived locus of causality (PLOC) inventory was used to measure controlling and autonomous motives for participating in physical activity.

Results: These data were analysed using structural equation modelling. The resulting well‐fitting model demonstrated that attitude and PBC mediated the influence of autonomous motives to perform physical activity on physical activity intentions. The presence of autonomous motives resulted in the effects of the controlling motives being attenuated to zero.

Conclusions: The present results indicate that general autonomous motives to participate in physical activity act as sources of information when childen make their judgments regarding their specific attitudes and PBC. Attitudes and PBC are necessary to translate these general motives from SDT into intentions in the TPB. In terms of targets for intervention, practitioners may positively influence intentions by providing a choice of physical activities to foster increased autonomy in children.
Can the Theory of Planned Behaviour mediate the effects of age, gender and multidimensional health locus of control?
Authors: Armitage Christopher J. , Norman Paul , Conner Mark
Published: February 2003

Objectives: The present paper reports two studies designed to test the ability of the theory of planned behaviour (TPB) to mediate the effects of age, gender and multidimensional health locus of control (MHLC) on behavioural intentions and behaviour.

Design: Two studies are reported. Study 1 (N = 124) employed a cross‐sectional design and examined three self‐reported health‐related behaviours: safe sex (condom use), binge drinking and drink‐driving. Study 2 (N = 201) employed a prospective design and examined actual attendance at health screening.

Methods: Respondents completed questionnaires containing measures of MHLC and TPB. The data were analysed using a combination of bivariate correlations and hierarchical multiple regression.

Results: Study 1 showed that the TPB was a superior predictor of health‐related behavioural intentions than both demographic variables and MHLC. Study 2 corroborated the findings of Study 1, and showed that TPB variables were useful predictors of actual behaviour, although the TPB failed to fully mediate the effects of gender on screening attendance.

Conclusions: Whilst the TPB accounted for significant proportions of the variance in health‐related behavioural intentions and behaviour, it failed to completely mediate the effects of demographic variables. Future work is required to identify social cognitive variables that will fully mediate the effects of demographics.
Individually elicited versus modal normative beliefs in predicting attendance at breast screening: Examining the role of belief salience in the Theory of Planned Behaviour
Authors: Steadman Liz , Rutter D. R. , Field S.
Published: February 2003

Objective: To examine the influence of an individually derived versus modal subjective norm component of the Theory of Planned Behaviour (TPB) in predicting attendance at breast screening.

Design: A prospective, longitudinal design was employed using a postal questionnaire at Time 1 and objective attendance data from screening records at Time 2.

Method: Questionnaires were sent to 1000 women from East Kent due to be invited for X‐ray mammography under the UK's National Health Service Breast Screening Programme. The TPB constructs were used to predict attendance, with a focus on subjective norm. Two versions of the questionnaire were distributed: one assessed subjective norm using individually generated normative beliefs (individual condition) and the other provided a list of modal referents (modal condition).

Results: The mean number of normative referents in the individual condition was just two, almost all of whom were family members, in contrast to the modal condition where ‘GP’ led the rank table. The results suggest that a more senstive measure of subjective norm is attained using individually derived beliefs. Structural equation modelling revealed that, contrary to theoretical prediction, the effect on attendance of the individually derived subjective norm was not entirely mediated by intention: an independent contribution to attendance was shown. In the modal condition the construct was entirely mediated by intention.

Conclusions: For health behaviours that have implications for others as well as self, measuring individually salient normative beliefs may both improve theoretical prediction and yield information of potential value for designing intervention programmes.
Sickle cell disease: Pain, coping and quality of life in a study of adults in the UK
Authors: Anie Kofi A. , Steptoe Andrew , Bevan David H.
Published: February 2003

Objective: To examine the relationship between pain, coping, and quality of life in adult patients with sickle cell disease (SCD) in the UK, and to assess the influence of these factors on the utilization of health services.

Design: This cross‐sectional study involved 96 adult patients with SCD attending hospitals in London.

Method: Interview and questionnaire study involving standard measures of pain, health service utilization, coping responses (measured with the Coping Strategies Questionnaire — revised for SCD), and quality of life (measured by the SF36). Data concerning clinical history, complications and haemoglobin levels were also collected.

Results: The number and duration of painful sickle cell episodes in the past 12 months varied widely between patients. We found that 49.5% of accident and emergency visits and 45% of hospitalizations were of 10.4% (10) patients. Pain experience accounted for 12.3% of hospital and general practice service use, independently of age, sex, number of SCD complications and haemoglobin levels. Three higher order factors emerged from analysis of the coping strategies questionnaire, reflecting active behavioural and cognitive coping, affecting coping, and passive adherence (e.g. resting, taking fluids). Active coping was positively associated with the number of pain episodes, while passive adherence coping was related to pain intensity. Psychological coping was unrelated to health service utilization. Marked impairment onmany dimensions of quality of life was apparent in the analyses of the SF36. Affective coping was associated with impaired quality of life independently of demographic and clinical variables.

Conclusions: It is evident that sickle cell disease involves not only severe recurrent pain, but also other impairments in health‐related quality of life. Psychological coping patterns are relevant both to the experience of pain, and to broader adjustment. Patients may benefit from interventions that enhance the use of appropriate pain coping techniques and other strategies to improve quality of life.
The psychosocial experience of people with sickle cell disease and its impact on quality of life: Qualitative findings from focus groups
Authors: Thomas V. J. , Taylor L. M.
Published: February 2003

Objectives: In this exploratory study, an in‐depth analysis of accounts of the experiences of people with sickle cell disease (SCD) was undertaken to gain an understanding of the psychosocial impact of the disease. An additional aim of the study was to determine whether these experiences could be conceptualized in terms of quality of life as defined by the World Health Organization (WHOQOL) with the intention of informing psychosocial research.

Design: This study utilized a series of non‐directive, patient‐led, focus groups that specifically addressed the ways in which sickle cell disease impacts on life. Participants were recruited from four centres in London and eight focus group discussions (each one hourin length) were held separately for each centre.

Method: Altogether 32 hours of focus group materials were tape‐recorded and transcribed verbatim. Data were analysed using a phenomenological approach to identify emerging themes.

Results: Six themes were identified: Growing up with SCD; Education; Impact of the unremitting nature of the disease; Employment; Effects on relationships; and Hospitalization.

Conclusion: This research has clearly shown that SCD carries a huge psychosocial burden impacting on physical, psychological, social and occupational well‐being as well as levels of independence and environment. These aspects of life are equivalent to the core domains of the multi‐dimensional WHOQOL and consequently we have argued that SCD undermines quality of life in important ways. The paper provides a rich source of qualitative data to complement quantitative findings and provides detailof the complex human processes and experiences consequent on a life‐long chronic illness such as SCD.
Appraisal and psychological distress six months after diagnosis of breast cancer
Authors: Gallagher Jill , Parle Michael , Cairns David
Published: February 2003

Objectives: Four in ten women with breast cancer experience high levels of anxiety or depression, despite advances in oncology treatments. The study investigates the role of psychosocial, disease and treatment characteristics, and appraisal processes to better understand factors contributing to this high psychological morbidity.

Design: A postal survey was employed to observe psychological morbidity in women 2 and 6 months after initial diagnosis and treatment of breast cancer. The study was conducted as an adjunct to an Australian multi‐centre feasibility study of an evidence‐based specialist breast nurse (SBN) model of care.

Methods: In total, 195 women with a new diagnosis of early or locally advanced breast cancer completed the data collection relating to this study. Psychosocial, disease and treatment information for each woman at diagnosis was recorded in research logs. Women completed the GHQ‐12 questionnaire 2 months after diagnosis, and at 6 months they completed the GHQ‐12 and an appraisal process questionnaire designed by the National Breast Cancer Centre (NBCC). Bivariate and multiple regression analyses were undertaken to build a statistical model to account for GHQ‐12 scores at 6 months.

Results: According to the GHQ‐12, 43% of women had a likely affective disorder at either 2 or 6 months after diagnosis. Point prevalence decreased from 2 to 6 months yet remained substantial compared with general population statistics. Psychological functioning in women with breast cancer is related to a woman's psychiatric history, grade of tumour, and her appraisal processes. Most importantly, improvedpsychological functioning from 2 to 6 months after diagnosis is related to a woman having a lower primary appraisal of threat and a greatersecondary appraisal of self‐efficacy in terms of having confidence in her own ability to cope with concerns associated with the illness.

Conclusion: Appraisal processes play a significant role in psychological adjustment to breast cancer. Adjustment may be facilitated by ensuring that the treatment team responds to shortfalls in a woman's appraisal of her illness and her perceived ability to cope, especially where a difficult prognosis is evident.
Adverse life‐events and risk of breast cancer: A meta‐analysis
Authors: Petticrew Mark , Fraser Jeannine M. , Regan Martin F.
Published: February 2003

Objective. Studies examining the relationship between adverse life events and breast cancer have produced conflicting results. A systematic review of the published studies was therefore carried out. Methods. Electronic databases and bibliographies of review articles were searched for studies in any language. Studies were assessed for methodological quality by two reviewers. Results. Twenty‐nine studies were found. These were of variable quality. Random effects meta‐analysis of the higher quality studies found no significant relationship between breast cancer and either bereavement (summary odds ratio(OR)=0. 9;95% confidence interval (CI) 0. 57 to 1. 45) or other adverse life‐events (summary OR=0. 8; 95% CI 0. 61 to 1. 06). Funnel plots may be suggestive of publication bias, with small studies reporting negative findings less likely to be published. Conclusions. Good quality case‐control studies, and the single large prospective study in this area, do not support the hypothesis of a casual relationship between adverse life events and onset of breast cancer.
Factors influencing anticipated decisions about genetic testing: Experimental studies
Authors: Wroe Abigail L. , Salkovskis Paul M.
Published: February 2003

Objectives. Increasing availability of predictive testing highlights the importance of understanding the decision‐making process when people are confronted with the optionto have testing. The present study aimed to demonstrate experimentally the impact of (i) providing relatively positive versus relatively negative information, and (ii) focusing on positive or negative issues, on anticipated decisions regarding genetic testing. Method. Two experimental studies were carried out in order to investigate what influences the anticipated decision, one relating to breast cancer and the other heart disease. In each study, participants were randomly allocated to either the positive, the negative or the control group. There were two consecutive experimental manipulations. Firstly, participants were given further information on detecting and preventing the disease (positive group) and on the limitations of these methods (negative group). The control group received information about the common cold. Secondly, participants were encouraged to focus on positive (positive group) or negative (negative group) issues of predictive testing. The control group focused on statements referring to the common cold. Participants made pre‐experimental and post‐information and post‐focusing ratings including how likely they would be to opt for the test. Results. Both information and the focusing manipulations separately modified the rating of anticipated likelihood of being tested in the expected direction. There was also a significant decrease of rated anxiety in the negative group. Conclusion. It appears that anticipated decisions are strongly influenced not only by the information received by the decision maker, but also by the factors on which the decision maker focuses at the time of the decision. This second result in particular has implications for the way in which pre‐test counselling is carried out; counsellors may believe that they are being non‐directive in their questioning when they are in fact directly and systematically influencing the decision whether or not to be tested.
Patients' perceptions of the role of the general practitioner in the management of emotional problems
Authors: Bower Peter , West Robert , Tylee Andre , Hann Mark
Published: February 2003

Objectives. To investigate the nature of patients' perceptions of the role of the general practitioner in the management of emotional problems in primary care; the association between patient characteristics and perceptions; and the association between perceptions and the recognition of psychiatric morbidity by the GP. Design. Cross‐sectional correlation design. Methods. Patients attending their GPs completed the General Health Questionnaire (N = 1511) and a scale measuring perceptions of the GP's role (the Patient Perceptions Scale (PPS), N = 867). Forty‐three volunteer GPs assessed patients for psychiatric symptomatology. Self‐report and GP assessments of psychiatric status were compared to examine detection of disorder. Results. Principal component analysis of responses to the PPS indicated four dimensions. A multilevel model indicated that some of these PPS dimensions were related to patient age, sex and current levels of psychiatric symptomatology. Furthermore, in one dimension there was significant variation at the GP level (i. e. in the average PPS scores between patients consulting different GPs). The likelihood of a patient with significant psychiatric symptoms being recognized was related to the disorder's severity and to the patient's perception of the degree to which the GP was oriented to the management of emotional problems. There were no other significant associations with the perception questionnaire factors or patient demographic characteristics. Conclusions. The perceived role of the GP in the management of emotional problems varies among patients, reflecting both patient characteristics and the characteristics of their own GP. Perceptions of the orientation of the GP towards emotional issues may influence the likelihood of the recognition of disorder.
Male subfertility clinic attenders' expectations of medical consultation
Authors: Glover L. , Gannon K. , Platt Z. , Abel P. D.
Published: February 2003

Objective. To determine what patients considered important to gain from consultation, the extent to which these expectations were fulfilled and the relationship of this to patient satisfaction and distress. Congruence between patient and doctor expectations was also examined. Design. This was a questionnaire study using a repeated measures (pre‐ and postconsultation) design. Methods. Expectations of clinic attendance were assessed in 29 male clinic attenders. Participants completed questionnaires before and after consultation. Visual analogue scales were used to assess patient expectations of the consultation and the extent to which expectations were fulfilled. Results. Men rated increasing the chance of their partner conceiving as most important, with gaining information also rated highly. Informational expectations were rated more highly than discussing feelings. Following consultation, patients felt they had gained understanding and their expectations of having help with decision making were fulfilled. They rated their satisfaction with the consultation as high and distress during consultation low. Despite the fact that increasing chances of pregnancy was an important expectation, failure to fulfil this expectation did not relate to satisfaction. There was no significant correlation between doctor and patient ratings of distress. Conclusion. It appears that the medical consultation has a role beyond simply finding ways to increase the chance of pregnancy. For these men the benefits of increasing understanding seemed to outweigh the disappointment of not having pregnancy expectations increased as much as they had hoped for. Patients did not appear to be seeking emotional support from the consultation.
Identity and illness: The effects of identity salience and frame of reference on evaluation of illness and injury
Authors: Levine R. M.
Published: February 2003

Objectives. This paper describes two experiments which develop a self‐categorization theory (SCT) (Turner, Hogg, Oakes, Reicher & Wetherell, 1987) approach to the way people make sense of their symptoms. The first experiment builds upon a study by Levine & Reicher (1996) in which it is proposed that symptoms are evaluated, not against pre‐existing illness representations, but by reference to their impact on situationally salient identities. The second experiment extends the SCT perspective on symptom evaluation to argue that the identities that are instrumental in assigning meaning to symptoms are themselves situationally constructed. Design and methods. In the first experiment, 40 female secretaries, defined either in terms of a ‘secretary’ identity or in terms of a ‘gender’ identity, were asked to evaluate a number of scenarios which describe different illnesses or injuries. In the second experiment 40 men from a rugby club were asked to evaluate a number of scenarios relating to illness and injuries. The identity from which scenarios were evaluated was held constant, but the comparison groups (or frame of reference) was manipulated. Results. Overall, the results of the first study provide clear evidence that the significance ascribed to scenarios depends on which identity is salient. The results from the second study provide clear evidence that the significance ascribed by the males to the scenarios was a function of the comparison groups they believed they were being compared to. Conclusions. Taken together, these two experiments provide strong evidence for the viability of an SCT approach to symptom evaluation.
Coping style and self‐reported health promotion and disease detection behaviour
Authors: Van Zuuren Florence J. , Dooper Roeline
Published: February 2003

Objectives. In the present study we investigate the relevance of the monitoring‐blunting concept to the realm of health behaviour, and to health promotion and disease detection behaviour in particular. Design. The study is correlational in character, supplemented with some qualitative data. Methods. Sixty participants of varying sex, age and educational level filled out the Threatening Medical Situations Inventory, measuring the monitoring and blunting coping style, and the newly developed Health Promotion‐Detection Questionnaire, intended to measure the tendencies to exhibit health promotion and disease detection behaviours. In addition, they answered a few open questions concerning their health. Results. It emerged that disease detection behaviour is positively related to age, and it is more often carried out for health reasons than health promotion behaviour. The monitoring coping style is significantly, though modestly, related to both health promotion and disease detection. The latter relation still holds when we controlled for age and gender. No relations with blunting were found, except for individual health behaviours. Conclusion. The results of the present study encourage further investigation of the role of coping styles in the performance of different types of health behaviours. Hereby, the further distinction between health strivings of the approach and the avoidance type may prove useful.
The Appraisal of Life Events (ALE) scale: Reliability and validity
Authors: Ferguson Eamonn , Matthews Gerald , Cox Tom
Published: February 2003

Objectives. Monroe & Kelley (1995) have called for the urgent development of theoretically and psychometrically robust measures of primary appraisal. This paper highlights problems with existing measures and provides detail on the psychometric development of the Appraisal of Life Events (ALE) scale. Design. Five studies are reported. The first two studies examine the factor structure of the ALE scale and confounding with social desirability (Ns=260 and 344). Studies 3 and 4 examine the test‐retest reliability of the ALE scale (Ns=17 and 77). Finally, Study 5 examines the relationship between the ALE scale and the other parameters of the stress process (personality, coping and health) across two separate stressful transactions (N=268). Methods. A questionnaire methodology was used. The data were analysed using a mixture of exploratory factor analysis, confirmatory factor analysis and bivariate correlations. Results. The ALE scale demonstrated: (a) three stable factors (threat, challenge and loss), (b) no confounding with social desirability, (c) excellent internal and test‐retest reliabilities, and (d) theoretically appropriate associations with various stressors, coping behaviours, personality and health measures. Conclusions. This paper has answered Monroe & Kelley's (1995) call for the urgent development of theoretically and psychometrically robust measures of primary appraisal.