bluuebunny/crossref_metadata_2025 huggingface dataset:
A double blind placebo controlled trial examining the relationship between Health‐Related Quality of Life and dietary supplements
Authors: Ussher Jane M. , Swann Catherine
Published: February 2003

Objectives. This study was conducted to examine the relationship between HealthRelated Quality of Life (QOL) and dietary supplements. It was hypothesized that taking dietary supplements would lead to improvements in QOL. Design. A double blind placebo controlled trial was carried out, over an 8‐week period. Method. In a group of 313 healthy adults, QOL was examined at the beginning and end of the trial, through the Multi‐Modal Strain Questionnaire (MMSQ), Profile of Mood States (POMS) and the SF‐36 health survey questionnaire. The Dietary Instrument for Nutrition Education (DINE) questionnaire was used to examine quality of dietary intake, and the Dutch Eating Behaviour Questionnaire (DEBQ) to examine levels of restrained eating. Results. While those taking dietary supplements showed greater improvements in QOL than those in the placebo group, these improvements were not statistically significant at the .05 level, with the exception of the confusion bewilderment scale on the POMS, and the behavioural strain scale on the MMSQ. There were no significant interactions between condition (supplements or placebo) and quality of dietary intake. However, significant interactions were found between restraint and condition for the tension anxiety, depression dejection, fatigue inertia and confusion bewilderment scales of the POMS; the behavioural strain, cognitive strain, physical strain and overall strain scales on the MMSQ; and the bodily pain, vitality and mental health scales of the SF‐36. Conclusion. It is concluded that for high restrained eaters, otherwise healthy individuals who restrict their food intake to lose weight, dietary supplements may improve QOL.
Designing health communication: Testing the explanations for the impact of communication medium on effectiveness
Authors: Byrne Molly , Curtis Ruth
Published: February 2003

Objective. The written format has been found consistently to be the most effective medium for communicating relatively complex information (e.g. Furnham, Gunter, & Green, 1990). Looking at the communication of health information, Corston and Colman (1997) accounted for media differences by referring to the facts that reading a written presentation is self‐paced (the self‐pacing theory) and that a written presentation contains fewer distracting characteristics than either audio‐visual or auditory‐only presentations (the distraction theory). The present study sought to test these theories. Method. Female students (N = 175) between the ages of 16 and 18 from two secondary schools were exposed to a fictitious health warning and completed a questionnaire immediately afterwards, measuring communication effectiveness via recall. Participants were divided into seven treatment condition groups which varied in the medium of presentation (two written, three audio‐visual and three auditory‐only) and distraction level inherent to the design of the communication. Results. In line with previous literature, the written format was the most effective way to communicate a piece of health‐related information (p < .01). No evidence was provided for the ‘self‐pacing theory’. Substantial support, however, was found for the ‘distraction theory’. Conclusions. In general, minimally distracting communication proved maximally effective. A simple distraction effect, however, was not found within the audio‐visual medium. Here the presentation where the viewers see a reader conveying the message (the ‘talking head’ condition) proved most effective, even though it was not the least distracting. Being able to see someone reading the message appears to convey a special communication advantage on the presentation.
The Derriford Appearance Scale (DAS‐59): A new scale to measure individual responses to living with problems of appearance
Authors: Carr Tony , Harris David , James Christine
Published: February 2003

Objectives. To develop a reliable and valid self‐report scale which (1) will assess the distress and difficulties experienced in living with a problem of appearance; (2) can be used with clinical and non‐clinical populations; and (3) facilitates clinical decisionmaking and research through good standardization, sensitivity and discrimination. Design.Cross‐sectional survey designs using clinical and non‐clinical populations and a pre‐post intervention design using plastic surgery patients. Method. A large initial item set was refined through a controlled pre‐post surgery study and a cross‐sectional study of a plastic surgery waiting list (606). The resulting 59‐item scale was administered to 1740 patients with problems of appearance and to a representative general population sample (1001). Results. Principal component and factor analyses identified a stable five‐factor structure accounting for 63.5% of the variance, with a primary factor of self‐consciousness of appearance. Internal consistency was high (alpha= .98) and test‐retest reliabilities (three months) were good (.75 (general population); .86 (patients)). Correlations with existing tests showed appropriate criterion validity (.74‐.62). Good construct validity was evidenced in pre‐ and post‐operative changes, in differences between patients and controls and in convergent and divergent correlation patterns. The general population data reveal widespread concerns about appearance. Conclusions. The DAS‐59 provides a widely acceptable, psychometrically robust, factorial self‐report scale to assess distress and dysfunction in problems of appearance across the full range of ‘visibility’ and aetiologies. It is sensitive to therapeutic change and discriminates well between patient groups.
Measurement properties of the Nottingham Health Profile and Short Form 36 health status measures in a population sample of elderly people living at home: Results from ELPHS
Authors: Sharples L. D. , Todd C. J. , Caine N. , Tait S.
Published: February 2003

Objectives. To investigate reliability and validity of the Nottingham Health Profile (NHP) and Short Form 36 (SF‐36) in an elderly population living at home. Design. Interview survey of an age‐sex stratified random sample of people age 65+. Methods. In all, 481 people were sampled from 78 general practices across East Anglia. The NHP and SF‐36 were administered, in random order, alongside measures of physical performance, morbidity, symptoms, activities of daily living (ADL) and the Hospital Anxiety and Depression Scale (HAD). Repeat interviews were completed by 93 individuals after one month. Results. Neither questionnaire showed bias in test‐retest reliability at 1 month; the change in scale scores showed greater variability for the SF‐36 than the NHP. Internal consistency was comparable with Cronbach's alpha in the range of .7 to .85, except for NHP social isolation (.61) and SF‐36 physical functioning (.94). Substantial ceiling effects (> 20% of cases) were found for all six NHP scales and for four of eight SF‐36 scales (role limitations owing to physical and emotional problems, social functioning and bodily pain). Comparable scales of both questionnaires exhibited a significant and comparable relationship with actual physical performance and selfreported ADL, morbidities, symptoms and HAD (p < .001 in all cases). Conclusions. This study confirms that some SF‐36 scales are more sensitive to minor levels of morbidity in elderly people, but the SF‐36 has not made substantial improvements over the NHP in test‐retest reliability, internal consistency or validity for this population. The two questionnaires appear to have equally good psychometric properties in this age group.
Lung cancer and cigarette use: Cognitive factors, protection motivation and past behaviour
Authors: Kanvil Nashiba , Umeh Kanayo F.
Published: February 2003

Objective. To assess relationships between health cognitions and protection motivation regarding cigarette use and lung cancer. Design. Cross‐sectional questionnaire survey. Variables were intentions (i.e., motivation) perceptions of susceptibility to and severity of lung cancer, the benefits or effectiveness of not smoking in reducing the risk of lung cancer, barriers to not smoking, past smoking behaviour, and demographic factors (age, gender). Method. Two‐hundred and seventy‐five men and women (aged 18‐66 years) were administered and returned the questionnaire. Multiple regression analysis was used to analyse the data. Results. Past cigarette use predicted stronger intention to smoke, accounting for 70% of the variance. Perceptions of susceptibility and barriers increased the variance explained, but only marginally. Greater perceived likelihood of contracting lung cancer and stronger perceived barriers to not smoking predicted higher motivation to smoke. Conclusions. Results provide limited support for the role of health cognitions in intended cigarette use, and justify the incorporation of past risk behaviour in social cognition models applied to cigarette use.
The Theory of Planned Behaviour and exercise: Evidence for the moderating role of past behaviour
Authors: Norman Paul , Conner Mark , Bell Russell
Published: February 2003

Objectives. This study reports an application of the Theory of Planned Behaviour (TPB) to the prediction of exercise intentions and behaviour over a 6‐month period. The study also considers the moderating effect of past behaviour on the intention‐behaviour and perceived behavioural control‐behaviour relationships. Design and methods. A sample of 87 patients attending health promotions clinics in a primary care setting completed questionnaires on the TPB and exercise behaviour after their clinic appointment and were followed‐up at 6 months. Results. The TPB was found to be predictive of initial exercise intentions and future exercise behaviour at 6‐month follow‐up, with the perceived behavioural control construct emerging as the sole independent predictor in both cases. Past behaviour was found to have a direct effect on future exercise behaviour over and above the influence of the TPB. In addition, past behaviour moderated the perceived behavioural control‐behaviour relationship which was found to be significant when the frequency of past behaviour was moderate or high, but non‐significant when the frequency of past behaviour was low. Conclusion. The results highlight (1) the importance of the perceived behavioural control construct of the TPB in the prediction of exercise intentions and behaviour, and (2) the need to consider the moderating effect of past behaviour on TPB‐behaviour relations.
Causal attributions in patients and spouses following first‐time myocardial infarction and subsequent lifestyle changes
Authors: Weinman John , Petrie Keith J. , Sharpe Norman , Walker Sarah
Published: February 2003

Objectives. To assess causal attributions in first‐time myocardial infarction (MI) patients and their spouses and to relate these attributions to changes in patients' health‐related behaviour at 6 months after the MI. Design. A prospective single cohort design in which baseline attributions were related to health‐related behaviour change at 6 months. Patient and spouse attributions were compared using ANOVA and principal components factor analysis. Both sets of attributions were related to behaviour change using correlation and step‐wise multiple regression analysis. Method. A sample of 143 first‐time MI patients participated in this study. They completed questionnaires assessing their causal attributions and health‐related behaviour during their stay in hospital and at 6 month follow‐up (N = 115). Spouses (N = 84) completed the attribution questionnaire at 12 weeks post‐MI. Results. The most commonly endorsed attributions for both groups were ‘stress’, ‘high cholesterol’, and various health risk behaviours. The overall pattern of patient and spouse attributions was broadly similar but the factor analyses revealed some differences in the factor structures of the two sets of attributions. Most MI patients had made significant changes in health behaviour at 6 months, and those who believed that their MI was caused by their poor health habits were more likely to have made dietary changes at 6 months. Spouse attributions to poor health habits were associated with improvements in patients' exercise level at 6 months. Conclusion. The prospective associations between both patient and spouse causal attributions and subsequent changes in health‐related behaviour confirm the importance of specific causal attributions in adjustment to first‐time MI.
Cognitive processing of pain‐related words and psychological adjustment in high and low pain frequency participants
Authors: Koutantji M. , Pearce S. A. , Oakley D. A.
Published: February 2003

Objectives. This study tested the hypotheses that a group of students reporting a high number of pain episodes would present evidence of memory and processing time biases for pain‐related words and that they would be impaired on measures of mood when compared to a low pain frequency group. Design. A quasi‐experimental mixed model design was employed. Group (high pain frequency group, low pain frequency group) was the between‐participants factor, Wordtype (pain‐sensory, pain‐affective, neutral) and encoding condition (self, other‐reference) were the repeated measures. Percentage recall and processing time for each word type were used as dependent measures. Between‐groups comparisons were made for the questionnaire measures. Methods. A computerized word task comprising of pain‐sensory, pain‐affective and neutral words was administered to students. Students were asked to encode the words in a self‐ and other person reference condition followed by a delayed recall phase and the administration of the questionnaires. Results. The recall scores analysis showed that the high pain frequency students recalled significantly more affective words encoded in self‐reference than in the other‐reference. They also recalled significantly more sensory words encoded in self‐reference when compared to the low pain frequency group. The results of the processing time data showed that self‐reference encoding required significantly longer processing time. However, the high pain frequency group processed sensory words encoded in self‐reference significantly faster than neutral or affective words. There were no betweengroups differences on measurements of depression and anxiety. Conclusions. The results suggest that although mood levels are normal for a nonclinical young population experiencing a high number of pain episodes, they show some evidence of pain‐specific cognitive biases previously found in chronic pain patients. Future longitudinal research should assess whether these pain‐specific cognitive biases could be indicators of vulnerability to develop chronic pain in the future.
Mental and physical health in students: The role of economic circumstances
Authors: Roberts Ron , Golding John , Towell Tony , Reid Steven , Woodford Sally , Vetere Arlene , Weinreb Irene
Published: February 2003

Objectives. To investigate the relationship between the physical, social and psychological health of students and their financial circumstances. Design. A survey design was used. Methods. An opportunity sample of 482 university students from two London universities (one old and one new) completed a questionnaire providing information on demographic characteristics, financial circumstances, smoking, drug and alcohol use. Physical and psychological well‐being were assessed using a 14‐item inventory of physical symptoms, the SF‐36 and General Health Questionnaire (GHQ‐12). Results. All sub‐scales of the SF‐36 (except Physical Functioning) and the GHQ indicated levels of health significantly below population norms. Poorer mental health was related to longer working hours outside university and difficulty paying bills. Those who had considered abandoning study for financial reasons had poorer mental health, social functioning, vitality and physical health and were also heavier smokers. Being in debt was associated with knowing people involved in prostitution, crime or drug dealing to help support themselves financially. Conclusion. Results suggest that the financial circumstances of students may be having an adverse impact on their health.
Developing a quality of life measure for children aged 5‐8 years
Authors: Jirojanakul Pragai , Skevington Suzanne
Published: February 2003

Objectives. This study describes the development of a self‐reported quality of life measure for children‐the C‐QOL‐for Thai children aged 5‐8 years. The underlying concepts and procedure for assessing quality of life are based on the WHOQOL. Design and methods. The WHOQOL construct, consisting of 24 facets subsumed in six domains, was examined by focus group interviews to establish whether they were relevant to the quality of life. Ten focus groups (six with children and four with mothers) containing 31 children and 19 mothers were conducted. Two sets of questionnaires were developed and then further tested for psychometric properties with a sample of 35 children and 30 carers in a second study. Results. The analysis of quantitative data showed that the WHOQOL construct was relevant to the quality of life of Thai children. The information based on qualitative data enabled two sets of the C‐QOL to be developed: a children's form and a carer's form. Study 2 shows that there were differences between the parents' and children's scores on only seven facets out of 26 and mostly in the psychological domain, so the children's perceptions of their quality of life are largely confirmed by their carers. Preliminary psychometric analysis demonstrates face and content validity of the measure and showed good internal consistency and test‐retest reliability. Item analysis was performed to select the most acceptable items and to revise the scales. Conclusions. This measure draws upon the experience of children and their mothers and uses their reports in developing a multidimensional, child‐centred measure. It provides a model for carrying out this work with children in other countries and other age groups.
Coping, emotion and perceived health following myocardial infarction: Concurrent and predictive associations
Authors: Lowe Rob , Norman Paul , Bennett Paul
Published: February 2003

Objective. This paper examines concurrent and prospective relationships between coping, emotion outcomes and perceived health among first‐time myocardial infarction (MI) patients over the first 6 months of adjustment. Method. A longitudinal design was employed. Participants completed questionnaires at three time points; while in‐patients (N = 128), at 2 months follow‐up (N = 100) and at 6 months follow‐up (N = 74). The questionnaires included measures of coping (COPE), positive and negative affect (Global Mood Scale), anxiety (State Anxiety Inventory) and perceived health (Health Complaints Scale). Results. Both coping and outcomes tended to be stable across time. Significant concurrent relationships stressed the role of avoidant‐, acceptance‐ and social/emotion‐focused coping. Prospectively, results emphasized the adaptive influence of problem‐focused coping. Conclusions. Coping was both concurrently and predictively associated with outcomes post‐MI. A clear distinction between concurrent and predictive associations emerged. Problems associated with relying on cross‐sectional data to inform theory and practice are highlighted. The clinical implications of the results for rehabilitation programmes are also outlined.
Preoccupation and affect as predictors of protective action following natural disaster
Authors: Weinstein Neil D. , Lyon Judith E. , Rothman Alexander J. , Cuite Cara L.
Published: February 2003

The actions taken by individuals after natural disasters to prepare for future disasters were studied to see whether theories of self‐protective action are missing important variables. Residents of three communities struck by severe tornadoes who did not experience damage or injury (N = 715) were interviewed shortly after the tornadoes and again 14 months later. Initial responses to the tornadoes and details of the tornado experience were used to predict precautions reported at the initial and follow‐up interviews. Preoccupation with tornadoes strongly predicted action independent of affect, perceived risk, and perceived control. Recollections of fear felt during the tornado and negative affect when thinking about tornadoes were also related to action: both negative affect and high fear (if combined with preoccupation) were associated with less action in the initial period following the tornadoes. Our findings suggest that the conceptualization of action as reflecting a decision about the expected costs and benefits of action is inadequate and that theories of self‐protective behaviour need to include measures of preoccupation and affect as well.
Gender differences in response to infertility and infertility investigations: Real or illusory
Authors: Edelmann Robert J. , Connolly Kevin J.
Published: February 2003

Objectives. The study was designed to explore whether the suggestion arising from previous research, that women experience greater distress than their partners with regard to infertility investigations and treatment, is real or illusory. It is argued that findings from previous research reflect recognized gender differences in rates of distress rather than being fertility related and that infertility‐specific reactions can only be meaningfully explored with standardized measures administered in a longitudinal design. Design. Data were collected on a range of standardized measures relating to personality and psychopathology in two separate samples which were assessed longitudinally. Method. The first sample consisted of 130 couples presenting at an infertility clinic, 116 of whom completed a range of measures at the time of their initial consultation and again some 7 months later. The second sample consisted of 150 couples presenting for their first IVF treatment, they completed a comparable range of measures at the time of the first clinic consultation, some 6 weeks later and again at the completion of their first treatment cycle. Results. The anticipated gender differences on all measures for both samples were found but the scores showed few deviations from available normative data for either males or females and there was no evidence of a differential increase in infertility attributable distress scores for women over time. Indeed, scores on the State‐Trait Anxiety Inventory (STAI) and the General Health Questionnaire (GHQ) declined between assessments with scores for women showing a greater decline over time than scores obtained by men. Conclusion. It is argued that the claim women react more adversely to infertility than their partners is overly influenced by outdated gender stereotyping and is unsupported by research data.
Ultrasound screening for chromosomal abnormality: Women's reactions to false positive results
Authors: Baillie Catherine , Smith Jonathan , Hewison Jenny , Mason Gerald
Published: February 2003

Objective. Ultrasound scans have become a routine part of antenatal care. Recent developments have meant that ultrasound has gone beyond monitoring the pregnancy and diagnosis of major abnormalities. Its routine use now includes screening for subtle fetal abnormalities and indications of chromosomal abnormality. Unfortunately ultrasound screening for chromosomal abnormalities has a low positive predictive value (similar to maternal serum screening), and only about 2% of pregnancies identified as ‘high risk’ will be diagnosed with a chromosomal abnormality. The other 98% of ‘high risk’ results are termed ‘false positive’. The aim of this paper is to elucidate the range of subjective experiences of women in response to having these results. Method. The approach employed was interpretative phenomenological analysis. Semi‐structured interviews were carried out with 24 pregnant women after ‘false positive’ ultrasound results. These were subjected to a qualitative analysis. Results. Participants perceived the ultrasound scan primarily as a social, non‐medical event and were unprepared for the result the scan elicited. Two‐thirds described residual feelings of anxiety even after normal diagnostic results were known, sometimes attributed to continued fears about fetal abnormality, but more often attributed to a generalized feeling that something else unexpected could happen to threaten the pregnancy. Conclusions. The paper has pointed to important discrepancies in the experiences of women undergoing ultrasound screening and the aims of informed choice. We would suggest consideration should be given to providing information on both the medical purposes of screening and on possible outcomes from it. The study also points to the possible need for counselling support for the majority of women who go on to receive confirmation of a negative diagnosis, counselling addressed at helping women to readjust to having a ‘low risk’ pregnancy.
Self‐rated menopausal status and quality of life in women aged 40‐63 years
Authors: Jacobs Pamela A. , Hyland Michael E. , Ley Ann
Published: February 2003

Objectives. To determine whether quality of life (QOL) changes during the menopause as a function of menopausal status and other medical and lifestyle variables. Design. A postal questionnaire sent to three different samples of women. Method. A total of 1188 questionnaires were received from (a) two samples recruited from two Family Health Service Association (FHSA) lists and (b) one sample recruited through an advertisement in a women's magazine. The questionnaires consisted of (a) a seven domain, 48‐item, condition‐specific QOL questionnaire which was developed for this study (MQOL), (b) a single item global QOL questionnaire (GQOL), (c) questions about medical history, (d) questions about work status, (e) questions assessing menopausal status using two different techniques. Results. Both the MQOL and GQOL indicated a relationship with menopausal status. GQOL and MQOL showed a U‐shaped relationship with menopausal status, with lowest scoresassociated with the middle of the menopause. However, domain scores of Sleep and Energy failed to reach the levels reported by women who perceive themselves to be pre‐menopausal, and domain scores of Symptom Impact and Social Interaction indicate steady decline during the menopausal transition. Women who experienced the menopause long ago reported the highest GQOL, feelings and cognition domain scores. Medical history and work outside the home play an important role in determining MQOL‐womenwho had undergone hysterectomy, those who had tried but discontinued HRT while still in the middle of the climacteric, and those with greater co‐morbidity had poorer QOL. Those who worked outside the home reported better MQOL, and those recruited through the magazine reported poorer QOL. Conclusions. QOL is affected by the menopause, but the way it is affected depends on the measure of QOL used. QOL during the menopause is also affected by medical and lifestyle variables. QOL during the menopause is a complex interaction of several different kinds of variable.
Perceived control and recovery from functional limitations: Preliminary evaluation of a workbook‐based intervention for discharged stroke patients
Authors: Frank Gisela , Johnston Marie , Morrison Val , Pollard Beth , MacWalter Ron
Published: February 2003

Background. Previous research has demonstrated that control cognitions predict functional limitations following stroke. This paper reports a preliminary evaluation of the effects of a workbook intervention, designed to enhance perceptions of control, in reducing disability in patients discharged from hospital following stroke. Methods. Thirty‐nine patients living at home who had had a stroke within the 2 previous years completed baseline assessments of functional limitations, mood and perceived control. They were then randomly allocated to either a Workbook Intervention or a Wait control group and functional limitation and mood outcomes were assessed 1 month later. Results. Results showed no benefit of the intervention, but both groups showed reduced functional limitations. Reductions in functional limitations were correlated with increases in perceptions of control. Conclusions. Clearly, the workbook intervention needs to be strengthened before a full evaluation would be worthwhile for this clinical group. It is possible that both groups demonstrated spontaneous recovery or may have benefited from the additional attention given by the researcher. These benefits were associated with enhanced perceptions of control, contributing to previous findings suggesting that control cognitions may be both a consequence and a determinant of functional limitations.
Acne: A biopsychosocial and evolutionary perspective with a focus on shame
Authors: Kellett Stephen , Gilbert Paul
Published: February 2003

Purpose. Hypotheses regarding the psychological factors implicated in the development and maintenance of acne first emerged in the middle of the eighteenth century. However, the psychodermatological literature from this date relating to acne has variously been described as confusing, overly prone to conjecture and, in particular, atheoretical. The current paper has two key objectives; first, to present a biopsychosocial model of acne development and maintenance and, secondly, to understand the psychosocial strain imposed by acne from an evolutionary perspective with a particular emphasis on body shame reactions.

Methods. The psychodermatological literature relating to acne is reviewed with the data analysed for potential biopsychosocial interactions and shame eliciting responses.

Results. The review indicates that acne can be reconceptualized as a biopsychosocial phenomena which, in turn, provides the field with innovative hypotheses for empirical inquiry and the potential for expanding and evaluating treatment options. The evolutionary analysis illustrates that acne provides the potential for distressing body shame reactions due to the skin disease's potential for damaging self‐other evaluations of attractiveness.

Conclusions. Acne has tended to e viewed as a minor dermatological complaint which imposes minimal psychological distress upon sufferers. The paper concludes that acne has the aility to elicit in some sufferers significant mental health concerns due to a heightened sense of shame relating to appearance.
Self‐efficacy and goal importance in the prediction of physical disability in people following hospitalization: A prospective study
Authors: Orbell Sheina , Johnston Marie , Rowley David , Davey Peter , Espley Arthur
Published: February 2003

Objectives. This prospective study evaluates the role of self‐efficacy and goal importance in predicting decreases in disability in activities of everyday living. Method. Disability, self‐efficacy and goal importance were each assessed before and at 3 and 9 months after participants underwent joint replacement surgery. Results. Disability had decreased at 3 and 9 months post‐surgery assessments. Self‐efficacy beliefs were higher at 3 and 9 months following surgery while goal importance was increased at 9 months but not at 3 months. Medical variables and prior disability predicted disability at 3 months. Social‐cognitive variables did not contribute to the prediction of 3 months disability. Pre‐surgery goal importance and self‐efficacy at 3 months were independent predictors of disability at 9 months after controlling for pre‐surgery and 3 months disability. Evidence also suggested that goal importance and self‐efficacy interacted to predict levels of disability at 9 months following surgery. Conclusions. The findings demonstrate that recovery is governed not solely by medical phenomena but also by psychological variables and suggest that modification of these variables may have an impact on recovery outcomes. Moreover, attention should be paid to the timing of such intervention and to the length of follow‐up.
Psychological factors associated with short‐term recovery from total knee replacement
Authors: Kendell Katherine , Saxby Brian , Farrow Malcolm , Naisby Carolyn
Published: February 2003

Objective. To identify the psychological factors that predict short‐term recovery following total knee replacement. Method. A group of 42 patients undergoing total knee replacement received a pre‐operative psychological assessment. Four self‐report questionnaires were completed: the Pain Coping Strategies Questionnaire; the Short Form Social Support Questionnaire; the Recovery Locus of Control Scale; and the Brief Symptom Inventory. Post‐operative outcome was assessed in terms of the number of days taken to achieve key physiotherapy milestones (straight leg raise; 90° bend of the knee) and discharge. Results. The three response variables were analysed separately using an ordinal regression. Internal locus of control was associated with a shorter time to achieve a straight leg raise. Larger values of catastrophizing were associated with longer times to achieve a 90° bend. There was a trend towards larger values of satisfaction with social support to be associated with an earlier achievement of the 90° bend. No psychological variables were found to be associated with the length of hospital stay. Conclusions. As suggested by previous studies, coping style and locus of control appear to be important in the rehabilitation process. The current data suggest that psychological variables could be usefully included in a pre‐operative assessment for total knee replacement.
Ambivalence about health‐related behaviours: An exploration in the domain of food choice
Authors: Sparks Paul , Conner Mark , James Rhiannon , Shepherd Richard , Povey Rachel
Published: February 2003

Objectives. Interest in attitudes and ambivalence has highlighted problems with the adequacy of conceptualizing attitudes as unitary, unidimensional, evaluations. In this paper, we report an application of the Theory of Planned Behaviour (Ajzen, 1991) in the domain of dietary choice which investigates the hypothesis that ambivalence will attenuate observed attitude‐intention relationships (since the evaluations influencing the expression of attitudes are more likely to differ from the evaluations influencing the expression of intentions for people who are more ambivalent. Design. Participants completed a postal questionnaire which contained, inter alia, measures assessing the components of the Theory of Planned Behaviour and a measure of ambivalence. Methods. Participants (N = 296) were recruited via advertisements placed in local newspapers, asking for volunteers to assist in a research project. Participants were randomly assigned to complete a questionnaire about either their chocolate consumption or their meat consumption. Participants were paid £4. Results. The findings show considerable support for the hypothesis: there was a tendency for attitude‐intention relationships to be attenuated among participants with higher levels of ambivalence, compared to participants with lower levels of ambivalence. Conclusions. The research supports the widespread view that ambivalence is an important issue, both for those involved in basic attitude research and for those who seek to use attitude theories in applied research. In particular, the findings indicate that ambivalence may often have implications for the predictive ability of attitude‐intention‐behaviour models, especially when applied to health‐related behaviours that are characterized by motivational conflicts.
Factors associated with self‐disclosure of HIV serostatus to significant others
Authors: Petrak Jenny A. , Doyle Anne‐Marie , Smith Alan , Skinner Celia , Hedge Barbara
Published: February 2003

Objectives. To examine rates and patterns of self‐disclosure of HIV serostatus amongst individuals attending an out‐patient HIV clinic in East London. Design. A cross‐sectional survey design was used. Methods. A volunteer sample of 95 out‐patient HIV clinic attendees completed a self‐report questionnaire examining patterns of disclosure to self‐identified significant others, reasons for disclosure and non‐disclosure, satisfaction with social support (SSQ6), quality of life (MOS‐30) and anxiety and depression (HADS). Self‐disclosure was examined in relation to cultural background, gender, satisfaction with social support, and medical and psychological variables. Results. Seventy‐nine men and 16 women reported a mean disclosure rate of 68% to self‐identified significant others. Five individuals had not disclosed their HIV status to anyone; 91% of individuals had informed their partner. Friends were more frequently informed (79%) than family (53%). Ethnicity (p < .001) and length of time since testing HIV seropositive (p < .05) emerged as significant predictors of disclosure. Global satisfaction with social support was negatively correlated with depression but was not associated with the total rate of HIV disclosure. Frequently reported reasons for non‐disclosure included wanting to protect others from distress and fear of discrimination. Conclusions. HIV serostatus rates was highest for partners, followed by friends, and lowest for family members. Patterns of disclosure of HIV serostatus varied in relation to ethnicity. Fifteen years into the HIV epidemic, social stigma continues to contribute towards non‐disclosure of diagnosis.
Spontaneous, elicited and cued causal attributions in the year following a first myocardial infarction
Authors: Gudmundsdóttir Hafrún , Johnston Marie , Johnston Derek , Foulkes Joan
Published: February 2003

Objectives. To assess myocardial infarction (MI) patients' causal beliefs, how they change over time and the effects of different assessment methods. Method. The study used a longitudinal design with a follow‐up to 1 year. The participants were 100 MI patients who were recruited within 72 hours of admission. Each participant was interviewed and their causal attributions (spontaneous, elicited and cued) were assessed using four different methods. Results.‘Stress’,‘smoking’,‘it is in the family’,‘eating fatty foods’ and‘work’ items were the most commonly mentioned causes for the MI at all times of measurement and across all measures. On each occasion‘stress’ and‘smoking’ were selected as the most important causes and patients made fewer attributions over time. Finally, the attributional assessment method used did not affect type of attributions but fewer attributions were reported using the spontaneous method. Conclusion. Patients do provide causal attributions following an MI. While many are similar to causal factors identified by medicine, patients appear to place more emphasis on‘stress’. As predicted by attribution theory, attributions changed over time. The method of obtaining the attributions does not appear to affect the attributions made but greatly affects their number. While all the methods used have their place, the cued method with a list of possible attributions offers a rich return for effort expended.
Delinquency, health behaviour and health
Authors: Junger Marianne , Stroebe Wolfgang , Van der Laan André M.
Published: February 2003

Objectives. This study investigated the association between delinquency and health in a sample of adolescents and young adults (aged 13‐24) and examined whether the association could have been due to delinquency‐related differences in demographic, socio‐economic and life‐style factors.

Method. The study is based on cross‐sectional data from a sample of 3677 adolescents and young adults interviewed as part of a survey of Dutch households. Health, health behaviour, and delinquency were assessed through self‐report measures.

Results. Delinquency was significantly related to three of the four measures of health behaviour (smoking, alcohol consumption, and drug use), even after control for demographic and socio‐economic factors. Delinquency was also significantly associated with all three measures of health assessed in this study (somatic symptoms, general health, and chronic conditions). However, only minimal support was found for the hypothesis that the association between delinquency and health was mediated by differences in health behaviour or demographic/socio‐economic differences.

Conclusions. Adolescent delinquents are less healthy than non‐delinquents. Potential causes for this relationship are proposed. Possibly, personality factors, such as hostility, or psychosocial stress might explain why delinquency correlates with health.
Do self‐help interventions in health education lead to cognitive changes, and do cognitive changes lead to behavioural change?
Authors: Dijkstra Arie , de Vries Hein
Published: February 2003

Objectives. The present study examined the extent to which self‐help interventions change specific cognitions and the extent to which changes in such cognitions are related to behavioural changes.

Design. A randomized field experiment with follow‐ups after 2 weeks and 3 months.

Method. Smokers (N = 1546) were randomly assigned to one of four conditions offering smoking cessation self‐help materials containing (1) outcome information, (2) self‐efficacy enhancing information, (3) both sorts of information, or (4) no information.

Results. First, with regard to behavioural effects, only self‐help interventions that included self‐efficacy enhancing information were more effective than no information. Second, with regard to the cognitive changes, the data showed that outcome information led to increase in expected positive outcomes but also to increases in self‐efficacy expectations. Further, self‐efficacy‐enhancing information led to increases in self‐efficacy. Third, different cognitive changes between T1 and T2 were related to different types of quitting activity at T3 in different groups of smokers.

Conclusions. Some types of information lead to specific cognitive changes, while other types have more generalized cognitive effects. Further, cognitive changes produced by a self‐help intervention predict future quitting activity.
Predicting exercise stage transitions over two consecutive 6‐month periods: A test of the theory of planned behaviour in a population‐based sample
Authors: Courneya Kerry S. , Plotnikoff Ronald C. , Hotz Stephen B. , Birkett Nicholas J.
Published: February 2003

Objectives. To predict exercise stage transitions over two consecutive 6‐month periods using the theory of planned behaviour (TPB). It was hypothesized that different social cognitive constructs would predict different stage transitions.

Design. Prospective and longitudinal in order to predict multiple stage transitions over time. Assessments were made at baseline, 6 months and 1 year.

Method. Participants were a randomly selected population‐based sample of 683 adults who completed two telephone interviews (baseline and 6 months) that assessed exercise stage, intention, perceived behavioural control, attitude, subjective norm, and social support, and a mailed survey (1 year) that assessed exercise stage.

Results. Progression from pre‐contemplation was predicted by intention, attitude and subjective norm; progression/regression from contemplation was predicted by intention, perceived behavioural control, attitude, and social support; progression/regression from preparation was predicted by intention and attitude; and regression from action/maintenance was predicted by intention, attitude and social support.

Conclusions. Different social cognitive constructs predicted different stage transitions, which indicates that exercise behaviour change may be represented by a series of stage transitions. Moreover, the TPB may be a useful model for highlighting the key social cognitive constructs that are important for exercise stage transitions.
Emotional expressivity and intrusive cognitions in women with family histories of breast cancer: Application of a cognitive processing model
Authors: Zakowski Sandra G. , Valdimarsdottir Heiddis B. , Bovbjerg Dana H.
Published: February 2003

Objectives. Women with family histories of breast cancer exhibit significant distress and intrusive cognitions about cancer. The role of intrusive cognitions in adjustment to chronic stressors is unclear. While they may be a source of distress in themselves, they may also be part of a cognitive processing strategy that aids in the adaptation process, particularly if they are accompanied by more deliberate processing such as emotional expression. Applying cognitive processing models of stress, the present study examined the role of dispositional emotional expressivity in intrusive cognitions about breast cancer and distress in women dealing with the stressful experience of having a family history of breast cancer. Two competing hypotheses were tested: (1) emotional expressivity is associated with reduced intrusive cognitions and thus lower distress; (2) emotional expressivity buffers the relations between intrusive cognitions and distress.

Design. Using a cross‐sectional design, hypotheses were addressed with multiple regression analyses according to established methods.

Method. Healthy women (N = 104) who had one or more first‐degree relatives with breast cancer were recruited from cancer screening programs. They completed questionnaires regarding family history of cancer, emotional expressivity, distress, and intrusive cognitions.

Results. Emotional expressivity was not associated with reduced intrusive cognitions (Hypothesis 1) but moderated the relations between intrusive cognitions and distress (Hypothesis 2).

Conclusions. The data further our understanding of cognitive processing theories of stress and underline the importance of including emotional expression in interventions, helping women to process the stressful experiences associated with having family histories of breast cancer.
Perceived stress and coronary heart disease risk factors: The contribution of socio‐economic position
Authors: Heslop Pauline , Smith George Davey , Carroll Douglas , Macleod John , Hyland Fawzia , Hart Carole
Published: February 2003

Objectives. The aim of this study was to explore the relationship between risk factors for coronary heart disease (CHD) and perceived stress, adjusted for socio‐economic position.

Design. Cross‐sectional analysis of CHD risk factors, perceived stress and socio‐economic position.

Method. A cohort of employed Scottish men (N = 5848) and women (N = 984) completed a questionnaire and attended a physical examination.

Results. Higher socio‐economic groups registered higher perceived stress scores. Perceived stress was associated with the following CHD risk factors in the expected direction: high plasma cholesterol, little recreational exercise, cigarette smoking, and high alcohol consumption. Contrary to expectations, stress was related negatively to high diastolic blood pressure, body mass index (BMI) and low forced expiratory volume. Correction for socio‐economic position tended to abolish the associations between stress and physiological risk factors; the associations between stress and behavioural risk factors withstood such correction. The residual patterns of associations between perceived stress and CHD risk were broadly similar for men and women. A lower BMI, a greater number of cigarettes smoked, and greater alcohol consumption were associated with higher levels of perceived stress for both sexes. Lower levels of recreational exercise were associated with higher levels of stress for men only.

Conclusions. Self‐reported stress is related to health‐related behaviours and to physiological CHD risk factors. The direction of the association with physiological risk was often contrary to expectation and appeared to be largely due to confounding by socio‐economic position. In contrast, the association with health‐related behaviours was in the expected direction and was largely independent of such confounding.