Christopher J. Kilby

The importance of coherently understanding cervical cancer vaccination: factors associated with young Australian women’s uptake of the HPV vaccine

ABSTRACT Background: Cervical cancer vaccination is efficacious and widely available, yet uptake is less than optimal, even in countries such as Australia that provide government-funded vaccination programmes. Effective communication strategies are needed for presenting Human Papillomavirus (HPV) vaccine-related information in a format that enhances understanding about the vaccine, and ultimately, uptake of the vaccine. Using the Common Sense Model framework, we aimed to assess the role of illness coherence in women’s decisions to undergo the vaccine. As a secondary aim, we piloted a communication strategy entailing the provision of Disease Risk-Action Link information about the links between HPV, cervical cancer, and vaccination on women’s cervical cancer illness coherence. Methods: In total, 132 young Australian women (18–26 years old) completed online surveys measuring illness coherence, vaccine status, intentions to undergo vaccination, and medical/demographic variables. Women who had not undergone vaccination were then randomised to receive either a brief or detailed information message about cervical cancer. Messages varied by the extent of detail (brief vs. detailed) providing Disease Risk-Action Link information about the link between the action of the vaccine, the HPV, and cervical cancer. Next, illness coherence was re-assessed. Results: ANOVA results suggested that women who were vaccinated reported higher levels of illness coherence. Linear regression analyses indicated that, in non-vaccinated women, illness coherence was significantly associated with intentions to vaccinate. ANCOVA analysis indicated that non-vaccinated women assigned to the detailed message condition reported greater increases in illness coherence compared to those assigned to the brief message condition. Conclusion: Illness coherence appears to be an important factor in actual vaccination uptake and intentions to vaccinate. The experimental informational message manipulation further demonstrated that the provision of detailed messages highlighting the Disease-Risk-Action Links in the cervical cancer context can promote illness coherence.

Reducing Body Image–Related Distress in Women With Breast Cancer Using a Structured Online Writing Exercise: Results From the My Changed Body Randomized Controlled Trial

Purpose Breast cancer treatment adverse effects result in one in three survivors experiencing body image-related distress (BID) that negatively impacts on a womans ability to recover after cancer and into survivorship. My Changed Body (MyCB) is a Web-based psychological intervention to alleviate BID and improve body appreciation in survivors of breast cancer (BCSs) through a single-session, self-compassion focused writing activity. This randomized controlled trial evaluated the impact of MyCB on BID and body appreciation in BCSs. The moderating effect of lymphedema status (affected or unaffected) and appearance investment (self-importance placed on personal appearance) and the mediating effect of self-compassion were evaluated. Patients and Methods Women (disease-free stage I to III BCSs who had experienced at least one negative event related to bodily changes after breast cancer) were randomly assigned to MyCB (n = 149) or an expressive writing control arm (n = 155). Primary outcomes were reduction in BID and improvement in body appreciation 1 week after intervention. Secondary outcomes included psychological distress (depression and anxiety) and self-compassion. Follow-up assessments occurred 1 week, 1 month, and 3 months after writing. Results Compliance with the MyCB intervention was 88%, and attrition was 9.2%. Intent-to-treat linear mixed models indicated that participants who received MyCB reported significantly less BID ( P = .035) and greater body appreciation ( P = .004) and self-compassion ( P < .001) than expressive writing participants. Intervention effects on BID were moderated by lymphedema status ( P = .007) and appearance investment ( P = .042). Self-compassion mediated effects on both primary outcomes. Therapeutic effects were maintained at 1 month (BID and body appreciation) and 3 months (body appreciation) after intervention. Significant reductions in psychological distress (1-month depression, P = .001; 1-week and 1-month anxiety, P = .007) were evident for MyCB participants with lymphedema. Conclusion This study supports the efficacy of MyCB for reducing BID and enhancing body appreciation among BCSs.

Factors associated with professional healthcare advice seeking in women at risk for developing breast cancer-related lymphedema

OBJECTIVES Approximately 6-20% of breast cancer patients undergoing lymph node surgery will develop lymphedema. At-risk individuals are encouraged to seek professional healthcare advice if symptoms arise. This study aimed to identify cognitive and affective factors associated with professional healthcare advice (PHCA) seeking behavior in women with heightened lymphedema risk. METHODS Women with increased lymphedema risk (N=462) completed an online survey measuring cognitive and affective responses to lymphedema risk, including the Illness Perception Questionnaire (Revised), and adherence to seeking PHCA. RESULTS Overall, 62% of women reported seeking professional healthcare advice if symptoms arose. Logistic regression analysis indicated that adherence to seeking PHCA if lymphedema symptoms arise was associated with greater illness coherence, belief in the efficacy of seeking PHCA, and lymphedema risk-related emotional distress. CONCLUSION Women were more likely to seek PHCA if symptoms arose if they held a coherent understanding of lymphedema and believed in the usefulness of seeking PHCA. For these women, psychological distress associated with lymphedema risk was associated with enhanced adherence to seeking PHCA. PRACTICE IMPLICATIONS Health professionals should target lymphedema education to ensure at-risk women have a coherent understanding of lymphedema and that they believe in the effectiveness of seeking PHCA to help manage lymphedema symptoms.

On the temporal stability of stress mindset

A systematic review of randomized controlled trials studying the preventive effects of physical exercise, manual and behavioural treatments in acute low back pain and neck painIntroduction: The global financial crisis has left governments struggling to reduce their budget deficits. Loans and taxes are two important financial instruments for governments to close their budget gaps. According to models of temporal discounting and expected utility individuals should experience loans as a greater loss than taxes, depleting psychological resources and reducing individuals’ capacity to cope with stressors. The present research examined patterns of cardiovascular (CV) reactivity associated with exposure to loans or taxes. Methods: We randomised 73 students to one of three groups: loans, taxes, control (baseline). Participants in the experimental groups imagined finishing university with debts and having to repay the sums outstanding as a proportion of their salaried income over the next 30 years either via a loan repayment, or via taxes. Participants in the control group imagined finishing university, and then working in salaried employment over the next 30 years. All participants then performed a variant of the Trier Social Stress Test (TSST), whilst CV responses were monitored [BP (blood pressure), ECG (electrocardiogram), ICG (impedance cardiogram)]. Results: Compared to the control group, participants in the loan group exhibited maladaptive CV responses during the stress task (higher BP and higher total peripheral resistance [TPR]). Conversely, participants in the taxes group exhibited more adaptive CV responses and did not differ from the control group. Conclusions: Economic considerations have dominated debates surrounding macro-financial performance. The present research highlights the need to consider the psychological costs and benefits of tax-based and loan-based financial instruments.

Understanding distress through the lens of positive psychology

A systematic review of randomized controlled trials studying the preventive effects of physical exercise, manual and behavioural treatments in acute low back pain and neck painIntroduction: The global financial crisis has left governments struggling to reduce their budget deficits. Loans and taxes are two important financial instruments for governments to close their budget gaps. According to models of temporal discounting and expected utility individuals should experience loans as a greater loss than taxes, depleting psychological resources and reducing individuals’ capacity to cope with stressors. The present research examined patterns of cardiovascular (CV) reactivity associated with exposure to loans or taxes. Methods: We randomised 73 students to one of three groups: loans, taxes, control (baseline). Participants in the experimental groups imagined finishing university with debts and having to repay the sums outstanding as a proportion of their salaried income over the next 30 years either via a loan repayment, or via taxes. Participants in the control group imagined finishing university, and then working in salaried employment over the next 30 years. All participants then performed a variant of the Trier Social Stress Test (TSST), whilst CV responses were monitored [BP (blood pressure), ECG (electrocardiogram), ICG (impedance cardiogram)]. Results: Compared to the control group, participants in the loan group exhibited maladaptive CV responses during the stress task (higher BP and higher total peripheral resistance [TPR]). Conversely, participants in the taxes group exhibited more adaptive CV responses and did not differ from the control group. Conclusions: Economic considerations have dominated debates surrounding macro-financial performance. The present research highlights the need to consider the psychological costs and benefits of tax-based and loan-based financial instruments.

Relating stress mindset to personality, emotional management, anxiety, and perceived stress

A systematic review of randomized controlled trials studying the preventive effects of physical exercise, manual and behavioural treatments in acute low back pain and neck painIntroduction: The global financial crisis has left governments struggling to reduce their budget deficits. Loans and taxes are two important financial instruments for governments to close their budget gaps. According to models of temporal discounting and expected utility individuals should experience loans as a greater loss than taxes, depleting psychological resources and reducing individuals’ capacity to cope with stressors. The present research examined patterns of cardiovascular (CV) reactivity associated with exposure to loans or taxes. Methods: We randomised 73 students to one of three groups: loans, taxes, control (baseline). Participants in the experimental groups imagined finishing university with debts and having to repay the sums outstanding as a proportion of their salaried income over the next 30 years either via a loan repayment, or via taxes. Participants in the control group imagined finishing university, and then working in salaried employment over the next 30 years. All participants then performed a variant of the Trier Social Stress Test (TSST), whilst CV responses were monitored [BP (blood pressure), ECG (electrocardiogram), ICG (impedance cardiogram)]. Results: Compared to the control group, participants in the loan group exhibited maladaptive CV responses during the stress task (higher BP and higher total peripheral resistance [TPR]). Conversely, participants in the taxes group exhibited more adaptive CV responses and did not differ from the control group. Conclusions: Economic considerations have dominated debates surrounding macro-financial performance. The present research highlights the need to consider the psychological costs and benefits of tax-based and loan-based financial instruments.