Debbie M Smith

General practitioners' beliefs about the clinical utility of complementary and alternative medicine

AIMnTo investigate GPs beliefs about complementary and alternative medicine (CAM) and its role in clinical practice.nnnBACKGROUNDnDespite the prevalence of CAM in the United Kingdom, little is known about GPs beliefs regarding these alternative approaches to patient management and how they view it in relation to their clinical conduct and practice.nnnMETHODnA qualitative study conducted on 19 GPs recruited from the North West of England. Semi-structured telephone interviews were analysed using an inductive thematic analysis.nnnRESULTSnThree themes emerged from the data: limited evidence base, patient demand and concerns over regulation.nnnCONCLUSIONnDespite recognising the limited evidence base of CAM, GPs continue to see a role for it within clinical practice. This is not necessarily led by patient demand that is highly related to affluence. However, GPs raised concerns over the regulation of CAM practitioners and CAM therapies.

THE ASSOCIATION BETWEEN PSYCHOLOGICAL FACTORS AND BREASTFEEDING BEHAVIOUR IN WOMEN WITH A BODY MASS INDEX (BMI) ≥30kg/m2: A SYSTEMATIC REVIEW

Breastfeeding can play a key role in the reduction of obesity, but initiation and maintenance rates in women with a body mass index (BMI) of ≥30 kg m−2 are low. Psychological factors influence breastfeeding behaviours in the general population, but their role is not yet understood in women with a BMI ≥30 kg m−2. Therefore, this review aimed to systematically search and synthesize the literature, which has investigated the association between any psychological factor and breastfeeding behaviour in women with a BMI ≥30 kg m−2. The search identified 20 eligible papers, reporting 16 psychological factors. Five psychological factors were associated with breastfeeding behaviours: intentions to breastfeed, belief in breast milks nutritional adequacy and sufficiency, belief about others infant feeding preferences, body image and social knowledge. It is therefore recommended that current care should encourage women to plan to breastfeed, provide corrective information for particular beliefs and address their body image and social knowledge. Recommendations for future research include further exploration of several psychological factors (i.e. expecting that breastfeeding will enhance weight loss, depression, anxiety and stress) and evidence and theory‐based intervention development.

Fear of birth in clinical practice: A structured review of current measurement tools

To identify measurement tools which screen for the presence of fear of birth (FOB) and to determine the most effective tool/s for use in clinical practice. Fear or birth (FOB) is internationally recognised as a cause for increasing concern, despite a lack of consensus on a definition or optimal measure of assessment. There is a wide array of FOB measurement tools, however little clarity on which tool should be used to screen for FOB in clinical practice. This review explores the use of tools that are used to screen for FOB and discusses the perceived effectiveness of such tools. A structured literature review was undertaken. Electronic databases were searched in July 2017 and manuscripts reviewed for quality. The review included 46 papers. The majority of studies were undertaken in Scandinavia (nu202f=u202f29) and a range of tools were used to measure FOB. The most widely used tool was the Wijma Delivery Expectancy Experience Questionnaire (W-DEQ). Inconsistencies were found in the way this tool was used, including variations in assessment cut-off points, implementation and use across a range of cultural settings and women of varying gestations. Moreover, the tool may be too lengthy to use in clinical practice. The Fear of Birth Scale (FOBS) has been shown to be as effective as W-DEQ but has the advantage of being short and easy to administer. The inconsistencies in tools reflect the difficulties in defining FOB. A clear consensus definition of FOB would aid comparisons across practice and research. The W-DEQ is not used in clinical practice; this may be due to its length and complexity. The FOBS is likely to be a more versatile tool that can be used in clinical practice.

Health behaviour and pregnancy: a time for change

Pregnancy has repeatedly been described as a time when women may be particularly receptive to changing their health behaviour. However, rarely acknowledged is the volume of behavioural expectations...

Do Self-Incentives and Self-Rewards Change Behavior? A Systematic Review and Meta-Analysis

Encouraging people to self-incentivize (i.e., to reward themselves in the future if they are successful in changing their behavior) or self-reward (i.e., prompt people to reward themselves once they have successfully changed their behavior) are techniques that are frequently embedded within complex behavior change interventions. However, it is not clear whether self-incentives or self-rewards per se are effective at bringing about behavior change. Nine databases were searched alongside manual searching of systematic reviews and online research registers. One thousand four hundred papers were retrieved, spanning a range of behaviors, though the majority of included papers were in the domain of health psychology. Ten studies matched the inclusion criteria for self-incentive but no studies were retrieved for self-reward. The present systematic review and meta-analysis is therefore the first to evaluate the unique effect of self-incentives on behavior change. Effect sizes were retrieved from 7 of the 10 studies. Analysis of the 7 studies produced a very small pooled effect size for self-incentives (k = 7, N = 1,161), which was statistically significant, d+ = 0.17, CI [0.06, 0.29]. The weak effect size and dearth of studies raises the question of why self-incentivizing is such a widely employed component of behavior change interventions. The present research opens up a new field of inquiry to establish: (a) whether or not self-incentivizing and self-rewarding are effective behavior change techniques, (b) whether self-incentives and self-rewards need to be deployed alongside other behavior change techniques, and, (c) when and for whom self-incentives and self-rewards could support effective behavior change.

A qualitative interview study of people living with well-controlled Type 1 diabetes

Objective: While many people with Type 1 diabetes find it difficult to achieve recommended blood glucose levels, a minority do achieve good control. Our study was conceived by patient and public (PP) partners and sought to learn about experiences of people living with well-controlled diabetes. Design: A collaboration between academic health psychologists and five PP partners with experience of diabetes, who were trained to conduct and analyse semi-structured interviews. Fifteen adults with well-controlled Type 1 diabetes were interviewed about the history of their diabetes and their current self-management practices. Interviews were subjected to inductive thematic analysis. Results: Eight sub-themes were arranged into two overarching themes, ‘facing up to diabetes’ and ‘balance leads to freedom’. Participants described a process of acceptance and mastery of diabetes, and talked about how they gained a deeper understanding of bodily processes through trial and error. Conclusion: Based on the experiences of people with well-controlled Type 1 diabetes, interventions for people with this condition should encourage acceptance of the diagnosis and increasing confidence to experiment with behaviours (trial and error) to encourage ‘mastery’ of self-management. The research collaboration described here is an example of best practice for future researchers wanting to actively engage PP partners.

Behaviour change opportunities at mother and baby checks in primary care: a qualitative investigation of the experiences of GPs

BACKGROUNDnPregnancy is widely recognised as a teachable moment for healthy behaviour change and the postnatal period has been identified as the opportune time to initiate this change. In the UK, all women are offered a routine health check at 6-8 weeks postpartum with their GP. This provides a potential opportunity to facilitate long-term behaviour change discussions.nnnAIMnTo explore GPs views and experiences of using the postnatal check as a health-related behaviour change opportunity.nnnDESIGN AND SETTINGnA qualitative, inductive study in general practice.nnnMETHODnSemi-structured telephone interviews were conducted with 18 GPs. Audiorecorded interviews were transcribed verbatim and analysed using thematic analysis.nnnRESULTSnOne theme emerged from the data: the postnatal check is an unrealised opportunity to facilitate health-related behaviour change. This theme was organised into three subthemes: opportunity for health-related behaviour change; role responsibility; and patient-led versus GP-led behaviour change.nnnCONCLUSIONnAlthough GPs recognise the postnatal check as a potential opportunity for health-related behaviour change, it is underutilised as they do not perceive this to be the purpose of the check and are uncertain as to their role in facilitating lifestyle changes. To enable this long-term lifestyle behaviour change opportunity to be utilised more fully, further research is needed to understand womens expectations of the postnatal checks and the scope for further recommendations, guidance, and communication training around behaviour change.

Self-Incentives Uniquely Boost Cessation in Community-Based Stop Smoking Programs: Randomized Controlled Trial

BACKGROUNDnSelf-incentives offer a plausible alternative to paying smokers to quit but have not yet been tested in a randomized controlled trial.nnnPURPOSEnThe present study tested whether, compared with a control group, prompting smokers explicitly to self-incentivize if they abstain from smoking for a week or a month encouraged sustained abstinence.nnnMETHODnOne hundred and fifty-nine smokers were recruited from stop smoking clinics and randomized to an active control condition (asked to form a plan to quit, n = 65) or one of two intervention conditions in which they were asked to form implementation intentions designed to ensure that they incentivized themselves if they had not smoked at all by the end of (a) the week (n = 44) or (b) the month (n = 50). The main outcome measure was self-reported abstinence at 3- and 6-month follow-ups, which was biochemically verified at baseline and in a subsample at 3-month follow-up.nnnRESULTSnAt 3-month follow-up, 34% (15/44; p < .05, d = 0.45) and 36% (18/50; p < .05, d = 0.49) of smokers abstained in the weekly and monthly self-incentivizing conditions respectively, compared with 15% (10/65) in the control. The same pattern of findings was observed at 6-month follow-up: 30% (13/44; p < .05, d = 0.35), 34% (17/50; p < .05, d = 0.45) and 15% (10/65) of smokers remained abstinent in the two intervention groups and control group, respectively.nnnCONCLUSIONSnEnsuring that smokers self-incentivized boosted significantly the effectiveness of the stop smoking program. Self-incentivizing implementation intentions could be implemented at low cost with high public health reach to change many health behaviors beyond smoking.nnnTRIAL REGISTRATIONnISRCTN11610200.