Derek R. Rutter

Systematic review of involving patients in the planning and development of health care

Abstract Objective: To examine the effects of involving patients in the planning and development of health care. Data sources:Published and grey literature. Study selection: Systematic search for worldwide reports written in English between January 1966 and October 2000. Data extraction: Qualitative review of papers describing the effects of involving patients in the planning and development of health care. Results: Of 42 papers identified, 31 (74%) were case studies. Papers often described changes to services that were attributed to involving patients, including attempts to make services more accessible and producing information leaflets for patients. Changes in the attitudes of organisations to involving patients and positive responses from patients who took part in initiatives were also reported. Conclusions: Evidence supports the notion that involving patients has contributed to changes in the provision of services across a range of different settings. An evidence base for the effects on use of services, quality of care, satisfaction, or health of patients does not exist.

Attendance and reattendance for breast cancer screening: A prospective 3‐year test of the Theory of Planned Behaviour

Objective. To test the ability of the Theory of Planned Behaviour (TPB) to predict attendance for breast cancer screening and reattendance 3 years later, using data from a prospective longitudinal study. Method. A total of 1215 women who had never had breast screening completed a postal questionnaire sent to them shortly before they were to receive their first invitation for X-ray mammography in the UKs National Health Service Breast Screening Programme. The questionnaire included items to tap attitude, subjective norm, perceived behavioural control and intention to attend. Attendance and then reattendance 3 years later were monitored from screening clinic records. Results. Two main results are reported. (1) Intention and first-time attendance were predicted successfully from the TPB, and attendance was the single predictor of reattendance 3 years later. (2) The TPB was able to distinguish between intenders who attended and those who did nor. Conclusion. The implications of the results are considered both for theory and for policy and practice. Particular attention is paid to the possibility of designing interventions to increase attendance and reattendance.

Predicting and understanding safety helmet use among schoolboy cyclists: A comparison of the theory of planned behaviour and the health belief model

Abstract The paper reports a prospective longitudinal comparison of the Health Belief Model (Rosenstock, 1966) and the Theory of Planned Behaviour (Ajzen, 1985) in which the ability of the models to predict and understand the factors determining use of protective helmets among 162 schoolboy cyclists was examined by path analysis. The TPB emerged with greater economy and less redundancy than the HBM. A second path analysis examined whether intention, which is not included among the original components of the HBM, might mediate the links between the predictor variables and behaviour, and this proved to be correct. Lastly, the effects of prior behaviour were examined and found to have a significant effect on helmet use in both models. It was concluded that the TPB had greater predictive utility than the HBM. The implications of the findings are discussed and suggestions for future research are offered.

Adherence to asthma medication: The role of illness representations.

The current study explores whether cognitive and emotional representations of asthma are associated with adherence to inhaled preventative asthma medication, as predicted by the Self-Regulatory Model (SRM). Three hundred and thirty individuals with asthma completed a questionnaire that assessed their cognitive and emotional representations of asthma and their adherence to prescribed medication. Multiple regression analyses revealed that including components of the SRM significantly improved the prediction of current adherence and intention to adhere in the future. Age, duration of asthma, gender, and components of the SRM were able to predict 28.7% of the variance in current adherence and 16.6% of the variance in intention to adhere. Current adherence was predicted by age, gender, certainty about asthma status, beliefs about antecedent causes, and beliefs about cure-control. Age, beliefs about cure-control, and beliefs about the duration of ones asthma significantly predicted intention to adhere in the future. It is concluded that future research is needed to test the SRM systematically and to explore the added value of incorporating emotional representations alongside cognitive representations. Such research may benefit from utilising innovative means of assessing emotional representations and should include beliefs about treatment. In addition, the possibility that representations of illness may not influence health behaviours linearly or uniformly across individuals should be considered.

Inequalities in pregnancy outcome: A review of psychosocial and behavioural mediators

The purpose of this paper is to review the literature on psychosocial factors in pregnancy outcome and to present a model which attempts to integrate the findings theoretically. There are four sections. The first presents published data on the incidence of early childhood mortality and low birth weight. Changes over time and differences between countries are noted and attention is drawn to the marked inequalities between occupational groups in the British data. The second section reviews the evidence that a variety of psychosocial risk factors influence pregnancy outcome, notably social, emotional, cognitive and behavioural factors. The third section develops the theme of inequalities and examines theories which have been advanced to account for the differences in adult mortality. We argue that material deprivation goes some way towards explaining inequalities in pregnancy outcome, but that any proper account will have to explain the links between inputs and outcomes--the processes and mechanisms by which material deprivation is translated into observable mortality and morbidity. In the concluding section, we argue that some of the principal links are the psychosocial risk factors described in the second section, and we present a model which traces the pathways of mediation.

Persuading school-age cyclists to use safety helmets: Effectiveness of an intervention based on the Theory of Planned Behaviour.

OBJECTIVES: To design and evaluate a theory-based intervention to encourage the use of protective helmets in school-age cyclists. DESIGN: Two-by-three mixed design on 97 cyclists who did not initially use a helmet: Condition (intervention/control) x Time (pre-intervention/immediately post-intervention/5-month follow-up). METHOD: The intervention builds on a previous study using the Theory of Planned Behaviour in which we identified a small number of salient beliefs that predict intention to use a safety helmet and helmet use (Quine et al., 1998). Participants were randomly assigned to intervention or control conditions. The intervention group was presented with a booklet containing a series of persuasive messages based on the identified salient beliefs, and the control group was presented with a different series of messages concerning a cycling proficiency and bicycle maintenance course. Initial beliefs were measured just before the intervention at Time 1, by questionnaire. The immediate effects of the intervention were evaluated by questionnaire at Time 2. Five months later, at Time 3, the long-term effects of the intervention on beliefs, intentions, and behaviour were assessed. RESULTS: The behavioural, normative and control beliefs and intentions of intervention participants became more positive than those of control participants, and the effect was maintained over time. There was also a significant effect on behaviour: at 5-month follow-up, none of the 49 control children had taken up helmet wearing, while 12 (25%) of the 48 intervention children had. CONCLUSIONS: The results suggest that in order to promote lasting helmet use in young cyclists, we need to change their beliefs. The intervention reported here may present an inexpensive solution to the problem of persuading adolescents to use safety helmets. The results point to the value of social cognition theories such as the Theory of Planned Behaviour in the design of effective interventions to change health behaviours.

Do health beliefs predict health behaviour? An analysis of breast self-examination

The purpose of this paper is to explore the relationships between health beliefs and health behaviour. The study we report was conducted as part of a national campaign to evaluate the benefits of breast self-examination in the early detection of breast cancer, and the purpose of our analysis was to test the Health Belief Model of Becker and his colleagues. Three groups of women were investigated--278 who accepted an invitation to attend self-examination classes and were taught the techniques in detail, 262 who declined the invitation and 594 controls to whom no classes were offered--and beliefs and self-reported behaviour were measured shortly before the classes took place and again a year later. The campaign, it emerged, produced marked changes in both beliefs and behaviour, but the relationships between beliefs and behaviour were much weaker than the model had led us to expect and accounted for no more than a quarter of the variance. Alternative models are considered, notably Fishbein and Ajzens Theory of Reasoned Action, and the paper concludes with some suggestions for improving health campaigns.

Discomfort and pain during mammography: description, prediction, and prevention.

OBJECTIVE--To identify the nature of pain and discomfort experienced during mammography and how it can be ameliorated. DESIGN--Questionnaire survey before invitation for mammography and immediately after mammography. Responses before screening were related to experience of discomfort. SETTING--Health district in South East Thames region. SUBJECTS--1160 women aged 50-64 invited routinely for screening; 774 completed first questionnaire, of whom 617 had mammography. 597 completed the second questionnaire. MAIN OUTCOME MEASURES--Reported discomfort and pain, comparisons of discomfort with that experienced during other medical procedures, qualitative description of pain with adjective checklist. RESULTS--35% (206/597) of the women reported discomfort and 6% (37/595) pain. 10 minutes after mammography these figures were 4% (24/595) and 0.7% (4/595) respectively. More than two thirds of women ranked having a tooth drilled, having a smear test, and giving blood as more uncomfortable than mammography. The most important predictor of discomfort was previous expectation of pain (discomfort was reported by 21/32 (66%) women who expected pain and 186/531 (35%) who did not). Discomfort had little effect on satisfaction or intention to reattend. CONCLUSIONS--The low levels of reported pain and discomfort shortly after mammography and the favourable comparisons with other investigations suggest that current procedures are acceptable. Since two thirds of the women experienced less pain than expected health education and promotion must ensure that accurate information is made available and publicized.

Longitudinal Analysis of the Illness Representation Model in Patients with Irritable Bowel Syndrome (IBS)

A prospective longitudinal study explored the illness representation model of patients with irritable bowel syndrome: how representations may change; whether they predict subsequent psychological outcome; and whether any link between representation and outcome may be mediated by coping. Patients were recruited from primary care. Representations were found to be stable over time, and they did predict outcome to some extent, but coping played no part in mediating the link. The findings raise important questions about using the illness representation model with chronic illness, and about the role of coping in the model.

Dedicated community-based services for adults with personality disorder: Delphi study

Dedicated community-based services have been recommended for people with personality disorder, but little is known about how such services should be configured. We conducted a Delphi survey to assess opinions about this. A panel of expert authors, service providers and service users agreed on only 21 (39%) of 54 statements on the organisation and delivery of care. Consensus was not reached on important issues such as working with people with a history of violent offending, the role of community outreach and the use of compulsory treatment. Further work needs to be undertaken before the optimal organisation of dedicated personality disorder services can be agreed.