Emma Scott

The theory of planned behaviour predicts self‐reports of walking, but does not predict step count

OBJECTIVES This paper compares multiple measures of walking in two studies, and the second study compares how well Theory of Planned Behaviour (TPB) constructs perform in predicting these different measures. METHODS In Study 1, 41 participants wore a New Lifestyles NL-2000 pedometer for 1 week. Subsequently, participants completed a questionnaire containing measures of the TPB constructs and two self-report measures of walking, followed by two interview measures of walking. For Study 2, 200 RAF trainee aircraftsmen wore pedometers for 2 weeks. At the end of each week, participants completed the questionnaire and interview measures of walking. RESULTS Both studies found no significant association between questionnaire measures of walking and pedometer measures. In Study 1, the interview measures produced significant, large correlations with the pedometer measure, but these relationships were markedly weaker in the second study. TPB variables were found to explain 22% of variance in intention to walk in Study 1 and 45% of the variance in Study 2. In Study 2, prediction of subsequent measures of behaviour was found to be weak, except when using a single-item measure of walking. CONCLUSIONS Recall of walking is poor, and accurate measurement by self-report is problematic. Although the TPB predicts intentions to walk well, it does not predict actual amount of walking, as assessed by pedometer. Possible reasons for these findings include the unique nature of walking as an activity primarily used to facilitate higher order goals. The use of single-item measures may exaggerate the effectiveness of the TPB model for walking, and possibly other forms of physical activity.

Using the affective priming paradigm to explore the attitudes underlying walking behaviour.

UNLABELLED Objectives. Walking is poorly represented in memory, making it difficult to measure using self-report and even harder to predict. To circumvent this, we used the affective priming paradigm (Fazio, Sanbonmatsu, Powell, & Kardes, 1986) to assess implicit attitudes towards walking. METHODS Royal Air Force trainee aircraftsmen (N=188) wore pedometers for 1 week prior to completing the affective priming paradigm, questionnaire and interview. The affective priming paradigm involved a computer-based response latency task containing physical activity words as primes followed by adjectives as targets to be evaluated. Targets were drawn from two bipolar dichotomies, good-bad (the original Fazio et al. items) and happy-sad (mood). RESULTS Priming for mood items was related to levels of physical activity with high frequency participants priming for the positive (happy) pole and low frequency participants priming for the negative (sad). Both groups primed for the negative element of the Fazio (good-bad) dichotomy. Regarding walking and running, there was no differentiation on the basis of participation level. Instead, facilitated responses to happy targets contrasted with inhibited responses to sad targets for both types of locomotion. There was weak evidence that intentions to run were associated with priming of positive target items, irrespective of category. CONCLUSIONS The relationship between implicit attitudes and behaviour is complex. Whereas implicit attitudes were related to overall exercise participation, they were not related to the specific activity of walking, despite the behaviour being mainly under automatic control.

Exploring the relationship between baseline physical activity levels and mortality reduction associated with increases in physical activity: a modelling study

Background Increasing physical activity (PA) levels among the general adult population of developed nations is important for reducing premature mortality and the burdens of preventable illness. Assessing how effective PA interventions are as health interventions often involves categorising participants as either ‘active’ or ‘sedentary’ after the interventions. A model was developed showing that doing this could significantly misestimate the health effect of PA interventions. Methods A life table model was constructed combining evidence on baseline PA levels with evidence indicating the non-linear relationship between PA levels and all-cause mortality risks. PA intervention scenarios were modelled which had the same mean increase in PA but different levels of take-up by people who were more active or more sedentary to begin with. Results The model simulations indicated that, compared with a scenario where already-active people did most of the additional PA, a scenario where the least active did the most additional PA was around a third more effective in preventing deaths between the ages of 50 and 60 years. The relationship between distribution of PA take-up and health effect was explored systematically and appeared non-linear. Conclusions As the health gains of a given PA increase are greatest among people who are most sedentary, smaller increases in PA in the least active may have the same health benefits as much larger PA increases in the most active. To help such health effects to be assessed, PA studies should report changes in the distribution of PA level between the start and end of the study.

Accessibility of salient beliefs about the outcomes of physical activity

OBJECTIVES Attitudes may influence behaviour through both deliberative and automatic processes. To investigate the automatic influences of attitudes, this study explores the accessibility of modally salient beliefs about physical activity outcomes using response latency measures. DESIGN Response latencies for modally salient beliefs for physically activity outcomes were compared with latencies for non-salient, hygiene outcomes. Possible relationships between self-report and response latency was assessed between- and within-subjects. METHOD Regularly active participants (N=148) completed a computer-based response latency task in which they indicated whether an outcome, for example more fit, was a likely or unlikely consequence of six different physical activities, for example go running. Self-reports of the likelihood of these outcomes, their importance, intentions to participate in the physical activities and frequency of participation were obtained. RESULTS As expected, the physical activity outcomes were more accessible than control outcomes. In addition, the outcome strong heart was less accessible than the outcomes more fit and have fun. There was only weak evidence, however, of any relationship between self-reports and the accessibility of the physical activity outcomes. CONCLUSION Response latency data may represent a source of between-subject variation that differs from self-report. Discussion focuses on the possible origins of such a discrepancy.

Factors influencing career intentions on completion of general practice vocational training in England: a cross-sectional study

Objectives General practice is experiencing a growing crisis with the numbers of doctors who are training and then entering the profession in the UK failing to keep pace with workforce needs. This study investigated the immediate to medium term career intentions of those who are about to become general practitioners (GPs) and the factors that are influencing career plans. Design Online questionnaire survey, with quantitative answers analysed using descriptive statistics and free text data analysed using a thematic framework approach. Setting and participants Doctors approaching the end of 3-year GP vocational training in the West Midlands, England. Results 178 (57.2%) doctors completed the survey. Most participants planned to work as salaried GPs or locums rather than entering a general practice partnership for at least the first 5 years post-completion of training; others failed to express a career plan or planned to leave general practice completely or work overseas. Many were interested in developing portfolio careers. The quality of general practice experience across undergraduate, foundation and vocational training were reported as influencing personal career plans, and in particular perceptions about workload pressure and morale within the training practices in which they had been placed. Experience of a poor work–life balance as a trainee had a negative effect on career intentions, as did negative perceptions about how general practice is portrayed by politicians and the media. Conclusion This study describes a number of potentially modifiable factors related to training programmes that are detrimentally influencing the career plans of newly trained GPs. In addition, there are sociodemographic factors, such as age, gender and having children, which are also influencing career plans and so need to be accommodated. With ever-increasing workload in general practice, there is an urgent need to understand and where possible address these issues at national and local level.

Childhood bullying: implications for general practice

The theme for 2016’s anti-bullying week (14–18 November) is ‘Power for Good’, with all adults who have positions of responsibility for young people being encouraged to: ‘... use their Power for Good … by valuing the difference they can make in a child’s life, and taking individual and collective action to prevent bullying and create safe environments for children to thrive.’ 1 How should general practice in the UK respond to this call to action? Bullying is a systematic abuse of power characterised by repeated psychological or physical aggression with the intention to cause distress to another person. It is a major risk factor for both acute and long-term physical and mental health problems, as well as educational and social development.2 Bullied children are twice as likely as their non-bullied peers to experience ill-defined symptoms, such as headaches, abdominal pain, or sleep problems,3 and are at substantially increased risk of psychiatric disorders, including depression, self-harm, eating disorders, and suicide.4 The negative effects of childhood bullying are seen worldwide and persist into adulthood with ongoing mental health and socioeconomic effects that are similar to those caused by adult abuse or maltreatment.5 Although young people who are being bullied are likely to have greater healthcare needs than their non-bullied peers, research into how the experience of being bullied affects presentation at GP services and consultation rates is lacking.6 Bullying is common, with over one-half of school-aged children having had experience of being bullied.7 It affects children of both primary and secondary school age and, although often perceived as a school-based problem, childhood …

Improving best practise for patients receiving hospital discharge letters: a realist review protocol.

Introduction Discharge documents are important for transferring information from hospitals to the referring clinician; in the UK and many countries, this is often the patient’s general practitioner or family physician. However, patients may or may not receive their discharge letters, and whether patients should routinely receive discharge letters remains unclear. Methods and analysis The review will consolidate evidence on patients receiving discharge letters through the theory-driven approach of a realist review. The review will be conducted systematically and seek to explain how, why, for whom and in what contexts does this practice ‘work’. The review will specifically explore whether there are benefits of this practice and if so what are the important contexts for triggering the mechanisms associated with these outcome benefits. Negative effects will also be considered. Several steps will occur: devising initial rough programme theory, searching the evidence, selecting relevant documents, extracting data, synthesising and finally programme theory refinement. As the process is viewed as iterative, this cycle of steps may be repeated as many times as is necessary to reach theoretical saturation and may not be linear. The initial programme theory will be tested and refined throughout the review process and by stakeholder involvement of National Health Service (NHS) policy makers, practitioners and service users. Ethics and dissemination Formal ethical review is not required. The resulting programme theory is anticipated to explain how the intervention of patients receiving written discharge communication may work in practice, for whom and in what contexts; this will inform best practice of patients receiving discharge communication. The review findings will be disseminated in a peer-reviewed journal and presentations and discussions with relevant organisations and stakeholders. While the review will be from the perspective of the UK NHS, its findings should be relevant to other healthcare systems. PROSPERO registration number CRD42017069863.