Ian Zajac

Preliminary Validation of a New Clinical Tool for Identifying Problem Video Game Playing

Research has estimated that between 6 to 13% of individuals who play video games do so excessively. However, the methods and definitions used to identify “problem” video game players often vary considerably. This research presents preliminary validation data for a new measure of problematic video game play called the Problem Video Game Playing Test (PVGT). Two studies were conducted: an online survey of 373 university student video game players, and a paper-and-pencil survey of 416 video game players from video game outlets and LAN businesses. This paper presents the internal consistency, score distribution, convergent validity and dimensionality of the PVGT. The PVGT demonstrates potential as a continuous measure of problem video game playing. Future research should investigate the use of the PVGT as a clinical instrument for screening individuals whose video game playing may be considered excessive or personally detrimental.

Psychosocial Variables Associated with Colorectal Cancer Screening in South Australia

BackgroundPopulation screening reduces mortality from colorectal cancer, yet factors associated with uptake of screening are incompletely understood.PurposeThe purpose of the study was to determine demographic and psychosocial factors associated with participation in faecal occult blood test (FOBT)-based colorectal cancer (CRC) screening in an average risk community programme in Adelaide, South Australia.MethodA questionnaire consistent with the Preventive Health Model was used to determine demographic and psychosocial differences between previous FOBT-based screening participants (n = 413, response rate 93.2%) and non-participants (n = 481, response rate 47.9%). Results were analysed by univariate and multivariate generalised linear modelling, and factors associated with participation were identified.ResultsFactor analysis of psychosocial items revealed an optimal three-factor solution (knowledge, faecal aversion, belief in the value of screening). Following multivariate analyses, two psychosocial and two demographic factors remained as predictors of FOBT screening behaviour: (1) items related to faecal aversion (Aversion), relative risk (RR) = 0.61, CI = 0.55–0.69, (2) perceptions about the value of screening (Value), RR = 1.45, CI = 1.13–1.85, (3) age band 65–69 (Age, five age bands, relative to age 50–54), RR = 1.43, CI = 1.16–1.76 and FOBT type (Test; three tests, Hemoccult®, FlexSure®, InSure® randomly assigned, relative to Hemoccult®: FlexSure®: RR = 1.41, CI = 1.17–1.71, InSure®: RR = 1.76, CI = 1.47–2.11.ConclusionsThe psychosocial factors associated with non-participation in FOBT-based CRC screening are amenable to interventions designed to improve participation. The small relative risks values associated with each predictor, however, raise the possibility that additional factors are likely to influence screening participation.

Internet usage and openness to internet-delivered health information among Australian adults aged over 50 years

BACKGROUND The cost of healthcare in Australias ageing population is ever increasing. In an attempt to reduce these rising costs, the internet has been suggested as a possible means of disseminating health-related information and promoting preventive health behaviours. OBJECTIVE Our objective was to determine the proportion of Australians aged 50-74 years who have internet access, and the characteristics of internet usage, current online health information seeking behaviour, and the willingness to receive unsolicited health information via the Internet. METHOD A random sample of N=25,511 urban older Australians aged 50 to 74 years received a questionnaire via mail and were asked to complete questions concerning variables related to internet usage. N=8,762 returned a competed questionnaire. RESULTS Eighty-two per cent of respondents reported having internet access, mainly at home (94%), and the majority actively use this technology (93%). Younger people and those of higher socio-economic status and higher education were more likely to have access (p<.001). Approximately 61% reported actively seeking health-related information online but only 32% expressed a willingness to receive unsolicited health information via the internet. Females were more likely to currently search for health-related information than males but were less likely to be open to receiving unsolicited health information (both p<.001). CONCLUSION According to the data it appears the majority of urban Australians aged over 50 have access to the internet at some location and 60% of them use the internet for health-related purposes. The data also suggests, however, that delivering health information via the internet alone would disadvantage those who are older, less educated, and less financially well-off.

Decision Support and the Effectiveness of Web-based Delivery and Information Tailoring for Bowel Cancer Screening: An Exploratory Study

Background Colorectal cancer (CRC) is the third most commonly diagnosed cancer in males and the second in females throughout the developed world. Population screening using fecal occult blood tests (FOBTs) facilitates early detection and greater chance of survival, but participation rates are low. We developed a Web-based decision tool to provide information tailored to an individual’s decision stage for CRC screening and attitude toward screening utilizing the Preventive Health Model (PHM) and Precaution Adoption Process Model (PAPM) as theoretical frameworks for screening behavior. We describe the practical steps employed in the tool’s design and the subsequent conduct of an exploratory study. Objective To design a decision tool for CRC screening and conduct an exploratory study among average-risk men and women to (1) test the impact of message type (tailored vs non-tailored) and message delivery modality (Web-based vs paper-based) on attitudes toward screening and screening uptake, and (2) investigate the acceptability of the decision tool and relevance of materials. Methods Participants (n = 100), recruited from a population sample of men and women aged 50-76 residing in urban Adelaide, Australia, were randomly assigned to a control group or one of 4 interventions: (1) Web-based and tailored information, (2) paper-based and tailored information, (3) Web-based and non-tailored (generic) information, or (4) paper-based and non-tailored information. Participation was augmented by snowball recruitment (n = 19). Questionnaires based on PHM variables were administered pre- and post-intervention. Participants were given the opportunity to request an FOBT. Following the intervention, participants discussed the acceptability of the tool. Results Full data were available for 87.4% (104/119) of participants. Post-intervention, perceived susceptibility scores for individuals receiving tailored information increased from mean 10.6 (SD 2.1) to mean 11.8 (SD 2.2). Scores on self-efficacy increased in the tailored group from mean 11.7 (SD 2.0) to mean 12.6 (SD 1.8). There were significant time x modality x message effects for social influence and salience and coherence, reflecting an increase in these scores for tailored Web-based participants only; social influence scores increased from mean 11.7 (SD 2.6) to mean 14.9 (SD 2.3), and salience and coherence scores increased from mean 16.0 (SD 2.2) to mean 17.7 (SD 2.1). There was no greater influence of modality or message type on movement toward a decision to screen or screening uptake, indicating that neither tailored messages nor a Web modality had superior effect. Overall, participants regarded tailored messages positively, but thought that the Web tool lacked “media richness.” Conclusions This exploratory study confirms that tailoring on PHM predictors of CRC screening has the potential to positively address attitudes toward screening. However, tailoring on these variables did not result in significantly increased screening uptake. Future research should consider other possible psychosocial influences. Mode of delivery did not affect outcomes, but as a delivery medium, the Web has economic and logistical advantages over paper.

Is Hope or Mental Illness a Stronger Predictor of Mental Health

Health promotion strategies often focus on the prevention or alleviation of mental illness in an attempt to indirectly promote mental health. But, while the absence of mental illness may be a consequence of mental health, it does not necessarily signal or lead to mental health (Keyes & Lopez, 2002), suggesting that a focus on mental illness may not be the optimal way to promote mental health. The current study adopted a positive psychological approach and tested whether hope was a stronger predictor of mental health in young people than was mental illness. Confirmatory factor analysis was used to test the proposed model, and data were drawn from a sample of young South Australians (N = 3913; 1317 years). The results indicated that hope was a significantly stronger predictor of mental health than was mental illness. These results have implications for the content of strategies to promote mental health in young people.

Self-reported bowel screening rates in older Australians and the implications for public health screening programs.

BACKGROUND This paper sought to determine the status of older Australians with regard to Bowel Cancer screening practices occurring outside of the National Bowel Cancer Screening Program. METHOD A random sample of N=25,511 urban Australians aged 50 to 74 years received a questionnaire via mail asking questions relating to bowel screening. N=8,762 (34.3%) returned a completed questionnaire. RESULTS Approximately 33% (N=2863) of respondents indicated they had undergone colonoscopy in the preceding five years and 21% (N=1840) had used a Faecal Occult Blood Test (FOBT) in the preceding 12 months. Furthermore, 27% (N=497) of those who had completed an FOBT had also undergone colonoscopy. CONCLUSION A significant proportion of older Australians might be participating in bowel screening practices outside of the national program (NBCSP). Moreover, the proportion of individuals reporting use of both FOBT and endoscopic services is much higher than the positivity rate of FOBT. Large population FOBT screening programs, such as the NBCSP, that do not consider participation in screening external to the program may underestimate true population screening rates.

Measuring Auditory Inspection Time in Primary School Children

This study investigated the relationship between visual inspection time (VIT) and a new measure of auditory inspection time (AIT: see Parker, Crawford, & Stephen, 1999). The purpose was twofold: first, to understand the generality of the mechanism underpinning performance on visual IT tasks (VIT); second, to evaluate the efficacy of this new auditory task. Participants were 80 primary school children aged 10–12 years. They each completed AIT, VIT, and a marker test for each of general speediness (Gs), fluid ability (Gf), and crystallized ability (Gc). AIT and VIT were positively correlated with each other, and they both correlated with the marker of Gs. However, the data suggest that the nature of IT tasks changes as task difficulty increases. Thus, IT appears to be a purer measure of processing speed at longer exposure durations. These findings are discussed in relation to the methodology employed in IT estimation and in light of recent comments concerning the psychological complexity of IT.

Ambivalence and Its Influence on Participation in Screening for Colorectal Cancer

Colorectal cancer (CRC) is one of the most prevalent cancers worldwide, and an ideal target for early detection and prevention through cancer screening. Unfortunately, rates of participation in screening are less than adequate. In this article we explore why people who were offered a fecal immunochemical test for CRC decided to participate or not, and for those who did participate, what influenced them to take action and complete the test. We conducted four focus groups and 30 telephone interviews with 63 people. The main reason people decided to screen was “wanting to know” their CRC status, which operated on a continuum ranging from wanting to know, through varying degrees of ambivalence, to not wanting to know. The majority of participants expressed ambivalence about CRC screening, and the main cue to action was the opportunity to screen without being too inconvenienced.

Comparison of mailed invitation strategies to improve fecal occult blood test participation in men: protocol for a randomized controlled trial

BackgroundMen have a significantly increased risk of being diagnosed with, and dying from, colorectal cancer (CRC) than women. Men also participate in fecal occult blood test (FOBT) screening at a lower rate than women. This study will determine whether strategies that target men’s attitudes toward screening, and matched to stage of readiness to screen, increase men’s FOBT participation compared to a standard approach.Methods/DesignEligible trial participants will be a national sample of 9,200 men aged 50 to 74 years, living in urban Australia and randomly selected from the Australian electoral roll. Trial participants will be mailed an advance notification letter, followed 2 weeks later by an invitation letter and a free fecal immunochemical test (FIT) kit. The intervention is a factorial design, randomized controlled trial (RCT) with four trial arms, including a control. The content of the advance notification and invitation letters will differ by trial arm as follows: 1) standard advance notification and standard invitation (control arm); 2) targeted advance notification and standard invitation; 3) standard advance notification and targeted invitation; and 4) targeted advance notification and targeted invitation. The standard letters will replicate as closely as possible the letters included in the Australian National Bowel Cancer Screening Program (NBCSP). Modified advance notification and invitation letters will incorporate additional messages to target men in the precontemplation (advance notification) and contemplation stages (invitation). The primary outcome is return of the completed FIT within 12 weeks of invitation. Analysts will be blinded to trial assignment and participants will be blinded to the use of varying invitational materials. Subsamples from each trial arm will complete baseline and endpoint surveys to measure the psychological impact of the intervention, and qualitative interviews will be conducted to evaluate attitudes toward the intervention.DiscussionThe outcomes of this study will have implications for the way FOBT screening is offered to men. Findings will help to identify how invitations for men to screen should be framed and delivered in order to maximize participation.Trial registrationAustralian New Zealand Clinical Trials Registry: ACTRN12612001122842

The impact of preparatory activities on medical school selection outcomes: a cross-sectional survey of applicants to the university of Adelaide medical school in 2007

BackgroundSelection into medical school is highly competitive with more applicants than places. Little is known about the preparation that applicants undertake for this high stakes process. The study aims to determine what preparatory activities applicants undertake and what difficulties they encounter for each stage of the application process to medical school and in particular what impact these have on the outcome.MethodsA cross-sectional survey of 1097 applicants who applied for a place in the University of Adelaide Medical School in 2007 and participated in the UMAT (Undergraduate Medicine and Health Sciences Admission Test) and oral assessment components of the selection process. The main outcome measures were an offer of an interview and offer of a place in the medical school and were analysed using logistic regression.ResultsThe odds of a successful outcome increased with each additional preparatory activity undertaken for the UMAT (odds ratio 1.22, 95% confidence interval 1.11 to 1.33; P < 0.001) and the oral assessment (1.36, 1.19 to 1.55; P < 0.001) stage of selection. The UMAT preparatory activities associated with the offer of an interview were attendance of a training course by a private organisation (1.75, 1.35 to 2.27: P < 0.001), use of online services of a private organisation (1.58, 1.23 to 2.04; P < 0.001), and familiarising oneself with the process (1.52, 1.15 to 2.00; p = 0.021). The oral assessment activities associated with an offer of a place included refining and learning a personal resume (9.73, 2.97 to 31.88; P < 0.001) and learning about the course structure (2.05, 1.29 to 3.26; P = 0.022).For the UMAT, applicants who found difficulties with learning for this type of test (0.47, 0.35 to 0.63: P < 0.001), with the timing of UMAT in terms of school exams (0.48, 0.5 to 0.66; P < 0.001) and with the inability to convey personal skills with the UMAT (0.67, 0.52 to 0.86; P = 0.026) were significantly less likely to be offered an interview.ConclusionsMedical schools make an enormous effort to undertake a selection process that is fair and equitable and which selects students most appropriate for medical school and the course they provide. Our results indicate that performance in the selection processes can be improved by training. However, if these preparatory activities may be limited to those who can access them, the playing field is not even and increasing equity of access to medical schools will not be achieved.