Jane C. Walsh

The impact of knowledge, perceived barriers and perceptions of risk on attendance for a routine cervical smear

Objectives Cervical cancer is one of the most preventable malignant tumours, and 90% of cases can be identified and treated in its early stages in a simple outpatient procedure. In spite of this, many new cases of cervical cancer are diagnosed each year. The present study examines the impact of knowledge, perceived risk, past experience and perceived barriers on attendance for a routine cervical smear test. Methods The study is based on a sample of over 1,000 women from the Irish Cervical Screening Programme (ICSP) database who were sent a letter of invitation to attend for a smear test. Results The results show that women have relatively poor levels of knowledge about cervical cancer and screening. Significant barriers to attendance included: the perception of having a cervical smear test as time consuming (P < 0.01), causing greater distress (P < 0.01) and being more afraid of the test (P < 0.05). Women who attended for a smear perceived themselves at greater risk of cervical cancer than non-attenders. Conclusions Barriers to attendance should be addressed in programmes that focus on the benefits outweighing the costs of attending for a cervical smear test.

Effect of patients seeing a general practitioner in accident and emergency on their subsequent reattendance: cohort study.

General practitioners working in an accident and emergency department manage non-emergency patients safely and use fewer resources than do usual accident and emergency staff.1 2 In our previous study we speculated that this intervention might have the potential to break the cycle of “inappropriate attendance” at accident and emergency, use of hospital resources, and perceived confirmation of need for a visit.2 We now report the results of a review of the reattendance rates of our original study group. The setting and methodology of our original study have been described.2 In short, patients who had attended St Jamess Hospital accident and emergency department between 1 August 1993 and 1 October 1994 were triaged using a validated system into four categories—“life threatening” (1), “urgent” (2), “semi-urgent” (3), and “delay acceptable” (4). Local general practitioners were employed on a sessional basis to manage patients only from categories 3 and …

Emotional distress and awareness following acquired brain injury: An exploratory analysis

Background: Symptoms of depression and anxiety are commonly reported following brain injury, providing ongoing challenges to patients, clinicians and carers. There is increasing interest in the influence of impaired awareness on emotional distress, supported by psychological investigations. Objective: To explore the relationship between awareness and time since injury on reported emotional distress. Method: Awareness was assessed by comparing the reports of persons with brain injury to the reports of their treating clinicians and significant others. Fifty-four participants with acquired brain injury (ABI) completed the Awareness Questionnaire, the Dysexecutive Questionnaire and the Hospital Anxiety and Depression Scales. Clinicians and significant others completed the Awareness Questionnaire and the Dysexecutive Questionnaire in relation to each participant. Results: Analyses of variance identified a main effect of awareness, such that participants with better awareness of their difficulties had higher emotional distress, regardless of time since injury. Conclusion: Findings support psychological theories suggesting that emotional distress is a response to the stressor of a brain injury and denial of difficulty, manifesting as impaired awareness, may play a protective role. They highlight the importance of understanding a patients level of awareness so as to provide support aimed at minimizing the impact of distress on the rehabilitation outcome.

Determinants of pre‐procedural state anxiety and negative affect in first‐time colposcopy patients: implications for intervention

Women experience significant emotional distress in relation to further diagnostic evaluation of pre-cancerous cell changes of the cervix. However, less is known about the specific variables that contribute to elevated state anxiety and negative affect prior to colposcopy. The study aims to identify psychosocial factors that predict distress in this patient group, which can help in the development of more sophisticated interventions to reduce psychological distress. Socio-demographic variables, scores for state anxiety, negative affect, trait anxiety, fear of pain, coping style, pain-related expectancy and knowledge were assessed in 164 first-time colposcopy patients immediately before the colposcopy examination. Twenty-six per cent of variance in pre-colposcopy state anxiety was significantly explained by marital status, parity, trait anxiety, fear of minor pain and expectations of discomfort. Twenty-nine per cent of variance in pre-colposcopy negative affect was significantly explained by trait anxiety and expectations of pain. Women who are single, have children, are high trait anxious, and anticipate pain and discomfort appear to be at risk for pre-colposcopy distress. Interventions aimed at reducing pre-colposcopy psychological distress should include situation-specific variables that are amenable to change, and trait anxious women are likely to benefit from interventions to reduce distress.

The effect of information and behavioural training on endoscopy patients' clinical outcomes

This study was designed to examine the effects of preparatory information and behavioural training on patients about to undergo an endoscopy procedure. Forty-five first-time endoscopy patients (aged 20-70 years), were randomly assigned to one of three groups (cognitive, cognitive/behavioural and control group). The cognitive group received a 12 min preparation with sensory and procedural information relating to the sensations and sequence of events associated with the endoscopy procedure. The cognitive/behavioural group received, in addition, instruction in deep breathing exercises, tongue depressor task and swallowing technique. Results indicated that patients in the two experimental conditions experienced significantly fewer signs of behavioural distress during endoscopy. The cognitive group required a significantly shorter time to induce the scope. There were no statistical differences between the groups however, for mood, physiological and anxiety measures, although a positive trend was evident for the two intervention groups.

An mHealth Intervention Using a Smartphone App to Increase Walking Behavior in Young Adults: A Pilot Study

Background Physical inactivity is a growing concern for society and is a risk factor for cardiovascular disease, obesity, and other chronic diseases. Objective This study aimed to determine the efficacy of the Accupedo-Pro Pedometer mobile phone app intervention, with the goal of increasing daily step counts in young adults. Methods Mobile phone users (n=58) between 17-26 years of age were randomized to one of two conditions (experimental and control). Both groups downloaded an app that recorded their daily step counts. Baseline data were recorded and followed-up at 5 weeks. Both groups were given a daily walking goal of 30 minutes, but the experimental group participants were told the equivalent goal in steps taken, via feedback from the app. The primary outcome was daily step count between baseline and follow-up. Results A significant time x group interaction effect was observed for daily step counts (P=.04). Both the experimental (P<.001) and control group (P=.03) demonstrated a significant increase in daily step counts, with the experimental group walking an additional 2000 steps per day. Conclusions The results of this study demonstrate that a mobile phone app can significantly increase physical activity in a young adult sample by setting specific goals, using self-monitoring, and feedback.

Attention focus, trait anxiety and pain perception in patients undergoing colposcopy.

Few studies have compared the relative efficacy of attention‐focus strategies in reducing clinical pain. Colposcopy, a medical diagnostic examination performed to identify premalignant cervical cell changes, elicits both anxiety and pain in patients, while allowing little or no behavioural control over the event. Employing a multi‐group experimental design, the present study sought to investigate how different types of attention‐focus strategies impacted upon pain perception, state anxiety and affect, in a sample of 123 colposcopy patients. Patients were randomly assigned to one of three groups: sensory focusing, active distraction and undirected control. Psychometric measures of pre‐colposcopy pain expectancy and dispositional trait anxiety were also taken, in order to assess whether these factors further contributed to outcomes. Overall, when controlling for pain expectancy and trait anxiety, self‐reported pain intensity, sensory pain and affective pain did not differ across groups. Further, there were no significant between‐group differences in colposcopy‐related state anxiety or affect. However, pre‐colposcopy psychometric measures were found to be predictive of a range of outcomes. Pre‐colposcopy pain expectancy, but not trait anxiety, was found to be positively related to colposcopy‐related pain. It was further demonstrated that heightened state anxiety following colposcopy was due to experienced pain and pain unpleasantness, rather than to aspects of the pre‐colposcopy prediction of pain. The results have implications for management of acute clinical pain.

Increasing Screening Uptake for a Cervical Smear Test: Predictors of Attendance and the use of Action Plans in Prior Non-Attenders

Abstract The present study investigated the role of anticipated regret within the framework of the theory of planned behaviour (TPB) in predicting attendance for a cervical smear test in prior non-attenders. The study also examined the effect of “action planning” on attendance for cervical screening in this “at risk” group. The results showed that intention was the only variable consistently related to attendance. The factors that were most predictive of intention were perceived behaviouralcontrol, anticipated regret and, to a lesser degree, subjective norm. Forming an action plan did not increase the likelihood of attendance. Low levels of intention should be addressed as a first step to achieving behaviour change. This might best be achieved by asking women to consider the possible aversive emotional consequences of not attending for a smear, and by developing strategies to foster a sense of personal control over engaging in the behaviour in this target group.

Rehabilitation psychology: Meeting the needs of individuals with acquired disabilities in Ireland

Purpose. The current articles reviews the epidemiology of disability in Ireland, discusses the political and social factors which have increased focus on disability issues and offers training guidelines for rehabilitation psychology based on those of the APAs Rehabilitation Psychology Division. Rationale. With the growing number of individuals with acquired (vs developmental) disabilities in Ireland, there is increased recognition of the need to train psychologists to assist persons with acquired disabilities (e.g. spinal cord injury, acquired brain injury, stroke, etc.) in adjusting to their impairments, reintegrating back into their communities and reducing the long-term financial costs associated with disability. Conclusion. Social and political factors suggest that the time is right to develop rehabilitation psychology as a specialty in Ireland given the increased focus on disability in Ireland, including recently passed disability legislation (i.e. 2005 Disability Bill), international events (e.g. 2003 Dublin World Special Olympics) and increases in rehabilitation training programmes (i.e. medicine; physio, occupational and speech therapy).

Patients’ perceptions of colposcopy pain

This study aimed to examine the sensory descriptors used by women undergoing their first ever colposcopy examination as part of cervical cancer screening. Immediately following colposcopy, women were asked to provide detailed information about the sensory, affective, evaluative and intensity properties of the colposcopy examination using a validated, standardised questionnaire. Overall, 160 colposcopy patients with different management options were assessed [53 women underwent diagnostic colposcopy only, 76 had colposcopy plus punch biopsy, 31 women had colposcopy plus see-and-treat large loop excision of the transformation zone (LLETZ) treatment]. The results demonstrated that women report greater pain intensity with more intensive management options, such that women who have punch biopsy or LLETZ treatment report significantly more pain than women who have diagnostic colposcopy. In addition, with increasing intensity of treatment, the number of qualitative sensory and pain descriptors increase. This information can usefully be incorporated into colposcopy information leaflets, to ensure the sensory and affective experience of colposcopy is fully explained to women prior to attending. Expanding the preparatory information that women receive may serve to reduce anxiety, pain and distress associated with colposcopy.