Lucy Yardley

Using the Internet to Promote Health Behavior Change: A Systematic Review and Meta-analysis of the Impact of Theoretical Basis, Use of Behavior Change Techniques, and Mode of Delivery on Efficacy

Background The Internet is increasingly used as a medium for the delivery of interventions designed to promote health behavior change. However, reviews of these interventions to date have not systematically identified intervention characteristics and linked these to effectiveness. Objectives The present review sought to capitalize on recently published coding frames for assessing use of theory and behavior change techniques to investigate which characteristics of Internet-based interventions best promote health behavior change. In addition, we wanted to develop a novel coding scheme for assessing mode of delivery in Internet-based interventions and also to link different modes to effect sizes. Methods We conducted a computerized search of the databases indexed by ISI Web of Knowledge (including BIOSIS Previews and Medline) between 2000 and 2008. Studies were included if (1) the primary components of the intervention were delivered via the Internet, (2) participants were randomly assigned to conditions, and (3) a measure of behavior related to health was taken after the intervention. Results We found 85 studies that satisfied the inclusion criteria, providing a total sample size of 43,236 participants. On average, interventions had a statistically small but significant effect on health-related behavior (d+ = 0.16, 95% CI 0.09 to 0.23). More extensive use of theory was associated with increases in effect size (P = .049), and, in particular, interventions based on the theory of planned behavior tended to have substantial effects on behavior (d+ = 0.36, 95% CI 0.15 to 0.56). Interventions that incorporated more behavior change techniques also tended to have larger effects compared to interventions that incorporated fewer techniques (P < .001). Finally, the effectiveness of Internet-based interventions was enhanced by the use of additional methods of communicating with participants, especially the use of short message service (SMS), or text, messages. Conclusions The review provides a framework for the development of a science of Internet-based interventions, and our findings provide a rationale for investing in more intensive theory-based interventions that incorporate multiple behavior change techniques and modes of delivery.

Dilemmas in qualitative health research

Abstract As the use of qualitative methods in health research proliferates, it becomes increasingly necessary to consider how the value of a piece of qualitative research should be assessed. This article discusses the problem posed by the novelty and diversity of qualitative approaches within health psychology and considers the question of what criteria are appropriate for assessing the validity of a qualitative analysis. In keeping with the ethos of much qualitative research, some open-ended, flexible principles are suggested as a guide to the quality of a qualitative study: sensitivity to context; commitment and rigour; transparency and coherence; impact and importance. Examples are given of the very different ways in which various forms of qualitative research can meet these criteria.

Qualitative research in psychology: expanding perspectives in methodology and design

Qualitative methodologies and the different paradigms which guide them can be seen as both an alternative and complementary approach to quantification and positivism in social, personality, developmental, health, clinical, couselling, community and school psychology. Qualitative methodology seen as an alternative approach seeks to answer questions that cannot be answered through quantification, random sampling, probability testing and other measures, which seek to control the environment of the participant. Viewed as a complementary approach to research, qualitative methodology can be utilized alongside quantitative methods, bringing a new depth and richness to data analysis. The variety of innovative techniques and theoretical perspectives offered in this volume should challenge readers to think about and expand on their understanding of qualitative research and its continually emerging applications

Research methods for clinical and health psychology

Introduction to Research Methods in Clinical and Health Psychology - Lucy Yardley and David F Marks Getting Started - Nichola Rumsey and David F Marks The Practicalities of Doing Research Qualitative Data Collection - Sue Wilkinson, H[ac]el[gr]ene Joffe and Lucy Yardley Interviews and Focus Groups Content and Thematic Analysis - H[ac]el[gr]ene Joffe and Lucy Yardley Qualitative Analysis of Experience - Kerry Chamberlain, Paul Camic and Lucy Yardley Grounded Theory and Case Studies Qualitative Analysis of Talk and Text - Lucy Yardley and Michael Murray Discourse and Narrative Analysis Observation and Action Research - Claire Ballinger, Lucy Yardley and Sheila Payne Questionnaires and Surveys - David F Marks Analysis of Questionnaire and Survey Data - David Clark-Carter and David F Marks Intervention Studies - David Clark-Carter and David F Marks Design and Analysis Synthesising Evidence - David F Marks and Catherine Marie Sykes Systematic Reviews, Meta-Analysis and Preference Analysis

Opportunities and Challenges for Smartphone Applications in Supporting Health Behavior Change: Qualitative Study

Background There is increasing interest from academics and clinicians in harnessing smartphone applications (apps) as a means of delivering behavioral interventions for health. Despite the growing availability of a range of health-related apps on the market, academic research on the development and evaluation of such apps is in the relatively early stages. A few existing studies have explored the views of various populations on using mobile phones for health-related issues and some studies are beginning to report user feedback on specific apps. However, there remains little in depth research on users’ (and potential users’) experiences and views on a wide range of features and technologies that apps are, or will soon be, capable of. In particular, research on young adults is lacking, which is an unfortunate omission considering that this group comprises of a good number of mobile technology adoptors. Objective The current study sought to explore young adults’ perspectives on apps related to health behavior change. It sought their experiences and views of features that might support health behavior change and issues that contribute to interest in and willingness to use such apps. Methods Four focus groups were conducted with 19 students and staff at a University in the United Kingdom. Participants included 13 females and 6 males with a mean age of 23.79 (SD 7.89). The focus group discussions centred on participants’ experiences of using smartphone apps to support a healthy lifestyle, and their interest in and feelings about features and capabilities of such apps. The focus groups were recorded, transcribed, and analyzed using inductive thematic analysis. Results Study findings suggested that young, currently healthy adults have some interest in apps that attempt to support health-related behavior change. Accuracy and legitimacy, security, effort required, and immediate effects on mood emerged as important influences on app usage. The ability to record and track behavior and goals and the ability to acquire advice and information “on the go” were valued. Context-sensing capabilities and social media features tended to be considered unnecessary and off-putting. Conclusions This study provided insight into the opportunities and challenges involved in delivering health-related behavioral interventions through smartphone apps. The findings suggested a number of valued features and characteristics that app developers may wish to consider when creating health behavior apps. Findings also highlighted several major challenges that appeared to need further consideration and research to ensure the development of effective and well-accepted behavior change apps.

Interventions to Reduce Fear of Falling in Community‐Living Older People: A Systematic Review

The objective was to assess which interventions effectively reduce fear of falling in community‐living older people. An extensive search for relevant literature comprised a database search of PubMed, EMBASE, PsycINFO, and the Cochrane Central Register of Controlled Trials; expert consultation; and manually searching reference lists from potentially relevant papers. Randomized, controlled trials that assessed fear of falling in community‐living older people were included. Two independent reviewers extracted data from full papers on study characteristics, methodological quality, outcomes, and process characteristics of the intervention. The search identified 599 abstracts, and 19 papers met the inclusion criteria. Seven of those papers were identified using expert consultation. Fifty‐five percent of all validity items and 39% of process characteristic items were fulfilled across the 19 trials. Twelve of the 19 papers were of higher methodological quality. In 11 of these trials, fear of falling was lower in the intervention group than in the control group. Interventions that showed effectiveness were fall‐related multifactorial programs (n=5), tai chi interventions (n=3), exercise interventions (n=2), and a hip protector intervention (n=1). Three of these interventions explicitly aimed to reduce fear of falling. Several interventions, including interventions not explicitly aimed at fear of falling, resulted in a reduction of fear of falling in community‐living older people. Limited but fairly consistent findings in trials of higher methodological quality showed that home‐based exercise and fall‐related multifactorial programs and community‐based tai chi delivered in group format have been effective in reducing fear of falling in community‐living older people.

Symptoms, anxiety and handicap in dizzy patients: Development of the Vertigo symptom scale

Questionnaires assessing symptoms, anxiety and handicap were completed by 127 vertiginous patients. Factor analysis identified four distinct symptom clusters which formed the basis for the construction of scales quantifying the number and frequency of symptoms of: (a) vertigo (of long and short duration); (b) autonomic sensations and anxiety arousal; and (c) somatization. Scores on the vertigo severity scale were significantly related to clinical diagnosis and had near-zero correlations with measures of anxiety. Vertigo severity, autonomic signs and depressed mood each independently contributed to variance in handicap, taking precedence over the relationship between handicap and trait and state anxiety. Our findings suggest that the familiar association between anxiety and vertigo may be mediated principally by autonomic symptomatology arising as a result of somatopsychic and psychosomatic processes.

Visual influences on balance

This paper discusses the impact of vision on balance and orientation in patients with vestibular disorders and in anxiety patients with space and motion discomfort (SMD). When the vestibular system is impaired, vision has a greater influence on standing postural control, resulting in greater sway when individuals are presented with erroneous or conflicting visual cues. Studies have shown that individuals with other motion sensitivities, such as motion sickness, also tend to rely on vision for balance and do not disregard erroneous visual cues. Recently, patients with anxiety disorders that include SMD also have been shown to have increased postural sway in conflicting visual environments, similar to patients with vestibular disorders. Thus, while specific vestibular deficits are not always directly associated with SMD, data regarding the impact of vision on balance suggest that some patients with SMD may have an underlying balance disorder.

A Systematic Review of Beliefs Involved in the Use of Complementary and Alternative Medicine

People might be attracted to and use complementary and alternative medicines (CAM) because they hold beliefs that are congruent with CAM. This article collates, examines and synthesizes the evidence surrounding this hypothesis. Most studies are cross-sectional and focus on a limited number of beliefs. Multivariate studies suggest that beliefs related to control and participation, perceptions of illness, holism and natural treatments, and general philosophies of life predict CAM use when controlling for demographic and clinical factors. Further research should examine the robustness of these relationships in different illness groups and the prospective relationships among beliefs and CAM use over time.

Factors associated with uptake of vaccination against pandemic influenza: a systematic review.

BACKGROUND In June 2009 a global influenza pandemic was declared by the World Health Organisation. A vaccination programme against H1N1 influenza was introduced in many countries from September 2009, but there was low uptake in both the general population and health professionals in many, though not all, countries. PURPOSE To examine the psychological and demographic factors associated with uptake of vaccination during the 2009 pandemic. METHOD A systematic literature review searching Web of Science and PubMed databases up to 24 January 2011. RESULTS 37 articles met the study inclusion criteria. Using the framework of Protection Motivation Theory the review found that both the degree of threat experienced in the 2009 pandemic influenza outbreak and perceptions of vaccination as an effective coping strategy were associated with stronger intentions and higher uptake of vaccination. Appraisal of threat resulted from both believing oneself to be at risk from developing H1N1 influenza and concern and worry about the disease. Appraisal of coping resulted from concerns about the safety of the vaccine and its side effects. There was evidence of an influence of social pressure in that people who thought that others wanted them to be vaccinated were more likely to do so and people getting their information about vaccination from official health sources being more likely to be vaccinated than those relying on unofficial sources. There was also a strong influence of past behaviour, with those having been vaccinated in the past against seasonal influenza being more likely to be vaccinated against pandemic influenza. Demographic factors associated with higher intentions and uptake of vaccination were: older age, male gender, being from an ethnic minority and, for health professionals, being a doctor. DISCUSSION Interventions designed to increase vaccination rates could be developed and implemented in advance of a pandemic. Strategies to improve uptake of vaccination include interventions which highlight the risk posed by pandemic influenza while simultaneously offering tactics to ameliorate this risk (e.g. vaccination). Perceived concerns about vaccination can be tackled by reducing the omission bias (a perception that harm caused by action is worse than harm caused by inaction). In addition, interventions to increase seasonal influenza vaccination in advance of a future pandemic may be an effective strategy.