Marie Johnston

Application of the Theory of Planned Behaviour in Behaviour Change Interventions: A Systematic Review

This paper reviews studies explicitly applying the Theory of Planned Behaviour (TPB) to behaviour change interventions. A systematic and multiple search strategy identified 30 papers, describing 24 distinct interventions. Studies were rarely explicit about use of the TPB. The TPB was mainly used to measure process and outcome variables and to predict intention and behaviour, and less commonly to develop the intervention. Behaviour change methods were mostly persuasion and information, with increasing skills, goal setting, and rehearsal of skills used less often. When reported, half of the interventions were effective in changing intention, and two-thirds in changing behaviour, with generally small effect sizes, where calculable. Effectiveness was unrelated to use of the theory to develop interventions. Evidence about mediation of effects by TPB components was sparse. The TPB may have potential for developing behaviour change interventions, but more comprehensive studies are needed that compare the utility of the TPB with other social cognition models and behavioural techniques.

Construct validation of the hospital anxiety and depression scale with clinical populations

OBJECTIVEnthe hospital anxiety and depression scale (HADS) attempts to measure anxiety and depression without confounding by somatic symptoms of physical disorder, and is widely used for this purpose. This paper addresses three questions about the validity of the HADS concerning its independence of physical symptoms, the extent to which its items robustly measure the identified constructs with varying clinical populations and situations, and its capacity to differentiate anxiety and depression.nnnMETHODSndata from patients with breast disease, myocardial infarction (MI), and stroke were examined using factor analytic and psychometric analyses.nnnRESULTSnusing exploratory factor analysis in patients with breast disease, 13 of the 14 HADS items fell on a psychological factor and loadings on the psychological factor were higher than loadings on the somatic factor for all items. The HADS showed high levels of internal consistency and there was little evidence that removing items would improve it. Confirmatory factor analyses (CFA) in MI and stroke groups confirmed the separation of anxiety and depression. Analyses indicated items, which were performing poorly for these clinical groups.nnnCONCLUSIONSnthere was support for the validity of the HADS for all three questions. However, there were some evidences of individual items performing poorly. Given the ease of administration and the acceptability of this measure to ill or weak respondents, the HADS continues to perform satisfactorily.

From health beliefs to self-regulation: Theoretical advances in the psychology of action control

Abstract The paper reviews the theoretical concepts included in a range of social cognitive models which have identified psychological antecedents of individual motivation and behaviour. Areas of correspondence are noted and core constructs (derived primarily from the theory of planned behaviour and social cognitive theory) are identified. The role of intention formation, self-efficacy beliefs, attitudes, normative beliefs and self-representations are highlighted and it is argued that these constructs provide a useful framework for modelling the psychological prerequisites of health behaviour. Acknowledging that intentions do not translate into action automatically, recent advances in our understanding of the ways in which prior planning and rehearsal can enhance individual control of action and facilitate the routinisation of behaviour are considered. The importance of engaging in preparatory behaviours for the achievement of many health goals is discussed and the processes by which goals are prioritised...

Attributions, expressed emotion, and patient relapse: An attributional model of relatives' response to schizophrenic illness

This study examines the concept of Expressed Emotion (EE) and tests the utility of an attributional model in understanding why relatives differ in their responses and attitudes to sufferers of schizophrenia, and how causal beliefs of family members might mediate relapse in patients. High EE relatives made more attributions about illness than did low EE. Within the high EE group, relatives with marked emotional overinvolvement were similar to the low EE group, with problems attributed to factors more external to and uncontrollable by the patient. Relatives with high criticism gave more causes internal to the patient and hostile relatives also tended to perceive the causes to be controllable by and personal to the sufferers of schizophrenia. Illness chronicity and severity was associated with more causal search. Attribution variables were better predictors of patient relapse at nine months follow-up than were EE measures.

Validation of the Oswestry Low Back Pain Disability Questionnaire, its sensitivity as a measure of change following treatment and its relationship with other aspects of the chronic pain experience

Recently, there has been growing interest in the development of methods for recording disability as an outcome measure to monitor treatment effectiveness in chronic pain patients. Where these methods have relied on self-report, further information is needed about the validity and reliability of the results. Three such studies are reported on the Oswestry Low Back Pain Disability Questionnaire (ODQ. These involved comparing actual performance on lifting, sitting and walking tasks with reported limitation on the relevant subsections of the ODQ. The results were able to show encouraging validity and reliability. A factor-analytic study was also undertaken, which determined that there were two distinct factors of disability measured by this instrument. A small cohort of patients were followed up after a pain rehabilitation programme and reductions in disability were found to be reliably measured by the ODQ. The relationships between reported disability and the emotional and cognitive context in which the pain...

Perceived control, coping and recovery from disability following stroke

Previous research has demonstrated that perceived control beliefs predict recovery from disability, allowing for initial levels of disability, in stroke patients. Theories of mental representations and coping would suggest that this relationship might be mediated by coping, by engaging in exercise, and that emotional factors might be involved. These hypotheses were examined in a longitudinal study of 71 patients interviewed in hospital within 3 weeks of the stroke, 1 month after discharge and 6 months after discharge. The results confirmed that perceived control predicted recovery from disability but no support was found for the mediating effects of exercise or mood. While the results offer some tentative suggestions for intervention, they point to deficiencies in current theories of disability.

Cognitive representations of illness and functional and affective adjustment following surgery for osteoarthritis

A prospective investigation is described which sought to test the role of illness cognitions in determining patient responses to a surgical intervention for osteoarthritis. Illness cognitions were assessed amongst a consecutive sample of patients with osteoarthritis of the knee or hip prior to undergoing joint replacement surgery. Functional activity and depression were assessed pre-operatively, and at 3 and 9 months post surgery. At pre-operative assessment, functional activity and depression were univariately associated with the perceived consequences of osteoarthritis. Path analyses using longitudinal data demonstrated that illness cognitions had predictive value in explaining outcomes. Depression at 3 months was associated with higher pre-operative perceived control beliefs suggesting that patients who have high control pre-operatively may be at risk for temporary depressed mood in the immediate aftermath of surgery. This effect was not maintained at 9 months. Depression at 9 months was lower amongst patients who were more active at 3 months, who did not attribute their condition to wear and tear and who had higher expectations of surgery. Functional activity at 9 months was higher amongst those who did not attribute their condition to growing older and who perceived more control over symptoms. Socio-demographic variables were not associated with change in functional activity or depression over the course of surgery. The results provide support for an illness cognition approach in explaining functional activity and depression outcomes following surgery.

Self-efficacy and goal importance in the prediction of physical disability in people following hospitalization: A prospective study

OBJECTIVESnThis prospective study evaluates the role of self-efficacy and goal importance in predicting decreases in disability in activities of everyday living.nnnMETHODnDisability, self-efficacy and goal importance were each assessed before and at 3 and 9 months after participants underwent joint replacement surgery.nnnRESULTSnDisability had decreased at 3 and 9 months post-surgery assessments. Self-efficacy beliefs were higher at 3 and 9 months following surgery while goal importance was increased at 9 months but not at 3 months. Medical variables and prior disability predicted disability at 3 months. Social-cognitive variables did not contribute to the prediction of 3 months disability. Pre-surgery goal importance and self-efficacy at 3 months were independent predictors of disability at 9 months after controlling for pre-surgery and 3 months disability. Evidence also suggested that goal importance and self-efficacy interacted to predict levels of disability at 9 months following surgery.nnnCONCLUSIONSnThe findings demonstrate that recovery is governed not solely by medical phenomena but also by psychological variables and suggest that modification of these variables may have an impact on recovery outcomes. Moreover, attention should be paid to the timing of such intervention and to the length of follow-up.

Problems with the sickness impact profile: a theoretically based analysis and a proposal for a new method of implementation and scoring.

The Sickness Impact Profile (SIP) is one of the most widely used health status measures, but there are problems with the measure that lead to inconsistent and illogical scores. There are many desirable features to the SIP development methodology in that it is based on a good range of items and the item weightings are valuable. The current method of scoring the SIP is the use of a summated total and was selected based on limited empirical evidence. However, in this paper we argue that there are problems with the SIP because the current empirically derived method of scoring is incompatible with both the underlying theoretical scaling framework (Thurstone scaling) and the nature of the items in the SIP. In addition, the items do not have properties consistent with the scaling methodology. We suggest that it is crucial to take both a theoretical and empirical approach to selecting a scoring method. To examine problems associated with the SIP we explored the underlying scaling methodology and identified the types of items in the SIP. A new method of scoring is proposed that is consistent with the items and scaling in the SIP, namely using the maximum individual weighting from the items that were checked as a category score. This new method of scoring resolves many of the previously observed problems in the SIP. The new method of scoring also presented the opportunity for a new implementation of the SIP that reduces the number of items that most respondents, especially those with severe limitations, would be asked. Without taking a theoretical approach to scoring we suggest that subsequent, empirically based, scale amendments are unlikely to solve the problems. It is proposed that this new method of scoring justifies a thorough empirical investigation.

Consequences of disease: testing the WHO International Classification of Impairments, Disabilities and Handicaps (ICIDH) model.

The International Classification of Impairments, Disabilities and Handicaps (ICIDH) model proposes that there are three consequences of disease, impairment (I), disability (D) and handicap (H) and that they are sequentially related. This paper examines first, whether I, D and H can be measured independently and second, whether there is support for the sequential or causal relationship between the three constructs. Cross-sectional data from a representative sample of 101 disabled adults and longitudinal data from 108 myocardial infarction (MI) and 68 Stroke patients were used. Standard measures of I were used for each clinical condition. Measures of D and H were derived from the British version of the Sickness Impact Profile (SIP) and additional measures of D were available for the Stroke group. Judges classified SIP items according to ICIDH definitions of D and H. Correlation, Confirmatory Factor Analyses and Path Analyses were used to examine the main hypotheses. Valid measures of D and H were derived and there was evidence of separation of the three constructs for the Stroke patients but not for the other groups. For both Stroke and MI, I was not predictive of D and H. For Stroke, the best path model included a path from D to H, but not from H to D and this was found for self-report and performance measures of D. Using these measures, the ICIDH model was supported in that D predicted H for stroke, but there was no support for a path between I and D or between I and H. Further it was not always possible to distinguish the three constructs. Possible limitations in the measures and in the ICIDH model as a testable scientific model are discussed.