Michael .W. Calnan

The health belief model and participation in programmes for the early detection of breast cancer: A comparative analysis

Extravagant claims have been made about the power of the Health Belief Model (HBM) to explain both decisions to adopt patterns of health behaviour and to use preventive health services. However, studies where information on beliefs are collected before information on behaviour are not common. The analyses presented here are based on prospective studies examining how far the variables which make up the HBM predict attendance at (i) a class teaching breast self-examination and (ii) a clinic providing mammography. The results show that different dimensions of the HBM are amongst the best predictors of attendance at each of the different services although the overall variance explained by the HBM in both sets of analysis was small.

Public trust in health care: the system or the doctor?

Objectives: To examine how the public assess trust in health care in England and Wales. Design: Postal structured questionnaire in cross sectional survey. Setting: Random sample of people on the electoral register in England and Wales. Subjects: People aged 18 and over. Main outcome measures: General levels of trust and confidence in health care. Results: The response rate was 48% (n = 1187). The mean level of confidence (trust) in the healthcare system was 6.0 out of a score of 10. Levels of distrust appeared relatively high with at least 356 (30%) respondents reporting little or very little trust for 28 of 32 specific aspects of health care. The highest levels of distrust were found in relation to how the health service was run and financed, particularly waiting times and the implication of cost cutting for patients. Statistical analysis by univariable linear regression of the specific determinants of generic assessments of public trust (confidence) suggested that the key aspects were patient centred care and levels of professional expertise. Being covered by private health insurance was also a key determinant of levels of public trust. Conclusion: Public assessment of trust tends to address the views of care at the micro level. Policy makers concerned with the erosion of public trust need to target aspects associated with patient centred care and professional expertise.

Facilitated physical activity as a treatment for depressed adults: randomised controlled trial

Objective To investigate the effectiveness of facilitated physical activity as an adjunctive treatment for adults with depression presenting in primary care. Design Pragmatic, multicentre, two arm parallel randomised controlled trial. Setting General practices in Bristol and Exeter. Participants 361 adults aged 18-69 who had recently consulted their general practitioner with symptoms of depression. All those randomised had a diagnosis of an episode of depression as assessed by the clinical interview schedule-revised and a Beck depression inventory score of 14 or more. Interventions In addition to usual care, intervention participants were offered up to three face to face sessions and 10 telephone calls with a trained physical activity facilitator over eight months. The intervention was based on theory and aimed to provide individually tailored support and encouragement to engage in physical activity. Main outcome measures The primary outcome was self reported symptoms of depression, assessed with the Beck depression inventory at four months post-randomisation. Secondary outcomes included use of antidepressants and physical activity at the four, eight, and 12 month follow-up points, and symptoms of depression at eight and 12 month follow-up. Results There was no evidence that participants offered the physical activity intervention reported improvement in mood by the four month follow-up point compared with those in the usual care group; adjusted between group difference in mean Beck depression inventory score −0.54 (95% confidence interval −3.06 to 1.99; P=0.68). Similarly, there was no evidence that the intervention group reported a change in mood by the eight and 12 month follow-up points. Nor was there evidence that the intervention reduced antidepressant use compared with usual care (adjusted odds ratio 0.63, 95% confidence interval 0.19 to 2.06; P=0.44) over the duration of the trial. However, participants allocated to the intervention group reported more physical activity during the follow-up period than those allocated to the usual care group (adjusted odds ratio 2.27, 95% confidence interval 1.32 to 3.89; P=0.003). Conclusions The addition of a facilitated physical activity intervention to usual care did not improve depression outcome or reduce use of antidepressants compared with usual care alone. Trial registration Current Controlled Trials ISRCTN16900744.

The Sociology of the health service

Introduction Jonathan Gabe, Michael Calnan, and Michael Bury 1. Medical Sociology and Health Policy: an Historical Overview Margaret Stacey 2. Privatisation in the British Health Service: a Challenge to the NHS John Mohan 3. The Politics of Professional Power: Medicine in a Changing Health Service Mary Ann Elston 4. Health Service Management - A Sociological View Griffiths and the Non-Negotiated Order of the Hospital David Cox 5. Evaluating the Outcomes of Health Care Angela Coulter 6. Recent Developments in General Practice: a Sociological Analysis Michael Calnan and Jonathan Gabe 7. Knowledge and Control in Health Promotion: a Test Case for Social Policy and Social Theory Alan Beattie 8. The Confused Boundaries of Community Care Hilary Land 9. The Agenda for Sociological Health Policy Research for the 1990s Margot Jefferys

Disseminating research findings: what should researchers do? A systematic scoping review of conceptual frameworks

BackgroundAddressing deficiencies in the dissemination and transfer of research-based knowledge into routine clinical practice is high on the policy agenda both in the UK and internationally.However, there is lack of clarity between funding agencies as to what represents dissemination. Moreover, the expectations and guidance provided to researchers vary from one agency to another. Against this background, we performed a systematic scoping to identify and describe any conceptual/organising frameworks that could be used by researchers to guide their dissemination activity.MethodsWe searched twelve electronic databases (including MEDLINE, EMBASE, CINAHL, and PsycINFO), the reference lists of included studies and of individual funding agency websites to identify potential studies for inclusion. To be included, papers had to present an explicit framework or plan either designed for use by researchers or that could be used to guide dissemination activity. Papers which mentioned dissemination (but did not provide any detail) in the context of a wider knowledge translation framework, were excluded. References were screened independently by at least two reviewers; disagreements were resolved by discussion. For each included paper, the source, the date of publication, a description of the main elements of the framework, and whether there was any implicit/explicit reference to theory were extracted. A narrative synthesis was undertaken.ResultsThirty-three frameworks met our inclusion criteria, 20 of which were designed to be used by researchers to guide their dissemination activities. Twenty-eight included frameworks were underpinned at least in part by one or more of three different theoretical approaches, namely persuasive communication, diffusion of innovations theory, and social marketing.ConclusionsThere are currently a number of theoretically-informed frameworks available to researchers that can be used to help guide their dissemination planning and activity. Given the current emphasis on enhancing the uptake of knowledge about the effects of interventions into routine practice, funders could consider encouraging researchers to adopt a theoretically-informed approach to their research dissemination.

Job strain, Effort-Reward Imbalance and mental distress: a study of occupations in general medical practice

There is increasing evidence to support the predictive power of social epidemiological models such as Effort-Reward Imbalance (Siegrist, 1996) and the Job-Strain Model (Karasek, and Theorell, 1990) for explaining occupational stress, although it has been suggested that the models may have distinctive contributions towards explaining work stress in specific work settings. Alternatively, it has been suggested that the explanatory power of the different models might be enhanced if they were combined. The aim of this paper is to explore these questions by examining the power of the two different models both separately and in combination for explaining job satisfaction and mental distress in general medical practice. This analysis was based on data collected from a postal survey of the members of staff (N=1089, response rate = 70%) of 81 practices, which were randomly selected from all general practices in the National Health Service Executive South East region. The results show that while both models were predictors of mental distress and job satisfaction the models that combined different dimensions were the strongest predictors.

Job strain, effort--reward imbalance, and stress at work: competing or complementary models?

Background: The Demand Control Model (DCM) and the Effort - Reward Imbalance Model (ERI) offer putative explanations of the relationship between stressful working conditions, job strain, and psychological and physical ill health. Aims: The aims of this study are to: (a) compare the predictive powers of the two models for explaining perceived job stress and mental distress amongst workers as a whole, (b) identify whether a model which combines dimensions of the DCM and ERI might have more predictive power than either of them separately, and (c) ascertain whether the models make distinct contributions to explaining stress at work in specific occupational settings. Methods: Statistical analysis was carried out on data collected from a cross-sectional postal survey of a random sample (n=7,069), of the adult population in an urban area in Southern England. The analysis focused on the 4,135 respondents who were in paid employment. Results: There was little support for combining the models as the combined model was dominated by the predictive power of dimensions from the ERI. However, the results also showed that the models or dimensions of the models made distinct contributions to explaining perceived work stress in different types of occupation. Conclusions: There is little evidence to support a combined model of work characteristics. The ERI appears to be the stronger of the two models although the DCM has explanatory value for specific occupations.

Researching trust relations in health care

– The aim of this paper is to provide a rationale for examining trust in health care., – Conducts a review of the literature of trust relations in health care that highlighted that most empirical research has addressed threats to patient‐provider relationships and trust in health care systems from the patients perspective, but studies in the organisational literature suggests that trust relations in the workforce, between providers and between providers and managers, may also influence patient‐provider relationships and levels of trust., – Suggests that trust is not primarily dispositional or an individual attribute or psychological state, but is constructed from a set of inter‐personal behaviors or from a shared identity. These behaviors are underpinned by sets of institutional rules, laws and customs., – This introductory paper has presented some evidence from an international, comparative study but there is the need for further, more detailed investigation into why trust relations may vary in different health care systems., – This introductory paper provides a rationale for examining trust in health care and a context for the different elements of trust.

Identity in the fourth age: perseverance, adaptation and maintaining dignity

ABSTRACT The fourth age remains a poorly understood phenomenon and there is a lack of understanding of the perceptions of those who might be considered to be living in it. This article draws on findings from a study of dignity in later life which examined the day-to-day experiences of participants who were in need of support and care because of failing health. It discusses their accounts of the changes to their sense of self and their identity that came about as a result of their ageing and health problems and looks also at the ways in which the support and care they received helped to shape their adjustment to those changes. The accounts given by participants reveal a great deal about the physical, mental and emotional effort entailed in maintaining a sense of self and highlight the essential role played by social relationships in the maintenance of identity. These findings are analysed by reference to emerging theories of the fourth age.

Do health beliefs predict health behaviour? An analysis of breast self-examination

The purpose of this paper is to explore the relationships between health beliefs and health behaviour. The study we report was conducted as part of a national campaign to evaluate the benefits of breast self-examination in the early detection of breast cancer, and the purpose of our analysis was to test the Health Belief Model of Becker and his colleagues. Three groups of women were investigated--278 who accepted an invitation to attend self-examination classes and were taught the techniques in detail, 262 who declined the invitation and 594 controls to whom no classes were offered--and beliefs and self-reported behaviour were measured shortly before the classes took place and again a year later. The campaign, it emerged, produced marked changes in both beliefs and behaviour, but the relationships between beliefs and behaviour were much weaker than the model had led us to expect and accounted for no more than a quarter of the variance. Alternative models are considered, notably Fishbein and Ajzens Theory of Reasoned Action, and the paper concludes with some suggestions for improving health campaigns.