Rachel Crockett

Time orientation and health-related behaviour: Measurement in general population samples

Research on health behaviour and time orientation has been hindered by a lack of consensus about appropriate measurement. Study 1 assessed the reliability of the Consideration of Future Consequences Scale (CFC) and the Zimbardo Time Perspective Inventory (ZTPI) in a general population sample (n = 300). Although more reliable, the CFC was less readable. Study 2 assessed the validity of a shortened ZTPI, measuring future and present orientation, and the full CFC. The measures had good discrimination to distinguish interpersonal differences. Construct validity of present, but not future, orientation as measured by the ZTPI, was evidenced by its mediation of the association between socioeconomic status and expectations of participating in diabetes screening. The CFC mediated this relationship more weakly. Further investigation of present orientation in understanding health-related behaviour is warranted.

Trial Protocol: Using genotype to tailor prescribing of nicotine replacement therapy: a randomised controlled trial assessing impact of communication upon adherence.

BackgroundThe behavioural impact of pharmacogenomics is untested; informing smokers of genetic test results for responsiveness to smoking cessation medication may increase adherence to this medication. The objective of this trial is to estimate the impact upon adherence to nicotine replacement therapy (NRT) of informing smokers that their oral dose of NRT has been tailored to a DNA analysis. Hypotheses to be tested are as follows:IAdherence to NRT is greater among smokers informed that their oral dose of NRT is tailored to an analysis of DNA (genotype), compared to one tailored to nicotine dependence questionnaire score (phenotype).II Amongst smokers who fail to quit at six months, motivation to make another quit attempt is lower when informed that their oral dose of NRT was tailored to genotype rather than phenotype.Methods/DesignAn open label, parallel groups randomised trial in which 630 adult smokers (smoking 10 or more cigarettes daily) using National Health Service (NHS) stop smoking services in primary care are randomly allocated to one of two groups:i. NRT oral dose tailored by DNA analysis (OPRM1 gene) (genotype), orii. NRT oral dose tailored by nicotine dependence questionnaire score (phenotype)The primary outcome is proportion of prescribed NRT consumed in the first 28 days following an initial quit attempt, with the secondary outcome being motivation to make another quit attempt, amongst smokers not abstinent at six months. Other outcomes include adherence to NRT in the first seven days and biochemically validated smoking abstinence at six months. The primary outcome will be collected on 630 smokers allowing sufficient power to detect a 7.5% difference in mean proportion of NRT consumed using a two-tailed test at the 5% level of significance between groups. The proportion of all NRT consumed in the first four weeks of quitting will be compared between arms using an independent samples t-test and by estimating the 95% confidence interval for observed between-arm difference in mean NRT consumption (Hypothesis I). Motivation to make another quit attempt will be compared between arms in those failing to quit by six months (Hypothesis II).DiscussionThis is the first clinical trial evaluating the behavioural impact on adherence of prescribing medication using genetic rather than phenotypic information. Specific issues regarding the choice of design for trials of interventions of this kind are discussed.Trial detailsFunder: Medical Research Council (MRC)Grant number: G0500274ISRCTN: 14352545Date trial stated: June 2007Expected end date: December 2009Expected reporting date: December 2010

Why don't health professionals check patient understanding? A questionnaire-based study.

Abstract Checking patient understanding, by asking questions about information presented in a medical consultation, is a core communication skill but its use is not frequently assessed. The newborn hearing screening commenced in England with a pilot of its implementation in January 2002. Because it is a new screening test, it provided an opportunity for studying the effective communication of novel information. A randomized controlled trial of training newborn hearing screeners to present information about the screening test and to ask questions to check understanding was commenced but had to be prematurely ended as the majority of the screeners did not ask the questions. The aim of this study was to understand why the screeners did not ask questions to check understanding of the information provided. Questionnaires were sent to screeners who participated in the study to elicit their responses to the use of the questions to check understanding. A response rate of 87% (26/30) was achieved. Screeners who reported not asking the questions were more likely to express a lack of confidence in their ability to ask questions, and to perceive asking questions as an ineffective way of increasing patient understanding. The study suggests that the ability and willingness of healthcare professionals to use simple communication skills may have been overestimated and training needs to target skills as well as beliefs about the effectiveness of using them.

Ageing at home? Meeting housing, health and social needs

Purpose – The purpose of this paper is to consolidate the range of issues relevant to owner occupiers who age in place and to offer an initial overview of how effective partnerships can respond to and meet the changing needs of housing, health and social care of our ageing population. Design/methodology/approach – Issues affecting older peoples changing needs are considered holistically and considered in terms of how partnerships can be enhanced to develop improved services in the future. Findings – Most owners wish to stay in their own homes for as long as possible and it can be cost-effective to do so; however, we need to look at new and innovative ways of developing and providing front-line services to enhance health and safety in the home, but also quality of life and wellbeing such as combating loneliness and isolation. However, although there are examples of evidence-based good practice, service provision is variable and there is a risk that many older home owners may miss out on services for which they may are eligible. With this in mind, it may be helpful to develop a new framework where one key practitioner holds responsibility to consolidate and coordinate the range of local services available as a package that offers a range of housing, health and social care services. Originality/value – There are currently many policy and practice gaps in older owner occupiers housing conditions and suitability to meet their changing needs. This paper has a particular starting point in housing, and how other personal or technological services can help support independence for as long as possible and adapt to the owner-occupiers changing health and social care needs as they age in place. The authors emphasise the importance of sharing evidence-based good practice partnerships.

Presentation of aversive visual images in health communication for changing health behaviour

This is the protocol for a review and there is no abstract. The objectives are as follows: