Theresa M Marteau

Publications of Theresa M Marteau

• The effectiveness of financial incentives for smoking cessation during pregnancy: is it from being paid or from the extra aid?

  Authors: Eleni Mantzari, Florian Vogt, Theresa M Marteau

  BMC pregnancy and childbirth. 04/2012; 12(1):24.

  ABSTRACT: BACKGROUND: Financial incentives appear to be effective in promoting smoking cessation in pregnancy. The mechanisms by which they might operate however, are poorly understood. The presentABSTRACT: BACKGROUND: Financial incentives appear to be effective in promoting smoking cessation in pregnancy. The mechanisms by which they might operate however, are poorly understood. The present study examines how financial incentives for smoking cessation during pregnancy may work, by exploring pregnant women's experiences of trying to stop smoking, within and outside of a financial incentives scheme. METHODS: Thirty-six (n = 36) UK-based pregnant smokers (n = 36), offered standard NHS Stop-Smoking Services, of whom twenty (n = 20) were enrolled in a financial incentives scheme for smoking cessation (n = 20) and sixteen (n = 16) were not, were interviewed about (i) their motivation to stop smoking, and (ii) the factors they perceived as influencing their quitting efforts. Framework Analysis was used to analyse the data. RESULTS: Women in the two groups reported similar reasons for wanting to stop smoking during pregnancy. However, they described dissimilar experiences of the Stop-Smoking Services, which they perceived to have differentially influenced their quit attempts. Women who were incentivised reported using the services more than women who were not incentivised. In addition, they described the motivating experience of being monitored and receiving feedback on their progress. Non-incentivised women reported problems receiving the appropriate Nicotine Replacement Therapy, which they described as having a detrimental effect on their quitting efforts. CONCLUSION: Women participating in a financial incentives scheme to stop smoking reported greater engagement with the Stop-Smoking Services, from which they described receiving more help in quitting than women who were not part of the scheme. These results highlight the complexity of financial incentives schemes and the intricacies surrounding the ways in which they operate to affect smoking cessation. These might involve influencing individuals' motivation and self-regulation, changing engagement with and provision of support services, or a combination of these.

• Effect on adherence to nicotine replacement therapy of informing smokers their dose is determined by their genotype: a randomised controlled trial.

  Authors: Theresa M Marteau, Paul Aveyard, Marcus R Munafò, A Toby Prevost, Gareth J Hollands, David Armstrong, Stephen Sutton, Chloe Hill, Elaine Johnstone, Ann Louise Kinmonth

  PloS one. 01/2012; 7(4):e35249.

  The behavioural impact of pharmacogenomics is untested. We tested two hypotheses concerning the behavioural impact of informing smokers their oral dose of NRT is tailored to analysis of DNA. WeThe behavioural impact of pharmacogenomics is untested. We tested two hypotheses concerning the behavioural impact of informing smokers their oral dose of NRT is tailored to analysis of DNA. We conducted an RCT with smokers in smoking cessation clinics (N = 633). In combination with NRT patch, participants were informed that their doses of oral NRT were based either on their mu-opioid receptor (OPRM1) genotype, or their nicotine dependence questionnaire score (phenotype). The proportion of prescribed NRT consumed in the first 28 days following quitting was not significantly different between groups: (68.5% of prescribed NRT consumed in genotype vs 63.6%, phenotype group, difference  =  5.0%, 95% CI -0.9,10.8, p  =  0.098). Motivation to make another quit attempt among those (n  =  331) not abstinent at six months was not significantly different between groups (p  =  0.23). Abstinence at 28 days was not different between groups (p = 0.67); at six months was greater in genotype than phenotype group (13.7% vs 7.9%, difference  =  5.8%, 95% CI 1.0,10.7, p  =  0.018). Informing smokers their oral dose of NRT was tailored to genotype not phenotype had a small, statistically non-significant effect on 28-day adherence to NRT. Among those still smoking at six months, there was no evidence that saying NRT was tailored to genotype adversely affected motivation to make another quit attempt. Higher abstinence rate at six months in the genotype arm requires investigation. Controlled-Trials.com ISRCTN14352545.

• Perceived effectiveness of stop smoking interventions: impact of presenting evidence using numbers, visual displays, and different timeframes.

  Authors: Florian Vogt, Theresa M Marteau

  Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco. 11/2011; 14(2):200-8.

  This study investigates the impact of visual and numerical representations of effectiveness and different lengths of follow-up upon the perceived effectiveness of stop smoking interventions. ThisThis study investigates the impact of visual and numerical representations of effectiveness and different lengths of follow-up upon the perceived effectiveness of stop smoking interventions. This study entails two between-subjects experiments with smokers from the general population. In Experiment 1, U.K. smokers (n = 318) viewed information about a stop smoking intervention that included (a) no effectiveness information, (b) standard numerical effectiveness information, or (c) numerical and visual absolute effectiveness information. In Experiment 2, U.K. smokers (n = 320) viewed numerical and visual absolute effectiveness information about a stop smoking intervention showing either the short-term (1-month) or the long-term (12-month) quit rate with and without intervention. Outcome measures included perceived effectiveness of stop smoking interventions and intentions to use them. In Experiment 1, numerical and visual absolute effectiveness information compared with no effectiveness information resulted in greater perceived effectiveness (Scheffé test, p = .033, Cohen's d = 0.36) and intentions to use stop smoking interventions (Scheffé test, p = .012, d = 0.43). No differences were detected between standard numerical effectiveness information and no effectiveness information. In Experiment 2, the short-term quit rate compared with long-term quit rate resulted in greater perceived effectiveness, t(318) = 3.2, p = .002, d = 0.35, but not significantly greater intentions to use stop smoking interventions, t(318) = 1.59, p = .11, d = 0.18. Presenting numerical and visual absolute effectiveness information about the short-term effectiveness of stop smoking interventions may increase the use of stop smoking interventions.

• Screening for sickle cell and thalassaemia in primary care: a cost-effectiveness study.

  Authors: Stirling Bryan, Elizabeth Dormandy, Tracy Roberts, Anthony Ades, Pelham Barton, Ariadna Juarez-Garcia, Lazaros Andronis, Jonathan Karnon, Theresa M Marteau

  The British journal of general practice : the journal of the Royal College of General Practitioners. 10/2011; 61(591):e620-7.

  Haemoglobinopathies, including sickle cell disease and thalassaemia (SCT), are inherited disorders of haemoglobin. Antenatal screening for SCT rarely occurs before 10 weeks of pregnancy. To exploreHaemoglobinopathies, including sickle cell disease and thalassaemia (SCT), are inherited disorders of haemoglobin. Antenatal screening for SCT rarely occurs before 10 weeks of pregnancy. To explore the cost-effectiveness of offering SCT screening in a primary care setting, during the pregnancy confirmation visit. A model-based cost-effectiveness analysis of inner-city areas with a high proportion of residents from ethnic minority groups. Comparison was made of three SCT screening approaches: 'primary care parallel' (primary care screening with test offered to mother and father together); 'primary care sequential (primary care screening with test offered to the mother and then the father only if the mother is a carrier); and 'midwife care' (sequential screening at the first midwife consultation). The model was populated with data from the SHIFT (Screening for Haemoglobinopathies In First Trimester) trial and other sources. Compared to midwife care, primary care sequential had a higher NHS cost of £34,000 per 10,000 pregnancies (95% confidence interval [CI] = £15,000 to £51,000) and an increase of 2623 women screened (95% CI: 1359 to 4495), giving a cost per additional woman screened by 10 weeks of £13. Primary care parallel was dominated by primary care sequential, with both higher costs and fewer women screened. The policy judgement is whether an earlier opportunity for informed reproductive choice has a value of at least £13. Further work is required to understand the value attached to earlier informed reproductive choices.

• Correction: Emotional impact of screening: A systematic review and meta-analysis.

  Authors: Ruth E Collins, Laureen M Lopez, Theresa M Marteau

  BMC public health. 09/2011; 11(1):752.

  ABSTRACT: After the publication of this work [1], we became aware that two of the twelve studies included in the review [refs 25 and 30] were erroneously described as not having presented outcomes byABSTRACT: After the publication of this work [1], we became aware that two of the twelve studies included in the review [refs 25 and 30] were erroneously described as not having presented outcomes by randomisation (ie those randomised to screening vs those randomised not to be screened). Instead they were described as having presented outcomes according to those who were randomised and who attended vs those randomised not to be screened). We have now extracted the correct data from these two studies which resulted in revised pooled Standardised Mean Differences (SMDs). None of the conclusions reached in the uncorrected version of the paper has been revised in the light of these changes. We describe here the changes arising from this error as shown in corrected form in the accompanying revised Tables 1 and 2 and Figure 2. (i) The number of participants included has now been amended to reflect the altered data extracted from studies 25 and 30, altering this from 170,045 to 170,277 participants, as shown in Table 1 and Table 2. (ii) The SMDs from the meta-analyses have been recalculated resulting in changes to the pooled SMDs now shown in Figure 2 where corrections have been made to the data for sections (a) (b) and (d). (iii) The sensitivity analyses have been redone so that studies 25 and 30, in addition to study 26, were removed to assess the impact of measurements in the primary outcome being made in all those randomised to be screened regardless of whether or not they attended (as opposed to those randomised and who attended). The inclusion of the two further studies did not alter the outcome of this sensitivity analysis, which reveals no impact on the primary outcome. In making these changes we became aware of three other errors that had not been corrected at final draft stage of the publishing process. These are described below: (iv) In the abstract, we erroneously reported the number of studies assessing depression as four. It should be five. (v) Data from [25] were erroneously included in pooled estimates of short term anxiety and depression by screening test outcome. (vi) The references listed as including data from attenders and non attenders in the intervention arm should now read: [25,26,27 & 30] and the reference to those including only attenders should correctly read: [24,28,29,31-35]. We regret any inconvenience that these corrections might have caused. We wish to thank Dr. Simon Griffin for bringing this matter to our attention in relation to reference 30, resulting in re-checking of all data extracted from the included studies.

• Emotional impact of screening: a systematic review and meta-analysis.

  Authors: Ruth E Collins, Laureen M Lopez, Theresa M Marteau

  BMC public health. 07/2011; 11:603.

  There is a widely held expectation that screening for disease has adverse emotional impacts. The aim of the current review is to estimate the short (< 4 weeks) and longer term (> 4 weeks) emotionalThere is a widely held expectation that screening for disease has adverse emotional impacts. The aim of the current review is to estimate the short (< 4 weeks) and longer term (> 4 weeks) emotional impact of such screening. Studies selected for inclusion were (a) randomised controlled trials in which (b) participants in one arm underwent screening and received test results, and those in a control arm did not, and (c) emotional outcomes were assessed in both arms. MEDLINE via PubMed (1950 to present), EMBASE (1980 to present), PsycINFO (1985 to present) using OVID SP, and CINAHL (1982 to present) via EBSCO were searched, using strategies developed with keywords and medical subject headings. Data were extracted on emotional outcomes, type of screening test and test results. Of the 12 studies that met the inclusion criteria, six involved screening for cancer, two for diabetes, and one each for abdominal aortic aneurysms, peptic ulcer, coronary heart disease and osteoporosis. Five studies reported data on anxiety, five [corrected] on depression, two on general distress and eight on quality of life assessed between one week and 13 years after screening (median = 1.3 years).Meta-analyses revealed no significant impact of screening on longer term anxiety (pooled SMD 0.01, 95% CI -0.10, 0.11), depression (pooled SMD -0.04, 95% CI -.12, 0.20), or quality of life subscales (mental and self-assessed health pooled SMDs, respectively: 0.03; -0.01, (95% CI -.02, 0.04; 0.00, 95% CI -.04, 0.03). Screening does not appear to have adverse emotional impacts in the longer term (> 4 weeks). Too few studies assessed outcomes before four weeks to comment on the shorter term emotional impact of screening.

• Why does genetic causal information alter perceived treatment effectiveness? An analogue study.

  Authors: Alison J Wright, Stephen R Sutton, Matthew Hankins, Sophia C L Whitwell, Angela Macfarlane, Theresa M Marteau

  British journal of health psychology. 07/2011;

  Objectives.  When a health problem is perceived as having a genetic cause, this appears to increase the perceived effectiveness of pharmacological treatments and reduce perceived effectiveness ofObjectives.  When a health problem is perceived as having a genetic cause, this appears to increase the perceived effectiveness of pharmacological treatments and reduce perceived effectiveness of non-pharmacological treatments. Potential mediators of this effect include causal attributions, perceived severity, and perceived control over the health problem. This study aimed to use experimental methods to establish which beliefs mediate the effect of genetic causal information on perceived effectiveness of treatments. Design. A 4(cause: environmental, family history, genetic test, family history & genetic test)×2(severity: higher or low) between-subjects design using vignettes about heart disease risk, obesity or depression. Methods.  A total of 647 adults, randomly assigned to read one of the experimental vignettes, were interviewed. Key outcomes were perceived effectiveness of medication and of non-pharmacological treatments. Potential mediators of perceived severity, perceived controllability, and causal attributions were also assessed. Results.  For heart disease risk, genetic causes reduced perceived effectiveness of non-pharmacological treatments (an effect mediated by causal attributions and perceived control) but did not influence perceived medication effectiveness. For obesity, neither severity nor cause influenced the perceived effectiveness of either treatment. For depression, genetic causes only increased perceived effectiveness of medication for more severe depression, an effect mediated by perceived control. Conclusions.  The impact of genetic causal information on perceived effectiveness of treatments varies with type of health problem. When genetic causal information influences perceived treatment effectiveness, it does so by altering causal attributions and perceived controllability. However, these effects are small and unlikely to translate into clinically meaningful differences in health-enhancing behaviours.

• Acceptability of financial incentives to improve health outcomes in UK and US samples.

  Authors: Marianne Promberger, Rebecca C H Brown, Richard E Ashcroft, Theresa M Marteau

  Journal of medical ethics. 06/2011; 37(11):682-7.

  In an online study conducted separately in the UK and the US, participants rated the acceptability and fairness of four interventions: two types of financial incentives (rewards and penalties) andIn an online study conducted separately in the UK and the US, participants rated the acceptability and fairness of four interventions: two types of financial incentives (rewards and penalties) and two types of medical interventions (pills and injections). These were stated to be equally effective in improving outcomes in five contexts: (a) weight loss and (b) smoking cessation programmes, and adherence in treatment programmes for (c) drug addiction, (d) serious mental illness and (e) physiotherapy after surgery. Financial incentives (weekly rewards and penalties) were judged less acceptable and to be less fair than medical interventions (weekly pill or injection) across all five contexts. Context moderated the relative preference between rewards and penalties: participants from both countries favoured rewards over penalties in weight loss and treatment for serious mental illness. Only among US participants was this relative preference moderated by perceived responsibility of the target group. Overall, participants supported funding more strongly for interventions when they judged members of the target group to be less responsible for their condition, and vice versa. These results reveal a striking similarity in negative attitudes towards the use of financial incentives, rewards as well as penalties, in improving outcomes across a range of contexts, in the UK and the USA. The basis for such negative attitudes awaits further study.

• Offering antenatal sickle cell and thalassaemia screening to pregnant women in primary care: a qualitative study of women's experiences and expectations of participation.

  Authors: Vicki Tsianakas, Karl Atkin, Michael W Calnan, Elizabeth Dormandy, Theresa M Marteau

  Health expectations : an international journal of public participation in health care and health policy. 03/2011;

  Objective To describe the acceptability to women of being offered antenatal Sickle cell and Thalassaemia (SC&T) screening in primary and secondary care at the visit to confirm pregnancy; and toObjective To describe the acceptability to women of being offered antenatal Sickle cell and Thalassaemia (SC&T) screening in primary and secondary care at the visit to confirm pregnancy; and to explore the implications of their views for participating in decisions about their health care. Methods  Qualitative semi-structured interviews were conducted with twenty-one ethnically diverse women registered at twenty-five general practices in two English inner-city Primary Care Trusts. The material was analysed thematically, using the method of constant comparison. Results  Women generally welcomed the opportunity of early diagnosis, although they expected screening to confirm they were carrying a healthy child. Women felt general practitioners did not present antenatal screening as a choice, but they did not necessarily see this as a problem. Doctors were believed to be acting out of concern for the women's well being. Conclusions  Women were generally positive about being offered screening in primary care at the first visit to confirm pregnancy. To this extent it was acceptable to them, although this was largely informed by assumptions associated with being a 'good mother' rather than a straightforward enactment of informed choice, assumed by health-care policy. This represents the context in which women participate in decisions about their health care.

• Using aversive images to enhance healthy food choices and implicit attitudes: An experimental test of evaluative conditioning.

  Authors: Gareth J Hollands, Andrew Prestwich, Theresa M Marteau

  Health psychology : official journal of the Division of Health Psychology, American Psychological Association. 03/2011; 30(2):195-203.

  To examine the effect of communicating images of energy-dense snack foods paired with aversive images of the potential health consequences of unhealthy eating, on implicit and explicit attitudes andTo examine the effect of communicating images of energy-dense snack foods paired with aversive images of the potential health consequences of unhealthy eating, on implicit and explicit attitudes and food choice behavior. Participants were randomly allocated to either an evaluative conditioning (EC) procedure that paired images of snack foods with images of potential adverse health consequences or a control condition that featured images of snack foods alone. Implicit attitudes were assessed pre- and post-intervention. Explicit attitudes and food choice behavior were assessed post-intervention. The conditioning intervention made implicit attitudes toward energy-dense snacks more negative, with this effect greatest in those with relatively more favorable implicit attitudes toward these snacks at baseline. Participants in the conditioning intervention were more likely to choose fruit rather than snacks in a behavioral choice task, a relationship mediated by changes in implicit attitudes. Presenting aversive images of potential health consequences with those of specific foodstuffs can change implicit attitudes, which impacts on subsequent food choice behavior.

• Impact on decisions to start or continue medicines of providing information to patients about possible benefits and/or harms: a systematic review and meta-analysis.

  Authors: Rachel A Crockett, Stephen Sutton, Fiona M Walter, Megan Clinch, Theresa M Marteau, John Benson

  Medical decision making : an international journal of the Society for Medical Decision Making. 03/2011; 31(5):767-77.

  The impact of providing information about medicines to patients on decisions about starting or continuing them is unknown. To estimate the impact on decisions to start or continue medicines, ofThe impact of providing information about medicines to patients on decisions about starting or continuing them is unknown. To estimate the impact on decisions to start or continue medicines, of providing information to patients about possible benefits and/or harms. Electronic searches from 1980 to October 2010; reference and citation searches of included studies. Two investigators assessed studies' eligibility against inclusion criteria: randomized or pseudorandomized trials; participants older than 16 years and deciding for themselves; one group received information about possible benefits and/or harms of a potentially beneficial medicine, compared with another who did not; d) a measure of decision about starting or continuing a medicine. One investigator extracted all data, checked by a second. Eight studies were included, covering a range of medicines. There was no consistent impact of interventions on decisions about whether to start or continue medicines (pooled odds ratio 1.08; 95% confidence interval [CI], 0.69-1.70; P = 0.74). Among those who received more information, knowledge was increased (pooled mean difference 8.47; 95% CI 2.17-14.77; P = 0.008), and decisional conflict was reduced (pooled mean difference -0.15; 95% CI -0.24 to -0.06; P = .001). A small number of studies across different clinical contexts, of uncertain heterogeneity, were included. Providing information to patients about possible benefits and/or harms has no consistent effect on the number who decide to start or continue medicines, although it increases patients' knowledge and reduces their decisional conflict.

• Trial Protocol: Communicating DNA-based risk assessments for Crohn's disease: a randomised controlled trial assessing impact upon stopping smoking.

  Authors: Sophia C L Whitwell, Christopher G Mathew, Cathryn M Lewis, Alastair Forbes, Sally Watts, Jeremy Sanderson, Gareth J Hollands, A Toby Prevost, David Armstrong, Ann Louise Kinmonth, Stephen Sutton, Theresa M Marteau

  BMC public health. 01/2011; 11:44.

  Estimates of the risk of developing Crohn's disease (CD) can be made using DNA testing for mutations in the NOD2 (CARD15) gene, family history, and smoking status. Smoking doubles the risk of CD, aEstimates of the risk of developing Crohn's disease (CD) can be made using DNA testing for mutations in the NOD2 (CARD15) gene, family history, and smoking status. Smoking doubles the risk of CD, a risk that is reduced by stopping. CD therefore serves as a timely and novel paradigm within which to assess the utility of predictive genetic testing to motivate behaviour change to reduce the risk of disease. The aim of the study is to describe the impact upon stopping smoking of communicating a risk of developing CD that incorporates DNA analysis. We will test the following main hypothesis:Smokers who are first degree relatives (FDRs) of CD probands are more likely to make smoking cessation attempts following communication of risk estimates of developing CD that incorporate DNA analysis, compared with an equivalent communication that does not incorporate DNA analysis. A parallel groups randomised controlled trial in which smokers who are FDRs of probands with CD are randomly allocated in families to undergo one of two types of assessment of risk for developing CD based on either: i. DNA analysis, family history of CD and smoking status, or ii. Family history of CD and smoking status. The primary outcome is stopping smoking for 24 hours or longer in the six months following provision of risk information. The secondary outcomes are seven-day smoking abstinence at one week and six month follow-ups. Randomisation of 470 smoking FDRs of CD probands, with 400 followed up (85%), provides 80% power to detect a difference in the primary outcome of 14% between randomised arms, at the 5% significance level. This trial provides one of the strongest tests to date of the impact of communicating DNA-based risk assessment on risk-reducing behaviour change. Specific issues regarding the choice of trial design are discussed.

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

  Authors: Theresa M Marteau, Marcus R Munafò, Paul Aveyard, Chloe Hill, Sophia Whitwell, Thomas A Willis, Rachel A Crockett, Gareth J Hollands, Elaine C Johnstone, Alison J Wright, A Toby Prevost, David Armstrong, Stephen Sutton, Ann Louise Kinmonth

  BMC public health. 11/2010; 10:680.

  The behavioural impact of pharmacogenomics is untested; informing smokers of genetic test results for responsiveness to smoking cessation medication may increase adherence to this medication. TheThe 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: I Adherence 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. An 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). This 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 DETAILS: Funder: Medical Research Council (MRC)Grant number: G0500274. ISRCTN: 14352545. Date trial stated: June 2007. Expected end date: December 2009. Expected reporting date: December 2010.

• Offering antenatal sickle cell and thalassaemia screening to pregnant women in primary care: a qualitative study of GPs' experiences.

  Authors: Vicki Tsianakas, Michael Calnan, Karl Atkin, Elizabeth Dormandy, Theresa M Marteau

  The British journal of general practice : the journal of the Royal College of General Practitioners. 11/2010; 60(580):822-8.

  Timely antenatal sickle cell and thalassaemia (SC&T) screening for all women in primary care facilitates informed decision making, but little is known about its implementation. To assess theTimely antenatal sickle cell and thalassaemia (SC&T) screening for all women in primary care facilitates informed decision making, but little is known about its implementation. To assess the feasibility of offering antenatal SC&T screening in primary care at the time of pregnancy confirmation. Cross-sectional investigation of GPs' beliefs and perceived practices. Informal face-to-face interviews with 34 GPs. Seventeen inner-city general practices that offered antenatal SC&T screening as part of a trial. GPs identified both barriers and facilitators. Organisational barriers included inflexible appointment systems and lack of interpreters for women whose first language was not English. Professional barriers included concerns about raising possible adverse outcomes in the first antenatal visit. Perceived patient barriers included women's lack of awareness of SC&T. Hence, GPs presented the test to women as routine, rather than as a choice. Organisational facilitators included simple and flexible systems for offering screening in primary care, practice cohesion, and training. Professional facilitators included positive attitudes to screening for SC&T. Perceived patient facilitators included women's desire for healthy children. GPs reported barriers, as well as facilitators, to successful implementation but the extent to which screening could be regarded as offering 'informed choice' remained fundamental when making sense of these barriers and facilitators.

• Impact of communicating personalized genetic risk information on perceived control over the risk: a systematic review.

  Authors: Ruth E Collins, Alison J Wright, Theresa M Marteau

  Genetics in medicine : official journal of the American College of Medical Genetics. 10/2010; 13(4):273-7.

  Much concern has been expressed that feedback of personalized genetic risk information may lead to fatalism, i.e., a lack of perceived control over the risk. This review aimed to assess the strengthMuch concern has been expressed that feedback of personalized genetic risk information may lead to fatalism, i.e., a lack of perceived control over the risk. This review aimed to assess the strength of evidence for such a view. Electronic databases were searched to find eligible studies, which comprised randomized, controlled trials and analog studies, in which participants in one arm received either real or imagined personalized genetic risk information and assessed perceived control in relation to the treatability or preventability of the health problem. Inspection of 1340 abstracts resulted in 5 studies meeting the inclusion criteria, involving the prediction of obesity, heart disease, depression, and diabetes. Meta-analyses of the clinical studies revealed no impact of personalized genetic risk information on perceived control in either the short term (pooled standardized mean difference 0.09, 95% confidence interval, -0.51 to 0.70) or longer term (pooled standardized mean difference 0.00, confidence interval, -0.20 to 0.21). Similarly, no impact on perceived control was evident in the three analog studies (pooled standardized mean difference 0.02, confidence interval, -0.17 to 0.20). Few studies have assessed empirically the impact of personalized genetic risk information on fatalism, assessed using perceptions of control over the risk. Limited evidence suggests feedback of genetic risk information may have little impact on such beliefs.

• What underlies the perception that a medical intervention is effective? An exploratory study among smokers.

  Authors: Florian Vogt, Mark Ashworth, Sue Hall, Falko F Sniehotta, Theresa M Marteau

  Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco. 03/2010; 12(5):508-15.

  The perceived ineffectiveness of medical interventions is a key predictor of their underuse. This study explores the nature of this perception with regards to a range of medical interventions. AdultThe perceived ineffectiveness of medical interventions is a key predictor of their underuse. This study explores the nature of this perception with regards to a range of medical interventions. Adult smokers (n = 18) completed interviews and questionnaires using the repertory grid technique to elicit personal constructs underlying perceptions of effectiveness of a range of medical interventions (three to stop smoking, three to prevent heart disease, one to reduce pain, one to lose weight, and one to treat depression). Principle components analysis was applied to identify the key underlying dimensions within the constructs. Numerical estimates of the effectiveness of the interventions were also collected from participants to compare them with the published evidence. Constructs clustered around three dimensions: "therapeutic impact," "behavior-dependent impact," and "impact facilitates general health." Smokers perceived impacts that are dependent on the individuals' behavior to offer small therapeutic impacts, while facilitating individuals' general health. These three characteristics were attributed to nonbiomedical interventions (e.g., talk-based interventions), while the opposite characteristics were attributed to biomedical interventions (i.e., medication and surgery). Numerical estimates showed that the effectiveness of stop-smoking interventions was underestimated relative to interventions to prevent heart disease. The elicited dimensions provide a basis for communicating evidence concerning the effectiveness of medical interventions, with a view to increasing their use.

• General practitioners' perceptions of the effectiveness of medical interventions: an exploration of underlying constructs.

  Authors: Florian Vogt, David Armstrong, Theresa M Marteau

  Implementation science : IS. 02/2010; 5:17.

  Many interventions shown to be effective through clinical trials are not readily implemented in clinical practice. Unfortunately, little is known regarding how clinicians construct their perceptionsMany interventions shown to be effective through clinical trials are not readily implemented in clinical practice. Unfortunately, little is known regarding how clinicians construct their perceptions of the effectiveness of medical interventions. This study aims to explore general practitioners' perceptions of the nature of 'effectiveness'. The design was qualitative in nature using the repertory grid technique to elicit the constructs underlying the perceived effectiveness of a range of medical interventions. Eight medical interventions were used as stimuli (diclophenac to reduce acute pain, cognitive behaviour therapy to treat depression, weight loss surgery to achieve weight loss, diet and exercise to prevent type 2 diabetes, statins to prevent heart disease, stopping smoking to prevent heart disease, nicotine replacement therapy to stop smoking, and stop smoking groups to stop smoking). The setting involved face-to-face interviews followed by questionnaires in London Primary Care Trusts. Participants included a random sample of 13 general practitioners. Analysis of the ratings showed that the constructs clustered around two dimensions: low patient effort versus high patient effort (dimension one), and small impact versus large impact (dimension two). Dimension one represented constructs such as 'success requires little motivation', 'not a lifestyle intervention', and 'health-care professional led intervention'. Dimension two represented constructs such as 'weak and/or minimal evidence of effectiveness', 'small treatment effect for users', 'a small proportion of users will benefit' and 'not cost-effective'. Constructs within each dimension were closely related. General practitioners judged the effectiveness of medical interventions by considering two broad dimensions: the extent to which interventions involve patient effort, and the size of their impact. The latter is informed by trial evidence, but the patient effort required to achieve effectiveness seems to be based on clinical judgement. Some of the failure of evidence-based medicine to be implemented may be more explicable if both dimensions were attended to.

• Effectiveness of earlier antenatal screening for sickle cell disease and thalassaemia in primary care: cluster randomised trial.

  Authors: Elizabeth Dormandy, Martin Gulliford, Stirling Bryan, Tracy E Roberts, Michael Calnan, Karl Atkin, Jonathan Karnon, Jane Logan, Fred Kavalier, Hilary J Harris, Tracey A Johnston, Elizabeth N Anionwu, Vicki Tsianakas, Patricia Jones, Theresa M Marteau

  BMJ (Clinical research ed.). 01/2010; 341:c5132.

  To evaluate the effectiveness of offering antenatal screening for sickle cell disease and thalassaemia in primary care as a way of facilitating earlier uptake of screening. Partial factorial clusterTo evaluate the effectiveness of offering antenatal screening for sickle cell disease and thalassaemia in primary care as a way of facilitating earlier uptake of screening. Partial factorial cluster randomised controlled trial. 25 UK general practices from deprived inner city areas. Anonymised data on all pregnant women attending participating practices during a six month period before randomisation and a seven month period after randomisation. This included 1708 eligible women. Practices were randomised to three groups for seven months: parallel testing in general practice (tests for sickle cell disease and thalassaemia offered to both parents when pregnancy was first reported); sequential testing in general practice (tests offered to mothers when pregnancy was first reported, and subsequently to the partners of women who were found to be carriers); and midwife care (tests offered to mothers at first consultation with a midwife). The primary outcome (available for all women) was the proportion of eligible women screened before 10 weeks' (70 days') gestation. Secondary outcomes were an offer of screening to women before 10 weeks' gestation, gestational age at testing, mean interval from first visit to the general practice visit to screening, and women's knowledge of the carrier status of their baby's father before 77 days' (11 weeks') gestation. The study was designed to detect a 20% absolute increase in screening uptake. Cluster level analyses were adjusted for age group, parity, ethnic group, primary care organisation, and number of general practitioners per practice. Data were analysed for 1708 eligible women. In the midwife care arm, 2% (9/441) of women were screened before 10 weeks' gestation compared with 24% (161/677) in the GP parallel testing arm and 28% (167/590) in the GP sequential testing arm. The estimated adjusted difference between the midwife care and GP parallel testing arms was 16.5% (95% confidence interval 7.1% to 25.8%; P=0.002) and between the midwife care and GP sequential testing arms was 27.8% (14.8% to 40.7%; P<0.001). By 26 weeks' gestation the proportion of women screened across the three trial arms was similar (81%). The proportion of women who knew the carrier status of the baby's father by 11 weeks' gestation was 0% (0/441) in the midwife care arm, 2% (13/677) in the GP parallel testing arm (P=0.003), and 1% (3/590) in the GP sequential testing arm (P=0.374). Offering antenatal screening for sickle cell disease and thalassaemia as part of consultations for pregnancy confirmation in primary care increases the proportion of women screened before 10 weeks' gestation. Even with intervention, however, only a minority of women were screened before 10 weeks. Additional interventions should be considered to achieve testing early in pregnancy for most women wanting such tests so that couples with affected pregnancies have less time pressure to choose options, which may include termination of the pregnancy. Current Controlled Trials ISRCTN00677850.

• Effects of communicating DNA-based disease risk estimates on risk-reducing behaviours.

  Authors: Theresa M Marteau, David P French, Simon J Griffin, A T Prevost, Stephen Sutton, Clare Watkinson, Sophie Attwood, Gareth J Hollands

  Cochrane database of systematic reviews (Online). 01/2010;

  There are high expectations regarding the potential for the communication of DNA-based disease risk estimates to motivate behaviour change. To assess the effects of communicating DNA-based diseaseThere are high expectations regarding the potential for the communication of DNA-based disease risk estimates to motivate behaviour change. To assess the effects of communicating DNA-based disease risk estimates on risk-reducing behaviours and motivation to undertake such behaviours. We searched the following databases using keywords and medical subject headings: Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 4 2010), MEDLINE (1950 to April 2010), EMBASE (1980 to April 2010), PsycINFO (1985 to April 2010) using OVID SP, and CINAHL (EBSCO) (1982 to April 2010). We also searched reference lists, conducted forward citation searches of potentially eligible articles and contacted authors of relevant studies for suggestions. There were no language restrictions. Unpublished or in press articles were eligible for inclusion. Randomised or quasi-randomised controlled trials involving adults (aged 18 years and over) in which one group received actual (clinical studies) or imagined (analogue studies) personalised DNA-based disease risk estimates for diseases for which the risk could plausibly be reduced by behavioural change. Eligible studies had to include a primary outcome measure of risk-reducing behaviour or motivation (e.g. intention) to alter such behaviour. Two review authors searched for studies and independently extracted data. We assessed risk of bias according to the Cochrane Handbook for Systematic Reviews of Interventions. For continuous outcome measures, we report effect sizes as standardised mean differences (SMDs). For dichotomous outcome measures, we report effect sizes as odds ratios (ORs). We obtained pooled effect sizes with 95% confidence intervals (CIs) using the random effects model applied on the scale of standardised differences and log odds ratios. We examined 5384 abstracts and identified 21 studies as potentially eligible. Following a full text analysis, we included 14 papers reporting results of 7 clinical studies (2 papers report on the same trial) and 6 analogue studies.Of the seven clinical studies, five assessed smoking cessation. Meta-analyses revealed no statistically significant effects on either short-term (less than 6 months) smoking cessation (OR 1.35, 95% CI 0.76 to 2.39, P = 0.31, n = 3 studies) or cessation after six months (OR 1.07, 95% CI 0.64 to 1.78, P = 0.80, n = 4 studies). Two clinical studies assessed diet and found effects that significantly favoured DNA-based risk estimates (OR 2.24, 95% CI 1.17 to 4.27, P = 0.01). No statistically significant effects were found in the two studies assessing physical activity (OR 1.03, 95% CI 0.59 to 1.80, P = 0.92) or the one study assessing medication or vitamin use aimed at reducing disease risks (OR 1.26, 95% CI 0.58 to 2.72, P = 0.56). For the six non-clinical analogue studies, meta-analysis revealed a statistically significant effect of DNA-based risk on intention to change behaviour (SMD 0.16, 95% CI 0.04 to 0.29, P = 0.01).There was no evidence that communicating DNA-based disease risk estimates had any unintended adverse effects. Two studies that assessed fear arousal immediately after the presentation of risk information did, however, report greater fear arousal in the DNA-based disease risk estimate groups compared to comparison groups.The quality of included studies was generally poor. None of the clinical or analogue studies were considered to have a low risk of bias, due to either a lack of clarity in reporting, or where details were reported, evidence of a failure to sufficiently safeguard against the risk of bias. Mindful of the weak evidence based on a small number of studies of limited quality, the results of this review suggest that communicating DNA-based disease risk estimates has little or no effect on smoking and physical activity. It may have a small effect on self-reported diet and on intentions to change behaviour. Claims that receiving DNA-based test results motivates people to change their behaviour are not supported by evidence. Larger and better-quality RCTs are needed.

• Impact of informed-choice invitations on diabetes screening knowledge, attitude and intentions: an analogue study.

  Authors: Eleanor Mann, Ian Kellar, Stephen Sutton, Ann Louise Kinmonth, Matthew Hankins, Simon Griffin, Theresa M Marteau

  BMC public health. 01/2010; 10:768.

  Despite concerns that facilitating informed choice would decrease diabetes screening uptake, 'informed choice' invitations that increased knowledge did not affect attendance (the DICISION trial). WeDespite concerns that facilitating informed choice would decrease diabetes screening uptake, 'informed choice' invitations that increased knowledge did not affect attendance (the DICISION trial). We explored possible reasons using data from an experimental analogue study undertaken to develop the invitations. We tested a model of the impact on knowledge, attitude and intentions of a diabetes screening invitation designed to facilitate informed choices. 417 men and women aged 40-69 recruited from town centres in the UK were randomised to receive either an invitation for diabetes screening designed to facilitate informed choice or a standard type of invitation. Knowledge of the invitation, attitude towards diabetes screening, and intention to attend for diabetes screening were assessed two weeks later. Attitude was a strong predictor of screening intentions (β = .64, p = .001). Knowledge added to the model but was a weak predictor of intentions (β = .13, p = .005). However, invitation type did not predict attitudes towards screening but did predict knowledge (β = -.45, p = .001), which mediated a small effect of invitation type on intention (indirect β = -.06, p = .017). These findings may explain why information about the benefits and harms of screening did not reduce diabetes screening attendance in the DICISION trial.