Psychology and Health

Published by Taylor & Francis (Routledge)
Online ISSN: 0887-0446
Publications
Article
This longitudinal study investigated differences in beliefs and perceived behavioural control between smokers and non-smokers in a large sample of adolescents. Positive and negative instrumental beliefs, normative beliefs, perceived behavioural control (PBC) and smoking status were assessed in the same participants at 11, 13 and 15 years of age. Prospective analyses among non-smokers revealed that for boys, negative instrumental beliefs in non-smokers at age 11 predicted smoking at age 15 years. For girls, normative beliefs and PBC in non-smokers at age 11 predicted smoking status at age 13; normative beliefs at age 11 predicted smoking at age 15; and positive instrumental beliefs and normative beliefs at age 13 predicted smoking status at age 15. Cross-sectional data revealed that smokers were significantly more likely than non-smokers to endorse positive instrumental beliefs, less likely to agree with negative instrumental belief items, more likely than non-smokers to perceive social pressure to smoke, and less likely to report control over smoking, and that female smokers reported less control over smoking and fewer negative instrumental beliefs than all other groups including male smokers at age 13. The need for belief-based preventative interventions that are age- and gender-relevant is discussed.
 
Article
Abstract This study investigated the validity of a Stages of Change algorithm with respect to independent measures of physical activity and fitness. dietary intake and alcohol consumption in 18 year-old Ausmlian men (n = 301) and women (n = 282). Stage of Change categories were related to fat and fibre intakes in men and fibre intake in women as well as hit and vegetable intakes in men and women. Physical activity and fitness for men and women also showed significant linear associations with Stage of Change categories. Alcohol consumption was significantly associated with Stage of Change categories for men but not for women although recorded alcohol consumption was very variable for women. However, the algorithm was valid for both men and women when drinking alcohol consistent with national guidelines on safe drinking was used. In summary, with reference to actual health behaviours, the Stages of Change algorithm was valid for young men and women for diet. physical activity and alcohol drinking. Independent behavioural data were not available for smoking behaviours. Using the algorithm, there were significant associations in men between prccontemplation status for diet and drinking and diet and physical activity, in women between diet and smoking and in both men and women between drinking and smoking. Covariance between precontemplation status for different health behaviours therefore suggests the need for multimodal interventions.
 
Article
The aim of the present work was to examine the association of depression and marital status, with the long-term prognosis of Acute Coronary Syndrome (ACS), among a Greek sample of cardiac patients. From October 2003-September 2004 a sample of 2,172 consecutive ACS patients from 6 hospitals was enrolled. In 2013-14, the 10-year follow-up was performed in 1,918 participants. Depressive symptoms were evaluated using the validated CES-D score (range 0-60), while marital status was classified as: single, married/cohabitants, divorced and widowed at the time of entry to the study. patients in the upper tertile of CES-D (>20 score) had 41% (95%CI 14%, 75%) higher risk of ACS incidence as compared with those in the lowest (<7 score). In contrary, married patients had 29% lower risk (95%CI 6%, 46%) of ACS mortality compared with single, widowed or divorced. Multi-adjusted analysis revealed that, among the "not married" patients, 1-point increase in the CES-D score was associated with 2% (p=0.02) and 4% (p=0.001) higher risk of having non- fatal or fatal cardiac events, respectively. The present study highlights the important role of depression in the context of marital relationships among ACS patients. Secondary public health care intervention programs are needed to improve patient outcomes and minimize disease burden in clinical and community setting.
 
Article
Whilst survival rates for childhood cancer have improved dramatically over the past three decades, it is still a devastating diagnosis for family members and an illness which severely disrupts the lifestyle of the family unit. Developing an understanding of the impact of the illness on the family is crucial to better support families' deal with the demands of the illness. In this study nine families in which a child was diagnosed with cancer were interviewed twice over a 12 month period, approximately 6 months apart. Using Interpretative Phenomenological Analysis, a semi-structured interview was used to explicate parent's experience of childhood cancer. The results revealed five super-ordinate themes; (1) a pivotal moment in time, (2) the experience of adaptation in relation to having a sick child, (3) the nature of support, (4) re-evaluation of values during a critical life experience and (5) the experience of optimism and altruism. Findings indicate that parents express both negative and positive experiences as they re-evaluate the meaning and purpose of life, seek to redefine themselves, often in terms of priorities, relationships, sense of community and achieve degrees of optimism and altruism. Implications for addressing the needs of parents and for further research are discussed.
 
Article
Abstract Objective: Key psychometric information was sought for three newly derived dimensions from an abridged Illness Behaviour Questionnaire (IBQ-31): Affirmation of Illness (AI), Concern for Health (CH) and General Affective State (GAS). The construct validity of these scales was examined along with their test-retest reliability and long-term stability. Design: A longitudinal, observational study was conducted with 675 participants (general community members and those with either asthma, diabetes, chronic pain or chronic fatigue syndrome) providing self-report questionnaire data at baseline, with additional information sought at three (n = 483; 71.6%) and 12 months (n = 517, 76.6%). Main Outcome Measures: Construct validity of the IBQ-31 was explored using well-validated psychological measures of Symptom Attributions and Symptom Experience, Cognitive Distortion of Somatic Information and Illness Likelihood. Results: In general, AI, CH and GAS shared predictable empirical overlap with related psychological indices across the five samples. Adequate three month test-retest reliability was evident, with greater score variability over 12 months. Conclusion: The IBQ-31 comprises three theoretically relevant dimensions which demonstrate relative short- and long-term stability for individuals with diverse illness experiences. Future investigations should explore the predictive validity of AI, CH and GAS, along with the potential value of 'cut-off' scores for clinical use.
 
Article
Stressful and traumatic events may trigger positive life changes, so-called adversarial growth. Despite growing interest in this topic, the structure and dimensionality of this concept has not been established. Recently, empirical reviews have suggested that the factors underlying this construct are highly related. Currently, the use of confirmatory factor analysis to test this hypothesis is advocated. Using data from cancer patients (n = 206), this study investigated the dimensionality of a Dutch translated version of the Silver Lining Questionnaire (SLQ-38). A 16-item SLQ (SLQ-16), with three subscales or first-order factors (enhanced personal relationships, changes in life philosophy and changes within the self) loading on a second-order general adversarial growth factor, was a good fitting model. In conclusion, the SLQ-16 may prove useful in the assessment of adversarial growth following illness.
 
CONSORT Flowchart (WSD = Written Self-Disclosure; SMC = Standard Medical Care)  
Article
Written self-disclosure (WSD) has rarely been evaluated as an intervention for paediatric diseases. To test the efficacy of WSD for youths aged 11-18 years with a diagnosis of functional recurrent abdominal pain (RAP), 63 were randomly assigned to receive standard medical care (SMC) alone or WSD in addition to SMC. WSD was administered in three 20-min sessions, one in the clinic and two by phone in the home. Measures of self-reported pain frequency, somatisation severity and quality of life (QOL) were completed at baseline and 3- and 6-month follow-up points. Blind review of electronic medical records provided data on clinic visit and phone consultation utilisation for the 6 months prior to and following baseline. Practice of WSD in addition to SMC was associated with significantly fewer activity-limiting gastrointestinal pain experiences (d = 0.61) and reduced health care utilisation (d = 0.59) 6 months later compared to SMC alone. There were no significant effects for somatisation severity or QOL in 6 months. WSD may be a useful treatment adjunct for reducing pain frequency and resulting health care utilisation in a portion of youths with functional RAP.
 
Article
The primary aim was to explore the factor structure of the Illness Behaviour Questionnaire (IBQ) and the generalisability of the derived dimensions to both general community members and four chronic illness groups. A questionnaire was administered to 675 participants, comprising 344 from the community, 80 with asthma, 95 with diabetes, 79 with chronic pain and 77 with chronic fatigue syndrome (CFS). Illness severity was calculated for all chronic illness participants (self-rated health for community members). Three IBQ scales were derived following an exploratory factor analysis for the whole sample: Affirmation of Illness (α = 0.71 (CFS)-0.79 (asthma, diabetes)), Concern for Health (α = 0.71 (asthma)-0.78 (pain)) and General Affective State (α = 0.70 (CFS)-0.80 (asthma)). Patterns of response across the five samples, and intercorrelations among the new scales and the original seven scales, were largely in accord with expectation. Long-standing criticisms of the IBQ were addressed by using systematic statistical principles to identify meaningful and psychometrically sound IBQ dimensions. The derived structure offers a more parsimonious account of possible illness responses, with the availability of a more concise yet informative index of abnormal illness behaviour having practical utility for researchers and clinicians alike.
 
Means, Standard Deviations and Cronbach Alpha Coefficients for the Illness Representation, Emotion and Demographic Variables for the Colposcopy and Colorectal Screening Samples 
Article
The present study examined the relationship of cognitive and emotional representations of illness specified by self-regulation theory on emotional responses of patients with abnormal screening results. Participants were 660 women who received an abnormal cervical smear and 701 men and women who received an abnormal colorectal cancer screening result. Participants completed postal questionnaires containing measures of illness representations and specific emotions. Factor analyses of cause components produced three factors for each sample, corresponding to psychological stress, biological, and behavioural causes. Regression analyses showed that, after controlling for demographic variables, perceived consequences, illness identity, and causal attributions to psychological stress explained significant variance in emotion. Emotional representations also accounted for unique variance in emotional responses. Results indicate congruence in the relationships between illness representations of an emotionally salient event and emotion in patients from the two cancer screening programmes and support the internal validity of self-regulation theory.
 
Article
All cancer screening tests produce a proportion of abnormal results requiring follow up. Consequently, the cancer-screening setting is a natural laboratory for examining psychological and behavioural response to a threatening health-related event. This study tested hypotheses derived from the social cognitive processing and cognitive-social health information processing models in trying to understand response to an abnormal ovarian cancer (OC) screening test result. Women (n = 278) receiving an abnormal screening test result a mean of 7 weeks earlier were assessed prior to a repeat screening test intended to clarify their previous abnormal result. Measures of disposition (optimism, informational coping style), social environment (social support and constraint), emotional processing, distress, and benefit finding were obtained. Regression analyses indicated greater distress was associated with greater social constraint and emotional processing and a monitoring coping style in women with a family history of OC. Distress was unrelated to social support. Greater benefit finding was associated with both greater social constraint and support and greater distress. The primacy of social constraint in accounting for both benefit finding and distress was noteworthy and warrants further research on the role of social constraint in adaptation to stressful events.
 
Mean job stress across three occasions.  
Mean burnout across three occasions.  
Rates of absenteeism for health reasons and for other reasons across two occasions.  
Article
Abstract The purpose of the present study was to test the hypothesis that vacation relief decreases psychological and behavioral strains caused by job stressors. We examined the impact of job stress and vacation on strain on 87 blue-collar employees in an industrial enterprise in central Israel. Whereas former respite research focused on the impact of vacation only on psychological strains such as burnout and job and life satisfaction, the current study also examined a behavioral strain, absenteeism. The employees completed questionnaires before and after vacation and again four weeks later. Our findings show that vacation alleviated perceived job stress and bumout as predicted, replicating findings that a respite from work diminishes levels of strain to lower than chronic, on-the-job levels. We found declines in burnout immediately after the vacation and a return to prevacation levels four weeks later, and a similar pattern with regard to absenteeism.
 
Article
Objective: Previous research has focused mostly on abstainer and/or general drinker prototypes. The present studies examined an abstainer, moderate drinker and heavy drinker prototype in relation to drinking behaviour. Design: Two studies among young adults aged 18-25 (paper-and-pencil, cross-sectional, N = 140; online, prospective, N = 451) assessed prototype favourability and participants' perceived similarity to the prototypes. Participants were also categorised into abstainers, moderate, and heavy drinkers. Results: Similarity and favourability had similar sequences in both studies: the moderate drinker and abstainer prototypes were evaluated most favourable and felt similar to; the heavy drinker prototype was rated the least favourable and felt similar to. Importantly, heavy drinking participants felt most similar to the moderate drinker prototype and rated the heavy drinker least desirable. The results suggest a need for research to include other prototypes, such as the moderate drinker, besides the abstainer and heavy drinker. Conclusion: The studies provide insights into the contribution of alternative prototypes (i.e. moderate drinker) into the relationship between prototype perceptions and drinking behaviour. The results suggest tailoring prototype-based interventions according to drinking behaviour. Importantly, realistic perceived similarity to the more favourable moderate drinker prototype may therefore need to be encouraged only after appropriate reductions in heavy drinkers' alcohol consumption.
 
Article
Abstract Two studies examined the association of gender and occupational group (nursing versus non-nursing) with perceived risk of abuse (sexual harassment and verbal and physical abuse) as well as the relationship of perceived abuse risk with burnout and sense of community. Study 1, comprising of two settings (tertiary care hospital, N = 3,062; psychiatric hospital, N = 383), found gender and occupational group associated with perceived risk of abuse (women felt greater risk than men; nurses felt greater risk than non-nurses). It also found a gender/occupational group interaction. Study 2, conducted at an Irish tertiary care hospital (N = 892), found nurses felt at greater risk for all three types of abuse than did non-nurses. Further, women perceived themselves at greater risk for sexual harassment and verbal abuse than did men; the study found no gender difference regarding physical abuse. The analysis identified a gender/occupational group interaction for sexual harassment. The study considers methods of reducing perceived risk in regard to the research literature on abuse at work.
 
Article
People with chronic physical conditions are at elevated risk of depression. Due to a shortage of Cognitive Behavioural Therapy (CBT) practitioners, computerised CBT (CCBT) is recommended for people with mild to moderate depression. We assessed the applicability of CCBT for the treatment of depression in people with multiple sclerosis (MS). Depth interviews with 17 people with MS and mild to moderate depression who used one of the two CCBT packages for either eight (Beating the Blues; n = 8) or five (MoodGym; n = 9) weekly sessions were analysed using 'Framework'. Participants found CCBT-use burdensome due to their physical symptoms. In addition to perpetuating social isolation, the lack of human input meant some participants were unable to define problems, set goals or distinguish between events, thoughts and beliefs as required. CCBT did not legitimise their grief over losses concomitant with their MS. They characterised depression symptom inventories as contaminated by somatic symptoms of their MS. One CCBT package (MoodGym) was perceived as using inappropriate case material for people with the symptoms of MS. It is likely that generic CCBT packages for the treatment of depression will need to be adapted for people with chronic physical conditions to maximise their potential for health benefit.
 
Article
Financial health incentives, such as paying people to exercise, remain controversial despite widespread implementation. This focus group study explored the acceptability of incentives among a sample of Canadian cardiac rehabilitation (CR) patients (n = 15). Focus groups were conducted between March and April 2013 until further sampling ceased to produce new analytical concepts. A thematic analysis approach was adopted in analysing the data. Three broad themes emerged from the focus groups. First, ethical concerns were prominent. Half of participants disagreed with the incentive approach believing that it was unfair, unnecessary or a waste of limited resources. Second, ethical concerns were mitigated in considering a range of incentive features including type, size and source. Specifically, privately sponsored (not government funded) health-promoting voucher-based incentives (e.g. grocery or gym vouchers) were perceived to be highly acceptable. Third, if designed like this, then financial incentives were considered potentially effective in motivating behaviour change and in reducing economic barriers to exercise participation. Overall, the majority of participants welcomed incentives if ethical concerns were addressed through thoughtful incentive programme design. The results of this focus group study will inform the design of a financial health incentive feasibility RCT to promote post-CR programme exercise compliance in this population.
 
Interactive effects of smoking status, mood and argument quality on attitudes towards smoking and attitudes towards the recommended action. 
Article
An experimental study tested the effects of positive and negative mood on the processing and acceptance of health recommendations about smoking in an online experiment. It was hypothesised that positive mood would provide smokers with the resources to systematically process self-relevant health recommendations. One hundred and twenty-seven participants (smokers and non-smokers) read a message in which a quit smoking programme was recommended. Participants were randomly assigned to one of four conditions: positive versus negative mood, and strong versus weak arguments for the recommended action. Systematic message processing was inferred when participants were able to distinguish between high- and low-quality arguments, and by congruence between attitudes and behavioural intentions. Persuasion was measured by participant's attitudes towards smoking and the recommended action, and by their intentions to follow the action recommendation. As predicted, smokers systematically processed the health message only under positive mood conditions; non-smokers systematically processed the health message only under negative mood conditions. Moreover, smokers' attitudes towards the health message predicted intentions to quit smoking only under positive mood conditions. Findings suggest that positive mood may decrease defensive processing of self-relevant health information.
 
Article
Abstract Based on a multidimensional model of the caregiving process, the main goal of this study was to examine the direct and indirect links, via acceptance and denial coping, between the caregiving burden and the quality of life (QoL) in parents of children with asthma. The sample was comprised of 182 parents of a child/adolescent between 8 and 18 years of age with a clinical diagnosis of asthma. Data were obtained via self-report questionnaires assessing the caregiving burden, acceptance and denial coping strategies and QoL. Results from structural equation modelling indicated a good fit for the mediation model, which explained 30% of the variability of the parents' QoL. Higher levels of caregiving burden were negatively and indirectly associated with the parents' QoL, via less use of acceptance and greater use of denial coping strategies. Multi-group analyses ascertained the invariance of these links across the children's asthma severity, age and socio-economic groups. These findings emphasize acceptance and denial as important coping mechanisms in the caregiving process. Thus, broad-spectrum family-centred interventions in paediatric asthma settings can target the development of the parents' coping tendencies characterized by greater acceptance and less denial as a way of reappraising caregiving demands as less burdensome and improving their QoL. Full text: http://www.tandfonline.com/eprint/FxDTu9xJWpew9nZ4nWap/full
 
Article
Acceptance of pain has been found to play an important role in adjusting to chronic pain, and the evidence-base is growing with regards to the effectiveness of acceptance-based interventions such as acceptance and commitment therapy, mindfulness and contextual cognitive behavioural therapy within pain management settings. Despite the growing interest in such interventions, previous studies into acceptance-based pain management programmes (PMPs) are quantitative and the exact processes at work during such programmes remain unknown. This study aims to add to previous quantitative research in the area by qualitatively exploring individual experiences of attending an acceptance-based PMP and identifying the key constituents of the programme that participants felt facilitated change. Semi-structured interviews (n = 6) were analysed using interpretative phenomenological analysis, and five themes emerged: I'm not alone, others understand my pain, Freedom from pain taking over, A new self - one with pain, Parts of the programme participants felt facilitated change and Exercise is possible. These findings are then considered in relation to past research and relevant constructs in the literature. Implications for future research and clinical practice are also discussed alongside participant reflections and suggested areas for improvement.
 
Article
This study examines relations between acceptance as defined in Acceptance and Commitment Therapy (ACT) and adjustment to multiple sclerosis (MS). A first step in this investigation was the development of a measure of acceptance of MS called the MS Acceptance Questionnaire (MSAQ). Consistent with prior findings and theoretical propositions, it was predicted that acceptance would be associated with better adjustment to MS (lower distress and higher positive affect, life satisfaction and marital adjustment and better health). A total of 128 persons with MS completed measures of demographics, illness and adjustment at Time 1 and measures of acceptance and adjustment 12 months later (Time 2). Factor analyses of the MSAQ revealed two factors, action and willingness. Associations between the MSAQ and other validated acceptance measures supported convergent validity. As predicted, after controlling for the effects of initial adjustment and relevant demographic and illness variables, greater acceptance was related to better adjustment, although the action factor emerged as the strongest predictor of better adjustment. This is the first study to examine the role of acceptance (as defined in ACT) in adjusting to MS over time and as such provides a first step for further investigation of acceptance in MS.
 
Article
Objective: The main aim of this study was to investigate the relationship between acceptance and well-being in adolescents with chronic illness from a daily process perspective. Furthermore, we explored the role of daily experienced interference and facilitation of life goals by treatment goals as mediating mechanisms. Methods: Thirty-eight adolescents with cystic fibrosis (CF) or diabetes completed questionnaires assessing acceptance, negative life events and goal-related self-efficacy. Furthermore, an online diary assessing daily mood, daily experienced interference and facilitation of life goals by treatment goals was completed during three consecutive weeks. Results: Acceptance of illness was positively related to daily well-being, but unrelated to daily goal interference and facilitation. Furthermore, daily goal interference and facilitation were unrelated to same-day and next-day well-being. Conclusion: This study suggests that acceptance of illness plays an important role in the daily mood of adolescents with CF and diabetes. This relationship, however, was not mediated by daily experienced interference and facilitation of life goals by treatment goals. Further research is needed to determine whether interventions promoting acceptance are beneficial for adolescents with CF and diabetes.
 
Article
Abstract Objective: HIV-related stigma is a major driver of poor prognosis for the treatment and reduced spread of HIV. The present article provides a qualitative analysis surrounding various themes related to stigma and shame as a result HIV Design: Eight gay men recruited from a community HIV clinic contacted the researchers in response to a study involving participation in a structured, 8-week group intervention for HIV-related stigma. Following this group, three men took part in open-ended interviews about their thoughts and experiences. Methods: IPA (interpretative phenomenological analysis) was used to examine the participants' experiences surrounding shame and stigma related to living with HIV. Results: Three superordinate themes were identified: social support and the disclosure of serostatus, stigma associated with serosorting, and attempts to negotiate a spoiled identity. Conclusion: In San Francisco, a city with a great deal of acceptance surrounding HIV and a large, politically active community of persons living with HIV, gay men continue to struggle with disclosure and stigma. This stigma may be an unexpected result of a high degree of HIV-testing and attempts by both HIV-positive and negative gay men to practice serosorting.
 
Mean proportion of healthy items in total items chosen for healthy eating intentions and control conditions, with 95% confidence intervals.
Article
Objective: The question-behaviour effect (QBE) refers to the finding that measuring behavioural intentions increases performance of the relevant behaviour. This effect has been used to change health behaviours. The present research asks why the QBE occurs and evaluates one possible mediator - attitude accessibility. Design: University staff and students (N = 151) were randomly assigned to an intention measurement condition where they reported their intentions to eat healthy foods, or to one of two control conditions. Main outcome measures: Participants completed a response latency measure of attitude accessibility, before healthy eating behaviour was assessed unobtrusively using an objective measure of snacking. Results: Intention measurement participants exhibited more accessible attitudes towards healthy foods, and were more likely to choose a healthy snack, relative to control participants. Furthermore, attitude accessibility mediated the relationship between intention measurement and behaviour. Conclusion: This research demonstrates that increased attitude accessibility may explain the QBE, extending the findings of previous research to the domain of health behaviour.
 
Means, SDs and correlations between the variables in Study 2 (N ¼ 54). 
Article
Objective: Two studies examined the hypothesis that making snacks less accessible contributes to the regulation of food intake. Study 1 examined whether decreasing the accessibility of snacks reduces probability and amount of snack intake. The aim of Study 2 was to replicate the results and explore the underlying mechanism in terms of perceived effort to obtain the snack and perceived salience of the snack. Methods: In Study 1 (N = 77) and Study 2 (N = 54) distance to a bowl of snacks was randomly varied at 20, 70 or 140 cm in an experimental between-subjects design. Main outcome measures were the number of people who ate any snacks (probability of snack intake), the amount of snacks consumed and risk of compensatory behaviour as measured by food craving. In Study 2, self-report ratings of salience and effort were examined to explore potential underlying mechanisms. Results: Study 1 showed lower probability and amount of intake in either of more distant conditions (70 and 140 cm) compared to the proximal condition (20 cm), with no unintended effects in terms of increased craving. Study 2 replicated the results of Study 1 and showed that distance affected perceived effort but not salience. Conclusions: Making snacks less accessible by putting them further away is a potentially effective strategy to decrease snack intake, without risk of compensatory behaviour.
 
Article
Abstract Ephedrine use in sport is a common practice among men (Magkos & Kavouras, 2004). Less well-understood is men's use of ephedrine as a slimming aid. Arguably fuelled by the 'war on obesity' and the drive for muscularity (Grogan, 2008; 2010) the internet has become awash with claims presenting ephedrine as safe. The use of this psychoactive substance can have acute health implications such as tachycardia, arrhythmias and cardiovascular disease (European Centre for Drugs and Drug Additions, 2013). Given the tension between health risk and ephedrine-induced weight loss, how men justify their use of ephedrine becomes an important question. In particular, we wished to analyse how male users talked to others about ephedrine in discussions linked to an online version of a popular men's magazine. Because we were particularly interested in how men accounted for their ephedrine use, we used discourse analysis to examine their posts (Potter, 1996). In analysing the data, we noted that a "community of practice" (e.g. Ba, 2001) was constructed online categorising legitimate (and barred) users, emphasising the benefits of ephedrine, and downplaying health-defeating side effects. Our analysis has clear implications for engaging men who use ephedrine in health promotion interventions.
 
Article
Type 2 diabetes is a metabolic disorder characterised by chronically elevated blood glucose and a high risk of cardiovascular and other complications. Self-management is central to diabetes care and includes taking regular exercise, low-fat/sugar diet and blood glucose monitoring. However, little is understood about how people with diabetes make sense of self-management. Our aim, therefore, is to explore the process of 'getting one's thoughts straight' in relation to illness self-management for women with poorly controlled type 2 diabetes. Eight women were recruited from two hospitals in the North of England. Each was interviewed using a biographic-narrative method. Narratives were analysed using a dialogical approach. We use Bakhtin's concepts of voice, official and unofficial truth, and internally persuasive discourse to explore how participants considered, struggled with, and, sometimes, acted upon self-management. We demonstrate how the truth by which participants lived shifted as they encountered new perspectives and experiences. The accounts revealed tension between official, authoritative voices, typically concerned with optimal illness control and unofficial voices that speak at a lived, embodied level. In conclusion, we suggest moving beyond the notion of self-management towards a conceptualisation of life with chronic illness that includes personal goals, values and embodied experience in context.
 
Article
There is consistent evidence that health care professionals (hcps) are not addressing the sexual information and support needs of people with cancer. Thirty-eight Australian hcps across a range of professions working in cancer care were interviewed, to examine constructions of sexuality post-cancer, the subject positions adopted in relation to sexual communication, and the ways in which discourses and subject positions shape information provision and communication about sexuality. Participants constructed sexual changes post-cancer in physical, psychological and relational terms, and positioned such changes as having the potential to significantly impact on patient and partner well-being. This was associated with widespread adoption of a discourse of psychosocial support, which legitimated discussion of sexual changes within a clinical consultation, to alleviate distress, dispel myths and facilitate renegotiation of sexual practices. However, this did not necessarily translate into patient-centred practice outcomes, with the majority of participants positioning personal, patient-centred and situational factors as barriers to the discussion of sex within many clinical consultations. This included: absence of knowledge, confidence and comfort; positioning sex as irrelevant or inappropriate for some people; and limitations of the clinical context. In contrast, those who did routinely discuss sexuality adopted a subject position of agency, responsibility and confidence.
 
Article
The degree of accuracy with which physicians understand their patients' views may be of central importance for promoting self-care in the majority of chronic illnesses and in type 2 diabetes in particular. The objectives of this study were to measure the accuracy of the general practitioners' understanding of the patients' views and relate it to health behavioural outcomes in patients with non-complicated type 2 diabetes. The participants in this cross-sectional study consisted of 14 clinicians and 78 of their patients from Paris, France. The predictors were levels of accuracy in understanding the patients' views derived from the illness perception questionnaire-revised (IPQ-R). The outcomes were patient-reported self-care measures. In regression models controlling for clinical and personal variables, higher accuracy on chronicity beliefs was associated with an improved diet and increased blood glucose self-testing and higher accuracy in identifying treatment control beliefs was associated with better dietary self-care. Accuracy was higher with regard to beliefs about causes, treatment control and consequences. These results suggest that accuracy may impact self-care in specific domains of illness perception but not others. The results may help identify useful avenues of communication training designed for professionals.
 
Article
Many people undergoing HIV testing experience substantial psychological distress. The psychological distress associated with testing may be influenced by monitoring. Monitoring refers to a strategy wherein a person tends to seek out information concerning threatening events. Furthermore, the ability to achieve cognitive structure (AACS) may influence the relationship between monitoring and psychological distress. The present study examined individuals who were undergoing HIV testing. Specifically, the researchers examined the association among monitoring and AACS on psychological distress during HIV testing. Results indicated that there was no interaction between monitoring and AACS on psychological distress. It was found that AACS was related to participants' level of psychological distress. However, the level of monitoring was not related to participants' psychological distress. Limitations of the study, clinical implications and suggestions for future research are also discussed.
 
Article
Despite a steady growth in research into men's health, little is known about how men experience life with a chronic illness like Type 1 diabetes. To address this knowledge gap, we conducted an interview study with 15 men who have Type 1 diabetes. Following grounded theory analysis of the interview transcripts, we generated a number of inter-related themes which were then formulated as a theory of adjustment to life with Type 1 diabetes. This theory indicates that men reduce the seriousness of diabetes by defining it in ways other than a serious illness. By viewing diabetes in this way, men are then able to prioritise the pursuit of their personal goals over adherence to the diabetes regimen. Finally, men reassess their relationship with diabetes in light of diabetes-related complications. The goal of this process is to find the 'best fit' for diabetes in their lives - a place which will allow them to pursue and satisfy their personal goals. As men progress through life, personal goals may change and so too will their relationship with diabetes.
 
Article
This study examines the effectiveness of a brief self-management intervention to support patients recently diagnosed with type-2 diabetes to achieve sustained improvements in their self-care behaviours. Based on proactive coping, the intervention emphasizes the crucial role of anticipation and planning in maintaining self-care behaviours. In a randomised controlled trial among recent screen-detected patients, participants who received the intervention were compared with usual-care controls, examining changes in proximal outcomes (intentions, self-efficacy and proactive coping), self-care behaviour (diet, physical activity and medication) and weight over time (0, 3 and 12 months). Subsequently, the contribution of proactive coping in predicting maintenance of behavioural change was analysed using stepwise hierarchical regression analyses, controlling for baseline self-care behaviour, patient characteristics, and intentions and self-efficacy as measured after the course. The intervention was effective in improving proximal outcomes and behaviour with regard to diet and physical activity, resulting in significant weight loss at 12 months. Furthermore, proactive coping was a better predictor of long-term self-management than either intentions or self-efficacy. Proactive coping thus offers new insights into behavioural maintenance theory and can be used to develop effective self-management interventions.
 
Conceptual framework of the mediation effect of change on the relationship between injury severity and well-being.  
Model assessing the role of personal and social changes in mediating the relationship between injury severity and life satisfaction. Note: Standardised betas are reported.  
Article
This study examined the roles of personal and social changes on the relationship between injury severity and life satisfaction among individuals with acquired brain injury (ABI). Personal change (i.e. having developed a survivor identity, identity strength), social changes (i.e. improved social relationships, support from services), injury severity (i.e. length of time in coma) and well-being (i.e. life satisfaction) were assessed in a sample of 630 individuals with ABIs. A counterintuitive positive relationship was found between injury severity and life satisfaction. Bootstrapping analyses indicated that this relationship was mediated by personal and social changes. Although identity strength was the strongest individual mediator, both personal and social changes each explained unique variance in this relationship. These findings suggest that strategies that strengthen personal identity and social relationships may be beneficial for individuals recovering from ABIs.
 
Article
Differences were examined in Theory of Planned Behaviour determinants of students' intention to smoke including parents' attitudes towards smoking and parents' current cigarette use among Greek students of different school grade levels. Students (N = 763) aged 10-18 years reported their attitudes towards smoking, subjective norms, perceived behavioural control, self-identity and intention to smoke while their parents (N = 525) reported their attitudes towards smoking and their current cigarette use. All the TPB variables increased from lower to higher school grade level. Multi-sample path analyses showed that parent's attitudes towards smoking positively predicted students' intention to smoke only for elementary school children. Parents' current cigarette use did not contribute significantly. Students' attitudes, perceived behavioural control and self-identity predicted systematically intention to smoke in contrast to the subjective norm that did not contribute at all. Perceived behavioural control contributed to a higher degree in intention to smoke for senior high school students compared to the junior high school and elementary students. Self-identity contributed to a higher degree in intention to smoke for elementary compared to the junior high school students. The results of this study suggests that the determinants of smoking vary between early and late adolescence.
 
Article
Objective: This study integrates healthy ageing and health psychology theories to explore the mechanisms underlying the relationship between health control expectancies and age-attitudes on the process of ageing well. Specifically, the aim of this study is to investigate the relationship between age-stereotypes and health locus of control. Design: A population-based survey of 739 adults aged 20-97 years (mean = 57.3 years, SD = 13.66; 42% female) explored attitudes towards ageing and health attitudes. A path-analytical approach was used to investigate moderating effects of age and gender. Results: Higher age-stereotype endorsement was associated with higher chance (β = 2.91, p < .001) and powerful other (β = 1.07, p = .012) health expectancies, after controlling for age, gender, education and self-rated health. Significant age and gender interactions were found to influence the relationship between age-stereotypes and internal health locus of control. Conclusion: Our findings suggest that the relationship between age-stereotypes and health locus of control dimensions must be considered within the context of age and gender. The findings point to the importance of targeting health promotion and interventions through addressing negative age-attitudes.
 
Article
Purpose: Applying the health action process approach (HAPA) to vaccination behaviour as a single-event health behaviour to study vaccination adherence and its predictors in a worksite flu vaccination programme. Methods: A total of N = 823 employees participated in a longitudinal survey. Predictors (risk perception, self-efficacy, positive and negative outcome expectancies, intention and planning) were assessed at Time 1, and behaviour was assessed five months later at Time 2. Intention and planning were specified as mediators in a path analytical logistic regression model. Results: Risk perception, self-efficacy and positive as well as negative outcome expectancies predicted intention (R² = .76). Intention and planning predicted subsequent behaviour, and planning mediated the relation between intention and vaccination behaviour (R² = .67). In addition, results suggested the adjustment of the theoretical model: risk perception and negative outcome expectancies showed direct effects on behaviour resulting in a significantly better model fit. Conclusions: Findings support the general applicability of the HAPA to vaccination behaviour and the importance of planning for translating intentions into behaviour. However, the adjusted model was superior and underlined the particular role of risk perception and negative outcome expectancies for vaccination behaviour to explain underlying mechanisms in vaccination behaviour.
 
Correlations Among Variables Included in Causal Model. 
Structural equation model, CFI ¼ 0.92, TLI ¼ 0.90, RMSEA ¼ 0.07, *50.05, **50.01. 
Article
This study tested several relationships predicted by the Health Action Process Approach (HAPA) in a sample of 175 generally healthy, inactive, middle-aged women (40-65 yrs old) over a 12 week period. Participants' physical activity, risk perceptions, outcome expectancies, action self-efficacy and intention were measured at baseline. Planning and maintenance self-efficacy were measured 4 weeks later. Physical activity behaviour was measured 12 weeks after baseline. The HAPA relationships were examined using a structural equation model. The data fit the model well and revealed several significant relationships. Action self-efficacy was the best predictor of intention. Maintenance self-efficacy was the best predictor of planning and behaviour. Contrary to the tenets of HAPA and to past research, planning did not predict behaviour. Overall, HAPA provides a useful framework for identifying determinants of physical activity intentions and behaviour within a group of inactive, middle-aged women.
 
Content of scales 
HIV antibody status by age category 
Frequency of predictors and the factors 
Article
A questionnaire based on the Theory of Reasoned Action was developed and tested to identify predictors of intention to use condoms. The questionnaire consisted of three original components: Behavioral Intentions, Attitudes and Subjective Normative Beliefs, and a new component, Behavioral Norms. Age of HIV antibody status were also collected. Internal consistency of the four components of the questionnaire was high: Cronbach's alpha coefficients ranged from 0.76 to 0.87. Logistic modelling identified the significant predictors of intentions to use a condom as Attitudes (Odds Ratio = 2.7, 95% CI 1.80−4.06, P < 0.001) and Behavioral Norms (Odds Ratio = 1.49,95% CI 1.06−2.11, P = 0.03). Contrary to the theory that demographic variables are not important predictive variables of intention, HIV antibody positive status and age were found to directly influence Behavioral Intentions to use a condom. About 50% of men older than 25 years of age intended to use a condom, irrespective of HIV status. Overall, 59% of men 25 years of age and younger intended to use a condom, but the percentage was affected by HIV status; 22% in men who were HIV positive and 63% in men who were HIV negative. These findings indicate that after modification, to include HIV antibody status, Age and Behavioral Norms, the Theory of Reasoned Action can identify significant predictors of intention to use a condom.
 
Article
The present study compared how well four modes of action control (intentional, habitual, reactive and stereotype activation) explain adolescents’ cigarette smoking, and examined whether individual differences in self-regulation (locomotion and assessment tendencies; Higgins, Kruglanski, & Pierro, 200345. Higgins , ET , Kruglanski , AW and Pierro , A . 2003. Regulatory mode: Locomotion and assessment as distinct orientations. Advances in Experimental Social Psychology, 25: 293–344. View all references) moderate the behavioural impact of the respective modes. Findings from a prospective questionnaire survey showed that (a) willingness, prototype perceptions and past behaviour–but not intention–predicted smoking behaviour, and explained 63% of the variance, and (b) the assessment mode of self-regulation moderated the past behaviour–future behaviour relation such that past behaviour had less impact on future smoking behaviour at high levels of assessment. These findings suggest that adolescents’ smoking is controlled by stereotype activation, habitual and reactive processes. Implications of the results for designing effective adolescent smoking cessation programmes are considered.
 
Prediction of intentions: fixed effects of variables at student level. Note: Unstandardised coefficients in bold, standard errors in parentheses. Controlled for sex, intervention and school level. * p < .05, ** p < .01.  
Prediction of physical activity: Fixed effects of variables at student level. Note: Unstandardised coefficients in bold, standard errors in parantheses. Controlled for sex, intervention and school level. * p < .05, ** p < .01.  
Article
Objective: Compensatory health beliefs (CHBs), defined as beliefs that healthy behaviours can compensate for unhealthy behaviours, may be one possible factor hindering people in adopting a healthier lifestyle. This study examined the contribution of CHBs to the prediction of adolescents’ physical activity within the theoretical framework of the Health Action Process Approach (HAPA). Design: The study followed a prospective survey design with assessments at baseline (T1) and two weeks later (T2). Method: Questionnaire data on physical activity, HAPA variables and CHBs were obtained twice from 430 adolescents of four different Swiss schools. Multilevel modelling was applied. Results: CHBs added significantly to the prediction of intentions and change in intentions, in that higher CHBs were associated with lower intentions to be physically active at T2 and a reduction in intentions from T1 to T2. No effect of CHBs emerged for the prediction of self-reported levels of physical activity at T2 and change in physical activity from T1 to T2. Conclusion: Findings emphasise the relevance of examining CHBs in the context of an established health behaviour change model and suggest that CHBs are of particular importance in the process of intention formation.
 
Article
Background: The primary purpose of our study was to determine if the content and tailoring of text messages affected action planning and physical activity. Second, we determined if the quantity and the quality of action plans changed between a month of receiving text messages (T1-T2) and a month without text messages (T2-T3). We further explored if the quantity and quality of action plans predicted changes in physical activity at T2 and T3. Methods: Adults (n = 337, M(age) = 30.72 ± 4.80) with intentions to be active were recruited on the internet. Participants were assigned to receive tailored text messages about action planning for physical activity, generic text messages about action planning for physical activity or generic text messages about physical activity. All participants received weekly planning tools. At T2 and T3, number of action plans created each month was tallied to generate a plan quantity score. For each plan created, three components (what, where and when) were assessed by independent coders to determine plan quality. Physical activity was assessed at each time point using the Godin Leisure Time Exercise Questionnaire. Mixed model ANOVA, paired sample t-tests and multiple regression were applied to test our hypotheses. Results: There were no differences in action planning or physical activity based on the content or tailoring of text messages. The absence of text messages corresponded with declines in the quantity, but not the quality, of action plans between T2 and T3. The quantity of action plans predicted changes in physical activity. Conclusions: Although there were no differences in action planning or physical activity based on the content or tailoring of messages, the absence of text messages corresponded with declines in the quantity, but not the quality, of action plans. Furthermore, the quantity of action plans predicted changes in physical activity. Future research is needed to determine ways to facilitate sustained formation of multiple, specific action plans over the duration of action planning interventions.
 
Article
This study examined the effects of the Positive Action (PA) programme in Chicago Public Schools on problem behaviours among a cohort of elementary school students from grade three through grade five. Using a matched-pair, randomised control design with 14 elementary schools, approximately 510 fifth-graders self-reported lifetime substance use, serious violence-related behaviour, and current bullying and disruptive behaviours. Three-level (i.e. students nested within schools within school pairs) overdispersed Poisson models were used to examine programme effects on the number of items endorsed for each of the four outcomes. Findings indicated that students in the intervention endorsed 31% fewer substance use behaviours (incidence rate ratio [IRR] = 0.69), 37% fewer violence-related behaviours (IRR = 0.63) and 41% fewer bullying behaviours (IRR = 0.59), respectively, compared to students in the control schools. Reduction in reported disruptive behaviours was of a similar magnitude (27%, IRR = 0.73), but was not statistically significant. These results replicate findings of an earlier randomised trial of the PA programme and extend evidence of its effectiveness to youth attending large urban school systems.
 
Scale characteristics (mean, SD, range, Cronbach's alpha, ).
Hypothesised model with smoking specific CHBs for smoking in adolescents. SE, self efficacy; CHBs, Compensatory Health Beliefs. Standardised solution. The correlations between the predictors of intention are not displayed. N 5000 Bootstrapping resamples. *p < 0.05; **p < 0.01; ***p < 0.001.  
Article
Compensatory Health Beliefs (CHBs) are defined as beliefs that the negative consequences of unhealthy behaviours can be compensated for by engaging in healthy behaviours. CHBs have not yet been investigated within a framework of a behaviour change model, nor have they been investigated in detail regarding smoking. Thus, the aim of this study was to investigate on a theoretical basis whether smoking-specific CHBs, as a cognitive construct, add especially to the prediction of intention formation but also to changes in smoking behaviour over and above predictors specified by the Health Action Process Approach (HAPA). The sample comprised 385 adolescent smokers (mean age: 17.80). All HAPA-specific variables and a smoking-specific CHB scale were assessed twice, 4 months apart. Data were analysed using structural equation modelling. Smoking-specific CHBs were significantly negatively related to the intention to stop smoking over and above HAPA-specific predictors. Overall, 39% of variance in the intention to quit smoking was explained. For the prediction of smoking, CHBs were not able to explain variance over and above planning and self-efficacy. Thus, smoking-specific CHBs seem mainly important in predicting intentions but not behaviour. Overall, the findings contribute to the understanding of the role of smoking-specific CHBs within a health-behaviour change model.
 
N = 487. Model 1 and 2 with standardized coefficient estimates. * p < .05; ** p < .01; *** p < .001 N = 487. Model 1 and 2 with standardized coefficient estimates. * p < .05; ** p < 
473 Descriptive statistics and correlations of the variables in the models 474
N = 487. Model 3 with standardized coefficient estimates. ** p < .01; *** p < .001 N = 487. Model 3 with standardized coefficient estimates. ** p < .01; *** p < 
Article
Objectives: Maintaining physical exercise levels may not only require motivation and planning but also action control which is supposed to mediate between planning and exercise. Design: Behavioural intention, action planning, coping planning and past behaviour were assessed at baseline, and action control and concurrent exercise were measured one month later in 497 young adults. Method: Three nested structural models were specified to examine different mediation mechanisms. One model reflected the intention-planning-behaviour chain, the other one focused on the intention-action control-behaviour chain and the third model comprised the full sequence. Results: Indirect effects from intentions on exercise involved either planning or action control as mediating variables. In Model 3, all three constructs (action planning, coping planning and action control) were sequential mediators between intentions and later physical exercise levels. Action and coping planning were not directly but indirectly related to exercise via action control. Conclusions: Findings support the sequential mediation for planning and action control as antecedents of physical exercise. Action control is needed for exercise, because planning in itself is not always sufficient. Maintaining exercise levels may be attributed to effective self-regulatory strategies such as action control in combination with planning.
 
Article
Objective: Using a moderated mediation model, the present study investigated whether the mediation of intention into physical activity (PA) behaviour via action planning depends on the level of coping planning. Method: A four-month prospective study was conducted among 157 French adults, who were recruited through a web-based survey. They were administrated measures of behavioural intention and sociodemographic variables at baseline and action and coping planning and PA four months later. Results: Action planning partially mediated the contribution of intention on PA level. However, this indirect effect was conditional on the level of coping planning, insofar as action planning acted as a mediator of the intention-PA relationship only for individuals with high level of coping planning. Conclusion: The results highlight the complexity of the relationship between intention and behaviour and provide evidence for the distinct role of both forms of planning.
 
Article
Objective: Based on two theoretical models--activation model of information exposure and psychological reactance theory--this study examined the individual and combined effects of message sensation value (MSV) and controlling language on young adults' information processing. Method: Two experimental studies on anti-drunken driving and anti-smoking public service announcements were conducted that were conceptual replications of one another. The measures included perceived threat to freedom, sensation seeking, perceived ad effectiveness and state reactance (anger). Results: Across the two studies, MSV was found to advance the perceived ad effectiveness, and controlling language contributed to anger. A consistent interaction was revealed, such that participants responded positively to the high sensation value messages when presented with low controlling language. The effect of high sensation value anti-smoking ads to advance persuasiveness particularly under the condition of low controlling language was more influential to low sensation seekers. Implication: This study suggests that increasing MSV coupled with high controlling language can backfire, especially when targeting young adults. The implications for persuasion in general are considered, as well as the specific findings for drunken driving and smoking.
 
Article
This study examined whether satisfaction from leisure activities moderates the relationship between caregiving demands (i.e., hours per day spent caring for a spouse with dementia) and resting levels of the catecholamines norepinephrine (NE) and epinephrine (EPI). Spousal caregivers (n = 107; mean age = 73.95 ± 8.12 years) were assessed in home for plasma levels of NE and EPI, amount of care provided, and leisure satisfaction. Regression was used to determine whether leisure satisfaction moderated the relationship between hours providing care per day and catecholamine levels. A significant interaction was found between hours caregiving and leisure satisfaction for NE, but not for EPI. Post hoc regressions were conducted for both NE and EPI. At low leisure satisfaction, time spent caring for a spouse was positively associated with plasma NE (β = 0.41; p = 0.005) and EPI (β = 0.44; p = 0.003). In contrast, at high levels of satisfaction, time caregiving was not significantly associated with plasma NE (β = -0.08; p = 0.57) or EPI (β = 0.23; p = 0.12). These findings suggest that leisure satisfaction may protect caregivers from increases in catecholamines, which have been implicated in cardiovascular risk. Further support for these findings may impact psychological treatments for distressed caregivers.
 
Article
This study explored youth caregiving for a parent with multiple sclerosis (MS) from multiple perspectives, and examined associations between caregiving and child negative (behavioural emotional difficulties, somatisation) and positive (life satisfaction, positive affect, prosocial behaviour) adjustment outcomes overtime. A total of 88 families participated; 85 parents with MS, 55 partners and 130 children completed questionnaires at Time 1. Child caregiving was assessed by the Youth Activities of Caregiving Scale (YACS). Child and parent questionnaire data were collected at Time 1 and child data were collected 12 months later (Time 2). Factor analysis of the child and parent YACS data replicated the four factors (instrumental, social-emotional, personal-intimate, domestic-household care), all of which were psychometrically sound. The YACS factors were related to parental illness and caregiving context variables that reflected increased caregiving demands. The Time 1 instrumental and social-emotional care domains were associated with poorer Time 2 adjustment, whereas personal-intimate was related to better adjustment and domestic-household care was unrelated to adjustment. Children and their parents exhibited highest agreement on personal-intimate, instrumental and total caregiving, and least on domestic-household and social-emotional care. Findings delineate the key dimensions of young caregiving in MS and the differential links between caregiving activities and youth adjustment.
 
Participant Biographic Details. 
Results of a principal-components analysis of the YACS items. 4-Factor solution 
Summary of analyses of relations between yacs and demographic, caregiving context, and illness/disability variables. 
Regression analyses of the effects of YACS score on adjustment. 
Article
The purpose of this study was to develop an empirically derived multi-item scale of care tasks performed by young people in the context of family illness/disability: the Youth Activities of Caregiving Scale (YACS). A total of 135 youngsters aged 10-24 years with an ill/disabled family member completed questionnaires. Factor analyses performed on the YACS yielded four factors, instrumental care, social/emotional care, personal/intimate care and domestic/household care, accounting for 57.78% of the variance. The internal reliabilities of all factors ranged from 0.74 to 0.92. Higher scores on the YACS related to higher youth age and several caregiving context variables (i.e. household type [single or dual-parent household], relationship with care-recipient and perceived choice in caregiving). Higher scores on the YACS also related to care-recipient illness/disability variables (onset, functional impairment, prognosis, predictability and illness/disability type). Strong positive correlations between the YACS and a conceptually related measure of young caregiving experiences provided good convergent validity data. Criterion validity was established with evidence that the YACS predicted youth adjustment in the domains of health and prosocial behaviour.
 
Article
Objective: Partners of acute coronary syndrome (ACS) patients are at risk of experiencing long-term distress and the purpose of this study was to identify its predictors. Design: Using an observational design, 80 partners of ACS patients completed validated questionnaires at three time points. The predictor variables, marital satisfaction and optimism were assessed three weeks after patient hospital discharge (T1). The outcomes, depressive symptoms and physical health status (from a quality of life scale) were measured 6 (T2) and 12 (T3) months post-discharge, and scores were combined to indicate the long-term response. Main outcome measures: Depressive symptoms and physical health status. Results: Partner depressive symptoms increased and physical health status deteriorated over the months following the patients' ACS. After controlling for demographics, clinical severity of ACS and T1 levels of the outcome variable, partners' long-term depressive symptoms were predicted by poor marital satisfaction and low optimism at T1, and poor physical health status was predicted by low T1 optimism. Conclusion: Psychosocial factors are predictors of long-term distress for ACS partners. Partners in an unhappy marriage or with low optimism after ACS are at an increased risk of depression and low physical health status, and should be the target of additional support.
 
Comparison of low and high control on reports of stress and fatigue.  
Repeated-measures effects of control on a) mean arterial pressure and b) joint pain.  
Article
Among individuals with Rheumatoid Arthritis (RA), pain-associated stress can severely impact wellbeing. Psychological attributes, such as a sense of personal mastery, may attenuate the effects of chronic pain on life quality. We tested the hypothesis that a high sense of mastery would predict lower pain, perceived stress, fatigue, and mean arterial pressure (MAP) than would a low sense of mastery during an acute, interpersonal stressor.Seventy-four individuals with RA completed a psychophysiological laboratory session involving MAP measurements, as well as self-ratings of stress, joint pain, and fatigue. Measurements were collected before, during, and after an interpersonal stressor. To assess personal mastery, exploratory and confirmatory factor analyses were conducted on the Pearlin Mastery Scale based on recommendations by Reich and Zautra (1991)The Pearlin Mastery Scale yielded two distinct factors: fatalism and control. Both fatalism and control were significant predictors of the wellbeing variables. Individuals with a highly fatalistic style demonstrated higher general levels of mean arterial pressure (F(1) = 3.41, p<.1) and reported greater joint pain (F(1) = 4.72, p<.05) across all periods. Individuals with a high sense of control also evidenced lower MAP (F(1) = 3.73, p<.1) and reported less stress (F(1) = 7.44, p<.01) and fatigue (F(1) = 5.16, p<.05). Neither fatalism nor control were related to objective measures of disease severity (r's = -.10, p=NS and -.02, p=NS, respectively).RA patients with a high level of personal mastery, as evidenced by scores on two distinct indices, experience lower MAP, and report less pain, stress and fatigue. Although fatalism and control were not related to objective disease state, they seem to play an important role in the experience of wellbeing for people with RA.
 
Article
Abstract The Sentinel Event Theory provides a stepwise approach for building models to understand how negative events can spark health behavior change. This study tested a preliminary model using the Sentinel Events Method in a sample (N = 300) of smokers who sought care for acute cardiac symptoms. Patients completed measures on: smoking-related causal attribution, perceived severity of the acute illness event, illness-related fear, and intentions to quit smoking. Patients were followed up one week after the health event and a 7 day time line follow back (TLFB) was completed to determine abstinence from tobacco. Structural equation models were performed using average predictor scale scores at baseline, as well as three different time anchors for ratings of illness severity and illness-related fear. Quit intentions, actual illness severity, and age were consistent, positive, independent predictors of 7 day point prevalence abstinence. Additional research on the influences of perceptions and emotional reactions is warranted.
 
Top-cited authors
John Weinman
  • King's College London
Rob Horne
  • University College London
Rona Moss-Morris
  • King's College London
Ralf Schwarzer
  • Freie Universität Berlin
Jonathan Alan Smith
  • Birkbeck, University of London