The development of a theory-based intervention to promote appropriate disclosure of a diagnosis of dementia

Background: The development and description of interventions to change professional practice are often limited by the lack of an explicit theoretical and empirical basis. We set out to develop an intervention to promote appropriate disclosure of a diagnosis of dementia based on theoretical and empirical work. Methods: We identified three key disclosure behaviours: finding out what the patient already knows or suspects about their diagnosis; using the actual words 'dementia' or 'Alzheimer's disease' when talking to the patient; and exploring what the diagnosis means to the patient. We conducted a questionnaire survey of older peoples' mental health teams (MHTs) based upon theoretical constructs from the Theory of Planned Behaviour (TPB) and Social Cognitive Theory (SCT) and used the findings to identify factors that predicted mental health professionals' intentions to perform each behaviour. We selected behaviour change techniques likely to alter these factors. Results: The change techniques selected were: persuasive communication to target subjective norm; behavioural modelling and graded tasks to target self-efficacy; persuasive communication to target attitude towards the use of explicit terminology when talking to the patient; and behavioural modelling by MHTs to target perceived behavioural control for finding out what the patient already knows or suspects and exploring what the diagnosis means to the patient. We operationalised these behaviour change techniques using an interactive 'pen and paper' intervention designed to increase intentions to perform the three target behaviours. Conclusion : It is feasible to develop an intervention to change professional behaviour based upon theoretical models, empirical data and evidence based behaviour change techniques. The next step is to evaluate the effect of such an intervention on behavioural intention. We argue that this approach to development and reporting of interventions will contribute to the science of implementation by providing replicable interventions that illuminate the principles and processes underlying change.This project is funded by UK Medical Research Council, Grant reference number G0300999. Jeremy Grimshaw holds a Canada Research Chair in Health Knowledge Transfer and Uptake. Jill Francis is funded by the Chief Scientist Office of the Scottish Government Health Directorate. The views expressed in this study are those of the authors

Adiposity induces lethal cytokine storm after systemic administration of stimulatory immunotherapy regimens in aged mice.

Aging is a contributing factor in cancer occurrence. We recently demonstrated that systemic immunotherapy (IT) administration in aged, but not young, mice resulted in induction of rapid and lethal cytokine storm. We found that aging was accompanied by increases in visceral fat similar to that seen in young obese (ob/ob or diet-induced obese [DIO]) mice. Yet, the effects of aging and obesity on inflammatory responses to immunotherapeutics are not well defined. We determine the effects of adiposity on systemic IT tolerance in aged compared with young obese mice. Both young ob/ob- and DIO-generated proinflammatory cytokine levels and organ pathologies are comparable to those in aged ad libitum mice after IT, culminating in lethality. Young obese mice exhibited greater ratios of M1/M2 macrophages within the peritoneal and visceral adipose tissues and higher percentages of TNF(+) macrophages in response to αCD40/IL-2 as compared with young lean mice. Macrophage depletion or TNF blockade in conjunction with αCD40/IL-2 prevented cytokine storms in young obese mice and protected from lethality. Calorie-restricted aged mice contain less visceral fat and displayed reduced cytokine levels, protection from organ pathology, and protection from lethality upon αCD40/IL-2 administration. Our data demonstrate that adiposity is a critical factor in the age-associated pathological responses to systemic anti-cancer IT

Developing the content of two behavioural interventions : using theory-based interventions to promote GP management of upper respiratory tract infection without prescribing antibiotics #1

Background: Evidence shows that antibiotics have limited effectiveness in the management of upper respiratory tract infection (URTI) yet GPs continue to prescribe antibiotics. Implementation research does not currently provide a strong evidence base to guide the choice of interventions to promote the uptake of such evidence-based practice by health professionals. While systematic reviews demonstrate that interventions to change clinical practice can be effective, heterogeneity between studies hinders generalisation to routine practice. Psychological models of behaviour change that have been used successfully to predict variation in behaviour in the general population can also predict the clinical behaviour of healthcare professionals. The purpose of this study was to design two theoretically-based interventions to promote the management of upper respiratory tract infection (URTI) without prescribing antibiotics. Method: Interventions were developed using a systematic, empirically informed approach in which we: selected theoretical frameworks; identified modifiable behavioural antecedents that predicted GPs intended and actual management of URTI; mapped these target antecedents on to evidence-based behaviour change techniques; and operationalised intervention components in a format suitable for delivery by postal questionnaire. Results: We identified two psychological constructs that predicted GP management of URTI: "Self-efficacy," representing belief in one's capabilities, and "Anticipated consequences," representing beliefs about the consequences of one's actions. Behavioural techniques known to be effective in changing these beliefs were used in the design of two paper-based, interactive interventions. Intervention 1 targeted self-efficacy and required GPs to consider progressively more difficult situations in a "graded task" and to develop an "action plan" of what to do when next presented with one of these situations. Intervention 2 targeted anticipated consequences and required GPs to respond to a "persuasive communication" containing a series of pictures representing the consequences of managing URTI with and without antibiotics. Conclusion: It is feasible to systematically develop theoretically-based interventions to change professional practice. Two interventions were designed that differentially target generalisable constructs predictive of GP management of URTI. Our detailed and scientific rationale for the choice and design of our interventions will provide a basis for understanding any effects identified in their evaluation. Trial registration: Clinicaltrials.gov NCT00376142This study is funded by the European Commission Research Directorate as part of a multi-partner program: Research Based Education and Quality Improvement (ReBEQI): A Framework and tools to develop effective quality improvement programs in European healthcare. (Proposal No: QLRT-2001-00657)

Do as we say and as we do: The interplay of descriptive and injunctive group norms in the attitude-behaviour relationship

This is the author's post-print version of an article whose final and definitive form has been published in the British Journal of Social Psychology. Reproduced with permission from the British Journal of Social Psychology © The British Psychological Society 2008. The definitve version is available at: http://www.bpsjournals.co.uk/journals/bjsp/Past research on the social identity approach to attitude-behaviour relations has operationalized group norms as a mixture of both descriptive information (i.e. what most people do themselves) and injunctive information (i.e. what most people approve of). Two experiments (Study 1=185 participants; Study 2=238 participants) were conducted to tease apart the relative effects of descriptive and injunctive group norms. In both studies, university students' attitudes towards current campus issues were obtained, the descriptive and injunctive group norms were manipulated, and participants' post-manipulation attitudes, behavioural willingness, and behaviour were assessed. Study 2 also examined the role of norm source (i.e. in-group vs. out-group injunctive and descriptive norms). In both studies, the injunctive and descriptive in-group norms interacted significantly to influence attitudes, behavioural willingness, and behaviour. Study 2 revealed that out-group norms were largely ineffective. The research illustrates that in-groups interactively influence decisions, not only by what they say, but also by what they do, and asserts the value of considering the interaction of descriptive and injunctive norms in accounts of normative influence

Instrument development, data collection, and characteristics of practices, staff, and measures in the Improving Quality of Care in Diabetes (iQuaD) Study

Peer reviewedPublisher PD

Using psychological theory to understand the clinical management of type 2 diabetes in Primary Care : a comparison across two European countries

Peer reviewedPublisher PD

An Exploratory Study into the Factors Impeding Ethical Consumption

Although consumers are increasingly engaged with ethical factors when forming opinions about products and making purchase decisions, recent studies have highlighted significant differences between consumers’ intentions to consume ethically, and their actual purchase behaviour. This article contributes to an understanding of this “ethical purchasing gap” through a review of existing literature, and the inductive analysis of focus group discussions. A model is suggested which includes exogenous variables such as moral maturity and age which have been well covered in the literature, together with further impeding factors identified from the focus group discussions. For some consumers, inertia in purchasing behaviour was such that the decision-making process was devoid of ethical considerations. Several manifested their ethical views through post-purchase dissonance and retrospective feelings of guilt. Others displayed a reluctance to consume ethically due to personal constraints, a perceived negative impact on image or quality, or an outright negation of responsibility. Those who expressed a desire to consume ethically often seemed deterred by cynicism, which caused them to question the impact they, as an individual, could achieve. These findings enhance the understanding of ethical consumption decisions and provide a platform for future research in this area

What drives political participation? Motivations and Mobilization in a Digital Age

The article provides insights into the driving forces that underpin new forms of political participation. Digital technologies offer opportunities for engaging in a wide range of civically-oriented activities, whether liking or sharing political content, joining online political communities or joining discussions, each can contribute to deeper democratic engagement and, for the individual, act as a pathway towards further civic participation. Conventional acts of political participation, demonstrating, petitioning and voting, are argued to be driven primarily by intrinsic motivations relating to self-efficacy and empowerment as the individual feels they can have influence over decision makers. Little research explores whether similar motivations drive participation in less conventional acts, as well as whether mobilisation attempts via social media by peers or political organisations mediate those motivations. Drawing on data from a survey among a representative sample of the UK electorate, we find the offline and online spheres of agency as still fairly distinct. Intrinsic and extrinsic motivations both matter but extrinsic motivations, following norms of behaviour within networks and supporting the activities of peers, have the strongest explanatory power independent of the sphere of activity. The mediating effect of mobilisation tactics has a minimal effect on extrinsic motivations, online or offline, but online intrinsic motivations lose their explanatory power. This finding suggests online political acts are carried out due to mobilisation, although as intrinsic factors offer little explanatory power these acts may lack meaning to the individual. We also found that campaign organisations are the most powerful mobilisers perhaps suggesting social media users are most likely to perform simple acts in support of non-contentious causes

The Social Diffusion of Influence Among Adolescents: Group Interaction in a Chat Room Environment About Antidrug Advertisements

One route to influence in mass communication campaigns to reduce risky behavior is through interpersonal discussion of the content of the campaign and other behaviors pertinent to those targeted by the campaign. The goal of this study was to test the effects of online group interaction among adolescents about anti-marijuana advertisements on relevant attitudes and behaviors. A between subjects post only experimental design was used to test two crossed factors, online chat and strength of arguments in antidrug ads. A sample of 535 students was randomly assigned to one of four conditions: chat and strong argument ads, chat and weak argument ads, no chat and strong argument ads, and no chat and weak argument ads. The group interactions about antidrug ads lead to negative effects such that those who chatted reported more pro-marijuana attitudes and subjective normative beliefs than those who just viewed the ads. No support was found for the hypothesis that strong argument ads would result in more antidrug beliefs relative to weak argument ads in either the chat or the no chat conditions. Overall, these findings suggest that viewing antidrug ads and discussing them with peers may result in deleterious effects in adolescents

How Sources of Sexual Information Relate to Adolescents\u27 Beliefs About Sex

Objectives: To examine how sources of sexual information are associated with adolescents\u27 behavioral, normative, and control beliefs about having sexual intercourse using the integrative model of behavior change. Methods: Survey data from a quota sample of 459 youth. Results: The most frequently reported sources were friends, teachers, mothers, and media. Regression analyses indicated that learning about sex from parents, grandparents, and religious leaders was associated with beliefs likely to delay sex; friends, cousins, and media were associated with beliefs that increase the likelihood of having sexual intercourse. Conclusions: Different sexual information sources were associated with different underlying beliefs