Behaviour change among overweight and socially disadvantaged adults: A longitudinal study of the NHS Health Trainer Service

Social disadvantage is associated with being overweight, a poor diet and physical inactivity. The NHS Health Trainer Service (HTS) is a national initiative designed to promote behaviour change among socially disadvantaged people in England and Wales. This study reports pre–post changes in Body Mass Index (BMI), associated behaviours and cognitions among service users who set dietary or physical activity goals during a 12-month period (2008–2009; N?=?4418). Sixty-nine percent of clients were from the two most deprived population quintiles and 94.7% were overweight or obese. Mean BMI decreased from 34.03 to 32.26, with overweight/obesity prevalence decreasing by 3.7%. There were increases in fruit and vegetable consumption, reductions in fried snack consumption, increases in frequency of moderate or intensive activity and gains in self-efficacy and perceived health and wellbeing. Clients with higher BMI, poorer diet or less activity at baseline achieved greater change. Findings suggest that the NHS HTS has the potential to improve population health and reduce health inequalities through behaviour change.     

Behaviour change among overweight and socially disadvantaged adults: a longitudinal study of the NHS Health Trainer Service

Social disadvantage is associated with being overweight, a poor diet and physical inactivity. The NHS Health Trainer Service (HTS) is a national initiative designed to promote behaviour change among socially disadvantaged people in England and Wales. This study reports pre-post changes in body mass index (BMI), associated behaviours and cognitions among service users who set dietary or physical activity goals during a 12-month period (2008-2009; N?=?4418). Sixty-nine percent of clients were from the two most deprived population quintiles and 94.7% were overweight or obese. Mean BMI decreased from 34.03 to 32.26, with overweight/obesity prevalence decreasing by 3.7%. There were increases in fruit and vegetable consumption, reductions in fried snack consumption, increases in frequency of moderate or intensive activity and gains in self-efficacy and perceived health and wellbeing. Clients with higher BMI, poorer diet or less activity at baseline achieved greater change. Findings suggest that the NHS HTS has the potential to improve population health and reduce health inequalities through behaviour change.     

Selective effects of excessive engagement in health-related behaviours on disgust propensity

The present study examined the extent to which engagement in health-related behaviours modulate disgust propensity, a purportedly stable personality trait. Participants were randomised into a health behaviour (n = 30) or control condition (n = 30). After a baseline period, participants in the health behaviour condition spent one week actively engaging in a clinically representative array of health-related behaviours on a daily basis, followed by a second week-long baseline period. Participants in the control condition monitored their normal use of health behaviours. Compared to control participants, those in the health behaviour condition reported significantly greater increases in disgust propensity after the health behaviour manipulation. This effect was most robust for contamination disgust propensity and remained significant when controlling for changes in health anxiety and disease fear. In contrast, self-disgust and anxiety sensitivity did not significantly differ between the two groups as a function of the health behaviour manipulation. Mediational analyses were consistent with the hypothesis that changes in the frequency of health-related behaviours, but not changes in health anxiety and disease fear, mediated the effects of the experimental manipulation on changes in contamination disgust propensity. These findings suggest that the purportedly stable personality trait of disgust propensity can be modulated by excessive engagement in health-related behaviours.     

A naturalistic study of the effectiveness of time-limited counselling with low-income clients

The role of counselling and psychotherapy services in relation to the needs of economically disadvantaged individuals has been largely neglected in the recent research literature. Although a small number of theoretical papers and case analyses have been published, there is an absence of studies that examine the effectiveness of counselling with this client group. The present paper reports on a naturalistic outcome study of the effectiveness of time-limited counselling (seven sessions) with low-income clients. Analysis of pre-counselling, postcounselling and follow-up measures of mental health and problem ratings indicated levels of change equivalent to those achieved in controlled studies of counselling and psychotherapy with other client groups. Factors influencing the effectiveness of counselling included gender and employment status. Qualitative client reports suggested that the main benefits experienced by clients were in the areas of self-understanding and self-belief. For illustrative purposes, data from low-income clients are compared with results from employee counselling clients receiving a similar service. The implications of these findings for further research are discussed.     

Health performance of individuals within the Campbell paradigm

In this paper, we developed a comprehensive health performance measure that formally links individual health attitudes with the likelihood of engaging in a wide variety of health‐related behaviours from various domains such as sustenance, hygiene, and physical exercise. Within what Kaiser, Byrka, and Hartig (2010) call the Campbell paradigm, we equated general health attitude with what a person does to retain or promote his or her health. Thus, health behaviours, on one hand, were expected to form a homogeneous, transitively ordered class of behaviours. On the other hand, the very behavioural class was in turn thought to be the basis from which an individual's health attitude could be directly assessed. A sample of 391 adults provided us with survey data containing different sets of health behaviours as well as variables and personality measures that had been corroborated as health‐behaviour relevant in previous research. We found that self‐reports of 50 behaviours and expressions of appreciation for 20 of these behaviours from various domains formed a transitively ordered class of activities. In contrast to the conventional view in health psychology, in which attitudes are regarded as a psychological cause behind individual behaviour, and in contrast to conventional findings in health psychology, where behaviours appear to fall into numerous sets of more or less distinct domains of health‐enhancing activities (e.g., exercising or avoiding risks), our findings speak of the psychological and formal unity of health behaviour. Inevitably, attitude measures grounded in the Campbell paradigm gauge individual attitudes, and just as much, they measure the health performance of individuals.     

Stability and changes in health behaviours in young adults over a one year period

Abstract

Data concerning 19 health-related behaviours and associated beliefs were collected by questionnaire from 282 students in the Netherlands on two occasions over one year. While all behaviours showed moderate stability, there were variations in the degree of change. The highest stability was reported for sleep time, tooth brushing frequency, seat belt usage and health care service utilization. The least stable behaviours included regular exercise and various dietary measures. Predictors of changes in smoking, dietary fat intake, alcohol consumption and regular exercise were analysed in detail. Beliefs assessed at year 1 in the importance of these activities for health predicted changes in behaviour over the study year independently of prior behaviour levels. Awareness of the risks associated with behaviours, and explicit wishes to modify behaviour patterns (eg stop smoking, exercise more), did not predict change from year 1 to year 2. The results indicated that health behaviours vary in their stability, and that health beliefs may predict future health behaviour changes.     

Improving access to psychological therapies: systemic therapy in the Newham pilot site

The improving access to psychological therapies (IAPT) programme, which started with two pilot sites, has dramatically changed the provision of mental health services for depression and anxiety disorders in the National Health Service. The IAPT initiative has focused on the provision of cognitive behaviour therapy but incorporated a small systemic therapy service in the Newham pilot site. The outcomes of this systemic service are presented in this article. Most clients seen by the service suffered from depression and anxiety disorders. The response rate for the evaluation questionnaires was high. For the depression and anxiety measures the recovery rate was above 50 per cent and the effect sizes were large. Most of the clients were satisfied with the service. A trend towards employment was identified. The outcomes are discussed in comparison with those of the cognitive behaviour therapy service and recommendations for the process of further studies are made.     

Children of mothers being released from incarceration: characteristics and potential targets for intervention

Incarcerated mothers and their children may face a multitude of problems. To identify possible targets for intervention, more clarity is needed about characteristics of these children and their mothers. This study examined children’s life events, behaviour problems and social cognitions and mothers’ parenting behaviours as potential targets for intervention with mothers being released from incarceration, in the Netherlands with a culturally diverse sample. Participants were 121 children of mothers being released from incarceration and 63 children of comparison mothers from disadvantaged areas, without a history of incarceration. Children of mothers being released from incarceration were more disadvantaged in life events, had more behaviour problems, and their mothers’ parenting behaviours were characterized by lower involvement and poorer monitoring compared with children of comparison mothers. Suboptimal parenting behaviours of mothers being released from incarceration were statistically associated with children’s behaviour problems. Hence, these children face more difficulties that may contribute to problematic development than children from another at-risk population.     

Why do they do it? Affective motivators in adolescents' decisions to participate in risk behaviours

Affective motivators have been targeted in many theories as playing a critical role in adolescents' decisions to participate in a variety of risky behaviours that may have life-altering consequences. In this study, we examined the role of several of these affective motivators across low and high experience groups to determine their perceived influence on the desire to participate in each of five risky behaviours (drinking alcohol, using drugs, having sex, smoking cigarettes, and skipping school). The affective motivators included those that: (a) promote risky behaviours by enhancing pleasant affective states (sensation seeking, social/emotional), (b) promote risky behaviours by reducing or avoiding negative affective states (negative emotions, tension reduction), and (c) deter risky behaviours by avoiding anticipated regret (e.g. of harming future). Results showed that the perceived motivational strength of the affective goals differed substantially between low and high experience groups and across the different risky behaviours. Adolescents with less experience were much more focused on avoiding the negative affective consequences associated with regretting unfavourable future outcomes. In contrast, adolescents with more experience participating in a risky behaviour held stronger beliefs that participation in the behaviour could both enhance positive and reduce negative affective states. We describe how the perceived importance of these motives varies across the risky behaviours, and offer insights into the likely motivational changes that occur as an adolescent moves from no experience to chronic experience engaging in risky behaviours.     

Genetic Counseling for Personal Genomic Testing: Optimizing Client Uptake of Post-Test Telephonic Counseling Services

The field of genetic counseling faces a broad challenge: many potential clients may not be aware of the value and benefit of genetic counseling services, and therefore may not utilize those services. Navigenics is a personal genomic testing company that provides telephonic genetic counseling services for multifactorial diseases and pharmacogenetics. When first offered in 2008, utilization of the Navigenics genetic counseling service was less than expected. To explore the basis for under-utilization and potential mechanisms for increasing uptake, Navigenics initiated a quality improvement study, in which three different methods of engaging clients in the uptake of genetic counseling services were assessed over the course of 1 year. Outcomes showed significant differences in uptake rates between methodologies (7.5%, 24.6%, and 60.1%), yielding an 8-fold increase in service utilization when post-test telephonic outreach to all clients was performed. Further, utilization spanned all risk levels based on client results, evidence that not only clients with high-risk results were motivated to engage in the genetic counseling service. This research indicates that implementing strategies to educate clients about genetic counseling can positively impact client engagement and utilization of available services.     

Family characteristics and health behaviours of adolescents and families

Abstract

The relationship between general family characteristics, represented by family cohesion and adaptability, and health behaviours (smoking, alcohol use, food choice, sleeping, Body Mass Index, and physical activity) is studied in a first study of 429 adolescents and young adults, and in a second study of 522 family triads (adolescent-mother-father). Using cluster analysis, adolescent groups with four different profiles of health behaviour were identified. Very similar results were found in the two studies. The health behaviour patterns in the different subgroups show that forms of (un)desirable health behaviours are interrelated in some clusters. Adolescents in the most healthy clusters, consistently reported highest levels of family cohesion. The relationship between family adaptability and health behaviours showed only limited significance. In families characterised by a high level of emotional bonding between family members together with stability and regularity in roles rules and power structure, adolescents' behaviour is the most healthy. The findings suggest that parental involvement is desirable in health promotion intervention. Further, it seems possible that health behaviours originate from a relatively small set of family Characteristics and that modifying family interactions might be powerful, albeit very difficult to do so, in changing a variety of health behaviours in adolescents.     

心理健康服务人员胜任特征与服务满意度的关系*

为考察心理健康服务人员胜任特征与服务双方满意度的关系,对分布于不同机构的心理健康服务人员及其来访者进行问卷调查。结果表明:心理健康服务人员胜任特征总分与自身服务满意度、来访者满意度均呈正相关,与自身服务满意度相关达到显著水平。胜任特征高分组心理健康服务人员自身服务满意度显著高于低分组自身服务满意度。与心理健康服务人员自身服务满意度显著相关的胜任特征条目,多数与知识、技能有关;与来访者满意度显著相关的胜任特征条目,均为来访者能感受到的与咨询关系建立有关的条目。     

Smartphone Use While Driving: An Investigation of Young Novice Driver (YND) Behaviour

Road traffic collisions are the leading cause of death for those between the ages of 15–29, according to the World Health Organisation. This study investigates one of the primary reasons for the high fatality rate amongst Young Novice Drivers (YNDs) – their use of smartphones while driving. We gathered responses from a representative sample of YNDs on their behaviour while driving using an updated version of the ‘Behaviour of Young Novice Drivers Scale’. Survey responses totalled 700 YNDs situated throughout Germany. From these responses, we examined the prevalence of certain driving behaviours that are described as ‘distracting’ and compared these driving behaviours to the respondents’ use of specific smartphone features. The responses report that music-related activities (e.g. changing music on a smartphone) are most common amongst YNDs. Speaking on the phone is seldom-reported, although more males than females indicated engagement in this behaviour. We further carried out a correlation analysis and correspondence analysis. On that basis we found that those who report speaking on a smartphone are significantly more likely to engage in driving behaviours with potentially fatal consequences, such as speeding and driving while impaired by prohibited substances (drugs, alcohol). We propose that the results could be used by policymakers for public information implications and to tailor financial penalties for those engaging in smartphone behaviours that are linked to harmful driving behaviours. In addition, our findings can also be used in a Usage-based Insurance (UBI) context to financially incentivise safer driving.     

Personality and health‐protective behaviour

Over the last decades much research has been devoted to the analysis of psychosocial factors associated with the development of health problems. However, less attention has been paid to mechanisms explaining why people keep engaging in risky behaviours and do not develop, instead, those habits that could increase their quality of life. To answer these questions, two lines of research have been followed: the main hypothesis of the first line is that there are personality characteristics that predispose the development of certain patterns of behaviour. The second line is focused on the analysis of the psychological processes that, together with situational factors, explain what behaviour is initiated and how it is maintained or changed. The main purpose of this paper is to review these two lines of research: what their main contributions are and what the problems they face are. Copyright © 1999 John Wiley & Sons, Ltd.     

Greater number of group identifications is associated with healthier behaviour in adolescents

We investigated the relationship between group identification (with the family, school, and friendship groups) and adolescent health behaviour (smoking, binge drinking, and cannabis use). 1,111 students from 4 Scottish secondary (high) schools completed a questionnaire which included measures of group identification, group contact, health behaviours, and demographic variables. We found that identification with the family and school groups predicted reduced odds of substance use, whereas identification with the friend group predicted increased odds of substance use. Furthermore, the greater the number of social groups with which the participant strongly identified, the lower the odds that he/she participated in negative health behaviours. In contrast, merely having contact (rather than identifying strongly) with these groups increased the odds of participation in these behaviours. We suggest that group identification influences behaviour to the extent that it encourages adherence to group norms.     

Approaching Religiosity/Spirituality and Health from the Eudaimonic Perspective

Religiosity/spirituality (RS) has been linked to positive health outcomes across a large number of studies, with these effects seen most strongly among disadvantaged groups such as minorities, women, and those of lower socioeconomic status (SES). Given that disadvantaged groups typically have worse health outcomes and not better, it is not clear why the effects of RS are stronger for disadvantaged groups. A key difficulty in understanding the relationship between RS and health lies in the theoretical perspectives used in research. Health and well‐being is typically assessed from the hedonic perspective which emphasizes pleasure and happiness as important outcomes and assumes that difficult life situations contribute to negative health. The eudaimonic perspective, on the other hand, emphasizes meaning and relationships, and assumes that difficult life situations can contribute to increased meaning in life and stronger relationships. The eudaimonic perspective provides a better framework for understanding why RS leads to better health for disadvantaged groups for three reasons. First, having meaning in life and strong relationships are related to positive health outcomes and buffer the negative effects of stress. Second, in addition to being more religious, disadvantaged groups report lower hedonic well‐being and report higher eudaimonic well‐being. Third, low SES religious individuals have better than expected health outcomes and low SES materialistic individuals have worse than expected health outcomes. Overall, the eudaimonic perspective better accounts for the research findings in RS and health and provides a strong foundation for future research in this area.     

From health beliefs to self-regulation: Theoretical advances in the psychology of action control

Abstract

The paper reviews the theoretical concepts included in a range of social cognitive models which have identified psychological antecedents of individual motivation and behaviour. Areas of correspondence are noted and core constructs (derived primarily from the theory of planned behaviour and social cognitive theory) are identified. The role of intention formation, self-efficacy beliefs, attitudes, normative beliefs and self-representations are highlighted and it is argued that these constructs provide a useful framework for modelling the psychological prerequisites of health behaviour. Acknowledging that intentions do not translate into action automatically, recent advances in our understanding of the ways in which prior planning and rehearsal can enhance individual control of action and facilitate the routinisation of behaviour are considered. The importance of engaging in preparatory behaviours for the achievement of many health goals is discussed and the processes by which goals are prioritised, including their links to self-representations, are explored. The implications of social cognitive and self-regulatory theories for the cognitive assessment of individual readiness for action and for intervention design in health-related settings are highlighted.     

Explorations of the effectiveness of a voluntary sector psychodynamic counselling service

This paper reports two studies of individual psychodynamic counselling provided by a voluntary sector service. The first study examines evidence of the effectiveness of counselling, as evaluated by the General Health Questionnaire and Personal Opinion Survey. Measures of the process of counselling indicated the improvements that clients attributed to counselling, the changes that occurred during it, and the factors that were most beneficial, as well as the approaches used by counsellors. The second study, using the CORE Outcome Measure and ratings of problem severity, found counselling to be equally effective with disadvantaged and non‐disadvantaged clients, as defined by British Department of Health criteria, but these clients differed somewhat in their perceptions of helpful aspects of counselling. Both studies also indicated predictors of positive outcome of counselling. The studies are used to illustrate some of the methodological issues around research in this area.     

Caregivers, young people with complex needs, and multiple service providers: a study of triangulated relationships

Five patterns of service provider-caregiver-adolescent interaction are discussed using qualitative interviews and file review data from 44 youth with complex needs who were clients of more than one psychosocial service (child welfare, mental health, addictions, juvenile justice, and special education). Findings show that young people and their families become triangulated with service providers, either engaging with, or resisting, interventions. For young people with complex needs involved with multiple service providers, both positive and negative patterns of interaction contribute to the complexity of caregiver-child interactions. According to young people themselves, the most functional of these patterns, empowerment, was experienced as protective when it helped them to meet their personal needs and enhance communication. In contrast, four problematic patterns produced triangulations described as conflictual or unsupportive. The implications of these patterns for family therapy are discussed with an emphasis on the therapist as both clinician and advocate for better services from multiple providers.