Modelling decisions to undergo genetic testing for susceptibility to common health conditions: An ancillary study of the Multiplex Initiative

New genetic tests reveal risks for multiple conditions simultaneously, although little is understood about the psychological factors that affect testing uptake. We assessed a conceptual model called the multiplex genetic testing model (MGTM) using structural equation modelling. The MGTM delineates worry, perceived severity, perceived risk, response efficacy and attitudes towards testing as predictors of intentions and behaviour. Participants were 270 healthy insured adults aged 25–40 from the Multiplex Initiative conducted within a health care system in Detroit, MI, USA. Participants were offered a genetic test that assessed risk for eight common health conditions. Confirmatory factor analysis revealed that worry, perceived risk and severity clustered into two disease domains: cancer or metabolic conditions. Only perceived severity of metabolic conditions was correlated with general response efficacy (β?=?0.13, p<0.05), which predicted general attitudes towards testing (β?=?0.24, p<0.01). Consistent with our hypothesised model, attitudes towards testing were the strongest predictors of intentions to undergo testing (β?=?0.49, p<0.01), which in turn predicted testing uptake (OR 17.7, β?=?0.97, p<0.01). The MGTM explained a striking 48% of the variance in intentions and 94% of the variation in uptake. These findings support use of the MGTM to explain psychological predictors of testing for multiple health conditions.     

Community as practice: social representations of community and their implications for health promotion

Health promotion researchers and practitioners have increasingly turned to community-based approaches. Although there has been much work around the diverse understandings of the term in areas such as community psychology and sociology, I am concerned with how such understandings relate directly to community health research and practice. From a discursive perspective ‘community’ is seen as a socially constructed representation that is used variously and pragmatically. However, from a wider view, community can be seen as a matter of embodied practice. This paper draws on social representations theory to examine the shifting constructions of ‘community’, the functional use of those understandings in social life, and the practices that suggest that it is important to attend to their use in particular contexts. Accordingly, the paper argues that meanings of community in the health promotion or public health context must be seen as representations used for specific purposes in particular situations. Furthermore, the broader notion of embodied practice in social life has implications for community participation in health promotion. Copyright © 2007 John Wiley & Sons, Ltd.     

Understanding body image disturbance in the promotion of mental health: a discourse analytic study

Health care interventions in the area of body image disturbance and eating disorders largely involve individual treatment approaches, while prevention and health promotion are relatively underexplored. A review of health promotion activities in the area of body image in Australia revealed three programmes, the most extensive and longest standing having been established in 1992. The aims of this programme are to reduce body image dissatisfaction and inappropriate eating behaviour, especially among women. Because health promotion is concerned with the social aspects of health, it was hypothesized by the authors that a social understanding of body image and eating disorders might be advanced in a health promotion setting and reflected in the approach to practice. In order to examine approaches to body image in health promotion, 10 health professionals responsible for the design and management of this programme participated in a series of semi‐structured interviews between 1997 and 2000. Three discursive themes were evident in health workers' explanations of body image problems: (1) cognitive‐behavioural themes; (2) gender themes; and (3) socio‐cultural themes. While body image problems were constructed as psychological problems that are particularly experienced by women, their origins were largely conceived to be socio‐cultural. The implications of these constructions are critically discussed in terms of the approach to health promotion used in this programme. Copyright © 2001 John Wiley & Sons, Ltd.     

Health behaviour and attitudes to publicity campaigns for health promotion

Abstract

A sample of 403 members of the public responded to a postal questionnaire concerning their own health behaviour and their attitudes towards health publicity. A principal components analysis of these attitudes revealed three factors, the first of which reflected a tendency to deny the “relevance” of health campaigns. This tendency was higher among those who smoked, took less exercise and had less healthy diets. It is inferred that the direct effects of such campaigns may be impeded by the fact that they appeal most to those people whose own behaviour (from the point of view of health) is in least need of change.     

Making the case for using personalised outcome measures to track progress in psychotherapy

The practice-based evidence movement has become increasingly influential in the practice of counselling. One element of this approach is the recommendation that therapists regularly administer standardised or nomothetic measures to track the progress made by their clients. When this feedback indicates that therapy is off course (i.e. out of kilter with the projected course of effective treatment) therapists are alerted to the risks of potential dropout and encouraged to take some form of corrective action. Despite an expanding evidence base supporting this strategy for improving psychotherapeutic outcomes, there are also concerns that the generic measures adopted do not always possess the specificity and sensitivity required to capture the unique experiences of individual clients. The paper argues that personalised or idiographic assessments can be designed to match the language and priorities of individual clients and so provide a more nuanced measure with which to track the course of therapy and promote informed reflective conversations between client and clinician on when and whether a change in direction is needed. However the idiographic alternative is not an easy option and practical as well as theoretical challenges in adopting this approach to monitoring treatment outcomes are acknowledged and discussed. Finally the virtue of using a strategy that combines nomothetic and idiographic measures is considered.     

Finding new ways to practise critically: applying a critical reflection model with Australian health promotion practitioners

Greater support is required in health promotion for practitioners to adopt critical approaches to their practice. Despite recognition of the role that critical reflection can play in supporting critical practice, it is underdeveloped in health promotion. This pilot study aimed to explore the use of critical reflection with health promotion practitioners. Critical postmodernism provided the theoretical perspective and critical reflection methodology guided the study. The data collection method involved the application of a critical reflection model via in-depth semi-structured interviews with two health promotion practitioners who were recruited using purposive sampling. Critical postmodernism and critical health promotion values and principles were the thematic frameworks used to analyse the data. Four types of assumptions were identified across both participants’ narratives: binary opposites and dichotomous thinking; identity and othering; professionalism; and power. Two key themes that evidenced these assumptions were conceptualising power as a commodity, and identity in the Aboriginal and Torres Strait Islander context. Both traditional and critical health promotion practice approaches were evident in participants’ practice. The process of engaging in critical reflection resulted in positive outcomes for the practitioners, including the identification of new, more critical ways of practising. Critical reflection provides a process for developing critical health promotion practice. The designation of critical reflection as a core health promotion competency may enhance the development of critical health promotion. Further research is needed to develop and test a critical reflection model incorporating the values and principles of health promotion with a larger sample of practitioners.     

The Global Coherence Initiative: A global psychological paradigm for health promotion

This review proposes the value of a global psychology-oriented initiative to promote health and wellbeing. It discusses the concept of collective consciousness, especially heart-based, moral consciousness and related actions as resources for health promotion. The review draws on a collaborative South African Global Coherence Initiative to support communal coherence and interconnectedness in an indigenous community setting.     

Predictors of interest in direct-to-consumer genetic testing

Direct-to-consumer (DTC) genetic testing is an increasingly available option among individuals searching for information about their health risk factors and ancestry. This study is one of the first to examine predictors of interest in DTC genetic testing. Participants read one of the three types of information about DTC genetic testing (positive only, negative only or both) and reported perceptions of and intentions to pursue testing. The information which people read, their perceptions of the benefits of testing, their perceptions of the barriers to testing and anticipated regret predicted intentions to undergo testing. Interestingly, people who read both positive and negative information did not differ from people who read only negative information in their intentions to pursue testing. We discuss the implications of these findings for predicting interest in this relatively new type of genetic testing and for designing interventions to encourage (or discourage) testing.     

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.     

Risk perceptions,worry, and attitudes about genetic testing for breast cancer susceptibility

This study assessed the unique associations of risk perceptions and worry with attitudes about genetic testing for breast cancer susceptibility. Women (general practitioner clinic attenders, university students, and first-degree relatives of breast cancer survivors; N?=?303) read information about genetic testing and completed measures assessing perceived cancer risk, cancer worry, and genetic testing attitudes and beliefs. Worry was associated with greater interest in genetic testing, stronger beliefs that testing has detrimental emotional consequences, and positive beliefs about benefits of testing and risk-reducing surgeries. Perceived risk was unrelated to interest and associated with more skeptical beliefs about emotional consequences and benefits of testing and risk-reducing surgeries. At low worry levels, testing interest increased with more positive beliefs about testing benefits; at high worry levels, interest was high regardless of benefits beliefs. The findings support Leventhal's Common-Sense Model of self-regulation delineating interactive influences of risk-related cognitions and emotions on information processing and behavior.     

Alternative factor structures of health-related psychological tendencies and their relationship to self-reported health seeking behaviors

Abstract

The MHQ-Multidimensional Health Questionnaire (Snell and Johnson, 1997) and a checklist of twenty Health Promoting Behaviors were administered to 1,011 Italian subjects aged 21 to 80 years. The MHQ measures twenty health related psychological tendencies (e.g, Health Efficacy, Locus of Control, Optimistic Expectations). A Principal Components Analysis was carried out on the twenty scales to study their internal structure. Both a four- and a two-factor solution are discussed, presenting different perspectives on the data. The former solution yielded a larger motivational factor, which we labeled Aspiration for Health, and three smaller factors, which we labeled Optimistic Expectations, Internal Control and Lack of Control. All factors, particularly the first one, discriminated self-reported health seeking behaviors. The latter solution yielded a Health Management factor and a Negative Thinking one, both discriminating health behaviors. Moreover, the two factors provide a useful model for distinguishing efficacy, optimism and internal control in terms of their cognitive and affective components.     

Prevalence of mental health problems in Australian university health services

General practice patients report greater mental health problems than the general population, and students attending one university health service have reported greater prevalence rates at the end of the academic year. This study assessed the overall prevalence rate of mental health problems in university students using a cross‐sectional survey design of 1,168 students from three large, predominantly urban, Australian university health services. Approximately half of the students attending university health services reported elevated levels of psychological distress. The majority of severely distressed students had not sought any professional assistance for mental health problems. While there is scope for general practitioners to take a lead role in the identification of mental health problems in tertiary students, adequate treatment pathways need to be available. Implications for the role of universities in prevention work are discussed.     

The interpretation of change in verbal reports: Implications for health psychology

Abstract

This paper raises a number of issues for health psychology in relation to the interpretation of change in verbal reports. Drawing on a typology of change developed to evaluate organisational interventions, it is suggested that change may occur at an alpha level (e.g. changed health status), beta level (e.g. a recalibration of the respondent's scale for assessing health status) or gamma level (e.g. a reconceptualisation of the meaning attached to health). Given the likely presence of beta and/or gamma change in intervention data in health psychology, researchers may be analysing their change data at an inappropriate level. A number of existing methodologies which attempt to detect beta and gamma change are presented and discussed. The need to develop further methodologies which focus more explicitly on the nature of change is highlighted. Finally, the proposed typology has a number of practical implications for the design of health promotion interventions.     

Resistance and adherence to the norms of genetic counseling

Genetic counseling for women of advanced maternal age who are considering prenatal testing continues to be based on a principle of nondirectiveness. We interviewed 11 genetic counseling students and four counselors about how they experience and manage, in practice, the tensions between the ideology of nondirectiveness and the acknowledged reality that one can never be truly nondirective. We found that our respondents creatively resolve this tension—simultaneously resisting and adhering to the values of nondirectiveness and information-giving—in individual and situation-specific ways. This resolution is facilitated by the extent to which information given to counselees is fluid, mobile and context-dependent, but these very features of information also have critical implications for both the norms and the practice of genetic counseling.     

Affective and cognitive attitudes,uncertainty avoidance and intention to obtain genetic testing: An extension of the Theory of Planned Behaviour

To ensure successful implementation of genetic screening and counselling according to patients best interests, the attitudes and motives of the public are important to consider. The aim of this study was to apply a theoretical framework in order to investigate which individual and disease characteristics might facilitate the uptake of genetic testing. A questionnaire using an extended version of the Theory of Planned Behaviour was developed to assess the predictive value of affective and cognitive expected outcomes, subjective norms, perceived control and uncertainty avoidance on the intention to undergo genetic testing. In addition to these individual characteristics, the predictive power of two disease characteristics was investigated by systematically varying the diseases fatality and penetrance (i.e. the probability of getting ill in case one is a mutation carrier). This resulted in four versions of the questionnaire which was mailed to a random sample of 2400 Norwegians. Results showed genetic test interest to be quite high, and to vary depending on the characteristics of the disease, with participants preferring tests for highly penetrant diseases. The most important individual predictor was uncertainty avoidance.     

A role for clinical psychology in health care and policy concerning the physical environment

Some persons adversely react to specific environments, while others are impervious or actually thrive. Medical attention often overlooks such sensitivities to the physical environment. Such sensitivities, including phobias and seasonal affectivity, fall within clinical psychology's purview. A theoretical/clinical approach called the Synchronous Systems Model, which defines and uses individual differences in people and in settings, could serve medical health care and policy. When specific people are matched appropriately with specific treatments within the most propitious settings, cost effectiveness and medical efficacy rise. Such documented accountability could make clinical psychologists central to triage of medical services as well as health care policy in these days of the shrinking health care dollar. The Synchronous Systems Model provides theory, supportive data, and clinical assessment devices to strengthen clinical psychology's role in medical settings.     

Crisis for community mental health: The use of groups in the struggle for survival

The task of community mental health is to provide quality services to clients despite funding cutbacks. This paper describes the recent evolution in conceptualization and service delivery in one center. The outcomes are a philosophy that is customer oriented, and treatment that draws upon brief techniques, in group and long term contexts.