Psychosocial effects associated with dental fear in adult dental patients with avoidance behaviours

Abstract

The most obvious consequence of a genuine dental phobic reaction is the avoidance of necessary dental care. Previous research has indicated that such avoidance has adverse effects on an individual's oral health status, and also reduces the quality of life. However, systematic investigations in this area of dentistry are few and clinical observations and interviews may often fail to elicit information regarding the impairment created outside the dental situation. The present investigation assessed the presence and levels of emotional and social life effects among dental phobic patients with regard to the prevalence of dental and general fears and the length of time for which dentistry had been avoided. It was shown that a majority of the patients felt that they had to curtail their social relations, and many, especially long-term avoiders, reported wide-spread negative social life effects. Often this had extended into feelings of loneliness or to overt social isolation. It remains to be seen whether fear of dentistry itself produces disadvantage or whether these effects are mainly related to personality factors, which can also promote the development of dental fear. Alternatively, poor dental health, which is probably more frequent in anxious patients, may be perceived by these patients and thus impair social relationships.     

Understanding smoking after acute illness: An application of the sentinel event method

The sentinel event theory provides a stepwise approach for building models to understand how negative events can spark health behaviour 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 seven-day timeline follow back 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 the consistent, positive and independent predictors of seven-day point prevalence abstinence. Additional research on the influences of perceptions and emotional reactions is warranted.     

The role of social cognition models in predicting attendance at health checks

Abstract

The present study sought to apply the Health Belief Model and the Theory of Planned Behaviour to the prediction of attendance at health checks. In addition, the way in which patients were invited to the health checks and the effect this had on both the uptake of the service and the role of cognitive factors in predicting attendance was analysed. Based in a single general practice, 818 patients were either sent an invitation letter which included an appointment time or they were sent an open invitation to contact the practice to make their own appointment time. Prior to the commencement of the programme health belief questionnaires were sent to patients. The results of the study firstly showed that letters offering patients an appointment produced a much higher attendance rate (70%) than letters containing an open invitation (37%). Secondly, through stepwise discriminant function analyses, the predictors of attendance behaviour were found to vary according to how patients were invited. For patients sent an appointment, attenders were found to be more likely than non-attenders to place a high value on their health, to believe that their health is influenced by powerful others, that certain referent groups would advise them to attend, that attending would lead to positive outcomes and that motivational barriers would not prevent them from attending. For patients sent an open invitation, intention to attend and perceived control were found to be independent predictors of attendance behaviour. These results suggest that attendance at health checks may not be a homogeneous behaviour such that the beliefs which distinguish attenders and non-attenders may be seen to vary according to the way in which the service is offered.     

The effects of anger management and social contact on risk of myocardial infarction in type as and type bs

Abstract

The risk of myocardial infarction (MI) associated with Type A behaviour, anger management and social contact was examined using a retrospective case-control design. Binary multiple regression analyses were used to compare 206 male and 67 female MI cases with 454 male and 316 female controls. To examine the potential moderating role of sex and Type A behaviour, moderated and subgroup regressions were run. Type A behaviour was significantly more prevalent in cases than controls. MI risk was further increased in males who combined Type A behaviour and aggressive expression of anger. In females MI risk was associated with the combination of Type A behaviour and not expressing anger. In addition female cases were significantly less likely than controls to discuss their anger, and reported fewer available social contacts. Discussion of results includes consideration of the problems generated by the retrospective case-control design.     

Predicting intention and behaviour following participation in a theory-based intervention to improve gluten free diet adherence in coeliac disease

Objective: To determine whether changes in theory of planned behaviour (TPB) constructs could predict intention and gluten-free diet (GFD) adherence following participation in an online theory-based intervention designed to improve adherence in coeliac disease.

Design: Theory-based process evaluation of the mechanisms of change over the course of a six-week online intervention. Measures of GFD adherence and TPB variables were administered at baseline and follow-up (immediate post-intervention: n = 74; three-month: n = 68; six-month: n = 65). Hierarchical regression analyses using residualised change scores were conducted at each time point (dependent variables: intention and adherence).

Results: Baseline intention and GFD adherence were the strongest predictors of follow-up intention and adherence, respectively. Change in attitude accounted for significant variance in intention. Change in intention accounted for significant variance in GFD adherence immediately post-intervention; by the six-month follow-up change in perceived behavioural control was the stronger predictor.

Conclusions: Partial support for the hypotheses suggests that, for certain behaviours, the TPB may be relevant in explaining the mechanism of action responsible for changes in intention and behaviour following participation in a behaviour change intervention. Additional predictive pathways are also likely to exist and, in the area of GFD adherence, may include habit strength and actual behavioural control.     

Self-efficacy and reasoned action: Predicting oral health status and behaviour at one,three, and six month intervals

Abstract

This study tested the usefulness of the theory of reasoned action and the addition of self-efficacy to this model for the prediction of oral health behaviour as part of a larger intervention at the State University of New York at Buffalo School of Dental Medicine. Self-efficacy is a belief in one's ability to perform a particular behavior. The theory of reasoned action is an attitudinal model focused on predicting behavior. One hundred and sixty-six patients volunteered for an intervention and assessment program at the Oral Health Enhancement Clinic. Participants visited the clinic 7 times over a 14 month period. Relationships among social cognitive model variables and clinical and self-report outcome measures were examined at three different time points over increasingly longer time spans. Results indicated that the theory of reasoned action model was useful in predicting oral health behavior, and adding self-efficacy to the model significantly increased the reliability of predictions of outcome measures. Relationships for social cognitive variables were stronger for self-report than for clinical indices. Reasons for these differences are suggested.     

Selective review,optimism and HIV risk perception

Abstract

Research suggests that review of risk factors increases optimism about health. The present experimental study explored the effects of reviewing risk increasing and risk decreasing factors on HIV risk perception (own risk, others' risk, optimism), self efficacy and behavioural intentions. 164 heterosexual subjects completed a questionnaire concerning their beliefs about HTV and their sexual behaviour. Subjects were allocated to either the risk increasing condition (eg. since being sexually active how often have you asked your partners HIV status?), the risk decreasing condition (eg. since being sexually active how often have you tried to select your sexual partners carefully?), or a control group. The results suggest that review of risk decreasing factors increased optimism and that this change in optimism was related to an increase in perceived others' risk. The results are discussed in terms of theories of selective focus and egocentricism in risk perception and the implications for health promotion.     

Social cognition models and health behaviour: A structured review

Abstract

A number of social cognition models have been developed to account for socio-demographic variations in health behaviour. This paper distinguishes between: (a) motivational, (b) behavioural enaction, and (c) multi-stage models of health behaviour. The models are evaluated in terms of advancement of existing knowledge and - where appropriate - predictive utility. Common themes that appear within- and between- these categories are discussed, with consideration of ways in which theory may be advanced by future research. Each approach has associated strengths and weaknesses, suggesting that a “consensus” approach to the study of health behaviour may prove fruitful. Identification of the key constructs across different model types would allow coherent integration and promote further understanding of the psycho-social determinants of health behaviour.     

Mediation analysis of decisional balance,sun avoidance and sunscreen use in the precontemplation and preparation stages for sun protection

Objective: Mediation analyses of sun protection were conducted testing structural equation models using longitudinal data with three waves. An effect was said to be mediated if the standardised path between processes of change, decisional balance and sun protection outcomes was significant.

Design: Longitudinal models of sun protection using data from individuals in the precontemplation (N = 964) and preparation (N = 463) stages who participated of an expert system intervention.

Main outcome measures: Nine processes of change for sun protection, decisional balance constructs of sun protection (pros and cons), sun avoidance behaviour and sunscreen use.

Results: With the exception of two processes in the preparation stage, processes of change predicted the pros (r = .126–.614), and the pros predicted the outcomes (r = .181–.272). Three models with the cons as mediator in the preparation stage, and none in the precontemplation stage, showed a mediated relationship between processes and outcomes.

Conclusion: In general, mediation analyses found both the process of change-to-pros and pros-to-behaviour paths significant for both precontemplation and preparation stages, and for both sun avoidance and sunscreen use outcomes. Findings provide support for the importance of assessing the role of underlying risk cognitions in improving sun protection adherence.     

Health enhancing physical activity as perceived in interviews based on the theory of planned behaviour

Abstract

The perception of behaviours from two categories of health enhancing physical activity (HEPA): outdoor aerobic exercise (OAE) and everyday commuting activity (ECA) was examined in a sample of middle-aged persons (N= 50). A focused semi-standardised interview was constructed on the bases of the components of the Theory of Planned Behaviour (TPB). The participants perceived OAE behaviours predominantly from the viewpoint of exercise and those of the ECA from that of the fluency of daily routines. They considered the OAE as sensible and associated it with positive health or fitness outcomes, but only those practising it also attributed positive psychological effects to OAE behaviours. A slightly better congruence with the TPB was found for the OAE behaviours than for those of the ECA. The difference is discussed in the light of the higher degree of decisional control with the OAE behaviours and the greater psychological heterogeneity of the ECA.