Predicting uptake of a routine cervical smear test: A comparison of the health belief model and the theory of planned behaviour

Abstract

This paper reports on a study carried out to identify predictors of uptake of cervical screening among 142 women (59% response rate) in inner London. Two social cognition models were used: The Health Belief Model (HBM; Becker, 1974) and the Theory of Planned Behaviour (TPB; Ajzen, 1991) and in addition anticipated affect following non-attendance for screening was assessed. The TPB emerged as by far the superior model for predicting screening intentions, explaining 51% of the variance in comparison with only 4% explained by the HBM variables. However, neither model was able to predict a significant amount of variance in uptake of screening three months later. Possible reasons for the poor prediction of this type of behaviour are discussed.     

Life events and psychological well-being in old age

Abstract

Although life event research has burgeoned in recent years, little attention has been paid to the prevalence of events among the elderly or their relationship to psychological well-being. This paper presents data from a three-wave longitudinal study of community elderly in Aberdeen. Negative life events were highly prevalent among both survivors [N=349) and non-survivors [N=108], but the relatively small differences between the groups indicate that attrition does not seriously affect longitudinal findings. Longitudinal analysis of survivors' data was performed using LISREL and yielded a model with a goodness of fit index of 0.918, demonstrating a close fit between the data and the model. The model parameters indicate that those in poor psychological state were more likely to report serious non-health events than health events, although the latter were more likely than the former to result in a decline in psychological well-being, even after prior psychological state was taken into account. While elderly people with low social integration experienced more severe reactions to life events in the short term than those with high social integration, there were no significant long term effects, even for those reporting highly stressful events. There was no evidence of a sub-group of elderly people lacked into a cycle of serious life events. However life events were not random occurrences; serious health events were more often reported by those with low education while women and those in lower social classes were more likely to report serious non-health events. Overall, long term disruption, directly attributable to life events, was minimal when viewed within the context of the community elderly's stable psychological state.     

The interplay of received social support and self-regulatory factors in smoking cessation

Objective: In smoking cessation, individual self-regulation and social support have both proven to be useful. However, the roles of self-regulatory processes and social support are mostly examined separately. The present study aims at examining the unique and joint interactive effects of self-regulation as specified in the health action process approach (HAPA) and social support on smoking cessation. The study tested whether social support can compensate for low levels of self-regulation or whether synergistic effects emerge.

Design & Measures: Around a self-set quit date, 99 smokers completed baseline questionnaires on HAPA-variables, smoking-specific received social support and smoking cessation (continuous abstinence and point prevalence), with a follow-up Cpproximately 29?days after the quitdate.

Results: Social support moderated the association between volitional self-efficacy and smoking, as well as coping planning and smoking but not between action planning and smoking. No compensatory effect of social support for lower levels of individual regulation emerged but the combination of high levels of the individual variables and social support was related to successful smoking cessation, indicating a synergistic effect.

Conclusions: The results confirm the importance of examining both self-regulation and social factors in smoking cessation. This should be considered when developing future interventions for smoking cessation.     

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.     

Self-determination and functional persuasion to encourage physical activity

This research advances a novel approach to promoting physical activity, based on the principle of functional matching in persuasion, and the self-concordance (SC) of people's motivations for physical activity. We propose that SC establishes a positive or negative orientation toward the challenge inherent in physical activity, and that the maximum yield of participation will be achieved by communications that appeal to each orientation. In two studies, we compared how messages emphasizing challenge versus available social support would influence recipients’ self-reported practices of physical activity and attitudes toward a physical activity setting. As hypothesized, these messages had differential effects for recipients whose pursuit of physical activity varied in SC, such that favorable outcomes were more reliably associated with challenge-oriented messages among respondents higher in SC versus support-oriented messages among respondents lower in SC. The findings suggest the merits of using self-regulatory, compared with object- or personality-based, constructs and measures to indicate psychological functions of ongoing health-related behaviors.     

Perceived behavioural control,subjective norms,attitudes and intention to use condom: A longitudinal cross-lagged design

Based on the Theory of Planned Behaviour (TPB), the purpose of this investigation was to examine the directionality of the association among condom use, intention, attitudes, subjective norms and perceived behavioural control. The present study investigated the nature of these relationships using a longitudinal cross-lagged design applied to data from a cohort of 958 randomly selected Italian adults. Using structural equation modelling, two cross-lagged panel analyses revealed reciprocal relationships between intention and attitudes and between intention and condom use. Contrary to expectations, baseline subjective norms and perceived behavioural control did not predict subsequent intention to use condom when controlled for the autoregressive effect of intention at T1 on the same variable at T2. Also, perceived behavioural control at T1 did not influence condom use at T2 after controlling for the effect of baseline intention. The possibility of reciprocity was also tested for all relations and significant results were found. The moderation effect of perceived behavioural control on the relationship between intention and condom use was not significant. The differences in age, gender and partnership status were taken into account in the analyses.     

Being and feeling liked by others: How social inclusion impacts health

This study examined the effects of perceived and actual social inclusion on health across and within individuals from a network perspective. During the first semester, 75 freshmen students provided bi-weekly ratings on their perceived social inclusion and health. To capture actual social inclusion, each student nominated liked and disliked fellow students. Perceived social inclusion mediated the effect of actual social inclusion on health. Specifically, students with more ‘likes’ perceived more social inclusion and those with higher perceived inclusion reported a better health status (between-person effect). In addition, at time points, when students received more ‘likes’ they also perceived more social inclusion. They reported better health at times when they felt more included (within-person effect). Thus, the perception of social inclusion is rooted in reality and actual social inclusion has an impact on health when passing the filter of perception.     

Physical activity and diabetes: An application of the theory of planned behaviour to explain physical activity for Type 1 and Type 2 diabetes in an adult population sample

Physical activity (PA) plays a key role in the management of Type 1 (T1D) and Type 2 diabetes (T2D) but there are few theory-based, effective programs to promote PA for individuals with diabetes. The purpose of this study was to investigate the utility of the Theory of Planned Behaviour (TPB) in understanding PA in an adult population with T1D or T2D. A total of 2311 individuals (691 T1D; 1614 T2D) completed self-report TPB constructs of attitude, subjective norms, perceived behavioural control (PBC), intention and PA at baseline and 1717 (524 T1D; 1123 T2D) completed the PA measure again at 6-month follow-up. Multi-group Structural Equation Modelling was conducted to: (1) test the fit of the TPB structure (2) determine the TPB structural invariance between the two types of diabetes and (3) to examine the explained variances in PA and compare the strength of associations of the TPB constructs in the two types of diabetes. The TPB constructs explained ≥40% of the variance in intentions for both diabetes groups. In cross-sectional models, the TPB accounted for 23 and 19% of the variance in PA for T1D and T2D, respectively. In prospective models, the TPB explained 13 and 8% of the variance in PA for T1D and T2D, respectively. When adjusting for past PA behaviour, the impact of PBC and intention on behaviour was reduced in both groups. The findings provide evidence for the utility of the TPB for the design of PA promotion interventions for adults with either T1D or T2D.     

Social support and cardiovascular responding to laboratory stress: Moderating effects of gender role identification,sex, and type of support

The objective of the present study was to examine moderating effects of gender role identification, sex, and type of support on the buffering role of social support on cardiovascular responses. We hypothesized that (a) gender role identification, more than sex, would moderate the effect of social support and (b) to obtain optimal attenuating effects of social support, type of support provided should match type of support preferred in terms of one's gender role identification. That is, feminine participants would benefit more from relatively direct support, whereas masculine participants would benefit more from indirect support. Healthy participants (N = 100) performed a psychological stressor in the presence of a friend, after mental activation of a friend, or alone. Results revealed no moderating effects of gender role identification whether or not in combination with type of support. Nevertheless, results demonstrated an attenuating effect of mental support on heart rate and cardiac output in men. It is concluded that pathways linking social relationships and health may differ between women and men.     

Understanding adolescent type 1 diabetes self-management as an adaptive process: A grounded theory approach

Objective: To develop a conceptual understanding of the process of adapting to the self-management of type 1 diabetes during adolescence.

Design: Participants were recruited from a National Health Service paediatric diabetes service within the south-west of England which runs six countywide diabetes clinics. Thirteen interviews were conducted using a social constructivist grounded theory approach.

Results: The findings illustrate how self-management can be understood in terms of a continuum-based framework, ranging from difficulties with, to successful self-management. Adaptation within the continuum can further be understood by specific transitional phases and process mechanisms, providing further depth to individuals’ experiences of adaptation.

Conclusion: This investigation provides a conceptual understanding of the complex issues adolescents encounter while adapting to and integrating a diabetes self-management regime into their lives. It provides an invaluable framework for exploring psychological mechanisms and contextualising them within a self-management continuum. Implications for healthcare professionals are discussed and further research proposes whether the model could be applicable to other chronic illnesses.