Showing papers by "Stephen Sutton published in 2008"

How does the Health Action Process Approach (HAPA) Bridge the Intention–Behavior Gap? An Examination of the Model's Causal Structure

Abstract: The health action process approach (HAPA) is attracting increasing interest from researchers who want to predict, explain, and change health-related behaviors. The main aim of this commentary is to examine the causal structure of the continuum version of the HAPA (HAPA-C), and, in particular, to consider the implications of this structure for the claim that the theory helps to bridge the intention–behavior gap. The article discusses, in turn, mediators of the intention–behavior relationship, additional proximal determinants of behavior, moderators of the intention–behavior relationship and implications for intervention. The commentary may contribute to a better understanding of the HAPA-C and to its further development. L’Approche des Processus d’Action en faveur de la Sante (HAPA) suscite de plus en plus d’interet de la part des chercheurs qui souhaitent predire, expliquer et modifier les comportements relatifs a la sante. L’objet de ce commentaire est l’examen de la structure causale de la version continuum de l’HAPA (HAPA-C) et, en particulier, de prendre en consideration les implications de cette structure dans la pretention de la theorie a combler le fosse intention–comportement. L’article aborde successivement les mediateurs de la relation intention–comportement, les determinants immediats additionnels de la conduite, les moderateurs de la relation intention–comportement et les retombees pour les interventions. Ce commentaire peut contribuer a une meilleure comprehension de l’HAPA-C et a son futur developpement.

The Role of a Flagship Species in the Formation of Conservation Intentions

Abstract: Environmental agencies increasingly use flagship species (those popular, relatively large, charismatic animals) as tools to trigger concern for the species and motivate community members to conserv...

Determinants of Health-Related Behaviours: Theoretical and Methodological Issues

Abstract: The term health behaviour (or health-related behaviour) is used very broadly in this chapter to mean any behaviour that may affect an individual’s physical health or any behaviour that an individual believes may affect their physical health. This chapter focuses on determinants of health behaviours. More specifically, it focuses on what we will refer to as ‘cognitive’ determinants, as specified by theories of health behaviour or ‘social cognition models’ as they are sometimes called. After briefly considering some of the more important distinctions and dimensions of health behaviours and the definition and measurement of target behaviours, we provide an extensive discussion of research designs that are used – or could be used – to investigate the cognitive determinants of health behaviours. Then, a classification of theories of health behaviour is presented, followed by a detailed discussion of one particular theoretical approach, the theory of planned behaviour (TPB: Ajzen, 1991, 2002b). Theories of health behaviour acknowledge that health behaviours may be influenced by numerous biological, psychological, and social factors, but they specify only a limited subset of cognitive determinants that are assumed to be most proximal to the behaviour. For a more complete explanation of particular health behaviours, it is necessary to extend the theories to include other relevant determinants. To this end, we outline a broader theoretical framework, drawing on the ‘social ecological framework’ (Emmons, 2000; Green, Richard & Potvin, 1996; McLeroy, Bibeau, Steckler & Glanz, 1988; Stokols, 1992, 1996) and ideas from multilevel modelling (Bryk & Raudenbush, 1992; Duncan, Jones & Moon, 1998; Hox, 2002). We conclude by making a number of recommendations to guide future research in this area. The chapter presents a generic approach to explaining health behaviours, focusing on theoretical and methodological issues. Although a number of different examples of health behaviours are used, we do not attempt to review the determinants of particular health behaviours.

Self-help smoking cessation interventions in pregnancy: a systematic review and meta-analysis

Abstract: Aims Self-help smoking cessation interventions for pregnant smokers are of importance due to their potential to be wide-reaching, low-cost and their appeal to pregnant smokers who are interested in quitting smoking. To date, however, there has been no systematic assessment of their efficacy.This systematic review aimed to assess the efficacy of self-help interventions for pregnant smokers and to investigate whether self-help material intensity, type or delivery are associated with cessation.Methods The literature was searched for randomized and quasi-randomized controlled trials of self-help smoking cessation interventions for pregnant smokers without significant cessation counselling. Fifteen trials met the inclusion criteria and relevant data were extracted independently. Results The primary metaanalysis pooled 12 trials comparing usual care (median quit rate 4.9%) with self-help (median quit rate 13.2%) and yielded a pooled odds ratio (OR) of 1.83 [95% confidence interval (CI) 1.23‐2.73], indicating that self-help interventions on average nearly double the odds of quitting compared with standard care. However, a further meta-analysis failed to find evidence that intervention materials of greater intensity increase quitting significantly over materials of lesser intensity (pooled OR = 1.25, 95% CI 0.81‐1.94). There was insufficient evidence to determine whether the tailoring of materials or levels of one-to-one contact were related to intervention efficacy. Conclusions Self-help interventions appear to be more effective than standard care although, due mainly to a lack of trials, it is unclear whether more sophisticated and intensive approaches increase intervention effectiveness.

Testing the convergent and discriminant validity of the Decisional Balance Scale of the Transtheoretical Model using the Multi-Trait Multi-Method approach.

Abstract: The authors extended research on the construct validity of the Decisional Balance Scale for smoking in adolescence by testing its convergent and discriminant validity. Hierarchical confirmatory factor analysis multi-trait multi-method approach (HCFA MTMM) was used with data from 2,334 UK adolescents, both smokers and non-smokers. They completed computerized and paper versions of the questionnaire on 3 occasions over 2 years. The results indicated a 3-factor solution; Social Pros, Coping Pros, and Cons fit the data best. The HCFA MTMM model fit the data well, with correlated methods and correlated trait factors. Subsequent testing confirmed discriminant validity between the factors and convergent validity of both methods of administering the questionnaire. There was, however, clear evidence of a method effect, which may have arisen due to different response formats or may be a function of the method of presentation. Taken with other data, there is strong evidence for construct validity of Decisional Balance for smoking in adolescence, but evidence of predictive validity is required.

Recreational Fishers' Perceptions about the Costs and Benefits of the 2004 Great Barrier Reef Marine Park Zoning Plan

Abstract: In recognition of the need for information about the social impacts of the 2004 Great Barrier Reef Marine Park Zoning Plan, the CRC Reef Research Centre (with continuation funding from the MTSRF) funded the Fishing and Fisheries Research Centre at James Cook University to examine recreational fishers’ perceptions of the costs and benefits of the 2004 Zoning Plan. The study was conducted with the support of and in consultation with the Great Barrier Reef Marine Park Authority and the recreational fishing community (through Sunfish Queensland and the Capricorn Reef Monitoring Program [CapReef]). Other elements of the MTSRF-funded project are currently examining the costs and benefits of the Zoning Plan to commercial fishers, charter fishers and tourism operators. This report details the methodology and descriptive results for the recreational fisher study. Results are organised into five subsections: 1) Demographic and fishing experience characteristics; 2) Attitudes towards the 2004 Zoning Plan; 3) Effects of the 2004 Zoning Plan on recreational fishing activity; 4) Beliefs about the 2004 Zoning Plan and management of the Great Barrier Reef; and 5) Attitudes towards public consultation programs. A further two sections then explore whether perceptions about the costs and benefits of the 2004 Zoning Plan differ between: 1) Fishers with different levels of personal attachment to recreational fishing; and 2) Geographic regions along the coast of the Great Barrier Reef.

Substitution in Recreational Fishing

Abstract: Fisheries managers need to measure participation rates and patterns to understand how anglers will respond to management actions and to changes in the recreational landscape. Understanding substitution in recreational fishing is an important component of gauging anglers' behavioural response to these changes. Substitution has implications for licence sales if anglers switch to different activities, stock impacts if anglers switch to different species and crowding if anglers switch locations. In this chapter, current methodologies used by social psychologists and economists to measure activity substitution, target-species substitution and site substitution are discussed. Each disciplinary approach reviews several studies that directly or indirectly examined angler substitution giving the reader the background necessary for more in-depth examination of substitution. Finally, both disciplinary approaches are compared and contrasted with an eye towards integrating substitution research across the two disciplines.

Protocol for SAMS (Support and Advice for Medication Study): a randomised controlled trial of an intervention to support patients with type 2 diabetes with adherence to medication.

Abstract: Although some interventions have been shown to improve adherence to medication for diabetes, results are not consistent. We have developed a theory-based intervention which we will evaluate in a well characterised population to test efficacy and guide future intervention development and trial design. The SAMS (Supported Adherence to Medication Study) trial is a primary care based multi-centre randomised controlled trial among 200 patients with type 2 diabetes and an HbA1c of 7.5% or above. It is designed to evaluate the efficacy of a two-component motivational intervention based on the Theory of Planned Behaviour and volitional action planning to support medication adherence compared with standard care. The intervention is delivered by practice nurses. Nurses were trained using a workshop approach with role play and supervised using assessment of tape-recorded consultations. The trial has a two parallel groups design with an unbalanced three-to-two individual randomisation eight weeks after recruitment with twelve week follow-up. The primary outcome is medication adherence measured using an electronic medication monitor over 12 weeks and expressed as the difference between intervention and control in mean percentage of days on which the correct number of medication doses is taken. Subgroup analyses will explore impact of number of medications taken, age, HbA1c, and self-reported adherence at baseline on outcomes. The study also measures the effect of dispensing medication to trial participants packaged in the electronic medication-monitoring device compared with conventional medication packaging. This will be achieved through one-to-one randomisation at recruitment to these conditions with assessment of the difference between groups in self-report of medication adherence and change in mean HbA1c from baseline to eight weeks. Anonymised demographic data are collected on non-respondents. Central randomisation is carried out independently of trial co-ordination and practices using minimisation to adjust for selected confounders. The SAMS intervention and trial design address weaknesses of previous research by recruitment from a well-characterised population, definition of a feasible theory based intervention to support medication taking and careful measurement to estimate and interpret efficacy. The results will inform practice and the design of a cost-effectiveness trial [ISRCTN30522359].

Perceptions of absolute versus relative differences between personal and comparison health risk.

Abstract: Objective: To explain inconsistent results in previous attempts to determine whether, when presented with health risk information, people focus primarily on information about their own risk status or on a comparison with others. Design: A randomized between-groups experiment in which participants were presented with hypothetical cardiac risk information. We examined whether affective responses were primarily sensitive to the relative difference between personal and comparison risk, rather than the absolute difference. Main Outcome Measures: Participants’ negative affective response to the risk information. Results: When relative differences were held constant, participants’ responses were independently influenced by both personal risk and comparative standing, effects that were greatly attenuated when absolute differences were held constant. When maintaining constant absolute differences, personal and comparison risk information appeared to interact. Conclusion: Previous studies tended to maintain constant absolute risk differences and so may have underestimated the impact of personal risk information. Participants’ responses were sensitive to the way the risk difference was constructed. Basing experimental design decisions on assumptions about the information participants will respond to can lead to misinterpretations of the basis of risk judgments.

Effectiveness of computer-tailored smoking cessation advice in primary care (ESCAPE): a randomised trial

Abstract: Background: Smoking remains a major public health problem; developing effective interventions to encourage more quit attempts, and to improve the success rate of self-quit attempts, is essential to reduce the numbers of people who smoke. Interventions for smoking cessation can be characterised in two extremes: the intensive face-to face therapy of the clinical approach, and largescale, public health interventions and policy initiatives. Computer-based systems offer a method for generating highly tailored behavioural feedback letters, and can bridge the gap between these two extremes. Proactive mailing and recruitment can also serve as a prompt to motivate smokers to make quit attempts or to seek more intensive help. The aim of this study is to evaluate the effect of personally tailored feedback reports, sent to smokers identified from general practitioners lists on quit rates and quitting activity. The trial uses a modified version of a computer-based system developed by two of the authors to generate individually tailored feedback reports. Method: A random sample of cigarette smokers, aged between 18 and 65, identified from GP records at a representative selection of practices registered with the GPRF are sent a questionnaire. Smokers returning the questionnaire are randomly allocated to a control group to receive usual care and standard information, or to an intervention group to receive usual care and standard information plus tailored feedback reports. Smoking status and cognitive change will be assessed by postal questionnaire at 6-months. Discussion: Computer tailored personal feedback, adapted to reading levels and motivation to quit, is a simple and inexpensive intervention which could be widely replicated and delivered cost effectively to a large proportion of the smoking population. Given its recruitment potential, a modest success rate could have a large effect on public health. The intervention also fits into the broader scope of tobacco control, by prompting more quit attempts, and increasing referrals to specialised services. The provision of this option to smokers in primary care can complement existing services, and work synergistically with other measures to produce more quitters and reduce the prevalence of smoking in the UK.

Recruiting new anglers: driving forces, constraints and examples of success

Abstract: We examine why fishery managers could be more proactive in increasing participation in angling, irrespective of local trends in participation. A brief review shows that in addition to the significant personal benefits from going fishing, there can be important benefits to broader society and the environment. A similarly brief review of the barriers preventing some people from going fishing shows similarities between countries, but also a level of difference that dictates local market information and tailored programmes in addressing them to be necessary. From the three case studies featured we found that locally configured programmes are effective in delivering increased recruitment, cultural integration and social inclusion. However, it is also clear that, to maximize the benefits accruing, there is a need for fisheries researchers and managers to integrate their fish - and fishing-based knowledge with that from socially facing sciences.