Showing papers by "Stephen Sutton published in 2011"

Constraints on community engagement with Great Barrier Reef climate change reduction and mitigation

Abstract: Engaging stakeholders in Great Barrier Reef climate change reduction and mitigation strategies is central to efforts aimed at reducing human impacts on the reef and increasing its resilience to climate change. We developed a theoretical framework to investigate subjective and objective constraints on cognitive, affective, and behavioural engagement with the Great Barrier Reef climate change issue. A survey of 1623 Australian residents revealed high levels of cognitive and affective engagement with the Great Barrier Reef climate change issue, but that behavioural engagement was limited by objective constraints that intervene between individuals’ desire to become engaged (affective engagement) and their ability to take relevant actions. Individuals were constrained from increasing their engagement with the Great Barrier Reef climate change issue primarily by lack of knowledge about actions they can take, lack of time, and having other priorities. Individuals’ age, gender, education level, income, and place of residence influenced the probability that they would experience these and other specific constraints on engagement. We suggest that future Great Barrier Reef engagement strategies must endeavour to identify specific behaviour that individuals can undertake to help reduce the impact of climate change on the reef, and find ways to help people overcome the constraints they face on engagement in those activities. The theoretical framework we developed should be useful for investigating constraints on engagement with other environmental issues, but further empirical and conceptual work is necessary.

Theory of planned behaviour cognitions do not predict self‐reported or objective physical activity levels or change in the ProActive trial

Abstract: Objective. The objective was to test, in a trial cohort of sedentary adults at risk of Type 2 diabetes, whether theory of planned behaviour (TPB) cognitions about becoming more physically active predicted objective and self-reported activity levels and change. Design. Participants of a randomized controlled trial underwent measurement at baseline, 6 and 12 months. Methods. Participants (N= 365, 30-50 years) were recruited via their parent or family history registers at 20 general practices in the UK. Energy expenditure was measured objectively at baseline and 1 year. Participants completed questionnaires assessing physical activity and beliefs about becoming more physically active over the next year at baseline, 6 and 12 months. Results. Between baseline and 12 months, objective energy expenditure in the cohort increased by an average of 20 minutes of brisk walking per day. Based on the 252 participants who provided complete data, affective attitude and perceived behavioural control consistently predicted intention, but intention and perceived behavioural control failed to predict physical activity levels or change (p-values >.05). Conclusions. Failure of the theory to predict behaviour and behaviour change may be due to inapplicability of the theory to this at-risk population or to trial participation and intensive measurement facilitating behaviour change without affecting measured cognitions, or lack of correspondence between cognitive and behavioural measures. A wide range of potential personal and environmental mediators should be considered when designing physical activity interventions among at-risk groups. High-quality experimental tests of the theory are needed in clinical populations.

Protocol for the ADDITION-Plus study: a randomised controlled trial of an individually-tailored behaviour change intervention among people with recently diagnosed type 2 diabetes under intensive UK general practice care

Abstract: The increasing prevalence of type 2 diabetes poses both clinical and public health challenges. Cost-effective approaches to prevent progression of the disease in primary care are needed. Evidence suggests that intensive multifactorial interventions including medication and behaviour change can significantly reduce cardiovascular morbidity and mortality among patients with established type 2 diabetes, and that patient education in self-management can improve short-term outcomes. However, existing studies cannot isolate the effects of behavioural interventions promoting self-care from other aspects of intensive primary care management. The ADDITION-Plus trial was designed to address these issues among recently diagnosed patients in primary care over one year. ADDITION-Plus is an explanatory randomised controlled trial of a facilitator-led, theory-based behaviour change intervention tailored to individuals with recently diagnosed type 2 diabetes. 34 practices in the East Anglia region participated. 478 patients with diabetes were individually randomised to receive (i) intensive treatment alone (n = 239), or (ii) intensive treatment plus the facilitator-led individual behaviour change intervention (n = 239). Facilitators taught patients key skills to facilitate change and maintenance of key behaviours (physical activity, dietary change, medication adherence and smoking), including goal setting, action planning, self-monitoring and building habits. The intervention was delivered over one year at the participant's surgery and included a one-hour introductory meeting followed by six 30-minute meetings and four brief telephone calls. Primary endpoints are physical activity energy expenditure (assessed by individually calibrated heart rate monitoring and movement sensing), change in objectively measured dietary intake (plasma vitamin C), medication adherence (plasma drug levels), and smoking status (plasma cotinine levels) at one year. We will undertake an intention-to-treat analysis of the effect of the intervention on these measures, an assessment of cost-effectiveness, and analyse predictors of behaviour change in the cohort. The ADDITION-Plus trial will establish the medium-term effectiveness and cost-effectiveness of adding an externally facilitated intervention tailored to support change in multiple behaviours among intensively-treated individuals with recently diagnosed type 2 diabetes in primary care. Results will inform policy recommendations concerning the management of patients early in the course of diabetes. Findings will also improve understanding of the factors influencing change in multiple behaviours, and their association with health outcomes. ISRCTN: ISRCTN99175498

Predictors of anxiety and depression among people attending diabetes screening: A prospective cohort study embedded in the ADDITION (Cambridge) randomized control trial

Abstract: Objective. This study aimed to identify factors predicting anxiety and depression among people who attend primary care-based diabetes screening. Design. A prospective cohort study embedded in the ADDITION (Cambridge) randomized control trial. Methods. Participants (N= 3,240) at risk of diabetes were identified from 10 primary care practices and invited to a stepwise screening programme as part of the ADDITION (Cambridge) trial. Main outcome measures were anxiety and depression at 12 months post-screening assessed using the Hospital Anxiety and Depression Scale (HADS). Results. Hierarchical linear regressions showed that demographic, clinical, and psychological variables collectively accounted for 52% of the variance in HADS anxiety scores and 53% of the variance in HADS depression scores 12 months after diabetes screening. Screening outcome (positive or negative for diabetes) was not related to differences in anxiety or depression at 12 months. Higher number of self-reported (diabetes) symptoms after first attendance was associated with higher anxiety and depression at 12-month follow-up, after controlling for anxiety and depression after first attendance. Conclusion. Participants in a diabetes screening programme showed low scores on anxiety and depression scales after first appointment and 1 year later. Diagnosis of diabetes was shown to have a limited psychological impact and may be less important than symptom perception in determining emotional outcomes after participation in diabetes screening.

The contribution of behavioural science to primary care research: development and evaluation of behaviour change interventions.

Abstract: Behavioural science is concerned with predicting, explaining and changing behaviour. Taking a personal perspective, this article aims to show how behavioural science can contribute to primary care research, specifically in relation to the development and evaluation of interventions to change behaviour. After discussing the definition and measurement of behaviour, the principle of compatibility and theories of behaviour change, the article outlines two examples of behaviour change trials (one on medication adherence and the other on physical activity), which were part of a research programme on prevention of chronic disease and its consequences. The examples demonstrate how, in a multidisciplinary context, behavioural science can contribute to primary care research in several important ways, including posing relevant research questions, defining the target behaviour, understanding the psychological determinants of behaviour, developing behaviour change interventions and selection or development of measures. The article concludes with a number of recommendations: (i) whether the aim is prediction, explanation or change, defining the target behaviour is a crucial first step; (ii) interventions should be explicitly based on theories that specify the factors that need to be changed in order to produce the desired change in behaviour; (iii) intervention developers need to be aware of the differences between different theories and select a theory only after careful consideration of the alternatives assessed against relevant criteria; and (iv) developers need to be aware that interventions can never be entirely theory based.

The angler in the environment : social, economic, biological, and ethical dimensions : proceedings of the 5th World Recreational Fishing Conference

Abstract: Based on papers presented at the 5th World Recreational Fishing Conference, this timely book focuses on the interactions between recreational anglers and the aquatic environment. Among the many emerging issues covered in the book are the consequences of various fishing rights for sustainable recreational fisheries; partnership approaches among the recreational fishing industry, managers, and researchers for solving sustainability challenges; biological impacts of recreational fisheries; the ethics of the sport; and innovative survey methods for assessing recreational fisheries.

Impact on decisions to start or continue medicines of providing information to patients about possible benefits and/or harms: a systematic review and meta-analysis.

Abstract: Background. The impact of providing information about medicines to patients on decisions about starting or continuing them is unknown. Purpose. To estimate the impact on decisions to start or conti...

The Angler in the Environment: social, economic, biological, and ethical dimensions

Abstract: Based on papers presented at the 5th World Recreational Fishing Conference, this timely book focuses on the interactions between recreational anglers and the aquatic environment. Among the many emerging issues covered in the book are the consequences of various fishing rights for sustainable recreational fisheries; partnership approaches among the recreational fishing industry, managers, and researchers for solving sustainability challenges; biological impacts of recreational fisheries; the ethics of the sport; and innovative survey methods for assessing recreational fisheries.

Psychometric Properties of the Processes of Change Scale for Smoking Cessation in UK Adolescents

Abstract: The transtheoretical model (TTM) proposes that individuals move stage and hence change behaviour through the use of processes of change (POC)—cognitive, emotional and behavioural activities related to the target behaviour. This study was a test of the psychometric properties of the POC scale. The sample consisted of year 9 students from 26 schools who completed a computer-based version of the POC questionnaire on up to three occasions. There were 1,160 former and current smokers who completed the questionnaire on the first occasion, 978 on the second, and 836 on the third occasion. Confirmatory factor analysis was used to explore three alternative factor structures. Cronbach alpha and test–retest reliability coefficients were examined. Construct validity was examined by calculating POC means for each stage and testing differences between means using analysis of variance. The TTM-hypothesised second-order factor that clustered ten primary factors into experiential and behavioural processes fitted the data reasonably, though an alternative model, removing the second-order factors, was a significantly improved fit. Cronbach alpha coefficients were reasonable except for two processes. Test–retest reliabilities were modest. Experiential processes showed differences across precontemplation to preparation, but differences between preparation, action, and maintenance were slight. Behavioural processes showed linear differences between stages, though helping relationships was not different across stages. There is evidence of some specific difficulties with the POC questionnaire that may be overcome with some reformulation. The POC questionnaire shows evidence of adequate factorial validity, sufficient to allow its use in future predictive testing.

Perceived benefits and costs of Recreational Only Fishing Areas to the recreational and commercial estuarine fishery within north Queensland

Abstract: Recreational Only Fishing Areas (ROFAs) (i.e., areas where commercial fishing is excluded, leaving sole fishing access to recreational fishers) are often implemented to reduce conflict between recreational and commercial fishing sectors, and to enhance recreational fishing quality. This study explored recreational and commercial fishers' perceptions of estuarine ROFAs in north Queensland, Australia with the aim of understanding whether desired socio-economic benefits are realized. Recreational and commercial fishers in the study area believed that competition between the sectors was a problem; however, only recreational fishers suggested increased segregation of the sectors via ROFAs as a solution. Recreational fishers were largely unaware of the location of current ROFAs in the study area and therefore did not preferentially use these areas compared to areas open to commercial fishing. Likewise recreational fishers did not deliberately avoid areas frequented by commercial fishers, and the presence or absence of commercial fishing was not a major factor influencing recreational fishing site choice. Further, while recreational fishers expected to catch more fish in areas where commercial fishing does not occur, they had not noticed an improvement in catches in more recently formed ROFAs. Collectively, these results suggest that the existing ROFAs in the study area are not currently providing the expected benefits for fishers, and that adding more ROFAs would be unlikely to reduce conflict between commercial and recreational fishers. The effectiveness of the ROFAs may be improved if recreational fishers are better informed about their location. Further investigation is required to understand why recreational fishers do not choose to use current ROFAS, the cause of conflict between the recreational and commercial sectors, and whether expected catch benefits of ROFAs are being realized.

Going Mobile: Delivering Behavioural Support via SMS Text Messages

Abstract: Health organisations, charities, pharmaceutical companies, and health services are increasingly delivering information and support by SMS text message to help us change our health behaviours. For example, the British Heart Foundation provide a ‘Heart Health’ texting support service for people wanting to either become more active, eat healthier or give up smoking. So what do we know about the potential of text messaging to deliver behavioural support?

Do increases in physical activity encourage positive beliefs about further change in the ProActive cohort

Abstract: Effects of behaviour change on cognitions are rarely examined within the Theory of Planned Behaviour. We tested whether increases in physical activity resulted in more positive beliefs about further change among a cohort of sedentary adults participating in a behavioural intervention trial (ProActive). At baseline, 6 and 12 months, 365 adults completed questionnaires assessing physical activity and cognitions about becoming more active over the coming year. Objective activity was assessed at baseline and 12 months. Participants reporting larger increases in activity were no more positive about making further increases than those reporting less behaviour change (p-values > 0.05). Participants with larger increases in objective activity reported weaker perceived control (β = −0.342; p = 0.001) and more negative instrumental attitudes (β = −0.230; p = 0.017) at 12 months. Participants may have felt that they had changed enough or measures of perceived success may be more sensitive to behaviour change. Alte...

Trial Protocol: Communicating DNA-based risk assessments for Crohn's disease: a randomised controlled trial assessing impact upon stopping smoking

Abstract: Background Estimates of the risk of developing Crohn's disease (CD) can be made using DNA testing for mutations in the NOD2 (CARD15) gene, family history, and smoking status. Smoking doubles the risk of CD, a risk that is reduced by stopping. CD therefore serves as a timely and novel paradigm within which to assess the utility of predictive genetic testing to motivate behaviour change to reduce the risk of disease. The aim of the study is to describe the impact upon stopping smoking of communicating a risk of developing CD that incorporates DNA analysis. We will test the following main hypothesis: Smokers who are first degree relatives (FDRs) of CD probands are more likely to make smoking cessation attempts following communication of risk estimates of developing CD that incorporate DNA analysis, compared with an equivalent communication that does not incorporate DNA analysis.

Recreational Activity and Place Meaning

Abstract: Although past research has documented the association between the types of activities an individual undertakes in a particular setting and the intensity of attachment that they hold for that place, little work has investigated the connection between activity type and place meaning. This lack of empirical evidence is most likely due to the fact that most place meaning studies have sought to describe the thoughts and feelings individuals ascribe to a place rather than to understand the relationships involved in meaning formation. Using data collected from a survey of recreational visitors to Australia’s Great Barrier Reef, this investigation attempted to identify the connections between individuals’ type of activity participation and the meanings they ascribed to the setting in which they recreated. Results indicated that, after controlling for visitation frequency, the importance of certain meanings to the individual does vary between activity types. 1.0 Introduction Since Tuan’s (1977) suggestion that a setting is a “blank space” that only becomes a “place” as it is endowed with meanings through lived experiences, only a few researchers (e.g., Lee 1972, Williams & Patterson 1996, Kyle & Chick, 2007) have attempted to investigate the social construction of place meanings. Such research has suggested that place meanings are fostered by “being at and engaging with a place and one's companions, extended stays, ritualized behaviors, family history in the outdoors, childhood socialization, and informal training and social learning” (Brooks et al., 2006, p. 339). Given that meanings are rooted in interactions with the setting and others in the setting, it is logical to hypothesize that different recreational activities (that allow for differing levels of interactions with the place and others) would be associated with different types of meanings. In fact, the literature already contains evidence of the relationship between the related concept of place attachment and activity type (Moore & Scott 2003, Kyle et al. 2004). The lack of empirical evidence supporting the association between place meaning and activity type is mainly due to the interpretive designs of most place meaning studies. These studies often sought to describe meanings individuals ascribed to particular settings rather than to understand the relationships involved in meaning formation. Hence, the purpose of our study was to investigate the connections between recreational visitors’ type of activity participation and the meanings they ascribed to the setting in which they recreated. 2.0 Background: Place Meaning First conceptualized by Tuan (1977), place meanings are the cognitions and evaluative beliefs concerning a setting that reflect the value and significance of the setting to the individual (Stedman 2002). Meanings are often assigned to important attributes in a setting that include both the physical characteristics of the setting and the social interaction that is experienced there (Eisenhauer et al. 2000). Because place meanings are an amalgamation of social, psychological, and cultural interpretations, they have a dynamic nature that is difficult to study. Given this fluidity, most place meaning research has sought to describe the thoughts and feelings ascribed to a setting at a particular point in time, rather than to explore the relationships between place meaning and other constructs. To identify associations between place meaning and potentially related constructs, it is necessary to understand that meanings are created through lived experiences (direct or indirect) as a product of the setting, the individual, and their social worlds (Kyle & Chick 2007). These interactions involve the assimilation of information stemming from sources external and internal to the individual. External information includes the popular media, tourist brochures, books, and friends and family who have previously visited the setting. For returning visitors, memories of past experience have an impact on shaping place meaning (Wynveen et al. 2010). Thus, the range and importance of meanings that an individual ascribes to a place is constrained by the attributes of the setting, the individual’s cognitions and perceptions related to the setting, and the individual’s interaction with others in relation to the setting. Hence, we suggest that different activities allow for differing interactions to be experienced by the individual; therefore the individual will ascribe diverse meanings to a setting as a result of the activities in which they participate within the setting. These differences will be evidenced in the level of importance they assign to the various meanings they ascribe to the setting.

A Case Study of Managers' Place Meanings and Environmental Governance of the Great Barrier Reef Marine Park, Australia

Abstract: [Extract] The Great Barrier Reef Marine Park (GBRMP) Survey of Managers Final Technical Report presents the findings from a social science research project designed to inform environmental planning and management. This project serves as preliminary dissertation research for the primary investigator and informs a larger study of human-environment interactions in the context of the GBRMP. The findings explore managers' perceptions of places within the GBRMP and the environmental governance system that managers exist within. This report is designed to improve the information, services, and products that managers of the GBRMP provide to their public constituents.

This Provisional PDF corresponds to the article as it appeared upon acceptance. Fully formatted PDF and full text (HTML) versions will be made available soon. Protocol for the ADDITION-Plus study: a randomised controlled trial of an individually-tailored behaviour change intervention among people with recently diagnosed type 2 diabetes under intensive UK general practice care

Abstract: BackgroundThe increasing prevalence of type 2 diabetes poses both clinical and public health challenges. Cost-effective approaches to prevent progression of the disease in primary care are needed. Evidence suggests that intensive multifactorial interventions including medication and behaviour change can significantly reduce cardiovascular morbidity and mortality among patients with established type 2 diabetes, and that patient education in self-management can improve short-term outcomes. However, existing studies cannot isolate the effects of behavioural interventions promoting self-care from other aspects of intensive primary care management. The ADDITION-Plus trial was designed to address these issues among recently diagnosed patients in primary care over one year.Methods/DesignADDITION-Plus is an explanatory randomised controlled trial of a facilitator-led, theory-based behaviour change intervention tailored to individuals with recently diagnosed type 2 diabetes. 34 practices in the East Anglia region participated. 478 patients with diabetes were individually randomised to receive (i) intensive treatment alone (n = 239), or (ii) intensive treatment plus the facilitator-led individual behaviour change intervention (n = 239). Facilitators taught patients key skills to facilitate change and maintenance of key behaviours (physical activity, dietary change, medication adherence and smoking), including goal setting, action planning, self-monitoring and building habits. The intervention was delivered over one year at the participant's surgery and included a one-hour introductory meeting followed by six 30-minute meetings and four brief telephone calls. Primary endpoints are physical activity energy expenditure (assessed by individually calibrated heart rate monitoring and movement sensing), change in objectively measured dietary intake (plasma vitamin C), medication adherence (plasma drug levels), and smoking status (plasma cotinine levels) at one year. We will undertake an intention-to-treat analysis of the effect of the intervention on these measures, an assessment of cost-effectiveness, and analyse predictors of behaviour change in the cohort.DiscussionThe ADDITION-Plus trial will establish the medium-term effectiveness and cost-effectiveness of adding an externally facilitated intervention tailored to support change in multiple behaviours among intensively-treated individuals with recently diagnosed type 2 diabetes in primary care. Results will inform policy recommendations concerning the management of patients early in the course of diabetes. Findings will also improve understanding of the factors influencing change in multiple behaviours, and their association with health outcomes.Trial registrationISRCTN: ISRCTN99175498