Showing papers in "Psychology & Health in 1996"

Beyond the divide between cognition and discourse: using interpretative phenomenological analysis in health psychology

Abstract: This paper introduces interpretative phenomenological analysis (PA) and discusses the particular contribution it can make to health psychology. This is contextualized within current debates, particularly in social psychology, between social cognition and discourse analysis and the significance for health psychology of such debates is considered. The paper outlines the theoretical roots of PA in phenomenology and symbolic interactionism and argues the case for a role for PA within health psychology. Discussion then focuses on one area in the health field, the patient's conception of chronic illness and research in medical sociology from a similar methodological and epistemological orientation to PA is introduced. The paper concludes with an illustration of PA from the author's own work on the patient's perception of renal dialysis.

The illness perception questionnaire: A new method for assessing the cognitive representation of illness

Abstract: The Illness Perception Questionnaire (IPQ) is a new method for assessing cognitive representations of illness. The IPQ is a theoretically derived measure comprising five scales that provides information about the five components that have been found to underlie the cognitive representation of illness. The five scales assess identity - the symptoms the patient associates with the illness, cause - personal ideas about aetiology, time-line - the perceived duration of the illness, consequences - expected effects and outcome and cure control - how one controls or recovers from the illness. The IPQ has a specific number of core items but allows the user to add items for particular patient groups or health threats. Data is presented supporting the reliability and validity of the IPQ scales in different chronic illness populations.

Perceived control, depressive symptomatology, and professional burnout: A review of the evidence

Abstract: The term “burnout” refers to a syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment that can occur in human service professionals. There are now over 2,000 publications on the topic. This paper reviews a subset of the literature concerned with burnout, depressive symptomatology, and perceptions of job control. It appears that the first two constructs share appreciable variance but are not isomorphic. Research also indicates that the development of burnout has a modest association with perceptions of job uncontrollability (i.e., perceived lack of autonomy and little decisional latitude). A conceptual model proposing that perceived uncontrollability induces depression indirectly. by operating through differences in the magnitude of burnout received only equivocal support in longitudinal studies. Prospective designs were proposed as a high priority for future burnout research. Other recommendations for future research included rests of a model that hypothesizes fr...

The lifestyle appraisal questionnaire: A comprehensive assessment of health and stress

Abstract: Lifestyle risk factors and perceived stress have been shown to have a significant impact on an individual's health. Interventions designed to minimise the negative effects of such risks which also reliably measure long-term health outcomes are therefore desirable. However, there is a lack of reliable and sensitive measures of lifestyle risks and stress. This paper presents initial research on the development of the Lifestyle Appraisal Questionnaire (LAQ), an instrument designed to assess lifestyle from a multifactorial perspective, that is, cumulative risks and perceived stress of life. Two samples were selected to test the LAQ. The first group was a randomly selected community sample. The second was a university sample of randomly selected staff. From the first group (n=600), the reliability, validity and factor structure were determined. From the second group (n=143), the clinical usefulness of the scale was demonstrated. Both groups provided adult norms. Implications of such a measure are disc...

The search for reliable and valid measures of patient-centredness

Abstract: While patient-centredness in medical consultations has often been advocated, there are no standard measures for it and relatively little empirical evidence for its beneficial effects. Using the transcripts of 210 general practice consultations we applied two different measures of patient-centredness, and related the results to doctor and patient satisfaction with the consultations and consultation length. One measure was based on combined Verbal Response Modes indicative of Doctor Receptiveness and Patient Involvement, and the other measure was based on global ratings of the extent to which doctors solicited patient views, responded to them, related information to them, involved the patient in decision-making and checked their understanding. There was little relationship between patient satisfaction and patient-centredness of the consultations; more patient-centred consultations tended to last longer and to deal with psychosocial or complex problems, and were related to relative doctor dissatisfa...

The european health and behaviour survey the development of an international study in health psychology

Abstract: (1996). The european health and behaviour survey the development of an international study in health psychology. Psychology & Health: Vol. 11, No. 1, pp. 49-73.

Understanding responses to predictive genetic testing: A grounded theory approach

Abstract: In view of the absence of data concerning the understanding and experience of families in which one or more members have undergone predictive genetic testing, a pilot study using a qualitative methodology was conducted with members of families at risk for the late-onset genetic disease, familial adenomatous polyposis (FAP) Semistructured interviews were conducted to elicit illness representations, with responses tape-recorded and analysed using a grounded theory approach Several themes emerged The most striking was that when genetic testing indicated an extremely low risk of developing the disease, there was a desire to continue regular bowel screening, even though it was experienced as extremely aversive Possible explanations draw upon both other themes of the interviews, and psychological models The role of “functional pessimism” and “uncertain wellness” in maintaining a high threat from the disease, and the role of reinforcement and the nature of tests in providing bowel screening with a high value are discussed

Experimental manipulation of perceived control and its effect on disability

Abstract: Perceived control is postulated as a possible moderator of the relationship between impairment and disability. This hypothesis was experimentally investigated in patients with chronic pain attending a clinical psychology department in a hospital. Patients were randomly allocated to experimentally increased (N = 25) or decreased (N = 25) perceptions of control and the effects on disability examined. Perceived control was manipulated using sections of the normal clinical interview which enhanced beliefs in control (asking about times when control had been high) or reduced them (asking about times when control had been low). Results showed that the cognitive manipulations had been effective in modifying cognitions and had resulted in the predicted effects on disability as assessed by a lifting task. The possible emotional mediation of the cognitive manipulation is considered but cannot be reconciled by these data. The results do, however, strengthen the findings from correlational studies suggesting...

The role of the general practitioner's affective behaviour in medical encounters

Abstract: In a random sample of 1524 consecutive consultations involving 30 General Practitioners (GPs), a study was made of the relationship between the GP's affective and instrumental behaviour and patient satisfaction as well as patients' space in the consultation, both at consultation and GP-level. In a subsample of 99 consultations with hypertensive patients, an additional study was made of the relationship between the GP's affective behaviour and the quality of care on three dimensions (technical-medical, psychosocial and doctor-patient relationship). The GP's affective behaviour was negatively correlated with some aspects of his/her instrumental behaviour, in particular with technical-medical interventions and prescriptions. On the other hand, the GP's affective behaviour related positively to several measures indicating patients' ‘space in the consultation’ (consultation length, proportion of patient talk, patient influence on the diagnosis and the discussion of psychosocial topics). As hypothesize...

Knowledge, attitudes and reported behaviours relevant to sun protection and suntanning in adolescents

Abstract: Adolescence is a risk period for skin damage that may lead to skin cancer. The present study measured knowledge, beliefs, attitudes, and usual self-reported behaviour relevant to sun protection and suntanning among a representative sample of 4721 secondary school students in Victoria, Australia. Using a cross-sectional design, the study investigated how the above variables varied across age group, sex, and self-rated skin sensitivity to the sun. Survey results indicate that students were highly aware of sun protection issues, that attitudes toward sun protection methods were generally positive but so were attitudes toward suntans. Those more likely to burn were more likely to hold positive attitudes to sun protection and to report sun protective behaviours. Girls, whilst generally being more knowledgeable and more pro sun-protection in their attitudes, than boys, still desired a darker tan than boys. Despite sun protection knowledge increasing with age, 15 year olds generally had attitudes and re...

Conditional versus unconditional risk estimates in models of aids-related risk behaviour

Abstract: This study focuses on the concept of perceived risk and its relations to behavioural intentions and behaviour. Most research on health related behaviour employs a measure of unconditional risk. Given the inconsistent findings concerning the relationship between perceived risk and behavioural measures in the health literature, we investigated the usefulness of a conditional risk estimate as an alternative measure. In total, 247 heterosexual visitors of a STD-clinic participated in this study. Hundred participants had private partners only, 147 engaged in prostitution contacts. The relationship between the unconditional measure of perceived risk and behavioural intentions was found to be dependent upon sample-differences. However, it appeared that when a conditional risk estimate was used, a significant positive relation with intention was observed, regardless of the risk-status of the sample. Given the results of the present study, and the closer resemblance of the conditional risk measure to the ...

The role of risk perception and efficacy cognitions in the prediction of HIV-related preventive behavior and condom use.

Abstract: Based on empirical findings on the central model variables of the Protection Motivation Theory, the influence of perceived susceptibility, perceived severity of the threat of AIDS, communicative and sexual self-efficacy, and outcome expectancy on various aspects of HIV-preventive behavior was examined. The study was based on a sample of 468 heterosexual adults between the ages of 20 and 45 years. The data were obtained by means of questionnaires filled out at various vacation sites that draw mass tourism or in the subjects' home town. The most significant predictor of behavior was found to be self-efficacy expectancy as regards assertiveness and use of HIV-related preventive measures. A high communicative self-efficacy expectancy, on the other hand, is associated with a higher level of risk behavior among certain subgroups and under certain behavioral aspects. This confirms the necessity of acknowledging the different forms of self-efficacy expectancy in sexual interactions. Perceived personal th...

How confidently can we infer health beliefs from questionnaire responses

Abstract: Recent theoretical and empirical research has challenged the assumption of health psychologists employing social cognitive models that beliefs can confidently be inferred on the basis of questionnaire responses. It is charged that responses to questionnaires are a function of the intelligibility of the items, constructs and theoretical framework to survey participants. To investigate this contention, cognitions specified by Protection Motivation Theory (PMT) were measured with respect to intentions to use a condom and intentions to use dental floss. Three alternative formats of a questionnaire which varied the order of presentation of PMT items were distributed to student samples. Analyses showed that while questionnaire format did not affect the reliability of cognition measures, there was some variation in the significance and strength of correlations between PMT cognitions across formats. Individual differences in social desirability and salience of the target behaviour had small and predictab...

Unrealistic optimism and genetic risk

Abstract: The occurrence of unrealistic optimism with regard to a genetic risk situation was investigated within a group of female adults (study 1) and a group of adolescents (study 2). In both studies, the indirect method of measurement elicited a significant optimistic bias. Contrary to Weinstein (1982, 1987) we found no relation between the direct or indirect measures of unrealistic optimism and personal experience with the risk, perceived frequency of occurrence or perceived preventability of the risk. Trait-Anxiety was significantly related to the extent of unrealistic optimism, but only when the direct measure was used. Together with the fact that the indirect measure resulted in a much stronger bias than the direct one, this suggests that there exists an important difference between both measures. Further research on the measurement of unrealistic optimism and on its determinants in specific risk situations is needed.

Avoidant coping style and verbal-cardiovascular response dissociation

Abstract: This study explored the relationship between an avoidant coping style and three responses during three experimental periods (i.e., speech preparation, speech delivery, and recovery). One response was cardiovascular reactivity, the two other responses were subjective in nature: self-reports of anxiety and self-estimations of blood pressure. Subjects were 20 male and 20 female students who scored either in the upper third (i.e., high-avoiders) or lower third (i.e., low-avoiders) on cognitive avoidance (Krohne, 1989). When compared to subjects scoring low on avoidance, those high on avoidance showed greater systolic blood pressure (SBP) reactivity and evidenced verbal-autonomic response dissociation across all experimental periods. That is, their SBP increases were stronger in relation to their increases in self-reported anxiety. Verbal-autonomic response dissociation, however, did not occur for estimations of SBP, suggesting that self-reports of anxiety and estimations of autonomic responses reflec...

Doctor-patient communication and outcome in cancer patients: An intervention

Abstract: Previous research suggests that the way in which doctors communicate with their patients has significant effects upon outcomes: “soft” outcomes such as satisfaction and compliance with treatment regimes; and “hard” outcomes such as need for analgesics and length of stay in hospital after surgical operations. The present investigation is concerned with cancer patients and tests whether providing oncologists with additional training in communication may promote patients' coping, quality of life and even survival. In the first part of the investigation, seventy-three patients at the University Hospital of Patras in Greece were followed for a year from the time of diagnosis. Patients were seen by the oncologist an hour or two before treatment began -chemotherapy or radiotherapy and were asked immediately after the consultation to rate the doctor's communication skills and behaviour. While there was little evidence that communication influenced either coping or quality of life six to eight weeks later...

The prediction of cardiac surgery outcome based upon preoperative psychological factors

Abstract: The present study was designed to investigate whether preoperative anxiety and anger were predictive of postoperative outcome in cardiac surgery parients. A standardized scale measuring state and trait anxiety and anger was completed by 94 patients awaiting cardiac surgery. Dependent measures included length of stay, number of complications, and clinical rating of surgical outcome. Higher levels of preoperative state anxiety and anger were associated with poorer postoperative outcome. These results were obtained after adjusting for medical status, surgical procedure, preoperative length of stay, priority of surgery, gender, and age. These relationships suggest a potential role for interventions aimed at altering presurgical psychological states.

Health optimism and control beliefs as predictors for treatment outcome of a multimodal back treatment program

Abstract: Predictors for treatment outcome, i.e. changes in subjective functional capacity (FCI) and work status 12 months after treatment, were analyzed with chronic low back pain (CLBP) patients (n = 175) who attended a 4-week multimodal back treatment program with intensive physical training. Locus of control beliefs, health optimism and symptoms of depression were used as predictors. The results showed that those with more optimistic views on their health and weak belief in control by powerful others had gained from the treatment more even after controlling for the initial scores of the FCI. Those Ss who were at work 12 months after treatment had before treatment more optimistic views on their future health and weaker belief in external control. They also had a significantly greater improvement in the FCI when compared with those on sick-leave or pension at the 12-month follow-up regardless of the initial value of the FCI. Symptoms of depression were not significant predictors for treatment outcome. Th...

Beautiful faces in pain: Biases and accuracy in the perception of pain

Abstract: The impact of appearance-based information on judgments about the psychological functioning of pain patients was investigated. Video-tapes of low back pain patients experiencing pain were used as stimulus materials. Subjects viewed silent video clips and photographs of the patients' faces and made judgments about the functioning of these patients. These judgments were affected both by patient physical attractiveness and gender. Physically attractive patients and male patients were judged to be functioning better than physically unattractive and female patients. The judgments were reasonably described as biased because the perceived differences about patients varying in attractiveness and sex were not associated with measures of actual patient functioning.

The relationship between marital quality and oral health status

Abstract: This study investigated whether oral health status is associated with marital quality. 164 families (father, mother and at least one 13-year-old child) from Belo Horizonte, Brazil, were selected from 13-year-old children from private and state schools. The parents' ages ranged from 35 to 44 years. A highly significant negative association between marital quality and the father's (p < 0.001), mother's (p < 0.001) and child's dental caries (p < 0.01) was found. A significant negative association between marital quality and periodontal diseases was also found for fathers (p < 0.01) and mothers (p < 0.05). Other significant associations were found within the population studied. Lower sugar consumption, upper socio-economic status, higher frequency of dental attendance, higher toothbrushing frequency and younger age were significantly associated (p < 0.05) with lower levels of dental caries. Upper socio-economic status, lower work-related mental demand and higher frequency of dental attendance were si...

An interview to measure vital exhaustion. I. Development and comparison with the Maastricht Questionnaire

Abstract: This article presents an interview designed to measure vital exhaustion (VE), a state characterized by unusual fatigue, increased irritability and feelings of demoralization, which has been found to be a short-term risk indicator of myocardial infarction (MI). This state can be measured by means of the Maastricht Questionnaire (MQ). However, the MQ was found to have some major shortcomings for the selection of subjects for laboratory or clinical investigations. For this reason we designed an interview to assess VE. To test the hypothesis that the interview registers prodromal feelings of MI, the interview was administered to a sample of 81 males who were hospitalized because of a first myocardial infarction (mean age 55.6 years; sd 6.8) and a sample of 168 healthy males (mean age 54.9 years; sd 6.9). Mean scores of cases and controls differed significantly (7.8; sd 6.0 and 3.6; sd 4.0, respectively; t=5.65; p=.000). Mean scores on the questionnaire discriminated significantly too, but the discrim...

An interview to measure vital exhaustion. II. reliability and validity of the interview and correlations of vital exhaustion with personality characteristics

Abstract: In the previous paper (Meesters and Appels, this issue) we described the development of an interview to measure feelings of vital exhaustion (VE). The current paper presents data on the reliability and the validity of the interview, which is labeled the Maastricht Interview for Vital Exhaustion (MIVE). Correlations with the Type A behavior pattern (TABP) and hostility are also discussed in this paper. The data were collected in a case-control study of 81 males with first MI and 168 healthy neighborhood controls. The interview was found to have a good reliability, Cronbach's alpha being .90 in the case group and .86 in the control group. The kappa coefficient was .95 in the case group and .91 in the control group. The validity was tested by computing the estimated relative risk of VE, controlling for angina pectoris and the classic risk factors. The odds ratio was found to be 8.11 (p<.001). This indicates that the interview makes a valid assessment of the mental precursors of MI. The interview cor...

Demand characteristics and research into drug use

Abstract: Health research makes frequent use of verbal reports; and such reports are usually assumed to be the surface indicants of measurable entities such as attitudes, beliefs, intentions, etc. which reside inside the person. It is our assertion that verbal reports themselves are motivated and variable; they are functional and context-dependent and their meaning and significance are localised. Consequently discourse cannot be treated as if it were fixed and categorical data to be retrieved from memory by asking questions that appear objective or disinterested. A method is postulated, using a social perception analogy with signal detection (SD) theory. The method allows for the assessment of subject criterion, and permits an examination of signal-strength in terms of the researcher's motivation. Data are evaluated in terms of their “robustness”, a measure which derives from the variability of response in different contexts, and under different elicitation procedures. The method requires few assumptions t...

Genetic counselling: Predicting patient outcomes

Abstract: With the rapid development of genetic testing, the demand for genetic counselling is increasing. Yet there is little known about what makes for effective or efficient genetic counselling. The aim of the current study is to determine the main factors influencing outcomes of genetic consultations. One hundred and thirty one routine consultations conducted in a regional genetics centre were audiotaped, transcribed and coded. The main predictors of outcome tested were pre-interview patient and counsellor expectations; pre-interview patient concerns; length of consultations; counsellor directiveness; and the extent to which social and emotional issues are addressed in the consultation. The main outcomes were the patient's view of the extent to which their expectations were met, their satisfaction with information provided, and concern about the problem they were referred with. Although there were six significant correlations between the process of consultation and outcome variables, multivariate analy...

A social cognition approach to health psychology: Philosophical and methodological issues

Abstract: Health psychologists working within a “social cognition” framework routinely regard verbal reports as indices of cognitive/mental representations and behavioural dispositions. Social cognition developed within social psychology but the philosophy of science, theoretical assumptions and methodological practices which constitute it are not universally accepted by social psychologists. This paper explores the implications of debates about the validity of a social cognitive perspective for research practice in health psychology. The realist foundations of social cognition are contrasted with the social constructionist perspective underpinning many discourse analysis studies. It is argued that a realist view of potentially accurate verbal reports and an individual cognitive focus are essential to health psychology research. However, it is emphasized that culture-bound self-presentational processes operating in data-collection contexts necessitate methodologies capable of monitoring and controlling the...

The nature of partner relationship and AIDS sexual risk-taking in gay men

Abstract: This study examined the importance of the nature of the relationship between sexual partners in predicting types of sexual practices for 293 gay and bisexual men. Demographics, personal beliefs, substance use, and variables from the health belief model, theory of self-efficacy, and theory of reasoned action were used to predict sexual behaviors. Sexual practices varied by type of partner relationship and duration, with a higher probability of risky behaviors occurring with primary partners than with non-primary partners; relationship status also moderated the effects of safer sex partner norms and denial on sexual risk-taking. In addition, men who were younger, had less education, and used alcohol or drugs prior to sex engaged in higher risk behaviors. This study indicates that a more comprehensive assessment of dimensions of partner relationship will lead to greater understanding of sexual risk-taking.

Health beliefs and teenage condom use: A prospective study

Abstract: Results from a longitudinal survey of sexual behaviour and HIV-relevant cognitions amongst 258 sexually-active adolescents are reported. Demographic characteristics, previous sexual experience, prior condom use, beliefs specified by the health belief model (I-IBM), peer norms regarding condom use and condom use intentions were measured using a confidential postal questionnaire. Measures of sexual behaviour and condom use consistency were included in a follow-up questionnaire one year later. A discriminant analysis revealed that demographic and HEM measures did not predict reported sexual activity over the study year. Path analysis revealed that intentions and HEM measures did not account for significant proportions of variance in consistency of condom use or mediate the effects of prior sexual experience or demographic measures; Those reporting more frequent sexual intercourse were less likely to use condoms consistently while those who had used condoms previously reported more consistent use. Gender differences suggested that young women's good intentions were less likely to be translated into subsequent, consistent condom use. Theoretical and applied in;plications are considered.

Towards an understanding of children's motivation for physical activity: Achievement goal orientations, beliefs about sport success, and sport emotion in zimbabwean children

Abstract: The study of children's physical activity motivation is important for public health promotion. However, more needs to be known about physical activity determinants across different groups and cultures. This study investigated the achievement goal orientations, beliefs about sport success and emotional feelings concerning sport in 159 children from Zimbabwe. The study was based on research conducted in the USA and England to test the replicability of findings across cultures. Results showed that children endorsing a task (self-referenced) orientation of sport success were more likely to believe that sport success was the result of effort rather than ability, whereas the reverse was true for those endorsing the normatively referenced ego (social comparative) goal. Children high in task orientation, either alone or in combination with a high ego orientation, were found to display the most motivationally adaptive profile. The results were very similar to those reported in the USA and England and high...

Western and african conceptualizations of health

Abstract: Views of health amongst southern African peoples are reviewed. Apparent in the review is the contrast between Western compartmentalized thinking about health issues and the more holistic approach that characterizes traditional Africa. The slow convergence of thinking between these views that is evolving is outlined. An approach which emphasises similarities rather than differences is advocated for future thinking about the integration of African and Western health care systems.

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.