Biomedical subjects

Jane Ogden

Publications and source records attributed to Jane Ogden.

At least 19 recordsLinked to original sources

PubMed2007

Symptom onset and the socially sanctioned pathway: the example of diet.

Theories of symptom perception do not explain symptom onset, nor why symptoms vary according to culture and time. This article attempts to explain cultural, temporal and individual variation in symptoms, and presents a new three-stage model of symptom onset. First, it is argued that tensions relating to issues of conflict and control arise as an individual interfaces with their social world and that this requires communication. Second, it is suggested that symptoms are embedded with culturally specific meanings which offer up a socially sanctioned pathway as a forum for communication. Third, if this pathway is appraised as personally relevant, the symptoms offered by the pathway will be adopted as the forum for communication. The resulting symptoms are therefore both culturally and personally meaningful. This model is derived from an analysis of the literature on diet, but is also offered as a means to understand the onset of other common symptoms.

Attitude to Health↗

PubMed2006

Understanding successful behaviour change: the role of intentions, attitudes to the target and motivations and the example of diet.

Although many attempts to change health behaviour fail, some individuals do show successful behaviour change. This study assessed the role of behavioural intentions, motivations and attitudes to the target in explaining successful changes in diet with a particular focus on positive and negative intentions and positive and negative attitudes. Participants (n=282) completed a questionnaire describing a recent change in eating behaviour (becoming a vegetarian, cutting out a food group, eating fewer calories), their intentions, their attitudes to the food being avoided, a range of motivations and their degree of success. The results showed that the three behaviour change groups differed in terms of their cognitions with those trying to eat fewer calories reporting less success in changing their behaviour. Successful vegetarianism was associated with a lower positive attitude; successfully cutting out a food group was related to ethical motivations, a lower positive attitude and greater positive and negative intentions, and reducing calorie intake was associated with greater positive intentions and a lower positive attitude. Therefore, success was associated with different cognitions depending upon the type of change being made, although cognitions such as 'I will eat more vegetables' and 'I no longer find high fat foods palatable' were consistently most predictive of success. Suggestions for the development of more effective interventions to change health behaviours are made.

Behavioral Research↗

PubMed2006

Expanding the concept of parental control: a role for overt and covert control in children's snacking behaviour?

The existing literature on parental control and children's diets is confusing. The present paper reports two studies to explore an expanded conceptualisation of parental control with a focus on overt control which 'can be detected by the child' and covert control which 'cannot be detected by the child'. In study 1, 297 parents of children aged between 4 and 11 completed a measure of overt control and covert control alongside ratings of their child's snacking behaviour as a means to assess who uses either overt or covert control and how these aspects of parental control relate to a child's snacking behaviour. The results showed that lighter parents and those with children perceived as heavier were more likely to use covert control and those from a higher social class were more likely to use overt control. Further, whilst greater covert control predicted a decreased intake of unhealthy snacks, greater overt control predicted an increased intake of healthy snacks. In study 2, 61 parents completed the same measure of overt and covert control alongside the three control subscales of the Child Feeding Questionnaire [Birch, L.L., Fisher, J.O., Grimm-Thomas, Markey, C.N., Sawyer, R. (2001). Confirmatory factor analysis of the Child Feeding Questionnaire: A measure of parental attitudes, beliefs and practices about child feeding and obesity proneness. Appetite, 36, 201-210] to assess degrees of overlap between these measures. The results showed that although these five measures of control were all positively correlated, the correlations between the new and existing measures indicated a maximum of 21% shared variance suggesting that covert and overt control are conceptually and statistically separate from existing measures of control. To conclude, overt and covert control may be a useful expansion of existing ways to measure and conceptualise parental control. Further, these constructs may differentially relate to snacking behaviour which may help to explain some of the confusion in the literature.

Adult↗

PubMed2006

Adherence, behavior change, and visualization: a qualitative study of the experiences of taking an obesity medication.

OBJECTIVE: Our objective was to examine patients' experiences of taking orlistat as a means to explore adherence and behavior change. METHOD: We performed qualitative interviews with 12 participants who had taken orlistat in the past 2 years. RESULTS: Their experiences were described in terms of beliefs about the causes of their obesity, their motivations for taking orlistat, and highly visual side effects. These themes have implications for understanding adherence and behavior change. For some, the side effects led to nonadherence and absence of behavior change. These individuals seemed to be motivated by routine effects of being overweight, such as lowered self-esteem. In contrast, those who were motivated by a life crisis seemed to tolerate the side effects of the drug, leading to adherence. In turn, these highly visual side effects enabled them to make an explicit link between food consumed and weight, creating a shift in their beliefs about the causes of obesity and making behavior change more likely. CONCLUSION: Orlistat use illustrates how treatment and illness beliefs interact to create both adherence and behavior change, particularly in the context of a life crisis and particularly when symptoms can be visualized.

Adult↗

PubMed2006

The role of etiquette and experimentation in explaining how doctors change behaviour: a qualitative study.

Despite increasing interest over the last 30 years in individual variations in clinical practice, various research studies have thrown only limited light on either understanding or changing doctors' behaviour. This qualitative study explored a sample of British general practitioners' accounts of the influences on their prescribing, and identified the locus of the problem in their defence of professional identity through clinical autonomy, a tactic that precluded use of more customary change agents such as line management and economic incentives. The study identified two mechanisms, clinical etiquette and clinical experimentation, however, that enabled change to occur within the constraints imposed by the commitment to clinical autonomy.

Humans↗

PubMed2005

Why do doctors issue sick notes? An experimental questionnaire study in primary care.

BACKGROUND: Issuing sick notes is one of the core tasks of General Practice and yet little research has explored how doctors decide whether or not to offer a sick note. AIM: To explore what factors influence this decision with a focus on the impact of type of problem (psychological versus physical), adverse family circumstances (present versus absent) and patient demand (asks for note versus does not ask). DESIGN: Experimental factorial design using questionnaire-based vignettes with eight scenarios which varied in terms of the three core factors. SETTING: East and West Sussex PCTs. OUTCOME MEASURES: Doctors' beliefs about the patient and their subsequent behaviour. PARTICIPANTS: Four hundred and eighty-nine GPs completed a questionnaire asking them to rate one of eight hypothetical patients in terms of their beliefs about the patient and their hypothetical behaviour. RESULTS: The doctors rated the patient with the psychological problem as more ill, less work-shy, more unfit for work and described feeling more sympathy towards him compared with the patient with the physical problem. The presence of adverse family circumstances generated more sympathy and doctors considered this patient as less work-shy. A patient demand for a sick note had no effect on doctors' beliefs about the patient. In terms of doctors' behaviour, the doctors were more likely to give the patient with the psychological problem a sick note overall and because they felt he needed or deserved one, and more likely to give the patient with the physical problem a sick note in order to maintain a relationship with him. The decision to give a sick note was not influenced by either adverse family circumstances or patient demand. CONCLUSION: Doctors have more positive beliefs about patients with a psychological problem and are more likely to offer them a sick note. Issuing sick notes is unrelated to the patient's family circumstances or patient demand.

Adult↗

PubMed2005

'What's in a face?' The role of doctor ethnicity, age and gender in the formation of patients' judgements: an experimental study.

BACKGROUND: Research has shown that doctor's make judgements about patients on the basis of their demographic characteristics. Little is known about how patients judge their doctors. AIM: The present study aimed to explore the impact of a doctor's ethnicity, age and gender on patients' judgements in the setting of a general practice consultation. METHODS: The study involved an experimental factorial design using vignettes with patients receiving one of eight photos of a doctor who varied in terms of ethnic group (Asian versus White), age (older versus younger) and gender (male versus female). Six general practices in South West London took part and 309 patients (response rate = 77%) rated the doctor in terms of the expected behaviour of the doctor, the expected behaviour of the patient and the patient ease with the doctor. RESULTS: The results showed that in terms of the impact of ethnic group, the Asian doctor and White doctor received comparable ratings for most questions; however, the Asian doctor was rated as being more likely to explore emotional aspects of health than the White doctor. Differences for age and gender were more profound. In particular, both the younger doctor and the female doctor were judged to have a better personal manner, better technical skills, better explanation skills, to be more likely to explore emotional aspects of health and empower the patient. Patients also stated that they were more likely to have faith in their diagnoses, advice and to comply with treatment and preferred both the younger and female doctors for a physical examination. In addition, younger doctors were deemed to be more likely to refer a patient to see a hospital specialist and female doctors were seen to be more likely to suggest complementary therapy. CONCLUSION: A doctor's age and gender have a stronger impact on a patient's judgements than their ethnicity.

Adult↗

PubMed2005

Do GPs practice what they preach? A questionnaire study of GPs' treatments for themselves and their patients.

Anecdotal evidence indicates a difference between doctors' health seeking behaviours for their patients and for themselves. This difference remains untested. This study aimed to assess any differences between the first-line treatment options GPs would accept for themselves and those they would advise their patients. A postal questionnaire was completed by 286 GPs based in two west London Health Authorities (response rate 51.4%) asking them to score the treatment options of 6 common symptoms for both themselves and their patients in terms of over the counter (OTC) remedies, prescriptions, referrals and complementary therapies. The results showed that GPs differentiated between themselves and their patients in terms of OTC remedies for indigestion and depression, prescriptions for indigestion, hypertension, depression and 'tired all the time' (TATT); referrals for indigestion, hypertension, low back pain and TATT; and complementary therapy for depression. GPs may be prepared to cross the boundary be treated the same as their patients if the symptoms are relatively uncontroversial. Stigmatised problems and those with clinical guidelines, however, seem to result in a 'do as I say not as I do' approach to health care.

Attitude of Health Personnel↗

PubMed2005

Doctors' use of euphemisms and their impact on patients' beliefs about health: an experimental study of heart failure.

Doctors often use a range of euphemisms as a means to facilitate communication in the consultation. The present experimental study aimed to assess whether GPs use or avoid the term 'heart failure' and to evaluate the relative impact of the term 'heart failure' versus their preferred euphemism on patients' beliefs about the illness. This two part study involved a cross sectional survey of GPs and an experimental study of patients' beliefs and was based on one General Practice in a semi-rural area of the UK. For the first part, 42 GPs completed a questionnaire about their preferred terms to describe symptoms of heart failure. The results showed that GPs rated the majority of euphemisms as preferable to the term 'heart failure'. Their preferred euphemism was 'fluid on your lungs as your heart is not pumping hard enough'. For the second part, 447 patients completed ratings of their beliefs about a condition, which was described as either 'heart failure' or the GPs' preferred euphemism. Patients who received the condition described as 'heart failure' believed that the illness would have more serious consequences for their life, that the problem would be more variable over time and that it would last for longer and reported feeling more anxious and depressed than those who received the condition described using the euphemism. GPs are encouraged to be open with their patients and to respect their experience. The choice of language, therefore, presents a dilemma for doctors. The term 'heart failure' may be in line with the current climate of openness but may evoke a more negative response from the patient. In contrast, a euphemism may be less open but more protective of the patient's experience. This study suggests that the area of heart failure may be one where GPs may chose to compromise openness for the sake of the patient's experience and that this fear of upsetting the patient is well founded.

Adaptation, Psychological↗

PubMed2005

Emergency contraception use and non-use in young women: the application of a contextual and dynamic model.

There have been many approaches to understanding contraception use including social cognition models which have been criticised for their individualistic approach and their static nature. The present quantitative study developed and refined a contextual and dynamic model of contraception use that was derived using qualitative research. This model conceptualizes the predictors of contraception use in terms of the meaning and importance of a range of social goals, perceptions of vulnerability, and constraints on or facilitators of contraception use each of which changes over time. The present study operationalized this model in relation to emergency contraception and explored differences between users and non-users and between episodes of use and non-use. In terms of users and non-users, the results showed that the users of emergency contraception showed a more positive view of an emergency contraception user, perceived greater support from their partner for emergency contraception use, rated themselves more at risk of pregnancy, and felt more confident about asking for emergency contraception. In terms of use and non-use, use was related to an increased belief about the risk of pregnancy, increased partner support, increased concern about health care professionals and the side-effects of the drug, and a more positive identity of an emergency contraception. The study has helped to develop and refine the model and has identified some key factors that are specifically relevant to emergency contraception use in a sample of women in education in and around London.

Adult↗

PubMed2005

Exploring the impact of obesity surgery on patients' health status: a quantitative and qualitative study.

BACKGROUND: Obesity surgery has been shown to result not only in sustained weight loss, but also in improvements in psychological morbidity and quality of life. The present study aimed to explore the mechanisms behind the success of surgery and to examine how it might bring about such changes in patients' health status. METHODS: Both quantitative and qualitative methods were used. A questionnaire was completed by patients who had undergone bariatric surgery in the past 4 years (n=22) and a matched-group of waiting list controls (n=39). In depth interviews were then carried out with 15 surgical patients. RESULTS: The quantitative study showed that the surgical group weighed less, had more negative experiences of eating and yet reported improved subjective health status using a range of validated tools. The qualitative study provided some insights into this improved health status, with the surgical patients reporting improved energy and self-esteem. The patients also reported a fundamental shift in their relationship with food. In particular, they described changes in their eating behavior and stated that they had a new experience of fullness and a reduction in their hunger. Furthermore, they described how food now had a reduced role in their lives and that the operation had made them feel more in control of their food intake. CONCLUSION: Post-surgical improvements in health status may not only be a result of the non-specific consequences of surgery brought about by weight loss, but also a result of the specific impact of the surgical procedure itself. By enforcing a reduction in the amount of food that can be eaten, restrictive surgery seems to generate changes in the individuals' relationship to food and may help to re-establish a perception of control over eating behavior.

Adaptation, Physiological↗

PubMed2005

A cross-sectional survey of patients' beliefs about stress and their help-seeking behaviour.

BACKGROUND: Stress has become an increasingly common presentation in general practice. This may relate to an increase in stress in people's lives or a change in the meaning of stress and its conceptualisation as a legitimate problem for the GP. AIM: To explore patients' beliefs about stress, their association with help-seeking behaviour, and to examine differences by ethnic group. DESIGN OF STUDY: Cross-sectional survey of general practice patients attending to see their GP. SETTING: An inner-city London practice. METHOD: Consecutive general practice patients completed a questionnaire, which involved rating a series of symptoms for the extent to which they were associated with stress and describing their help-seeking behaviour. In total, 548 patients completed the questionnaire. Most patients described themselves as black Caribbean (n = 163), black African (n = 48), or white British (n = 187). RESULTS: The symptoms most frequently associated with stress were sleeping problems, feeling depressed, feeling panicky, having high blood pressure and feeling anxious; feeling ashamed, experiencing indigestion, having diarrhoea, feeling hot or cold, and suffering from constipation were least commonly associated to stress. This model of stress did not vary by ethnic group. Ethnic group differences were found for the association between the model of stress and help-seeking behaviour. Although white British patients consistently reported that the more a symptom was seen as indicative of stress, the more likely they would be to visit the doctor for that symptom, this association was not found for either black Caribbean or black African patients. CONCLUSIONS: The belief that stress-related symptoms are a legitimate problem for the GP is not universal and varies according to ethnic group. Stress is used by different patients in different ways and offers a variable pathway to the doctor.

Adolescent↗

PubMed2005

Patients' experiences and expectations of general practice: a questionnaire study of differences by ethnic group.

BACKGROUND: Research has highlighted variations in morbidity, mortality and health needs by ethnic group, and suggests that some ethnic groups may receive a poorer service. AIM: To explore the impact of ethnic group on patients' experiences and expectations of their general practice consultation. DESIGN OF STUDY: Cross-sectional survey. SETTING: One general practice in a multicultural area of London. METHOD: A total of 604 consecutive patients attending their general practice (response rate = 60.4%) who described their ethnic group as white British, black African, black African Caribbean or Vietnamese completed a measure relating to their experiences and their expectations of the general practice consultation in terms of treatment, communication, patients' agenda, patients' choice and doctor consistency. RESULTS: No differences were found for the black African or black African Caribbean patients. The Vietnamese patients reported better experiences of communication, more focus on their agenda and more attention to their choices than the white British patients. However, they also reported expecting lower levels of communication, less focus on their own agenda and reported wanting less GP consistency than the other ethnic groups. CONCLUSION: Vietnamese patients state that they are receiving better standards of care in general practice than other ethnic groups. However, they also state that they expect less. This may illustrate a problem with assessing experiences of primary care. Higher scores of experience may not illustrate better consultations as such, but only better when compared with a lower level of initial expectation. A lower expectation is easier to fulfil.

Adult↗

PubMed2005

A qualitative study of GPs' views of treating obesity.

BACKGROUND: Due to the increased prevalence of obesity GPs now have a key role in managing obese patients. AIM: To explore GPs' views about treating patients with obesity. SETTING: An inner London primary care trust. DESIGN OF STUDY: A qualitative study using semi-structured interviews. METHOD: Twenty-one GPs working in an inner London primary care trust were interviewed about recent obese patients and obesity in general. An interpretative phenomenological approach was used for data analysis. RESULTS: GPs primarily believed that obesity was the responsibility of the patient, rather than a medical problem requiring a medical solution. They also believed that in contrast to this, obese patients wanted to hand responsibility over to their doctor. This contradiction created conflict for the GPs, which was exacerbated by a sense that existing treatment options were ineffective. Further, this conflict was perceived as potentially detrimental to the doctor-patient relationship. GPs described a range of strategies that they used to maintain a good relationship including offering anti-obesity drugs, in which they had little faith, as a means of meeting patients' expectations; listening to the patients' problems, despite not having a solution to them; and offering an understanding of the problems associated with being overweight. CONCLUSION: GPs believe that although patients want them to take responsibility for their weight problems, obesity is not within the GP's professional domain. Until more effective interventions have been developed GPs may remain unconvinced that obesity is a problem requiring their clinical expertise and may continue to resist any government pressure to accept obesity as part of their workload.

Adult↗

PubMed2005

Estimation of blood glucose levels by people with diabetes: a cross-sectional study.

BACKGROUND: Recommendations suggest that all patients with diabetes who use insulin should home test their blood glucose. Recommendations for those not using insulin remain contradictory. These recommendations are in part based upon the assumption that people with diabetes cannot make an accurate estimate. AIM: To explore whether people with diabetes can accurately estimate their blood glucose levels and to assess which factors explain variability in these estimates. DESIGN: A cross-sectional design. SETTING: One general practice in Oxfordshire, UK. PARTICIPANTS: One hundred and fifteen consecutive patients with diabetes attending a diabetic clinic were invited to estimate their blood glucose level prior to having it routinely measured. RESULTS: One hundred and four patients made estimates. Of these, 45 (43.3%) underestimated their blood glucose, 18 (17.3%) overestimated, and 41 (39.4%) made guesses that fell into the range defined as accurate. Of those not using insulin (n = 85), 37 (43.5%) underestimated their blood glucose, 12 (14%) overestimated and 36 (42.3%) were accurate. Accuracy in the non-insulin users was associated with home testing, lower blood glucose levels, coming to the clinic in a fasting state, and reporting no symptoms when they felt that their blood glucose level was high. Overestimation was associated with having co-occurring illnesses and experiencing no symptoms when their blood glucose was low. CONCLUSION: The majority of patients with diabetes in this study could not accurately estimate their blood glucose levels indicating that home testing may be a necessary part of diabetes self care. Home testing may also function as a form of biofeedback to facilitate an improved ability to estimate blood glucose levels.

Adult↗

PubMed2004

The impact of matching the patient's vocabulary: a randomized control trial.

BACKGROUND: Research in general practice emphasizes the importance of matched models, beliefs and vocabulary in the consultation. OBJECTIVE: The present study aimed to explore the impact of matched and unmatched vocabulary on patient satisfaction with consultations. METHODS: The study took place in one inner city general practice. Patients (n=62) were randomized to either matched or unmatched vocabulary consultations when consulting for problems relating to sexual or bodily function or anatomy. Matched consultations required the doctor to use the same vocabulary as the patient. Unmatched consultations required the doctor to use medical vocabulary. Completed questionnaires were received from 60 patients. The main outcome measure was patient satisfaction (using the Medical Interview Satisfaction Scale). This assesses total satisfaction and has four subscales: distress relief; communication comfort; rapport; and compliance intent. Doctor satisfaction with the consultation was also assessed. RESULTS: The results showed that the two groups were comparable for demographic variables and doctor satisfaction. However, patients in the matched consultation group had significantly higher total satisfaction scores and higher ratings of rapport, communication comfort, distress relief and compliance intent than those in the unmatched group. CONCLUSION: The results indicate that a doctor's choice of vocabulary affects patient satisfaction immediately after a general practice consultation and that using the same vocabulary as the patient can improve patient outcomes.

Adolescent↗

PubMed2004

"I want more time with my doctor": a quantitative study of time and the consultation.

BACKGROUND: Although consultations have increased in length, patients still express dissatisfaction with how much time they spend with their doctor. OBJECTIVES: This study aimed to explore aspects of consultation time and to examine the correlates of patients' desire for more time. METHODS: A quantitative cross-sectional design was used. General practice patients from eight UK practices (n = 294) completed a questionnaire following a consultation regarding their satisfaction with the consultation, their beliefs about how long the consultation lasted (perceived time) and how long they would have preferred it to last (preferred time). The actual consultation length (real time) was recorded by the doctor. RESULTS: The majority of patients underestimated how long the consultation took, and a large minority stated that they would have preferred more time. When controlling for both real time and perceived time, a preference for more time was correlated with a dissatisfaction with the emotional aspects of the consultation and a lower intention to comply with the doctors recommendations. It was unrelated to satisfaction with the information giving and examination components of the consultation. CONCLUSION: Patients' dissatisfaction with consultation length could be managed by making consultations longer. Alternatively, it could also be managed by changing how a given time is spent. In particular, a doctor who listens and tries to understand their patient may make the patient feel more satisfied with the consultation length and subsequently more motivated to follow any recommendations for change.

Appointments and Schedules↗

PubMed2004

Children's eating attitudes and behaviour: a study of the modelling and control theories of parental influence.

The present study compared the modelling and control theories of parental influence on children's eating attitudes and behaviour with a focus on snack foods. Matched questionnaires describing reported snack intake, eating motivations and body dissatisfaction were completed by 112 parent/child pairs. Parents completed additional items relating to control in terms of attempts to control their child's food intake and using food as a tool for controlling behaviour. The results showed significant correlations between parent and child for reported snack intake, eating motivations and body dissatisfaction, indicating an important role for modelling. Parents were then divided according to their control scores. Children whose parents indicated greater attempts to control their child's diets reported higher intakes of both healthy and unhealthy snack foods. In addition, those children whose parents indicated a greater use of food as a means to control their child's behaviour reported higher levels of body dissatisfaction. The results provide some support for both the modelling and control theories of parental influence. However, whereas modelling appears to have a consistent impact, parental control has a differential impact depending upon whether this control is focused on the child's diet or on other aspects of their behaviour. To conclude, a positive parental role model may be a better method for improving a child's diet than attempts at dietary control.

Adolescent↗