Biomedical subjects

S Orbell

Publications and source records attributed to S Orbell.

At least 19 recordsLinked to original sources

PubMed2004

Self-sampling in screening to reduce mortality from colorectal cancer: a qualitative exploration of the decision to complete a faecal occult blood test (FOBT).

OBJECTIVE: To explore beliefs that might impact upon public reactions to a proposed population level faecal occult blood test (FOBT) screening invitation and acceptability of completing an FOBT home self-sampling kit. METHODS: Four focus groups were conducted to explore men and women's beliefs about colorectal cancer risk, their understanding of screening and reactions to an FOBT kit. Participants were shown a kit and permitted to examine it during the focus groups. RESULTS: Colorectal cancer is viewed as having severe quality of life impacts and is commonly regarded as being caused by diet. Faecal blood is an expected symptom. A home self-sampling kit is viewed as highly acceptable, but some concerns were raised about collecting and storing faecal matter. CONCLUSIONS: The main implications for public education arising from the analysis were firstly, that communications regarding the potential to avoid quality of life impacts of colorectal cancer may motivate participation; secondly, that public education might address the ability of the test to detect asymptomatic abnormalities, in particular occult (as opposed to visible) blood; thirdly, in order to prevent avoidance responses to fear, communications need to emphasise that many abnormal test outcomes will not be cancer and early treatment may prevent cancer and associated adverse quality of life impacts; fourthly, that uptake may be promoted by emphasising messages that the test kit is very convenient; and finally, that instruction leaflets might minimise procedural concerns by suggesting simple and easy methods to collect and store faecal samples.

Attitude to Health↗

PubMed2002

Fear of falling, falls efficacy, and health outcomes in older people following hip fracture.

PURPOSE: This study sought to determine whether fear of falling and falls efficacy independently contribute to the prediction of health outcomes after a fall, controlling for length of stay in hospital, prefall activity problems, and history of falls. METHOD: Eighty-two older people (> or = 65 years) admitted to hospital as a result of a fall, with proximal femoral fracture, were interviewed to assess variables of interest. At two months after initial interview, participants (n = 57) were re-interviewed in their own home, and their functional limitation and further fall events were assessed. Regression analyses were carried out to determine the ability of the variables assessed in hospital to predict functional limitation and further falls post discharge. RESULTS: Perceived risk of falling and falls efficacy did not explain variance in functional limitation when added to a model containing biomedical factors. In the prediction of further falls, addition of falls efficacy and worry over further falls to a model containing biomedical factors resulted in a statistically reliable improvement, although falls efficacy was not independently associated with outcome. CONCLUSIONS: Assessing worry over further falls in hospital may help to identify older people with hip fracture at risk of poor health outcomes.

Accidental Falls↗

PubMed2001

Exploring the relationship between different psychosocial determinants of depression: a multidimensional scaling analysis.

BACKGROUND: The psychological literature concerned with the aetiology and maintenance of depression has generally been considered too diverse to allow for integration of concepts into a single comprehensive review. Moreover, there is little understanding of the original theorists' conceptualisation of the key themes underlying psychosocial theories of depression. This study aims to create a single framework of psychosocial depression concepts based on the opinions of key original theorists. METHOD: A quantitative integration of depression factors was conducted. Ninety-nine factors were identified from 27 theories. Fourteen of the original theorists sorted the factors into groups using a card sort task. RESULTS: Three-way multidimensional scaling (MDS) produced a four-dimensional solution with high explained variance and low stress. Dimension one describes cognitions resulting in a lack of positive intrapersonal and interpersonal communication. Dimension two emphasises behaviours and the impact of environmental stressors. Dimension three describes the individual's pursuit of unrealistic goals and a perceived lack of control. Finally, Dimension four describes concepts relating to self-focus and self-reinforcement. LIMITATIONS: future research could examine clinicians and depressed individuals' understandings of the literature. CONCLUSIONS: the MDS solution identifies the original theorists' collective understanding of the literature. Clinicians could usefully employ the framework to identify the underlying psychosocial themes involved in depression. Moreover the study highlights the need for clinicians to consider the relationships between different conceptual areas in order to challenge the chronic nature of the depressive experience and the high rates of relapse.

Cognition Disorders↗

PubMed2001

Self-efficacy and goal importance in the prediction of physical disability in people following hospitalization: a prospective study.

OBJECTIVES: This prospective study evaluates the role of self-efficacy and goal importance in predicting decreases in disability in activities of everyday living. METHOD: Disability, self-efficacy and goal importance were each assessed before and at 3 and 9 months after participants underwent joint replacement surgery. RESULTS: Disability had decreased at 3 and 9 months post-surgery assessments. Self-efficacy beliefs were higher at 3 and 9 months following surgery while goal importance was increased at 9 months but not at 3 months. Medical variables and prior disability predicted disability at 3 months. Social-cognitive variables did not contribute to the prediction of 3 months disability. Pre-surgery goal importance and self-efficacy at 3 months were independent predictors of disability at 9 months after controlling for pre-surgery and 3 months disability. Evidence also suggested that goal importance and self-efficacy interacted to predict levels of disability at 9 months following surgery. CONCLUSIONS: The findings demonstrate that recovery is governed not solely by medical phenomena but also by psychological variables and suggest that modification of these variables may have an impact on recovery outcomes. Moreover, attention should be paid to the timing of such intervention and to the length of follow-up.

Journal Article↗

PubMed2000

Using implementation intentions to increase attendance for cervical cancer screening.

This article evaluates an intervention based on P. M. Gollwitzer's (1993) concept of implementation intentions. Women registered at a medical practice in rural England (N = 114) completed measures of the theory of planned behavior variables before a manipulation that induced one half of the sample to form implementation intentions specifying when, where, and how they would make the appointment. Subsequent attendance was determined from medical records. Findings show that the theory of planned behavior variables and previous delay behavior provided good prediction of attendance. However, despite equivalent motivation to attend, participants who formed implementation intentions were much more likely to attend for screening compared with controls (92% vs. 69%). Evidence also suggests that implementation intentions attenuated the relationship between previous delay behavior and subsequent attendance.

Adult↗

PubMed1999

Psychosocial correlates of heterosexual condom use: a meta-analysis.

Despite increasing incidence of HIV/AIDS, there has been no systematic review of correlates of condom use among heterosexual samples. To rectify this, the present study used meta-analysis to quantify the relationship between psychosocial variables and self-reported condom use. Six hundred sixty correlations distributed across 44 variables were derived from 121 empirical studies. Variables were organized in terms of the labeling, commitment, and enactment stages of the AIDS Risk Reduction Model (Catania, Kegeles, & Coates, 1990). Findings showed that demographic, personality, and labeling stage variables had small average correlations with condom use. Commitment and enactment stage variables fared better, with attitudes toward condoms, behavioral intentions, and communication about condoms being the most important predictors. Overall, findings support a social psychological model of condom use highlighting the importance of behavior-specific cognitions, social interaction, and preparatory behaviors rather than knowledge and beliefs about the threat of infection.

Acquired Immunodeficiency Syndrome↗

PubMed1999

Predicting perceived recovered activity in older people after a fall.

PURPOSE: Fall injury represents a common cause of disability in older people. Much research in this area ignores the importance of psycho-social factors in recovery from a fall. METHOD: Data were collected from a sample of 40 people (> or = 65 years) admitted to hospital as a result of a fall. Details included: the fall event; causal beliefs; psychological impact; history of falls; pre-fall activity; general health; and beliefs concerning recovery, including efficacy and affective beliefs. After 2 months, participants were recontacted by letter and completed a questionnaire assessing perceived residual levels of disability (65% response). RESULTS: Results indicated that beliefs that the fall was due to external causes and was preventable were each associated with higher perceived recovered activity, even when controlling for pre-fall activity, health status and fall injury. CONCLUSION: The implications of these findings are discussed with regard to promoting recovery after a fall in older people.

Accidental Falls↗

PubMed1998

Cognitive representations of illness and functional and affective adjustment following surgery for osteoarthritis.

A prospective investigation is described which sought to test the role of illness cognitions in determining patient responses to a surgical intervention for osteoarthritis. Illness cognitions were assessed amongst a consecutive sample of patients with osteoarthritis of the knee or hip prior to undergoing joint replacement surgery. Functional activity and depression were assessed pre-operatively, and at 3 and 9 months post surgery. At pre-operative assessment, functional activity and depression were univariately associated with the perceived consequences of osteoarthritis. Path analyses using longitudinal data demonstrated that illness cognitions had predictive value in explaining outcomes. Depression at 3 months was associated with higher pre-operative perceived control beliefs suggesting that patients who have high control pre-operatively may be at risk for temporary depressed mood in the immediate aftermath of surgery. This effect was not maintained at 9 months. Depression at 9 months was lower amongst patients who were more active at 3 months, who did not attribute their condition to wear and tear and who had higher expectations of surgery. Functional activity at 9 months was higher amongst those who did not attribute their condition to growing older and who perceived more control over symptoms. Socio-demographic variables were not associated with change in functional activity or depression over the course of surgery. The results provide support for an illness cognition approach in explaining functional activity and depression outcomes following surgery.

Adult↗

PubMed1998

'Inclined abstainers': a problem for predicting health-related behaviour.

A longitudinal test of the association between motivation to undertake a precautionary health action and subsequent behaviour was conducted on women's uptake of the cervical screening test. A sample of never-screened women (N = 166) completed measures derived from protection-motivation theory (PMT; Rogers, 1983). One year later, screening uptake was reliably determined from medical records. While regression analyses demonstrated that PMT variables predicted both motivation to undergo cervical screening and screening uptake, there was, nonetheless, a good deal of inconsistency between protection motivation and screening behaviour. Fifty-seven per cent of those who indicated they were willing to undergo the test did not do so within a one-year period. Discriminant analysis was therefore used to test the ability of cognitions specified by PMT to distinguish four patterns of association between motivation and behaviour: inclined actors, inclined abstainers, disinclined actors and disinclined abstainers. While PMT variables could successfully classify the four groups, it was not possible to derive a reliable discriminant function which distinguished between inclined actors and inclined abstainers. The results suggest that PMT provides a useful account of choice motivation but does not address the psychological processes by which intention is translated into action. Recent calls for the development of a social psychology of volition are discussed in the light of these findings.

Adult↗

PubMed1998

Do intentions predict condom use? Meta-analysis and examination of six moderator variables.

This study used meta-analysis to quantify the relationship between intentions and behaviour in prospective studies of condom use. The effects of six moderator variables were also examined: sexual orientation, gender, sample age, time interval, intention versus expectation and condom use with 'steady' versus 'casual' partners. Literature searches revealed 28 hypotheses based on a total sample of 2532 which could be included in the review. Overall, there was a medium to strong sample-weighted average correlation between intentions and condom use (r+ = .44), and this correlation was similar to the effect sizes obtained in previous reviews. There were too few studies of gay men to permit meaningful comparison of effect sizes between homosexual versus heterosexual samples. Gender and measurement of intention did not moderate the intention-behaviour relationship. However, shorter time intervals, older samples and condom use with 'steady' rather than 'casual' partners were each associated with stronger correlations between intentions and condom use. Factors which might explain the significant effects of moderator variables are discussed and implications of the study for future research on intention-behaviour consistency are outlined.

Adolescent↗

PubMed1998

Can social cognitive models contribute to the effectiveness of HIV-preventive behavioural interventions? A brief review of the literature and a reply to Joffe (1996; 1997) and Fife-Schaw (1997)

A recent debate in the British Journal of Medical Psychology has considered the role of social cognitive models, such as the theory of reasoned action and the theory of planned behaviour, in understanding HIV-preventive behaviour. In this paper we clarify some of the assumptions involved in applications of social cognitive models. We briefly review available evidence on the capacity of such models to predict HIV-preventive sexual behaviour and outline a number of criteria for judging their predictive success. The importance of behavioural prediction for the development of effective HIV-preventive behavioural interventions is discussed and recent evaluations of interventions based on these models are reviewed. We conclude that the models are effective in predicting HIV-preventive behaviours and provide empirically supported theoretical guidance on psychological changes likely to result in HIV-preventive behaviour change. In addition we argue that, to date, evaluations of theoretically specified interventions are encouraging. Further development and rigorous testing of HIV/AIDS interventions based on social cognitive models is recommended.

Cognition↗

PubMed1998

Health benefits of joint replacement surgery for patients with osteoarthritis: prospective evaluation using independent assessments in Scotland.

STUDY OBJECTIVES: To determine extent of change in psychological, functional, and social health after knee and hip joint replacement surgery using independent assessments. DESIGN: Patients were recruited before surgery and interviewed preoperatively, three months after surgery, and nine months after surgery. Interviews were conducted in the patients' own homes. SETTING: Two orthopaedic surgery units in Scotland. PARTICIPANTS: A consecutive sample of 107 patients with osteoarthritis having primary replacement of the knee or hip. MAIN OUTCOME MEASURES: Assessments of depression, anxiety, pain, functional activity, informal care, and formal service utilisation were made at three time points. MAIN RESULTS: Anxiety and pain were significantly reduced and functional activity levels significantly increased after surgery. While gains in anxiety and pain reduction occurred between the preoperative and three month assessments, gains in activity were made between the three month and nine month assessments. Although pain was reduced and activity increased, levels of depression were unchanged after surgery. Patients reported need for assistance with fewer activities after surgery, but increases in the use of formal services and increases in the number of hours per week of informal support received were observed at both three month and nine month follow up. CONCLUSIONS: The main benefit of joint replacement surgery is pain relief. Gains in functional activity, particularly mobility and leisure activities are made by many patients. Paradoxically, surgery for osteoarthritis seems to act as a "gateway" to increases in formal and informal community support, which are maintained into the longer term.

Activities of Daily Living↗

PubMed1996

Cognition and affect after cervical screening: the role of previous test outcome and personal obligation in future uptake expectations.

276 women aged 20 to 60 years who had recently undergone the cervical smear test for detection of cervical abnormalities were interviewed concerning their experiences at screening, the screening test and their future screening expectations. The vast majority of women indicated that it was very likely they would undergo future tests, in spite of recently publicised concerns about negative impacts of positive results. The analysis further demonstrated that future screening expectations were best examined not by appraisals of disease threat, but by a sense of obligation to attend and by perceptions of the aversiveness of the test procedure. Women who reported that their last test had been painful or embarrassing held more negative views of a future test, but a prior positive result was not implicated in women's expectations concerning future screening. Social class was associated with future uptake expectation, even amongst this sample of women who had already undergone the test. Multivariate analysis showed that the effects of social class on expectation concerning future participation in screening was explained by the tendency of lower class women to view the test as aversive and to feel less personal obligation to attend.

Adult↗

PubMed1995

Women's experiences at cervical screening.

Concerns about attendance for cervical screening has focussed on determining the reasons why some women never attend. Less attention has been paid to whether women continue to attend for further smears, although this is essential for further screening. This study investigated women's experiences of cervical screening and their views on subsequent attendance. Three hundred and thirty nine women aged 20-64 were identified from a computerised register of cervical smears as having had a smear test within the previous three years. They were interviewed at home about their most recent experience of screening. Just over half of the women (53%) recalled being anxious before the test, and about one fifth reported embarrassment (19%) or pain (20%) during it. The frequencies of discomfort were higher amongst those who were anxious about the test, although 24% of those who were embarrassed and 28% who had pain reported being unconcerned beforehand. The frequencies of pain and embarrassment were only slightly higher when the smear taker was male. Many women (22%) reported being concerned about the test result although only 10% of those who were concerned were recalled for further assessment. Although a number of women had unpleasant experiences, almost all (95%) who were under 60 years of age said they were likely to attend for a subsequent smear. Taking cervical smears is often an unpleasant experience for women, although some of the distressing events could easily have been avoided. Attention to technique and to the concerns of individual patients, especially ensuring privacy, could reduce the extent of the problem. The uptake of subsequent smears should be monitored to ensure that women are not being discouraged from attendance.

Adult↗

PubMed1995

Assessing the effectiveness of a screening campaign: who is missed by 80% cervical screening coverage?

A case-control study was conducted to assess the effectiveness of a regional call programme in reaching women at risk of cervical cancer. Home interviews were conducted with a random sample of 614 women aged 20-64 who were identified from a computerized register as either having had a smear test within the previous 3 years or not having an up-to-date smear history. Unscreened women fell principally into two age cohorts: under 35 years and over 50 years. A small social class differential was found to persist following the campaign. Overall, unscreened women were not at epidemiologically higher risk than the screened population. Thirty-five per cent of unscreened women reported never having had sexual intercourse compared to 3% of screened women: 17% of the unscreened and 38% of screened women reported two or more lifetime sexual partners. No difference was observed between screened and unscreened women in the frequency of current cigarette smoking (37% unscreened, 38% screened). Cigarette smoking was, however, associated with social class (31% classes 1 or 2 compared with 50% classes 4 and 5). Level of practical difficulties did not differentiate those who attended from those who did not, suggesting that recent changes to delivery or screening services have been effective in ensuring equity of access. Non-attenders and lower class women held more negative attitudes towards the test procedure and were less likely to believe that they were at risk of cervical cancer. Perceived personal risk was not associated with cigarette smoking, suggesting that further attention might be given to this factor in educational campaigns.

Adult↗

PubMed1994

A randomized trial of immediate discharge of surgical patients to general practice.

BACKGROUND: This study compares, in clinical and economic terms, out-patient follow-up with immediate discharge to general practice of patients undergoing any one of 29 defined surgical procedures. METHODS: A randomized controlled trial was undertaken in which patients recruited from two general surgery wards in Ninewells Hospital, Dundee, were randomized to follow-up care in the out-patient clinic or in general practice. Outcome was measured as clinical effectiveness in terms of morbidity and mortality; economic costs to the hospital compared with general practice; patient benefits and satisfaction; and General Practitioners' (GPs') opinions of the system. RESULTS: A total of 455 patients were randomized to outpatient and 454 to general practice follow-up. They were followed up for a minimum of six months. There were no differences in readmission rates, mean number of operations or mortality. The difference between the groups in the total health service costs was very small (2.68 pounds per patient more for those receiving out-patient follow-up). More of the general practice group preferred general practice care than the out-patient group preferred out-patient care (p = 0.03). The patient's travel costs and travel and treatment time were greater for the out-patient group (27.99 pounds, 113 min) than for the general practice group (24.90 pounds, 82 min). The GPs felt they had been given adequate information in the discharge documentation and were willing to accept immediate discharge as normal policy, although they expected it to increase their workload. If immediate discharge were instituted, the time saved in an out-patient clinic session of 40 patients would be an estimated 54 minutes, enough to see three extra new patients. CONCLUSION: General practice based follow-up care for this group of patients is as effective as, but less costly than outpatient care and is acceptable to GPs. Because of only small differences in costs between the two forms of follow-up, real gains to the health service will depend on the use of the time freed by a reduction in follow-up appointments in the out-patient clinic.

Aftercare↗

PubMed1994

Cervical screening: the optimum visit plan for contacting users and non-users in Scotland.

OBJECTIVE: To investigate the numbers of visits required to obtain interviews with users and non-users of cervical screening, and to determine the workload involved to enable an optimum visit plan to be developed. DESIGN: Case-control study of users and non-users of cervical screening using a flexible visit plan that involved up to eight attempts at contact. Visits were made in mornings, afternoons, and evenings, the visit pattern being determined by information gained from local sources. PATIENTS: Altogether 660 non-users of cervical screening (cases), aged 20-64 and registered with 23 randomly selected general practitioners (GPs), were identified from the Tayside computerised register of cervical smears. These women were selected from the computerised lists of 18 GPs in Dundee and five in Perth. A total of 417 women recorded as having a smear within the previous three years (controls), matched by age and GP, were also identified from the computerised register. RESULTS: Altogether 1834 attempts were made to contact the cases, of whom 339 were interviewed, giving a workload of 18 interviews per 100 attempts. For the controls 1359 attempts were made at contact to yield 339 interviews, a workload of 25 interviews per 100 attempts. Refusals (19%) and incorrect addresses (23%) were the two major reasons for failing to achieve interview. Only for four (0.6%) of the cases and one (0.2%) of the controls was no information gained. The proportion of attempts which led to interview remained constant with increasing numbers of call-backs (up to six for the cases and eight for the controls). CONCLUSIONS: A flexible approach to visit scheduling that takes account of local knowledge can lead to interviews with 66% of non-users of health screening, when incorrect addresses are removed. It is preferable to plan for many (up to six) visits to achieve interview. This will minimise non-response bias without increasing the workload per successful interview.

Adult↗

PubMed1993

Behavioural sciences and the real world: report of a community interview scheme for medical students.

A community interview scheme was designed to provide preclinical medical students with an opportunity to investigate the role of social and psychological variables in patient care and gain insight into interpersonal aspects of the interview process. Evaluation of the scheme showed that students and community interviewees found their participation valuable. Eighty per cent of interviewees were willing to take part in the scheme in the following year. The strongest predictor of willingness to participate was interviewees' rating of the extent to which they had enjoyed the experience. Students valued the opportunity to meet 'real people', to explore social and psychological determinants of health and illness and to develop communication skills. A significant positive change in perceived interviewing competence was observed. It is suggested that the scheme might be further developed by using feedback from interviewees to provide students with evidence of both their own skill development and the benefits of self-disclosure to the patients involved.

Behavioral Sciences↗