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PubMed1994

HIV and the work intentions of public health nurses.

Studies have examined the association between attitudes about the human immunodeficiency virus (HIV) and nurses' willingness or intentions to work with infected persons. However, the relationship between these intentions and perceived concern from nurses' family and friends, or factors of professional nursing experience is relatively unexplored. An anonymous questionnaire was completed by 311 public health nurses from areas with high and low prevalence of acquired immunodeficiency syndrome (AIDS) in North Carolina. Multiple regression analysis showed that nurses had stronger intentions to work with HIV-infected clients if they had more favorable attitudes about the disease, perceived significant others [corrected] to be supportive of such work, had stronger professional ties to public health, and had worked fewer years in public health. In addition, nurses from low AIDS-prevalence areas had stronger intentions to work with these clients if they had professional nursing care experience with them. These findings are consistent with the Theory of Reasoned Action, but also identify professional nursing experience as independently associated with behavioral intentions. This suggests that attitudinal, normative, and professional experiences are all important in examining nurses' intentions to work with clients infected with HIV.

Adult↗

PubMed1991

Clinical correlates of intent in attempted suicide.

The seriousness of suicide attempts was evaluated in 62 consecutive referrals in 2 general hospitals. As measured by the Suicide Intent Scale (SIS) the majority of cases had a low to moderate intention to die. Increasing age, psychosis and deliberate self-injury were associated with high suicidal intent. Hopelessness and a sense of isolation are significantly more frequent antecedent ideo-affective states in cases with high intent and anger and frustration are more prevalent in cases with low intent. Two other measures of seriousness, the medical condition on admission and lethality of the method used, correlate significantly with the degree of intent. The SIS can distinguish between relatively homogeneous subgroups of suicide attempters for depth studies of aetiology and management.

Adolescent↗

PubMed1989

The predictive relationship between beliefs, attitudes, intentions and secondary school mathematics learning: a theory of reasoned action approach.

This study investigated how attitudes and intentions about learning mathematics might be related to subsequent mathematics learning and achievement using the Ajzen and Fishbein theory of reasoned action. The sample consisted of 142 boys and girls between 12 and 14 years old in a large inner city comprehensive school who were assessed in a follow-up design over a nine-month period. Beliefs about the outcomes of learning, attitudes to learning, perceptions of significant others' prescriptions about learning, intentions to engage in learning behaviours, self and teacher reported learning behaviour and mathematics achievement were assessed at both stages. Regression analysis suggested that while the expectancy-value components of attitude did relate to learning behaviour intentions, perceived prescriptions did not relate to intentions. There was a weak relationship between the two measures of learning behaviour, but with neither measure did intention independently predict future behaviour once prior behaviour was taken into account. The best predictor of subsequent mathematics achievement was prior achievement, though teacher-reported learning behaviour did have an independent relationship with subsequent achievement. The findings are discussed in terms of the assessment of learning behaviours, the relevance of the behaviour intention construct for repeated multiple behaviours and future work on how affective variables might be related to cognitive achievements.

Achievement↗

PubMed1999

A new paradigm of injury intentionality.

OBJECTIVE: To improve understanding of processes leading to injury and assess more specifically the degree of intentionality. METHODS: A new paradigm was developed that characterizes the act of inflicting injury (self, other, not inflicted) and the motive. Motives are determined for the act of injury and for the outcome. To test this, 986 cases of adolescent injuries in seven hospitals were reviewed. Three investigators independently classified all cases using the new paradigm and three used standard definitions of intent. Inter-rater reliability was measured. RESULTS: Of injuries inflicted by others, 61% were intentional using the standard classification. In the new paradigm 67% were intended acts and 59% involved intentional motive for outcome. Altogether 87% of sports injuries were coded as unintentional acts compared with 96% using standard methods. Using standard classification there was 93% agreement between paired raters, with an average kappa of 0.86. In the new paradigm questions on intentionality of act, outcome, and infliction of act, the agreement was 89%, 91%, 88%, with a kappa of 0.79, 0.80, 0.76, respectively. CONCLUSIONS: This paradigm defines a spectrum of injury intent, enhances understanding of the causal sequence of injury, and has important implications for research and prevention.

Adolescent↗

PubMed2002

Predictors of intention to promote family planning: a survey of Protestant seminarians in the United States.

The purpose of this study was to examine Protestant seminary students' intention to promote family planning. Intention to promote family planning and its predictors were examined by testing a conceptual model based on the theory of planned behavior and social cognitive theory. A nonrepresentative sample of 635 seminarians (90.5% Anglo; 66.5% male) from 10 theological schools in the United States completed a mailed survey. Students were classified according to their religious beliefs as conservative (61.9%) and nonconservative (38.1%), and group differences in intention (and its correlates) were examined. Structural equation modeling was used to assess relationships among attitudes toward sexuality, attitudes toward family planning, subjective norms, knowledge, self-efficacy, and intention for both conservative and nonconservative students. Results indicated that the relationships among predictors of intention were essentially similar for both conservative and nonconservative seminarians, with attitudes and self-efficacy for promoting family planning exhibiting the strongest direct effects on intention.

Analysis of Variance↗

PubMed2005

Women and postfertilization effects of birth control: consistency of beliefs, intentions and reported use.

BACKGROUND: This study assesses the consistency of responses among women regarding their beliefs about the mechanisms of actions of birth control methods, beliefs about when human life begins, the intention to use or not use birth control methods that they believe may act after fertilization or implantation, and their reported use of specific methods. METHODS: A questionnaire was administered in family practice and obstetrics and gynecology clinics in Salt Lake City, Utah, and Tulsa, Oklahoma. Participants included women ages 18-50 presenting for any reason and women under age 18 presenting for family planning or pregnancy care. Analyses were based on key questions addressing beliefs about whether specific birth control methods may act after fertilization, beliefs about when human life begins, intention to use a method that may act after fertilization, and reported use of specific methods. The questionnaire contained no information about the mechanism of action of any method of birth control. Responses were considered inconsistent if actual use contradicted intentions, if one intention contradicted another, or if intentions contradicted beliefs. RESULTS: Of all respondents, 38% gave consistent responses about intention to not use or to stop use of any birth control method that acted after fertilization, while 4% gave inconsistent responses. The corresponding percentages for birth control methods that work after implantation were 64% consistent and 2% inconsistent. Of all respondents, 34% reported they believed that life begins at fertilization and would not use any birth control method that acts after fertilization (a consistent response), while 3% reported they believed that life begins at fertilization but would use a birth control method that acts after fertilization (inconsistent). For specific methods of birth control, less than 1% of women gave inconsistent responses. A majority of women (68% or greater) responded accurately about the mechanism of action of condoms, abstinence, sterilization, and abortion, but a substantial percentage of women (between 19% and 57%) were uncertain about the mechanisms of action of oral contraceptives, intrauterine devices (IUDs), Depo-Provera, or natural family planning. CONCLUSION: Women who believe that life begins at fertilization may not intend to use a birth control method that could have postfertilization effects. More research is needed to understand the relative importance of postfertilization effects for women in other populations, and in relation to other properties of and priorities for birth control methods. However, many women were uncertain about the mechanisms of action of specific methods. To respect the principles of informed consent, some women may need more education about what is known and not known about the mechanisms of action of birth control methods.

Journal Article↗

PubMed2003

Factors affecting the intention of providers to deliver more effective continuing medical education to general practitioners: a pilot study.

BACKGROUND: Despite the importance of continuing medical education (CME) for GPs, there has been little research into how providers decide what types of CME to deliver to GPs. This study aimed to identify factors affecting the intention of providers to provide more effective types of CME; and to design a survey instrument which can be used to test the applicability of Triandis' model of social behaviour to the provision of CME to general practitioners. METHODS: This was a cross-sectional study on a convenience sample of 11 Australian providers of CME for interviews and a random sample of 25 providers for the pilot test. Open-ended interviews structured on Triandis' theory were performed with key informants who provide CME to GPs. These were used to develop a pilot survey instrument to measure the factors affecting intention, resulting in a revised instrument for use in further research. RESULTS: There was a broad range of factors affecting providers' intention to deliver more effective forms of CME identified, and these were classifiable in a manner which was consistent with Triandis' model. Key factors affecting providers' intention were the attitude toward CME within organisations and the time and extra work involved. CONCLUSIONS: We identified a range of potential factors influencing the intention of providers to provide more effective forms of CME, in all categories of Triandis model. Those interested in increasing the choice of more effective CME activities available to GPs may need to broaden the methods used in working with providers to influence them to use more effective CME techniques. The interview material and questionnaire analysis of the pilot survey support the use of Triandis model. Further research is needed to validate Triandis'model for the intention to deliver more effective forms of CME. Such research will inform future strategies aimed at increasing the amount and choice of effective CME activities available for GPs.

Australia↗

PubMed2005

Value of measuring suicidal intent in the assessment of people attending hospital following self-poisoning or self-injury.

BACKGROUND: Self-harm is associated with a high risk of suicide. It is unclear whether suicidal intent at the time of self-harm is a risk factor for future suicidal behaviour. AIMS: To investigate the relationship between suicidal intent and patient characteristics, repetition of self-harm, and suicide. METHOD: Clinical and demographic data on 4415 patients presenting to hospital following self-harm between 1993 and 2000 were analysed. Suicidal intent was measured using the Beck Suicide Intent Scale (SIS). Follow-up information on repetition of self-harm and suicide was investigated for 2489 patients presenting between 1993 and 1997. RESULTS: Suicidal intent at the time of self-harm was associated with risk of subsequent suicide, especially within the first year and among female patients. Suicide was more strongly associated with scores on the circumstances section of the SIS than the self-report section. The association between repetition of self-harm and SIS scores was different for male and female patients. CONCLUSIONS: The measurement of suicidal intent in the assessment of self-harm patients is beneficial for the evaluation of future suicide risk. A shortened measuring scale might be useful in clinical practice.

Adolescent↗

PubMed2002

An examination of suicidal intent in patients with multiple sclerosis.

OBJECTIVE: To examine neurologic and psychiatric correlates of suicidal intent in a community sample of 140 patients with MS. METHODS: Patients with (28.6%) and without lifetime suicidal intent were compared across MS disease-related and psychiatric variables. All subjects were interviewed with 1) the Structured Clinical Interview for DSM-IV Axis 1 disorders (SCID-IV) to determine lifetime prevalence of major depression and anxiety disorders; and 2) the Social Stress and Support Interview to assess psychological stressors. Suicidal intent was documented with questions from the SCID-IV and Beck Suicide Scale. Patients also completed the Hospital Anxiety and Depression Scale and cognitive testing. RESULTS: Suicidal patients were significantly more likely to live alone, have a family history of mental illness, report more social stress, and have lifetime diagnoses of major depression, anxiety disorder, comorbid depression-anxiety disorder, and alcohol abuse disorder. By logistic regression analysis, the severity of major depression, alcohol abuse, and living alone had an 85% predictive accuracy for suicidal intent. A third of suicidal patients had not received psychological help. Two-thirds of subjects with current major depression, all suicidal, had not received antidepressant medication. CONCLUSIONS: Suicidal intent, a potential harbinger for suicide, is common in MS and is strongly associated with major depression, alcohol abuse, and social isolation. Suicidal intent is a potentially treatable cause of morbidity and mortality in MS.

Adolescent↗

PubMed2002

Combining motivational and volitional interventions to promote exercise participation: protection motivation theory and implementation intentions.

OBJECTIVE: This study compared a motivational intervention based on protection motivation theory (PMT, Rogers, 1975, 1983) with the same motivational intervention augmented by a volitional intervention based on implementation intentions (Gollwitzer, 1993). DESIGN: The study had a longitudinal design, involving three waves of data collection over a 2-week period, incorporating an experimental manipulation of PMT variables at Time 1 and a volitional, implementation intention intervention at Time 2. METHOD: Participants (N=248) were randomly allocated to a control group or one of two intervention groups. Cognitions and exercise behaviour were measured at three time-points over a 2-week period. RESULTS: The motivational intervention significantly increased threat and coping appraisal and intentions to engage in exercise but did not bring about a significant increase in subsequent exercise behaviour. In contrast, the combined protection motivation theory/implementation intention intervention had a dramatic effect on subsequent exercise behaviour. This volitional intervention did not influence behavioural intention or any other motivational variables. CONCLUSIONS: It is concluded that supplementing PMT with implementation intentions strengthens the ability of the model to explain behaviour. This has implications for health education programmes, which should aim to increase both participants' motivation and their volition.

Clinical Trial↗

PubMed2002

The influence of autonomous and controlling motives on physical activity intentions within the Theory of Planned Behaviour.

OBJECTIVES: This study aimed to examine how general motives from self-determination theory (SDT; Deci & Ryan, 1985) influence intentions to engage in physical activity within the Theory of Planned Behaviour (TPB; Ajzen, 1985). It was hypothesized that the general motives will influence intentions only when mediated by the specific cognitions of attitude, subjective norms and perceived behavioural control (PBC) from the TPB. DESIGN: A cross-sectional study assessing psychological variables from two theoretical perspectives. METHOD: Self-report questionnaires were administered to 1088 children aged 12-14 years. The children's intentions, attitudes, subjective norms and PBC towards participating in physical activity were assessed using a TPB questionnaire. A modified verson of Ryan and Connell's (1989) perceived locus of causality (PLOC) inventory was used to measure controlling and autonomous motives for participating in physical activity. RESULTS: These data were analysed using structural equation modelling. The resulting well-fitting model demonstrated that attitude and PBC mediated the influence of autonomous motives to perform physical activity on physical activity intentions. The presence of autonomous motives resulted in the effects of the controlling motives being attenuated to zero. CONCLUSIONS: The present results indicate that general autonomous motives to participate in physical activity act as sources of information when childen make their judgments regarding their specific attitudes and PBC. Attitudes and PBC are necessary to translate these general motives from SDT into intentions in the TPB. In terms of targets for intervention, practitioners may positively influence intentions by providing a choice of physical activities to foster increased autonomy in children.

Journal Article↗

PubMed2003

Help-seeking intentions for breast-cancer symptoms: a comparison of the self-regulation model and the theory of planned behaviour.

PURPOSE: Delays in seeking help for symptoms have been found to be associated with poorer outcome in breast-cancer patients. This study explores symptom perceptions and health beliefs as predictors of intentions to seek medical help in a general female population. The utility of the self-regulation model of illness cognition and the theory of planned behaviour were examined in predicting help-seeking intentions for potential symptoms of breast cancer in a general population sample. METHODS: A general population sample of 546 women completed a postal questionnaire comprising items examining components of the self-regulation model and the theory of planned behaviour. Help-seeking intention was determined by asking participants to rate the likelihood of visiting their GP for a range of breast symptoms. RESULTS: Hierarchical multiple regression analysis revealed that the cognitive component of the self-regulation model accounted for approximately 22% of the variance in help-seeking intention. Identity (beta = 0.45, p <.001) emerged as a significant predictor of intention to seek help. Inclusion of the components of the theory of planned behaviour accounted for an additional 7% of the variance; the significant predictors were attitude to help-seeking (beta = 0.19, p <.001) and perceived behavioural control (beta = 0.12, p <.01). CONCLUSIONS: Intention to seek medical help for a potential breast-cancer symptom may be mediated, partly, by cognitive representations of the identity and consequences of breast cancer and by attitudes towards help-seeking and perceived behavioural control. Although less than one-third of the variance was accounted for, these results have important implications for future research (in terms of identifying which variables should be examined) and for the development of a model of help-seeking behaviour in women with breast-cancer symptoms.

Adolescent↗

PubMed2002

On the validity of retrospective assessments of pregnancy intention.

Information on pregnancy intention is often gathered retrospectively (after the birth of a child). This article investigates whether the retrospective assessment of pregnancy intention leads to biased estimates of the extent or consequences of unintended fertility. Comparisons are made between pregnancy intentions ascertained during pregnancy and after birth using data from the National Longitudinal Survey of Youth. To address the bias caused by selective recognition or acknowledgment of pregnancy, we used the longitudinal feature of the data to determine actual pregnancy status at the time of interviews, which, in turn, was used as an instrumental variable for the retrospective (versus prospective) reporting of pregnancy intention. After correction for selective pregnancy recognition, we found no evidence that the retrospective assessment of pregnancy intention produces misleading estimates of either the number or the consequences of unintended births. This finding is supported by additional analyses of a small subsample of women for whom information on pregnancy intention was collected both during pregnancy and after birth.

Adolescent↗

PubMed2002

The effect of stepchildren on childbearing intentions and births.

This article reports on a study of the effect of stepchildren (children from previous unions) on couples' fertility intentions and childbearing behavior using longitudinal data from the National Survey of Families and Households. The results indicated that stepchildren negatively affect childbearing intentions and childbearing risks. Intentions to have a child are weakened by one's own previous biological children and the previous biological children of one's current spouse or partner. This effect varies by the parenting configuration of the couple and gender of the respondent. Among couples with stepchildren, intentions remain high until each partner has had a biological child. Unlike women, men's previous biological children do not affect their intentions of having a child. Stepchildren exert a weak negative effect on couples' childbearing risks, and this effect is mediated by the couples' childbearing intentions. The findings suggest that stepchildren should be incorporated into future models of fertility.

Adult↗

PubMed2001

Intention to return for papanicolaou smears in adolescent girls and young women.

OBJECTIVE: Sexually active adolescent girls have high rates of abnormal cervical cytology. However, little is known about factors that influence intention to return for Papanicolaou screening or follow-up. The aim of this study was to determine whether a theory-based model that assessed knowledge, attitudes, and behaviors predicted intention to return. METHODS: The study design consisted of a self-administered, cross-sectional survey that assessed knowledge, beliefs, perceived control over follow-up, perceived risk, cues for Papanicolaou smears, impulsivity, risk behaviors, and past compliance with Papanicolaou smear follow-up. Participants were recruited from a hospital-based adolescent clinic that provides primary and subspecialty care, and the study sample consisted of all sexually active girls and young women who were aged 12 to 24 years and had had previous Papanicolaou smears. The main outcome measure was intention to return for Papanicolaou smear screening or follow-up. RESULTS: The enrollment rate was 92% (N = 490), mean age was 18.2 years, 50% were black, and 22% were Hispanic. Eighty-two percent of participants intended to return. Variables that were independently associated with intention to return included positive beliefs about follow-up (odds ratio [OR]: 1.07; 95% confidence interval [CI]: 1.02-1.11), perception that important others believe that the participant should obtain a Papanicolaou smear (OR: 1.93; 95% CI: 1.38-2.74), perceived control over returning (OR: 1.24; 95% CI: 1.06-1.46), and having received cues to obtain a Papanicolaou smear (OR: 1.31; 95% CI: 1.08-1.60). CONCLUSIONS: Analysis of this novel theoretical framework demonstrated that knowledge and previous behaviors were not associated with intention to return for Papanicolaou smear screening and follow-up in this population of young women. However, modifiable attitudinal components, including personal beliefs, perception of others' beliefs, and cues to obtaining Papanicolaou smears, were associated with intention to return.

Adolescent↗

PubMed2005

Intentional injury management and prevention in pediatric practice: results from 1998 and 2003 American Academy of Pediatrics Periodic Surveys.

OBJECTIVE: Intentional injuries are significant causes of pediatric morbidity and mortality in the United States. A 1998 American Academy of Pediatrics (AAP) survey identified child abuse, domestic violence, and community violence as concerns for pediatricians, although the majority of pediatricians also reported feeling unprepared to manage these issues. A second AAP survey in 2003 analyzed trends in pediatrician experience and attitudes related to these issues. METHODS: Surveys were sent to national random samples of AAP members in 1998 (n = 1629) and 2003 (n = 1603); response rates were 62% and 53%, respectively. Surveys measured pediatrician experience in the past 12 months in managing injuries caused by child abuse, domestic violence, and community violence. Attitudes regarding available resources and adequacy of training about intentional injury management were also collected. Trends between surveys were analyzed using chi2 analysis. RESULTS: The proportion of pediatricians who reported treatment of intentional injuries increased between surveys. The percentage of pediatricians who indicated that screening for domestic violence and community violence risk should be included in routine health visits increased from 66% to 72% and 71% to 77%, respectively. Confidence in ability to identify and manage injuries that were caused by domestic violence and community violence increased but remained low, whereas the proportion of pediatricians who expressed confidence in ability to identify child abuse decreased (65% vs 60%). CONCLUSIONS: Despite overall improvement in acceptance of intentional injury prevention in routine care as well as confidence in intentional injury management, pediatrician confidence to identify and manage intentional injuries remains low.

Attitude of Health Personnel↗

PubMed1997

Snakebite injuries: contributing factors and intentionality of exposure.

The objective was to study the intent of exposure to snakes and other factors contributing to snakebite injuries in order to develop prevention strategies. We used a retrospective chart review and a follow-up telephone interview of snakebite victims who were admitted to a tertiary care center between 1985 and 1994. The data collected included demographics, intent of exposure and host and environmental factors. I performed descriptive analysis. Twenty-four males and six females ranging in age from 2 to 93 years sustained bites from a variety of snakes including rattlesnakes, copperheads, and Egyptian cobra, and others. Sixty-seven percent (20/30) of all bites resulted from intentional exposures to snakes: professional snake handlers (7), snake hunts (8), and playing with (aggravating) snakes in the wild (5). Sixty-five percent (13/20) of intentional exposures involved novices in a recreational/home setting, and 35% (7/20) occurred in an occupational setting. Unintentional exposures occurred while victims were walking in wooded areas, fishing by streams, gardening, and washing dishes indoors. Forty percent (12/30) of all victims had consumed alcohol before the snakebite, 92% (11/12) of whom were nonprofessionals with intentional exposures. Only eight victims (seven of whom were professional handlers) were using protective equipment. I concluded that the majority of snakebite injuries resulted from intentional exposures to snakes in which a variety of factors such as the use of alcohol and lack of protective equipment likely played a role.

Adolescent↗

PubMed2000

Intentional weight loss and mortality among overweight individuals with diabetes.

OBJECTIVE: To estimate the effect of intentional weight loss on mortality in overweight individuals with diabetes. RESEARCH DESIGN AND METHODS: We performed a prospective analysis with a 12-year mortality follow-up (1959-1972) of 4,970 overweight individuals with diabetes, 40-64 years of age, who were enrolled in the American Cancer Society's Cancer Prevention Study I. Rate ratios (RRs) were calculated, comparing overall death rates, and death from cardiovascular disease (CVD) or diabetes in individuals with and without reported intentional weight loss. RESULTS: Intentional weight loss was reported by 34% of the cohort. After adjustment for initial BMI, sociodemographic factors, health status, and physical activity, intentional weight loss was associated with a 25% reduction in total mortality (RR = 0.75; 95% CI 0.67-0.84), and a 28% reduction in CVD and diabetes mortality (RR = 0.72; 0.63-0.82). Intentional weight loss of 20-29 lb was associated with the largest reductions in mortality (approximately 33%). Weight loss >70 lb was associated with small increases in mortality CONCLUSIONS: Intentional weight loss was associated with substantial reductions in mortality in this observational study of overweight individuals with diabetes.

Adult↗