Factors associated with recency of HIV testing amongst men residing in Scotland who have sex with men.

Rates of HIV testing are increasing among men who have sex with men (MSM) in Scotland and the UK. However, it remains vital to encourage MSM to test for HIV. The aim of the current study was to determine which factors discriminated among three groups of MSM: those tested for HIV within the previous year, those who had tested over one year previously, and those who had never tested. Cross-sectional data were collected using self-report, anonymous questionnaires from MSM frequenting gay venues in Glasgow, Scotland, during July 2010 (N = 822, response rate 62.6%). Those who identified themselves as HIV positive (n = 38), did not normally reside in Scotland (n = 88), and did not provide information on HIV testing (n = 13), were excluded (139 excluded, leaving N = 683). Around 57% (n = 391) had tested for HIV within the previous year, 23% (n = 155) had tested over one year previously and 20% (n = 137) had never tested. Compared with those tested within the previous year, those tested over one year previously and those never tested had greater fear of a positive-HIV test result, a weaker norm for HIV testing, and were more likely to have had no anal sex partners at all within the previous year. Those tested over one year previously were significantly older than both other groups (who were more likely to be under 25 years of age). Unprotected anal intercourse (UAI) did not discriminate among the HIV testing groups. The results highlight the need to promote HIV testing in Scotland among those under 25 years and over 45 years, those with high fear of testing, and those whose sexual behaviour puts them at risk. Interventions to increase HIV testing should promote positive norms and challenge the fear of a positive result.

Methicillin-resistant Staphylococcus aureus screening as a patient safety initiative: using patients' experiences to improve the quality of screening practices.

AIMS AND OBJECTIVES: To explore the patient experience and acceptability of methicillin-resistant Staphylococcus aureus screening of inpatient admissions to acute hospital settings. BACKGROUND: Prevention of healthcare-associated infections such as methicillin-resistant Staphylococcus aureus is a major patient safety concern internationally. Screening of patients for methicillin-resistant Staphylococcus aureus colonisation is becoming a routine aspect of hospital admission; however, evidence of the patient experience and acceptability of methicillin-resistant Staphylococcus aureus screening is limited. DESIGN: A mixed-methods study set in six acute care hospitals in three Scottish regions. METHODS: Data collection involved postdischarge self-report survey of patients who had been screened (n = 54) and qualitative patient interviews (n = 10). Theoretical constructs derived from the Health Belief Model and Theory of Planned Behaviour used in analysis. RESULTS: Findings indicated that methicillin-resistant Staphylococcus aureus screening was broadly acceptable to patients. The experience of screening did not appear to be problematic; responses demonstrate that screening provided reassurance and generated confidence that health organisations were tackling healthcare-associated infections. Patients were less positive regarding the provision of information, the possibility of refusing a screen and the consequences of a positive test result. Furthermore, there were indications that patients wanted to be told the results of the screen and strong support for screening of hospital staff. CONCLUSIONS: Analysis of constructs from our theoretical frameworks provides evidence that attitudes were largely positive; responses indicate a belief in the beneficial impact of methicillin-resistant Staphylococcus aureus screening for patients and the wider community. However, it is important that health professionals continually assess the patient experience of 'routine' aspects of health care such as MRSA screening. RELEVANCE TO CLINICAL PRACTICE: The findings from this study suggest that while methicillin-resistant Staphylococcus aureus screening is generally acceptable to patients as a regular patient safety initiative, to enhance the quality of the patient experience, clinicians should consider the timing, content and effectiveness of information provision.

Sexually transmitted infection testing and self-reported diagnoses among a community sample of men who have sex with men, in Scotland.

INTRODUCTION: To examine sexually transmitted infection (STI) testing and self-reported diagnoses among men who have sex with men (MSM), in Scotland. METHODS: Cross-sectional survey of seven Glasgow gay bars in July 2010 (n=822, 62% response rate); 693 are included in the analyses. RESULTS: 81.8% reported ever having had an STI test; 37.4% had tested in the previous 6 months; 13.2% reported having an STI in the previous 12 months. The adjusted odds of having ever tested were significantly higher for men who had 6+ sexual partners in the previous 12 months (adjusted OR=2.66), a maximum sexual health knowledge score (2.23), and had talked to an outreach worker/participated in counselling (1.96), and lower for men reporting any high-risk unprotected anal intercourse (UAI) in the previous 12 months (0.51). Adjusted odds of recent testing were higher for men who had 6+ sexual partners (2.10), talked to an outreach worker/participated in counselling (1.66), maximum sexual health knowledge (1.59), and higher condom use knowledge (1.04), and lower for men aged ≥ 25 years (0.46). Adjusted odds of having had an STI in the previous 12 months were higher for men who had 6+ sexual partners (3.96) and any high-risk UAI in the previous 12 months (2.24) and lower for men aged ≥ 25 years (0.57). CONCLUSIONS: STI testing rates were relatively high, yet still below the minimum recommended for MSM at high risk. Consideration should be given to initiating recall systems for men who test positive for STIs, and to developing behavioural interventions which seek to address STI transmission.

Exposure and impact of a mass media campaign targeting sexual health amongst Scottish men who have sex with men: an outcome evaluation.

BACKGROUND: This paper explores the exposure and impact of a Scottish mass media campaign: Make Your Position Clear. It ran from October 2009 to July 2010, targeted gay men and other men who have sex with men (MSM), and had two key aims: to promote regular sexual health and HIV testing every 6 months, and to promote the use of appropriate condoms and water-based lubricant with each episode of anal intercourse. METHODS: A cross-sectional survey (anonymous and self-report) was conducted 10 months after the campaign was launched (July 2010). Men were recruited from commercial venues. Outcome measures included use of lubricant, testing for sexually transmitted infections and HIV, and intentions to seek HIV testing within the following six months. Linear-by-linear chi-square analysis and binary logistic regressions were conducted to explore the associations between the outcome measures and campaign exposure. RESULTS: The total sample was 822 men (62.6% response rate). Men self-identifying as HIV positive were excluded from the analysis (n=38). Binary logistic analysis indicated that those with mid or high campaign exposure were more likely to have been tested for HIV in the previous six months when adjusted for age, area of residence and use of the "gay scene" (AOR=1.96, 95% CI=1.26 to 3.06, p=.003), but were not more likely to be tested for STIs (AOR=1.37, 95% CI=0.88 to 2.16, p=.167). When adjusted for previous HIV testing, those with mid or high campaign exposure were not more likely to indicate intention to be tested for HIV in the following six months (AOR=1.30, 95% CI=0.73 to 2.32, p=.367). Those with no campaign exposure were less likely than those with low exposure to have used appropriate lubricant with anal sex partners in the previous year (AOR=0.42, 95% CI=0.23 to 0.77, p=.005). CONCLUSIONS: The campaign had demonstrable reach. The analysis showed partial support for the role of mass media campaigns in improving sexual health outcomes. This suggests that a role for mass media campaigns remains within combination HIV prevention.

Breaking the habit: a qualitative exploration of barriers and facilitators to smoking cessation in people with enduring mental health problems.

BACKGROUND: Smoking in people with mental health problems (MHPs) is an important public health concern as rates are two to three times higher than in the general population. While a strong evidence base exists to encourage and support smoking cessation in the wider population, there is limited evidence to guide the tailoring of interventions for people with MHPs, including minimal understanding of their needs. This paper presents findings from theoretically-driven formative research which explored the barriers and facilitators to smoking cessation in people with MHPs. The aim, guided by the MRC Framework for the development and evaluation of complex interventions, was to gather evidence to inform the design and content of smoking cessation interventions for this client group. METHODS: Following a review of the empirical and theoretical literature, and taking a critical realist perspective, a qualitative approach was used to gather data from key stakeholders, including people with enduring MHPs (n = 27) and professionals who have regular contact with this client group (n = 54). RESULTS: There was a strong social norm for smoking in participants with MHPs and most were heavily addicted to nicotine. They acknowledged that their physical health would improve if they stopped smoking and their disposable income would increase; however, more important was the expectation that, if they attempted to stop smoking, their anxiety levels would increase, they would lose an important coping resource, they would have given up something they found pleasurable and, most importantly, their mental health would deteriorate. Barriers to smoking cessation therefore outweighed potential facilitators and, as a consequence, impacted negatively on levels of motivation and self-efficacy. The potential for professionals to encourage cessation attempts was apparent; however, they often failed to raise the issue of smoking/cessation as they believed it would damage their relationship with clients. The professionals' own smoking status also appeared to influence their health promoting role. CONCLUSIONS: Many opportunities to encourage and support smoking cessation in people with MHPs are currently missed. The increased understanding provided by our study findings and literature review have been used to shape recommendations for the content of tailored smoking cessation interventions for this client group.

HIV-related sexual risk behaviour between 1996 and 2008, according to age, among men who have sex with men (Scotland).

OBJECTIVE: To examine changes in the proportions of those reporting 2+ unprotected anal intercourse (UAI) partners in the previous 12 months among men who have sex with men (MSM) in Scotland between 1996 and 2008. Differences according to age group were also examined. METHODS: Logistic regression was used with data from eight cross-sectional anonymous, self-report surveys in commercial gay venues in Glasgow and Edinburgh (N=10,223). Data were stratified according to survey and age group (<25 years vs ≥25 years). RESULTS: The percentage of 2+ UAI partners reported in the previous 12 months increased significantly between 2000 and 2002, adjusted for age group. When the surveys were divided into two time periods (1996-2000 and 2002-2008), no significant differences were found within each time period in the percentage of 2+ UAI partners reported (adjusted for age group). However, a significant increase was found when the aggregated figures for 2002-2008 were compared with those for 1996-2000. At the aggregate level, those aged <25 years were significantly more likely than those aged ≥25 years to report 2+ UAI partners in the previous 12 months (adjusted for survey). CONCLUSIONS: HIV-related sexual risk behaviour did not change significantly between 2002 and 2008 among MSM in Scotland, after the increases noted between 2000 and 2002. A significant minority of MSM continue to engage in relatively high levels of sexual risk, and younger generations appear to be at particular risk. This represents a public health concern and highlights the need for targeted age-specific interventions.

Notification of syphilis test results by telephone: acceptability ratings in a community-based sample of Scottish gay men.

Notifying patients of the results of syphilis testing by telephone can be cost-effective for clinic staff. This study compared the acceptability ratings among potential patients of three methods of learning of syphilis test results: with a call to a mobile phone; with a call to a home phone; and with the patient phoning in for results. A questionnaire was distributed to male clients of gay venues in Glasgow, Scotland, during 2005 (n = 150). Phoning in for results was rated as significantly more acceptable than either learning of results with a call to a mobile phone, or receiving a phone call at home (both P < 0.001). Further, receiving a call on a mobile phone was rated as significantly more acceptable than receiving a call at home (P < 0.001). It is recommended that patients be given the option of initiating the communication of test results.

A mixed method study to compare use and experience of hospital care and a nurse-led acute respiratory assessment service offering home care to people with an acute exacerbation of chronic obstructive pulmonary disease.

BACKGROUND: Over the past 10 years hospital at home schemes for the treatment of an acute exacerbation of Chronic Obstructive Pulmonary Disease have proliferated throughout developed countries. For selected patients treatment at home is no less advantageous in terms of readmission rates and length of stay than treatment in hospital. Although care at home might seem to be a more desirable option than admission to hospital, little is known about care preferences and how people exercise service choice. OBJECTIVES: 1. to determine patients' recent use of and satisfaction with health care services during exacerbations of Chronic Obstructive Pulmonary Disease. 2. To determine and compare patients' and families' perceived future care preferences. 3. To complete an in-depth exploration of care experiences and preferences with a subset of respondents and their families. DESIGN: A mixed method design was used consisting of a postal survey and in-depth qualitative interviews with a subset of questionnaire respondents. SETTING: An outreach service provided by a large university hospital within Scotland, UK. PARTICIPANTS: One hundred and four out-patients registered with the Acute Respiratory Assessment Service and who had experienced hospital inpatient care during the past year, and their families. A subset of respondents was invited to take part in qualitative interviews. RESULTS: The majority of respondents indicated a preference for the home care service, and this was positively associated with high coping skills. There was a strong relationship between personal and family preferences. There was no linear relationship between a clinical measure of severity of lung disease and service use or care preferences. Results from the qualitative interviews endorsed and explained these findings. CONCLUSIONS: A range of factors combined to influence service use at a particular point in time, implying a need for increased self-management support from nurses and increased service provision.

Catastrophizing Mediates the Relationship Between the Personal Belief in a Just World and Pain Outcomes Among Chronic Pain Support Group Attendees.

Health-related research suggests the belief in a just world can act as a personal resource that protects against the adverse effects of pain and illness. However, currently, little is known about how this belief, particularly in relation to one's own life, might influence pain. Consistent with the suggestions of previous research, the present study undertook a secondary data analysis to investigate pain catastrophizing as a mediator of the relationship between the personal just world belief and chronic pain outcomes in a sample of chronic pain support group attendees. Partially supporting the hypotheses, catastrophizing was negatively correlated with the personal just world belief and mediated the relationship between this belief and pain and disability, but not distress. Suggestions for future research and intervention development are made.

Interventions to increase condom use among middle-aged and older adults: A systematic review of theoretical bases, behaviour change techniques, modes of delivery and treatment fidelity.

This systematic review collates, examines and syntheses condom use interventions for middle-aged and older adults. Associations between effectiveness and theoretical basis, behaviour change techniques, mode of delivery and treatment fidelity were explored. Five interventions were included; one was effective. Compared to interventions with non-significant findings, the effective telephone-administered intervention used theory to a greater extent, had a higher number of behaviour change techniques and employed more treatment fidelity strategies. There is a need to develop theory-based interventions targeting condom use among this population and evaluate these in randomised controlled trials that are rigorously designed and reported. Health psychologists have a key role in this endeavour.

Sexual identities and sexual health within the Celtic nations: An exploratory study of men who have sex with men recruited through social media.

Associations of sexual identity with a range of sexual and sexual health behaviours were investigated amongst men who have sex with men (MSM). Data from 1816 MSM recruited from 4 Celtic nations (Scotland, Wales, Northern Ireland and the Republic of Ireland) were collected via a cross-sectional online survey advertised via social media. About 18.3% were non-gay identified MSM (NGI-MSM). In the last year, 30% of NGI-MSM reported high-risk unprotected anal intercourse and 45% reported never having had an sexually transmitted infection (STI) test. When compared to MSM who were gay identified (GI-MSM), NGI-MSM were more likely to be older, have a female partner, fewer sex partners, fewer anal sex partners, STI diagnoses and less likely to be HIV positive, more likely to never use the gay scene and be geographically further from a gay venue. NGI-MSM were also less likely to report STI and HIV testing behaviours. The findings highlight variations in risk by sexual identities, and unmet sexual health needs amongst NGI-MSM across Celtic nations. Innovative research is required regarding the utility of social media for reaching populations of MSM and developing interventions which target the heterogeneity of MSM and their specific sexual health needs.

Effects of age on symptoms of anxiety and depression in a sample of retired police officers.

This study addressed the effects of age on anxiety and depressive symptoms. The analysis was based on the responses of 1,334 retired male Scottish police officers (34-94 years old) to the Hospital Anxiety and Depression Scale. Multiple regression analysis was used to determine the partialed linear and curvilinear effects of symptoms of, separately, anxiety and depression on age and retirement variables. Significant partialed effects of retirement type and present age were found. Early retirement was a vulnerability factor for both disorders. The authors found a consistent linear reduction in anxiety across age and a U-shaped function for depression across age. The differing profiles and independent effects of age on anxiety and depression are consistent with their status as separate entities. Respondents were increasingly susceptible to depression from the mid-50s onward, whereas susceptibility to anxiety was reduced with age.

Re-appraising HIV testing: an exploration of the psychosocial costs and benefits associated with learning one's HIV status in a purposive sample of Scottish gay men.

OBJECTIVE: This study explored contemporary understandings of the psychosocial costs and benefits associated with learning one's HIV status within a purposive sample of Scottish gay men. It seeks to provide insight into the psychosocial factors associated with decision-making processes relating to the HIV antibody test. METHOD: Transcripts of one-to-one interviews (N = 19) and four focus groups (N = 18) were analysed using Interpretative Phenomenological Analysis. Participants had varied HIV testing histories, and the sample included men who identified their HIV status as positive, men who identified it as negative, and men who did not know. RESULTS: The HIV test could resolve doubt and anxiety for some men, but only when 'not knowing' was experienced as less tolerable than an imagined positive result. Many participants were deterred from seeking an HIV test because of their fears of the implications of a positive result. The decision to take an HIV test could be understood as a choice between living with uncertainty and the perceived impact of ascertaining HIV status. CONCLUSION: For the participants in this study, the decision to test or not involved many complex medical, psychological and social factors. It is argued that the development of HIV testing policy must start with a perspective grounded in an understanding and appreciation of these complexities.

The disclosure of a diagnosis of an autistic spectrum disorder: determinants of satisfaction in a sample of Scottish parents.

Satisfaction with disclosure of the diagnosis of an autistic spectrum disorder was investigated using a self-report questionnaire completed by 126 parents. On a rating of satisfaction, 55 percent indicated that they were satisfied or very satisfied with the disclosure. Parents were more likely to be satisfied if they gave positive ratings to the manner of the professional and the quality of the information provided; if they had been given written information and the opportunity to ask questions; and if their early suspicions had been accepted by professionals. These factors were combined into a global index of satisfaction; those gaining higher scores were more likely to have been given the diagnosis of Asperger syndrome (as opposed to autism), to have had a definite diagnosis, and to have children who were not currently in an educational placement. These results underline the importance of the interaction between parent and professional during the disclosure interview.

Hearing disability: a source of distress for older people and carers.

Many older people develop hearing disability: however, only a small proportion who would benefit from a hearing aid own one. Communication is a shared experience that can be substantially limited by hearing difficulty, so this lack of hearing aid provision is likely to affect both individuals and those around them. This study, a randomized, controlled trial, was designed to examine the influence of hearing aid provision on dependent older people and caring family members who lived together within multigeneration households. A total of 63 intervention families and 70 control group families participated in the trial. We found that hearing disability and handicap are related to reduced well-being and depression in older people, and in turn these are related to increased levels of carer distress. Of the 63 older people in the intervention group fitted with hearing aids, all but one was experiencing benefit at 6 months, although no changes in depression were detected. Hearing aids significantly reduced the carer's perception of related difficulties and was a welcome intervention.

Just world beliefs moderate the relationship of pain intensity and disability with psychological distress in chronic pain support group members.

The impact of pain beliefs on coping and adjustment is well established. However, less is known about how beliefs unrelated to pain might impact upon this experience. In particular, just world beliefs could impact upon and be influenced by chronic pain, given that pain is not experienced in a vacuum but instead is experienced in a social context where justice issues are potentially salient. The focus of this study was the ability of personal and general just world beliefs to moderate the relationships psychological distress held with pain intensity and disability in chronic pain. The sample (N=95) was recruited from members of arthritis and fibromyalgia support groups to investigate these social beliefs in a controlled community pain context. A cross-sectional, questionnaire design was adopted. The personal just world belief was endorsed significantly more than the general just world belief, and endorsement of the personal just world belief was negatively correlated with pain intensity, disability and psychological distress, while the general just world belief was unrelated to these variables. When interaction terms relating to personal and general just world beliefs were entered simultaneously into regression analyses, the personal just world belief did not predict psychological distress. However, pain intensity positively predicted psychological distress at low but not high levels of the general just world belief, while disability predicted psychological distress at low and high levels of this belief. This suggests that a strong general just world belief has implications for psychological well-being in chronic pain, and as such this belief may occupy a potential coping function in this context.

'That was my old life; it's almost like a past-life now': identity crisis, loss and adjustment amongst people living with Chronic Fatigue Syndrome.

Individual in-depth interviews were conducted with 14 people with Chronic Fatigue Syndrome (CFS). The interviews centred on the experience of living with the condition from the participants' own perspectives. All interviews were transcribed verbatim and were analysed using Interpretative Phenomenological Analysis. Three inter-related themes were presented: 'Identity crisis: agency and embodiment'; 'Scepticism and the self' and 'Acceptance, adjustment and coping'. Participants reported an ongoing sense of personal loss characterised by diminishing personal control and agency. An inability to plan for the future and subsequent feelings of failure, worthlessness and insignificance ensued. Scepticism in the wider social environment only heightened the consequential identity crisis. The importance of acceptance for adjusting to a life with CFS was highlighted. The findings are discussed in relation to extant literature and issues for health psychology are raised.

Family caregivers of older relatives: ways of coping and change in distress.

The aim of this secondary analysis was to examine the relationships between the ways in which caregivers coped with caregiving stressors and their experience of distress over time. Three coping subscales were derived from the Carers' Assessment of Management Index (CAMI) coping scale: "maintaining balance", "focusing on caregiving" and "avoidance". A proportional (relative) scoring technique was applied. The analysis was based on the responses of 115 pairs of caregivers and care recipients. Care recipients were aged 66-92 years, with no symptoms of dementia, and the majority had mild to moderate hearing impairment. Data were collected at baseline and 6 months later. Caregivers who increased the proportion of strategies endorsed in the "maintaining balance" subscale experienced a decrease in distress, irrespective of change in the proportion of strategies endorsed in the "avoidance" subscale. "Focusing on caregiving" was not significantly related to distress. The results highlight the potential benefits to these caregivers of maintaining a balance in their lives by taking breaks from caregiving.

The intentions of gay men in taking an HIV test.

The objective of this study was to determine the contributions of a range of psychosocial, demographic and behavioural variables to gay men's intentions to take an HIV test. A cross-sectional self-report survey was undertaken. Researchers approached patrons of all known gay bars in Glasgow and Edinburgh during May 2000. Questionnaires were completed by 803 men (response rate of 78%). Those with a stronger intention to test had previously tested, and they were younger, with two or more recent unprotected anal sex partners. They perceived their HIV status to be unknown, had less fear of a positive test result, and perceived more benefits of testing. Intention to test in those with two or more recent unprotected anal sex partners was attenuated if accompanied by increased fear of a positive test result. Results are considered in the context of the theories of reasoned action and planned behaviour. Intention to test is far from a unitary phenomenon, and the existence of various sub-groups within the gay population demands a new approach to both research and health promotion.