Applying the theory of planned behaviour to understand mental health professionals' intentions to work using a human rights-based approach in acute inpatient settings.

BACKGROUND: There has been a shift to implement human rights-based approaches in acute mental health care due to increasing concerns around quality of care. National Health Service (NHS) Trusts have a legal duty to uphold a person's human rights, therefore it is important to understand what any barriers might be. Using psychological theory may help to develop this understanding. AIM: To test whether the theory of planned behaviour can be an effective model in understanding mental health professionals' intentions to work using a human rights-based approach. METHOD: Participants were recruited from two NHS Trusts in the North West of England. A cross-sectional, survey design was used to examine mental health professionals' intentions to use human rights-based approaches. RESULTS: Multiple regression analyses were performed on the theory of planned behaviour constructs showing that attitude and subjective norm significantly predicted intention. Perceived behavioural control did not add any significant variance, nor any demographic variables. CONCLUSION: There could be factors outside of the individual clinician's control to fully work within a human rights-based framework on acute mental health wards. The theory of planned behaviour offers some understanding, however further development work into measuring human rights outcomes on acute mental health wards is needed.

Health professionals interface with cultural conflict in the delivery of type 2 diabetes care.

OBJECTIVE: This study explored the knowledge and experiences of health professionals (HPs) caring for South Asian patients with type 2 diabetes (T2D). DESIGN: Fourteen HPs, who supported patients with T2D, were interviewed. The recruitment strategy employed purposeful and theoretical sampling methods to recruit HPs who worked across primary and secondary care settings. MAIN OUTCOME MEASURES: Grounded Theory (GT) methodology and analysis generated a theoretical framework that explored HP's perceptions and experiences of providing diabetes care for South Asian patients. RESULTS: A GT, presenting a core category of Cultural Conflict in T2D care, explores the influences of HP's interactions and delivery of care for South Asian patients. This analysis is informed by four categories: (1) Patient Comparisons: South Asian vs White; (2) Recognising the Heterogeneous Nature of South Asian Patients; (3) Language and Communication; (4) HPs' Training and Experience. CONCLUSIONS: The findings consider how the role of social comparison, social norms, and diminished responsibility in patient self-management behaviours influence HPs' perceptions, implicit and explicit bias towards the delivery of care for South Asian patients. There was a clear call for further support and training to help HPs recognise the cultural-ethnic needs of their patients.

Self-rated health and multimorbidity in patients with type 2 diabetes.

The relationship between multimorbidity and self-rated health is well established. This study examined self-rated health in relation to multimorbidity, glycaemia and body weight specifically in adults with type 2 diabetes. Bootstrapped hierarchical logistic regression and structural equation modelling (SEM) were used to analyse survey data from 280 adults with type 2 diabetes. The odds of 'fair/bad/very bad' self-rated health increased 10-fold in patients with three (OR = 10.11 (3.36-30.40)) and four conditions (OR = 10.58 (2.9-38.25)), irrespective of glycaemic control (p < 0.001). The relationship between multimorbidity and perceived health was more pronounced in male patients. SEM generated a model with good fit, χ2 (CMIN) = 5.10, df = 3, p = 0.164, χ2 (CMIN)/df = 1.70, RMSEA = 0.05, CFI = 0.97, TLI = 0.95 and NFI = 0.94; self-rated health mediated relations between multimorbidity and BMI. Overall, this study highlights the potential of self-rated health to mediate relationships between multimorbidity and BMI, but not glycaemic control, in adults with type 2 diabetes.

The best possible self-intervention as a viable public health tool for the prevention of type 2 diabetes: A reflexive thematic analysis of public experience and engagement.

BACKGROUND: Public health initiatives seek to modify lifestyle behaviours associated with risk (e.g., diet, exercise, and smoking), but underpinning psychological and affective processes must also be considered to maximize success. OBJECTIVE: This study aimed to qualitatively assess how participants engaged with and utilized the best possible self (BPS)-intervention specifically as a type 2 diabetes (T2D) prevention tool. DESIGN AND METHODS: Fourteen participants engaged with a tailored BPS intervention. Reflexive thematic analysis analysed accounts of participant's experiences and feasibility of use. RESULTS: All participants submitted evidence of engagement with the intervention. The analysis considered two main themes: Holistic Health and Control. The analysis highlighted several nuanced ways in which individuals conceptualized their health, set goals, and received affective benefits, offering insights into how people personalized a simple intervention to meet their health needs. CONCLUSIONS: To our knowledge, this is the first study to tailor the BPS intervention as a public health application for the prevention of T2D. The intervention enabled users to identify their best possible selves in a way that encouraged T2D preventive behaviours. We propose that our tailored BPS intervention could be a flexible and brief tool to assist public health efforts in encouraging change to aid T2D prevention. PUBLIC CONTRIBUTION: The format, language and application of the BPS intervention were adapted in response to a public consultation group that developed a version specifically for application in this study.

Cultural Identity Conflict Informs Engagement with Self-Management Behaviours for South Asian Patients Living with Type-2 Diabetes: A Critical Interpretative Synthesis of Qualitative Research Studies.

The prevalence of type-2 diabetes (T2D) is increasing, particularly among South Asian (SA) communities. Previous research has highlighted the heterogeneous nature of SA ethnicity and the need to consider culture in SA patients' self-management of T2D. We conducted a critical interpretative synthesis (CIS) which aimed to a) develop a new and comprehensive insight into the psychology which underpins SA patients' T2D self-management behaviours and b) present a conceptual model to inform future T2D interventions. A systematic search of the literature retrieved 19 articles, including 536 participants. These were reviewed using established CIS procedures. Analysis identified seven constructs, from which an overarching synthesizing argument 'Cultural Conflict' was derived. Our findings suggest that patients reconstruct knowledge to manage their psychological, behavioural, and cultural conflicts, impacting decisional conflicts associated with T2D self-management and health professional advice (un)consciously. Those unable to resolve this conflict were more likely to default towards cultural identity, continue to align with cultural preferences rather than health professional guidance, and reduce engagement with self-management. Our synthesis and supporting model promote novel ideas for self-management of T2D care for SA patients. Specifically, health professionals should be trained and supported to explore and mitigate negative health beliefs to enable patients to manage social-cultural influences that impact their self-management behaviours.

A grounded theory of type 2 diabetes prevention and risk perception.

OBJECTIVE: Type 2 diabetes (T2D) prevention programmes should target high-risk groups. Previous research has highlighted minimal engagement in such services from South Asian (SA) people. Given SA's elevated risk of T2D, there is a need to understand their perceptions, risks, and beliefs about T2D. DESIGN: This study aimed to assess T2D risk perception within a community sample of SA people using Grounded Theory methodology. Specifically, health beliefs were assessed, and we explored how these beliefs affected their T2D risk perceptions. METHOD: Twenty SA participants (mean age = 38 years) without a diagnosis of T2D were recruited from community and religious settings across the North West of England. In line with grounded theory (Strauss & Corbin, 1990, Basics of qualitative research: Grounded theory procedures and techniques. Newbury Park: Sage Publications), data collection and analysis coincided. RESULTS: The superordinate category of Culturally Situated Risk Perception incorporated a complex psychological understanding of the formation of T2D risk perception, which takes into account the social, cultural, and community-based environmental factors. This superordinate category was explained via two core categories (1) Diminished Responsibility, informed by sub-categories of Destiny and Heredity, and (2) Influencing Healthy Lifestyle Behaviours, informed by sub-categories of Socio-cultural and Environmental. CONCLUSION: This study investigated risk perception of T2D within the SA community. When considering health prevention in the context of an individual's culture, we need to consider the social context in which they live. Failure to acknowledge the cultural-situated T2D risk perception relevant to health promotion and illness messages may account for the issues identified with health care engagement in the SA population.

Efficacy of the Best Possible Self protocol in diabetes self-management: A mixed-methods approach.

Recent research has demonstrated that positive affect may facilitate illness self-management. This study used a sequential exploratory mixed-methods typology to assess whether a brief writing task designed to boost positive affect (the Best Possible Self protocol) could improve aspects of diabetes self-management, specifically. A qualitative investigation explored people with diabetes' (n = 20) views regarding Best Possible Self feasibility and acceptability, while a subsequent quantitative investigation assigned people with diabetes (n = 50) to a Best Possible Self or non-Best Possible Self condition and assessed affect and self-management behaviours over a 4-week period. Findings indicated that individuals were receptive to the Best Possible Self and that it provided benefits for diabetes self-management.

Ethnic inequalities in doctor-patient communication regarding personal care plans: the mediating effects of positive mental wellbeing.

OBJECTIVE: There is limited understanding of ethnic inequalities in doctor-patient communication regarding personal care plans (PCPs). This study investigated the mediating effects of positive mental wellbeing on differences in PCP-related doctor-patient communication amongst South Asian and Caucasian UK residents. DESIGN: Data from 10,980 respondents to the 2013 Health Survey for England was analysed using bootstrapping methods. Constructs from the WEMWBS (Warwick and Edinburgh Mental Wellbeing Scale) (Stewart-Brown, S., and K. Janmohamed. 2008. Warwick, UK) were assessed as mediators of relations between ethnicity and several doctor-patient communication variables, including PCP-related interactions; (a) had a PCP-related discussion about a long-term condition with a doctor/nurse, and (b) had this conversation within the past year, (c) agreed to a PCP with a health professional; and (d) talked to a doctor in the past 2 weeks. RESULTS: Bootstrapped mediation analysis (Hayes, A. F. 2013. Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-based Approach. New York, NY: The Guilford Press) showed that three positive mind-sets mediated associations between ethnicity and doctor-patient contact, including PCP-related communication. Being able to make up one's mind (ab = -0.05; BCa CI [-0.14, 0.01]) mediated the effect of ethnicity on agreeing to a PCP, while having energy to spare (ab = 0.07; BCa CI [-0.04, 0.12]), and feeling good about oneself (ab = 0.03; BCa CI [0.01, 0.07]), mediated ethnic effects on talking to a doctor during the past fortnight. The mediating effect of reported energy persisted after controlling for medical history, perceived health, and other covariates. CONCLUSIONS: Ethnic disparities in doctor-patient interaction, including PCP-related communication, are partly explained by positive mental wellbeing. Gauging positive psychological moods in patients, particularly self-worth, self-perceived vigour and decisiveness, are relevant to addressing ethnic inequalities in doctor-patient communication. As PCPs may have direct implications for patient health it is important for health professionals to address deficits in psychological functioning that may precipitate ethnic inequalities in setting up PCPs.

Are Ethnic Disparities in HbA1c Levels Explained by Mental Wellbeing? Analysis of Population-Based Data from the Health Survey for England.

AIMS: It is unclear how ethnic differences in HbA1c levels are affected by individual variations in mental wellbeing. Thus, the aim of this study was to assess the extent to which HbA1c disparities between Caucasian and South Asian adults are mediated by various aspects of positive psychological functioning. METHODS: Data from the 2014 Health Survey for England was analysed using bootstrapping methods. A total of 3894 UK residents with HbA1c data were eligible to participate. Mental wellbeing was assessed using the Warwick-Edinburgh Mental Well-being Scale. To reduce bias BMI, blood pressure, diabetes status, and other factors were treated as covariates. RESULTS: Ethnicity directly predicted blood sugar control (unadjusted coefficient -2.15; 95% CI -3.64, -0.67), with Caucasians generating lower average HbA1c levels (37.68 mmol/mol (5.6%)) compared to South Asians (39.87 mmol/mol (5.8%)). This association was mediated by positive mental wellbeing, specifically concerning perceived vigour (unadjusted effect 0.30; 95% CI 0.13, 0.58): South Asians felt more energetic than Caucasians (unadjusted coefficient -0.32; 95% CI -0.49, -0.16), and greater perceived energy predicted lower HbA1c levels (unadjusted coefficient -0.92; 95% CI -1.29, -0.55). This mediator effect accounted for just over 14% of the HbA1c variance and was negated after adjusting for BMI. CONCLUSIONS: Caucasian experience better HbA1c levels compared with their South Asian counterparts. However, this association is partly confounded by individual differences in perceived energy levels, which is implicated in better glycaemic control, and appears to serve a protective function in South Asians.

Personal care plans and glycaemic control: the role of body mass index and physical activity.

BACKGROUND: although body mass index (BMI) and physical activity are implicated in diabetes complications, it is unclear how these factors influence personalised care planning linked to glycaemic control. This study assessed the mediating effects of BMI and physical activity on relations between personalised care plans (PCPs) and glycated haemoglobin (HbA1c) levels, using population-based data. METHOD: Bootstrapping was used to analyse PCP, HbA1c, BMI, and physical activity data from 3894 respondents to the 2014 Health Survey for England, for whom HbA1c data were available, regardless of diabetes status. This group comprised 1812 (46.5%) males and 2082 (53.5%) females, aged 16 to 90 (mean=51.68 years, SD=17.25). RESULTS: patients with a PCP had higher HbA1c levels compared with those without a care plan. BMI influenced this relationship among patients aged 40 to 60 years; those with a PCP and higher HbA1c also tended to have higher BMI values. Physical activity did not affect the relationship between PCPs and glycaemic control. CONCLUSIONS: BMI, but not physical activity, partly explained higher HbA1c levels in patients with a PCP. Given recent population-based evidence implicating exercise in diabetes complications, some debate is needed on the role of physical activity in personalised care planning and glycaemic control.

Health professional feedback on HPV vaccination roll-out in a developing country.

BACKGROUND: Worldwide, Zambia has the highest cervical cancer incidence rates (58.4/100,000 per year) and mortality rates (36.2/100,000 per year). The human papilloma virus (HPV) vaccine is considered a vital preventative measure against cervical cancer, particularly in sub-Saharan countries, such as Zambia. Past research suggests health professionals' experiences with HPV vaccination rollout can have practical implications for effective delivery. OBJECTIVE: To explore health professionals' perspectives on the HPV vaccination programme in Zambia. METHODS: Researcher travelled to Zambia and conducted semi-structured interviews with fifteen health professionals working in private, government, and missionary clinics/hospitals. Observation was conducted for triangulation purposes. Thematic analysis was used to analyse the data. FINDINGS: Five main themes emerged; medical misconceptions about the HPV vaccination, particularly with regards to infertility; fear of the unknown, including possible side effects and inadequate empirical research; need for prior desensitisation to resolve cultural barriers prior to vaccination rollout; a rural-urban divide in health awareness, particularly in relation to cancer vaccines; and economic concerns associated with access to the HPV vaccination for most of the Zambian population. CONCLUSION: Overall, the findings indicate that an essential avenue for facilitating HPV vaccination rollout in Zambia is by implementing a pre-rollout community effort that removes or softens cultural barriers, particularly in rural areas. It is also essential to correct erroneous HPV presumptions health professionals may have around infertility. Affordability remains a seemingly intractable hindrance that hampers HPV vaccination rollout in Zambia.

Information and Communication Technology, Well-Being, and Ethnicity.

The relationship between use of information and communication technologies (ICTs) and well-being is an increasingly debated public health issue. Currently, there is limited understanding of how the ethnic digital divide influences this association. Thus, this study assessed how ethnicity has historically moderated relations between ICT (mobile phone, computer, and TV) uptake, and several well-being indicators: (a) long-term health (chronic illness), (b) cigarette smoking, and (c) self-perceptions of personal health. Archived data from a U.K. Office for National Statistics household survey 2007-2011 (97,697 participant records) were analyzed, controlling for multiple sociodemographic confounders. Mobile phone dependence was associated with poorer health perceptions in Caucasian women, but more favorable appraisals in ethnic minority females (OR = 0.51). Furthermore, mobile phone uptake was more strongly related to increased behavioral risk (cigarette smoking) in Caucasian men compared with ethnic minority males (OR = 1.68). Ethnicity did not influence relations between ICT uptake and long-term health. Overall, ethnicity was implicated in relations between mobile phone use and well-being indicators: unfavorable associations occurred primarily in Caucasians.

Early detection of testicular cancer: revisiting the role of self-efficacy in testicular self-examination among young asymptomatic males.

Research suggests that self-efficacy is an important factor in behaviors that facilitate the early-detection of various cancers. In general people with high self-efficacy are more likely to attend cancer screening sessions or perform bodily self-exams. However, there is a paucity of research focusing on testicular cancer and testicular self-examination (TSE). The effect of self-efficacy on TSE remains unclear especially given the relative obscurity of the testicular cancer threat, and appropriate clinical- and self-detection procedures, in the young asymptomatic male population. Thus, the present study tested the interaction of self-efficacy with young men's appraisals of the threat of testicular cancer. The study was based on 2 × 2 × 2 mixed factorial experimental design. Over 100 young asymptomatic men were exposed to a health warning about testicular cancer and randomly assigned to high/low self-efficacy, vulnerability, and severity conditions. High self-efficacy increased motivation to perform TSE given high vulnerability, but damaged attitudes to self-exams given low vulnerability and severity estimates. High self-efficacy also facilitated subsequent TSE. Overall, these findings support preexisting notions of self-efficacy but raise new questions about the moderating effects of threat appraisals.

Ethnic differences in diabetes prevalence and ICT use.

BACKGROUND: Uptake of information and communication technology (ICT) by individuals with diabetes can assist nursing care delivery, and improve patient outcomes. However, it is unclear how such uptake relates to ethnic differences in diabetes risk. AIM: To assess the moderating effects of ICT uptake on South Asian excess diabetes prevalence over a specific elapsed timeframe, accounting for selected environmental, socio-economic, and behavioural risk factors. METHOD: Archived data from a UK Office for National Statistics household survey 2006-2011 (120 621 partly non-orthogonal participant records) were analysed using hierarchical binary logistic regression analyses. RESULTS: ICT uptake qualified ethnic differences in diabetes prevalence. Non-smoking diabetes cases living in terraced housing with a home computer were more likely to be South Asian than Caucasian. By contrast, such cases were more likely to be Caucasian if a computer was unavailable (OR: 0.61; CI: 0.43-0.86; P=0.005). Furthermore, diabetes cases from low-income, mobile-dependent homes were probably South Asian (OR: 0.05; CI: 0.00-0.50; P=0.012). CONCLUSIONS: Home computing was linked to better tobacco control among South Asians with diabetes living in terraced properties. Mobile phone dependence was pronounced in those that received income support. Implications for nursing care are considered.

Psychological issues in voluntary hospice care.

BACKGROUND: Hospices require a multidisciplinary team of health workers to ensure that patients receive appropriate palliative care. One way to tackle this challenge has been to rely increasingly on volunteer carers. Recruiting and retaining volunteers requires some understanding of the psychological challenges (thoughts, emotions and actions) associated with voluntary care. AIM: This study examined the psychological experiences of volunteer carers in a UK hospice. METHODS: The study employed a qualitative design. Nine voluntary careers in one UK hospice were interviewed about their experiences using a largely unstructured interview format. Data were analysed using a grounded theory protocol. FINDINGS: Five major themes emerged: motivation to volunteer, volunteering skills, psychological support and holistic care, positive perceptions of the hospice, and performance hindrances. The skills theme (reflecting abilities acquired from previous experience) was especially prominent. Overall, a model emerged suggesting that volunteers experience cognitive-affective-behavioural challenges involving themselves, patients and the work environment. Self-related challenges seem especially prominent. Implications for nursing care are considered.

Heroin users' experiences of depression: a qualitative study.

BACKGROUND: Heroin users represent a challenging group of patients for GPs, with a high morbidity including a high prevalence of depression. Compared to other groups, management of 'depression' in heroin users is likely to require different approaches. Aim. To examine heroin users' beliefs about connections between depressive symptoms and drug taking. DESIGN: Qualitative. SETTING: Primary care. METHODS: A total of 17 semi-structured interviews were conducted with patients receiving opioid substitution therapy and antidepressants. One focus group of service users was also interviewed. RESULTS: A wide range of thoughts and emotions were described as 'depression'. Adverse childhood events were viewed as both the cause of depression and as simultaneously placing the individual in social circles where drug use was common. Drug taking was thought to lead to depression through resultant adverse social consequences, though illicit drug use was also regarded as an understandable way to cope with depression. Examples of stigma from taking drugs were commonly described and thought a cause of depression; in contrast, stigmatizing effects of depression were not apparent. The participants often felt isolated. Beliefs about how antidepressants worked incorporated ideas about blocking out thoughts, stopping thoughts racing and keeping emotions level. Self-management techniques for treating depression were rarely described. CONCLUSIONS: Heroin users' experiences of depression-including ideas about causation, how symptoms are felt and experienced and treatment strategies-are overwhelmingly framed by the context of drug taking.

Emotional vulnerability and coping styles for resolving decisional conflict.

This investigation supplements the study by D. Bouckenooghe, K. Vanderheyden, S. Mestdagh, and S. van Laethem (2007) on the role of cognitive dispositions in coping patterns for resolving decisional conflict. Literature suggests emotional vulnerabilities may significantly affect decision making. Thus, the present authors assessed the role of trait anxiety and depression in decision coping styles as specified by I. L. Janis and L. Mann's (1977) conflict-theory model. The participants--100 young adults--completed the Taylor Manifest Anxiety Scale (J. A. Taylor, 1953), Beck's Depression Inventory (A. T. Beck, R. A. Steer, & G. M. Garbin, 1988), and the Melbourne Decision-Making Questionnaire (L. Mann et al., 1998), which measures 4 coping strategies: vigilance, buck-passing, procrastination, and hypervigilance. Hierarchical multiple regression analysis, controlling for demographic and lifestyle factors, revealed trait anxiety and depression as significant predictors of procrastination and hypervigilance. Depression failed to predict buck-passing but functioned as an important moderator variable whereby trait anxiety better predicted hypervigilance in nondepressed participants. Consistent with past research, emotional dispositions failed to predict vigilance. Overall, these findings implicate emotional vulnerabilities in the quality of decision making but raise important questions about their unique and conditional effects.

Mutually dependent health beliefs associated with breast self-examination in British female university students.

OBJECTIVE: Whereas research suggests young women's beliefs about breast cancer (susceptibility/severity) and its early detection (barriers/benefits) reliably distinguish breast self-examiners from nonexaminers, this study assessed whether these impressions are interreliant, especially in the context of familial risk. PARTICIPANTS: The sample comprised over 200 female undergraduates from a university in England, United Kingdom. METHODS: Participants completed a self-administered survey on their attitudes concerning breast cancer and early detection. Data were analyzed using logistic regression analysis. RESULTS: Nonexaminers were distinguished by a combination of greater perceived hindrances to self-examinations and stronger appraisals of breast cancer severity, and also by a permutation of fewer perceived benefits in self-examinations and lower perceived susceptibility to breast cancer. The latter interaction persisted after accounting for family history. CONCLUSIONS: Interwoven attitudes may depict sophisticated efforts on the part of nonexaminers to justify inaction. Clinical implications for college health providers are considered.

Work stress differentials between psychiatric and general nurses.

Reducing occupational stress among nursing staff is a public health priority in many western countries. This study assessed stress differentials between psychiatric nurses (PNs) and general nurses (GNs), and the moderating function of social support. It was expected that PNs would report different (higher) stress levels than GNs given PNs' lower levels of social support. A questionnaire was completed and returned by 73 nurses at several public hospitals in England. Multivariate analysis of variance showed that social support moderated stress differentials between PNs and GNs, albeit not as anticipated; the latter group reported significantly higher and lower stress levels when social support was low and high, respectively. This interaction was applicable to both the quality and quantity of social support. Overall, the benefits of social support seemed to accrue primarily to GNs. Implications of these findings for the development of stress-reduction interventions are considered.

Theory of planned behaviour and ecstasy use: an analysis of moderator-interactions.

OBJECTIVE: This study tested potential moderator interactions between components of the Theory of Planned Behaviour (TPB) in relation to ecstasy use, extending previous research. It was expected that attitudes, subjective norms and perceived behavioural control (PBC) would moderate each other in predicting intended use of this drug. METHOD: A cross-sectional survey was administered to 200 young adults. RESULTS: In hierarchical multiple regression analysis, past behaviour and attitude independently predicted intention; previous use of ecstasy and more positive attitudes towards ecstasy use were associated with stronger intentions to use this drug in the future. Moreover, there was a significant interaction between attitude and PBC (R(2)(change) = 0.05). Slope analysis revealed that PBC better predicted intention given more positive attitudes towards ecstasy use. CONCLUSIONS: This moderator function may help explain predictive inconsistencies reported in the literature. Implications for the TPB are considered.