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.

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.

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.

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.

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.

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.

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.

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.