Comparison of barriers and facilitators of MIND diet uptake among adults from Northern Ireland and Italy.

BACKGROUND: The aim of the study was to identify and compare components of the COM-B (capability, opportunity, motivation and behaviour) model, that influences behaviour to modify dietary patterns in 40-55-year olds living in Northern Ireland (NI) and Italy, in order to reduce the risk of cognitive decline in later life. METHODS: This was a qualitative study examining factors influencing Mediterranean-DASH (Dietary Approaches to Stop Hypertension) Intervention for Neurodegenerative Delay (MIND) diet behaviour. This study further elaborated the COM-B components into the 14 domains of the Theoretical Domains Framework to further understand behaviour. Twenty-five Northern Irish and Italian participants were recruited onto the study, to take part in either a focus group or an interview. Participants were both male and female aged between 40 and 55 years. RESULTS: Thematic analysis revealed that the main barriers to the uptake of the MIND diet were; time, work environment (opportunity), taste preference and convenience (motivation). Culture (motivation), seasonal foods and lack of family support (opportunity) to be a barrier to the Italian sample only. The main facilitators reported were; improved health, memory, planning and organisation (motivation) and access to good quality food (opportunity). Cooking skills, knowledge (capability) and heathy work lunch (opportunity) reported as a facilitator to the Italian sample only. CONCLUSIONS: Cross-cultural differences in relation to psychosocial barriers and facilitators were found in both samples. More barriers than facilitators towards uptake of the MIND diet were found. There is a need for interventions that increase capability, opportunity, and motivation to aid behaviour change. The findings from this study will be used to design a behaviour change intervention using the subsequent steps from the Behaviour Change Wheel.

The design and psychometric assessment of a child-friendly TPB-based questionnaire.

Background: Despite the popularity of the theory of planned behaviour (TPB), a lack of research assessing the efficacy of the model in understanding the health behaviour of children exists. The aim of this study was to develop and test a TPB-based measure suitable for use with schoolchildren aged 9-10 years. Methods: A mixed-method sequential design was employed. In Phase 1, semi-structured focus group discussions were conducted to elicit the underlying beliefs specific to tooth brushing. Using content thematic analysis, the beliefs were identified and a TPB measure was developed. A repeated measures design was employed in Phase 2 using test-retest reliability analysis in order to assess its psychometric properties. In all, 184 children completed the questionnaire. Results: The questionnaire proved to be reliable for assessing the tooth brushing beliefs of children. Pearson's product moment correlations were calculated for all of the TPB constructs, achieving substantial to almost perfect agreement levels, providing strong predictive power of the TPB. Conclusions: The design and development of the measure are described, which could serve as a guide to fellow researchers and health professionals interested in using theoretical models to investigate the health and well-being of children.

Service user involvement in mental health care: an evolutionary concept analysis.

BACKGROUND: The concept of service user involvement is an evolving concept in the mental health-care literature. OBJECTIVE: This study sought to explore and analyse the concept of service user involvement as used in within the field of mental health care. METHODOLOGICAL APPROACH: An evolutionary concept analysis was conducted using a literature-based sample extracted from an electronic database search. One hundred and thirty-four papers met the inclusion criteria and were analysed to discover key attributes, antecedents and consequences of service user involvement and to produce a definition of the concept. FINDINGS: Five key attributes of service user involvement within the context of mental health care were identified: a person-centred approach, informed decision making, advocacy, obtaining service user views and feedback and working in partnership. DISCUSSION AND CONCLUSIONS: Clarity of the attributes and definition of the concept of service user involvement aims to promote understanding of the concept among key stakeholders including mental health professionals, service users and community and voluntary organizations. The findings of the research have utility in the areas of theory and policy development, research on service user involvement in mental health care and service user involvement in mental health practice. Directions for further research regarding the concept are identified.

Promoting positive attitudes to breastfeeding: the development and evaluation of a theory-based intervention with school children involving a cluster randomised controlled trial.

The objective of this study was to design, implement and evaluate an intervention based on the theory of planned behaviour (TPB) to enhance young peoples' motivations to breastfeed/support a partner to breastfeed. Six semi-structured focus groups were first conducted with 48 13-14-year-olds from two schools in Northern Ireland. The salient beliefs elicited were subsequently used to design a TPB-based questionnaire that was then administered to 2021 13-14-year-old pupils (852 males; 1169 females) from 36 post-primary schools to identify the most important determinants of breastfeeding. The results were used to inform the design and implementation of an intervention package that was subsequently evaluated using a cluster randomised controlled trial involving 44 randomly selected schools across Northern Ireland. Questionnaires were administered to 18 intervention and 26 control schools at baseline and again at 1 and 6 months post-intervention to evaluate its effectiveness. Multi-level modelling was employed to analyse the data. The results revealed significant effects on women's intention to breastfeed, ß = 0.208, t(1275) = 2.715, P = 0.007; attitudes, ß = 0.223, t(1275) = 4.655, P < 0.001; moral attitudes, ß = 0.231, t(1275) = 4.211, P < 0.001; subjective norm, ß = 0.118, t(1275) = 2.521, P = 0.012; and knowledge, ß = 0.109, d.f. (1275) = 7.843, P < 0.001. However, for men, the results revealed significant effects on only the construct of knowledge, ß = 0.104, t(541) = 4.345, P < 0.001.The research has provided evidence to support the need for breastfeeding education in schools and has shown how a theoretical framework may be used to inform the design and evaluation of a health behaviour intervention.

Prospective evaluation of the pyramid plus psychosocial intervention for shy withdrawn children: an assessment of efficacy in 7- to 8-year-old school children in Northern Ireland.

BACKGROUND: Social withdrawal is known to precede and contribute to the development of internalization problems in shy children. This study examined the efficacy of a selective primary school-based psychosocial intervention for withdrawn children. METHOD: The sample comprised 82 Primary 4 children aged between 7 and 8 years from 7 schools across Northern Ireland. There were 31 children in the comparison group (50.6% male) and 57 children received the intervention (41.7% male). A 2 × 2 mixed-model design was used: group (intervention group vs. comparison group) × 3 time points (pre- vs. 10 postintervention vs. 12-week follow-up) with repeated measures on the time factor. Teachers completed the SDQ at the three time points to assess participants' socio-emotional health status. RESULTS: Pyramid participants showed greater reductions than the comparison group on the Emotional Symptom and Peer Problem factors following the intervention and their scores did not return to baseline levels at follow-up. Pyramid attendance accounted for approximately 12% and 9% of the variance in the Emotional Symptom and Peer Problems decreases respectively. CONCLUSIONS: Pyramid Plus helped to alleviate internalization problems in participants and initially had a positive impact on social re-integration. The incorporation of cognitive restructuring techniques may be a necessary intervention modification to affect participants' emotion regulation strategies.

Prevalence, knowledge and factors associated with e-cigarette use among parents of secondary school children.

Objectives: Identify prevalence rates and attitudes towards e-cigarette use among parents to inform prevention strategies designed to reduce uptake in young people. Study design: A mixed methods sequential study guided by the Theory of Planned Behaviour. Methods: This research involved two phases. Phase one was an elicitation study using focus groups, interviews and open-ended questionnaires (N = 17) to elicit parental behavioural, normative, and control beliefs around e-cigarette use. Findings from phase 1 were used to inform a questionnaire administered to a sample of 612 parents in phase 2. The aim of phase 2 was to identify and explain factors that influence parental attitudes and motivations towards e-cigarette use. Parents were recruited through post-primary schools and were sent a link to an online survey. Results: Approximately 19% of parents had tried an e-cigarette, with 9% reporting current use. Sociodemographic variables, TPB constructs and knowledge of e-cigarettes, accounted for 43% and 60% of ever use and intention to use an e-cigarette, respectively. Intention, gender, age and free school meal entitlement were associated with ever use. Intention to use an e-cigarette was related to lower educational level, current smoking of traditional cigarettes, more positive attitudes, greater social pressure, having greater control over use and knowledge. Conclusions: Prevention strategies designed to reduce uptake in young people should raise awareness of the health risks of e-cigarette use, legislation and regulations and highlight the role parents play in encouraging young people to abstain from using an e-cigarette.

Parental and school effects on children's political attitudes in Northern Ireland.

BACKGROUND: Recent research has suggested that intergroup contacts with out-group members can both reduce prejudice and is associated with attitude change. AIM: This study extends prior work in Northern Ireland to examine parental and schooling effects on children's attitudes in a post-conflict environment. SAMPLE: A large-scale cross-sectional survey of secondary schoolchildren (N=1,732) and their parents (N=800) in Northern Ireland assessed the effects of in-school and out-of-school intergroup contacts on intergroup attitudes. METHOD: Multivariate analysis of variance was employed to examine associations between children's political attitudes and parental, group membership, school, and contact variables. CONCLUSIONS: The results suggest that parental attitudes, group membership, and cross-group contacts explain the majority of variance (58%) in children's political attitudes. The findings provide a comprehensive account of the factors that influence children's political attitudes within a deeply divided society and offer teachers and educationalists a way to improve community relations in a segregated society.

Women's experience of social media breastfeeding support and its impact on extended breastfeeding success: A social cognitive perspective.

OBJECTIVE: This paper investigates the experiences of women using a social media Facebook group for breastfeeding support and attempts to explore whether it has aided in extended breastfeeding success. In addition, it aims to explore the value of social cognitive theory (SCT) in explaining these experiences. DESIGN: Exploratory, deductive approach. METHODS: Qualitative, audio-recorded, semi-structured interviews were conducted from eight women who were members of a private Facebook group'. Data were analysed using theoretical thematic analysis, and SCT was used as a theoretical lens through which the data were interrogated. RESULTS: A number of themes were identified from the women's experiences, with analysis uncovering the superordinate theme 'increased self-efficacy' which provided an understanding of how the group impacted women's experiences and aided them in breastfeeding success. The sub-themes of education, accessibility, online community, normalization, and extended goals provided a more detailed understanding of how self-efficacy was increased through group membership. CONCLUSION: The symbiotic relationship between members of a social media group facilitates greater breastfeeding success and a longer duration of breastfeeding through the central concept of the SCT: reciprocal determinism. Therefore, it is posited that the SCT is a suitable theory of behaviour change which can potentially be used to develop interventions aiming to increase breastfeeding rates and duration.

The culture of condoms: culturally grounded variables and their association with attitudes to condoms.

OBJECTIVE: To examine attitudes toward condoms and their association with culturally grounded beliefs among young South African adults. METHODS: A questionnaire survey undertaken in three different locations (urban, rural, and mixed), including 1100 participants, and implementing both a cross-validational and a bootstrap multivariate design. Outcome measures were intention to use a condom at next sex and condom salience (i.e., confidence in the protective value of condoms). Culturally grounded predictors included traditional beliefs about illness, beliefs in ancestral protection, endorsement of AIDS myths, and mortality salience (CONTACT). RESULTS: Participants exhibited strong endorsement of indigenous beliefs about illness and ancestral protection, and moderate endorsement of AIDS myths. Participants who viewed condoms as important for HIV prevention were more likely to show strong endorsement of both beliefs in ancestral protection and traditional beliefs about illness. Participants who strongly endorsed AIDS myths viewed condoms as less important and also had lower intention to use scores. Finally, participants who knew HIV positive people, and/or people who had died of HIV-related illnesses, had higher condom salience and higher intention to use scores. CONCLUSIONS: Results challenge the assumption that culturally grounded variables are inherently adversarial in their relationship to biomedical models of HIV prevention, and offer insights into how traditional beliefs and cultural constructions of HIV/AIDS might be used more effectively in HIV education programs.

Understanding pre-, peri- and post-menopausal women's intentions to perform muscle-strengthening activities using the Theory of Planned Behaviour.

Although physical activity guidelines recommend muscle-strengthening activities (MSA), public health initiatives tend to focus on increasing aerobic activity and fail to mention MSA. This study sought to identify the issues influencing pre-, peri- and post-menopausal women's intentions to perform MSA with a view to informing future interventions for these populations. Mixed methods guided by the Theory of Planned Behaviour (TPB) were used to explore factors that influence women's intentions to perform MSA. In stage one, 34 women participated in either a focus group or interview. Discussions were transcribed verbatim and analysed based on menopausal status using a deductive approach. In stage two, 186 women (M = 47 years, SD = 9) completed a questionnaire to assess participant demographics, levels of MSA, affective and instrumental attitudes, injunctive and descriptive norms, self-efficacy and perceived behavioural control. Quantitative data were analysed using descriptive statistics, bivariate correlations, regression analyses and analysis of variances. Behavioural beliefs were: improved muscular health; psychological benefits; improved body shape. Normative beliefs were: health professionals; family members; work colleagues. Control beliefs were: equipment; motivation; time constraints; knowledge; physical capability; fear of judgement. However, these beliefs were not well established. Self-efficacy was the strongest predictor of intentions (spc2 = 0.11) followed by affective attitudes (spc2 = 0.09), with no significant differences on TPB variables between groups. If rising rates of musculoskeletal conditions in women are to be prevented, there is an urgent need to increase women's knowledge of recommended levels of muscle strengthening, with a view to promoting positive attitudes and enhancing women's sense of self-efficacy across all menopausal phases.

Benefit finding and resilience in child caregivers.

OBJECTIVES: A substantial number of children are involved in informal caregiving and make a significant contribution to health care delivery. While this places high levels of demand on their coping resources, there is some evidence that these children find benefit in their caring role. DESIGN: A survey design using questionnaire data collection was used with a sample of 442 children (174 boys and 268 girls) between the ages of 12 and 16. METHODS: The role of benefit finding and resilience was explored within a stress and coping model of the impact of caregiving. RESULTS: Hierarchical multiple regression analysis (HMRA) identified resilience and benefit finding as accounting for significant amounts of variance in positive health and mediating the impact of caregiving. In regard to negative health, only benefit finding played a significant role. CONCLUSIONS: Young caregivers do experience benefit finding and exhibit resilience although the relationship with caregiving burden was inverse. Benefit finding seems to be related to social recognition of the caregiving role and to family support. STATEMENT OF CONTRIBUTION: What is already known on this subject? There is some emerging evidence that child caregivers experience some positive effects or benefits from their caring in spite of the demands of the role. However, the main focus has been on reducing negative outcomes rather than on building resilience. What this study adds? This study provides evidence that young caregivers do experience benefit finding in situations where the role demand is not overly excessive and where the role is socially recognized.

The role of the speech-language pathologist in home care.

Speech language pathologists play an important role in the care of patients with speech, language, or swallowing difficulties that can result from a variety of medical conditions. This article describes how speech language pathologists assess and treat these conditions and the red flags that suggest a referral to a speech language pathologist is indicated.

Benefit finding in response to general life stress: measurement and correlates.

Benefit finding herein defined as "the process of deriving positive growth from adversity" has become a key construct in the evolution of positive psychology, and research suggests that it may provide the basis for a resource model of stress and coping. However, measures of benefit finding have tended to be domain specific. The current study focused on developing a more generic multidimensional measure of benefit finding. A measure of benefit finding was developed and tested in 855 students (574 females and 281 males) aged between 18 and 40 years. A 28-item scale with six dimensions was produced and Confirmatory Factor Analysis (CFA) confirmed the scale structure. The model proposed that psychological and social resources would mediate the relationship between experienced stressors and benefit finding. Structural equation modelling with Analysis of Moment Structures (AMOS) shows that the model is a good fit for the data and psychological and social resources partially mediated the relationship. It is argued that psychological and social resources enable benefit finding in relation to life stress and provide a focus for the development of preventive interventions to improve positive health.

Evaluation of a theory of planned behaviour-based breastfeeding intervention in Northern Irish schools using a randomized cluster design.

OBJECTIVE: The aim of this research was to evaluate the effectiveness of a school-based intervention designed to enhance young people's motivations to breastfeed. DESIGN: A cluster randomized controlled trial was conducted involving 50 post-primary schools from across Northern Ireland. However, dropout and exclusion criteria utilized for the current study resulted in an effective sample size of 42 schools. METHODS: The intervention was delivered in two 35-min classroom sessions targeting those beliefs identified by the theory of planned behaviour (TPB) as significant in predicting motivation to breastfeed. Questionnaires incorporating the key components of the TPB were administered to all intervention and control schools at baseline, 1 and 6 months post-intervention. Multi-level modelling was used to analyse the data. RESULTS: Findings suggest that the intervention was effective in that it increased females' intentions to breastfeed, expanded their knowledge and led to more favourable attitudes and perceptions of subjective norms. Notably, females' knowledge increased more in secondary schools than in grammar schools irrespective of whether they were control or intervention schools. CONCLUSION: The research has provided evidence to support the use of the TPB in the design and evaluation of an intervention to increase females' intentions to breastfeed.

Further exploration of the Young Carers Perceived Stress Scale: identifying a benefit-finding dimension.

OBJECTIVES: A substantial number of children are involved in informal caregiving and make a significant contribution to health care delivery. While this places high levels of demand on their coping resources, there is some evidence that these children find benefit in their caring role. The Young Carers Perceived Stress Scale (YCPSS) (Early et al., 2006, J. Child Fam. Stud., 15, 169) identified a positive dimension of caring, which appears to have potential in terms of measuring benefit finding in this group. The current study aimed to further explore YCPSS to clarify this dimension. DESIGN: A survey design using questionnaire data collection was used with a sample of 329 children between the ages of 12 and 16. METHODS: A pool of 52 items based on the YCPSS was administered along with measures of support, coping, and psychological distress to 329 young carers attending organized support groups. RESULTS: Factor analysis with maximum likelihood extraction identified six factors including one 8-item dimension labelled benefit finding, which had good internal reliability and produced a pattern of correlations with support, coping, and psychological distress indicating initial evidence of validity. CONCLUSIONS: The study produced initial evidence for reliability and validity of an 8-item benefit-finding measure, as well as a clearer set of dimensions for the original YCPSS. The resulting measures should prove useful in further explorations of benefit finding and resilience in young carers.

Measuring young people's attitudes to breastfeeding using the Theory of Planned Behaviour.

BACKGROUND: The focus of this study was to design and pilot a questionnaire to measure young people's attitudes to breastfeeding using the Theory of Planned Behaviour (TPB). This is intended for subsequent use in a large-scale attitude survey, which in turn will inform the design of a breastfeeding intervention programme with adolescents. METHODS: The first three phases of a research programme employing the theory are described: belief elicitation, questionnaire development and a pilot study. Firstly, an elicitation study to identify the modal salient beliefs underlying young peoples' motivations to breastfeed, using six semi-structured focus groups with 48 young people, was performed. Secondly, the measurement instrument was constructed, incorporating all the key theoretical constructs and both direct and belief-based measures. The questionnaire was then piloted on a sample of 121 female and male schoolchildren to identify and assess the relative importance of the determinants of breastfeeding intention. RESULTS: The questionnaire proved to be reliable, and preliminary analysis provided strong support for the predictive power of the TPB. CONCLUSIONS: Some key issues involved in the operationalization of the theory are highlighted, which may be of interest to researchers involved in the design of TPB questionnaires for use in other intervention programmes.