Using fear appeals to promote cancer screening - are we scaring the wrong people?

There is debate regarding the use of fear appeals (emphasizing severe threats to health) in social marketing, to encourage preventive behaviours, such as screening for breast cancer. While it has been found that fear appeals may result in attitude and behaviour change there is also the risk of inciting inappropriate levels of fear, motivating the wrong audience or instigating maladaptive behaviour in the target group such as denial or defensive avoidance. This study examined the impact of an experimental threat manipulation for mammography screening on a group of women in regional Australia. The study found that varying the level of threat had no impact on stated intentions of the women to undergo mammographic screening. However, it also found that high-threat messages resulted in stronger negative emotional reactions and greater perceived susceptibility among younger women who are not the target group for screening in Australia. The results of this study emphasize the importance of limiting the use of high levels of threat in social marketing campaigns, and ensuring that campaigns are appropriately designed to specifically impact upon and motivate the target group. Copyright © 2006 John Wiley & Sons, Ltd.

Self monitoring of blood glucose in type 2 diabetes:Longitudinal qualitative study of patients' perspectives

Objective: To explore views of patients with type 2 diabetes about self monitoring of blood glucose over time. Design: Longitudinal, qualitative study. Setting: Primary and secondary care settings across Lothian, Scotland. Participants: 18 patients with type 2 diabetes. Main outcome measures: Results from repeat in-depth interviews with patients over four years after clinical diagnosis. Results: Analysis revealed three main themes - the role of health professionals, interpreting readings and managing high values, and the ongoing role of blood glucose self monitoring. Self monitoring decreased over time, and health professionals' behaviour seemed crucial in this: participants interpreted doctors' focus on levels of haemoglobin A1c, and lack of perceived interest in meter readings, as indicating that self monitoring was not worth continuing. Some participants saw readings as a proxy measure of good and bad behaviour - with women especially, chastising themselves when readings were high. Some participants continued to find readings difficult to interpret, with uncertainty about how to respond to high readings. Reassurance and habit were key reasons for continuing. There was little indication that participants were using self monitoring to effect and maintain behaviour change. Conclusions: Clinical uncertainty about the efficacy and role of blood glucose self monitoring in patients with type 2 diabetes is mirrored in patients' own accounts. Patients tended not to act on their self monitoring results, in part because of a lack of education about the appropriate response to readings. Health professionals should be explicit about whether and when such patients should self monitor and how they should interpret and act upon the results, especially high readings.

Controlled study into the effectiveness of individual client-centred counselling for young offenders in residential care

This study is toe first documented account in the British Isles of an evaluation of the effectiveness of client-centred counselling with young offenders in secure residential care. It is a test of Rogers' (1957) position on the 'necessary and sufficient' conditions of therapeutic personality change within a counselling relationship. Forty teenage male offenders, the subjects of Training School Orders, were randomly allocated in equal numbers to either an experimental or control group. Boys in the experimental group received weekly individual sessions of client-centred counselling over a seven month period. Boys in the control group received no formal counselling but were shown to have similar intellectual, personality, socio-economic and criminal backgrounds to those in the experimental group. It was hypothesised that counselled subjects would show more positive outcomes than control subjects over a range of measures relating to criminal behaviour and self-conception. The results indicated that the counselled subjects had a significantly lower rate of offending and a srnaller range of offences over a mean follow-up period of 2.5 years. They were also licensed from the institution significantly earlier and spent less time in custody during a one year follow-up after counselling was completed. Self-conception measures gave less clear-cut results. The direction of change towards better adjustment favoured the counselled subjects but the magnitude was often small. Those counselled subjects with most positive behaviour change tended to have significantly improved self-evaluation, less self/ideal self discrepancy and more variation on 'actual' self concept compared to pre-counselling. The results are discussed in the context of client-centred theory, methodological adequacy of the experimental design, and their application to the future treatment of young offenders in secure residential care.

Experiential learning:inspiring the business leaders of tomorrow

Purpose: The complex challenges of sustainable development and the need to embed these issues effectively into the education of future business leaders has never been more urgent. The purpose of this paper is to discuss different approaches taken by two UK signatories to the UN Principles for Responsible Management Education (PRME). Design/methodology/approach: The two approaches examined are: MSc Entrepreneurship students opting for placements with social enterprises; and MBA students undertaking workshops using "live" case studies. A content analysis of the experiences of students from their written reflective narratives is presented. This is supplemented by reflections of the facilitators and tutors. Findings: The analysis reveals that the opportunity to work with social entrepreneurs and/or "responsible" business professionals provides the business students with inspirational role models and positive social learning opportunities. Research limitations/implications: This paper suggests that experiential learning is an effective way of integrating ethics, responsibility and sustainability into the curriculum but the research draws on the experience of two schools. Further research is important to explore these findings in other contexts. Practical implications: The authors argue that direct exposure to a business culture (and/or behaviour) that is predicated upon ethical/social responsibility and sustainability is an effective means to embed these values in the curriculum. Originality/value: This paper contributes by drawing on social psychological research related to behaviour change to examine how experiential learning on traditional Business Masters programmes can provide students with the knowledge, motivation and skills to contribute positively to society, in a way that more traditional pedagogies cannot. © Emerald Group Publishing Limited.

Developing a complex intervention to reduce time to presentation with symptoms of lung cancer

Background - Lung cancer is the commonest cause of cancer in Scotland and is usually advanced at diagnosis. Median time between symptom onset and consultation is 14 weeks, so an intervention to prompt earlier presentation could support earlier diagnosis and enable curative treatment in more cases. Aim - To develop and optimise an intervention to reduce the time between onset and first consultation with symptoms that might indicate lung cancer. Design and setting - Iterative development of complex healthcare intervention according to the MRC Framework conducted in Northeast Scotland. Method - The study produced a complex intervention to promote early presentation of lung cancer symptoms. An expert multidisciplinary group developed the first draft of the intervention based on theory and existing evidence. This was refined following focus groups with health professionals and high-risk patients. Results - First draft intervention components included: information communicated persuasively, demonstrations of early consultation and its benefits, behaviour change techniques, and involvement of spouses/partners. Focus groups identified patient engagement, achieving behavioural change, and conflict at the patient–general practice interface as challenges and measures were incorporated to tackle these. Final intervention delivery included a detailed self-help manual and extended consultation with a trained research nurse at which specific action plans were devised. Conclusion -The study has developed an intervention that appeals to patients and health professionals and has theoretical potential for benefit. Now it requires evaluation.

Effectiveness and uptake of screening programmes for coronary heart disease and diabetes:a realist review of design components used in interventions

Objective - To evaluate behavioural components and strategies associated with increased uptake and effectiveness of screening for coronary heart disease and diabetes with an implementation science focus. Design - Realist review. Data sources - PubMed, Web of Knowledge, Cochrane Database of Systematic Reviews, Cochrane Controlled Trials Register and reference chaining. Searches limited to English language studies published since 1990. Eligibility criteria - Eligible studies evaluated interventions designed to increase the uptake of cardiovascular disease (CVD) and diabetes screening and examined behavioural and/or strategic designs. Studies were excluded if they evaluated changes in risk factors or cost-effectiveness only. Results - In 12 eligible studies, several different intervention designs and evidence-based strategies were evaluated. Salient themes were effects of feedback on behaviour change or benefits of health dialogues over simple feedback. Studies provide mixed evidence about the benefits of these intervention constituents, which are suggested to be situation and design specific, broadly supporting their use, but highlighting concerns about the fidelity of intervention delivery, raising implementation science issues. Three studies examined the effects of informed choice or loss versus gain frame invitations, finding no effect on screening uptake but highlighting opportunistic screening as being more successful for recruiting higher CVD and diabetes risk patients than an invitation letter, with no differences in outcomes once recruited. Two studies examined differences between attenders and non-attenders, finding higher risk factors among non-attenders and higher diagnosed CVD and diabetes among those who later dropped out of longitudinal studies. Conclusions - If the risk and prevalence of these diseases are to be reduced, interventions must take into account what we know about effective health behaviour change mechanisms, monitor delivery by trained professionals and examine the possibility of tailoring programmes according to contexts such as risk level to reach those most in need. Further research is needed to determine the best strategies for lifelong approaches to screening.

"I'm a better manager":A biographic narrative study of the impact of personal trauma on the professional lives of managers in the UK

This doctoral study aims to understand how experiences of critical illness or bereavement affect the way managers view and approach their work and their relationships at work. This is an interpretative phenomenological study examining the subjective meanings of personal experience and is underpinned by biographic narratives from four participants and interviews with their nominated workplace witnesses (i.e. colleagues who worked alongside the individual at the time of their trauma). As a consequence of the findings that have emerged across this study, three contributions to theory are presented. All four participants described their traumas as a professional growth experience for themselves as managers, which resulted in self-reported and observed behaviour change at work. Consequently, the first area of theoretical contribution is a suggested extension to the post-traumatic growth (PTG) framework (Calhoun & Tedeschi, 2006) with the addition of a new behavioural dimension called ‘managerial growth’, when applied to the context of ‘ordinary’ organizations. The second area of theoretical contribution arose through the reflexive process that was created during data collection where participants and their witnesses remembered episodes of compassion interaction at work. The second area of contribution thus seeks to extend the existing model of compassion at work (Dutton, Worline, Frost and Lilius, 2006), by conceptualising compassion as a dyadic process between a compassion ‘giver’ and a compassion ‘receiver’ in which the compassion receiver ‘trusts or ‘mistrusts’; ‘discloses’ or ‘withholds’; ‘connects’ or ‘disconnects’ with the compassion giver. The third area of contribution is a new conceptualisation of reflexivity, ‘three-dimensional reflexivity’ (3DR) (Armstrong, Butler and Shaw, 2013). 3DR brings together three of the elements that have been missing from critically reflexive management research; by working with multiple variants of reflexivity in the same study; surfacing different reflexive voices to guard against the researcher’s (potentially) solipsistic own; and remaining sensitive to the concept of reflexive time. In doing so, 3DR not only provides a deeper understanding of individual lived experience; it is also a vehicle in which self-insight is gained. Furthermore, by engaging in its practice, those involved in this study have developed both personally and professionally as a result.

Be SMART:examining the experience of implementing the NHS Health Check in UK primary care

Background: The NHS Health Check was designed by UK Department of Health to address increased prevalence of cardiovascular disease by identifying risk levels and facilitating behaviour change. It constituted biomedical testing, personalised advice and lifestyle support. The objective of the study was to explore Health Care Professionals' (HCPs) and patients' experiences of delivering and receiving the NHS Health Check in an inner-city region of England. Methods: Patients and HCPs in primary care were interviewed using semi-structured schedules. Data were analysed using Thematic Analysis. Results: Four themes were identified. Firstly, Health Check as a test of 'roadworthiness' for people. The roadworthiness metaphor resonated with some patients but it signified a passive stance toward illness. Some patients described the check as useful in the theme, Health check as revelatory. HCPs found visual aids demonstrating levels of salt/fat/sugar in everyday foods and a 'traffic light' tape measure helpful in communicating such 'revelations' with patients. Being SMART and following the protocolrevealed that few HCPs used SMART goals and few patients spoke of them. HCPs require training to understand their rationale compared with traditional advice-giving. The need for further follow-up revealed disparity in follow-ups and patients were not systematically monitored over time. Conclusions: HCPs' training needs to include the use and evidence of the effectiveness of SMART goals in changing health behaviours. The significance of fidelity to protocol needs to be communicated to HCPs and commissioners to ensure consistency. Monitoring and measurement of follow-up, e.g., tracking of referrals, need to be resourced to provide evidence of the success of the NHS Health Check in terms of healthier lifestyles and reduced CVD risk.

Understanding sustainable development

This new and expanded edition builds upon the first edition’s powerful multi-perspective approach and breath of coverage. A truly comprehensive introduction to sustainable development, it is designed specifically to allow access to the topic from a wide range of educational and professional backgrounds and to develop understanding of a diversity of approaches and traditions at different levels. This second edition includes: •a complete update of the text, with increased coverage of major topics including ecosystems; production and consumption; business; urban sustainability; governance; new media technologies; conservation; leadership; globalization and global crises; sustainability literacy and learning; •more examples from the Global South and North America, while retaining its unique coverage of first world countries; •chapter aims at the start and summaries at the end of each chapter; •glossary of key terms; •a new chapter on Conservation with a focus on behaviour change and values; •a brand new website which includes discussion of how projects are done on the ground, additional exercises and online cases, test questions and recommended readings and films. Offering boxed examples from the local to the global, Understanding Sustainable Development is the most complete guide to the subject for course leaders, undergraduates and postgraduates.

An examination of the UK community pharmacist's role in facilitating patient self-management of cardiovascular disease through lifestyle behaviours

The progression of cardiovascular disease (CVD) is largely modifiable through lifestyle behaviours. UK pharmacists are contractually obliged to facilitate patient self-management of chronic conditions such as CVD. Pharmacists are easily accessible health professionals who are well placed to identify “at risk” patients through medication regimes. Research has identified varying attitudes towards and levels of involvement in pharmacist-led health promotion activity. Given the diverse and exploratory nature of the work, a pragmatic, mixed methods approach was used to explore community pharmacists’ role in facilitating patient self-management of CVD. The thesis presents four studies: a qualitative study with pharmacists; a cross sectional questionnaire of community pharmacists; a systematic review and a qualitative study with patients with CVD. The qualitative study with pharmacists gave an insight into pharmacists’ experiences of giving patients with CVD lifestyle advice and the factors underpinning commonly cited barriers to providing public health services. This informed the development of the cross-sectional questionnaire which identified the predictors of pharmacists’ intentions to give two different types of advice to facilitate patient self-management. The systematic review identified a small number of interventions to prepare pharmacists to facilitate patient lifestyle behaviour change and evaluated the theories and behaviour change techniques used in successful interventions; however due to poor study quality and poor reporting of the interventions limited conclusions about the efficacy of the interventions could reliably be drawn. Finally, the qualitative study gave an insight into the experiences of patients with CVD using community pharmacy services and their expectations of the service they receive from community pharmacists. Recommendations about changes to pharmacy policy and practice in order to support pharmacists’ provision of CVD self-management advice are made.

Does self-affirmation promote physical activity regardless of threat level?

Background: Self-affirmation (i.e., focusing on a valued aspect of the self-concept) can promote health behaviour change. This study aimed to see if self-affirmation increased physical activity (PA) regardless of threat level presented in health messages. Methods: Sixty-eight participants were randomly allocated to condition in a 2 (self-affirmation, no affirmation) x 2 (high threat, low threat) between-participants design. Participants completed the Godin Leisure-Time Exercise Questionnaire at baseline and one week later to assess PA. Findings: A two-way ANCOVA with affirmation condition and threat level as predictor variables, controlling for baseline PA, was performed on follow up PA. Baseline PA was a significant predictor (F(1,63) = 399.63, p<0.001) and the main effect of affirmation condition approached significance (F(1,63) = 3.55, p=0.06). There were no other significant effects. Discussion: This study provides further evidence that self-affirmation can increase PA, but found no interaction between self-affirmation and threat level presented in health messages.

Developing a complex educational–behavioural intervention:the TREAT intervention for patients with atrial fibrillation

This article describes the theoretical and pragmatic development of a patient-centred intervention for patients with atrial fibrillation (AF). Theoretical models (Common Sense Model, Necessity-Concerns Framework), clinical frameworks, and AF patient feedback contributed to the design of a one-off hour-long behaviour-change intervention package. Intervention materials consisted of a DVD, educational booklet, diary and worksheet, which were patient-centred and easy to administer. The intervention was evaluated within a randomised controlled trial. Several “active theoretical ingredients” were identified (for e.g., where patients believed their medication was less harmful they spent more time within the therapeutic range (TTR), with general harm scores predicting TTR at 6 months). Allowing for social comparison and adopting behaviour change techniques enabled accurate patient understanding of their condition and medication. The process of developing the intervention using theory-derived content and evaluation tools allowed a greater understanding of the mechanisms by which this intervention was successful. Alleviating concerns about treatment medication by educating patients can help to improve adherence. This process of intervention development could be adopted for a range of chronic illnesses and treatments. Critical elements should include the use of: (1) clinical guidelines; (2) appropriate theoretical models; (3) patient input; and (4) appropriate evaluation tools.

A longitudinal evaluation of the acceptability and impact of a diet diary app for older adults with age-related macular degeneration

Ongoing advances in technology are increasing the scope for enhancing and supporting older adults’ daily living. The digital divide between older and younger adults raises concerns, however, about the suitability of technological solutions for older adults, especially for those with impairments. Taking older adults with Age-Related Macular Degeneration (AMD) as a case study, we used user-centred and participatory design approaches to develop an assistive mobile app for self-monitoring their intake of food [12,13]. In this paper we report on findings of a longitudinal field evaluation of our app that was conducted to investigate how it was received and adopted by older adults with AMD and its impact on their lives. Demonstrating the benefit of applying inclusive design methods for technology for older adults, our findings reveal how the use of the app raises participants’ awareness and facilitates self-monitoring of diet, encourages positive (diet) behaviour change, and encourages learning.

An exploration of the impact of the Green-Schools programme on the development of sustainable behaviours in the home

Concern for the sustainability of our planet is widespread. The ever-increasing economic activity and large scale industralisation our consumer society requires has increased concerns among academics, politicians, and consumers alike on natural resource depletion, waste management, dangers of toxic chemicals, and climate change. Human consumption is causing major issues for the space we inhabit. Much work has been done over the past four decades to remedy human impact on our environment at corporate, policy and consumer level. But concerns on our ability to progress the sustainability agenda remain. Consumer behaviour plays a pivotal role in sustainable development. In light of this, we need to explore and understand the ways in which consumption occurs in consumers lives, with an aim to changing behaviours that do not support the natural environment. Questions on how to change consumer behaviour dominate much of the literature on sustainable consumption, but substantial behaviour change among individuals has not occurred as predicted. Some focus has shifted to look at upstream interventions, such as education. The Green-Schools Programme (known internationally as Eco-Schools) is one such intervention. The aim of this thesis was to explore consumption in the context of the Green-Schools Programme. The main research question asks: in the context of the Green-Schools, how are sustainable behaviour practices developed in the home? The findings presented in this thesis show that sustainable behaviour has developed in the home from both internal and external factors, the Green-Schools effect being one such factor; the programme does influence behaviour in the home context to some degree. One of the main findings of this research indicates that schoolchildren are imparting ‘positive pester power’ on household behaviour practices and the majority of households are passively practicing sustainable consumption. These findings contribute to knowledge on sustainable consumption in the home context.

Randomized Trial for a Mobile Health Approach to Increase Uptake of Cervical Cancer Screening in Tanzania

Background: Largely due to low availability and uptake of screening in low- and middle-income countries, cervical cancer is the second ranked cancer among women in these countries. This is a tragedy because cervical cancer is one of the most preventable carcinomas. This thesis will investigate behaviour change methods, which capitalize on the recent exponential increase in ownership of mobile phones in Tanzania, to increase uptake of cervical cancer screening (CCS) in the Kilimanjaro region of Tanzania. Objectives: 1) To evaluate the effectiveness of behaviour change messages delivered via short message service (SMS) on the uptake of CCS in the Kilimanjaro region; 2) to evaluate the effectiveness of a transportation eVoucher on the uptake of CCS in the Kilimanjaro region; 3) to explore characteristics associated with CCS uptake in the Kilimanjaro region; and 4) to determine the attitudes towards and perceived benefit of behaviour change SMS messages and eVouchers intended to increase uptake of CCS. Methods: In the Kilimanjaro Region, 853 women participated in a randomized controlled trial. Baseline data was collected through self-report through systematic stratified random sampling. Participants were randomized to one of three groups: a control group, a group receiving behaviour change messages delivered via SMS, or a group receiving a travel eVoucher and identical SMS as the SMS group. A fieldworker recorded participants attending screening at the CCS clinics and administered a post-screening survey. The follow-up period was two months from the time of the participant’s enrolment. Logistic regression (both for the combined and stratified data sets) was used to determine associations between the behaviour change interventions, baseline characteristics and cervical cancer screening uptake. Results: All participants receiving SMS messages (SMS or eVoucher group) were more likely to attend cervical cancer screening in comparison with the control group. 83% of participants who attended screening shared the information contained in the messages with others. Conclusions: Behaviour change messages delivered via SMS and transportation eVouchers have the potential to increase uptake of cervical cancer screening in the Kilimanjaro region of Tanzania. Harnessing this potential will require implementing these interventions alongside other methods to achieve maximum impact.