Adherence to anti-hypertensive medication: proposing and testing a conceptual model.

OBJECTIVES: A conceptual model of the psychological factors underpinning adherence to anti-hypertensive medication is proposed and tested. The model suggests that adherence is influenced by three sets of variables: demography, health status, and perceived effects of medication; cognitions and motivation; and intention to adhere. METHODS AND DESIGN: Patients with known hypertension were recruited from three primary care practices in South-East England and were asked to complete a postal questionnaire. A total of 1,070 responses were received. The questionnaire asked about the three sets of predictor variables, and adherence. Eight weeks after the first questionnaire, a second was posted to all respondents, this time asking about adherence over the intervening period. RESULTS: The three sets of predictor variables were treated as blocks in a hierarchical model, so that each successive block added to the variance in adherence explained by the previous blocks. The data were analysed by hierarchical multiple regression. The predictors accounted for 19% of the variance in adherence at Time 1, and 34% at Time 2. The leading individual predictors at Time 1 were age, gender, conscientiousness, hypertensive identity, perceived behavioural control, and intention. At Time 2, they were the same, except that gender made way for adherence at Time 1. CONCLUSIONS: The model offers a parsimonious account, and the findings suggest a number of approaches to designing interventions to modify behaviour.

Living with Ankylosing Spondylitis: the patient's perspective.

Ankylosing Spondylitis (AS) is a potentially debilitating chronic condition that necessitates a biopsychosocial approach for successful long-term management. However, the psychosocial consequences of AS are not well understood. In this study patients (N = 68) reported impacts of AS across a wide range of life domains; negative impacts included physical effects of AS, changes in mood or personality, effects on social life and relationships with friends and family, low self-esteem, stigma and worry about the future; positive impacts included increased exercise, feelings of achievement and empathy, stronger relationships, slower pace of life and a more positive perspective. Implications for treatment are discussed.

An implementation intentions intervention to increase uptake of mammography.

BACKGROUND AND PURPOSE: This study tested an implementation intentions intervention to increase uptake in the United Kingdom's National Health Service Breast Screening Programme. The intervention asked women to plan how they would overcome up to 3 previously identified barriers to attending. METHODS: In a randomized controlled trial, 2,082 participants were allocated to an intervention condition, an assessment-only condition, or a nonassessment control condition. The intervention condition was designed to help women plan how to change their appointment, how to arrange transport, and how to negotiate time off work. The assessment-only condition controlled for the possibility that completing a questionnaire about mammography might in itself influence attendance, and the nonassessment condition was a control against any effect on attendance that mere contact with the research team might have. RESULTS: Mean age of respondents was 56.1 years, and 99.4% were White British. In the full intention-to-treat analysis, which included all participants, attendance was found to be almost identical across the 3 conditions, around 80%. Some of the women in the intervention condition, however, failed to write their plans on the questionnaire (10.6% for changing the appointment, 2.1% for travel arrangements, and 21.1% for taking time off work) or said that planning was irrelevant to them (2.4% for changing the appointment, 1.7% for travel arrangements, and 32.4% for taking time off work). A second analysis, of planning time off work, therefore, examined the 620 respondents in the intervention condition more closely and found that those who planned were significantly more likely to attend than those who did not. A 3rd analysis, excluding the 209 respondents for whom planning time off work was irrelevant, revealed that the most likely to plan were those whose initial intentions to attend were strong but whose perceptions of control over making the necessary arrangements to attend were weak. CONCLUSIONS: Two main implications of the findings are discussed: the importance of planning in implementation intentions interventions and the validity of the theoretical distinction between motivation and volition.

Encouraging young males to perform testicular self-examination: a simple, but effective, implementation intentions intervention.

OBJECTIVES: The objective of this study was to examine the effectiveness of a simple psychological intervention known as 'implementation intentions' to promote performance of testicular self-examination (TSE) in a sample of young males. METHOD: A prospective, randomized controlled design measured knowledge of testicular cancer, prior experience with TSE and intention to perform TSE within a 3-week period. Participants in the intervention group were instructed to formulate specific plans for when and where they would perform TSE. Three weeks later, a second questionnaire assessed self-reported performance of TSE during the study period and future intention to perform TSE. One hundred and fifty-nine male undergraduates aged between 18 and 35 were assigned, at random, to an intervention or non-intervention group. Men over 35 were excluded so that the sample reflected the highest risk age group for testicular cancer. Just under half the original participants (76/159) completed the study. We measured performance of TSE and future intention to perform TSE. RESULTS: Responders and non-responders did not differ on any of the measures assessed at Time 1. At Time 2, 30 (65%) participants in the intervention reported performing TSE compared with 12 (40%) in the control condition, and chi-squared analyses revealed that the difference was significant. CONCLUSIONS: The implementation intentions intervention procedure, which encourages the use of environmental and contextual 'cues' to prompt a desired behaviour, appears to offer a promising strategy for encouraging the performance of TSE.

Persuading school-age cyclists to use safety helmets: Effectiveness of an intervention based on the Theory of Planned Behaviour.

OBJECTIVES: To design and evaluate a theory-based intervention to encourage the use of protective helmets in school-age cyclists. DESIGN: Two-by-three mixed design on 97 cyclists who did not initially use a helmet: Condition (intervention/control) x Time (pre-intervention/immediately post-intervention/5-month follow-up). METHOD: The intervention builds on a previous study using the Theory of Planned Behaviour in which we identified a small number of salient beliefs that predict intention to use a safety helmet and helmet use (Quine et al., 1998). Participants were randomly assigned to intervention or control conditions. The intervention group was presented with a booklet containing a series of persuasive messages based on the identified salient beliefs, and the control group was presented with a different series of messages concerning a cycling proficiency and bicycle maintenance course. Initial beliefs were measured just before the intervention at Time 1, by questionnaire. The immediate effects of the intervention were evaluated by questionnaire at Time 2. Five months later, at Time 3, the long-term effects of the intervention on beliefs, intentions, and behaviour were assessed. RESULTS: The behavioural, normative and control beliefs and intentions of intervention participants became more positive than those of control participants, and the effect was maintained over time. There was also a significant effect on behaviour: at 5-month follow-up, none of the 49 control children had taken up helmet wearing, while 12 (25%) of the 48 intervention children had. CONCLUSIONS: The results suggest that in order to promote lasting helmet use in young cyclists, we need to change their beliefs. The intervention reported here may present an inexpensive solution to the problem of persuading adolescents to use safety helmets. The results point to the value of social cognition theories such as the Theory of Planned Behaviour in the design of effective interventions to change health behaviours.