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Reporting of the content and delivery characteristics of comparator interventions in published articles is often incomplete. This study examines the feasibility and validity of two methods for collecting additional information on comparator interventions from trial authors. In a systematic review of smoking cessation trials (IC-Smoke), all trial authors were asked to send unpublished comparator intervention materials and complete a specially-developed comparator intervention checklist. All published and additionally obtained information from authors were coded for behaviour change techniques (BCTs) and other characteristics (type of comparator, provider, provider training, delivery mode and treatment duration). To assess representativeness, we assessed the amount of additional information obtained from trial authors compared with the amount that was published. We examined known-group and convergent validity of comparator intervention data when using only published or also unpublished information. Additional information were obtained from 91/136 (67%) of trial authors. Representativeness, known-group and convergent validity improved substantially based on the data collected by means of the comparator intervention checklist, but not by requesting authors to send any existing comparator materials. Requesting authors for unpublished comparator intervention data, using specially-developed checklists and unpublished materials, substantially improves the quality of data available for systematic reviews. [ABSTRACT FROM AUTHOR]

Although HIV incidence and mortality rates have declined over the past 20 years, HIV health disparities continue to persist among patients living in urban communities. Barriers to proficient health outcomes for persons with HIV (PWH) in urban communities include lack of access to care, resulting from limited transportation or clinic availability. While healthcare systems in rural communities provide telemedicine (TM) services to PWH to eliminate transportation and accessibility barriers, few examples exist regarding TM use for PWH in urban communities. This project's goal was to increase the provision of healthcare services in an urban setting to PWH, using TM. As guided by "Integration of Healthcare Delivery Service" theories and key principles, we created an integration framework comprised of several simultaneous, overlapping activities to include: (1) capacity building (2) clinical standardization (3) community and patient engagement and (4) evaluation performance and measurements. This paper describes major activities involved with developing, implementing and evaluating a TM program for PWH. We discuss results, challenges, and lessons learned from integrating this program into our existing healthcare system. [ABSTRACT FROM AUTHOR]

There is a need for a measure to monitor adherence to transmission-reducing behaviours (TRBs) during pandemics. An adherence measure can monitor current TRBs, assess change over time and, potentially, predict later behaviours. The TRB adherence measure (scale consisting of seven items) includes questions based on government behavioural directives in Scotland that were common internationally, i.e., physical distancing, face covering and hand hygiene. Data were collected weekly for 6 weeks at the beginning of the pandemic, including a later follow-up repeated measure of some participants, in 20-minute structured telephone surveys with a nationally representative random sample of adults in Scotland. A total of 2969 people completed the adherence items and were highly adherent. Confirmatory factor analysis supported a unidimensional scale (CFI =.95; TLI =.93; RMSEA =.08; SRMR =.08), although internal consistency was low (Cronbach's alpha =.49). The adherence score significantly predicted adherence to a validity test item (ΔR2 =.114, F(1,2964) = 379.76, p <.001). It also predicted adherence to TRBs later over and above personal habitual styles (Creature of Habit Scale: COHS). The adherence score has been developed for routine monitoring of adherence to TRBs during the COVID-19 pandemic. It can be used to predict future similar behaviours and adherence to other behaviours, although it may be necessary to explore adherence to the specific behaviours occasionally. Adherent behaviour for one TRB is likely to be associated with adherence to government directives to other TRBs. Importantly, these TRBs are likely to be crucial in reducing COVID-19 case numbers, as well as protecting against other infectious diseases including influenza and the common cold. [ABSTRACT FROM AUTHOR]

ehaviour change is a key to addressing many health and healthcare problems and interventions have been designed to improve health outcomes. These behaviour change interventions have been evaluated in many ways, including randomised controlled trials, and over recent decades there has been considerable progress in the conduct and reporting these studies. This paper is a personal retrospection on the changes occurring that have resulted in our current improved methods and their potential for future advancement. There has been steady development of methods for conducting trials, including advances in statistical methods enabled by increase computing power and programmes, greater attention to the recruitment of participants and in the specification of outcomes. Trial reporting has improved, largely due to publication of guidelines for reporting interventions and trials, but until recently the reporting of behaviour change interventions has been quite limited. Developments in the specification of active ingredients of these interventions, the behaviour change techniques, has transformed our ability to report interventions in a manner that facilitates evidence synthesis and enables replication and implementation. However, further work using ontological approaches is needed to adequately represent the evidence contained in the mass of accumulated studies. Meanwhile, attention is gradually being paid to the comparator groups in trials leading to better reporting but with continuing challenges about how control groups are selected. These developments are important for the advancements of behavioural science – but also in consolidating the expertise needed to address global social, environmental and health challenges. [ABSTRACT FROM AUTHOR]

To describe the process of developing a cognitive rehabilitation intervention for patients with post-stroke cognitive impairment (PSCI) and to describe the intervention prior to evaluation in a pilot randomised controlled trial (RCT). Method: The Medical Research Council framework, 'Developing and evaluating complex interventions', was used to develop the cognitive rehabilitation intervention. We conducted a combined analysis of the existing evidence base for PSCI rehabilitation alongside qualitative exploration of the perspectives of stroke survivors, their families, and healthcare professionals providing stroke care, on the necessary components for a cognitive rehabilitation intervention for PSCI. The Template for Intervention Description and Replication checklist was used as a structural framework for the description of the intervention. Results: The intervention comprises a five-week intervention integrating group-based activities, supported by a clinical neuropsychologist, with home-based activities to encourage self-efficacy through the practice of adjustment and compensatory strategies learned in the group format to achieve the patients' identified goals in managing their PSCI. Conclusion: A cognitive rehabilitation intervention for patients with PSCI has been developed and described. We are in the process of developing a structured intervention manual to standardise the content and delivery of the intervention for further testing in a pilot RCT. [ABSTRACT FROM AUTHOR]

Despite its importance, underreporting of the active content of experimental and comparator interventions in published literature has not been previously examined for behavioural trials. We assessed completeness and variability in reporting in 142 randomised controlled trials of behavioural interventions for smoking cessation published between 1/1996 and 11/2015. Two coders reliably identified the potential active components of experimental and comparator interventions (activities targeting behaviours key to smoking cessation and qualifying as behaviour change techniques, BCTs) in published, and in unpublished materials obtained from study authors directly. Unpublished materials were obtained for 129/204 (63%) experimental and 93/142 (65%) comparator groups. For those, only 35% (1200/3403) of experimental and 26% (491/1891) of comparator BCTs could be identified in published materials. Reporting quality (#published BCTs/#total BCTs) varied considerably between trials and between groups within trials. Experimental (vs. comparator) interventions were better reported (B(SE) = 0.34 (0.11), p <.001). Unpublished materials were more often obtained for recent studies (B(SE) = 0.093 (0.03), p =.003) published in behavioural (vs. medical) journals (B(SE) = 1.03 (0.41), p =.012). This high variability in underreporting of active content compromises reader's ability to interpret the effects of individual trials, compare and explain intervention effects in evidence syntheses, and estimate the additional benefit of an experimental intervention in other settings. [ABSTRACT FROM AUTHOR]

Objective: Communication of the content of a behaviour change intervention (BCI) involves clear description followed by appropriate recognition and interpretation. We investigated accuracy of recognition of BCI descriptions and the effects of training in the behaviour change taxonomy BCTTv1. Methods: Materials were 166 written descriptions of two BCIs previously written by 166 separate writers after viewing a video of the BCI. Each of the current participants (12 naïve and 12 trained in BCTTv1) was presented with a random sample of the written descriptions and asked to form groups of descriptions they judged to be describing the same intervention. For each participant, we assessed the number of groupings of BCI descriptions, their purity (containing only one BCI) and their differentiation (having a dominant BCI). Results: All except one participant classified the descriptions into more than two groupings. Naïve participants created significantly more groupings, fewer ‘pure’ groupings and less differentiated groupings (all Mann-Whitney p < .05). Conclusions: Written communications of BCI contents may not be recognised and interpreted adequately to support implementation. BCT taxonomy training may lead to some progress in interpreting the active content of interventions but, based on this limited study, further progress is needed if BCIs for accurate implementation. [ABSTRACT FROM AUTHOR]

The article presents the opinion of the author on variation in the behaviour of people as described by Professor J. Ogden. The author favors the role of variability in theories, methods and practices to create the link between health and behaviour of both patients and healthcare professionals. The author also supports Behaviour Change Technique Taxonomy, but also suggests that not all variability is effective.

The author discusses the aspects of design and implementation of behavior change interventions and the techniques used for meta-analyses of randomised controlled trials. The author is critical of limitations in the analysis of single behavior change techniques (BCTs) and notes the methods of behavior change. Also investigated is Great Britain's public health guidance on behavior change by National Institute of Health and Care Excellence's (NICE).

Purpose: After stroke, physical activity and physical fitness levels are low, impacting on health, activity and participation. It is unclear how best to support stroke survivors to increase physical activity. Little is known about the barriers and facilitators to physical activity after stroke. Thus, our aim was to explore stroke survivors' perceived barriers and facilitators to physical activity. Methods: Semi-structured interviews with 13 ambulatory stroke survivors exploring perceived barriers and facilitators to physical activity post stroke were conducted in participants' homes, audio-recorded and transcribed verbatim. The Theoretical Domains Framework (TDF) informed content analysis of the interview transcripts. Results: Data saturation was reached after interviews with 13 participants (median age of 76 years (inter-quartile range (IQR) = 69-83 years). The median time since stroke was 345 d (IQR = 316-366 d). The most commonly reported TDF domains were 'beliefs about capabilities', 'environmental context and resources' and 'social influence'. The most commonly reported perceived motivators were: social interaction, beliefs of benefits of exercise, high self-efficacy and the necessity of routine behaviours. The most commonly reported perceived barriers were: lack of professional support on discharge from hospital and follow-up, transport issues to structured classes/interventions, lack of control and negative affect. Conclusions: Stroke survivors perceive several different barriers and facilitators to physical activity. Stroke services need to address barriers to physical activity and to build on facilitators to promote physical activity after stroke. [ABSTRACT FROM AUTHOR]

The International Classification of Functioning Disability and Health (ICF) offers an agreed language on which a scientific model of functional outcomes can be built. The ICF defines functional outcomes as activity and activity limitations (AL) and defines both in behavioural terms. The ICF, therefore, appears to invite explanations of AL as behaviours. Studies of AL find that psychological variables, especially perceptions of control, add to biomedical variables in predicting AL. Therefore, two improved models are proposed, which integrate the ICF with two psychological theories, the theory of planned behaviour (TPB) and social cognitive theory (SCT). These models have a sound evidence base as good predictors of behaviour, include perceived control constructs and are compatible with existing evidence about AL. When directly tested in studies of community and clinic-based populations, both integrated models (ICF/TPB and ICF/SCT) outperform each of the three basic models (ICF, TPB and SCT). However, when predicting activity rather than AL, the biomedical model of the ICF does not improve prediction of activity by TPB and SCT on their own. It is concluded that these models offer a better explanation of functional outcomes than the ICF alone and could form the basis for the development of improved models. [ABSTRACT FROM PUBLISHER]

Purpose: The aim of the study was to explore if the impact of osteoarthritis varies with respect to age, gender and social deprivation. Impact was defined as impairment, activity limitations and participation restriction (International Classification of Functioning, Disability and Health (ICF)). Investigating the functioning of the ICF model for subgroups is important both practically and theoretically. Method: The sample comprised a community sample of 763 people diagnosed with osteoarthritis. Uncontaminated measures of the ICF constructs were developed using discriminant content validity from a pool of 134 items, including the WOMAC and SF-36. Multigroup Structural Equation Modelling was used to explore if the same pathways exist for subgroups of gender, age and social deprivation. Results: Different significant paths were found for gender and social deprivation: impairment did not predict participation restriction for women and those most deprived, whereas these paths were significant for men and those less deprived. No difference in the paths was found for age. Conclusions: The impact of osteoarthritis appears to vary with respect to gender and social deprivation but not age. This suggests both that osteoarthritis per se does not adequately explain the health outcomes observed and that different clinical approaches may be appropriate for people of different gender and levels of deprivation. [ABSTRACT FROM AUTHOR]

Objectives: Stroke can cause impairment in emotion perception, but the social consequences of these problems have not been explored to date. In a group of patients with stroke, this study investigated whether difficulties in emotion perception related to social participation and quality-of-life. It also assessed whether these relationships remained significant when controlling for activity limitations. Method: Individuals 1 year post-stroke ( n = 28) and control participants ( n = 40) were assessed on emotion perception across different modalities. Activity limitations, social participation, and multiple domains of quality-of-life were assessed in patients. Results: Participants with stroke were impaired on emotion perception compared to controls. Emotion perception problems in stroke were significantly correlated with social participation and psychological aspects of QoL, but not with activity limitations. Conclusions: The strong relationships of emotion perception with social participation and psychological aspects of QoL following stroke may have implications for post-stroke outcomes. [ABSTRACT FROM AUTHOR]

Background: Previous research has supported an integrated biomedical and behavioural model explaining activity limitations. However, further tests of this model are required at the within-person level, because while it proposes that the constructs are related within individuals, it has primarily been tested between individuals in large group studies. We aimed to test the integrated model at the within-person level. Method: Six correlational N-of-1 studies in participants with arthritis, chronic pain and walking limitations were carried out. Daily measures of theoretical constructs were collected using a hand-held computer (PDA), the activity was assessed by self-report and accelerometer and the data were analysed using time-series analysis. Results: The biomedical model was not supported as pain impairment did not predict activity, so the integrated model was supported partially. Impairment predicted intention to move around, while perceived behavioural control (PBC) and intention predicted activity. PBC did not predict activity limitation in the expected direction. Conclusions: The integrated model of disability was partially supported within individuals, especially the behavioural elements. However, results suggest that different elements of the model may drive activity (limitations) for different individuals. The integrated model provides a useful framework for understanding disability and suggests interventions, and the utility of N-of-1 methodology for testing theory is illustrated. [ABSTRACT FROM AUTHOR]

Purpose: This study examined whether the mental representations of people with osteoarthritis (OA) were consistent with the International Classification of Functioning Disability and Health (ICF) model. Methods: A geographical cohort of 202 people with OA about to have joint replacement surgery completed postal questionnaires. Mental representations were measured by asking participants what they were hoping for from their joint replacement. Two expert judges classified these illness representations to the main ICF constructs of Impairment (I), Activity Limitation (A) and Participation Restriction (P). Results: There was strong agreement between the expert judges. There were a similar number of illness representations for each of the ICF constructs. The primary biomedical route of the ICF model was suggested by the ordering of the participants' illness representations i.e. I to A to P. Conclusions: The mental representations of people with OA were consistent with the ICF theoretical framework with all three ICF constructs of importance. It appeared that people with OA implicitly apply a biomedical causal model of disability, suggesting that treatments and interventions aimed at reducing impairment may only affect P indirectly, through A. Additionally, the methods provide a novel way of exploring the potential causal relationships between constructs of the ICF model. [ABSTRACT FROM AUTHOR]

The Theory of Planned Behaviour (TPB) can identify cognitions that predict differences in behaviour between individuals. However, it is not clear whether the TPB can predict the behaviour of an individual person. This study employs a series ofn-of-1 studies and time series analyses to examine the ability of the TPB to predict physical activity (PA) behaviours of six individuals. Sixn-of-1 studies were conducted, in which TPB cognitions and up to three PA behaviours (walking, gym workout and a personally defined PA) were measured twice daily for six weeks. Walking was measured by pedometer step count, gym attendance by self-report with objective validation of gym entry and the personally defined PA behaviour by self-report. Intra-individual variability in TPB cognitions and PA behaviour was observed in all participants. The TPB showed variable predictive utility within individuals and across behaviours. The TPB predicted at least one PA behaviour for five participants but had no predictive utility for one participant. Thus,n-of-1 designs and time series analyses can be used to test theory in an individual. [ABSTRACT FROM AUTHOR]

Purpose: The predictive utility of an integrated model of disability is tested. The integrated model incorporates an impairment based model (International Classification of Functioning, Disability and Health (ICF)) and the behavioural models. Methods: Community dwelling adults (n = 628) completed a postal questionnaire measuring the integrated model. The ability of the model to predict disability in the form of activity limitations (ALs) and walking, in the full community sample and in respondents reporting chronic pain was tested. Results: In both the community and chronic pain samples each version of the integrated model explained a majority (55%-67%) of the variance in ALs but only 11%-29% of the variance in walking behaviour (WB). Impairment directly predicted ALs but did not directly predict WB. Control related cognitions were direct predictors, and mediators, of the relationship between bodily impairment and both ALs and WB. In addition, intentions and outcome expectancies predicted WB. Self-efficacy (SE) was the most consistent predictor of both ALs and WB. Conclusions: An integrated model which combines psychological constructs and impairment is required for an adequate understanding of ALs. By contrast, behavioural models, but not degree of impairment, are necessary to explain activity levels. [ABSTRACT FROM AUTHOR]

Purpose: A formal decision-making and consensus process was applied to develop the first version of the International Classification on Functioning, Disability and Health (ICF) Core Sets for Hand Conditions. Method: To convene an international panel to develop the ICF Core Sets for Hand Conditions (HC), preparatory studies were conducted, which included an expert survey, a systematic literature review, a qualitative study and an empirical data collection process involving persons with hand conditions. A consensus conference was convened in Switzerland in May 2009 that was attended by 23 healthcare professionals, who treat hand conditions, representing 22 countries. Results: The preparatory studies identified a set of 743 ICF categories at the second, third or fourth hierarchical level. Altogether, 117 chapter-, second-, or third-level categories were included in the comprehensive ICF Core Set for HC. The brief ICF Core Set for HC included a total of 23 chapter- and second-level categories. Conclusions: A formal consensus process integrating evidence and expert opinion based on the ICF led to the formal adoption of the ICF Core Sets for Hand Conditions. The next phase of this ICF project is to conduct a formal validation process to establish its applicability in clinical settings. [ABSTRACT FROM AUTHOR]

Information on this issue of the journal "Health Psychology Review" is presented, including a discussion on the conceptual and methodological advances in behavior change, standards for identifying and evaluating behavior change intervention and an overview of articles that used behavior change therapy (BCT).

Reducing obesity is an important preventive strategy for people who are at increased risk of major disabling or life-threatening conditions. Behavioural treatments for obesity are complex and involve several components aiming to facilitate behaviour change. Systematic reviews need to assess the components that moderate intervention effects. Electronic databases and journals were searched for randomised controlled trials of behavioural interventions targeting dietary and/or physical activity change for obese adults (mean BMI≥30, mean age≥40 years) with risk factors and follow-up data≥12 weeks. A reliable taxonomy of theory-congruent behaviour change techniques (BCTs; Abraham & Michie, 2008) was used to identify programme components. Meta-regression suggested that increasing numbers of identified BCTs are not necessarily associated with better outcomes. The BCTs provision of instructions (β =− 2.69, p=0.02), self-monitoring (β = − 3.37, p<0.001), relapse prevention (β = − 2.63, p=0.02) and prompting practice (β = − 3.63, p<0.001) could be linked to more successful interventions. Studies including more BCTs aimed at dietary change that are congruent with Control Theory were associated with greater weight loss (β = − 1.13, p=0.04). Post-hoc ratings of intervention components in published trials can lead to the identification of components and theories for behaviour change practice and research. [ABSTRACT FROM PUBLISHER]

Failing to achieve healthy intentions can have a direct impact on subsequent health. The extent of this impact is partially determined by the size of the discrepancy between intentions and behaviour, that is, on whether an unachieved behavioural target is missed by an inch or a mile. Over two studies, measures of 'executive control' ability were used to predict the size of the intention-behaviour gap for two dietary behaviours - eating fruits and vegetables and snacking. In Study 1, participants (n = 50) reported intended dietary intake, completed objective and self-report measures of executive control ability and recorded actual dietary intake over 3 days with computerised diaries. Using multiple regression, general executive control ability was found to account for 16-23% of the variance in the size of intention-behaviour gap for both the dietary behaviours. In Study 2 (n = 52), deviation from intentions about snacking was significantly related to individual differences in prepotent response inhibition. Overall, individuals with weak executive control ate less fruits and vegetables and more snacks than intended. Intention-behaviour 'failures' are not homogenous, but instead vary predictably with the availability of executive control resources. This suggests that individuals with large intention-behaviour shortfalls may benefit from interventions designed to reduce the demands on executive control. [ABSTRACT FROM AUTHOR]

In interview studies, sample size is often justified by interviewing participants until reaching 'data saturation'. However, there is no agreed method of establishing this. We propose principles for deciding saturation in theory-based interview studies (where conceptual categories are pre-established by existing theory). First, specify a minimum sample size for initial analysis (initial analysis sample). Second, specify how many more interviews will be conducted without new ideas emerging (stopping criterion). We demonstrate these principles in two studies, based on the theory of planned behaviour, designed to identify three belief categories (Behavioural, Normative and Control), using an initial analysis sample of 10 and stopping criterion of 3. Study 1 (retrospective analysis of existing data) identified 84 shared beliefs of 14 general medical practitioners about managing patients with sore throat without prescribing antibiotics. The criterion for saturation was achieved for Normative beliefs but not for other beliefs or studywise saturation. In Study 2 (prospective analysis), 17 relatives of people with Paget's disease of the bone reported 44 shared beliefs about taking genetic testing. Studywise data saturation was achieved at interview 17. We propose specification of these principles for reporting data saturation in theory-based interview studies. The principles may be adaptable for other types of studies. [ABSTRACT FROM AUTHOR]

Cognitions influence recovery from activity limitations. In this study we aimed to independently test, compare and combine the common sense self-regulation model (CS-SRM) and social cognitive theory (SCT) in predicting recovery from activity limitations due to acute injury. Measures were gathered at two time points 5-6 weeks apart. The sample consisted of 146 university students (Mean age: 21.86, SD: 4.83, 62% female) with a heterogeneous range of injuries that limited their participation in physical activity. The dependent variable was recovery from activity limitations (Physical Functioning - Short Form-36). The predictor variables were measured using the Brief Illness Perception Questionnaire and SCT items designed according to theoretical recommendations. Time-line (TL) and self-efficacy (SE) were significant predictors of recovery in a multivariate analysis, controlling for reported pain at Time 1. A combined model including the best predictors from both models, TL (β = -0.25, p < 0.05, R2 change = 0.17, p < 0.01) and SE (β =0.31, p < 0.05, R2 change = 0.05, p < 0.05), accounted for a significant amount of the variance in recovery from activity limitations. A combination of key variables from both models may be particularly useful for understanding the cognitive factors that influence recovery from activity limitations. [ABSTRACT FROM AUTHOR]

This editorial addresses two key aspects of the investigation of behaviour: the science and the application. On the one hand, researchers and policy makers recognise a need for good scientific evidence about behaviour and behaviour change, but are slow to turn to psychology for such evidence. On the other hand, there is a gap in scientific thinking about behaviour and behaviour change. [ABSTRACT FROM AUTHOR]

This study investigated whether Negative Affectivity (NA) causes bias in self-report measures of activity limitations or whether NA has a real, non-artifactual association with activity limitations. The Symptom Perception Hypothesis (NA negatively biases self-reporting), Disability Hypothesis (activity limitations cause NA) and Psychosomatic Hypothesis (NA causes activity limitations) were examined longitudinally using both self-report and objective activity limitations measures. Participants were 101 stroke patients and their caregivers interviewed within two weeks of discharge, six weeks later and six months post-discharge. NA and self-report, proxy-report and observed performance activity (walking) limitations were assessed at each interview. NA was associated with activity limitations across measures. Both the Disability and Psychosomatic Hypotheses were supported: initial NA predicted objective activity limitations at six weeks but, additionally, activity limitations at six weeks predicted NA at six months. These results suggest that NA both affects and is affected by activity limitations and does not simply influence reporting. [ABSTRACT FROM AUTHOR]

Provides information on a study that reviewed several studies explicitly applying the Theory of Planned Behavior to behavioral change interventions. Methodology used; Results and discussion.

Presents a study that investigated whether measures of several perceived control concepts tapped independent dimensions, were invariant to population characteristics of health and culture, were differentially sensitive to health outcomes, and were discriminable from self-report disability. Information on perceived control; Details on locus of control; Relationship between various measures of perceived control and disability.

Presents information on a study which identified clinical predictors of distress following an acute stroke. Reasons for the occurrence of depressed mood following an acute stroke; Methods used; Results; Discussion.

Focuses on a study which investigated whether the finding that perceived control cognition predicted recovery from stroke could be replicated in a larger sample recruited at an early stage following stroke. Methodology; Results of the study.

In this article, the author responds to the paper by Tom Shakespeare and Nicholas Watson that defends the social model of disability in its wider context. The WHO model has been widely used as a model of disability and continues to be the implicit model adopted in the delivery of health care. The model has been criticised in a variety of ways with resulting suggestions that it be modified or abandoned. However the model offers a useful starting point by clearly separating the concepts of "impairment" and "disability." The model proposes that disability is the result of impairment, but opens up the possibility that other factors may also influence disability. Clarification of these other factors is essential to the viability of this model. Since disability is defined in behavioural terms, it seems obvious that disability should be influenced by the same variables as influence other behaviours, including physiological, environmental, social, cognitive and emotional factors. The author has proposed that it is possible to integrate the WHO model with some of the current most strongly validated theories of behaviour.

The proposal that theories in health psychology are becoming more “intra-active” may arise because earlier “intra-active” theories which were unsuccessful have been omitted from the analysis. A greater problem for health psychology would appear to be the lack of well-developed theories. [ABSTRACT FROM PUBLISHER]

The purpose of the current study was to determine which psychological models are most useful in predicting uptake of a prenatal screening test, maternal-serum alphafetoprotein screening for spina bifida and Down's syndrome. 1000 women eligible for the test completed standardised self-report questionnaires at two routine clinic visits to an antenatal clinic prior to the time when the test could take place. 902 underwent the screening test; 51 declined the test; and 47 did not undergo the test, giving no reason for this to staff. Knowledge of the test, the subjective expected utility attached to the test, and attitudes to doctors and medicine were all significant predictors of uptake behaviour. Results of a discriminant function analysis demonstrated distinct psychological processes underlying each of these three uptake behaviours, explaining 21% of the variance in uptake of screening. If uptake of screening is examined not as a dichotomous variable but as a group of behaviours, predictive models are identified accordingly. This would lead to rnodels of health-related behaviours as a heterogeneous rather than homogeneous phenomena, predicted and influenced by different causes. [ABSTRACT FROM PUBLISHER]

The behaviour of health professionals is rarely considered systematically by psychologists. This paper makes the following argument: first, that the behaviour of health professionals is influenced by other factors as well as medical knowledge; second, that various psychological models of human behaviour previously used only in considering the behaviour of patients may also be used to explain, predict and change the behaviour of health professionals; third, to implement effective care the behaviour of health professionals needs to be considered alongside that of patients. [ABSTRACT FROM PUBLISHER]

The main approach to rectifying the well documented poor basic life support (BLS) skills of doctors and nurses, based on a Skills Model, has met with only partial success. This study compares the utility of a Skills Model with one that incorporates a cognitive component in predicting BLS skills. Outcome-expectancy, self-efficacy, training and experience of BLS, and BLS ability were assessed in 53 trained nurses. Ability was unrelated to training or experience of BLS. Nurses who scored highest on the BLS skills assessment perceived the procedure as significantly more successful than those with lower scores. Self-efficacy was unrelated to ability, but was related to status: senior nurses were significantly more confident but no more competent in performing BLS than junior nurses. Nurses who had attended more arrests, while more confident, were no more competent than those who had attended fewer. Assessment of BLS skills reduced self-efficacy beliefs. A model for predicting the relationship between self-assessed ability and objectively assessed skill is outlined. [ABSTRACT FROM PUBLISHER]

Patients participating in an in vim fertilisation with embryo transfer (IVF and ET) programme face uncertainty at each stage of the procedure. Research on heuristics and on stress lead to predictions about behaviour in situations of uncertainty. It was predicted that IVF and ET participants would overestimate the likelihood of success, due to publicity the process has received, and would underestimate the likelihood of an earlier, less publicised. stage in the procedure. Both predictions were confirmed in a total of 70 participants (26 women at out-patient clines, 23 of their partners and 21 surgical in-patients). All the men and all but one woman overestimated the likelihood of becoming pregnant and having a baby. and most of the surgical patients underestimated the likelihood of egg recovery. Estimates were not related to patients' confidence about their information, confirming previous evidence about confidence in inaccurate judgements based on heuristics. Data on patients' distress as indicated by mood rating show high anxiety at points of uncertainty and Pailure, as found in other studies of stress. While the couples shared their inaccurate judgements. they did not necessarily share their distress. The results are discussed in terms of patients' decision making. coping strategies and the implications for doctor-patient communication. [ABSTRACT FROM PUBLISHER]