Predicting and facilitating upward family communication as a mammography promotion strategy

Breast cancer is the second most common cause of cancer-related death amongst Australian women. Regular screening mammography is the best way to facilitate early detection of breast cancer, which in turn increases the chances of survival. Although BreastScreen Australia offers free biennial mammograms to women aged 40 and above (particularly targeting women between the ages of 50-69), many eligible women fail to attend for regular mammography. Mass media campaigns that have aimed to promote mammography to eligible women have not been sufficient to raise the mammography screening rate from the current 57.1% to the target 70%. The central premise of this thesis is that interpersonal influence may complement the mass media approach to mammography promotion, and serve to increase the national screening rate. In particular, in light of previous research that has identified the family has as a potential vehicle for delivering health promotion messages, the potential role that a daughter could play in influencing her mother’s health behaviour was given particular attention in the current project. Everyday interpersonal communication initiated by the daughter directed at the mother is referred to as ‘upward family communication’ in this thesis. Upward family communication about mammography is a novel approach to mammography promotion, and the purpose of the research presented in this thesis was to explore the viability of this strategy. Family Communication Patterns theory describes four family types based on two dimensions: the conversation orientation and the conformity orientation. This theoretical framework is used in the current project to inform predictions about upward family communication about mammography, particularly in relation to identifying which mother-daughter dyads are likely to engage in such communication effectively. The Revised Family Communication Patterns (RFCP) instrument, used to classify families according to type, was modified as part of the current project for use specifically with mother-daughter dyads. Tailoring the instrument for use specifically with mother-daughter dyads has not previously been attempted, and the data from this project indicate that the internal consistency of the instrument was not compromised in this process. Semi-structured interviews were conducted with eight mother-daughter pairs to explore the nature of existing communication patterns within this relationship, and the modified RFCP instrument was able to differentiate between mother-daughter dyads with different communication patterns. The data from these interviews indicate that while upward family communication about health is commonplace within these dyads, mammography is not likely to be a spontaneous topic of conversation initiated by daughters. Thus, two daughter-targeted interventions were piloted that aimed to predict and facilitate upward family communication about mammography. With the Theory of Planned Behaviour (TPB) providing the theoretical background, a volitional intervention using implementation intentions and a motivational intervention using counterfactual thinking were piloted with independent samples. These studies represent the first attempts at using the TPB to predict and facilitate upward family communication about mammography and at applying implementation intentions and counterfactual thinking to this communication behaviour. Young women who participated in the implementation intention (volitional) intervention were significantly more likely to have initiated a conversation with their mothers about mammography within an eight-week period than controls (N = 116). In contrast, young women who participated in the counterfactual thinking (motivational) intervention were no more likely to have initiated the specified conversation than controls (N = 131). In both studies, the TPB variables predicted both intention and behaviour with some accuracy, thus contributing to the body of knowledge about the utility of this theoretical model. Notably, in both studies, young women reported that initiating a conversation about mammography with their mother had positive consequences, such as increases in knowledge, and an elevated likelihood that their mother would have a mammogram. This result provided evidence for daughters’ willingness to engage in an upward family communication mammography promotion strategy, and for the effectiveness of this novel approach. The primary contribution of the project presented in this thesis is the provision of convergent evidence for the viability and effectiveness of an upward family communication strategy to promote mammography to target women. The current project has also presented a means for identifying mother-daughter dyads most amenable to this novel mammography promotion approach using the predictions of Family Communication Patterns Theory. Further, the results of this project have demonstrated that the TPB model has utility for predicting upward family communication about mammography, and has potential for guiding interventions aimed at facilitating this behaviour

Highlighting the unmet needs of Australian adults with diabetes : first results from Diabetes MILES - Australia

In July 2011, The Australian Centre for Behavioural Research in Diabetes undertook a national survey of adults with type 1 and type 2 diabetes. The survey focused on the psychological, social, and behavioural aspects of living with diabetes.<br /

“I call it the blame and shame disease”: a qualitative study about perceptions of social stigma surrounding type 2 diabetes

AbstractObjectives While health-related stigma has been the subject of considerable research in other conditions (obesity and HIV/AIDS), it has not received substantial attention in diabetes. The aim of the current study was to explore the social experiences of Australian adults living with type 2 diabetes mellitus (T2DM), with a particular focus on the perception and experience of diabetes-related stigma.Design A qualitative study using semistructured interviews, which were audio recorded, transcribed and subject to thematic analysis.Setting This study was conducted in non-clinical settings in metropolitan and regional areas in the Australian state of Victoria. Participants were recruited primarily through the state consumer organisation representing people with diabetes.Participants All adults aged &ge;18 years with T2DM living in Victoria were eligible to take part. Twenty-five adults with T2DM participated (12 women; median age 61 years; median diabetes duration 5 years).Results A total of 21 (84%) participants indicated that they believed T2DM was stigmatised, or reported evidence of stigmatisation. Specific themes about the experience of stigma were feeling blamed by others for causing their own condition, being subject to negative stereotyping, being discriminated against or having restricted opportunities in life. Other themes focused on sources of stigma, which included the media, healthcare professionals, friends, family and colleagues. Themes relating to the consequences of this stigma were also evident, including participants&rsquo; unwillingness to disclose their condition to others and psychological distress. Participants believed that people with type 1 diabetes do not experience similar stigmatisation.Conclusions Our study found evidence of people with T2DM experiencing and perceiving diabetes-related social stigma. Further research is needed to explore ways to measure and minimise diabetes-related stigma at the individual and societal levels, and also to explore perceptions and experiences of stigma in people with type 1 diabete

Suicidal ideation or non-suicidal self-harm? A mismatch between the DSM-IV criterion and PHQ-9 item nine

Keywords: Depression, Suicidal ideation, Self-harm, Diabetes, PHQ-9, Diabetes MILES Stud

Diabetes MILES Youth–Australia: methods and sample characteristics of a national survey of the psychological aspects of living with type 1 diabetes in Australian youth and their parents

Background Type 1 diabetes is a complex and demanding condition, which places a substantial behavioural and psychological burden on young people and their families. Around one-third of adolescents with type 1 diabetes need mental health support. Parents of a child with type 1 diabetes are also at increased risk of psychological distress. A better understanding of the motivators, behaviours and psychological well-being of young people with diabetes and their parents will inform improvement of resources for supporting self-management and reducing the burden of diabetes. The Diabetes MILES (Management and Impact for Long-term Empowerment and Success) Youth–Australia Study is the first large-scale, national survey of the impact of diabetes on the psychosocial outcomes of Australian adolescents with type 1 diabetes and their parents. Methods/design The survey was web-based to enable a large-scale, national survey to be undertaken. Recruitment involved multiple strategies: postal invitations; articles in consumer magazines; advertising in diabetes clinics; social media (e.g. Facebook, Twitter). Recruitment began in August 2014 and the survey was available online for approximately 8 weeks. A total of 781 young people (aged 10–19 years) with type 1 diabetes and 826 parents completed the survey. Both genders, all ages within the relevant range, and all Australian states and territories were represented, although compared to the general Australian population of youth with type 1 diabetes, respondents were from a relatively advantaged socioeconomic background. Discussion The online survey format was a successful and economical approach for engaging young people with type 1 diabetes and their parents. This rich quantitative and qualitative dataset focuses not only on diabetes management and healthcare access but also on important psychosocial factors (e.g. social support, general emotional well-being, and diabetes distress). Analysis of the Diabetes MILES Youth–Australia Study data is ongoing, and will provide further insights into the psychosocial problems facing young people with type 1 diabetes and their parents. These will inform future research and support services to meet the needs of young Australians with type 1 diabetes and their families. Keywords Type 1 diabetes Psychological well-being National survey Adolescents Self-care Quality of life Diabetes distress Depressio

Associations between economic hardship and markers of self-management in adults with type 2 diabetes: results from Diabetes MILES - Australia

A socioeconomic gradient exists in Australia for type 2 diabetes mellitus (T2DM). It remains unclear whether economic hardship is associated with T2DM self-management behaviours

Cohort profiles of the cross-sectional and prospective participant groups in the second Diabetes MILES-Australia (MILES-2) study

Purpose More research into the psychosocial aspects of diabetes is needed so that the health and quality of life of people with the condition can be improved. To fill this gap, we conducted the second Diabetes MILES&mdash;Australia study (MILES-2), a survey focused on psychological, behavioural and social aspects of diabetes. The aim of the MILES-2 study was to provide a (1) longitudinal follow-up of the original MILES 2011 study cohort; (2) cross-sectional assessment of a new cohort.Participants Eligible participants were English-speaking Australians with type 1 or type 2 diabetes, aged 18&ndash;75 years. Longitudinal cohort participants were mailed/emailed study invitations directly by researchers. Random sampling (stratified by diabetes type, insulin use, state) of the National Diabetes Services Scheme (NDSS) database and nationwide advertisements were used to recruit new cohort participants. The final sample included N=2342 eligible respondents (longitudinal cohort: n=504; 2015 new cohort: n=1838); 54% had type 2 diabetes.Findings to date Survey respondents were from an advantaged socioeconomic background compared to the general population. Respondents with type 1 diabetes were over-represented in the new cohort (45%) relative to the planned stratification (40% type 1 diabetes, 60% type 2 diabetes). Respondents with insulin-treated type 2 diabetes were under-represented in the new cohort relative to the stratified sampling (42% invited vs 50% response). Participants who completed both the 2011 and 2015 surveys were more likely than those completing the 2011 survey only to have type 1 diabetes, report a higher education and annual income, and live in metropolitan areas. Participant feedback indicated that the survey was perceived as relevant and valuable.Future plans The depth and breadth of the data available in this large sample will highlight unmet needs and priority areas for future investigation and, crucially, will inform policy, programme and intervention development and evaluation in Australia.<br /

A tailored intervention to promote uptake of retinal screening among young adults with type 2 diabetes - an intervention mapping approach

BACKGROUND: Young adults (18-39&nbsp;years) with type 2 diabetes are at risk of early development and rapid progression of diabetic retinopathy, a leading cause of vision loss and blindness in working-age adults. Retinal screening is key to the early detection of diabetic retinopathy, with risk of vision loss significantly reduced by timely treatment thereafter. Despite this, retinal screening rates are low among this at-risk group. The objective of this study was to develop a theoretically-grounded, evidence-based retinal screening promotion leaflet, tailored to young adults with type 2 diabetes. METHODS: Utilising the six steps of Intervention Mapping, our multidisciplinary planning team conducted a mixed-methods needs assessment (Step 1); identified modifiable behavioural determinants of screening behaviour and constructed a matrix of change objectives (Step 2); designed, reviewed and debriefed leaflet content with stakeholders (Steps 3 and 4); and developed program implementation and evaluation plans (Steps 5 and 6). RESULTS: Step 1 included in-depth qualitative interviews (N&thinsp;=&thinsp;10) and an online survey that recruited a nationally-representative sample (N&thinsp;=&thinsp;227), both informed by literature review. The needs assessment highlighted the crucial roles of knowledge (about diabetic retinopathy and screening), perception of personal risk, awareness of the approval of significant others and engagement with healthcare team, on retinal screening intentions and uptake. In Step 2, we selected five modifiable behavioural determinants to be targeted: knowledge, attitudes, normative beliefs, intention, and behavioural skills. In Steps 3 and 4, the &quot;Who is looking after your eyes?&quot; leaflet was developed, containing persuasive messages targeting each determinant and utilising engaging, cohort-appropriate imagery. In Steps 5 and 6, we planned Statewide implementation and designed a randomised controlled trial to evaluate the leaflet. CONCLUSIONS: This research provides an example of a systematic, evidence-based approach to the development of a simple health intervention designed to promote uptake of screening in accordance with national guidelines. The methods and findings illustrate how Intervention Mapping can be employed to develop tailored retinal screening promotion materials for specific priority populations. This paper has implications for future program planners and is intended to assist those wishing to use Intervention Mapping to create similar theoretically-driven, tailored resources

Severely obese people with diabetes experience impaired emotional well-being associated with socioeconomic disadvantage: results from diabetes MILES – Australia

AimTo examine the emotional well-being of severely obese Australians with type 2 diabetes, along with markers of social and economic disadvantage, using the Diabetes MILES &ndash; Australia dataset.MethodsDiabetes MILES &ndash; Australia was a national survey of 3338 adults with diabetes that focused on psychosocial issues; 1795 had type 2 diabetes and reported BMI. We extracted data regarding depression (PHQ-9), anxiety (GAD-7), obesity- and diabetes- related comorbidities, and demographics. The severely obese group (SOG) (BMI &ge; 35; median BMI = 41.6) constituted 530 (30%) of the type 2 diabetes respondents and was matched with 530 controls (CG) (BMI &lt; 35; median BMI = 28.2). Within- and between- group trends were examined.ResultsThe SOG had higher depression scores (median (IQR) 6.0 (3&ndash;12)) than CG (5.0 (2&ndash;10)); p &lt; 0.001, and were more likely to report moderate-severe depressive symptoms (37% versus 27%; p &lt; 0.001). The groups did not differ on anxiety. The SOG, compared with the CG, were more likely to live alone (21% versus 17%), receive a disability pension (21% versus 15%), earn &le;$40.000/year (51% versus 41%; all p &lt; 0.05), and were less likely to be employed (46% versus 53%), university or higher educated (17% versus 26%), or have health insurance (50% versus 60%; all p &le; 0.01). Moderate-severe depression was positively associated with cumulative stressors of severe obesity, socioeconomic disadvantage, and obesity- and diabetes- related comorbidity.ConclusionsSeverely obese people living with type 2 diabetes have cumulative stressors related to health, disability, demographic and socioeconomic factors, and impaired emotional well-being.</span