The role of usability, usefulness and frame in persuasive health communication

Background: A large proportion of ill-health is preventable (Signorelli 1993). A goal for health promoters is to provide information about health risks with the aim of persuading individuals to modify their behaviour. Previous research suggests that the readability of many health promotion materials is too low for effective comprehension. Evidence suggests that much of the health information available is written at a level that is too difficult for the target populations (e.g. Dollahite et al. 1996, Meade & Byrd 1989, Greenfield et al. 2005). Whilst this work is useful in identifying barriers to accessibility to health information, there has been little research that systematically explores the concept of usability within the context of health information. Objectives: The first objective of the thesis was to examine whether the concepts of usability and usefulness as outlined in the Technology Acceptance Model (Davis 1993) can be applied to the domain of health promotion and used to predict intentions to follow the advice given in health promotion leaflets. Second, the studies sought to make distinctions between subjective and objective usability and to explore the factors underlying subjective ratings of the usability of health information. Further, the thesis sought to demonstrate that both objective and subjective usability would influence the persuasive effect of health promotion materials. Finally, using theory from dual-processing models of persuasion (e.g. Elaboration Likelihood Model. Petty and Cacioppo 1986) it was predicted that when usability of leaflets was high, participants would be more likely to make judgements about their intentions to follow the advice given in the leaflets based on peripheral clues such as frame (Tversky and Kahneman 1981, Rothman and Salovey 1997, Levin et al. 1998). Methodology: 5 empirical studies examined the research questions. The first study consisted of two samples from working populations (n=441), and explored manual handling and use of hearing protection. Participants evaluated existing health and safety leaflets in relations to their usability and usefulness, and rated their intentions to follow the advice in the leaflets. The second study, also conducted on a working population (n=97), used experimentally manipulated leaflets on safe manual handling to test the hypothesis that framing effects would be found when usability of leaflets was high. The third study used a student sample (n=127) to explore factors that influence subjective usability. The study used experimentally manipulated leaflets about safe alcohol consumption to examine whether the concept of subjective usability is a function of reader characteristics (psychological constructs, mood, past exposure to the health problem) and leaflet characteristics (frame, objective reading ease). The fourth study used a student sample (n=238) to test the effect of objective reading ease on recall, in order to test for differences in processing of two experimentally manipulated leaflets about safe alcohol consumption. It was predicted that easy leaflets would be processed at a more shallow level than difficult leaflets. The fifth study, also conducted on a student sample using experimentally manipulated safe alcohol leaflets (n= 135), used pre and post testing to further explore the effects of usability on framing effects, and to test for a moderating role of prior knowledge on the effect of usability on intentions. Results: The studies showed that readers distinguish two separate components to health information leaflets: usability and usefulness. Subjective perceptions of usability and perceived usefulness predicted intentions to follow the advice given in the leaflets. Objective usability (reading ease) influenced the persuasive effect of the leaflets, with easy leaflets being more persuasive than difficult leaflets. Perceived usefulness partially mediated the relationship between subjective usability and intentions. Objective reading ease affected recall, with easy leaflets resulting in higher levels of both accurate and false recall of the information in the leaflets. Prior knowledge moderated the relationship between usability and intentions. Those with low prior knowledge were more persuaded when usability was high. Usability influenced the effect of frame on intentions. Framing effects were only found where usability was high. Where framing effects were found, negative frame was more persuasive than positive frame, offering support for Levin et al.'s (1998) typology of framing effects. Conclusions: Results from the studies show that the concepts of usability and usefulness, formalised in models of technology acceptance (TAM), can be applied to health information and used to predict intentions to follow health promotion recommendations. A distinction can be made between subjective and objective usability, and both of these can influence persuasion. Using theory from dual-processing models of persuasion, usability of health information leaflets can influence the effect of frame on intentions to follow the health promotion advice

The role of usability, usefulness and frame in persuasive health communication

Background: A large proportion of ill-health is preventable (Signorelli 1993). A goal for health promoters is to provide information about health risks with the aim of persuading individuals to modify their behaviour. Previous research suggests that the readability of many health promotion materials is too low for effective comprehension. Evidence suggests that much of the health information available is written at a level that is too difficult for the target populations (e.g. Dollahite et al. 1996, Meade & Byrd 1989, Greenfield et al. 2005). Whilst this work is useful in identifying barriers to accessibility to health information, there has been little research that systematically explores the concept of usability within the context of health information. Objectives: The first objective of the thesis was to examine whether the concepts of usability and usefulness as outlined in the Technology Acceptance Model (Davis 1993) can be applied to the domain of health promotion and used to predict intentions to follow the advice given in health promotion leaflets. Second, the studies sought to make distinctions between subjective and objective usability and to explore the factors underlying subjective ratings of the usability of health information. Further, the thesis sought to demonstrate that both objective and subjective usability would influence the persuasive effect of health promotion materials. Finally, using theory from dual-processing models of persuasion (e.g. Elaboration Likelihood Model. Petty and Cacioppo 1986) it was predicted that when usability of leaflets was high, participants would be more likely to make judgements about their intentions to follow the advice given in the leaflets based on peripheral clues such as frame (Tversky and Kahneman 1981, Rothman and Salovey 1997, Levin et al. 1998). Methodology: 5 empirical studies examined the research questions. The first study consisted of two samples from working populations (n=441), and explored manual handling and use of hearing protection. Participants evaluated existing health and safety leaflets in relations to their usability and usefulness, and rated their intentions to follow the advice in the leaflets. The second study, also conducted on a working population (n=97), used experimentally manipulated leaflets on safe manual handling to test the hypothesis that framing effects would be found when usability of leaflets was high. The third study used a student sample (n=127) to explore factors that influence subjective usability. The study used experimentally manipulated leaflets about safe alcohol consumption to examine whether the concept of subjective usability is a function of reader characteristics (psychological constructs, mood, past exposure to the health problem) and leaflet characteristics (frame, objective reading ease). The fourth study used a student sample (n=238) to test the effect of objective reading ease on recall, in order to test for differences in processing of two experimentally manipulated leaflets about safe alcohol consumption. It was predicted that easy leaflets would be processed at a more shallow level than difficult leaflets. The fifth study, also conducted on a student sample using experimentally manipulated safe alcohol leaflets (n= 135), used pre and post testing to further explore the effects of usability on framing effects, and to test for a moderating role of prior knowledge on the effect of usability on intentions. Results: The studies showed that readers distinguish two separate components to health information leaflets: usability and usefulness. Subjective perceptions of usability and perceived usefulness predicted intentions to follow the advice given in the leaflets. Objective usability (reading ease) influenced the persuasive effect of the leaflets, with easy leaflets being more persuasive than difficult leaflets. Perceived usefulness partially mediated the relationship between subjective usability and intentions. Objective reading ease affected recall, with easy leaflets resulting in higher levels of both accurate and false recall of the information in the leaflets. Prior knowledge moderated the relationship between usability and intentions. Those with low prior knowledge were more persuaded when usability was high. Usability influenced the effect of frame on intentions. Framing effects were only found where usability was high. Where framing effects were found, negative frame was more persuasive than positive frame, offering support for Levin et al.'s (1998) typology of framing effects. Conclusions: Results from the studies show that the concepts of usability and usefulness, formalised in models of technology acceptance (TAM), can be applied to health information and used to predict intentions to follow health promotion recommendations. A distinction can be made between subjective and objective usability, and both of these can influence persuasion. Using theory from dual-processing models of persuasion, usability of health information leaflets can influence the effect of frame on intentions to follow the health promotion advice

Supporting the routine collection of patient reported outcome measures in the National Clinical Audits for assessing cost-effectiveness. Work Package 1. What patient reported outcome measures should be used in the 2013/14 National Clinical Audit Programme.

To assess the appropriateness of the EQ-5D in 13 specified conditions (inflammatory bowel disease (IBD), epilepsy, diabetes, bowel cancer, head and neck cancer, psychological therapies, schizophrenia, dementia, cardiac arrhythmia, heart failure, coronary angioplasty, acute coronary syndrome, adult cardiac surgery); identify what measures may be used when the EQ-5D is not appropriate; identify if fields in corresponding National Clinical Audits (NCA) will suffice to conduct economic evaluations; present recommendations and future research questions in this area

Psychotherapeutic benefits of compassion-focused therapy: an early systematic review

Background. Compassion-focused therapy (CFT) is a relatively novel form of psychotherapy that was developed for people who have mental health problems primarily linked to high shame and self-criticism. The aim of this early systematic review was to draw together the current research evidence of the effectiveness of CFT as a psychotherapeutic intervention, and to provide recommendations that may inform the development of further trials. Method. A comprehensive search of electronic databases was undertaken to systematically identify literature relating to the effectiveness of CFT as a psychotherapeutic intervention. Reference lists of key journals were hand searched and contact with experts in the field was made to identify unpublished data. Results. Fourteen studies were included in the review, including three randomized controlled studies. The findings from the included studies were, in the most part, favourable to CFT, and in particular seemed to be effective for people who were high in self-criticism. Conclusions. CFT shows promise as an intervention for mood disorders, particularly those high in self-criticism. However, more large-scale, high-quality trials are needed before it can be considered evidence-based practice. The review highlights issues from the current evidence that may be used to inform such trials

The cost-effectiveness of changes to the care pathway used to identify depression and provide treatment amongst people with diabetes in England: a model-based economic evaluation.

BACKGROUND: Diabetes is associated with premature death and a number of serious complications. The presence of comorbid depression makes these outcomes more likely and results in increased healthcare costs. The aim of this work was to assess the health economic outcomes associated with having both diabetes and depression, and assess the cost-effectiveness of potential policy changes to improve the care pathway: improved opportunistic screening for depression, collaborative care for depression treatment, and the combination of both. METHODS: A mathematical model of the care pathways experienced by people diagnosed with type-2 diabetes in England was developed. Both an NHS perspective and wider social benefits were considered. Evidence was taken from the published literature, identified via scoping and targeted searches. RESULTS: Compared with current practice, all three policies reduced both the time spent with depression and the number of diabetes-related complications experienced. The policies were associated with an improvement in quality of life, but with an increase in health care costs. In an incremental analysis, collaborative care dominated improved opportunistic screening. The incremental cost-effectiveness ratio (ICER) for collaborative care compared with current practice was £10,798 per QALY. Compared to collaborative care, the combined policy had an ICER of £68,017 per QALY. CONCLUSIONS: Policies targeted at identifying and treating depression early in patients with diabetes may lead to reductions in diabetes related complications and depression, which in turn increase life expectancy and improve health-related quality of life. Implementing collaborative care was cost-effective based on current national guidance in England