Beliefs and behavioural intentions towards pharmacotherapy for stuttering : a survey of adults who stutter

Purpose Although considerable efforts have been made to investigate the effectiveness of pharmacological treatments for stuttering, little is known about how the stuttering community perceives these treatments. This study aimed to assess and quantify beliefs regarding pharmacotherapy for adults who stutter and to establish whether behavioural intentions to undertake treatment were related to these beliefs. Method An adapted version of the Beliefs about Medicine Questionnaire was completed by adults who stutter. Participants also reported perceptions of their stuttering including its overall impact, ratings of previous speech therapy, and behavioural intentions to initiate pharmacotherapy and speech therapy in future. Results Necessity and concern beliefs were distributed widely across the sample and in a pattern indicating a relatively balanced perception of the benefits and costs of medication prescribed specifically for stuttering. Of the study’s measures, the necessity-concerns differential most strongly predicted the behavioural intention to initiate pharmacotherapy. The overall impact of stuttering predicted intentions to seek both pharmacotherapy and speech therapy. Participants reported the likelihood of pursuing pharmacotherapy and speech therapy in equal measure. Conclusions The theoretical model of medication representations appears to be a useful framework for understanding the beliefs of adults who stutter towards the medical treatment of their disorder. The findings of this study may be of interest to clinicians and researchers working in the field of stuttering treatment and to people who stutter considering pharmacotherapy

Using cognitive dissonance inducing interventions to change drivers' attitudes and reduce drivers' speeding behaviour

Cognitive dissonance (Festinger, 1957) is an unpleasant state of arousal experienced when people hold conflicting attitudes or do not behave in line with their attitudes. Cognitive dissonance can promote attitude-change (induced compliance paradigm) or help translate desirable attitudes into behaviour (hypocrisy induction paradigm). Two randomised controlled trials (RCTs) tested dissonance inducing interventions based on the induced compliance paradigm (one face-to-face and one online intervention). Another two RCTs tested dissonance inducing interventions based on the hypocrisy induction paradigm (one face-to-face and one online intervention). All RCTs tested reductions in drivers’ speeding behaviour. The dissonance inducing interventions based on the induced compliance procedure generated a change in drivers’ attitudes towards speeding but did not reduce speeding behaviour. The dissonance inducing interventions based on the hypocrisy induction procedure, however, did generate reductions in speeding behaviour. The results demonstrate that cognitive dissonance interventions based on induced compliance promote attitude-change and cognitive dissonance interventions based on hypocrisy induction can generate changes in driver behaviour (reductions in speeding). The results therefore have practical implications for attitude and behaviour-change with regards to road safety. Induced compliance and hypocrisy induction interventions could be usefully delivered as part of road safety campaigns or training courses (e.g., Stephenson et al, 2010) to promote attitude and behaviour-change

Using a cognitive dissonance inducing intervention to change drivers' attitudes towards speeding

Cognitive dissonance (Festinger, 1957) is an unpleasant state of arousal experienced when people hold conflicting attitudes or do not behave in line with their attitudes. The induced compliance paradigm is a technique used to promote attitude-change by inducing feelings of cognitive dissonance. A randomised controlled trial (RCT) tested a dissonance inducing intervention based on the induced compliance paradigm. The RCT was delivered face-to-face and tested changes in drivers’ attitudes towards speeding. The induced compliance procedure generated a change in drivers’ attitudes towards speeding. Specifically, the intervention group reported more desirable attitudes towards speeding (i.e., less positive attitudes) compared to the control group. The results demonstrate that the cognitive dissonance intervention based on induced compliance can promote attitude-change. The results therefore have practical implications for attitude-change with regards to road safety. Induced compliance interventions could be usefully delivered as part of road safety campaigns or training courses (e.g., Stephenson et al, 2010) to change drivers’ attitudes towards speeding

Bi-dimensional attitudes, attitude accessibility and speeding behaviour

Positive and negative attitude dimensions (i.e., bi-dimensional attitudes) asymmetrically predict behaviour, with the positive dimension being the better predictor than the negative dimension. These findings have been demonstrated using self-reported behaviour measures. In this study, we aimed to test the bi-dimensional attitude-behaviour relationship using objectively measured speeding behaviour derived from a driving simulator and test if the asymmetrical prediction of behaviour from the positive and negative attitude dimensions could be explained by attitude accessibility (how available an attitude is in memory and therefore how readily it is able to guide behaviour). One hundred and six drivers completed online measures of the positive and negative dimensions of their attitudes towards exceeding the speed limit. Response latency measures of the accessibilities of both dimensions were also taken. A driving simulator was used to measure speeding behaviour. Both attitude dimensions independently predicted speeding, with the positive dimension being the stronger predictor. The positive attitude dimension was also more accessible than was the negative dimension. The difference in the accessibilities of the positive and negative attitude dimensions significantly mediated the difference in their predictive validities. The results demonstrate that the positive attitude dimension is the principle predictor of speeding and a reason for this is that it is more accessible in memory than is the negative attitude dimension. Road safety interventions (e.g., education) that aim to reduce speeding and associated traffic crashes might usefully decrease the valence or accessibility of the positive attitude dimension. There would also appear to be scope to reduce speeding by increasing the valence or accessibility of the negative attitude dimension. were also taken. A driving simulator was used to measure speeding behaviour. Both attitude dimensions independently predicted speeding, with the positive dimension being the stronger predictor. The positive attitude dimension was also more accessible than was the negative dimension. The difference in the accessibilities of the positive and negative attitude dimensions significantly mediated the difference in their predictive validities. The results demonstrate that the positive attitude dimension is the principle predictor of speeding and a reason for this is that it is more accessible in memory than is the negative attitude dimension. Road safety interventions (e.g., education) that aim to reduce speeding and associated traffic crashes might usefully decrease the valence or accessibility of the positive attitude dimension. There would also appear to be scope to reduce speeding by increasing the valence or accessibility of the negative attitude dimension

Using smartphones in cities to crowdsource dangerous road sections and give effective in-car warnings

The widespread day-to-day carrying of powerful smartphones gives opportunities for crowd-sourcing information about the users' activities to gain insight into patterns of use of a large population in cities. Here we report the design and initial investigations into a crowdsourcing approach for sudden decelerations to identify dangerous road sections. Sudden brakes and near misses are much more common than police reportable accidents but under exploited and have the potential for more responsive reaction than waiting for accidents. We also discuss different multimodal feedback conditions to warn drivers approaching a dangerous zone. We believe this crowdsourcing approach gives cost and coverage benefits over infrastructural smart-city approaches but that users need incentivized for use

Conditional or unconditional? The effects of implementation intentions on driver behavior

Implementation intentions (IF-THEN plans) exert conditional effects on behavior, meaning that their ability to change behavior is conditional upon encountering the critical situation specified in the IF component of the plan. In the present study, we tested whether implementation intentions can exert unconditional effects on behavior. Consistent with the process of operant generalization, we hypothesized that implementation intentions would change behavior, not only in situations that are contextually identical to those specified in the IF component but also in contextually similar situations. Implementation intentions were not expected to generate behavior-change in contextually different situations to those specified. Participants (N = 139) completed questionnaires measuring speeding behavior and motivation to speed. Experimental participants then specified implementation intentions to avoid speeding in critical situations that were either contextually identical, similar or different to those subsequently encountered on a driving simulator. Control participants received educational information about the risks of speeding. All participants then drove on a driving simulator. Consistent with the hypotheses, participants in both the contextually identical and similar conditions exceeded the speed limit less frequently than did controls. There was no difference in speeding behavior between the contextually different and control conditions. Implications of the findings for behavior-change are discussed

Measuring explicit and implicit bi-dimensional attitudes to predict studying behaviour and outcome

Attitudes have traditionally been measured as unitary constructs i.e. a person has a positive or a negative evaluation of a concept. However, Elliott et al., (2015) suggests that attitudes are better measured as having concurrent positive and negative dimensions which act as independent predictors of behaviour. In addition to these explicit measures of attitude, implicit measures also have been shown to be predictive of behaviour (see Greenwald & Banaji, 1995) but the relationship between bi-dimensional explicit and implicit measures has never been examined. This study measures bi-dimensional explicit attitudes via questionnaire and implicit bi-directional attitudes via a specially constructed Implicit Association Test and regression modelling examines the relationship between these, studying behaviour and exam performance in Higher Education students. Theoretical conclusions from these results and implications for real world behaviour change will be discussed

Measuring implicit bi-dimensional attitudes and predicting speeding behaviour

Attitudes are bi-dimensional predictors of behaviour, meaning that attitudes comprise separate positive and negative dimensions, which both predict behaviour independently (Elliott et al., 2015). Furthermore, the positive dimension of attitude is the stronger predictor for risky behaviours (e.g., speeding). This implies that evaluative beliefs about positive behavioural consequences strongly influence subsequent behavioural performance. Beliefs about negative behavioural consequences do not. In previous research, bi-dimensional attitudes have been measured using questionnaires, which tap explicit cognitive judgements. However, implicit cognitive processes are likely to dictate the performance of habitual behaviours such as speeding. We therefore measured bi-dimensional attitudes using an implicit association test (IAT). The presentation will cover the development of the IAT and the results from regression modelling, in which test performance was used to predict speeding behaviour. The implications for better understanding the cognitive processes that dictate behavioural performance and how to change behaviour will be discussed

An application of the prototype willingness model to drivers' speeding behaviour

We tested the prototype willingness model (PWM). The participants (N=198) completed online questionnaire measures of PWM constructs (time 1) and subsequent speeding behaviour (time 2). Path analyses showed that the PWM accounted for 89% of the variance in subsequent (self-reported) speeding behaviour. This significantly exceeded the variance accounted for by the theory of planned behaviour. In line with the PWM, both behavioural intention and behavioural willingness had direct effects on behaviour. Behavioural willingness had a significantly larger effect. Attitude and subjective norm both had indirect effects on behaviour through both behavioural intention and behavioural willingness. Prototype (similarity) perceptions had indirect effects on behaviour through behavioural willingness only. The findings support the notion that driving is governed by reactive decision-making (willingness), underpinned by prototype perceptions, attitudes and subjective norms, to a greater extent than it is deliberative decision-making (intentions), underpinned by attitudes and subjective norms. The implications for safety interventions are discussed

The impact of immediate breast reconstruction on the time to delivery of adjuvant therapy: the iBRA-2 study

Background: Immediate breast reconstruction (IBR) is routinely offered to improve quality-of-life for women requiring mastectomy, but there are concerns that more complex surgery may delay adjuvant oncological treatments and compromise long-term outcomes. High-quality evidence is lacking. The iBRA-2 study aimed to investigate the impact of IBR on time to adjuvant therapy. Methods: Consecutive women undergoing mastectomy ± IBR for breast cancer July–December, 2016 were included. Patient demographics, operative, oncological and complication data were collected. Time from last definitive cancer surgery to first adjuvant treatment for patients undergoing mastectomy ± IBR were compared and risk factors associated with delays explored. Results: A total of 2540 patients were recruited from 76 centres; 1008 (39.7%) underwent IBR (implant-only [n = 675, 26.6%]; pedicled flaps [n = 105,4.1%] and free-flaps [n = 228, 8.9%]). Complications requiring re-admission or re-operation were significantly more common in patients undergoing IBR than those receiving mastectomy. Adjuvant chemotherapy or radiotherapy was required by 1235 (48.6%) patients. No clinically significant differences were seen in time to adjuvant therapy between patient groups but major complications irrespective of surgery received were significantly associated with treatment delays. Conclusions: IBR does not result in clinically significant delays to adjuvant therapy, but post-operative complications are associated with treatment delays. Strategies to minimise complications, including careful patient selection, are required to improve outcomes for patients