The influence of psychological preparation on short- and long-term recovery from surgery

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Evaluating the evaluation : understanding the utility and limitations of evaluation as a tool for organizational learning

Objective Organizational learning, underpinned by evidence-based health care, and greater user involvement in planning and delivery were key objectives of the NHS Plan. Evaluation, and specifically participatory evaluation, offers the potential to address these elements of the NHS modernization agenda. We discuss the strengths and limitations of evaluation in delivering the modernization agenda through use of a case study — the evaluation of a Healthy Living Centre project, catchon2us! Setting A Healthy Living Centre project in Merseyside. Results There was evidence that collaborative research can promote opportunities which foster significant learning and change, thus making the effort and time involved worthwhile. However, the two-way flow of information necessary for development of shared goals and learning at strategic, as well as provider, levels is not easily achieved. Barriers include the rigidity of organizational structures within large agencies such as the NHS, with priorities imposed from national levels overriding local priorities. Conclusions The inherent contradictions in current strategic drivers in the NHS need to be addressed if services can ever deliver the goal of true organizational learning

From design to interpretation: Lessons from a public health campaign promoting physical activity

Objective: Rising inactivity has led to an increase in health promotion campaigns aimed at encouraging healthy behaviour change. While this has become common place, often practices advised by social marketing to maximise effectiveness are overlooked. This study investigates the development and effectiveness of one particular physical activity public health campaign implemented in Liverpool, United Kingdom (UK). A formative evaluation feedback session was included to communicate findings back to key stakeholders to reflect on the experience and identify learning points for future campaigns. Design: Based on a pragmatic paradigm the study was conducted in three parts: (1) campaign designer interview; (2) public on-street survey; and (3) stakeholder formative evaluation feedback session. Setting: The context of this study was Liverpool, UK. Method: Deductive content analysis was guided by key themes of the campaign design, including the poster image, tagline, main text, and overall layout. Results: The design team had aimed for a ‘tongue in cheek’ image and message on which to base the campaign. However, the public survey suggests that the campaign largely failed to translate the proposed message and reach the intended Liverpool population. Formative evaluation feedback highlighted a lack of application of social marketing principles in campaign development, in particular audience targeting and pilot assessment. Conclusion: This study highlights the importance of the inclusion of social marketing principles in the development of health promotion campaigns in an attempt to aid audience understanding and adoption of the desired health behaviour. </jats:sec

Children's changing understanding of wicked desires: From objective to subjective and moral

Previous work makes two conflicting claims about children's developing judgments of the emotions of an actor committing a desired but immoral act: children's judgments change (1) from sad to happy, as they come to appreciate desire as a subjective mental state, or (2) from happy to sad, as children acknowledge the role of moral values in emotion. In three experiments designed to explain this conflict, 3-10-year-olds judged emotions of actors committing neutral and immoral acts. Experiment 1 rules out procedural differences as an explanation of conflicting findings. Experiment 2 shows an age change from sad, to happy, to sad (remorseful), integrating the conflicting claims. Experiment 3 shows that 5- but not 3-year-olds can judge ill-doers pleased with their success or remorseful at their wrongdoing, depending on the salience of moral issues. We discuss the roles of cognitive development, moral understanding and moral climate in influencing children's understanding of desire and moral emotion

Patients' reactions to attempts to increase passive or active coping with surgery

It is generally regarded as valuable for patients to exercise control over aspects of their medical treatment. Although psychological and other interventions are commonly used with the aim of increasing patients' ability or willingness to control events, it is not known whether patients experience these procedures in the way assumed. The present study compared responses to (i) a psychological intervention designed to increase patients' readiness to exercise control and cope actively and (ii) a comparable intervention intended to induce acceptance and passive coping. Hip or knee arthroplasty patients were visited preoperatively by a researcher who administered the active (N=15) or passive (N=15) intervention in a dialogue with the patient. Patients' verbal responses to the interventions were analyzed qualitatively to identify the range of reactions to each type of intervention. Patients readily accepted the passive message on the grounds of doctors' and nurses' authority and the value of the patients' emotional detachment from their surgery. Few responses to the active message indicated acceptance that patients have control over their care and its outcomes; instead, recipients typically interpreted it in terms of the need for obedience to medical and nursing authority. In conclusion, patients do not automatically accept messages intended to change ways of coping. In particular, the attempt to increase patients' readiness to take control over aspects of care can be perceived by patients in an opposite way to that intended. This and previous studies suggest that patient control over aspects of treatment is a professional and theoretical construction that often means little to patients.control choice active coping surgery