Occupational stress, job satisfaction and role conflict in doctors

Based on a transactional model of stressors, mediators/moderators and strains, this large scale study investigated occupational stress, job satisfaction and role conflict in doctors in Scotland using a self-report questionnaire methodology. The sample of 986 doctors included male and female general practitioners (GPs) and specialist consultants. The relationship between sources and levels of occupational stress and job satisfaction was investigated using scales from the Occupational Stress Indicator (OSI) (Cooper et al 1988), considering the role of intervening variables mcludmg age, gender, marital/parental status, medical speciality, coping and attitudes. The relationship between occupational and domestic stressors and satisfactions was examined using theoretically denved models of additivity and asymmetric permeability of roles. A range of analytic procedures mcluding multivanate analysis of variance, hierarchical regression, factor analysis and qualitative content analysis methods were employed. Results mdicated that GPs recorded greater stress and lower job satisfaction than consultants on the OSI scales Managenal or structural occupational factors, and factors intrinsic to medical work were major stressors. Patient care was both a main source of stress and job satisfaction. The rather small magnitude of differences in stress and satisfaction between subject groups, and between subject groups and norms for the OSI scales was offset by clear evidence of stress related to doctors occupational roles, domestic roles, and gender roles elucidated using more qualitative methodologies. Subjects' age, gender and medical speciality were shown to affect the relationship between occupational stress and job satisfaction. Younger doctors, male GPs and female consultants experienced greater stress and less job satisfaction. Coping efficacy was negatively related to occupational stress and positively related to job satisfaction for GPs, and male and female GPs employed different styles of coping with stressors. Comparison of consultant specialities revealed differences in sources and levels of occupational stress and job satisfaction with Public Health Consultants recording most stress. Both male and female doctors with multiple occupational and domestic role demands reported higher levels of stress. Stress from work to home was found to be greater than stress from home to work for both male and female doctors. Recommendations and implications of the research for doctors, patients, and the National Health Service are discussed

Gender and diet management in type 2 diabetes

Introduction Type 2 diabetes is a chronic health condition that requires ongoing self-management. This often includes changes in diet, which may be open to influences from relatives. Family support in terms of diet may be linked with gender and the assumption that meal preparation is a traditionally female activity. This article looks at the role of gender in diet management in people with type 2 diabetes and their relatives. Methods Seventeen semi-structured interviews were conducted with 23 participants (10 people with type 2 diabetes, 13 relatives of people with type 2 diabetes) in Scotland, UK. The aim was to uncover changes people have made to their diet following diagnosis of type 2 diabetes in oneself or a family member. Data were analysed using Framework Approach. Findings: Female relatives were more likely to manage the patient’s diet while male relatives provided support but were less likely to monitor the person’s diet. Female patients may prioritise the needs of their family while male patients are more likely to rely on their female relatives in terms of diet management. Discussion The study findings have implications for family-based interventions as gender may play a crucial role in the management of type 2 diabetes.Output Status: Forthcoming/Available Onlin

A health assessment tool for multiple risk factors for obesity: psychometric testing and age differences in UK adults

Abstract Objective. Although many individual health behaviours (e.g. diet/activity) have been implicated in the current rise in obesity levels, their confounding or cumulative effects have yet to be established. This study psychometrically tested a previously piloted comprehensive measure of obesity risk factors, designed to assess their relative importance at individual and population levels. Methods. A user-friendly, self-report questionnaire, completed by 359 adult volunteers (71% female, age range 18-81 years), was subjected to exploratory factor analysis and related to Body Mass Index (BMI) and age. Results. The final solution had 74 items and showed a clear factor structure, with 5 dietary and 5 activity factors, plus 8 unrelated factors covering dieting behaviour, alcohol consumption, sleep, and varied developmental influences. Younger respondents generally reported unhealthier behaviours. Once age was controlled for, less healthy eating, more emotional eating, higher amounts eaten, less physical activity, more use of mechanised transport, and more/less successful dieting behaviour were all strongly related to higher BMI, with lesser associations for more TV watching and less parental encouragement to be active. Conclusion. This easy-to-use self-report measure of multiple risk factors showed good psychometric properties and has merit in determining the contribution of varied factors in the tendency to overweight and obesity. Practice Implications. The finding that younger adults generally reported less healthy dietary and activity behaviour indicates a pressing need for early intervention

Interventions for prevention of type 2 diabetes in relatives:A systematic review

The relatives and partners of people with type 2 diabetes are at increased risk of developing type 2 diabetes. This systematic review examines randomized controlled trials, written in English that tested an intervention, which aimed to modify behaviors known to delay or prevent type 2 diabetes, among the relatives or partners of people with type 2 diabetes. Study quality was assessed using the Cochrane Collaboration’s tool for assessing risk of bias. Seven studies met the inclusion criteria. The majority of studies were at low risk of bias. Six studies tested an intervention in first-degree relatives of people with type 2 diabetes and one in partners. Intervention components and intervention intensity across studies varied, with those targeting diet and physical activity reporting the most significant changes in primary outcomes. Only one study did not observe significant changes in primary outcomes. There were three main recruitment approaches: advertising in the community, recruiting people through their relatives with diabetes, or identifying people as high risk by screening of their own health care contacts. Some evidence was found for potentially successful interventions to prevent type 2 diabetes among the relatives and partners of people with type 2 diabetes, although finding simple and effective methods to identify and recruit them remains a challenge. Future studies should explore the effect of patients’ perceptions on their family members’ behavior and capitalize on family relationships in order to increase intervention effectiveness

Does body image influence the relationship between body weight and breastfeeding maintenance in new mothers?

Objectives  Obese women have lower breastfeeding initiation and maintenance rates than healthy weight women. Research generally focuses on biomedical explanations for this. Psychosocial factors including body image and well-being after childbirth are less well understood as predictors of breastfeeding. In obese and healthy weight women, we investigated changes in body image between 72 hrs post-delivery and 6–8 weeks post-natal, studying how women's body image related to breastfeeding initiation and maintenance. We also investigated how psychological distress was related to body image.  Design  Longitudinal semi-structured questionnaire survey.  Methods  Body image and psychological distress were assessed within 72 hrs of birth and by postal questionnaire at 6–8 weeks, for 70 obese and 70 healthy weight women initiating exclusive (breastmilk only) breastfeeding or mixed feeding (with formula milk) in hospital. Breastfeeding was re-assessed at 6–8 weeks.  Results  Obese women were less likely to exclusively breastfeed in hospital and maintain breastfeeding to 6–8 weeks. Better body image was related to maintaining breastfeeding and to lower post-natal psychological distress for all women, but education level was the most significant predictor of maintenance in multivariate regression including body image and weight status. Body image mediated, but did not moderate the relationship between weight and breastfeeding maintenance. Body image was lower overall in obese women, but all women had low body image satisfaction around childbirth, reducing further at 6–8 weeks.  Conclusions  Health professionals should consider women's body image when discussing breastfeeding. A focus on breast function over form may support breastfeeding for all women

A health assessment tool for multiple risk factors for obesity: age and sex differences in the prediction of body mass index

The aim was to establish the relative importance of multiple dietary, activity and other risk factors in determining BMI. A cross-sectional survey was conducted with 322 adults (71 % female; aged 18-79 years; BMI 16·5-40·9 kg/m2) using a previously developed, psychometrically tested, seventy-three-item questionnaire covering a wide range of obesity risk factors (consisting of five dietary, five activity and seven other risk factor subscales). Outcome was self-reported weight and height for BMI, cross-validated with items on clothes size and perceived need to lose weight. Stepwise regression analysis predicted 25-55 % of the variance in BMI with physical activity participation, current and past dieting behaviour, amount eaten, and age being the most important predictors. The association of lower BMI and younger age appeared to be due to higher activity levels, as younger participants reported much less healthy eating behaviour than the older age group. Amount eaten and physical activity participation were stronger predictors of BMI than other factors including healthy eating and use of mechanised transport. Results showed that the relationship between various risk factors and obesity may differ by both sex and age group, suggesting that different interventions may need to be targeted at different groups. The higher-risk eating behaviour observed in younger participants is of concern and needs to be addressed, if the current trend of rising obesity levels is to be halted

Is diagnosis of type 2 diabetes a “teachable moment”? A qualitative study

Aims To explore the potential of a type 2 diabetes diagnosis to be a “teachable moment”. Methods Semi-structured interviews were conducted with 23 participants (10 people with type 2 diabetes, 13 relatives of people with type 2 diabetes) in Scotland, UK. They explored cognitive, emotional and behavioural changes following diagnosis of type 2 diabetes in oneself or in a relative. Data were analysed using Framework approach. Results Strong emotional responses are not always related to the occurrence of a teachable moment. Risk perception and outcome expectancy were found to be teachable moment factors for patients with type 2 diabetes and their offspring, but not their partners. Change in self-concept increases the likelihood of type 2 diabetes diagnosis to be a teachable moment for patients but not for relatives. In some cases, type 2 diabetes is perceived as incompatible with current roles thus hindering diabetes self-management. Relatives often engage in caring for patients and “policing” their behaviour but did not report perceived changes in social roles. Conclusions The study suggests that diagnosis of type 2 diabetes is a teachable moment for some patients and their relatives. These findings have implications for interventions to address diabetes self-management in patients and primary prevention in their relatives

Motivational and behaviour change approaches for improving diabetes management

Effective diabetes management requires both good clinical care, and good self‐management by the person with diabetes to achieve optimal health outcomes. Both diabetes‐specific behaviours, and lifestyle behaviours need to be addressed. Self‐management is challenging, due to the characteristics of diabetes, a condition which can be unpredictable, variable over the lifespan, lifelong, and often psychologically demanding, requiring knowledge, confidence, motivation and behaviour change skills to maintain optimal control. Health professionals can support people to self‐manage more effectively if they have psychological skills to promote motivation and to support behaviour change. This review summarises some of the skills needed by people with diabetes and by health professionals to support self‐management, including person‐centred working and ‘MAP’ motivational, action and prompting behaviour change techniques. The review takes a critical look at motivational and behavioural interventions and their outcomes, in the wider context of the process of behaviour change. We look at evidence for effectiveness of motivational approaches – from the perspective of the patient outcomes and health practitioner training required. We also evaluate behaviour change interventions which use ‘action‐based’ approaches, followed by suggestions for longer‐term, sustainable models of training

A mixed-methods analysis of the role of online social support to promote psychological well-being in new mothers

Objective: Perinatal mental health problems affect between one in three and one in ten women globally. Using social media could offer helpful support to new mothers to mitigate this. This research examines the impact of online social support on parental stress, and the mediating effect of maternal wellbeing. The goal is to improve understanding of how to optimise online maternal support to improve anxiety and reduce long-term stress for mother and child. Design: A mixed-methods, convergent parallel design (QUANT- QUAL) is adopted to facilitate examination of the complex association between constructs. Methods: A Qualtrics online survey was administered via social media to mothers of children under two (n = 151). Quantitative multiple regression analyses assessed perceptions of online social support overall and in separate domains (Social networking sites usage and needs scale) as a predictor of parental stress (Parental Stress Scale) and the potential mediation effect of mental wellbeing (Short Warwick-Edinburgh Mental Wellbeing Scale). Purposely designed survey open-text questions allowed participants to describe the detail and impact of online support experiences and common stresses and formed the basis of a qualitative reflexive thematic analysis examining online support and maternal mental health. Results: Mixed-method findings indicate that mothers perceiving more value in online support have higher stress levels and lower wellbeing than others. Mental well-being was a partial mediator of the relationship between online support and parental stress. Non-significant statistical effects were reinforced by qualitative themes indicating online support provided safe guidance, peer solidarity and parenting escape. Conclusions: Maternal online support was predominantly used to cope with high stress, explaining positive stress correlations. Statistically, online coping strategies contributed little to mental wellbeing. Nevertheless, online support was regarded as a valuable and reassuring tool by some participants. Health professionals could improve perinatal anxiety coping by facilitating quality online support networks.Output Status: Forthcoming/Available Onlin

Parenting stress in the early years – a survey of the impact of breastfeeding and social support for women in Finland and the UK

Background Being a new parent can be both joyful and stressful. Parenting stress is associated with poorer health and well-being for parents and infant and increased psychological distress. For new mothers, physical and hormonal changes, expectations of mothering and demands of a new baby may cause additional stress. Breastfeeding is promoted as optimal for maternal and infant health, but can have both positive and negative psychological impacts. Formal and informal social support can offset parenting and breastfeeding stress. Source, content and context of support for new parents are important considerations. This study compares two countries with different parenting and breastfeeding contexts, Finland (more supportive) and the UK (less supportive), investigating the role of breastfeeding stress, self-efficacy and social support as predictors of stress and role strain for new mothers. Methods A cross-sectional online survey was completed by 1550 breastfeeding mothers of infants up to 2 years old, recruited via social media platforms in Finland and the UK. Predictors of parenting stress and strain, including demograpic factors, childbirth experiences, breastfeeding and social support were investigated. Results We found fewer differences between countries than expected, perhaps due to demographic and contextual differences. Women in Finland reported better childbirth experiences, more positive breastfeeding attitudes, and more self-efficacy than in the UK. Levels of parenting stress were similar in both countries. Women in the UK reported more parental role strain, but fewer breastfeeding stressors. Participants accessed more informal than formal supports, including their partner for parenting and facebook groups and family for breastfeeding. Analysis suggested breastfeeding stress and social support had significant direct effects – respectively increasing and reducing parenting stress and role strain, but no moderating effects of social support suggesting support did not change the relationship between breastfeeding and parenting stress. Conclusions Results have important implications for the provision of breastfeeding and parenting support for new mothers. Simple interventions to manage stress for mothers in the postnatal period could be beneficial and are easily delivered by supporters. As shown elsewhere, socio-economic and cultural factors are crucial influences on parenting experiences