Psychological factors associated with episodic chelation adherence in thalassaemia

Beta-Thalassaemia-Major is a life-long genetic haemoglobin disorder where patients require intensive treatment regimens to stay alive, including frequent blood transfusions and daily chelation therapy. Adherence to chelation therapy is vitally important to prevent organ damage and potential death. Little research has been conducted into the psychosocial correlates of chelation adherence representing a significant gap in the literature. Information concerning psychosocial factors is important when considering potential interventions to improve adherence and improve health outcomes. The present study aimed to address this gap in the literature by investigating correlates of chelation adherence on a daily (episodic) basis as well as on a generic (global) basis. Using constructs suggested by the Health Action Process Approach, the study hypotheses were that situational self-efficacy and positive outcome expectancies would differentiate episodes of adherence and non-adherence. A secondary hypothesis was that lower levels of depression and perceptions of severe illness consequences would be associated with higher global adherence. Thirty-seven participants with Beta-Thalassaemia Major were recruited for the study, 31 of whom completed the episodic part of the study and all who completed the global parts of the study. A structured interview was used to obtain accounts of adherent and non-adherent episodes including behavioural situational variables as well as psychological situational variables (e.g. self-efficacy, mood and outcome expectancies). Validated questionnaires were used to assess depression, anxiety and illness perceptions and their relationship with adherence. Bivariate analyses revealed that a number of behavioural situational variables were associated with adherence episodes as well as ratings of self-efficacy and outcome expectancies. Conditional logistic regression analysis revealed that positive outcome expectancies and higher self-efficacy together Significantly predicted adherent episodes, however, only self-efficacy independently predicted adherent episodes. No associations between global adherence and depression, anxiety and illness perceptions were found. The findings are discussed in relation to general adherence literature as well as to chelation adherence specifically. Theoretical and practice implications are explored.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Using stated preference choice modelling to determine treatment preferences : investigating preferences for depression treatment

Background & Aim The PhD aimed to quantify preferences for depression treatments using Discrete Choice Experiments (DCEs). A secondary aim was to investigate the relationship between demographic variables, psychological variables and preferences. Methods & Analysis Two DCEs were designed and administered, investigating preferences for treatment of depression by: (1) a drug and (2) a physical activity intervention. The DCE designs were informed by focus groups and qualitative interviews. A best-worst scaling DCE was used for both studies. The physical activity intervention DCE was included in the baseline questionnaire of an RCT at the University of Bristol. Demographic information and psychological measures (including BDI scores) were analysed alongside the DCE. The drug treatment DCE was distributed as a postal questionnaire to a general population sample of 5000. Psychological measures of illness and medicine beliefs as well as the BDI were included in the questionnaire. Demographic data were also collected. Quantitative data were analysed primarily using conditional logistic regression. Results Results from the Physical activity DCE (for 152 patients) indicated that on average, patients particularly valued key aspects of the intervention, such as small goals, fitting activity into daily routine and having support over the intervention itself (being one giving choice of activity rather than exercise on prescription). Results from Drug study DCE (for 425 respondents) revealed a particular desire for no side-effects: large improvements in likely effectiveness are required to compensate respondents for non-zero risks of these. Heterogeneity analysis for both studies revealed effects of a number of demographic and psychological variables on preferences for attributes of depression treatment. Discussion Results of both studies are discussed in terms of their policy relevance and also from a methodological angle. The implications the results have on the use of DCEs in health care is considered.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

The Impact of Mindfulness-Based Programmes on Self-Compassion in Nonclinical Populations: a Systematic Review and Meta-Analysis

Objectives Self-compassion has been proposed as a mechanism of change in mindfulness-based programmes (MBPs). The current study systematically reviewed the evidence for the effect of MBPs on self-compassion, in randomised controlled trials addressing broad mental health outcomes (depression, anxiety and stress) in nonclinical populations, and statistically synthesisesd these findings in a meta-analysis. Methods Three databases were systematically searched, and pre-post programme between group effect sizes (Hedges g) were calculated and synthesised using meta-analytic procedures. Correlation between change in self-compassion and distress (r) was also assessed. Moderator analyses were conducted and publication bias was assessed. Results Twenty-six studies met inclusion criteria (n = 598). A significant medium effect of pre-post change on self-compassion was found for MBPs compared to control conditions (g = 0.60, 95% CI = 0.41 to 0.80, p < 0.001). There was significant heterogeneity in the study sample, and no differences found for any of the moderators tested. There was no strong evidence for publication bias. Meta-analysis of correlation between change in self-compassion and distress was underpowered and found no significant effect. The improvement in self-compassion following MBI was not always consistent with improvements in depression or anxiety. Conclusions The results suggest that MBPs can increase self-compassion in nonclinical populations, though the moderators of this effect remain unknown. Methodological limitations include small sample sizes, over-reliance on wait-list control conditions and limitations in how self-compassion is measured. Theoretical and clinical implications of the review, and future research directions, are also discussed

Using qualitative methods for attribute development for discrete choice experiments : issues and recommendations

Attribute generation for discrete choice experiments (DCEs) is often poorly reported, and it is unclear whether this element of research is conducted rigorously. This paper explores issues associated with developing attributes for DCEs and contrasts different qualitative approaches. The paper draws on eight studies, four developed attributes for measures, and four developed attributes for more ad hoc policy questions. Issues that have become apparent through these studies include the following: the theoretical framework for random utility theory and the need for attributes that are neither too close to the latent construct nor too intrinsic to people's personality; the need to think about attribute development as a two-stage process involving conceptual development followed by refinement of language to convey the intended meaning; and the difficulty in resolving tensions inherent in the reductiveness of condensing complex and nuanced qualitative findings into precise terms. The comparison of alternative qualitative approaches suggests that the nature of data collection will depend both on the characteristics of the question (its sensitivity, for example) and the availability of existing qualitative information. An iterative, constant comparative approach to analysis is recommended. Finally, the paper provides a series of recommendations for improving the reporting of this element of DCE studies.