Identifying and applying psychological theory to setting and achieving rehabilitation goals: development of a practice framework

Goal setting is considered to be a fundamental part of rehabilitation; however, theories of behaviour change relevant to goal-setting practice have not been comprehensively reviewed. To identify and discuss specific theories of behaviour change relevant to goal-setting practice in the rehabilitation setting. (ii) To identify 'candidate' theories that that offer most potential to inform clinical practice. The rehabilitation and self-management literature was systematically searched to identify review papers or empirical studies that proposed a specific theory of behaviour change relevant to setting and/or achieving goals in a clinical context. Data from included papers were extracted under the headings of: key constructs, clinical application and empirical support. Twenty-four papers were included in the review which proposed a total of five theories: (i) social cognitive theory, (ii) goal setting theory, (iii) health action process approach, (iv) proactive coping theory, and (v) the self-regulatory model of illness behaviour. The first three of these theories demonstrated most potential to inform clinical practice, on the basis of their capacity to inform interventions that resulted in improved patient outcomes. Social cognitive theory, goal setting theory and the health action process approach are theories of behaviour change that can inform clinicians in the process of setting and achieving goals in the rehabilitation setting. Overlapping constructs within these theories have been identified, and can be applied in clinical practice through the development and evaluation of a goal-setting practice framework

Men's reactions to receiving objective feedback on their weight, BMI and other health risk indicators

Background  Receiving information about one’s weight, Body Mass Index (BMI) and other indicators of health risk may prompt behaviour change. This study investigated men’s reactions to receiving information on indicators of health risk prior to taking part in a men-only weight management programme, Football Fans in Training (FFIT). It also investigated the extent to which the information was reported as influencing lifestyle change and having adverse consequences.  Methods  We undertook a qualitative, semi-structured, telephone interview study with 28 men who took part in FFIT. We sought to interview approximately equal numbers of men who had and had not lost 5% or more of their pre-programme body weight by the end of the 12-week programme. Data were analysed thematically utilising principles of framework analysis.  Results  Some men were apprehensive about receiving information which confirmed their overweight/obese status, particularly those less familiar with having similar information fed back to them. The professional football setting and the people present (including other men on the programme whom they perceived to be ‘like them’ and the fieldwork staff) were important factors in making the men feel comfortable in an otherwise potentially threatening situation. Men who achieved greater weight loss were more likely to report being motivated by this pre-programme feedback and to perceive themselves as responsible for their current weight and health status. However, for others the information only reaffirmed what they suspected about their relatively poor health status and was insufficient to prompt behaviour change.  Conclusion  Undertaking measurements and receiving information on health risk indicators, such as weight or BMI, within the context of behaviour change programmes can enhance motivation for behaviour change when communicated in an empathic and non-stigmatising way, and therefore should be considered as an integral part of interventions. However, providing feedback on health risk may be insufficient to prompt behaviour change in some people and may be detrimental to those with poor body image and/or lacking personal agency to adopt lifestyle changes. It is therefore imperative that adequate support and opportunities are made available when information on weight and disease risk are fed back within research or other settings

The experience of facilitators and participants of long term condition self-management group programmes: a qualitative synthesis

Objective: Our aim was to systematically review the qualitative literature about the experiences of both facilitators and participants in a range of group-based programmes to support the self-management of long-term conditions. Methods: We searched 7 databases using the terms ‘self-management’, ‘group’ and ‘qualitative’. Full text articles meeting the inclusion criteria were retrieved for review. A thematic synthesis approach was used to analyse the studies. Results: 2126 articles were identified and 24 were included for review. Group participants valued being with similar others and perceived peer support benefits. Facilitators (HCP and lay) had limited group specific training, were uncertain of purpose and prioritised education and medical conformity over supportive group processes and the promotion of self-management agency and engagement. Overall, studies prioritised positive descriptions. Conclusion: Group programmes’ medical self-management focus may reduce their ability to contribute to patient-valued outcomes. Further research is needed to explore this disconnect. Practice implications: This review supports broadening the scope of group-based programmes to foreground shared learning, social support and development of agency. It is of relevance to developers and facilitators of group self-management programmes and their ability to address the burden of long-term conditions

How do facilitators of group programmes for long-term conditions conceptualise self-management support?

Objectives: Increasing self-management skills in people with long-term conditions is widely advocated in policies and guidelines. Group programmes are a common format; yet, how self-management support objectives are enacted in their delivery is poorly understood. Our aim is to explore the perspectives of group programme facilitators. Methods: We undertook thematic analysis of transcribed data from in-depth semi-structured interviews with health professional facilitators (n = 13) from six diverse self-management support group programmes (of obesity, diabetes and chronic obstructive pulmonary disease). Results: Facilitators viewed group programmes as responses to health system pressures, e.g. high patient demand. They focussed on providing in-depth education and instruction on physical health, risks and lifestyle behaviour change and emphasised self-responsibility for behaviour change whilst minimising goal setting and support amongst group participants. There were tensions between facilitators’ professional identity and group leader role

The influence of socio-economic deprivation on mobility, participation and quality of life following major lower extremity amputation in the West of Scotland

Objective: Lower extremity amputation (LEA) is more common in people from lower socio-economic groups. This study examined this further by investigating the influence of socio-economic status on mobility, participation, and quality of life (QoL) after LEA. Methods: Prospective data were gathered for all LEAs performed in one year in one Scottish Health Board, commencing March 2014. A postcode derived Scottish Index of Multiple Deprivation (SIMD) was applied by quintile (SIMD 1 = most deprived). Routine data were collected on the cohort of 171 patients; 101 participants consented and received postal questionnaires on QoL (EQ-5D-5L), participation (Reintegration to Normal Living Index [RNLI]), and mobility (Prosthetic Limb User Survey of Mobility), six (n = 67) and 12 months (n = 50) after LEA. Results: The mean ± SD age of the cohort was 66.2 ± 11.4 years; 75% were male and 53% had diabetes. In total, 67% lived in SIMD 1 and 2 and 11.1% in SIMD 5. Sixty per cent had a transtibial amputation. Mortality was 6% at 30 days 17% at six, and 29% at 12 months. Those in SIMD 1 were significantly younger (62.9 years) than those in SIMD 5 (76.3 years). Significantly more participants with a transfemoral amputation (TFA) lived in SIMD 1 (44%) compared with SIMD 5 (11%) (p = .004). Participation was low (RNLI scores: 6 months = 55.7; 12 months = 56.6) and PLUS M scores suggested mobility was poor overall at six (39.1) and 12 months (38.9). Mean QoL was 0.37 at 6 months and 0.33 at 12 months. Conclusion: Although this study observed more LEAs in those from low socio-economic areas, it is impossible to conclude whether QoL after LEA is truly influenced by socio-economic status. There was an association between the disproportionately high rate of LEAs in SIMD groups 1 and 2 and the high prevalence of smoking, 61% vs. only 21% of those in the least deprived areas (SIMD 3, 4, and 5) being current smokers

Weight management for overweight and obese men delivered through professional football clubs : a pilot randomized trial

Peer reviewedPublisher PD

Self-care behaviour for minor symptoms : can Andersen’s Behavioral Model of Health Services Use help us to understand it?

Funding Information: Chief Scientist Office of the Scottish GovernmentPeer reviewedPostprin

Does gender matter? An analysis of men's and women's accounts of responding to symptoms of lung cancer

Peer reviewedPublisher PD

Responses to chest pain : development and initial evaluation of an evidence-based information resource

Coronary heart disease is the leading cause of premature death in the UK. Chest pain, the most common symptoms associated with this disease, accounts for 1% of all primary care consultations, 5% of visits to emergency departments, and up to 40% of emergency admissions to hospital. When people experience acute coronary symptoms such as chest pain, or other symptoms such as pain in the arms, back or shoulder pain and pain in the jaw and neck, we know that prompt diagnosis and treatment of heart disease can significantly reduce mortality. However, we also know that when people experience these symptoms they can wait sometime before seeking medical help. Part of the problem may be that people do not attribute their symptoms a serious problem such as heart disease. Whilst several campaigns have been aimed at the general population there is no information resource targeted at people who may be at risk of heart disease to help them understand and evaluate their symptoms and take prompt action. The overall aim of this thesis is to fill this gap by producing a piloted draft information resource which aims to help people to respond effectively to symptoms that might be attributable to heart disease for people at high risk of heart disease. Using focus group discussions and individual interviews with people who had experienced symptoms that might be attributable to heart disease or might be at high risk of heart disease experiential data about their response to symptoms were gathered. Participants were also asked their views on what an information resource should be like and their experiences and views formed the basis of the content of the first draft of the information resource. In making sense of their symptom the participants drew upon a range of past experiences and the experiences of others to help them; participants who experienced severe symptoms sought help quickly; those whose symptoms were mild or transient waited, in some cases a considerable time, before seeking help. Previous personal experience may be the factor that helped those who acted quickly. Whereas the experience of others, evident in many of the accounts of those who waited, may not be sufficient to help people interpret and make sense of their own symptom experiences. The information resource incorporated the experiences of people with symptoms that ended up being attributable to heart disease and included examples of the range of symptoms that can be encountered to illustrate the different ways in which heart disease can be manifested as well as information drawn from best practice resources in the management of heart disease. Participants in the original focus group discussions and interviews were asked to be involved in the development of the resource and seventeen agreed. The information resource went through three drafts; at each stage changes were made to incorporate respondent views; at the penultimate draft health professionals’ views were also sought and used to inform the final draft which is now ready for further evaluation.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

The influence of socioeconomic deprivation on multimorbidity at different ages: a cross-sectional study

<b>Background</b> Multimorbidity occurs at a younger age in individuals in areas of high socioeconomic deprivation but little is known about the 'typology' of multimorbidity in different age groups and its association with socioeconomic status.<p></p> <b>Aim</b> To characterise multimorbidity type and most common conditions in a large nationally representative primary care dataset in terms of age and deprivation.<p></p> <b>Design and setting</b> Cross-sectional analysis of 1 272 685 adults in Scotland.<p></p> <b>Method</b> Multimorbidity type of participants (physical-only, mental-only, mixed physical, and mental) and most common conditions were analysed according to age and deprivation.<p></p> <b>Results</b> Multimorbidity increased with age, ranging from 8.1% in those aged 25–34 to 76.1% for those aged ≥75 years. Physical-only (56% of all multimorbidity) was the most common type of multimorbidity in those aged ≥55 years, and did not vary substantially with deprivation. Mental-only was uncommon (4% of all multimorbidity), whereas mixed physical and mental (40% of all multimorbidity) was the most common type of multimorbidity in those aged <55 years and was two- to threefold more common in the most deprived compared with the least deprived in most age groups. Ten conditions (seven physical and three mental) accounted for the top five most common conditions in people with multimorbidity in all age groups. Depression and pain featured in the top five conditions across all age groups. Deprivation was associated with a higher prevalence of depression, drugs misuse, anxiety, dyspepsia, pain, coronary heart disease, and diabetes in multimorbid patients at different ages.<p></p> <b>Conclusion</b> Mixed physical and mental multimorbidity is common across the life-span and is exacerbated by deprivation from early adulthood onwards