Dimensions of Resilience and Their Predictive Utility Among Clients With Anxiety Disorders or Depressive Disorders: A Factor Analytic Study

The Connor-Davidson Resilience Scale is a commonly used measure of resilience. However, while resilience is considered multidimensional, the specific dimensions embedded within this scale remain equivocal. The aim of this article was to contribute to this debate by analyzing responses from a large sample obtained within a mental health setting. Baseline data from 672 consecutive referrals to a publicly funded outpatient service for adults with anxiety and depression were subjected to exploratory factor analysis. Outcome data from 349 of these participants who had completed treatment were analyzed using confirmatory factor analysis. Both analytical strategies suggested that two dimensions were evident (Adaptability and Tenacity), although comparisons of Adaptability and Tenacity across sociodemographic, diagnostic, psychological distress, and functional impairment variables provided little support for their discriminability. The practical utility to mental health nurses of subcomponents of resilience remains clinically persuasive yet empirically elusive with current instrumentation.

A novel method for the translation and cross-cultural adaptation of health-related quality of life patient-reported outcome measurements

BACKGROUND

This paper presents a novel methodology for translation and cross-cultural adaptation of health-related quality-of-life patient-reported outcome measures, incorporating the Delphi method. Specifically, we describe the process of translating the Pelvic Floor Distress Inventory-20 and Pelvic Floor Impact Questionnaire-7 from English to Norwegian using this method.

METHODS

The multistep translation method combined the European Organization for Research and Treatment of Cancer Quality of Life guidelines, an Expert Panel review, and the Delphi method. It comprised two independent forward- and back-translations. While the bilingual pelvic floor Expert Panel ensured rigorous cross-checking and effective cross-cultural adaptation, the addition of the Delphi method (comprising the attributes of anonymity, controlled feedback, and statistical group response) further established consensus on translated items.

OUTCOMES

The application of the Delphi method in the Expert Panel phase proved adequate in producing comprehensible intermediate Norwegian versions ready for pilot testing. The Expert Panel reviewed the comments made by patients completing the instruments and offered advice to allow final translated versions to be produced and tested for measurement properties. This iterative approach, internal logic, and anonymity between rounds improved the evaluations that the panel members provided, which in turn enhanced the final translated Patient Reported Outcome Measures (PROMs).

CONCLUSIONS

To our knowledge, this work represents the first demonstration of the application of an Expert Panel review incorporating a Delphi method to assess health-related quality-of-life instruments. The controlled feedback approach, iterative nature, internal logic, and anonymity of the Delphi consensus method appeared to ensure a good cross-cultural adaptation of these PROMs.

Does Illness Behavior Contribute to the Understanding of Self-Efficacy and Quality of Life Among People With Hearing Loss? A Test of Concept

PURPOSE

The study sought to first confirm the mediating role of self-efficacy (SE) in the link between hearing loss and reduced quality of life (QOL) and introduce the construct of illness behavior (IB) as a further correlate of self-reported QOL that may itself be mediated by SE.

METHOD

Cross-sectional data were attained using a questionnaire that was completed by 61 adults with self-reported acquired hearing loss.

RESULTS

Support was provided for low SE being a barrier to QOL, with hearing loss only predictive of emotional QOL when SE was an intermediary (mediating) variable. Cognitive and affective indices of IB also predicted QOL. Those participants with elevated emotional distress and, to a lesser extent, exaggerated concerns for their health, were found to have both lower SE and poorer QOL.

CONCLUSIONS

Attempts to replicate these findings longitudinally and with larger and more diverse samples (e.g., congenital or illness-derived hearing loss) are encouraged. A more objective assessment of hearing loss may also reduce the potential for spurious associations that may arise from the use of self-reported data. Nevertheless, the analytical results provide encouragement for the continued consideration of IB in the evaluation of the well-being of individuals with hearing loss. It is proposed that IB could be a useful supplement to the study of motivation among this cohort, such as an addition to the commonly used Health Belief Model, to improve the predictive validity of appropriate health behaviors.

Predictive Validity of Resilience in the Treatment of Individuals With Anxiety and Depressive Disorders

The current study sought to evaluate the predictive validity of resilience among individuals with anxiety and/or depressive disorders. Receiver operating characteristics were calculated for each of the 25-item and 10-item versions of the Connor-Davidson Resilience Scale, evaluated against psychological distress and treatment response, at screening and post-treatment. New referrals to an anxiety and related disorders clinic were recruited for this purpose (N = 672 at screening, N = 349 post-treatment). Robust cross-sectional associations between resilience and psychological distress and treatment response were noted and were strongest at post-treatment. However, the related sensitivity (63% to 66% at screening, 69% to 76% post-treatment), specificity (78% to 83% at screening, approximately 73% post-treatment), and areas under the curve (AUC; approximately 73% at screening, 78% to 82% post-treatment) were modest. Furthermore, there was minimal support for resilience as a predictor of recovery using the longitudinal data (sensitivity and specificity could not be determined, with AUC of approximately 68% for psychological distress and 56% for treatment response). Although a relatively large homogeneous sample was available for this study, analyses of specific diagnostic subgroups may offer valuable further insight. [Journal of Psychosocial Nursing and Mental Health Services, 59(7), 35-41.].

Pathways to psychological wellbeing for patients with bladder cancer and their partners-in-care

PURPOSE

The goal of the current analyses was to describe pathways through which Psychological Wellbeing might be better understood for clinical participants with bladder cancer and their partners. This was achieved by applying Roy's Adaptation Model that provides a framework with which to understand responses to challenging circumstances that has proved useful in the study of a range of chronic conditions.

METHODS

The sample comprised 119 patients with a diagnosis of bladder cancer, and 103 supportive partners. Participants completed a self-report questionnaire comprising the Bladder Cancer Index, Mini-Mental Adjustment to Cancer Scale, Psychosocial Adjustment to Illness Scale, and sociodemographic details. For each sample, structural equation modelling was used to determine goodness of fit, guided by Roy's Adaptation Model.

RESULTS

For patients, increasing age and disease duration, the negative appraisal of health care, perceived poor functioning and elevated burden of disease provided pathways to Psychological Wellbeing. For partners, increasing age, being male, a negative health care experience, and perceived burden of disease were significant. However, for both groups a positive evaluation of family and social support was the key indicator of lower Psychological Wellbeing.

CONCLUSIONS

The models presented describe a suite of issues that could inform a nursing model of care to enhance the experience of living with bladder cancer for both patients and their supportive partners.

Medical student selection criteria and junior doctor workplace performance

BACKGROUND

Medical school selection decisions have consequences beyond graduation. With generally low attrition rates, most medical students become junior doctors. Universities are therefore not just selecting students into a medical course; they are choosing the future medical workforce. Understanding the relationship between selection criteria and outcomes beyond the successful completion of a medical degree may inform approaches to student selection.

METHODS

A retrospective data matching study was conducted involving 39 interns employed by a South Australian local health network in 2017 who had originally entered Flinders University's medical school through a graduate pathway. Student selection data were matched with internship workplace performance scores (measured by supervising consultants' reports across five clinical rotations using a standardised assessment). Correlational analyses then examined associations between these two sets of variables.

RESULTS

An overall selection rank (equal thirds of weighted Grade Point Average from a prior degree, a panel interview, and a national selection test) was moderately associated with all performance measures, accounting for up to 25% of variance. Both weighted Grade Point Average and the interview had multiple and mostly moderate correlations with performance. An increasing number of years taken to complete the course was associated with poorer workplace performance across multiple outcome measures (moderate to strong negative associations with 31 to 62% of shared variance), as was age to a lesser extent (7 to 14%). The national selection test contributed a single and small relationship accounting for 5% of variance with one outcome measure.

CONCLUSIONS

Selection into medicine is a critical assessment given that most students become doctors. This study found multiple associations between selection scores and junior doctor workplace performance measures in the internship year, with weighted Grade Point Average from a prior degree and an interview appearing more important than the national selection test. Future collaborative research should map desired workplace performance outcomes to initial student selection and explore the impact of changes to selection which focus on assessment of these domains. The association between slower course progression and poorer workplace performance should also be examined.

E-health: psychosocial challenges for South Australian rural mental health consumers

INTRODUCTION

Rates of mental health issues are increasing, coupled with insufficient resources to provide appropriate support. This is a particular challenge for rural areas in Australia that face significant social inequities including a scarcity of health resources. E-health initiatives are often proposed to maximise the number of rural mental health consumers able to receive support. The Australian Government has prioritised e-health within the remit of the Australian Digital Health Agency and the National Digital Health Strategy. However, despite increasing interest in e-health in policy and practice settings, uptake has been underwhelming. This study investigated the factors affecting the likely engagement with the internet, both for general and e-health purposes, within the context of South Australian rural mental health consumers. The focus was on psychosocial predictors, which embraced intrinsic (motivation), as well as extrinsic factors concerning equity, such as income, occupation, education and geographic location.

METHODS

Participants in this quantitative study included 208 mental health consumers in rural South Australia who had recently accessed a local health network mental health service. Data were sourced from the service's clinical management database and a questionnaire constructed for the study. The questionnaire included measures of personal characteristics, motives, equity and internet use.

RESULTS

Motives and equity-related variables were directly linked to general internet use, which subsequently affected the likelihood of using the internet for health purposes. Intrinsic rather than extrinsic factors were the most significant drivers of internet use; that is, higher levels of general internet use were associated with being younger, having stronger motivation, greater trust, higher education, being employed, having a higher income and having home internet access. For health internet use, the identified significant associations were more modest and included only being younger, having stronger motivation, and greater trust. The model indicated that there were no direct predictors of internet use for health beyond use of the internet for general purposes. However, key study variables provided significant indirect paths to health internet use. General internet use was strongly influenced by motivation, and age and equity to a lesser extent. Motivation was influenced by trust, and age and equity, with trust also influenced by age and equity.

CONCLUSION

This quantitative investigation sought to describe the barriers to and enablers of internet use generally, based on the assumption that before people will use the internet for health, they need to be prepared to use it for general purposes. The model proposed in the current research offers an indication of some of the factors that may influence rural mental health consumers' use of the internet for both general and health purposes. To appropriately design future e-health initiatives, the initial focus must be on consumers' individual capacity and willingness to use the internet generally. Policymakers and service providers are acutely interested in leveraging internet use to facilitate positive health outcomes. Understanding the factors that affect rural mental health consumers' use of the internet in general is beneficial in informing the efficient allocation of resources and the appropriate design of e-health initiatives to produce innovative solutions.

Effects of vitamin supplementation on inflammatory markers and psychological wellbeing among distressed women: a randomized controlled trial

BACKGROUND

Multivitamins are a popular supplement taken to promote physical and mental health. During periods of stress, they may have a protective role for health and wellbeing, although the current evidence of their efficacy is mixed.

OBJECTIVE

To determine whether multivitamin supplementation impacts psychological and inflammatory markers of women who are experiencing psychological distress.

DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS

An 8-week randomized controlled trial was conducted to assess changes in both psychological state and pro-inflammatory markers of patients receiving multivitamins or placebo. The sample comprised women who reported elevated psychological distress in the previous 4 weeks.

MAIN OUTCOME MEASURES

Psychological state was assessed using Spielberger's State-Trait Personality Inventory to assess anxiety, curiosity, depression and anger. Pro-inflammatory markers comprised interleukin (IL)-1β, IL-5, IL-6, tumour necrosis factor (TNF)-α and TNF-β.

RESULTS

Improvements across time were observed for all psychological measures and cytokines, except IL-5, but were independent of the active intervention. Only TNF-β demonstrated a significant differential change between groups over the course of the intervention, in favour of multivitamin supplementation (active group mean rank decreased from 11.1 to 7.1; placebo group mean rank decreased from 8.9 to 7.8).

CONCLUSION

The results suggest that administration of multivitamins was not effective in improving psychological state. However, some evidence supported the positive impact of multivitamin supplementation on pro-inflammatory cytokine profiles of women currently experiencing stress.

The Role of Negative Affect in the Assessment of Quality of Life among Women with Type 1 Diabetes Mellitus

BACKGROUND

The purpose of this study is to determine the impact of negative affect (defined in terms of lack of optimism, depressogenic attributional style, and hopelessness depression) on the quality of life of women with type 1 diabetes mellitus.

METHODS

Participants (n=177) completed either an online or paper questionnaire made available to members of Australian diabetes support groups. Measures of optimism, attributional style, hopelessness depression, disease-specific data, and diabetes-related quality of life were sought. Bivariate correlations informed the construction of a structural equation model.

RESULTS

Participants were 36.3±11.3 years old, with a disease duration of 18.4±11.2 years. Age and recent glycosylated hemoglobin readings were significant contextual variables in the model. All bivariate associations involving the components of negative affect were as hypothesized. That is, poorer quality of life was associated with a greater depressogenic attributional style, higher hopelessness depression, and lower optimism. The structural equation model demonstrated significant direct effects of depressogenic attributional style and hopelessness depression on quality of life, while (lack of) optimism contributed to quality of life indirectly by way of these variables.

CONCLUSION

The recognition of negative affect presentations among patients, and an understanding of its relevance to diabetes-related quality of life, is a valuable tool for the practitioner.

A pilot study: Can the UFOV assessment be used as a repeated measure to determine timing of on-road assessment in stroke?

BACKGROUND/AIMS

Useful Field of View scores are predictive of on-road performance post-stroke. No objective data exist to determine if the Useful Field of View (UFOV) assessment can be used as a repeated measure in the post-stroke population to determine timing of occupational therapy on-road assessment as recovery occurs. The aims of this study were to determine whether there is a practice effect if the UFOV is administered at one, two and three months' post-stroke and to assess optimal time post-stroke to refer to an on-road assessment.

METHOD

Forty-two participants, 17 men (40.5%), with a mean age of 71 years (SD 9.33) were randomly allocated to 1. Assessment group - UFOV at one, two and three months' post-stroke, 2. Control group-UFOV at three months' post-stroke. Parametric and non-parametric tests were utilised depending on data distribution.

RESULTS

No significance was found between; three months' subtest 1 (P = 0.463), three months' subtest 2 (P = 0.729) and three months' subtest 3 (P = 0.534) between the assessment and control groups. Both group's scores were combined to examine pass/fail rates of UFOV assessment to indicate timing of referral to on-road assessments. At one month, 16.9% stroke survivors passed the UFOV, when reassessed at three months 69.1% passed and 28.6% again failed.

CONCLUSION

Improvements in scores at one month intervals over three months are due to improvements in abilities assessed by the UFOV as no practice effect was found to influence scores. UFOV scores performed at monthly intervals post-stroke can be used to guide the timing of an occupational therapy on-road assessment, with an increased likelihood of passing, as recovery occurs. This repeated use of the UFOV assessment can assist referral practices that best utilise driving rehabilitation programmes. Larger studies need to be conducted to confirm these results.

Appearance Investment, Quality of Life, and Metabolic Control Among Women with Type 1 Diabetes

BACKGROUND

Concomitants of Type 1 diabetes management include weight gain and dietary restraint. Body image concerns, particularly among women, are therefore common.

PURPOSE

The study evaluated associations between the appearance investment component of body image, age, quality of life and self-reported metabolic control were examined, along with the practice of insulin restriction as a weight control strategy.

METHOD

A questionnaire comprising demographic and diabetes-related information, the Appearance Schemas Inventory, and Diabetes Quality of Life Brief Clinical Inventory was completed by Australian women diagnosed with type 1 diabetes (N = 177).

RESULTS

Self-evaluative salience was higher among younger participants, those with a lower quality of life, and those with better metabolic control of their diabetes, with the relationships between metabolic control and all of age, quality of life, and self-evaluative salience noted to be non-linear. Among participants who reported restricting insulin for weight control, self-evaluative salience was particularly relevant. Motivational salience was not related to other study variables.

CONCLUSION

Clinically, the provision of information regarding appearance changes that might arise in order to mitigate later body image difficulties is a potentially beneficial adjunct to standard diabetes management protocols that may lead to more successful disease adjustment.

Norwegian translation, and validation, of the Pelvic Floor Distress Inventory (PFDI-20) and the Pelvic Floor Impact Questionnaire (PFIQ-7)

INTRODUCTION AND HYPOTHESIS

The goal was to translate into Norwegian, and validate, short versions of the Pelvic Floor Distress Inventory (PFDI-20) and the Pelvic Floor Impact Questionnaire (PFIQ-7) using a sample of women with symptomatic pelvic organ prolapse and pelvic floor dysfunction.

METHODS

Modified European Organization for Research and Treatment of Cancer Guidelines were used for translation and cultural adaptation. Of 212 eligible Norwegian women who consented to participate, 205 completed the questionnaires, of whom 50 were retested after 1 - 3 weeks, and 76 were tested 6 months after surgery. Reliability, validity and responsiveness were evaluated. Additionally, interpretability, the smallest detectable change, the standard error of measurement, floor and ceiling effects, and the percentages of missing items are reported.

RESULTS

Reliability ranged from 0.66 to 0.93 and intraclass correlation coefficients from 0.85 to 0.94. Both construct validity and responsiveness were found to be adequate. The responsiveness of the PFDI-20 was further supported by areas under the curve above 0.70. Estimates were lower for the PFIQ-7. The smallest detectable changes at the individual level were 15 - 21 % and 17 - 27 % for the PFDI-20 and PFIQ-7, respectively. The absolute values of the minimal important changes in the total scores were 48 and 47, respectively. No floor or ceiling effects were evident in the distributions of the PFDI-20 and PFIQ-7 total scores.

CONCLUSIONS

The translated questionnaires provided adequate reliability, validity and good responsiveness to change. These short versions of the PFDI and PFIQ are robust measuring instruments that will enable symptom severity and health-related quality of life to be evaluated in the Norwegian context.

Predicting success in medical school: a longitudinal study of common Australian student selection tools

BACKGROUND

Medical student selection and assessment share an underlying high stakes context with the need for valid and reliable tools. This study examined the predictive validity of three tools commonly used in Australia: previous academic performance (Grade Point Average (GPA)), cognitive aptitude (a national admissions test), and non-academic qualities of prospective medical students (interview).

METHODS

A four year retrospective cohort study was conducted at Flinders University Australia involving 382 graduate entry medical students first enrolled between 2006 and 2009. The main outcomes were academic and clinical performance measures and an indicator of unimpeded progress across the four years of the course.

RESULTS

A combination of the selection criteria explained between 7.1 and 29.1 % of variance in performance depending on the outcome measure. Weighted GPA consistently predicted performance across all years of the course. The national admissions test was associated with performance in Years 1 and 2 (pre-clinical) and the interview with performance in Years 3 and 4 (clinical). Those students with higher GPAs were more likely to have unimpeded progress across the entire course (OR = 2.29, 95 % CI 1.57, 3.33).

CONCLUSIONS

The continued use of multiple selection criteria to graduate entry medical courses is supported, with GPA remaining the single most consistent predictor of performance across all years of the course. The national admissions test is more valuable in the pre-clinical years, and the interview in the clinical years. Future selections research should develop the fledgling research base regarding the predictive validity of the Graduate Australian Medical School Admissions Test (GAMSAT), the algorithms for how individual tools are combined in selection, and further explore the usefulness of the unimpeded progress index.

The relative contributions of function, perceived psychological burden and partner support to cognitive distress in bladder cancer

OBJECTIVE

Bladder cancer is a genitourinary disease of increasing incidence. Despite improvements in treatment, outcomes remain equivocal with high recurrence rates. It is associated with poor psychosocial outcomes due to reduced functioning of the genitourinary system. The objective of these analyses was to query whether reported loss of function or the perception of psychological burden caused by this functional impedance was the key to understanding psychosocial outcomes.

METHODS

The sample comprised 119 participants with a confirmed diagnosis of bladder cancer. They completed a self-report questionnaire comprising the Bladder Cancer Index, Mini-mental Adjustment to Cancer Scale, Psychosocial Adjustment to Illness Scale and standard sociodemographic details. Simple mediation and serial mediation were used to explore the potential for psychological burden to mediate associations between loss of function and cognitive distress, and the potential additional contribution of positive partner support on these relationships. Age and duration of cancer were considered as covariates.

RESULTS

Simple mediation demonstrated that the association between function and cognitive distress was fully mediated by perceived psychological burden. Serial mediation, which allowed for the addition of partner support, again demonstrated full mediation, with partner support being the key predictive variable.

CONCLUSIONS

These analyses emphasise the importance of an appreciation of individuals' interpretation of the burden occasioned by bladder cancer and the role of a supportive partner. The implications for management discussions and support services in alleviating negative psychological outcomes in bladder cancer are highlighted. Copyright © 2015 John Wiley & Sons, Ltd.

Patients' perspectives regarding long-term warfarin therapy and the potential transition to new oral anticoagulant therapy

OBJECTIVES

To examine patients' perspectives regarding long-term vitamin K antagonist (VKA) therapy and the potential transition to new oral anticoagulants (NOACs) such as dabigatran and rivaroxaban, and to determine if factors such as residential location affect these opinions.

DESIGN SETTING AND PARTICIPANTS

Patients on VKA therapy for at least 12 weeks completed a questionnaire specifically designed for the study. They were recruited while attending point-of-care international normalized ratio (INR) testing at six South Australian general practice clinics during the period July-September 2013.

MAIN OUTCOME MEASURES

Opinions of current VKA therapy, level of awareness of NOACs, and ratings of potential benefits and deterrents of transition to NOACs were sought.

RESULTS

Data from 290 participants were available for analysis (response rate 95.4%). The majority of the sample (79.5%, 229/288) were either satisfied or very satisfied with current VKA therapy. The mean score for the potential benefits of transition to NOACs was 7.6 (±4.2) out of a possible 20, which was significantly lower than the mean score 10.9 (±4.5) for the perceived deterrents to transition (p < 0.001). Rural patients (82.0%, 82/100) were significantly more likely (p = 0.001) to have not heard of NOACs than metropolitan patients (50.3%, 95/189) and also perceived significant less benefits in a transition to NOACs (p = 0.001).

CONCLUSION

When considering potential transition from VKAs to NOACs it is important for prescribers to consider that some patients, in particular those from a rural location, may not perceive a significant benefit in transitioning or may have particular concerns in this area.

An investigation of the support needs of men and partners throughout the prostate cancer journey

OBJECTIVE

Prostate cancer is one of the mostly commonly diagnosed cancers in men. Unfortunately, the treatment for this cancer can have a number of negative side effects, both for the man himself and his partner. This study investigated the support needs of both men and partners throughout the prostate cancer journey and how this journey may be optimally managed.

METHODS

Thirty-one men who had undergone prostate cancer treatment within the last 6 years and 31 partners answered a questionnaire, which explored support care issues as identified in the literature and from focus groups.

RESULTS

Men and partners were moderately satisfied with information given regarding diagnosis, treatment and side effects, but partners were more satisfied with information relating to the particular chosen treatment. Men's understanding of their chosen treatment's potential side effects was significantly different from their understanding of diagnosis, cancer outcome, treatment options and selected treatment. Timing of information delivery was preferred by men at diagnosis, whereas partners preferred after the diagnosis. Men wanted more time to think about the diagnosis and treatment, whereas partners wanted an opportunity to discuss the diagnosis. The management of common side effects such as emotional changes, incontinence and erectile dysfunction was rated as 'somewhat' satisfactory.

CONCLUSION

Men and partners may have different educational and supportive needs throughout the prostate cancer journey that require attention and tailored management.

Transition from the spouse dementia caregiver role: A change for the better?

One in 15 Australians over 65 experience dementia, and are commonly supported by spouses. Evidence demonstrates declining wellbeing for these caregivers as their role continues. There are indications of improvement once caregivers transition out of the role (recovery) but alternate suggestions that caregiving stress may be too damaging to be appeased (wear and tear). It seems plausible that reason for transition (care recipient's move into residential care or death) will affect caregivers' outcomes. A synthetic cohort method compared caregivers' stress and wellbeing prior to, and one and two years post-transition. There was evidence of wear and tear for physical wellbeing but recovery for psychological wellbeing over time; with little difference based on reason for transition. Caregiver outcomes seem to be a function of the action rather than the reason for transition, but factors such as age must be considered when designing methods to support post-transition wellbeing.

Construct validity and temporal stability of the abridged 31-item Illness Behaviour Questionnaire

OBJECTIVE

Key psychometric information was sought for three newly derived dimensions from an abridged Illness Behaviour Questionnaire (IBQ-31): Affirmation of Illness (AI), Concern for Health (CH) and General Affective State (GAS). The construct validity of these scales was examined along with their test-retest reliability and long-term stability.

DESIGN

A longitudinal, observational study was conducted with 675 participants (general community members and those with either asthma, diabetes and chronic pain or chronic fatigue syndrome) providing self-report questionnaire data at baseline, with additional information sought at three (n = 483; 71.6%) and 12 months (n = 517, 76.6%).

MAIN OUTCOME MEASURES

Construct validity of the IBQ-31 was explored using well-validated psychological measures of Symptom Attributions and Symptom Experience, Cognitive Distortion of Somatic Information and Illness Likelihood.

RESULTS

In general, AI, CH and GAS shared predictable empirical overlap with related psychological indices across the five samples. Adequate three-month test-retest reliability was evident, with greater score variability over 12 months.

CONCLUSION

The IBQ-31 comprises three theoretically relevant dimensions which demonstrate relative short- and long-term stability for individuals with diverse illness experiences. Future investigations should explore the predictive validity of AI, CH and GAS, along with the potential value of 'cut-off' scores for clinical use.

Correspondence between alternate measures of maladaptive exercise, and their associations with disordered eating symptomatology

AIMS

The study sought to contribute to the measurement of maladaptive exercise by examining the psychometric properties of a variety of instruments and classification algorithms. The primary aim was to identify the items or scales necessary and sufficient to quantify the construct. A secondary aim was to comment on the construct validity of these measures by examining their relationships with disordered eating symptomatology.

METHODS

Questionnaire booklets comprising the Exercise Dependence Scale, the Obligatory Exercise Questionnaire, the Frequency, Intensity, Time Index, and the Eating Attitudes Test were distributed to women attending health and fitness centres. Self-reported age, height, current and desired weight, and length of time as a regular exerciser were also sought. Data were obtained from 302 regular exercisers.

RESULTS

While there were statistically significant associations among the measures, no two operationalised maladaptive exercise in the same manner. The Frequency-Intensity-Time Index (FIT) was found to be particularly poor. While variation in the size of relationships between maladaptive exercise and disordered eating was noted, all measures were strongly correlated with the exception of FIT, which demonstrated a modest correlation.

CONCLUSIONS

Different conceptualisations of maladaptive exercise have led to alternative operational definitions, resulting in its classification being instrument dependent. Further exploration using samples with differing characteristics (e.g., high/low probability of dependence) may allow more specific recommendations to be made about the optimal measurement of maladaptive exercise. Further, the question of whether maladaptive exercise is more likely a cause or consequence of eating disorders remains.

Somatic symptom disorders and illness behaviour: current perspectives

The behavioural aspects of somatic symptom disorders have received minimal research attention to date. The first section of this paper identifies key theoretical perspectives relevant to behavioural responses to illness. Specifically, the sociological concept of illness behaviour is offered as a general framework in which to consider the range of psychosocial factors associated with responses to perceived illness. Further, the potential relevance of the construct of abnormal illness behaviour and the cognitive behavioural conceptualization of health anxiety is explored. The second part of the paper describes various approaches to the operationalization of illness behaviour, with particular emphasis on the Illness Behaviour Questionnaire, an instrument with a rich history of application. Additional insight is provided into two contemporary instruments which aim to measure overt behavioural aspects of illness more specifically. The third and final section of the paper makes recommendations for how future research may advance the understanding of state- versus trait-based characteristics of illness behaviour. Suggestions are made for how adaptive forms of behaviour (e.g. self-management, appropriate coping) may reduce the risk of developing a somatic symptom disorder or alternatively, minimizing the potentially negative psychosocial implications of such a presentation.

Protocol for a randomised controlled trial of chronic disease self-management support for older Australians with multiple chronic diseases

The prevalence of older Australians with multiple chronic diseases is increasing and now accounts for a large proportion of total health care utilisation. Chronic disease self-management support (CDSMS) has become a core service component of many community based health programs because it is considered a useful tool in improving population health outcomes and reducing the financial burden of chronic disease care. However, the evidence base to justify these support programs is limited, particularly for older people with multiple chronic diseases. We describe an ongoing trial examining the effectiveness of a particular CDSMS approach called the Flinders Program. The Flinders Program is a clinician-led generic self-management intervention that provides a set of tools and a structured process that enables health workers and patients to collaboratively assess self-management behaviours, identify problems, set goals, and develop individual care plans covering key self-care, medical, psychosocial and carer issues. A sample of 252 older Australians that have two or more chronic conditions will be randomly assigned to receive either CDSMS or an attention control intervention (health information only) for 6 months. Outcomes will be assessed using self-reported health measures taken at baseline and post-intervention. This project will be the first comprehensive evaluation of CDSMS in this population. Findings are expected to guide consumers, clinicians and policymakers in the use of CDSMS, as well as facilitate prioritisation of public monies towards evidence-based services.

New dimensions of abnormal illness behaviour derived from the Illness Behaviour Questionnaire

The primary aim was to explore the factor structure of the Illness Behaviour Questionnaire (IBQ) and the generalisability of the derived dimensions to both general community members and four chronic illness groups. A questionnaire was administered to 675 participants, comprising 344 from the community, 80 with asthma, 95 with diabetes, 79 with chronic pain and 77 with chronic fatigue syndrome (CFS). Illness severity was calculated for all chronic illness participants (self-rated health for community members). Three IBQ scales were derived following an exploratory factor analysis for the whole sample: Affirmation of Illness (α = 0.71 (CFS)-0.79 (asthma, diabetes)), Concern for Health (α = 0.71 (asthma)-0.78 (pain)) and General Affective State (α = 0.70 (CFS)-0.80 (asthma)). Patterns of response across the five samples, and intercorrelations among the new scales and the original seven scales, were largely in accord with expectation. Long-standing criticisms of the IBQ were addressed by using systematic statistical principles to identify meaningful and psychometrically sound IBQ dimensions. The derived structure offers a more parsimonious account of possible illness responses, with the availability of a more concise yet informative index of abnormal illness behaviour having practical utility for researchers and clinicians alike.

Do doctors, nurses and managers have different thinking styles?

A study of the preferred thinking styles among senior health professionals is reported. A total of 49 medical consultants, 50 senior nurses and 53 health managers from two public teaching hospitals in Adelaide, Australia, were invited via a personal letter to complete a questionnaire comprising measures of thinking style (the Rational Experiential Inventory) and cognitive style (two dimensions of the Myers-Briggs Type Indicator). Managers reported a higher preference for 'rational' reasoning than nurses, whereas medical consultants reported a lower preference for 'experiential' reasoning than both managers and nurses. Cognitive style was largely homogenous. Although generalisation of the findings may be limited due to small sample sizes and the self-selection of participants, an understanding of the thinking styles of senior health professionals will likely inform the design and evaluation of future change strategies.

Psychological responses to cancer: a case for cancer support groups

This study investigates the responses of patients and their carers to the diagnosis of cancer. The reporting of stress by patients, using linear analogue scales, and their psychological distress, as measured by the General Health Questionnaire, indicated benefits for members of a community-based cancer support group. The responses of carers revealed that the impact of the diagnosis was as great on them as on patients. Various mediators were considered and age was found to significantly influence the reporting of stress. The limitations and implications of the findings are discussed.

Measuring disability with parsimony: evidence for the utility of a single item

PURPOSE

To provide evidence for the utility of a single item measure designed to quantify disability in the past 30 days.

METHOD

Australian data from studies comprising a community-dwelling elderly sample (N = 328) and a sample of chronic osteoarthritis (OA) patients (N = 119) are reported. Degree of disability was classified as 0-30 days, 0 vs. 1 or more days, and 0-9 vs. 10 or more days. Associations between disability and a range of demographic, health-related, and psychological variables were assessed.

RESULTS

Participants with OA reported a significantly higher level of disability than participants from the community sample regardless of how disability was classified. Modest levels of association were noted between the number of disability days (0-30) and both health and psychological indices in both samples. The three alternative classifications of disability made little difference to the significance of associations. On balance, the comparison of 0-9 vs. 10 or more days appeared the more predictive classification of disability.

CONCLUSIONS

The performance of the single item measure of disability was generally very satisfactory. Future investigations into the clinical application of the item across a range of patient groups are encouraged.

Why don't doctors wash their hands? A correlational study of thinking styles and hand hygiene

BACKGROUND

The World Health Organization has identified cognitive determinants of hand hygiene as an outstanding research question. This study investigated whether doctors' preferences for a rational thinking style or an experiential thinking style are associated with hand hygiene compliance.

METHODS

This was an observational study of hand hygiene practices of 32 doctors in 2 teaching hospitals in South Australia. Compliance rates were correlated with self-reported thinking styles. The doctors were observed by a trained observer during a ward round or outpatient clinic and were unaware that hand hygiene was under observation. The main outcome measures were hand hygiene compliance (hand hygiene compliance tool) and thinking style (Rational-Experiential Inventory).

RESULTS

An overall mean compliance rate of 7.6% (standard deviation +/- 7.2%) was found. Compliance was significantly positively correlated with experiential/automatic thinking (r = .46; P = .004) and the observational setting of ward rounds (vs clinics) (r = -.47; P = .003). No significant relationship was found between compliance and a rational/deliberate thinking style (r = -.01; P = .472).

CONCLUSIONS

Hand hygiene is more experiential than rational. Findings suggest that certain promotional strategies appealing to the experiential thinking mode may improve compliance, and that traditional approaches based on logic and reasoning alone probably will not work.

The measurement of abnormal illness behavior: toward a new research agenda for the Illness Behavior Questionnaire

Abnormal illness behavior (AIB) refers to a maladaptive manner of experiencing, evaluating, or acting in response to health and illness that is disproportionate to evident pathology. The construct was originally informed by the sociological notions of the sick role and illness behavior. The present article provides a comprehensive review of the conceptual and empirical development of AIB with a detailed insight into the variety of illness contexts to which it has been applied using the Illness Behavior Questionnaire (IBQ). While the relevance of AIB continues to be demonstrated within the prescribed contexts of the chronic pain and psychiatric literatures, criticisms of AIB and its measurement have arisen when researchers have attempted to move beyond these contexts. In recognition of these criticisms, this article presents a new research agenda to address key limitations that currently impede the broader development and application of AIB. Most importantly, it is proposed that greater consideration needs to be given to the definition of AIB according to type of illness and for general community members without a current illness. The article concludes with comment on the potential practical implications of any future reconceptualization of AIB, including the need to reconsider the manner in which IBQ scores are derived and interpreted, and the need for caution when applying the label "abnormal" in specific illness contexts.

Environmental stress, psychological stress and allostatic load

The mechanism by which chronic caregiving stress results in poor health is not well understood. The objective was to determine whether such a mechanism may be allostatic load, a novel concept specifying physiological systems that may suffer cumulative wear and tear following chronic stress, leading collectively to poor health. The study examines the association of allostatic load with environmental and psychological stress in the contexts of dementia caregiving and relinquishment of care, and is a 2-year longitudinal comparison of three groups: 80 new dementia spouse caregivers, 120 veteran caregivers, and 60 non-caregivers. Data comprised allostatic load markers and environmental and psychological stress measures. Cross-lagged analyses produced a statistically significant association between psychological stress and one allostatic load component (primary mediators). Psychological stress was a better predictor of primary mediators than environmental stress. Primary mediators rose with time for caregivers, but not for non-caregivers. A greater rise was evident for caregivers who had relinquished their role by the second year, although the level of psychological stress actually declined. Primary mediators are a key component of the relationship between allostatic load and prior stress. When allostatic load is treated as an outcome of stress, it is important to distinguish environmental and psychological stress.

The contributions of psychological disposition and risk factor status to health following treatment for coronary artery disease

BACKGROUND

Successful adjustment following treatment for coronary artery disease is related to both psychological disposition and risk factor status. Consideration of the interplay between these variables is required to better acknowledge their relationship with health outcome.

AIMS

To determine the salience of self-efficacy and locus of control to both general self-rated health and current cardiac health, relative to risk factor status. To determine whether self-efficacy is a more salient predictor of health status than locus of control.

METHODS

Men (n=248) treated in the previous 3 years for either coronary artery disease alone or a myocardial infarction completed a questionnaire in which clinical, risk factor (knowledge of risk factors, current risk factors, change in risk factors), psychological (self-efficacy, locus of control) and health information were sought.

RESULTS

Self-efficacy and internal locus of control had both direct and indirect influences on health in the models in which knowledge of risk factors was treated as the potential mediator. This pattern of results was not evident when either current risk factors or change in risk factors were examined as potential mediators. In the models in which self-efficacy was considered as a potential mediator of locus of control in the prediction of health status, self-efficacy was determined to be the more relevant psychological construct.

CONCLUSION

The consistent positive associations obtained among self-efficacy, cognitive risk factor status and health suggest that health professionals involved in cardiac rehabilitation should be encouraged to tailor interventions that allow patients to both improve their understanding of CAD and also to develop greater self-confidence in their ability to implement the acquired knowledge.

Implementation science: a role for parallel dual processing models of reasoning?

BACKGROUND

A better theoretical base for understanding professional behaviour change is needed to support evidence-based changes in medical practice. Traditionally strategies to encourage changes in clinical practices have been guided empirically, without explicit consideration of underlying theoretical rationales for such strategies. This paper considers a theoretical framework for reasoning from within psychology for identifying individual differences in cognitive processing between doctors that could moderate the decision to incorporate new evidence into their clinical decision-making.

DISCUSSION

Parallel dual processing models of reasoning posit two cognitive modes of information processing that are in constant operation as humans reason. One mode has been described as experiential, fast and heuristic; the other as rational, conscious and rule based. Within such models, the uptake of new research evidence can be represented by the latter mode; it is reflective, explicit and intentional. On the other hand, well practiced clinical judgments can be positioned in the experiential mode, being automatic, reflexive and swift. Research suggests that individual differences between people in both cognitive capacity (e.g., intelligence) and cognitive processing (e.g., thinking styles) influence how both reasoning modes interact. This being so, it is proposed that these same differences between doctors may moderate the uptake of new research evidence. Such dispositional characteristics have largely been ignored in research investigating effective strategies in implementing research evidence. Whilst medical decision-making occurs in a complex social environment with multiple influences and decision makers, it remains true that an individual doctor's judgment still retains a key position in terms of diagnostic and treatment decisions for individual patients. This paper argues therefore, that individual differences between doctors in terms of reasoning are important considerations in any discussion relating to changing clinical practice.

SUMMARY

It is imperative that change strategies in healthcare consider relevant theoretical frameworks from other disciplines such as psychology. Generic dual processing models of reasoning are proposed as potentially useful in identifying factors within doctors that may moderate their individual uptake of evidence into clinical decision-making. Such factors can then inform strategies to change practice.

Relationships between family conflict, perceived maternal verbal messages, and daughters' disturbed eating symptomatology

The objective was to investigate relationships between family conflict and the perceived communication of negative messages regarding weight and shape from mothers to daughters, and daughters' disordered eating symptomatology. A correlational study was conducted in which a questionnaire was completed by 315 women aged between 14 and 28 years. The sample comprised both secondary school students (n=196) and university students (n=119). Disordered eating symptomatology was operationalised as drive for thinness, body dissatisfaction, and bulimic symptoms. Family conflict and the perceived frequency of negative messages regarding weight and shape communicated from mothers were also reported by participants. With current BMI treated as a covariate, support was provided for the proposition that frequency of negative messages is a more important contributor to disordered eating symptomatology than family conflict for both secondary school students and university students. However, for secondary students there was no relationship between family conflict and drive for thinness. Recommendations for future research are provided, including the possibility of considering the perception of both positive and negative weight-related messages, and the relative importance of such messages when conveyed by people other than the maternal figure, such as fathers, siblings and peers.

Piriformis syndrome: Correlation of muscle morphology with symptoms and signs

OBJECTIVE

To determine the relation of symptoms and pain provocation tests to abnormal piriformis morphology among people with chronic buttock pain.

DESIGN

Each of 2 clinical symptoms and 2 clinical signs were compared with the abnormal morphology found on ultrasound. The pain-free side was used as an internal control.

SETTING

A tertiary referral center.

PARTICIPANTS

A series of 27 consecutive patients (26 women, 1 man; average age, 48 y) with chronic low lumbosacral or buttock pain, who presented to a musculoskeletal clinic over a 12-month period, underwent ultrasound assessment of piriformis muscle morphology. Four patients were excluded because their body mass index was in excess of 30 kg/m 2 .

INTERVENTION

The symptomatic piriformis muscle was injected with bupivacaine after pain was assessed on a visual analog scale (VAS), using the resisted abduction test.

MAIN OUTCOME MEASURE

A 70% reduction of pain on the VAS was considered positive for pain in the piriformis muscle.

RESULTS

Odds ratios (ORs) and 95% confidence intervals were calculated comparing each of the signs and symptoms with normal morphology. The highest ORs were found for pain on walking up inclines (10.8), referred pain (5.3), and pain on needling the piriformis muscle (6.0).

CONCLUSIONS

This study did not provide a criterion standard for the diagnosis of piriformis syndrome, but it did support the syndrome as a contributing factor in chronic buttock pain and very low back pain.

Dimensions of osteoarthritis self-management

Our aims were to determine whether a taxonomy of self-management strategies for osteoarthritis could be identified, and whether the resultant dimensions of such a taxonomy demonstrate predictable relationships with health status indices. Participants (n = 117) from community-based self-help groups and a general rheumatology outpatient clinic completed a self-management inventory consisting of 11 items, answered for both the past 7 days and a day on which symptoms were worse than usual. Duration of symptoms, level of pain, perceived functional ability and self-rated health were recorded as indicators of health status. Three essentially identical factors were obtained for both past 7 days and worse day items. Resultant scales were labeled passive, complementary and active, respectively. Correlations with health status measures provided modest evidence for the construct validity of these self-management scales. Compared with a simple aggregate score based on the total number of strategies used, the scales provided a clearer understanding of the relationship between self-management and health. The study provided a useful extension to existing research, addressing a number of shortcomings identified by previous researchers. The identified self-management dimensions offered a greater insight into the self-management choices of patients. Suggestions for further improvements to the measurement of self-management are outlined.

The quality of life of spouse dementia caregivers: changes associated with yielding to formal care and widowhood

The focus of the study was the effect on spouse dementia caregivers of relinquishing care. The study used a longitudinal design, in which a group of 150 dementia caregivers were interviewed 2 years apart (designated Time 1 and Time 2), with data collected from both continuing caregivers and those who had relinquished care. The aims were to determine the extent to which changes over time in quality of life differed between continuing caregivers, those who had yielded to formal care, and those who had been widowed; and to examine whether change in quality of life variables was associated with time since yielding to formal care and time since death of the spouse. Quality of life was defined in terms of health status, psychological well-being, and activity participation. All participants were interviewed in their own homes. Three groups of participants were identified at Time 2: those who continued to provide care for their spouses (n=60); those who had yielded their caregiver role by admitting their spouses to permanent residential care (n=53); and those who had admitted their spouses to permanent institutional care, but whose spouse had then died (n=37). Different patterns of quality of life changes were observed between the three groups, with both positives and negatives associated with disengagement from the caregiving role. Positive changes were particularly evident in psychological well-being and activity participation. These findings were discussed in terms of their relevance for a life transitions approach to the relinquishment of caregiving.