Factors associated with health behaviours among stroke survivors: A mixed-methods study using COM-B model

AIMS

To identify factors associated with health behaviours among stroke survivors, through a multi-centre study.

DESIGN

A sequential mixed methods design.

METHODS

In the quantitative research phase, a total of 350 participants were recruited through multi-stage sampling from December 2022 to June 2023. General information questionnaires, The Stroke Prevention Knowledge Questionnaire (SPKQ), Short Form Health Belief Model Scale (SF-HBMS), Health Promoting Lifestyle Profile (HPLPII), and the WHOQOL-BREF (World Health Organization Quality of Life Questionnaire, Brief Version) were distributed across five tertiary hospitals in Henan province, China. For the qualitative research component, semi-structured interviews were conducted to explore the barriers and facilitators of health behaviour. This study adheres to the GRAMMS guidelines.

RESULTS

A total of 315 participants (90.0%) completed the survey. Identified barriers to health behaviour included residing in rural areas, higher scores on the Charlson Comorbidity Index (CCI) and mRS, as well as lower scores on SPKQ, SF-HBMS and WHOQOL-BREF. Twenty-four individuals participated in qualitative interviews. Twenty-eight themes were identified and categorised by frequency, covering areas such as knowledge, skills, intentions, social influences, social/professional role and identity, environmental context and resources, beliefs about capabilities, beliefs about consequences and behavioural regulation. Both quantitative and qualitative data suggested that health behaviour among stroke survivors is at a moderate level, and the identified barrier factors can be mapped into the COM-B model (Capability, Opportunity, Motivation and Behaviour).

CONCLUSION

The study indicates that key barriers to health behaviour among stroke survivors align with the COM-B model. These identified factors should be carefully considered in the planning of future systematic interventions aimed at improving health behaviours among stroke survivors.

PATIENT OR PUBLIC CONTRIBUTION

Patients were invited to completed questionnaires in the study and semi-structured interviews. The investigators provided explanation of this study' content, purpose and addressed issues during the data collection.

A survey regarding the role of UK dietitians in spiritual care

BACKGROUND

Users of dietetic services have unmet spiritual needs, although no study has yet explored dietitians' opinion, perceptions or experience of assessing spiritual needs and delivering spiritual care in clinical practice.

METHODS

A cross-sectional survey assessed the role of UK dietitians in spiritual care.

RESULTS

Thirty-seven practicing dietitians, with experience ranging from newly qualified to over 21 years of practice, took part in the survey containing open and closed questions. Almost half (49%) of dietitians said they always conducted spiritual assessments and most (57%) said they sometimes made a referral for spiritual concerns. When spiritual issues arose, dietitians were highly likely to listen well (score 4.6 out of 5) and encourage service users in their own (the service user) spiritual or religious practices (score 4 out of 5). However, the likelihood of taking the initiative and enquiring about religious and spiritual issues was lower (score <3 out of 5) in all areas of practice including end of life care. This may have been because confidence around spiritual care was also low (score 4.7 out of 10), uncertainty was high (score >3.5 out of 5) and there was a strong desire to receive training (>4 out of 5). Qualitative responses expanded further on these results suggesting that there was positive "intention" to provide spiritual care, but lack of training was a significant barrier (qualitative theme: "inadequacies"). The recognition of necessity but uncertainty of how to meet spiritual needs was also shown through qualitative findings to be a source of "emotional labour", particularly where there were conflicting beliefs between a dietitian and service user.

CONCLUSIONS

Although limited by a small sample size, these results provide new knowledge that spiritual care is considered an important part of the dietitians' role and that this is the case regardless of the dietitians own spiritual identity or religion. Dietitians would value training in spiritual care so that they can support service user needs more readily and confidently.

Dressing up social psychology: Empirically investigating the psychological functions of clothing using the example of symbolic protection

Clothing behaviour remains an understudied research area within social psychology. Through the present research, we aim to anchor attire as an empirical research subject by investigating the psychological properties of one of its functionalities, namely, to provide protection. We argue that attire's undisputed role in shielding humans from environmental hazards may extend to the psychological level and protect them from the incorporeal consequences of existential threats symbolically. In this Registered Report, a mixed-methods approach links an ecologically valid field study of self-presentation in social media posts during Russia's war on Ukraine (Study 1; N = 248) with supraliminal priming of mortality salience in an online experiment (Study 2; N = 248). Across both studies, we expect that mortality concerns let people accentuate the physically protective attributes of clothing (e.g. more layers of clothing) and resort to more in-group prototypical dress styles (i.e. more gender-stereotypical). Findings show that people adjust their clothing preferences in response to existential threats, favouring in-group prototypical clothing (more gender-typical for both women and men in Study 1) and physically protective attire (higher in women and lower in men in Study 2) during high (vs. low) levels of existential threat. By positioning clothing as a research area within social psychology, our goal is to stimulate a wave of research on its profound role for humankind. Furthermore, we provide a dynamic and robust methodological approach to researching terror management theory.

A post-diagnosis information and support programme for dyads-People living with dementia or mild cognitive impairment and family carers: A feasibility study

AIM

The aim of the study was to establish the feasibility of delivering a structured post-diagnosis information and support program to dyads (persons living with dementia or mild cognitive impairment and family carers) in two primary care settings.

DESIGN

A two-phase explanatory mixed-method approach guided by the Bowen Feasibility Framework focused on acceptability, implementation, adaptation, integration and efficacy of a five-part programme. In phase 1, the quantitative impact of the programme on the dyadic programme recipients' self-efficacy, quality of life, dyadic relationship and volume of care was measured. In phase 2, inductive content analysis focused on nurse and dyad participant experiences of the programme. Quantitative and qualitative data were reviewed to conclude each element of feasibility.

METHODS

Four registered nurses working within the participating sites were recruited, trained as programme facilitators and supported to deliver the programme. Eligible dyads attending the respective primary health clinics were invited to participate in the programme and complete surveys at three time points: recruitment, post-programme and 3-month follow-up. Post-programme semi-structured interviews were conducted with dyads and programme facilitators.

RESULTS

Twenty-nine dyads completed the program; the majority were spousal dyads. The programme proved acceptable to the dyads with high retention and completion rates. Implementation and integration of the programme into usual practice were attributed to the motivation and capacity of the nurses as programme facilitators. Regarding programme efficacy, most dyads reported they were better prepared for the future and shared the plans they developed during the programme with family members.

CONCLUSION

Implementing a structured information and support programme is feasible, but sustainability requires further adaptation or increased staff resources to maintain programme fidelity. Future research should consider selecting efficacy measures sensitive to the unique needs of people living with dementia and increasing follow-up time to 6 months.

IMPACT

This study established the feasibility of registered nurses delivering a post-diagnosis information and support programme for people living with early-stage dementia or mild cognitive impairment and their informal carers in primary care settings. The motivation and capacity of nurses working as programme facilitators ensured the integration of the programme into usual work, but this was not considered sustainable over time. Family carer dyads reported tangible outcomes and gained confidence in sharing their diagnosis with family and friends and asking for assistance. Findings from this study can be used to provide direction for a clinical trial investigating the effectiveness of the structured information and support programme in the primary care setting.

REPORTING METHOD

The authors have adhered to the EQUATOR STROBE Statement.

PATIENT OR PUBLIC CONTRIBUTION

A public hospital memory clinic and general medical practice participated in project design, study protocol development and supported implementation.

Account-Holding Intensity in the EU Accountability Landscape: A Comprehensive Review of EU agencies' Institutional Accountability Relationships

In this article, we propose a novel conceptualization of account-holding intensity - defined as both the frequency and diligence of account-holding - as an instrument for analysing the behaviour of account-holders in the accountability landscape of EU agencies. We examine the account-holding intensity of six major institutional EU account-holders through a complementary mixed-methods approach that combines quantitative survey data and qualitative interview data collected from directors and senior managers of EU agencies. Account-holding intensity is measured through the survey data, with the interview data providing detailed insight into why some account-holders are more/less active and/or diligent than others. The survey and interview data are furthermore triangulated with in-depth interviews with account-holders and unobtrusive indicators of account-holding intensity. This amounts to a comprehensive empirical review of the EU agencies' institutional accountability relationships, which reveals how different account-holders are driven by different institutional logics that are associated with different account-holding intensities.

Changing the gendered status quo in engineering? The encouraging and discouraging experiences of young women with engineering aspirations

Young women remain underrepresented among engineering bachelor's degree holders. While there is a relatively large body of extant research on the many factors that curtail young women's interest in pursuing engineering, less is known about high school girls who are on an engineering pathway. Therefore, this study focuses on a select group of precollege young women who express a strong interest in engineering. Specifically, informed by theories of gender as a social system and previous empirical research, this mixed-methods study explores the constellation of significant actors within the daily lives of these young women, to understand from whom and how they are supported in pursuing this gender-atypical field, and simultaneously, from whom and how they are discouraged. To do so, the researchers analyzed survey and interview data from a sample of diverse high school girls who participate in the Society of Women Engineers' (SWE) SWENext programme. Quantitative results indicate that young women report high levels of encouragement from most sources, including parents, teachers, and other young women. However, across various peer contexts, they receive much more support from other young women than from young men. Qualitative results further reveal that parents and teachers stand out in young women's recollections of encouragement, often through advocating their participation in engineering activities or providing mentoring support. In contrast, young men in engineering spaces were recalled as particularly discouraging of their engineering participation, by socially or physically excluding them or refusing to provide recognition. Implications for future research and practice are discussed.