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Biomedical subjects

John Weinman

Publications and source records attributed to John Weinman.

At least 37 records · Page 2Linked to original sources
PubMed2004

Perceived stress, stress attributions and psychological distress in psoriasis.

OBJECTIVE: The objective of this study was to measure causal beliefs in individuals with psoriasis and to explore their relationship with perceived stress, quality of life, psychological well-being and psoriasis severity. METHODS: This study was cross-sectional in design, and patients were required to complete validated questionnaires assessing perceptions of illness, quality of life, psoriasis severity, perceived stress and psychological mood. A total of 141 individuals were recruited from two settings: an outpatient skin clinic at King's College Hospital and the Psoriasis Association. RESULTS: A strong belief in stress/psychological attributes as a causal factor was found in 61% of the sample. This belief was significantly associated with higher levels of anxiety, depression and perceived stress (r > or = .38; P < or = .0001). Perceived stress in this sample was significantly associated with a poorer level of quality of life, higher levels of anxiety and depression (r > or = .27; P < or = .002) but not with psoriasis severity. CONCLUSIONS: The belief that stress is causal was associated with lower levels of psychological well-being. However, there was no association between perceived stress and more objective measures of psoriasis severity.

Adult↗
PubMed2004

Using the self-regulatory model to cluster chronic pain patients: the first step towards identifying relevant treatments?

The pain literature indicates that, despite extensive investigations and recommendations, treatment outcomes can be poor. This study assesses whether a theoretical approach using the self-regulatory model (SRM) could usefully categorise chronic pain patients on the basis of their illness representations, since these have been shown to influence outcomes for other health-related conditions. One hundred and thirty newly referred patients of a pain relief clinic completed the revised Illness Perceptions Questionnaire and other measures. Cluster analysis supported the utility of a theoretical model of illness representations to identify pain groups, with the groups so identified differing in measures of pain, mood, and functioning. This study can be viewed as a preliminary step for future research employing stronger design methodologies to explore the validity of the SRM for classifying chronic pain patients, and to compare efficacy of treatment choice and outcome for this population based on illness representations.

Adaptation, Psychological↗
PubMed2004

Medicine in a multi-cultural society: the effect of cultural background on beliefs about medications.

This exploratory, cross-sectional study examined the effect of self-reported cultural background on beliefs about medicines (modern pharmaceuticals) and perceptions of personal sensitivity to the adverse effects of taking medication. Using a validated questionnaire, beliefs about pharmaceutical medication were compared between 500 UK undergraduate students who identified themselves as having an Asian or European cultural background. There was a significant association between cultural background and beliefs about the benefits and dangers of medicines. Students who self-reported to have an Asian cultural background expressed more negative views about medication than those who reported a European cultural background. Students with an Asian cultural background were significantly more likely to perceive medicines as being intrinsically harmful, addictive substances that should be avoided. They were significantly less likely to endorse the benefits of modern medication. There was no significant relationship between cultural background and perceptions of personal sensitivity to medication effects or belief about how doctors use medication. In the total sample, past and present experience of taking medication was associated with a more positive orientation to medicines in general. Students who considered themselves to have a European cultural background had significantly more experience with prescribed medication than those who selected an Asian cultural background. The relationship between cultural background and beliefs about medicines in general was maintained after controlling for potential confounding variables, including chosen degree course, experience of taking prescribed medication, age, and gender. The identification of differences in beliefs about medication, between two specific cultural groups, suggests the need for a greater understanding of the effects of cultural background on medicine-usage with potential implications for the conduct of prescribing-related consultations and for the provision of patient information on medication.

Adolescent↗
PubMed2004

Perceived stress and cortisol levels predict speed of wound healing in healthy male adults.

The main purpose of the present study was to investigate the association between perceived stress and impaired cutaneous wound healing in humans using a novel wound assessment technique, and taking into account putative mediating factors such as cortisol levels, health behaviours, and personality factors. The study made use of a prospective, within-subjects design in which 24 male non-smokers participated. Every subject received a standard 4mm-punch biopsy, and the healing progress was monitored via high-resolution ultrasound scanning. Participants completed questionnaires on perceived stress, health behaviours, and personality factors, and sampled saliva for cortisol assessment after awakening at 2 weeks prior, directly after, and 2 weeks after the biopsy. The overall results showed a significant negative correlation between speed of wound healing, and both Perceived Stress scale (PSS) scores (r=-.59; p<.01), and General Health Questionnaire (GHQ) scores (r=-.59; p<.01) at the time of the biopsy. The area under the morning cortisol response curve was negatively correlated with speed of wound healing (r=-.55; p<.05), indicating a clear elevation in the morning cortisol slope of those whose wounds were slowest to heal. A median split of the complete sample yielded that the 'slow healing' group showed higher stress levels (PSS t=3.93, p<.01, GHQ t=2.50, p<.05), lower trait optimism (t=3.25, p<.05), and higher cortisol levels to awakening (F=5.60, p<.05) compared with the 'fast healing' group. None of the health behaviours investigated (i.e. alcohol consumption, exercise, healthy eating, and sleep) were correlated with healing speed at any time point. Our data hint at a considerable influence of stress on wound healing, and suggests that elevated cortisol levels, rather than altered health behaviours, play a role in this effect.

Adult↗
PubMed2004

The motivating impact of informing women smokers of a link between smoking and cervical cancer: the role of coherence.

This research assessed the role of having a coherent explanation of the link between smoking and cervical cancer in motivating women to stop smoking. In the 1st study, women were given a leaflet with either a detailed or a minimal explanation of the link or no leaflet. The leaflets were similarly effective at providing a coherent explanation. In a cross-sectional analysis, having a coherent explanation moderated the relationship between perceived vulnerability and intention: Higher perceived vulnerability to cervical cancer was associated with greater intention to quit smoking only amongst women with a more coherent explanation of the link between smoking and cervical cancer. This finding was replicated in a 2nd study. These results are consistent with H. Leventhal et al.'s (1997) self-regulatory model, which suggests that motivation to change behavior depends not only on perceiving a threat but also on having a coherent model linking the behavior with the threat.

Adult↗
PubMed2004

Doubts about necessity and concerns about adverse effects: identifying the types of beliefs that are associated with non-adherence to HAART.

This cross-sectional study assessed beliefs about highly active antiretroviral therapy (HAART) and their association with reported adherence to HAART among 109 HIV-positive patients receiving HAART while attending an ambulatory care clinic in Brighton, UK. Patients' beliefs about the necessity for and concerns about HAART and their adherence to it were assessed using validated questionnaires. There was considerable variation in beliefs and reported adherence. A quarter of participants reported low adherence to HAART and this was related to concerns about adverse effects as well as to the way in which each individual balanced concerns against perceptions of necessity. Patients were significantly more likely to report low adherence rates if their concerns were high relative to their perceptions of personal need for HAART. Patients with higher CD4 counts were significantly more likely to hold a view of HAART in which perceptions of necessity were higher relative to their concerns about adverse effects. CD4 was not related to reported adherence. A comparison of most recent viral load results between high and low adherence group identified differences in the predicted direction but these were not statistically significant. These preliminary findings suggest that patients' perceptions of HAART are important determinants of adherence with implications for future research and clinical practice.

Adult↗
PubMed2003

Patient-centredness in chronic illness: what is it and does it matter?

The evidence as to whether patient-centredness is associated with beneficial physical and psychological outcomes is inconsistent. This review of published research on health care communication in chronic illness investigates whether (i) studies of patient-centred consultations use distinctive concepts, (ii) different concepts are differentially associated with health outcomes. Studies of patients with a chronic illness consulting a health professional were included if they measured health professional-patient interaction and a physical or psychological outcome. Thirty studies were identified, falling into two, reliably distinct, categories. In the first, health professionals took the patient's perspective and in the second, they sought to "activate" the patient. The 10 studies taking the latter approach were more consistently associated with good physical health outcomes than were the 20 studies taking the former approach. The suggestion that different types of patient-centredness have different associations with physical health outcomes should be investigated further in experimental studies.

Chronic Disease↗
PubMed2002

Informing participants of allocation to placebo at trial closure: postal survey.

OBJECTIVES: To assess whether and how investigators of placebo controlled randomised trials inform participants of their treatment allocation at trial closure and to assess barriers to feedback. DESIGN: Postal survey with a semistructured questionnaire. PARTICIPANTS: All investigators who published a placebo controlled randomised trial in 2000 in five leading medical journals, and a random sample of 120 trials listed in the national research register database. MAIN OUTCOME MEASURES: Number of investigators who informed participants of their treatment allocation at trial closure, methods for delivering the information, and barriers to unmasking treatment. RESULTS: 45% of investigators informed either all or most participants of their treatment allocation, and 55% did not inform any participant or only informed those who asked. The main reasons for not informing participants were that the investigators never considered this option (40%) or to avoid biasing results at study follow up (24%). CONCLUSION: Further research is required to examine sensitive ways to communicate treatment information to trial participants.

Communication↗
PubMed2002

Variation in uptake of serum screening: the role of service delivery.

The present study aimed to determine the extent to which variation in the uptake of serum screening for Down syndrome reflects variation in the way the test is offered. A higher uptake of serum screening was seen at hospitals that offered the blood test as part of a routine visit than at those where screening required a separate visit. The type of screening test offered and whether a reminder was sent were not associated with uptake. Given the consensus that undergoing screening should be the result of an informed choice, further research is needed to determine which methods of offering serum screening facilitate and which impede informed choice.

Delivery of Health Care↗
PubMed2002

Predictive genetic testing: high risk expectations in the face of low risk information.

The aims of this cross-sectional, questionnaire study were (1) to estimate the proportion of those receiving negative ("low risk") results following predictive genetic testing who expect to undergo clinically unnecessary future screening and (2) to examine the factors associated with this expectation. Of 127 adults receiving negative results following predictive genetic testing for familial adenomatous polyposis (FAP), 54 people (42%) were expected to attend for future bowel screening. The main predictor was doubt about the accuracy of genetic test results. Expecting to attend was also associated univariately with perceiving the chance of developing FAP as higher, being more worried about this, perceiving the test result to be more uncertain and threatening, and holding a behavioral model of the cause of FAP. Attendance for health screening may be influenced by people's perception of the accuracy of genetic tests that they have undergone. Future research should investigate test presentation and influences on test perception.

Adult↗
PubMed2002

The 'Medical Interview Satisfaction Scale' (MISS-21) adapted for British general practice.

BACKGROUND: The 29-item 'Medical Interview Satisfaction Scale' (MISS-29) was developed in the USA to assess patient satisfaction with individual doctor-patient consultations. It has been used in studies from British general practice. However, there is limited evidence for its psychometric properties in this population. OBJECTIVES: The present study was designed to examine the validity, reliability and applicability of the MISS-29 in British general practice populations. METHODS: The study was divided into two phases. The first investigated the properties of the MISS-29 in a UK general practice population and resulted in a modified MISS (MISS-21). The second investigated the properties of the MISS-21 in a wider UK general practice population. In phase 1, 150 patients over 16 years were recruited sequentially from patients attending a large group practice in suburban north London. Patients completed a questionnaire which collected demographic data and the MISS-29. In phase 2, 159 patients with a new problem were recruited from patients over 16 years consulting 18 GPs in north London, Essex and Suffolk. Patients completed a questionnaire while waiting to see the doctor; this collected demographic data and included six separate items, designed by the author, intended to measure patient satisfaction with previous consultations with the doctor. The patients completed the MISS-21 when they left the doctor's consulting room. RESULTS: The response rates for the phase 1 and phase 2 studies were 76.9 and 72.6%, respectively. Factor analysis, using principal component analysis with a varimax rotation, of the data collected in phase 1 resulted in a 21-item scale with the same four subscales as the original MISS-29. Correlations between subscales range from 0.46 to 0.65. Values of Cronbach's alpha between 0.67 and 0.92 suggest that the subscales are internally consistent under the conditions of the study. In phase 2, 92.1% completed all the items in the MISS-21 and there were no significant relationships between patients' demographic variables and the proportion of completed MISS-21 questionnaires, nor were there any differences in the proportion of completed MISS-21 questionnaires between type of practice or between practices serving different geographic populations, suggesting that the items were acceptable to patients. There were highly significant positive correlations (0.21-0.63) between scores on the MISS-21 and all aspects of satisfaction with previous consultations, providing supportive evidence for the construct validity of the MISS-21. CONCLUSION: This study has demonstrated that the use in British general practice of the 29-item MISS developed in the USA should be treated with caution. However, a new 21-item version with the same four subscales as the 29-item MISS was developed which has satisfactory internal reliability. The correlations between subscales suggest that they represent fairly discrete but overlapping aspects of satisfaction. Evidence is produced suggesting that patients have less difficulty completing the MISS-21 and that it is applicable for assessing satisfaction with the consultation in different practice types and populations in the UK. Limited data supporting the construct validity of the MISS-21 are presented. While this study does not provide a full assessment of the MISS-21, we believe it provides evidence for its psychometric properties, which suggests that it is a valid and reliable instrument for the assessment of patient satisfaction with individual consultations in British general practice.

Adult↗
PubMed2002

The influence of perceived control over causes and responses to health threats: a vignette study.

OBJECTIVES: To test the hypothesis that a disease caused by controllable, compared with uncontrollable, factors is more likely to result in negative emotions and less likelihood of disclosure to significant others. DESIGN AND METHODS: A between-participants design in which students (N=108) imagined they had just been diagnosed with either HIV or hypertension and where the cause for each was described as either controllable or uncontrollable. Anticipated emotional and behavioural responses by self and others were assessed by questionnaire. RESULTS: When the vignette represented a more controllable cause, participants thought they would have more negative feelings and that they would be less likely to disclose information about the disease to their family or an acquaintance than when the vignette represented a less controllable cause. The type of disease, but not the cause, influenced anticipated responses by others. CONCLUSIONS: Although greater perceived control over future outcomes is often psychologically adaptive, these findings suggest that the perception that the onset of a disease was controllable may be maladaptive, resulting in more negative feelings and a greater reluctance to disclose the diagnosis to others. In the light of the increasing use of medical technologies aimed at primary prevention of disease, together with a cultural shift toward individual responsibility for health, there is a need for greater understanding of how the perceived controllability of the cause of a disease affects subsequent adjustment.

Journal Article↗
PubMed2002

Living with Huntington's disease: Illness perceptions, coping mechanisms, and patients' well-being.

OBJECTIVES: To describe the illness perceptions and coping mechanisms of patients with Huntington's disease (HD), and to assess their role in the well-being of these individuals. DESIGN: A single group, cross-sectional study. METHODS: In 77 individuals with a clinically confirmed diagnosis of HD, illness perceptions, coping mechanisms, motor and cognitive performance, and well-being were assessed by means of questionnaire-guided interviews, and subjected to correlational analyses, t-tests and two-stage regression analyses. RESULTS: HD patients' illness perceptions were characterized by a strong illness identity, combined with beliefs about a long duration of HD, perceived negative consequences for their daily lives, and little hope for cure or improvement of their symptoms. In turn, the coping strategies that HD patients reported adopting to deal with their disease were comparable with those adopted by reference individuals dealing with everyday life stressful situations. Where the well-being of HD patients is concerned, compared with Dutch community sample, HD patients scored significantly lower on measures of physical well-being and general health. Both illness perceptions and coping mechanisms were significant predictors of patients' well-being. CONCLUSIONS: More systematic research within a health psychology framework is justified in order to assess the role of illness perceptions and coping mechanisms in the well-being of HD patients.

Journal Article↗
PubMed2002

The structure of beliefs about the causes of heart attacks: A network analysis.

OBJECTIVES: To explore the structure of causal beliefs about heart attack, using network analysis, in particular to determine whether there is a consensual representation and, if so, which putative causes of heart attacks were perceived as being proximal or distal causes and which were perceived to mediate the effects of other causes. METHODS: A total of 107 adult respondents completed questionnaires, indicating the extent to which they perceived each of eight agents as causes of a heart attack, as well as whether they perceived that each of these eight causal agents, in turn, causally affects each of the other seven causal agents. RESULTS: A consensual representation was produced, indicating how these eight agents were perceived as causally relating to each other, and to heart attack. Three key features were evident. First, the type of work a person does was perceived to be a distal cause of heart attack, operating mainly through stress and high blood pressure. Second, the causal impact of stress on heart attack was not seen as mediated by behaviour, but mediated via blood pressure. Third, the causal impact of genes on heart attack was perceived as unmediated by behaviour or physiological processes. CONCLUSIONS: The general public appears to share a reasonably complex view of how different agents lead to heart attack. This complexity would not be elicited by standard methods, suggesting that the network analysis method may be usefully employed as either a process or an outcome measure in health-promotion research.

Journal Article↗
PubMedDate not supplied

Changing illness perceptions after myocardial infarction: an early intervention randomized controlled trial.

OBJECTIVE: This study was designed to examine whether a brief hospital intervention designed to alter patients' perceptions about their myocardial infarction (MI) would result in a better recovery and reduced disability. DESIGN: In a prospective randomized study, 65 consecutive patients with their first MI aged were assigned to receive an intervention designed to alter their perceptions about their MI or usual care from rehabilitation nurses. Patients were assessed in hospital before and after the intervention and at 3 months after discharge from hospital. RESULTS: The intervention caused significant positive changes in patients' views of their MI. Patients in the intervention group also reported they were better prepared for leaving hospital (p<.05) and subsequently returned to work at a significantly faster rate than the control group (p<.05). At the 3-month follow-up, patients in the intervention group reported a significantly lower rate of angina symptoms than control subjects (14.3 vs. 39.3, p<.03). There was no significant differences in rehabilitation attendance between the two groups. CONCLUSIONS: An in-hospital intervention designed to change patients' illness perceptions can result in improved functional outcome after MI.

Attitude to Health↗
PubMedDate not supplied

The uncertain consultation and patient satisfaction: the impact of patients' illness perceptions and a randomized controlled trial on the training of physicians' communication skills.

OBJECTIVE: To identify predictors of patient satisfaction among a range of patient and practitioner variables. In particular, to focus on patients' illness perceptions and the impact of a randomized controlled trial on the training of physicians in general communication skills and how to treat patients presenting with poorly defined illness. METHODS: A randomized controlled follow-up study conducted in 28 general practices in Aarhus County, Denmark. Half of the physicians were randomized into an educational program on treatment of patients presenting with medically unexplained symptoms (somatization). One thousand seven hundred eighty-five general practice attenders presenting a new health problem completed questionnaires on illness perceptions, physical functioning, and mental distress before the consultation. After the consultation, a questionnaire including relational and communicative domains of patient satisfaction with the current consultation was completed. The physicians completed a questionnaire for each patient on diagnostics and prognostics. Predictors of patient satisfaction were determined by logistic regression. RESULTS: A large number of patient and practitioner variables predicted satisfaction in univariate logistic regression models. Results from a multivariate logistic model showed that the illness perceptions "uncertainty" (patient not knowing what is wrong) and "emotional representations" (the complaint making the patient feel worried, depressed, helpless, afraid, hopeless) predicted dissatisfaction at OR (CI) = 1.8 (1.3-2.4), p < .001 and OR (CI) = 1.5 (1-2.3), p = .03 respectively. Trained physicians were associated with dissatisfaction at OR (CI) 0.7 (0.5-1), p = .06 in the multivariate model. Furthermore, uncertain patients consulting a trained physician were less likely to be dissatisfied OR (CI) = 0.6 (0.3-1), p = .04. CONCLUSIONS: A randomized controlled trial on the training of general practitioners' communication skills improved patient satisfaction. Illness perceptions predict satisfaction. In particular, patients feeling uncertain and negatively emotionally involved in their health problem were more inclined to being dissatisfied with the consultation.

Adolescent↗
PubMedDate not supplied

The patients' illness perceptions and the use of primary health care.

OBJECTIVE: To investigate if primary care patients' perceptions of a current health problem were associated with use of health care. METHOD: One thousand seven hundred eighty-five patients presenting a new health problem to 1 of 38 physicians from 28 general practices in Aarhus County, Denmark. Patients completed a questionnaire on their illness perceptions and emotional distress before the consultation. The physicians completed a questionnaire for each patient on diagnostics and prognostics. Register data on primary health care utilization 3 years before and 2 years after baseline were obtained. Odds ratios were estimated to examine associations between previous health care use and illness perceptions. Linear regression analysis was performed to examine if illness perceptions predicted later health care use. RESULTS: Previous use: Higher use was associated with psychosocial, stress, and lifestyle attributions. Accident/chance attributions were associated with higher use for patients with a chronic disorder but with lower use for patients without a chronic disorder. A strong illness identity (number of self-reported symptoms), illness worry, a long timeline perspective, a belief that the symptoms would have serious consequences, and all emotional distress variables were associated with higher use. Use during follow-up: Infection/lowered immunity attributions were associated with higher use for patients with a chronic disorder, whereas psychosocial and lifestyle attributions were associated with higher use for all patients. Illness worry and all emotional distress variables predicted higher health care use. A strong illness identity, a long timeline perspective, a belief in serious consequences, and stress and accident/chance attributions were among the strongest predictors of health care use in a multivariate model including all variables. CONCLUSIONS: Patients' perceptions of a current health problem are associated with health care use and may offer an obvious starting point for a biopsychosocial approach in primary care.

Adolescent↗