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Biomedical subjects

M Calnan

Publications and source records attributed to M Calnan.

At least 37 records · Page 2Linked to original sources
PubMed1993

Breast cancer screening services in three areas: uptake and satisfaction.

The objective of our study was to test whether attendance for breast cancer screening and satisfaction with the service could be predicted from a knowledge of the woman's social and psychological characteristics. In a prospective design, demographic characteristics, self-reported health status and behaviour, expectations and attitudes were examined through postal questionnaires sent out shortly before the invitation to screening, and the measures were used to predict subsequent attendance and satisfaction. The sample was taken from three areas in the South-East Thames Regional Health Authority providing a Forrest service--one rural, one provincial and one inner city--and consisted of 3160 women aged 50-64 invited routinely for screening. The main predictors of attendance were the woman's attitude to being screened and her belief that 'salient others' wanted her to attend. The main predictors of satisfaction with the service were the behaviour of the staff and the facilities at the centre. Three implications of the findings are discussed: (a) health education should include partners, relatives and friends of the target women, as their views had as much effect on attendance as did the women's attitudes; (b) staff training and development should focus on communication with the patient; (c) further research should examine the precursors of reported discomfort and pain.

Attitude to Health↗
PubMed1992

Discomfort and pain during mammography: description, prediction, and prevention.

OBJECTIVE: To identify the nature of pain and discomfort experienced during mammography and how it can be ameliorated. DESIGN: Questionnaire survey before invitation for mammography and immediately after mammography. Responses before screening were related to experience of discomfort. SETTING: Health district in South East Thames region. SUBJECTS: 1160 women aged 50-64 invited routinely for screening; 774 completed first questionnaire, of whom 617 had mammography. 597 completed the second questionnaire. MAIN OUTCOME MEASURES: Reported discomfort and pain, comparisons of discomfort with that experienced during other medical procedures, qualitative description of pain with adjective checklist. RESULTS: 35% (206/597) of the women reported discomfort and 6% (37/595) pain. 10 minutes after mammography these figures were 4% (24/595) and 0.7% (4/595) respectively. More than two thirds of women ranked having a tooth drilled, having a smear test, and giving blood as more uncomfortable than mammography. The most important predictor of discomfort was previous expectation of pain (discomfort was reported by 21/32 (66%) women who expected pain and 186/531 (35%) who did not). Discomfort had little effect on satisfaction or intention to reattend. CONCLUSIONS: The low levels of reported pain and discomfort shortly after mammography and the favourable comparisons with other investigations suggest that current procedures are acceptable. Since two thirds of the women experienced less pain than expected health education and promotion must ensure that accurate information is made available and publicized.

Female↗
PubMed1992

Professional reimbursement and management of time in general practice. An international comparison.

A hypothetical model was proposed for explaining the relationship between general practitioners' system of payment and the amount of time spent in patient and non-patient work. It was hypothesized that GPs reactions to higher workload vary according to the payment system. In this paper we compare two health care systems which have both mixed systems of payment of GPs. In England and Wales up until April 1990 GPs are partly paid by capitation (approx 45% of their income), partly by allowance (38% of their income) and for a much smaller part fee for service (18% of their income). In the Netherlands GPs are paid by capitation for the publicly insured patients (63% of the average practice list) and fee for service for the privately insured patients. We expect (among other things) a stronger, positive relationship between list size and hours worked in the Netherlands and a comparably strong, negative relationship between list size and booking intervals in the Netherlands and in England and Wales. Drawing on data collected from national surveys of GP workload in the Netherlands and England and Wales these propositions were examined. The results of this comparative analysis showed some support for the propositions in that the relation between list size and number of hours worked in patient related activities is stronger in the Dutch setting than in England and Wales, and about the same strength for the relationship between list size and booking intervals.

Appointments and Schedules↗
PubMed1991

Convergence and divergence: assessing criteria of consumer satisfaction across general practice, dental and hospital care settings.

This paper describes the results of the first-stage of a study carried out in the spring of 1988 in the South East of England. The study looked at general and specific aspects of consumer satisfaction with general practitioner services, general dental care services and hospital in-patients care. It also examined which specific consumer criteria were the key predictors of overall satisfaction within each of these particular medical care settings. A related aim was to assess the degree of congruence or divergence of consumer criteria across these differing medical care settings. The evidence suggests that whilst general levels of consumer satisfaction are high (i.e. 83-97%), questions of a more detailed and specific nature revealed greater levels of expressed dissatisfaction (e.g. 38% of the sample felt that they could not discuss personal problems with their GP, 51% felt their dentist was not easy to reach at weekends/holidays, whilst 35% felt hospital doctors did not give sufficient information). Whilst different areas of dissatisfaction were found in each specific medical care setting examined, what was particularly striking was the degree of convergence of the key predictors of overall consumer satisfaction across the medical care settings. That is to say, our findings clearly suggest that issues concerning 'professional competence', together with the nature and quality of the patient-professional relationship, are the key predictors of overall consumer satisfaction with general practice, dental and hospital care [e.g. GP giving sufficient information correlated 0.64 (P less than 0.001) with overall GP satisfaction scores; competent dentist 0.52 (P less than 0.001) with overall dental satisfaction scores; and full confidence in hospital doctors 0.49 (P less than 0.001) with overall hospital satisfaction scores]. The theoretical importance and policy implications of these findings, particularly in the light of the recent NHS reforms, are discussed.

Adolescent↗
PubMed1991

Key determinants of consumer satisfaction with general practice.

Consumer satisfaction is an increasingly important issue, both in the evaluation and the shaping of health care, yet the relationship between specific criteria of health care and overall levels of consumer satisfaction with primary care is rarely addressed. The study reported here, based upon the results of a postal questionnaire of a random sample of adults in the south east of England (response rate 62%, n = 454), attempts to address this issue. Whilst general levels of satisfaction were high (95%), questions of a more detailed and specific nature revealed greater levels of dissatisfaction (e.g. 38% felt unable to discuss personal problems with their GP, 26% expressed dissatisfaction with the level of information they received, and 25% were dissatisfied with the length of time spent in consultation). Key dimensions such as communication (0.64; p less than 0.001), the nature and quality of the doctor-patient relationship (0.61; p less than 0.001) and the GP's professional skills (0.58; p less than 0.001)--vis-a-vis issues such as access, availability and type of service provision--were found to be the criteria which were most strongly associated with overall levels of satisfaction with general practice. The policy implications of these findings in the light of the recent Government White Papers, Promoting Better Health and Working for Patients, are discussed.

Adolescent↗
PubMed1989

Control over health and patterns of health-related behaviour.

This paper empirically examines the relationship between position in the social structure, beliefs about control over health and three different types of health-related behaviour. The data are drawn from two large scale community surveys (N = 4224) carried out in southern England. The results show that the relationship between the Multi-dimensional Health Locus of Control (MHLC) and exercise, cigarette smoking and use of alcohol was never more than modest even within different social and economic contexts. Doubts are cast upon the value of the MHLC for explaining variations in health-related behaviour and more fruitful areas for research are suggested.

Alcohol Drinking↗
PubMed1989

The limits of medicine: women's perception of medical technology.

This paper develops an analysis of women's perceptions of medical technology and the elements which shape them, and then draws out the implications for medicine and the and the medicalization thesis. In the first part of the paper we outline the macro-theoretical debates about medicalization and the role of medical technology in this process, and the consequences for those who use health care. The implications for women are given particular attention as they have a higher level of contact with health care than men. We then evaluate the arguments of these macro-theorists against evidence from two ethnographic studies, concerning women patients' and their doctors' attitudes to the use of minor tranquillizers and women's evaluations of medicine and medical practice. This provides a basis for questioning some of the assumptions of the macro-theorists regarding the social relations of medical technology and the medicalization thesis.

Anti-Anxiety Agents↗
PubMed1988

Images of general practice: the perceptions of the doctor.

During the post second world war period there has been considerable discussion both within and outside the medical profession about what the role of the general practitioner should be. This study, drawing on data gathered from a national representative sample of general practitioners in England and Wales, explores general practitioners' own perceptions of their work role. The evidence shows that general practitioners might be divided into those who see a broad role for the general practitioner and place emphasis on the social aspects of care, and those who see a more traditional role for the general practitioner focusing specifically on organic illness. Those with a social orientation were also more likely to doubt the value of financial incentives, whereas the medical oriented doctors were more likely to say that their behaviour was influenced by financial incentives. The analysis also showed that the medically oriented were distinctly different to those with a social orientation in terms of personal characteristics and the setting in which they worked. The implications of these findings are discussed in full.

Attitude of Health Personnel↗
PubMed1988

Towards a conceptual framework of lay evaluation of health care.

It is argued in this paper that much of the empirical research into the public's and patients' perceptions of the adequacy of health care has suffered from conceptual weaknesses. In addition, and maybe as a result of these weaknesses, a contradictory pattern of findings has emerged from this research. To overcome some of these problems it is suggested that an investigation of lay evaluation of health care should be carried out within a conceptual framework which incorporates the following elements. (i) The goals of those seeking health care in each specific instance. (ii) The level of experience of use of health care. (iii) The socio-political values upon which the particular health care system is based. (iv) The images of health held by the lay population. Each of these elements interrelates with the others and their influence will be mediated through socio-demographic characteristics of the service users.

Consumer Behavior↗
PubMed1988

The economy of time in general practice: an assessment of the influence of list size.

A lack of time is one of the major reasons given to account for low quality care provided in general practice. One of the basic assumptions inherent in this explanation is that activities in general practice are shaped by the level of patient demand and general practitioners have little control over their work. The objective of this study is to explore empirically this assumption that general practice is demand led by examining the relationship between list size and the time general practitioners spend at work-related activities. The analysis uses data gathered from a survey carried out on a nationally representative sample of unrestricted principals (N = 1419) living in England and Wales. The results show that list size is statistically significantly associated with each of the different indices of time allocation, although it is only relatively strongly associated with hours spent on surgery consultations and surgery consultation rates. The implications of these findings are discussed and it is suggested that the demand led model provides only a partial explanation for variations in time allocation in general practice.

Appointments and Schedules↗
PubMed1988

Do health beliefs predict health behaviour? A follow-up analysis of breast self-examination.

In a previous paper, we suggested that women who attended classes on breast self-examination showed significant improvements in behaviour, and that part of the reason was a change in their beliefs. Further analysis of our data confirms the original conclusion, and indicates that the perceived value of doing the behaviour is a more important predictor than perceived vulnerability to cancer.

Breast↗
PubMed1988

Variations in the range of services provided by general practitioners.

The debate about the future role of the general practitioner includes discussion about the range of services which should be on offer in addition to general medical services. Drawing on evidence from a nationally representative sample of 1419 general practitioners this paper examines the reality of what is currently being provided in general practice in the UK. The analyses produce figures that are compatible with the hypothesis that there is a form of creeping specialization taking place with general practitioners tending to provide one type of service at the exclusion of the others. Doctors appeared to cluster into three distinct groups--opportunistic health educators, minor surgeons and those who provide services for women. The implications of these and other findings are discussed.

Family Practice↗
PubMed1988

Examining the general practitioner's role in health education: a critical review.

Recent international and national policy documents have placed great emphasis on health promotion programmes and one of the key figures in these programmes has been the general practitioner and the primary health care team. This review, drawing mainly on evidence from the United Kingdom, critically reviews the role of the general practitioner in health promotion and disease prevention. The first part of the paper examines the assumptions in contemporary policy and outlines alternative roles for the general practitioner in health education. The second part focuses on the social organization of the doctor-patient relationship and its influence on health education, specifically examining the structure of the doctor-patient relationship, the uncertainties in scientific health knowledge and the lay perspective on health.

England↗
PubMed1988

Lay evaluation of medicine and medical practice: report of a pilot study.

Sociologists appear to differ in the way they portray the public's ideas about modern medicine. Some argue that the public accepts that modern medicine is effective, and others say that as a whole the public is skeptical about its value. There is a dearth of empirical evidence about what the public thinks of modern medicine; this pilot study attempts to fill this gap. Tape-recorded interviews were carried out with small samples of women from Social Classes I and II and Classes IV and V to find out what they felt about the value of modern medicine and to identify the criteria that they used to assess a "good" and "bad" medical practitioner. The results showed that there is some degree of skepticism about the value of modern medicine, particularly amongst working-class people. However, the criteria for assessing the performance of a medical practitioner were only rarely seen to be tied up with the criteria used to assess the value of modern medicine.

Consumer Behavior↗
PubMed1986

Do health beliefs predict health behaviour? An analysis of breast self-examination.

The purpose of this paper is to explore the relationships between health beliefs and health behaviour. The study we report was conducted as part of a national campaign to evaluate the benefits of breast self-examination in the early detection of breast cancer, and the purpose of our analysis was to test the Health Belief Model of Becker and his colleagues. Three groups of women were investigated--278 who accepted an invitation to attend self-examination classes and were taught the techniques in detail, 262 who declined the invitation and 594 controls to whom no classes were offered--and beliefs and self-reported behaviour were measured shortly before the classes took place and again a year later. The campaign, it emerged, produced marked changes in both beliefs and behaviour, but the relationships between beliefs and behaviour were much weaker than the model had led us to expect and accounted for no more than a quarter of the variance. Alternative models are considered, notably Fishbein and Ajzen's Theory of Reasoned Action, and the paper concludes with some suggestions for improving health campaigns.

Attitude to Health↗