Biomedical subjects

Theresa M Marteau

Publications and source records attributed to Theresa M Marteau.

At least 19 recordsLinked to original sources

PubMed2006

General practitioners' beliefs about effectiveness and intentions to prescribe smoking cessation medications: qualitative and quantitative studies.

BACKGROUND: General practitioners' (GPs) negative beliefs about nicotine dependence medications may act as barriers to prescribing them. METHODS: Study1: Twenty-five GPs from 16 practices across London were interviewed in this qualitative study. Framework analysis was used to identify key themes. Study 2: A convenience sample of 367 GPs completed an internet-based survey. Path-analysis was used to examine the relations between beliefs and intentions to prescribe smoking cessation medications. RESULTS: Study 1: Whilst nicotine replacement therapy (NRT) and bupropion were generally perceived as effective and cost-effective, the effectiveness of NRT was seen as critically dependent on behavioural support for smoking cessation. This dependence appeared to be influenced by perceptions that without support smokers would neglect psychological aspects of smoking and use NRT incorrectly. GPs perceived bupropion as dangerous and were concerned about its side-effects. Study 2: GPs' beliefs had medium (NRT, f2 = .23) to large (bupropion, f2=.45; NRT without support, f2=.59) effects on their intentions to prescribe medications. Beliefs about effectiveness of NRT and bupropion and the perceived danger of bupropion were the key predictors of intentions to prescribe NRT and bupropion, respectively. Beliefs about neglecting psychological aspects of smoking and incorrect use had indirect effects on intentions to prescribe NRT without support, operating via beliefs about effectiveness. CONCLUSION: GPs vary in their beliefs about the effectiveness and safety of smoking cessation medications. Their intentions to prescribe these medications vary in line with these beliefs. Interventions aimed at increasing the likelihood with which GPs prescribe these medications may be more effective if they addressed these beliefs.

Adult↗

PubMed2006

Recruiting first-degree relatives for prevention research: a comparison of clinician and proband-led methods of contact in Crohn's disease.

The most effective and acceptable ways of approaching relatives of identified probands to participate in research are unknown. We report on two methods. A total of 640 probands with Crohn's disease were contacted by post and invited to select how the research team would contact their relatives to assess their interest in participating in prevention research. Clinician-led approach: required probands to provide contact details for their first-degree relatives so that the research team could send them study questionnaires; proband-led approach: required probands to request questionnaires with stamped envelopes for them to forward to their relatives. Fifty-six percent (356/640) of probands contacted participated, with 80% (284) providing details of eligible relatives. Forty-eight percent (136/284) of probands requested 392 relatives be contacted by the researchers and 50% (142/284) requested that the questionnaire be sent to them so that they could give this to their 437 relatives personally. Two percent (6/284) requested mixed methods. Eligible responses came from 73% of relatives (587/805), 81% (299/368) of those contacted by the researchers and 66% (288/437) of those contacted via probands (difference 15%, 95% CI 10, 22). Both methods yielded similarly high levels of interest from relatives in participating in prevention research (89% (265/299) direct; 86% (248/288) indirect). Direct clinician-led contact maximised response rates. High levels of interest in research across the two recruitment methods suggest that although proband-led methods may maximise privacy, they may deny relatives the opportunity to take part in research that would be of interest.

Adult↗

PubMed2006

Protocol for stage 1 of the GaP study (Genetic testing acceptability for Paget's disease of bone): an interview study about genetic testing and preventive treatment: would relatives of people with Paget's disease want testing and treatment if they were available?

BACKGROUND: Paget's disease of bone (PDB) is characterised by focal increases in bone turnover, affecting one or more bones throughout the skeleton. This disrupts normal bone architecture and causes pain, deformity, deafness, osteoarthritis, and fractures. Genetic factors are recognised to play a role in PDB and it is now possible to carry out genetic tests for research. In view of this, it is timely to investigate the clinical potential for a programme of genetic testing and preventative treatment for people who have a family history of PDB, to prevent or delay the development of PDB. Evidence from non-genetic conditions, that have effective treatments, demonstrates that patients' beliefs may affect the acceptability and uptake of treatment. Two groups of beliefs (illness and treatment representations) are likely to be influential. Illness representations describe how people see their illness, as outlined in Leventhal's Self-Regulation Model. Treatment representations describe how people perceive potential treatment for their disease. People offered a programme of genetic testing and treatment will develop their own treatment representations based on what is offered, but the beliefs rather than the objective programme of treatment are likely to determine their willingness to participate. The Theory of Planned Behaviour is a theoretical model that predicts behaviours from people's beliefs about the consequences, social pressures and perceived control over the behaviour, including uptake of treatment. METHODS/DESIGN: This study aims to examine the acceptability of genetic testing, followed by preventative treatment, to relatives of people with PDB. We aim to interview people with Paget's disease, and their families, from the UK. Our research questions are:1. What do individuals with Paget's disease think would influence the involvement of their relatives in a programme of genetic testing and preventative treatment? What do relatives of Paget's disease sufferers think would influence them in accepting an offer of a programme of genetic testing and preventative treatment? DISCUSSION: Our research will be informed by relevant psychological theory: primarily the Self-Regulation Model and the Theory of Planned Behaviour. The results of these interviews will inform the development of a separate questionnaire-based study to explore these research questions in greater detail.

Adult↗

PubMed2006

A comparison of Australian and UK obstetricians' and midwives' preferences for screening tests for Down syndrome.

OBJECTIVE: To establish and compare obstetricians' and midwives' preferences for hypothetical prenatal screening tests for Down syndrome. METHODS: A cross-sectional questionnaire survey was completed by 296 obstetricians and midwives at two teaching hospitals: one in Melbourne, Australia (n = 175), and one in London, UK (n = 94). Conjoint analysis was undertaken using random effects probit regression. RESULTS: No significant differences were seen in any measurements when comparing obstetricians in Australia and the UK or midwives in Australia and the UK. Obstetricians and midwives shared similar relative values regarding the importance of the detection rate of the screening tests. However, obstetricians placed higher relative values on both timing of prenatal tests and risk associated with the subsequent diagnostic test than did midwives when considering optimal tests to offer women. Marginal rates of substitution suggest that, compared with midwives, obstetricians would wait longer and accept a greater decrease in detection rate for a test if it was safer. Younger midwives placed higher value on both detection rate and safety of prenatal tests than older midwives. Female obstetricians placed higher value on the timing of a test than male obstetricians. CONCLUSION: Obstetricians in Australia and UK placed almost identical importance on test attributes, as did the midwives in the two countries. However, different attitudes towards tests were seen between obstetricians and midwives.

Adult↗

PubMed2006

Attitudes towards sex selection for non-medical reasons: a review.

Early non-invasive fetal sexing is widely available over the Internet, leading to concerns about its possible use for sex selection. The aim of this review is to summarise the results of surveys describing lay attitudes towards sex selection for non-medical reasons to help address or inform such concerns. A search of electronic databases and key journals was supplemented by an Internet search and citation-tracking. Twenty-one quantitative studies were identified. Most were conducted in the US, with five recent studies in the UK and Germany. Most studies found that, overall, people were not in favour of sex selection. However, this varied from 94 to 18%. People may hold more negative attitudes when the method of sex selection is specified, particularly if this involves termination of pregnancy (TOP). Attitudes towards the general availability of sex selection are less negative than those towards personal use. Attitudes were consistently negative in German surveys. Little is known of such attitudes outside the US, the UK and Germany, and how such attitudes may change as new sex selection technologies become available. Studies of use of early non-invasive fetal sexing for sex selection for non-medical reasons are needed to assess the extent to which concerns about usage are justified and to assist in debates on how these might be most appropriately addressed.

Attitude↗

PubMed2006

The psychological costs of inadequate cervical smear test results: three-month follow-up.

We have previously shown that upon receipt of inadequate cervical smear test results, women have elevated levels of state anxiety and concern about their test results, similar to those of women receiving abnormal smear test results. The current paper reports data on the psychological impact three months after receiving an inadequate smear test result. Two groups of women who initially received a normal test result (n=184) or either a first or non-consecutive inadequate smear test result (n=140) responded. Women with initially received inadequate smear test results no longer had higher state anxiety than women who received normal test results. However, women who initially received inadequate smear test results were still more concerned about their test results and less satisfied with the information they had received about these initial test results, even after receiving normal results from repeat cervical smear tests. Concern was strongly predicted by dissatisfaction with information provided about inadequate smear test results. These results underscore the need to improve communication about inadequate cervical smear test results.

Adult↗

PubMed2006

Informed choice in antenatal Down syndrome screening: a cluster-randomised trial of combined versus separate visit testing.

OBJECTIVE: Building upon the results of an observational study, this clinical trial aimed to test the hypothesis that conducting antenatal Down syndrome screening (DSS) at the same time as other tests result in higher rates of informed choice to accept DSS, than when it is conducted separately from other tests. METHODS: The trial used a cluster-randomised controlled design, with informed choice as the outcome measure. The post of midwife was randomised to offer DSS at the same time as other tests (combined visit) or separately from other tests (separate visit). RESULTS: Overall 43.5% of women made an informed choice about DSS. There was no difference in rates of informed choice for women accepting DSS according to the method of conducting testing (23.7% at combined visit versus 22.5% at separate visit, OR = 1.1, 95% CI: 0.70-1.7, p = 0.67). CONCLUSION: Rates of informed choice about DSS were low, but there was no evidence to support that hypothesis that conducting testing at that same time as other tests increased rates of informed choice. This may reflect the limitations of conducting the trial in one centre.

Adult↗

PubMed2006

Can genetic risk information enhance motivation for smoking cessation? An analogue study.

Protection motivation theory and the extended parallel processing model are used to predict the motivational impact of information regarding a genetic susceptibility to heart disease. One hundred ninety-eight smokers read 1 of 3 vignettes: gene positive, gene negative, or standard smoking risk information. Analyses examined whether the impact of type of risk information was moderated by smokers' self-efficacy (SE) levels. Key outcomes were intention to quit and intention to attend an information session about quitting. There were significant main effects of SE and of receiving gene-positive risk information on intentions to quit. There was a significant Risk x SE interaction on intentions to attend an information session. SE was not associated with intentions to attend the information session for smokers in the gene-positive group. Intentions to attend the session were negatively associated with SE for smokers in the lower risk groups. Implications for using genetic risk information to motivate smoking cessation are discussed.

Adolescent↗

PubMed2006

Personal and social comparison information about health risk: reaction to information and information search.

This study extended previous research on the impact of personal and social comparison information about health risk by asking respondents what other information they require. A total of 197 students responded to 1 of 12 vignettes describing hypothetical risks of developing pancreatic disease. These vignettes varied in terms of personal risk, comparison group risk and disease severity. Higher threat manipulations elicited higher ratings of negative affect, although perceived ambiguity moderated this effect. When information was more threatening, respondents requested more information, especially about controlling the disease threat. These results indicate the importance of providing unambiguous information, information about how to control a threat and information people want.

Analysis of Variance↗

PubMed2006

Maternal anxiety following newborn hearing screening: the moderating role of knowledge.

OBJECTIVES: To describe the impact upon maternal anxiety of newborn hearing screening and examine the Possible moderating role of knowledge. METHODS: Questionnaires assessing maternal state anxiety, worry and certainty about the baby's hearing, and knowledge about screening, were sent to four groups of mothers three weeks after screening: Group 1 consisted of mothers whose babies had clear responses on a first or second screening test (n=103); Group 2 consisted of mothers whose babies had clear responses on the third screening test (n=81); Group 3 consisted of mothers whose babies did not have clear responses in one ear at the third screening test and were referred for audiological assessment (n=105); and Group 4 consisted of mothers whose babies did not have clear responses in either ear at the third hearing test and were referred for audiological assessment (n=55). RESULTS: Although mean anxiety levels were in the normal range, there was a significant trend for anxiety to rise as testing increased (F(1,327)=4.280, P<0.05). Worry increased significantly (F(1,337)=70.432, P<0.001) and certainty decreased significantly (F(1,339)=27.474, P=0.001) as the number of tests increased. Although total knowledge did not significantly moderate anxiety (R(2)=0.016, P=0.096), there was a significant interaction between mothers' group and one knowledge item, understanding that receipt of no clear responses was unlikely to mean that the baby had a hearing loss: mothers in Group 4 who understood this had lower anxiety (F(3,323)=4.791, P<0.01) and lower worry (F(3,332)=3.565, P<0.01) compared with mothers who did not. CONCLUSIONS: Understanding the meaning of being recalled following screening may avoid some of the anxiety associated with this.

Adult↗

PubMed2006

Does changing the order of threat and efficacy information influence the persuasiveness of threat messages?

OBJECTIVES: The aim of this study is to investigate the impact of changing the conventional threat-before-efficacy order of threat messages on the persuasiveness of a leaflet informing women smokers of the link between smoking and cervical cancer. DESIGN: The study used a between-groups design in which women smokers were sequentially allocated to one of three groups. Two groups received one of two leaflets aimed at providing information about the link between smoking and cervical cancer: one provided threat-before-efficacy information; the other provided efficacy-before-threat information. The third group received no leaflet. METHODS: Participants (N=178) were recruited by a commercial survey organization. Purposeful sampling was used to ensure that women with a wide range of ages and educational qualifications were included. Outcomes were intention to stop smoking, recall of information, and threat and efficacy perceptions. RESULTS: Although women in the 'efficacy-before-threat' group recalled more efficacy information, and those in the 'threat-before-efficacy' group recalled more threat information, the leaflets were similarly persuasive. Compared with women not given a leaflet, those given either of the two leaflets had greater intentions to stop smoking and higher threat and efficacy perceptions. CONCLUSIONS: Informing women of the link between smoking and cervical cancer increases their intentions to stop smoking. Changing the order of threat and efficacy information does not influence the persuasiveness of this message. Order effects may be more likely in experimental contexts using weaker messages or those that are not novel.

Adult↗

PubMed2005

Self-regulation and the behavioural response to DNA risk information: a theoretical analysis and framework for future research.

The few studies conducted to date suggest that DNA risk information may be less likely to achieve behaviour change than other types of health risk information. We draw upon self-regulation theory to explain and predict the characteristics of risk information that are more and less likely to motivate behaviour change. Self-regulation theory describes how information about a health threat is processed within individuals' pre-existing cognitive schema, and how the cognitive representations within these schemas activate coping procedures for dealing with the perceived threat. We explore the proposition that the initial impact of information about a health threat depends upon how well it "fits" with existing cognitive representations of that threat. For example, in one study DNA risk information regarding an inherited form of bowel cancer was perceived as more accurate and had a greater impact on risk perceptions in those whose representation of the threat included genes as the single cause, as opposed to one of several. Since the cognitive representation of a threat activates coping procedures that fit with that representation, we also explore the proposition that cognitive representations of a threat that has a genetic identity are less likely to activate coping procedures that include risk-reducing behaviours. For example, using DNA risk information to assess an inherited predisposition to heart disease increased the extent to which the condition was seen as caused by genes, which in turn reduced the expectation that a behavioural means of coping would be effective (eating a low fat diet), but increased the expectation that a biological means was effective (taking lipid lowering medication). Describing the heuristics that operate between risk information, the cognitive representations of threat and coping procedures could be used to identify the cognitions to target so as to optimize the motivational impact of DNA and other risk information.

Adaptation, Psychological↗

PubMed2005

A short report: survey of practice nurses' attitudes towards giving smoking cessation advice.

BACKGROUND: Although practice nurses play an important role in implementing smoking cessation strategies in primary care, relatively little is known of their attitudes and beliefs about giving smoking cessation advice. OBJECTIVES: To describe practice nurses' attitudes towards giving smoking cessation advice. METHODS: 152 of 200 (76%) practice nurses randomly selected from Medical Research Council General Practice Research Framework records completed a postal survey. The Attitudes to Smoking Cessation Advice Questionnaire was used. RESULTS: Overall, nurses were enthusiastic about giving smoking cessation advice and perceived such advice as effective. Nurses who were non-smokers perceived such advice as more effective than current smokers, as did those who had been trained in smoking cessation, who were also more enthusiastic than those who had not been trained. CONCLUSION: Training all practice nurses in smoking cessation, and offering nurses who smoke effective smoking cessation services, is likely to help achieve Government targets for smoking cessation.

Adult↗

PubMed2005

Low uptake of prenatal screening for Down syndrome in minority ethnic groups and socially deprived groups: a reflection of women's attitudes or a failure to facilitate informed choices?

BACKGROUND: It is not known if lower uptake of prenatal screening for Down syndrome in women from minority ethnic groups and socioeconomically disadvantaged women reflects more negative attitudes towards undergoing the test or women not acting in line with their attitudes i.e. not making an informed choice. METHODS: Uptake of prenatal screening, attitudes towards undergoing the test, uptake-attitude consistency, and informed choice were assessed in a prospective study of 1499 pregnant women attending two UK hospitals. RESULTS: Uptake was higher in white and socioeconomically advantaged women than in other women. There were no differences in attitudes towards undergoing the test; all women expressed relatively positive attitudes. Uptake-attitude consistency was higher in white and socioeconomically advantaged women than others, particularly in those with positive attitudes towards undergoing the test (76% white women with positive attitudes had the test compared with 45% South Asian women [difference 31%, 95% confidence interval (95% CI) 18-43] and 78% socioeconomically advantaged women compared with 63% more disadvantaged women (difference 15%, 95% CI 7-24)). Controlling for demographic variables, South Asian and socioeconomically disadvantaged women with positive attitudes were less likely to make an informed choice than other women [odds ratio (OR) 0.22, 95% CI 0.10-0.45 and OR 0.62, 95% CI 0.41-0.93, respectively]. CONCLUSION: Lower uptake of screening for Down syndrome in women from minority ethnic groups and socioeconomically disadvantaged women does not reflect more negative attitudes towards screening but rather lower rates of informed choice, as assessed in this study. Healthcare systems appear to facilitate informed choices in the context of prenatal screening for Down syndrome screening less well for women from minority ethnic groups and those who are socioeconomically disadvantaged than for other women.

Adult↗

PubMed2005

The purpose of attributing cause: beliefs about the causes of myocardial infarction.

Patients' beliefs concerning the causes of their illnesses are core to a number of theoretical models of illness behaviour. The current study explored the themes that emerged from patients' accounts of the causes of their first myocardial infarctions (MIs). Semi-structured interviews were conducted with 12 patients within a week of their MI, at a UK district hospital. Transcripts were analysed using interpretative phenomenological analysis. Three researchers noted themes that emerged from each interview, then common themes were selected and refined on the basis of an aggregation of interviews. Three dominant themes emerged: (1) single versus multiple causation, (2) causes as triggers versus underlying dispositions, and (3) the potentially conflicting motives of avoiding blame whilst at the same time, seeking control. Whilst many participants had complex ideas concerning what caused their MI, and could often name several causes, they tended to emphasise the importance of a single cause, which often related to their symptoms. Further, several participants interpreted "cause" in terms of an acute trigger of MI, rather than as a chronic causal factor. Participants were apparently attempting to answer the question about why they had an MI now, leading to talk about single causes that trigger MI. By contrast, much previous research has been concerned with patients' knowledge of "risk factors", considering the production of only a few causes to reflect ignorance. A key process in participants attributing cause appeared to be attempting to avoid blaming themselves or others for their MI, whilst simultaneously seeking to assert control over future recurrence. Analysis of the functions and purposes of causal attribution suggests that patients' focus on blame and control may be both emotionally and behaviourally adaptive, if not necessarily epidemiologically precise. These findings suggest that interventions to change causal attributions may be misguided, and may even be harmful.

Adult↗

PubMed2005

Genetic susceptibility testing versus family history-based risk assessment: Impact on perceived risk of Alzheimer disease.

PURPOSE: We examined how an Alzheimer disease (AD) family history assessment as compared to a risk assessment incorporating the absence of a disease-associated susceptibility allele affected risk perception among adult children with a family history of AD. METHODS: The REVEAL study is a clinical trial in which adult children of patients with AD were randomized to receive a risk assessment based upon family history alone or family history plus apolipoprotein E (APOE) disclosure. In this analysis, two subsets of women were identified, each of whom received identical 29% lifetime risk estimates of developing AD. One group received a risk estimate that incorporated APOE epsilon4-negative genetic test results (Genotype Group, n = 30), whereas the other received a risk estimate based on family history and gender (Family History Group, n = 36). Six weeks after risk disclosure, we surveyed participants regarding the impact of the risk assessment on their perceptions of AD risk. RESULTS: 73% of the Genotype Group judged their risk to be lower compared to 25% of the Family History Group (P < 0.0001). 67% of the Genotype Group reported lower anxiety about AD, versus 26% of the Family History Group (P < 0.01). 80% of the Genotype Group indicated that the risk information had a positive impact, versus 36% of the Family History Group (P < 0.001). The Genotype Group was less likely to believe that they would develop AD (13% vs. 36%, P < 0.05) and was more likely to report that the risk assessment removed uncertainty about their chances of developing AD (63% vs. 9%, P < 0.0001). CONCLUSIONS: These data suggest that risk estimates incorporating negative genetic test results affect perceptions of disease susceptibility more strongly than identical estimates based on family history alone.

Alzheimer Disease↗

PubMed2005

General practitioners' and family physicians' negative beliefs and attitudes towards discussing smoking cessation with patients: a systematic review.

OBJECTIVE: To estimate the proportion of general practitioners (GPs) and family physicians (FPs) with negative beliefs and attitudes towards discussing smoking cessation with patients. METHODS: A systematic review. STUDY SELECTION: All studies published in English, in peer-reviewed journals, which allowed the extraction of the proportion of GPs and FPs with negative beliefs and attitudes towards discussing smoking cessation. DATA SYNTHESIS: Negative beliefs and attitudes were extracted and categorised. Proportions were synthesized giving greater weight to those obtained from studies with larger samples. Those assessed in two or more studies are reported. RESULTS: Across 19 studies, eight negative beliefs and attitudes were identified. While the majority of GPs and FPs do not have negative beliefs and attitudes towards discussing smoking with their patients, a sizeable minority do. The most common negative beliefs were that such discussions were too time-consuming (weighted proportion: 42%) and were ineffective (38%). Just over a quarter (22%) of physicians reported lacking confidence in their ability to discuss smoking with their patients, 18% felt such discussions were unpleasant, 16% lacked confidence in their knowledge, and relatively few considered discussing smoking outside of their professional duty (5%), or that this intruded upon patients' privacy (5%), or that such discussion were inappropriate (3%). CONCLUSIONS: In addition to providing skills training, interventions designed to increase the implementation of smoking cessation interventions by primary care physicians may be more effective if they address a range of commonly held negative beliefs and attitudes towards discussing smoking cessation. These include beliefs and values that influence primary care physicians' judgements about whether discussing smoking is an effective use of their time.

Attitude of Health Personnel↗

PubMed2005

Predictive genetic testing for Alzheimer's disease: impact upon risk perception.

UNLABELLED: The aim of this study was to determine the impact on risk perceptions of disclosing genetic test results used to estimate the risk of Alzheimer's disease (AD). Adult children (n = 149) of people with AD were randomized to one of two groups--Intervention group: lifetime risk estimates of AD based on age, gender, family history, and Apolipoprotein E (APOE) genotype; CONTROL GROUP: lifetime risk estimates of AD based on the same risk factors excluding APOE genotype. Perceptions of personal risk (PPR) for AD were assessed six weeks after risk assessments. PPR were correlated with actual lifetime risk estimates (r = 0.501; p < 0.0001). After controlling for lifetime risks communicated to participants, age, and number of affected relatives, PPR scores among those with an epsilon4-positive test result (the test result associated with increased AD susceptibility) (adjusted mean: 3.4 (SD: 0.7)) were not different from the PPR scores in the CONTROL GROUP (adjusted mean: 3.4 (SD: 0.7) (F1,91= 1.98; p = 0.162). Again, controlling for lifetime risk estimates, age, and number of affected relatives, the PPR score of those receiving an epsilon4-negative test result was significantly lower (adjusted mean: 3.1 (SD: 0.8)) than those in the CONTROL GROUP (adjusted mean: 3.4 (SD: 0.7) (F1,95 = 6.23; p = 0.014). Perceptions of risk of developing AD are influenced by genetic test disclosure in those receiving epsilon4-negative, but not those receiving epsilon4-positive test results. Despite the reduced perceptions of risk in the former group, there was no evidence of false reassurance (i.e., perceiving risks as equal to or lower than population risks of AD), although this possibility should be assessed in other testing contexts.

Age Factors↗