This article reflects on how tools such as the Outcomes Star can support public servants to take a learning-oriented, relational approach, filling the gap left by Public Administration (PA) education not keeping up with the challenges facing public servants today. We describe the distinctive design features of the Outcomes Star suite of tools and draw on empirical evidence, alongside our experience supporting Outcomes Star users, to illustrate how these features allow it to act as a pedagogical tool for service users, practitioners, managers and commissioners. Barriers to using tools like the Outcomes Star to benefit service delivery are framed in the context of misplaced ideas borrowed from other fields that run counter to aspirations for relational, responsive, joined up service delivery. The case is made that the PA needs to root its theoretical foundations in the human sciences alongside political studies and management science. We end with recommendations for greater involvement from human science disciplines in PA teaching, incorporating the Outcomes Star into PA teaching, and further research into the role of such tools in public service pedagogy.

This article examines the psychometric properties of the Homelessness Star, a widely used keywork and outcome measurement tool developed for homelessness services but often used in the context of more generic complex needs. The Homelessness Star was the first version of the Outcomes Star, a suite of more than 30 tools tailored to specific service users and contexts. In this study, routinely collected Homelessness Star data was provided by UK women’s centers offering holistic support to women involved with, or at risk of involvement with the criminal justice system. The analyses included assessing factor structure, internal consistency, item-redundancy, (N = 1703), responsiveness (n = 1307) and predictive validity (n = 175) of the Homelessness Star. A unidimensional factor structure was found with good internal consistency, no item redundancy, and an average effect size of r = .38 across outcome areas (range .28 to .44). Higher initial Homelessness Star readings were associated with later accommodation and employment status as well as a greater likelihood of attending education and training. Greater change in the Managing tenancy and accommodation outcome area was also associated with being more likely to transition from being homeless to having housing. These findings support the validity and reliability of the Homelessness Star as an outcomes measurement tool.

Aims The aims were to develop and validate a tool for monitoring and supporting the mental health of young people. Based on extensive experience of developing similar tools, the hypothesis was that a user-friendly tool could be produced with sound psychometric properties. Background The Outcomes Star is a suite of collaboratively completed, strengths-based tools with the dual roles of both supporting and monitoring change. Service users are empowered through their active involvement in identifying their strengths and creating their care plan. Triangle, the creators of the Outcomes Star was approached by a number of organisations to develop a version of the Star for young people with mental health issues in early intervention services and also to support young people in managing a diagnosed mental illness. Method Using a series of focus groups and an iterative process of refinement we gathered data from practitioners and service users on the domains in which they wish to create change, and the steps of the change process. A draft version of the new tool was piloted in two organisations by 67 workers and 177 young people over six months. The pilot data were analysed to assess the psychometric properties of My Mind Star (acceptability, skew, factor structure, internal consistency, item redundancy and responsiveness). Result The resulting tool, My Mind Star consisted of seven domains: Feelings and emotions, Healthy lifestyle, Where you live, Friends and relationships, School, training and work, How you use your time and Self-esteem. Almost all young people and practitioners (94%) agreed that their completed Star was ‘a good summary of my life right now’ and that it gave a better idea of service users’ support needs. Psychometric analyses indicated a unidimensional structure with good internal consistency (α = .76) and no item redundancy. My Mind Star was responsive to change between the first and second readings, with medium and small-medium effect sizes. Conclusion Initial findings suggest that My Mind Star has good psychometric properties and is perceived as acceptable and useful by young people and practitioners, Further research is planned to conduct a full validation of the psychometric properties of this Star including inter-rater reliability and predictive validity. Financial sponsorship of the study: Action for Children

Objective To examine the psychometric properties of the Family Star Plus, an assessment of family functioning using a collaborative mode of completion between the caseworker and service user. Background The Family Star Plus is widely used to assess strengths and needs within services supporting families. Method In Phase 1, interrater reliability was assessed. Phase 2 established factor structure, internal consistency, item redundancy, and responsiveness. In Phase 3, the Family Star Plus was used to predict children's unauthorized school absence. Results Workers reliably applied Family Star Plus scales. A unidimensional factor structure was found with good internal consistency and responsiveness. School absence was predicted by the Family Star Plus. Conclusions These findings demonstrate the validity of the Family Star Plus as a tool for assessing needs and measuring progress of family support interventions. Implications The Family Star Plus can be confidently used and recommended as an outcomes measurement tool.

Purpose The purpose of this article is to explain why Sweet et al.'s assertions are not well founded and raise unsubstantiated doubt over the use of the Family star Plus and the Outcomes Star suite of tools as outcomes measures. Design/methodology/approach Evidence is presented of flaws in the analysis, reporting and conclusions of an article published in this journal (Sweet et al. , 2020). Findings Sweet et al. failed to mention a body of Outcomes Star validation work, including over 20 online reports and a manuscript they had seen of a now published article supporting the reliability and validity of the Family Star Plus (Good and MacKeith, 2020). There are significant issues with their methodology, presentation of results and conclusions including: reliance on statistical significance with a small sample size; use of statistics not intended for ordinal data and; and inappropriate conclusions from convergence with measures conceptually different to the Family Star Plus. Originality/value Evidence is presented that the Family Star Plus is a useful and valid outcome measure and that Sweet et al. ’s conclusions can be attributed to issues with their methodology and interpretation.

Background The government is committed to increasing access to palliative care that meets best-practice guidelines advocating patient-centred and holistic support (Our commitment to you for end of life care. The government response to the review of choice in end of life care. Department of Health, 2016; Siouta, van Beek, Preston, Hasselaar et al., 2016). The Preparation Star was developed in response to this commitment, and to calls within the palliative care sector for a tool to empower patients to talk with professionals, family or support workers about what is important for them and make plans when approaching end of life. Aims The development of the Preparation Star addressed the need for a collaborative tool as identified above, particularly in relation to psychosocial support needs. Specific aims were to determine the outcome areas and the Journey of Change describing movement in each area, and to conduct initial validation work on the pilot version. Methods A literature review informed the first focus group, which included professionals from two hospices and two organisations managing care homes. Scales were drafted and discussed at a second focus group and refinements made before piloting in the organisations. Patient feedback and pilot data was discussed at two final focus groups before further refinements. Results The Preparation Star identified patients' needs, with 91% reporting significant issues in at least one area. All patients reported that completing the Preparation Star was positive and 88% felt it provided a helpful picture of their situation. It was completed most successfully in hospice outpatient facilities with those not immediately facing end of life. Internal consistency was good (α=0.79) and there was no item redundancy. Conclusions Initial findings suggest that the Preparation Star has good psychometric properties and is perceived as acceptable and useful. It may be best suited for use earlier in the end of life pathway. Further research is planned to conduct a full validation of the psychometric properties of this Star including factor analysis and responsiveness.

The study aim was to develop a mobile application (app) supported by user preferences to optimise self-management of arm and shoulder exercises for upper-limb dysfunction (ULD) after breast cancer treatment.Focus groups with breast cancer patients were held to identify user needs and requirements. Behaviour change techniques were explored by researchers and discussed during the focus groups. Concepts for content were identified by thematic analysis. A rapid review was conducted to inform the exercise programme. Preliminary testing was carried out to obtain user feedback from breast cancer patients who used the app for 8 weeks post surgery.Breast cancer patients' experiences with ULD and exercise advice and routines varied widely. They identified and prioritised several app features: tailored information, video demonstrations of the exercises, push notifications, and tracking and progress features. An evidence-based programme was developed with a physiotherapist with progressive exercises for passive and active mobilisation, stretching and strengthening. The exercise demonstration videos were filmed with a breast cancer patient. Early user testing demonstrated ease of use, and clear and motivating app content.bWell, a novel app for arm and shoulder exercises, was developed by breast cancer patients, health care professionals and academics. Further research is warranted to confirm its clinical effectiveness.Mobile health has great potential to provide patients with information specific to their needs. bWell is a promising way to support breast cancer patients with exercise routines after treatment and may improve future self-management of clinical care.

Background: Narrative storytelling can be used to convey health risk information. This research aimed to determine the influence of temporally framed narratives about excessive sugar consumption on motivation to reduce intake and behaviour at follow-up. Methods: In study 1 (N = 69), participants read a narrative which described negative outcomes as occurring to a significant number of people every day (‘day-frame’) vs. every year (‘year-frame’). Sugar consumption was recorded 7-days later. In study 2 (N = 294), we also included a control condition in which the outcomes were presented without a temporal frame. Findings: In study 1, participants spent longer reading the narrative message in the ‘day’ vs. ‘year’ frame condition. For those low in eating self-efficacy, the ‘day’ frame was associated with greater worry and higher intentions to reduce sugar consumption. In study 2, there was greater transportation when the narrative contained the ‘day’ frame compared to when it contained the ‘year’ frame or no frame. Discussion: The persuasive effects of narrative communications may depend on the temporal context in which the outcomes are set.

ObjectivesSelf‐affirmation (e.g., by reflecting on important personal values) has been found to promote more open‐minded appraisal of threatening health messages in at‐risk adults. However, it is unclear how self‐affirmation affects adolescents and whether it has differential effects on the impact of these messages amongst those at relatively lower and higher risk. The current study explored moderation by risk.DesignParticipants were randomly assigned to either a self‐affirmation or a control condition before receiving a health message concerning physical activity.MethodsOlder adolescents (N = 125) completed a self‐affirmation or control writing task before reading about the health consequences of not meeting recommendations to be physically active for at least 60 min daily. Most of the sample did not achieve these levels of activity (98%, N = 123). Consequently, the message informed these participants that – unless they changed their behaviour – they would be at higher risk of heart disease. Participants completed measures of responses to the message and behaviour‐specific cognitions (e.g., self‐efficacy) for meeting the recommendations.ResultsFor relatively inactive participants, self‐affirmation was associated with increased persuasion. However, for those who were moderately active (but not meeting recommendations), those in the self‐affirmation condition were less persuaded by the message.ConclusionsWhilst self‐affirmation can increase message acceptance, there are circumstances when the open‐mindedness it induces may decrease persuasion. The evidence provided in this study suggests that caution may be needed when recommendations are challenging and it could be considered reasonable to be sceptical about the need to change behaviour. Statement of contribution What is already known on this subject? Self‐affirmation can facilitate open‐mindedness and sensitivity to whether health messages suggest high or low risk on the basis of current behaviour. What does this study add? Demonstrates that self‐affirmation effects can be moderated by the extent of failure to meet recommendations. Shows that self‐affirmation can be associated with less persuasion when challenging health guidelines are used.

Self-affirmation (e.g., by reflecting on important personal values) has been found to promote more open-minded appraisal of threatening health messages in at-risk adults. However, it is unclear how self-affirmation affects adolescents and whether it has differential effects on the impact of these messages amongst those at relatively lower and higher risk. The current study explored moderation by risk. Participants were randomly assigned to either a self-affirmation or a control condition before receiving a health message concerning physical activity. Older adolescents ( N  =   125) completed a self-affirmation or control writing task before reading about the health consequences of not meeting recommendations to be physically active for at least 60 min daily. Most of the sample did not achieve these levels of activity (98%, N  =   123). Consequently, the message informed these participants that – unless they changed their behaviour – they would be at higher risk of heart disease. Participants completed measures of responses to the message and behaviour-specific cognitions (e.g., self-efficacy) for meeting the recommendations. For relatively inactive participants, self-affirmation was associated with increased persuasion. However, for those who were moderately active (but not meeting recommendations), those in the self-affirmation condition were less persuaded by the message. Whilst self-affirmation can increase message acceptance, there are circumstances when the open-mindedness it induces may decrease persuasion. The evidence provided in this study suggests that caution may be needed when recommendations are challenging and it could be considered reasonable to be sceptical about the need to change behaviour. What is already known on this subject? What does this study add?

OBJECTIVE:To evaluate an intervention based on implementation intention principles designed to increase uptake of colorectal cancer screening, and to examine differential efficacy by socioeconomic deprivation. METHOD:In England, adults aged between 60 and 69 years are invited for biennial fecal occult blood testing. A test kit and an information leaflet are mailed to each individual by the "Hubs" that deliver the national screening program. In the intervention group, three preformulated implementation intentions, based on known barriers to carrying out the test, were added to the information leaflet. Over a 12-week period, each week was randomly allocated to either the intervention (n = 12,414 invitations) or the control condition (n = 10,768), with uptake recorded at the Hub. Socioeconomic deprivation of each individual's area of residence was categorized into tertiles. RESULTS:There was no overall difference in uptake between control (40.4%) and intervention (39.7%) conditions, odds ratio (OR) = 0.97, 95% confidence interval (CI) [0.91, 1.04]. There was an interaction with deprivation, OR = 1.11, 95% CI [1.04, 1.18], but the positive effect observed in the lowest socioeconomic status (SES) tertile was small (35.2% vs. 33.0%), OR = 1.103, 95% CI [1.01, 1.21], and offset by a negative effect in the least deprived tertile (45.6% vs. 48.2%), OR = 0.90, 95% CI [0.82, 0.99]. The intervention had no significant effect in the middle tertile (38.9% vs. 40.8%), OR = 0.92, 95% CI [0.81, 1.04]. CONCLUSION:Preformulated implementation intentions did not increase overall colorectal cancer screening uptake and failed to make a sufficiently large impact on uptake among lower SES groups to merit their future use in this context.

Background: Message framing outcomes of healthy behaviours as occurring 'every day' vs. 'every year' can influence the temporal proximity and perceived likelihood of these outcomes. However, it is not known how pre-existing beliefs such as confidence in one's ability to perform health-related behaviour interact with such messages. Objective: The purpose of this research was to investigate whether eating self-efficacy moderates the effect of temporal framing (day-frame vs. year-frame) on snacking behaviour. Methods: Participants (N=95) completed the short form of the Weight Efficacy Lifestyle Questionnaire (WEL-SF) and read either a day-framed or year-framed message about the health benefits associated with avoiding snacking. Consumption of snacks was reported 7 days later. Findings: For those with low levels of eating self-efficacy (WEL-SF score <4.3 on a 7-point response scale), the year-framed message was associated with lower levels of snacking than the day-framed message. Discussion: The current research identifies a key role for eating self-efficacy in shaping recipients' responses to temporally framed messages about the health benefits associated with the avoidance of snacking. (C) 2014 Elsevier Ltd. All rights reserved.

Background Colorectal cancer (CRC) screening participation is low despite its effectiveness in reducing CRC mortality. Identifying benefits and barriers requires consideration of specific characteristics of screening modalities. Aims and Research Questions To monitor the impact of providing information about CRC screening via faecal occult blood testing (FOBt) on intentions to participate. To investigate moderation by individual differences in consideration of future consequences (CFC). Design, setting and participants A total of 211 healthy adults (aged 4559) with no experience of CRC screening were presented with eight consecutive statements about FOBt-based screening in a web survey. Participants completed measures of i) intention (after each statement), ii) CFC and iii) the importance of screening practicalities (e.g. unpleasantness of completing the test) and benefits (e.g. early detection of cancer). Results An 8 (information) x 2 (CFC) mixed ancova showed that intentions varied across the eight statements. (P < 0.001): increasing after information about FOBt being completed at home (P < 0.001) before subsequently decreasing after information about the requirement to collect faecal samples (P < 0.001) in a plastic tub (P < 0.01) on three occasions (P < 0.01) with the low CFC group generally being less inclined to complete the test (P < 0.01). Two between-group anovas demonstrated that the low CFC group attributed greater importance to practicalities of screening than the high CFC group while the opposite was found for the importance of benefits (both Ps < 0.001). Conclusion Deconstructing FOBt-based screening pointed to specific benefits and barriers which can advance research into public preferences of screening and educational materials.

Temporal framing has been heralded as a promising strategy to make risks appear more proximal and concrete and thus counter temporal discounting effects that are often limiting the appeal of long-term benefits of health behaviors. Previous research has shown that temporal framing affects behavioral intention. This study extends on this previous research by examining the effects of temporal framing on behavioral expectations-which are said to better reflect feasibility concerns than intentions-and actual behavior in the context of eating five portions of fruit and vegetables a day. Results show that while temporal framing has effects on behavioral expectations similar to those on behavioral intentions, this effect was not significant for actual behavior.

Health-risk communications frequently target self-efficacy in order to encourage adaptive responses. Research has also indicated that self-affirmation may be a useful supplementary or alternative intervention technique. This study compared the effects of self-efficacy, self-affirmation and a combination of these techniques for two risk messages. Young British females (N=677) read about ultraviolet light and skin cancer or skin ageing ('photoageing') and were randomly assigned to a single intervention (self-affirmation/self-efficacy), the combined intervention or no intervention. The efficacy intervention led to greater message acceptance and perceived risk in both the cancer and photoageing conditions, while the only main effect of self-affirmation was on acceptance of the photoageing message. However, self-affirmation moderated the effect of efficacy information. For photoageing messages, efficacy information was associated with greater message acceptance only amongst self-affirmed participants, but the opposite occurred for skin cancer messages. Although these findings should be interpreted cautiously, they imply that health promoters should select efficacy information if only one intervention is used but that self-affirmation can influence responsiveness to efficacy interventions for particular messages.

Cancer screening participation shows a strong, graded association with socioeconomic status (SES) not only in countries such as the United States, where insurance status can be a barrier for lower income groups, but also in the United Kingdom, where the National Health Service provides all health care to residents, including screening, for free. Traditionally, the literature on socioeconomic inequalities has focused on upstream factors, but more proximal (downstream) influences on screening participation also need to be examined, particularly those that address the graded nature of the association rather than focusing specifically on underserved groups. This review offers a framework that links some of the components and corollaries of SES (life stress, educational opportunities, illness experience) to known psychosocial determinants of screening uptake (beliefs about the value of early detection, fatalistic beliefs about cancer, self-efficacy). The aim is to explain why individuals from lower SES backgrounds perceive cancer screening tests as more threatening, more difficult to accomplish, and less beneficial. A better understanding of the mechanisms through which lower SES causes negative attitudes toward screening could facilitate the development of intervention strategies to reduce screening inequalities.