OBJECTIVES:A conceptual model of the psychological factors underpinning adherence to anti-hypertensive medication is proposed and tested. The model suggests that adherence is influenced by three sets of variables: demography, health status, and perceived effects of medication; cognitions and motivation; and intention to adhere.METHODS AND DESIGN:Patients with known hypertension were recruited from three primary care practices in South-East England and were asked to complete a postal questionnaire. A total of 1,070 responses were received. The questionnaire asked about the three sets of predictor variables, and adherence. Eight weeks after the first questionnaire, a second was posted to all respondents, this time asking about adherence over the intervening period.RESULTS:The three sets of predictor variables were treated as blocks in a hierarchical model, so that each successive block added to the variance in adherence explained by the previous blocks. The data were analysed by hierarchical multiple regression. The predictors accounted for 19% of the variance in adherence at Time 1, and 34% at Time 2. The leading individual predictors at Time 1 were age, gender, conscientiousness, hypertensive identity, perceived behavioural control, and intention. At Time 2, they were the same, except that gender made way for adherence at Time 1.CONCLUSIONS:The model offers a parsimonious account, and the findings suggest a number of approaches to designing interventions to modify behaviour.

Objectives.   A conceptual model of the psychological factors underpinning adherence to anti-hypertensive medication is proposed and tested. The model suggests that adherence is influenced by three sets of variables: demography, health status, and perceived effects of medication; cognitions and motivation; and intention to adhere. Methods and Design.   Patients with known hypertension were recruited from three primary care practices in South-East England and were asked to complete a postal questionnaire. A total of 1,070 responses were received. The questionnaire asked about the three sets of predictor variables, and adherence. Eight weeks after the first questionnaire, a second was posted to all respondents, this time asking about adherence over the intervening period. Results.   The three sets of predictor variables were treated as blocks in a hierarchical model, so that each successive block added to the variance in adherence explained by the previous blocks. The data were analysed by hierarchical multiple regression. The predictors accounted for 19% of the variance in adherence at Time 1, and 34% at Time 2. The leading individual predictors at Time 1 were age, gender, conscientiousness, hypertensive identity, perceived behavioural control, and intention. At Time 2, they were the same, except that gender made way for adherence at Time 1. Conclusions.   The model offers a parsimonious account, and the findings suggest a number of approaches to designing interventions to modify behaviour.

PurposeThe purpose of this study was to establish the level of occupational stress in UK NHS radiographers, and to examine its causes. A total of more than 1600 radiographers sampled nationally completed a postal questionnaire. Four groups were represented – mammography, diagnostics, radiotherapy, and ultrasound – and both junior staff and superintendents were examined.MethodThe questionnaire measured role ambiguity, role conflict, work problems, social support from colleagues, and perceived stress.ResultsLevels of perceived stress were high in all four groups. The mean was significantly lower in the mammography group than the others, however, and junior staff reported lower levels than superintendents. Role ambiguity, role conflict and work problems all contributed significantly to stress, but the effects were sometimes buffered by social support from colleagues.ConclusionThe implications of the findings are discussed for theory and for policy and practice: occupational stress was predicted by intrinsic features of the job; the levels were similar to those reported by other NHS professionals; and the pattern of findings suggests possible ways to intervene to reduce it.

Leventhal's commonsense model of self-regulation has attracted a great deal of research in recent years, but its possible implications for understanding young people with chronic illness have received little attention. The purpose of this study is to examine children and young people with chronic fatigue syndrome (CFS) and to explore (a) the characteristics of their illness representations, (b) whether those representations are associated with their physical functioning and perceived quality of life and (c) whether coping strategies may act as mediators between representations and those outcomes. A total of 85 participants, ranging in age from 8 to 25 years, were recruited from the website of a self-help group for young people with CFS. They were asked to complete three questionnaires, measuring illness representations, coping strategies, and physical functioning and quality of life. The results showed that illness representations formed characteristic patterns, that they were associated with both physical functioning and quality of life, and that coping partially mediated the relationship between illness representations and outcome. We conclude that young people's representations of their CFS play an important role in coping and outcome. The implications of the findings are discussed for both theory and clinical practice, and suggestions are made for further research.

Background and Purpose: This study tested an implementation intentions intervention to increase uptake in the United Kingdom's National Health Service Breast Screening Programme. The intervention asked women to plan how they would overcome up to 3 previously identified barriers to attending. Methods: In a randomized controlled trial, 2,082 participants were allocated to an intervention condition, an assessment-only condition, or a nonassessment control condition. The intervention condition was designed to help women plan how to change their appointment, how to arrange transport, and how to negotiate time off work. The assessment-only condition controlled for the possibility that completing a questionnaire about mammography might in itself influence attendance, and the nonassessment condition was a control against any effect on attendance that mere contact with the research team might have. Results: Mean age of respondents was 56.1 years, and 99.4% were White British. In the full intention-to-treat analysis, which included all participants, attendance was found to be almost identical across the 3 conditions, around 80%. Some of the women in the intervention condition, however failed to write their plans on the questionnaire (10.6% for changing the appointment, 2.1% for travel arrangements, and 21.1% for taking time off work) or said that planning was irrelevant to them (2.4% for changing the appointment, 1.7% for travel arrangements, and 32.4% for taking time off work). A second analysis, of planning time off work, therefore, examined the 620 respondents in the intervention condition more closely and found that those who planned were significantly more likely to attend than those who did not. A 3rd analysis, excluding the 209 respondents for whom planning time off work was irrelevant, revealed that the most likely to plan were those whose initial intentions to attend were strong but whose perceptions of control over making the necessary arrangements to attend were weak. Conclusions: Two main implications of the findings are discussed: the importance of planning in implementation intentions interventions and the validity of the theoretical distinction between motivation and volition.

A prospective longitudinal study explored the illness representation model of patients with irritable bowel syndrome: how representations may change; whether they predict subsequent psychological outcome; and whether any link between representation and outcome may be mediated by coping. Patients were recruited from primary care. Representations were found to be stable over time, and they did predict outcome to some extent, but coping played no part in mediating the link. The findings raise important questions about using the illness representation model with chronic illness, and about the role of coping in the model.

The present research tested whether people display comparative optimism for environmental risks and the link between comparative optimism and pro-environmental activity. Study 1 found comparative optimism for water pollution, air pollution and nuclear energy in normal conditions, but not when participants were asked to think about pollution arising from a hypothetical accident. In Study 2, both environmental activists and nonactivists displayed comparative optimism for a list of 22 environmental risks. However, comparative optimism was not associated with self-reported pro-environmental behaviour. Instead, absolute perceived risk, ecological attitude and social value orientation were associated with behaviour. Furthermore, when controlling for group membership, the effect of absolute risk disappeared. These findings are used to address ways in which pro-environmental behaviour might be encouraged.

This study explored whether an emotional Stroop paradigm might represent an appropriate means of assessing individuals' emotional representations of asthma. In addition, the opportunity was taken to investigate whether emotional representations of asthma, as assessed by this method, were associated with adherence to inhaled preventative medication. An asthma Stroop task was devised which comprised three sets of stimuli: asthma symptom words, general negative words, and neutral words. Three groups of participants were compared on their performance on this task: individuals with asthma, individuals without asthma, and individuals without asthma who had been primed about the condition. It was found that individuals with asthma experienced significantly more interference when colour-naming the asthma symptom words, but not when colour-naming the general negative words. Furthermore, their performance on the asthma Stroop task was associated with self-reported adherence levels. Specifically, individuals who reported the highest and lowest levels of adherence displayed more interference when colour-naming the asthma symptom words than individuals with intermediate levels of adherence. It is concluded that the emotional Stroop paradigm might provide an objective and sensitive means of assessing individuals' emotional representations of illness. Additionally, it is proposed that emotional responses to illness should be assessed and included in research designed to explain health behaviours and, furthermore, that such research should not assume that any relationship between emotional representations and health behaviours will be linear.

OBJECTIVE:The objective of this study was, to compare the predictive utility of two measures of the attitude, subjective norm and perceived behavioural control constructs of the theory of planned behaviour (TPB; Ajzen, 1991) in predicting intention and subsequent attendance at breast screening. One construct was based on a modal set of underlying beliefs; the other was based on the three beliefs from each construct considered by the participant to be the most important.METHOD:We used a prospective, longitudinal design using a postal questionnaire at Time 1 and objective attendance data from screening records at Time 2. Questionnaires were sent to 1657 women from southeast England due to be invited for X-ray mammography under the UK's National Health Service Breast Screening Programme. After evaluating a set of modal behavioural, normative and control beliefs, women were asked to select the three beliefs they saw as the most important for them, and to rank them. The products of these three beliefs formed the 'important' (vs. the modal) measures.RESULTS:The 'important' attitude and subjective norm measures showed similar associations with direct measures and were equivalent to the modal measures in predicting intention and attendance at screening. The modal control construct was marginally more robust than the 'important' one in its association with the direct measure of control, and with intention. Key individual important beliefs that predicted intention and behaviour were identified.CONCLUSIONS:Measuring belief importance can help more fully identify the structures underlying attitude, subjective norm and perceived behavioural control, and can provide useful information when the TPB is used as the basis for intervention to help change behaviour.

The current study explores whether cognitive and emotional representations of asthma are associated with adherence to inhaled preventative asthma medication, as predicted by the Self-Regulatory Model (SRM). Three hundred and thirty individuals with asthma completed a questionnaire that assessed their cognitive and emotional representations of asthma and their adherence to prescribed medication. Multiple regression analyses revealed that including components of the SRM significantly improved the prediction of current adherence and intention to adhere in the future. Age, duration of asthma, gender, and components of the SRM were able to predict 28.7% of the variance in current adherence and 16.6% of the variance in intention to adhere. Current adherence was predicted by age, gender, certainty about asthma status, beliefs about antecedent causes, and beliefs about cure-control. Age, beliefs about cure-control, and beliefs about the duration of one's asthma significantly predicted intention to adhere in the future. It is concluded that future research is needed to test the SRM systematically and to explore the added value of incorporating emotional representations alongside cognitive representations. Such research may benefit from utilising innovative means of assessing emotional representations and should include beliefs about treatment. In addition, the possibility that representations of illness may not influence health behaviours linearly or uniformly across individuals should be considered.

OBJECTIVE: To examine the influence of an individually derived versus modal subjective norm component of the Theory of Planned Behaviour (TPB) in predicting attendance at breast screening. DESIGN: A prospective, longitudinal design was employed using a postal questionnaire at Time 1 and objective attendance data from screening records at Time 2. METHOD: Questionnaires were sent to 1000 women from East Kent due to be invited for X-ray mammography under the UK's National Health Service Breast Screening Programme. The TPB constructs were used to predict attendance, with a focus on subjective norm. Two versions of the questionnaire were distributed: one assessed subjective norm using individually generated normative beliefs (individual condition) and the other provided a list of modal referents (modal condition). RESULTS: The mean number of normative referents in the individual condition was just two, almost all of whom were family members, in contrast to the modal condition where 'GP' led the rank table. The results suggest that a more senstive measure of subjective norm is attained using individually derived beliefs. Structural equation modelling revealed that, contrary to theoretical prediction, the effect on attendance of the individually derived subjective norm was not entirely mediated by intention: an independent contribution to attendance was shown. In the modal condition the construct was entirely mediated by intention. CONCLUSIONS: For health behaviours that have implications for others as well as self, measuring individually salient normative beliefs may both improve theoretical prediction and yield information of potential value for designing intervention programmes.

Notes on Contributors Acknowledgements List of abbreviations Introduction social cognition models and changing health behaviours Encouraging safer-sex behaviours development of the SHARE sex education programme Smoking and smoking cessation modifying perceptions of risk Reducing the risks of exposure to radon gas an application of the Precaution Adoption Process Model Reducing fat intake interventions based on the Theory of Planned Behaviour Increasing participation with colorectal cancer screening the development of a psycho-educational intervention Changing health behaviours the role of implementation intentions Changing drivers' attitudes to speeding using the Theory of Planned Behaviour Improving pedestrian road safety among adolescents an application of the Theory of Planned Behaviour Increasing cycle helmet use in school-age cyclists an intervention based on the Theory of Planned Behaviour Conclusion using social cognition models to develop health behaviour interventions: problems and assumptions Index

OBJECTIVE: Irritable bowel syndrome has no observable symptom markers and there is little that the medical profession can do to help sufferers. Psychotherapy, antidepressants and drugs aimed at the most problematic symptoms have been shown to have limited efficacy. In an attempt to help understand the illness better, and to suggest alternative forms of intervention, the study tested whether outcome might be influenced by patients' representation of their illness and by their coping strategies. METHOD: All members of the IBS Network (an independent charitable support network based in the UK) were invited to participate via their quarterly newsletter, and 209 completed questionnaires were returned. Participants completed the Illness Perception Questionnaire (IPQ), the COPE, and the Hospital Anxiety and Depression Scale (HADS), and rated their quality of life and their satisfaction with their health. RESULTS: The reporting of serious consequences was associated with lower quality of life and lower satisfaction with health, and with higher scores for anxiety and depression (p <.001). Weaker control beliefs were related to lower quality of life, lower satisfaction with health, and higher depression scores (p <.01). Lower illness scores were associated with more satisfaction with health (p <.01), but not with quality of life (p >.05). Psychological causal attribution of IBS was positively correlated with anxiety (p <.001) and depression (p <.01). Path analyses based on multiple linear regression demonstrated that (1) the reporting of serious consequences was a strong independent predictor of outcome; (2) coping mediated the link between representation and outcome; and (3) when predicting depression, coping strategies predicted coping independently of representation dimensions. CONCLUSIONS: The findings indicate that the illness representations of IBS sufferers can have significant implications for outcome. Therapeutic interventions based on illness representations may prove useful for treatment.

Objective: Irritable bowel syndrome has no observable symptom markers and there is little that the medical profession can do to help sufferers. Psychotherapy, antidepressants and drugs aimed at the most problematic symptoms have been shown to have limited efficacy. Inan attempt to help understand the illness better, and to suggest alternative forms of intervention, the study tested whether outcome might be influenced by patients' representation of their illness and by their coping strategies. Method: All members of the IBS Network (an independent charitable support network based in the UK) were invited to participate via their quarterly newsletter, and 209 completed questionnaires were returned. Participants completed the Illness Perception Questionnaire (IPQ), the COPE, and the Hospital Anxiety and Depression Scale (HADS), and rated their quality of life and their satisfaction with their health. Results: The reporting of serious consequences was associated with lower quality of life and lower satisfaction with health, and with higher scores for anxiety and depression ( p < .001). Weaker control beliefs were related to lower quality of life, lower satisfaction with health, and higher depression scores ( p < .01). Lower illness scores were associated with more satisfaction with health ( p < .01), but not with quality of life ( p > .05). Psychological causal attribution of IBS was positively correlated with anxiety ( p < .001) and depression ( p < .01). Path analyses based on multiple linear regression demonstrated that (1) the reporting of serious consequences was a strong independent predictor of outcome; (2) coping mediated the link between representation and outcome; and (3) when predicting depression, coping strategies predicted coping independently of representation dimensions. Conclusions: The findings indicate that the illness representations of IBS sufferers can have significant implications for outcome. Therapeutic interventions based on illness representations may prove useful for treatment.

Objectives. To design and evaluate a theory-based intervention to encourage the use of protective helmets in school-age cyclists.Design. Two-by-three mixed design on 97 cyclists who did not initially use a helmet: Condition (intervention/control) X Time (pre-intervention/immediately post-intervention/ 5-month follow-up).Method. The intervention builds on a previous study using the Theory of Planned Behaviour in which we identified a small number of salient beliefs that predict intention to use a safety helmet and helmet use (Quine et al., 1998). Participants were randomly assigned to intervention or control conditions. The intervention group was presented with a booklet containing a series of persuasive messages based on the identified salient beliefs, and the control group was presented with a different series of messages concerning a cycling proficiency and bicycle maintenance course. Initial beliefs were measured just before the intervention at Time 1, by questionnaire. The immediate effects of the intervention were evaluated by questionnaire at Time 2. Five months later, at Time 3, the long-term effects of the intervention on beliefs, intentions, and behaviour were assessed,Results. The behavioural, normative and control beliefs and intentions of intervention participants became more positive than those of control participants, and the effect was maintained over time. There was also a significant effect on behaviour: at 5-month follow-up, none of the 49 control children had taken up helmet wearing, while 12 (25%) of the 48 intervention children had.Conclusions. The results suggest that in order to promote lasting helmet use in young cyclists, we need to change their beliefs. The intervention reported here may present an inexpensive solution to the problem of persuading adolescents to use safety helmets. The results point to the value of social cognition theories such as the Theory of Planned Behaviour in the design of effective interventions to change health behaviours.

Objective. To test the ability of the Theory of Planned Behaviour (TPB) to predict attendance for breast cancer screening and reattendance 3 years later, using data from a prospective longitudinal study.Method. A total of 1215 women who had never had breast screening completed a postal questionnaire sent to them shortly before they were to receive their first invitation for X-ray mammography in the UK's National Health Service Breast Screening Programme. The questionnaire included items to tap attitude, subjective norm, perceived behavioural control and intention to attend. Attendance and then reattendance 3 years later were monitored from screening clinic records.Results. Two main results are reported. (1) Intention and first-time attendance were predicted successfully from the TPB, and attendance was the single predictor of reattendance 3 years later. (2) The TPB was able to distinguish between intenders who attended and those who did nor.Conclusion. The implications of the results are considered both for theory and for policy and practice. Particular attention is paid to the possibility of designing interventions to increase attendance and reattendance.

It is well established that tinnitus is sometimes associated with marked psychological distress, including anxiety and depression. As yet, however, it is unclear whether the problems are specific to tinnitus or may occur in other hearing disorders too. A total of 95 patients with tinnitus were compared with 73 people with hearing loss but no tinnitus, and with a further 80 people attending an out-patient clinic for a variety of other ear, nose and throat (ENT) problems. The principal measures were the Hospital Anxiety and Depression Scale and the Eysenck Personality Questionnaire. The tinnitus patients were significantly more anxious, depressed, and neurotic than the hearing loss group, but were equivalent to the ENT group; and, like the hearing loss group, they were significantly less extraverted than the ENT controls. There were no differences between tinnitus patients with severe hearing loss, mild hearing loss, and no hearing loss. Results from Hallam's Short Tinnitus Questionnaire revealed that tinnitus patients without hearing loss reported significantly fewer difficulties with auditory perception than either of the other tinnitus groups, and significantly fewer irrational beliefs than the group with severe hearing loss. It is concluded that patients with tinnitus were more distressed than people with hearing loss, but that their distress was shared by patients with a variety of other ENT problems. People who reported the greatest problems with their tinnitus were generally those who also had severe hearing loss.