Psychosocial factors influencing the practice of preventive behaviors against the severe acute respiratory syndrome among older Chinese in Hong Kong

OBJECTIVE: This study explored psychosocial factors that influenced the practice of preventive behaviors against the severe acute respiratory syndrome (SARS) among older adults. METHOD: A total of 354 older Chinese were telephone interviewed during the outbreak of SARS in Hong Kong. They were asked about their perceived health threats, efficacy beliefs, and the practice of SARS preventive behaviors. RESULTS: Only 40.7% of the elderly participants practiced the recommended SARS preventive behaviors. Elderly participants who perceived greater personal vulnerability to the disease, who possessed greater self-efficacy, who had greater confidence in local health authorities, and who had lower educational attainment were more likely to adopt the suggested SARS preventive behaviors. DISCUSSION: This study supported the conceptual framework that specified perceived health threats and efficacy beliefs as the two core dimensions of motivating factors in adopting SARS preventive behaviors.     

Attributional processes in rheumatoid arthritis patients

In a study of 92 patients with rheumatoid arthritis, we examined patients' beliefs about the causes of their illness, disease flares, and disease remissions, and about the selective incidence of the disease. Numerous self-report measures were used to elucidate the patients' attitudes and perceptions; the tendency of patients to present themselves in socially desirable ways was taken into account and was found not to influence the study results. The causes for the illness that were most frequently cited by patients were heredity (34.7%), autoimmune factor (24.4%), personal behaviors (22.8%), and psychological stress (22.8%). Patients who were more actively searching for the causes of the illness and who continued to ask "Why me?" reported greater functional problems and a greater sense of helplessness. The most frequently cited causes for symptom flares were psychological stress (45.5%), changes in weather (34.0%), and excessive physical activity (34.1%). Symptom remissions were most frequently believed to be related to medication changes (49.4%) and the absence of psychological stress (21.0%). Several of these causal beliefs were related to perceptions of helplessness and the illness' predictability and to health care providers' assessments of disease severity and patients' psychosocial adjustment.     

Epidemiology and Individual,Household and Geographical Risk Factors of Podoconiosis in Ethiopia: Results from the First Nationwide Mapping

Although podoconiosis is one of the major causes of tropical lymphoedema and is endemic in Ethiopia its epidemiology and risk factors are poorly understood. Individual-level data for 129,959 individuals from 1,315 communities in 659 woreda (districts) were collected for a nationwide integrated survey of lymphatic filariasis and podoconiosis. Blood samples were tested for circulating Wuchereria bancrofti antigen using immunochromatographic card tests. A clinical algorithm was used to reach a diagnosis of podoconiosis by excluding other potential causes of lymphoedema of the lower limb. Bayesian multilevel models were used to identify individual and environmental risk factors. Overall, 8,110 of 129,959 (6.2%, 95% confidence interval [CI] 6.1–6.4%) surveyed individuals were identified with lymphoedema of the lower limb, of whom 5,253 (4.0%, 95% CI 3.9–4.1%) were confirmed to be podoconiosis cases. In multivariable analysis, being female, older, unmarried, washing the feet less frequently than daily, and being semiskilled or unemployed were significantly associated with increased risk of podoconiosis. Attending formal education and living in a house with a covered floor were associated with decreased risk of podoconiosis. Podoconiosis exhibits marked geographical variation across Ethiopia, with variation in risk associated with variation in rainfall, enhanced vegetation index, and altitude.     

Economic costs of endemic non-filarial elephantiasis in Wolaita Zone, Ethiopia

BACKGROUND: Endemic non-filarial elephantiasis or podoconiosis is a chronic and debilitating geochemical disease occurring in individuals exposed to red clay soil derived from alkalic volcanic rock. It is a major public health problem in countries in tropical Africa, Central America and North India. OBJECTIVE: To estimate the direct and the average productivity cost attributable to podoconiosis, and to compare the average productivity time of podoconiosis patients with non-patients. METHODS: Matched comparative cross sectional survey involving 702 study subjects (patients and non-patients) supplemented by interviews with key informants in Wolaita Zone, southern Ethiopia. RESULTS: Total direct costs of podoconiosis amounted to the equivalent of US$ 143 per patient per year. The total productivity loss for a patient amounted to 45% of the total working days per year, causing a monetary loss equivalent to US$ 63. In Wolaita zone, the overall cost of podoconiosis exceeds US$ 16 million per year. CONCLUSIONS: Podoconiosis has enormous economic impact in affected areas. Simple preventive measures (such as use of robust footwear) must be promoted by health policy makers.     

Patients' beliefs about the causes of heart disease: relationships with risk factors, sex and socio-economic status.

BACKGROUND: Patients' beliefs about the causes of their heart disease (causal attributions) are important to effective medical communication, psychological adaptation, and adherence to advice. We assessed the extent to which causal attributions relate to risk factors, sex and socio-economic status in men and women diagnosed with acute coronary syndrome. DESIGN: We conducted an interview and questionnaire study of 171 acute coronary syndrome patients assessed within 5 days of admission to three hospitals in the London area. METHOD: Patients rated beliefs in the role of 16 factors in causing their heart disease. Associations between attributions and risk factors were assessed, and differences in beliefs by sex and socio-economic status (defined by educational attainment) analysed. RESULTS: The most common attributions were to stress, smoking, high blood pressure, chance or bad luck, and heredity. Attributions were strongly associated with risk factors: 90% of smokers attributed heart disease to smoking, compared with 0% never smokers; 90.4% of hypertensives attributed heart disease to high blood pressure, 72.2% of patients with a positive family history to heredity, 85% of obese patients to being overweight, and 49% of sedentary patients to lack of exercise. Attributions to stress were related both to current mood and reports of recent life stress. There were few sex differences, but higher socio-economic status patients were more likely to attribute heart disease to heredity and genetic factors. CONCLUSIONS: Causal beliefs about heart disease are strongly associated with risk factors. Effective communication about modifiable risk factors may influence causal beliefs and stimulate lifestyle change, thereby promoting secondary prevention.     

Cultural differences in rated typicality and perceived causes of memory changes in adulthood

This study examined cultural differences in stereotypes and attributions regarding aging and memory. Two subcultures belonging to the same country, Italy, were compared on general beliefs about memory. Sardinians live longer than other areas of Italy, which is a publically shared fact that informs stereotypes about that subculture. An innovative instrument evaluating simultaneously aging stereotypes and attributions about memory and memory change in adulthood was administered to 52 Sardinian participants and 52 Milanese individuals divided into three age groups: young (20–30), young–old (60–70), and old–old (71–85) adults. Both Milanese and Sardinians reported that memory decline across the life span is more typical than a pattern of stability or improvement. However, Sardinians viewed stability and improvement in memory as more typical than did the Milanese. Interestingly, cultural differences emerged in attributions about memory improvement. Although all Sardinian age groups rated nutrition and heredity as relevant causes in determining the memory decline, Sardinians’ rated typicality of life-span memory improvement correlated strongly with causal attributions to a wide number of factors, including nutrition and heredity.     

Cultural differences in rated typicality and perceived causes of memory changes in adulthood

This study examined cultural differences in stereotypes and attributions regarding aging and memory. Two subcultures belonging to the same country, Italy, were compared on general beliefs about memory. Sardinians live longer than other areas of Italy, which is a publically shared fact that informs stereotypes about that subculture. An innovative instrument evaluating simultaneously aging stereotypes and attributions about memory and memory change in adulthood was administered to 52 Sardinian participants and 52 Milanese individuals divided into three age groups: young (20–30), young–old (60–70), and old–old (71–85) adults. Both Milanese and Sardinians reported that memory decline across the life span is more typical than a pattern of stability or improvement. However, Sardinians viewed stability and improvement in memory as more typical than did the Milanese. Interestingly, cultural differences emerged in attributions about memory improvement. Although all Sardinian age groups rated nutrition and heredity as relevant causes in determining the memory decline, Sardinians’ rated typicality of life-span memory improvement correlated strongly with causal attributions to a wide number of factors, including nutrition and heredity.     

HIV and HCV health beliefs in an inner-city community

Summary. Chronic infection with the hepatitis C virus (HCV) is more prevalent than human immunodeficiency virus (HIV) infection, but more public health resources are allocated to HIV than to HCV. Given shared risk factors and epidemiology, we compared accuracy of health beliefs about HIV and HCV in an at‐risk community. Between 2002 and 2003, we surveyed a random patient sample at a primary care clinic in New York. The survey was organized as domains of Common Sense Model of Self‐Regulation: causes (‘sharing needles’), timeline/consequences (‘remains in body for life’, ‘causes cancer’) and controllability (‘I can avoid this illness’, ‘medications may cure this illness’). We compared differences in accuracy of beliefs about HIV and HCV and used multivariable linear regression to identify factors associated with relative accuracy of beliefs. One hundred and twenty‐two subjects completed the survey (response rate 42%). Mean overall health belief accuracy was 12/15 questions (80%) for HIV vs 9/15 (60%) for HCV (P < 0.001). Belief accuracy was significantly different across all domains. Within the causes domain, 60% accurately believed sharing needles a risk factor for HCV compared to 92% for HIV (P < 0.001). Within the timeline/consequences domain, 42% accurately believed HCV results in lifelong infection compared to 89% for HIV (P < 0.001). Within the controllability domain, 25% accurately believed that there is a potential cure for HCV. Multivariable linear regression revealed female gender as significantly associated with greater health belief accuracy for HIV. Thus, study participants had significantly less accurate health beliefs about HCV than about HIV. Targeting inaccuracies might improve public health interventions to foster healthier behaviours and better hepatitis C outcomes.     

Lay explanations of chronic illness in later life

This study explores lay explanations of chronic illness in later life. More specifically, perceived causes, treatment strategies, and perceived outcomes of arthritis and heart/circulatory problems from the perspective of older adults who have such problems are examined. Variations in these explanations according to selected sociodemographic and health status characteristics are explored. Among the arthritis sufferers, the most prevalent explanations were physical work/working conditions, age, and injury, whereas those with heart/circulatory problems most often explained the cause as due to tension/stress, physiology, or heredity. A variety of treatments were identified, including doing nothing, seeking or continuing medical treatment, altering lifestyle, and using folk remedies. Selected sociodemographic and health status characteristics appear important for understanding explanations about arthritis, although it is primarily health status indicators that emerge for heart/circulatory problems. Directions for future research are highlighted.     

Older adults’ lay theories of abilities predict their willingness to engage in preventive health behaviors

ObjectivesThe present studies examined the linkages between older adults’ lay theories regarding the modifiability of abilities and their intentions to perform preventive health behaviors. The ‘entity theory’ refers to the belief that traits are fixed. The ‘incremental theory’ is the belief that traits are malleable. We hypothesized that older adults who held a stronger incremental theory would perceive more benefits to health behaviors, which in turn would lead to higher intentions to perform those behaviors.MethodData from two independent, cross-sectional studies were analyzed via mediation analyses (Study 1: n = 147, Mean age = 68.62, SD = 5.40; Study 2: n = 152, Mean age = 70.56, SD = 4.98). Data were collected via an online survey and/or during an in-lab session at the university. Community-dwelling older adults completed, among other measures, a questionnaire assessing their lay theories of abilities. Participants also reported their perceptions of the benefits of different health behaviors for slowing the effects of aging, and their intentions to engage in those behaviors.ResultsIn both samples, the more older people believed that abilities are changeable (i.e., endorsed the incremental theory), the more they perceived the benefits of preventive health behaviors (Study 1: b = .22, p = .005; Study 2: b = .11, p = .03), which in turn predicted greater intention to perform such behaviors (Study 1: b = .74, p < .001; Study 2: b = .36, p < .001).DiscussionThese results suggest that entity beliefs may discourage older people from adopting health behaviors.     

Using the theoretical domains framework to identify barriers and enablers to pediatric asthma management in primary care settings

Objectives: This study aimed to apply a theory-based approach to identify barriers and enablers to implementing the Alberta Primary Care Asthma Pediatric Pathway (PCAPP) into clinical practice. Phase 1 included an assessment of assumptions underlying the intervention from the perspectives of the developers. Phase 2 determined the perceived barriers and enablers for: 1) primary care physicians' prescribing practices, 2) allied health care professionals' provision of asthma education to parents, and 3) children and parents' adherence to their treatment plans. Methods: Interviews were conducted with 35 individuals who reside in Alberta, Canada. Phase 1 included three developers. Phase 2 included 11 primary care physicians, 10 allied health care professionals, and 11 parents of children with asthma. Phase 2 interviews were based on the 14 domains of the Theoretical Domains Framework (TDF). Transcribed interviews were analyzed using a directed content analysis. Key assumptions by the developers about the intervention, and beliefs by others about the barriers and enablers of the targeted behaviors were identified. Results: Eight TDF domains mapped onto the assumptions of the pathway as described by the intervention developers. Interviews with health care professionals and parents identified nine TDF domains that influenced the targeted behaviors: knowledge, skills, beliefs about capabilities, social/professional role and identity, beliefs about consequences, environmental context and resources, behavioral regulation, social influences, and emotions. Conclusions: Barriers and enablers perceived by health care professionals and parents that influenced asthma management will inform the optimization of the PCAPP prior to its evaluation.     

Podoconiosis, a neglected tropical disease

Podoconiosis or 'endemic non-filarial elephantiasis' is a tropical disease caused by exposure of bare feet to irritant alkaline clay soils. This causes an asymmetrical swelling of the feet and lower limbs due to lymphoedema. Podoconiosis has a curable pre-elephantiasic phase. However, once elephantiasis is established, podoconiosis persists and may cause lifelong disability. The disease is associated with living in low-income countries in the tropics in regions with high altitude and high seasonal rainfall. It is found in areas of tropical Africa, Central and South America and north-west India. In endemic areas, podoconiosis is a considerable public health problem. Social stigmatisation of patients is widespread and economic losses are enormous since it mainly affects the most productive people, sustaining the disease-poverty-disease cycle. Podoconiosis is unique in being an entirely preventable, non-communicable tropical disease with the potential for eradication. Low-cost preventive measures are a simple but effective solution. However, so far it has received little attention from health care policy makers and, until recently, research into the disease has been scarce and the pathogenesis and genetic basis are partly unclear. A better understanding of these aspects may lead to new prevention and treatment opportunities. In the past few years, several projects fighting podoconiosis have been started by non-governmental organisations. In February 2011, the World Health Organisation designated podoconiosis as one of the 20 neglected tropical diseases, marking an important step in the fight against the disease.     

Perceived controllability of expected psychological change across adulthood and old age

This cross-sectional study focuses on adults' beliefs about the controllability of developmental change in adulthood and old age. Young (n = 33; age range 20-36 years), middle-aged (n = 35; age range 40-55 years), and older (n = 32; age range 60-85 years) adults rated an extensive list of psychological attributes in terms of the degree of expected developmental increase across the adult life span (ages 20-90), the perceived controllability of these changes, their desirability, and their expected age-related timing. The findings indicate a substantial degree of similarity in young, middle-aged, and old adults' overall beliefs about controllability. The three adult age groups agreed in perceiving developmental changes in adulthood as fairly controllable, and with regard to their relative controllability (rank ordering of change-sensitive attributes). Changes expected to occur later in life were consensually perceived to be less desirable, and less desirable changes were perceived as less controllable. However, there were clear age-related differences involving both the age timing of expected changes and the age of respondents. A comparison between the three subject age groups revealed twofold differences: First, the relationship between desirability and perceived controllability was found to increase with subjects' age; second, Q-technique factor analysis showed that large subgroups of the young and the middle-aged adults, but not the old adults, tended to perceive psychological attributes associated with late onset decline as relatively lower in controllability.     

Self-efficacy beliefs and perceived declines in functional ability: MacArthur studies of successful aging

Longitudinal data from a cohort of older men and women, aged 70-79, were used to test the hypothesis that stronger self-efficacy beliefs would protect against onset of perceived functional disabilities over a 2.5-year follow-up, independent of underlying physical ability. Standard self-report scales were used to assess perceived functional disabilities, ranging from mild performance difficulties (measured by a 5-item scale based on items by Nagi) to more severe disabilities (measured by the 7-item Katz Activities of Daily Living Scale [ADL]). Performance-based measurements of strength, balance, and gait provide more objective assessments of physical abilities. Self-efficacy beliefs were measured in terms of beliefs relating to managing interpersonal relationships and beliefs relating to managing more instrumental daily activities. Gender-specific multiple regression models revealed that weaker instrumental self-efficacy beliefs predicted declines in reported functional status as measured by the Nagi performance scale among both men and women, independent of standard sociodemographic, health status, and health behaviors. Among men, instrumental efficacy beliefs were also negatively related to reports of onset of Katz ADL. Self-efficacy beliefs were unrelated to measured changes in actual physical performance abilities for both men and women. These findings suggest that self-efficacy beliefs have significant impacts on perceptions of functional disability, independent of actual underlying physical abilities. Through such influences on perceptions of disability, self-efficacy beliefs may importantly affect lifestyles and quality of life at older ages.     

The relationship between health beliefs, adherence, and metabolic control of diabetes.

There is evidence that an individual's health beliefs influence performance of health behaviors. The purpose of this study was to determine whether health beliefs in persons with diabetes could be modified during a clinical education program and whether the health beliefs were related to adherence to self-care instructions and metabolic control of diabetes. Health beliefs and HbA1c were measured at baseline in 189 adult outpatients with diabetes. Diabetes educators then attempted to modify health beliefs that were not conducive to positive health behaviors. Following education, some health beliefs were modified in a positive direction. Modest, but statistically significant increases in perceived severity of diabetes, perceived ability to carry out recommended behaviors, and perceived benefits of treatment were observed. Although HbA1c improved significantly in a subgroup of patients, this improvement could not be directly associated with any health belief or with self-reported adherence by the measures used in this study.     

The role of individual time preferences in health behaviors among hypertensive adults: a pilot study

An economic framework incorporating patients' time-value preferences may help explain individual variation in preventive health behaviors. We conducted a pilot study to examine the relationship between health discount rates and preventive health practices. A group of 422 hypertensive individuals were assessed by written survey regarding their actual or likely preventive health behaviors, and they were posed a series of time preference questions. Regression methods that account for the interval nature of the time preference responses were used to estimate individual respondents' discount rates. Dichotomous regression analyses (using probit models) adjusted for gender, age, race, income, and health status revealed mean health discount rates of 0.438 or (43.8%) per year (standard deviation [SD], 0.07). Analyses adjusted for age, gender, race, income level, insurance status, and health status indicated that a 1% increase in discount rate increased the likelihood respondents would not check their BP by 3.5% (P = .003), not alter diet and exercise habits by 0.6% (P = .004), and not follow doctors' treatment plans by 1.6% (P = .05). Compared to the four lowest quintiles, patients in the highest quintile of discount rates (annualized discount rates between 50% and 57.2%) tended to have lower likelihood of ever checking blood pressure (BP) at home (42.5% vs. 47.6%; P = .36), of not using their physician's office for sick care (16.5% vs. 27.6%; P = .01), and of not altering their diet and exercise habits in response to a diagnosis of hypertension (6.8% vs. 12.4%; P = .07). These preliminary data indicate that the degree to which individuals discount the future has a significant impact on their health behaviors.     

Development and testing of a de novo clinical staging system for podoconiosis (endemic non-filarial elephantiasis)

Objective To develop and test a robust clinical staging system for podoconiosis, a geochemical disease in individuals exposed to red clay soil. Methods We adapted the Dreyer system for staging filarial lymphoedema and tested it in four re‐iterative field tests conducted in an area of high‐podoconiosis prevalence in Southern Ethiopia. The system has five stages according to proximal spread of disease and presence of dermal nodules, ridges and bands. We measured the 1‐week repeatability and the inter‐observer agreement of the final staging system. Results The five‐stage system is readily understood by community workers with little health training. Kappa for 1‐week repeatability was 0.88 (95% CI 0.80–0.96), for agreement between health professionals was 0.71 (95% CI 0.60–0.82), while that between health professionals and community podoconiosis agents without formal health training averaged 0.64 (95% CI 0.52–0.78). Conclusions This simple staging system with good inter‐observer agreement and repeatability can assist in the management and further study of podoconiosis.