Drop-out and attendance in pulmonary rehabilitation: the role of clinical and psychosocial variables. Can we identify patients with different illness schema following an acute exacerbation of COPD: a cluster analysis. The role of goal cognitions, illness perceptions and treatment beliefs in self-reported adherence after kidney transplantation: a cohort study. Cognitive Treatment of Illness Perceptions in Patients With Chronic Low Back Pain: A Randomized Controlled Trial A study to assess the feasibility of undertaking a randomized controlled trial of adherence with eye drops in glaucoma patients A prospective comparison of cardiac rehabilitation enrollment following automatic vs usual referral. The effect of gym training on multiple outcomes in Parkinson's disease: a pilot randomised waiting-list controlled trial. Untangling the relationship between medication adherence and post-myocardial infarction outcomes: medication adherence and clinical outcomes. Management of asthma in pregnancy guided by measurement of fraction of exhaled nitric oxide: a double-blind, randomised controlled trial A prospective examination of body image and smoking cessation in women. Effect of a self-management program on patients with chronic disease. The prediction of self-care behaviors in end-stage renal disease patients using Leventhal's Self-Regulatory Model. The Relationship Between Quality of Life and Adherence to Medication in Glaucoma Patients in Singapore No symptoms, no asthma: the acute episodic disease belief is associated with poor self-management among inner-city adults with persistent asthma. Chronic Disease Self-Management Program: 2-Year Health Status and Health Care Utilization Outcomes Personal models of osteoarthritis and their relation to self-management activities and quality of life Predicting self-care behaviours of patients with type 2 diabetes: the importance of beliefs about behaviour, not just beliefs about illness. A brief office-based intervention to facilitate diabetes dietary self-management. Evaluation of a Web-based Intervention Providing Tailored Advice for Self-management of Minor Respiratory Symptoms: Exploratory Randomized Controlled Trial Psychosocial Variables Are Related to Future Exacerbation Risk and Perinatal Outcomes in Pregnant Women with Asthma Self-monitoring of blood glucose changed non-insulin-treated Type 2 diabetes patients' beliefs about diabetes and self-monitoring in a randomized trial.
BACKGROUND In spite of the well-demonstrated benefits for patients with COPD , pulmonary rehabilitation programmes show considerable drop-out and suboptimal attendance rates . The purpose of this prospect i ve study is to examine causes for drop-out and non-attendance during a 12 week multidisciplinary pulmonary rehabilitation programme , and to investigate whether sociodemographic and medical factors as well as patients ' perception of their illness are related to drop-out and non-attendance . METHODS Two hundred and seventeen patients with COPD who were referred to a rehabilitation centre participated in this multicentre study . Prior to treatment , patients received a question naire , which included the Illness Perception Question naire-Revised . Clinical data were drawn from medical records . Drop-out and attendance were recorded during the programme . RESULTS Fifty patients ( 23 % ) did not complete the rehabilitation course , of which half was due to medical reasons ( e.g. exacerbations , hospitalisations ) . Non-completion could not be predicted by baseline sociodemographic , clinical or psychological variables . Patients who declined treatment did not differ from patients who dropped out due to medical reasons . On average , patients attended 92 % of all scheduled appointments . Of all missed appointments , approximately 20 % were accountable to factors beyond patients ' control ( e.g. absent therapists , hospitalisations ) . Smoking , living alone , a lower fat free mass and lower confidence in treatment increased the chance of patients not attending an appointment during rehabilitation . CONCLUSION In general , adherence in rehabilitation is high . However , paying attention to patients ' nutritional status and creating a positive expectation of treatment during referral and intake appear to be important if one aims to optimise patients ' attendance during rehabilitation INTRODUCTION Pulmonary Rehabilitation ( PR ) reduces hospital admissions following an acute exacerbation of Chronic Obstructive Pulmonary Disease ( COPD ) but adherence is known to be poor . Patients ' illness perceptions may affect adherence to disease-management strategies but to date have not been explored following an exacerbation . The study aim is two-fold ; firstly to prospect ively explore acceptance and uptake of post-exacerbation PR and secondly to identify possible clusters of patients ' illness perceptions following hospitalisation for an exacerbation of COPD . METHODS Patients admitted to hospital with an exacerbation of COPD were recruited to a prospect i ve observational study . Self-reported illness perceptions , mood , health status and self-efficacy were assessed . Acceptance and uptake of PR were recorded at six months . Cluster analysis of Illness Perceptions Question naire-Revised data was used to establish groups of patients holding distinct beliefs . RESULTS 128 patients were recruited .  Acceptance and uptake of PR following an acute exacerbation was poor with only 9 % ( n = 11 ) completing the programme . Cluster analysis revealed three distinct groups : Cluster 1 ' in control ' ( n = 52 ) , Cluster 2 ' disengaged ' ( n = 36 ) and Cluster 3 ' distressed ' ( n = 40 ) . Significant between-cluster differences were observed in mood , health status and self-efficacy ( p < 0.01 ) . Acceptance and uptake of PR did not differ between clusters . CONCLUSIONS Acceptance/uptake of post-exacerbation PR was found to be poor . Three distinct illness schema exist in patients following an acute exacerbation . This information may be useful in developing novel psychologically-informed interventions design ed to reduce feelings of distress and perhaps facilitate a PR intervention for this vulnerable population OBJECTIVE Nonadherence to immunosuppressive medication ( IM ) after kidney transplantation is related to poorer patient and graft outcomes ; therefore research into modifiable factors associated with nonadherence is a priority . In this prospect i ve cohort study we investigated whether changes in goal cognitions , illness perceptions , and treatment beliefs were related to self-reported medication adherence six months after kidney transplantation . METHODS Interviews were conducted with patients in the out-patient clinic six weeks ( T1 : n=113 ) and six months ( T2 : n=106 ) after transplantation .  Self-reported adherence was measured using the Basel Assessment of Adherence to Immunosuppressive Medications Scale ( BAASIS © Interview ) . The  Brief Illness Perceptions Question naire , Beliefs about Medicines Question naire and questions on goal cognitions were also administered at both time points . RESULTS Self-reported nonadherence increased significantly between 6 weeks and 6 months after transplantation from 17 % to 27 % . Importance of medication adherence as a personal goal and self-efficacy to successfully carry out this goal decreased significantly over time . Perceived necessity of immunosuppressive medication was high but significantly decreased over time . Concerns about the medicines were low . There were no significant changes in illness perceptions or concerns over time . An increase in perceived graft longevity ( timeline ) was related to higher likelihood of nonadherence six months post-transplant . Furthermore , younger adult patients were more likely to be nonadherent six months after transplantation . CONCLUSION The self-reported nonadherence levels found in this study so soon after transplantation demonstrate the need for early and continued intervention after kidney transplantation in order to maximise adherence and consequently clinical outcomes . Changes in ( unrealistic ) beliefs regarding the longevity of the graft may offer a potential target for intervention among nonadherent patients Background Illness perceptions have been shown to predict patient activities . Therefore , studies of the effectiveness of a targeted illness-perception intervention on chronic nonspecific low back pain ( CLBP ) are needed . Objective The purpose of this study was to compare the effectiveness of treatment of illness perceptions against a waiting list for patients with CLBP . Design This was a prospect ively registered r and omized controlled trial with an assessor blinded for group allocation . Setting The study was conducted in an outpatient rehabilitation clinic . Participants The participants were 156 patients ( 18–70 years of age ) with CLBP ( > 3 months ) . Intervention Patients were r and omly assigned to either a treatment group or to a waiting list ( control ) group . Trained physical therapists and occupational therapists delivered 10 to 14 one-hour treatment sessions according to the treatment protocol . Measurements The primary outcome measure was change in patient-relevant physical activities ( Patient-Specific Complaints question naire ) . The secondary outcome measures were changes in illness perceptions ( Illness Perceptions Question naire ) and generic physical activity level ( Quebec Back Pain Disability Scale ) . Measurements were taken at baseline ( 0 weeks ) and after treatment ( 18 weeks ) . Results A baseline-adjusted analysis of covariance showed that there were statistically significant differences between intervention and control groups at 18 weeks for the change in patient-relevant physical activities . This was a clinical ly relevant change ( 19.1 mm ) for the intervention group . Statistically significant differences were found for the majority of illness perception scales . There were no significant differences in generic physical activity levels . Limitations Longer-term effectiveness was not studied . Conclusions This first trial evaluating cognitive treatment of illness perceptions concerning CLBP showed statistically significant and clinical ly relevant improvements in patient-relevant physical activities at 18 weeks Background Adherence with therapy could influence the progression of glaucoma and ultimately affect the onset of visual impairment in some individuals . This feasibility study evaluated the measures to be used for a future r and omized controlled trial assessing the effects of group-based education on adherence with eye drops . Methods People diagnosed with glaucoma within the previous 12 months attending a regional ophthalmology clinic in the North West of Engl and were recruited . A two-session education program delivered one week apart had been devised as part of a previous project . A combined adult learning and health needs approach to education was taken . Outcomes measured were knowledge of glaucoma , self-report of adherence , illness perception , beliefs about medicines , patient enablement , and general health ( Short Form-12 ) . Adherence was also measured objective ly using a Medical Events Monitoring System device . Results Twenty-six participants consented to undertake the educational program and 19 produced analyzable data . Knowledge of glaucoma , illness perception , beliefs about medicine , and patient enablement all showed statistically significant improvements after education . Mean adherence with eye drops was maintained above 85 % before and for 3 months after attendance at the educational program . Self-report exaggerated adherence by at least 10 % when compared with the objective Medical Events Monitoring System data , and in fact the kappa agreement was zero . Conclusion All question naires other than the Short Form-12 were considered to be valuable measures and use of a Medical Events Monitoring System device was considered to be an objective surrogate measure for adherence with eye drops . A multicenter , r and omized , controlled equivalence trial of group versus individualized education using adherence as the primary outcome is the next step OBJECTIVE Cardiac rehabilitation remains grossly under-utilized despite its proven benefits . This study prospect ively compared verified cardiac rehabilitation enrollment following automatic vs usual referral , postulating that automatic referral would result in significantly greater enrollment for cardiac rehabilitation . DESIGN Prospect i ve controlled multi-center study . PATIENTS AND METHODS A consecutive sample of 661 patients with acute coronary syndrome treated at 2 acute care centers ( 75 % response rate ) were recruited , one site with automatic referral via a computerized prompt and the other with a usual referral strategy at the physician 's discretion . Cardiac rehabilitation referral was discerned in a mailed survey 9 months later ( n = 506 ; 84 % retention ) , and verified with 24 cardiac rehabilitation sites to which participants were referred . RESULTS A total of 124 ( 52 % ) participants enrolled in cardiac rehabilitation following automatic referral , vs 84 ( 32 % ) following usual referral ( p < 0.001 ) . Automatically referred participants were more likely to be referred from an in- patient unit ( p < 0.01 ) , and to be referred in a shorter time period ( p < 0.001 ) . Logistic regression analyses revealed that , after controlling for sociodemographic characteristics and case-mix , automatically referred participants were significantly more likely to enroll in cardiac rehabilitation ( odds ratio = 2.1 ; 95 % confidence interval 1.4 - 3.3 ) than controls . CONCLUSION Automatic referral result ed in over 50 % verified cardiac rehabilitation enrollment ; 2 times more than usual referral . It also significantly reduced utilization delays to less than one month There is accumulating evidence for the benefits of exercise in Parkinson 's disease ( PD ) , but less is known about group exercise interventions . We evaluated the effect of gym-training programme on people with PD . Thirty-two adults with mild to moderate PD , not currently exercising formally , were r and omised to an immediate 20-week biweekly gym training programme at a local leisure complex , or a 10-week programme starting 10 weeks later . Assessment s at baseline ( T1 ) , 10 weeks ( T2 ) and 20 weeks ( T3 ) included reaction time , motor performance ( UPDRS ) , quality of life and illness perceptions . Experiences of the programme were assessed via question naire and a focus group . Overall UPDRS motor function score did not change over time . However , gym training was associated with significant improvements in reaction times and some timed tests in the immediate training group ( T1-T2 ) . The delayed group showed similar improvements following gym training ( T2-T3 ) . Participants reported enjoyment , obtaining social benefits , and increased confidence . However , the question naire measures did not show improvements in subjective health ratings or illness perceptions . Although benefits were not apparent in the question naire measures or overall UPDRS scores , our findings suggest that a 10-week gym training programme in a community setting can provide some benefits for people with PD BACKGROUND Patients who adhere to medications experience better outcomes than their nonadherent counterparts . However , these observations may be confounded by patient behaviors . The level of adherence necessary for patients to derive benefit and whether adherence to all agents is important for diseases that require multiple drugs remain unclear . This study quantifies the relationship between medication adherence and  post-myocardial infa rct ion (  MI ) adverse coronary events . METHODS This is a secondary analysis of the r and omized MI FREEE trial . Patients who received full prescription coverage  were classified as adherent ( proportion of days covered ≥80 % ) or not based upon achieved adherence in the 6 months after r and omization . First major vascular event or revascularization rates were compared using multivariable Cox models adjusting for comorbidity and health-seeking behavior . RESULTS Compared with patients r and omized to usual care , full coverage patients adherent to statin , β-blocker , or angiotensin-converting enzyme inhibitor/angiotensin receptor blocker were significantly less likely to experience the study 's primary outcome ( hazard ratio [ HR ] range 0.64 - 0.81 ) . In contrast , nonadherent patients derived no benefit ( HR range 0.98 - 1.04 , P ≤ .01 for the difference in HRs between adherent and nonadherent patients ) . Partially adherent patients had no reduction in clinical outcomes for any of the drugs evaluated , although their achieved adherence was higher than that among controls . CONCLUSION Achieving high levels of adherence to each and all guideline -recommended post-MI secondary prevention medication is associated with improved event-free survival . Lower levels of adherence appear less protective BACKGROUND Asthma exacerbations during pregnancy are common and can be associated with substantial maternal and fetal morbidity . Treatment decisions based on sputum eosinophil counts reduce exacerbations in non-pregnant women with asthma , but results with the fraction of exhaled nitric oxide ( F(E)NO ) to guide management are equivocal . We tested the hypothesis that a management algorithm for asthma in pregnancy based on F(E)NO and symptoms would reduce asthma exacerbations . METHODS We undertook a double-blind , parallel-group , controlled trial in two antenatal clinics in Australia . 220 pregnant , non-smoking women with asthma were r and omly assigned , by a computer-generated r and om number list , before 22 weeks ' gestation to treatment adjustment at monthly visits by an algorithm using clinical symptoms ( control group ) or F(E)NO concentrations ( active intervention group ) used to uptitrate ( F(E)NO > 29 ppb ) or downtitrate ( F(E)NO < 16 ppb ) inhaled corticosteroid dose . Participants , caregivers , and outcome assessors were masked to group assignment . Longacting β2 agonist and minimum dose inhaled corticosteroid were used to treat symptoms when F(E)NO was not increased . The primary outcome was total asthma exacerbations ( moderate and severe ) . Analysis was by intention to treat . This study is registered with the Australian and New Zeal and Clinical Trials Registry , number 12607000561482 . FINDINGS 111 women were r and omly assigned to the F(E)NO group ( 100 completed ) and 109 to the control group ( 103 completed ) . The exacerbation rate was lower in the F(E)NO group than in the control group ( 0·288 vs 0·615 exacerbations per pregnancy ; incidence rate ratio 0·496 , 95 % CI 0·325 - 0·755 ; p=0·001 ) . The number needed to treat was 6 . In the F(E)NO group , quality of life was improved ( score on short form 12 mental summary was 56·9 [ 95 % CI 50·2 - 59·3 ] in F(E)NO group vs 54·2 [ 46·1 - 57·6 ] in control group ; p=0·037 ) and neonatal hospitalisations were reduced ( eight [ 8 % ] vs 18 [ 17 % ] ; p=0·046 ) . INTERPRETATION Asthma exacerbations during pregnancy can be significantly reduced with a vali date d F(E)NO-based treatment algorithm . FUNDING National Health and Medical Research Council of Australia This study prospect ively examined body image in a community sample of women smokers ( N = 141 , 89 % European-American , M age = 39.5 , M BMI = 25.5 ) participating in a 12-week r and omized smoking cessation trial . Participants completed measures assessing subjective and perceptual aspects of body image .  Regression analyses showed that subjective body image was predictive of smoking rate at the end of treatment . A MANCOVA revealed that perceptual body image ( body size estimation ) significantly predicted smoking cessation . Quitting smoking actually worsened body image , although these results were no longer significant after controlling for weight gain . Results support the theory that a negative body image may hamper cessation attempts . In addition , weight gain during smoking cessation may adversely impact body image and lead to an increased risk for relapse CONTEXT For patients with chronic disease , there is growing interest in " self-management " programs that emphasize the patients ' central role in managing their illness . A recent r and omized clinical trial demonstrated the potential of self-management to improve health status and reduce health care utilization in patients with chronic diseases . OBJECTIVE To evaluate outcomes of a chronic disease self-management program in a real-world " setting . STUDY DESIGN Before-after cohort study . PATIENTS AND SETTING Of the 613 patients from various Kaiser Permanente hospitals and clinics recruited for the study , 489 had complete baseline and follow-up data . INTERVENTION The Chronic Disease Self-Management Program is a 7-week , small-group intervention attended by people with different chronic conditions . It is taught largely by peer instructors from a highly structured manual . The program is based on self-efficacy theory and emphasizes problem solving , decision making , and confidence building . MAIN OUTCOME MEASURES Health behavior , self-efficacy ( confidence in ability to deal with health problems ) , health status , and health care utilization , assessed at baseline and at 12 months by self-administered question naires . RESULTS At 1 year , participants in the program experienced statistically significant improvements in health behaviors ( exercise , cognitive symptom management , and communication with physicians ) , self-efficacy , and health status ( fatigue , shortness of breath , pain , role function , depression , and health distress ) and had fewer visits to the emergency department ( ED ) ( 0.4 visits in the 6 months prior to baseline , compared with 0.3 in the 6 months prior to follow-up ; P = 0.05 ) . There were slightly fewer outpatient visits to physicians and fewer days in hospital , but the differences were not statistically significant . Results were of about the same magnitude as those observed in a previous r and omized , controlled trial . Program costs were estimated to be about $ 200 per participant . CONCLUSIONS We replicated the results of our previous clinical trial of a chronic disease self-management program in a " real-world " setting . One year after exposure to the program , most patients experienced statistically significant improvements in a variety of health outcomes and had fewer ED visits OBJECTIVE To assess the utility of Leventhal 's Self-Regulatory Model ( SRM ) to predict self-care behavior with regard to dietary , medication , and fluid regimes in end-stage renal disease ( ESRD ) patients . METHODS In a prospect i ve study , ESRD patients treated via hospital-based haemodialysis ( N=73 ) were screened for cognitive deficits and completed question naires that enquired about illness perceptions , coping strategies , knowledge of kidney disease , and psychological distress at Time 1 . Physiological proxy measures of self-care behaviors regarding  diet ( serum potassium levels ) , fluid intake  ( mean and st and ard deviation of interdialytic weight gain )  , and  medication ( serum phosphate levels ) regimes were collected 3 weeks later at Time 2 . RESULTS Illness representations ( emotional and timeline perceptions ) predicted self-care behaviors with regard to diet and medication . Emotion-focused coping strategies predicted higher levels of variation in adherence to fluid restrictions . Younger males were less likely to adhere to the fluid restrictions . CONCLUSIONS The SRM has predictive utility . Psychological interventions should focus on alleviating disease-specific distress and challenging erroneous timeline perceptions in order to increase adherence to dietary and medication regimes in ESRD patients . A more specific measure of coping for ESRD is required to clarify the role of coping strategies in this population . Younger , male patients should be targeted for extra support with fluid restrictions Purpose : ( i ) To evaluate the  medication adherence rate of glaucoma patients in Singapore . ( ii ) To evaluate patients ’ quality of life status . ( iii ) To explore the factors related to patients ’ nonadherence to medication . Patients and Methods : A cross-sectional , prospect i ve study , using interviewer-administered survey question naires . A total of 314 patients were interviewed altogether , of which 175 ( 55.7 % ) were male and 139 ( 44.3 % ) were female . ( i ) Patients ’ medication adherence was assessed using the Reported Adherence to Medication scale . ( ii ) Patients ’ beliefs about glaucoma and treatment were evaluated using the Brief Illness Perception Question naire and the Beliefs about Medicine-Specific Question naire . ( iii ) Patients ’ quality of life was evaluated using  Glaucoma Symptom Scale  and The Glaucoma Quality of Life-15 question naire . Results : Sixty-two ( 19.7 % ) patients reported themselves to be adherent to their medication . Male patients ( P=0.044 ) and smokers ( P=0.002 ) were more likely to be nonadherent to their medication regimen . Nonadherent patients were more likely to have ( i ) more concerns about their glaucoma medications ( P=0.000 ) ; ( ii ) less belief in the effects of their medications ( P=0.026 ) ; ( iii ) a lower quality of life ( higher score of GQOL-15 , P=0.014 ) ; ( iv ) less symptoms from their glaucoma ( lower score of Glaucoma Symptom Scale , P=0.026 ) ; and ( v ) more effect on their lives from glaucoma ( P=0.01 ) . Conclusions : The full-adherence rate is low among glaucoma patients . Having less belief in the need for and more concerns about their medication are the 2 factors associated with nonadherence . In the future , effective strategies should be explored to improve patients ’ beliefs . Nonadherence has an association with decreased quality of life . Strategies to improve adherence will need to deal with these areas OBJECTIVE Asthma morbidity and mortality is highest among inner-city population s. Suboptimal beliefs about the chronicity of asthma may perpetuate poor asthma control among inner-city asthmatics . This study sought to characterize beliefs about the chronicity of disease and its correlates in a cohort of inner-city adults with persistent asthma . DESIGN Prospect i ve , longitudinal , observational cohort study . PATIENTS One hundred ninety-eight adults hospitalized with asthma over a 12-month period at an inner-city teaching hospital . MEASUREMENTS Sociodemographics , clinical history , disease beliefs , and self-management behaviors were collected by interview . Information on self-reported use of inhaled corticosteroids ( ICS ) , peak flowmeters , and regular asthma visits was collected during hospitalization , and 1 month and 6 months after discharge . RESULTS This cohort was predominantly low income and nonwhite , with high rates of prior intubation , oral steroid use , and emergency department visits and hospitalizations . Overall , 53 % of patients believed they only had asthma when they were having symptoms , what we call the no symptoms , no asthma belief . Men patients , those > or = 65 years old , and those with no usual place of care had greater odds of having the no symptoms , no asthma belief , and those receiving oral steroids all or most of the time or with symptoms most days had half the odds of having this belief ( p < 0.05 for all ) . The no symptoms , no asthma belief was negatively associated with beliefs about always having asthma , having lung inflammation , or the importance of using ICS , and was positively associated with expecting to be cured . The acute disease belief was associated with one-third lower odds of adherence to ICS when asymptomatic at all three time periods ( p < 0.02 for all ) . CONCLUSION The single question , " Do you think you have asthma all of the time , or only when you are having symptoms ? " can efficiently identify patients who do not think about or manage their asthma as a chronic disease Objectives .To assess the 1- and 2-year health status , health care utilization and self-efficacy outcomes for the Chronic Disease Self-Management Program ( CDSMP ) . The major hypothesis is that during the 2-year period CDSMP participants will experience improvements or less deterioration than expected in health status and reductions in health care utilization . Design .Longitudinal design as follow-up to a r and omized trial . Setting .Community . Participants .Eight hundred thirty-one participants 40 years and older with heart disease , lung disease , stroke , or arthritis participated in the  CDSMP . At 1- and 2-year intervals respectively 82 % and 76 % of eligible participants completed data . Main Outcome Measures . Health status ( self-rated health , disability , social/role activities limitations , energy/fatigue , and health distress ) , health care utilization ( ER/outpatient visits , times hospitalized , and days in hospital ) , and perceived self-efficacy were measured . Main Results . Compared with baseline for each of the 2 years , ER/outpatient visits and health distress were reduced ( P < 0.05 ) . Self-efficacy improved ( P < 0.05 ) . The rate of increase is that which is expected in 1 year . There were no other significant changes . Conclusions .A low-cost program for promoting health self-management can improve elements of health status while reducing health care costs in population s with diverse chronic diseases We examined the personal models of osteoarthritis ( OA ) of 61 patients over 60 years of age .  Models were elicited using a structured interview . Shared beliefs included perceiving OA as a serious , painful , chronic , and incurable condition that can be managed by recommended medical treatment . Considerable individual differences were found on six personal-model constructs : Symptoms , Seriousness , Cause , Control , Helpfulness of Treatment , and Negative Feelings about Treatment . The constructs of Symptoms and Seriousness were consistently related to a variety of important outcomes . For example , participants with higher scores on Symptoms and Seriousness reported higher levels of self-management ( both concurrently and prospect ively ) , reported more utilization of medical services , and experienced a poorer quality of life . The implication s for the design of health-education material s and for patient-provider interactions are discussed OBJECTIVE There is evidence that perceptions of treatment may be more predictive than illness perceptions , e.g. medication adherence is often better predicted by beliefs about medication than by beliefs about illness . The present study aims to assess the generality of this finding , by comparing the extent to which self-care behaviours of patients with type 2 diabetes are predicted by patients ' beliefs about those behaviours , compared with their illness perceptions . METHODS This study is a one year prospect i ve cohort analysis of 453 patients recruited to a r and omised trial of blood glucose self-monitoring . Behaviour was assessed by the  medication adherence report scale ( MARS ) and diabetes self-care activities ( DSCA ) scales ; illness perceptions by IPQ-R ;  study -specific scales of beliefs about diet and physical activity were constructed by factor analysing items based on beliefs elicited in an earlier interview study involving patients with type 2 diabetes . RESULTS Past behaviour , trial group allocation , and clinical and demographic factors predicted between 16 % and 35 % variance in medication adherence , exercise , and diet scales . Illness perceptions added between 0.9 % and 4.5 % additional variance ; beliefs about behaviour added a further 1.1 % to 6.4 % additional variance . Beliefs regarding , respectively , the importance of exercise in controlling diabetes , the need to east less , and enjoyment from eating sweet or fatty food , added unique variance . CONCLUSION Beliefs about behaviour are at least as important as beliefs about illness in predicting several health-related behaviours . This suggests the possibility that behaviour change interventions with patient groups would be more effective by targeting beliefs about behaviour , rather than beliefs about illness There is a pressing need for brief , practical interventions that address diabetes management . We have developed an office-based intervention to prompt both patients and providers to focus on behavioral issues relevant to dietary self-management that is being evaluated in a r and omized trial . The intervention is design ed to be broadly applicable to the majority of adult diabetes out patients during medical visits ; uses touchscreen computer assessment to provide immediate feedback on key issues to patients and providers just prior to their interaction ; and provides goal setting and problem-solving assistance to patients following their meeting with the physician . Follow-up components include phone calls and videotape or interactive video instruction as needed . The program is described , and demographic and behavioral characteristics of participants are presented for the first 95 patients r and omized . Initial process results suggest success in producing modest , targeted behavior changes among a broad cross-section of patients . If the long-term results are equally positive , this intervention could provide a prototype for a feasible , cost-effective way to integrate patient views and behavioral management into office-based care for diabetes Background There has been relatively little research on the role of web-based support for self-care in the management of minor , acute symptoms , in contrast to the wealth of recent research into Internet interventions to support self-management of long-term conditions . Objective This study was design ed as an evaluation of the usage and effects of the “ Internet Doctor ” website providing tailored advice on self-management of minor respiratory symptoms ( eg , cough , sore throat , fever , runny nose ) , in preparation for a definitive trial of clinical effectiveness . The first aim was to evaluate the effects of using the Internet Doctor webpages on patient enablement and use of health services , to test whether the tailored , theory-based advice provided by the Internet Doctor was superior to providing a static webpage providing the best existing patient information ( the control condition ) . The second aim was to gain an underst and ing of the processes that might mediate any change in intentions to consult the doctor , by comparing changes in relevant beliefs and illness perceptions in the intervention and control groups , and by analyzing usage of the Internet Doctor webpages and predictors of intention change . Methods Participants ( N = 714 ) completed baseline measures of beliefs about their symptoms and self-care online , and were then automatically r and omized to the Internet Doctor or control group . These measures were completed again by 332 participants after 48 hours . Four weeks later , 214 participants completed measures of enablement and health service use . Results The Internet Doctor result ed in higher levels of satisfaction than the control information ( mean 6.58 and 5.86 , respectively ; P = .002 ) and result ed in higher levels of enablement a month later ( median 3 and 2 , respectively ; P = .03 ) . Underst and ing of illness improved in the 48 hours following use of the Internet Doctor webpages , whereas it did not improve in the control group ( mean change from baseline 0.21 and -0.06 , respectively , P = .05 ) . Decline in intentions to consult the doctor between baseline and follow-up was predicted by age ( beta = .10 , P= .003 ) , believing before accessing the website that consultation was necessary for recovery ( beta = .19 , P < .001 ) , poor underst and ing of illness ( beta = .11 , P = .004 ) , emotional reactions to illness ( beta = .15 , P < .001 ) , and use of the Diagnostic section of the Internet Doctor website ( beta = .09 , P = .007 ) . Conclusions Our findings provide initial evidence that tailored web-based advice could help patients  self-manage minor symptoms to a greater extent . These findings constitute a sound foundation and rationale for future research . In particular , our study provides the evidence required to justify carrying out much larger trials in representative population sample s comparing tailored web-based advice with routine care , to obtain a definitive evaluation of the impact on self-management and health service use Objective . To determine the relationship between psychosocial variables , future exacerbation risk during pregnancy , and perinatal outcomes . Methods . A secondary analysis of a r and omized controlled trial of exhaled nitric oxide versus guideline -based treatment adjustment in pregnant women with asthma . Women were recruited between 12 and 20 weeks gestation and monitored for the remainder of the pregnancy . Psychosocial question naires including the Perceived Control of Asthma Question naire , the Brief Illness Perception Question naire , and the Six-Item Short-Form State Trait Anxiety Inventory were assessed at r and omization . Exacerbations were defined as hospitalization , emergency visit , unscheduled doctor visit , or oral corticosteroid use for worsening asthma . Perinatal outcomes included preterm birth , small for gestational age , and cesarean section . Multiple logistic regressions were performed with predictor variables , including demographics and psychosocial and clinical variables . Results . The 175 participants had a mean ( SD ) age = 28.5(5.4 ) years , forced expiratory volume in 1 second ( FEV1 % ) predicted = 95.9(13.4 ) , and asthma control score = 0.88(0.70 ) . Greater perceived control of asthma reduced the odds of subsequent exacerbation ( odds ratio ( OR ) [ 95%CI ] 0.92 [ 0.85 , 0.98 ] , p = .016 ) , cesarean without labor ( 0.84 [ 0.75 , 0.94 ] , p = .003 ) , and preterm birth ( 0.84 [ 0.72 , 0.97 ] , p = .019 ) , while increased anxiety increased the odds of subsequent exacerbation ( 1.05 [ 1.01 , 1.08 ] , p = .008 ) . Conclusion . Women ’s perceptions of asthma control and their psychosocial state ( anxiety ) are related to future exacerbation risk , cesarean section , and preterm birth AIMS To determine whether differences in beliefs about diabetes and its treatment result ed from different intensities of self-monitoring of blood glucose ( SMBG ) in non-insulin treated patients with Type 2 diabetes in the Diabetes Glycaemic Education and Monitoring ( DiGEM ) trial . METHODS Patients ( n = 453 ) were r and omized to usual care , less-intensive SMBG and more intensive SMBG .  Beliefs about diabetes were measured with a st and ard question naire ( the revised Illness Perceptions Question naire ; IPQ-R ) . Changes in beliefs were analysed using analysis of covariance ( ancova ) with adjustment for baseline values . Mediation analyses assessed whether differences in behavioural outcomes between groups could be attributed to differences in beliefs . RESULTS Completed question naires were returned by 339 patients ( 74.8 % ) . Respondents were mean ( + /- sd ) age 65.9 + /- 10 years and with diabetes duration of 4.8 + /- 4.7 years ( median 36 , range 1 - 384 months ) . Concerns about the consequences of diabetes increased in both self-monitoring groups , relative to control subjects [ P = 0.004 ; Cohen 's d st and ardized effect size = 0.19 less intensive and d = 0.36 more intensive monitoring ] . No other beliefs about diabetes differed between groups . Beliefs about the importance of self-testing increased in both self-monitoring groups relative to the usual-care group ( P < 0.001 ; d = 0.57 less intensive and d = 0.63 more intensive monitoring ) . Changes in psychological well-being did not differ between groups , but control patients reported greater increases in general ( P = 0.014 ) and specific ( P < 0.001 ) dietary adherence than did patients in the self-monitoring groups . These outcomes were not mediated by intervention-related changes in beliefs . CONCLUSIONS Despite changes in some beliefs about diabetes differing between groups there were no corresponding changes in self-reported health behaviours . This suggests that changes in illness beliefs result ing from SMBG do not cause changes in diabetes-related health behaviours
OBJECTIVE To determine whether people 's beliefs about their illness , conceptualised by the common sense model ( CSM ) , can prospect ively predict adherence to  self-management behaviours ( including ,  attendance , medication , diet and exercise )  in adults with acute and chronic physical illnesses .