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Psychology and HealthAugust, 2005, 20(Supplement 1): 9–301

Abstracts

In alphabetical order by first author

Validation of short-form scales for measuring depression in health-survey context

*Aalto, A.-M., Kivimaki, M., Pirkola, S.; *Stakes (National Research and Development Centre forWelfare and Health), Helsinki, Finland

Depression is highly relevant and associated with various physical illnesses. Therefore a validmeasure of depression in health-related surveys is well-grounded. However, conventional measuresof depression such as BDI21, are often burdensome for respondents in extensive surveys. Thisstudy examines validity and usability of short-form measures of depression in a survey context.

Methods The data (n¼ 6005) was derived from the Finnish population based ‘‘Health 2000’’ – study,which included questionnaires and health examination. The scales under validation were BDI13,GHQ12 and GHQ12 depression & anxiety subscale (GHQad; Graez, 1991). The criterions forconvergent-discriminant validity were BDI21 and CIDI-diagnosis (depressive or anxiety disorder).Also other psychometric properties as well as sociodemographic, personality and health-relatedcorrelates of depression scales were examined.

Results The Cronbach alpha was highest for GHQ12 (0.90) and lowest for GHQad (0.79).Correlations with BDI21 were: 0.96 (BDI13), 0.69 (GHQ12) and 0.59 (GHQad). Depressivedisorder explained clearly more of variance in all scales than anxiety disorder, though this patternwas less clear among women. Sociodemographic differences (age, gender & education) were foundmainly in BDI scales. Correlations of BDI21, BDI13, GHQ12 and GHQad with cynical hostilitywere 0.31, 0.31, 0.18 and 0.19, with handicapping chronic illness 0.40, 0.34, 0.28 and 0.22, andwith use of mental health services 0.26, 0.26, 0.22 and 0.21 respectively.

Conclusions All scales showed acceptable reliability and convergent – discriminant validity in termsof CIDI classification, but the sociodemographic patterning of GHQ12 scores differed from that ofBDI scales. Particularly the 13-item version of BDI seems to perform equally well as the longerform and can be recommended as an alternative to questionnaire surveys.

Sequencing and prioritising of intentions in planned behaviour

Abraham, C.; University of Sussex, UK

Objectives This paper will demonstrate that social cognition models can be enhanced by lookingbeyond single intentions to the multiple, conflicting, congruent and interdependent intentions fromwhich planned behaviour emerges.

Method and Results Results from a number of surveys will be presented demonstrating thatconsideration of multiple intentions can enhance the predictive utility of the theory of planned

ISSN 0887-0446 print/ISSN 1476-8321 online � 2005 Taylor & Francis Group LtdDOI: 10.1080/14768320500221275

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behaviour and help clarify the nature of intention–behaviour discrepancies. Many health behaviours(e.g., studying or using a condom) involve sequences of actions so that the strength of a behaviouralintention depends on the establishment of intentions to undertake prerequisite actions. For example,in a cross sectional survey of 2120 Scottish 16 year olds, after controlling for TPB predictors,measures of preparatory intentions (e.g., the intention to suggest condom use to a sexual partner)added 10% to the variance explained in the intention to always use condoms. Moreover, the strengthof conflicting intentions may moderate intention-behaviour relationships. For example, in a surveyof 419 students who had intended to use a condom during their last sexual intercourse with a newpartner, the relative importance of having sex versus using a condom during sex discriminated mosteffectively between those who had and had not used a condom on that occasion. Finally, resultsform intervention evaluations focusing on physical activity will be reviewed, demonstrating the efficacyof goal setting as a behavioural intervention technique.

Conclusion Predictive models should assess congruent, competing and prerequisite intentions aswell as behavioural intentions matched to target behaviours.

Simple explanations increase comprehension of terms used in oncology consultations

*Abraham, C., Dudley, J.; *University of Sussex, UK

Objectives To assess and enhance understanding of terms used in oncology consultations reportedto be difficult to understand by patients.

Methods Two street surveys were conducted. In the first survey phrases and terms were presentedas recorded in consultations. In the second short, simple explanatory phrases were added to state-ments used in the consultations. Identical comprehension assessments were employed.

Results In line with previous findings, the first survey (N¼ 101) demonstrated that understandingof terms and phrases used to describe cancer screening, diagnoses, prognoses, and treatment ispoor. For example, less than 40% of participants understood terms such as: ‘‘spots within theliver’’, ‘‘seedlings’’ and ‘‘in remission’’. Even common terms were not understood by all with 30%of respondents failing to understanding that ‘‘metastasise’’ meant spreading of cancer. There wereno significant demographic differences between the first and second survey samples (N¼ 101).Both samples were recruited in the same manner. In survey two simple explanations were added tooncologists original statements. For example, in the case of ‘‘spots within the liver’’, the explanation‘‘This means that you have cancer in your liver’’ was added. These additions improved comprehen-sion so that the same statements referring to ‘‘spots within the liver’’, ‘‘seedlings’’, ‘‘in remission’’ and‘‘metastasise’’ were understood correctly by 93, 83, 73 and 98%, respectively.

Conclusions Simple clarifications which would take only seconds to add to a consultation cansubstantially alter the proportion of lay people who understand statements made in oncologyconsultations.

Changes in HAPA–model constructs predict type 2 diabetesrisk factor reduction in life-style counselling

*Absetz, P., Heinonen, H., Valve, R., Talja, M., Uutela, A, Nissinen, A., Fogelholm, M.; *NationalPublic Health Institute, Finland

Objective To study clinical risk factor changes among participants of a theory- and evidence-basedlife-style counselling program, and the effect of social-cognitive predictors on the change.

Methods Subjects were Finnish men (N¼ 102) and women (N¼ 286, age 50–65) at an increasedrisk for type 2 diabetes recruited from primary care centres to participate in the GOAL life-style

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modification program. The program includes six sessions of group counselling facilitated bytrained nurses, and it takes place at the primary care centres. Program contents are basedon the HAPA-model and the self-regulation theory. Clinical risk factors (weight, BMI, waistcircumference, blood pressure, cholesterol, blood glucose) were measured at baseline and atone-year. Predictors from HAPA model (risk perceptions, outcome expectations, diet and physicalactivity related self-efficacy expectations, goal planning) were measured at baseline and at threemonths.

Results Of the 388 participants starting the program, 360 have completed the one-year clinicaltests. Statistically significant decrease was found in waist circumference ( p< 0.001 both genders),weight and BMI ( p< 0.001 for men, p< 0.05 for women), and diastolic blood pressure ( p< 0.001,only for men). Baseline HAPA constructs did not predict risk factor change, but in regressionmodels changes in self-efficacy for healthy diet and outcome expectations for healthy life-stylepredicted change in waist circumference, and changes in self-efficacy for physical activity and healthydiet predicted weight loss. Goal planning for physical activity and diet measured at three months didnot yield statistical significance in the models.

Conclusions Life-style counselling based on HAPA model had significant effect on risk factorsfor type 2 diabetes. Changes in self-efficacy and outcome expectations during the counselling had astatistically significant effect on the risk factor change.

Evaluating follow-up care for adult survivors of childhood cancer:The influence of different models of care and illness perceptions

*Absolom, K., Eiser, C., Greenfield, D., Ross, R., Glaser, A., Horne, B., Waite, H., Davies, H.;*Psychology Department, University of Sheffield, UK

Objectives The number of survivors of childhood cancer in the UK is increasing by approximately850 people per year. Traditionally survivors receive follow-up with the paediatric teams who treatedthem. This is becoming less feasible due to (1) the rising numbers and (2) the assumption thatadult professionals may be better equipped to deal with the potential health problems survivorsface. In this study we compared adult survivors’ satisfaction with follow-up care at two differentclinics, one paediatric led and the other multidisciplinary in nature and held at an adult hospital.We also investigated how illness perceptions impacted on survivors’ views of the care they werereceiving.

Methods One hundred and ninety-eight survivors between the ages of 16–45 completed a question-naire while waiting at routine follow-up appointments (paediatric clinic n¼ 105, adult clinic n¼ 93).A second questionnaire was posted a week later. Participants completed measures of clinic satisfac-tion, satisfaction with consultations, topics they wanted to discuss with the staff, perceptions of riskto future late effects and the Illness Perception Questionnaire-Revised.

Results Survivors attending the paediatric based clinic reported significantly greater satisfactionthan those attending the adult clinic ( p< 0.05). The number of topics survivors reported discussingduring consultations had the greatest association with consultation satisfaction. Illness perceptionshad a small impact on satisfaction. Survivors who felt the illness had had greater consequenceson their lives were less satisfied with clinic organisation ( p< 0.05) and interaction with clinicstaff ( p< 0.05). A higher perception of personal control over health was associated with increasedsatisfaction with consultation ( p< 0.05).

Conclusions Issues of follow-up care for survivors need to be addressed. Our data suggests thatsatisfaction relates primarily to organisational aspects of clinics. Individual differences in beliefsabout the illness and its consequences appear to have a minimal impact on survivors’ satisfactionwith follow-up.

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Childhood chronic illness: Impact of parent and child coping on the psychologicalhealth and coping processes of children with cancer

*Aguilar-Vafaie, M., Bastani, F., Vali-Mirza, M., Elham; *Department of Psychology, TarbiatModarres University, Iran

The mediating and moderating mechanisms of how family coping, adjustment and resilience affectthe chronic disease coping process was examined with 75 children diagnosed with cancer (leukemia)with uncertain prognosis and undergoing treatment in Governmental Hospitals of Iran. Parentalcoping was assessed with the CHIPS (McCubbin et al., 1986), children’s psychological healthwas assessed with Spielberger’s State-Trait Anxiety Scale, and children’s coping behaviors weremeasured via Moos’ CRI-Y scale. In addition, a short religions coping scale was adapted from pre-vious research for the parents and the children. Data from children and parents were collected inthe hospitals were the children were undergoing treatment. Anxiety levels of children were abovenormal. Consistent with the hypothesized predictions, parental coping was a positive predictor oflower anxiety levels in children and of approach coping, seeking alternative rewards, use of problemsolving strategies, reliance on positive reappraisal. CHIP scores also predicted less use of acceptanceresignation and logical analysis. Results also provided evidence for the mediating role of parentalcoping. Children classified as ‘low’ cognitive and ‘low’ behavioral, obtained significantly higheracceptance resignation and logical analysis scores. Children classified as ‘high’ cognitive and ‘high’behavioral obtained significantly higher scores on seeking alternative rewards and positive reappraisal.Religious coping predicted higher CHIP scores in parents and approach coping in children, and higheruse of positive reappraisal, seeking alternative rewards, and lower use of acceptance resignationand seeking guidance and support. Moreover, as predicted, appraisals of event controllability bythe children moderated both the degree to which parental support influenced coping and the effective-ness of the children’s coping responses. With perception of controllability, CHIP scores predictedanxiety in children, but not coping style. Results are discussed in light of theoretical frameworksthat emphasize the role of supportive family particularly in the case of children with chronic illness.

Carrying on or giving in: The role of (implicit) cognition in self-control

*Alberts, H., Martijn, C., de Vries, N.; *University of Maastricht, The Netherlands

Objective Our aim is to study the role of (implicit) cognitions in self-control performance.This approach is in contrast with recent theories about self-control in which self-control is viewedas ‘‘energy’’ (Baumeister et al., 1998). According to energy theories of self-control, failure ofself-control is caused by loss of energy (ego-depletion). Our main question is whether the energymodel of ego-depletion satisfies as an adequate description of the underlying process. In our view,self-control is strongly influenced by perceptual, cognitive and motivational factors.

Methods Four studies examined the hypothesis that success and failure of self-control can bemanipulated by changing people’s (implicit) cognitions about control. Study 1 used an emotion-suppression paradigm In Study 2–4 we used a priming procedure to enhance people’s performanceon subsequent self-control tasks. The accessibility of ‘‘perseverance’’ was established by presentingpeople with a seemingly unrelated text about a persevering role model (Study 2), a scrambled sentencetask (Study 3), and a screensaver that triggered perseverance and pseudo-accidentally appearedon participants’ computer (Study 4).

Results Study 1 showed that challenging people’s expectancies about self-control increased theirperformance quite dramatically. A group that received no such expectancy-challenge performedmuch worse and, thus, showed a ‘‘classic’’ pattern of ego-depletion. All our studies, using differentmeasures of self-control, unequivocally show that people in a state of ego-depletion are able to controlthemselves again if the concept of perseverance is accessible.

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Conclusions Self-control does not depend on energy (alone) but also on an adequate ‘‘state of mind’’.By default, people assume and act upon the implicit theory that successive acts of self-controlwears you out. If this theory is challenged, or if an alternative theory is triggered, people are able tokeep their performances on the same level.

Women’s and providers’ voices on cervical cancer prevention: Conflicting or complementary?

*Alexandrova, A., Todorova, I., Bradley, J.; *Health Psychology Research Center, Sofia, Bulgaria

Objectives The current analysis aims to compare Bulgarian women’s and medical providers’ posi-tions regarding different aspects of cervical cancer prevention. The results are part of the studyPsychosocial and Health Systems Dimensions of Cervical Cancer Screening in Bulgaria andRomania, which aims to investigate the role of psychosocial, economic and structural factors in shap-ing preventive and health care seeking behaviours of Bulgarian and Romanian women in regards tocervical cancer.

Methods We conducted semi-structured interviews with 35 Bulgaria women with the purpose ofunderstanding their attitudes and perceptions of cervical cancer and cervical cancer screening.Fifty medical providers were interviewed through semi-structured questionnaires and 6 focusgroups discussions were conducted. The interviews were analyzed through thematic analysis usingAtlas.ti software.

Results The parallel, but more often contradictory positions of women and medical providers regard-ing cervical cancer prevention will be presented. The focus will be on particular themes as seen fromthe perspectives of women and providers: availability of information about screening, responsibility forscreening, initiative for screening, access and pathways to screening, barriers to screening, women’sattitudes towards screening, the role of the healthcare system, woman-provider relationship, andthe impact of the transition.

Conclusions The findings indicate the need for mediating dialogues between women and providersfor achieving mutual understanding, which will lead to increased effectiveness of cervical cancerscreening programs. Specific implications of the study will be in the development of educationinitiatives for women and discussions with providers, facilitating the development of effectiveprograms for cervical cancer prevention.

Coping strategies relate to poor health, substance abuse andmental health problems in a college population

*Anagnostopoulou, T., Velikis, Y., Mastorakou, A.; *Hellenic Institute of Psychology and Health,Greece

The aim of this study is to identify (1) the coping strategies relating to poor health, substance abuseand mental health problems in a college population, (2) the dispositional correlates of these copingstrategies. The sample consisted of 352 Greek college students, age 17–30, 30% male, 70% female.Instruments used included:

(1) self-reports of health problems, substance abuse, depression, anxiety and suicidal ideation,(2) standardized questionnaires to measure coping strategies (COPE), alexithymia (TAS-20), sense

of coherence (SOC-13) and the cynical distrust scale.

Results indicate that students reporting neurotic coping strategies (denial, mental and behavioraldisengagement and substance use) had higher scores of poor health (t¼ 4.234, p< 0.000), depression(t¼ 4.012, p< 0.000), anxiety (t¼ 3.970, p< 0.000) and suicidal ideation (t¼ 4.213, p< 0.000).Additionally, students reporting use of the coping strategy ‘‘turn to religion’’ had lower rates of

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substance use (t¼�2.190, p< 0.05) and suicidal ideation (t¼�2.483, p< 0.05). Neurotic coping alsocorrelated positively with the first factor of alexithymia, difficulty to identify feelings (r¼ 0.476,p< 0.000) and negatively with all three factors of the sense of coherence (r¼�0.671, p< 0.000).It also presented moderate correlations with the other two factors of alexithymia, difficulty to describefeelings (r¼ 0.241, p< 0.000), external orientation (r¼ 0.206, p< 0.000) and cynical distrust(r¼ 0.232, p< 0.000). Results suggest that neurotic coping is used more frequently by studentswho present with somatic and mental health problems and relates to dispositional characteristicssuch as alexithymia, sense of coherence and cynical distrust.

Stress management effects on mood and immunity in HIV1 men:The role of social support

Antoni, M.; Department of Psychology, University of Miami, Coral Gables, FL, USA

Objectives To summarize the effects of a 10-week group-based cognitive behavioral stressmanagement (CBSM) intervention on mood, immune status and disease progression in HIV-infectedmen and the role of perceived social support as a mediator of its effects.

Methods We developed a 10-week CBSM intervention that was hypothesized to improve psycho-social adjustment and immune status by improving stress management skills, building socialsupport, and decreasing the output of adrenal hormones associated with stress and immune systemdecrements.

Results HIVþ men assigned to CBSM revealed reductions in mood disturbance, increased perceivedsocial support and increased adaptive coping strategies such a acceptance and positive reframing.Path analysis revealed that CBSM intervention-associated increases in perceived social support andcoping co-mediated the mood improvements during CBSM. These mood improvements mediatedreductions in 24-hour urinary cortisol and norepinephrine (NE). CBSM-related changes in thesehormones explained, in part, the effects of this intervention on short-term changes in anti-viralimmunity (IgG antibody titers to herpesviruses with reductions in cortisol), and longer-term changesin lymphocyte subpopulations such as CD8 suppressor/cytotoxic cells (with reductions in NE output)and transitional naıve CD4þ cells (with reductions in cortisol output). HIVþ men receiving CBSMshow less disease progression (HIV viral load) over longer periods and these effects are mediated,in part, by improvements in depressed mood.

Conclusions Group-based stress management intervention can improve psychological adjustmentand immunity in HIV-infected persons by modifying social support perceptions and cognitivecoping skills through the use of cognitive behavioral techniques in a supportive group environment.This provides empirical support for a PNI model to explain the health effects of stress managementin persons with HIV.

Stress management intervention for women undergoing treatment for breast cancer:Effects on psychosocial adjustment and physiological regulation

Antoni, M.; Department of Psychology, University of Miami, USA

Aims To test the effects of a 10-week Cognitive Behavioral Stress Management (CBSM) inter-vention on psychosocial adjustment and physiological regulation in different cohorts of women diagnosedwith early-stage breast cancer who were undergoing treatment.

Methods This intervention provides training in relaxation techniques, coping skills, and interpersonalskills, in a supportive group. Approximately 4–8 weeks after surgery just before beginning adjuvanttherapy for Stage I–III breast cancer, women were randomized to 10-week CBSM group or a 1-day

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educational seminar as a control condition. We administered questionnaires and collected bloodsamples before and after CBSM intervention and at 3-mo and 9-mo post-intervention follow-ups.

Results Women assigned to CBSM revealed improvements in psychosocial adjustment (e.g., decreasesin depression, anxiety, interpersonal functioning) and maintained these changes at follow-up.The intervention also increased participants’ reports of optimism, emotional processing and benefitfinding. We also observed improvements in fatigue and physical quality of life after CBSM.Women assigned to CBSM also revealed improvements in physiological regulation reflected in reduc-tions in evening serum cortisol levels and increases in cellular immunity. Increases in perceivedrelaxation skills and emotional processing during the intervention were associated with greaterincreases in psychosocial adjustment. Greater improvements in psychosocial adjustment predictedthe magnitude of reductions in serum cortisol levels during the 10-week intervention and increasesin immune functioning over the follow-up period.

Conclusions Improving stress management skills and increasing emotional processing during agroup-based CBSM intervention may improve psychosocial adjustment and physiological regulationin women undergoing treatment for breast cancer. The next challenge is to evaluate the impact ofthis intervention on longer-term quality of life and physical health outcomes in clinical cancer caresettings.

Bullying at work and organizational climate: A study in Portuguese workers

*Araujo, S., McIntyre, T., McIntyre, S.; *Escola Superior de Estudos Industriais e de Gestao,Portugal

Aims The phenomenon of bullying at work has become a growing concern for academicians andprofessionals who work in the domain of Occupational Health Psychology. Many studies haveaddressed the causes and consequences of bullying at work in Europe, especially in NorthernEurope, but this research in Southern European countries, such as Portugal, is virtually nonexistent.The main goal for this study is an assessment of the magnitude of bullying at work in Portugueseworkers in the services and textile industry sectors. The study also aims at investigating the relation-ship between bullying and organizational climate (e.g., degree of autonomy and participation).

Method Correlational design:

Sample: Random sample of 500 workers of both sexes in services and textile industry sectors.Instruments: Portuguese version of the Negative Acts Questionnaire-Revised (Einarsen &Raknes, 1997), the Organizational Climate Questionnaire (McIntyre & McIntyre, 2000), anda Demographic form.

Results Preliminary results have indicated a high prevalence of reported bullying among thisPortuguese sample, in comparison to other European countries. Other analyses are still beingconducted to determine which dimensions of bullying are more evident for these workers and therelationship of bullying with organizational climate dimensions. The implications of these data forwork safety and health policy in Portugal will be discussed.

Impact of parents’ self-regulatory cognitions and physical activity on theirchildren’s cognitions and practice of physical activity

*Araujo-Soares, V., McIntyre, T., Sniehotta, F.; *Instituto de Educacao e Psicologoa, Departamentode Psicologia, Universidade do Minho, Portugal

Background Bandura proved that a significant part of what we learn is due to modelling; behaviour,cognitive and contextual factors interact in such a strong way that one is an indissoluble determinant

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of the other. Despite the growing importance of peers during adolescence, parents continue to actas important models for health and risk behaviours.

Aims To investigate the relationship between parents’ self-regulatory variables (TPB andHAPA models), action planning, coping planning and physical activity levels, and their children’scorresponding self-regulatory processes and behaviours.

Sample 135 adolescents of both sexes attending 6–7th grades, ages 10–15 (M¼ 12.09; SD¼ 0.88)and 135 parents (M¼ 41; SD¼ 7).

Method Cross-sectional design. Instruments used for parents and children: Health habits andhealth risk behaviours questionnaire and a Health Behaviour Assessment for Physical Activity thatincludes, theory of planned behaviour measures (attitude toward behaviour; behavioural beliefs;outcome evaluation; subjective norms; normative beliefs; motivation to comply; perceived behaviouralcontrol; control beliefs), health action process approach measures (outcome expectancy; self-efficacy;behavioural intention) and a measure of planning.

Results Significant correlations were found between parents and children in planning (r¼ 0.27;p¼ 0.005) which indicate that in establishing concrete plans for initiating physical activity as wellas planning ways to deal with possible barriers, the parent’s social cognitions may be modellingtheir children’s. Ongoing regression analyses will determine the predictive value of parents selfregulatory cognitions on their children’s cognitions and levels of physical activity.

Can the guided disclosure protocol increase sense of coherence?

*Arden-Close, E., Gidron, Y., Duncan, E.; *University of Southhampton, UK

A strong sense of coherence (SOC) has been associated with many health benefits. Recently,Gidron et al. (2002) developed and tested the Guided Disclosure Protocol (GDP) for writingabout trauma. The GDP aims to shift trauma processing from an implicit, limbic and somatic/emotional manner to an explicit, frontal-lobe and verbal, more cognitive manner. Since the elementsof the GDP appear to be directly related to the concept of SOC, this study aimed to see whether theGDP increased SOC in individuals with low SOC (a score of 10 or below on SOC-3). After screeningfor SOC using a 3-item scale, participants (n¼ 32) were randomly assigned to either guided disclosure(n¼ 16) or control writing (n¼ 16) for 45 minutes. The GDP group wrote about an unpleasant eventchronologically, without reference to emotions in part 1; described their thoughts and feelings at thetime of the event, and whether it had affected their life in part 2; and wrote about how they currentlythink and feel about the event, and what they would do in future if they experienced a similar event,in part 3. The control group wrote about neutral topics, in an unemotional manner. Participantscompleted Antonovsky’s 13-item SOC scale both immediately prior to writing, and after 1 month.Although there was no time-by-group interaction as expected, within the GDP group SOC increasedsignificantly in those who wrote about a controllable event relative to those who wrote aboutan uncontrollable event. This is interpreted using the goodness of fit hypothesis of coping withstress. Future research needs to focus on understanding the mechanisms by which guided writtendisclosure produces its positive effects, and whom it benefits.

Construction and validation of a new mobbing self perception scale

*Argentero, P., Bonfiglio, N., Zanaletti, W., Giorgi, G., Majer, V.; *Italy

Objectives Different questionnaires have been used to assess mobbing focusing on internalperceptions of mobbed subjects (self perceptions), but their analysis shows some specificlimitations that suggest the opportunity to develop a new measurement instrument (Argentero,

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Zanaletti, & Bonfiglio, 2004). In this study we examine the psychometric properties of a new italianquestionnaire, the Q.A.M. 1.5 (Mobbing Self Perception Questionnaire) and we highlight differentresults from various social and professional category of employees.

Methods The questionnaire was administered to 240 subjects in different work fields in order toanalyze the Q.A.M. 1.5 psychometric features, in particular its factorial structure, its reliability andvalidity requirements. The 81 items of the Q.A.M. 1.5 concern the following eight areas: relationalarea (7 items), professional area (14 items), aggression area (12 items), extraworking consequences(5 items), cognitive area (10 items), psychoemotional area (16 items), psychophysical area (8 items)and mood area (9 items).

Results Principal component analysis identified 17 dimensions, whose reliability values rangefrom 0.54 to 0.85. Multiple regression and anova analysis showed how the education variable affectsthe perception of relational, communicative and professional anomalous condictions.

Conclusions This study illustrates the positive metric features of Q.A.M. 1.5 and indicates howemployees with higher school degree report more difficulties in some working situations, whilethose with lower school degree have a better adaptation. Also other results about influence ofsex and age variables confirm what has already been described in literature and so they are to beconsidered as further elements of instrument validity.

Safety training, occupational risk perception and injuries prevention

*Argentero, P., Zanaletti, W., Dell’Olivo, B., Majer, V., Giorgi, G.; *Italy

Objectives The aim of this study is to examine the role of training in relation to occupational riskperception and injuries prevention, investigating the importance of cognitive and behavioral variablesin determining occupational injuries.

Methods 350 workers, from 6 different departments of a printing industry, filled in a questionnaireto measure risk perceptions referred to the following areas: hazardness of risk factors in the workingenvironment, frequency of injuries, personal exposure, risk factor control, training received; we alsocollected social and demographic data and injuries occurred. The questionnaire items were basedon a 7 point Likert scale. We analyzed data by descriptive, anova, correlational and factorial analyis.

Results Data analysis shows significantly different risk perceptions among departments, due toparticular productive processes and working tasks. Hazardness perception is positively correlatedwith the perception of injuries frequency and risk exposure. Control risk perception is correlatedwith the level of training received. The number of injuries occured positively influences the perceptionof risk exposure and determines negative evaluations about the training received. These resultsagree with other studies that demonstrated the role of traumatic events in modifing riskevaluation (Weinstein, 1989; Mearns e Flin, 1995; Rundmo, 1996; Cree e Kelloway, 1997; Bonnieet al., 2001).

Conclusions The results obtained confirm the findings of previous research, and also highlightthe importance of training interventions and social support inside work team, in order to adoptsafety procedures and to prevent injuries risks (Leiter, 1997; Duffy, 2003; Becker e Morawetz, 2004).

Individuals’ experience of chronic fatigue syndrome:An interpretative phenomenological analysis

Arroll, M.; Department of Psychology, University of Surrey, Guildford, Surrey, UK

Objectives To explore individuals’ experience of Chronic Fatigue Syndrome (CFS).

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Methods Semi-structured telephone interviews were conducted with 10 individuals diagnosedwith CFS. Interpretative Phenomenological Analysis (IPA; Smith, 1996) was used to uncovercommon themes in the verbatim transcripts.

Results Four superordinate themes emerged from the raw data: symptomology and illness course,impact on life, interaction with the medical profession and coping. Severe fatigue was definedas the predominate, but by no means sole, symptom. All symptoms were reported to follow a fluctu-ating course although there were no clear insights to why this should occur. CFS was reported to havea sever impact on the participants lives, leaving all unable to maintain full-time work or study.Although most of the participants’ social networks diminished following their illness, the ‘quality’of their relationships appeared to be unaffected. The majority of the interviewees cited negativeinteractions with medical professionals and a common theory to why this may occur was concernedwith the individual differences of the patients themselves. A transition from a negative pre-morbidcoping style (denial of illness) to a type of ‘pacing’ was reported in the interviews.

Conclusions Areas highlighted for further research include the examination of the fluctuatingnature of CFS, which has been overlooked in previous cross-sectional research, and studies todetermine whether medical professionals respond differently to patients with differing characteristicsand, in turn, if this interaction affects morbidity.

Expressive writing and psychological health: An examination of the role of alexithymia

*Ashley, L., O’Conner, D., Jones, F.; *University of Leeds, UK

Objectives A number of studies have found expressive writing to produce salutary health effects.However, the literature is equivocal, suggesting that individual differences variables may moderatethe effects of emotional writing.

Methods Ninety-seven healthy male and female undergraduates were randomly assigned to writeabout either their most stressful and traumatic experiences or trivial topics, for 15 minutes on eachof three consecutive days. Alexithymia was assessed at baseline. Psychological health was assessedvia the General Health Questionnaire-28 both at baseline and two weeks after the intervention.The writing of the emotional group was also analysed using the Linguistic Inquiry and WordCount program.

Results Preliminary analyses revealed no main effect of writing condition or alexithymia on psycho-logical health. However, a significant writing condition� alexithymia interaction was found( p< 0.05). Within the disclosure group, high alexithymics had poorer psychological well-being thanlow alexithymics two weeks post writing. The findings of the linguistic analyses of the expressiveessays will also be presented.

Conclusion These preliminary findings suggest that alexithymia moderates the effects of expressivewriting on psychological health. They also indicate that alexithymics may not benefit from the writingintervention. The implications of the results will be discussed within the context of the existingresearch on individual differences and the emotional writing paradigm more broadly.

Understanding barriers to cervical cancer screening among Romanian women

*Baban, A., Balazs, R., Szentagotai, A.; *Babes-Bolyai University, Romania

Objectives Romania is currently the country with the highest mortality from cervical cancerin Europe, with rates 6.3 times higher than the average of European Union countries. The aim ofthis study is to determine women’s beliefs, knowledge and attitudes about cervical cancer screening,and to identify the interconnectedness between screening behaviour, health care system andpsychosocial factors.

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Method We constructed a nationally representative sample of women aged 20–65 (N¼ 1053).The selection of the variables included in the questionnaire was guided partly by Health BeliefModel and the Theory of Reasoned Action.

Results Our data document that Romanian women have a very low rate of participation in cervicalscreening programs: only 20.2% of our sample reported they had ever had a screening for cervicalcancer. The level of women’s knowledge about Pap smear was virtually limited. Around half ofthe participants are not aware of the purpose of this test (48%), and 26% of the women believe thetest should be requested only when symptoms appear. A t-test comparison of the mean scores ofthose who have had screening and those who have never had the test shows that the two subgroupsof women are different from the perspective of knowledge, the perception of Pap smear benefitsand costs, normative beliefs, and beliefs of self-efficacy and control over attending a cervical screeningtest in the following 3 months (all p¼ 0.000). We conducted logistic regression analysis to identifythe best predictors of intention for screening behavior.

Conclusion The findings will inform educational campaigns aim to increase the adherence to cervicalscreening programs and to encourage women to take a longer perspective on their health.

The efficacy of the theory of planned behaviour in predicting dietary behaviourfor different foods in different groups

*Baker, A., Bakhshi, S., Surujlal-Harry, A., Rees, G.; *London Metropolitan University, UK

Objectives The theory of planned behaviour (TPB) has been widely used in the study of healthbehaviours. However there is a lack of research investigating possible differences in various dietarybehaviours and also in different ethnic groups. This study investigates the efficacy of the Theoryof Planned Behaviour in explaining intake of wholemeal bread, wholegrain cereal, fruit and vegetablesin a sample of ethnic minority girls.

Method A sample of 654 girls (14–15 years) of mixed ethnicity took part in a survey (24% white,32% asian, 28% black and 33% other). A questionnaire using constructs from the TPB was designedto investigate dietary predictors. This study was conducted as part of a larger project commissionedby the Food Standards Agency.

Results Stepwise linear regressions were carried out for all the different dieting behaviours usingthe TPB. In addition separate analyses by ethnicity were also conducted. The Theory of PlannedBehaviour successfully explained 28–40% of the variance in fruit, vegetable and cereal intake, withintention being the largest predictor. However it explained only 4% of the variance in bread intake.It was found that different beliefs were significant for different foods. The analysis betweenethnic groups showed contrasting results in variance with 1–15% for bread, 29–51% for cereal,19–33% for fruit and 32–63% for vegetables. This indicates that the model and its constructs maybe more appropriate for different ethnic groups and or foods than others.

Conclusions The results suggest that some aspects of TPB such as the role of important othersand the influence of perceived behavioural control differ between ethnic groups. Therefore the applic-ability of the model may be dependent on the behaviour rather than the success of its constructs.In addition it may be that ethnic or cultural influences may moderate these psychological constructs.More analysis is currently being carried out to review the ethnic differences.

Gender differences in weight loss behaviour and beliefs in ethnic minority adolescents

*Bakhshi, S., Baker, A., Surujlal-Harry, A., Rees, G.; *London Metropolitan University, UK

Objectives Past research on westernised groups indicates dieting for weight loss to be 5–15% forboys and 20–25% for girls. Frequency of weight loss activities, and the methods and reasons forthese were examined in ethnic minority adolescents to check for possible gender differences.

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Method The sample consisted of 414 girls and 200 boys aged 14–15 years, from 3 ethnic groups(Asian, 56%; Black, 34%; and Mixed, 10%). A Healthy Eating questionnaire was distributedand the results were derived from this data. This study was conducted as part of a larger projectcommissioned by the Food Standards Agency.

Results As expected, significantly more girls than boys were trying to lose weight. Results showed that25% of the boys and 41% of the girls were trying to lose weight. More boys were found to use exercise(44%) whilst restrictive dieting was more commonly used in girls ( p< 0.001) (73%). Girls were foundto be more concerned about physical attributes such as having good skin (F(1, 630)¼ 24.010;p< 0.01), looking good (F(1, 629)¼ 5.972; p< 0.05), and being thin (F(1, 629)¼ 6.325; p< 0.05)on weight loss. Boys were found to be happier with their bodies compared to girls(F(1, 621)¼ 14.201; p< 0.01) and were more likely to do what their friends did than girls. Resultsindicate a positive interaction between body image and gender on weight loss behaviour. This suggeststhat girls who have concerns about their body image are much more likely to actively diet thanboys, but boys may succumb to peer pressure to lose weight by increased exercise.

Conclusions The findings are consistent with past research although the heightened frequencyof weight loss activities in both genders and ethnic groups is of concern. More work is needed toinvestigate whether these rates are a result of the potential conflict between ethnicity and thewesternised culture, or the culture itself.

Development and prediction of health-related behaviour in childhood and adolescence

*Ball, J., Vierhaus, M., Lohaus, A.; *University of Marburg, Germany

This paper focuses on the development of health-related behaviour in middle childhood andadolescence. Additionally, possible predictor variables associated with health-related behaviour areanalyzed. In health psychology, it is without controversy that the development of health-relatedbehaviour is initiated quiet early in childhood. Furthermore, health-related behaviour in earlystages of development is a precursor of later protective and risky behaviour in adolescence and adult-hood. Finding early psychological variables that are important for the prediction of later health-relatedbehaviour would be of significance for health-prevention. This study describes the development ofpositive and negative health-related behaviour and investigates the importance of psychologicalvariables (stress symptomatology, self-efficacy and coping behaviour) that may influence their devel-opmental trajectories. In a longitudinal study, about 800 German children and adolescents fromsecond- to seventh grade were interviewed about their health behaviour and possible predictorvariables. The results show a mediate to high stability in terms of positive and negative health-relatedbehaviour. The predictor variables show the significance of symptomatology, self-efficacy and copingfor later health-related behaviour, but differential relations for the gender groups. The significance ofthe results for health-promotion during early developmental stages is discussed.

Overstretched? The effect of multiple roles on informal carerssupporting younger stroke survivors

*Banks, P., McVey, C.; *University of Aberdeen, Scotland

Background In the UK stroke is the single biggest cause of severe disability. Because the incidenceof stroke increases with age, services often target older individuals and their families whoprovide the bulk of informal care. However, the incidence of stroke amongst younger individualshas been attracting increasing interest. Although informal carers can play an important role inpromoting successful rehabilitation in stroke survivors, few studies have looked at the experiencesof younger carers.

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Method The study adopted a longitudinal approach collecting data over a period of nine monthsfrom 18 spouse-carers, five males and 13 females, supporting younger stroke survivors (YSS) aged38–49. Participants took part in one-to-one semi-structured interviews and completed six sub-scalesfrom the SF36 3–6 months after discharge from hospital and again nine months later. Betweeninterviews participants were invited to keep diaries. Interviews and diaries were transcribed andanalysed by thematic analysis based on IPA.

Results Scores on the SF36 subscales role physical, general health, vitality, social function, and roleemotional, were not found to be associated with level of support needs of YSS, gender, age, or depri-vation of home area. Females were found to have lower scores than males on the mental healthsub-score, and carers who lived in households including children had lower scores on all six sub-scales,indicating that carers who had additional responsibilities of childcare experienced poorer physical andmental health than carers who did not have children.

Conclusions Burnout theory offers some understanding of the process of caring. Professionals shouldidentify informal carers who are experiencing difficulty due to the multiple tasks they face, and targetsupport towards families in which the adoption of a caring role and the transition to disability mayaffect parenting.

An intervention for changing high-risk HIV behaviors of inner-city women:The role of personal resources

Banou, E.; Kent State University, USA

Objective The purpose of this study was to test the effectiveness of an AIDS prevention program,General AIDS Health (GAC) for inner-city women.

Methods Participants were recruited from inner-city clinics, serving primarily inner-city in a mediumsized, Midewestern city in USA. Women were randomly assigned to experimental (GAC) or acontrol group (Standard Control; SC). Women in the experimental group attended six group sessionsdesigned to promote to reduce AIDS high-risk behaviors by making healthy choices about their bodiesand increasing personal resources such as self-esteem and mastery. Women in the control groupattended 2 individual sessions with a study researcher aiming in giving women basic AIDSinformation. A total of 254 women completed all phases of the study, including longitudinal posttestsat 6 months after enrollment. The mediational role of personal resources for the two groups wasexamined.

Results We hypothesized, that women in the experimental group would have higher levels ofself-esteem and mastery and this in turn would lead to lower levels of AIDS high-risk behaviors.Path analysis indicated compared to the control group, there was more increase of personal resourcesfor the experimental group and that these resources in turn led to less reported AIDS high-riskbehaviors.

Conclusions The findings of this study supported the effectiveness of the AIDS prevention andthe mediational role of personal resources in changing safer-sex behaviors. Implications of the findingsfor AIDS prevention programs as well as the limitations of this study are discussed.

Are perceptions of ageing related to indices of health status in older people?

*Barker, M., O’Hanlon, A., McGee, H., Hickey, A.; *Royal College of Surgeons, Dublin, Ireland

Objectives Perceptions of ageing can predict morbidity and mortality. However little is knownabout the complex and multi-dimensional nature of these perceptions, or their relationship

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to health. This study investigated the relationship between perceptions of ageing and a range of healthindices.

Method Perceptions of ageing were assessed using a new, theoretically-derived measure, the AgeingPerceptions Questionnaire (APQ). The APQ is multi-dimensional with nine subscales each ofwhich assesses a specific perception of ageing. Indices of health status were current self-assessedhealth, health compared to 1 year ago, future health (1-year from now), comparative health (healthcompared to peers) and functional capacity (the Health Assessment Questionnaire DisabilityIndex (HAQ-DI). Participants were randomly-selected community-dwelling older Irish adults(n¼ 2, 053; age 65–98; 43% men).

Results The nine APQ subscales were found to have good psychometric properties. Perceptionsof ageing were related to health status indices with the exception of future health. On each of thenine APQ subscales, perceptions of ageing were differentially related to self-assessments of healthand functional impairment. Perceptions of ageing accounted for a significant proportion of variancein self-assessed health even after controlling for demographic variables and functional ability.The most significant APQ predictors of self-assessed health were control positive, consequencesnegative and emotional representations.

Conclusions Results highlight the dynamic interrelationship between perceptions of ageing andperceptions of health. Perceptions of ageing were associated with variations in self-assessed health.This highlights the potential role of ageing perceptions in health-related outcomes. Helpingindividuals modify their perceptions of ageing could have important implications for facilitatinghealth in later life.

Quality of life and cardiac rehabilitation

*Bath, J., Giles, M., Anderson, A., Harrison, J., Gallacher, M., Earll, L.; *Gloucestershire HospitalsNHS Foundation Trust, UK

Objectives The aim of this study was to assess whether Quality of Life (QoL) improved for patientsattending the Cardiac Rehabilitation (CR) programme in Gloucestershire.

Methods Sixty-seven patients completed the Quality of Life after a Myocardial Infarction (QLMI)questionnaire and the Hospital Anxiety and Depression Scale (HADS) at 3 time points; 2–4months post cardiac event (1), two months post CR programme (2) and 12 months postcardiac event (3). The QLMI measures three QoL domains; physical, emotional and social andprovides global QoL scores. 82.4% of the sample were male, 17.6% were female. The mean agewas 58.8 years.

Results Improvements in global QoL were found between time point one and time point two( p< 0.01). These were maintained between time point two and time point three ( p< 0.01).Emotional, social and physical QoL domains showed significant improvements between timepoint one and time point two ( p< 0.01). Women had lower QoL scores on all domains and globallyat all time points, but showed greater improvement over time than men. Levels of anxiety anddepression lowered over time for the whole sample ( p< 0.01). Although women were significantlymore depressed than men at all three time points ( p< 0.01), women’s levels of depression decreasedmore over time than men’s.

Conclusions This study showed significant improvements in QoL and in levels of anxiety anddepression for patients attending the Gloucestershire CR programme. These were maintained overtime. Women may have more to gain from attending the programme than men as their initialscores for QoL and depression are worse and show greater improvement over time. This hasimplications for recruitment of women onto the CR programme, as acceptance rates are at presentmuch lower than for men.

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Promotion of wellness in deaf children: What parents say they do to help their child

*Beaulen, V., Jutras, S., Gauthier, J., Dubuisson, C., Lepage, G., Tougas, A.-M.; *PsychologyFaculty, Universite de Liege, Belgique

According to Pourtois and Desmet (1997), the child’s identity is built through the responses of his orher parents to twelve psychosocial needs categorized within four dimensions: emotional, social,cognitive and ideological. The objective of this study was to find out how hearing parents of deafchildren perceive to fulfil these needs through specific strategies that support their child’s wellness.The participants were 98 hearing parents of deaf children (aged 5 to 17) coming from all regions ofQuebec. They described what they do to help their child (a) feel better, (b) make friends andget along with others, (c) develop cognitively, and (d) be more autonomous. Transcriptions of theinterviews were segmented in units of signification, and then coded according to a pre-establishedscale covering a variety of themes. By consensus, the researchers classified the units of significationwithin the twelve needs. The prevalence of the themes for each need was established and intergroupcomparisons were carried out according to the following variables: the parent’s or child’s gender,the age of the child, and his or her mode of communication: oralist (French) or bilingual(French & Quebec Sign Language). The statistical analyses (Fisher’s test) reveal significant differ-ences. To support autonomy, the parents of bilingual children insist more on the need for structure(setting for the child the just limits necessary for his or her development) while the parents of oralistchildren emphasize the need for acceptance (creating a friendly and reassuring surrounding for thechild). In addition, to encourage cognitive development, parents of teenagers mention more fre-quently, than parents of youngsters, the need for structure. Results will be further discussed by com-paring and merging Jutras’s model of wellness and Pourtois and Desmet’s model of good parenting.

Couple relationship and depression: Impact on cardiac rehabilitation

*Bellardita, L., Compare, A., Molinari, E.; *Catholic University of Milan, Dept. of Psychology;Universita degli Studi di Bergamo, Italy

Studies have shown that depressive symptoms are influenced by couple relationship and thatdepression is associated with a decrease in quality of couple relationship which, on its turn, isassociated with a higher risk for morbility and mortality in CHD patients. The aims of this study are:

1. to analyse the impact of depressive condition on cardiac rehabilitation;2. to investigate the influence of couple relationship quality on the association between depression

and cardiac rehabilitation outcomes in male depressed patients.

An observational restricted cohort study was conducted in a sample of 223 patients at S. Giuseppehospital Cardiac Rehabilitation Unit (Istituto Auxologico Italiano, Piancavallo, Verbania). Averageage was 50 (SD: 4.98). Beck Depression Inventory was used to measure depression: scores weredichotomized based upon a cut-off score and patients were divided into ‘‘high depression’’ and‘‘low depression’’ groups. Quality of couple relationship was measured using the Experiences inClose Relationship questionnaire and the Partner Relation Inventory. Rehabilitation outcomes weremeasured as METs (metabolic equivalents), i.e., the quantity of oxygen used during stress test.A Log Linear analysis was conducted and results showed that patients with higher depression weremore likely to experience poorer rehabilitation otcomes (METs’ OR¼ 0.797; CI 95%: 0.87,�0.99). Results also showed that low perception of couple relationship quality enhanced theimpact of depressive symptoms thus reducing the positive METs change following rehabilitation(RR¼ 1.65; 95% CI¼ 1.25–2.17; p< 0.001). These results emphasize that individual and relationalpsychological variables and biological factors are stricly connected: the association betweenpoor couple relationship quality and cardiac risk represents a dynamic and reciprocal process.

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Clinical implications concern the inclusion of partner in cardiac rehabilitation programs, which shouldinclude couple therapy.

Unhealthy and healthy automaticity: Investigating the cognitive processof habit formation and change

*Bender, M., de Vries, N., Danner, U., Aarts, H.; *Psychology Dept, University of Maastricht, TheNetherlands

Recent developments in psychology suggest that much of health behavior is automaticallytriggered and executed. Interventions on changing unhealthy behaviors therefore also need to considerautomatic, habitual behavior. Theoretical knowledge about the origin and change of habits ishowever lacking. We developed and tested a new paradigm to simulate the process of habitformation and breakdown, building on a model of habits as schematic sequences of situation-goals-means-behavior. Participants had the goal to judge stimuli on color (is it blue?) and type(is it a letter?). The means to fulfill this goal was represented as pressing one of two keys. In halfof the trials the stimulus was either blue or a letter and participants had to press either left or right.In a quarter of the trials the stimulus was neither a letter nor blue and the correct response wasrepresented by not pressing any key. In the critical quarter of the trials the stimulus was bothblue and a letter. Both keys represented correct means and participants had to choose. Resultsshowed that, in accordance with our expectations of the process of habit formation, for thosecritical trials participants developed a strong preference for one of the two keys during the experiment;at first 75% of the responses, but at the end the habitual response consisted of 87%. Reactiontimes became faster and fewer mistakes were made. In a second phase we prescribed the choicein the critical trials. Participants made more mistakes and had slower reaction times when adaptingto these new behavior patterns. We will discuss the utilization of the model and experimentalparadigm to study the effects of operant conditioning, awareness and planning on changingunhealthy habits.

Perceptions of changing friendships and their impact on psychological wellbeing

Bennett, K.; School of Psychology, Liverpool, UK

Objectives Older widowed women frequently perceive that their friendships change following theloss of their spouses. This study aims to examine the nature of perceived changes to friendships,and their impact on psychological wellbeing.

Methods Data is taken from two studies of late life widowhood both of which use primarily qualitativemethods. There were 65 participants in total aged over 55. Interviews were analysed using a groundedtheory approach.

Results Friendships were perceived to change following the loss of a spouse, which in turn impactedon adjustment to widowhood. Many women reported being ‘dropped’ by their married friends whichcaused the widows additional stress, at an already distressing time. However, over time these friend-ships with married women were replaced with friendships with other widowed women – women‘in the same boat’. In addition, women often talked about the importance of ‘true friends’.

Conclusions Friendships play an important role in the adjustment to widowhood amongst womenin later life. Friendships carry with them both positive and negative consequences. An impact ofthese inter-relationships is important in understanding the mechanisms which assist in successfuladjustment to late life widowhood.

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Predicting emotional responses to cancer genetic risk assessment

*Bennett, P., Brain, K., Wilkinson, C., Gray, J.; *Psychology Dept., University of Wales, Swansea,UK

Objectives To identify predictors of emotional distress prior to and after receiving informationconcerning genetic risk for breast, ovarian, and colon cancer.

Methods Patients taking part in a cancer genetic risk assessment programme completed question-naires which included levels of intrusive thoughts, mood, the big-five personality factors, socialsupport, and perceived risk of developing cancer. Measures were taken one month prior to (time 1)and following provision (time 2) of information on risk level.

Results One hundred and fifty four participants completed both questionnaires. Cross sectional andlongitudinal analyses were used to identify factors associated with mood at both time points.Multiple regression analyses suggested that prior to testing, anxiety was associated with high levels ofneuroticism, low levels of extroversion, low perceived health, and low levels of confidant support. Attime 2, they were associated with perceived control over cancer (negatively), low levels of affective sup-port, perceived health (negatively), and levels of intrusive thoughts. Extroversion (negatively), agree-ableness, perceived health (negatively), and levels of intrusive thoughts were associated with higherlevels of depression at time 1. At time 2, perceived lack of control over cancer, lack of affective support,and low perceived health were the main associates of depression scores. Longitudinal analyses foundtime 2 scores were only predicted by time 1 scores for each emotion.

Conclusions These data suggest we can identify those at high risk of poor emotional reaction tocancer genetic risk assessment. Interventions may focus on increasing perceptions of control andhealth, and the use of emotion-focused coping strategies. Support groups may also be of benefit.

Stereotypes of flourosed teeth: A reaction time study

*Bennett, P., Williams, D., Chestnutt, I., Lowe, R.; *Psychology Dept, University of Wales, Swansea,UK

Objectives To identity stereotypes of people with differing levels of fluorosis using explicit andimplicit methodologies.

Methods 80 participants completed a series of trials in which target (one male, one female) and fillerfaces were presented briefly on a computer screen. The target faces were digitally manipulated toportray four levels of fluorosis: none, mild, moderate, severe. Following presentation of the faceand a brief orienting cross in the centre of the screen, one of 18 single word descriptors (some positive,some negative) appeared on the screen. Participants indicated whether each was true or false foreach face using a response box. Reaction times were also measured. In all, participants respondedto 432 trials.

Results Analyses involved logistic regression to analyse binary data, and linear regression to analysereaction time data. These examined main and interaction effects across pooled data from alldescriptors as well as data from individual items. Results indicated that participants were significantlyless likely to give a ‘‘yes’’ response, endorsing a positive descriptor, for faces with severe fluorosisthan those with less fluorosis or normal enamel ( p< 0.001) on the following descriptors: attractive-ness, carefulness, cleanliness, health, intelligence, kindness, reliability, and sociability. The fastestresponses to severe fluorosis were for ‘‘yes’’ responses to negative words: this was the slowest typeof response across the other three levels of fluorosis. The difference between response times washighly significant ( p< 0.001).

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Conclusions Faces with severe (but not mild-moderate) fluorosis appeared to trigger both consciousand, perhaps, unconscious negative stereotypes. These were wider than simply aesthetic judge-ments, and included attributes of health and self-care. These data add to studies in otherpopulations suggesting that even minor health problems can trigger negative stereotypes.

Impact of mastectomy on identity and body image in women with breast cancer

*BenSassi, M.-L., Demierre, M., Castelao, E., Delaloye, J.-F., Piot-Ziegler, C.; *Health Psychology,University of Lausanne, Switzerland

Diagnosis of breast cancer is distressing and its impact is increased when mastectomy is announced.A longitudinal qualitative study followed 21 women throughout their illness biography. Semi-structured interviews were performed before reconstruction and analysed. Concerns related to bodytransformation were identified. Mastectomy induced a de-construction of the body’s integrity withthe void and asymmetry caused by the breast ablation, and a deep existential questioning on identityissues. Women had to mourn a part of their body, which had participated in their social, symbolic,gender and personal identity construction. The mutilated body was compared to the ideal imagesconveyed by society and to the symbolic body images linked to sexuality, maternity and breast-feeding. They became estranged from their body, and were reluctant to talk about their emotionalsuffering, as if too much importance granted to their breast might be interpreted as provocative orpointless. They expressed fear of no longer being considered feminine, desirable and ultimately tobe different. Several forms of silence were outlined: the silence of the woman confronted to her mod-ified body, the silence, of the medical community, the silence of the spouse. All these cumulatedsilences caused great loneliness. The look of others was feared. This was the beginning of a paradox:one might not talk about it, touch it or look at it. Yet women expressed the need to talk about it, to betouched and to be physically accepted. A dialogue was lost, a gap was widening on the void of the lostbreast. A new way of communicating had to be found. The breast might be re-constructed but thisnew breast and this new body will have to be re-discovered.

Patient and spouse representations of the patient’s heart disease and their associationswith received and provided social support and undermining

*Benyamini, Y., Medalion, B., Garfinkel, D.; *School of Social Work, Tel Aviv University, Israel

Objectives To compare patient and spouse representations of heart disease and to assess theirassociations with social support and social undermining, as reported by patients and spouses.

Methods Fifty heart disease patients, mean age 79, 38% females, and their spouses, were interviewedat their homes simultaneously by two separate interviewers. Both interviews included the IllnessPerception Questionnaire and the Social Support and Social Undermining questionnaire, adaptedto ask about support and undermining (criticism and disagreement) in the patient’s coping withheart disease.

Results Patients’ illness cognitions were mostly correlated with their spouses’ cognitions, with theexception of personal control over the disease. Patients reported stronger illness identity and tendedto attribute their illness more to lifestyle factors, compared with their spouses. Patients who perceiveda longer timeline and less control also reported receiving less support from their spouse; those withstronger illness identity, reported receiving more undermining. Spouses who perceived stronger illnessidentity, consequences, and attributions of the partner’s disease to lifestyle and stress, reported provid-ing more support but also more undermining. Specific combinations of patient and spouse illnesscognitions interacted in their association with support/undermining (e.g., least support was reportedby patients who perceived their disease as chronic while their spouses received it as less chronic).

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Conclusions Patient and spouse illness perceptions could affect the patient’s perception of the spouse’ssupport/undermining and their actual provision by the spouse. Specific combinations of congruentand incongruent patient-spouse perceptions could be especially related to given and received spousesupport. In order to understand spouse support or undermining of patient’s coping efforts, it isimportant to study their illness perceptions and compare them with the patient’s perceptions.

The conceptual structure of subjective well-being

*Bertoquini, V., Pais Ribeiro, J.; *Faculdade de Psicologia e de Ciencias da Educacao – U. Porto,Portugal

In the past decade subjective well-being (SWB) work has grown greatly as in the positivepsychology movement. SWB usually refers to the presence of positive emotions, absence of negativeemotions, and satisfaction with life.

Objective To analyse the conceptual structure of SWB.

Method The PANAS (Watson, Clark, & Tellegen, 1988) and the SWLS (Diener, Emmons, Larsen,& Griffin, 1985) were administered to a Portuguese sample of 191 subjects aged between 17 and63 (M¼ 25, 1, DP¼ 10, 51). Competing models of the latent structure of the SWB were evaluatedusing confirmatory factor analysis (EQS 6.1).

Results The best fitting model (robust comparative index¼ 0.95) of the latent structure of theSWB consisted of one general factor and three specific components – positive affect, negative affectand general satisfaction with life. However, in PANAS correlated error between items derived fromthe same content categories in Zevon and Tellegen’s (1982) mood checklist were allowed.

Conclusion The present findings provide substantial support for the idea that SWB consists of ageneral dimension of evaluation of a person’s life, comprising an affective component (positive andnegative emotions) and a cognitive component (satisfaction with life).

‘‘SNAKE’’ – a stress prevention program for adolescents:Evaluation and further development

*Beyer, A., Lohaus, A.; *Department of Psychology Philipps-University Marburg, Germany

The present study is concerned with the development of a stress prevention program for adolescentsto be applied in school settings. Children and adolescents are daily confronted with a series ofstressful situations. Especially adolescence is a vulnerable time. This phase includes rapid biological,cognitive and social changes which can be accompanied with various amounts of stress. Therefore itseems to be important to establish an appropriate scope of coping strategies early in life. A programwas developed with a basic module focusing on a problem-solving approach and knowledgeabout stress and coping. The basic module can be expanded by additional program modulesrelated to cognitive reconstruction, seeking for social support, and relaxation and time management.461 adolescents of grades 8 and 9 from 18 school classes participated at the first program evaluationcombining the basic module (problem solving) with one of the three additional modules. The threetraining conditions were contrasted to a control group without intervention (339 adolescents from14 school classes). The results showed significant knowledge improvements as well as changes of theassessment of stress evoking situations and of the coping behaviour. The effects were stable over aninterval of at least two months. A second program evaluation is planned to further improve the effec-tiveness of the training. In the second study a new internet platform will be tested. The site will providedifferent tasks and games relevant to the training subjects. Additionally the youth’s specific interestsand needs will be considered and they will be permitted to choose the program module they like.

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Why do people (re)turn to complementary medicine? Abstract beliefs andconcrete experiences

*Bishop, F., Yardley, L., Lewith, G.; *School of Psychology, University of Southampton, Highfield,Southampton, UK

Objectives The aim was to investigate the predictors of ongoing use of and adherence to comple-mentary medicine. Drawing on Leventhal’s Self Regulation Model it was hypothesised thatwhile patients’ beliefs about treatment and perceptions of illness would predict ongoing use ofcomplementary medicine, patients’ experiences of treatment would be the strongest predictors.

Methods This was a postal questionnaire study involving 2 waves of data collection. The dependentvariables were measured 3 months after the predictor variables. The predictor variables were patients’beliefs about treatment, perceptions of illness, and experiences of treatment. The dependent variableswere ongoing use of complementary medicine (making follow-up appointments) and adherenceto practitioners’ recommendations to make lifestyle changes (e.g., diet, exercise). Variables wereassessed by previously validated self-report questionnaires. Two hundred and seventy nine patientsfrom 6 complementary medicine clinics participated in the study.

Results Logistic regression analyses showed that patients beliefs about and experiences of treatmentaccounted for 47% of the variance in making lifestyle changes and 35% of the variance inmaking follow-up appointments. Abstract beliefs and concrete experiences were statistically reliablepredictors of making lifestyle changes (�2(25)¼ 59.79, p< 0.001) and making follow-up appointments(�2(18)¼ 52.98, p< 0.001). Overall experiences of treatment were stronger predictors of adherencethan beliefs about treatment and illness.

Conclusion The results suggest that people return to complementary medicine primarily becausethey have positive experiences of the treatment process. Furthermore, this study emphasises theneed to attend not only to patients’ abstract beliefs about treatment but also their concrete experiencesof treatment when investigating adherence.

Attitudes towards and beliefs about falls prevention interventionsin 7 European countries: A framework analysis

*Bishop, F., Yardley, L., Beyer, N., Hauer, K., Kempen, G., Piot-Ziegler, C., Todd, C.; *School ofPsychology, University of Southampton, UK

Aim The aim was to determine which attitudes and beliefs influence uptake of and adherence tofalls prevention interventions across community-dwelling older people living in 7 different ECcountries.

Methods Semi-structured interviews (based on the Theory of Planned Behaviour) were carriedout with 73 community-dwelling older people (from Denmark, The Netherlands, Germany,Greece, Italy, Switzerland and the UK). Participants were recruited to provide a range of experiencesrelated to falls interventions (people who had/not fallen, people who had/not taken up or adheredto interventions). Framework analysis (Ritchie & Spencer, 2004) was used to identify the influenceson uptake and adherence to falls prevention interventions.

Findings Factors which encouraged intervention uptake were anticipated benefits (e.g., physical,psychological, but rarely related to falls prevention), predispositions (e.g., past experience), and trig-gers (e.g., offer of transport). Factors which encouraged adherence to interventions were positiveeffects of the intervention and supporting factors (e.g., enjoyment). Factors which discourageduptake included having concerns about the intervention (e.g., ability to take part), lack of motivation

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or interest, and practical difficulties. Factors which discouraged adherence were negative effects ofthe intervention (e.g., on identity) and barriers (e.g., health status).

Discussion There is consistency across European countries in the factors that influence uptakeand adherence to falls prevention interventions. The presentation of such interventions needs totake into account older peoples’ attitudes and beliefs in order to encourage uptake and adherence.

Time perspective and the intention–behaviour relation: The case of quitting smoking

*Bobo-Kovac, V., Rise, J.; *Norwegian Institute for Alcohol and Drug Research, Norway

The present paper sets out to explore the role of three individual difference variables related to timeperspective: future orientation (FO), consideration of future consequences (CFC), and a self-reportmeasure of delay discounting (DD) as well as various measures of desires in the self-regulatoryphase related to quitting smoking. At T1 (October 2004) relevant measures of the intention formationphase were collected along with time perspective variables in a group of daily smoking studentsat University of Oslo (N¼ 156) aged 24.5, and they had been smoking for 8 years. Quitting behaviourwill be measured at T2 (March 2005). Consistent with other studies two CFC-factors were identified:future and present consequences (FC and PC). FO correlated strongly with FC (r¼ 0.51, p< 0.001)and weakly with PC (r¼ 0.21, p< 0.01) and DD (r¼ 0.17, p< 0.05), while the two CFC scales did notcorrelate with DD. None of the time perspective variables correlated with the measures at TI (quittingintentions, planning, number of cigarettes, number of prior quit attempts, and various measuresof desires). Consistent with other studies the various time perspective variables are expected toplay a role in the volitional phase. However, their relative importance has not yet been fully exploredin literature.

Proactive investment in the future in middle and late adulthood:The evaluation of an intervention study

*Bode, C., de Ridder, D.; *Utrecht University, The Netherlands

Objectives The ability to perceive stable and meaningful life goals is a significant predictor oflife satisfaction and well-being, while investment strategies such as selection, optimisation andcompensation contribute to successful aging. In how far people in middle and late adulthood aremotivated to invest in their future and whether an intervention promoting future investment in theelderly might be effective is rarely examined. This presentation introduces such an intervention andexamines its effects.

Methods The program ‘‘In anticipation of the golden years’’ was developed in order to train compe-tencies which can help promote desired and prevent undesired future developments. The interventionalso aimed to stimulate proactive behaviour as well as proactive attitudes. The program has beentested in a RCT design with one pre-test and two post-test SOC measurements. 158 participantsbetween 50 and 75 years of age participated in the program. Participant evaluations and the feasibilityof the program were good.

Results Regarding the proximal intervention effects, proactive competencies increased significantlyin the intervention group, but not in the control group. This effect decreased slightly after4 months, but it remained significant. Attitudes and behavioural aspects associated with futureinvestment did not show significant change.

Conclusion Results point to the potential but also to the difficulties associated with future investment.The increase in proactive competencies was meaningful and relatively stable. This showed that

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future investment can be supported by teaching and practicing associated skills. Possibly the durationof the intervention was too short or changes in proactive attitudes and behaviour need more timeto become manifest. Consequences of our findings for the use of investment strategies such asSOC and proactive coping will be discussed.

What is the benefit of different components of marital distress prevention programsfor couples in lowering their risk to become maritally distressed again?

*Bodenmann, G., Widmer, K.; *University of Fribourg, Switzerland

Objectives Most marital distress prevention programs focus on the improvement of maritalcommunication skills in couples, as one key element of intervention. As communication turned outto be one of the most powerful predictors of the decline of marital satisfaction and of a higher riskfor divorce in many international studies, this emphasis seems logical. However, how are the effectsof communication trainings and what are the contributions of other elements, e.g., dyadic coping?

Methods/Results In a 2-year follow-up and a 6-months follow-up study, evaluating the effects ofthe Couples Coping Enhancement Training (CCET), a new marital distress prevention programaiming to enhance communication and coping skills of the couples, the question of the relevancy ofmarital communication and dyadic coping are examined. Both, the initial level of communicationand dyadic coping as well as the improvement of these variables after the intervention are assessed.Whereas, communication seems to be a very important predictor of a lower risk of becoming martiallydistressed after the participation in the CCET, when dyadic coping is not considered, the effectof communication is no longer present, when dyadic coping is introduced in the analyses. Whenboth variables are considered, only dyadic coping reveals to be the most significant and strongestpredictor of a lower risk of relapse, whereas communication has no longer predictive power.Furthermore, interesting gender differences will be discussed.

Conclusions Findings reveal that marital communication is important, but that it makes sense tostrengthen also dyadic coping in interventions aiming to improve marital quality and stability.Implications of these findings for marital distress prevention programs and the concept of dyadiccoping are discussed.

Does subjective aging reflect a change in quality of life?A longitudinal study among cancer patients

Boehmer, S.; Dept. Health Psychology, Free University of Berlin, Germany

Objectives A body of research points to relationships between aspects of subjective aging andhealth. Morbidity and functional capacity are relevant predictors of felt age. The present study onpost-surgical cancer patients addressed two questions: (1) Do people with distinct subjective ageidentities differ in subjective health-related quality of life (HRQOL)? (2) Is change in felt ageassociated with change in subjective HRQOL?

Methods Data were collected at 1 month and 6 months after cancer surgery (N¼ 159; 58% men,aged 24 to 86 years). Mailed questionnaires comprised the EORTC-QLQ-C30 for assessment ofHRQOL and an assessment of felt age. MANOVAs and t-tests for independent samples were usedfor data analyses.

Results At both waves, about 50% of the cancer patients reported younger age identities and lessthan 14% indicated older age identities. Patients with younger age identities reported betterHRQOL than patients with older age identities. In general, patients’ subjective HRQOL improved

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over time; Wilks’ Lambda¼ 0.45, F(15, 126)¼ 10.12, p< 0.001, �2¼ 0.55. An increment of

felt age was observed in 29% and a decrement in 28% of cases between both waves. Contrary toexpectations, HRQOL improved also among patients with an increment or stability of felt age, butin fewer aspects and with substantially lower effect sizes than among those with a decrement of feltage.

Conclusion Subjective HRQOL is a correlate of felt age in cancer patients. But an increment in felt agedoes not imply a decrease of HRQOL.

Goal facilitation as an independent predictor of patient satisfaction after hospitalization

*Boersma, S., de Boer, C., Maes, S.; *Leiden University, Leiden, The Netherlands

Introduction Increasingly, hospitals use patient satisfaction as one of the benchmarkers for the qualityof care they provide. Factors related to hospital stay could enable hospitals to improve patientsatisfaction by intervening on the quality of care delivered. However, improvements in provider char-acteristics will not automatically result in higher patient satisfaction, also psychological characteristicsof patients should be taken into account (e.g., Nguyen Thi et al., 2002; Steptoe et al., 1991). Based ongoal theory (e.g., Carver & Scheier, 1998), we propose that patient satisfaction, in addition to bothprovider characteristics and demographicand medical characteristics of the patient, will to a largeextent be determined by whether the hospital stay was detrimental or beneficial for the attainmentof long-term personal goals.

Method In this survey study, a questionnaire was sent to a representative stratified sample of 1108recently hospitalized patients of an academic hospital in The Netherlands. Response rate was 52%(254 8, 309 9; 230 age <40 and 338 age �40). Patients were asked to rate their satisfaction withdifferent aspects of the hospital stay (e.g., information or medical care) as well as overall satisfactionin addition to provider characteristics, demographic and medical variables, HRQL (SF-12), and goalhindrance and facilitation (GFI).

Results Preliminary results show that after correction for both provider and patient characteristics,the extent to which the hospital stay had been beneficial in the attainment of long-term personalgoals, added significantly to the explained variance in overall patient satisfaction. At the conferencemore differential results will be presented concerning moderating effects between providercharacteristics and (different domains of) goal facilitation.

Dyadic coping with stress: How trouble shared turns into trouble halveddistress contagion in couples

*Bolger, N., Iida, M., Burke, C., Green, A., Shrout, P.; *New York University, USA

Objectives One of the defining features of a close relationship is that one partner’s psychologicalstates and actions have the capacity to influence those of the other partner. An example is emotionaltransmission, where one partner’s emotional states can shape those of the other. In this presenta-tion we investigate how emotional transmission can help explain how external stressors can affectrelationships and how initial relationship quality moderates this effect.

Methods The sample comprised of sixty-eight couples in which one member was preparing totake the Bar Examination. This event is the final hurdle in the course of legal training, and it typicallyevokes high levels of distress in examinees. Examinees and partners provided daily diary reports ofemotional states for 35 days surrounding the event.

Results/Conclusions For the typical couple, analyses indicated that examinees’ depressed mood ona given day was related to partners feeling less positive and more negative about the relationship.

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However as the examination approached, this association declined to a negligible level. These resultssuggest that partners increasingly made allowances for examinees’ negative affect. Following theexamination, transmission increased again, and for some outcomes returned to its initial level.This effect was moderated by the initial quality of the couple’s relationship. Couples who reportedrelatively low relationship quality were less sensitive to the partner’s emotional states: they showedless emotional transmission overall and negligible changes as the examination approached. Coupleswho reported relatively high relationship quality showed the opposite pattern: high initial transmissionand sharp declines over time.

Irritability and anxiety predict long-term mortality in patients with myocardial infarction

*Bonaguidi, F., Michelassi, C., Carpeggiani, C., L’Abbate, A.; *CNR Institute of Clinical Physiology,Pisa, Italy

Aim Aim of this study was to evaluate in patients who survived to acute myocardial infarction (AMI)the importance of the personality traits and behavioral responses as predictors of recurrences.

Methods Two hundred twenty-three patients with AMI (200 males) were studied. Psychologicaldimensions were evaluated using both the 16PF questionnaire of Cattell (Extraversion; Anxiety;Sensitivity; Self-control) and the Psy Inventoty scales (Responsibility, Energy, Obsessiveness,Anger/Irritability, Stress-related disturbances and Time urgency). Clinical data such as sex, age,traditional risk factors, peak necrosis enzyme (CPK), left ventricular wall motion score and heartrate variability were also considered in the study. Patients were followed up for eight years for hardevents (cardiac death plus non fatal re-infarction).

Results In the follow-up period, 43 events were recorded. Multivariate analysis (Cox hazardmodel), indicated that only Irritability and Anxiety were significant predictors of successive events( p< 0.01). High score on irritability and on Anxiety increased the risk of new events 2.01 and1.9 times respectively.

Conclusion the results of the follow-up suggest that emotions of anger/irritability and anxiety play animportant role on the long term outcome of AMI. They also suggest the opportunity of psychologicalinterventions to reduce negative emotion and improve prognosis.

Corporate fitness centres: Do they contribute to a healthy organisation?

*Botten, J., McMurray, N., Prasuna, R.; *The University of Melbourne, Australia

The study investigated the association between corporate fitness centres (CFCs) and psychologicalwell-being, in addition to perceived physical health/fitness and work-specific variables, with theobjective of evaluating the benefits associated with installing a CFC, both for the organisation andits employees. A longitudinal and cross-sectional design was employed, whereby 147 respondentscompleted a survey prior to the opening of a CFC at the participating organisations, and a follow-up survey six months later. Both surveys included measures of psychological well-being, perceivedphysical health/fitness, and work and exercise-specific variables, with the follow-up survey additionallyassessing the following levels of usage for the CFC: corporate exerciser, irregular/lapsed corporateexerciser, non-corporate exerciser and non-exerciser. According to their level of usage, respondentswere also required to rate reasons for exercising/not exercising and using/not using the CFC.The results indicated that participating in regular exercise was associated with benefits in relationto physical and psychological well-being, with corporate exercisers and non-corporate exercisersalso perceiving their employment more positively than irregular/lapsed corporate exercisers andnon-exercisers. Corporate exercisers, however, tended to obtain higher scores for these variablesthan the other three levels of usage, indicating that there may be additional benefits associated with

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exercising inside the workplace. The level of causality that could be directly attributed to exercising ata CFC, however, was unclear, with many of these benefits detectable at baseline. Given that therewere no significant differences for absenteeism across the levels of usage, it was concluded thatalthough CFCs may serve as a positive personnel investment for organisations, theimplementation of initiatives designed to increase the participation and adherence rates for thesefacilities may be required in order to achieve a positive financial outcome.

Emotional responses to living at increased risk of breast cancer

*Brain, K., Tyndel, S., Henderson, B., Clement, A., Bankhead, C., Austoker, J., Watson, E.;*Institute of Medical Genetics, Cardiff University School of Medicine, UK

Objective To explore factors associated with cancer worry in women living with the threat ofbreast cancer associated with a family history. This formed part of an ongoing study of thepsychological impact of a national mammography screening programme for younger women atincreased risk of breast cancer (PIMMS).

Methods Questionnaires were completed by 480 women prior to attendance at familial breastscreening centres across the UK. Measures included the Breast Cancer Worry Scale (Lerman et al.,1991), cognitive/affective perceptions of breast cancer risk, appraisals and emotions related tohaving a family history (Lazarus & Folkman, 1984), dispositional optimism (LOT-R: Scheier et al.,1994), and clinical/demographic background variables.

Results Positive emotions such as hope and determination were more frequently reported thannegative emotions such as anger and sadness. Most women appraised their family history as relevantto personal well-being, felt that they were able to do something about their situation as well asdeal with it emotionally, and were optimistic about the future. Issues to do with self/other blamewere not relevant in this context. Hierarchical regression revealed that a high level of cancer worrywas most strongly associated with higher perceived risk and primary appraisals of high relevanceand threat associated with the family history.

Conclusions Most women experienced positive emotions and appraisals in relation to their familyhistory. Future prospective analyses will test the possibility that those women who appraise theirfamily history in a negative light may not be reassured by clear screening results.

Examining the relationship between alexithymia and coronary risk factorsin cardiac rehab patients

Brennan, L.; Department of Psychology, NUI, Galway, Ireland

Objectives The present study explored the relationship between alexithymia, deficient psychologicalawareness, and coronary risk factors. The justification for pursuing this line of research lies inthe potential it holds for advancing cardiac rehabilitation techniques. Specifically, the objectivewas to identify the potential problems alexithymia may create, and use this knowledge to help suggesthow to accurately diagnose and suitably treat patients with alexithymia.

Method Alexithymia was measured using the well-validated twenty-item Toronto AlexithymiaScale (TAS-20). The study population comprised of 50 cardiac rehabilitation out-patients fromSt. Colimcilles and Beaumont Hospital in Dublin. Ages ranged from 39 to 75, with 42 males and8 females. The researcher administered to the group of 50 CHD patients, a questionnaire includingmeasures of alexithymia (TAS-20), anxiety and depression (HADS), maladaptive lifestyle behaviour(LAQ), social support (Significant Others Scale), neuroticism (EPQ-R-N short scale), perceived

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stress (PSS-10), type A behaviour pattern (Framingham Type A Behaviour Pattern Measure) andtype D personality (DS14).

Results Results indicated that 60% of the CHD patients were ‘‘alexithymic’’. Correlational analysisrevealed alexithymia to be negatively associated with stress, depression, anxiety, and maladaptivelifestyle behaviours. T-tests indicated measures of depression to be significantly reduced in alexithymicpatients as compared with non-alexithymic patients ( p< 0.05).

Conclusion It is advocated that the present study provided preliminary evidence that alexithymiais associated with a tendency to deny emotional problems in CHD patients and is thereby associatedwith psycho-behavioural coronary risk factors in this patient group. With respect to implications it issuggested that assessment for alexithymia be made a number one priority of cardiac rehabilitationprogrammes. Furthermore, due to the tendency to deny emotional problems, it is postulated thatobserver-rater measures and expert judgements may be a more effective means of diagnosis.

An investigation into the experience of parents/guardians caring for a young person withjuvenile huntington’s disease: An interpretative phenomenological analysis

Brewer, H.; Birkbeck College, Huntington’s Disease Association, UK

Objectives The aim of this study was to identify the needs of families affected by JuvenileHuntington’s Disease (JHD), by exploring the experiences of parent/guardian carers.

Methods Semi-structured interviews were carried out with twelve primary carers. The interviewsexplored the experiences of parents caring for a child with JHD, and in particular their experiencesof services. The interviews were transcribed verbatim and analysed using InterpretativePhenomenological Analysis (IPA).

Results One of the main themes that emerged was the isolation that families felt. This sense ofisolation resulted from an engagement in social comparison with a number of different groups(e.g., adult-onset Huntington’s Disease and other teenagers without a major condition) and a senseof JHD as being different. This meant that the child with JHD and the parents were unable tonormalise their experiences. This sense of isolation was exacerbated by a general lack of knowledgeand understanding, as well as the reactions of other people and the way the family responded tothis. Other themes included a definition of what was helpful and unhelpful support in the contextof a rare, chronic condition from the experiences of the families.

Conclusions JHD is a rare condition, and the aim of the study was to use the information gained toinform service provision and health care policy formulation in the area. The findings are also ofrelevance more broadly to those working with families where a child has a rare, chronic conditionto promote family well-being and coping with illness.

Increased size of patients’ drawings of the heart during recovery from myocardial infarctionpredicts cardiac anxiety and poor functional outcomes

*Broadbent, E., Petrie, K.; *Department of Psychological Medicine, The University of Auckland,New Zealand

Background We recently reported that myocardial infarction (MI) patients’ drawings of damageon their hearts predict later disability (Broadbent et al., 2004). In a new study we have investigatedhow changes in patients’ drawings over time relate to health outcomes, heart focused anxiety andcardiac invalidism.

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Objectives To investigate whether increase in size of drawings of the heart during recovery from MIis associated with cardiac anxiety and poor functional outcomes.

Methods Seventy-four patients were asked to draw their hearts at discharge, 3-month and 6-monthfollow-ups. They also completed the Brief Illness Perception Questionnaire, Cardiac AnxietyQuestionnaire, Healthy Days Measures, Seattle Angina Questionnaire, worry about future MI,days to return to work, frequency of exercise, and health care use.

Results Increases in size from discharge to 3-months were significantly associated with increasedconsequence perceptions, emotional representations, worry about future MI, cardiac anxiety, fewerhealthy days, slower return to work, less exercise, greater use of alternative medicines and morephone calls to the hospital or general practitioner. Increases in size over 6 months were associatedwith increased worry and consequence perceptions and decreased treatment control perceptions.Increases in size between 3-months and 6-months were associated with increased cardiac anxiety,fewer healthy days and increased angina frequency.

Conclusions Increases in size of patients’ drawings of their hearts indicate increased cardiac anxietyand poorer illness perceptions and are associated with greater disability and health care use.Drawings of the heart may be useful in identifying heart attack patients who are likely to developgreater heart focused anxiety, complaints of ill health and higher use of health care.

An exploratory study of the cognitive, academic and behavioural functioning of paediatriccardiothoracic transplant recipients

Brosig, C.; Medical College of Wisconsin, Mikwalkee, USA

Objectives This study was designed to increase knowledge about the cognitive, academic, andbehavioural functioning of paediatric cardiothoracic transplant recipients.

Methods Subjects: Children who received heart, lung or heart-lung transplants at Children’s Hospitalof Wisconsin were eligible to participate. Of the 17 surviving cardiothoracic transplant recipients,13 agreed to participate, representing a 76% response rate. Subjects ranged in age from 1 to21 years (Mean¼ 8.9 years, SD¼ 6.9). Time since transplant ranged from 3 months to 8 years(Mean¼ 3.0 years, SD¼ 2.3). The sample was 54% male and 46% female. Mean socioeconomicstatus was middle class.

Procedure Children were evaluated by a paediatric psychologist and completed age-appropriatedevelopmental, cognitive, and academic achievement tests. Parents, teachers and subjects (ifappropriate) completed standardized measures of behavioural functioning. Parents and subjectsalso responded to open-ended questions about concerns related to transplant.

Results On measures of cognitive functioning, 54% fell within the average range of intelligence,whereas 46% showed significant delays (>2 SD below the normative population). Of those eligiblefor academic achievement testing, 78% fell within the average range (within 1 SD of the normativepopulation) for reading and spelling, and 57% fell within the average range for math. 27% of mothers,11% of fathers and 17% of teachers rated subjects as having significant behavioural concerns.A majority of parents and subjects indicated that they were glad they proceeded with transplant.Current concerns related to organ rejection and qualify of life.

Conclusions Results of this small study suggest that cardiothoracic transplant recipients are at riskfor cognitive, academic and behavioural problems post-transplant. Transplant teams should workclosely with school personnel to optimize outcomes. In addition, patients and families may benefitfrom psychological intervention post-transplant as there are ongoing concerns regarding lifeexpectancy and quality of life.

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The SEIQoL-DW’s relationship with positive and negative affect in healthy older females

*Bruhn, H., Teunisse, S., Lauche, K., Phillips, L.; *School of Psychology, University of Aberdeen,UK

Objectives There are no gold standards against which to evaluate measures of Individual Qualityof Life (IQoL) such as the SEIQoL-DW. The SEIQoL-DW is a respondent-generated IQoL measurein which the respondents themselves nominate important areas of QoL to be rated for satisfactionand weighted in terms of importance. One method of evaluation is comparison with otherconstructs. In this study we looked at relationships between SEIQoL-DW scores and positive andnegative affect.

Methods: N¼ 74 older healthy females took part, mean age 71.9. All were screened for absence ofdepression and cognitive impairment. Participants were administered a range of affect and QoLmeasures, including: (1) The Positive and Negative Affect Scale (PANAS), which provides separatescales for positive and negative affect, (2) The Schedule for the Evaluation of Individual Quality ofLife Direct Weighting Procedure (SEIQoL-DW).

Results The mean SEIQoL-index score was 78.5 (SD¼ 14.3), while the mean positive affectscore was 31.8 (SD¼ 6.3) and the mean negative affect score was 11.1 (SD¼ 2.8). The SEIQoLindex correlated significantly with the PANAS.

Conclusions The SEIQoL-DW seems to be sensitive to affect. This is clearly a strength as concep-tually affect constitutes part of, but does not exhaustively define QoL. Epistemologically, theSEIQoL is also unique in giving priority to the perspective of the individual, which makes comparisonswith other measures even more meaningful to aid our understanding of QoL.

Smoking cessation and dyadic planning: A study with pregnant women and their partners

*Burkert, S., Knoll, N., Scholz, U.; *Institut fur Medizinische Psychologie, Berlin, Germany

The ‘‘intention-behavior-gap’’ emerges when intentions are not acted upon. Planning as a postinten-tional volitional process could yield a means of bridging this gap. Changing one’s health behaviourgoes along with shifts in one’s social context because it is influenced by or performed together withother people. To take this into account, this study examines a new construct, called DyadicPlanning. This refers to planning with a partner (i.e., spouse) when, where, and how one personinitializes an intended behaviour (action planning; Leventhal, Singer, & Jones, 1965; Gollwitzer,1993) and how obstacles during its implementation are overcome (coping planning; Sniehotta,Schwarzer, Scholz, & Schuez, in press). In this study the efficacy of dyadic planning is comparedwith individual planning. Additionally, social and cognitive processes as proposed mechanisms ofdyadic planning are analysed. In this experimental, longitudinal study, 40 dyads of pregnantwomen who were habitual smokers and their husbands completed questionnaires concerning theirsmoking habits, social-cognitive constructs like intentions, planning, and self-efficacy as well associal constructs such as, social control and social support. The two measurement points tookplace within the first (t1) and second month (t2) of the pregnancy. According to their randomlyassigned group membership the participants planned individually or dyadically either how tochange their smoking behavior (intervention group) or how to change their eating behaviour (controlgroup). Preliminary results indicate that both planning interventions were more effective than thecontrol-group intervention. Dyadic planning was slightly more beneficial for the promotion ofsmoking cessation than individual planning. Its effects were partially mediated by social control andsupport processes. Future research should investigate social influences on planning in lifestylechanges more deeply. Furthermore, it should focus on how abstinence may be maintained after thepregnancy.

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The SPHERE study: Development of theory-informed behaviour change trainingfor primary care staff to increase secondary prevention of coronary heart disease

*Byrne, M., Corrigan, M., Cupples, M., Smith, S., Leathem, C., Murphy, A.; *Department ofPsychology, National University of Ireland, Galway, Ireland

Background Lifestyle change is a core aspect of secondary prevention of coronary heart disease.However, facilitating patients to make lifestyle changes has proven difficult. Health psychologytheory has the potential to enhance the effectiveness of practice in the area of facilitating patientsto change their behaviour; however translating these theories into practical strategies presents a realchallenge for health psychologists.

Objectives To develop a theory-informed behaviour change training intervention for practitioners inIrish primary care. This intervention is one component of a larger, multi-faceted intervention, calledthe SPHERE study, which is targeting organisational, educational and behavioural aspects ofsecondary prevention of coronary heart disease in primary care.

Methods We followed Campbell’s phased approach to the development of randomised controlledtrials of complex interventions. ‘Intervention mapping’ was adopted as a strategy for guiding ourselection of psychological theory and development of the intervention.

Results The intervention was informed by qualitative research with practitioners and patients.A number of theories were drawn upon to develop the intervention content: health educationtheory, social cognitive theory, goal theories, the two-stage approach suggested by the health actionprocess approach and the patient centred approach. Key strategies being taught to practitioners inthe intervention training are enabling patient-centred selection of behaviour for focus, facilitatingpatient identification of facilitators and barriers, goal setting, action planning and monitoring.Ongoing process evaluation is enabling us to provide a detailed and thorough description of theimplementation of our intervention.

Conclusions The application of theory to the development of behavioural interventions is challenging.Future research needs to focus on experimental testing of theories and their constructs. Healthpsychology urgently needs to develop an evidence-based taxonomy of behaviour change techniquesto aid interventionists in their selection of appropriate theories and methods.

Heart rate variability and emotion recognition in psychopathological subjects

*Cabrini, S., Nucifora, V., Ottaviani, C., Brighetti, G.; *Postgraduate School of Health Psychology,Department of Psychology, University of Bologna, Italy

Objectives Given that Heart Rate Variability (HRV) is compromised in psychiatric patientswithout cardiac impairment (Valkonen-Korhonen et al., 2003) and given that difficulties in emotionrecognition are associated with psychopathology, we developed a multicentric study with the aim ofevaluating the correlation between emotional and physiological impairment in subjects withPersonality Disorders (PD).

Methods Participants were 20 subjects with a SCID-II diagnosis of PD. The clinical group wasrecruited from consecutively admitted patients who were attending an inpatient treatment programfor severe PD. Patients were submitted to a 2-hour testing. HRV was measured continuously.Psychological assessment consisted in BPRS and SCL-90-R. A computer-based Facial EmotionDiscrimination test was used to assess performance in emotion discrimination. Forty youngadult faces showing four emotional expressions (anger, fear, sad, and joy) were used as stimuli.All pictures were selected from the Ekman and Matsumoto (1988) set of facial display of emotions.Stimuli were presented using the E-Prime software. Participants were instructed to respond to atarget emotion, and to discard other pictures by pressing a different response key.

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Results Our results confirmed the hypothesis that HRV is compromised in psychiatric subjects.Moreover we observed a positive correlation between HRV and emotion recognition, in particularin accuracy ( p< 0.05), mean reaction time ( p< 0.01), and negative emotion recognition ( p< 0.001).In addition, our results showed a lower vagal tone in patients with a greater degree of symptomatology.

Conclusions The positive correlation between HRV and task performance supports the idea thatautonomically mediated cardiovascular variability is critical as an index of neurovisceral integration.Comprehensive models of emotions and disorders should consider the complex mix of cognitive,affective, behavioral, and physiological concomitants of normal and pathological affective statesand dispositions.

Using the self-regulatory model to determine psychological predictors of prosthetic useand function following lower limb amputation

*Callaghan, B., Johnston, M., Condie, E.; *University of Strathclyde, UK

Objectives To determine if illness cognitions within the self-regulatory model (SRM: Leventhal et al.,1984) predict prosthetic use and function in amputees.

Methods A longitudinal predictive study was conducted at eight Scottish hospitals. The 166amputees recruited were assessed using the illness perception questionnaire-revised (IPQ-R:Moss-Morris et al., 2002) at 3–4 weeks post-operatively, then assisted by a trained amputee visitorto complete the functional measure for amputees items (FMA: Callaghan et al., 2002) and thelocomotor capabilities index (LCI: Gauthier-Gagnon et al., 1998) for evaluating prosthetic use andfunction respectively, at 1-month and 6-months post-discharge. Outcome measures were enteredinto regression equations in order to assess the extent to which they were predicted by the illnesscognitions.

Results Significant SRM illness cognition regression models emerged for predicting prosthetic use,with timeline cyclical (perceptions of symptoms fluctuating) and treatment control (beliefs abouttreatment efficacy) being the most influential determinants. Their effect was stronger at 6-monthsthan at 1-month. For predicting function, timeline cyclical and treatment control were again the mostinfluential illness cognitions at both 1-month and 6-months. Emotional representations (distressingthoughts) also predicted function, but only at 1-month.

Conclusions This study has identified how specific psychological variables determine prosthetic useand function in amputees. Such knowledge is valuable because it raises the prospect of being ableto (a) identify patients whose psychological profile renders them more at risk of not rehabilitatingand functioning successfully with a prosthesis and (b) formulate elements of acute psychologicalcare aimed at increasing the number of patients making effective use of their prosthesis and achievingimproved functional outcome post-discharge from hospital.

Knowledge and attitudes towards genetic testing, a two-year follow-up study in patientswith asthma, diabetes mellitus and cardiovascular disease

*Calsbeek, H., Morren, M., Bensing, J., Rijken, M.; *NIVEL, The Netherlands

Objectives (1) To assess the level of actual knowledge on genes and heredity in patients with asthma,diabetes mellitus (DM) and cardiovascular diseases (CVD), (2) to determine whether thelevel of perceived knowledge on genetic testing in these patients has been increased since 2002,(3) to determine whether their attitude towards genetic testing has been changed in two years, and(4) to investigate the predictive role of perceived knowledge on the attitude towards genetic testing.

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Methods Patients with asthma, DM (type II) and CVD were selected from the Panel of Patientswith Chronic Diseases (PPCD). In the first survey on genetic testing (April 2002) data from586 patients could be analysed. Of these patients, 403 also participated in the second survey ongenetic testing in April 2004.

Results Most genetic knowledge relates to associations between genes and diseases, least isknown about associations between genes, chromosomes, cells and body. Perceived knowledge onDNA-testing has not been increased. Attitudes towards genetic testing hardly changed either.Most positive are patients about general subjects covered by rather distant statements, many patientshowever are still worried about the consequences for taking out insurances. More medical geneticknowledge was found predictive for less reserved attitudes, whereas more personal genetic knowledgeresults in a more reserved attitude.

Conclusions Advanced developments in scientific knowledge in the field of medical genetics are notaccompanied by increased knowledge in patients with asthma, diabetes mellitus, and cardiovasculardisease. Their attitude towards DNA-testing also hardly changed in a two years-period. Geneticknowledge was found predictive for the attitude towards genetic testing.

Understanding UK hospital consultants’ intentions to retire early from the NHS:A qualitative study

*Candy, J., Taylor, C., Ramirez, A.; *King’s College London, UK

Objectives The NHS has a shortage of hospital consultants and increasing numbers are retiringearly from the NHS (Department of Health, 1997). Drawing on theories from health psychology,this study sought to explore hospital consultants’ intentions and explanations regarding earlyretirement from the NHS.

Methods In-depth semi-structured interviews were conducted with 19 hospital consultants basedthroughout the UK, purposively selected as intending to retire early (�60 years). The frameworkmethod was used to analyse the data.

Results 17/19 of participants had made concrete financial plans to facilitate early retirement, andof those with partners 14/16 had discussed the prospect of leaving medicine early and received supportfor this, including encouragement to leave even earlier or reduce present commitments. Explanationsfor wanting to retire early related mostly to work and including experiencing high job demands,diminished rewards and job satisfaction, low job control; and concerns about the impact of continuingwork on their physical and mental health. 17/19 participants were able to identify changes to theNHS that would make them reconsider early retirement, e.g., extra staff and resources, the optionto move away from the ‘coal face’ of work, an increased sense of being valued, and having greateropportunity for flexible working.

Conclusions The findings reflect Karasek’s (1979) and Siegrist’s (1996) models, suggesting that earlyretirement may be one consequence of a working life characterised by high strain or imbalancedefforts and rewards. Interventions and policy aimed at reducing the early retirement trend amongsthospital consultants could be informed by such findings.

Benefits and challenges: The experience of volunteers working in the provisionof health and social care services

*Carey, C., Mac Neela, P., Gallagher, P.; *Dublin City University, Ireland

Volunteers are a vital resource for many health and social care organisations; however there hasbeen little conceptual work to date on the benefits of volunteering and the challenges to continued

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or increased involvement. The aim of this study is to generate a conceptual model and classification ofbenefits and challenges to volunteers working in voluntary health and social care services in Ireland.Eight focus groups (5 Dublin, 3 Galway) were undertaken to investigate current volunteers’ experi-ences of benefits and challenges related to volunteering participation. Eight semi-structured interviewswere also used to assess benefits and challenges from the perspectives of volunteer co-ordinatorsand to further elaborate the concepts generated through focus groups. Preliminary analysis hasrevealed a set of key benefits associated with volunteering (e.g., appreciation, learning, satisfactionof personal needs, self-esteem enhancement, constructive use of time, and the feeling of belongingto something important). A preliminary set of challenges to continued or increased involvement hasalso been identified (e.g., conflict with other commitments, frustration with organisational supports,lack of role preparation, and unsatisfactory person-job fit). This is the first phase of a wider study,resulting in the development of a conceptual model and classification of volunteer benefits andchallenges. The second phase of the project is centred on devising a psychometric instrument toassess these benefits and challenges. This will be the first measure designed expressly for the purpose.The issues involved in devising a measure on the basis of qualitative data will be discussed.

Sex differences in psychosocial predictors of depressive mood upon entry intoa cardiac rehabilitation program

*Carlyle, L., Fraser, S., Rodgers, W., Courneya, K., Daub, B.; *University of Alberta, Edmonton,Canada

Objectives Symptoms of depression are prevalent in newly diagnosed cardiac patients and are asignificant predictor of recurrent cardiac events within the first year after a myocardial infarction(Bush et al., 2001). Thus, the purpose of this study was to examine the differential influence ofpsychosocial predictors on depressive mood prior to beginning cardiac rehabilitation (CR) amongmen and women.

Methods Participants referred to CR were mailed a questionnaire assessing depressive mood,perceived stress, and three types of social support: emotional, tangible and belonging. Demographicinformation was collected from patient medical records. Participants (men¼ 129, women¼ 38)returned the questionnaire at an introductory CR orientation session prior to beginning the rehabili-tative program.

Results Two regression analyses were used to separately examine the influence of the psychosocialfactors on depressive mood for men and women. Results showed that perceived stress and socialsupport accounted for significant variability in depressive symptoms among both men (R2

adj ¼ 0.50,p< 0.001) and women (R2

adj ¼ 0.49, p< 0.001). For men, being younger, having less tangible support,and reporting more stress were significantly related to depressive mood. Among women, a lack ofbelonging support and stress were significantly related to depressive mood.

Conclusions Results support previous research on the occurrence of depressive mood in cardiacpatients. However, this study highlights the importance of examining stress and different types ofsocial support in both men and women prior to attending CR. In furthering our understanding ofdepressive mood following a cardiac event, tangible support may be particularly important for menand belonging support for women.

Exploring the urinary iceberg: A systematic review of help-seeking behaviourin men with lower urinary tract symptoms

*Cartwright, M., Grunfeld, B., Weinman, J.; *King’s College London, UK

Background It has long been recognised that physical symptoms brought to the attention ofhealth care professionals represent only the tip of the illness iceberg (Last, 1963). Further, men are

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less likely to seek medical help for physical symptoms than women (Green & Pope, 1999). Lowerurinary tract symptoms (LUTS) represent an archetypal example of the illness iceberg and men’sunwillingness to seek medical help. Around 20–30% of men (�50 yrs) experience moderate to severeLUTS but 60–70% of these have never spoken to their GP about their symptoms. QoL implicationsand the sheer volume of untreated urinary symptoms in our communities make male LUTS animportant public health concern (Cartwright & Emberton, 2005).

Objective To review published studies to identify variables associated with GP help-seekingbehaviour in men with LUTS.

Methods A broad search strategy was developed and individually tailored to seven online databases(Medline, EMBASE, CINAHL, PsychINFO, Sociological Abstracts, ASSIA, AMED) coveringmedicine, nursing and the social sciences. The search was limited to English language articlesreporting quantitative data.

Results There is a general consensus among published studies (n¼ 26) that symptom variablessuch as aggregate measures of self-reported severity and perceived bother are positively associated withhelp-seeking behaviour. However, the influence of psychological variables on help-seeking has beenlargely neglected.

Conclusions To date published studies have almost universally failed to apply pertinent psychologicaltheory to this particular help-seeking context and those that have attempted to do so are conductedwithout due consideration to methodological issues. The on-going Health Matters for Men studyseeks to remedy this omission with a theory-driven analysis of men’s help-seeking behaviour inresponse to LUTS.

Leisure, coping and health: The role of social, family, school and peer relationship factors

Cassidy, T.; De Montfort University, UK

Objectives The relationship between social, family, peer and school factors, and leisure engagementwithin a transactional model of stress and health was investigated in 655 young adults.

Methods The study used a survey method with questionnaire data collection.

Results Results show that the family environment, encouragement from parents and teachers,relationships with peers and socioeconomic factors in childhood predict adult attitudes to, andengagement in, leisure. In turn leisure attitude and engagement are related to psychological distress,optimism, perceived control and social support.

Conclusions It is argued that the development of patterns of leisure attitudes and engagementin childhood need to be understood in predicting and changing adult leisure behaviours relevantto health and illness.

Resourcefulness in various psychopathological condition

*Celinski, M., Gow, K., Allen III, L.; *Psychological & Neuropsychological Services, Canada

Objectives We consider resourcefulness as separate dimension to assess, along with emotionaland personality disorders, when planning rehabilitation or therapy. Celinski and Antoniazzi’sResourcefulness for Recovery Inventory (RRI) is a 238 item self-report instrument that assessescognitive and emotional resourcefulness. The RRI is applicable to almost any health related conditionand assesses both reality specific knowledge and coping skills. We will present data on the basic

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psychometric properties of the RRI, and explore its clinical utility in several populations by comparingcommon psychopathological conditions with the dimensions of resourcefulness. We will also offersupport for our thesis that resourcefulness is distinct dimension that is worth assessing.

Methods The RRI consists of 220 face valid questions that relate to 18 bipolar scales repre-senting either health-enhancing or health-inhibiting resourcefulness factors. The RRI also assesses‘‘fundamental values’’ and contains 18 additional validity items that assess positive and negativeimage presentation. The RRI was administered to 150 patients diagnosed with burnout, PTSD,chronic pain or depression, along with the MCMI-III, BDI, BAI, MPI, RSPC and DTS.

Results The RRI has promising psychometric properties and acceptable levels of concurrent andconstruct validity. Patterns of RRI scale endorsements common to all patient groups were observed,along with others that were diagnosis specific. The existence of common RRI patterns supports thethesis that resourcefulness is at least semi-independent of diagnosed psychopathology.

Conclusion Supplementing traditional measures of psychopathology, the RRI assesses cognitiveand emotional strength that may counterbalance health-inhibiting weaknesses that in turn maybecome foci for therapeutic interventions. In this manner, the RRI is a promising new diagnosticinstrument that may aid therapy planning for a wide variety of psychopathological and physicalconditions, and therefore represents an alternative mind’s dimension applicable to achieving optimalhealth.

Psychosocial pathways mediating the relationship between family environmentand quality of life in adolescents with asthma

*Cesareo, J., French, D., Sly, P., Silburn, S.; *School of Psychology, The University of WesternAustralia, Australia

Objectives This study examines factors mediating the relationship between family environment andpsychological outcomes in children with chronic illness. Drotar (1997) noted a paucity ofresearch examining hypothesized pathways of family influence on children’s psychological adjustmentusing specific, process-oriented measures. This study undertook to describe the mediatinginfluence of a range of specific psychosocial variables including specific supportive behaviours pro-vided by family members to adolescents with asthma. Illness-specific support was expectedto mediate the relationship between family environment and quality of life (QOL) since poorlyfunctioning families would be less able to provide valuable and accessible support as defined by theadolescent.

Method Adolescents participating in the 13 yr follow-up of a longitudinal prospective study ofchildren’s health and well-being completed a semi-structured interview adapted from theDiabetes Social Support Interview (La Greca et al., 1995) to assess supportive behaviours and theKINDL to assess QOL. Adaptive family relationships were assessed using the Family AssessmentDevice.

Results Using multiple regression analyses, asthma-specific support perceived as helpful and availableby the adolescent mediated the relationship between family functioning and QOL for adolescentswith asthma. Together these variables accounted for 12.1% of the variance in QOL. Preliminaryanalyses suggest that the adolescent’s self-efficacy is also an important factor in explaining thisrelationship.

Conclusions The relationship between family environment and psychological outcomes in youngpeople with asthma is mediated by specific psychosocial factors including the ways in whichfamily members support asthma management practices. Specific comparisons suggest that thenature (e.g., tangible, emotional) and source (e.g., parents, siblings) of this support are importantin understanding the perceived value for the adolescent.

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Long versus short family focused cognitive behaviour therapy for chronic fatiguesyndrome in 11–18 year olds: A randomised controlled trial

*Chalder, T., Deary, V., Husain, K.; *Academic Department of Psychological Medicine, Guy’s,King’s & St Thomas’ School of Medicine, Weston Education Centre, London, UK

Aims Chronic fatigue syndrome (CFS) is characterised by severe disabling fatigue resulting inlong periods of time away from school accompanied by impairment in social and leisure activities.We conducted a randomised controlled trial to examine whether 13 sessions of family focusedcognitive behaviour therapy was more effective than 4 sessions in improving school attendance andreducing fatigue in adolescents with CFS.

Methods All participants were investigated by a Paediatrician prior to referral and met criteriafor CFS. Outcomes included school attendance, fatigue, social adjustment, depression, strengthsand difficulties and anxiety. Parents and adolescents completed outcome measures at dischargeand 3 and 6 months after treatment finished. An independent assessment was carried out at6 months follow up.

Results Seventy-six patients were assessed; 62 families were randomised. One dropped out of the 13session arm and 3 dropped out of the 4 session arm. There were no statistically significant differencesat baseline. Both groups had improved in terms of school attendance, fatigue and social adjustment by6 month follow up. However, the 13 session group improved more quickly and were showing markedimprovements at discharge and 3 months follow up.

Conclusion It appears that fewer sessions of CBT are as effective in the longer term as moresessions. However, given the dramatic effect of CFS on children’s lives it is important that they areenabled to return to healthy functioning as quickly as possible.

A health assessment tool for multiple risk factors for obesity:Results from a pilot study with UK adults

*Chambers, J., Swanson, V.; *University of Stirling, UK

Objectives Obesity has been described as a global epidemic by the WHO. In 2001, 59% of allUK adults were either overweight (37%) or obese (22%). Health risks of obesity are extensiveincluding heart disease, diabetes, some cancers and psychosocial problems. Although many individualhealth behaviours have been implicated in the rise in obesity, little is known about their confoundingor cumulative effects. This study aimed to develop and pilot a psychometrically-derived, comprehen-sive measure of obesity risk factors, which can be used to assess their relative importance at individualand population levels.

Methods A 100-item self-report questionnaire, completed by a convenience sample of 80 adultvolunteers across the UK (67% female, age range 19–73 years), was related to Body Mass Index(BMI). The user-friendly questionnaire was developed after an in-depth review of currently identifiedrisk factors, and was designed to be acceptable across socio-economic groups.

Results Most of the individual items correlated with BMI in the expected direction. Summaryrisk factors were calculated based on item content. Dietary factors significantly related to BMI werereporting higher amount of food consumption and more non-hunger related eating (bothp< 0.001). Whilst reported participation in physical activity/exercise was not significant, BMI wassignificantly related to negative attitudes/emotions towards ( p< 0.05) and negative social influenceson ( p< 0.01) physical activity/exercise. BMI positively correlated with more sedentary leisure pursuits(e.g., TV watching) ( p< 0.05) and lower general activity levels (e.g., more car usage) ( p< 0.01).

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The total risk factor score differentiated the obese weight group from the overweight, normal weightand low weight groups ( p< 0.001), as did a number of dietary and activity risk factors.

Conclusions Results demonstrate that an easy-to-complete, self-report tool has potential inassessing multiple dietary and activity risk factors for obesity. Future research will concentrate ondevelopment and psychometric validation of the tool in different populations.

Health goal orientations and diet: Predictions of intentions and behaviours

*Chan, C., Cameron, L.; *Department of Psychology, University of Auckland, New Zealand

Background Self-regulation theory has suggested two feedback systems in the process of selectinghealth status and attaining health goals. In particular, approach goals (motivating individualsto move towards desired states) and avoidance goals (motivating individuals to move awayfrom feared states) may have distinctive influences on the understanding of behavioural initiationand maintenance.

Objectives To investigate how approach and avoidance goals differ in predicting intentions oftaking up a healthy diet (consuming 5 servings of fruit and vegetables daily and eating a low fatdiet) and actual behaviour during the subsequent month.

Methods A sample of 211 university students and adults completed either an online or writtenquestionnaire at baseline and one month afterwards. Measures included the newly developedHealth Goal Orientations Scale, which assesses their approach and avoidance motivations forhaving 5 servings of fruit and vegetables daily and a low fat diet, diet behaviour intentions, actualdiet behaivours and self-efficacy.

Results Regression analyses showed that after controlling for self-efficacy, approach motivationpredicted greater intention for having 5 servings of fruit and vegetables a day (�¼ 0.37, p< 0.01)and low fat diet (�¼ 0.32, p< 0.05) at baseline. Furthermore, approach motivation predictedincreased intake of 5 servings of fruit and vegetables at follow up (�¼ 0.41, p< 0.05) whereasavoidance motivation predicted a decrease (�¼�0.38, p< 0.05). These results only emerged forpeople who were low consumers of such a diet at baseline.

Conclusions Promoting approach orientation may be of particular importance for healthy dietinitiation as it facilitates people’s intention and hence initiating the health behaviour. Avoidancemotivation, on the other hand, may have detrimental effects on behavioural initiation.

Post Industry out-transmission distress: occupational stressors, stress consequences,and stress management among employees of manufacturing industries in Taiwan

*Chin-Yi, C., Hsiu-Tsu, C., Lin, P.-C.; *Dept. of Business Administration, National YunlinUniversity of Science and Technology, Taiwan

Employees of the manufacturing industries have long been the major work force in Taiwan. About1.76 million employees work in the small-/medium-sized manufacturing enterprises. Recently, thefast structural transformation of the industries, i.e., the out-transmission of the industries fromTaiwan to China, accompanied by organization downsizing and outplacement, has caused greatpressure on employees. It is the purpose of this research to investigate the stressors and stress out-comes among these employees, and to explore plausible moderating/mediating intervention

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variables to solve the problem. Questionnaires were administered to manufacturing employees intwo studies. Study one consists of 370 respondents from small/medium manufacturing enterprises,and study two, 313 respondents from large manufacturing enterprises following a systematic sam-pling design.

Study 1 revealed that the major work stressors were work/family conflict, career difficulty, andnatural disasters. 14.67% of the employees were highly depressed. There were 20.33, 11.96, and14.91%, respectively, of the employees who are high on the psychological, physiological, and behav-ioral indices of stress outcomes. Workload, work/family conflict, and interpersonal relationship werethe three significant stressors that explained 0.39, 0.34, and 0.31 of each stress outcome variance.We also found that support from the top management, and individual emotional regulation mightserve as key moderators that contribute 13.2% to the stress outcomes.

In study 2, the major work stressors were economical/political, living environment, and societal pres-sure. An average of 24.9% employees rated high on work stress consequences (depression), comparingto the 5.8� 9.5% depression prevalence estimated by the WHO. Career/future uncertainty and man-agement leadership style, have exhibited statistical importance to the stress outcomes. Both of theinternal and external stressors contribute 38.3, 25.2, and 12.1%, respectively, to the three stress out-comes. It is interesting to note that the perceived external stress levels (i.e., political, economic, andliving-environment) were significantly higher than those of the internal organization stress ( p< 0.000).To conclude, employees have been distressed in Taiwan’s manufacturing workplace. Plausible stressmanagement was discussed. Finally, a theoretical stress intervention model was presented and testedthrough the SEM approach, with satisfactory fit resulted (GFI¼ 0.91; AGFI¼ 0.87; NNFI¼ 0.94;SRMR¼ 0.067).

Smoking cessation in copd outpatients: 12-month results of the smoke study

*Christenhusz, L. P., Job van der Palen, M., Seydel, E.; *Communication Studies, University ofTwente, Netherlands; Pulmonary Medicine, Medisch Spectrum Twente, The Netherlands

Objectives This study compares the effectiveness of a newly developed multi-component intensivesmoking cessation intervention, SmokeStopTherapy (SST), with a less intensive application of theDutch Minimal Intervention Strategy for Lung Patients (L-MIS).

Methods The SMOKE study is a randomised controlled multi-centre trial with one yearfollow-up. COPD outpatients (N¼ 234) willing to quit smoking were enrolled in three hospitalsand randomly allocated to SST or LMIS. SST contains 4 group sessions, 4 individual sessions,4 telephone contacts, Zyban�, and the possibility to restart the individual sessions in case ofrelapse within three months (‘recycling’). Quit rates based on intention to treat were measuredby salivary cotinine. Point prevalence abstinence rates after six months and twelve months will bepresented here.

Results After six months self-reported abstinence is 25% for LMIS and 31% for SST ( p¼ 0.29).Validated abstinence rates after six months are 17 and 22% for the LMIS and the SST respectively( p¼ 0.31). After twelve months self-reported abstinence rate is 18% for the LMIS group and 23%for the SST group ( p¼ 0.32) whereas the validated quit rates are 11 and 18% for LMIS and SSTrespectively ( p¼ 0.13).

Conclusions Although the observed differences between SST and LMIS seem clinically relevant,these appear to be non-significant. This suggests that both interventions are effective, but thatLMIS may be more cost-effective. Furthermore, salivary cotinine measurements indicate a high

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deceiving rate in COPD patients. Therefore, biochemical validation of self-reports in these trialsseems to be imperative.

A cross-cultural study of emotional awareness and negotiation behavior:Evidence from China, Taiwan, and the United States

*Chung, T., Hsieh, M.-H., Chen, C.-Y.; *Dept. of Business Administration, National YunlinUniversity of Science and Technology, Taiwan

As an increasing interest in the role of emotional intelligence (EI) on organizational behavior inthe workplace, this study explores cross-culturally validating the factor structure of an emotionalawareness measurement from management perspective in general and provides empirical evidencefor the effects of emotional awareness on negotiation behaviors. Data were collected from 341participants (middle-senior manager), including 79 from China, 172 from Taiwan, and 90 fromUSA in three phases experimental design. In phase I, self-evaluating the level of emotion awarenessthrough 16-item questionnaire regarding negotiator’s attractiveness and self/other’s problem-solvingapproach (PSA). In phase II, participants conduct a one-time, dyad bargaining exercise on threecommercial items, and a post-game survey in phase III. Exploratory factor analyses showed remark-able similarity in the four-factor structure of the emotional awareness across the three groups. The totalvariance explained ranged from 57.36% to 64.73%. Confirmatory factor analyses on the combinedsample also supported the four-factor solution (GFI¼ 0.93; AGFI¼ 0.90; NNFI¼ 0.93;RMR¼ 0.054). No mean differences were found in the three groups. The cultural inequality is evidentin the relationship patterns of EI and negotiation behaviors. Chinese has the highest PSA scoresamong the three groups. However, the correlations between emotional awareness and negotiationvariables are not significant in this sample. In the U.S. sample, emotional awareness is negativelycorrelated with self-other agreement on PSA (r¼�0.2348, p< 0.05), while in the sample fromTaiwan, emotional awareness is highly associated with both the self-other agreement on PSA andevaluations on negotiator’s attractiveness. Interpretations and implications are further discussed.

Is brochure information effective in encouraging increased risk perceptionand screening behaviour for type 2 diabetes in high-risk groups?

*Clark, M., Kritz, M.; *Department of Psychology, University of Surrey, Guildford, UK

Objectives To investigate whether brochure information on symptoms and risk factors for type 2diabetes is effective in encouraging increased risk perception and screening behaviour in high-riskgroups.

Methods One hundred and thirteen patients recruited in a G.P. surgery in Austria, aged 45–89 years,not known to have diabetes, were randomly assigned to an intervention or control group. All partic-ipants completed a questionnaire on diabetes-related risk factors, previous medical advice on diabetesrisk, perception of personal control, risk and seriousness of the illness. The intervention group thenreceived the Diabetes UK ‘‘Are YOU at risk?’’ brochure followed by further questions regardingtheir risk perception of diabetes. Both groups were asked about intention to screen and subsequentscreening behaviour was recorded.

Results Risk of developing diabetes was generally underestimated in the whole sample. Previousmedical advice on risk but not actual risk status predicted perceived risk of diabetes. The interventiongroup was more likely to subsequently screen for diabetes, than the control group. Retiredfemales were more likely to translate expressed screening intention into subsequent behaviour thanemployed males. Members of the high-risk group were more likely to change risk perceptionand the definition of their risk compared to members of the low-risk group. However, an overallunderestimation of risk remained in all groups.

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Conclusion These results will be discussed in light of the importance of psychological and behaviouralfactors in the primary prevention of type 2 diabetes in individuals at high risk, together with theimplications for practice and future research.

Parental communication of illness information with newly diagnosed childrenand survivors of childhood cancer

Clarke, S.-A.; Child and Family Research Group, Dept of Psychology, University of Sheffield,UK

Objectives To report two studies concerning parental communication with newly diagnosedchildren and survivors of childhood cancer. Parents find decisions about what to tell their childwith cancer difficult. Open communication is generally considered the best policy and most healthprofessionals encourage parents to talk openly about the illness. However, parents differ in theirviews about what to tell the child and how best to do so.

Study one

Method: In the first study, 55 parents of children (36 boys, mean age¼ 7.33 years) diagnosedwith acute lymphoblastic leukaemia (ALL) were interviewed about (i) the child’s behaviourfollowing diagnosis, (ii) their views about communication and (iii) factors influencing parents’communication.Results: Thematic analysis revealed that most children showed behavioural and mood difficultiesafter diagnosis. Older children were given more information. Parents’ perceptions of childhoodcancer were found to affect communication with their child.

Study two

Method: The second study included 39 parents of survivors of retinoblastoma (Rb) (23 boys, meanage¼ 10.26). Parents were interviewed about communication of illness related information, futurehealth, and factors influencing decisions to inform their child.Results: Thematic analysis revealed that although most children were informed about diagnosis andtreatment, parents were less likely to disclose late effects including the possibility of secondary canceror genetic risk.

Conclusions Findings may be used to inform training packages in order to facilitate improvedcommunication amongst health professionals. Parents may benefit from learning about the benefitsof open communication and risks associated with withholding information. This includes informingchildren at diagnosis about their disease and treatment as well as establishing a supportive andopen environment, which facilitates further discussion of health and late effects during the survivalperiod. This will equip survivors to make informed decisions regarding their own health and medicalcare later on.

Cluster analysis in illness perceptions research: A Monte Carlo study to identifythe most appropriate method

*Clatworthy, J., Hankins, M., Buick, D., Weinman, J., Horne, R.; *Centre for Health Care Research,University of Brighton, UK

Objectives To conduct a Monte Carlo study to determine which of the many available cluster analysismethods is the most appropriate for use with illness perceptions data.

Methods Four hundred and twenty artificial datasets with a predetermined cluster structure weregenerated to resemble Revised Illness Perception Questionnaire data. Sample size (small n¼ 42,

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medium n¼ 126, large n¼ 378) and equality in the size of the three clusters (equal¼ 1 : 1 : 1,unequal¼ 1 : 2 : 4) were manipulated. Average Linkage, Complete Linkage, Ward’s method andK-means (using the number of clusters and the cluster centroids derived from Ward’s method)were applied to the artificial datasets and the percentage of cases correctly classified in each datasetby each method was recorded.

Results A 4� 3� 2 ANOVA revealed that K-means correctly classified a greater percentageof cases than the other cluster analysis C(F(2.08, 862.70)¼ 203.01, p< 0.001). Sample size did notsignificantly affect the cluster recovery of K-means method (F(2, 417)¼ 3.86, p> 0.01). Whilethe performance of K-means was adversely affected by the unequal cluster size condition, it stillperformed as well or better than the other methods.

Conclusions K-means cluster analysis is the most appropriate method for use in illness perceptionsresearch. It is an acceptable method for use in samples as small as 42 cases. It is likely that theseresults are generalisable to cluster analysis in other similar types of health psychology data.

The personality profile of exercise dependents: A cross-sectional study

*Clementi, C., Grandi, S., Tossani, E.; *University of Bologna, Italy

Background Although efforts to understand the associations among exercise dependence, personalityfactors, and disordered eating have been the focus of much debate, research has been plagued byinconsistent findings.

Objectives To explore the concept of exercise dependence, its related eating pattern and personalityprofiles, according to the Cloninger’s biosocial model of personality.

Methods A cross-sectional study was carry out with 188 (F¼ 107, M¼ 81, mean age¼ 30.40;SD¼ 8.15) habitual exercisers divided in two different groups: exercise dependent (n¼ 40) andno-exercise dependent (n¼ 148). Questionnaire assessment, using validated tools, was undertakenof eating behaviour (EDI-2), exercise beliefs and behaviours (EDQ), temperament and characterfactors (TCI).

Results Exercise dependent group scored significantly highter in EDI-2 total score and in 8 of its11 subscales (weight and diet concern, drive for thinness, perfectionism, interpersonal distress,enteroceptive awareness, ascetism, impulse regulation and social insecurity), showing greatersymptoms of eating disturbance than controls. Furthermore, in the TCI character scales, exercisedependents reported significantly highter level of immaturity and lower cooperativeness than controls;whereas in the temperament scales they scored significantly lower than no-exercise dependents onreward dependence (linked with noradrenaline system).

Conclusions The self-focussed attitude and disinterest toward others reported in exercise dependentgroup, seem to be related to their higher level of immaturity, insecurity and concern about theirbody and weight. These are only preliminary findings. Further studies are needed to better clarifythese personality patterns.

Evaluation of a patient-centred, pharmacist-delivered intervention to improve patients’adherence to medication

*Clifford, S., Barber, N., Elliott, R., Hartley, E., Horne, R.; *School of Pharmacy, University ofLondon, UK

Objectives To assess the effects of a patient-centred, pharmacist-delivered adherence supportservice for patients starting a new medication for a chronic condition.

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Methods The intervention was developed using a theoretical (necessity-concerns framework)and pragmatic approach. A randomised-controlled trial was used to evaluate the effect ofthe intervention on self-reported adherence, medication-related problems and beliefs aboutmedicines. Patients were eligible if they were collecting a prescription for a new medicationand were aged 75 or over, or suffered from stroke, cardiovascular disease, asthma, diabetesor rheumatoid arthritis. Two community pharmacists delivered the intervention, via telephone,two weeks after patients started their new medication. Follow-up was at 4 weeks via semi-structured telephone interview and postal questionnaire. An expert panel assessed 100 cases toestablish the safety and usefulness of the advice given. Patients’ perspectives of the interventionwere sought.

Results Five hundred patients were recruited. Of those still prescribed their medication at 4-weekfollow-up, non-adherence was significantly less frequent in the intervention (9%) compared to thecontrol group (16%). Number of patients with medication-related problems was also significantlylower in the intervention (23%) compared to the control group (34%). The median scores onthe ‘‘necessity-concerns differential’’ showed that the intervention group was more likely tobelieve that the necessity of the medicine outweighed their concerns about taking it ( p¼ 0.007).Experts rated 55 of the 100 cases reviewed as ‘‘helpful’’; 32 were classed as ‘‘uncertain’’and 13 ‘‘unlikely to be helpful’’. The majority of patients (77%) rated the intervention as useful;the rest expressed neutral views.

Conclusions It appears that community pharmacists can have a positive impact on patient outcomes,including adherence to new medication for a chronic condition.

Mental health following bereavement of spouse in later life:The influence of strength of spiritual belief

*Coleman, P., McKiernan, F., Mills, M., Speck, P.; *School of Psychology, University ofSouthampton, Southampton, England, UK

Objectives In a series of studies in the south of England we have been investigating the influenceof religious and spiritual belief on coping with the social and health crises and losses of later life.In the present study we aimed to explore the role of spiritual belief in adaptation to bereavementof spouse.

Methods We interviewed in depth 28 older bereaved spouses on three occasions during the secondyear after their loss. Assessments were also made of mental health indicators as depressive symptoms,and included the Royal Free Interview for Spiritual and Religious Beliefs and the SouthamptonReligious History questionnaire.

Results Our sample demonstrated a large variation in spiritual belief and religious practicefrom strong confidence in a transcendent power to an atheistic philosophy of life. A strikingcurvilinear relationship linking mental health indicators with strength of belief was evident inthe data. Depressive symptoms and a low sense of personal meaning were concentrated in thoseof weak to moderate belief. Investigation of their religious histories strongly suggest that inmost cases uncertain belief predated rather than succeeded the onset of depression. By meansof case analysis we have also investigated the antecedents of insecure faith in social and familybackground.

Conclusions The study has drawn attention for the need of further research into the origins andconsequences of insecure belief. There are also clear implications for improving pastoral ministryand religious education with older people.

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The need for risk or variety? Relationships between sensation seeking,risk perception, high risk sports and behaviours

*Cook, E., Pattison, H.; *Aston University, Birmingham, UK

Objectives To investigate relationships between sensation seeking and risk perception and highrisk sports participation and non-sports high risk behaviours.

Methods A sample of 80 undergraduate students was recruited from 8 university sports clubs(dance, netball, football, basketball, hockey, kayaking, climbing and skiing). For the purposes ofanalysis participants were divided into 3 groups, those who took part in high risk sports only(n¼ 12), low risk sports only (n¼ 39) or both (n¼ 29). They completed self-report questionnaireson: past risky behaviours; perceptions of the risk of a range of activities; risk taking in hypotheticalsituations. They also completed the Arnett Inventory of Sensation Seeking.

Results An ANOVA suggested that sensation seeking was highest in those who participated inboth high and low risk sports rather than high risk sports alone, though this failed to reach significance(F(2, 77)¼ 2.76, p¼ 0.070). A 2 way ANOVA showed a significant main effect of sensation seeking(high or low) on actual risk behaviour (F(1, 74)¼ 4.86, p< 0.05), but no main effect of sports groupand no interaction. Regression analyses showed that high sensation seeking and decreased riskperception independently predicted increased actual risky behaviours (F(2, 75)¼ 15.89, p< 0.01,Adjusted r2¼ 0.28) and hypothetical risk behaviour (F(2, 75)¼ 7.63, p< 0.01, Adjusted r2¼ 0.15).

Conclusions Previous research has investigated sensation seeking and risk perception in relationto sports participation or high risk behaviours, but rarely investigated both in the same group.This study suggests that sensation seekers may not seek risk per se, but variety in activities, whichthey perceive as less risky than others do, though the direction of these effects cannot be ascertainedwithout further research.

What do people think about when they answer Theory of Planned Behaviour questionnaires?A ‘‘think aloud’’ study

*Cooke, R., French, D., Williams, M., Sutton, S.; *Aston University, UK

Background Ajzen’s (1991) theory of planned behaviour (TPB) is a popular framework for predictingand explaining health behaviours. Ajzen has developed detailed guidelines on the development andimplementation of a TPB questionnaire, which can be readily applied to most health behaviourcontexts. However, limited consideration has been given to the clarity or understandability of theitems generated following Ajzen’s recommendations. The present research used a questionnairedesigned following Ajzen’s guidelines, which focused on binge-drinking behaviour, to address twoconcerns. First, how well do participants understand how to answer TPB questions? Second, areparticipants drawing on the information that researchers think they should be when answeringthese questions?

Methods Twelve participants (7 females, 5 males, aged 18–26) were asked to ‘‘think aloud’’ i.e.,to say everything they were thinking, while they completed a TPB questionnaire designed to measurebinge-drinking behaviour. Data was tape-recorded, transcribed and coded.

Results In general, participants found completing the questionnaire straightforward, and there werefew problems with clarity or understanding. However, some problems with comprehension ofquestions, retrieval of appropriate information, and formatting of responses were identified.In particular, the normative measures (normative beliefs, motivation to comply, subjective norm)yielded many more problems than the other items ( p< 0.001).

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Conclusions A TPB questionnaire designed to measure binge-drinking cognitions was generallyrated as clear and understandable. This supports the use of TPB questionnaires designed followingAjzen’s guidelines. However, the study highlights some issues to do with clarity and understandabilitywhen considering the normative measures. Suggestions for how these measures might be improvedare made.

Testing the impact of social influences on binge-drinking behaviour: An application of thetheory of planned behaviour

*Cooke, R., Cheek, M., Nash, V., McGullion, A., French, D.; *Aston University, Birmimgham,UK

Objectives To examine the utility of the Theory of Planned Behaviour (TPB), augmented bydescriptive norms, in predicting binge-drinking intentions and behaviour.

Method Data were collected from 197 undergraduates (96 males; 101 females) in a University bar,concerning binge-drinking that evening, defined as consuming more than 7 (women) or 10.5 (men)units of alcohol. At the start of the evening, participants completed measures of attitudes, subjectivenorms, PBC, intentions and descriptive norms regarding binge-drinking during the evening ahead.At the end of the evening, participants reported the number of units of alcohol they had consumed.

Results A three step hierarchical regression was used to predict intentions to binge-drink. On thefinal step, the equation accounted for 67% of the variance in intentions, with significantbeta values for gender (�¼ 0.13, p¼ 0.005), affective attitudes (�¼ 0.34, p¼ 0.001), subjectivenorms (�¼ 0.15, p¼ 0.003), PBC (�¼ 0.14), and descriptive norms (�¼ 0.39, p¼ 0.001). A fourstep logistic regression was used to classify participants as either binge-drinkers or non-binge-drinkers.On the final step, 83% of participants had been correctly classified, with significant Wald valuesfor intention (Wald¼ 26.23, p¼ 0.001) and subjective norms (Wald¼ 5.61, p¼ 0.03).

Conclusions The present study broadly supports the utility of the TPB, because attitudes, subjectivenorms and PBC predicted intentions, and intentions predicted behaviour. In addition, the presentstudy found that (i) subjective norms directly predicted behaviour and (ii) descriptive norms predictedintentions. Thus, normative influences are important in predicting binge-drinking intentions andbehaviour when measures are collected in a drinking context. Attempts to reduce binge-drinkingmight focus on altering perceptions of peer approval for binge-drinking.

Exploring perceptions of fMRI: Some quantitative findings

*Cooke, R., Peel, E., Senior, C., Shaw, R.; *Aston University, Birmingham, UK

Objectives To explore participants’ attitudes and perceptions about functional magnetic resonanceimaging (fMRI); a neuroimaging procedure that is increasingly being used in clinical health settings.

Method Data were collected from 21 undergraduates (9 males, 12 females) after participation in anfMRI study, which involved responding to stimuli while being inside an fMRI scanner. Participantscompleted measures of their views about the procedure, reported any side effects they experienced,and reported their attitudes, perceptions of control, and intentions regarding future studiesinvolving fMRI.

Results Overall, participants reported satisfaction with fMRI procedures; all participants describedfMRI as safe and 95% would recommend fMRI studies to friends and family. However, 38% ofparticipants reported being upset by the noise produced by the scanner, and 43% of participantsreported being uncomfortable at being in a confined space. In terms of emotion, 81% of participants

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said that they were not nervous before entering the scanner, whilst 43% of participants said thatthey were not calm. 19% of participants indicated having a headache after being in the scanner.Participants reported positive attitudes towards scanning, high levels of control over taking partin future research, and positive intentions to participate in future fMRI research.

Conclusions The present study indicates that participants find fMRI procedures safe, see theprocedure as both positive and under their control, and would take part in future research usingfMRI. The study also shows that some participants report headaches after fMRI, and suggests thatparticipants’ emotional experiences lie somewhere between feeling calm and feeling nervous.Future research is needed with larger samples, particularly as fMRI procedures become morecommon in health psychology research.

Impact of Colorectal cancer on patient and family: Implications for care

*Cotrim, H., da Graca Pereira, M.; *ESSEM, Portugal

Objectives Impact of colorectal cancer in terms of: Quality of Life, psychological morbility,marital satisfaction, body image, sexual satisfaction and family burden.

Methods Fifty-five colorectal cancer patients who had underwent surgery for colorectal cancer andtheir caregivers participated in the study. Patients filled out the quality-of-life questionnairesbetween 6 and 8 months after surgery. The instruments for Patients were: EORTC QLQ – CR 30and 38; Index of Marital Satisfaction (Hudson, 1992); Index of Sexual Satisfaction (Hudson,1992); Body Image Scale (Hopwood et al., 2001); Hospital Anxiety and Depression Scale(Zigmond & Snaith, 1983); For caregivers: Caregiver Reaction Assessment Scale (Given et al.,1992); State-Trait Anxiety Inventory (Bieling, Anthony, & Swinson, 1998); Beck DepressionInventory (Beck, Steer, & Brown, 1996).

Results A positive correlation between marital satisfaction and sexual satisfaction was found inboth ostomized and non-ostomized patients. There were no significant differences between bodyimage and marital or sexual satisfaction indexes in both groups. Ostomized patients report lowersexual satisfaction, lower body image and poorer quality of life. They also have higher psychologicalmorbidity (anxiety and depression) when compared with non-ostomized patients. We also founda positive correlation between caregiver burden and psychological morbility.

Discussion of Results and implications for care with colorectal cancer patients in particular the needto inform and establish a good patient-medical provider relationship is emphasized.

From research to practice the development of a psychological servicefor individuals diagnosed with an iatrogenic Hepatitis C infection

Coughlan, B.; School of Nursing and Midwifery, University College Dublin, Ireland

Following the Irish Blood Transfusion Service Board’s 1994 ‘look back’ screening programme,over 1,000 Irish women presented with Hepatitis C Virus (HCV) antibodies and over one third ofthese women were found to have chronic HCV infection having received contaminated anti-Dimmunoglobulin in the later 1970’s and early 1990’s. A series of studies carried out at a LiverCentre in a large teaching hospital in Dublin, suggested that women diagnosed with an iatrogenicchronic HCV infection experienced many psychosocial difficulties in adjusting to their illness.These adjustment problems though specific to the impact of iatrogenically acquired HCV infectionconcur with those identified world-wide, such that chronic HCV infection carries a physical,psychological and social burden. Each study completed at the Liver Centre was designed to

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achieve a particular aim or answer a specific question. One study question was addressed using Moosand Schaefer’s (1984) model of coping with the crisis of illness as the conceptual frame. Thepsychosocial factors which were identified in a new model of adjustment to an iatrogenic HCVinfection included, positive appraisals, ability to work, negative behaviour, mother role, feelings ofanger and blame, experiences of stigma, pain and fatigue. In light of these findings a psychological/educational programme was developed and when evaluated participation was perceived as a positiveexperience, associated with improvements in physical functioning and psychological well-being. As aconsequence of these research findings and of those reported internationally, a psychologicalservice was established at the Liver Centre to assist in the delivery of a biopsychosocial model ofcare. This service is ongoing and is achieved through the provision of clinical assessment, briefintervention and counselling, facilitation of psychological/educational workshops and referral toother service providers.

Coping with breast cancer in cyberspace: Understanding the role of the online support group

*Coulson, N., Walker, A.; *Department of Psychology, University of Derby, UK

Objectives To understand how online support groups affect the experience of coping withbreast cancer.

Methods Two online support groups were identified for the purposes of the study and 500 messagesposted during the study period [June–July, 2004] were selected from each. Thematic analysis wasthen performed on each posted message.

Results The analysis suggests that the primary function of the online support groups was theprovision and receipt of social support, notably informational and emotional support. Other functionsof the groups were to assist patients adjust to the diagnosis of breast cancer, develop copingstrategies, undertake treatment decisions, deal with the medical challenges of breast cancer as wellas the shorter and longer term consequences of the disease.

Conclusions It was evident from the analysis that the online support groups addressed a range ofpractical as well as psycho-social needs, notably social support. Participants appeared to benefitfrom the vitality and utility of the interactions, however, potential negative aspects of the onlinesupport group were also recognised. Nevertheless, it is our contention that online support groupsprovide a unique opportunity for health professionals to learn about the experiences and views ofpatients and other interested persons and explore where and why gaps may exist between evidence-based medicine and consumer behaviour and expectations. Undertaking this type of research mayreveal a range of valuable data which may be useful in informing priorities for research as well aspatient care.

‘‘You’ve taken something really good and made it, you know, monstrous’’:Lay negotiations of the permissibility of pre-implantation genetic diagnosis

*Coyle, A., Walton, C.; *University of Surrey, UK

Over recent years, the possibility that embryos may be purposefully selected for implantation onthe basis of the presence or absence of some desirable or undesirable trait has entered into publicawareness. The complex ethical and legal issues surrounding Preimplantation Genetic Diagnosis(PGD), and the associated technology of Human Leukocyte Antigen (HLA) typing – ‘tissuetyping’ – have been debated at length within the Human Fertilisation and Embryology Authority,in the British High Court and in the UK media. Specifically, PGD and HLA were brought topublic attention by the desire of two British families to use the technologies to ensure that children,

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born through Assisted Reproductive Technologies, would be able to act as donors to their ill oldersiblings. Both cases were often represented in the British press as resulting in ‘saviour siblings’ or‘designer babies’. This paper draws upon data collected from focus group discussions on the topicof health-related new genetic technologies with members of the UK general public and adopts a dis-course analytic approach. The paper provides an overview of the diverse range of discursive resourcesdrawn upon by members of the British public in constructions of PGD and in negotiations of itspermissibility and value. Through the detailed analysis of a single excerpt, the paper demonstrateshow these diverse resources are brought to bear in lay negotiations of complex ethical dilemmas.

Improving the reporting of couples interventions in health psychology: Some data and a plea

Coyne, J.; Abramson Cancer Center of the University of Pennsylvania, Philadelphia, USA

Objectives Evaluate the quality of reporting of randomized controlled trials (RCTs) of couplesand spousal interventions in cancer and cardiovascular disease, using the Consolidated Standardsof Reporting Trials (CONSORT) modified for behavioral and psychosocial interventions.

Methods Systematic Review of the literature starting with MEDLINE, ISI Web of Science, Psycinfo,and CINAHL, followed by searches of the bibliographies of relevant papers and email and telephonecontacts with investigators active in the field. Abstracts of candidate papers were reviewed, anda final subset was selected for ratings, with the criteria being inclusion of spouses in a randomizedcontrol trial. Three raters trained to reliable consensus evaluated these papers using standardCONSORT items plus four items tailored to behavioral and psychosocial interventions.

Results Overall ratings of reports of couples and spousal interventions were low. Most studies lackedadequate description of the flow of patients from initial contact to enrollment and completion ofthe trial; any indication how sample size was determined; or intent to treat analysis. Analyses andinterpretations of data tended to favor alternative endpoints and secondary analyses where primaryanalyses did not support the investigators’ hypotheses.

Conclusions The conduct of RCTs with couples and spouses is difficult, compared to with individualpatients. This could be expected to be reflected in reporting of RCTs. However, available papersare on the whole seriously deficient in other respects. These deficiencies limit independent evaluationof what is done in clinical trials, the results obtained, and the appropriate range of situations to whichthese results can be generalized. CONSORT need to be more widely disseminated among couplesresearchers and the special technical knowledge concerning the design, conduct, and reportingof RCTs should become more integral to the training of health psychologists.

Maternal anxiety following newborn hearing screening: The moderating role of knowledge

Crockett, R.; Section of Health Psychology, King’s College London, UK

Objectives To describe the impact upon maternal anxiety of newborn hearing screening and examinethe possible moderating role of knowledge.

Methods Questionnaires assessing maternal state anxiety, worry and certainty about the baby’s hear-ing, and knowledge about screening, were sent to four groups of mothers three weeks after screening:Group 1: mothers whose babies had clear responses on a first or second screening test (n¼ 103);Group 2: mothers whose babies had clear responses on the final screening test (n¼ 81); Group 3:mothers whose babies did not have clear responses in one ear at the final screening test and werereferred for audiological assessment (n¼ 105); Group 4: mothers whose babies did not have clearresponses in either ear at the final hearing test and were referred for audiological assessment (n¼ 55).

Results Although mean anxiety levels were in the normal range, there was a significant trend foranxiety to rise as testing increased (F(3, 327)¼ 4.280, p< 0.05). Worry (F(3, 34)¼ 25.282,

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p< 0.001) and uncertainty (F(3, 347)¼ 9.738, p¼ 0.001) were significantly raised as the number oftests increased. Although total knowledge did not have a significant moderating effect on anxiety(R2

¼ 0.016, p¼ 0.096), there was a significant interaction between mothers’ Group and one knowl-edge item, understanding that the receipt of no clear responses was unlikely to mean that the baby hada hearing loss: mothers in Group 4 who understood this had lower anxiety (F(3, 323)¼ 4.791,p¼ 0.01) and lower worry (F(3, 332)¼ 3.565, p< 0.01) compared with those who did not.

Conclusions Knowledge about the meaning of being recalled following screening may avert someof the adverse psychological effects of being recalled.

The effects of work rumination on self-reported sleep time and sleep qualityin a sample of Italian workers

*Cropley, M., Pravettoni, G.; *Department of Psychology, University of Surrey, Guildford, Surrey,UK

Background Sleep is one of the most important recovery mechanisms available to humans, allowingfor recovery from daily strains, and therefore a prerequisite for optimal daily functioning and health.Some workers report disturbed sleep and attribute this to them experiencing unwanted, ruminativethoughts and concerns about work-related issues. In the present study, we assessed the effectsof work rumination, that is, difficulty switching-off from work-related thoughts during leisure time,on total sleep time and perceptions of sleep quality in a group of high and low ruminators.

Participants Italian workers (N¼ 317) completed a short structured diary about their work-relatedthoughts over the evening and sleep, everyday over a period of 7 days. Participants were classifiedas being high/low ruminators by tertile split based on their average weekday rumination score.

Results For self-reported total sleep time, there was a significant effect of Time (F(6, 191)¼ 50.0,p< 0.001), but there was no significant main effect of Group or Group�Time interaction. Plannedcomparisons revealed that was no difference in reported sleep time between Monday and Thursdaynight, but all individuals reported sleeping more on Friday night and Saturday night, comparedto midweek. Individual also reported sleeping less on Sunday night in comparison to Friday andSaturday nights. The analysis of sleep quality revealed a significant main effect of Group(F(6, 189)¼ 25.8, p< 0.001), and a significant Group�Time interaction (F(6, 189)¼ 4.5,p< 0.05), but there was no significant main effect of Time (F(6, 189)¼ 0.3, n.s.). Planned compari-sons revealed that there was no significant difference in perceived sleep quality over the 7 days inthe low ruminators. High ruminators however reported better sleep quality for Friday and Saturdaynight compared to their mid week sleep. Sleep quality Sunday night was rated lower in comparisonto Friday and Saturday night, but there was no difference between Sunday night and mid weekratings.

Conclusion High and low ruminators did not differ in their self-reported sleep time across the week,but high ruminators report poorer sleep relative to low ruminators. Thus, despite getting a similaramount of sleep, high ruminators nevertheless experience less rewarding sleep. These findings mayhave implications for how we assess and manage sleep disturbance in stressed workers.

Discrepancy between real and ideal body image considering age and gender:Does it affect body-dysmorphic disorder symptoms? A population-based survey

*Daig, I., Albani, C., Brahler, E.; *Charite – Universitatsmedizin Berlin, Germany

Objective The aim of this study was to examine the overlap between differences in body imagevariables, such as physical vitality or dismissive body appraisal and symptoms of body dysmorphic

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disorder (BDD). In many cases the ideal body image differs from the real body image of a person.Does this discrepancy affect symptoms of body dysmorphic disorder?

Method Two thousand five hundred and fifty-two persons aged 16 to 99 years participated ina nationwide survey. Participants were analysed in terms of their ideal and real physical vitality anddismissive body appraisal. Furthermore symptoms of BDD as a category of constitutional healthas well as age and gender were measured.

Results The score of the ideal body image was higher than the real one. Men reported higherphysical vitality in the ideal and real body image whereas women reported more dismissivebody appraisal in their ideal and real body image. The ideal and real body image differedsignificantly in both sexes. Younger participants reported a better physical vitality than older partici-pants. Regarding the dismissive body appraisal no age-group differences were found. Moreover,participants who showed a high difference between ideal and real body image reported anincreased occurrence of BDD symptoms. In most cases these effects were moderated neitherby gender nor age.

Conclusions This is the largest survey investigating prevalence rates for the discrepancy in ideal andreal body image and associated problems, such as BDD, to date. Age- and gender-specific differencesin body experience are discussed against the background of cultural standards of western society and interms of internalised social norms.

Instrumental and affective beliefs about walking in the general population:A theory of planned behaviour belief elicitation study

*Darker, C., Longdon, S., Morris, K., Eves, F., French, P.; *University of Birmingham, UK

Objectives To elicit salient beliefs about walking, for an average of 30 minutes per day, with the aimof investigating the affective/instrumental distinction in relation to beliefs and attitudes towardswalking. To investigate potential biasing effects, due to the ordering of Theory of planned behaviourbelief elicitation questions.

Method Quota sampling (N¼ 180) was employed to obtain a sample that was broadly representativeof the UK general population in terms of age and gender. Participants were required to respondto open-ended questions to elicit their salient beliefs about walking, as well as closed questions.The order of the open-ended questions, attitudes; subjective norm and perceived behavioural control,were varied within the questionnaire.

Results The most common positive behavioural beliefs that were elicited concerned cardiovascular/health benefits; stress relief; fresh air/weather; fitness; scenery; weight loss and transport. Negativebehavioural beliefs elicited concerned inclement weather; time; unpleasant environment;injury/illness; tiring; and boredom. The affective/instrumental attitude distinction was upheld formost of the positive and negative behavioural beliefs; questions about affective aspects of walking(like/enjoy; dislike/hate) elicited different beliefs than instrumental (advantages/disadvantages).However, the closed measures of attitudes provided no evidence of this distinction. The TPBtraditional constructs of attitude, subjective norm and perceived behavioural control showed littleinfluence from construct order manipulation.

Conclusion This first ever belief elicitation study about walking, has shown that beliefs about freshair/weather and stress relief are associated with attitudes to walking. We found less clear evidenceof the affective/instrumental distinction for walking than previous research within the physical activitydomain has suggested. There was little evidence that the beliefs elicited were biased to any great extentby the ordering of the constructs presented within the questionnaire.

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Increasing uptake of the MMR vaccine: Development and evaluation ofa theory-based intervention

*Davies, A., Michie, S.; *Department of Psychology, University College London, UK

Objectives To increase uptake of the vaccination against measles, mumps and rubella (combinedMMR), using a psychological theory-based intervention.

Methods Design Randomised controlled trial, with five month follow-up. The Intervention Theintervention was based on the Elaboration Likelihood Model to encourage deep (central route)processing, in order to elicit stable, resistant attitude change, and on Self Regulation Theory toencourage specific planning of desired behaviour. The intervention took the form of a quiz andaction plan. Sample Parents of all babies reaching nine months within a London borough over asix-week period were eligible. Data on parental ethnicity, number of previous children and vaccinationhistory were available for all parents, allowing representativeness of sample to be assessed.Procedure Parents were invited to take part by letter and randomised into control and interventionsgroups following consent. All participants completed three questionnaires at three time points duringa five month period: at nine months, at eleven months, and as soon as possible after the vaccinationappointment date (between 12 and 15 months). The first questionnaire requested demographicinformation, vaccination history, attitudes and intentions. The second questionnaire consisted ofthe quiz (intervention only) and questions about attitudes and intentions, and asked those indicatinga high intention to vaccinate to create an action plan. After the vaccination appointment date, parentscompleted another questionnaire about their attitudes and vaccination behaviour. Actual vaccinationbehaviour was drawn from the community child-health database. Randomisation was conductedindependently of the research group.

Results Data will be analysed and available by August 2005.

Conclusions The results of this study will be discussed in light of both intervention developmentand its underpinning theories.

Person-organization fit: Value congruence and the impact on global job satisfactionand psychological well-being

*De Clercq, S., Fontaine, J.; *Ghent University, Belgium

This study, part of an extended study on the influence of value congruence on a variety of organiza-tional outcomes, was carried out in 27 organizations in Flanders, Belgium. The main objective ofthis research is to investigate the influence of work and organizational values and the congruencebetween work values and organizational values on psychological well-being and job satisfaction.In total, 695 respondents completed the Values and Organizational Culture Scale (De Clercq &Fontaine, 2004), an adapted version of the Schwartz Value Survey (Schwartz, 1992), the GeneralHealth Questionnaire GHQ-12 (Koeter & Ormel, 1991) and the Global Job Satisfaction scale(Warr, Cook, & Wall, 1979). Linear regression analysis shows significant main effects of workand organizational values on global job satisfaction; and significant main effects of work values onpsychological well-being. Value congruence was measured for 3 factors. Given the limitations oftraditional congruence measures we used analytical procedures recommended by Edwards (1994,2002). Results of the polynomial regression analyses with job satisfaction and psychologicalwell-being as dependent variables show significant linear effects for work-organizational value congru-ence. Congruence for the first factor (self-enhancement versus self-transcendence) has significantinfluence on job satisfaction and psychological well-being. Congruence for the second factor(openness to change versus conservation) has significant influence on job satisfaction. Congruence

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for the third factor (focus on productivity versus no focus on productivity) has significant influence onboth job satisfaction and psychological well-being. This study underlines the importance of supple-mentary person-organization fit and value congruence for job satisfaction and psychologicalwell-being. Traditional limitations concerning commensurate measurement are avoided using factorscores as a base for polynomial regression analysis (De Clercq & Fontaine, 2005, manuscript inpreparation). The moderate effects of value congruence on psychological well-being need furtherinvestigation with different methods of measurement.

Fear of negative consequences and self evaluative emotions in relation to smokers’ quit attempts

*de Groot, C., Dijkstra, A.; *University of Groningen, The Netherlands

This study examines which factors motivate behavior change in people who engage in a healthrisk behavior. Until now the fear of the negative consequences of the behavior has been viewedas central in the motivation to change. In the present study we propose a second negative affectivestate that might motivate change, self-evaluative emotions such as shame and regret. The questionis whether experiencing self evaluative emotions is a better predictor of actual quitting attemptsamong smokers than fear of the negative consequences alone. A total of 432 smokers filled in aquestionnaire which assessed their fear of the negative consequences of smoking and how oftenthey felt emotions as shame and regret in relation to their smoking behavior. A follow up question-naire measured whether these smokers actually tried to quit smoking. As the regression analysesshowed, consistent with our expectations, the stronger smokers experienced negative self evaluativeemotions at T1, the more often they tried to quit smoking, as reported after nine months. Theseresults were even found when controlled for fear of the negative consequences of smoking. Alsoconsistent with our expectations was that the fear of the negative consequences at T1 predictedquitting activity at T2. However, after controlling for self-evaluative emotions, fear no longer pre-dicted quitting significantly. Apparently people do not simply change their behavior because theyfear the negative consequences. It seems that these negative consequences contribute to the percep-tion of a decreased self-integrity and lowered adequacy and coherency of the self, which is experi-enced as self-evaluative emotions. Thus, only if people evaluate their health risk behavior asdiscrepant with a perception of themselves as consistent and adaptive, people will eventuallychange their behavior.

The development of the self-regulation skills scale

*De Gucht, V., Maes, S.; *Clinical, Health & Medical Psychology, Leiden University,The Netherlands

Objective To measure self-regulation skills, which relate to physical health and illness.

Method Based on a review on self-regulation assessment in physical health and illness, 14 differentrelevant self-regulation skills were identified. On the basis of these 14 dimensions a self-reportquestionnaire was developed. The factor structure of the scale was first explored in a healthypopulation sample (N¼ 161) by means of principal component analysis.

Results Nine highly reliable factors related to health behaviour pursuit emerged: goal commitment(�¼ 0.96); goal efficacy (�¼ 0.98); social comparison (�¼ 0.91); goal communicative actions(�¼ 0.93); self-criticism (�¼ 0.95); self-determination (�¼ 0.86); self-reward (�¼ 0.95); emotioncontrol (�¼ 0.95) and coping with problems (�¼ 0.92). On the basis of this analysis a new scalewas constructed and subsequently administered to 50 CHD-patients in order to explore whetherpatients with better self-regulation skills are more successful in disease-related life-style changes

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than patients with less developed self-regulation skills. The results of this study will also be reportedand discussed.

Conclusions A theory based self-regulation skills questionnaire was developed, which can be usedto evaluate health behaviour pursuit in healthy populations and self-management in diseasedpopulations.

Self-esteem among Portuguese patients of health-care centres: The methodological questionabout the score’s inversion in the answers to negative items

*de Lourdes de Vasconcelos, M., Fonseca, M., Santos, R., Tap, P.; *European Research Centre intoConducts and Institutions, Fundacao Bissaya-Barreto, Portugal

The main aim of the present paper is to analyze the methodological question about the score’sinversion of the answers to negative items on a scale of self-esteem. Previous findings highlightto the fact that answers to negative items, when the score is inverted, produce independentfactors. This suggests that peoples’ reaction to negative items is different from the one to the sameitems formulated in a positive way. This study is part of a research on ‘‘Health, hardship and psycho-social vulnerability’’, which emerged from a preliminary international study, recently published.Since we intended to analyze the effects of precariousness in physical and psychological health,self-esteem appears as a fundamental variable. A total of 448 participants were interviewed in fourteenhealth-care centres of the Central Region of Portugal, in order to compare people living underprecarious socio-economic conditions (N¼ 201) with another group not affected by those difficulties.This comparison comprises dimensions as diverse as stress, self-esteem, feelings of social integration,values, subjective and objective health (doctors were also interviewed). To evaluate self-esteem,the scale used resulted from the adaptation of Tap and Vasconcelos (2004) to the ‘‘Scale of self-esteem from Toulouse’’ (Oubrayrie et al., 1994). The present scale is constituted by ten items: fiveof them of negative sense. In relation to the methodological question about how to deal with thesenegative items, our option was not to inverse the answers’ score. The variance analysis found twofactors: one positive (self confidence and self valorisation) and another negative (self depreciation), thelast composed by the five negative items. The separate study of positive and negative factors allowsthe knowledge and the understanding of the difficulties felt by individual.

E-health promotion: The state of the art and implications for future program development,implementation and evaluation

*de Nooijer, J.; *Department of Health Education and Promotion, Universiteit Maastricht,Maastricht, The Netherlands

Objectives Although Internet belongs to the most promising communication channels today, nosystematic overview of the applications and effectiveness of health promotion interventions throughInternet is currently available. This study was conducted to obtain insight into the applicationsand the effectiveness of interventions to promote health via Internet and to identify factors thatinhibit or enhance the effects of such interventions.

Methods Data were collected by means of a systematic review of the literature and interviewswith experts. We searched in Central, PubMed, Web of Science and PsychInfo from 1995 tillOctober 2004. Experts were invited to complete an e-mail questionnaire with open-ended questionsabout their opinion on future interventions via Internet.

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Results Of the approximately 4,000 titles that were selected from the databases, nine studies wereincluded in the systematic review. These studies addressed various health behaviors and the resultswere not consistently in favor of Internet interventions. The experts stressed the potential ofInternet to tailor the information to the individual and the possibility of immediate feedback.Nevertheless, it is difficult to attract people to the website and to keep their attention. The inventoryshowed that most information via Internet is generic information, while little tailored informationis available yet.

Conclusions Internet is admired because of its ability to tailor health information to the individualand to provide him/her with immediate feedback and for the potential high reach. However, moreresearch is needed to identify the effective (components of) interventions via Internet and strategiesto evaluate these interventions in the most appropriate way should be developed. Moreover, effectivestrategies should be developed to get people on websites providing health promoting information.For development and implementation it should be taken into account that not everybody hasthe same digital skills and opportunities to use Internet.

Do the transtheoretical processes of change predict transitions in stagesof change for fruit intake?

*De Vet, E., De Nooijer, J., De Vries, N., Brug, J.; *Department of Health Education and Promotion,Universiteit Maastricht, The Netherlands

Aims According to the Transtheoretical Model (TTM), processes of change are hypothesizedto predict transitions in stages, though the processes of change are the TTM’s least studiedcomponent. In a longitudinal design, it is explored whether the processes of change do predictstage transitions in fruit intake.

Methods The data were derived from a larger longitudinal study on stages of change and fruit intake,in which a cohort of 735 adults is examined several times with varying time intervals by means ofelectronic questionnaires. Questionnaires assessed fruit intake, stage of change and processes ofchange (a.o.). The data on processes of change were analysed cross-sectionally for three assessments,i.e., T1, 53 days later at T2, and another 53 days later at T3, and longitudinal for the two equal timeintervals in between.

Results Cross-sectional differences were found for the processes of change between precontemplationand all further stages. Experiential as well as behavioral processes increased from precontemplationto action with similar patterns. Both experiential and behavioral processes predicted forward transitionout of precontemplation and forward transition into action, while only behavioral processes predictedforward transition out of contemplation.

Conclusion More frequent application of processes of change seems associated with more advancedstages of change, although the frequently found two-factor structure of experiential and behavioralprocesses may not be distinguishable for fruit intake. Implications for interventions will be discussed.

The transtheoretical stages of change and fruit intake: Real or pseudostages?

*De Vet, E., De Nooijer, J., De Vries, N., Brug, J.; *Department of Health Education and Promotion,Universiteit Maastricht, The Netherlands

Objectives In the present study we explored if the pre-action Transtheoretical stages of changeapplied to fruit intake in fact may reflect pseudostages, i.e., a stage-like categorisation of a continuousbehavioural intention scale.

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Methods The data were derived from a larger longitudinal study on stages of change and fruit intake,in which a cohort of 735 adults is examined several times with varying time intervals by means ofelectronic questionnaires. Data about fruit intake, stage of change and intention from threeassessments in the longitudinal study were used, i.e., baseline (T0), 35 (T1) and 67 (T2) dayslater. Dichotomising the continuous intention measure created an unmotivated pseudostage anda motivated pseudostage. These were compared to the precontemplation and contemplation stagesof change, respectively.

Results Strong associations were found between pseudostages and stages of change (r�¼ 0.64at T1 and r�¼ 0.63 at T0 and T2, all p< 0.001). Second, 73% and 75% of the respondents hadsimilar transitions for pseudostage as for stage of change between T0 and T1, and between T1and T2, respectively (both time intervals K¼ 0.59; p< 0.001), indicating that stability andtransitions in stages of change resembled transitions in pseudostages. Test-retest reliabilities forboth measures were similar, varying from r�¼ 0.61 to 0.67 for stage of change and from r�¼ 0.64to 0.73 for pseudostage for the two intervals (all p< 0.001). Finally, stages and pseudostages bothpredicted fruit intake, but in a regression model with both measures, only pseudostages contributedsignificantly.

Conclusion The present study indicates that pre-action stages of change for fruit intake mightreflect pseudostages and using a continuous variable instead of the categorical pre-action stageswould probably pick-up more subtle changes in fruit intake.

Memory for emotional events. The effects of stress hormone activationon memory consolidation in man

*Deady, D., O’Carroll, R.; *Psychology Department, University of Stirling, UK

Objectives Recent research indicates that stress hormone activation induced after viewing emotionalmaterial interacts with the degree of arousal at encoding to enhance memory for that material.For example, administration of adrenaline or Cold Pressor Stress (CPS; a reliable stress hormoneinducer), immediately after viewing emotional material, have both been found to enhance memoryof that emotional material. However, disparities in this field of research have emerged: using identicalstimuli and closely matched methodology, other research has found that noradrenergic system stimu-lation did not enhance memory consolidation of emotional material. This present study aims tofurther investigate whether ‘post learning stress’ interacting with arousal at encoding enhancesmemory of emotional events.

Methods Sixty students (33 female 27 male) viewed an emotionally arousing slide presentation,consisting of 11 slides with a neutral beginning and an emotionally arousing middle phase (slides 5to 8). Immediately following this, half the participants were administered CPS, which involvessubmerging one’s hand in ice cold water. The other half submerged their hand in lukewarm water(control condition). One week later participants were given a free recall and recognition memorytest on the slide presentation.

Results Both control and CPS groups showed enhanced memory for the emotionally arousingphase in comparison to the neutral phase. However, there was no differential effect of CPS relativeto control for the emotional phase.

Conclusions The results of this study are not easily reconcilable with some previous research.However, they highlight the need for further thorough investigation if ‘post learning stressinteracting with arousal at encoding to enhance memory’ is to be considered a real and replicablephenomenon.

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Illness perceptions, pain and function in patients with low back pain: A prospective study

Dean, S.; University of Otago, New Zealand

Objectives Illness perceptions offer a basis for understanding patient beliefs’ about Low BackPain (LBP) and its management. We adapted the revised Illness Perception Questionnaire (IPQ) topredict outcome in a cohort of patients with LBP receiving physiotherapy.

Methods Participants were 143 patients, mean age 50 years (SD¼ 12.8; 60% female) with 94%experiencing LBP and/or leg pain for longer than 3 months (serious pathologies excluded).Questionnaires included the IPQ-LBP, the Modified Roland and Morris Functional DisabilityScale; a Pain numerical rating scale and a general health measure, these were completed at baseline,discharge from physiotherapy and six months from entering the study. Baseline scores were assessedfor internal validity of the adapted scales. Multiple regression modelling was employed to identifyany predictors of pain and disability at follow-up.

Results Internal validity for adapted scales was high (Cronbach’s alpha > 0.72). At six-monthschanges in pain and disability were predicted by changes in four baseline IPQ (LBP) variables:Identity (total); Identity (LBP); Consequences and Coherence.

Conclusions The IPQ was successfully adapted for LBP. Whilst three predictive variables couldbe considered proxy indicators of severity it is known that the IPQ can predict outcome that is overand above objective markers of illness. As a theoretically based assessment of patients’ beliefs theIPQ-LBP could be used to identify patients and help physiotherapists target suitable psychosocialinterventions: patients’ perceptions of symptoms appear important, suggesting these need to bediscussed early on to ensure patients’ hold appropriate expectations about which symptoms aretargeted by management; negative beliefs about consequences may reflect catastrophising althoughthe former might be a more acceptable term for use with patients and the low IPQ coherencescores suggest a poor patient understanding of LBP, indicating further work is required concerningdelivery of patient education.

Health-related quality of life (HRQoL) in children with recurrent urinary tract infections

Deibl, M.; Department for Medical Statistics, Informatics and Health Economics, Innsbruck MedicalUniversity, Austria

Objectives HRQoL is an important topic in paediatric practice. However, there is a lack of HRQoLstudies and suitable instruments in the scientific literature. The aim of the study was to develop anew disease specific module for children with recurrent urinary tract infections in addition to thegeneric HRQoL questionnaire KINDLR.

Methods The development of the instrument was conducted in 2 phases. In the first phase, issuesthat are important for children with a bladder dysfunction were identified. Therefore, interviewswith 20 children and their parents were performed. Open-ended questions were used to identifythe main areas of concern and allow maximum input from the children. In the second phase, theseareas were further discussed with 10 children and their parents based on a semi-structured interviewerguide, the key issues were summarized and a pool of relevant items was developed.

Results The following domains were found to be relevant influencing the HRQoL of children withchronic cystitis: physical wellbeing (burning on urination, pain in the bladder and kidney area, incon-tinence, reduced general state of health, reduced immunological state), psychological wellbeing (fearof recurrent urinary tract infections, frustration, psychological distress due to frequent visits to thedoctor) and social wellbeing (limitations of social activities, sense of shame towards other children).

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Conclusions This new disease-specific module of the KINDLR for children with recurrenturinary tract infections is expected to become a useful tool for HRQoL research in pediatric urologicalpopulations.

Dyadic coping and support processes

*DeLongis, A., Holtzman, S., Lee-Baggley, D., Puterman, E., Pomaki, G.; *University of BritishColumbia, Canada

Objectives Three studies examined dyadic coping and support processes: coping with pain amongRheumatoid Arthritis (RA) patients, coping among married couples in stepfamilies, and copingamong parents with a child with a chronic health problem.

Methods/Results Multi-level analyses examining RA patients and their spouses indicated significanttemporal associations among social support from the spouse and patient pain severity, both throughencouraging the use of specific coping strategies, and by impacting the effectiveness with which thesecoping strategies were employed. A second study examined coping and support processes amongmarried couples in stepfamilies across two years. Two stressful social contexts emerged as primarydimensions of stepfamily stress: marital conflict and child misbehavior. Both the social context anddimensions of personality were significantly and independently related to coping strategy use.Moreover, there were significant personality by stress interactions. In stepfamilies in which wivesused confrontation to cope with family stressors, husbands withdrew emotionally from stepchildren.When husbands withdrew consistently, emotional closeness between wives and stepchildrendeteriorated, tension between wives and their own children increased. In coping with marital stress,empathic responding represented an adaptive way of coping, whereas reactive rumination wasassociated with negative short and long-term outcomes. Feeling unsupported by the spouse bothled to more dysfunctional ways of coping and exacerbated the negative effects of that coping.Spousal support and spousal strain made significant, independent contributions to negative affect.Findings from a study of parents of children who are challenged by a chronic health problemindicate the utility of a new scale for assessing dyadic coping that assesses partner reactions to spousalcoping behaviors. Results suggest a synergistic effect between coping and the response of others indetermining coping outcomes.

Conclusions Studies highlight the importance of the role of interpersonal processes in promotingadaptive coping strategies. Implications for models of dyadic coping will be discussed.

Validation of the Pediatric Inventory for Parents in Spain

*Del Rincon, C., Remor, E., Arranz, P.; *Hospital Universitario La Paz – Centro de CoagulapatıasCongenitas, Madrid

Objectives To translate, adaptate and validate to Spainish a measure of parenting stress relatedto caring for a child with an illness: The Pediatric Inventory for Parents (PIP, Streisand et al., 2001).

Methods First the original English version of the questionnaire (PIP) was translated and back-translated by experts to ensure linguistically equivalence of the North American questionnaire toSpainish. The PIP consists in a 42-items questionnaire assessing the frequency and difficulty of par-ents to deal with stressors related to caring for a chronically ill child. Second a psychometric testingin a sample of 64 parents (38 mothers and 26 fathers) of children living with haemophilia(Mean age 38 y.o.) was performed. Sociodemographic characteristics of the parents were assessed,severity of the son’s illness was took into account as well. To assess concurrent validity of the

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questionnaire parents were assessed at the same time in anxiety (STAI-S) and stress (PSS). Statisticalanalysis addressing reliability, concurrent validity and sensitiveness of the questionnaire wereperformed. Finally, normative data for Spanish haemophilia parents population was proposed.

Results No differences regarding gender and age were found in the scores questionnaire. Internalconsistency reliability for the PIP was acceptable (range: 0.71–0.94). PIP scores were significantlycorrelated with a measure of state anxiety and stress. Differences in parent stress regarding severityof the son were found, however this differences do not achieve statistic significant power.

Conclusions The Spanish version of the Paediatric Inventory for Parents showed to be useful, reliableand valid tool to assess parenting stress in parents of children with a chronic illness as haemophilia.The PIP is also useful to identify the stressors experienced by parents as part or their role associatedwith medical care, communication, emotional and role function.

Illness representations of adolescents with chronic illness andrepresentations of the adolescent’s illness by a parent

Dempster, M.; Queens University, Belfast, Northern Ireland

Objectives (1) To examine the similarity between illness representations of adolescents with a chronicillness and the representation of the adolescent’s illness by a parent. (2) To examine the relationshipbetween the degree of similarity of illness representations and psychological well-being.

Methods Young people with diabetes mellitus (n¼ 49) and congenital heart disease (n¼ 50)completed self-report questionnaires of illness-related cognitions and psychological well-being. Foreach adolescent, one of their parents completed questionnaires pertaining to illness representations,impact of the condition on the family, family environment, own mental health and socio-demographicfactors.

Results Approximately 62% of young people with congenital heart disease scored above clinical levelsfor behavioural problems, compared to 32% of young people with diabetes. The parent considered thecondition to have a stronger impact and influence on the adolescent’s life and well-being thanthe young people perceived. Parents’ and adolescents’ beliefs regarding the adolescents’ understand-ing of the condition; its consequences, both practical and emotional; and symptom control wererelated to adjustment across each illness group. Dissimilar and similar perceptions (between parentand child) for specific illness representations were also related to psychological well-being for theyoung people.

Conclusions The relative influence of illness representations on adjustment varies with illness type.However, agreement between adolescent’s and parent’s illness representations is an importantpredictor of adjustment across the illness types included in this study. Clinical interventions shouldaddress such discrepancies in illness representations.

Coping strategies as predictors of psychosocial adaptation to lower limb amputation

*Desmond, D., MacLachlan, M.; *Dept. of Psychology, National University of Ireland, Maynooth,Ireland

Objective To examine the contribution of demographic/amputation-related variables and copingstrategies to the prediction of psychosocial adaptation in veterans with acquired lower limbamputations.

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Methods Multiple indicators of the psychosocial adjustment of 796 individuals aged between 26–92years with lower limb amputations were assessed. Hierarchical linear regressions were performed toinvestigate relationships between demographic/amputation-related variables (i.e., age, time sinceamputation, amputation level and amputation aetiology), the dimensions of coping (namely problemsolving, seeking social support and avoidance) and self-reported adaptation to amputation, as well assymptoms of intrusion, anxiety and depression.

Results Coping styles were important predictors of psychosocial adaptation. Avoidance was stronglyassociated with psychological distress and poor adjustment. In contrast, problem solving was nega-tively associated with depressive and anxious symptomatology whereas seeking social support wasnegatively associated with symptoms of depression and positively associated with social adaptation.

Conclusions These findings suggest the potential for interventions designed to promote particularcoping strategies to improve psychosocial outcomes.

Familial influences on sexual behaviour of adolescent: Implications for health promotion

*Dias, S., Matos, M., Goncalves, A.; *Universidade Nova de Lisboa, Lisboa, Portugal

The purpose of this study is to examine the influence of family characteristics and parental processesin adolescents’ sexual behaviour. The study utilized mixed quantitative-qualitative methods. Datawere collected through self-administered questionnaire from the Portuguese sample of the ‘‘HealthBehaviour in School-Aged Children-2002 – (HBSC)’’ – a collaborative WHO study. The studyprovides national representative data of 3762 Portuguese adolescents, randomly chosen from thoseattending of high school that includes 13 and 15 year old pupils (52% girls). In addition, 12 focusgroup were conducted, a purposeful sample of 74 adolescents from secondary schools. Chi-squarewas used to examine sexual behaviour according to adolescents’ demographic characteristics.A logistic regression analysis was conducted considering the ‘‘sexual intercourse’’ as dependent vari-able and a set of demographic (age, gender, ethnic group), family characteristics (family structure,socioeconomic status) and family processes (communication, parental monitoring and supervision,and parental style) used as independent variables. The percent of reporting ever to have had sexualintercourse was 23.7%. Boys were more likely than females to report ever having had sexual inter-course (33% vs. 15%). Regression analysis identifies associations with adolescents’ sexual behaviour(sexual intercourse) and several demographic, family characteristics and parenting processes.The themes of focus group are discussed in terms of family protective and risk factors in sexualbehavior. Adolescents identified several family factors, such as family connectedness, parent-childcommunication, parental monitoring and parent’s socioeconomic status influencing adolescents’sexual protective or risk behaviour. The results are consistent with a growing body of literature thathighlights the impact of parents in adolescents’ sexual behaviour. These findings lend support forthe design and implementation of family-based approaches to promoting healthy adolescent sexualbehaviour.

Living with chronic fatigue syndrome: Diagnosis and the consequential experienceof stigma and delegitimation

*Dickson, A., Knussen, C., Flowers, P.; *University of Stirling, UK

Objectives The purpose of this study was to generate a rich and detailed insight into the experience ofChronic Fatigue Syndrome (CFS) from the participants’ perspectives.

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Methods Fourteen people with CFS took part in a semi-structured interview. The interviews wereanalysed using Interpretative Phenomenological Analysis (IPA).

Results Stigma arose from the participants’ perceptions of the medical profession’s attitude that CFSwas psychosomatic in nature and was not a ‘‘real’’ or valid condition. Such attitudes may be the resultof the absence of a measurable, testable pathology of the condition, the absence of one, agreeddiagnostic criterion and a lack of information or awareness of the condition. These attitudes mayalso exhibit the social construction of CFS as being psychogenic and people with the condition asbeing ‘‘malingerers’’. This then leads to the delegitimation of people who are rejected from thewider society and have doubt cast over their moral characters. This is experienced not only in amedical context, but also within the social and family domain.

Conclusions The research findings highlight the need for a more social constructionist approachto diagnosis. The findings also highlight the failure of a biomedical approach to CFS and the needfor a biopsychosocial perspective.

Action plans as goal setting strategy in non-smoking and smoking Dutch adolescents

*Dijk, F., Reubsaet, A., De Vries, H.; *Maastricht University, The Netherlands

Introduction According to the I-CHANGE model, action plans contribute to the transition fromintention to behavioral change. Action plans are plans a person makes to obtain a certain goal, inthis case non-smoking. The objective of this study is to describe action plans of Dutch adolescentshelping them to quit smoking or refuse offered cigarettes.

Methods 5,000 Dutch adolescents will engage in the smoking prevention and cessation intervention‘‘Smoke Alert’’. So far 360 smokers and 1,478 non-smokers are included. Action plans weremeasured using a 5-point scale on which respondents had to state whether they agree to make theaction plan described. Action plans will be described and a comparison between smokers whointent to quit and who don’t will be made with regard to these action plans.

Results The most common plan for non-smokers was to simply refuse the cigarette offered (88%),followed by explaining why they don’t want to smoke (74.1%). The most common action planfor smokers was to inform others about their quit attempt (61.7%) followed by removing all smokingmaterials in the direct environment (59.3%). All other action plans were reported by less than 50% ofthe respondents. Smokers with the intention to quit within 6 months had were more likely tothrow away all smoking materials than smokers with the intention to quit within 1 or 5 years.Additional results will be discussed during the conference, as well as the correlations of actionplans with other determinants.

Conclusions As action plans can contribute to successfully carrying out intended behavior, they canplay an important role in smoking prevention and cessation interventions. Adolescents should bestimulated to form action plans to make them less vulnerable to the temptation to startsmoking (again).

A match-mismatch test of a stage model of behaviour change in tobacco smoking

*Dijkstra, A., Conijn, B., De Vries, H.; *Univesity of Groningen, The Netherlands

Background An innovation offered by stage models is that of stage-matched interventions. Match-mismatch studies are the primary test of this premise but also the primary test of the validity ofstage models.

Methods A match-mismatch study was conducted among smokers in the precontemplation stage,the contemplation stage, and the preparation stage, and among ex-smokers in the action stage.

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487 participants in these different stages were randomly assigned to 1 of 3 intervention conditions.The three intervention conditions were developed to (1) increase the pros of quitting; (2) decreasethe cons of quitting; (3) increase self-efficacy. The following matches were expected.Precontemplators were expected to benefit only from an increase in the pros. Contemplators wereexpected to only benefit from a decrease in the cons. Preparers were expected to benefit equallyfrom an increase in the pros and a decrease in the cons. Ex-smokers in action were expected to benefitonly from self-efficacy enhancing information.

Results The results show that at the 2 months follow-up, the Condition � Stage interactionon forward stage transition was significant, meaning that participants in different stages benefitedfrom different types of information. The pattern was according to our expectations. Furthermore,the overall match-mismatch test showed that the matched interventions were significantly moreeffective than mismatched interventions. The evaluation of the information in the interventionsmoderated the matching effects: the matching effect was significantly smaller when the informationwas rated as highly believable or as highly understandable.

Conclusion The present study provides experimental support for the benefits of stage-matchingand for the validity of a stage model of behaviour change.

Content validity of perceived behavioural control measures:The impact on the predictive power of the theory of planned behaviour

Dixon, D.; University of Aberdeen, Scotland

Objectives Existing measures of perceived behavioural control (PBC) vary in their content validity.This study aimed to establish the effect of varying the content validity of PBC measures on theTPB applied to disability in an orthopaedic sample.

Methods The TPB and locomotor disability were measured in a postal questionnaire. Discriminantcontent validation was used to design two measures of PBC, one with high, and one with lowcontent validity (Cronbach’s �¼ 0.84 and 0.80, respectively). Patients (n¼ 184) awaiting hip orknee replacement surgery completed the questionnaire (response rate 40%).

Results Locomotor disability was regressed onto intention together with each of the two PBCmeasures in turn. When the PBC measure with high content validity was used, intention was notpredictive of disability (�¼ 0.03; n.s.) but PBC was (�¼�0.76; p� 0.01); overall, this version ofthe TPB accounted for 54% ( p�0.01) of the variance in disability. In contrast, when the PBCmeasure with low content validity was used, both intention and PBC were predictive of disability(�¼�0.18; p� 0.05 and –0.51; p� 0.01, respectively); overall, this version of the TPB accountedfor 38% ( p� 0.01) of the variance in disability. Mediation analyses indicated intention was asignificant mediator of the relationship between the PBC measure with low content validity anddisability (z¼�2.39, p� 0.01).

Conclusions These data demonstrate the importance of establishing the content validity of latentconstruct measures before their empirical application. Varying the content validity of the PBCmeasure affected the qualitative nature of the relationship between constructs within the TPB.In addition, the TPB may have greater predictive utility than shown in previous studies that usedPBC measures with low content validity.

Gender differences in physical activity after cardiac rehabilitation

Dohnke, B.; Center for Gender Research in Medicine, Charite, Berlin, Germany

Objectives The health action process approach (HAPA) is used to examine gender differences inthe motivation to participate in physical activity after cardiac rehabilitation.

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Methods The sample was drawn from the 6-month follow-up of the cardiac rehabilitation outcomestudy (CARO-II). 719 cardiac patients (13% women) participated. Main study variables wereintention, physical activity, outcome expectancies, and maintenance and recovery self-efficacy.

Results No significant gender difference was found in intention, but men were more physically activethan women. Factor analyses examined the structures in the relationships between the outcome-expectancy and self-efficacy variables. First, three factors of outcome-expectancies were extracted,one reflecting cons. The two factors reflecting pros differed between the two samples. In men, onefactor related to physical health, the other to psychosocial consequences. In women, one factor relatedto health, the other to social consequences. Social pros were less expected by women than men.Second, the factors structures of the maintenance self-efficacy variables differed between the twosamples. In men, two factors were extracted: One related to teething troubles, the other to failure.In women, three factors were extracted: The first factor related to failure, the second to teethingtroubles, and the third to emotional barriers. Women obtained higher scores in all self-efficacyscales. An analysis of variance examined gender� activity status on the social-cognitive variablesand revealed significant interaction effects in maintenance self-efficacy and physical health prosindicating higher scores of women particularly in active patients.

Conclusion These data suggest that gender differences exist in the importance of perceived benefitsand barriers to physical activity. Building on these results, gender differences in HAPA-predictionswill be tested by SEM and longitudinally. Confirming gender differences in the importance of thesocial-cognitive factors, implications for theory-based motivation will be drawn.

Adoption and maintenance of an outpatient cardiac rehabilitation program

*Dohnke, B., Nowossadeck, E., Muller-Fahrnow, W.; *Centre for Gender Research in Medicine,Charite Berlin, Germany

Objective The health action process approach (HAPA) was used to examine adoption andmaintenance of an institutional based outpatient phase III rehabilitation program after completingan inpatient cardiac rehabilitation. Based on this three-stage model of health behaviour change,we examined program adoption (i.e., change from intender at discharge to participant at 6-monthfollow-up) and dropout (i.e., change from participant at 6-month follow-up to nonparticipant at12-month follow-up).

Methods Participants of this longitudinal study were more than 1,400 cardiac rehabilitationinpatients. Questionnaires were administered at discharge (T2), 6- and 12-month follow-up(T3þT4). Main study variables were intention to program participation (T2), program participation,self-efficacy and outcome expectancies regarding regular participation (T3þT4).

Results Intentions at T2 were translated into regular participation by 25%, whereas 75% intendersremained nonparticipants. Compared to participants, nonparticipants reported lower intentions toparticipate in a program, lower pros and higher cons at T3. In addition, they had lower coping andrecovery self-efficacy regarding regular participation than participants (T3). Participation at T3 wasmaintained by 77%, whereas 23% dropped out at T4. To identify factors that contributed to programmaintenance, differences between maintainers and dropouts in the main study variables at T3 weretested. The results showed that dropouts reported lower intentions to participate in a program, andlower levels of coping and recovery self-efficacy regarding regular participation (T3).

Conclusions The importance of the social-cognitive variables was stage-specific: outcome expectan-cies and self-efficacy played a role in the initiation process; maintained participation was mainlydirected by self-efficacy. The findings underline the usefullness of a three-stage model of health behav-iour change to the process of adoption and maintenance of an institutional based outpatient phase IIIrehabilitation program and facilitate the development of theory-based motivation strategies.

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Stroke and well-being: Implications of initial stroke severity and strategies of adaptation

*Donnellan, C., Hickey, A., O’Neill, D., Hevey, D.; *Trinity College, Dublin, Ireland

Objectives To examine the relationship between stroke severity and strategies of adaptation, andtheir implications for psychological well-being in a population of patients with stroke.

Methods Participants were inpatients with a diagnosis of stroke (ICD-10 classification) at two Irishhospitals, interviewed within two to six weeks of diagnosis. Stroke severity (mild, moderate, severe)was measured using the Orpington Prognostic Scale (OPS) (Kalra et al., 1993). Adaptation wasmeasure using the 18-item Selection, Optimisation and Compensation questionnaire (SOC-18).The Hospital Anxiety and Depression Scale (HADS) was used to assess psychological well-being.

Results N¼ 43 patients, 44% men with most (59%) of strokes classified as mild, 33% as moderateand 8% as severe. Loss-based selection was the most commonly used SOC strategy by all threestroke severity groups. Mean anxiety and depression scores (mean anxiety: 7.8 (SD: 4.6); meandepression: 6.7 (SD: 4.1)) were at the upper level of the normal range (cut-off score¼ 8). Nosignificant relationship emerged between psychological well-being and use of SOC strategies.

Conclusions Stroke severity does not account for variance in the use of selection, optimisation andcompensation strategies, or for levels of psychological well-being in the acute phase of stroke.Anxiety and depression levels were within normal levels and were not related to use of SOC strategies.

The need to facilitate informed choice equitably

*Dormandy, E., Marteau, T.; *Health Psychology Section, Dept of Psychology (at Guy’s), King’sCollege London, UK

Background The importance for individuals to make healthcare decisions in line with their values iswell recognised. In many clinical contexts in which healthcare professionals and patients reachdecisions together this is described as shared decision-making. In the context of antenatal screeningwhere the possibility of a termination of pregnancy means that parents’ decisions should be in linewith their own values, not those of healthcare professionals, this is described as informed choice.Concerns have been raised that acting in line with personal values may be socially patterned, resultingin inequality in rates of shared decision making and informed choice.

Objective This study aims to determine if the likelihood of women acting in line with theirvalues varies according to socio-economic status when offered an antenatal screening test for Downsyndrome.

Methods Design: A descriptive study of 982 women offered antenatal Down syndrome screening.Outcome measures: Attitudes towards undergoing the screening test (index of values) and screeninguptake. Socio-economic status was assessed using a simple classification based on education, housingtenure and car access.

Results Logistic regression showed no difference in the extent to which women across socio-economic categories acted in line with their attitudes towards undergoing the test when controllingfor other demographic variables (OR 1.2, 95% CI 0.8–1.7) Repeating the analysis in women withpositive attitudes towards undergoing the test showed that women with higher socio-economicstatus were more likely than women with lower socio-economic status to act in line with their attitudes(OR 1.4, 95% CI 1.1–1.9).

Conclusion Women with higher socio-economic status were more likely to act in line with theirpositive attitudes than were women with lower socio-economic status. These results suggest that

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to facilitate shared decision-making and informed choice equitably decision aids should be targetedat women from lower socio-economic groups.

A school-based parent education program to reduceyouth suicide risk factors

*Douglas Gregg, M., Hughes, B., James, J.; *Monash University, Australia

Objectives To present findings from a large school-based Australian study and an Irish pilotreplication evaluating a parenting programme aimed at improving family relationships and reducingadolescent risk behaviours associated with suicide.

Methods In Australia, there were 14 target and 14 control schools. In Ireland, there were 2 targetand 2 control schools. An 8-week Australian programme, ‘Parenting Adolescents: A CreativeExperience’ (PACE) was offered to parents of adolescents in target schools. Group facilitatorsreceived theoretical, practical and experiential PACE training. Adolescent surveys measuring riskbehaviours associated with youth suicide and parent surveys exploring parenting and familyrelationships were administered before and after PACE. In Ireland, qualitative data also assessedthe programme’s suitability in a European setting.

Results Compared with controls, adolescents in Australian target schools showed reduced familyconflict, increased family attachment and reductions in delinquency, substance use and self-harm.In Ireland, there was a significant improvement in parent-reported family relationships and a signifi-cant reduction in parental depressive symptoms. Adolescent data indicated a trend towards reductionof suicidal ideation, and a positive trend in parental monitoring. Implications of trends forimprovement on other behaviours associated with suicide risk are discussed in the context of thesmall pilot sample.

Conclusions PACE, a parenting programme adapted for use in a range of culturally diverse groups,appeared to be an effective method in Australia for reducing adolescent risk behaviours associatedwith youth suicide. Trends in Ireland provide a rationale for a national trial. The mode of deliveryof PACE, thoroughly endorsed by participating Irish parents, suggests its suitability for furthertrials in other European countries. Two major strengths are the development of supportive parentnetworks through PACE parenting groups and the empowerment of schools and communitiesthrough training of group facilitators.

Complexity of affect and optimism: The effect of stress and trait anxiety

*Dowd, H., Hogan, M.; *National University of Ireland, Galway, Ireland

Objectives Research into our ability to experience emotion has supported two conflicting models:bipolar and bivariate. A parallel debate has taken place on the relationship between optimism andpessimism. This experiment tests the effects stress and trait-anxiety on these relationships in thecontext of the dynamic model of affect (DMA).

Methods A convenience sample of 56 first-year psychology students was allocated to four conditionsin a 2� 2 model (stress/no stress & high/low trait-anxiety). Before and after measures of emotion andoptimism were taken using the Positive and Negative Affect Schedule (PANAS) and Life OrientationTest (LOT), as were cardiovascular measures of reactivity and recovery.

Results No significant effect was found for complexity of affect or expectancy. However,both constructs were shown to be bivariate in nature and trends in the correlation effect size were

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supportive of the DMA. It was found that higher positive affect had an effect ( p¼ 0.013, �2¼ 0.231)

on systolic blood pressure recovery.

Conclusions The findings that PA and NA are independent constructs, that PA has a buffering effecton cardiovascular recovery, taken in conjunction with the trends that support the effect of stress asposited by the DMA, indicate that further ongoing research in this area is likely to be productive.

Short-form depression scales predict mortality in patients with acute coronary syndrome

*Doyle, F., McGee, D., De La Harpe, D., Shelley, E., Conroy, R.; *Royal College of Surgeons inIreland, Dublin, Ireland

Objectives To investigate the use of short-form (7-item) depression scales in assessing one-yearmortality risk in a national sample of acute coronary syndrome (ACS) patients.

Methods The Hospital Anxiety and Depression Scale depression subscale (HADS-D) and the BeckDepression Inventory – Fast Scale (BDI-FS) were assessed in a national sample (38 hospitals) ofconfirmed ACS patients (N¼ 598). Inpatients completed either the HADS-D or BDI-FS andone-year mortality risk was modelled using Cox proportional hazards survival analysis.

Results Prevalence of depression was 15% (HADS-D) vs. 22% (BDI-FS) ( p¼ 0.034). Patientsdepressed at baseline (combining HADS-D and BDI-FS cases) had an almost threefold increasedrisk of death at one year (HR 2.78, 95% CI 1.36–5.68, p¼ 0.005). Controlling for length of hospitalstay, total cholesterol, sex, having private health insurance and diabetes increased the predictivevalidity of depression (HR 4.02, 95% CI 1.67–9.72, p¼ 0.002). Scoring above threshold predictedmortality with the HADS-D (HR 4.22, 95% CI 1.78–9.96, p¼ 0.001), but not the BDI-FS(HR 1.83, 95% CI 0.59–5.65, p¼ 0.291).

Conclusions A seven-item depression screening scale, the HADS-D, successfully predicted increasedrisk of one-year mortality in ACS patients. Depression can be assessed in a brief but clinicallymeaningful way in acute settings.

Multimedia patient education for patients undergoing bronchoscopy

*Drossaert, C., Brouwer, L., Van den Berg, S., Christenhusz, L.; *University of Twente, Departmentof Communication Studies, The Netherlands

Objectives Multimedia patient education may have many advantages (such as user control andvarious types of information), but may not be suitable for elderly patients. In this study aCD-ROM was developed to prepare patients for undergoing bronchoscopy. Based upon self-regulation theory, the CD-ROM contained text, pictures and video fragments to provide proceduralinformation, sensory information and behavioural instructions. In addition, based upon modeling-theory, the CD-ROM contained video-fragments of several patients of different age, sex andbackground, reporting about their experiences with bronchoscopy. The effects of the CD-ROMwere studied in a field experiment.

Methods During a period of three months patients were given either a standard information leaflet(n¼ 35), or the standard leaflet and the CD-ROM (n¼ 46). Patients were asked to fill out question-naires immediately prior to and after their scheduled bronchoscopy. Questionnaires containedquestions about the use of the education material, and their satisfaction about it. Anxiety (STAI,stait-anxiety), self-efficacy and expectations with respect to pain and inconvenience caused by theexamination, were assessed both before and after the bronchoscopy.

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Results Most patients from the experimental group (77%) had actually used the CD-ROM. Both theleaflet and the CD-ROM were positively judged, however, patients from the experimental group weresomewhat more satisfied with the received information than patients from the control group.No effects were found on anxiety, self-efficacy and expectations relating to pain and inconvenience.

Conclusion Multimedia patient education is used and positively evaluated by elderly patients.The theories of self-regulation and modeling were not confirmed in this study.

Children’s behavioural response to diagnosis of acute lymphoblastic leukaemia

Earle, E.; University of Sheffield, UK

Objectives Newly diagnosed children with cancer may show behaviour problems in response to thedemands of treatment on their quality of life (QOL). The way in which treatment compromisesQOL is likely to be age-dependent. We explored the different ways children respond followingthe diagnosis in three age-groups (0–4, 5–9, 10–14 years).

Methods 32 mothers of children up to the age of 14- years who were diagnosed with AcuteLymphoblastic Leukaemia (ALL) were interviewed at three time points: 3, 15 and 27 monthsfollowing diagnosis. Interview themes included how the illness affected social, emotional, cognitiveand behavioural function. Transcripts were transcribed and analysed using thematic analysis.

Results Mothers’ reports about younger children (0–4 years) primarily focused on how childrenresponded to treatment procedures. Although responses included distress, sleep problems and seekingsecurity, they appeared the most adaptable to the cancer experience and accepted it as part of normallife. Children in the middle age group (5–9 years) were beginning to understand the consequencesof the cancer experience, displaying aggression and withdrawal. The older children (10–14 years)were more concerned with body image, and being treated the same as others. They found adjustmentproblematic, frequently worried about the future and death; and expressed feelings of vulnerability,blame and guilt.

Conclusions These findings have implications for caring for newly diagnosed children withcancer, and provide some insight for clinic staff about the concerns typically expressed by childrenat different ages.

Patients’ experiences of screening for Type 2 diabetes: A qualitative study

*Eborall, H., Davies, R., Lawton, J.; *Institute of Public Health, University of Cambridge, UK

Objectives Increasing evidence suggests that earlier detection and treatment of Type 2 diabetesmay lead to improved patient outcomes. However, uncertainty remains regarding the benefits ofearly treatment over the adverse effects of screening. There is a lack of qualitative data regardingpatients’ perceptions of the screening process in depth, especially in a prospective manner as thepatients are going through the screening process. Running in parallel with the ADDITION screeningstudy, a qualitative study aims to examine people’s experiences and views of participating in screening.

Methods Qualitative in-depth individual interviews are being conducted with patients at crucialstages in the screening process: 15 patients are being interviewed before and after their initialrandom capillary glucose test. 25 patients who have tested positive at both initial random and fastingcapillary test are being interviewed before and after their subsequent diagnostic glucose tolerance test.This group includes those who screen negative, intermediate, and be diagnosed diabetic.

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Results Two practices have been recruited from which patients are invited. Interviews prior to thescreening test are exploring patients’ expectations of the test and result, and people’s understandingof diabetes and perceptions of personal risk. Following the tests, patients’ reactions and interpretationsof their result are being explored. Interviews are being recorded and fully transcribed. Transcriptsare being analysed in an ongoing iterative manner, guided by grounded theory. The emergentthemes will be presented at the conference.

Conclusions This patient-centered qualitative study will provide an in-depth insight intopsychological aspects of screening. The findings will contribute to the overall conclusions andrecommendations from the ADDITION study, which will be communicated to policy makersinvolved in the development of national policy regarding screening for Type 2 diabetes.

Changes in individual quality of life of advanced cancer patientsadmitted to a palliative care unit

*Echteld, M., Passchier, J., van Zuylen, L., Witkamp, E., van der Rijt, C.; *Erasmus Medical Centre,Amsterdam, The Netherlands

Objectives The main aim of palliative care is to achieve optimal QOL. The aim of this study was toassess changes in advanced cancer patients’ individual quality of life (QOL) and explore the correlatesof these changes.

Methods 15 patients admitted to a palliative care unit in a cancer hospital were included (meanage¼ 63 years; range¼ 34–88). All patients were admitted for symptom control. Individual QOLwas measured using the Schedule for the Evaluation of Individual Quality of Life (SEIQoL). TheSEIQoL total score (SEIQoL Index; range¼ 0–100) is based on the patients’ ratings of five individu-ally nominated important life areas. Pain was measured using a numeric rating scale (0–10), andfatigue was measured using a visual analogue scale. Patients were interviewed within two days ofadmission (T0) and at least one week later or at discharge (T1). Mean interval between interviewswas 8.2 days (range¼ 7–14).

Results Mean SEIQoL Index scores changed from 48.5 (13.5–89.9) at T0 to 61.6 (6.3–91.6) atT1. Fatigue and pain were moderately and negatively related to the SEIQoL index score both atT0 and T1, and changes in pain were negatively related to changes in the index score. Life areasmost often nominated were relationships with family members and friends, symptoms, and aspectsrelated to maintaining control.

Conclusions Individual QOL improved, and the improvements appear to be related to the adequacyof symptom management. However, symptoms were mentioned as life areas only by a minority ofthe patients. The results will be discussed in light of QOL conceptualisation.

Self-determined motivational regulations as predictors of exercise behaviourand affect among obese individuals referred to an exercise on prescription scheme

*Edmunds, J., Ntoumanis, N., Duda, J.; *School of Sport and Exercise Sciences, University ofBirmingham, UK

Objectives Physical inactivity and obesity are inextricably linked. To successfully reduce sedentarybehaviour the psychological determinants of exercise need to be understood. Self-determinationtheory (SDT; Deci & Ryan, 1985) proposes that self-determined motivational regulations (i.e., intrin-sic motivation and integrated and identified regulations) result in more adaptive behaviouraland affective outcomes than more controlling regulations (i.e., introjected and external regulations

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and amotivation). The current study aims to test these propositions among obese patients referred toan Exercise on Prescription (EoP) scheme.

Methods One-month post referral to an EoP scheme, 52 obese participants (41 females, 11 males;M age¼ 44.06, SD¼ 14.63; M BMI¼ 38.09, SD¼ 7.13) completed an SDT-based measure ofexercise motivational regulations. At 3-months post referral participants completed measures ofself-reported exercise behaviour, commitment and exercise-related affect (i.e., positive and negativeaffect and subjective vitality). Using attendance records, 3-month adherence codes were calculated.

Results Standard multiple regression analyses revealed that adherence to the scheme was positivelypredicted by identified regulation (�¼ 1.01, p¼ 0.01) and negatively predicted by introjectedregulation (�¼�0.68, p¼ 0.01). Exercise-related positive affect at 3-months was positively predictedby intrinsic motivation (�¼ 0.65, p¼ 0.02). For all other dependent variables under investigation, thestandard ß coefficients of at least one of the most self-determined motivational regulations exceeded0.35. However, probably due to the small sample size, these betas were not significant.

Conclusions The current study supports the basic propositions of SDT among obese patients referredto an EoP scheme. Self-determined forms of motivational regulation predicted adaptive engagementand affect. Future research should delineate how health professionals can facilitate self-determinedmotivation so that more individuals derive associated benefits.

The effect of an autonomy supportive teaching style on exercise classparticipants’ behaviour and affect

*Edmunds, J., Ntoumanis, N., Duda, J.; *The University of Birmingham, UK

Objectives Self-determination theory (SDT; Deci & Ryan, 1985) postulates that autonomy suppor-tive teachers will facilitate the satisfaction of 3 basic psychological needs (autonomy, relatednessand competence), which will promote self-determined motivation (i.e., intrinsic motivation andintegrated and identified regulation) and ensuing positive behavioural and affective outcomes. Morecontrolling environments are assumed to thwart psychological needs, induce more controllingmotivational regulations (i.e., introjected and external regulation) and result in maladaptive outcomes.This study tested SDT’s propositions in the exercise domain.

Methods Participants from 2 content-equivalent exercise classes, scheduled to run for 10 weeks, wereexposed to an autonomy supportive (AS) versus standard practice (SP) teaching style. The AS styleacknowledged participants’ feelings and perspectives, provided choice, rationale, structure andinterpersonal involvement. The SP condition reflected a typical exercise class environment withsome elements of a controlling teaching style, primarily the lack of choice and authoritarian leadership.At baseline, 6 wks and 10 wks, participants completed measures of perceived autonomy support,psychological need satisfaction, motivational regulations and affect.

Results A significant difference in attendance ( p¼ 0.05) was observed (AS, M¼ 6.52; SP, M¼ 5.19).Repeated measures ANOVA revealed that participants in the AS class reported significantly increasedcompetence ( p¼ 0.01), relatedness ( p¼ 0.05) and identified regulation ( p¼ 0.02) over time.Participants in the SP class reported decreased positive affect ( p¼ 0.03). Mixed between-withinAVOVA demonstrated that the AS style was more effective than the SP style in increasing competence( p¼ 0.05), integrated regulation ( p¼ 0.05) and positive affect ( p¼ 0.00). All significant differencesreflected large effect sizes.

Conclusions Supporting SDT, an autonomy supportive teaching style resulted in enhancedpsychological need satisfaction, self-determined motivation, and behavioural and affective responses.Exercise instructors should be taught to use an autonomy supportive teaching style.

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Identifying psychosomatic symptoms affecting illness behaviourin out-patients psychotherapy

Ehrhard, K.; Psychiatrie III, Universitatsklinikum Ulm, Germany

Objectives Many patients in the outpatient clinic presenting with a variety of psychological disordersalso suffer from hypochondriacal anxiety and multiple somatoform symptoms. Aim of the study wasto establish if these collateral symptoms affect illness behaviour patterns.

Method The sample consisted of 60 out-patients of the Poliklinische Institutsambulanz of theJohannes Gutenberg-Universitat Mainz screened with the Illness Attitude Scale (IAS, Kellner,1986; German translation, Rief & Hiller, in press) and the Screening for Somatoform Disorders(SOMS, Rief, Hiller, & Heuser, 1997). Patients were assigned to either a high health anxiety group(HHA, score� 40 in the IAS, N¼ 27), or a multiple somatoform symptoms group (MSS, score � 24in the IAS, score > 6 in the SOMS, N¼ 33). Additionally, patients completed, the Scale for theAssessment of Illness Behaviour (SAIB, Rief, Ihle, & Pilger, 2003), the Symptom Check List (SCL90-R, Franke, 1995, German version) and a semi-standardized interview developed by our researchgroup.

Results HHA patients reported significantly more illness behaviour as measured with ‘SAIB’, hadvisited more physicians the previous year, showed more ‘doctor shopping’ and took more medication.Health anxiety appeared to be a stronger predictor of illness behaviour than multiple somatoformsymptoms. HHA patients reported actively avoiding dealing with illness in the mass media. Therewas no significant difference in psychopathology between the two groups.

Conclusions Health anxiety has a greater impact on illness behaviour in out-patients than multiplesomatoform symptoms, even when it is not the presenting complaint. Psychotherapists shouldaddress health anxiety in affected patients to be effective in reaching their avowed treatment targetsand changing their illness behaviour patterns.

Gender differences in coping styles and physical symptom report

*Eschenbeck, H., Kohlmann, C.-W.; *University of Education, Institute of Humanities, Departmentof Psychology, Germany

Objective The present study analyzed coping strategies and symptom report among boys and girls.

Method Nine hundred and thirty school children from class levels 3 to 8 (aged 8–15 years; 46% boys)responded to a new coping questionnaire with the dimensions problem solving, seeking social support,palliative emotion regulation, destructive emotion regulation and problem avoidance. In addition,somatic symptoms were assessed with a short checklist.

Results The results show significant gender differences for three coping strategies: Independentof age, girls reported higher social support seeking and higher problem-solving than boys. Boysreported higher problem avoidance than girls, especially among the older children (class level 5–8).For the younger children no gender differences in avoidant coping were present. Avoidant copingand destructive emotion regulation were associated with more symptoms.

Discussion Boys report more coping styles associated with potentiallly health damaging consequenceswhen compared with girls. In accordance with findings among adults, low social support andhigh avoidance seem to be related to male gender. Possible interventions and school settings targetingmaladaptive coping among younger boys (age 8–10) and general implications of these findings forhealth-promotion among boys are discussed.

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Effects of different goals within a message for a stair climbing campaign

*Eves, F., Webb, O., Gillings, C.; *University of Birmingham, UK

Objectives Although stair climbing at work is a current public health target (DoH, 2004), no studyhas increased stair climbing in the worksite using standard health promotion messages. This studydeveloped an alternative approach based on mountain climbing.

Methods Interviewees (n¼ 1350) choose the message that would encourage them to climb stairsthe most from statements of the form, ‘Did you know? Walk to the top of this building each dayand in one year you would have climbed Everest. Now that would keep you fit’. The 4 time framesand associated goals were 1 year for Everest, 6 months for the Alps, 2 months for Ben Nevis (thehighest mountain in the UK) and 2 weeks for the Eiffel Tower. Analyses used logistic regression.

Results Everest was the most popular goal (60%) followed by the Eiffel Tower (22%), with minoritieschoosing the Alps (7%) or Ben Nevis (6%). Only 4.7% thought none of the alternatives wouldencourage them to climb stairs. Younger participants (OR¼ 2.85, p< 0.001) and males(OR¼ 1.84, p< 0.001) were more likely to choose Everest. While participants in an active Stage ofChange were slightly more likely to choose Everest (OR¼ 1.28, p< 0.05), there was no effect ofweight status (OR¼ 1.00, CIs 1.36–0.74, p> 0.05).

Conclusions Unlike health promotion messages, the mountain climbing campaign targets regularstair climbing by including a time frame. This approach has considerable promise; less than 5% ofinterviewees remained unconvinced by the alternatives. While the more difficult goal of Everest wasmost popular, this effect was greater in men, younger individuals and those currently active, consistentwith observational studies of the demographics of those choosing to climb stairs.

Adaptation to the demands of teaching: Psychological distress andcoping among trainee teachers

Exton, C.; University of Oxford, UK

Objectives This longitudinal study examined the adaptation of trainee teachers to the demands of anintensive one-year course, with particular reference to the role of coping behaviours.

Methods Survey data were collected from postgraduates (N¼ 189) at the start (Time 1), middle(Time 2), and end (Time 3) of a one-year teacher-training programme. Psychological distress(assessed by the 12-item General Health Questionnaire) was measured at each time point. Self-perceived ability to cope with teaching stressors was assessed at Time 2, when participants wereundertaking full-time classroom teaching practice. At Time 3, the coping strategies used to managethe demands of classroom teaching were assessed.

Result Levels of psychological distress showed a pattern of adaptation to demand over time. Overall,distress was lowest at Time 1, peaked at Time 2, and reduced again at Time 3; however, personality(specifically, neuroticism) significantly moderated this pattern. Using hierarchical regression methods,distress at Time 3 (controlled for Time 1) was significantly predicted by two types of coping;avoidance was associated with increased distress, while active ‘problem-focused’ coping actedto decrease distress. The relative extent to which these coping strategies were used was affectedby participants’ perceptions of their ability to cope with teaching stressors; high self-perceivedcoping ability was associated with less avoidance and greater use of active coping.

Conclusions The results demonstrate the significant impact of initial teaching experience onpsychological distress, and the role of coping behaviours in facilitating or impeding adaptation tothe demands of classroom teaching. The research thus highlights the need for teacher-training

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organizations to encourage the development of active coping skills among students at an early stageof their training.

The role of psychosocial factors in the recurrence of Herpes simplex virus

Faulkner, S.; School of Humanities and Social Sciences, University of Glamorgan, UK

Objectives The purpose of the study was to investigate the use of social comparison among membersof self-help groups. Of particular interest were the relationships between the different kinds ofsocial comparison processes (upward identification, upward contrast, downward identification,downward contrast; cf. van der Zee et al., 2000; lateral comparison), coping strategies and well being.

Methods A self-administered questionnaire was submitted to a sample of 97 individuals, belonging to13 different self-help groups. Social comparison processes were assessed by an extended version ofvan der Zee et al. (2000) social comparison scale, including also additional items measuring lateralcomparisons. The instrument included also: the Psychological Well Being scale by Ryff and Keyes(1995), the Coping Strategy Indicator (Amirkhan, 1990) and the General self-efficacy scale bySchwarzer and Jerusalem (1993). Individuals’ experience with self-help groups was also assessed.

Results Results confirm that members of self-help groups mostly use ‘‘positive’’ social comparisons,associated with positive affect (e.g., upward identification and downward contrast) and lateralcomparisons. The use of such kinds of social comparison positively correlates with problem-focusedcoping and search for social support and is negatively correlated with avoidance. Moreover, socialcomparison correlates with psychological well-being and self-efficacy in the expected direction.Some differences in social comparison preferences were found according to the kind of support group.

Conclusions Results support the hypotheses and previous research on the effects of different kindsof social comparisons on coping and well-being (cf. Buunk & Ybema, 1997; Taylor & Lobel,1989), thereby suggesting some explanations of the effectiveness of self-help groups in promotingindividuals’ well-being. Such groups appear to be a privileged context for the operation of differentkinds of ‘‘functional’’ social comparison.

Evaluating the efficacy of a psychological multimodal intervention in the rehabilitation ofportuguese post-myocardial infarction patients

*Fernandes, A., Mendonca McIntyre, T.; *Dept. of Psychology, University of Minho, Portugal

Aims The aim of this study was to test the efficacy of a psychological intervention program targetingpost-myocardial infarction (MI) patients at 1-month after hospital discharge, in comparison tostandard care (monthly follow up medical visits). Hypothesis 1 predicted a positive impact of theintervention in the experimental group (EG) in terms of the psychosocial variables anxiety, depression,illness representations and health habits. Hypothesis 2 predicted better psychosocial outcomes for theEG group in comparison to the control group (CG).

MethodDesign: randomized control trial.Sample: 41 MI male patients recruited from cardiology services in three central hospitals, 20 in theEG and 21 in CG. Age range 35–70.Instruments: assessments took place during inpatient stay, post-intervention and at follow up (3 and 4months after discharge). The instruments were the Portuguese versions of the Hospital Anxiety andDepression Scale, the Illness Perception Questionnaire-Revised, a Health Habits Survey, Clinicaland Demographic forms.

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Intervention Program: The psychological intervention includes the training of coping andrelaxation strategies, cognitive restructuring; health education concerning the disease andassociated risk factors; facilitation of social support, goal setting and problem resolution.The program had 8 weekly 1.5 hour sessions.

Results The data showed some benefit of the intervention on the levels of anxiety of the EG patients,in comparison to the CG. In terms of illness cognitions, the intervention increased personal control,whereas the values decreased for the CG. The intervention seemed to benefit most health habit changein terms of nutrition (fat consumption) and physical activity, favouring the EG. The results areencouraging, despite the small sample size, and support the replication of these interventions andfuture study of their efficacy.

Do people have an overall attitude towards genomics: Differentiation of attitudesaccording to type of application

*Fife-Schaw, C., Cooper, H., Sturgis, P., Shepherd, R.; *University of Surrey, UK

Drawing on survey data collected in 2003 (n¼ 3272) and previous British Social Attitude surveyswe describe public opinion toward a broad range of genetic technologies among representativecross-sections of the British public. We consider to what extent the proliferation of information andnews stories about genes and genetics has had a concomitant impact on people’s attitudes and beliefs.Does growing familiarity with genetic technologies result in people becoming less opposed totheir development and application in society and does this vary across applications? The paper focuseson within-individual patterns of acceptance/rejection of differing aspects of genetic technologies.

A key finding of the research is that attitudes towards the same genetic technology vary substantiallyaccording to the context in which that technology is applied. Thus, the public are far less acceptingof genetic intervention for the purposes of sex selection, increasing healthy life expectancy ordetermining characteristics such as sexuality than they are for treating breast cancer. Also there isan increase over time in the numbers of people showing support for the use of gene therapy for treatingbreast cancer while attitudes to other applications have remained constant. Similarly, a sizeableproportion of the public are favourable towards genetic databanks where there is a clear societalbenefit in terms of improved health or crime reduction, but the use of individual genetic data in away that might adversely affect the person concerned attracts little public support.

Risk profiles for serious illnesses in healthy individuals: Implications for preventive measures

*Figueiras, M., Nuno Correia, A.; *Instituto Piaget, Portugal

Objectives To investigate a set of illness beliefs (Tuberculosis, AIDS and Skin cancer) in healthyindividuals, and the extent to which these beliefs may contribute to delineate a risk profile that mayinfluence the intention to adopt preventive measures.

Method The participants (n¼ 1113; 70% female) were adults recruited from working environmentsacross the country with an age range between 18 and 65 years old (mean 31.1). Each participantcompleted a self-administered questionnaire based on 1 of 3 diseases (AIDS; TB; Skin cancer)which included measures of individual risk perception of getting the disease, relative risk, perceivedlevel of exposure, perceived behaviour control, the probability of adopting preventive measures, andoptimism.

Results The results indicate that (1) there are significant differences in the individual beliefs concern-ing each illness (2) there is a significant difference between the perception of individual risk andrelative risk, for all the diseases, suggesting a minimization effect, and (3) a ‘‘coherent’’ risk profile

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was found for each illness, which is influenced by levels of optimism. Higher levels of optimism wereassociated with a lower risk perception and a higher probability of adopting preventive measures,although there were differences for each illness group.

Conclusions Although this is an exploratory study, the results suggest that the illness beliefs doexist independently of the direct experience with the illness, and that a deeper understanding ofhow healthy individuals perceive their risks of developing specific illnesses may provide a helpfulbasis for planning health promotion campaigns aimed at reducing behavioural risks.

Teaching patients to cope with illness

Fiore, N.; Clinical Psychology (private practice), formerly with University of California, Berkeley,USA

Objective Lower patient stress, pain, and anxiety and improve rate of recovery and adaptation toillness and medical treatment.

Methods Patients are trained in Self-hypnosis, relaxation, and Cognitive-Behavioral techniques togain a sense of effectiveness in soothing their body and quieting their anxieties.

(1) The meanings patients attribute to their illness are discussed and augmented with beliefs thatcontribute to adaptation and less self-criticism and anxiety.

(2) Inner dialogue that exacerbates tension and anxiety is replaced with self-statements that offer‘‘a safe sense of worth regardless of what happens’’ and ‘‘choice’’ replaces a sense of beinga victim.

(3) A subjective scale of 1–10 measures patient pain or discomfort before and after therapy sessionsand homework sessions with tape-recorded relaxation/self-hypnotic techniques.

(4) Patients practice rapidly shifting ‘‘from Worry to Wonder.’’ They spend less than 10 secondsholding muscle tension and worry before delegating the processes of coping and healing tothe body’s superior wisdom and to the ‘‘Inner Healer.’’ Patients can relax as they feel supportedby, and connected to, the subconscious mind that begins a healing and problem-solving processthat leads to a pleasant surprise.

(5) Patients use a one-minute relaxation technique 5 to 10 times a day to keep the patient in an‘‘Alpha Brain-wave state,’’ replicating the recuperative, R.E.M. (rapid eye-movement) sleepcycle.

Results All patients experienced some relaxation. Most report a significant reduction in pain andall but the most obsessive (10%) report less worry and improved adjustment to their illness andcompliance with medical treatment.

Conclusions Teaching patients relaxation or self-hypnosis along with Cognitive-Behavioral tech-niques can improve adaptation to illness and compliance with medical treatment. In many cases,it can speed recovery from illness and reduce pain.

Mind-body connection: Coping with cancer

Fiore, N.; Clinical Psychology (private practice), formerly with University of California, Berkeley,USA

This presentation will draw on 25 years of work with cancer patients, focusing on stress and anxietyreduction, preparation for surgery, chemo- and radio-therapies, active participation in theirhealthcare, building a working relationship with medical staff, and communications with family.

Integrative medicine approaches that attend to the needs of the whole patient – emotions, cognitions,and spiritual – will be explained and detailed from case examples. The use of therapeutic techniques

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from Cognitive-Behavioral Modification, Clinical Hypnosis, and Ego State Therapy will be explainedas will imagery techniques employing the concept of the ‘‘Inner Healer.’’

Objective To teach patients to access inner researches that help reduce stress and anxiety, andpromote recovery from surgery and medical treatment.

Methods Training in Self-hypnosis, relaxation, and the use of Cognitive-Behavioral Modificationhelps patients to gain a sense of effectiveness in soothing their body, quieting their anxieties, andhealing the mind-body alienation.

Results Enhanced sense of inner peace and access to more resources to cope with both the emotionaland physiologic consequences of cancer and its treatment. Improved ability to complete medicalprotocols and reduction of pain and side effects of chemotherapy.

Conclusions Most patients can experience more rapid healing from medical procedures andimprovement in their coping with cancer by taking part in ‘‘rehabilitation’’ and holistic models.That is, while patients with physical illness may not seek ‘‘psychotherapy,’’ they may more readilyaccept ‘‘rehabilitation’’ that acknowledges their emotional distress and their for skills in coping withdoctors, family, and the side-effects of their medical treatment.

Outpatient pulmonary rehabilitation: Patients’ expectancies, goals and wishes

Fischer, M.; Medical Psychology, Leiden University Medical Centre, The Netherlands

Objectives Pulmonary rehabilitation is one of the main non-pharmacological strategies for themanagement of patients with Chronic Obstructive Pulmonary Disease (COPD). Although resultsof multidisciplinary outpatient rehabilitation programmes consisting of exercise, education andpsychosocial support are satisfactory in terms of improvement of quality of life, a high proportionof participants fail to enter or complete such programmes. The aim of this study is to explore goalsand expectancies of COPD patients regarding pulmonary rehabilitation.

Methods Between March and June of 2005 twelve open interviews will be held with COPD patientswho have been referred to one of two rehabilitation centres in The Netherlands for participation in anoutpatient pulmonary rehabilitation programme.

Results Four topics will be presented: (a) patients’ personal reasons for participation, (b) personalgoals that are served by participating, (c) individual wishes about content of rehabilitationprogrammes, (d) anticipated reasons for drop-out or non-adherence.

Conclusions Results obtained from the interviews will be used for the construction of a questionnairethat will be used in a consecutive study about non-adherence. Individual wishes will be incorporatedin the design of the program as it has been demonstrated that tailored interventions will positivelyinfluence adherence rates. Furthermore the identification of factors that are associated withnon-adherence has important implications for clinical practice as at-risk groups can be monitoredand additionally supported during these rehabilitation programmes to prevent drop-out.

The development and implementation of the Australian clinical practice guidelines forthe psychosocial care of adults with cancer

Fletcher, J.; National Cancer Control Initiative, Victoria, Australia

This paper describes the development and implementation of the Australian Clinical practiceguidelines for the psychosocial care of adults with cancer.

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Methods The guidelines are an evidence-based document aimed at all health professionals who workwith cancer patients and their families. Produced by two key Australian cancer organisations,the National Cancer Control Initiative and the National Breast Cancer Centre, and funded bythe Australian Government, the guidelines are based on comprehensive and systematic reviewsof the research literature and have undergone an extensive consultation process to ensure their clinicalrelevance. Following their publication in August 2003, an active, multifaceted implementationstrategy for the guidelines has been developed.

Results The clinical practice guidelines predominately cover evidence relating to the mostcommonly occurring cancers in Australia and address psychosocial issues relating to cancer care.Given that a comprehensive implementation strategy is essential to facilitate uptake of guidelinerecommendations into routine clinical practice, a four-module implementation strategy has beendeveloped. A series of interactive educational workshops have been conducted and healthprofessional summary cards have been produced. A consumer and rural and remote strategyhas also been developed.

Discussion The psychosocial guidelines are the world’s first evidence-based recommendationsto assist health care professionals in providing optimal psychosocial care to cancer patients andtheir families. The implementation strategy should facilitate the uptake of the guidelines among allhealth professionals involved in the care of cancer patients.

Anxiety and depression in women with breast cancer related lymphoedema:An Australian study

Fletcher, J.; National Cancer Control Initiative, Victoria, Australia

Objectives Breast cancer related lymphoedema is a significant cause of distress for womenafter treatment for breast cancer. This paper describes the findings from a study investigat-ing anxiety and depression in a sample of Australian women with breast cancer relatedlymphoedema.

Methods Anxiety and depression were assessed using the Hospital Anxiety and DepressionScale (HADS) in 101 Australian women with breast cancer related lymphoedema. The HADSis a reliable and valid measure of both anxiety and depression and has been used extensivelyin a cancer population.

Results Results from the HADS suggested that 15% of the women had scores indicative ofclinical anxiety and 5% had scores indicative of clinical depression. T-test analyses revealedthat women who described their lymphoedema as moderate/severe had higher levels ofdepression than those who described their lymphoedema as mild. There was no significant differencein anxiety levels between the mild and moderate/severe lymphoedema severity groups. Significantlyhigher levels of depression were experienced in women who reported reductions in everydayand leisure activities and decreased levels of independence since their lymphoedema diagnosis.Higher levels of anxiety and depression were observed in those with more lymphoedemasymptomotology.

Discussion The Results of the current study indicate that higher levels of anxiety than depressionexist in women with breast cancer related lymphoedema. Those with mild lymphoedema are lessdepressed than those with moderate/severe lymphoedema. Those experiencing lymphoedemasymptoms, such as pain, numbness, swelling, stiffness and movement restriction, reported higherlevels of anxiety and depression than those without symptoms. Such results highlight the distressassociated with lymphoedema severity and symptom burden.

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Sociodemographic, medical, treatment and psychosocial correlates of pain in scoliosis

Flynn, D.; School of Health and Social Care, University of Teesside, Middlesbrough, UK

Objectives Despite people with idiopathic scoliosis (PwIS) experiencing pain of significantly greaterfrequency and severity to matched controls, a paucity of attention has been devoted to elucidatingpsychosocial correlates of pain in this population. Therefore, the aim of this study was to investigatethe predictive value of clinical and psychosocial factors for the pain experiences of PwIS in the UK.

Methods A sample of 126 PwIS (88% female) with a mean age 39.0 years completed a questionnaireto examine associations between pain experiences, sociodemographic, medical, treatment andpsychosocial factors (stressors, coping styles, coping functions, perceived body image [PBI],acceptance of scoliosis [AoS], health-related quality of life [HRQoL] and Health Locus of Control[HLoC]). Pain experiences (presence [yes, no], intensity, description and location of pain) wereassessed with the McGill Pain Questionnaire (MPQ).

Results The majority (85%) of PwIS reported pain and 56% reported using medication for paindue to scoliosis. Logistic regression revealed that medication use was associated with undergoing sur-gery, increased sleep disturbances and reporting that medication decreased their pain. Presence ofpain was correlated with education stressors, coping functions (emotional regulation and avoidance),AoS and HRQoL. Predictors of MPQ measures were predominately psychosocial factors. Painintensity was predicted by pre-treatment Cobb angle, PBI, HRQoL, absence of stress due to inade-quate hospital services and reporting abdominal pain. Total pain on the MPQ was associated withabsence of bereavement stressors, increased satisfaction with appearance before adolescence,HRQoL, not taking medication and reporting abdominal pain.

Conclusions The findings indicate that psychosocial interventions have the potential to impactpositively on the prevalence of pain, analgesic usage and satisfaction with healthcare in PwIS. Thefindings also highlight a need to develop clinical guidelines for the multidisciplinary management ofscoliosis that adequately address the medical and psychological aspects of this condition.

Adolescents’ psychological adjustment during hospitalization

*Fonseca, M., Vasconcelos, M., Tap, P., Santos, R.; *Portugal

Admission to hospital has been portrayed as a negative experience that can bring undesirableemotional effects on children. First studies gave a general negative overview of the consequences ofhospitalization experience on the child (Spitz, 1946). Today, the nature of those results are attributednot only to the characteristics of the hospital environment itself, but also to the methodology used(Barros, 1999). Recent studies are more complex and far-reaching, and are concerned with bothpositive and negative consequences attempting to identify not only perturbing factors but also pro-cesses and strategies to cope with the hospitalization (Rutter, 1981; Rutter & Rutter, 1993;Gaughan et al., 2004). The purpose of this study is to improve understanding of adolescent’scharacteristics, attitudes and behaviours that promote an adaptative and growing experienceof the hospitalization process. This study is carried out on 60 adolescents hospitalized on theUniversity Hospital of Coimbra and on another district hospital within Portugal’s Central Region.Parents and health-care personnel also complete questionnaires. Data from adolescents comprises,in a general way, the perception of their disease and hospitalization, the satisfaction about qualityof life and health care assistance during hospitalization, perceived stress, coping strategies and otheremotional responses to hospitalization. A questionnaire for parents gathers information aboutsocio-economic characteristics, perceptions of their son’s behaviour and attitudes during hospitaliza-tion, parent’s own attitudes and behaviours toward their son’s hospitalization and disease, satisfactionabout the quality of life and health care assistance during hospitalization. Data on information from

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nurses and doctors is collected in order to have a more objective approach about the disease andthe adaptation to hospitalization experience. This research project may contribute to design andto implement prevent and intervention programmes to minimize the possible adverse effects ofthe process of hospitalization on adolescents.

Impact of educational and professional status on women’s subjective meanings aboutbreast cancer: An exploratory study

Fradique, F.; University of Lisbon, Portugal

Impact of educational and professional status on women’s subjective meanings about breast cancer:An exploratory study.

Breast cancer is one of the most common oncological problems in women. However, women’ssubjective meanings about breast cancer aetiology, identity and possibility of prevention may varysignificantly. Previous works (Reis & Fradique, 2001) point out that, generally, lay people andMedicine present alternatives explanations about health and diseases processes. Those differentexplanations may coexist and compete with each other.

In this study educational and professional backgrounds constitute the independent variables forassessing subjective meanings of 88 women about aetiology, identity and possibility of preventionof breast cancer.

A small questionnaire, composed of open and closed questions addressing the dimensions referredabove, was developed specifically for this study. 88 women with different educational and professionalbackgrounds responded to the questionnaire. The results show that in spite of some marginaldifferences between groups, the variables considered may not be as relevant as it was hypothesized.

How do behaviour change techniques map on to psychological constructs?Results of a consensus process

*Francis, J., Michie, S., Johnston, M., Hardeman, W., Eccles, M.; *University of Aberdeen, Scotland,UK

Objectives Psychological theory can inform interventions to change clinical behaviour, but only ifthere is a clear link between theory and behaviour change techniques. The objective of this studywas to specify the theoretical constructs that are likely to be altered by a range of behaviour changetechniques.

Methods Theoretical construct domains (n¼ 11) were identified by Michie et al. (2005) as factorsthat explain behaviour. Behaviour change techniques (n¼ 36) were identified by Hardeman et al.(2000). Four experienced psychologists judged the extent to which each of the 36 techniqueswould be effective in changing each of the 11 constructs. Judgements were aggregated to representfour outcome categories: agreement (technique changes construct); agreement (technique does notchange construct); uncertainty; and dissent.

Results For the 396 the cells in the 36�11 matrix, judges agreed in 73% of cells (12% agreementtechnique changes construct; 61% agreement technique does not) and dissented in only 8% ofcells. Each construct had at least one technique identified with it. Of the 11 constructs, three(skills; beliefs about capabilities; motivation and goals) were judged to be changeable by 8–10 techni-ques, whereas, for five constructs, only 1–2 techniques were judged to be effective change strategies.

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Conclusions The consensus task identified a range of techniques that could be effective for changingspecific constructs, and also the techniques that are not appropriate. This approach makes it possibleto build interventions based on theoretical principles and makes it feasible to frame testable hypoth-eses about the technique effects. Design of theory-based interventions to change clinical behaviourcould be informed by these findings. The study has highlighted the need to develop a comprehensivelist of techniques and their definitions. This will assist in building and reporting interventions.

Changing normatively-driven intentions to attitudinally-driven intentions:Explaining effects of a randomised controlled trial to implementevidence-based diabetes care

*Francis, J., Eccles, M., Johnston, M., Kaner, E., Grimshaw, J., Whitty, A., Walker, P., Smith, L.;*University of Aberdeen, Scotland, UK

Methods A RCT was conducted in 3 Primary Care Trusts in England’s north-east. A questionnairebased on the Theory of Planned Behaviour (TPB) was used to evaluate the intervention with respectto 3 clinical behaviours recommended in diabetes care: measuring blood pressure; inspecting feet;and prescribing statins (to lower cholesterol). General medical practitioners and practice nurses(intervention, n¼ 55; control, n¼ 57) completed the questionnaire at the end of the intervention.Multiple regression analyses were used to explore trial effects in the context of the TPB model.

Results Trial results indicated that patients in intervention practices were significantly morelikely than in control practices to have had a foot check. The mean cholesterol level in patientsfrom intervention practices was significantly lower than in control practices. In the questionnairestudy, control group clinicians had ‘normatively-driven’ intentions, whereas intervention group clin-icians had ‘attitudinally-driven’ intentions for foot inspection and statin prescription. After controllingfor effects of attitudes, subjective norms and perceived behavioural control, this trend was significantfor foot inspection behaviour (trial group� attitude interaction, �¼ 0.72, p< 0.05; trial group�

subjective norm interaction, �¼�0.65, p< 0.05). There were no differences between groups inmean scores for attitudes, subjective norms or intentions.

Conclusions This analytic approach demonstrates the potential of the TPB to explain trial effects interms of different relationships between variables rather than differences in mean scores. Attitudinally-driven intentions are proposed to be translated into action more than are normatively-drivenintentions. This proposition was supported by the study findings, thus explaining the positive trialeffects.

Do illness perceptions predict attendance at cardiac rehabilitation andquality of life following myocardial infarction?

French, D.; School of Sport and Exercise Sciences, University of Birmingham, UK

Objective To examine the extent to which illness perceptions predict attendance at cardiacrehabilitation and quality of life following myocardial infarction (MI).

Methods The illness perceptions of 194 MI patients were assessed whilst the patients were still inhospital following an MI. The mean age was 63.3 years (SD 10.6), and 142 of the patientswere men. Cardiac rehabilitation attendance was obtained from hospital records, and quality of lifewas assessed via a postal questionnaire six months later.

Results In contrast to previous work reported in this area, illness perceptions were not significantlyassociated with attendance at cardiac rehabilitation. Illness perceptions measured within 24 hoursof an acute MI were predictive of quality of life six months later.

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Conclusions Previous reports may have over-estimated the extent to which illness perceptions predictattendance at cardiac rehabilitation. The relationship between illness perceptions and quality of lifeat six months suggests that interventions to alter illness perceptions, especially perceptions ofconsequences, may be useful in improving health related quality of life following an MI.

Patient reported outcomes as unique indicators of rehabilitation efficacy inthe field of mobility disturbances

Fritz, C.; Clinical and Health Psychology, University of Vienna, Austria

Objectives As the patient is the primary recipient of treatment, there is a need to recognize andvalue the patients perception of change in response to treatment in clinical trials. The aim of thestudy was to evaluate the situation of patients with mobility disturbances before a crucial ligamentarthroplasty and after intensive rehabilitation by means of health-related quality of life (HrQoL)measures.

Methods The theoretical scheme was based on a modification of the model by Filipp and Ferring(1991) where four possible types of patients can be differentiated: the fortunate and unfortunate,the satisfaction paradox and the dissatisfaction dilemma. The implemented procedure allows acharacterization of patients in terms of accordance versus discrepancies in functional capacity froma subjective (patient-rated) and an objective (expert-rated) point of view. For assessing functionalcapacity the score of the Swiss Association for Orthopaedics (objective measure) and theFunctional Questionnaire Hannover (subjective measure) was used. The health-related quality oflife (Short-Form-36) was compared on basis of corresponding or discordant functional capacityestimations.

Results The study showed markedly different scores in HrQoL between the four patient groups.According to expectations the ‘‘fortunate’’ patients showed best progress in HrQoL in the follow-upafter three months. But also patients of the ‘‘satisfaction paradox’’ group reached nearly the samerehabilitative level, while the two remaining groups were characterized by a significantdisimprovement especially in the subscale of ‘‘physical role’’.

Conclusions The subjective patient ratings of the functional capacity are of high importance inthe rehabilitation process. Special medical and psychological support should be offered mainly tothese patients who report subjectively of low levels of functional capacity (‘‘unfortunate’’ and‘‘dissatisfaction dilemma’’ patients) after rehabilitation.

Self-determination and sense of coherence: Predictors of satisfaction with life ina prospective study and changeability through Autogenic Training?

Frohlich, S.; University of Osnabruck, Germany

Many studies have shown that Sense of Coherence and Self-determination play an important rolefor well-being and health. Without intervention they are rather stable. First, we wanted to comparetheir predictive ability for well-being in a longitudinal study. Second, we were interested ifself-determination as well as sense of coherence can be enhanced through a 10-week-coursein Autogenic Training. In two studies (N¼ 25 and N¼ 69), different measures of self-determinationand sense of coherence were significant predictors of satisfaction with life 12 weeks later. The resultsof our third study (N¼ 24), in which half of the test persons participated in an Autogenic Trainingcourse, suggest that self-determination is more sensitive to changeability by the chosen trainingmethod than sense of coherence. The implications for future research and therapy are discussed.

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Do illness perceptions predict emotional and physical functioning in primary care patients?A two years follow-up study

Frostholm, L.; The Research Clinic for Functional Disorders and Psychosomatics, Aarhus UniversityHospital, Denmark

Objectives To examine if illness perceptions predict physical and emotional functioning in primarycare patients at 3, 12, and 24 months follow-up.

Methods Thirty-eight general practitioners (GPs) and 1785 patients presenting a new health problemparticipated in the study. Patients completed measures of illness perceptions and physical andemotional functioning (SF-36) in the waiting room. GPs completed a questionnaire for each patienton diagnostics and prognostics after the consultation. Patients completed mailed questionnaireson physical and emotional functioning at 3, 12, and 24 months follow-up. Changes in SF-36scores were dependent variables in multivariate linear regressions. The predictive value of illnessperceptions were examined for all patients, and for patients who presented with a physicalproblem and patients presenting with medically unexplained symptoms respectively based on theGPs’ categorization.

Results Results are still pending. Preliminary analysis suggests that illness perceptions, in particular astrong illness identity and a belief in severe consequences predict functioning at 3 and 12 monthsfollow-up.

Conclusions Documentation of the predictive role of illness perceptions in primary care can assistin the development of intervention studies targeted at patients’ illness perceptions.

Self-concordance and physical exercise: A cluster-analytical differentiation ofdifferent forms of maintenance and dropout

Fuchs, R.; Department of Sport and Exercise Science, University of Freiburg, Germany

Objective The focus of this work is on the processes that are responsible for the continuous mainte-nance of physical exercise over a time period of several months. Two questions will be examined:First, how can the phenomenon of continuous maintenance be conceptualized adequately?Second, what is the role of goal self-concordance in the process of maintenance? It is hypothesizedthat highly self-concordant goals will be pursued with stronger persistence and will therefore leadless likely to a cessation of the behaviour than low self-concordant goals.

Method We conducted a longitudinal study with N¼ 255 participants of the General UniversitySport and Exercise Program. In the first week of the semester participants filled out a questionnairewhich contained the scales ‘‘self-determination’’ and ‘‘introjection’’ from the VolitionalComponents Questionnaire (VCQ-3; Kuhl & Fuhrmann, 2000). Both scales assess the dispositionto select self-concordant goals and actions. In the 12 weeks thereafter participants’ attendanceat their exercise course was registered on a weekly basis, leading to a data matrix with 13 points ofmeasurement.

Results A cluster-analysis revealed four clearly distinct groups of participants: maintainers,fluctuators, early and late dropouts. Results confirmed our theoretical expectation that maintainerspossess higher levels of self-determination and lower levels of introjection than dropouts. However,this holds true only for late dropouts. Early dropouts, compared to all other groups, have the highestvalues on self-determination and the lowest on introjection.

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Conclusion In summary, results show that non-adherence and non-compliance are not alwaysthe consequence of low motivation or lacking will-power. It can also be the result of a rational decisionprocess that is oriented to attain self-concordant goals.

Emotional disclosure, emotional secrecy and psychosocial adjustmentin women undergoing in vitro fertilization treatment

*Gaintartzi, C., Panagopoulou, E., Tarlatzis, B.; *Aristotle University, Thessaloniki, Greece

Objectives The purpose of the study was to explore (1) predictors of emotional secrecy and emotionaldisclosure and (2) associations of emotional secrecy and emotional disclosure to physical andpsychosocial adjustment in women undergoing IVF treatment.

Methods 180 women were interviewed two times, on the day of the embryo transfer and one daybefore pregnancy test. Outcome measures included physical and psychological stress, and maritalinteraction. Information from the medical records, negative affectivity, and coping were includedin the study as control variables.

Results Hierarchical linear regression analyses showed that emotional disclosure was stronglypositively related to physical stress ( p< 0.01). Emotional disclosure to the partner was also stronglyand negatively related with marital problems ( p< 0.01).

Discussion Results are discussed in relation to the role of emotional disclosure in influencing theoutcome of medical treatment. In addition suggestions for interventions during the waiting periodin women undergoing IVF treatment are discussed.

The theory of planned behaviour, anticipated regret and influenza vaccination decisionsin people aged 65-years or older

*Gallagher, S., Povey, R.; *Centre for Health Psychology, Staffordshire University, UK

Objectives Globally, the influenza virus is responsible for 3–5 million cases of severe illness andbetween 250, 000 and 500, 000 deaths annually, with about 90% of these occurring in older adults.However, despite a free and effective vaccine being available to older adults, its uptake among thispopulation is below many government targets. The aim of this study was to investigate influenzavaccination intentions in Irish adults aged 65 and over. Specifically, it tested whether (a) anticipatedregret (AR) and (b) past behaviour (PB) would enhance the prediction of intentions after theconstructs of the Theory of Planned Behaviour (TPB) are held constant.

Methods A qualitative study (N¼ 12) served to inform the development of a TPB questionnaire.A cross-sectional quantitative study followed and participants (N¼ 193) completed the multi-itemmeasure which included demographic, AR and PB items.

Results Sequential multiple regression analysis revealed that the TPB variables predicted 48.5% ofthe variance in influenza vaccination intentions. When the TPB variables were controlled for,inclusion of past behaviour contributed to an increment of 10.7% and finally incorporating AR, thevariance increased by a further 14%. In addition, associations were found between frequency of GPvisits, education and intentions.

Conclusions The findings of the present study provide support for the Theory of Planned Behaviouras a model for understanding older adults’ intentions to vaccinate against influenza, and the additionalvariables past behaviour and anticipated regret contribute substantially to this understanding.

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The implications of this research are discussed with a view towards future directions for influenzavaccination uptake initiatives using theoretically driven applications.

Experience of critical incidents and their impact on the health and well-being

*Gallagher, S., McGilloway, S.; *Pre-Hospital Emergency Care Council, Ireland

Background Emergency Medical Technicians and Controllers (EMT/Cs) are often exposed totraumatic or Critical Incidents, but little is known about the precise nature of these, or their effecton overall health and well-being.

Objectives This study assessed: (1) the nature and extent of exposure to Critical Incidents amongstEMT/Cs; (2) the impact of CIs on their health and well-being; and (3) their utilisation and viewsof support services.

Method Phase One of the study included a cross-sectional survey of all staff working in a largeambulance service (n¼ 180), 63% (n¼ 112) of whom completed a Screening Questionnaire andthe GHQ-12. Phase Two involved one-to-one interviews with a sub-sample of participants (n¼ 27)who had experienced CIS and who agreed to be interviewed. Several questionnaires were alsoadministered to assess PTSD, burnout, and health-related quality of life.

Results Eighty-one per cent (80/94) of participants in Phase One reported that their health andwell-being had been affected by a CI; 42% (44/106) were identified as ‘cases’ on the GHQ-12.The Peer Support service was utilised by only 2% of this group. Participants reported a wide rangeof mental and physical health problems. Approximately two-thirds of interviewees reported severePTSD symptoms (19/27) and ‘moderate’ to ‘high’ levels of burnout (20/27) whilst over one-thirdreported physical ill health (10/27). Conversely, levels of optimism and personal accomplishmentwere high. Key themes from a qualitative analysis included a need for professional counselling andstress awareness training; fears relating to confidentiality and machismo; and a perceived lack ofconcern from management.

Conclusions The findings suggest an alarmingly high prevalence of mental ill health amongstemergency ambulance personnel, a significant (but largely ignored) impact on overall health andwell-being and a low uptake of support services. This has important implications for the appropriateand effective management of Critical Incident Stress in this occupational group.

Predicting fitness and activity in congestive heart failure: Application of the theory ofplanned behaviour in RCT of exercise

*Gao, C., Johnston, D., Johnston, M., Witham, M., McMurdo, M., Struthers, A.; *School ofPsychology, University of Aberdeen, Scotland

Objectives To examine whether the theory of planned behaviour (TPB) variables (a) predict fitnessand activity, (b) are affected by an exercise intervention and (c) mediate the effects of the interventionon fitness and activity in patients with congestive heart failure (CHF).

Methods CHF patients (n¼ 82) aged� 70 years were recruited for a randomised controlled trial ofa 12 week exercise programme. A 12 item TPB questionnaire assessing attitudes, subjective norms,perceived behavioural control (PBC) and intention to take ‘‘gentle exercise’’ was administeredbefore randomisation and 12 weeks later. Behaviour was measured by the 6-minute-walk-test(6-MWT) and 7 day accelerometer records of daily activity before and after the intervention, and6 months later. Standard multiple regressions were used to determine the independent predictorsof intention, 6-MWT and daily activity. Repeated-measure ANOVA was used to assess interventioneffects between groups across time.

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Results Pre-intervention neither 6-MWT nor daily activity were reliably predicted. Post-interventionPBC predicted 6-MWT (�¼ 0.40) and with intention explained 13% of variance ( p< 0.01).Post-intervention PBC (�¼ 0.27) predicted daily activity at 6 months, and with intention explained39% of variance ( p< 0.01). The intervention led to significant changes in attitudes[F(1, 76)¼ 7.58, Eta squared¼ 0.09, p< 0.05)] and PBC [F(1, 76)¼ 9.26, Eta squared¼ 0.11,p< 0.01)]. There was a small delayed effect of the intervention on daily activity at 6 months. Wefound no convincing evidence that post-intervention PBC mediated the later behaviour change.

Conclusions Critical measures from the TPB predicted intention and objective measures of behaviourin an older clinic population and were altered by an exercise intervention. Further work is neededto examine the roles of intention and PBC in mediating behaviour change.

Self-efficacy, expectations and engagement: Patterns of interaction to predict well-being

*Garrosa Hernandez, E., Rodrıguez-Carvajal, R., Moreno-Jimenez, B., Morante Benadero, M.;*Faculty of Psychology, Universidad Autonoma de Madrid, Spain

Over twenty years job burnout has spread out over the research on occupational health, but thisknowledge is one-sided because it has an exclusively negative focus. Positive psychology has beenformulated as an approach, primarily interested in explaining the positive sides of job functioning(e.g., commitment, satisfaction). Simultaneously to this psychological approach a shift took placefrom burnout: work engagement.

Objective To study the relation between engagement and well-being according to job expectationsand self-efficacy.

Methods Data came from surveys of 164 nurses working in several general hospitals in downtownMadrid (Spain).

Results Hierarchical regression analyses revealed different significant interactions according to thedependent variable (positive, negative, and balance affect). After controlling for gender and age,the relationship between expectations and both positive and balance affect is qualified by a significantinteraction: reinforcement expectation with self-efficacy (Positive affect: Adjusted R2

¼ 127; p¼ 0.01;Affect balance: Adjusted R2

¼ 0.351; p¼ 0.03). However, negative affect is predicted by acknowledge-ment expectation and self-efficacy (Adjusted R2

¼ 0.312; p¼ 0.03). On the other hand, the relationshipbetween engagement and balance affect is qualified by another significant interaction: reinforcementexpectation and engagement (Adjusted R2

¼ 0.247; p¼ 0.01). Three-way interaction analyses wereconducted to asses the interaction pattern between all the concepts. The results showed differentsignificant interactions among the three dimensions of engagement, job expectations and self-efficacythat revealed interesting dynamics of the process to predict well-being.

Conclusions These results show that engagement, job expectations and self-efficacy not onlyare important predictors of well-being, but also influence and are related differently in the aspectsof well-being. Furthermore, regression analyses suggest that the role of engagement, job expectationsand self-efficacy in the process of well-being at workplace deserves attention in future studies.

Use of focus group techniques to inform the development ofa Directly Observed Therapy (DOT) intervention in HIV-1 infected adolescents

Garvie, P.; Behavioral Medicine Division, St. Jude Children’s Research Hospital, Memphis,Tennessee, USA

Objectives Via focus group techniques, adolescents with HIV-1 provided input to inform the designof a community-based directly observed therapy (DOT) antiretroviral adherence intervention.

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Methods This study is a summary of Pediatric AIDS Clinical Trials Group protocol 1036A.Participants: 17 adolescents age 17–22 years (7 male, 64.7% African-American) from 3 geographicallydistinct US PACTG sites. Focus group sessions were audio-taped and transcribed verbatim. A codingdictionary was developed and validated. Ethnograph v5.08 was used to summarize coded data acrossand within the 3 sites. Common themes were identified via frequencies and are reported as percentages.

Results Initially, participants reported DOT could work for someone other than themselves (44%)or for non-adherers only (25%). Focus group findings regarding a DOT intervention indicate:The DOT facilitator should be familiar to the participant (14%), and empathetic (13%); theintervention location should be mutually agreed upon (24%), flexible (20%), and private (17%);participant and facilitator communication should be bidirectional (31%), preferably by phone(27%). The DOT program should include a weaning phase (30%) continued until patients indepen-dently demonstrate adherence (30%). Participants desire facilitators to provide case management(36%) and counseling (18%), although many adolescents felt DOT is the only interaction thatshould take place (27%). Identified barriers to DOT include it being an invasion of privacy (65%)and participants potentially being too busy to meet the facilitator (13%). In the end, 31% reportedthat they would consider participating in a DOT program.

Conclusions Focus group feedback provided clarification about feasibility, logistics, and patientconcerns to better design and implement a community-based DOT intervention pilot study accept-able to adolescent participants with HIV-1 who struggle with medication adherence. The DOTintervention study currently is under development.

Cognitive planning, motives for having sex and female adolescent condom usewith a new partner

Gebhardt, W.; Clinical - and Health Psychology, Leiden University, The Netherlands

Objectives This study examined the extent to which cognitive planning and motives for sex canexplain condom use at first intercourse with young people’s most recent partner.

Methods A total of 133 female adolescents completed a questionnaire on cognitive planning(i.e., mentally preparing oneself for discussing condom use and for managing condoms), motivesfor having sex (i.e., having sex to express love, to experience pleasure, to enhance mood, and toplease others), and condom use at this particular occasion.

Results Logistic regression analyses showed that condom use was positively related to cognitiveplanning with respect to discussing condom use and negatively related to the motive for having sexto enhance mood. Cognitive planning for the management of condoms did not have a significantoverall effect on condom use, but it did appear to be very effective for those adolescents who had alow score on the motive for having sex to express love.

Conclusions It thus appears useful to strengthen the skills of adolescents to discuss the use ofcondoms. Furthermore, stressing the negative affective consequences of unsafe sex may be particularlyeffective for those who are inclined to have sex to enhance mood, while encouraging adolescents tomake plans for the management of condoms is likely to positively affect the use of condoms amongthose who are not primarily motivated to express love by having sex.

Coping through humour – vignette based study on the emotion-regulating function of humour

*Geisler, F., Weber, H.; *University of Greifswald, Germany

Objective The objective of our study was to examine, if humour dampens the experiential andmotivational component of the emotional reaction to an anger- or shame-eliciting situation, lessens

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the perceived ego-involvement, and leads to a positive affect. Furthermore we test the hypothesis,that emotion-regulation through humour and emotion-regulation through distancing differ in theiroutcome.

Methods Our assumptions about the emotion-regulating function of humour were examined usingthe vignette method. 100 student participants were presented with vignettes depicting two angerand two shame situations. The protagonists of the vignettes either appraised the situation in a waytypical for anger or shame according to appraisal theories of emotion, or took the situation withhumour, or distanced him- or herself from the situation.

Results The results support the idea of successful emotion-regulation through humour. The effect ofcoping through humour on the experiential, motivational and ego-involvement component ofthe emotional reaction will be discussed. Positive affect is part of the outcome of copingthrough humour in contrast to the other examined coping forms. Furthermore the resultsconfirm the expected differences between emotion-regulation through humour and regulation throughdistancing.

Conclusions We understand emotion-regulation through humour as an antecedent-focused emotionregulation. We believe that emotion-regulation through humour is characterized by the acknowledge-ment of loss or threat together with the appraisal of the situation as being not significant for well-being.It would be interesting to see, if our results can be replicated using an in vivo design, in whichparticipants are actually exposed to an anger or shame eliciting situation in which either a humorousor serious reaction to the situation is suggested to and adopted by the participant.

The perceived impact of antiretroviral treatment on gay men’s sexual relationships:An interview based study

*Gellaitry, G., Cooper, V., Peters, K., Fisher, M., Horne, R.; *Centre for Health Care Research,University of Brighton and Brighton and Sussex University Hospitals NHS Trust, UK

Objectives Whilst HAART has improved the health and future outlook for many people withHIV, it can lead to physical and psychological problems which have a detrimental impact onquality of life. Satisfaction with sexual relationships is often an important facet of quality oflife. The aim of this interview-based study was to explore the impact of HAART on gay men’ssexual relationships.

Methods Eighty-three gay men who were taking antiretroviral therapy were interviewed in relationto their views about the impact of HAART on their sexual relationships. Interviews took place inparticipants’ homes during the first twelve months of treatment. All interviews were audio-tapedand transcribed verbatim.

Results Over half of the men interviewed (57%) stated that HAART had had some impact on theirsexual relationships. A thematic analysis of these interview transcripts generated twenty-sixthemes associated with the impact of HAART on sexual relationships. These were grouped into sixmain categories:

(1) Concerns about HIV infection – either contracting or transmitting a drug-resistant strain ofHIV.

(2) Impact of HAART on libido and/or erectile function.(3) Issues relating to disclosure of HIV status.(4) Impact of HAART on relationship with long-term partner.(5) Changes in sexual behaviour due to taking HAART.(6) The psychological effects of taking HAART. Inter-rater reliability was good (kappa¼ 0.8).

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Conclusions This study highlights some of the physical and psychosocial issues which impact on thesexual relationships of gay men taking HAART. Further quantitative research is indicated to assessthe association between the impact of HAART on sexual relationships and overall quality of life.Clinicians should ensure that the sexual well-being of HIV positive people taking HAART is notoverlooked when assessing outcomes of treatment.

A dual-process approach to altering adolescent risk behavior:Changing intentions and willingness

*Gerrard, M., Gibbons, F., Cleveland, M., Brody, G., McBride Murry, V.; *Iowa State University,USA

Objective This paper will address the implications of the Prototype/Willingness Model for interven-tions. More specifically, it will examine the Strong African American Families Program (SAAF), arandomized, dual-focus prevention trial intended to delay onset and reduce alcohol consumptionamong rural African American youth. SAAF was based on the assumption that changes in alcoholconsumption are mediated by changes in both willingness and intentions.

Methods Participants were 281 African American children (age 11) and their parents who partici-pated in seven two-hour weekly interventions sessions designed to alter the children’s prototypes ofyoung drinkers, willingness and intentions to drink. The Children’s sessions focused on reinforcingnegative images of drinkers, distinguishing between intentions and willingness, and consideringpotential responses to risk-conducive situations. The parents’ sessions were designed to complementthese goals by encouraging parents to clarify their expectations about alcohol use and communicatethese effectively, increase monitoring and nurturant involvement with their children.

Results Consistent with the dual-path hypothesis of the prototype/willingness model, the effects ofthe intervention on alcohol consumption two years after the intervention were mediated throughtwo different paths – a social reaction path and an intention/reasoned path. The social reactionpath provided evidence that the intervention decreased children’s willingness to drink by makingtheir images of drinkers less favorable. The intention/reasoned path provided evidence that theintervention decreased the children’s intentions to drink by increasing targeted parenting behaviorrelated to alcohol. Furthermore, the data suggest that the SAAF dual-process approach thattargets both intentions and willingness can be more successful than either approach alone.These implications of these results will be discussed in the light of recent research indicatingthat neighborhood risk environment moderates the relation between willingness and subsequentrisk behavior.

Differences in illness perceptions between cancer patients and their carers

*Giannousi, Z., Manaras, I., Georgoulias, V., Samonis, G.; *Department of Oncology, UniversityHospital of Iraklion, Crete, Greece

Objectives The aim of this paper is to present findings on the degree of congruence between patients’and carers’ illness perceptions of cancer by comparing their responses to the Illness PerceptionsQuestionnaire (IPQ-R).

Methods A total of 140 cancer patients attending the Oncology Clinic of the University Hospital ofIrakleion in Crete, Greece and their carers, were recruited. Participants taken both from inpatient andoutpatient units completed a Greek translation of the Illness Representations’ Questionnaire Revised(IPQ-R) and the Greek version of the Beck Depression Inventory (B.D.I.).

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Results The results showed significant differences ( p< 0.001) between patients and their carers in theConsequences, Emotional and Acute Timeline subscales of the IPQ-R with carers scoring higher thanpatients.

Conclusions The findings suggest differences in the understanding and experience of cancer betweenpatients and their carers. Possible implications of these findings on patient adjustment and recoveryare discussed.

Reactive vs. reasoned processing: Proven predictors or proximal proxies?

Gibbons, F.; Iowa State University, USA

Objectives Previous studies have provided evidence of the predictive and discriminant validity ofboth behavioral willingness (bw) and behavioral intention (bi) vis a vis health behavior, as theprototype model would suggest. These studies have been correlational, however. This talk will discusslab studies designed to demonstrate the independence of the two constructs.

Methods Three lab studies will be discussed briefly, two with college students, one with hi-wayworkers, all of which involve manipulations intended to change willingness and intention in differentmanners. One involves a mood manipulation, one involves a persuasion attempt – admonitions toadjust risk behavior and risk attitudes in a safer or healthier direction – the third involves priming(of risk prototypes).

Results All three studies showed that bw was more malleable than bi. Mood had more impact onbw than on bi; i.e., positive mood led to less bw, negative mood led to more, whereas bi was essentiallyunaffected by affect change. In Study 2, health messages led to compliance on ‘‘reasoned’’ measures,namely, bi; whereas these same messages led to reactance – change in attitudes toward (rather thanaway from) risky behavior – on the bw items and the prototype measures (which are focal elementsof the social reaction path in the prototype model). Finally, priming of risk prototypes had moreimpact on bw than on bi.

Conclusions The type of processing that occurs in the social reaction pathway resembles that seen inprocessing modes variously labeled as heuristic, experiential or peripheral; i.e., it is image-based, lessreasoned (and premeditated), and more unstable. Implications for this latter difference for interven-tions and preventive-interventions are discussed (as an introduction or segue to the talk by colleague.Meg Gerrard).

Occupational stress in teaching – a review and directions for further research

Gibbons, C.; School of Psychology, Queens University, Belfast, Northern Ireland

Objective To review studies on occupational stress in teachers in schools and collegesfrom a UK and international perspective and to identify recommendations for further research inthis area.

Method A literature review was undertaken in the area of occupational stress in teaching in schoolsand colleges.

Results Common sources of stress include time pressure and workload increases; having to deal withchange and the expectations of others, and relationships with colleagues, management, parents andpupils. Across a range of studies almost a third of teachers sampled described their job as very orextremely stressful and compared with other professional groups teachers are more than twice aslikely to report work as their main source of stress. Common stress responses include changes inbehaviour – such as increased fatigue, irritability and disturbed sleep, a withdrawal from staff contacts

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and increased work absence; changes in emotional responses such as frustration and unhappiness; andphysical responses, such as increased blood pressure and depression. A number of studies concludethat teaching is a high stress profession with teachers at a greater risk of psychological and healthproblems compared to other professions. A number of mediating factors have been investigated.These include job control and social support; how stress is perceived and the affect of teacherexperience and coping style. Within the teaching profession it is equivocal as to which of these factorsalone or together can best buffer against the adverse affects of stress.

Conclusion The equivocal results on the affect of mediating factors may well reflect methodologicallimitations in the instruments used, such as the need for measures of social support to consider thetypes of social support available as well as the quantity and quality of support offered. Measures ofjob control should also consider the individual’s preference for autonomy and control.

Adaptation to chronic illness: Applying Selective Optimisation with Compensation (SOC)to the management of arthritis disability at work

Gignac, M.; University of Toronto, Toronto, Canada

Objectives This study examines the behavioural strategies people with arthritis used to managedisability at home and at work using SOC theory as a conceptual framework.

Methods Participants were 414 people with either osteoarthritis (OA) or inflammatory arthritis (IA).They were administered an in-depth, structured questionnaire at two time points, 18 months apart.The study used an inductive approach and content analyzed the behaviours people used to managedisability using SOC theory as a framework.

Results Fewer SOC behaviours were reported at work than at home at both time points. SOCbehaviours were significantly correlated, but differed in their frequency and the variables associatedwith them. Women, those with more joints affected, and people expecting to remain employedreported more optimization behaviours. Expectation of continued employment, longer diseaseduration, and disclosing arthritis to an employer were associated with compensation. Workplacedisability was related to increased reports of SOC. Reports of greater SOC at home were associatedwith changes in work participation (e.g., absenteeism, work hours), after controlling for diseaseseverity.

Conclusions The results expand our understanding of the experience of working with a chronicillness and highlight the ways that people accommodate to workplace limitations by using SOCbehaviours.

Young people’s attitudes to breastfeeding: A pilot study using the theory of planned behaviour

*Giles, M., Connor, S., McClenahan, C., Mallett, J., Stewart-Knox, B., Wright, M.; *University ofUlster at Coleraine, Northern Ireland

Objectives The aim of this poster presentation is to present the findings of a pilot study whichconsidered young people’s attitudes to breastfeeding using the theory of planned behaviour – TPB(Ajzen, 1991).

Methods Behavioural, normative and control beliefs elicited from focus groups, in conjunction withprevious literature, were used to design a theory of planned behaviour based questionnaire. Thismeasured attitudes, knowledge and decision making regarding breastfeeding among 121, year 10schoolchildren (61 female and 60 male) in a pilot study in Northern Ireland.

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Results A standard multiple regression was performed with intention to breastfeed as the dependentvariable and feeling based attitudes, moral based attitudes, subjective norm, perceived control andself-efficacy as the predictor variables. The TPB successfully predicted intention among males andfemales. 72% of the females reported an intention to breastfeed. For the females 69% of the variancein intention [F (5, 55)¼ 27.58, p< 0.001] was explained with moral-based attitudes (�¼ 0.33,p< 0.001), subjective norm (�¼ 0.32, p< 0.01) and self-efficacy (�¼ 0.28, p< 0.05). Meanwhile,60% of the males reported an intention to encourage their partners to breastfeed, and among themales the TPB accounted for 86% of the variance in intention [F(5, 54)¼ 70.65, p< 0.001].Perceived control (�¼ 0.39, p< 0.01), subjective norm (�¼ 0.36, p< 0.01) and feeling-based attitudes(�¼ 0.20, p< 0.05) were the main predictors.

Conclusions The results of the pilot study were used to design questionnaires for a major, cross-sectional study targeting 2500 year 10 schoolchildren across approximately 45 schools in NorthernIreland. This study is now underway. The results will provide useful information to aid the designof effective educational programmes to help young people make informed choices regarding infantfeeding.

When does compunction help or hinder self-control? The role of guilt and shame proneness

*Giner-Sorolla, R., Sheeran, P.; *University of Kent, Canterbury, UK

Objectives Models such as restraint theory (Herman & Mack, 1980) implicate self-consciousemotions of compunction such as guilt and shame in failures of self-control. But many others empha-size the positive regulatory function of such emotions (e.g., Baumeister, Stillwell, & Heatherton, 1995;Giner-Sorolla, 2001; Monteith, Devine, & Zuwerink, 1993; van der Pligt, Zeelenberg, et al., 1998).

Methods Two experimental studies examined the possibility that self-conscious emotions associatedwith a self-control domain motivate self-control efforts primarily among the dispositionally guilt-prone – for whom feelings of compunction mean blaming their behavior and attempting tomake reparations – rather than the shame-prone – for whom feelings of compunction meanself-disparagement and attempting to escape, which can impede self-regulation (Tangney & Dearing,2002).

Results Study 1 found that among guilt-prone people, relative to shame-prone people, greater self-conscious negative affect associated with eating ‘‘junk’’ foods was related to a higher concern withself-control as measured by the cognitive-behavioral control factor of a version of the Temptationand Restraint Inventory, modified to cover unhealthy eating (Collins & Lapp, 1992). Guilt-pronepeople also were aware that self-conscious emotions helped them keep control, whereas shame-prone people were aware that negative non-self-conscious emotions were bad for their control.Study 2 extended the domain of attitude objects to self-generated dilemmas of self-control, introducedvariations in the wording of affective items (past vs. future focus), and measured response times toitems.

Conclusions Our results supported the hypothesis that being able to access self-conscious negativeaffect quickly, but only in a future context (‘‘would you feel’’), helped guilt- but not shame-pronepeople achieve self-control in their chosen dilemmas.

Organizational politics, illegitimate demands, and well-being among managers

*Gisler, V., Jacobshagen, N., Semmer, N., Kuster, M.; *Department of Psychology, University ofBerne, Switzerland

Objective Based on the ‘‘Stress as Offense to Self ’’ approach (Semmer & Jacobshagen, 2005),we investigated (1) if the well-being of managers is associated with stressors related to fairness and

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legitimacy, (2) if affective reactions towards the organization mediate the relationship of these stressorswith general well-being indicators, and, (3) if hostility moderates the relationship between stressorsand well-being.

Methods Eight hundred and eighty-four Managers filled in a questionnaire through the intranet oftheir internationally operating company. The stressors concerned are (1) Perceived OrganizationalPolitics (POPS; Kacmar, 1991), referring to the impression that decision depend too much on theself-interest of people in the organization (2) Illegitimate tasks (Semmer & Jacobshagen, 2005),asking to what extent participants have to carry out tasks that are unreasonable or unnecessary.Well-being Indicators were (a) Feelings of Resentment towards the organization (Geurts, 1998), (b)Irritation (Mohr, 1991), (c) Psychosomatic Complaints (Mohr, 1986). Data analysis involved multipleregression analysis, including mediation (Baron & Kenny, 1986), and moderated regression analysis.

Results Each stressor explained unique variance in well-being. Resentments (partially) mediatedthe relationships between the stressors and the other well-being indicators. The relationship betweenstressors and Resentments was stronger for people high in Hostility.

Conclusions (1) The study underscores the importance of issues of legitimacy and fairness formanagers, in terms of both scientific study and intervention. (2) Although our cross-sectional resultsconstitute a weak test, they support the reasoning that well-being indicators that are ‘‘close to work’’constitute an immediate reaction, which then affects more general indicators. (3) Enhancing the effectof stressors that have to do with fairness/legitimacy may be a possible mechanism involved in therelationship between hostility and health.

Pre-service education and teacher burnout

Goddard, R.; University of Southern Queensland, Australia

Objective To determine whether different pre-service teacher education programs impact differentlyon the rate at which burnout develops at the beginning of a teaching career.

Method Two separate studies compared beginning teacher burnout across categories of entry-levelqualifications were conducted. In Study 1, 96 teachers were administered the Maslach BurnoutInventory (Maslach, Jackson, & Leiter, 1996) at the beginning of their teaching career and in thefinal term of their second year. In Study 2, 112 beginning teachers in either the first or second yearof teaching were surveyed once.

Results In Study 1, a series of repeated measures analysis of variance demonstrated that after 2 yearsof teaching, teachers with two degrees were reporting significantly higher levels of EmotionalExhaustion and Depersonalization than teachers with a single degree. In Study 2, a multivariateanalysis of variance confirmed that different categories of pre-service qualifications were againassociated with significantly different mean Emotional Exhaustion and Depersonalization levels.

Conclusions The results strongly suggest that burnout may develop at different rates for teachersentering the profession with two degrees in comparison to teachers who enter teaching after a 4-yearprogram of undergraduate training. The pattern of results observed are consistent with predictionsmade on the basis of Adam’s (1964) equity theory.

Asking questions changes behaviour: The mere-measurement effectin the field of blood donation

*Godin, G., Conner, M., Sheeran, P., Germain, M.; *Faculty of Nursing, Universite Laval, Canada

Objectives This research examined the impact of asking questions regarding blood donation onbehaviour among blood donors.

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Methods Three independent samples of 2900 blood donors each were selected. Two sampleswere used as controls (C1 & C2) whereas blood donors in the third sample (E) were asked tocomplete a questionnaire investigating social cognitive determinants of blood donation basedupon the theories of Ajzen, Bandura and Triandis. Objective measures of blood donation(behaviour) at 6- and 12-months follow-up were extracted from the official data set of the provincialblood agency.

Results The three samples did not differ in past behaviour. At 6-month follow-up, the proportionsof those who had giving blood in each of the samples were 48.2% (C1), 48.9% (C2) and 57.6% (E);a 9% difference between control and experimental. At 12 months, these proportions were,respectively, 68.3% (C1), 67.7% (C2), and 73.9% (E); a 6% difference. At each time-point, theE group was significantly more likely ( p< 0.0001) to be donors than the C groups; the C groupsdid not differ.

Conclusions The findings suggest that the mere-measurement of social cognitions regarding a givenbehaviour in the health domain is sufficient to substantially change the likelihood of performance ofblood donation. This finding has important implications for the selection of appropriate evaluationdesigns to assess the impact of interventions aimed at changing behaviour.

Relationship between junior schoolchildren smoking initiation and psychological adjustment

*Gostautas, A., Pilkauskiene, I., Zardeckaite-Matulaitiene, K.; *Vytautas Magnus University,Lithuania

It is well known that smoking initiation in children depends on psychological and social factorsmore than on the physiological ones.

Objectives The aim of this study was to disclose possible relationship between psychological factorsand smoking initiation among junior schoolchildren.

Methods The study was conducted within the frame of collaborative preventive program carriedout in 24 Kaunas region secondary schools in 2003–2004. 458 girls and 478 boys from the 6thgrade were invited to participate in the survey on their smoking behavior twice within a year.Initially, they were evaluated on depressive mood, school adjustment, self-evaluation, nicotinedependence and three personality traits – extraversion/introversion, psychoticism and neuroticism(assessed by EPQ).

Results It was found ( p< 0.05) that both boys and girls, who had ever smoked, had more expressednegative readings of depressiveness, school adjustment, emotional stability, self-evaluation and weremore dependent on nicotine than children who had never smoked. The boys also had higher scoreson psychoticism scale ( p< 0.05) as compared to the boys who had never smoked. Future smokers,both boys and girls, initially had negative readings of self-evaluation ( p< 0.05). Also, the futuresmokers (boys) had negative scores on depressiveness and school adjustment. A statistical tendencyhas been found that boys (future smokers) scored higher on neuroticism scale while girls (futuresmokers) – on psychoticism scale as compared to the children who remained non-smokers duringa year.

Conclusions This study confirmed that smoking initiation was related to worse psychologicaladjustment for both boys and girls. Schoolchildren, who were present smokers and futuresmokers at the time of the first screening, had more signs of worse psychological adjustment thannon-smokers.

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Changes of self-damaging behaviour through school years related to social values

*Gostautas, A., Seibokaite, L.; *Vytautas Magnus University, Lithuania

The discussion on factors influencing self-damaging behaviour and its prevention still continues.

Objective The objective of this study is to disclose relationship of smoking, usage of alcoholicbeverages, other drugs, suicidal ideation changes from grade 5 through grade 12 with prosocial andmaterial well-being values.

Methods Self-reported questionnaire was used for 1570 girls and 1324 boys in all schools of regionalcity in Lithuania in 2003. Questionnaire includes items for status of smoking, alcohol usage, otherdrugs usage, presence of suicidal thoughts and suicidal attempts. 21 social values were factorizedinto 2 subcategories: social values (towards others) and material well-being values (towards self).Factor score is used in this study.

Results There was found significant negative correlation ( p< 0.05) between dominance of prosocialvalues and any form of self-damaging behaviour (smoking, usage of alcoholic beverages and otherdrugs, suicidal ideation), also significant positive correlation ( p< 0.05) between dominance ofmaterial well-being values and any form of self-damaging behaviour (except suicidal attempts).Students with higher prosocial values differ from students with lower prosocial values in self-damagingbehaviour only in early school age. In contrary, students with higher material well-being values differfrom students with lower material well-being values in some forms of self-damaging behaviour(smoking, usage of other drugs) in senior school age.

Conclusion the higher prevalence of self-damaging behaviour is positively related to orientation tomaterial well-being and negatively related to prosocial values.

Does age affect the perceived importance of sex to quality of life?

*Gott, M., Hinchliff, S.; *Sheffield Institute for Studies on Aging, UK

Objectives To explore the role of age in determining the perceived importance of sex to quality of life.

Methods Both quantitative and qualitative data were collected from 34 women and 35 men aged30–92 years recruited from one primary care practice in Sheffield, UK. Ratings of the importanceof sex to quality of life were gathered from the WHOQOL Importance Scale; in-depth interviewsenabled the basis for prioritisation to be explored.

Results All participants felt that sex was important to quality of life at a general level, and60 participants felt it was important to their quality of life at the present time. Although older agewas associated with a lower priority being placed upon sex (r¼�0.502, p< 0.01), analysis of thequalitative data identified that the association was only indirect. Indeed, a key theme to emergefrom the interview data was that the prioritisation of sex was most affected by perceived barriersto being sexually active, notably not having a sexual partner and experiencing health problems.Age only influenced this prioritisation indirectly as the prevalence of such barriers, and their perceivedseriousness, increased in later life. Indeed, many participants >70 years rated sex as ‘very’ or‘extremely’ important to their quality of life, with perceived benefits to remaining sexually activediscussed in relation to relationship quality, pleasure and body image.

Conclusions Stereotypes of an asexual old age are pervasive, shaping not only popular images of olderpeople, but also research and policy agendas. However, findings from this study indicate theimportance of addressing sex as an important component of quality of later life.

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Exploring attitudinal responses to dermatological conditions using psychophysiology,implicit reactions and individual differences

*Grandfield, T., Thompson, A., Turpin, G.; *University of Sheffield, UK

Objective The purpose of the study was to explore the nature of attitudes to a range of dermatologicalconditions.

Methods Participants were asked to complete a series of tasks. There were four components to theexperiment, which were counterbalanced across participants. (1) They were asked to completean implicit association test (IAT) assessing implicit preference for people with clear skin orskin conditions. (2) Each participant was asked to view 25 pictures (5 skin condition, 5 clear skin,5 positive, 5 neutral & 5 negative) whilst SCR, ECG and EMG were taken. EMG was taken from3 muscles in the face to try and ascertain emotional responses to the stimuli. (3) Participants wereasked to rate all of the pictures they viewed using the self-assessment mannequin (SAM) to ascertaintheir positioning in affective space. They were also asked to rate the images of people with and withoutskin conditions according to severity and attractiveness. (4) A battery of questionnaires measuringindividual differences like disgust sensitivity and shame proneness were measured.

Results Still in the preliminary analysis stage. Initial findings are showing a difference betweenpeople who have been exposed to a skin condition and those who have not. There also appear tobe interactions with disgust sensitivity and external motivation.

Conclusions The results of this study expands our understanding of the links between implicitattitudes, psychophysiological responses and individual differences with respect to skin conditions.This information is likely to have important clinical implications in the development of improvedcommunity and individual interventions within this area.

Comparison of written vs. verbal oral hygiene instruction:Effects on self-efficacy and gingivitis

*Granrath, N., Herforth, A., Deinzer, R.; *University of Dusseldorf, Germany

Objectives Although oral hygiene behavior is a very common behavior, the prevalence of oral diseasessuggest that this behavior is not performed efficiently; thus, the present study aimed to comparethree modes of short-time interventions to improve oral hygiene skills in their effects on oral healthand self efficacy expectations.

Methods Eighty-three non-medical students took part in the study. Current oral hygiene, gingivitisand oral hygiene skills were assessed. Subjects were randomly assigned to either written, verbal-stan-dardized, verbal-tailored oral hygiene instruction or a control condition with no instruction, respec-tively. The intervention lasted app. 15 minutes, material and procedures met the criteriaformulated by Ley for increasing patients’ recall and understanding. A day prior to interventionparticipants received a professional tooth cleaning. Four weeks afterwards, intervention effects ongingivitis and oral health behavior self-efficacy expectations were assessed.

Results Both written (d¼ 0.57; p¼ 0.034) and verbal-tailored (d¼ 0.80; p¼ 0.007) intervention sig-nificantly reduced gingivitis four weeks after intervention as compared to controls. Additionally,hygiene instruction significantly increased self-efficacy expectations in these groups. Effects inthe verbal standardized intervention group pointed into the same direction (gingivitis: d¼ 0.32 selfefficacy: d¼ 0.28) but were not significant.

Conclusions Our results are remarkable in two aspects: first, plain hygiene behavior instruction(i.e., skill training) turned out to be effective in improving patients self efficacy expectations – awell-known mediator of health behavior. Skills are neglected in current health behavior models.

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Furthermore, effects of written intervention exceeded that of verbal-standardized instruction andshowed only a non-significant disadvantage as compared to tailored intervention. These results indi-cate that a plain skill training is effective in increasing self-efficacy expectations and that writtenintervention may turn our to be a cheap and effective way to improve oral hygiene skills, self-efficacyexpectations, and oral health – a promising finding regarding public health interests.

Think aloud interviewing: An example of its application to patient reported outcome measures

Greenhalgh, J.; Aston University, UK

Objectives This pilot study used think aloud interviewing to assess the interpretability and relevanceof a new symptom diary for people with MS and explore the process through which respondents judgethe severity and impact of their symptoms.

Methods Think aloud interviews and non-directive probing were used to access this process by askingnine people with MS to ‘‘think aloud’’ while they completed the symptom diary. Interviews weretape recorded and transcribed and analysed to identify problems with comprehension, recall andjudgement in answering questions.

Results The think aloud interviews uncovered problems in the comprehension of some symptomssuch as ‘‘altered sensations’’ and difficulties in recalling health related information from one weekago. They also revealed a number of important difficulties that respondents experienced in makingjudgements about the severity and impact of their symptoms. To provide an answer to these questions,respondents utilised several conflicting personal and social comparisons. These included internalcomparisons with themselves during relapse or when they were feeling well and with themselvesprior to having MS. Respondents also compared themselves to the general population and otherpeople with MS. Their confusion lay in which comparison to make in order to provide a judgementabout the severity and impact of symptoms and their health. Respondents reported that using differenttargets for comparison to judge current symptoms and their impact would give different answers tothe same questions.

Conclusions Think aloud interviewing is a valuable method for health psychologists to assessthe interpretability and relevance of standardised health questionnaires and can also shed light onthe complex cognitive processes involved in responding to such questionnaires.

Development and validation of a new questionnaire to assess eating behavioursin obese patients

*Gremigni, P., Letizia L., Ricci Bitti, P., Dalle Grave, R.; *Department of Psychology, University ofBologna, Italy

Objectives Nowadays aetiology and maintenance of obesity, a chronic and recurring disorder,is discussed as a combination of biological, psychological and sociological factors. Most studies ofdiet included a behavioural component to enhance effectiveness of treatment. Identification ofeating patterns of obese patients is of great help to deliver individualized psychological interventions.The present study examined the psychometric properties of the QACAO, a new questionnairedeveloped to assess eating behaviours in obese patients.

Methods The study involved 640 participants (79% female, aged between 18 and 72 years) classifiedas follows based on the Body Mass Index (BMI): 125 were obese, 73 overweight, 365 normal-weightand 80 under-weight. Participants completed: QACAO (questionnaire on eating habits andbehaviours in obesity), Binge Eating Scale, Eating Disorder Examination Questionnaire, andWeight Efficacy Life-Style Questionnaire.

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Results For 59 items used in the Likert-type QACAO content domain was specified and a panel ofexperts assessed the relevance of each item. Based on responses from 640 participants, the QACAOwas evaluated for internal consistency, reliability and validity using factor analysis and correlationtechniques. The orthogonal factor solution isolated 10 I order factors and 5 II order factors, including:night eating, restraint, overeating at meal and between meals, and skipping breakfast. Factors ofthe final 37-item version of the QACAO showed alpha coefficients ranging from 0.64 to 0.87.Retesting after four weeks (N¼ 34) yielded correlation coefficients that ranged between 0.77 and0.88. QACAO subscales also correlated predictably with select subscales from other relatedconstructs suggesting convergent validity (correlation coefficients ranging from 0.38 to 0.75).Discriminant validity was supported by significant ANOVA differences in QACAO subscales betweenobese and normal-weight or under-weight subjects ( p ranging from 0.03 to 0.0001).

Conclusion Findings provide tentative support for future use of the QACAO to identify eatingpatterns in obese patients.

Illness representation, wellbeing and adherence to diet in adult celiac patients

*Gremigni, P., Di Meo, C., Ricci Bitti, P.; *Department of Psychology, University of Bologna, Italy

Objectives Celiac disease (CD) is caused by ingestion of gluten-containing foods by gluten-sensitiveindividuals. It is now estimated that CD may affect 1 in 200 individuals, it can occur at any age, andfemales are more commonly affected than males. When a patient with CD is treated with a strictgluten-free diet, the prognosis is excellent, but adherence to the diet is not simple and it is notclear whether this ensures well-being of the patient. This study is the first one using theLeventhal’s Self Regulation Theory to investigate the role of illness representation and perceiveddisease burden on quality of life, psychological well-being and adherence to gluten-free diet in asample of adult celiac patients.

Methods Cases included 67 adult celiac patients, 52 females and 15 males, aged 18–62 years.Controls comprised 61 healthy subjects matched by sex and age with no clinical evidence or familyhistory of celiac disease. Patients completed: Illness Perception Questionnaire-Revised (IPQ-R),Burden of Illness Questionnaire (BIQ), Short Form 12 Health Survey (SF-12), PsychologicalWell Being Questionnaire (PWB), and 4 items to assess adherence to diet and distress related todieting.

Results Celiac patients scored lower in the Autonomy scale of the PWB than healthy controls( p< 0.04). Celiac men were less compliant with the diet than women ( p< 0.04), while women hada less coherent view of celiac disease than men ( p< 0.03). Using stepwise multiple regressionmodels, specific dimensions of illness representations and burden of illness explained 6–10% ofvariance of quality of life, 9–30% of variance of psychological well-being, and 15% of variance ofadherence to diet.

Conclusions The results imply that in the management of celiac patients, illness representation,perceived disease burden, and gender-related aspects need to be taken into account to improvetreatment outcome.

Screening for Type 2 diabetes in general practice: Feasibility, uptakeand effects on psychological health

*Griffin, S., Park, P., Eborall, H., Prevost, T., French, D., Kinmonth, A.-L., Sutton, S.; *Institute ofPublic Health, University of Cambridge, UK

Objectives Type 2 diabetes (T2DM) fulfills many of the criteria for suitability for screening: it iscommon, costly and in 50% of cases unrecognised. At clinical diagnosis most patients already have

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diabetes-related complications. Continuing uncertainty exists over feasibility, method, benefits andcosts of screening. We aimed to assess feasibility, uptake and effect on psychological outcomes ofscreening in a pilot study and large-scale longitudinal study.

Methods: Pilot study: Diabetes risk scores were calculated for 1280 randomly selected people(40–69 years), without known diabetes. Those at greatest risk (355) of undiagnosed diabetes wererandomly allocated to invitation to screening (random capillary glucose measurement and glucosetolerance test if necessary) or control group (239). Participants completed questionnaires on anxiety(STAI) and self-perceived health 6 weeks after the last study contact (response 70%).

Large-scale study Following the same procedure, 6800 patients invited to screening and a controlgroup (1000) are being administered questionnaires on anxiety (SSAI and HADS), diabetes-specificworry, self-perceived health, risk and severity of T2DM (IPQ-R) at initial screening, 3 and 12 monthslater.

Results In the pilot study 95 (82%) attended initial screening. Anxiety scores were higher amongthose invited for screening (mean STAI: invited 37.6, not invited 34.1, p¼ 0.015). For the 6 patientsdiagnosed with diabetes, mean STAI score was 46.7 seven weeks after diagnosis, considerably higherthan the ICD-10 threshold for clinical anxiety (42). Preliminary results from the large-scale studywill be presented at the conference.

Conclusions Although the pilot study suggests that screening is feasible and acceptable, it isassociated with clinically important increases in anxiety that persist for at least 7 weeks. Beforeadvocating widespread screening for diabetes it should be established that the benefits outweighthe harm.

Prevalence and determinants of adherence to immunosuppressive medicationin renal transplant recipients

*Griva, K., Davenport, A., Thompson, D., Harrison, M., Newman, S.; *London MetropolitianUniversity, UK

Aims Poor adherence is known to be an important cause of graft failure after renal transplantation.This study examined the prevalence and determinants of medication adherence in kidney transplanta-tion. Correlations of adherence were sought among sociodemographic, clinical variables and patientsillness and treatment cognitions.

Methods A sample of 177 adult renal transplant patients completed measures of illness and treatmentcognitions, medication beliefs, and mood. Medication adherence was assessed using patientsself-reports and concurrent blood assays of serum levels of prescribed immunosuppressants(cyclosporin or tacrolimus).

Results Adherence rates and determinants differed between the two adherence indices. Self-reportadherence rates were very high with only 10% of the patients admitting medication adherencelapses. In contrast, 42.7% of patients were classified as low adherers based on low cyclosporin(<150 ng/ml) or tacrolimus (<6 ng/ml) serum concentrations. Self-reported adherence was positivelyassociated with medication necessity beliefs ( p< 0.001) and perceptions of responsibility to do well( p< 0.05) whereas expressed concerns regarding medication side effects was negatively correlatedwith self report adherence ( p< 0.005). Using serum concentration levels, ANOVAs revealed signifi-cant differences between low vs. adequate adherence subgroups in sociodemographic and moodvariables and illness cognitions. Low adherence patients were more likely to be in cohabiting relation-ship ( p< 0.01) and have had their transplants for longer ( p< 0.05). They expressed lower beliefs thatrenal disease is amenable to control ( p< 0.05), perceived more consequences associated with theircondition ( p< 0.05), and stronger chronic timeline beliefs ( p< 0.005).

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Conclusion There is little correspondence between self and physiological indices of immunosuppres-sive medication adherence underlying the complexity of measuring adherence and limitationsassociated with each methods. The observed differential associations between adherence indicesand illness and medication cognitions warrants further investigation.

Self-care behaviour in heart failure patients: Implications of illness perceptions,disease severity and time since diagnosis

*Grogan, K., McGee, H.; *Royal College of Surgeons, Dublin, Ireland

Objectives To identify factors which are associated with self-care behaviour in heart failure patients.

Method Participants were heart failure patients (ejection fraction >35%; NYHA class I–IV) recruitedfrom out-patient departments of four Irish hospitals (N¼ 60). Self-care behaviour was measuredusing the 12-item European Heart Failure Self-Care Behaviour Scale (Jaarsma et al., 2003).Perceptions of illness were measured using the Illness Perception Questionnaire-revised(Moss-Morris et al., 2002).

Results ANOVA and multiple regression analyses indicated that many participants reported partialnon-adherence to professional recommendations of self-management. Variance in self-care behaviourwas accounted for by specific illness perceptions. Medical variables (disease severity and time sincediagnosis) did not account for variation in self-care behaviour.

Conclusion Results indicate that psychological rather than medical factors explain self-carebehaviour. Perceptions of illness may play a role in influencing this outcome. Educating heart failurepatients by modifying their perceptions of illness may promote better self-management of theircondition.

Mothers of obese children and mothers of normal weight children – child-feeding style andnutritional knowledge

*Grubic, M., Ritmanic, V., Gregurincic, I.; *Department of Pediatrics, University Hospital Zagreb,Zagreb, Croatia

Objective To compare two groups of mothers according to their child-feeding style and nutritionalknowledge.

Methods The participants were mothers of obese children (N¼ 55) and mothers of normal weightchildren (N¼ 60). They were compared by their results on the three subscales (Restriction,Pressure to Eat and Monitoring) of the ‘‘Child Feeding Questionnaire’’ – CFQ, and by their resultson the modified version of ‘‘Nutritional Knowledge Questionnaire For Adults’’.

Results The results showed a significant difference between mothers of obese children and mothers ofnormal weight children referring to their results on CFQ. Mothers of obese children showed ahigher control over child’s nutrition using Restriction and Monitoring, while mothers of normalweight children showed a higher control over child’s nutrition using Pressure to Eat.

Conclusion These findings are in accordance with the theory of Costanzo and Woody (1985),considering that a higher parental control over the child’s nutrition does not necessarily leadto the expected results. The two groups did not differ in their nutritional knowledge, but it isimportant to emphasize that the questionnaire used in this study seemed to be too difficult for theparticipants.

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Resource change, emotion and coping. The study of Polish women working abroad

Gruszczynska, E.; Warsaw School of Social Psychology, Poland

Using Hobfoll’s conservation of resources (COR) theory for guiding hypotheses, the study examinedthe relationships between resource change, emotional state nad coping strategies in the situation ofworking abroad. Subjects were 56 women who left Poland 5 years ago on avarage, mainlybecause of financial reasons. The resource change and coping strategies were evaluated by thePolish adaptation of COR-Evaluation (Hobfoll, 1998) and Ways of Coping Questionnaire (Lazarus &Folkman, 1984), respectively. To measure the emotional state a questionnaire was constructed upontool by Folkman and Lazarus (1985). The assessment of all the variables was done in the USA duringautumm 2004. The results revealed the pattern of relations between emotions and resource changeconcordant with Hobfoll’s theory. Although the anticipatory emotions (threat and challenge) wereuncorrelated with resource change, outcome emotions (hurt/loss and benefit) were significantlycorrelated in predicted direction only with resource loss, but not with resource gain. There was alsoa positive association between recource loss and avoidance strategies and between resource gainand confrontation strategies. As avoidance strategies could be a mediator between resource loss andemotions the apprioprate models were tested. None of effects reached the level of statisticalsignificance. However, when a bootstrap method instead of Sobel’s test was used, significant media-tional effects were present for the threat and challenge emotions. Findings suggest that resource lossnad resource gain could be antecendents for different coping mechanisms. As COR theory predicts,gain followed by confrotation strategies could create further gains, whereas loss seems to requireresource protection, which coud lead to the increase in negative and decrease in positive emotionalstates. Nonetheless, these conclusions should be treated with caution due to cross-sectionalprocedure, sample size and its specificity.

Distress in couples coping with cancer: A meta-analysis of role and gender effects

*Hagedoorn, M., Tuinstra, J., Coyne, J., Sanderman, R.; *University of Groningen, Northern Centrefor Healthcare research, Groningen, The Netherlands

Objectives There is a large body of research on distress in patients with cancer and their spouses.However, there is a large variability between studies with respect to sample and disease characteristicsand there appear to be inconsistencies between findings. This review applies meta-analytic proceduresto integrate research findings that examined differences in distress between patients and their spousesand associations between patients’ and spouses’ distress. Specific attention will be paid to theinfluence of gender of the patient and disease characteristics, such as time since diagnosis.Moreover, role effects (i.e., being the patient versus the spouse) on distress will be examined forwives and husbands, respectively.

Methods We performed extensive literature searching strategies and located published andunpublished studies that measured psychological distress in both patients and their spouses. Themeta-analysis includes 36 independent samples of 20 or more couples. Moderator analyses will beperformed to determine whether sample characteristics are associated with effect-size differences.

Results The analyses are currently being performed. Preliminary results appear to indicate thatspouses report more distress than patients only in male patient couples.

Conclusions Important issues concerning conducting meta-analyses in this field of research will bediscussed, including the dependence of patient and spouse data, the use of distress scorescorrected for sex, and heterogeneity of study characteristics.

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Injury representations, coping, emotions, and functional outcomes in athleteswith sport-related injuries: A test of self-regulation theory

Hagger, M.; University of Essex, Colchester, Essex, UK

Objectives The present study examined the influence of cognitive and emotional representationsof injury on the emotional responses and functional outcomes of athletes with sport-relatedmusculoskeletal injuries using Leventhal et al.’s (1980) self-regulation theory.

Methods Participants were recreational and competitive athletes from the United Kingdom (N¼ 220,152 men, 68 women; mean age¼ 23.44, SD¼ 8.42) with a current sport-related musculoskeletalinjury. Participants self-reported their cognitive and emotional injury representations, emotionalresponses, coping procedures, physical and sports functioning, attendance at treatment centers, andthree-week follow-up attendance.

Results Participants’ negative and positive affect were mainly influenced by emotional representa-tions. Identity, causal attributions of injury to risk factors and overtraining, and emotional representa-tions influenced physical functioning and identity, serious consequences, attribution of cause tochance, and emotional representations predicted sports functioning. Importantly, injury severity,identity, and personal control significantly predicted attendance at treatment centers, but the effectof personal control was completely mediated by problem-focused coping. Problem-focused copingwas the only predictor of three-week follow-up attendance.

Conclusion Results provide some support for self-regulation theory for examining relationsamong cognitive and emotional representations and coping in athletes with musculoskeletal injuries.

BRCA1/2 Mutation carriers: Living with susceptibility

*Hagoel, L., Neter, E., Dishon, S., Barnett, O., Rennert, G.; *Ruppin Academic Centre, Israel

Objectives To examine whether being a carrier affects a wide array of life aspects, and if so, how.

Methods Participants were grouped according to their carrier status (carrier and non-carrier status),health status (affected or unaffected by cancer), and their enrollment into the service (proband andother family members). One hundred and sixty five women completed a self-administeredquestionnaire following their genetic consultation session.

Results Probands/non-probands and carriers/non-carriers did not differ with regard to demographiccharacteristics, health behaviors including medical check-ups, the distress they experience, andtheir resources (sense of coherence, social integration, religiosity). Individuals affected by cancerdid differ on some of these aspects from participants without cancer.

Conclusions From this study, being a carrier could not be considered a psychosocial risk factornor does it have an effect on carriers’ resources and lifestyle.

The relationship between illness perceptions, anxiety and panicin chronic obstructive pulmonary disease

Hallas, C.; Rehabilitation & Therapies, Royal Brompton & Harefield NHS Trust, UK

Objectives This cross-sectional study investigated the relationship between illness perceptions,anxiety and panic in chronic obstructive pulmonary disease (COPD) patients.

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Methods Fifty-nine patients from a tertiary care hospital diagnosed with COPD completed a seriesof standardized, validated questionnaires measuring illness perceptions (IPQ-R), anxiety and depres-sion (HADS), panic disorder severity (PSSD) and impact of COPD on daily life and well-being(St George’s Respiratory Impacts Scale). The percent forced expiratory volume in the first second(FEV1%) was used as an objective measure of airways obstruction and illness severity. 7% wereclassified as having severe disease (<30%), 32% moderate disease (<50%) and 61% mild disease(<80%). Data was collated from medical records on co-morbid conditions and medication.

Results 35% of patients reported psychiatric levels of anxiety and 19% of patients withpsychiatric levels of depression. 22% of patients reported a score on the PSSD equivalent topsychiatric levels of panic disorder. One-way analyses on variance tests revealed no significantdifferences in psychological outcomes between categories of pulmonary function (mild, moderateand severe). Differences in illness perceptions were observed for patients categorized aspanickers compared with non-panickers. Panickers perceived their COPD as havingsignificantly more serious consequences on the IPQ-R and had significantly greater emotionalrepresentations of their COPD. Results from hierarchical multiple regression analyses revealedthat perceptions of COPD consequences significantly and independently predicted the diseaseimpact rating.

Conclusions The results highlight the importance of patients’ perceptions of the consequences ofCOPD within its management. It also indicates that objective measures of disease severity are notrelated to the psychological adjustment of patients and are unrelated to subjective reports of thephysical, social and psychological impact of COPD. The high level of panic attacks, behaviours andcognitions in this study, indicate a need for the development of routine psychological servicesand interventions for patients with COPD and further research into the perceptions and beliefssurrounding the consequences of symptoms, treatment and impact of COPD to determine howthey are involved in the aetiology of panic.

The relations between parents’ smoking, general and smoking-specific parenting practices,and adolescents’ smoking

Harakeh, Z.; Institute of Family & Child Care Studies, Radboud University of Nijmegen, TheNetherlands

Objectives The present study examined whether the associations between general parenting practices(i.e., support, strict control and psychological control) and parental smoking on the one handand older and younger siblings’ smoking on the other hand were mediated by smoking-specificparenting practices (i.e., the frequency of parent-child communication and the quality of parent-childcommunication concerning smoking-related issues).

Method We used the data from the first wave of a longitudinal survey study called ‘‘Familyand Health’’, in which different socialization processes underlying several health behaviorsin adolescence are studied. Participants were 428 Dutch families (mother, father and twosiblings in the age of 13 and 17 years old), who were approached between November 2002and April 2003.

Results The findings indicated that the association between general parenting practices andolder and younger siblings’ smoking was mediated by smoking-specific parenting practices.Parents who are controlling and supporting use more smoking-specific parenting practices,especially quality of communication, than parents who are less controlling and supporting. Highfrequency and low quality of communication on smoking related issues are related to a higherlikelihood of smoking in both siblings. Compared to non-smoking parents, smoking parents

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were less likely to have satisfactory discussions on smoking-related issues. Further, the magnitudeof associations between parenting and adolescent smoking did not differ for older and youngersiblings.

Conclusions Parents who are controlling and adequately supporting their children are using moresmoking-specific parenting practices (such as quality of communication and frequency of communi-cation) and, therefore, prevention has to be focused on smoking-specific parenting practices as well asgeneral parenting practices. Further, smoking parents should also be encouraged to build up a goodsetting to communicate with their children, although the benefits of parents who quit smoking shouldnot be underestimated.

Do trained intervention facilitators use theory-based behaviour change techniques?Results: From the proactive fidelity project

*Hardeman, W., Michie, S., Prevost, T., Fanshawe, T., Kinmonth, A.; *Institute of Public Health,University of Cambridge, UK

Objectives An understanding of how behavioural interventions work requires an assessment ofintervention delivery, but this is rarely done. The study’s aims were to determine (a) whether useof theory-based behaviour change techniques in a randomised trial could be reliably assessed,and (b) to what extent trained facilitators used specified techniques.

Methods We assessed fidelity in ProActive, a trial of a theory-based programme to promote physicalactivity among individuals at risk of Type 2 diabetes (30–50 years, N¼ 365). Trained facilitators useddetailed protocols for each intervention session (face-to-face or distance). Coding frames weredeveloped to record the occurrence of 169 unique facilitator behaviours from transcripts of fourkey sessions of a random sample of 27 participants. A first rater assessed all four sessions, and thesecond rated two sessions (86 behaviours). Facilitator behaviours were classified under 14 techniques,and validated by two independent raters (72% agreement).

Results Inter-rater agreement for the two assessed sessions was high: >75% for 88% (76/86) ofbehaviours, and intra-class correlation 0.96 across all techniques. Facilitator adherence to techniqueswas modest, with median of 50% (range: 25 to 66%). Adherence differed between facilitators( p< 0.03) and decreased in later sessions ( p< 0.001), but was unrelated to programme type andparticipant gender. Facilitators’ use of techniques was unrelated to participants’ subsequentconfidence in using related self-management strategies, and confidence was positively related toparticipants’ self-reported use of strategies ( p< 0.02).

Conclusions The study demonstrates the potential for assessing fidelity, and raises importantquestions about the degree of fidelity to theories in behavioural interventions, the translation oftheories into practice, and the feasibility of training practitioners in theory-based techniques.Information on fidelity will be used to interpret results from ProActive (reports 2005).

Revelations from the analysis of free-text responses in the lung informationneeds questionnaire

Harding, S.; University of Plymouth, Plymouth, Devon, UK

Objectives Explore the additional information provided by patients in free-text sections ofquantitative questionnaires.

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Methods The Lung Information Needs Questionnaire (LINQ) was developed to measure therequirements of patients with Chronic Obstructive Pulmonary Disease (COPD). An iterativeprocedure reliant on patient comment, initially from focus groups was used in its evolution. TheLINQ was refined and validated by sending the questionnaire to 502 patients. 307 patients returnedthe questionnaire, 74 (24%) of these responses contained free-text. The free-text were entered into aQualitative Research Tool (NUD IST) and reflected on using a thematic analysis methodology.

Results Discourse obtained from questionnaires tended to fall into seven categories, reflected andexpanded on the six domains of LINQ; Disease Knowledge, Medicines, Self-Management,Smoking, Exercise and Diet, whilst the seventh identified category was Anxiety. The commentsrelating to patients anxieties split into; those with problems related to past events, and those relatedto foreboding and trepidation regarding long-term outcomes of COPD. It is of note, that althoughthis data was collected during validation of the questionnaire, no free-text comments were madeabout the layout, construction, or content of the form.

Conclusions There are inherent limitations in free-text comments, the relative merits of quantifyingthe frequencies of themes, and the ways in which free-text comments can be used to enhancequestionnaires. Free-text comments of this kind are no substitute for properly designed research.They are valuable in understanding and illustrating the responses to questionnaires (perhaps givingthe viewer an idea of the patients state of mind), as well as indicating further areas that cliniciansmay act upon to improve their patients’ care, whilst also suggesting topics for further research.Researchers are traditionally wasteful of this important form of data, systematic analysis of free-textcomments may reveal important outcomes.

Evidence based professional practice: Predicting advice giving in pharmacy counter assistantsusing the theory of planned behaviour

*Hart, J., Johnston, M., Watson, M., Bond, C.; *University of Aberdeen, UK

Objectives To use Theory of Planned Behaviour (TPB) cognitions (1) to assess beliefs aboutgiving advice and (2) as predictors of advice giving by trained pharmacy counter assistants (PCAs)(there is evidence that professional advice leads to changes in health behaviours that are associatedwith health outcomes).

Methods PCAs (n¼ 47) were audio taped during normal pharmacy practice in community pharma-cies in Scotland, involving 195 clients. The recordings were coded (by two independent coders) foradvice given (time, number of words, type of advice) and for communication pattern usingthe Roter Interaction Analysis System (RIAS). Following audio taping PCAs completed TPBquestionnaires (21 items). Participants responded using a 0–10 scale of how many customers theywould give advice to.

Results On average, PCAs reported that they gave advice to 53.8% (SD 2.64) of customers, butintended to give advice to significantly more people, 78.6% (SD 1.85) (t(41)¼ 6.19, p< 0.01).They felt confident (perceived behavioural control – PBC) about giving advice to 52.5% (SD 2.65)of people, significantly less than they intended to (t(31)¼ 5.09, p< 0.01). Behavioural intention andPBC predicted advice giving (adjusted R2

¼ 0.31, p< 0.01) Attitudes, subjective norm and PBCpredicted intention (adjusted R2

¼ 0.51, p< 0.01). These cognitions were used to predict audiotaped advice and RIAS communication patterns.

Conclusions For PCAs, there is an intention–behaviour gap, but additionally their intentions exceedtheir perceived control over giving advice. The TPB is predictive of PCAs’ behaviour. These patternsare similar to those observed in medical professionals in training. Since all TPB cognitions appearto predict this behaviour, interventions that enhance these cognitions might be effective in increasingthe rate of delivery of evidence-based practice.

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The experience of discontinuing antiepileptic drug treatment: An exploratory investigation

Hart, S.; University of Teeside, UK

Objective To explore the experience of making the decision to discontinue antiepileptic drugtreatment, following a seizure-free period of two years.

Method Semi-structured interviews were conducted with five epilepsy sufferers who had attemptedwithdrawal from their medication. All five of the participants lived in the North-East ofEngland. A phenomenological approach was taken in order to gain an in depth understanding oftheir withdrawal decisions.

Results Six themes emerged from the interviews, including the negative effect an epilepsy diagnosiscan have on self esteem. Principally, the timing of when to withdraw was a key concern. Fear anduncertainty were also reported, but the side effects of the medication and the feeling that withdrawalwas ‘‘worth a try’’ emerged as the primary factor in the decision to withdraw from their prescribedanti-epileptic treatment. Two participants had unsuccessfully withdrawn from their medication yetthey reported an acceptance of their condition since their seizures were now controlled. Mixed feelingsregarding satisfaction with GP support were also reported.

Conclusions Overall, dissatisfaction with available support related to the decision to withdraw wascentred around a lack of information. There is a paucity of research investigating the withdrawaldecision, therefore the findings from this study should be used for the production of appropriateand relevant information regarding the key issues which have been raised regarding withdrawaldecisions.

Differences in the care and support needs of women with breast cancer related lymphoedema

*Hay, M., Fletcher, J.; *Faculty of Medicine and Health Sciences, Monash University, Victoria,Australia

Objectives This poster describes a sub-set of findings from a study assessing the wellbeingof Australian breast cancer (BC) survivors with co-morbid lymphoedema. Findings relatingto differences in the care and support needs of lymphoedema patients with regard to differences inthe time since diagnosis of their BC are reported.

Methods Participants were 101 Australian women (mean age 61.4 years, SD 9.4) with upper bodylymphoedema resulting from treatment for BC. Recruitment was via advertisements placed inlymphoedema society newsletters. Participants completed and returned via reply paid mail a rangeof measures, including the Supportive Care Needs Survey (SCNS-SF34).

Results A oneway ANOVA revealed a significant effect for time since BC diagnosis (0–2, 2–3, 3þyears), where DV¼SCNS patient care and support (F2, 98¼ 5.88, p> 0.01). A Tukey’s post-hoctest revealed significant differences on the patient care and support domain of the SCNS betweenthose diagnosed with BC 0 to 2 and 2 to 3 years ago ( p¼ 0.028), and between 2 to 3 andmore than 3 years ago ( p¼ 0.003). There was no significant difference between those diagnosedwith BC between 0 to 2 and more than 3 years ago ( p¼ 0.965).

Conclusions Women who had received their BC diagnosis between 2 to 3 years ago reportedsignificantly greater need on the SCNS domain ‘patient care and support’ relative to those receivingtheir diagnosis either within the previous 2 years, or more than 3 years ago. These findings suggest thatfollowing the initial intense contact with medical services during BC treatment, there exists periodwhere women’s needs in relation to patient care and support are not met, after which adjustment isevident. The importance of providing ongoing care and support for women post-BC treatment,when their regular and intensive contact with health professionals ceases, is therefore indicated.

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Encouraging organ donation in the antipodes: The impact of a high profile ‘‘celebrity’’organ donation on organ donation registration in australia

*Hay, M., Donnelly, A.; *Monash University, Australia

Objectives Australia’s organ donor rate per 1000 deaths of 1.5 is low by world standards. The demandfor donor organs greatly exceeds supply with almost 2000 people currently listed as requiring an organtransplant. The publicity surrounding the 2004 premature death and organ donation (OD) of aprominent Australian sportsman prompted a moderate increase in donor registrations. This paperdescribes the findings from a study investigating the influence of knowledge and attitudes towardorgan donation and the impact of a high profile donation on an individual’s decision to register asan organ donor.

Methods Data collection was via a random phone survey of n¼ 146 residents of Melbourne (meanage 45.15 years, SD 16.56) of which n¼ 73 (50%) reported being registered organ donors.Participants responded to questions regarding their knowledge of, attitudes towards and communica-tions around OD. Participants also rated their awareness of the organ donation of the prominentsportsman, and the impact his donation had on their decision to register as an organ donor.

Results There were no differences between those who had and had not registered as organ donors bygender, age, or educational level. More registered donors had higher income (�2

¼ 4.400, df¼ 1,p¼ 0.036), reported friends and family as major source of information about OD (�2

¼ 12.422,df¼ 1, p¼ 0.000 and �2

¼ 4.067, df¼ 1, p¼ 0.044 respectively), and had informed their next of kinof their decision (�2

¼ 29.909, df¼ 1, p¼ 0.000). The majority (96%) of the sample were aware ofthe sportsman’s OD. Organ donation registration status was predicted by four unique predictors; dis-cussions with friends as an important source of information about OD, informing next of kin of theirOD decision, willingness to discuss their donor status with family members, and the influence of aprominent sportsman’s OD on their decision regarding OD.

Discussion The results of the current study indicated that levels of communication with familyand friends are important predictors of OD status, as was the OD of a high profile sportsman.These finding indicate the need for increased public communication around OD. Celebritydonations may constitute a viable public health strategy to increase the number of Australianscurrently registered as organ donors.

Psychosocial impact of paediatric acquired brain injury on children and their families:A qualitative investigation

*Heary, C., Hogan, D., Smyth, C.; *National University of Ireland, Galway, Ireland

Objectives The current study assessed the psychosocial adjustment of children with acquired braininjury (ABI) and their family members and examined their re-integration into the home communityfollowing a period of rehabilitation.

Methods A national random sample of families, whose child attended the National RehabilitationHospital with a severe acquired brain injury, were chosen to take part. For each family who wasselected, the child with ABI, their parents, a sibling, a teacher and a health professional whoworked with the child were invited to take part in an interview. Ninety-six individual interviewswere carried out, plus 2 focus groups with staff from the rehabilitation facility. Average age of thechildren was broad (5–20 years) given the low prevalence of severe ABI.

Results Many of the children experienced a variety of changes in their lives ranging from limitationsin functional abilities, cognitive impairment, distress and turmoil, and changes in interpersonal

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relationships. Most notable amongst these changes was the difficulties in peer relations which many ofthe children experienced. Many families also experienced fundamental changes in the roles and rela-tionships of family members. Parents frequently were involved in an intensive care-giving role,placing many restrictions on their lives. Consequently, they often expressed concern over the neglectof their other children.

Conclusion This research provides insight into variations and commonalities in the lives of childrenwith ABI and their families. The need for family-centred care in the aftermath of acquired braininjury that is tailored to the needs of individual families was apparent.

Caring for the COPD patient: What makes it difficult?

Heijmans, M.; NIVEL, Utrecht, The Netherlands

Background Caring for a person with COPD can be a stressful experience. COPD is a progressivedisease and patients often have to rely (partly) on the care of their spouse or other relatives in thedaily management of their illness. Carers differ however, in the amount of stress they experiencebecause of this caring task and probably also differ in the kind of things they find particularly stressful.

Objective (1) To examine the intensity and type of subjective burden carers of COPD patientsexperience; (2) to explore to what extent individual differences in subjective caregiver burden canbe explained by characteristics of the carer, disease characteristics, illness perceptions, the perceivedquality of the relationship with the patient and characteristics of objective burden such as timespent on care giving and number of care giving tasks.

Method Spouses and other close relatives of patients with a medical diagnosis of Chronic ObstructivePulmonary Disease (COPD, n¼ 183) were included in this study. Subjective caregiver burden wasmeasured with the Caregiver Reaction Assessment Scale (CRA) and an overall subjective judgementof caregiver burden.

Results More than half of the carers feel that caring for the COPD patient puts a strain on theirpersonal life (disrupted schedule, loss of physical strength, lack of family support). Objectiveburden was the main predictor of subjective caregiver burden. After controlling for objectiveburden, illness perceptions and perceived quality of the relationship added significantly to theprediction of subjective caregiver burden.

Conclusion Illness perceptions of carers and perceptions of equity or balance in the relationship areimportant for understanding subjective caregiver burden.

Predictors of successful and unsuccessful efforts, intentions and reluctance to health behaviourchange among middle-aged and older individuals

*Heinonen, H., Absetz, P., Valve, R., Uutela, A., Fogelholm, M., Nissinen, A.; *National PublicHealth Institute, Finland

Objective To identify age-related differences in health behaviors and their predictors in order todevelop interventions for healthy aging.

Methods The study is part of the GOAL Program (Good Ageing in Lahti region). Subjects(N¼ 2, 815) were randomly selected from population registry to represent three age cohorts, bornin 1946–50 (baby-boomers), 1936–40 (retiring) and 1926–30 (retired). Data were collected withtwo survey questionnaires (participation rate 66%). Measures included: socio-demographicbackground; health behavior outcome variables (reduced fat intake, increased vegetable intake,increased physical activity, weight loss, and smoking cessation); and social-cognitive predictors

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(generalized positive outcome and efficacy expectancies, risk perceptions for cardiovascular diseasesand functional incapacity, health-related self-efficacy and outcome expectations).

Results The retired more often indicated always having had healthy habits, while the baby boomersindicated most unhealthy habits. Furthermore, the baby boomers also expressed most reluctanceto change behaviors towards more healthy. Between the behaviors, the percentage of unsuccessfulefforts varied from 10% for dietary behaviors to 20% for physical activity and 34% for weight loss.In case of quitting smoking, prevalence of unsuccessful efforts was 4%, with only 1% of the retiredreporting unsuccessful efforts to quit. Generalized positive outcome and efficacy expectancieswere lower among those retiring or already retired. However, health-related self-efficacy was foundto be the most important predictor of all health behaviors in all the age groups.

Conclusions Our results point to a need to target motivational interventions to change the unhealthyhabits of the baby boomers. Furthermore, middle-aged and older individuals are likely to benefitfrom efforts to increase their health-related self-efficacy irrespective of their age.

Preconceptional cystic fibrosis carrier couple screening: Impact, understanding and satisfaction

*Henneman, L., Gille, J., van der Ploeg, H., ten Kate, L.; *EMGO Institute, The Netherlands

An important criterion set for genetic screening programmes is that such a programme should only beconsidered if participants’ benefits outweigh harm. This study assessed the impact, understanding,and satisfaction among participants in a cystic fibrosis (CF) carrier screening programme. Duringthe period 1997–2000, individuals at the age of 20–35 years in the Midwest of the Netherlandswere invited by mail, by either the Municipal Health Service (MHS) or their general practitioner(GP), to participate in the screening programme together with their partner. Pre-test counsellingwas provided during a group educational session or by a GP. Mouthwashes were taken forDNA-mutation analyses. Questionnaires were completed before and after counselling, and at 6months follow-up.

Full data were obtained from 17 of 18 identified carriers, 15 negative tested partners (þ/� coupleresult), and 794 (74%) participants with a negative or no test-result (�/ ? couple result). The resultsshow that none of the þ/� couples changed their reproductive plans because of their test-results.When asked after 6 months, eight participants were worried about their results and seven carriersfelt less healthy. Nevertheless, satisfaction with testing was high; all of these, and 95% (756/794) ofthe other participants, would make the same decision to be tested again. Overall, 88% of participants,would recommend testing to others. Predictors of a correct understanding of test-results (correct in62% of participants) were: positive (unfavourable) test-results high level of knowledge of CF, highlevel of education, attending an educational session, and previously heard of CF. When weighingthe beneficial and harmful aspects of screening, these findings suggest that there is no evidence thatthe psychological effects of a positive carrier test-result are so burdensome as to make it unacceptableto offer such a test. In order to maximise understanding of the meaning of the test-results the bestway of offering tests should be investigated.

The level and stability of perceived control after the diagnosis of breast cancer

*Henselmans, I., Ranchor, A., Tuinstra, J., Sanderman, R., van Sonderen, E.; *Northern Center forHealth Care Research, University Medical Center Groningen, The Netherlands

Objectives Breast cancer is generally considered a low-control situation with few possibilities to exertcontrol. This longitudinal study examines the level and stability of a sense of control over life afterdiagnosis.

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Methods Three months after diagnosis 92 breast cancer patients were included and matched to64 healthy women. Perceived control was assessed with the Mastery list (Pearlin & Schooler, 1978)at 3, 9 and 15 months after diagnosis.

Results Three months after diagnosis, breast cancer patients did not differ from healthy women intheir sense of control over life. In addition, neither half a year later nor one year later any significantchanges in the mean level of perceived control appeared. The scores at all assessments correlatedstrongly. However, when differentiating groups on the basis of treatment modalities and controllingfor age differences between groups, it turned out that receiving chemotherapy is related to a significantdecrease in perceived control from 3 to 9 months after diagnosis. Nine months after diagnosis,these patients perceived significantly less control over life than healthy controls or patients whowere not treated with chemotherapy. Half a year later, the difference between the three groupsagain disappeared.

Conclusions Apparently, it is not being diagnosed with breast cancer as such that affects perceivedcontrol, but the receiving of chemotherapy, which can be considered as an indicator of diseaseseverity. This study shows that breast cancer patients who do not have to be treated withchemotherapy, are able to maintain a sense of control over life on the short, middle and long term.

Acceptance and cognitive control strategies in smoking-cessation interventions:A comparison between treatments

*Hernandez Lopez, M., Roales-Nieto, J., Luciano Soriano, M.; *University of Almerıa, Spain

Aims This study compares two different psychological treatments aimed at smoking-cessation.One of them focuses in the acceptance of aversive private events related to nicotinic abstinence,and consists of an adaptation of the core components of Acceptance and Commitment Therapy(ACT). The other one focuses in controlling these private aversive experiences, and consists ofa multi-component cognitive-behavioral intervention program that is currently employed by theSpanish Association against Cancer (SAC).

Methods Both treatments were group-administered with an equal number of sessions to differentgroups of smokers (each group ranging from 5 to 10 people). The ACT-based treatment wasadministered to groups of smokers either in their worksites or in a university-based psychologicalclinic. The cognitive control-based treatment was applied to different groups attending the SACpsychological services.

Results Treatment and post-treatment results are presented with up to one year follow-up.Results indicate a higher effectiveness of the ACT-based treatment.

Conclusions This suggests that recent behavioral therapeutic approaches based on the acceptanceof aversive private events can be successfully applied in smoking-cessation interventions, just asthey have been in the treatment of a wide array of psychological problems.

Spiritual resources, dispositional and situational coping, and health

Heszen, I.; Health Psychology, Warsaw School of Social Psychology, Poland

Objectives Substantial evidence has been collected indicating a positive influence of spirituality,understood as an individual attribute, on physical and psychological health. The research was focusedon seeking psychological mechanisms of this connection. Particularly, the aim of the study was to

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explore the role of dispositional and situational coping as ‘‘transmitters’’ in the influence of spiritualityon health.

Methods Two studies were performed with parents suffering from severe, long-lasting stress, causedby health condition of their children. In the first study 100 parents of chronically ill children wereexamined, while in the second – 44 parents of disabled children participated. In both studies aself-developed questionnaire was applied to measure spirituality. In the first study dispositionalcoping was evaluated with the Polish version of CISS by Endler and Parker and subjects’ subjectivehealth was assessed using questionnaires and semi-structured interview. In the second studysituational coping was examined with the Polish adaptation of WCQ by Folkman and Lazarus.All research tools met the psychometric criteria.

Results In the first study it was found that spirituality influenced health both directly and indirectly,via coping style. Spirituality was connected with two dimensions of coping style: task-oriented andavoidance by social diversion (path values 0.39 and 0.31, respectively). Next, social diversiondimension was connected with spiritual (0.23) and psychological (0.17) indexes of health. The resultsof the second study revealed positive relationships between spirituality and the following strategiesof coping: fighting (r¼ 0.30), positive reframing (r¼ 0.41), planned problem solving (r¼ 0.20) andwishful thinking (r¼�0.41).

Conclusions Dispositional and situational coping may be considered as factors transmitting theeffects of spirituality on health. Spirituality enhances coping dispositions and strategies which areuseful in solving problems and elevating emotions in the situation of prolonged life stress.

Changes in psychological states during cardiac rehabilitation:Does initial level of distress matter?

Hevey, D.; Trinity College Dublin, Ireland

Objectives High rates of psychological distress have been reported in cardiac patients. To-date littleresearch has compared psychological effects of multidisciplinary cardiac rehabilitation (CR) onpatients with clinical levels of distress and patients in the normal range. The present study examinesthe changes in levels of psychological distress and health-related quality of life in a sample of distressedand non-distressed patients who received CR or usual care.

Methods 151 cardiac patients completed the Hospital Anxiety and Depression Scale (HADS), theHealth Complaints Checklist (HCS), and the Quality of Life Index Cardiac Version III (QLICVIII) before and after attending a multidisciplinary CR program. 165 cardiac patients completedthe same scales at equivalent times post-cardiac event to the CR participants. Changes in psychologi-cal states were assessed using a 2 (distressed or non-distressed)�2(CR or usual care)� 2 (time 1 ortime 2) repeated measures ANOVA.

Results There were no statistically significant differences between the CR group and the comparisongroup in relation to rates of clinical depression (CR: 10% vs. comparison: 8%) or clinical anxiety(CR: 17% vs. comparison: 13%). Analysis revealed a statistically significant interaction ( p< 0.001)between time and clinical anxiety for changes in anxiety, with clinical anxious cardiac patients showingsignificant reduction in anxiety. A similar statistically significant interaction ( p< 0.001) between timeand clinical depression was noted for changes in depression, with clinical depressed cardiac patientsshowing significant reduction in depression. In addition, clinically anxious and clinically depressedpatients showed statistically significant changes ( p< 0.05) in the HCS and on the QLICV-III.

Conclusions Results indicated changes in the psychological variables investigated were significantlyrelated to the initial levels of distress of cardiac patients, irrespective of whether they attended CR.Implications of the research for cardiac rehabilitation outcomes assessment are considered.

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Individual quality of life: Relationship with psychological and subjective well-being

*Hickey, A., Ring, L., Hofer, S., McGee, H., O’Boyle, C.; *Royal College of Surgeons in Ireland,Ireland

Objectives Previous research has focused on the relationship between negative emotions (e.g., depres-sion) and quality of life (QoL). However, less is known about the relationship between positiveemotions (highlighted by the ‘‘positive psychology’’ movement) and QoL. Well-being researchconsists of two broad traditions: psychological well-being (PWB) deals with human potential andsubjective well-being (SWB) with happiness. Keyes (2002) provides a theoretical model of therelationship between these components. The aim of this study was to examine the relationship ofPWB and SWB respectively with individual QoL (IQoL).

Methods IQoL was assessed using the Schedule for the Evaluation of Individual Quality ofLife (SEIQoL). PWB (autonomy, environmental mastery, personal growth, positive relations withothers, purpose in life, self-acceptance) was assessed using the Psychological Well-being Scale andSWB by the Satisfaction with Life Scale and the Positive and Negative Affectivity Scale.

Results N¼ 136 university students completed the questionnaires. The mean SEIQoL index scorewas 65.05 (�13.22 SD) (range 28–97; possible range: 0–100). Expected correlations were foundbetween the SEIQoL index score and the PWB (r¼ 0.26 to 0.43, all p< 0.01) and SWB scales(r¼�0.40 to 0.54, all p< 0.01). Using structural equation modeling, Keyes’ model was tested(CHI2

¼ 48.34, df¼ 24, GFI¼ 0.92, CFI¼ 0.93, RMSEA¼ 0.08) showing an acceptable fit.In a second step, the SEIQoL index score was entered into the model (CHI2

¼ 61.8, df¼ 31,GFI¼ 0.92, CFI¼ 0.92, RMSEA¼ 0.08). The model explained 41% of variance of the SEIQoLindex (SWB �¼ 0.83, p< 0.001; PWB �¼�24, p¼ 0.44).

Conclusions Correlations among measures suggest no redundancy of measures, nor that individualQoL is equivalent to either PWB or SWB. Results indicate that IQoL measured by SEIQoL primarilyassesses SWB rather than PWB. These findings raise the question of whether, and to what extent,IQoL is primarily driven by SWB.

Toward launching as contributing factors for soldiers in training

*Hochdorf, Z., Klingman, A.; *Haifa University, Israel

The current research focused on the contribution of the family to the adjustment of the youngstersto the army within the phase of leaving home. A sample of 176 youngsters (age 18) (boys andgirls) and their parents answered self reported questionnaires at home, before and through outarmy service. Young participants were administered: Adult Attachment Scale (AAS) and FamilyEnvironment Scale (FES). Parents were administered: Family Environment Scale (FES), andHolding\Releasing Questionnaire (HRQ). Adjustment to the army was examined by the MilitaryLife Questionnaire (MLQ) and Mental Health Inventory (MHI). Soldiers’ sense of well-being wasexplained by attachment styles. High sense of stress was explained by soldiers’ anxious and avoidantattachment styles in contrast to secure attachment styles. Parents’ reactions towards ‘‘launching’’explained soldiers’ adjustment to the military service: Parents’ tendency to hold or release explainedsoldiers’ sense of well-being or distress. We found the mother as having a great influence on a soldiers’functioning. Parents’ attitude toward life in Israel, and their own military service, explained thesoldiers’ sense of well-being. Soldiers reported about positive relations with their parents, andchoose them as a primary support object. The results showed that the parents have a large influenceon the soldiers even within the phase of leaving home and joining the army. Possible implicationsof the findings for school based intervention with adolescents in order to promote their well-being,

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and possible intervention with their parents toward and during the ‘‘launching’’ stage, are discussed aswell as through the lens of family therapy.

Empowering couples victimized by terror in Israel

*Hochdorf, Z., Gill-Lev, I.; *Haifa University, Israel

Israel has been exposed to intensive terror for the last years. Daily, people are brutally attacked athome, while sleeping in their beds, driving a car or just walking down the street. The purpose ofthis work was to examine the effect of group interventions on health promotion. Subjects: 30 couples(one of whom had been recently injured during a terrorist attack).

Methods Use of group interventions (Yalom, 1985), openness, warmth, dialog techniques (Handrix,1988), and the Narrative approach (White & Epston, 1999), over a three-day workshop (sponsoredby the ‘‘One Family’’, Israel Emergency Solidarity Fund). Findings: the interventions helped theparticipants to listen to each other empathetically, provide social support even though they had notknown each other before and cope with the trauma better. A follow-up questionnaire revealed thatthe effect of the interventions on the participants remained in effect for a term of 6–8 months.

Conclusions The characteristics of resilience (Garmezy, 1991) self-efficacy (Badura, 1988) hardiness(Kobasa, 1979) optimism, religious belief, a strong drive to survive and a healthy marriage, helpedthe participants in their recovery, despite being diagnosed as suffering from Post Traumatic StressDisorder (PTSD).

Smokefree class competition in Switzerland: Does it work with negative peer pressure?

Holger, S.; Swiss Institute for the Prevention of Alcohol and Drug Problems SIPA, Switzerland

Objectives Early onset of smoking is the strongest single predictor for continued regular smoking.The Smokefree Class Competition (SCC) is a school-based smoking prevention project, with theidea that school classes who decide not to smoke for a period of six months can win a prize. It ishypothesized that social norms within classes are influenced in a way that non-smoking becomesa standard. However, the project has been criticized for working with negative peer pressure mainlyfor students who smoke already.

Methods Data was collected from the Swiss part of the 2002 World Health Organization (WHO)cross-national survey on Health Behavior in School-Aged Children (HBSC). The representativesample consisted of 7811 students: 3803 boys and 4008 girls. A total of 455 classes from grade 6 to9 and 440 teachers delivered information about the class characteristic, e.g., their participation inthe SCC. We use multilevel modelling to analyse the effects of class characteristics as contexts onstudents smoking, bullying and well-being.

Results There are 60 classes participating in the SCC, 25 classes stopped participation, 320 classesdid not participate and for 35 classes no information was delivered by the teachers. Mean age ofstudents was between 13 and 14 years, with students in the classes that stopped participation beingsignificantly older than in the other groups. Daily smoking is significantly lower in participating classescompared to the other groups (2.7% versus 9.3%). Being bullied, being accepted from class matesand being rejected does not differ between classes as well as between smokers and non smokerswithin classes.

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Conclusions Smoking is reduced in the participating classes. However, this may be due to theselection bias in classes with mainly non smokers and the selective drop out of classes with manysmokers. The SCC seems to create no negative peer pressure on students who smoke.

Language use and affective states

*Horn, A., Possel, P., Hautzinger, M., Traue, H.; *Health Psychology Section, University of Ulm,Germany

Recent research proposes that language can serve as markers of emotional and cognitivephenomenon. Especially in the area of affect and emotion regulation and the risk factors ofmood disorders this approach seems to a promising research tool. In this study written languagesamples of 190 adolescents were taken, instructed to write five times 20 minutes about a disturb-ing experience. Self reported depressive symptoms and Negative and Positive Affect were collectedas well as general Negative and Positive Affectivity. Language use was analysed using the Germanversion of the LIWC (Linguistic Inquiry Word Count; Pennebaker, Francis, & Booth, 2001),a computer software that counts and allocates words into a linguistic categories. Consistent withcognitive models of depression that underline the crucial role of self focus in depressive moodmore depressive symptoms and Negative Affect reporting adolescents used more the first personpronoun ‘‘ich’’, an effect that is vice versa in Positive Affect. More depressive symptomsgo along with more emotion word use regardless of valence. However, higher levels of NegativeAffect go along with not only more emotion words in total but there was also the expecteddifference regarding valence observable (more negative, less positive emotion words).Dispositional Negative or Positive Affectivity did not show any effect on these aspects oflanguage use. The results of this study are consistent with other findings that encourage furtherresearch including language use as possible marker of cognitive, affective, and social aspects ofhuman life.

An intervention to modify patients’ beliefs about maintenance therapyand improve adherence to medication

*Horne, R., Scrase, A., Weinman, J., Perry, K., Main, J., Hartley, J., Rees, J., Webb, J., Barnes, M.,Powrie, K., Barnes, N.; *Centre for Health Care Research, University of Brighton, UK

Objectives To develop a theory based intervention to improve adherence to asthma medicationby training asthma nurse specialists to elicit and address beliefs about inhaled corticosteroids (ICS)which have been shown to act as barriers to adherence.

Methods A pre-post test design was implemented. Three nurses recorded their consultationswith asthmatic patients before (n¼ 44) and after (n¼ 38) an intervention. The interventionconsisted of consultation training (1.5 days) and manual. Consultations were transcribed andthe consultation skills were rated by two independent researchers (kappa 0.7). The interventionwas based on self-regulatory theory using the necessity-concerns framework to operationaliseadherence-related treatment perceptions. Patients’ perceptions of ICS (perceived necessityfor ICS and concerns about potential adverse effects of ICS) and their reported adherence tomedication were assessed at the time of the consultation and at one month follow-up, usingvalidated questionnaires. The beliefs and adherence of the pre and post intervention patientswere compared.

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Results Treatment perceptions predicted adherence, with low reported adherence rates predictedby baseline doubts about personal need for ICS (t(77)¼ 1.79, p< 0.05 one-tailed) and concernsabout potential adverse effects (t(77)¼�1.86, p< 0.05 one-tailed). Analysis of nurse consultationtranscripts showed a significant improvement in nurse consultation skills following theintervention training session and manual with scores of 62% vs. 38% at baseline (t(106)¼ 12.2,p< 0.001). However, this did not influence patient adherence or change the key beliefs influencingadherence.

Conclusions The association between patients’ perceptions of ICS and adherence confirms the needto target such beliefs in interventions to improve adherence. However, whilst this interventionchanged nurses’ consultation behaviour, this did not impact on patients’ beliefs about ICS northeir reported adherence. This suggests that more effective technologies are needed to elicit andmodify beliefs about treatment to effect behaviour change.

Predictors of smoking cessation and relapse in Dutch adults

Hoving, C.; University of Maastricht, Maastricht, The Netherlands

Objectives To investigate predictors of smoking cessation and relapse in Dutch adults, in particularthe influence of gender and action plans.

Method Adult smokers (N¼ 637) completed a written baseline questionnaire concerning smokingand smoking cessation and were contacted by telephone after 3 months. Demographic andmotivational determinants were assessed, as well as preferred action plans and smoking behaviour.The I-CHANGE model formed the theoretical basis of this study. Results are based on logisticregression analyses.

Results Smokers who had attempted to quit more often in the past, had a higher intention to quit andpreferred the action plan to inform people around them were more likely to quit smoking.Additionally, quitters were less likely to have a non-smoking partner than continued smokers andscored higher on habitual self-efficacy. Male quitters had a lower addiction level than male continuedsmokers and saw more cons of cessation. Women were more likely to quit smoking if theypreferred the action plan of informing people around them about their quit attempt. Quitters weremore likely to relapse if they had quit more often in the past and were more motivated to quit.The use of bupropion during the quit attempt protected against relapse. For men only, relapsecould be predicted by a higher intention to quit smoking and a smoking partner. Women weremore likely to relapse if they had a higher addiction level and a higher intention to quit smokingat baseline.

Conclusions Men and women do not differ in cessation and relapse rates, but predictors ofthese behaviours differ between the sexes. Preferred action plans also influence the occurrence ofsmoking cessation and relapse. Both concepts should be taken into account when developingsmoking cessation and/or relapse prevention programmes.

Stimulating organ donation: The role of empathic cues

*Huebner, G., Six, B.; *Martin-Luther University of Halle-Wittenberg, Germany

Due to a crucial shortage of organ donors, annually thousands of patients waiting for organs die.If more people who die from causes that would allow them to become donors would actuallydonate, the supply of donor organs could meet demand. However, despite positive donor attitudes,only a minority signs organ donor cards. To stimulate behavioural commitment in the form ofsigned organ donor cards, we developed an organ donor specific information processing model.

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This model is based on the terror management theory (Greenberg et al., 1997), the model of responseto organ donor card appeals (Skumanich & Kintsfather, 1996), and recent organ donor research.It links issue involvement, donor attitude, and fears to behavioural intention and actual behaviour.Empathic cues in an organ donor message are hypothesized to increase issue involvement. In turn,heightened issue involvement is assumed to positively influence attitude, behavioural intention andactual behaviour. Parallel, empathic cues are supposed to increase fears concerning organ donor.Fears concerning organ donor are known to influence behavioural commitment negatively.Therefore, empathic cues are supposed to be less efficient in stimulating organ donor card signingcompared to fear reducing information. A first study was conducted to test the organ donor specificinformation processing model. Results were in accord with predictions: Following an empathic cuein form of an emotive, narrative story concerning a young woman undergoing a transplantationprocess, participants showed significantly higher issue involvement and fears concerning organdonor, compared to participants who read an only informative organ donor message. However,neither attitudes towards organ donor nor willingness to donate or actually signing an organ donorcard were significantly different between the experimental conditions. We tentatively conclude thatsolely empathic cues should be used with precaution in organ donation signing campaigns.

Adolescent: The relationship between illness, suicidality and substance use

Huesler, G.; Universitiy of Fribourg, Switzerland

Objectives The study tests illness suicidality and substance use as outcome measures in a pathanalysis of 1500 Swiss adolescents.

Methods A national project, initiated by the Swiss Federal Office of Public Health target adolescentsaged 11 to 20 who face situations that place them at risk for school drop-out, substance use or deviantbehaviour.

Results Negative mood (depression and anxiety) was a powerful predictor of both illness andsuicidality, directly and of substance use, indirectly, through suicidality. While age differences wereapparent, gender differences were most striking. For boys, negative mood led most frequently tosuicidality and thence to substance use (younger boys 0.52 and 0.32; older boys 0.61 and 0.63).For girls, negative mood was slightly more likely to lead to illness (0.48, younger girls and 0.53older girls) than to suicidality (0.44 and 0.39) and thence to substance use (0.27 and 0.04 ns).Further, good parental relationships protected girls against suicidality (�0.14 and �0.31) and sub-stance use (�0.25 and �0.40). A good relationship with the parental was a strong protective factorfor younger boys against substance use (�0.43), but served no protective factor for older boys, oragainst suicidality. Finally, substance use was slightly related to illness except among older boys.

Conclusions These observations are important for prevention programs. Our results suggest that asecure sense of self is protective in the presence of good family relations against substance use.This means that helping youth to develop a secure sense of self may militate against negative mood,which, in this model, was the core risk. This suggests that prevention efforts might morefruitfully target the negative mood that underlies all three risks (illness, suicidality, substance use).

Day-to-day support moderates the effects of availability of laboratory supporton cardiovascular reactivity to stress

*Hughes, B., O’Donovan, A.; *National University of Ireland, Galway, Ireland

This study examined if people reporting high and low quantities of day-to-day social support differedin cardiovascular reactivity to acute laboratory stress (CVR) across availability-of-laboratory-support

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conditions. Two hundred and nineteen female, first-year psychology students were screened forquantity of day-to-day social support using the Social Support Questionnaire-6N (Sarason &Sarason, 1983). Seventy-four participants, who ranked in the top and bottom tertiles accordingto day-to-day social support score, were randomly assigned to complete a reading task ineither a support-available, no-support-available or control, support-not-mentioned, condition.Measures of systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR)were taken during a resting baseline period and during the reading task. A series of independent-samples, 2� 3 analyses of covariance were conducted on HR, SBP and DBP change scores.Change scores were computed by subtracting mean baseline HR, SBP and DBP from meanHR, SBP and DBP during the reading task. Independent variables were quantity of day-to-daysupport available and availability of laboratory support. Baseline cardiovascular measures wereentered as covariates. Results indicate that the effects of availability of laboratory support onHR are moderated by quantity of day-to-day social support ( p< 0.02). Those participants whoreported low quantities of day-to-day social support available had significantly higher HR changescores than those reporting high quantities of day-to-day social support available, but only in theno-support-available condition. Perceptions of the quantity of day-to-day support available may bean important variable in determining cardiovascular reactions to situations where local support isnot available.

Antecedents and consequences of conflict between work and home life

Hughes, E.; University of Oxford, UK

Objectives The aim of the present study was to examine occupational and individual predictorsand health consequences of the two directions of work-family conflict: work interference withfamily (WIF) and family interference with work (FIW).

Methods Data relating to individual, work, and family variables were obtained by questionnaire froma sample of 242 healthcare and office workers (218 females, 24 males) employed in the UK NationalHealth Service.

Results Hierarchical regression analyses indicated that WIF and FIW had different antecedents.‘Work-interference with family’ was explained by work variables (hours worked, job demand,and manager support), individual differences (e.g., neuroticism), and family size. ‘Familyinterference with work’ was explained by family variables (family size and satisfaction). WhilstWIF and FIW were both significant predictors of physical health rating, only WIF wassignificantly related to psychosomatic disorders (e.g., headaches, muscular and digestive complaints)and psychological distress (GHQ). Previous research suggests that WIF may mediate therelationship between work characteristics and health indicators. This path was evident in thepresent study in that WIF acted to mediate the relationship between job demand and psychosomaticcomplaints.

Conclusions The findings support assertions in the literature that work-family conflict isa bi-directional construct (i.e., work interferes with family, and family interferes with work),and that WIF and FIW have different antecedents and outcomes. In particular, WIF (largelydetermined by work variables) was uniquely related to psychosomatic complaints and psychologicalhealth, whereas both WIF and FIW were related to physical health ratings. Longitudinal datacollection (currently in progress) is needed to clarify the causal mechanisms involved, but the presentstudy confirms the importance of separating the two components of work/family conflict in suchresearch.

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Does the dissimilarity between couple’s perceptions of infertility predict stressand distress following the failure of IVF treatment?

*Humphrey, K., Moss-Morris, R., Johnson, N.; *Dept. of Psychological Medicine, The University ofAuckland, New Zealand

Objective To investigate whether couple’s perceptions of their fertility delay can predict stressand distress following the failure of in-vitro fertilisation (IVF) treatment.

Method In a prospective pilot study, fifteen couples completed a measure of infertility perceptions(Illness Perceptions Questionnaire-Revised) prior to beginning IVF treatment, and approximatelyseven weeks later, after the conclusion of treatment, measures of stress (Perceived Stress Scale) anddistress (General Health Questionnaire) were completed.

Results For men, pre-treatment personal beliefs about infertility were predictive of their distressfollowing the failure of IVF treatment. Men’s beliefs about personal control were most strongly relatedto both stress and distress outcomes. For women, dissimilarity of infertility perceptions between themand their spouse was predictive of stress following treatment failure, rather than their own personalbeliefs.

Conclusions Men’s own perceptions about infertility were most important in determining stressand distress following the failure of IVF treatment. Women’s post-treatment stress was most stronglyrelated to the difference in infertility beliefs between them and their partner.

Fears of recurrence and psychological distress in head and neck cancer patients:Preliminary findings of a cohort study

*Humphris, G., Hodges, L., Lowry, R., Macfarlane, G., Macfarlane, T., McKinney, T.; *Universityof St. Andrews, UK

Patients treated for head and neck (H&N) cancer have a 30 to 40% risk of recurrence in the first yearfollowing diagnosis. These patients experience appreciable fear that the disease will recur, with firmbeliefs that the recurrence will become unmanageable and life threatening. Although this is oneof the major concerns for many cancer patients little empirical investigation has been reported ofhow these specific fears may lead to more permanent psychological distress. The fear of recurrenceand psychological distress project (FORPSYCH Project) is a 3 wave cohort study.

Objectives (i) To assess the levels of fears of recurrence (FOR) over a 6-month period followinga diagnosis of head and neck cancer, and (ii) evaluate the role of these fears in the development ofanxiety and depression.

Methods Patients were recruited from three UK centres – Manchester, Edinburgh and Newcastle.Baseline data from a sample of 220 patients have so far been collected (female patients, 35.2%mean age¼ 57.94 years). The intention is to recruit over 300 patients. A fear of recurrencemeasure and the Hospital Anxiety and Depression scale were administered at baseline, 3 and6 months following diagnosis.

Results Anxiety scores and FOR were fairly stable over time, but depression levels significantlyincreased between the baseline and 6-month interviews ( p< 0.02). Structural equation modellingshowed some evidence of recurrence fears driving levels of psychological distress rather than thereverse at each stage following diagnosis.

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Conclusions Some evidence has been found therefore to support the intervention of reducingrecurrence fears to prevent the development of anxiety and depression.

Screening for emotional and behavioural problems in children with chronic illness

*Hysing, M., Elgen, I., Lundervold, A.; *Department of Medical and Biological Psychology,University of Bergen, Norway

Objectives Children with chronic illness have increased risk of emotional and behavioural problems.Finding effective screening instruments is of importance to detect problems and increase access toeffective treatments.

Methods The sample is part of the Bergen Child Study, a population of 9430 children attending2–4th grade in schools in Bergen (Norway). 74% (7008) of the parents filled out a screening question-naire, including the strengths and difficulties questionnaire (SDQ) and questions about chronicillness. High scorers were interviewed with The Development and Well-Being Assessment (DAWBA), astructured interview to assess psychiatric diagnoses in children.

Results According to parent report 540 (8%) of the children had a chronic illness. These childrenshowed a twofold increase in risk of emotional and behavioural problems for both boys (OR¼ 2.07,CI 95% 1.54–2.78) and girls (OR¼ 2.00, CI 95% 1.40–2.86) according to the SDQ. Childrenwith neurological disorders showing the largest increase in risk (OR¼ 6.37, CI 95% 4.02–10.09).Invitation to a diagnostic interview was given to 238 parents of children with a chronic illness,46% (110) of the invited parents underwent a diagnostic interview. According to DAWBA therate of psychiatric diagnosis were higher in children with a chronic illness (OR¼ 1.7, CI 95%1.04–2.85), with children with neurological diagnosis showing a higher increase in risk of psychiatricdiagnosis (OR¼ 4.86, CI 95% 2.12–11.17). The SDQ identified children with a psychiatric diagnosiswith a high sensitivity and specificity.

Conclusions Children with a chronic illness have increased risk for mental health problems. SDQ is asensitive screening instrument and is recommended as a routine paediatric assessment for detection ofpsychiatric disorders.

Behavioural regulation of exercise: The effects of personality traits and participation motives

*Ingledew, D., Markland, D.; *University of Wales, Bangor, UK

Objectives The aim was to examine whether some motives for participating in exercise and somepersonality traits are more conducive to self-determined regulation of exercise and thereby to greaterparticipation. In the causal model to be tested, personality traits influenced participation motiveswhich influenced behavioural regulation which influenced participation.

Methods The participants were 249 office workers, mean age 40.27, SD 10.95 years, 52% male.They completed questionnaire measures of personality (five-factor), motives for exercise participation(the EMI2), behavioural regulation of exercise (BREQ2), and exercise participation (an intensity-frequency measure). The motives for exercise participation (excluding enjoyment-related motives)were factor analysed. The causal model was tested using structural equations modelling with observedvariables.

Results Three broad motives were derived from the factor analysis: health, social engagement, andappearance. In the final causal model, all three motives acted to increase identified regulation andthereby increase exercise participation. However, appearance motive also acted to increase externalregulation and thereby reduce exercise participation. The net effects were that health and socialengagement motives increased participation, whereas appearance motive did not affect participation.

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Conscientiousness reduced external regulation, and thereby increased exercise participation.Neuroticism increased appearance motive and introjected regulation, but did not affect exerciseparticipation.

Conclusions Appearance motives are less conducive than health and social engagement motives toself-determined motivation for exercise. This has implications for health promotion, since manyindividuals begin exercise for appearance reasons. Such individuals may need supplementary interven-tions to facilitate more integrated motivation. Less conscientious individuals will also requireadditional consideration.

Personality as predictor of anxiety and depression in chronic pain patients

*Irachabal, S., Martin-Sentinelli, M., Bruchon-Schweitzer, M., Pedinielli, J.-L.; *Universite deProvence (Aix Marseille I), Universite de Bordeaux II, France

Objective– To examine the association between personality and depressive and anxious symptoms.– To explore the hypothesized mediating effects of cognitions and coping on this relationship.

Method First study: a community sample comprising fifty-five chronic pain patients and fifty-fivepain-free control subjects are compared on measures of personality disorders (SCID II, version2.2) and depressive and anxious symptoms (HAD, Zigmond & Snaith, 1983). Second study: it is athree-stage prospective study. One hundred forty-five chronic pain patients completed questionnaireon personality (NEO-PI-R, Costa & McCrae, 1985) before the beginning of their treatment in a painclinic. Cognitions (PBPI, Williams & Thorn, 1989; MHLC, Wallston et al., 1978) and coping(CSQ, Rosenstiel & Keefe, 1983; CPCI, Jensen et al., 1995) are assessed one month later. Data onanxious and depressive symptoms (HAD, Zigmond & Snaith, 1983) is collected at the six-monthfollow-up. Path analysis is employed to investigate the relationship among the variables.

Results First study: personality disorders are more common among chronic pain patients than inhealthy controls. Rates of depressive and anxious symptoms are higher in chronic pain patients.Borderline personality seems to be a risk factor for anxiety and depression. Second study: the onlydimension of neuroticism that is strongly related to anxiety and depression is hostility. It appearsthat lack of perceived control and belief in pain permanence mediate this relation.

Discussion As far as therapeutic developments are concerned, the results of these two studies suggestthe relevance of using cognitive behaviour therapy with chronic pain patients.

The relationship between self-care system and sport injury for athletes

*Ishii, K., Shimizu, Y.; *Tokyo Medical University, Japan

Objective The purpose of this study is to investigate the relationship between the psychologicaland physiological self-care system and athlete’s sport injuries.

Background At present, health psychological researches for sport injuries are mainly progressed inEurope and the US. To this date, however, little research has been conducted on the relationshipbetween self-care system and sport injuries in Japan. The meaning of this study is to explore somefactors in self-care system connecting with sport injuries.

Method/Results The first, to develop the questionnaire of self-care system, 316 college athletes (male239, female 77, mean age 19.4) in Tokyo area answered the questionnaire. The results of factoranalysis identified 5 factors (relationship and concentration, physical self-care, physical conditioning,social support, nutrition) with 28 items in Self-care Scale for Preventive Sport Injuries. Each of factorsshowed appropriate Cronbach’s � coefficient. Confirmatory factor analysis was also indicated that

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the structure of this model satisfied the statistical requirements (GFI¼ 0.912, AGFI¼ 0.870,RMR¼ 0.061, RMSEA¼ 0.081, CFI¼ 0.885). The second, to investigate the relationship betweenthe questionnaire of self-care system and athlete’s sport injuries, two-way ANOVA was conductedexperience or inexperience in sport injuries by male and female. Significant main effects in eachgroups and gender differences were found in this questionnaire.

Conclusions In this research suggested that self-care system is different in each gender, and alsoshowed that recognition of self-care system is deeply connected with sport injuries. In general,female athletes tend to show high score in self-care scale, and athletes who have experienced injuriestend to show high score in self-care scale. It is assumed that athletes who experienced many injurieshave a lot of opportunities to learn self-care system.

Psychometric properties of the posttraumatic growth inventory in Dutch cancer patients

*Jaarsma, T., Pool, G., Sanderman, R., Ranchor, A.; *Northern Centre for Healthcare Research,Department of Health Sciences, The Netherlands

Objectives In this study we wanted to investigate the psychometric properties of a Dutch translationof the Posttraumatic Growth Inventory (PTGI) in a sample of cancer patients.

Methods First, we investigated the factor structure of our translated questionnaire by comparing ourdata with the original dataset of Tedeschi and Calhoun (1996). Next, we investigated the reliabilityof the questionnaire by calculating alpha’s and inter-item correlations of the total scale and itssubscales. Finally, we investigated the validity of the questionnaire by calculating correlations withpresumed related measures and the demographics age and gender, selected by theoretical insights.

Results The original factor structure of the PTGI could be maintained in our sample of cancerpatients. Furthermore, the internal consistency of the total scale as well as of the subscales wassatisfactory. As was expected, the translated PTGI appeared to be related to the personality trait open-ness to experience, to sharing with others, feelings of intrusion about the cancer experience, and tofeelings of innerness. The PTGI appeared not to be related to feelings of anxiety and depression.As was expected, younger patients reported more growth than older patients, and women reportedmore growth than men.

Conclusions With the Dutch version of the PTGI we do have a sound measure for the experience ofposttraumatic growth in cancer patients, and it offers the opportunity to further investigate to whatdegree and under which circumstances people can experience posttraumatic growth after a negativeexperience.

Attitudes to irritable bowel syndrome (IBS), epilepsy and chronic asthma

*Jacobs, C., Shepherd, R.; *University of Surrey, UK

Objectives This study investigated general population perceptions of IBS sufferers in comparison withother chronic illnesses (epilepsy and asthma).

Methods Participants (N¼ 121, M37, F¼ 84, mean age 35.5, age range 18–79) were recruited usingopportunity and snowball sampling. A questionnaire was administered by post or e-mail. It included28 Likert scale questions about attitudes to discussing and witnessing symptoms, perceivedconsequences of having the illnesses (adapted from the IPQ-R), a concessions scale, and a qualitativesection to establish current illness knowledge.

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Results People do not hold negative views towards discussing any of the illnesses, although two of thefour most difficult symptoms to discuss were related to IBS (loss of bowel control and urgent need todefecate). Importantly none of the mean scores on the 8-point Likert scales were above four (neithercomfortable nor uncomfortable) indicating that although some people did not feel completelycomfortable this did not warrant recordings on the uncomfortable dimension. Witnessing symptomsdid score higher, but the highest reported mean was still below 6 indicating that at most peoplefelt slightly uncomfortable. Paired sample t-tests revealed people felt significantly morecomfortable discussing IBS than epilepsy but less comfortable than discussing asthma, with similareffects for witnessing symptoms. Results on the perceived consequences showed that people donot hold negative feelings towards any of the illnesses, and the concession scale (6 point)recorded an average response of indicating that people are prepared to avoid activities more oftenthan average.

Conclusions The perception held by IBS sufferers that people hold negative views towards themis inaccurate and therefore in a therapeutic setting challenging these perceptions is legitimate andpotentially beneficial in improving representations of IBS and related illness outcomes.

Hemodynamic reactivity and ambulatory blood pressure in men and womenin response to common ‘‘stressful’’ events

*James, J., Douglas Gregg, M.; *National University of Ireland, Galway, Galway, Ireland

Background The reactivity hypothesis of hypertension states that persistent and exaggerated bloodpressure responses to common ‘‘stressful’’ events may lead to chronic elevations in blood pressureand subsequent development of cardiovascular disease. Recently, particular attention has beengiven to the profile of changes in cardiac output (CO) and total peripheral resistance (TPR) inducedby such events.

Objectives To examine hemodynamic reactivity and profile induced by behavioural challenges inthe form of sleep restriction and time-pressured cognitive performance, and pharmacologicalchallenge in the form of caffeine ingestion, and to relate these observations to 24-hour ambulatoryblood pressure levels.

Methods A double-blind placebo-controlled crossover design with counterbalancing was used with96 healthy women and men, each of whom remained in the study for 4 weeks. All participantsexperienced alternating periods of sleep restriction versus normal rest, caffeine exposure versusabstinence, and were observed during performance of a variety of laboratory tasks. The mainmeasurements of blood pressure, heart rate, CO and TPR were obtained using a Finapres continuousblood pressure monitor. Twenty-four hour ambulatory monitoring was also performed on a subsetof 48 participants (equal number of men and women).

Results Sleep restriction had a pronounced effect on hemodynamic profile (marked vascularresponse), despite having no appreciable effect on blood pressure. Increased blood pressureand changes in hemodynamic profile as measured in the laboratory were found for caffeineand the laboratory tasks. Modest effects were also observed in relation to ambulatory blood pressurelevels.

Conclusions The findings suggest that frequently encountered stressors in the form of sleeprestriction, dietary caffeine, and time-pressured cognitive activity produce hemodynamic effectswith the potential to contribute to the development of cardiovascular disease.

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‘It might happen or it might not’: How patients with multiple sclerosis explaintheir perception of prognostic risk

Janssens, C.; Erasmus University Medical Centre, The Netherlands

Aim To examine, in a qualitative study, how patients with multiple sclerosis base their perceptionof the risk and seriousness of wheelchair dependence.

Methods Perceived risks, both absolute and comparative, were assessed for 2-year, 10-year andlifetime prognosis of wheelchair dependence using visual analogue scales (VAS). Using a think-aloudmethod patients (n¼ 85) were asked to elucidate these VAS scores.

Results Explaining perceived absolute risk, patients mentioned disease-related factors as well aspsychological factors. Uncertainty about future disease progression was a predominant factor for allpatients, even those with low and high perceptions of risk. In assessing their comparative risk, patientsperceived themselves as being equally at risk, since they do not know what to use as a basis forcomparison. Wheelchair dependence was perceived as serious primarily because of its possibleimplications such as loss of independence. When perceptions of 2-year, 10-year and the lifetimeprospect of wheelchair dependence were compared, it was found that patients discriminated intheir perception of absolute risk, but less in that of the comparative risk and seriousness.

Conclusions Comparison of quantitative and qualitative assessments indicated good constructvalidity for perception of the absolute risk and seriousness of wheelchair dependence, but not forthe comparative prognostic risk.

Gender differences in illness representations of stroke patients

*Joice, S., Johnston, M.; *University of St. Andrews, UK

Objectives Gender differences in response to health care have been ‘‘highlighted but overlookedby medical research’’, (Wardle et al., 2004). Can gender differences be explained through illnessrepresentations?

Aim To investigate the illness representations of men and women following a stroke.

Methods A cross sectional study examining the stroke patients (n¼ 114) from an RCT evaluatinga stroke intervention. Demographic and clinical variables were recorded by health professionalsprior to discharge and IPQ-R, Barthel Index, HADS, IPQ-R and RLOC were taken 2 weeksfollowing to discharge at home.

Results Demographic and clinical variables showed women to be significantly older than the men( p¼ 0.03) and significantly more impaired (Modified Rankin p¼ 0.04, Barthel Index, p¼ 0.003).There were no differences on the identity scale of the IPQ-R between the two groups. Womendescribed their condition as significantly more cyclic ( p¼ 0.04) and more emotional ( p¼ 0.02)than the men. Men perceived that their own behaviour contributed to the cause of their stroke( p¼ 0.00). Women scored higher on the HADS anxiety scale ( p¼ 0.01) but there were no differenceson RLOC.

Discussion Whilst women were more impaired clinically than men they did not describe themselves asexperiencing more symptoms. Health professionals may have different observations of impairmentthan the patient perceives about them self. Furthermore self reported disability may be dueto gender. Women experienced more fluctuations in their illness than the men whereas the men

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acknowledged their own behaviour as being contributory to the cause of their stroke. Both illnessrepresentations have been associated with behaviour change. These findings have implications forassessment of impairment and for the programmes of rehabilitation.

Work life balance, physical and psychological well-being in UK academics

*Jones, F., Kinman, G.; *University of Leeds, UK

Objectives This paper aims to investigate job stressors and perceptions of work life balance inUK academics. It further aims to examine the extent to which these predict physical symptoms andpsychological distress.

Methods A sample of 840 academics, drawn from 99 different educational institutions in the UK,completed postal questionnaires. Measures included a range of work stressors, (e.g., job demands,supports, job control and effort-reward imbalance), work home conflict, aspects of work life balance,psychological well-being, job satisfaction and physical health.

Results University academic staff work on average do approximately 25% of their work athome and most do at least 10% of their work outside of work hours. Most report blurred boundariesbetween work and home and would like greater separation between the two domains. Demands werehigh and levels of psychological well-being were typically poor in the sample. Having unclear bound-aries between home and work was associated with poor physical wellbeing over and above the effectsof job stressors. Furthermore relationships between work stressors, blurred boundaries and negativeoutcomes are mediated by work home conflict.

Conclusion Work home conflict and poor work-life balance is common in academic staff and isrelated to a range of strain outcomes, including physical symptoms for academic staff. Greaterattention needs to be paid to issues of work life balance in academic staff.

Role of familial and genetic factors in behavioural change

Kaprio, J.; University of Helsinki, Finland

Objectives Family, twin and adoption studies are used to provide estimates of the relative roles ofgenetic and environmental roles in many traits and diseases. Until recently such studies on changesin health-related behaviours have been relatively rare. Longitudinal twin and family studies areinformative of such changes.

Methods and Results In Finland, the older Finnish Twin Cohort of adult twin pairs (10,000þ) hasbeen followed-up since 1975, while the FinnTwin16 study of adolescent twins and their parentscovers nine years of follow-up from age 16 to 25. In the presentation I will review the study designsand developments in statistical methodology for longitudinal genetically informative samples. I willprovide illustrative examples of the importance of familial and genetic influences on smokingcessation, weight change and intentional weight loss from these data sets. For example, the proportionof variance in the liability to smoking cessation attributable to genetic factors is in excess of 50% in amodel where age at smoking initiation is also taken into account. The estimates are similar in bothmen and women. In contrast, there are significant, gender-specific genetic components on thenumber of intentional weight loss episodes by age 25. The heritability in women (66%, 95% CI55, 75%) is higher than in men (38%, 95% CI 19, 55%). These genetic influences are only partlyshared with those on body mass index.

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Conclusion Genetic factors can influence changes in behaviour, and might explain why change ismuch more difficult for some persons compared with others. The more detailed genetic architectureand individual genes underlying these genetic factors are largely unknown.

Predicting recovery from arthroscopic knee surgery: The role of outcome expectanciesand dispositional factors

*Kaproski, O., Flanagan, J., Walsh, J.; *University of East London, UK

Based on Leventhal et al.’s (1980) model of Self-Regulation, this study examined the predictive valueof patients’ pre-operative expectations, dispositional optimism and trait anxiety, on both subjectiveand objective indices of surgical recovery. The surgeon’s prognosis ratings of each patient were alsoassessed immediately post-operatively. Type, nature and extent of surgery were all controlled for.Forty-eight patients undergoing arthroscopic knee surgery completed questionnaires before, andthree weeks after, surgery. Multiple regression analyses indicated that specific pre-operativeexpectations accounted for a broad range of recovery outcomes. In particular, expectations aboutsymptoms positively predicted reported symptom severity at follow-up whilst expectations aboutreturning to work were predictive of a number of recovery indices (e.g., symptom severity, timeback to work, state anxiety and pain). Patients’ expectations remained predictive of recovery whenpersonality factors were added to the regression models; the latter failed to account for significantamounts of variance in any of the outcomes. Finally, the surgeon’s prognoses were found to predictpositively patients’ psychological state at follow-up. In conclusion, patients’ pre-operative expectationsappear to be important predictors of recovery from surgery; eliciting such expectations in advance mayhelp identify patients at risk of delayed recovery. An additional opportunity for detecting predictors ofsub-optimal recovery is available immediately post-operatively based on surgeons’ outcome ratings.Appropriate interventions, designed to promote recovery, may usefully be implemented at eithertime-point.

Modern health worries in medical students

*Kaptein, A., Helder, D., Kleijn, W., Rief, W., Moss-Morris, R., Petrie, K.; *Leiden UniversityMedical Centre, The Netherlands

Objectives To examine the associations between modern health worries (MHW), subjective healthcomplaints, and use of health care services in first-year Dutch medical students, and to compareMHW in Dutch medical students and New Zealand cohorts.

Methods Questionnaires assessing MHW (Petrie et al., J Psychosom Res, 2001, 51: 395–40),subjective health complaints, positive and negative affect, and use of health care services, werefilled out by 227 Dutch first-year medical students.

Results The factor structure of the MHW-scale was replicated. Dutch medical students reported sig-nificantly lower scores on all MHW-items than did New Zealand students. Dutch medical studentsworried most about drug resistant bacteria, and least about vaccination programmes. Female studentswere more concerned about MHW-issues than were male students. MHW-scores were significantlyassociated with subjective health complaints. Subjective health complaints were also significantlyrelated to the use of health care services.

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Conclusions Worries about modernity are reliably associated with subjective health complaintsand use of health care services in Dutch medical students.

Ways of coping with breast cancer and mastectomy

*Karademas, E., Argyropoulou, K., Sidiropoulou, D., Karvelis, S.; *Department of Psychology,University of Crete, Greece

One of the purposes of the study presented here was to investigate into the ways that women, whowere diagnosed with breast cancer and had undergone mastectomy, were dealing with their healthcondition. One hundred and eighteen women participated in our study (average age 54.11 years).Of these, 40.4% had received their initial diagnosis less than 5 years ago, 39% had undergonemastectomy within the last 5 years, 25.2% were currently in therapy, and 11.2% were dealing witha metastasis. Participants completed a series of questionnaires including certain psychological factorsand sociodemographic variables, a set of items regarding cancer-related stressors, and the Ways ofCoping questionnaire as adapted in the Greek population. Several items of the WOC questionnairewere dropped due to their inappropriateness to cancer, as in earlier relevant studies. The mostfrequent problems related to health were ‘fear and uncertainty about the future’ and ‘the pain,symptoms and discomfort resulting from illness’. A factor analysis of the coping questionnaire withvarimax rotation revealed a stable and clear five-factor solution. These factors were: focusing onthe positive, seeking and using social support, passive hope, cognitive avoidance, and behavioralavoidance. Participants reported more frequent use of focusing on the positive (39.5%), seekingand using social support (18.13%), and passive hope (15.28%). Self-efficacy expectations were themost powerful predictor of coping strategies, while demographic variables seem to exert little influenceon coping. On the other hand, focusing on the positive and behavioral avoidance accounted for 27%of the current psychological health variance. These results have implications on designing andimplementing intervention programs, as well as on research in stress and coping processes.

Using an illness perceptions based approach for improving end stage renal disease (ESRD)patients’ understanding of and adherence to phosphate binding medication

*Karamanidou, C., MacLean, D., Weinman, J.; *Department of Psychology (at Guy’s), Institute ofPsychiatry, King’s College London, UK

Background The incidence of non-adherence is a major treatment problem in ESRD particularly forphosphate binding medication (Christensen et al., 1997). Persistent elevated phosphate blood levelscan result in metastatic calcification leading to cardiovascular disease, the most common cause ofdeath in ESRD patients (Stone & Rabin, 1983). Results of an earlier qualitative study identifiedthe role of patients’ illness and treatment beliefs and misconceptions in non-adherent behavior withphosphate-binding medication.

Objectives To evaluate the efficacy of a novel intervention in increasing knowledge, modifyingtreatment beliefs and risk perceptions, and improving adherence. Sample: Thirty-nine patientswere included in this study, nineteen intervention and twenty controls. Patients were recruited ifthey had been receiving renal replacement therapy for at least six months and were takingphosphate-binding medication.

Method A single session intervention was performed, targeting patients’ illness and treatment beliefs.Patients were taken through a personalized leaflet giving a coherent explanation of the adverse effectsof elevated phosphate levels, efficient phosphate management and medication use and were alsogiven a demonstration of how the treatment works. Questionnaires assessing level of knowledge,

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patients’ beliefs about their phosphate binders, self-report medication adherence, risk perception andgeneral understanding were administered at baseline, post intervention and at two more follow-up ses-sions in the next 3 to 4 months. Serum phosphate levels were recorded at baseline and at the timeof each follow-up for both groups.

Results Results show a significant increase in knowledge, belief of phosphate-binding medicationefficacy as well as a reduction of concerns about this type of medication in the intervention group.

Conclusions The findings demonstrate the values of using patients’ illness and treatment beliefsas basis for developing interventions to improve understanding and use of treatment in ESRD.

MMR immunisation uptake: Understanding the role of protection motivation theoryand subjective norm

*Kaur, B., Swanson, V., Power, K.; *University of Stirling, UK

Objectives The main aim of the study was to determine whether subjective norm (SN) is an importantpredictor of MMR (measles, mumps and rubella) vaccination uptake, and whether it significantlycontributes to Protection Motivation Theory (PMT).

Methods A cross-sectional design was employed. 423 parents of children aged 2–5 (born in Dundee)completed questionnaires measuring PMT variables and SN in relation to first MMR immunisationand booster immunisation.

Results Logistic regression analysis indicated that significant variables for the first vaccine intentionsincluded: response efficacy (positive attitudes: �¼ 0.760, OR¼ 2.139) and internal self-efficacy(�¼ 0.659, OR¼ 1.932); and for the booster vaccine: vulnerability to disease (�¼�1.375,OR¼ 0.253) and response efficacy (positive attitudes: �¼ 0.897, OR¼ 2.453; safety evidence:�¼ 1.997, OR¼ 7.370; vaccine efficacy: �¼ 1.153, OR¼ 3.167). SN was found to be a significantpredictor of intentions to immunise with the first MMR vaccine (�¼ 0.032, OR¼ 1.032) and thebooster vaccine (�¼ 0.030, OR¼ 1.031). The inclusion of SN in the regressions resulted in morerobust models and a greater number of participants being predicted correctly. With regards todifferent referents, immunising parents were motivated to immunise by their partner, GP andhealth visitor, whereas non-immunising parents were more motivated by their partner and significantlyless likely to comply with advice given by health professionals.

Conclusion PMT is a useful framework when focusing on MMR immunisation, but can be a strongermodel with the addition of SN. Health promoters should target family members as motivationalcues rather than only relying on health professionals. Booster vaccine and first MMRvaccine behaviour need to be examined separately as threat and coping appraisal differ for bothbehaviours.

Barriers for stage movement – what are we overlooking?

Keller, S.; Phillips University, Marburg, Germany

Background Stage models and especially the Transtheoretical Model (TTM) have received a lot ofattention. While current research on the TTM is focussing mostly on (a) evaluating the validity ofthe stage concept, (b) replicating findings across behaviours and (c) evaluating interventions basedon the TTM, we may be overlooking important other variables which can help us to better understandthe complex mechanisms of behaviour change.

Method Two examples will be used to illustrate this assumption.

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Results It is postulated for the TTM that the use of certain processes of change will helpindividuals progress from one stage to the next. While this seems intuitively plausible, the empiricalsupport for behaviours other than smoking is mixed, at best. One reason could be that thereare also cognitive and behavioural processes that individuals use which keep them from makingprogress. Several of such processes (e.g., reactance, focussing on loss, minimization) will beintroduced based on an empirical study in the context of smoking cessation (N¼ 397), and theirsignificance for the TTM will be discussed. While the TTM has been used to describe psycho-therapy motivation and behaviour change mechanisms in the general population, the role ofpsychopathology variables for the process of behaviour change has not yet been researched extensively.Especially in clinical samples, however, variables like anxiety or depression may have an impacton patients’ readiness to change relevant behaviour. Based on a study with low back painpatients (N¼ 1378), the significance of depression for the readiness to change exercise behaviourwas demonstrated.

Conclusion Whereas it is an important goal to develop parsimonious models that describe generalprinciples of behaviour change, these examples raise the question whether such models can everbe satisfactory if behaviour-specific and/or population-specific variables are neglected.

Examining perceptions of illness experience in heart failure and heart transplant populations

*Kidd, T., Hallas, C., Sheffield, D.; *Staffordshire University, UK

Objective To examine perceptions of illness experience in heart failure and heart transplantpopulations.

Methods Analysis was conducted using grounded theory applied to data derived from a semistructured interview. Four heart failure patients and seven transplant patients from a specialist tertiarycare UK Hospital.

Results Change emerged as a fundamental element in participants constructions of their illnessexperience and was identified as the core category for all participants. Conceptual categories ofcontrol, support, rationalisation, normality, emotion and their sub categories were found to be directlyrelated to the core category of change. No differences were found in the categories that emergedbetween the two groups of heart failure and heart transplant.

Conclusions The ability to cope with change and utilise both emotional and instrumental supportare important in psychological and physical outcomes in these cardiac populations. Future researchshould be directed toward developing interventions aimed at empowering individuals to embracechange and implement these changes in their daily lives.

Irish kidscreen project – health related quality of life

Kilroe, J.; Child Health, HSE, Programme of Action for Children, Ireland

The Irish Kidscreen study provides unique insight into the self-perceived health related quality of lifeof Irish children aged 8–17 years. The standardised generic cross-cultural Kidscreen questionnairedeveloped by the international Kidscreen group is the survey instrument used. The questionnairewas administered to school children aged 8–17 years within the four health service regions of theRepublic of Ireland. The KIDSCREEN instrument measures 10 HRQOL dimensions: Physical(5 items), Psychological Well-being (6 items), Moods and Emotions (7 items), Self-Perception(5 items), Autonomy (5 items), Parent Relations and Home Life (6 items), Social Support andPeers (6 items), School Environment (6 items), Social Acceptance (Bullying) (3 items), Financial

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Resources (3 items). It was constructed and pilot tested using the data of more than 3.000 Europeanchildren and adolescents. Kidscreen gives a voice to young people’s perceptions of health and well-being in Ireland. Through these children’s own words, we are provided with an evidence base for chil-dren’s perceptions of health and well-being. Health providers can gain a better understanding of thebroader determinants of children’s health which will enable the monitoring and planning of futurehealth service delivery effectively and efficiently.

Self-esteem, social support, and health: Cross-lagged

*Kinnunen, M.-L., Feldt, T., Pulkkinen, L.; *University of Jyvaskyla, Department of Psychology,Jyvaskyla, Finland

Objective This study investigated the relationships between self-esteem, social support, and healthin cross-lagged longitudinal data with two measurement points and a time lag of 6 years.

Methods One hundred and twenty-nine participants were drawn from the ongoing JyvaskylaLongitudinal Study of Personality and Social Development (JYLS), conducted in Finland since1968. The present study focused on data collected at ages 36 and 42. The variables were: Self-Esteem (10-item scale; Rosenberg, 1965), social support (eight questions, e.g., ‘I have peoplearound me who support me’.) and health (19 item-psychosomatic symptom checklist, Aro, 1981,and a single self-rated health question). The data was analysed using the structural equation modelling(SEM).

Results The cross-lagged analyses of SEM indicated that high self-esteem at age 36 wasassociated with a higher level of social support at age 42, and high social support at age 36 withgood health at age 42. Self-esteem, social support, and health were relatively stable between ages36 and 42.

Conclusions Perceptions of social support developed in a more favourable way over the courseof 6 years among high self-esteem individuals than among their counterparts with low self-esteem. Furthermore, social support received at age 36 was associated with health 6 years later, atage 42.

Mobilization of social support in dyads: The effects of depression, gender,and relationship type

Klauer, T.; Universitaet Rostock, Germany

Objectives Social support mobilization may be characterized as a mode of coping which is alwaysevident (i.e., ‘‘overt behavior’’) by definition. Therefore, support provision and mobilization maybe investigated in a common dyadic framework with self and other reports of the respective actionsbeing equally privileged ways of assessment. The present study focused upon the effects of depression,gender (recipient and provider), and relationship type on several modes of mobilization as well asdyadic consistency and mobilization effectiveness.

Methods Subjects who had encountered a stressful event within the year before interview andtheir most important providers of support in that episode were assessed with regard to supportmodes (emotional, instrumental, informational support) and mobilization strategies (search foradvice; ostentative withdrawal; emotional expression; demanding help; search for physical care) onitem-parallel measures. The sample consisted of 31 psychotherapy inpatients with depressivedisorders, 31 inpatients without depressive symptoms (psychotherapy controls), and 71 healthycontrols as well as their respective providers (N¼ 133 dyads).

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Results Each of the five modes of mobilization under study was affected by at least one of the factorsunder study, e.g., depressive inpatients exhibited stronger preferences for ostentative withdrawalthan both control groups did. Female support recipients revealed a stronger tendency to search forfeedback and advice than male recipients. There was also strong evidence for relationship-specificpatterns of mobilization. Furthermore, recipient and provider reports of demanding help were moreconsistent in intimate relationships.

Conclusions The interplay between social support provision and mobilization is best regarded ina dyadic framework using both recipient and provider reports of both types of action.

Do couples facing multiple sclerosis benefit from supportive interactions?A diary study using an equity perspective

*Kleiboer, A., Kuijer, R., Hox, J., Bensing, J.; *Health Psychology, Utrecht University, Faculty ofSocial Sciences, The Netherlands

Objective This study examined the effects of daily supportive interactions in couples facing multiplesclerosis (MS). Two issues were examined, the imbalance between received and provided supportand the effects of received and provided support on end-of-day well-being (positive and negativemood and self-esteem). Guided by equity theory we hypothesised that one-sided support provisionor receipt would be harmful for well-being for both patients and partners. We hypothesised thatthese negative outcomes could be offset by reciprocating support, that is, when both partners receiveand provide support.

Methods Sixty-one patients and their partners filled out questionnaires on demographics anddisease related characteristics and subsequently completed computerised daily diaries for fourteendays. At the end of each day both partners completed diaries on end-of-day mood, self-esteem,received and provided emotional and instrumental support, and several control variables (dailyhassles, and MS related symptoms for patients). Data were analysed with regard to the issuesmentioned above using multilevel hierarchical regression analyses.

Results Reciprocity in instrumental support transactions was associated with higher levels ofself-esteem among both patients and partners. The other results all showed independent effects ofsupport received and provided, however. Interestingly, overall patients benefited most from providingemotional support and instrumental support, whereas partners benefited most from receivingemotional support from their ill partner.

Conclusion Most studies and interventions on support in chronic illness focus on the patient as thesupport recipient and the partner as the support provider. However, this study showed the importanceof providing support to the partner for patients and receiving support from the ill partner forpartners. To further understand support processes in couples facing chronic illness the whole contextof support should be taking into account.

Does prenatal screening influence anxiety levels of pregnant women?A longitudinal randomised controlled trial

*Kleinveld, J., Timmermans, D., de Smit, D., van der Wal, G., ten Kate, L.; *EMGO Institute, TheNetherlands

Objectives Questions addressed are (1) Does offering prenatal screening increase anxiety? (2) Doesreceiving a negative screening result make women less anxious and does a positive screening resultmake women more anxious? (3) What are the longer term consequences on anxiety of offeringscreening and receiving a screening result?

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Methods Women were offered prenatal screening or no screening in a randomised controlled trial.State anxiety (STAI) and child-related anxiety (PRAQ-R) were measured. Questionnaires werefilled in before prenatal screening was offered (T1), after the offer (T2), after the test result (T3),and in the third trimester of pregnancy (T4).

Results Child-related anxiety levels were higher in women who chose to be screened compared towomen who declined screening. Offering prenatal screening did not lead to increased anxiety levels.Anxiety increased in positively screened women. State scores of these women decreased, but child-related anxiety remained increased. Women who were negatively screened or declined screeningscored lower than the control group.

Conclusion In most women, offering prenatal screening and receiving the test result do not negativelyaffect anxiety. Giving pregnant women a choice to have prenatal screening done or not even seems tohave a small positive effect on general feelings of anxiety.

Dyadic support processes in couples undergoing in-vitro fertilization

*Knoll, N., Kienle, R., Rosemeier, H.; *Charite Universitatsmedizin Berlin, Germany

Objectives Assessing the way a loved one appraises an ongoing situation should yield importantinformation for concurrent supportive interactions between partners.

Methods To study the role of partner-rated stress appraisal detection accuracy in the adaptation toa stressful episode, 50 couples undergoing in-vitro fertilization were analyzed in terms of their recipro-cal appraisal assessments, their mutual receipt and provision of support and related outcomes.At three measurement points in time during the treatment, couples reported about their own andeach other’s stress perceptions, the extended and received social support, affect, and depressivesymptoms.

Results In general, a more accurate partner perception of stress symptoms within dyads was relatedto better affect and less depressive symptoms at different points in time. However, in most cases theseeffects were not moderated by support processes between partners.

Conclusions Whereas mostly mutual appraisal detection was associated with higher well-being incouples undergoing IVF, concurrent actual support interactions only had a small part in this effect.Alternative processes of couple interaction supporting the adaptation to a stressful episode arediscussed.

Hostility & cardiovascular risk in the NHLBI family heart study

*Knox, S., Weidner, G., Ellison, R.; *Department of Epidemiology, Statistics & Prevention, NationalInstitute of Child Health & Human Development, USA

Objectives Earlier reports from the multi-center NHLBI Family Heart Study, link Cook-MedleyHostility to coronary endpoints (myocardial infarction and bypass surgery) and to carotid arteryatherosclerosis, but only in individuals with high familial risk (H-R) for coronary heart disease(CHD). The current analyses investigated mechanisms that might explain these results.

Methods There were 535 average-risk (A-R) women, 491 A-R men, 1950 (H-R) women, and 1667H-R men from 3 ongoing epidemiologic studies of CHD (Framingham Heart Study, AtheroscleroticRisk in Communities Study & Utah Health Family Tree Study). High-risk was defined by relatingobserved events to expected events based on findings from the Framingham Study. General estimatingequations with family specified as the clustering variable were calculated to regress coronary riskfactors: PAI-I, fibrinogen, blood pressure, lipids, homocysteine, fasting glucose and metabolic indexon hostility scores.

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Results In analyses adjusting only for age, significant associations between hostility and CHD riskfactors were observed among H-R women (six of ten risk factors), but not for H-R men. In theA-R group, hostility was significantly related to only one (men) and two (women) of the risk factors.After also controlling for health-related behaviors, hostility was significantly associated with fastingglucose and metabolic risk in H-R women, and with metabolic risk and PAI-1 in H-R men.Hostility was associated with metabolic risk in A-R women, and with fibrinogen in A-R men.A genome scan for hostility showed no significant lod scores.

Conclusions Hostility is associated with a greater number of CHD events and coronary risk factorsin H-R men and women. Gene � environment interactions are suspected but need to be furtherelucidated.

The national children’s study – social determinants of health

Knox, S.; Department of Epidemiology, Statistics & Prevention, National Institute of Child Health &Human Development, USA

Objectives To investigate the influence of physical, biological, chemical and psychosocialenvironments on health and development in children from birth to age 21 years.

Methods The NCS is a multi-agency, longitudinal, epidemiologic study of individual and communityrisk factors in 100, 000 children from randomly selected U.S. households. Outcomes includepremature birth, as well as physical, behavioral, neuropsychological, and social/emotional develop-ment in children. Social determinants of health and chemical risk factors will be measured onindividual, family, school and community levels. Time points will include multiple measures duringpregnancy and childhood developmental stages.

Results Because complex diseases and traits involve multiple genetic and environmental contributors,results from epidemiologic studies demonstrating social determinants of health have sometimes beenquestioned. The NCS will have sufficient scope and power to investigate the relative contribution ofsocial determinants on multiple levels, including their influence on phenotypic expression in definedgenotypes. This data set is also intended as a resource for use by other investigators. Currently,an international collaboration is being established to examine some common exposures in multiplecohorts and to discuss issues related to measuring the same construct with different instruments atdifferent developmental stages.

Conclusion Using hierarchical models, social determinants of health will be tested withlongitudinal data using quantified exposure and outcome measures obtained at multiple timepoints. The purpose is to delineate the relative contribution of social determinants to physical andpsychological endpoints.

The effect of communication ability on cardiovascular reactivityto a speech task

*Kola, S., Walsh, J.; *National University of Ireland, Galway, Ireland

Objectives To assess whether individuals with different levels of communication ability reactdifferently to a speech task with regards to their cardiovascular responses, and whethercommunication ability has a buffering effect for cardiovascular reactivity.

Methods Fifty-six female undergraduate students assessed as either high or low in communicationability on the re-standardised version of the Norton Communicator Style Questionnaire participated.After an initial resting period where baseline measures of heart rate and blood pressure were

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established, participants were exposed to a speech stressor which required them to prepare(3 minutes) and deliver (5 minutes) a speech about a hypothetical situation. Heart rate and bloodpressure measures were recorded throughout.

Results The speech task was successful in eliciting stress for all cardiovascular parameters, such thatheart rate and blood pressure increased during the speech task (P¼ 0.000). No significant interactioneffects were found for effective communication ability on any of the cardiovascular measures(P> 0.05), and no significant differences were observed between high and low effective communica-tors on pulse or blood pressure reactivity (P> 0.05). Regarding dominant communication ability,no significant interaction effects were found for any of the cardiovascular measures (P> 0.05), norwere any significant differences observed between high and low dominant communicators onpulse or blood pressure reactivity (P> 0.05).

Conclusions While the speech task was effective in eliciting stress, no stress buffering effects werefound for communication ability. This suggests that the stress response was moderated by someother variable. Trait anxiety, extraversion/introversion, communication apprehension, and evaluationapprehension may have influenced the degree of reactivity. Further studies are needed to examinethe role of communication ability in cardiovascular reactivity.

Quality of life in adult hematopoietic cell transplant patients at leastfive years after treatment: A comparison with healthy controls

*Kopp, M., Holzner, B., Meraner, V., Sperner-Unterweger, B., Kemmler, G., Nguyen-Van-Tam, D.,Nachbaur, D.; *Department of General Psychiatry, Innsbruck University Hospital, Austria

Background and Objective As long-term survivors of hematopoietic cell transplantation (HCT)become more numerous, studies addressing the issue of long-term follow-up are necessary. In thisstudy, we report on the quality of life (QOL) of HCT-patients, who were alive at least at 5 yearsafter transplantation in comparison to an age- and sex-matched sample of healthy controls assessedin the same time-period and the same geographical region.

Design and Methods The EORTC-Quality of Life Questionnaire (EORTC-QLQ C30) was sent bypost to 39 HCT-survivors. Thirty-four patients answered the questionnaire. Patients were comparedwith 68 healthy controls from the same geographical region. Patients and controls completed theEORTC in the same time period.

Results Mann-Whitney-U tests identified significantly lower QOL on the dimensions of physical andsocial functioning and on the financial impact symptom scale.

Conclusions Patients who had survived their HCT for more than 5 years did generally well in terms ofglobal QOL. This is consistent with Kiss et al. (2002) who found that CML-patients, who werealive at least 10 years after HCT report lower physical functioning in comparison to healthy controls.Interdisciplinary (medical, psychological and social) treatment of patients should not cometo an end after the acute phase of the illness but should continue during check-ups followingtransplantation.

Humiliation and impairment of health-related quality of life as consequencesof weight-teasing in obesity patients

Kovacs, D.; University of Vienna, Austria

Objectives To find out, if obese patients’ humiliation in reaction to weight-teasing correlates withtheir extent of health-related quality of life, life satisfaction and/or assessment of ones own body.

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Methods Seventy-three female and 86 male patients of 45 years mean age (range 18–67 years)suffering from obesity assessed the extent of feeling humiliated by weight-teasing using a Visual-Analogue-Scale. The patients additionally were tested with the Short-Form-36 (SF-36), theLife-Satisfaction-Questionnaire (FLZ) and the Body-Assessment-Questionnaire (FBeK).

Results About one third of the sample stated to have experienced weight-teasing. Concerningthe extent of humiliation reactionary to weight-teasing, significant differences in gender,WHO-obesity-classes and fat-distribution types were found. The findings as well show significant rela-tionships between the extent of humiliation and five SF-36-scales, four dimensions of the FLZ or threeFBeK-scales, respectively.

Conclusions Obesity-class, fat-distribution type and gender are responsible for a higher or lowerextent of humiliation, respectively. Patients, who are at high risk to feel humiliated by weight-teasingshould be offered special interventions concerning this matter.

Cognitive emotion regulation, goal disturbance and psychological distressin people infected with HIV

*Kraaij, V., Garnefski, N., van der Veek, S., Joekes, K., van Koppen, W.; *Leiden University,Division of Clinical and Health Psychology, The Netherlands

Objectives The aim of the present study was to explore the relationships between cognitive emotionregulation, goal disturbance and psychological distress in people infected with HIV. A secondobjective was to examine whether the current HIV phase was related to cognitive emotion regulation,goal disturbance or psychological distress.

Methods Respondents were contacted through organizations for HIV positive people. Theorganizations distributed questionnaires to their members. In total, 43 respondents completed thequestionnaires, which included the Cognitive Emotion Regulation Questionnaire (CERQ;Garnefski, Kraaij, & Spinhoven, 2002), the Goal Facilitation Inventory (GFI: Ter Doest, Maes, &Gebhardt, in press), the Hospital Anxiety and Depression Scale (Zigmond & Snaith, 1983), andthe Medical Outcomes Study Short-form General Health Survey (MOS-SF 12; Wu & Rubin, 1992).

Results The amount of goal disturbance and three cognitive emotion regulation strategies(i.e., Positive Refocusing, Rumination and Catastrophizing) were found to be related to psychologicaldistress. The current phase of HIV was not related to cognitive emotion regulation, goal disturbanceor psychological distress.

Conclusions The present study suggests that it may be advisable to include aspects of cognitiveemotion regulation and goal disturbance in programs which focus on teaching people how tohandle being infected with HIV, regardless of the phase of HIV they are in.

Can the disadvantages of online support groups be disproved?

*Kraan, C., Taal, E., Drossaert, C., Seydel, E., van de Laar, M.; *Institute for Behavioural Research,University of Twente, The Netherlands

Background People often turn to support groups, when they find themselves in stressful circum-stances, such as serious health conditions. With the increase in the availability and popularity ofinternet, the possibility has arisen to join online support groups. A number of studies have tried toclassify potential disadvantages posed by these groups, like the lack of control of the quality of theinformation that is exchanged and the concern that the exchange within the group might include

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socially inappropriate remarks. However it appears that there is little research to actually substantiatethe potential disadvantages of online support groups.

Objectives To explore to what extent potential disadvantages of online support groups, as mentionedin the literature, actually occur.

Methods We have downloaded a random sample of 1500 messages exchanged in publicly availablediscussion groups for patients with breast cancer, rheumatoid arthritis and fibromyalgia. At themoment we are in the process of analyzing the content of the postings by two independent raters.A coding system, consisting of 22 unique coding categories, was developed to detect the potentialdisadvantages of online support groups. These coding categories were classified in four broadgroupings: ‘‘disadvantages due to online asynchronous communication’’, ‘‘quality of the informa-tion’’, ‘‘disadvantages uttered by health professionals’’ and ‘‘negative postings’’. In addition eachposting is coded for demographic information of the sender, as well as for the topics of the posting.

Results The final results will be presented at the conference. Preliminary findings suggest that onlyin a minor proportion of the postings analyzed, potential disadvantages were coded as present.In addition it appears that a major part of the postings contained off topic remarks. Popular healthrelated topics were ‘‘restrictions that people experience as a consequence of being ill’’ and ‘‘regularmedications’’.

Diagnosing psychologically oncological diseases: The cognitive orientation approach*

*Kreitler, S., Kreitler, M.; *Department of Psychology, Tel-Aviv University, Israel

Objectives The major purpose is to present a new approach to studying psychological correlatesof cancer. It is grounded in the cognitive orientation theory (S. Kreitler & H. Kreitler) for predictingand changing behaviors, which has generated a set of methodological tools for identifyingmotivationally relevant cognitive contents relating specifically to particular disorders.

Methods Two studies will be presented briefly, one dealing with colon cancer patients, the secondwith prostate cancer patients. In each study there were two groups of participants – patients andhealthy controls. The number of participants was in study I 129 patients and 101 controls (of bothgenders), and in study II 120 patients and 98 controls (only males). Both groups completed acognitive orientation questionnaire assessing beliefs of four types (about self, rules and norms, reality,and goals) in regard to themes relevant for the diseases, identified in pretests.

Results In each of the studies, discriminant analysis demonstrated that the four belief types predictedsignificantly group membership of patients and controls.

Conclusions The findings show that there are specific personality correlates for each group ofcancer patients. These correlates may be considered as risk factors but may also be used forstructuring therapeutic interventions.

Effects and possible moderators of tailoring health messages on lifestyle

*Kremers, S., de Vries, H., Smeets, P.; *Maastricht, The Netherlands

Objectives The aim of this study was to examine the effectiveness of a computer-tailored interventionaimed at increasing physical activity, fruit, vegetable intake, decreasing fat intake and smokingcessation and to test for possible moderators (Body Mass Index (BMI), sex, level of education,level of motivation, number of behaviours meeting recommendation).

*From EHPS2004 Helsinki.

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Methods Respondents (N¼ 2827) were randomly assigned to a tailored intervention group or astandard information control group. Physical activity, fruit, vegetable, fat intake, smoking anddeterminants of all behaviours were measured at baseline and after 3 months.

Results Effective but small overall effects were found of the tailored health-messages on fruit,vegetables, fat intake and physical activity. For smoking no difference was found between groups.No moderating effects were found for BMI, level of education and level of motivation in the 5behaviours. Significant and large effects were found in fruit intake for number of behaviours meetingthe recommendation and in fat intake for sex, but not for the other behaviours. At the post-test theparticipants who do not meet the recommendation for any behaviour increase their fruit intakecompared to a decrease in the control condition (�¼ 0.29, p¼ 0.04). The effect becomes smaller asparticipants meet more guidelines. The separate analyses for males (�¼�0.04, p¼ 0.22) and females(�¼�0.05, p¼ 0.06) showed small non-significant effects.

Conclusions Research showed that computer tailoring is difficult for multiple behaviours,because respondents may feel overwhelmed or distracted by the number of ‘‘bad habits’’ they needto improve. This study on the contrary showed that the strongest effect was found in participantswho do not meet the recommendation for any behaviour and that these participants are not over-whelmed but do indeed change. Therefore, it is important to find these people although this groupwill be small.

Couples coping with a recent diagnosis of cancer – pilot results

*Kuenzler, A., Zindel, A., Joerg Znoj, H.; *University of Bern, Switzerland

Objectives Reveal predictors of posttraumatic stress/growth in cancer patients and their spouseswith special emphasis on dyadic coping processes. This presentation reports on preliminary baselinedata including acceptance rates.

Methods In an on-going study, 79 patients (49% male) with any type and stage of cancer and theirpartners (n¼ 50) were assessed 2–8 weeks after diagnosis using a pre-tested mailed self-reportquestionnaire including standard measures of (a) psychological impact of and (b) coping withcancer; (c) potential salutogenic factors; (d) relationship; and (e) health related Quality of Life.Medical control variables included performance, stage of disease, treatment factors, and psychiatricmedication.

Results Up to now, overall acceptance rate of the 1 hþ questionnaire is 83%. Sixty-nine percentof patients declared completing the questionnaire was neither distressing nor relieving, 12% saidit was somewhat distressing, for none of the patients it was a lot distressing, 10% stated it wassomewhat relieving, for 6% it was a lot relieving. First descriptive and inferential statistics on patientsand partners will be presented. Analyses will include differential effects between stages of disease.

Conclusions Despite the burden of a recent diagnosis of cancer and a considerable length of question-naire, acceptance of the study from both patients and their partners was generally high. Results of theon-going study are expected to further differential insights into coping: what style in what situation ismost helpful for the patient and the couple?

Self-control in the face of possible failure: Does reminding of dieting goals helpor hinder resisting temptation and planning?

*Kuijer, R., DeRidder, D.; *Utrecht University, The Netherlands

Objectives Most self-regulation models emphasize the role of self-control (or resistingtemptations) in order to continue striving for long-term health goals. However, exerting

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self-control is demanding and often fails. Metcalfe and Mischel (1999) hypothesized that whenthe long-term goal is made more salient, self-control may be strengthened. One way in whichgoals may become more salient is when the attainment of that goal is threatened to someextent. Major setbacks or threats may discourage people, but medium threats may entail the infor-mation that more work is needed and remind people of the importance of self-control. In addition,some threat may have a positive impact on long-term planning efforts. The present studiesexamine the hypothesis that confrontation with possible failure to achieve a diet goal(thus making the goal more salient) will have a positive effect on both self-control and planningefforts.

Methods In three experimental studies among women for whom losing weight was an importantgoal, either normal weight or overweight (N¼ 65þ52þ50), possible failure to achieve their dietgoal was manipulated by giving them feedback on (a) the attainability of diet goals in general and(b) their personal chances of attaining their goal.

Results In line with our hypothesis it was found that those confronted with medium levels of goalthreat (either high general risk or high personal risk of failure) showed most self-control (i.e., bestresisted the temptation to eat cookies) and spent most time on writing down plans to realize theirdiet goal.

Conclusions We conclude that reminding people of possible failure to attain their goal may havea positive effect on self-control to resist immediate temptation and planning efforts to achieve theirlong-term goal.

Long-term cognitive and psychosocial functioning of paediatricbone marrow transplant patients

*Kupst, M., Bingen, K.; *Dept. of Pediatrics, Medical College of Wisconsin, USA

Objectives This presentation will focus primarily on the results of a prospective, longitudinal studyof the cognitive and psychosocial functioning of paediatric bone marrow transplant (BMT) patientsover a two year period. It will also describe an ongoing study of quality of life in the first yearpost-BMT.

Methods All candidates for bone marrow transplantation received a psychological evaluation(cognitive and psychosocial) prior to BMT. Interviews, standardized tests, e.g., WISC-III, andscales, e.g., CBCL, were used, and data were obtained for 153 children and adolescents pre-BMTand at one year post-BMT, with two year data available for 70 children.

Results The cognitive assessment indicated stability of IQ and cognitive subtest scores, and thestrongest predictor was pre-BMT cognitive functioning. Age, gender, diagnosis, type of treatment,type of transplant, acuity of problems, e.g., graft-versus-host disease were not correlated with cognitiveoutcome. The psychosocial assessment indicated a low prevalence of behavioural and socialproblems, stability in functioning over time, with pre-BMT functioning strongly predictive of laterfunctioning. Less conclusive data were available for infants and very young children due to a smallsample size over time.

Conclusion Advances in paediatric bone marrow transplantation (BMT) have resulted in increasedsurvival and greater attention to long-term medical and psychological effects of treatment. Childrenand adolescents generally show stability in cognitive and psychosocial functioning over time. Giventhe strong relationship of early factors, early and comprehensive assessment of these children andadolescents is crucial to determine those who may be at risk for later declines in functioning. Ascognitive problems may not occur until several years later, the present study is being extended tofive years post-BMT.

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Cognitive-behavioural model of chronic pain and depression: A longitudinal analysis

Kuusinen, P.; Rehabilitation Centre, Kiipula Foundation, Finland

Objective The purpose of this study was to extend and to test the mediation model of pain anddepression (Rudy et al., 1988) in longitudinal design. It was assumed that the relationship betweenpain and somatic-behavioural and cognitive-affective symptoms of depression is insignificant, andthat this relationship is mediated by perceived life interference, life control and social support.

Method The subjects were 772 consecutive individuals with a chronic musculo-sceletal painproblem who had been admitted to Social Insurance Institution-financed inpatient multidisciplinaryrehabilitation program. A battery of standardised questionnaires, including the MultidimensionalPain Inventory (MPI) and Beck Depression Inventory (BDI), was used. Both exploratory (e.g., hier-archical multiple regression) and confirmatory (confirmatory factor analysis and path analysis)statistical methods were used in this study.

Results Perceived pain did not predict somatic-behavioural and cognitive-affective symptoms ofdepression. As expected, the relationship between pain and depression was mediated by perceivedlife interference. However, contrary to expectation, the path from pain to perceived life control wasnon-significant. It seems that both lowered perceived life control and negative social interactionsare secondary reactions not to pain, but rather to perceived life interference induced by pain.

Conclusions If the mediation model of chronic pain and depression (Rudy et al., 1988) is viewedfrom the perspective of Beck’s cognitive theory of depression, it is the secondary consequences ofpain, perceived life control and negative social interactions, which may carry the meaning of loss(Beck, 1967, 1976, 1991; Beck et al., 1979). This result also lends some initial support to themodel of two separate diatheses described by Beck (1991).

Communication behaviors and spousal support in individuals withtype 2 diabetes and their partner: An exploratory study

*Lafontaine, M.-F., Heyens, A., Belanger, C., Nouwen, A., Sabourin, S.; *University of Ottawa,Canada

Communication is an integral component of any individual’s ability to function effectively and takeson an even more important role when it comes to quality of life and effective functioning forindividuals suffering from an illness. Moreover, effective communication is cited as an importantdimension of marital quality (e.g., Feeney, Noller, & Ward, 1997) and is related to social support(e.g., Query, Perry, & Flint, 1992). The purpose of the present study is to explore the relationshipsbetween: (1) individuals with type 2 diabetes own communication behaviors and their perceptionof the spousal support they receive regarding their self-care program; (2) non-diabetic partners’own communication behaviors and their perception of the support they provide with respect totheir diabetic partner’s dietary plan. Forty-six individuals with type 2 diabetes and their non-diabeticpartner completed the Multidimensional Diabetes Questionnaire (Talbot, Nouwen, Gingras,Gosselin, & Audet, 1997), and the Perceptions of Spousal Support Efficacy Scale (Nouwen, 2000).In addition, participants were filmed for 15 minutes as they discussed a mutually agreed upon conflictin their relationship, enabling researchers to code their communication behaviors with the GlobalCouple Interaction Coding System (Belanger, Dulude, Sabourin, & Wright, 1993). Results indicatedthat the diabetic spouses’ perception of their partner’s ability to help them with their self-care programwas positively related to their support/validation communication behaviors. Moreover, the non-diabetic spouses’ perception of their own ability to aid their partner with their dietary self-care wasnegatively correlated to their withdrawal communication behaviors and positively correlated to theirsupport/validation communication behaviors. Implications of these findings are discussed in relationto improving diabetic individuals’ self-care practices through a collaborative relationship with theirpartner.

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The role of positive expectancies in written emotional expression

*Langens, T., Schuler, J.; *University of Wuppertal, Germany

Objectives Empirical research has demonstrated that expectancies play a key role in affect-regulation.For example, studies have repeatedly found that active coping strategies have positive effectson emotional well-being only to the extent that an individual has positive affect-regulation expectan-cies. In the present research, we suggest that the effects of written emotional expression – which arecommonly attributed to confrontation leading to a new understanding – may also in part depend onthe expectancies induced by writing about emotional experiences.

Methods Two studies were conducted to test this hypothesis. In both studies, participants eitherwrote about an upsetting event or about trivial issues. After the writing period, participants ratedtheir expectancies that the writing intervention will improve (or impair) their emotional well-beingover time. Central variables (Study 1: a measure of the emotional impact of an upsettingevent; Study 2: a checklist of physical symptoms) were collected both before and six weeks afterthe writing intervention.

Results Both studies found that (1) writing about upsetting experiences induced higher positiveexpectancies than writing about trivial issues and (2) only expectancies associated with writtenemotional expression were related to changes in the emotional impact of an upsetting event(Study 1) and to changes in physical symptoms (Study 2).

Conclusions We suggest that there may be two alternative ways which may render written emotionalexpression effective in reducing negative emotions: (1) by rendering an emotional experience moremeaningful and (2) by inducing positive affect-regulation expectancies.

The role of illness perceptions, coping mechanisms and personality variablesin predicting psychosocial and physical functioning in cardiac patients

Lavelle, A.; National University of Ireland, Galway

Objectives This longitudinal study was carried out to find out the extent to which illness perceptions,coping mechanisms and personality variables predict health outcome in a cardiac population.

Methods Following baseline assessment, data was collected on a sample of 66 cardiac patientsat 2 six-monthly intervals over the following year. Full data was available for a final studysample of 51. A range of psychological measures was administered during a semi-structuredinterview. These included the Illness Perception Questionnaire (IPQ) and the COPEQuestionnaire. Personality variables were examined using the Cynical Distrust Scale, tbeBrief Type A Scale and the State Trait Anxiety Scale. Health outcome was assessed usingthe Rand 36 Item Health Survey, the Heart Patient Psychological Questionnaire (HPPQ),The Hospital Anxiety and Depression Scale (HADS) and the Maastricht Vital ExhaustionQuestionnaire.

Results Statistically significant correlations (P< 0.01) were in the expected direction. Variousaspects of adjustment (good physical function, low pain, less affective distress and good psycho-social functioning) were associated with low illness identity, a chronic time-line, high control andmore serious illness consequences and high cynical distrust. A number of coping strategies (activecoping, acceptance, positive reinterpretation and growth) related to good psychological adjust-ment. The use of venting emotions related to poor emotional and psychosocial outcome.Partial correlations revealed that the relationship between illness perceptions and adjustmentwas not mediated by coping responses. In hierarchical regression analyses illness perceptionsaccounted for variance in all three adjustment domains ranging from 25% to 35% and

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outweighed the influence of personality. Coping also predicted variance on emotional adjustment(10–19%).

Conclusions Results suggest that interventions which modify illness perceptions may prove usefulin cardiac rehabilitation.

Facial appearance signals stress hormone levels in adults

*Law Smith, M., Cornwell, R., Jones, B., Feinberg, D., Moore, F., Sharp, M., Al-Dujaili, E., Perrett,D.; *School of Psychology, University of St Andrews, Scotland, UK

This study investigated the impact of raised cortisol levels on facial appearance. We used salivarymetabolites of cortisol assays to investigate the relationship between circulating stress hormonesand ratings of attractiveness, health and sexual dimorphism of male and female faces. Facialphotographs of male and female students (aged 18–24) were rated individually. Negative correlationswere observed between cortisol levels and ratings of apparent health and attractiveness in both maleand female faces. There was no relation between cortisol levels and sexual dimorphism in either malesor females. There were no qualifications on these findings; the same relationships were found inmale and female faces and there was no effect of sex of the rater. Composite (average) male andfemale faces were created from the faces of the 10 highest and 10 lowest levels of cortisol. High cortisolcomposites (males and females) were rated as less healthy and attractive than low cortisol composites.These findings demonstrate that both male and female facial appearance holds detectable cues tounderlying health, as indexed by levels of stress hormones.

Lasting impressions: Influence of the initial consultation for chronic pelvic painon dimensions of patient satisfaction at follow-up

*Lawrence, W., William Stones, R., Selfe, S.; *Medical Research Council Epidemiology ResourceCentre, University of Southampton, UK

Objectives Chronic pelvic pain (CPP) is a common condition in women, and experiences of careare distressing and unsatisfactory for many. Research suggests that elements of the initial hospitalconsultation influence clinical outcome. This study aimed to identify the dimensions through whichinitial consultations were subsequently recalled at follow-up.

Methods A questionnaire study of 100 women 6 months following a hospital gynaecology consulta-tion for CPP. At the initial consultation, patients completed visual analogue scale (VAS) basedinstruments to measure the ‘‘usual’’ and ‘‘most severe’’ levels of pain in the previous 4 weeks, aswell as a Patient Satisfaction Questionnaire. Doctors also rated the consultation using VAS. At 6month follow-up, the patients repeated VAS measures of current pain levels and completeda 12-item questionnaire to assess their satisfaction with the initial consultation.

Results Follow-up questionnaire items loaded to constructs of ‘‘affect’’, ‘‘expectation’’ and ‘‘cogni-tion’’ forming 3 subscales. Current pain was negatively associated with all 3 subscales. Patients’ initialratings of the consultation and scores on these subscales were positively correlated, remainingsignificant for both ‘‘affect’’ and ‘‘expectation’’ after controlling for current pain status.

Conclusions Doctor’s affect and the appropriateness of information to meet expectations are impor-tant influences on experiences of care, and contribute to the long term therapeutic element of theconsultation. This has important training implications for health care providers, as findings such asthese could form an evidence base from which health care professionals can adapt their consultationstyle where necessary. This should optimise the impact of the time spent with their patients, and is abeneficial step forward for all those involved in these medical encounters.

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Non-smokers: How come you never smoked?A preliminary study in the Balkans

Lazarus, L.; University of Sheffield, South-East European Research Centre, Greece

Smoking is especially prevalent in the Balkan countries where to date there have been fewsystematic smoking prevention initiatives and where social pressures against smoking are farweaker that in Northern Europe and North America. Adolescents therefore grow up in anenvironment where smoking, both in public and private, appears relatively normative. In thiscontext, considering why some adolescents choose not to become smokers may be morerevealing than (as has been typical in previous research) studying the motives and beliefs of thosewho smoke.

Objectives The present study examined the variables that adults perceive, in retrospect, as havingprevented them from smoking when they were adolescents.

Method Multiple samples of non-smoker young adults completed an open-ended question-naire, asking them to list the factors that prevented them from becoming smokers duringadolescence.

Results Results provided useful insight into the factors that young adults perceive to actually haveprevented them from smoking in adolescence.

Conclusions The study of predictors of non-smoking behaviour is perhaps of equal or better value tothe study of predictors of smoking uptake.

Assessment of occupational health risk among Greektelecommunication employees

*Lazarus, L., Rodafinos, A.; *University of Sheffield, South-East European Research Centre,Greece

Occupational stress is as a major work-related health hazard. Researchers have attempted to explorethe sources of stress in the workplace, and to identify personality traits that accentuate the impactof stress on employees. To examine variables related to physical health symptoms, such asjob-stressors and negative affectivity, in non-English speaking countries, existing scales need to betranslated and validated.

Objectives The aim of this study was to evaluate the psychometric qualities of the Greek versionsof the Job-related Affective Well-being Scale (Van Katwyk et al., 2000), and Spector and Jex’s(1998) Physical Symptoms Inventory, Organizational Conflict Scale, Interpersonal Conflict atWork Scale, and Qualitative Workload Inventory.

Method Forward and backward translation was used. A total of 751 telecommunication employeescompleted the translated questionnaires during regular working hours.

Results Findings provided support for the internal consistency of the questionnaires. In accordancewith previous studies, moderate to high, and significant correlations were found among the scales.Negative affectivity and high levels of job stress significantly predicted physical health symptomsexplaining 23.8% of the variance.

Conclusions The properties of the Greek versions of the five questionnaires are comparable withthose reported in previous studies. Thus, the questionnaires may be useful in estimating the sourcesand levels of work-related stressors and strains in Greek populations.

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Depression in mothers and fathers during pregnancy andthe postnatal period – exploratory data from Portuguese couples

*Leal, I., Gomez, R.; *Portugal

Objectives Studies on the male experience of pregnancy and postpartum, especially in Portugal, arerare. The available data on the risk for the appearance or worsening of depression and otherpsychiatric symptomatology pre and postnatally in women is also inconclusive. The main aim ofthis study was to explore the incidence and course of depression in Portuguese mothers and fathersduring the birth period.

Method Level of depression was measured with The Beck Depression Inventory as a continuousand as a dichotomic variable (cutoff point of 9) in both members of expectant couples, once duringlate pregnancy (44 couples), once again between the 1st and the 3rd month postpartum (27 couples)and once again between the 4th and 6th month postpartum (14 couples), and once in both membersof 36 non-expectant couples. Participants further responded to questionnaires on marital adjustment,personality, physical and other psychiatric symptomatology, but the analysis of these variables isnot reported here.

Results The most relevant results indicate that: (1) rates of pre and postnatal depression inportuguese men and women conform to the estimatives in other countries; (2) from pregnancy tothe initial postpartum period, the risk of depression in men increases while in women decreases,what conforms to the observation that couple comorbidity increases postnatally and that, while inwomen postpartum depression is most of times ‘recurrent depression’, in men is ‘de novo depression’;(3) when compared with control subjects, only women during late pregnancy are in greater riskfor depression.

Conclusions Results from this and others studies that included reference group show that theassumption that pregnancy and birth increase the risk for depression need to be better appreciatedin future research. Results also indicate the need to better understand the effect, in depression, offactors where the expectant and non-expectant participants in this study weren’t equivalent, namelyprevious parental experience.

The content and effect of workload and burnout – A study oftourism industry in Taiwan

*Lee, Y.-L., Chen, C.-Y., Lee, Y.-I.; *Chungchou Institute of Technology, Taiwan

Objectives Employees in service industries, such as tourism, are often over-loaded with differenttypes of work demand. Attempting to satisfy these demands may result in burnout that can negativelyinfluence future job intentions. In this study, researchers identified three different types of workload,investigated their impact as antecedents to burnout, and also examined burnout as a mediatorbetween workload and subsequent turnover intention.

Method Data were collected from 342 respondents out of 432 employees who workin hotels, chain restaurants, amusement parks, and travel agencies. The valid response rate was79.17%.

Results Indicated three prominent types of workload – the emotional, physical, and cognitivelabor. Employees generally rated high on these labors. There was 60.5, 74.0, and 59.1, respec-tively, of the employees who felt highly-charged with these labors (mean > 4.0). Average scoresfor the three dimensions of burnout – emotional exhaustion, depersonalization, and personalaccomplishment were 3.26, 2.74, and 2.25 on a 5-point scale. The mean turnover intentionwas 3.50, with 58.2% of the employees reporting a score higher than 4.00. Regression analyses

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further revealed the mediation effect of burnout between workload and turnover intention. Thethree types of labors explained 3� 14% variance of burnout, and 3.3% of turnover intention,both being statistically significant. Burnout contributed additional 21% to the total variance ofturnover intention. The emotional labor was positively correlated with burnout; while the physi-cal and cognitive labors were negatively correlated with it. A causal path model was then testedby LISREL 8, yielding a sound fit (GFI¼ 0.98; AGFI¼ 0.92; RMR¼ 0.034). Content of thethree labors and their relationship patterns with burnout for tourism industry were discussed.

Determinants of blood donation intentions among working young adults

*Lemmens, K., Ruiter, R., Hoekstra, T., de Kort, W., Schaalma, H.; Health Education andPromotion; *Maastricht University, The Netherlands

Objectives. In the past decade the number of blood donors declined steadily in the Netherlands.In order to recruit new donors it is important to understand their cognitions, attitudes and beliefsabout blood donation and reasons for non-donation.

Methods. A questionnaire based on the Theory of Planned Behaviour (TPB) and extended withconcepts like personal moral norm (PMN), altruism, and fear for blood and/or needles was distributedamong working young adults. Questionnaires were filled out and returned by 823 participants, with amean age of 23 (18–30 years). This sample included 86 blood donors and 733 non-donors.

Results Separate multiple regression analyses were conducted for the donors and non-donors. It wasfound that for donors, the intention to donate blood in the future was mainly influenced by attitudetowards blood donation (Beta¼ 0.26) and self-efficacy regarding blood donation (Beta¼ 0.40).These 2 factors explained 37% of the variance in intention (R2

¼ 0.37). For non-donors, the intentionwas influenced by attitude (Beta¼ 0.19), subjective norm (Beta¼ 0.12), social support to becomea blood donor (Beta¼ 0.14), self-efficacy (Beta¼ 0.12), personal moral norms (Beta¼ 0.25), andfear for blood and/or needles (Beta¼�0.13). Together, these factors explained 38% of the variancein blood donation intentions (R2

¼ 0.38). For both blood donors and non-donors, altruism did notsignificantly influence the intention to donate blood.

Conclusions In order to motivate blood donors to make future donations, retention strategiesshould highlight positive donating experiences and ways to cope with blood donation. To encouragenon-donors to register for blood donation and make a first donation, recruitment strategies shouldlower expectations of fear and pain, enhance self-efficacy by describing the donation procedurein greater detail, and enhance personal moral norms, subjective norm and social support.

Religious denomination, gender, and attendance at worship as predictorsof psychological well-being: Results from Northern Ireland

Lewis, C.; School of Psychology, University of Ulster at Magee College, Northern Ireland

Objectives Previous research examining the relationship between religiosity and mental health hasgenerally demonstrated the positive effects that religion has on mental ill health. However, thisrelationship is not a robust one, and is sensitive to the measures employed and samples used.The aims of the present study were to examine whether there were any gender or denominationaldifferences in psychological well-being, and to determine the association between religious attendanceand psychological well-being in Northern Ireland.

Methods A representative sample of the Northern Irish general population (N¼ 5205) completedthe 12-item General Health Questionnaire (Goldberg & Williams, 1988; GHQ-12) and questionson religious denomination and religious attendance.

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Results A two (gender) by two (denomination) ANCOVA demonstrated that Catholics recordedsignificantly lower levels of psychological well-being compared to Protestants, and that femalesshowed significantly lower levels of psychological well-being compared to males. In addition, femalesreported higher frequency of religious service attendance than males, and Catholics reportedhigher attendance rates than Protestants. A significant positive association was found betweenfrequency of religious attendance and GHQ-12 scores. This association was moderated by genderand denomination.

Conclusions The results suggest that there may be gender and denominational differences in furtherunderstanding the relationship between frequency of religious attendance and mental health.These finding suggests ways in which religiosity, in terms of religious denomination and religious prac-tice, may be a matter of social significance in understanding variations in levels of self-reported generalhealth across different sectors of the community. If religiosity is a significant predictor of self-assessedgeneral health, it is clearly a mistake to build models of health-related needs without taking religiosityinto account.

Using the interplay of theory and practice to develop a clinical programme forhealth behaviour changeing the interplay of theory and practice to develop aclinical programme for health behavior change

*Lindahl, B.; *Behavioral Medicine, Umea University, Sweden

Objectives An epidemic of obesity and type 2 diabetes is in progress across the world. Muchevidence supports this to be an effect of adverse behaviours in modern society, such as poor dietaryhabits, sedentary lifestyles and high levels of stress. Simultaneously, evidence accumulates thatadopting a healthy lifestyle may prevent or at least postpone worsening to diabetes. Probably, thisis due to the ability of lifestyle change to influence a multitude of important biological systems inthe body. The question, then, is not why, but how to achieve a healthy long-term lifestyle change.

Methods The treatment programme was based on empowerment using motivational interviewingand cognitive-behavioural techniques. A main goal was to change the patients views on lifestyle andhealth in order to facilitate long-term behavioral change. The programme was developed utilizingboth theory and the content of the group discussions. Important themes in the programme’sagenda were values clarification and goal-setting.

Results At 3-year follow-up, all parameters of the health-related quality-of-life measure (SF-36) werestill significantly improved. The attained favourable health behaviour changes found at 1-year follow-up in physical activity and dietary habits were still maintained. There was also a maintained riskfactor reduction in the treatment group with a mean weight loss of 3.3 kg and a decrease in waistcircumference of 2.4 cm, along with an increase in HDL-cholesterol of 17%.

Conclusions A long-term health behaviour change is attainable in many high-risk individuals.However, the treatment programme must be persistent and build on a holistic view of the situationand not just be seen as a risk factor reduction.

Young adults who drink and drive: Motivators and mediators of intendedand actual avoidance of drink driving

*Liourta, E., Van Empelen, P.; *Department of Clinical and Health Psychology, Leiden University,The Netherlands

Objective Driving under the influence of alcohol is related to increased risk for traffic accidents.A number of pre- and post-intentional cognitions were tested as possible determinants of the intention

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to avoid drink driving and actual behaviour. First, Attitudes, subjective norms, descriptive norms,self-efficacy and past behaviour were examined as potential predictors of future intention to avoiddrink driving. Furthermore, the extent to which intention could distinguish drunk driversfrom non-drunk drivers/drunk non-drivers was tested. Finally, differences in planning, self-efficacy,relative goal importance and behavioural willingness were examined between acting and non-actingintenders.

Method Questionnaires were completed by 361 university and technical school students in Greece.The study was a retrospective cross-sectional survey.

Results Attitudes (�¼ 0.23, p< 0.001), subjective norms (�¼ 0.13, p< 0.01), descriptive norms(�¼ 0.12, p< 0.01) and self-efficacy (�¼ 0.19, p< 0.001) were significant predictors of the intentionto avoid drink driving. Past behaviour had a direct effect on intention formation (�¼ 0.27, p< 0.001).Intention to avoid drink driving was able to distinguish between actors and non actors (�2(1)¼ 31.91,p< 0.001). A logistic regression model including planning (b¼ 1.29, p< 0.05), self-efficacy (b¼ 0.68, p< 0.01), relative goal importance (b¼ 0.43, p< 0.01) and behaviouralwillingness (b¼�0.90, p< 0.01) distinguished between intenders who reported avoidance of drinkdriving or not.

Discussion This study provides useful tools for effective interventions to restrict drink driving.By focusing on both motivational and volitional factors interventions could approach and affectpeople who are not motivated to avoid drink driving, as well as people who intend to avoid drinkdriving but have difficulties in acting on their intention.

Stages of protection motivation in dietary-fat behaviour – is the architectureof the PMT-variables different within the stages of the TTM?

*Lippke, S., Plotnikoff, R., Birkett, N., Hotz, S.; *University of Alberta, Centre for Health PromotionStudies, Canada

Objectives Health behaviour results, according to the Protection Motivation Theory (PMT), fromconsequence of threat and coping appraisals. To date, it is undetermined whether the interrelationshipof the PMT-variables is the same for individuals in different stages of the Transtheoretical Model(TTM). The purpose of the study was to investigate whether the PMT works differently withinthe stages of the TTM, and whether the stage assumptions can be supported with the variables ofthe PMT.

Methods In a cross-sectional mail-out survey, questionnaires were completed by a randomizedcommunity sample (N¼ 1.216). Study participants’ TTM-stage on a validated measurement ofdietary behaviour and corresponding PMT-variables were assessed.

Results Stage distributions were nPC¼ 711; nC¼ 96; nP¼ 49; nA¼ 55; nM¼ 227. Discontinuitypatterns were found in terms of higher ordered terms in self-efficacy, vulnerability, severity andbehaviour ( ps< 0.05). Differences between the stage groups were found in their architecture ofthe PMT-variables: Vulnerability was highly associated with intention in C (r¼ 0.62) andmoderately in PC, A and M (r¼ 0.21–0.25). Severity was significantly correlated with intentionin all stages except P (r¼ 0.20–0.35). Self-efficacy was significantly associated with intentionin PC, C and M (r¼ 0.12–0.26). Intention and behaviour were strongly correlated only in M(r¼ 0.25).

Conclusions The results demonstrate that the PMT works differently within the TTM-stages andthat the PMT-variables support the stage assumptions. Assessing stages of change and tailoringinterventions which target PMT variable to TTM-stages may improve health promotion.

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Social-cognitive predictors of stage transition

*Lippke, S., Sniehotta, F., Luszczynska, A.; *University of Alberta, Centre for Health PromotionStudies, Canada

Objectives To examine transitions between non-intentional, intentional and action stages of theHealth Action Process Approach (HAPA). Hypotheses: (1) the majority of participants remain inone stage over time; (2) depending on the stage, different variables predict transition form stageto stage.

Method In a longitudinal study, respondents were asked about social-cognitions and HAPA-stages.Stages at both measurement points were compared and two groups created: (a) individuals innon-intentional stage who remained in this stage as well as intenders and actors who moved back-wards; (b) participants in any stages who progressed or remained to act or to intend to act.Logistic regression analyses were used to predict stages by means of risk-awareness, motivationaland volitional self-efficacy, intention, pros and cons.

Result Of 303 individuals, 79% remained in their previous stage. By predicting progression to ahigher stage or maintenance in the habituated-actional stage, stage-specific patterns were found:Lower risk-awareness was associated with progression in non-intenders (OR¼ 0.88) and maintenancein actors (OR¼ 0.91). Non-intenders with higher pros were 3 times more likely to progress andintenders perceiving more pros were 5 times more likely to remain or progress. Non-intenders withlower cons were about half as likely to progress whereas the cons did not predict stage progress.Motivational self-efficacy was helpful in all stages (OR¼ 2.61/1.24/1.42) while the volitional self-efficacy prevented regression in intenders (OR¼ 1.81). Finally, non-intenders with higher intentionwere twice more likely to progress. In habituated actors, a higher intention was related to regression(OR¼ 0.37).

Conclusions Discontinuity patterns in the predictions urge stage-specific promotion of individuals.If the decision to change is not set, one should balance pros and cons whereas after goal setting,one should mainly focus on positive aspects. Results support the distinction of the three stages ofthe HAPA model.

How well do patients treated for cancer of the head region adapt long-term?A cross-sectional comparison study of levels of cognitive and emotional well-beingusing three patient samples and a matched non-clinical sample

*Llewellyn, C., McGurk, M., Weinman, J.; *Institute of Psychiatry, Psychology (Health Psychologysection), UK

Objectives Little is known about the long-term emotional and cognitive well-being of patients withcancer of the head region. The main aim was to establish whether post-treatment patients wereat risk of long-term problems with adaptation, whilst investigating the factors that contributed toemotional and cognitive well-being using a framework of Subjective Well-Being as proposed byDiener et al. (2003).

Methods Three samples of patients treated for either: cancer of the head region (n¼ 115), cancer ofthe throat (n¼ 47), and benign conditions of the salivary gland requiring surgery (n¼ 33), anda gender and age matched non-clinical sample (n¼ 115) were recruited into a cross-sectional,postal questionnaire study. Measures included: the Satisfaction with Life Scale (SWLS), SF-12,LOT-R and HADS.

Results Time since treatment had no effect on adaptation in any of these samples. Patients withcancer of the head had similar levels of cognitive well-being (as measured by satisfaction with life)

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as the other samples. Levels of depression were similar between all samples thus demonstrating thatthe cancer patients were not suffering long-term emotional consequences. The biggest determinant ofcognitive adaptation was level of optimism. The majority of clinical and treatment factors had noinfluence on cognitive adaptation. In the head cancer sample only, optimism, surgery,role emotional functioning and social functioning explained 54% of the variance in cognitiveadaptation. Emotional adaptation (depression) was explained by levels of HR-QoL and optimismonly (adj. R2

¼ 0.70).

Conclusions Survivors of cancer of the head reported similar levels of satisfaction with life asother non-malignant patient samples and a non-clinical sample, thereby suggesting that havingtreatment for cancer does not necessarily lead to long-term problems with cognitive and emotionalwell-being.

The impact of psychological stress and social support on wound healingimmune factors following breast surgery

*Loft, P., Pertie, K., Booth, R.; *University of Auckland, New Zealand

Objectives To investigate whether perceived psychological stress and social support prior to breastsurgery predict levels of wound healing immune factors over the first 48 hours following surgery.

Methods Thirty-eight women undergoing breast surgery completed a questionnaire one week prior tosurgery, measuring health behaviours, perceived stress (Perceived Stress Scale), negative affect(PANAS), perceived social support, illness worry (brief Illness Perceptions Questionnaire) andsurgical anxiety. Wound fluid was collected from wound drains 24 and 48 hours following surgeryand analysed for MMP-9, IL-1� and IL-10 concentrations, immune factors essential in earlywound repair. Ten days following surgery participants completed measures of quality of life(Functional Assessment of Cancer Therapy – Breast), anxiety and depression (Hospital Anxietyand Depression Scale) and rated their own surgical recovery.

Results Higher illness worry and surgical anxiety was significantly correlated with lower levels ofIL-1� in wound fluid 24 hours following surgery, and perceived social support from a spouse orpartner was found to influence MMP-9 secretion 24 hours post-surgery. Women reportinghigher perceived social support had lower pre-surgical and post-surgical psychological distress andrecovery perceptions.

Conclusions Findings suggest that pre-surgical psychological stress and illness worry may negativelyinfluence the secretion of important wound healing immune factors during the first 24 hours followingsurgery. Adequate social support may significantly reduce psychological distress both before andafter breast surgery. These results imply that psychosocial interventions prior to surgery maysignificantly benefit women undergoing breast surgery.

The relationship between physical self-discrepanices on fatness andmuscularity to physical self-concept in men and women

*Loitz, C., Rodgers, W.; *University of Alberta, Edmonton, Canada

Objectives Physical self-perceptions are an important part of self-concept and are believedto be associated with certain health behaviours such as exercise. The objective of this studywas to examine the gender differences in perceptions of the physical self and self-discrepanciesis body muscularity and body fatness as they relate to exercise using Higgins self-discrepancy theory.

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Methods Students (N¼ 207, 61 men and 146 women, mean age¼ 19.3 years) completed a question-naire package which included three sets of gender specific silhouettes rated on three aspects of self(actual, ought and ideal) (Higgins, 1986) and two body attributes (fatness and muscularity), andthe Physical Self Description Questionnaire (PSDQ: Marsh, 1994). Physical self-discrepancy scoresfor actual-ideal (AI) and actual-ought (AO) were created. The size of the self-discrepancy was relatedto PSDQ self-ratings.

Results Both men and women’s AI discrepancy scores were greater than their AO scores formuscularity and fatness. Correlational analysis ( p< 0.05) demonstrated that men with smaller A-Oand A-I self-discrepancies on muscularity, but not fatness, were associated with more positiveself-descriptions. In women, more positive self-descriptions were associated with smallerself-discrepancies on both muscularity and fatness. Women who perceived themselves as both toomuscular and too fat had less favourable physical self-descriptions.

Conclusions Men’s perceptions of themselves seem to vary more in relation to perceived muscularitythan fatness. Women’s concept of their physical selves seems to be vary according to perceptions ofboth muscularity and body fatness. Men’s and women’s satisfaction with their physical selves arerelated to different physical self attributes.

Control beliefs; their impact on psychosocial adaptation in womenwith breast cancer at follow-up stage

*Lopez-Roig, S., Neipp, M., Terol, M., Pastor, M., Martınez-Gonzalez, M.; *Health PsychologyDept., University Miguel Hernandez, Spain

Studies of cancer patients have shown that some control beliefs were associated with better psycho-social adjustment. After successful treatment, for breast cancer women are monitored for 10 years(follow-up stage). At this stage women have experienced successfully overcoming the earlierstages of diagnosis and treatment. These experiences may influence the subsequent attribution andexpectations of control beliefs and consequently, in women’s final sense of control.

Aim Our aim was to analyse the relationship between control beliefs and patients’ adaptation overtime.

Method It was a longitudinal study. 131 women with unilateral primary breast cancer, currently freeof disease attending standard follow-up protocol in the Oncology Unit of the General Hospitalof Alicante (Spain) were recruited. Patients were interviewed before their medical check-up.Data were gathered at three points. Standard questionnaires and questions designed to this studywere used. 12 SPSS program was used to analyse data.

Results Women had high control beliefs (mean < 75, range 0–100). Two general control beliefs(General Self-efficacy, Perceived Health Competence) and one specific control belief(Perceived Professional Efficacy) were the strongest predictors of better emotional status andpsychosocial adaptation to cancer over time.

Conclusions Both general control beliefs referred to the capacity and competence to deal withstressful events related to both health and daily life of women with breast cancer were important onthe prediction of women’s adaptation. It was also important that health professionals be perceivedby their patients as reliable and efficacious.

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Psychosocial mediators of forward transition in stages of physical activitychange in an adult community population

*Lorentzen, C., Ommundsen, Y.; *Norwegian University of Sport and Physical Education, Norway

Objectives The purpose of this study was to examine the influence of a multiple strategy community-based physical activity intervention on forward transition in stages of physical activity change and toexamine the mediating role of psychosocial variables in these changes.

Methods A 3-year-long quasi-experimental intervention was implemented in a community in Oslo,with another community serving as control. The intervention strategies were designed to positivelyinfluence physical activity levels by targeting social support, self-efficacy, attitude, perceivedbehavioural control, and identity as potential mediators. One thousand one hundred and eighty onewomen and men (50.6% of those attending the baseline examination, 616 in the intervention districtand 565 in the control district) aged 31 to 67 (mean age 49.3 years) completed a self-administeredquestionnaire pre- and post-intervention.

Results Regression analyses using change scores revealed a significant favourable intervention effecton forward transition in stages of physical activity change (�¼ 0.062, p¼ 0.037), and on social supportfrom family (�¼ 0.069, p¼ 0.036), perceived behavioural control (�¼ 0.065, p¼ 0.031), andidentity (�¼ 0.099, p¼ 0.001). Baseline to follow-up changes in these psychosocial variables werepositively related to forward transition in stages of physical activity ( p< 0.000). Further, the� weight of the effect of the intervention on changes in stages of physical activity was reduced to0.055, 0.045, and 0.033, respectively, after controlling for changes in these three variables, indicatingthese psychosocial factors to act as mediators of forward stage transition.

Conclusions Results suggest that community based intervention strategies targeting social supportfrom family, perceived behavioural control, and identity may be effective in forward transition ofadults in the stages of change in physical activity.

Serious and traumatic injury: The acute, short-term, and long-termmental health impact on the family

*Loutsiou-Ladd, A., Kyprianou, T., Sofroniou, S., Panayiotou, G.; *University of Cyprus, Cyprus

Objective Studies on coping and stress suggest the need for investigation of the impact of specificstressors. We assessed the mental health impact, coping and psychological functioning, on the familiesof ICU patients who were injured seriously following acute trauma.

Methods A cross-sectional methodology was used. 59 close relatives of ICU patients in a generalhospital completed self-report questionnaires (Brief Symptom Inventory (BSI), COPE, Recent LifeEvents, WHO-QOL) within 15 days, one to six months, and six to twelve months post injuryof the patient.

Results Acceptance, planning, and positive reframing were the dominant coping styles employedby the relatives. A one-way Anova indicated significant variability of coping over time since theinjury. Post-hoc comparisons suggested a decrease in the use of coping skills 6 months post-injury.A Manova showed a main effect of time on mental health functioning. Specifically, scores on theFeeling of Guilt item of the BSI dropped 15 days post-injury. Other mental health functioningmeasures tended to be elevated between 1 and 6 months post injury. A Manova indicated thatgender had a significant main effect on mental health scores, with women scoring higher on phobicanxiety than men.

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Conclusions Findings suggest that coping with the particular stressor is variable over time. The declinein the families’ employment of coping skills at 6 months post-injury combined with a tendency forimproved psychological functioning may relate to a decrease in the stressor (i.e., improved healthand functional status of the patient) or a general adaptation to the stressful situation. Families ofacutely injured patients hospitalized in ICU continue to experience psychological distress and needsupport up to 6 months post injury.

Methodological issues in the assessment of social support

Lowe, M.; University of Manchester, UK

Objectives To gain insight into short-term patterns of received support following myocardialinfarction (MI).

Methods Semi-structured interviews were conducted with 29 individuals attending a cardiacrehabilitation program post MI. All interviews were audio-recorded, transcribed verbatim, and thensubjected to interpretative phenomenological analysis.

Results Analysis indicated a pattern of short-term received support following MI that was broadlyconsistent across the 29 participants. Participants described an immediate marked elevation inreceipt of support for the first few weeks after MI. This was followed by a period of graduallydecreasing support receipt over several months. This decrease in support receipt might be seenas intuitively appropriate: as the participants regain their former physical fitness over the weeksof rehabilitation, they require progressively less help in performing the tasks beyond their reachin the early stages of recovery. However participants’ accounts indicate that they actively anddeliberately initiate and maintain this reduction, primarily in order to bolster their sense ofself-efficacy and autonomy.

Conclusions In addition to providing insight into the complex pathways by which social supportinfluences the success of cardiac rehabilitation, the delineation of short-term changes in supportreceipt carries implications for the ways in which social support should be assessed.Conceptualising level of support receipt in the short-term as a dynamic rather than a static processhighlights the inability of current social support measures to assess accurately these short-termchanges. This might explain why many studies have found support received to have less explanatoryvalue than perceived availability of support.

Changes in self-efficacy, coping and emotions: Their associations among rheumatoidarthritis patients participating in routine self-management programmes

Lowe, R.; University of Wales, Swansea, UK

Objectives Illness adaptation involves dynamic relationships between self-efficacy and coping, andemotional outcomes. This process was examined in rheumatoid arthritis patients (RA) undergoingpatient education programmes.

Methods RA patients were recruited from 11 centres offering routine education/self-managementprogrammes. Patients completed questionnaires at baseline, and at 2 and 8 weeks after education.Participants (n¼ 128) provided data on a range of dispositional and situational variables includingcoping (MCMQ), Anxiety and Depression (HADS), and Rheumatoid Arthritis Self-Efficacy(ASES).

Results Independent and dependent variables were measures of change between baseline and 8weeks. Regression analyses focused on Coping and Self-efficacy change, and their impact on changesin Anxiety and Depression. An interaction between Avoidance coping and Self-efficacy accounted

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for 13% of Anxiety: where participants experienced improved Self-efficacy, an increased use ofAvoidance was associated with heightened Anxiety. With deterioration in Self-efficacy, an increaseduse of Avoidance was associated with lowered Anxiety. Twenty four percent of Depression wasexplained by negative relationships with Self-efficacy and disease duration, as well as an interactionbetween Acceptance/resignation coping and Self-efficacy. The interaction showed that withimprovement in Self-efficacy, an increased use of Acceptance/resignation was associated with reducedDepression. However, with deterioration in Self-efficacy, an increased use of Acceptance/resignationwas associated with heightened Depression.

Conclusions Findings highlighted a dynamic relationship between changes in self-efficacy, coping andemotional outcomes. The specific consequence of altering adjustment efforts is itself affectedby changes in efficacy beliefs.

Development and evaluation of acceptance and commitment therapy forthe treatment of refractory epilepsy in South Africa and India

*Lundgren, T., Dahl, J., Nandan, Y.; *University of Uppsala, Sweden

Objectives Due to the stigmatisation of the diagnosis of epilepsy, individuals with frequent seizuresare often marginalized causing unnecessary suffering. In many cases drugs are too expensive andinaccessible. The aim of this study was to develop and evaluate a treatment model based onacceptance and commitment therapy (ACT). The treatment was applied to a group of people withrefractory seizures in South Africa and India.

Methods The design of the study was RCT ABC group design (n¼ 48) with three conditions; ACT,Yoga and Attention Control. The inclusion criteria for participation were: at least 4 seizures in the lastthree months, age 14 or older, no progressive disease, able and willing to participate in the study. Eachcondition consisted of one individual session, two group sessions followed by one more individualsession. The ACT condition consisted of the treatment principles: Values identification, cognitivediffusion, exposure, commitment and seizure control. The Yoga condition consisted of 5 differentpositions stimulating the vagus nerve and education in Yogic philosophy. The control group wasgiven attention control based on reflective listening. Treatment effects were measured by means oflooking at life quality, experiential avoidance, seizure Index, Bulls-eye, EEG and blood serumlevels. Follow ups were done after treatment and at 6 month and one year.

Results The results showed a significant interaction effect in seizure index in favour for the ACT andthe Yoga group compared to the attention control. There was also a significant interaction effect inlife quality and life function in favour of the ACT group.

Conclusions ACT appears to be a useful psychological intervention in cases of epilepsy.

Positive body image in adolescent girls

*Lunner, K., Erling, A., Lunde, C., Hwang, P.; *University of Gothenburg, Gothenburg, Sweden

Objectives Adolescent girls frequently report normative discontent and weight loss attempts. Previousresearch on body image has primarily focused on body dissatisfaction in females. The aim of thepresent study was to explore the influence of and attitudes to sociocultural beauty ideals in girlswith positive body image.

Method Fifteen adolescent girls (age¼ 14) participated in individual interviews. In two previousdata collections, the girls reported positive body image measured by the Body Esteem Scale for

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Adolescents and Adults (Mendelson, 2001). Semi structured interviews assessed descriptionsof and attitudes to personal appearance, cultural beauty ideal, and influences from media, family,and peers.

Results evidenced five main categories. These were (1) Sociocultural and personal beautyideals, (2) Sociocultural influences, (3) Attitudes to sociocultural ideals, (4) Description ofpersonal appearance, and (5) Association between appearance and cognitions. The majority ofthe girls had good knowledge about sociocultural beauty ideals and the associated influences.Some found that the beauty ideals may be negative but also acknowledged related healthand job benefits, while others referred to the ideals as exaggerated and awkward. Most of thegirls reported that they were highly satisfied with their appearance and did therefore notwant to change anything about it; had rarely received negative commentaries about theirappearance; had strong support from their parents and peers who either frequently paid themcompliments or supported the notion that personality was more important than appearance;and felt empathy for girls who think they have to conform to sociocultural ideals in order to gainpopularity.

Conclusions Results suggested that girls with positive body image reasoned about beauty andself-worth quite independent of the current sociocultural ideals. Peers and family positively reinforcedbody image, indicating the importance of support in these issues. Implications of findings for researchand prevention will be discussed.

Implementation intention intervention effects mediated by action planning

Luszczynska, A.; University of Sussex, UK

Objectives The study investigates the relations between the intention to exercise, an implementationintention intervention, self-assessed action planning and moderate physical activity after myocardialinfarction (MI). The study tested whether: (1) intention predicts self-assessed action planning,(2) effects of an implementation intention intervention on behaviour change are mediated bychange in self-assessed action planning, and (3) patients who maintained an implemented mindsetfor half a year engage in physical activity as frequently as they were recommended by a rehabilitationspecialist.

Methods One hundred and fourteen patients after first uncomplicated MI took part in thestudy. Data were collected individually at approximately 1 week after MI (Time 1), 2 weeksafter short-term rehabilitation (about 8 weeks after MI; Time 2), and 8 months after MI(Time 3). After Time 2 of data collection, patients were randomly assigned to the control orintervention groups.

Results The intention to exercise (measured at Time 2) predicted action planning atTime 2 and Time 3. Patients who participated in the implementation intention interventionmaintained the same number of sessions of moderate physical activity at 8 months afterMI as at 2 weeks after rehabilitation. By contrast, patients from the control groupperformed significantly less sessions of moderate physical activity at Time 3, compared to Time2. The intervention had a significant effect on frequency of action planning at Time 3.Change in forming action plans completely mediated effects of the intervention on change in physicalactivity.

Conclusions Only a subgroup of patients who participated in the implementation intentionintervention and maintained an implemented mindset (frequent action planning after theintervention) adhered to the recommended 3 or more sessions of moderate physical activityper week.

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Gender, occupational class and work-life spillover: A comparison of Britain and Portugaltowards a global health psychology

MacLachlan, M.; Centre for Global Health & Department of Psychology, Trinity College, Dublin,Ireland

Objectives This paper seeks to introduce some of the major challenges presented by the global healthperspective and outlines the pivotal contribution that health psychology can make in addressing them.

Method A review of the ‘grey literature’ produced by multilateral, bilateral and NGO aid agenciesidentifying salient themes in developing countries and of the most popular areas of activity asrepresented in the largely Western health psychology literature.

Results While the ‘grey literature’ is increasingly emphasising issues such as the 10/90 gap, health as ahuman right, the psychological empowerment of groups oppressed by social or cultural practices, thedetrimental effects of knowledge flows and the development of effectives health systems, healthpsychology largely eschews these concerns.

Conclusion Health psychologists have an opportunity and an obligation to broaden their researchand practice. With the potential to address policy, treatment, systems and advocacy issues, healthpsychology has the potential to make an overarching contribution to health, particularly in lowincome countries.

Self-esteem in burn-injured adolescents

*Maertens, K., Ponjaert-Kristoffersen, I., Peeters, R.; *Vrije Universiteit, Brussels, Belgium

Objectives The purpose of this study was to enlarge knowledge on how psychological, psychosocialand family factors increase rehabilitation in adolescents with burns.

Methods Subjects aged 12 to 20 years were recruited from the Stuivenberg Hospital Burn Unit inAntwerp, Belgium. A packet with questionnaires was mailed to all potential subjects. Three weeksafter the packets were mailed, all potential subjects who had not yet returned their questionnaires,received a telephone call to remind them to the study. The Dutch versions of the RosenbergSelf-Esteem Scale, the Self Perception Profile for Children and the Perceived Competence Scalefor Children, the Impact of Event Scale for Children and the State-Trait Anxiety Inventory forChildren were filled in by adolescents with burns at 2 to 5 years post-burn and compared witha matched control group of adolescents without burns. Parents of burn-injured adolescents filled ina demographic information form with burn-related findings.

Results Preliminary results showed no significant differences between adolescents with andwithout burns concerning self-esteem. As previous research already pointed out boys report ahigher self-esteem than girls. Further results are being analysed at this time.

Conclusions The first results are consistent with the literature and the hypothesis that adolescentswith burns don‘t perceive a lower self-esteem than their peers.

A longitudinal study about some protective dimensions againstpsychological distress in a population of hospital workers

*Magrin, M., Madotto, F., Scrignaro, M., Vigano, V.; *Department of Psychology, University ofMilano-Bicocca, Italy

Objectives The aim of this research is to investigate the role of some protective dimensions, as‘salutogenic factors’, on psychological well-being. We focus on the relationship between, on one

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hand, the dimension of sense of coherence SOC (Antonovsky, 1988) – and general self-efficacy GSE(Schwarzer, 1992) – and, on the other hand, psychological distress both in terms of perceived distressand in terms of risk of occupational distress.

Methods The sample is composed of 300 hospital workers who attended a training programon human development. Data collection is performed in three steps: pre-test (before thebeginning of the training program), post-test (at the end of the training program i.e., one monthfrom the pre-test) and a follow-up (six months from the pre-test). The instrument used is astructured questionnaire composed of the following scales: the Sense of Coherence Questionnaire(Antonovsky, 1993), the General Self-efficacy Scale (Schwarzer et al.1995), the General HealthQuestionnaire (12 items) (Politi et al., 1994), and the Job Content Questionnaire (36 items)(Ferrario et al., 2003).

Results The confront between pre-test and post-test show the existence of significant correlationsbetween on the one hand SOC and GSE and, on the other hand perceived distress (GHQ).This correlation is in the direction of confirming the protective role of SOC and GSE on thelevel of perceived distress. On the contrary we haven’t found any significant correlation with resultsfrom JCQ.

Conclusions From a theoretical point of view results obtained at the first step of this longitudinalstudy allow us to specify the role played by some dimensions that might be at the core of the stressprocess; from an applicational point of view this results could be translated in future interventionon stress managing and stress prevention.

PTSD and health in a sample of Portuguese colonial war veterans

*Maia, A., McIntyre, T., Pereira, G., Fernandes, E.; *Department of Psychology, University ofMilano-Bicocca, Italy

Aims About one million Portuguese men went to Africa during the sixties and early seventies tofight in the colonial war in Angola, Mozambique and Guinea during the dictatorial governmentin Portugal. The number of victims was very high, but with the political change it was ‘‘forbidden’’to study those years of our history and only now, thirty years later, is PTSD being recognizedas a potential consequence of the war. The aim of this study, the first in Portugal since the endof the war, was to evaluate the psychological and health impact of this experience in veterans, aswell as to understand the risk and protective factors for the development of PTSD and healthproblems.

Methods Participants (n¼ 400) were selected in a database of a Veterans Association and werecontacted by phone. The ones that accepted to participate filled: 1. A developmental history andsocio-demographic questionnaire; 2. A trauma exposure questionnaire that was created for thisstudy in order to evaluate war experience; 3. PTSD scale (McIntyre, 1993); 4. Brief SymptomsInventory (Derogatis, 1993); 5. Rotterdam Scale (Haes et al., 1990); 6. List of health problems;7. Brief Personal Survey social support sub-scale.

Results In order to determine the relation between exposure, P TSD and health symptoms,correlation and regression analysis were run. The results will be presented and discussed consideringthe different variables that are related to present symptoms.

Conclusions Research had shown that the psychological and health impact of trauma, as can be theparticipation in war, can have life-long effects. Although three decades is a long period of time, clinicalobservations show that an important percentage of veterans suffer from PTSD. Our study willcontribute to better determine the extent of the problem and the factors that are related to thepsychological and health symptoms.

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Modelling the influence of illness representations on adherence in asthma

*Main, J., Weinman, J., Hankins M., Horne, R.; *University of Auckland, New Zealand

Objective An extended self regulatory model (Horne, 1997) suggests that patients’ decisions touse preventer medication will be influenced by their beliefs about their treatment which are in turninfluenced by illness representations. The purpose of this study was to test the ability of this modelto explain relationships observed between preventer use and illness representations in asthma.

Methods From a national postal survey on preventer treatment adherence, 2096 primary care asthmapatients (aged 18–55) returned a questionnaire. Measures were, Beliefs about MedicationQuestionnaire, the Revised Illness Perception Questionnaire, demographic and illness variables.Adherence was assessed by self-report and prescription redemption rates.

Results The hypothesised model of the relationships between illness representations, treatmentbeliefs and adherence was tested using the structural equation modelling programme AMOS(version 4). It was found to be a good fit of the data (RMSEA¼ 0.060, 95% CI¼ 0.059–0.062).Using this model 53% of the variance in self report adherence was explained. Beliefs about personalneed for preventer medication were found to mediate the relationship between a belief that asthmahas serious consequences and adherence. A belief that asthma is a chronic condition was similarlyrelated to adherence. The complete model will be presented and discussed.

Conclusions Adherence to preventer medication in asthma may be improved by addressingpatient’s beliefs about the potential consequences of their illness and how long it is likely to lastfor. Modifying these illness representations may influence beliefs about the need for medicationand in turn adherence.

Italian adaptation of the negative act questionnaire revised (NAQR).Correlations with Q.A.M. 1.5 questionnaire

*Majer, V., Giorgi, G., Argentero, P., Zanaletti, W.; *Italy

Objectives According to the definition of Einarsen and Raines (1997) mobbing is defined as asituation where one of more persons persistently over a period of time, perceive themselves to beon the receiving end of negative actions from one or several others in a situation where the victimhas difficulties in defending himself against these actions. Based on interviews with victims and arevision of literature, the NAQR presents 22 items that are answered in a 5 point Likert scale thatgoes from never to daily. The aim of this study was to determine the reliability and construct validityof the Negative Acts Questionnaire Revised (Einarsen e Hoel, 2001) in the Italian context.

Methods The database of the research was built by data collected through a questionnaire realizedby industrial and public firms. Proper statistical analysis has been taken: Crombach’s Alpha values,factorial analysis with Varimax rotation and specification of factors Pearson correlations. In orderto explore the concurrent validity, Pearson correlations with Q.A.M. 1.5 questionnaire (Argentero,Bonfiglio, & Zanaletti, 2004) have been used. In the latter the emerging areas are communication,job, hostilities/critics, overtime, intellectual efficiency, job perceptions, psychophysical conditions,and mood.

Results From this research relevant findings emerged. Indeed, data from this sample show thatthe Italian adaptation of the NAQR provide valid and reliable psychometric properties very close tothe original version.

Conclusions Further research will be taken to get complete data for the Italian validation.

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The factorial invariance of the GHQ-12 across time:Evidence from two community-based samples

*Makikangas, A., Kinnunen, U., Feldt, T., Kinnunen, M.-L., Pulkkinen, Lea; *University ofJyvaskyla, Finland

Objectives The previous studies of the factor structure of the General Health Questionnaire (GHQ)have mainly based on cross-sectional data using exploratory factor analysis method. This study aimedat providing new knowledge about the structure of the GHQ-12 by analysing the factorial invarianceacross time and the stability of the GHQ-dimensions.

Methods Two community-based longitudinal samples with a one-year (n¼ 621, Sample 1) and asix-year (n¼ 231, Sample 2) follow-up time were used. Three alternative factor analysis models ofthe GHQ-12 were tested and compared using confirmatory factor analysis (CFA). The factorialinvariance across time and the stability of the GHQ-dimensions were analysed by using structuralequation modelling (SEM).

Results The correlated three-factor model (i.e., anxiety/depression, social dysfunction and lossof confidence) fitted with the both samples better than the compared one- and two-factor models.The best-fitting correlated three-factor structure was invariant across time in both samples. Thestability coefficients of the three factors were fairly low varying between 0.39–0.56 over a one-yearand between 0.24–0.33 over a six-year follow-ups.

Conclusions The structure of the GHQ-12 remained the same over the course of time, which givesevidence for the good construct validity of the measure. However, the stability coefficients of thefactors of anxiety/depression and loss of confidence suggest that the scale does not purely measuretemporal mental state as it is hypothesized. From a practical perspective, this study suggests thatalthough CFA supported three factors, the high correlation between the factors of anxiety/depressionand loss of confidence (0.83 in Sample 1 and 0.90 in Sample 2) limits their use as separate factors inempirical studies.

Blood donation: A test of the theory of planned behaviour

*Mallett, J., McClenahan, C., Giles, M., Cairns, E.; *School of Psychology, University of Ulster,Northern Ireland

Objectives To test the predictive utility of the Theory of Planned Behaviour – TPB (Ajzen, 1991)in explaining blood donation behaviour among blood donors.

Method An Ajzen & Fishbein-type questionnaire was completed by 499 blood donors from theNorthern Ireland Blood Transfusion Service’s register of blood donors. Subsequently, attendanceat blood donation sessions was recorded during the following year.

Results Hierarchical linear analysis demonstrated that the TPB explained 85.7% of the variancein intention on step 1. Moral norm added 0.2% variance on step 2 and anticipated regret explaineda further 0.3% variance on step 3. Past behaviour was non-significant, but self-efficacy (�¼ 0.964,p< 0.001), anticipated regret (�¼ 0.057, p< 0.001), perceived control (�¼�0.074, p< 0.01) andmoral norm (�¼ 0.044, p< 0.05) were all significant predictors on the final step. Overall, 86.2% ofthe variance in intention was explained on step 4 [F(7, 491)¼ 436.822, p< 0.001]. The underlyingcontrol beliefs explained 10.2% of the variance in intention in a subsequent linear regression analysis.Ordinal logistic regression found that intention as a single predictor explained attendance but thisrelationship was non-significant when perceived control, self-efficacy and past behaviour were enteredinto the equation. Past behaviour was the only significant predictor when all these variables wereincluded (Cox & Snell, pseudo-R¼ 0.165).

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Conclusions In line with a previous study by Giles, McClenahan, Mallett and Cairns (2004) withmainly non-donor undergraduate students, the major determinant of blood donation intention wasself-efficacy. In the present study, a short waiting time, an efficient service, a hygienic environmentand previous experience of giving blood were the most important control beliefs predicting intention.As expected, the intention scores were range restricted, thus reducing the intention-behaviour link andaccounting for the finding that past behaviour was the only predictor of donor behaviour.

Risk communication strategies in breast cancer

Marinca, M.; Babes-Bolyai University, Cluj-Napoca, Romania

Objectives The present research had three objectives (1) to investigate the impact of different messageformats (positive framing versus negative framing, respectively emotional messages) used inbreast cancer prevention campaigns. (2) To explore the social representation of breast cancer.(3) To investigate the frequency with which women engage in screening behaviours.

Methods The participants were 90 women with the ages between 19 and 69 years old (mean: 32.8,SD 12.28) and were randomly distributed in the three experimental groups. They completed a pretest-posttest questionnaire of 18 items grouped in 4 scales: (1) risk perception, (2) perception of theefficiency of the screening, (3) nature and frequency of screening behaviors, (4) evaluation of theengagement intention in screening behaviors through hypothetical scenario.

Results The statistical analysis of the data (descriptive and t test) showed that the hypothesis of thepresent study was partially validated. The three message formats modified the risk perception butnot the intention of engagement in screening behaviors: risk perception estimation and intention ofengagement in screening behaviors were modified depending on the information presented; negativeinformation about breast cancer risk factors and about the efficiency of screening methods raised therisk perception estimates and reduced the confidence in the screening methods, positive informationabout breast cancer risk factors and efficiency of screening methods reduced the risk perceptionestimates and the intention of engagement in screening behaviors.

Conclusions The results of the present study are useful in designing breast cancer educationcampaigns and in doctor-patient communication. The study proves that personal attitudes andintentions are modeled by the type and content of information with which they come into contact.Therefore different risk communication strategies should be used for different objectives.

Depressive cognitions in patients with myocardial infarction

*Martens, E., Denollet, J., Bonnier, H., Appels, A.; *Medical Psychology, Tilburg University,The Netherlands

Objectives Cognitive-behavioral therapy (CBT) has been proposed as a mode of treatment indepressed myocardial infarction (MI) patients. However, for CBT to be successful, depressive cogni-tions must be present in these patients. We therefore examined the prevalence of depressive cognitionsin depressed post-MI patients.

Methods Clinical diagnostic interviews were administered to 240 post-MI patients to determinethe prevalence of DSM-IV major depression (MD). All post-MI patients as well as 28 depressedpsychiatric patients and a group of healthy respondents from the general population (n¼ 347)completed the Beck Depression Inventory (BDI) and the Cognition Checklist assessing depressivecognitions.

Results The level of depressive cognitions in post-MI patients with depressive symptoms (BDI � 10)was similar to that observed in healthy individuals with depressive symptoms ( p¼ 0.675). Depressivecognitions were less prevalent in post-MI patients with MD as compared to psychiatric patients with

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MD ( p¼ 0.003). Post-MI patients with MD did not differ significantly in depressive cognitionscompared with post-MI patients with depressive symptoms but no diagnosis of MD ( p¼ 0.612).Multivariate regression analysis entering baseline characteristics, depressed post-MI statusand depressed psychiatric status revealed that only depressed psychiatric status was independentlyassociated with increased depressive cognitions ( p< 0.0001).

Conclusions We found mixed evidence for the involvement of depressive cognitions in post-MIpatients with comorbid depression. It is possible that CBT is the treatment of choice for somedepressed post-MI patients but not for others.

Improvement in health-related quality of life is a protective factorfor major adverse cardiac events post percutaneous coronary intervention

*Martens, E., Pedersen, S., Appels, A.; *Medical Psychology, Tilburg University, TheNetherlands

Objectives Health-related quality of life (HRQL) may serve as a valuable factor in risk stratificationin research and clinical practice and guide clinical decision-management, but it is not yet used instandard clinical practice. We examined the impact of a deterioration or an improvement in HRQLbetween the index event and 6 months’ post-percutaneous coronary intervention (PCI) on clinicaloutcome at a median of 2 years’ follow-up.

Methods Consecutive patients (n¼ 659) post-PCI aged 35–68 participating in the randomizedEXhaustion Intervention Trial (EXIT) completed the MacNew Heart Disease Health-RelatedQuality of Life questionnaire at baseline and at 6 months and were followed up for major adversecardiac events (MACE). MACE was a composite of death, non-fatal myocardial infarction, coronaryartery bypass graft surgery, and PCI.

Results Of 659 patients, 388 (58.9%) improved, 156 (23.7%) experienced no change, and 115(17.5%) deteriorated in HRQL between the index event and 6 months’ post-PCI as measured byCohen’s effect size index. In unadjusted analyses, an improvement in HRQL between baseline and6 months was a strong protective factor for MACE at follow-up (HR: 0.58; 95% CI: 0.38–0.89),whereas a deterioration was not significantly associated with MACE (HR: 1.21; 95% CI:0.70–2.09). In adjusted analyses, improved HRQL (HR: 0.55; 95% CI: [0.34–0.91) remained astrong independent protector for clinical adverse events adjusting for sex, age, multi-vessel disease,cardiac history, comorbidity, participation in a behavioral intervention, and deterioration in HRQL.Cardiac history (HR: 2.09; 95% CI: 1.32–3.29) and comorbidity (HR: 3.17; 95% CI: 1.88–5.34)were also independent predictors of MACE.

Conclusions Improvement in HRQL between the index PCI and 6 months was a strong protectivefactor for MACE at 18 months’ follow-up, whereas deterioration in HRQL was not associated withthe risk of adverse events. Multiple assessments of HRQL may provide us with a better understandingof the impact of disease and be a better risk indicator for adverse clinical outcome than a singleassessment.

Illness and health recovery – experiences of patients with supraventricular tachycardiaand atrial fibrillation treated with ablation

Maryniak, A.; Warsaw, Poland

Supraventricular tachycardia and atrial fibrillation are the most common cardiac rhythm disturbances.They are associated with significant distress because of recurrent and frequent symptoms theygive and severe limitations of daily life activities. Ablation is an effective treatment procedure.It brings special experience to the patients, who after a long time illness are totally cured during a

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several-hour procedure. 85 patients aged 17–75, who underwent ablation in Warsaw Institute ofCardiology, participated in the study. Every patient was examined three times: before the ablation,few days after and about 3–4 months after the ablation. A semi-structured interview (addressedexperiences of symptoms, emotions, social and family functioning and daily activity), questionnaireof symptoms and SF-36 were used. Before ablation patients reported significant problems withdaily activity and emotions, due to unpredictable time of arrhythmia paroxysms’ occurrence, lifedisorganization and permanent anxiety. After ablation all patients reported slowly progressingimprovement in quality of life (SF-36, mean before ablation 51.8; 3 months after 78.1;p¼ 0.0001). However they complained of the first weeks after ablation as being really difficult,because of concentration on the heart beats, feeling ‘‘phantom arrhythmias’’, and waiting for parox-ysms. They had to reorganize their life to the functioning of a healthy person. Experiences of thepatients who underwent ablation show, that when the person recovers from a long time illness, thedifficult process of ‘‘adaptation to health’’ takes place. The factors, which facilitate the process,are presented in the study, too.

Self regulation and coping adolescent goal pursuit: A pilot study

*Massey, E., Gebhardt, W., Garnefski, N., den Hartog, H., Boubkari, S.; *Department of Clinicaland Health Psychology, Leiden University, The Netherlands

Objectives Adolescents must negotiate a series of specific, age-graded goals for adaptive developmentinto adulthood (Nurmi, 1991). However, how these normative goals translate into specificpersonal goals, and how adolescents approach goal pursuit and deal with setbacks has been little inves-tigated. The objectives of this study are therefore to explore within a self-regulation theory framework:(1) the content of goals set by adolescents; (2) goal-related processes, in particular goal frustration (orhindrance); (3) the relationship between goal content, goal frustration and well-being; and (4) theinfluence of age, gender, educational level and ethnicity on these relationships.

Methods Employing a cross-sectional design, questionnaires were administered to 148 Dutch schoolstudents (71 female, 76 male) aged 12 to 18. Questionnaires were administered during regular schoolhours. An open goal elicitation procedure was used, and goal frustration questions were developed.Along with life and health satisfaction ratings, a modified version of the Fordyce (1988) HappinessScale was used to measure well-being.

Results and Conclusions Findings will be presented and discussed. Qualitative data collected inthis study will be used to develop an easy to administer standardized goals checklist be used in furtherstudies.

Developing a dedicated service to infant mental health

*Matacz, R., Maguire, C.; *Department of Child, Adolescent and Family Psychology, Mallow,Ireland

Every infant has the right to emotional well-being, yet this is often not reflected in health policies,preventative/early intervention programs or clinical practice. Infant mental health is a new anddeveloping area within psychology in Ireland and can be defined as a field ‘dedicated to understandingand treating children 0–3 years of age within the context of family, caregiving and communityrelationships’ (World Association of Infant Mental Health, 2002). To date, limited attention hasbeen given to formalising a screening, assessment and intervention protocol for infant mentalhealth. The aim of this pilot study is to promote positive mental health in infancy by implementinga standardized assessment and intervention protocol. Five families with infant’s exhibiting symptomsof a mental health disorder are participating in this pilot study. Families have completed theassessment phase, consisting of five sessions involving the collation of qualitative and quantitative

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data. Following assessment and diagnostic formulation, families were invited to participate in a12 session therapeutic home visiting model which includes a video taping program, Seeing ISBelieving (STEEP; Farrell-Erikson & Egeland, 1986). This strength-based model aims to promoteand strengthen parent-child interaction through the use of infant mental health principles and thera-peutic videotaping. Following completion, it is hypothesised that post analysis will indicate a decreasein dyadic disturbance, increase in parental responses to infant cues and an improvement in parentalcaregiving behaviours. Families are currently completing the intervention phase of this study. It ishoped that this study will highlight the necessity of intervention with the zero to three populationand it’s importance in preventing and reducing mental health problems in childhood and adulthood.

Development of an observational measure of hospital staff hand-hygiene behaviour

*McAteer, J., Michie, S., Stone, S., Fuller, C.; *Department of Psychology, University College,London

Objective In order to develop and evaluate effective interventions to improve hand hygiene behav-iours amongst hospital staff and reduce hospital acquired infections, a valid and reliable measure ofhand hygiene behaviour is needed. This study develops an observational measure for use in a clusterrandomised controlled trial of the effectiveness of a psychologically grounded intervention to improvehospital staff hand-hygiene behaviour.

Key aims

. To determine key opportunities for hand-hygiene behaviour and actual hand-hygiene behavioursoccurring within the daily routine of hospital staff.

. To investigate whether or not hospital staff behave reactively during observations and if so howlong it takes for habituation to occur.

. To test for inter-observer reliability.

Methods Design: Observational study. Sample: Five categories of staff – nurses, doctors, healthcareassistants, professions allied to medicine, and others – from 2 types of ward: Acute Care of theElderly (ACE), and Intensive Care Units (ICU) in three UK National Health Service (NHS) hospitalsin London.

Procedure Key opportunities and behaviours were informed by three sources of information:

1. Empirical observation. After verbal consent to observe was sought and obtained from wardmanagers, two investigators conducted preliminary observations on wards for between 30–60 min-utes using 2 established observation tools. Each observation session focused upon one bay withinthe ward, and the activity of all staff entering and exiting that bay was monitored and observed.

2. Evidence-based guidelines for HCWs’ hand-hygiene behaviours and3. Discussions with those trial investigators who have relevant clinical experience.

Two investigators tested for reactivity and habituation by monitoring the frequency of reactive behav-iours exhibited by hospital staff during three two-hourly observation periods over three days on eachward of interest. The inter-observer reliability of these hand-hygiene observations is presented withgeneral results.

Conclusions This study has implications for the study of hand hygiene across a range of settings andfor the use of observational methods in health psychology research.

Strengthening health systems in Africa: Motivational aspects of human resources

McAuliffe, E.; Centre for Global Health, Trinity College, Dublin, Ireland

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Objectives Notwithstanding the need to develop effective treatments for the major ‘killer diseases’in Africa, there is also a need to develop and strengthen effective systems of health care delivery.This paper considers some of the human resource factors that impede the effectiveness of healthsystems in poorer countries.

Methods A review of the literature on human resources in healthcare systems in Africa and casestudies of the human resource mix in healthcare systems in South Africa, Malawi and Ethiopia.

Results The diminishing numbers of health workers in sub-Saharan Africa and the poor performanceof services is at least partly explained through various motivational push and pull factors, as wellother non-pecuniary incentives. Alternatives to conventional healthcare delivery systems showpromise in addressing issues of performance and coverage, especially in more rural areas.

Conclusions It is argued that alternative models of healthcare may need to be developed in orderfor care to effectively reach and be responsive to community needs. Such alternatives present achallenge to ‘Western’ healthcare orthodoxies, challenges that might also benefit the qualityof healthcare in wealthier countries.

Focus on body and weight among Indigenous Australian adolescents

*McCabe, M., Mellor, D., Ricciardelli, L., Ball, K.; *School of Psychology, Deakin University,Australia

Objectives Despite their elevated risk of health problems and a propensity to be more overweightor underweight relative to the other members of the Australian population, there has been noprevious investigation of body image concerns among Indigenous Australian.

Method In this study we investigated the level of body image importance and body imagedissatisfaction among 19 rural Indigenous adolescents (7 males, 12 females) and 28 urbanIndigenous adolescents (15 males and 13 females).

Results Our hypotheses that there would be gender differences in body image importance andbody imager satisfaction were not generally supported. However, males placed more importance onmuscle size and strength than females, and rural participants placed more importance on weightthan urban participants. The findings suggested that Indigenous youth may be less concerned anddissatisfied with body weight and shape compared to Caucasian adolescents.

Conclusions These results are discussed in relation to findings from studies of non-Indigenousadolescents, and Indigenous health issues.

The emotional consequences of immediate versus delayed breast reconstructionin women who underwent a mastectomy following a breast cancer diagnosis

*McCann, L., Walsh, J., Kerin, M., Regan, P., Curran, C., Lee, E., Lee, W.; *Dept. of Psychology,National University of Ireland, Galway, Ireland

Objectives The objective was to compare psychological adjustment (as measured by depression andanxiety scores) and self-concept (as measured by self-esteem and body image scores) across fourdifferent breast cancer treatment groups (breast conserving surgery, mastectomy alone, mastectomyand immediate breast reconstruction, mastectomy and delayed breast reconstruction). The studyspecifically examined the role of immediate versus delayed breast reconstruction in the psychologicalrehabilitation process of breast cancer survivors in Ireland.

Methods This retrospective study employed a quasi-experimental design. Participants (N¼ 185)were selected from hospital databases according to the type of treatment they had undergone since

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their breast cancer diagnosis. All women were outpatients and were between one and seven years postsurgery. They were registered under the care of a general surgeon and a plastic surgeon (in the case ofthe reconstruction groups). Participants received a postal questionnaire which theyself-administered and returned.

Results Similar levels of positive psychological adjustment and self-concept were found across thefour groups. However differences were observed between the two reconstruction groups on levelsof depression ( p< 0.05) with the immediate reconstruction group faring better. Interestingly,72% of women who had undergone delayed breast reconstruction would have preferred to have theprocedure immediately at the time of their mastectomy.

Conclusions The high preference rate for immediate breast reconstruction amongst mastectomypatients needs to be considered by the Irish Health Services. Many regional hospitals do not providethis service and so patients should be made aware of the option of attending a specialized BreastUnit where reconstructive services are available.

Non-melanoma skin cancer: Outdoor workers’ perceptions of risk and use of sunscreen

*McCool, J., Gorman, D., Petrie, K., Reeder, A.; *Department of Psychological Medicine, Universityof Auckland, New Zealand

Non-melanoma skin cancer is a preventable personal and population health issue. Every year atleast 45,000 new cases of non-melanoma skin cancer are confirmed in laboratory tests in New Zealand.

Objective The purpose of this study was to assess the relationship between sunscreen use and riskperceptions among outdoor workers.

Method New Zealand outdoor workers (N¼ 1131) were surveyed during the 2004 summer period, toassess the socio-demographic and occupational group differences in sunscreen and perceptions of riskof developing skin cancer.

Results Differences in risk perceptions were evident across socio-demographic and occupationalgroups. Multiple regression analysis revealed that sun protection use is associated with concernabout sun-exposure; high priority of sun-protection relative to other workplace hazard prevention;a supportive workplace culture and high perceived level of knowledge about sun-exposure. Overall,outdoor workers tend to downplay sun exposure as a workplace hazard.

Conclusions Despite high skin cancer prevalence, sun-protection use among outdoor workers inNew Zealand is marginalized as an occupational safety issue. Sun-exposure interventions shouldbe developed in conjunction with other workplace risk interventions, and take into account workersperceptions of the salience of workplace risks, in an increasingly safety-conscious occupationalenvironment.

Predictors of psychological distress in Irish ambulance personnel

*McCrudden, E., O’Boyle, C., Glanville, B.; *Department of Psychology, Medical School, RoyalCollege of Surgeons in Ireland, Ireland

Objective To examine organisational, operational and individual predictors of psychological distressin Irish ambulance personnel.

Methods Cross-sectional postal survey. Self-report questionnaires were available from Irishambulance personnel (595¼ 50% response rate; 504 male; age 18–65; years of experience 1–37).Measures of psychological well-being (General Health Questionnaire, GHQ-28), occupational

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stress (items from the Occupational Stress Indicator, OSI), operational characteristics (specificambulance service stressors) and individual variables (age, sex, years of experience, reactivity to pre-vious trauma) were used.

Results Thirty percent of respondents were categorised as ‘cases’ on the GHQ. Scores on the GHQwere not significantly different for males and females (chi-square¼ 4.48, df¼ 3, p¼ 0.21) or for dif-ferent ranks (Z¼�1.14, p¼ 0.26). Logistic regression analysis was conducted with GHQ casenessas the dependent variable and organisational stressors, operational characteristics and individualvariables as predictors. A full model, combining all three predictors, was reliable (chi-square¼ 108.98,08.98, df¼ 7, p< 0.001). This model accounted for between 18.8% and 26.7% of the variance inGHQ case status. In the full model reactivity to traumatic incidents (OR¼ 1.44, CI¼ 1.22–1.68,p< 0.001), lack of supervisory support (OR¼ 1.3, CI¼ 1.12–1.53, p< 0.01) and organisationmorale (OR¼ 1.2, CI¼ 1.04–1.42, p< 0.05) reliably predicted GHQ caseness scores.

Conclusions Nearly one third of personnel showed significant levels of psychological distress.Individual and organisational, but not operational, variables were predictive of psychological distress.Individual and organisational factors present unique challenges for prevention and management.

The use of relaxation training to reduce physiological arousal in peoplewith a moderate intellectual disability

*McDonald, B., McGuire, B.; *Department of Psychology, National University of Ireland, Galway,Ireland

Objectives This study sought to examine the feasibility and effectiveness of relaxation trainingto reduce physiological arousal in people with a moderate degree of intellectual disability and limitedcommunication ability.

Methods A modified progressive muscular relaxation programme was implemented with threeclients with a moderate intellectual disability. Outcome measures were pulse rate, respiration rate,systolic and diastolic blood pressure.

Results After six sessions of relaxation training, all clients demonstrated significant pre-to-postreductions in physiological arousal as measured by average pulse rate, respiration rate, and systolicand diastolic blood pressure. Clients also appeared to find the relaxation exercise enjoyable andrelatively easy to master.

Conclusions This study provides preliminary support for modified relaxation training with peoplewith an intellectual disability.

Classifying health behaviours: Understanding how individuals perceivehealth-related behaviours

McEachan, R.; Institute of Psychological Sciences, University of Leeds, UK

Objectives A classification of health behaviours according to key characteristics would be ofconsiderable use in understanding how best to predict and change behaviour. However, as yet theclassification of health behaviours remains relatively unexplored. Although existing research classifiesbehaviours based on frequency of engagement (e.g., Roysamb, Rise, & Kraft, 1997), this approachignores the rich perceptions of behaviours which individuals may use as a means of classification.The aim of this study was to create a new taxonomy of ways in which individuals perceive healthbehaviours.

Methods Twenty-four interviews utilising repertory grid technique were conducted with healthpromotion specialists, lay public and postgraduate students. Additionally three focus groups were

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conducted with health psychologists. Respondents were asked to explain in what way certainbehaviours were similar or different from one another.

Results The interviews elicited 287 items describing similarities and differences. These wereindependently grouped into dimension categories by three expert judges. Items were rated accordingto their ‘fit’ in each category. Items not ‘fitting’ a category were re-categorised or discarded. At the endof this process 41 dimensions remained. These encompassed subjective (e.g., motivational, affective,and knowledge related dimensions), and more objective perceptions (e.g., likelihood, severityand valence of consequences, social impact and acceptability, frequency and approach/avoidancedimensions).

Conclusions This study is the first to provide a comprehensive taxonomy of ways in which individualsperceive health-related behaviours. In addition to replicating previous distinctions in the literature(e.g., approach/avoid), new dimensions which discriminate amongst behaviours were uncovered.Subsequent research will ascertain which of these are key in discriminating behaviours, and a newclassification of health behaviours will be developed. It is hoped the resulting classification will bevaluable in understanding the determinants of health-related behaviours.

Emotions disclosure and health: A tutor’s perspective

*McFarland, L., Barlow, J., Turner, A., Wright, C.; *Interdisciplinary Research Centre in Health,Coventry University, UK

Objectives This study examines the process of disclosure, emotions, and self-managementissues symptomatic of living with a long-term health condition (LTHC) from the perspective oflay-tutors of a chronic disease self-management (CDSM) course.

Methods Transcriptions of semi-structured interviews provided the data for analysis usingInterpretive Phenomenological Analysis (IPA). The participants were ten CDSM tutors, all diagnosedwith a LTHC.

Results Emotions were used to express personal meaning in the participants’ lives. Feelings of anger,fear, and frustration, rather than being negative, are inner mechanisms and motivators to action.Emotions engage attention and have adaptational consequences, necessary to self-manage a LTHC.The uncertainty of chronic illness occurs when a person is unable to make sense of illness-relatedevents and feel that they lack necessary information. Disclosure from the group provided guidanceand knowledge and was seen to redirect anger to a sense of empowerment and facilitate a positiveoutcome. Emotional disclosure serves as a bonding tool by highlighting to each individual, throughtheir shared emotional experience, their commonality with the group. Through this unity a peergroup evolves and sense of isolation that often accompanies a LTHC is removed.

Conclusions CDSM courses provide the opportunity for participants to reform their emotionalschema and relocate their thought processes away from an isolated inner state. Emotional stagesfrom anger, fear, and frustration to positive emotions demonstrate an evaluative process and areadiness to self-manage. Emotion narrative indicates this evaluative process, which Results inprogression to a positive stage. This suggests that negative emotions constitute necessary constructiveemotional stages essential to motivate the individual.

Health and well-being of Northern Ireland school children involved in bully/victim problems

*McGuckin, C., Lewis, C.; *Dublin Business School, Dublin, Ireland

Objectives From the largest research study to date into the nature, prevalence, and correlates ofbully\victim problems among pupils within the Northern Ireland school system, the current study

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presents data regarding the physical and psychological well-being of pupils involved in such problemsas either bullies, victims, bully\victims, or bystanders.

Methods A sample of primary and post-primary school children in Northern Ireland (N> 7,000)completed measures of physical and psychosomatic health (Health Complaints Scale: Rigby, 1998,1999), happiness (Delighted-Terrible Faces Scale: Andrews & Withey, 1976), self-esteem(Self-Esteem Scale: Rosenberg, 1965), depression (Depression Self-Rating Scale: Birleson, 1981),and psychological well-being (General Health Questionnaire-12: Goldberg & Williams, 1988) along-side measures of bully/victim behaviour (Bully\Victim Questionnaire: Olweus, 1989; PeerVictimization Scale: Neary & Joseph, 1994; Bullying Behaviour Scale: Austin & Joseph, 1996;Peer Relations Questionnaire: Rigby & Slee, 1993; Bully Scale: Rigby & Slee, 1993; Victim Scale:Rigby & Slee, 1993a).

Results It was found that all actor groups directly involved in bully\victim problems (i.e., bullies,victims, bystanders) recorded significantly impaired levels of physical and psychological well-beingthan those pupils not directly involved (i.e., bystanders). Inter-group differences on these indices ofphysical and psychosomatic health are presented and discussed.

Conclusions Recommendations and suggestions for health professionals are made in light ofthese data, in relation to prevention and intervention program design and delivery.

Acceptance-based strategies and pain tolerance: The role of rule-followingand relational coherence

*McMullen, J., Barnes-Holmes, D., Barnes-Holmes, Y., Stewart, I.; *National University of Ireland,Maynooth, Ireland

Objectives The success of acceptance-based procedures may be described by various components ofthe therapeutic protocol that work concurrently to create effective change. Acceptance based strategiesborrow from a wide range of therapeutic techniques including, defusion, deliteralization, values-orienting exercises, and the use of metaphor etc. (Hayes et al., 1999). The current study aimedto investigate one particular component of the therapeutic process by focusing on the role ofrule-following behaviour in an acceptance- versus control-based experimental preparation.

Methods The experiment employed an independent participants design with four conditions:full Acceptance Intevention, Rule-Based Acceptance Intervention, Full Control Intervention, andRule-Based Control Intervention. Fifteen participants were assigned to each condition, controllingfor gender, age, and levels of experiential avoidance (as measured by the AAQ), and anxiety levels(as measured by the STAI).

Results The results provide insight into the role of rules in therapeutic interventions.

Conclusions The implications of the results for the role of verbal relations in acceptance- andcontrol-based therapeutic interventions will be discussed.

Self-efficacy to quit smoking in psychiatric patients and their care-takers – whereinlies the difference?

*Meganck, J., Vinck, J.; *Universiteit Hasselt, Belgium

Objectives It has often been found that the prevalence of smoking is much higher inpsychiatric patients in comparison with the general population. This study explores to what extendthe difference in self-efficacy between these two groups is based on the patient versus non-patientdistinction or other attributes like age, gender, number of cigarettes and stages of change.

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Methods Information regarding attitudes towards (stopping) smoking was collected from 213patients and 207 staff-members in a psychiatric institute. Self-efficacy was assessed in two ways:‘I feel confident I can quit on my own’ (SE-OWN) and ‘I feel confident I can quit if I get help’(SE-HELP). Originally a 5-point Likert scale was used but extreme categories were recoded intolow (SE-OWN: n¼ 134; SE-HELP: n¼ 101) and high (SE-OWN: n¼ 38; SE-HELP: n¼ 61)self-efficacy. A first binary logistic regression analysis included only the patient-personnel distinction.Subsequent analyses were done adding each of the other covariates separately.

Results The patient-personnel distinction is significant both for SE-OWN ( p¼ 0.018, OR¼ 2.478)and for SE-HELP ( p¼ 0.008, OR¼ 2.627) indicating that personnel are about 2.5 times as likely tohave a high self-efficacy. However, for SE-OWN the patient-personnel distinction lost significancewhen taking into account the number of cigarettes smoked and when including the stage ofchange of the subjects. Similarly, for SE-HELP the difference between patients and personnel lostsignificance when including gender, number of cigarettes smoked and stage of change of the subjects.

Conclusions It is clear that the difference in self-efficacy to quit smoking between patients andnon-patients is also due to other elements. Interventions to increase self-efficacy (e.g., as part of aprogram to quit smoking) should take these aspects into account as well.

Defense mechanisms in infertile couples

*Melo, V., Justo, J.; *Universidade de Lisbon, Portugal

Objectives To compare defence mechanisms of infertile couples beginning infertility treatmentwith defence mechanisms of fertile couples.

Methods The general hypothesis is that infertile couples beginning specialized treatment in hospitalmedical settings will show an important change in their defence mechanisms due to the stressexpectations associated to medical procedures and to future pregnancy possibility. One sample ofinfertile couples was gathered at the Infertility Service of Maternidade Alfredo da Costa (Lisbon).One sample of fertile couples was gathered in order to be as close as possible to the demographicvariables of the first sample. The D.M.I. (Defense Mechanisms Inventory; Gleser e Ihilevich,1969) was used to assess defence mechanisms of couples in both samples. Analysis of variance wasperformed to compare data of the two samples on the DMI five scales: turning against object(TAO), projection (PRO), principalization (PRN), turning against self (TAS) and, reversal (REV).

Results Comparing infertile men with fertile men we obtained five significant differences (infertilemen showed lower TAO & PRO, and higher PRN, TAS & REV than fertile men). Comparinginfertile women with fertile women we obtained three significant differences (infertile womenshowed lower TAO, and higher PRN & REV than fertile women).

Conclusions Data support the hypothesis that beginning medical treatment for infertility in hospitalsettings is characterized by major changes in couples defence mechanisms organization. Hospitalstaff should be aware of those changes while dealing clinically with these patients.

The influence of culture on men’s expression of bodily complaints andillness-related behaviour

*Merbach, M., Wittig, U., Brahler, E.; *Dept. of Medical Psychology and Medical Sociology,University of Leipzig, Germany

Objectives To examine the expression of bodily complaints and illness-related behaviour amongmen differing in cultural background.

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Methods In several studies men with different cultural backgrounds (368 living in East Germany, 372in West Germany, 113 in Moscow, 70 in Istanbul, 146 Ethnic German Migrants in East Germany,94 Turkish Migrants in West Germany and 77 Polish Migrants in Germany) were administered theShort Form of the Giessen Symptom Check List (GSCL-24) and asked about their generalpractitioner consultation during the last year. Their responses were compared to those of womenfrom the same regions. The GSCL-24 (one of the most widely used instruments in Germany)comprises 24 complaints rated on a five-point scale. The sum of all 24 items represents the scalecalled ‘‘Overall Distress’’.

Results Men in Istanbul report the highest score in Overall Distress, men in West Germany thelowest. Turkish migrants and Ethnic German migrants are more similar in their complaint-expressionto their cultures of origin than to the people in the arriving country. Men in East Germany report moredistress than men in West Germany. The differences between men of all groups regarding OverallDistress are statistically significant (F¼ 27.5, p< 0.001, df¼ 1.330). The effect size of the meandifferences between both gender range between d¼�0.15 and d¼ 0.59. The magnitude of thecorrelation coefficients between distress and general practitioner consultation was the lowest for theTurkish migrants (r¼�0.02) and highest for the Polish migrants (r¼ 0.40, p< 0.001).

Conclusions The results suggest that culture influences men’s expression of distress and illness-related behaviour. Men in cultures of relatedness (collectivism) report more distress than men incultures of separateness (individualism). Culture-specific aspects of the male role influencingcomplaint-expression and illness-related behaviour will be discussed.

Why adolescents start to smoke: Peer influence versus peer selection processes

*Mercken, L., Snijders, T., Candel, M., Steglich, C., De Vries, H.; *Health Education and HealthPromotion, University of Maastricht, The Netherlands

The main goal of this study was to unravel social influence processes from social selection processesregarding smoking initiation in young adolescents. The data were collected in the ESFA(European Smoking prevention Framework Approach) project, a large longitudinal study on smokinginitiation among adolescents, in which also friendship networks within the year-group at school wereassessed. The longitudinal design contained one pretest and two follow – up tests at 12 and 18months. This data was studied using Structural Equation Modelling. Results showed no support forpeer smoking as an important predictor of smoking initiation. However, evidence was found that selec-tion processes played an important role, implying that adolescents choose their own behavior, and thenselect their (smoking) friends. Results also showed the impact of parents on adolescent behavior and thechoice of friends. Smoking uptake during adolescence may be more strongly influenced by personal andparental influences than initially believed. Hence, social inoculation programs teaching youngstersto resist the pressures to smoke may be less appropriate if youngsters have a positive attitudetowards smoking and associate smoking with various advantages and look for peers with similarvalues. A different method for analysing selection and influence processes will also be discussed:actor-driven modelling of social network evolution as implemented in SIENA. This method differsstrongly in terms of data requirements as well as explanatory focus. The ESFA data providesa unique opportunity for comparing Structural Equation Modelling with Social Network Analysis.

The effectiveness of migraine lay trainers in a behavioral management group intervention:Preliminary results: Of a randomized controlled trial

*Merelle, S., Sorbi, M., Passchier, J.; *Erasmus Medical Centre, Rotterdam, The Netherlands

Objective To establish the effectiveness of a behavioral management group intervention (BMT)provided by migraine lay trainers.

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Method BMT consisted of 7� 2-hour sessions aimed at prevention of migraine attacks by proactiverelaxation and trigger-management. After successful completion of BMT, migraine patients wereselected to conduct BMT under supervision of a professional trainer to one fellow patient. Whenagain successful, migraine lay trainers provided BMT to small groups at home. Migraine lay trainersreceived structured supervision by e-mail, phone and biannual workshops directed at modelling,reinforcement, verbal persuasion and progressive goal setting to improve migraine trainers’ self-efficacy and training skills. The effectiveness of BMT provided by migraine lay trainers was evaluatedand compared to a waiting list control group pre-post training (0–6 months) and at follow up(12 months).

Results Preliminary results of the first 30 home trained patients showed a significant pre-postdecrease in migraine attack frequency (mean 39%) compared to control (6%). In addition, trainedpatients achieved a decrease of migraine medication use (27% for acute treatment of attacks; 36%for analgesics) and significant differences from the control group regarding increased internal( p¼ 0.002) and decreased external ( p¼ 0.001) locus of control over headache. Multivariate analysesindicated the maintenance of effects on migraine frequency ( p¼ 0.058) and internal headache locusof control ( p¼ 0.018) at follow up. These data will be combined with those of 30 additionalhome trained patients and presented at the conference.

Conclusion The above results suggest that migraine lay trainers are successful in training fellowpatients in behavioral prevention of migraine attacks. The investment in professional supervisionand the stepwise training for trainers is likely to have implications for cost-effectiveness andimplementation.

Psychosocial factors in women’ cancer disease adaptation

Meringolo, S.; Dept. of Psychology, University of Florence, Italy

The cancer disease involves the patient not only as individual, but also as a member of a relationshipsystem, both informal (family, friends) and formal (health services). The patient’s ability to copewith disease depends on different medical, psychological, social (Holland, 1998), and psychosocialresources (Faller, 1999; Katapodi, 2003).

Aim The aim of this research is to identify the Primary CareGiver (PCG), and to investigatesocial support, coping strategies, self-efficacy and self-esteem of the patient.

Method 50 women, oncological patients in treatment and remission, have filled in a specificallyadapted questionnaire.

Results The PCG is Son/Daughter in the 34% of subjects (Son in the 75%), Partner in the 32%,Another Relative in the 14% (woman in the 66%), Friend in the 14%. Different caregivers providedifferent level of social support. The gender is an important variable: in the 71% PCG is a man.Social Support level is satisfactory, even if friends and community seem to be less appreciated,particularly by patients in remission. The sense of community seems below the average also inwomen attending associations. Coping: the patients prefer task-oriented strategies, which don’tseem to be invalidated by emotional reaction. Medium-high score appears in the avoidance-orientedstrategies. High-level task-oriented strategies correlate to high-level self-efficacy, and self-efficacycorrelates to perceived social-support.

Conclusions The results show that the cancer disease is a family-disease. Its effects involve allthe family system, sometimes making it stronger, sometimes breaking it. The cancer patientsfeel that people think of them as someone facing sure death, and so they highlighted theirisolation. It seems that psychosocial factors of cancer disease may influence adaptation to theillness.

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Using scenario information and frequency information to alterrisk perceptions on chlamydia and HIV

*Mevissen, F., Schaalma, H., Meertens, R., Ruiter, R.; *Maastricht University, Maastricht,The Netherlands

Objectives Worldwide STIs/HIV infections are amongst the most serious health problems. Tocommunicate the health risks of unsafe sex, many health education programs make use of so-calledfrequency-based risk information. Some studies, however, suggest that people not only base theirrisk perceptions on probability information but also on information about the process that underliesthe occurrence of a risky event: risk scenario information. Studies on the perception of risks of outdooractivities suggested that this is especially the case with low-probability risks. This poster presentsthe results of a study on the effects of risk-scenario information on HIV/STI- related risk perceptions.

Methods We conducted a laboratory experiment in which participants were randomly exposed toeither risk frequency information, risk-scenario information or a combination of frequencyinformation and risk scenario’s about either Chlamydia (relatively high prevalence, relatively lowseverity) and HIV (relatively low prevalence, relatively high severity). In total 160 studentsparticipated in the study.

Results Results showed different effects of the risk information for people with or without asexual relationship at the time of measurement. Among those with a relationship, only frequencyinformation resulted in the highest perceived susceptibility scores while scenario information hadno effect. For participants without a relationship, the effects of frequency information and risk-scenario information seemed to depend on the prevalence and the severity of the STI. Frequencyinformation about Chlamydia resulted in the highest perceived susceptibility scores, whereasfrequency information about HIV resulted in the lowest perceived susceptibility scores. Risk-scenarioinformation about HIV resulted in the lowest perceived susceptibility scores while risk-scenarioinformation about Chlamydia resulted in the highest perceived susceptibility scores.

Conclusion Future health interventions should take into account that the effects of differentmethods of risk communication depend on target population characteristics and on characteristicsof the health risks involved.

Children’s voices: Qualitative data from the ‘Barretstown Studies’

*Meyler, E., Kiernan, G., Guerin, S.; *Dublin City University, Dublin, Ireland

In light of the growing interest in child-centred research, this paper aims to describe the experi-ences of children affected by life-threatening illness participating in a therapeutic recreationprogramme. European children between the ages of 7 and 16 years attending the Barretstownprogramme were invited to take part in a postal study investigating the impact of the programmeon their well-being. As part of this, they were asked to respond to a series of open-ended ques-tions in a longitudinal design: before attending camp and at two weeks and six months followingtheir attendance at camp. These questions included their expectations and worries about camp,what their time at Barretstown taught them and what changes they would like to make to theprogramme itself. The responses to these questions were analysed and major themes were iden-tified. Children’s expectations focused on the activities and social interactions they were lookingforward to. While the majority of children said that they had no worries, some were concernedabout being away from home and having difficulty making friends. While approximately a thirdof the children reported that they had not learnt anything at Barretstown, the largest proportionof children felt that they had acquired skills that enhanced personal and social functioning, and

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gained new insights into different cultures, amongst other benefits. These findings are discussedin relation to the value of qualitatively accessing children’s views and experiences within alongitudinal research design, as well as the practical recommendations that emerged from thefindings.

Evaluation of educational programs from the Social Cognitive perspective

*Michalowska-Zinken, K., Skinner, T.; *University of Southampton, UK

Social cognitive techniques work on both the task-oriented and emotion-oriented level focusingon enhancement of perceived capability, creating a role model environment and opportunitiesfor mastery experience. There is no analysis system that addresses implementation of self-efficacy oriented interventions. To fill in the gap an analysis system for the coding of self-efficacy related interventions in training programs (ASSET: Analysis System for Self-EfficacyTraining) has been developed. Four super categories have been deductively derived fromSocial Cognitive Theory: Mastery Experience, Role Model, Verbal Persuasion, and Physicaland Affective State (Bandura, 1997). In the next step, the materials from self-managementprogram manuals (DESMOND, 2004; Lorig, 1996) were used to inductively identify particularinterventions as subcategories. Finally, the subcategories have been extended and refined on thebasis of observation of self-management education programs run in local health care services.In the next step, ASSET will be validated. Participants’ behavioural, cognitive and emotionalchange, derived from self-report questionnaires, will be related to the frequency of utilizedself-efficacy enhancing strategies. Having considered the high predictability of self-efficacybelief on behaviour change, it is expected that programs with high numbers of utilized self-efficacy oriented interventions will result in better illness adjustment. The validation studyresults will be presented in this poster.

Identifying effective techniques: The example of physical activity

*Michie, S., Hardeman, W., Abraham, C.; *University College London, UK

Objectives To outline two approaches to clarifying links between specific behaviour changetechniques and specified health behaviour changes.

Methods Two systematic literature reviews of community, workplace and primary care interventionsto increase physical activity were analysed to identify the component techniques of effectiveinterventions. A family-based intervention to increase physical activity amongst those at risk ofType 2 diabetes was evaluated in terms of protocol adherence (i.e., the extent to which taughttechniques were used in practice). Transcripts of four audio-taped intervention sessions with27 participants were analysed using a reliable coding frame.

Results The first review, of 21 randomised controlled trials of general physical activity interventions,found that techniques associated with self-regulation theory (e.g., goal setting, self-monitoring, actionplanning) and operant theory (stimulus cues and reinforcers) were associated with effectiveinterventions whilst techniques tailored to stages of change were not. The second review, of self-regulation interventions evaluated in controlled trials, found that effective interventions used specificbehavioural techniques, taught by trained staff, and targeted inactive or ‘‘low active’’ populations.Mediation of change was rarely analysed: where it was, changes in behaviour were mediated,as predicted, by specified theoretical constructs and techniques (e.g., enhanced self-efficacy, social/partner support, and the use of behavioural and cognitive techniques). In the family-based interven-tion analysis, average adherence of the 14 taught techniques specified in the protocol was only 50%,

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range 25–66%. There were consistent differences between the four trained behaviour changefacilitators, and lower adherence in later sessions. Thus, specifying techniques in behaviour changeprotocols does not guarantee their delivery in practice.

Conclusions Interventions should be evaluated in terms of identifying evidence-based techniquesthat are reliably delivered in practice.This will enable us to understand mechanisms of change,improve theories of behaviour change, and develop more effective interventions, appropriatelygeneralised across population and situation.

Relationships between illness perception, anxiety and depressionin cardiac rehabilitation patients

*Miglioretti, M., Nasorri, C., Mozzi, C., Passoni, E.; *Psychological Unit, Cardiovascular Institute ofCamogli, Italy

Objectives To describe the illness perception of the cardiac rehabilitation patients and toevaluate the relationships between illness perception, anxiety and depression.

Methods One hundred and ten patients (M: 70.9%; F: 29.1%; mean age: 62.6� 8.1) in cardiac reha-bilitation were recruited in their first week of intensive rehabilitation. The patients were subdivided bypathology in three groups: patients with PTCA and by-pass outcomes (group 1; 62.7%); patients withcardiac valve replacement (group 2; 20%) and patients who are in their second period ofcardiac rehabilitation after one or more years from cardiac surgery intervention (group 3; 17.3%).Illness Perception was assessed by the Brief-Illness Perception Questionnaire; anxiety and depressionwere evaluated by STAY-Y1, STAY-Y2 and Beck Depression Inventory.

Results There is no difference in depression, trait and state anxiety between the threepathology groups. On the contrary there is a different illness perception about the timeline ofthe illness: the patients, who have a second period of cardiac rehabilitation, perceived to have alonger illness than patients of the other two groups (F: 10.4; p< 0.001). The depression score, thetrait and state anxiety score are significantly correlated with different aspects of illness perception:depression is related to how much illness affects life (r2¼ 0.348), timeline (r2¼ 0.309), illness concern(r2¼ 0.396), symptoms perception (r2¼ 0.198), illness comprehension (r2¼�0.214), and emotionalchange (r2¼ 0.420). Trait anxiety is related to how much illness affects life (r2¼ 0.258), illnessconcern (r2¼ 0.217), and illness comprehension (r2¼�0.213). State anxiety is related to howmuch illness affects life (r2¼ 0.455), timeline (r2¼ 0.367), illness concern (r2¼ 0.332), symptomsperception (r2¼ 0.276), illness comprehension (r2¼�0.276), and emotional change (r2¼ 0.338).

Conclusions The results of this study underline the importance to evaluate the relationship betweenillness perception and the emotional reaction to illness in order to develop a psychological supportprogramme for cardiac rehabilitation patients.

The relationship between illness perceptions, coping and psychological adjustmentin siblings of children with congenital heart disease

*Miller, N., Pattison, H.; *Aston University, Birmingham, UK

Objectives To investigate the relationships between illness perceptions, coping strategies andpsychological adjustment in siblings of a child with congenital heart disease.

Methods Data were gathered by mailing standardised questionnaires to 67 eligible families fromthe charity ‘Little Heart Matters’. Thirty-four families agreed to participate and completed all

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questionnaires, 17 male children, 17 female children and their parents. The mean age of the siblingparticipants was 10.58 years. Siblings were asked to complete two questionnaires. The first was anadapted version of the Brief Illness Perceptions Questionnaire (BIPQ: Broadbent et al., 2005)which measured participants’ perceptions of their siblings’ illness. The internal consistency ofthis was found to be acceptable (Cronbach’s �¼ 0.778). The second questionnaire was theKidcope (Spirito et al., 1988) measuring coping strategies. Parents completed the Conners’Parent Rating Scale (CPRS: Conners et al., 1998), a measure of children’s psychological adjust-ment.

Results Siblings showed poorer psychological adjustment on all 4 scales of the CPRS than the scalenorms for their age and gender. Regression analyses on the 4 CPRS scales revealed that illnessperceptions predicted between 61 and 52% of the variance in psychological adjustment:oppositional behaviour (F1,32¼ 50.0, r2¼ 0.61, p< 0.01); hyperactivity (F1,32¼ 37.08, r2¼ 0.537,p< 0.01); inattention (F1,32¼ 34.8, r2¼ 0.518, p< 0.01); ADHD (F1,32¼ 42.83, r2¼ 0.573,p< 0.01). Neither age nor gender was found to predict illness perception, coping strategies orpsyc adjustment. Siblings who used more emotion-focused than problem-based coping had higherADHD scores (r¼ 0.3, p< 0.05).

Conclusions Siblings of children with congenital heart disease are vulnerable to poor psychologicaladjustment associated with negative perceptions of their siblings’ illness. Interventions designedto address this could have an impact not only on the wellbeing of the child but also parents andthe ill siblings themselves.

Age, gender, and patterns of coping with cancer in the first year following surgery

*Mohamed, N., Luszczynska, A., Boehmer, S.; *University of Sussex, UK

The study analyzes the relations between socio-demographic variables and patterns of coping withcancer. Patients after tumor surgery (N¼ 97, 40% women) with a mean age of 62 years (SD¼ 10,Range 27–86 years) participated in this study. Measurements were applied 3 days before the cancersurgery and seven days, one month, six months, and one year after surgery. Assessments used tomeasure coping included The Mental Adjustment to Cancer Scales (MAC; Greer & Watson,1987), and the Brief COPE (Carver, 1997). Coping strategies examined included assimilative,accommodative, and avoidant coping strategies. Repeated measures ANOVA was carried out withthe five measurement points serving as time factors to test changes in coping. Results indicated asignificant time effect on the three types of coping strategies applied by patients. A significant decreasein avoidant coping and a marked increase in both assimilative and accommodative coping strategiesover the one-year follow-up period emerged. Results also showed effects of age and gender on theuse of coping strategies. Women were more likely to use avoidant coping than men, whereas agewas related to frequent use of accommodative coping, but to rare use of assimilative coping. Thepresent study emphasizes the roles of the patients’ age and gender for differential use of copingstrategies during the time of post-surgical adaptation.

Received social support enhances patients’ active and accommodative copingwithin the year following cancer surgery

*Mohamed, N., Boehmer, S., Luszczynska, A., Schulz, U.; *University of Sussex, UK

Changes of the level of support received from the social network within one year following cancersurgery were studied. Furthermore, the study investigates patterns of associations between receivedsocial support, age, gender, marital status, and active and accommodative coping. Ninety-seven

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patients with cancer (40% women) participated in the study. Their mean age was 62 years (SD¼ 10,Range 27–86 years); about 55% of patients were married. The sample was heterogeneous regardingthe site of cancer reported. Measurements were applied at 3 days pre-surgery, and 7 days, 1 month,6 months, and 12 months post-surgery. Received social support was measured by using items selectedfrom the Berlin Social Support Scales (Schwarzer & Schulz, 2000). Items selected from the BriefCOPE (Carver, 1997) and The Mental Adjustment to Cancer Scales (MAC; Greer & Watson,1987) were employed to assess active and accommodative coping. Social support was high aroundthe surgery, however it decreased significantly thereafter. This decrement in received support wasmarked only among women. Across different assessments, a high level of received support was asso-ciated with more frequent use of active and accommodative coping. The present study highlights therole of the patients’ gender for the receipt of support from their social environment. Results emphasizethe crucial role of received support for patients’ adjustment to cancer through enhancing the use ofactive and accommodative coping strategies.

Predictors of positive health among Irish adolescents: Finding from the 2001/2 hbsc study

*Molcho, M., Nic Gabhainn, S.; *National University of Ireland, Galway, Ireland

Objectives Many studies that address youth health focus on risk behaviours, their predictors andtheir outcomes. Fewer examine aspects of positive health among youth and their predictors. Thecurrent study examines five aspects of adolescents’ positive health (lack of emotional and somaticsymptoms, life satisfaction and self-reported happiness), as predicted by adolescents’ relationshipswith their parents and peers, their perceptions of relationships within their school and theirperceptions of relationships within their local community area.

Methods This study is based on data collected on the 2002 Irish Health Behaviours in SchoolAged children national representative study. The sample comprises of 8,424 schoolchildren(aged 10 to 18 years) from 176 primary and post-primary schools.

Results For all measures of positive health, as the number of positive perceptions of relationships withparents, school and local community area increase so does the likelihood of reporting positive health.The odds ratios for good relationships with both parents in predicting positive health vary from 2.00to 3.81, the odds ratios for number of positive school based relationships vary from 1.92 to 4.16 andthe odds ratios for number of local community area perceptions vary from 2.22 to 4.47, all of whichare significant at the level of p< 0.001.

Conclusions These data illustrate the extent to which relationships are important for adolescenthealth. Specifically, they indicate the extent to which relationships with adults and withincommunities are at least as important as those with peers. This has implications for the emphaseswe place on supporting adults as well as children within our communities, as well as the potentialsignificance of relationship building, maintenance and enhancement skills.

Using the demand-control model of job strain to predict caregiver burden:A longitudinal study

*Molloy, G., Johnston, D., Johnston, M., Witham, M., Struthers, A., McMurdo, M.; *School ofPsychology, University of Aberdeen, UK

Objective To apply the Karasek Demand-Control model of job strain to predict self-reportedcaregiver burden in the informal caregivers of older patients with congestive heart failure (CHF).

Methods Caregivers of 82 CHF patients attending outpatient clinics were recruited. Data wasgathered from 60 caregiver/ patient dyads at two time points, 3 months apart. The dependent variable

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was Care Work Strain, a measure of the subjective burden of caregiving. The independent variableswere: (1a) Demand, which was measured as the care-recipient (CR) assessment of their ownfunctional limitations (Functional Limitations Profile) and (1b) the walking limitations (6-minutewalk test) of the CR (2) Control was measured using a previously used self-report measure.Hierarchical multiple regression was used as the primary method of analyses.

Results In cross-sectional analysis the model explained 15% at Time 1, p< 0.05 and 16%, p> 0.05 atTime 2 of the variance in Care Work Strain, after controlling for socio- demographics using the(1a) measure of Demand and 19%, p< 0.05 at Time 1 and 24%, p< 0.05 of the variance usingthe (1b) measure of Demand. Main effects for Control were found at Time 1 and 2. LowerControl was associated with higher Care Work Strain. Support was found for the interactive predic-tion between Demand and Control in cross-sectional analysis at Time 2 using the 1(b) measureof Demand. Higher Control reduced the effect of high Demand on Care Work Strain. There wasno support for the model in longitudinal analysis of change.

Conclusion In this study we found support for the application of the Demand-Control modelto examine a caregiver health outcome. Control appears to be the most dominant predictor in themodel. Models of job strain may provide a useful framework for understanding and improvingcaregiver health.

Illness representation as a predictor of psychological distress inparents of pediatric cancer patients

*Molnar, E., Kajtar, P., Ottoffy, G., Tiringer, I., Kallai, J.; *Institute of Behavior Sciences, Faculty ofMedicine, University of Pecs, Hungary

The main objective of the present study was to establish how the social and personal representationsappeared in the parents of children with cancer. According to Leventhal’s model the five componentsof cognitive illness representation – identity, causes, time-line, cure/control, consequences – andemotional illness representation of parents were compared to their anxiety, depression and psychol-ogical well-being. This study was performed out at Haemato-Oncologic Ward of Department ofPediatrics, Faculty of Medicine, University of Pecs. Parents of pediatric cancer patients (childrenwith acute lymphoid leukaemia, acute myeloid leukaemia and solid tumors) were participated inthe study. After a semi-structured interview refering to parental representation of their children’sillness they completed questionnaires about their emotional well-being (Hospital Anxiety andDepression Scale), posttraumatic stress symptoms (Impact of Event Scale-R). Based on our expecta-tions the parents’ cognition that the illness was highly symptomatic, unpredictable negatively relatedto the parental emotional and psychological well-being, as well as the perception of the seriousconsequenses, fatal outcome. The latter is general in the social and personal representation ofchildhood cancer, inspite of the better conditions of treatment and favourable life expectancies.Our findings suggest that not only the children with malignant disease but also their parents requiresdifferent psychological interventions.

Work-family interference as a mediator between job demandsand job burnout among greek doctors

*Montgomery, A., Panagopolou, E., Benos, A.; *Aristotle University of Thessaloniki, Greece

Objectives The present study examined the relationship between job demands and burnout, andthe mediational role of work-family interference (WFI) in a sample of Greek doctors. Morespecifically, the first hypothesis examined whether job demands are positively associated withburnout, controlling for demographic variables and NA. The second hypothesis examined whether

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WFI mediates the relationship between job demands and burnout, controlling for demographicvariables and NA.

Methods The methodology consisted of a cross-sectional survey completed among a sample ofGreek doctors (N¼ 162) attending professional development courses in the university medical school.

Results In terms of the first hypothesis, results indicated that emotional job demands was a strongpredictor of both emotional exhaustion and depersonalisation. With regard to the secondhypothesis, WFI was found to partially mediate the relationship between both quantitative/emotionaljob demands and emotional exhaustion. Additionally, WFI partially mediated the relationshipbetween emotional job demands and depersonalization.

Conclusions The present study indicates that for Greek health professionals, the need to reconcilework and family demands is a significant problem. The emotional ‘‘people work’’ that Greek doctorsconstantly engage in is an important predictor of burnout. Quantitative job demands were found to pre-dict emotional exhaustion, meaning that heavy workloads or overwork is reducing the energyavailable to these health care professionals. Additionally, the large reduction in the direct effect betweenquantitative job demands and emotional exhaustion (after including WFI) provides strong evidencethat work to family spillover is a significant problem and is having a detrimental effect on work func-tioning. Results are discussed with regard to the implications for the medical community in Greece.

‘‘As I get older, I…’’: Aging self-stereotypes mediate relationship betweenneuroticism and subjective health

*Moor, C., Zimprich, D., Kliegel, M.; *University of Zurich, Switzerland

Since the global item of subjective health has emerged as a strong predictor of importanthealth outcomes such as mortality, there have been many attempts to uncover its correlates.Recently, personality has been found to predict subjective health, but actual health status was notoften assessed objectively. In this study, we tested whether personality as assessed via the big fivepersonality factors predicted subjective health when physician-rated health and depression werecontrolled for. We analysed a cohort of 362 German community-dwelling 60-year-olds from thefirst wave of the ongoing Interdisciplinary Longitudinal Study on Aging. We found that neuroticism,but none of the other four personality factors, predicted worse subjective health. However, the asso-ciation between neuroticism and subjective health was completely mediated by aging self-stereotypes(attitudes toward oneself as an aging person, e.g., ‘‘As you get older, you are less useful’’), which inrecent studies have been shown to influence older individuals’ health behaviours and functionalhealth. The results indicate that at age 60, those high in neuroticism tend to have more negativeaging self-stereotypes; these aging self-stereotypes, in turn, seem to affect how those individualsglobally perceive their own health. Unlike many predictors of subjective health, such as age,gender, socio-cultural differences, medical burden, or personality traits, negative attitudes aboutone’s own aging may be modified through adequate intervention. Moreover, as work by Levy andcolleagues on memory (Levy, 1996) and cardiovascular stress (Levy et al., 2000) suggests, by activat-ing positive self-stereotypes of aging, the effects of negative stereotypes might in fact be overpowered.

The effects of acceptance and valuing on tolerance for and perception of pain

*Moore, H., Stewart, I., McGuire, B., Barnes-Holmes, D., Barnes-Holmes, Y.; *National Universityof Ireland, Galway, Ireland

Objective This study examined the effects of acceptance and valuing on tolerance for and perceptionof pain in the form of periodic electric shock.

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Methodology Participants (n¼ 40) were required to write down examples from their own livesin which the pursuit of valued objectives required exposure to aversive experiences. For half theparticipants (Value Primed), the examples required were ones in which they had pursued thevalued objective, while for the remainder (Value Non Primed), the examples were ones in whichthey did not. Half of the ‘Value Primed’ participants were then assigned to an acceptance-basedprotocol (ACT), the goal of which was to disconnect pain-related thoughts and feelings from literalactions, while the rest were assigned to a control-based protocol (CONT) that focused on changingor controlling pain-related thoughts and feelings. All participants took part in a nonsense-syllables-matching task that involved successive exposures to increasingly painful shocks. At times throughoutthe task, participants were asked to choose to continue with the task and be shocked or stop the taskand avoid being shocked. Participants performed the task twice, both before and after receiving theassigned experimental protocol (i.e., either ACT or CONT). Two further measures were obtainedat pre- and post-intervention: tolerance of the shocks and self-reports of pain.

Results The results raised a number of issues with regard to the usefulness of acceptance andvaluing in the context of chronic pain, and these will be discussed.

Conclusions This study provides further empirical evidence pertaining to the effectiveness of ACT.

Evaluation of the clinical and cost effectiveness of a brain injury vocationalrehabilitation service: Quest brain injury services, Galway

*Moore, L., McGuire, B., Donlon, D., Wall, I., Allen, S.; *Department of Psychology, NationalUniversity of Ireland, Galway

The value of post-acute, community based social and behavioural rehabilitation for people withserious neuropsychological disability is an area of continuing debate.

Aim This study will examine the clinical and cost effectiveness of ‘Quest’, the only vocationalrehabilitation programme in the West of Ireland.

Objectives Primary Objective: To determine the extent to which participation in a multi-disciplinary rehabilitation programme predicts improvements in community integration, occupationalstatus, psychosocial adjustment following mild to severe traumatic brain injury (TBI). SecondaryObjective: To ascertain cost effectiveness outcomes and client satisfaction with the programme.

Research design A non-randomised case control study will be conducted employing a pre-treatment,post-treatment and 6 month follow up design. Focus groups and survey will measure clientsatisfaction.

Methods and Procedures Archival assessment data for 17 clients with mild to severe TBI whocompleted a battery of questionnaires at intake, discharge and at 6 months follow up will be analysed.

Results Preliminary results will be presented and discussed.

Patients’ reactions to venous thrombosis: An application of the theory of cognitive adaptation

*Moore, T., Norman, P., Harris, P.; *University of Sheffield, UK

Objectives In contrast to other common and life-threatening diseases (e.g., heart disease and cancer),venous thrombosis has received little attention in health psychology. The present study aimed to assesspatients’ reactions to a recent venous thrombosis (i.e., deep vein thrombosis; DVT, and pulmonary

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embolism; PE), and to test whether Taylor’s (1983) Theory of Cognitive Adaptation (TCA) wouldpredict positive adjustment.

Method One hundred and twenty-three thrombosis patients (56% male) (mean age, 52.5 years)completed measures of the TCA constructs (meaning, mastery, self-esteem and optimism), riskperceptions and a range of outcome variables (anxiety, depression, positive affect, thrombosis worriesand quality of life).

Results A series of multiple regression analyses was conducted to examine the predictors of the mainoutcome variables. Overall, the TCA was able to account for more than 50% of the variance inpositive affect, anxiety, thrombosis worry and intrusive thoughts. In addition, the TCA variableswere also able to explain large amounts of the variance in depression, mental functioning andavoidance. Multiple regression analyses indicated that in line with the TCA, higher mastery,self-esteem and optimism predicted positive adaptation to thrombosis. However, contrary to predic-tions, meaning emerged as a significant predictor of anxiety, thrombosis worries and intrusivethoughts.

Conclusions The present results suggest that (i) thrombosis may cause considerable psychologicaldistress and may warrant screening for anxiety and depression, (ii) a search for meaning in theearly stages of adaptation may be related to increased levels of anxiety and worries, (iii) secondarycontrol efforts may be more adaptive than primary control efforts when coping with conditions thathave an uncertain prognosis, and (iv) both dispositional and situated measures of the TCA constructsare required to understand patients’ reactions.

Opinions about depression and attitudes towards suicidal behaviour amongthe general public and general practitioners

*Moore-Corry, M., Arensman, E., Corcoran, P., Perry, I.; *National Suicide Research Foundation,Cork, Ireland

Objectives To examine opinions about depression and attitudes towards suicidal behaviour andits prevention among the general public and General Practitioners (GPs) in Ireland.

Methods Randomly selected samples of the General Public (N¼ 1000) and GPs (N¼ 100) wereinvited to participate in a baseline assessment as part of a four-level community based interventionsstudy on depression and suicidal behaviour in the Southern and Western region in Ireland.The study is part of a larger European study: The European Alliance Against Depression (EAAD).Data were obtained through telephone interviews, using a questionnaire on opinions aboutdepression developed by the EAAD and a questionnaire on Attitudes Towards Suicide (ATTS,Renberg, 2001).

Results Preliminary results based on interviews with the general public show that one third of thesample stated that depression cannot be treated and over two thirds were of the opinion that use ofantidepressants would change a person’s personality. Although on items related to the preventionof suicide, the majority replied in the favourable direction, the findings with regard to knowledgeabout suicidal behaviour were inconsistent. Forty percent believed that suicidal thoughtscould be evoked by asking about it and nearly half stated that suicide happens without anywarning. Thirty percent stated that there may be situations where the only reasonable resolutionis suicide.

Conclusions The baseline findings underline the need for increased awareness about depressionand suicidal behaviour among the general public. This is a key objective of the four-level communitybased intervention programme on depression and suicidal behaviour.

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Boundary points used for defining burnout levels: An alternative view

*Moreno-Jimenez, B., Rodrıguez-Carvajal, R., Galvez Herrer, M., Rodrıguez-Munoz, A.; *Faculty ofPsychology, Universidad Autonoma de Madrid, Spain

Objective To test the prevalence of medical burnout according to an alternative way of assessmentdifferent from the established criteria for burnout on the MBI manual.

Methods The sample resembled the overall area population in age distribution as well as healthstatus and sociodemographic characteristics. A total of 485 physicians, general practitioners (GPs)and specialists working in the general hospitals and health centers in Madrid (Spain) filled out andreturned the completed questionnaire.

Results Through t-student and �2, the analyses showed a prevalence of burnout of 6.6% withsignificant differences among two of the three dimensions of the syndrome according to the sample(GPs or specialist).

Conclusions Recent studies in the United States have shown prevalence from 30 to 70% in physicians(Deckard, Meterko, & Field, 1994; Linzer et al., 2001; Anderson, 2002), while other studiesin different countries placed it in 40–60% (Garcia Izquierdo y cols, 2000; Molina et al., 2003).Our results show the need to overcome the deficits of the boundary points system used fordefining burnout levels and the specificity of the instrument to adjust the external validity of thesyndrome.

The sufficiency of the theory of planned behaviour as a model of adolescents’ decisionsabout having sex

*Morrison, D., Wells, E., Beadnell, B., Rogers Gillmore, M., Hoppe, M.; *University of Washington,Seattle, WA, USA

Objectives The purpose of this study is to examine the effects of constructs external to the Theoryof Planned Behaviour (TPB) on attitudes, social norms, self-efficacy, intentions and behaviour; andto determine whether the effects of these constructs on intention and behaviour are mediated asspecified by the TPB.

Methods Data are from two waves of an annual survey of a cohort of public school students. Students(n¼ 790) were in grades 9–11 in year 1 (ages 15–17), and 10–12 in year 2 (ages 16–18). Year 1measures included (1) TPB variables of attitudes, norms, self-efficacy, and intentions regardinghaving (or avoiding) intercourse in the next year; (2) interpersonal variables (parent communication,pressure to have sex, number of friends having sex, and school attachment); and (3) personal variables(commitment to working hard in school, moral beliefs, sensation seeking, and substance use).Behaviour (engaging in sexual intercourse) was measured in Year 2. Hypotheses were tested usingstructural equation modelling.

Results Effects of attitude, norm and self-efficacy on behaviour were mediated by intention, aspredicted by the TPB. Norm also had a direct effect on behaviour. Of the personal variables,sensation-seeking, alcohol use, and hard work had only mediated effects; moral beliefs and smokinghad both mediated and direct effects. Of the interpersonal factors, effects of school attachmentwere completely mediated by attitude, norm, and self-efficacy; pressure to have sex had a directeffect on behaviour and no mediated effects, and parent communication and number of friendshaving sex had both mediated and direct effects.

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Conclusions The effects of personal variables are well described by the TPB model; the effectsof interpersonal variables, less so. Delineating the roles of a variety of antecedent factors should bethe next step in building on this influential theory.

Perceptions of disability and control in stroke couples and lay respondents:Associations with carer wellbeing

*Morrison, V., Jones, E.; *School of Psychology, University of Wales Bangor, Wales, UK

Objectives The cognitive and emotional representations of stroke amongst 72 stroke patient-carerdyads and the hypothetical representations of stroke generated by a healthy adult sample (n¼ 83)are presented. Illness representations are examined in relation to perceived carer wellbeing (mood,carer strain).

Methods Seventy-two couples where one had experienced a stroke were assessed following hospitaldischarge (T1), and at 2 subsequent timepoints up to 5 months post discharge (T2, T3). Strokestudy participants completed the HADS (anxiety/depression); and measures of illness representationincluding perceived control, self-efficacy and confidence in recovery, and perceived patientdisability. Healthy adults completed the IPQ (illness representations), and the CIAS (caring impactappraisal scale).

Results At T1, carers perceive patients to be more disabled than they perceive themselves to be,carers are more anxious and less depressed than patients, and have less recovery confidence.Perceived control did not differ between groups. By follow-up, carers are more anxious when patientspreviously report less disability than carers attributed them, and are more depressed wherepatients reported lower self-efficacy and recovery confidence. In spite of some misperceptions ofstroke identity, healthy adults perceive stroke as having serious consequences for patients andcarers, with control over recovery perceived to be low. Hypothetical carer satisfaction was associatedwith low control patients and chance causal attributions.

Conclusions Results suggest that perceptions of control over stroke recovery are associated withemotional outcomes for caregivers – both amongst those actually living with stroke and amongstpotential caregivers (or receivers) of the future. Implications for primary and secondary interventionat an individual and dyadic level are highlighted.

Safe sex in young people non attending school: Attitude towards risk andinformation about AIDS prevention

*Moscardi, E., Meringolo, P.; *Dept. of Psychology, University of Florence, Italy

Introduction The attitude towards risk and the intention to undertake risky behaviors have beenemphasized in the researches about life styles in young people. Risky behaviors are often for youngpeople the way to test their abilities and competences, and it seems to help them in achievingautonomy and a more adult identity. It is moreover important to underline that the psychosocial lit-erature shows that a risky behavior is often associated with undertaking other kind of unhealthybehaviors, such as unsafe sex. This is particularly significant for the great number of AIDS cases inthe younger age.

Aim This study is a step of a wider research carried out in agreement with LILA, an Italian NGOcommitted to prevention of AIDS. The aim of this step is to know perception of the risks comingfrom unsafe sex and attitudes to health promotion in young people not students. It is important toinvolve this target, since the most of studies and health programs concern school time.

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Participant Young people aged between 14 and 25 years, living in Florence, dropped out ofhigh school.

Instrument A specifically adapted questionnaire to gather information about their lifestyles, attitudestoward risk and risky behaviors, specifically as regards unsafe sex.

Results Knowledge of this target will let us able to carry out, in following steps, an action researchin order to form local community in facing this problem, improving health promotion programsparticularly addressed to those who are usually left out of AIDS prevention.

A new self-management programme for irritable bowel syndrome:Does it work and if so why?

Moss-Morris, R.; University of Auckland, New Zealand

Aims The aims of this study were (i) to assess the effectiveness of an empirically derived selfmanagement treatment for IBS patients in primary care and (ii) to determine whether patients’perceptions of their IBS altered as a result of the treatment.

Methods Sixty-four IBS patients were randomised into either a self-help intervention (n¼ 31) orstandard medical care (n¼ 33). The intervention group received a manual which included informationon a biobehavioural model of IBS, education on the role of diet, exercise and bowel habits, challengingnegative automatic thoughts about symptoms and perfectionism, and stress management. Theyhad one face-to-face session with a therapist and two phone call follow-ups over a 6-week periodand completed various worksheets. All participants completed standardised measures at baselineand two, five and eight months post treatment including the Subjects Global Assessment of Relief(SGA), the Irritable Bowel Syndrome Severity Scoring System (IBS-SSS) and the Brief IllnessPerception Questionnaire (B-IPQ).

Results Analysis of the SGA showed that 96% of the treatment group experienced relief at the endof treatment compared to 47% of controls. These gains rose at eight months for the treatmentgroup but dropped for the controls. 2 (group) � 4 (time) repeated measures ANOVAS of theIBS-SSS and the subscales of the B-IPQ showed that the treatment group had a significant lineardecrease in IBS symptoms over the eight months, decreases in concern and distress about the conse-quence of their symptoms, and increases in a sense of control over symptoms and understandingof their condition.

Conclusions The findings from this study suggest that a brief CBT based intervention is aneffective treatment for IBS in primary care. The intervention appears to work in part by changingpatients’ beliefs about their symptoms and providing a coherent understanding of their symptoms.

Sense of coherence (SOC) and other psychological resources vs. quality of lifein patients with rheumatoid arthritis

*Mroziak, B., Marek Z., Ewa G.; *Institute of Psychiatry and Neurology, Warsaw, Poland

Objectives Relationships between SOC and other psychological resources, as well as betweenresources and quality of life in patients with rheumatoid arthritis (RA) were investigated in the study.

Methods Participants were 64 RA patients (15 men and 49 women) undergoing rehabilitation at theInstitute of Rheumatology in Warsaw. The following resources were measured using a set of question-naires: sense of coherence (SOC-29 Questionnaire by Antonovsky), coping style (CISS by Endler &Parker), primary appraisal of stress related to illness (the Challenge-Threat-Loss Scale by Sek &

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Szaladzinski), perception of positive aspects of illness (selected items from the Silver LiningQuestionnaire by Hyland). Quality of life (QoL) was assessed using the SF-36 scale by Ware.

Results Among 10 QoL variables three factors were distinguished by means of factor analysis: mentalhealth, physical health, and social functioning. Against expectations structural equations modellingdid not confirm the presence of a direct effect of either primary appraisal of illness-related stressor coping style on mental health. In the best fitting model SOC turned out to be the only directdeterminant of mental health, while both appraisal of illness and emotion-oriented coping affectedmental health only indirectly, through their effect on SOC. No direct relationship was found betweenSOC and physical health. Further analyses are in progress.

Conclusion The analyses suggest that in patients suffering from a chronic somatic diseaseSOC directly enhances only one aspect of quality of life, i.e., mental health.

An evaluation of a healthy living centre: Implications for evidence basedhealth promotion and the role of the health psychologist

*Mulholland, E., Bunton, R., Van Wersch, A.; *University of Teesside, Middlesbrough, UK

Objectives Little is known about the use of theory in public health promotion, exposing a gap betweenresearch findings, recommendations for preventive care, and the extent to which evidencedbased interventions are implemented in practice. As theory application is dependent upon theknowledge, skills and values of a workforce, structures that may influence this include the organisa-tional and policy context within which interventions are delivered. This paper examines the useof theory in one Healthy Living Centre (HLC) in the North of England.

Method 35 members of the workforce involved in the planning and delivery of 11 individualHLC projects participated in the study. Employing case study methodology, data collection involvedethnographic observation, document reviews, questionnaires and semi-structured interviews. The datawere analysed thematically.

Results Difficulties to target achievement consistently reported were associated with issuessurrounding; how to motivate the beneficiaries, what are the best methods of delivery, and how tomeasure outcomes. Although 95% (n¼ 19) of practitioners had received training, this waspredominantly in the form of short seminars on specific health topics. Only 15% (n¼ 3) had attendedseminars on behaviour change theories, and 35% (n¼ 7) on health promotion theories. Theoreticalmodels were utilised to inform practice in only 3 out of 11 projects.

Conclusion Knowledge and skill deficits were evident, impacting upon the workforce’s abilityto achieve many of the targeted outcomes. This was influenced by the epistemological incompatibilitybetween target driven ‘‘top down’’ organisational directives, and the principles underlying ‘‘bottomup’’ community oriented directives. These findings indicate that future evaluative research on thistopic is essential to further expose the structural barriers to evidenced based health promotion.The importance of the role of health psychologists’ to contribute to the pedagogical and practiceneeds of community based health promoters is also indicated.

Psychological factors influencing infant breast-feeding in first-time mothers:An application of a modified version of the theory of planned behaviour

*Mullaney, L., Walsh, J.; *Dept. of Psychology, National University of Ireland, Galway, Ireland

Objectives This study aimed to examine the psychosocial predictors of breast-feeding intentionand behaviour within an Irish sample of first-time mothers, by using a modification of the Theoryof Planned Behaviour (TPB: Ajzen, 1991).

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Methods Data was collected from 91 first-time mothers in their third trimester of pregnancy,attending antenatal classes at University College Hospital, Galway. Participants completed aTPB-specific questionnaire on the first (Time 1) and last week (Time 2) of classes, with behaviouralinterviews conducted at between 3 and 6 weeks post-partum (Time 3). Predictor variables includeddemographic information, and measures of maternal attitudes, subjective norms, perceivedbehavioural control and anticipated regret (AR). Criterion variables were antenatal feeding intentionand post-partum feeding behaviour.

Results Multiple regression analyses revealed that attitudes, subjective norms and anticipated regretwere significant predictors of feeding intention. Further multivariate analyses were conducted toexamine the overall ability of the TPB and AR variables to predict infant feeding behaviour at 3 and6 weeks post-partum. AR was found to be the only significant predictor of breast-feeding behaviour at3 weeks; while antenatal feeding intention was the only significant predictor of breast-feedingbehaviour at 6 weeks.

Conclusions Results suggest that women who reported greater feelings of anticipated regretwere more likely to be exclusively breast-feeding at 3 weeks post-partum; while those whoreported stronger intentions to breast-feed were more likely to be still exclusively breast-feedingat 6 weeks. The findings support the application of social cognition model variables to theprediction of antenatal breast-feeding intentions and post-partum behaviour within an Irishsample of first-time mothers. The findings also suggest that AR is an independent antecedentof breast-feeding intention formation, and may play a role in the performance of breast-feedingbehaviour.

Changing patients’ perceptions to improve health outcomes: Improving reassurancein patients following a negative stress exercise test result

*Muller, T., Schirmbeck, F., Broadbent, E., Ellis, C., Petrie, K.; *Dept. of Clinical Psychology andPsychotherapy, Philipps-University of Marburg, Germany

Objective To improve reassurance in patients undergoing exercise stress testing by changingpatients’ perceptions of symptoms and knowledge about the diagnostic test.

Participants Seventy-two chest pain patients without prior diagnosed cardiac pathology referredto the ECG clinic at Greenlane and North Shore Hospitals, New Zealand participated in therandomized trial.

Methods Participants completed questionnaires prior to exercise testing assessing demographics,state anxiety and illness perceptions. They were then randomly assigned to one of threegroups: A pamphlet giving detailed information about the stress testing and causes of chestpain; pamphlet plus the opportunity to ask questions in a brief face to face discussion; or standardcare. Levels of patient reassurance were assessed immediately after testing and again onemonth later. Medical use, symptom frequency and concern about chest pain were also assessedat one month.

Results Data analysis indicated significant differences between the three treatment groups inreassurance scores directly after the exercise stress testing and at the one month follow-up. Thepamphlet plus discussion group showed the greatest improvement in levels of reassurance followedby the pamphlet group and standard care.

Conclusion A pamphlet and brief face to face discussion prior to exercise stress testinghelps to improve reassurance in non-cardiac chest pain patients. These findings suggest giving patientsadditional information about the testing and alternative causes for chest pain may decrease disabilityand the high medical care use in non-cardiac chest pain patients.

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Secondary prevention of heart disease in general practice: Impact of personal and practicecharacteristics on patients’ lifestyles and service provision

*Murphy, A., Byrne, M., Walsh, J., Shryane, E., McGroarty, M.; *Departments of General Practiceand Psychology, National University of Ireland, Galway

Objectives To determine the impact of patient (age, gender, type of and time since diagnosis) andpractice (rurality, number of partners, availability of practice nurse) characteristics on levels ofsecondary preventive care of, and behaviour among, patients with established heart disease from astratified, random sample of general practices.

Methods Process of care data on a random sample of patients were collected from general practicemedical records in 35 randomly selected practices in the west of Ireland. Health and lifestyle datawere collected by postal questionnaire. Eligibility criteria were patients aged under 80 with a recordedhistory of AMI, PTCA or angina. Univariate analyses were conducted to examine relationshipsbetween patient and practice variables, and adherence to secondary preventive guidelines. Thesewere complemented by multivariate analyses of hierarchical multiple and logistic regression analyses.

Results Data were collected for 1,611 patients and the postal questionnaire was received from 68.7%.Univariate analysis confirmed that younger, more affluent, male patients, with a recent history ofAMI or PTCA were significantly ( p< 0.01) more likely to achieve ‘optimal care’. Practicecharacteristics had relatively little impact. The results of the multivariate analyses were less consistent.For example, increasing systolic BP was predicted by increasing age only (�¼ 0.14, adjustedR2

¼ 0.025, p< 0.001) and younger patients (Wald¼ 23.44, p< 0.001) were more likely to smoke.In the hierarchical multiple regression analyses the amount of variance explained by practice andpatient variables overall for each of the measures was small, ranging from 2–6% in total.

Discussion Univariate analyses confirm results of other international studies regarding the impact ofpatient characteristics on levels of secondary preventive cardiac care. The lack of subsequent consis-tency in the multivariate analyses is interesting and relatively novel. Of interest also, is that practicecharacteristics are found to have relatively little effect.

The effects of implementation intentions on exercise self-efficacy and behavior

*Murray, T., Rodgers, W., Fraser, S.; *University of Alberta, Edmonton, Canada

Objectives Implementation intentions have been shown to increase performance of a variety ofhealth behaviors (Armitage, 2004; Milne, Orbell, & Sheeran, 2002). With regard to exercise moststudies have examined behavior in the short term (e.g., over one week) and few studies have examinedthe effects of implementation intentions on other determinants of exercise behavior, such asself-efficacy (SE). Therefore, the purpose of this study was to examine the effect of implementationintentions on exercise adherence and 3 different types of exercise SE.

Methods Women (N¼ 72) from a Canadian university were recruited to participate in a 9-weekexercise study. Participants were randomly assigned to an implementation intentions (IMP) conditionor to a no IMP condition. Three types of exercise SE were assessed: task, coping and scheduling. In theIMP condition, participants also received written instructions at the end of the questionnaire toprovide a specific plan regarding the number of sessions, days and times they planned to completetheir exercise. Adherence was measured as the mean number of days per week participants performedtheir exercise program.

Results The effect of the implementation intentions on adherence was tested using RepeatedMeasures MANOVA. Results showed the experimental group had significantly better adherence(F¼ 4.08, p¼ 0.047) overall. Also, adherence over time declined in both groups (F¼ 3.51,

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p¼ 0.036). Repeated measures MANOVA also showed the IMP group had higher scheduling SE(F¼ 4.82, p¼ 0.034).

Conclusions Implementation intentions seem to be an effective way to increase adherence toan exercise program. Further, as expected, creating implementation intentions increasesscheduling SE.

Children’s psychological morbidity, anxiety and cognitive function after general anaesthesia

*Musiello, T., Asbury, J., Bowman, A., Hosey, M.-T., Millar, K., Welbury, R.; *Dept ofPsychological Medicine, University of Glasgow, UK

Objectives This study explores the occurrence and duration of psychological morbidity and anxiety inchildren after general anaesthesia (GA), and the effects of GA upon their cognitive function.

Methods The prospective study recruited 50 children (25 females; mean age 6.10 years), havingmultiple dental extractions under GA. Psychological morbidity, anxiety and cognition were assessedprior to GA (baseline), post-operatively prior to discharge, and at 48 hours at home. Psychologicalmorbidity was assessed using the Revised Rutter Parent Scale. Anxiety was assessed using theFacial Image Scale and the Modified Child Dental Anxiety Scale (MCDAS). Cognition was assessedby choice reaction time, attention, perceptual-motor co-ordination and memory.

Results There were no significant differences between pre- and post-GA morbidity assessed by theRutter scale. Children did, however, report significantly higher post-GA levels of dental anxiety( p< 0.01). Reaction time was significantly impaired post-operatively, followed by recovery tobaseline level at 48 hours ( p< 0.001). Similar results were seen for perceptual-motor co-ordination( p< 0.001) and attention ( p< 0.02). Explicit memory for stimuli presented prior to anaesthesia wasvery poor post-operatively and at 48 hours: implicit memory, however, was much superior( p< 0.001), hence confirming the encoding of information in memory but its inaccessibility tospontaneous recall.

Conclusions Although levels of psychological morbidity were not affected by undergoinggeneral anaesthesia, the experience of a GA significantly increased subsequent dental anxiety,hence implying a specific sensitising effect of the prior experience. In addition, although averagecognitive impairment resolved at 48 hours, a proportion of children continued to suffer residual effectsthat may have adverse real-life consequences. Conscious memory for peri-operative events was alsoimpaired.

Self-responsibility perceptions related to health behaviours of university students

*Mutlu, N., Selcuk Tabak, R.; *Faculty of Health Education, Ankara University, Turkey

The main aim of this descriptive study is to reveal the responsibility perception levels of universitystudents for development and application of their health behaviours. The theoretical frameworktermed the Steps to Behaviour Change (SBC) was taken as the basis for this research. This frameworkis an adaptation of diffusion of innovations theory and the input/output persuasion model, and wasenriched by social marketing approach. It consists of 16 items under five major steps of change:knowledge, approval, intention, practice and advocacy. Each step includes personal responsibilityperceptions for health behaviour. The Likert-type scale used in this study was developed by adaptingSBC and by testing cultural appropriateness. The scale was oriented to self-responsibility perceptionsof students according to health messages and information conveyed through different communication

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levels. The reliability and validity tests were done before application. Students (322) of two faculties ofAnkara University, which train students as teachers in different fields, were involved in this study.According preliminary evaluations, the students expressed more responsibility in advocacy of healthbehaviours than in other four steps. Approval step of health knowledge for health behaviour changeand adoption has the lowest level showing that students are ignoring attitudinal responsibility tohealth behaviours. As for the intention step for health behaviour application, students were foundhave rather higher responsibility perception level than knowledge, approval and practice levels. Thedifferences between the responsibility perception levels by the change steps were found statisticallysignificant. The results of our study has underlined that intention is very important for behaviourchange, and students support correct health behaviours in community whereas they have problemsin adopting health behaviours in internal procedures.

How successful are repressors at self-care behaviour?

*Myers, L., Davies, A., Evans, E., Stygall, J.; *University College, London, UK

Objectives Previous studies have suggested a link with possessing a repressive coping style (repressors,low trait anxiety–high defensiveness) and poor physical health including cancer and cardiovasculardisease (e.g., Frazure-Smith et al., 2002). Recently it has been suggested that repressors may bebetter than nonrepressors at adhering to behaviours where personal control is needed (Myers et al.,2005). Good self-care behaviours are necessary in both asthma and diabetes.

Method In study 1 lung function, patients ratings of their personal control of asthma and self-reported adherence were measured in asthma patients (N¼ 31). In study 2 participants with type Ior type II diabetes (N¼ 87) completed measures of metabolic control (HbA1c) and self-reportedadherence. In both studies, repressors scored low on trait anxiety (the Manifest Anxiety Scale), andhigh on defensiveness, (the Marlowe-Crowne Scale). Using tertiary splits on these self-reportmeasures, borderline repressors were omitted and all other participants were defined as nonrepressors.Participants in both studies were recruited from out-patient clinics in the UK.

Results ANOVA were performed. Repressors compared to nonrepressors showed significantly betterphysiological control in both studies, with higher scores on lung function (study 1) and lower HbA1cscores (study 2). In neither study were there any differences in self-reported adherence. However,in study one repressors reported being more in control of their asthma than non-repressors. Therewere a high number of repressors in the samples, 38 and 50% respectively, compared to around10% in non clinical samples.

Conclusions These studies strongly suggest that repressors exhibit better physiological control thannonrepressors, which may be considered an objective measure of adherence, but no differencesin self-reported adherence. These results suggest that repressors may exhibit better physical healthin situations when they may have control over their behaviour.

Young people’s intentions to use self-test kits for signs of coronary heart disease:An application of the Theory of Planned Behaviour

*Nandha, S., Pattison, H.; *Aston University, Birmingham, UK

Objectives In the context of coronary heart disease (CHD) death rates in the UK being amongstthe highest in the world and of people being encouraged to take more responsibility for their ownhealth, this study investigated whether the Theory of Planned Behaviour (TPB) could predictyoung people’s intentions to use self test kits to measure signs of coronary heart disease (CHD).

Methods Participants (29 female and 24 male university students) were recruited by poster for aone-shot questionnaire study. They were given information on CHD, blood pressure monitors and

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cholesterol tests and completed 4 questionnaires. Two questionnaires collected data on demographics,experience of CHD and self-testing, and perceptions of CHD. Separate questionnaires were used tomeasure intentions to use blood pressure monitors and cholesterol tests, and attitudes, social norms,perceived behavioural control in relation to the 2 tests.

Results Multiple-regression analyses revealed that the only TPB variable which significantly indepen-dently predicted intention to self monitor blood pressure was attitudes (r2¼ 0.473, F(3,52)¼ 16.584;p< 0.001) but past use improved the prediction. Subjective norms and perceived behavioural controlpredicted intention to use a cholesterol test, but not attitudes (r2¼ 0.382, F(3,52)¼ 11.705; p< 0.001).

Conclusions The TPB proved a useful theoretical framework to investigate intention to use self testkits. Differences in the variables which predict blood-pressure monitoring and cholesterol testingare likely to be due to differences in the nature of test kits, the information they provide (on bothhealth and illness states) and behaviour required to perform them. This type of health behaviourcould become increasingly important as high blood pressure and cholesterol levels are riskfactors for CHD which can now be relatively easily self-monitored.

Representation of the interpersonal relationships in the parents of adolescentswith anorexia nervosa or with substance abuse disorders

*Nandrino, J., Doba, J., Lafay, V.; *University of Lille, France

Objectives Research on family risk factors for addictive behaviours in young people has not paida great deal of attention to parents’ knowledge of their own family functioning. The aim of thiswork is to compare knowledge in two groups of parents that differ regarding their adolescent’sdeclared drug addiction and anorexia nervosa. We hypothesize that the behaviours developed bythe adolescents designate internal or external addicted objects that could be related to differenttypes of familial patterns.

Methods Our study employed the multiple perspectives of mothers, fathers, and adolescents toevaluate whether the degree of autonomy and perceived cohesion and adaptability of the familydistinguish the two types of addiction. Members of 52 families have responded to a battery of self-questionnaires, including information concerning recent consumption of substances or eatingdisorders (EDI, Gardner, 1982), interpersonal autonomy (Hirschfeld, 1977), levels of cohesion andadaptability (FACESIII) and expressed emotions in the family (The Family Questionnaire,Wiedeman, 2002).

Results Parents of the both groups perceived the cohesion of their family as disengaged and expresseda high level of emotions (criticism and overprotection). Adolescents of the two groups and theirmother depict a high level of dependence significantly different of the father’s attitude. The fathersshow a low level of affective dependence but the lowest self-esteem.

Conclusion The comparison between the two types of addiction show that the perception of theparents of the familial interactional patterns is quite similar. The existence of a typical organizationof family at risk for addictive behaviours is discussed.

Are there differences in social comparison dimensions between chronic patientsattending hospital settings and associations?

*Neipp, M., Terol, M., Sanchez, P., Pons, N., Aubalat, C., Lledo, A., Lopez-Roig, S., Pastor, M.;*Health Psychology Department, Miguel Hernandez University, Spain

Research in Social Comparison (SC) try to study different factors that explain the use of SC dimen-sions: reference group (patients or healthy people), direction (upward or downward) and content

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(symptoms or to join in social activities) of comparison (Wood y VanderZee, 1997; Suls & Wheeler,2001).

Aims To describe the direction, referents and contents of SC, analysing the differencesbetween women with breast cancer and with fifromyalgia attending hospital settings and belongingto asociations.

Method 100 women with breast cancer (69 in hospital and 31 in asociation) and 139 women withfibromyalgia (90 in hospital and 49 in asociation) were interviewed. We used the Illness SC Scale(Vander Zee, Buunk, Sanderman, Botke, & Van den Bergh, 2000) to assess: direction (upward-downward, contrast-identity); contents (emotional status, symptoms, physical condition and socialactivity); and referents (other patients or healthy people).

Results Patients with breast cancer attending associations used more frequently upward-identity(Mean¼ 73.05; Range¼ 0–100). The content of the SC more frequently reported by patients withfibromyalgia attending association was emotional status (Mean¼ 3.71; Range¼ 1–5). The lowestused of downward SC dimension was reported by patients with breast cancer attending hospital(F¼ 5.04; p¼ 0.002).

Conclusions The characteristics of pathology and settings influenced the use of one or anotherdimension of SC, in order to facilitate patient’s adaptation to their illness situation.

Predicting choice and outcome of miscarriage management: A prospective study

*Nelson, M., Ogden, J.; *Department of Psychology, University Of Surrey, UK

Objectives To explore which clinical and psychological factors predict patient management choicefor incomplete first trimester miscarriage and how management approach relates to outcomes attwo week follow up.

Methods The study employed a cohort design with measures of profile, clinical data, and psycho-logical data collected at baseline and after two weeks.

Results The majority of women opted for expectant management. Those who chose surgeryreported more general health somatic symptoms, more depression, and expressed moresymptomatic pain. They were also more likely to have had a previous ectopic pregnancyand were found at scan to have a larger mean size of retained products and/or a thickerendometrium. At two weeks both groups had seen a significant improvement over time in theirpain, bleeding, vigour, and fatigue. The only significant difference between the groups intheir improvement over time was in their levels of fatigue. The surgical group having started offfeeling more fatigued at diagnosis, by two weeks were feeling less fatigued than the expectant manage-ment group. The only differences at diagnosis between those women who were successful withtheir expectant management had significantly smaller gestational products and/or endometrialthickness than those who were unsuccessful.

Conclusions Scan findings, mood, and symptoms were the best predictors of the choice for surgery,while scan findings alone predicted the need for surgery after commencement of expectantmanagement. The clinical and psychological consequences of delaying surgical treatment by allowingwomen who are less likely to complete their miscarriage naturally to undertake expectant managementmerits further investigation.

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Smoking water pipe: Are educators and parents more lenient towards itthan towards cigarettes?

*Neter, E., Krim, M., Zamuks, M., Malkian, Z., Notkewietz, M.; *Behavioral Sciences, RuppinAcademic Center, Israel

Objectives Due to the high prevalence of smoking water pipe among Israeli youth (even exceedscigarettes), the studies attempted to uncover whether part of the reason is adults’ relative lenient atti-tudes towards smoking water pipe.

Methods Two studies were conducted (1) among high school teachers, and (2) among parents toadolescents. A self-administered questionnaire was used, assessing attitudes, perceived control,subjective norms, intentions and behaviors with respect to both smoking cigarettes and smokingwater pipe. The questionnaire to parents included also their position along the TTM model withrespect to their children’s smoking.

Results In both samples the attitudes towards water pipe smoking was significantly more lenient thantowards smoking cigarettes. In the teachers’ sample the biggest difference was in perceived controlfollowed by the difference in subjective norms. Among parents the biggest difference between waterpipe and cigarettes was in subjective norms. Parents also exhibited more involvement in their actionsregarding cigarette smoking than water pipe.

Conclusions Adults’ relative lenient attitude towards smoking water pipe was evident. Theneed for public discussion and construction of interventions, both mass media and school-based,is highlighted.

Exploring young women’s intentions to use condoms to protect against chlamydia

*Newby, K., Wallace, L.; *Health Services Research Centre, Coventry University, UK

Objectives The purpose of this study was to identify salient risk perceptions of young women withregards to chlamyida infection. This is the first in a series of studies that will develop and test acombined Theory of Planned Behaviour (Ajzen, 1985, 1988, 1991) and risk perception frameworkfor predicting young adults’ intentions to use condoms to protect against chlamydia.

Methods Seventeen women aged 16–20 years old were interviewed about their perceptions ofpersonal risk to chlamydial infection. Twelve participants were attendees at a genito-urinary medicineclinic and five participants were attendees at a condom distribution scheme. Interviews weretranscribed verbatim and analysed using grounded theory (Glaser & Strauss, 1967).

Results Analytical categories were generated from the data that illuminate the decision-makingprocess of young women regarding chlamydial infection. ‘They just name the diseases’ refers toevidence that young women are not receiving the information they need to form strong inten-tions to use condoms as protection against chlamydia. ‘It’s the best one to get’ refers to evi-dence that young women do not consider chlamydia a serious threat to health. ‘The last thingto come into your mind’ refers to evidence that young women do not process chlamydial riskat the time of sexual intercourse. ‘He was clean, good looking and had a nice car’ refers toevidence that young women use overt clues to determine whether a sexual partner is likelyto be infected.

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Conclusions In addition to the value of this evidence for the wider project, the findings will be usedirectly to inform both the content of formal sex education in schools and dialogue within relevantprimary care consultations. Essentially, these vehicles of communication can used to encourageyoung adults to make more realistic risk assessments of the likelihood that they will become infectedwith chlamydia and in doing so capitalise on opportunities for condom use.

Stress-induced eating: An investigation of attentional biases for food words in external eaters

*Newman, E., O’Connor, D., Conner, M.; *University of Leeds, UK

Background External eaters are characterised by a tendency to eat in response to environmentaleating cues rather than internal hunger signals, and are reported to increase intake under stress(Conner et al., 1999). It has been proposed that certain stressors cause a shift in attention towardsexternal information (Heatherton et al., 1991), which could underlie food intake changes in individ-uals who eat in response to external information. External eaters have shown attentional biases forfood words in a modified Stroop task (Johansson et al., 2004); though research has not examinedthe influence of stress.

Objectives To test whether external eaters show an attentional bias for food words when stressed,using modified Stroop and dot probe paradigms.

Methods Independent groups of 32 high and 37 low external eaters were taken from a studentsample. Both groups performed a computerised modified Stroop and dot probe task with foodword stimuli as measures of attentional bias, in either a stressful or a control condition.

Results The low external eaters in the control condition showed the greatest bias foroverall food words in the Stroop task. A significant interaction emerged between stress and externaleating for snack words specifically ( p< 0.05), where high external eaters showed anincreased bias when stressed, and low external eaters demonstrated the opposite pattern.This pattern was not shown for other categories of food words and was not replicated in the dotprobe paradigm.

Conclusions These data may suggest a role for an attentional processing shift in understanding therelationship between stress and increased intake in external eaters, although it would be useful toalso explore attentional biases for pictorial stimuli in high external eaters.

Attentional bias and outcome expectancies in smokers, ex-smokers and non-smokers

*Niazi, A., Albery, I.; *London Metropolitan University, UK

Objectives To explore cognitive biases and explicit and implicit expectancy mechanism in cigarettesmoking.

Methods 16 Smokers, 16 Non-smokers and 8 Ex-smokers were used. A supraliminal primingparadigm (scrambled sentence task – priming vs. no-priming) was followed by a modified Strooptask. The Stroop task measured 3 different interference scores (smoking, positive, negative) presentedin 4 orders. The design was 3� 2� 3� 4. Smoking Consequences Questionnaire – Adult andFagerstrom Test were also used.

Results Implicit: Smokers showed a significant attentional bias effect for smoking words(F (2,68)¼ 4.1, p< 0.05). Ex-smokers were also slower to smoking words than to neutralwords, but this effect was ns. Smokers were slower to respond to both positive and negative

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outcome expectancy words than neutral words. Non-smokers attended faster to negativewords than to neutral words and slowed down for positive words. Ex-smokers attendedfaster both to positive and negative words than to neutral words. Explicit: Smokers scoredhigher than ex-smokers on the SCQ Positive scale (180 and 140, respectively) andex-smokers scored higher on the SCQ Negative scale (73 and 69, respectively). Smokersand ex-smokers differed significantly only in their responses to implicit measures (t¼ 2.045,df¼ 22, p¼ 0.053).

Conclusions This study was the first step in exploring implicit expectancy mechanism in cigarettesmoking using a modified Stroop task. It was interesting to find that ex-smokers have an intermediatelevel of attentional bias for smoking-related stimuli and even after quitting they associate both positiveand negative outcomes with smoking. This finding has important practical implications insmoking cessation programmes where classifying ex-smokers according to length of abstinencemay prove useful.

Assessing the impact of binge drinker prototypes within the theory of planned behaviour

*Norman, P., Quigley, C., Armitage, C.; *University of Sheffield, UK

Objectives This paper examines the impact of binge drinker prototypes on the bingedrinking intentions and behaviour of young people, within the framework of the theory of plannedbehaviour (TPB).

Methods A sample of 94 UK undergraduates completed questionnaires assessing the main constructsof the theory of planned behaviour (TPB) in relation to binge drinking, as well as measures ofprototype evaluation and prototype similarity from the prototype/willingness model. Of theserespondents, 79 were followed up at one week.

Results The TPB explained 58% of the variance in binge drinking intentions, with attitude andself-efficacy emerging as significant predictors, and 22% of the variance in binge drinking atone-week follow-up, with intention and perceived control (negative relationship) emerging assignificant predictors. The prototype perception measures explained additional variance in bothbinge drinking intentions (�R2

¼ 0.04) and behaviour (�R2¼ 0.09), although only prototype

similarity was a significant predictor. A significant interaction was also found between prototypesimilarity and subjective norm in relation to the prediction of binge drinking behaviour.

Conclusions The results suggest that measures prototype perceptions may be an additional source ofnormative influence that could be usefully added to the TPB. In addition, the results suggest that theimpact of prototype perceptions may be enhanced by a supportive social environment. Future workis needed to examine the precise mechanisms through which prototype perceptions may impact ofbinge drinking intentions and behaviour. The implications of the findings for interventions toencourage more appropriate drinking behavior are outlined.

Self-concealment, self-disclosure and defense mechanisms

Nuutinen, H.; Finnish Diabetes Centre (University of Jyvaskyla), Finland

Objective To investigate the connections between self-concealment, self-disclosure and defensemechanisms. To study differences in information processing between the persons with thepredisposition to conceal the most and the least.

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Method Fifty nine 17–25-year-old students completed self-report questionnaires: Self-Concealment-Scale (SCS; Larson and Chastain 1990), Wheeless’ Revised Self-Disclosure Scales (1978) andDefence Style Questionnaire (DSQ40; Andrews, Pollock, & Stewart 1989). Rorshach- test (Exner’sComprehensive System) was used to study differences between the 5 persons with the predispositionto conceal the most and the 5 persons with the predisposition to conceal the least personal informationthat one perceives as distressing or negative.

Results There was a negative correlation between self-concealment and depth of self-disclosure at astatistically significant level. Its correlation with the amount of self-disclosure was positive, althoughnot very significant. There was also a very significant negative correlation between the amount ofself-disclosure and humour. The correlation between self-concealment and splitting was positive ata statistically very significant level, and its correlation with somatisation, passive-aggressiveness,isolation, and rationalisation was positive at a significant level. In Rorshach tests of persons with apredisposition to conceal the most, much negative introspection (MOR and FD responses) wasseen. In two cases there were also VISTA responses (a tendency towards negative rumination). Intwo cases the HVI index indicated that the subjects suffered from hypervigilance regarding others.

Conclusions It is necessary to see the distinction between the depth and the amount of self-disclosure.Amount of disclosure may be connected with rumination, and may rather be seen as a category ofinhibition and cognitive control. Defense mechanisms may be analysed as more or less flexible effortsto deal with negative information about oneself or some conflict which threatens self-coherence.Rorscach- tests support the validity of SCS.

How do African-Americans view cultural competence in patient-physician interactions?

*O’Brien, K., Morse, E., Gipson, T., Loudd, R., Saha, S.; *Portland State University, USA

Objectives To learn what African-American patients with diabetes or hypertension regard asimportant deficits in the quality of their interactions with physicians.

Methods Eight focus groups (FGs) with African-American patients living with diabetes and/orhypertension were moderated by African-American community members trained in FG facilitation.FGs explored good and bad experiences with physicians, perspectives on physician race/ethnicity,physicians’ handling of sensitive topics (e.g., drug use, domestic violence), trust, respect, andadherence to physician recommendations. FG discussions were audiotaped and verbatim transcribed,then coded using NUD*IST software, with iterative review of codes by research team members.

Results Several themes emerged from FG data. One prominent theme was frustration withphysicians’ invalidation of patients’ understandings of their illnesses. One woman reported, indica-tively, ‘‘Sometime I don’t think they have a lot of respect for a woman knowing her own body.’’Participants also expressed the importance of physicians’ stereotyping and bias with regard toAfrican-Americans. Bias was often related to drug use and ranged from subtle – ‘‘Just the wayhe talks to you. . . . they’re not looking at you, they’re looking through you’’ – to overt – ‘‘I said,‘Read my lips! I told you I don’t use drugs, I never use drugs, I don’t even take medication [poundingtable for emphasis], so don’t ask me no more.’ ’’ Most participants said physician race wasunimportant, instead underlining the importance of physicians’ communication and respect towardpatients.

Conclusions FGs with African-Americans with diabetes and/or hypertension revealed the importanceof physicians’ not discounting patients’ explanatory models of illness. Patients reported beingable to discern manifestations of physician bias, yet patients said that physician race was less importantto them than physician interpersonal competence.

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Functional outcome following liver transplantation

*O’Carroll, R., Turner, F., Flatley, K., Hayes, P.; *Psychology Department, Stirling University, UK

Objectives Our previous research (O’Carroll et al., 2003) identified the presence of residual cognitiveimpairment (reaction time slowing) in some liver transplant recipients (LTR) at 1 year post-transplant. This study aimed to test for ‘‘real world’’ functional impairment in a new sampleof LTR, compared with (a) healthy participants (HP), and (b) liver transplant candidates (LTC).

Methods Cross-sectional, between-group comparison, 18 LTR, 19 LTC and 32 HP were comparedon a variety of measures of functional outcome, including the Hazards Perception Test (HPT) drivingsimulator, the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS),Functional Limitations Profile (FLP), WHOQOL-Bref and the Hospital Anxiety and DepressionScale (HAD). LTR were assessed mean¼ 16 (SD¼ 7) months post-transplant.

Results The 3 groups were matched for age, premorbid intellectual ability, social deprivationcategory, years of driving experience and gender. Several between group-differences emerged(Attention, Language and Psychological and Functional limitations), with HP > LTR > LTC.No significant between-group differences were observed on the HPT driving simulator.

Conclusions This study indicates that functional recovery occurs following liver transplantation,but that this recovery may be incomplete. The HPT driving simulator may have been insensitive inassessing differential performance in experienced drivers.

Is pre-transplant quality of life a predictor of liver transplant outcome?

*O’Carroll, R., Turner, F., Hayes, P.; *Psychology Department, Stirling University, UK

Objectives UK guidelines state that the criteria for liver transplantation should be: (a) a based on thequality of life (QoL), and (b) a greater than 50% probability of the patient being alive 5 years aftertransplant with a QoL acceptable to the patient (Neuberger & James, 1999). Some patients aretransplanted primarily for QoL reason, i.e., they are unlikely to die soon because of liver failure,but symptoms, such as fatigue or itch make life intolerable. The objective of this study was todetermine if patients transplanted for primarily QoL reasons have a differential outcome followingliver transplant.

Methods Cross-sectional, between-groups design, 84 patients were assessed at a mean¼ 4.8(SD¼ 2.1) years post-transplant. All completed an individualised METHOD: of assessing QoL(SEIQoL) and also a questionnaire based measure (WHOQOL-Bref), as well as the HospitalAnxiety and Depression scale (HAD). Severity of liver disease at transplant was assessed usingChild’s criteria, grading A¼mild (N¼ 17), B¼moderate (N¼ 43), C¼ severe (N¼ 24). (Child’scategory A patients are transplanted primarily for QoL reasons).

Results The 3 groups did not differ in terms of age, or time since transplant. There were significantlymore females/males graded Child’s A (14/3) than B (28/15) and C (10/14). Controlling for gender,there was no significant between-group difference on the SEIQoL or HAD. However, bothWHOQOL Psychological and Environmental domains showed significantly higher self-rated QoLin the Child’s A group.

Conclusions In this study, patients who were transplanted primarily for QoL reasons rated their QoL4 years post-transplant as significantly better than the comparison groups. This provides reassuranceagainst the fear that this radical and potentially life-threatening surgical intervention would notalleviate the distressing symptoms.

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Written emotional disclosure, alexithymia and stress reactivity: Does it matterwho you are or what you write?

*O’Connor, D., Ashley, L., Bellerby, S.; *University of Leeds, UK

Objectives Writing about stressful or traumatic events has been found, in many studies, to havebeneficial effects on health outcomes. However, the evidence has been inconsistent. Recent workhas suggested individual differences variables such as alexithymia and/or the linguistic structure ofdisclosures may moderate the effects of the intervention.

Methods Ninety-seven healthy men and women were randomised into either a written emotionalexpression group or a control group. The emotional disclosure group was instructed to write aboutthe most stressful or upsetting experience of their life, for 15 minutes over three consecutive days.The control group wrote about non-emotional, non-stressful experiences over the same period.Two weeks later, systolic and diastolic blood pressure measures were taken in response tolaboratory-based psychological stressors (e.g., delivering a presentation). Trait alexithymia wasassessed at baseline. The linguistic structure of the disclosures was analysed using the LinguisticInquiry Word Count package.

Results Preliminary analyses revealed no significant main effects of condition on any ofthe cardiovascular outcomes two weeks later. However, in the disclosure group, a significantinteraction ( p< 0.01) was observed such that participants high on alexithymia who discloseda larger number of positive emotions had greater systolic blood pressure stress reactivitycompared to low alexithymics. The results of other multivariate and univariate analyses will also bepresented.

Conclusions These preliminary results point to the importance of considering individualdifferences variables and the linguistic structure of the written disclosures when investigating thebenefits or otherwise of writing interventions.

Illness perceptions and quality of life in neurological illness: Comparing amyotrophic lateralsclerosis and multiple sclerosis populations

*O’Doherty, L., Hickey, A., Hardiman, O.; *Royal College of Surgeons in Ireland and BeaumontHospital, Dublin, Ireland

Objectives This study investigates the illness representation profiles of two neurological illnesses,and examines the relationship between illness perceptions and quality of life (QoL).

Methods: N¼ 91 in two groups: ALS: N¼ 50 (28 male, mean age¼ 58 yrs); MS: N¼ 41 (12 male,mean age¼ 42 yrs). Measures: (i) Illness Perceptions: IPQ-R; (ii) Health-Related QoL: ShortForm-12 [mental (MCS) and physical (PCS) component scales]; (iii) Individual QoL (IQoL):Schedule for the Evaluation of Individual Quality of Life-Direct Weighting (SEIQoL-DW).Participants recruited through two specialist neurology clinics.

Results Significant differences between ALS and MS groups in perceptions of illness consequences,personal and treatment control and cyclical timeline ( p< 0.0001). The ALS group had lowerscores on PCS ( p< 0.0001) but not on MCS or SEIQoL. In ALS, identity and consequences werenegatively related to PCS ( p< 0.05), emotional representations to MCS ( p< 0.0001) andconsequences and emotional representations to SEIQoL ( p< 0.05). In MS, identity and coherencewere related to PCS ( p< 0.005), emotional representations to MCS ( p< 0.005) and coherence toSEIQoL ( p< 0.05). Overall, multiple regression analyses indicated that IPQ-R subscales accountedfor more variance in PCS (39%) than in MCS (36%) and SEIQoL (29%) scores.

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Conclusion This study supports Leventhal et al.’s (1980) proposition that individuals exhibita characteristic illness representation profile based on symptoms and chronicity. Compared tothe MS group, ALS patients perceived the consequences of their illness to be more profound,reported less personal and treatment control, and perceived a more predictable disease course.Both groups perceived a chronic timeline, identified a similar number of illness symptomsand showed strong emotional representations. The IPQ-R subscales appear to have particularutility in accounting for variance in health-related QoL while accounting for slightly less variancein relation to IQoL.

Efficacy of an internet-delivered life-style computer-tailored intervention

*Oenema A., Dijkstra A., de Weerdt I., Brug J.; *Department of Public Health, Erasmus MC,University Medical Center Rotterdam, The Netherlands

Objectives The aim of the study was to evaluate the short-term efficacy of an Internet-deliveredcomputer-tailored life-style intervention for adults. The intervention aimed at decreasing saturatedfat intake, increasing physical activity (PA)-level and quitting smoking, since these behaviors areassociated with the risk for CVD. The Internet appears to be an appropriate tool to provideindividualized computer-tailored information to large groups of people, but the effects of such anintervention are not yet established.

Methods A two-group randomized trail with a pretest and a one months posttest was conducted.Respondents (N¼ 2159) were recruited from an Internet research panel. After completion ofthe baseline questionnaire respondents were randomly assigned to the intervention group or awaiting list control group. The posttest was conducted four weeks after the intervention groupwas given access to the intervention website. Behavioral determinants and behavior weremeasured at baseline and at posttest. Posttest group differences were analyzed using linear andlogistic regression analysis.

Results The website was evaluated positively and the information was rated as personally relevant,individualized and useful. The intervention resulted in a significantly lower saturated fat intake inthe intervention group. For physical activity and smoking there was a slightly higher proportion ofrespondents meeting the PA guideline and more forward stage transition for quitting smoking inthe intervention group.

Conclusions The present study indicates that it is feasible to distribute a computer-tailored life-styleintervention through the Internet and that a decrease in intake of saturated fat can be achievedthrough such an intervention. In the short-time follow-up an effect on smoking cessation could notbe expected, but more forward stage transition is a first step toward behavior change. Further analysisshould demonstrate why we did not find a more powerful effect for PA.

Use of selective optimisation with compensation (SOC) adaptation strategies byolder people differing in health status

*O’Hanlon, A., Barker, M., McGee, H., Hickey, A., Conroy, R.; *Royal College of Surgeons inIreland, Dublin, Ireland

Objectives The model of selective optimisation with compensation (SOC) (Baltes & Baltes, 1990)proposes that older people actively select goals, maximise functioning through the use ofoptimisation strategies, and counteract losses through compensatory mechanisms when facedwith challenges. Although SOC has intuitive appeal, little empirical evidence is available about

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the use of SOC strategies. This study assessed use of SOC strategies by older people withdiffering health status.

Methods SOC was assessed using a shortened (18 paired item) scale with good English languagepsychometric properties. Health challenges were assessed by a generic measure of functional capacity(the Health Assessment Questionnaire Disability Index (HAQ-DI)) and a measure of depression(the Hospital and Anxiety Depression Scale (HADS)).

Results Use of SOC strategies was differentially associated with functional ability (HAQ-DI) anddepression (HADS). There were significant effects of the level of functional ability (self-sufficient,minor difficulties, major difficulties, disabled) and depression (normal, borderline, depressed) whenSOC strategies were entered as outcome variables. Functional ability and depression also accountedfor a significant proportion of the variance in SOC strategies. Contrary to proposals from the theory onSOC, use of all four types of SOC strategies was lower with higher levels of depression and functionalimpairment.

Conclusion The cross-sectional evidence available means that cause and effect cannot be determined.It is possible that lower use of SOC strategies accentuates health difficulties over time. Furtherevidence is needed to determine whether SOC strategies are activated in the context of challengesand whether they promote more positive outcomes.

Diet, alcohol and tobacco use among college age women in cork, Ireland

O’Leary, A.; University College Cork, Ireland

Objectives Obesity is one of the fastest growing health problems in Ireland and college agewomen are no exception. The aim of the study was to examine the diet of women college studentsin Ireland.

Methods The study was a descriptive survey of 200 women of child bearing age averaging 19 years.A structured questionnaire and a modified food frequency questionnaire were used to obtaininformation on the dietary intake and alcohol and smoking habits of these women.

Results Of the respondents, 2.8% were underweight, 35.2% were overweight and 11.7% were in theobese category. 96.8% of the respondents consumed alcohol and an alarming 20.1% of therespondents consumed greater than the recommended intake of alcohol (14 units) per week forfemales. Nearly a quarter of women were current smokers. The uptake of folic acid, vitamins andother supplements was poor.

Conclusions Compliance with the recommended servings from the food pyramid was not evidentin this study, with 60–90% consuming below the recommended servings in the five food groups.The findings were staggering, half the group were overweight and obese. These data suggestthat young college age women have inadequate health behaviours in relation to diet, alcohol andtobacco use.

Can the theory of planned behaviour predict screening uptake amongfirst-degree relatives of patients with colorectal cancer?

*O’Sullivan, B., McGee, H., Keegan, O., McLoughlin, R., O’Morain, C.; *Department ofPsychology, Royal College of Surgeons in Ireland, Ireland

Objectives Colorectal cancer is the second most common cause of cancer death in Ireland. Lifetimerisk is 2–3 times higher for those with an affected first-degree relative. The objective of this studywas to investigate determinants of screening uptake in relatives as an under-researched population.

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Methods A prospective telephone survey, based on the Theory of Planned Behaviour (Ajzen, 1991),was conducted (N¼ 81 relatives of consecutive patients, response rate: 82%).

Results Eighty percent of participants attended for screening. Two normative beliefs were found to dis-tinguish attenders and non-attenders, according to a Mann-Whitney U test. Those who attended forscreening agreed more strongly with the normative beliefs that their parents and siblings (z¼�3.09,p< 0.01) and their partner and children (z¼�4.16, p< 0.001) thought they should go for screening.Logistic regression showed that attitude, subjective norm and perceived behavioural control predictedintention to go for screening (�2

¼ 26.2, p< 0.001), with subjective norm being the most influential pre-dictor. Intention predicted attendance (�2

¼ 16.1, p< 0.001). Attitude, subjective norm and perceivedbehavioural control did not significantly add to the predictive value of intention (�2

¼ 1.7, p¼ 0.65).

Conclusions Findings in relation to subjective norm are consistent with growing evidence that behav-iours with the potential to affect others as well as self, such as condom use and cancer screening, aremore influenced by normative beliefs. Thus individuals might best be persuaded to attend forscreening by interventions emphasizing that their family would approve of this action.

Effects of two types of food planning interventions on body weight goal attainmentamong women with different regulation styles

*Otis, N., Pelletier; L.; *University of Ottawa, Canada

Objective To examine whether the effectiveness of two implementation intention interventions onbody weight goal attainment is moderated by regulation styles for eating behaviors.

Method Forty-seven university women attended two laboratory sessions separated by a one-monthinterval. They were randomly assigned to one of three conditions: (1) Implementation intentionson wanted responses (WR); (2) Implementation intentions on the suppression of unwanted responses(SUR); (3) and control. At both sessions, all participants completed a questionnaire and wereweighted. At session 1, all participants were asked to specify their body weight goal. Participants inthe intervention conditions were asked to write down context-specific plans. Body weight goalattainment represents the difference between participants’ body weight goal and weight changebetween T1 and T2.

Results A hierarchical multiple regression on body weight goal attainment was performed. An inter-action approaching significance between the experimental conditions (WR & SUR vs. control) andautonomous regulation revealed that at high levels of autonomous regulation, both interventionsled to more goal attainment compared to the control condition (�¼ 0.243), t(37)¼ 1.986,p¼ 0.055. A significant interaction between the experimental conditions (WR vs. SUR) andautonomous regulation indicated that at low levels of autonomous regulation, the suppression ofunwanted responses intervention was more efficacious while at high levels of autonomous regulation,the wanted responses intervention was more efficacious (�¼ 0.29), t(37)¼ 2.519, p¼ 0.016.

Conclusions Our findings suggest that levels of autonomous regulation moderate the efficacy ofthe two types of planning strategies. Further, the greatest goal attainment was observed amongwomen with high levels of autonomous regulation and who received the wanted response intervention.

Overcoming the limitations of traditional reactivity measures inThe prediction of everyday-life blood pressure

*Ottaviani, C., Shapiro, D., Goldstein, I., James, J., Weiss, R.; *Department of Psychology,University of Bologna, Italy

Objectives This study hypothesized that orthogonal, physiologically grounded patterns ofhemodynamic profile and compensation deficit (Gregg et al., 2002) would be superior to traditionalblood pressure (BP) reactivity in the prediction of daily-life BP.

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Methods Impedance cardiography-derived measures and beat-to-beat BP were monitoredcontinuously in 45 subjects (16 men and 29 women) during a 10-min baseline and four 2.5-mintasks (handgrip exercise, mirror tracing, logical-mathematical, rumination). The sample includedapproximately equal numbers of subjects with and without a positive family history of hypertension.Ambulatory BP measures were obtained combining data from one work and one off day.

Results The mediating effect of gender and family history of hypertension were considered. Onlygender was significantly associated with hemodynamic profile. Specifically, women showed amarkedly vascular profile during most tasks ( p< 0.0001). Conversely, men showed a mixed profileduring all tasks ( p> 0.05). Stepwise hierarchical regressions indicated that typical BP reactivitymeasures based on difference scores largely failed to predict everyday life BP. Hemodynamic profileduring the mirror task accounted for an additional 10% of the variance of systolic BP sleep( p¼ 0.02) and 15% of diastolic BP sleep ( p¼ 0.002) above and beyond gender, baseline and tradi-tional reactivity BP. The interaction of hemodynamic profile and compensation deficit during thelogical task accounted for 44% of the variance of 24-hr systolic BP ( p¼ 0.03), 44% of systolic BPsleep ( p¼ 0.03) and 41% of systolic BP wake ( p¼ 0.04), after controlling for other relevant variables.

Conclusions The results show that measures of hemodynamic profile and compensation deficitcan overcome limitations of previous reactivity models in predicting everyday life BP.

Parent-child communication and adolescent smoking. The mediatingeffect of smoking cognitions

*Otten, R., Vermulst, A., Harakeh, Z., van den Eijnden, R., Engels, R.; *Behavioral Science Institute,Radboud University Nijmegen, The Netherlands

Objectives The present study aimed to examine whether the associations between smoking specific par-enting practices (i.e., frequency and quality of communication) and adolescent smoking are mediatedby the smoking cognitions of the theory of planned behavior (attitude, self efficacy and social norms).Moreover, we examined whether there are differences in the effects of smoking specific parenting prac-tices on adolescent smoking between oldest and youngest child. Parental smoking was also included.

Methods A full family design was used; each family member was asked to fill out a questionnaire inwhich several concepts were assessed. To test whether smoking specific parenting practices indirectlyaffected adolescent smoking behavior by affecting smoking cognitions, structural equation modelswere tested on both cross sectional and longitudinal data (Mplus).

Results Attitudes, self efficacy, and social norms appeared to mediate the association betweensmoking specific parenting practices and adolescent smoking. In general, more frequent communica-tion about smoking was found associated with an increased risk to smoke. Higher quality ofcommunication had an indirect protective effect on adolescent smoking.

Conclusions Elaborating on earlier studies on smoking specific parenting practices, the present studyshowed that frequency and quality about smoking indirectly affect adolescent smoking throughsmoking cognitions. These findings may help to make parents aware of the effects of parent-childcommunication about smoking.

The impact of dispositional optimism on the emotional consequencesof receiving DNA-test results: For hereditary breast cancer

*Otten, W., van Dijk, S., Meijers-Heijboer, H., van Asperen, C.; *Leiden University Medical Center,The Netherlands

Objectives To assess the impact of dispositional optimism on breast cancer specific distress ofwomen being tested for carrying a mutation on the BRCA genes. The hypothesis is that optimisticwomen can better cope with the result of being a carrier.

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Methods Women seeking genetic counselling for familial breast cancer responded to threequestionnaires: (a) before the DNA-test, (b) one month, and (c) six months after the test. All ques-tionnaires included the Lerman Worry scale, and the intrusion subscale (Impact of Event Scale). Inthe first questionnaire the Life Orientation Test- Revisited was filled out and dichotomised. Resultsof the DNA-test were (1) carrying a mutation, (2) not being a carrier of a known familial mutation,and (3) inconclusive, i.e., no mutation could be detected. The data were analysed with arepeated measures ANOVA with the DNA-test result and the LOT-R as between-participants factorsand the three measurement points as within factor.

Results Of the 762 women who participated in the study 374 had a DNA-test result, of which 272 hadfilled out all three questionnaires. High optimists were less worried than low optimists, and non-carriers were less worried than carriers and inconclusives. After the DNA-test result the level ofworry decreased, but only for non-carriers and inconclusives. Carriers showed an increase of worrydirectly after the test result that decreased after six months. This pattern was only observed for lowoptimists; the level of worry of high optimistic carriers was not affected by the DNA-test result.The same results were observed for intrusion.

Conclusions Optimistic women show the least cancer specific distress. Moreover, optimism seemsto protect women against the negative emotional consequences of learning that one is a BRCAmutation-carrier.

Personality as a predictor of employee absence

*Owens, S., Briner, R.; *Birkbeck College, University of London, UK

Objectives The primary aim of this study was to examine the relationship between personality andabsence behaviour, looking specifically at the traits of conscientiousness, neuroticism andextraversion. The second aim arose from the fact that the distribution of absence data deviatessubstantially from normality, and there is some debate within the field as to how researchers shoulddeal with this statistically. Therefore, a further aim of the study was to explore the effect that differentstatistical analyses have on the conclusions drawn from the data.

Method Call centre employees (N¼ 143) completed surveys comprising self-report measures ofabsence over the past year (time lost and frequency) and personality scales. Four parallel analyseswere run on the data: three parametric correlational tests (using the raw absence data, and twodifferent data transformations, respectively), and a non-parametric test, using Spearman¼ s rho.

Results The results revealed a robust negative association between conscientiousness and absence,and a weaker positive relationship between neuroticism and absence; these findings are discussedwith reference to previous research and practical implications are considered. With respect to thesecond aim of the study, the different analyses produced somewhat different conclusions fromthe same data, illustrating the importance of the researcher’s choice of statistical analysis, and thedangers of using untransformed absence data.

Conclusions While there do appear to be relationships between personality and absence, thenature and strength of these relationships depends on the statistical analysis used.

Predicting condom use intentions and behaviour among two groupsof Turkish university students: A test of the theory of planned behavior

*Ozakinci, G., Weinman, J.; *Bute Medical School, University of St Andrews, UK

Objectives The assumptions of Theory of Planned Behavior (TPB) to predict condom use intentionsand behaviour are examined.

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Methods Using a cross-sectional design, responses from eighty-nine participants who reported thatthey were sexually active and currently dating (47 women, 42 men, mean age¼ 21.72) and 113 ofthose who reported that they have never had sexual intercourse (30 women, 83 men, meanage¼ 20.46) were obtained. They completed a questionnaire on knowledge of HIV transmissionroutes, attitudes to and norms about condom use, condom use self-efficacy, condom use intentionsand behaviour as well as constructs from Health Belief Model (HBM), namely, perceivedbarriers to condom use, perceived benefits of condom use, and perceived risk of contracting HIV.

Results Although knowledge was high in both groups, misconceptions still existed. Sexually activesample reported low perceived risk and condom use was inconsistent. Multiple hierarchical regressionanalyses were performed to examine the effects of TPB variables in predicting condom use intentionsand behavior over and above HBM constructs. The results revealed that the determinants of condomuse intentions differed depending on whether the participant has ever been sexually active or not.For sexually inactive students, perceiving benefits of condom use and condom use self-efficacywere associated with stronger condom use intentions (�¼ 0.25, p< 0.05; �¼ 0.40, p< 0.005,respectively). For sexually active and dating students, positive attitudes towards condom use werethe most important determinant of condom use intentions (�¼ 0.34, p< 0.05). Condom useintentions strongly predicted condom use in this group (�¼ 0.65, p< 0.001).

Conclusions The results suggest that the TPB has merit in informing health promotion campaignsin non-Western settings. Current findings provide important information for designing HIV/AIDSeducation campaigns and materials for Turkish university students with different sexual history.

The role of stress and emotional disclosure in predicting the outcome of IVF treatment

*Panagopoulou, E., Tarlatzis, B., Gaitartzi, Ch.; *Medical School Aristotle University, Thessaloniki,Greece

Objectives This paper explores the role of stress, emotional disclosure, and marital interaction inpredicting the outcome of In Vitro Fertilization treatment.

Methods 187 women were interviewed on the day of the embryo transfer. Stress was measuredusing the State-Trait Anxiety Inventory (STAI), and the Stress related to Infertility Scale used byBoivin et al. (1999). Marital interaction was measured using the Golombok Rust Inventory ofMarital State (GRIMS). Emotional disclosure was assessed using the Emotional Disclosure andInfertility scale developed by Boivin et al. (1999). Success of the IVF treatment was measured bythe serum hormone test two weeks after the embryotransfer.

Results Hierarchical regression analyses showed that controlling for the effect of age, and severalmedical characteristics, stress was significantly related to the probability of success of the IVFtreatment ( p¼ 0.002). No effects were found for emotional disclosure or marital interaction.

Discussion Results are discussed in terms of the role of psychological factors in predicting successof IVF treatment.

Test anxiety, alcohol expectancies, and alcohol use among college studentsin the USA and Cyprus

*Panayiotou, G., Strahan, E., Clements, R.; *University of Cyprus, Cyprus

Objectives Examined the relationship between test anxiety, alcohol expectancies, and alcohol useamong college students in two countries.

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Methods Participants were 824 college students from (a) a medium-sized US university (b) a smallUS liberal arts college, and (c) a University in Cyprus. Instruments included the Revised TestAnxiety Scale, the Alcohol Outcome Expectancies Questionnaire, and the Alcohol Use DisordersIdentification (AUDIT).

Results There were significant cross-cultural differences in alcohol consumption, with Americanstudents drinking and binging more than Cypriot students. Differences may be explainable by differ-ent expectancies regarding alcohol use across the two cultures: Cypriots had significantly fewerpositive (especially about social facilitation and increased fun) and significantly more negativeexpectations (e.g., negative emotions, physical and cognitive effects) about alcohol use compared totheir American counterparts. There were significant positive correlations between drinking, and thetest irrelevant thinking and worry dimensions of test anxiety. Also significant were negativecorrelations between drinking, and the tension, and bodily sensations dimensions of test anxiety.Partial correlations, indicated that the previous correlations may be mostly mediated by how testanxiety affects socializing at places where alcohol is served.

Conclusions Results point to cross-cultural differences in alcohol consumption between Americanand Cypriot (southern European) college students. These may be mediated by contrastingexpectations regarding the effects of alcohol. Importantly, test anxiety seemed to be associated withalcohol use, with some of its dimensions predicting increased and others decreased alcohol use.Given that academic stressors, especially during exam periods, may escalate test-related anxietyamong college students, these findings help identify a domain where interventions, aimed at reducingdrinking among students, may be targeted.

Unrealistic optimism in Germany and Korea: Comparable risk perception butdifferent comparison standards?

*Panzer, M., Oeberst, A., Renner, B.; *International University, Bremen, Germany

Objectives Previous research demonstrated that older adults feel more at risk for cardiovasculardiseases than younger adults. However, despite acknowledging objective risk attributes, older adultsperceive their risk as lower than that of an average peer, demonstrating unrealistic optimism.Some research suggests that unrealistic comparative risk judgements are caused by egocentric tenden-cies. Particularly, people appear to base their comparative risk judgements on risk perceptionsfor the self while ignoring risk perceptions for the comparison target. However, previous results areprimarily based on European or Northern American samples, which might be especially proneto egocentric biases. Therefore, we aimed at replicating these findings in a South Korean and aGerman sample.

Methods Perceived vulnerability for cardiovascular diseases was assessed by asking for(1) comparative risk perceptions and (2) absolute risk judgements for the self and an average peer,respectively. In both samples (Germany: n¼ 2549, South Korea: n¼ 619), differences betweenfive age groups (<30, 31–40, 41–50, 51–60, >60) were explored.

Results Participants in both countries took their age into account when evaluating their risk: withincreasing age, participants felt more vulnerable. Replicating previous results, both samples showedclear evidence for unrealistic optimism. However, pronounced differences were found regardingthe relations between comparative and absolute risk perceptions. In accordance with previous find-ings, comparative risk perception in the German sample was primarily correlated with the absoluterisk perception for the self. Conversely, in the Korean sample comparative risk perception wasequally positively correlated to the absolute risk perception for the self and the absolute risk for theaverage peer.

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Conclusions Results indicate that in a collectivist culture, comparative risk appraisals may be basedon different comparison standards than in a more individualistic culture.

Physician findings/patients ratings and health related quality of life

*Papadopoulos, C., Jagsch, R., Pils, K., Griesser, B., Magenheim, E., Mozelt, C., Chhatwal, C.,Kryspin-Exner, I.; *Clinical and Health Psychology, University of Vienna, Austria

Background Health related quality of life (HrQoL) is broadly accepted as an evaluation criterionof medical therapy effects.

Objectives (a) the measuring of the effects of rehabilitation therapy on the HrQoL of elderly patientsafter a hip fracture, (b) the study of discrepancies between the physicians findings on the one handand the subjective rating of the patients on the other hand and their influence on HrQoL on thebasis of the disturbance specific functional capacity.

Methods 95 surgically treated patients after a fall-induced hip fracture where interviewed before andafter rehabilitation. Using the median as splitting criterion, the patients and physicians ratingsconcerning disturbance specific functional capacity were separated in ‘‘positive’’ and ‘‘negative’’.This leads to adaptation of the theoretical model of Filipp and Ferring and to separation of thesample into a four subgroups scheme (‘‘the fortunate’’ (congruent positive ratings), satisfactionparadox (positive subjective, negative objective ratings), dissatisfaction dilemma (negative subjective,positive objective ratings), ‘‘the unfortunate’’ (congruent negative ratings).

Results The four patient subgroups diverged significantly in their ratings concerning HrQoLwith the subgroups of ‘‘the fortunate’’ and the satisfaction paradox having the highest subjectivegains in HrQoL after therapy.

Conclusions The results stress the importance of the subjective factors by processes concerningtherapy evaluations and their influence on HrQoL. Not the objective therapy success is of primaryimportance for the height of the HrQoL, but the subjective evaluation of it.

Musculo-skeletal disorders among North Sea personnel: Work environment perceptions,mental health, and individual characteristics as predictors

*Parkes, K., Farmer, E., Carnell, S.; *Department of Experimental Psychology, University of Oxford,UK

Objectives This study examined the roles of work perceptions and individual factors as predictorsof musculo-skeletal disorders (MSD), and change in MSD over a five-year period.

Method The prevalence and severity of MSD in neck, shoulders, and back were assessed in a self-report survey of male offshore personnel (N¼ 1462, response rate 83%, mean age 39, SD 9 yrs).A sub-sample (N¼ 359) was re-assessed five years later. Measures of work perceptions and anxietysymptoms were included on each occasion; demographic variables and personality traits were assessedat baseline.

Results 47% of the sample reported experience of one or more neck, shoulder, or back MSDproblems at baseline; highest prevalences were associated with ‘strenuous’ (as compared with‘active’ or ‘sedentary’) jobs. In logistic regression analyses, job type, physical environment stressors,and anxiety were most strongly predictive of the occurrence of MSD. In the longitudinal data,five-year MSD change was predicted by age, and by changes in anxiety and in supervisor support.

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More detailed analyses suggested that prior anxiety was implicated in subsequent MSD increase,rather than prior MSD acting to increase anxiety.

Conclusion Consistent with other research findings, relatively high prevalences of MSD (associatedcross-sectionally with both work environment and personal factors) were observed in this study.Longitudinally, the findings highlight the favorable role of social support in mitigating increasesin MSD over time, and the unfavorable role of anxiety. In suggesting that anxiety may play acausal role in MSD, the results imply that organizational interventions focused on work characteristicsknown to be associated with elevated anxiety (e.g., high workload, role conflict) could act indirectly toreduce MSD, and thus improve well-being and productivity at work.

Effects on glycaemic control of pennebaker’s writing technique: An empirical studyon 32 subjects with type II diabetes

*Pastena, R., Tabasso, C., Pepe, L., Solano, L.; *University of Rome, Italy

Objectives To check the effects of Pennebaker’s writing technique on diabetic patients with apoor metabolic control and to study how alexithymia may affect writing effects on diabetic subjects.

Method 32 subjects with Type 2 diabetes, and a very poor glycaemic control were selected. Their lastthree HbA1c values were significantly increasingly high(sample’s average levels were: 8.6; 9; 9.6,p¼ 0.0002). 16 subjects wrote 3 times, once a week, for 20 minutes each time, about emotionaltopics related to their desease; the other 16 subjects were considered control group and didn’t write.2 and 4 months after writing we collected other HbA1c values.

Results Subjects in the writing group showed significant improvements in HbA1c levels, both 2 and4 months after writing sessions ( p¼ 0.01). Control group’s HbA1c levels worsened at 2 months, andwere not significantly different at 4 months. Moreover, the two groups did differ significantly at4 months ( p¼ 0.05). SCL-90 scores (a self-report well-being scale) obtained before and after writing,showed a significant improvement in the writing group only ( p¼ 0.02). A significant interactionbetween writing and alexythimia levels (measured by TAS-20) emerged. High alexithymic subjectswho wrote showed a non-significant improvement in their HbA1c values, 2 and 4 months afterwriting. High alexithymic who did not write, on the other hand, worsened significantly ( p< 0.04).Among low alexithymic subjects, a significant improvement emerged the writing group( p< 0.0005), while a non significant improvement was shown by the control group.Conclusions The research shows that the writing technique, when applied properly (and studyingalso other variables of interest such as alexithymia), allows to obtain beneficial effects, as well as toidentify groups at health risk.

Control beliefs and health status evolution in primary care fibromyalgia patients

Pastor, M., Pons, N., Lledo, A., Lopez-Roig, S., Rodrıguez-Marın, J., Sanchez, S.,Martın-Aragon, M., Martınez, M., Neipp, M.; Spain

Introduction Little is known about control beliefs and health status evolution in primary care patientsand it has been required more studies focussed on this population.

Objective (1) To explore the time stability of the different control beliefs constructs and the perceivedhealth status after 6 moths of follow-up.

Methods We performed a longitudinal study with 3 measurements, but we present the preliminaryresults using the first two (after 6 months). Subjects: We interviewed 96 primary care Fibromyalgiawomen. Variables and Instruments: We used the Spanish validation of the following instruments:Locus of control (Multidimensional Locus of Control Pain Inventory; Pastor et al., 1990);

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Self-efficacy Expectancies (Chronic Pain Self-efficacy Scale; Martın-Aragon et al., 1999); PerceivedHealth Competence (Perceived health Competence Scale; Pastor et al., 1997); Health Status(Sickness Impact Profile; Badıa y Alonso 1994) and Emotional Status (Hospital Anxiety andDepression Scale; Terol et al., 1997). We also assessed Pain intensity (NRS) as a symptomsdimension of health status.

Results Control beliefs and most of the health status factors were similar after 6 months follow-up.Regarding emotional status, patients showed similar level of anxiety but significant higher levels ofdepression (t¼�2.23*). Household management had a higher and intellectual activity a lowerimpact after 6 months (t¼�2.18* and t¼ 2.12* respectively). Taken into account the SIPdimensions, only psychosocial dimension showed a lower impact at follow-up (t¼ 2.29*).

Conclusions After 6 months, primary care Fibromyalgia patients keep their control beliefs and most ofthe health status stable. Their depression level can be affected by their worse household management(most of them are housewives). However, they showed an improvement in intellectual activity andthe psychosocial dimension, supporting the importance of focussing on illness first steps to getlong-term better health results.

The relationship between sub-clinical thyroid disease, cognitive dysfunction andmood disorder in the elderly

*Pattison, H., Roberts, L., Roalfe, A., Franklyn, J., Wilson, S., Parle, J.; *Aston University, UK

Objectives The associations between sub-clinical thyroid disease and cognitive dysfunction andmood were investigated as part of the community-based Birmingham Elderly Thyroid Study.

Methods Patients aged 65þ in participating general practices were invited to attend a screeningsession, which included tests of thyroid function, mood (HADS) and cognition (MMSE,MEAMS). Participants were categorised by TSH and Free T4 results (normal ranges 0.4–5.5 mIU/land 9–20 pmol/l respectively) and associations with depression, anxiety and cognition exploredthrough regression analyses.

Results 5960 participants attended for screening, 5867 (mean age 73.6, 51% female) met eligibilitycriteria and completed all tests. Most patients (94%) were euthyroid, with 2.9 and 2.2% beingsub-clinically hypothyroid and hyperthyroid respectively and 0.4% falling into each of the overtdisease groups. Abnormal depression and anxiety scores were observed in 2.3 and 6.3% respectivelyand 5.2% had MMSE scores indicating cognitive dysfunction. After controlling for age and sex, therewas no association between thyroid status and cognition or mood. Pre-specified secondary analyses ofTSH and Free T4 as continuous variables demonstrated extremely small but statistically significantpositive associations between Free T4 and depression ( p¼ 0.001: 1 point increase in depressionscore per 20 pmol/l increase in Free T4), and between TSH and cognitive dysfunction ( p¼ 0.02:1 point increase in MMSE per 50 mIU/l increase in TSH), the opposite of associations predictedby the literature.

Conclusions Little evidence of an association between thyroid dysfunction and cognitive functioningor mood was found. The associations identified between Free T4 and depression, and TSH andcognition, are too small to have clinical relevance. This evidence does not support the suggestion inthe literature that routine thyroid function screening would reduce the burden of cognitivedysfunction or mood disorder in the elderly.

Increased risk of mortality or myocardial infarction 2 years post-pci inType D patients treated with sirolimus-eluting stents

*Pedersen, S., Denollet, J., Ong, A., Sonnenschein, K., Erdman, R., Serruys, P., van Domburg, R.;*Department of Cardiology, Thoraxcentre, Erasmus Medical Centre Rotterdam, The Netherlands

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Objectives Little is known about the impact of psychological risk factors on cardiac prognosis inthe drug-eluting stent era. We examined whether the distressed personality (Type D) moderatesthe effect of percutaneous coronary intervention (PCI) with sirolimus-eluting stent (SES)implantation on adverse clinical events at 2 years’ follow-up.

Methods Three-hundred-and-fifty-eight patients with ischemic heart disease, who consecutivelyunderwent PCI with SES and participated in the Rapamycin-Eluting Stent Evaluated AtRotterdam Cardiology Hospital (RESEARCH) registry, completed the Type D Personality Scalepost-PCI and were followed for 2 years. The endpoint was a composite of death and non-fatalmyocardial infarction (MI) 2 years’ post-PCI.

Results At follow-up, there were 22 events. Type D patients had a greater than two-fold risk of anevent at follow-up compared with non-Type D patients (10.4% vs. 4.4%, p¼ 0.031). In multivariateanalysis, Type D remained an independent predictor of adverse outcome (HR: 2.61; 95%CI: 1.12–6.09; p¼ 0.027) adjusting for sex, age, history of CAD, multi-vessel disease, diabetes,hypercholesterolemia, hypertension, renal impairment, and smoking. Previous cardiac history wasalso an independent predictor of death or MI (HR: 2.83; 95% CI: 1.00–7.96; p¼ 0.049).

Conclusions Type D personality moderated the effect of PCI on hard clinical events despite treatmentwith the latest innovation in interventional cardiology. The inclusion of psychological risk factorsin general and personality factors in particular may optimize risk stratification also in the drug-elutingstent era.

Type D personality and diabetes predict the onset of depressive symptomsin patients following percutaneous coronary intervention

*Pedersen, S., Ong, A., Serruys, P., Erdman, R., van Domburg, R.; *Department of Cardiology,Thoraxcentre, Erasmus Medical Centre Rotterdam, The Netherlands

Objectives Depressive symptoms are common in patients with ischemic heart disease (IHD) andhave been associated with adverse clinical outcome. However, little is known about predictors ofthe onset of depressive symptoms.

Methods Unselected patients with IHD treated with percutaneous coronary intervention (PCI) witheither drug-eluting or bare stent implantation as part of the Rapamycin-Eluting Stent EvaluatedAt Rotterdam Cardiology Hospital (RESEARCH) registry were evaluated for depressive symptomsat baseline and 12 months’ post-PCI and Type D personality at baseline using the HospitalAnxiety and Depression Scale and the Type D Personality Scale. Type D is defined as the tendencyto experience increased negative emotions paired with the tendency not express these emotionsin social interactions.

Results Of 542 non-depressed patients, 41 (8%) had developed significant depressive symp-tomatology at 12 months. The incidence of depressive symptoms was higher in Type D than innon-Type D patients (14/41 (15.2%) vs. 27/41 (6%); p¼ 0.003) and in patients with diabetes com-pared with non-diabetic patients (10/41 (15.6%) vs. 31/41 (6.5%); p¼ 0.01). In patients with no riskfactors (Type D or diabetes), the incidence of depression was 5.1% with the incidence more thandoubling to 13.2% and 30% for every additional risk factor. Type D personality (OR: 2.86; 95%CI: 1.43–5.75) and diabetes (OR: 2.81; 95% CI: 1.29–6.12) remained independent predictors ofthe onset of depressive symptoms 12 months’ post-PCI adjusting for all other factors.

Conclusions Type D personality and diabetes comprise risk factors for the onset of depressivesymptoms post-PCI. In clinical practice, patients with these risk factors should be identified andconsidered for psychosocial intervention in order to enhance secondary prevention.

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Risks and challenges in the transition to parenthood after a preterm birth

*Pedrosa, A., Canavarro, M., Oliveira, C., Ramos, M.; *Psychology Unit of Maternity Daniel deMatos, HUC, Portugal

Objectives The birth of a premature infant usually represents a moment of family crisis, withconsequences that may go beyond the period immediately following the puerperium. The anxietyconcerning the health and survival of the newborn is frequently accompanied by negative emotionsand instability, that may persist even when the baby’s survival is certain and health risks areattenuated. The main objective of this study, which is part of a wider longitudinal study, was tocompare mothers and fathers of premature infants in terms of possible indicators of adjustment intheir transition to parenthood (emotional reactivity and psychopathology symptoms).

Methods Psychological symptom patterns and emotional reactivity of parents (49 mothers and44 fathers) of prematurely born infants needing NICU care were assessed at two distinct moments:three to five days after birth, and three months later. Data was obtained using a semi-structured inter-view, and questionnaires: BSI – Brief Symptom Inventory (Derogatis, 1983) and EAS – EmotionalAssessment Scale (Carlsson et al., 1989).

Results Differences were found in the adjustment processes of mothers and fathers. In both cases,indicators of distress had decreased three months after birth. Differences found do not significantlyassociate with medical variables of the premature infant, such as birth weight and gestational age.Further studies are needed to clarify risk and protective factors that may interact in these adaptationprocesses.

Conclusions These data, if related to a more thorough knowledge of dimensions such as medicalelements, parents’ and infants characteristics and social factors, may contribute to more effectivelydiscriminate individuals at risk of developing psychopathology when facing an hazardous situationsuch as preterm birth, and to the elaboration of psychological attendance programs that may helpreduce developmental risks and promote a healthier development of the family system.

Neurocognitive implications in chronic hepatitis C infected patients

*Peixoto, B., Lopez, L., Areias, J., Cerqueira, R., Arias, J.; *Departament of Clinical Psychology ofthe Health Sciences Superior Institute, North Gandra, Portugal

Background The neuropsychological implications of severe liver dysfunction have been widelyexplained in currently available literature. However, the harmful effects of neurocognitive processesin mild liver dysfunction, as well as the direct action of the hepatitis C virus (HCV) on the centralnervous system are in their initial stages.

Objective The purpose of this study is to investigate the possible existence of certain neurocognitivealterations in patients infected with HCV (with varying degrees of liver fibrosis) who are notundergoing treatment with alpha interferon.

Methods The authors administered a series of neuropsychological tests in two different groups,namely a group of patients with chronic hepatitis C (group HCV, n¼ 18) – who were not undergoingtreatment with alpha interferon, were cirrhosis free, and had varying degrees of fibrosis – and a groupcomprised of frequent blood donor subjects (control group, n¼ 17).

Results The results obtained from the two groups were compared, showing in the representativeHCV group the existence of alterations in terms of audioverbal attention, visuospatialperception and visual constructional abilities. These alterations are not assocated with the existinglevel of fibrosis.

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Conclusion These observations seem to foster the idea that there is a direct effect of the HCV on thecentral nervous system.

Health beliefs and prescription medication complianceamong diagnosed hypertension clinic attendersin a rural South African hospital

Peltzer, K.; University of Venda, South Africa

Objectives This study examines the relationship between health beliefs and the use of bothprescribed medication and alternative healing agents among at least one year diagnosedhypertensives attending an hypertension out-patient clinic in a rural South African hospital.

Methods The sample included 33 men and 67 women, in the age range of 31 to 81 years,(M¼ 60.7 years, SD¼ 9.8 years). Main outcome measures included causative beliefs, health beliefs,and quality of the health care provider patient interaction.

Results From the 100 patients studied 35% were not compliant with prescription medication.Most patients (almost 80%) had taken something else for their high blood pressure apartfrom prescription medication, especially those who had been non-compliant with prescriptionmedication. Most popular were the use of home remedies and faith healing, followed bytraditional healing and over-the-counter drugs. Non-compliant behaviour was associated withthe use of alternative healing agents, the belief of curability of hypertension by traditionaland faith healers, perceived benefits and barriers of antihypertensive medication andsome items of the quality of the practitioner-patient relationship such as not explaining medicalproblems.

Conclusion Cultural concepts and perceptions should be incooperated to improve culturally sensitivecompliance behaviour among hypertensive patients.

Training primary care nurses to conduct alcohol screeningand brief interventions in South Africa

*Peltzer, K., Seoka, P., Babor, T.; *University of Venda, South Africa

Objectives Although progress has been made in developing a scientific basis for alcohol screening andbrief intervention (SBI), training packages are necessary for its widespread dissemination in primarycare settings in developing societies.

Methods This paper evaluates a training package developed the World Health Organisation, theSBI programme. The training participants consisted of 121 nurses from one rural site (29 clinicsin Vhembe District) and one urban site (3 clinics and 6 mobile clinics in Polokwane/Seshego)in South Africa.

Results Although the training effects were at times moderate, all changes were in a direction moreconducive to implementing SBI. Health care providers significantly increased in knowledge,confidence in SBI and higher self-efficacy in implementing SBI at follow-up after 9 months afterreceiving the training.

Conclusion When delivered in the context of a comprehensive SBI implementation programme,this training is effective in changing providers’ knowledge, attitudes, and practice of SBI for at-riskdrinking in South Africa.

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Health risk behaviours, health education needs and perspectives towardspublic health services in the rural South African communities

Pengpid, S.; Department of Public Health, University of Venda for Sciences and Technology, SouthAfrica

Aim The aim of this study is to investigate health risk behaviours of rural South Africans, identifytheir health needs, specify the preferred health education methods and assess their attitude towardrural public health services.

Methods and Materials Through cluster sampling 310 adult participants from rural communities wereinterviewed using a structured interview, including items on history of illness and treatment, healthrisk behaviours, knowledge about health risk factors, health information needs, and satisfactionwith rural public health services.

Results A quarter of rural people have history of illness in the past month. The majority havenever had annual health check up (77.5%) and dental check up (91.3%). Few (22.33% men,20.7% women) of them had had self breast and testicles examination. The majority have highhealth risk behaviours especially lack of physical exercise (67.5%), and eating behaviour (added saltto meal 88.3% and eat fatty food 76.4%). The majority have insufficient knowledge about healthrisk behaviours and possible disease. Health information was felt highly needed and group educationwas the preferred method.

Conclusion and Recommendations Unhealthy health behaviours were identified in this ruralpopulation. Health education and health promotion programme is highly needed in rural SouthAfrica communities.

Impact of life skills and HIV/AIDS education among youth:A South African secondary school teacher’s perspective

*Pengpid, S., Peltzer, K.; *Department of Public Health, University of Venda for Sciences andTechnology, South Africa

Objectives This qualitative study was aimed to explore and describe South African secondaryschool teacher’s perspectives towards impact of life skills education programmes on HIV/AIDSamong youth.

Method The study was conducted on 150 teachers (mostly life skills teachers) selected throughstratified proportional random sampling for 9 provinces in South Africa. Data was collected using asemi-structured interview in schools. All interviews were tape-recorded and transcribed verbatim.The QSR Nvivo computer programme was used for data analysis.

Results Almost all teachers indicated that the life skills education programme had a high impact onthe learners, including the increase in learner’s knowledge about HIV/AIDS/STDs, sex, safe sex, andpregnancy, encouraged learners to seek more information such as from the TV, addressing problemsthat they are facing, increase decision-making and problem solving skills, positive behaviour changeincluding delay of sex and abstinence, knowledge and skills how to use condoms, taking responsibilityfor their actions and relationship without sex, being able to transfer their knowledge, and reducethe pregnancy rate. The life skills education programme also had impact on the teachers by givingthem skill how to handle learner’s problems, making them aware about real life and things happeningin and outside classroom and create a conducive atmosphere between teachers and the learners. Mostteachers felt that the life skills education programmes promote values that will effectively reducethe spread of HIV/AIDS.

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Conclusion South African secondary school teachers perceive that life skills education reducesHIV/AIDS among youth. The HIV/AIDS life skills education should be incorporated critically intoformal education for youth in school.

Reproductive decision among HIV-infected women: Preliminary results

*Pereira, M., Canavarro, M., Pinho, L., Araujo Pedrosa, A.; *Departamento de Medicina Materno-Fetal, Genetica e Reproducao Humana Maternidade Universidade de Coimbra, Portugal

About 2.5 million women who become pregnant each year worldwide are HIV-positive. Withincreasing numbers of HIV-infected women in Portugal, about 80% in childbearing age, andincreasing concerns about reproductive decision and vertical transmission of HIV, pregnancy hasbeen a focus of attention and research.

Objectives The purpose of this study was to identify and describe the medical, demographic and somepsychological characteristics of HIV-positive women who become pregnant; and also to discriminatethe profile of those who decide to continue from those who decide to terminate pregnancy, after beingreported and becoming aware of an HIV diagnosis.

Methods A sample of pregnant women was assessed by a clinical interview; by medical, obstetricand social grids; and by self-reported questionnaires. Data was collected considering the followingvariables: demographic characteristics (age; race/ethnicity; marital status; socio-economic status;mode of transmission; knowledge of serological status), obstetric history, pregnancy information;and medical information associated with HIV (viral load; CD4 count).

Results Preliminary results show that HIV-positive women who decide to continue their pregnancycan be distinguished from the ones that decide to terminate, under several aspects. The mostsignificative are marital status, social support and knowledge of HIV infection prior or subsequentto pregnancy.

Impact of parental relationship on young adult health

*Pereira, M., Araujo-Soares, V.; *University of Minho, Portugal

Aims To analyze the impact of the marital relationship on adult children’ health using psychosocialand physiological measures.

Methods 200 young adults composed the sample that was made of undergraduate students atthe University of Minho (Portugal) and Professional Schools.

Instruments Portuguese Versions of: Separation-Individuation Process Inventory (Christenson &Wilson, 1985); Miller Social Intimacy Scale (Miller & Lefcourt, 1982); Perceived Social SupportScale (Procidano & Heller, 1983); Ways of Coping Questionnaire (Coyne, Aldwin, & Lazarus,1981); Beck Depression Inventory (1973); State-Trait Anxiety Inventory (Spielberger et al.);Rotterdam Symptom Check List (Haes et al., 1990); and Perception of Parental Relationship(Pereira & Araujo-Soares, 2002). Physiological Measures – Heart rate, blood pressure and skinconductance. Subjects were submitted to a physiological protocol that included watching twomovies’ sketches that elicited positive and negative emotions.

Results Data were analysed using LISREL. The effect of parental relationship upon physicalmorbidity is mediated by a long chain of significant paths, going through family support, directcoping, and distress. Family support also influences friend support, but the latter variable seems to

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be of no further consequence. When the physiological measures were added, the chain of mediatingeffects from parental relationship to physical morbidity remained significant, now accompaniedby a significant direct effect of the parental relationship on psychological distress. However, no signif-icant effects were obtained between physiological measures and psychosocial ones. This was true forboth moments (negative and positive emotions). In sum, the effects of distress upon physicalmorbidity seem to be mediated by psychological, more than physiological variables, at least inthe current study.

Conclusion There seems to be a need to intervene with children from problematic familiesparticularly in terms of coping and family support in order to minor the intergenerational risk ofparental relational problems on physical and mental health.

Improving recovery following heart attacks by changing illness perceptions:A randomized trial

*Petrie, K., Broadbent, E., Ellis, C., Ying, J.; *The University of Auckland, New Zealand

Background Patients’ beliefs and perceptions about their illness are important determinants ofrecovery following myocardial infarction (MI). Previous research has shown that patients with morenegative illness perceptions have greater illness related disability and return to work at a slowerrate. Negative perceptions of the MI and high levels of worry about another heart attack by patients’spouses can also lead to overprotective behaviour and a poorer functional outcome for patients.

Objectives In a prospective randomized study, we investigated whether a brief in-hospital interventionwould improve functional outcome in myocardial infarction patients and whether the inclusionof spouses would reduce spouses’ distress and concern about a future MI.

Methods One hundred and three consecutive MI patients were assigned to receive either a 4 sessionintervention designed to alter perceptions about their MI or usual care. Of the 71 patients withspouses, 56 (79%) agreed to participate in the study. Patients and spouses were assessed beforeand after the intervention and patients were assessed again at 3 months following hospital discharge.

Results Results showed that patients in the intervention group reported they were better preparedto leave hospital ( p< 0.01), and were more likely to subsequently return to work ( p< 0.05) and bein full-time employment ( p< 0.05) than control participants. Spouses who participated in theintervention reported a greater belief that the heart could recover, improved understanding oftheir partner’s heart condition, less distress about symptoms and lower worry about a future MI(all p’s < 0.05).

Conclusions The study suggests that a brief psychological intervention designed to change patientsillness perceptions can improve functional outcomes in MI patients. Inclusion of patients’ spousesin the intervention can improve negative illness perceptions and reduce distress levels. Results indicatethat the intervention has potential to reduce work-related disability following MI.

A qualitative analysis of free-text comments from questionnaires investigatingthe psychological impact of undergoing cancer genetic risk assessment

*Phelps, C., Brain, K., Bennett; P., Gray, J.; *Cancer Genetics Service for Wales, Wales, UK

Objectives To identify the main issues facing participants upon referral for cancer genetic riskassessment (Time 1), whilst waiting for genetic risk information (Time 2) and post risk notification(Time 3).

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Methods At each time-point, participants wrote about their current thoughts about the assessment.A thematic analysis of the comments was conducted using NUD*IST. Common themes wereidentified and axial coding used to link themes.

Results Many participants wanted to learn more about personal risk and risk to family members.There was a belief that entering CGSW would aid in early detection and prevention but limitedunderstanding of the assessment process. Participants’ were concerned about how they would copewith the implications of being at risk. Waiting for notification of risk was anxiety-provoking andpartly caused by the lack of information about the timescales and process. Completing the familyhistory questionnaire also raised some anxieties, although many participants reported positiveexpectations of the assessment process. Many of those told that they were at increased risk were reas-sured by the information and by the opportunity for increased surveillance or genetic testing. Someparticipants at lower risk were not satisfied with the information given and doubted the accuracy ofthe assessment.

Conclusions Many of the concerns faced by participants undergoing cancer genetic risk assessmentwere related to a lack of understanding about cancer genetic risk assessment and issues related topersonal control. Better information about different aspects of the assessment process may result inmore accurate expectations. Analysing free-text comments from research questionnaires can providevaluable data which can enrich interpretation of quantitative data.

The role of appraisals and core relational themes in predicting emotional responsesto cancer genetic risk assessment

*Phelps, C., Bennett, P., Brain, K., Gray, J.; *Cancer Genetics Service for Wales, Wales, UK

Objectives To explore the degree to which appraisals and core relational themes were associatedwith emotional responses to cancer genetic risk assessment. Based upon the theory of appraisal andcoping developed by Smith and Lazarus (1993), pre-specified appraisals and core relational themeswere expected to predict specific emotions.

Methods Data were collected from 157 women undergoing cancer genetic risk assessment.Participants completed scales measuring emotions, appraisals, core relational themes, and copingbehaviour upon referral for cancer genetic risk assessment and at follow-up. The measures wereadapted from questionnaires used by Smith and Lazarus (1993).

Results Hierarchical regression analyses revealed that whilst some emotions were stronglypredicted by individual appraisal components and core relational themes, others were notpredicted so well. The strongest relationships were for the emotions of anxiety, hope, gratitudeand fear: between seventeen and forty per cent of the variance was explained for theseemotions respectively. The emotion of challenge was not as well predicted by the hypothesisedappraisals and core relational themes. The three emotions not previously modelled – relief,tranquillity and interest – showed different strengths of associations between the correlatedappraisals and core relational themes. Coping behaviour was not well predicted by appraisalsand emotions.

Conclusions This study adds to our existing knowledge by (1) identifying emotions relevant to cancergenetic risk assessment, (2) testing the degree to which positive and negative emotions could bepredicted by the hypothesized appraisals and core relational themes, and (3) providing an indicationof the relevant appraisals and core relational themes for emotions previously untested in the contextof the Smith and Lazarus (1993) model.

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Psychosocial factors and antibody response to influenza vaccination inthe young and elderly

*Phillips, A., Carroll, D.; *University of Birmingham, UK

Objective The association between psychosocial factors and the antibody response to the sameinfluenza vaccination was examined in young students and an elderly community sample.

Methods Life events in previous year, customary social support, neuroticism were measured in57 healthy students (mean age¼ 20 years) and 184 elderly persons (mean age¼ 75 years). In theelderly cohort, marital status and satisfaction, and quality of life were also assessed. Antibody titreswere measured at baseline and four to five weeks following vaccination with the same trivalentinfluenza vaccination.

Results Adjusting for baseline antibody titre, poorer antibody responses to the B/Shangdongstrain were associated with higher life events exposure in students. In addition, studentscharacterized by good social support and low neuroticism had better responses to the A/Panamastrain. In the elderly cohort, being married and having higher marital satisfaction wereassociated with a better antibody response to the A/Panama strain. A higher quality of life in themonth following vaccination was associated with a better antibody response to the A/NewCaledonia strain. Life events exposure and social support were not associated with response toany of the influenza strains in the elderly.

Conclusion The psychosocial factors influencing peak antibody response appear to alter over thelife course. In older populations, factors such as marriage and quality of life may come to assume agreater significance for immune function than stressful life events exposure.

Cardiac mortality in frequent panic: Neurochemical abnormalities and their modification

*Pier, C., Alvarenga, M., Lambert, G., Barton, D., Wilkinson, D., Lambert, E., Richards, J., Esler,M.; *School of Primary Health Care, Monash University, Australia

Background Frequent panic attacks are distressing and disabling but until recently have not beenthought to constitute a risk to life. Panickers often fear they have heart disease, because of thenature of their symptoms, but have been reassured this is not so. Epidemiological studies suggesthowever there is a 3–6 fold increased risk of sudden death and myocardial infarction in frequentpanickers.

Objectives To identify the neurochemical basis for increased cardiac risk in frequent panickers.

Methods Fifty-two people with panic disorder and 81 healthy controls underwent arterial and cardiaccatheterisation to measure sympathetic nervous system activity. Measures involved isotope dilutiondetermination of whole-body and cardiac catecholamine plasma kinetics. A subgroup of panickerssubsequently received CBT or an SSRI for panic disorder, and was re-assessed in the catheterlaboratory.

Results We found evidence for elevated whole body plasma adrenaline secretion during panic.This plasma adrenaline appears to be extracted by the cardiac sympathetic nerves resultingin the continuous release of adrenaline from the heart. Specifically, adrenaline was released asa co-transmitter from the cardiac sympathetic nerves, which may produce arrhythmias given thehigh affinity of adrenaline for �2-adrenoceptors in the heart. There was also evidence of impairedneuronal reuptake of noradrenaline by cardiac sympathetic nerves, causing persistence of thetransmitter in the synaptic space thereby augmenting neural stress responses. A reduction in thefrequency of panic after treatment reduced cardiac sympathetic nerve adrenaline co-transmission,

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probably through elimination of the plasma surges of adrenaline which accompany panics and load thesympathetic nerve vesicles.

Conclusions The neurochemical basis for increased cardiac mortality among frequent panickersappears to be a result of abnormal cardiac adrenaline and noradrenaline function, leading to increasedfrequency and intensity of cardiac sympathetic nerve firing. Best-practice treatment for frequentpanic attacks appears to modify these neurochemical abnormalities.

Can deceiving COPD smokers be detected by measuring exhaled CO to determinesmoking status? A validation of three Co monitors

*Pieterse, M., Christenhusz, L., de Jongh, F., van der Valk, P., Seydel, E., van der Palen, J.;*Communication Studies, University of Twente, The Netherlands

Objectives Validating three different CO monitors for verifying self-reported smoking statusin COPD-patients and healthy participants.

Methods 26 healthy smokers, 25 healthy non-smokers, 25 smoking COPD patients and 25 formersmoking COPD patients were included (N¼ 101). Subjects were aged between 40 and 75 years.COPD patients had a clinical diagnosis of stable COPD. Non-smokers were measured once andsmokers twice: at the start – following a 12-hour period of abstinence – and again one hour aftersmoking a cigarette.

Results With a prescribed 9 ppm cut-off point the Breath CO� generates 68% sensitivity for COPDpatients and 42.3% for healthy participants. With a 10 ppm prescribed cut-off point theSmokelyzer� scores 56% sensitivity for COPD patients and 23.1% for healthy participants. Bothmonitors generate 100% specificity in both groups. The cut-off point prescribed for the Micro COmeter� is 6 ppm, generating 88% sensitivity and 91.7% specificity for COPD patients. For healthyparticipants sensitivity is 92.3% and specificity is 88%. Both other monitors reach comparablescores, however, when cut-off points are adjusted, similar to that of the Micro CO.

Conclusions Biochemical validation of self-reported smoking status is imperative to verify compliancewith smoking cessation, especially in COPD-patients. Compared to other validation methods exhaledCO measurement is attractive for clinicians because it is cheap, non-invasive and provides directfeedback. All three CO monitors are valid tools for determining the smoking status in both a healthyand a COPD population, but only if the prescribed cut-off points are adjusted properly.

Integral mapping of care giving to oncological palliative patients by doctors andnurses in a Dutch hospital

*Pietersma, S., Buunk, A.; *University of Groningen, The Netherlands

Although overall treatment efficacy of cancer is reaching 50 percent, still many people are confrontedwith the fact that treatment is no longer possible. This underlines the importance of adequatepalliative care. But which factors determine whether the care for incurable patients is optimal?How can this care be improved? The present study was designed to find answers to these questions.In contrast to focusing on one single behavior, the present study maps multiple behaviors of healthprofessionals concerning palliative care to reach an integrated and embedded view of what isgoing on in the palliative care. The present study assessed the beliefs of doctors and nurses in theMartini Hospital Groningen in Holland (n¼ 151) about the following 4 behaviors: asking advicefrom a palliative team; attending a consultation of the palliative team; breaking bad news to patients;

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and communicating with patients about palliative care. This mapping of beliefs was based on thetheory of planned behavior. Perceived knowledge was added to this theory. The behaviors were mea-sured by means of a self-report questionnaire, which was based on interviews with doctors and nurses.The results showed that the intention to perform each of the 4 behaviors can be nicely predicted by acombination of attitude, social norm, perceived barriers and knowledge (explained variance rangedfrom 37 to 41 percent). One interesting finding, which could only surface due to the integratedapproach, concerns the perceived social norm: it appeared that doctors and nurses both think thatespecially (other) nurses expect them to perform all 4 behaviors. Thus, nurses seem central in shapingthe professional culture of palliative care. Moreover, this study gives strong indications for practicalinterventions.

Modulus ‘‘Students to students’’ as drug prevention measure

*Pilkauskien_ee, I., Gostautas, A., Marksaityt_ee, R.; *Vytautas Magnus University, Lithuania

Objectives The aim of this study is to compare two versions of modulus ‘‘Students to students’’for drug prevention.

Methods Intensive education method as a comprehensive prevention model was elaborated on thebackground of the National smoking prevention program in Lithuanian schools (1994). The intensiveeducation model consists of three levels: (1) general knowledge; (2) consolidation of knowledge andskills education; (3) relating skills and personal experience. This method is being used atCommunication Psychology School in the modulus ‘‘Students to students’’ since 1999. Two differentversions of this modulus were applied in Communication Psychology School for drug prevention.The modulus ‘‘Students to students’’ in both versions consists of two stages. The first stage issenior students’ preventive skills education. During this stage students get knowledge about tobacco,alcohol and other drugs abuse dangers, acquire preventive work skills, learn to act responsibly and tohold their commitments: not to smoke and not to drink alcohol. The second stage is senior students’work with younger schoolchildren on drug use hazards. In the first version of the modulus 143 seniorstudents participated in three days Communication skills education camp ‘‘Sniego gniuzte’’ and wereprepared to carry out discussions on tobacco consumption hazards with 5th grade students. In thesecond version 122 senior students were prepared for preventive work with 3rd grade studentsduring one day intensive learning.

Results Thirty-eight percent of students from the first version sample applied preventive measures for1301 younger students and 54% of students from the second version sample preventive measures for1080 younger students.

Conclusion In conclusion, the second version of the modulus ‘‘Students to students’’ is moreeffective in drug prevention.

The quest for normality: A qualitative study of end-stage renal diseasepatients awaiting transplantation

*Piot-Ziegler, C., Fasseur, F., Ruffiner-Boner, N., Demierre, M., Castelao, E., Ben Sassi, M.-L.,Pascual, M.; *Health Psychology, University of Lausanne, Switzerland

Long-term consequences of end-stage renal disease (ESRD) and renal transplantation (Rtx)have been the subject of numerous studies, but few have concentrated on the pre-transplantationperiod and on the impacts of illness on psychological reactions. This study proposes somespecifically relevant themes to understand the experience of ESRD patients. Through qualitative

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analysis of semi-structured interviews, experience of illness was explored in 30 patients suffering fromESRD and awaiting Rtx. Specific concerns were identified, which differed from other organ awaiting-patients. Loss of freedom was extensively debated as ESRD imposed heavy limitations. Patientsresponded to the constraints of dialysis, regimen and liquid intake by scheduling their life very care-fully. They led a dual life, trying to maintain a conspicuous normality in front of others while avoidingillness intrusiveness. They developed a controlled capacity of taking leave with constraints and medicaldirectives. Rtx was considered as a mean to recover freedom, and remaining on renal replacementtreatment was reported to be unacceptable. The different types of donors (non-living donor, livingrelated donor and illegal sources) were reviewed, which gave an opportunity to debate ethical andpersonal choices. Death as a way out and suicidal thoughts were frequently cited and related toexistential concerns such as the meaning of life in a recurrent life-threatening illness, and theloss of an acceptable quality of life. Difficulty in emotional disclosure isolation, and a feeling ofbeing misunderstood were reported. Patients hid negative feelings in order to protect their significantones. Recurrence of illness was mentioned. They put their energy in handling uncertainty andkeeping an appearance of normality. Negative feelings should be contextualised in the constraintsof ESRD and patients should be acknowledged as persons having normal reactions in a recurrentillness.

The experience of transplantation for patients and their significant ones:A difficult encounter of two worlds

*Piot-Ziegler, C., Ruffiner-Boner, N., Fasseur, F., Demierre, M., Castelao, E., Ben Sassi, M.-L.,Pascual, M.; *University of Lausanne, Switzerland

Objectives This paper reports on a longitudinal qualitative study exploring concerns of 60 patientsbefore and after transplantation.

Methods Semi-structured interviews were conducted without time constraints in a protected spaceout of the hospital. Qualitative analysis was performed.

Results Prior to transplantation, all patients talked freely about negative feelings, stigmatisation,being misunderstood by others, loneliness and culpability caused by increasing physical depen-dency or abandoned roles. They mentioned alternative ways to cope (magic, spirituality), andeven expressed their right to let go. In a subset of 13 patients, significant ones allowed themselvesin the interview, or were integrated on the request of the patients. In this modified setting, twoillness-worlds were confronted. If common themes were mentioned (e.g., modified life plans,restricted space, physical and psychological barriers), they were experienced differently. Fear oftransplantation or guilt towards the donors was overtly expressed, often for the first time.Mutual hiding of anxiety in order to protect loved ones or to prevent loss of control was disclosed.The significant ones talked about accumulated stress and exhaustion related to the physical degra-dation of the patient, fear of the unpredictable evolution of illness and financial problems, andstressed their difficulty to adapt adequately to the fluctuating state of the patient. After transplan-tation, other themes emerged, where difficulty in disclosure was observed: intensive care and neardeath experiences, being a transplanted person, debt to the donor and his/her family, fear ofrejection.

Conclusions With the self-imposed strategy of hiding concerns to protect one another, a discrepancybetween two illness-worlds was created. When concerns were confronted during the interviews, a newmutual understanding emerged. Patients and their families stated the need for sharing concerns in thecourse of illness.

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Health and mental impact of road traffic accidents

*Pires, T., Maia, A.; *University of Lausanne, Switzerland

The purpose of this study was to evaluate pre, peri and post-traumatic factors associated withpsychological symptoms related to road traffic accidents, especially those associated with acutestress disorder and post-traumatic stress disorder (PTSD). Participants (n¼ 50) were first evalu-ated in the hospital about 4 days after the accident (most had fractures; people in a coma or suf-fering from amnesia were not included), and again four months later. The following instrumentswere used: a socio-demographic questionnaire that included questions about past exposure to acci-dents and the characteristics of the present motor vehicle accident (perceived responsibility,danger, others involved, time waiting for help, etc.); the list of CAPS major stressors (Blakeet al., 1998; Portuguese version Maia & Fernandes, 2002); the General Health Questionnaire12 (Goldberg, 1978; Portuguese version, McIntyre, McIntyre, & Redondo, 1999); the PTSDscale (McIntyre, 1993); the PeriTraumatic Dissociative Experiences Questionnaire (Marmaret al., 1997; Portuguese version Maia, Fernandes, & McIntyre, 2001); and SIP (Pollard &Johnston; Portuguese version McIntyre, McIntyre, & Soares, 2000). Results showed that mostparticipants have serious physical limitations and 28 (56%) had full criteria PTSD symptomsin the first evaluation. Half have maintained the initial diagnosis four months later. A smallpercentage (5%) were not symptomatic at first, but they were so in the second evaluation.Distress measured through GHQ and peritraumatic dissociation were related to PTSD. Stepwiseregression analysis showed that peritraumatic dissociation is the first predictor of PTSD symptoms.This study shows that road traffic accidents can have a serious physical and psychological impact.In countries like Portugal, where the rates of traffic accidents are very high, we estimate thata considerable number of people live with the psychological and health consequences of atraumatic experience. Health workers should be prepared to deal with the psychologicalsuffering of these victims.

The psychometric properties of the Multidimensional Diabetes Questionnaire (MDQ):An Italian validity study

*Pisanti, R., Lazzari, D.; *Department of Psychology, University of Rome ‘‘La Sapienza’’, Italy

Objectives The Multidimensional Diabetes Questionnaire (MDQ – Talbot e coll., 1997) is ascreening instrument that provides a comprehensive assessment of diabetes-related cognitive andsocial factors. This study examines the internal consistency as well as the factorial and discriminantvalidity of the MDQ in an Italian sample of diabetic patients.

Method A questionnaire was filled out by 247 individuals with insulin-dependent and non insulin-dependent diabetes mellitus. The subjects answered the MDQ scale, which included 41 itemsgrouped into three sections: (1) general perceptions of diabetes and related social support, (2) positiveand misguided reinforcing behaviours related to self care activities, and (3) self efficacy and outcomeexpectancies; as well as some scales on diabetes self-care, and psychological distress. Glycosylatedhemoglobin (HbA1c) was used as a measure of metabolic control.

Results Confirmatory maximum likelihood factor analysis supported the adequacy of theoriginal factor structure of the MDQ. Adequate internal consistency and significant demographic,psychological, behavioral, and disease-related correlates were found.

Conclusion It is concluded that the MDQ is a valid and reliable self-report instrument to assesspatients’s psychosocial adjustment to diabetes in a non English-speaking country like Italy.

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Reliability and dimensionality of an Occupational Coping Self-Efficacy Questionnairefor Nurses (OCSE-N)

*Pisanti, R., Lombardo, C., Lazzari, D., Bertin, M.; *Department of Psychology, University of Rome‘‘La Sapienza’’, Italy

Objectives Among health care workers, nursing is one of the professions identified asparticularly stressful. Social cognitive theory is a usable conceptual framework to study the impactof emotionally charged relationships on stress and burnout. This study aims to develop a new andreliable questionnaire to assess the optimistic belief of being able to cope successfully with thespecific occupational stressors of nursing profession (Occupational Coping Self Efficacy for Nurses– OCSE-N).

Methods Data were collected by self administered questionnaires including the OCSE-N and othermeasures relevant for validation (Maslach Burnout Inventory and Scl-90). The sample was madeup by 836 nurses (77% female) with a mean age of 40.4 years (SD¼ 8.3).

Results Principal components factor analyses revealed a unidimensional structure for the OCSE-Nwhich explained approximately 45% of variance. Internal consistency of the OCSE-N was satisfactory(�¼ 0.86). Correlation data demonstrated the predicted association between the OCSE-N andmeasures of anxiety, depression, somatic complaints, sleeping disturbances, emotional exhaustion,depersonalization and personal accomplishment.

Conclusion Preliminary analyses of the OCSE-N demonstrate acceptable reliabilityand validity. Future research will examine the value of the OCSE-N to detect the changes followingintervention.

From negative mood to substance use

Plancherel, B.; University of Fribourg, Switzerland

Objectives This study examines gender and age group differences in substance use (alcohol, cannabis,tobacco) in taking into account risk factors.

Methods The participants of this study are integrated in a larger, national, secondary preventiveintervention study in Switzerland (supra-f ) for adolescents at risk. The study uses a structuralequation model as the main method of analysis.

Results The model examines various risks of negative mood, secure self, and parent and peerrelations. The model identified that negative mood posed a risk for substance use among youngboys and girls. Negative mood was associated with bad family relationships for boys (�0.31) andgirls (�0.23) and with negative peers (substance consuming and delinquent peers) for girls (0.64).Negative peers were a greater risk for young girls (0.82) than for young boys (0.61). Secure self isin favor of good relationship with parents for younger (0.30) and older boys (0.30) and for younger(0.47) and older girls (0.18). Finally a good relationship with parents stands against substanceusing peers and substance use itself. Gender and age group differences warrant prospectivelongitudinal replication and targeted intervention.

Conclusions This suggests that the focus of prevention should be first on negative mood whichitself have some influence on family and peer relation.

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Behavioral factors determining low adherence in tuberculosis patients

Popa-Velea, O.; University of Medicine and Pharmacy, Carol Davila, Bucharest, Romania

Objectives The therapeutical adherence in tuberculosis is one of Romania’s major public healthproblems, this country having, among European countries, one of the highest prevalenceof the disease. The clinical empirical observations suggest a certain role of behavioral factors in thepoor outcome of some cases. The purpose of this research was to investigate the possiblecorrelations between some behavioral traits, lifestyles and attitudes versus treatment, and the pooradherence, the aim being to profile a possible model of non-compliance, dependent on psychologicalfactors.

Methods The 91 patients participating in the study were investigated using the Freiburg PersonalityInventory (a 212 items Y/N standardized questionnaire), and a specific set of questions, regardingthe general lifestyle and attitudes versus medical institutions and doctors. After a period of follow-up of 6 months, we estimated the proportion of compliant and, respectively, non-compliant patients,the criterion for non-compliance being a percentage of more than 20% failure of daily drugadministration. The correlation between non-compliance and the results in psychological tests wasexamined at a threshold of statistical significance of p< 0.05.

Results There are significant differences between the compliant and noncompliant patients, inwhat concerns structural traits (like domination, depression, and aggressiveness), general behavioralstyles (external locus of control) and, in some cases, helplessness-hopelessness (all are more frequentin noncompliant patients). These patients are averagely, younger as the compliant patients, this factbeing a supplementary argument for the increase of the importance given to the amelioration oftherapeutic adherence.

Conclusions Our research offers a possible argument for a precocious screening ofpsychological traits, in order to anticipate a poor outcome, in terms of compliance, for tuberculosispatients.

The development of a resource pack to assist practice nurses in promoting uptakeand maintenance of dietary self-care behaviours

Povey, R.; Staffordshire University, UK

Objectives This project was divided into three studies with the ultimate objective of producinga resource for nurses working with people with type 2 diabetes in primary care.

Methods Study 1 consisted of a survey based on the Theory of Planned Behaviour of 127 people withtype 2 diabetes to examine the extent to which different beliefs were associated with healthy eating beha-viour. Study 2 consisted of three focus groups consisting of practice nurses, diabetes specialist nursesand one diabetes specialist dietician. A structured interview schedule was used to identify perceptionsof existing problems associated with patients’ attitudes towards dietary self-care and techniques alreadyused by the interviewees to deal with such problems. Finally, Study 3 consisted of an evaluation of theResource Pack. The resource was evaluated by 3 diabetes specialist nurses, 3 dietitians, one consultantdiabetologist, one professor in health psychology, one podiatrist, and 5 practice nurses.

Results Findings from Studies 1 and 2 were used to inform the development and structureof the Resource Pack. The Resource Pack was divided into seven chapters, ranging from:Motivating Change and Putting the Message Across, to Making and Maintaining the Changes.Results from Study 3 indicated that health professionals were generally very positive aboutthe Resource Pack, considering it to be valuable (mean score: 9.1/10) and acceptable to practitioners(8.8/10).

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Conclusions Results from Studies 1 and 2 were successfully used in the development of a ResourcePack for practitioners working with type 2 diabetes. The results from the initial evaluation of theresource were positive, and consideration must now be given to the way in which it is introducedto health professionals, and implemented in practice.

Unsafe sex with casual partners and quality of life among HIV-infected homosexual men

*Preau, M., Bouhnik, A.-D., Shiltz, M.-A., Spire, B., Lert, F., Obadia, Y.; *Health Social Psychologydepartment, University Aix Marseille I, Aix en Provence, France

Since the introduction of highly active antiretroviral therapy (HAART), sexual risk behaviourhave increased among HIV-infected homosexual men (HM).

Objective This study analysed factors associated with unsafe sex with casual partners, andparticularly the impact of health related quality of life (HRQL), in a representative sample ofFrench HIV-infected HM.

Design In 2003, a face-to-face survey was conducted among patients selected in a random stratifiedsample of 102 French hospital departments delivering HIV care. Unsafe sex was defined as reportingat least one anal sexual intercourse without condom with a casual partner in the previous 12 months.HRQL was assessed using the SF-36 scale. Patients who declared unsafe sex were compared to thosewho did not using chi-squared test and logistic regressions.

Results Overall, 2,932 patients agreed to participate, 607 homo/bisexual men declared sexualintercourse with casual partners in the last 12 months and 140 (20%) reported unsafe sex. Factorsindependently associated with unsafe sex were a high number of partners, use of internet network tomeet partners, casual heavy drinking, anxiolytics use, having not declared giving money for AIDSorganizations and not having declared searching sexual partners via encounters at friends/associations/work in the prior 12 months. An higher mental HRQL was associated with safe sex,physical HRQL was not associated with unsafe sex.

Conclusions Risky sexual behaviour with casual partners remains frequent among HM. It seems tobe related to HRQL, lifestyles choices, unlike other populations, where socio-economic conditionsplay a major role in risk-taking. Risk reduction programs should be tailored on lifestyles in orderto better target individuals more concerned by HIV transmission risk. It appears important toinvestigate the utility of using the internet as forum for promoting safer sex behaviors and to generatea global follow-up of in order to optimize HRQL.

Time perspective orientation and health related quality of life among HIV infected patients

*Preau, M., Apostolidis, T., Morin, M.; *INSERMU379/ORS-PACA, Marseilles, University Aix-Marseille I, Aix en Provence, France

Objectives We investigated associations between psychosocial and personal characteristics and qualityof life (QOL) among HIV-infected patients. With the French validated version to the Zimbardo TimePerspective Inventory, we evaluated the time perspective orientation (TP) of the patients.

Methods A self-administered questionnaire gathered information about HRQL (WHOQOL-HIV),TP, relationship with medical staff and self-reported side effects of HAART. Six dimensionsof QOL were used in order to figure out relationship with TP and others psychosocial characteristics.The sample (N¼ 72) for this study was recruited from an hospital departments specialised in HIV careand consisted of 48 (67%) HIV-infected women and 24 (33%) HIV-infected men with a mean age of42 years old.

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Results Cronbach alpha of each dimensions of TP were high, between 0.78 and 0.92 and showa good internal consistency. Using ANCOVA adjusted on clinical characteristics (CD4 cell-count,HCV-seropositivity, clinical stage and viral load), number of self-reported side effects andpsychosocial characteristics (patient-provider relationship, perceived social support),significant relationships were observed between negative past TP orientation and an impairmenton three dimensions of QOL: psychological, social relationship, and environment. A futureTP was positively associated with two dimensions of QOL: the level of independence and socialrelationship.

Discussion Literature report links between future TP with risk taking and health behaviour. Ourresults show that QOL is associated with the type of TP and that could give some information todisentangle the relationship with self-perception and self-esteem for example. These results shouldbe used in order to optimise HRQL in the long term, that is an important challenge for treatedHIV-infected patients.

Factor structure and reliability of the revised illness perception questionnairesin a Spanish eating disorder sample

*Quiles Marcos, Y., Terol Cantero, M., Tirado Gonzalez, S., Belendez Vazquez, M.; *UniversityMiguel Hernandez. Health Psychology Department, Spain

Just as people construct representations of the external world to explain and predict events, patientsdevelop similar cognitive models of the bodily changes that reflect either transient symptoms ormore long-term illness. The Revised Illness Perception Questionnaire (IPQ-R) was developed toprovide a quantitative assessment of the cognitive and emotional components of the illnessrepresentation in Leventhal’s Self-Regulation Model, and has been used in studies of illnessadaptation in patients with a wide range of illness conditions.

Objective The aim of this study was to analyze the factor structure and reliability of the SpanishVersion of the IPQ-R in a sample of 98 patients with eating disorders (12 to 35 years) selectedfrom the Eating Disorders Unit of San Juan Hospital (Alicante).

Method To validate the factor structure of the IPQ-R two separate principal components analyses(PCA) were conducted, one of them with the causal items, and the other with control, cure, timeline,cyclical timeline, consequences, coherence and emotional representation dimensions. The validityof the identity subscale was tested with a paired samples t-test using the symptoms experiencedsubscale and the identity subscale.

Results The analyses revealed four factors which account for 44.8% variance of the causal items, andsix factor solution including timeline, consequences, control, cure, emotional representation andcyclical timeline dimensions (49.61% of variance). Internal consistency of the IPQ-R subscaleswere adequated (�¼ 0.71; �¼ 0.80).

Conclusions The present findings show that this Spanish version could be a reliable instrumentfor research in illness perception in patients with eating disorders.

Video-relayed social support and casrdiovascular reactivity to a speech task:The influence of repressive personality and evaluation

*Quinn, T., Hughes, B.; *National University of Ireland, Galway, Ireland

Objectives Many studies have found that the repressive personality style is associated withexaggerated physiological reactivity to a wide variety of stressors. There is also considerable evidence

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to suggest that the direct provision of social support in laboratory settings serves to reduceparticipants’ cardiovascular responses to stress. As repressive copers are less likely to communicatedistress and are so less likely to attract social support, an interesting question emerges as to whetheror not the repressive personality style impedes the cardiovascular stress-buffering effects of socialsupport.

Method Eighty female undergraduates had their blood pressure and heart rate monitored whileperforming a speech task in the presence of a video-relayed confederate (social support). Participantswere randomly allocated to receive either positive social support or negative social support and highor low evaluation instructions. Evaluation apprehension has been shown in many studies to significantlyeffect cardiovascular reactivity. As positive and negative social support conditions have inherently dif-ferent levels of evaluation that may confound results an important aspect of this study was to examinecardiovascular responses to high and low evaluation. These participants also underwent psychometricevaluations of personality style and related psychological variables.

Results The results suggest that the participants were unable to detect that the confederates they wereexposed to were actually pre-recorded. An ANOVA revealed that diastolic blood pressure reactivity inthe positive social support condition was significantly greater than in the negative condition( p¼ 0.03). No main effects were found for personality style.

Conclusions The discussion will include a consideration of how the impact of social support oncardiovascular reactivity can elucidate the mechanisms by which risk for associated physical diseases,in particular heart disease, is conferred.

Sibling gender, family structure, family relations and health

*Regan, L., Cassidy, T.; *De Montfort University, UK

Objectives The aim of this study was to explore the relationship between the gender of siblings, familystructure, family relations and health in a sample of 424 young adults.

Methods The study used a survey design with questionnaire data collection.

Results Results show that the gender of siblings mediates the impact of family structure on healththrough its impact on family relations. Girls from non traditional families tended to exhibit lessdistress than boys and boys who had sisters tended to be better off than boys with brothers.

Conclusions The research suggests that gender of siblings has an impact on expres-siveness and support which is an important determinant of the longer term impact of family breakup on health.

Alcohol detoxification from primary care in the NWHB

*Reid, V., Mills, M., Sharkey, T., Stewart, P.; *North Western Health Board, Ireland

General Practitioners (GPs) have an important role to play in treating problem drinkers althoughno study in Ireland has attempted to document their opinion or use of detoxification for patients athome. A questionnaire was mailed to all GPs in the North Western Health Board (n¼ 119) toascertain current practice in this area and identify demographics of patients availing of this treatment.A total of 45 responses were obtained representing 67% of group practices and 42% of single-handedpractices. Overall, the majority (80%) of GPs who responded to the questionnaire offer home alcoholdetoxification. Within a year, the mean number of patients detoxified per GP was 4 and almost twothirds (64%) of GPs believed that a standard NWHB protocol for home detoxification was required.The majority of patients detoxified (73%) were male. The average duration of alcohol problems was15 years (SD 7.69). Librium was the most common pharmacological drug prescribed to patients

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(63%). Training on home detoxification was requested by 34% of GPs and 87% of GPs requestedinformation on this treatment.

Quality of life in children and adolescents with gaucher disease.Proposing a new measure: Gaucher-QoL questionnaire

*Remor, E., Baldellou, A., Dalmau, J., Feitos-Caldas, C., Fernandes-Epifanio, J., Fornell, J., Grascia,M., Sanjurjo, P., Garcia, H.; *Universidad Autonoma de Madrid, Spain

Background Inside a Spanish multicentre collaboration study of 10 Hospitals, a disease-specific QoLmeasure for in children and adolescents with Gaucher Disease was developed.

Methods Step 1 [questionnaire development] – A review of literature were performed and an expertspanel (four experts) were consulted to develop the items included in the questionnaire. In addiction,a preliminary version of the questionnaire with a standardized evaluation form was sent to anothergroup of experts (N¼ 6) in Gaucher Disease to make an evaluation regarding comprehensibility,adequacy and relevance to the disease of all items developed. Items assignation to a scale domainby experts were performed, as well. Expert ratings on the items formulated were used to screenthem for potential omission, or reformulation. Step 2 – A pilot study with 18 children and parentswere performed to assess reliability, validity and test-retest reliability of the new questionnaire.For this step a generic QoL measure (PedsQL 4.0), medical status and socio-demographical datawere also assessed.

Results Experts rating let us to omit three items who do not achieve agreement regarding qualityof the item, and a few items were rephrased with experts suggestions. A final four age groupsquestionnaire versions – 2 to 4 (parents form only, 17 items), 5–7 (19 items), 8–12 (19 items),13–17 (20 items) – distributed in five domains (physical health, physical functioning, well-being,social support and treatment satisfaction) were developed. Participants assessed were children agedfrom 5 to 18 years (N¼ 15) and parents of children aged 2 to 18 (N¼ 17). For child-self report,the average age was 10.02 years (SD¼ 4.7). Disease severity level was mild to 76.9% and moderateto 23.1% of the participants. Psychometric properties of the new questionnaire regarding reliability(>0.70), validity and test-retest (r> 0.85) was good.

Conclusions Experts ratings indicated that the face validity and content validity of thequestionnaire was good. The questionnaire shows be reliable and valid to assess quality-of-life.And test-retest reliability was confirmed.

Unrealistic optimism and reality constrains: Being more vulnerable but still invincible

Renner, B.; International University Bremen, Germany

Numerous studies demonstrated that people tend to believe that they are less at risk than others, aphenomenon termed as ‘‘unrealistic optimism’’. However, empirical studies have shown that realityconstraints such as the current health status or illness experiences reduce unrealistic optimism.Moreover, recent experimental studies suggest that people tend to lose their unrealistic optimisticoutlook for future health events, if they anticipate receiving feedback informing them about theaccuracy of their predictions. From a practical standpoint, the question how reality constraints suchas age, perceived health status, or the anticipation of risk feedback influence people’s estimations oftheir own risk and their estimations for the average person risk is important because it addresseshow interventions should be designed to effectively reduce the optimistic bias. The present studyaddresses this issue within the context of a public health screening (N¼ 1909). The results indicatethat reality constraints such as poor health status and the prospect of feedback lead participants to

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perceive themselves as more vulnerable towards future health problems. Conversely, the perceived riskfor an average peer did not vary in dependence of these constraints. Thus, personal risk judgments areadaptive to reality constraints. However, this adaptive mechanism appears to have clear margins sinceall groups still demonstrated evidence for an optimistic bias.

Systematic review: Psychological interventions to improve adherence tooral hygiene instructions in adults with periodontal disease

*Renz, A., Smith, D., Ide, M., Robinson, P., Newton, T.; *Dept.of Oral Health Services Researchand Dental Public Health, Dental Institute, King’s College London, UK

Objectives Adherence to oral hygiene is an important aspect in the treatment of periodontal disease.The aim of this review was to determine the impact of interventions aimed to increase adherence tooral hygiene instructions in adult periodontal patients based on psychological models and theoreticalframeworks, on the following outcomes:

. Clinical markers of periodontal disease

. Self-reported oral hygiene behaviour

Methods All randomly controlled trials testing psychological interventions aimed to improveadherence to oral hygiene in adult patients with periodontal disease were considered for thisreview. That is, the intervention had to be specifically designed within a psychological framework.

Results The review identified 4 studies in which a psychological model or theory had been explicitlyused as the basis for the design of the intervention. The four studies adopted four different theoreticalframeworks, though there was some overlap in that three of the studies incorporated elements of socialreinforcement. There was some evidence that these interventions can produce improvements inplaque scores and gingival bleeding as well as self-reported behaviour.

Conclusions There is tentative evidence that psychological approaches to behaviour managementcan improve oral hygiene related behaviours. However, the overall quality of the included trials waslow. Further, the application of the psychological model or theory was extremely poor. Thus, thereis a need for greater methodological rigour in the design of trials in this area.

Adherence to treatment and wellbeing in renal trasplanted patients

*Ricci Bitti, P., Bacchi, F., Gremigni, P.; *Department of Psychology, University of Bologna, Italy

Objectives Renal transplant recipients report many post-transplant physical symptoms that shouldbe controlled, moreover immunosuppressive medications are required to avoid the risk of renalgraft loss. Non adherence to treatment is a major problem in these patients and may be associatedto poor health outcome and perceived well-being. This study was aimed at evaluating the relationshipbetween poor adherence to treatment, perceived quality of life and psychological characteristics suchas style of coping and perceived social integration in a group of transplanted patients (TP).

Methods Thirty-four TP (13 females and 21 males), mean aged 48 � 12 years, at a mean distance oftime 5.50þ 4 years from renal transplant completed: a questionnaire on adherence to treatment, ShortForm 12 Health Survey (SF-12), Psychological Well Being Questionnaire (PWB), Social WellbeingScale, LOT-R, and COPE.

Results No associations were found between age, gender, time from transplant, and the psychologicalvariables. Multiple analyses of regression show that 55% of variance of non adherence to treatment isexplained by a model including specific style of coping based on active coping (�¼ 0.35) and a lackof information seeking (�¼�0.42) ( p� 0.0001), poor perceived psychological well-being(�¼�0.30), and poor mental quality of life (�¼�0.45). Moreover, specific aspects of intentional

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non adherence are influenced also by poor perceived social integration and relationship with themedical staff.

Conclusions The results imply that, in the management of transplant patients, subjectivepsychological variables and internal resources should be taken into account to improve adherenceto post-transplant treatment.

The role of culture in the construction of male body and self image

*Ricciardelli, L., Williams, R., McCabe, M.; *Deakin University, Melbourne, Australia

Objectives One way of understanding the influence of sociocultural factors on the development ofbody image concerns and disordered eating is to study these attitudes and behaviours in differentcultures and to examine how culture moderates the effects of gender. To date there has been nocomprehensive review that has synthesized our current knowledge of these attitudes and behavioursamong males.

Method This paper evaluates research that has examined body image concerns and other aspects ofthe self among males from non-Western cultural groups. This includes research with Samoans andother Pacific Islanders, Black and other minority males in the United States, and IndigenousAustralian adolescents.

Results Overall, the findings suggest that males from minority cultural groups are more similar toWhite women than White men in terms of their higher body image concerns, lower self-esteem andother related measures. Similarly, gay males have also been found to be more similar to women onvarious dimensions of self-image and disordered eating. On the other hand, women from someminority cultural groups are more similar to White men in terms of their low body image concerns,high self-esteem, and the fact that fewer sociocultural influences are associated with their bodyimage concerns.

Conclusions The findings will be discussed in relation to theoretical models which emphasize therole of competition, sport and other facets of masculinity which are protective factors for malesin mainstream Western culture.

Rates and correlates of DSM-IV diagnosis in patients with psoriasis

*Richards, H., Fortune, D., Sanderson, J., Cassels, C., Griffiths, C.; *Academic Division of ClinicalPsychology, School of Psychological Sciences, University of Manchester UK

Objectives Psoriasis is a chronic and disfiguring skin condition affecting in the region of 2% of the UKpopulation. The presence of psychological distress has been frequently documented in patients withpsoriasis, however, previous studies in this area have not established rates of DSM-IV diagnosis in aUK population. This study aimed to identify rates and correlates of DSM-IV diagnoses in consecutivepatients attending a psoriasis speciality clinic.

Methods This study examined DSM-IV diagnoses, assessed via the Structured Clinical Interview forDSM-IV (SCID-I), in a consecutive sample of 50 patients with a dermatologist confirmed diagnosis ofpsoriasis attending a psoriasis speciality clinic.

Results Thirty-three (66%) of patients assessed met the criteria for a current DSM-IV disorder.Anxiety disorders accounted for almost 80% (n¼ 26) of all diagnoses. Of these Generalised anxietydisorder (GAD) was the most prevalent with the same number of individuals being diagnosedwith GAD (n¼ 17) than those without any formal diagnoses (n¼ 17). Only 4 patients agreed witha checklist item indicating that they had previously experienced psychological problems, however,

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the SCID identified 14 (28%) patients meeting the criteria for a past diagnosis. The most prevalentpast psychiatric diagnosis was depression with 26% (n¼ 13) experiencing this and the remainingpatient with a past diagnosis of GAD. Current psychiatric diagnoses were not significantly more fre-quent among this group of patients with a previous diagnosis than those without a previous psychiatrichistory (�2

¼ 0.08, p> 0.77). There were no associations between gender and having a current(�2

¼ 1.74, p¼ 0.19) or past (�2¼ 1.38, p¼ 0.24) psychiatric diagnosis. Moreover individuals who

had more severe psoriasis were not significantly more likely to have a SCID diagnosis (�2¼ 0.92,

p¼ 0.34).

Conclusions To our knowledge this is the first report of the SCID-I being used to assess psychiatricdiagnosis in patients with psoriasis. The findings of this study highlight the prevalence and complexityof distress experienced by patients with psoriasis which cannot be accounted for by severity ofdisease. Given the potential role of psychological distress in accounting for manifestations ofpsoriasis the implications of this study include the value of routinely screening all patients withpsoriasis attending tertiary services so that appropriate management may be offered.

Altered HPA axis response to acute social stress in patients with psoriasis

*Richards, H., Ray, D., Kirby, B., Mason, D., Plant, D., Main, C., Fortune, D., Griffiths, C.;*University of Manchester, Hope Hospital, Salford, Manchester, UK

Objective Psoriasis may, in some patients, be triggered and/or exacerbated by stress. As activationof the hypothalamus pituitary adrenal (HPA) axis is critical to a successful stress response weinvestigated this in patients with psoriasis.

Methods Forty patients with chronic plaque psoriasis and 40 age-matched normal controlsexperienced three randomly presented acute psychological stressors (cognitive, emotional andsocial). Serial serum cortisol, pulse rate and blood pressure assessments were undertaken at baselineand following each of the stressors. 9am salivary cortisol samples were collected on the day of testing.

Results In control subjects there was a significant (r¼ 0.38; p< 0.05) correlation between pulse rateand serum cortisol level following the social performance stressor; this was not evident in the psoriasisgroup (r¼ 0.07; p¼ns). Patients who believed their psoriasis was highly stress-responsive hadsignificantly lower salivary cortisol levels at baseline ( p< 0.01) and lower serum cortisol levelsfollowing the social performance stressor ( p¼ 0.016) than patients with non-stress-responsive diseasewho believed stress had no impact. In contrast, there was no difference between the groups for changein pulse rate post-stressor.

Conclusions This study shows that patients with psoriasis, and in particular those whose diseaseappears stress-responsive, exhibit altered sympathetic and HPA responses to acute social stress.The implication is that such patients may perhaps be primed to flares of their psoriasis. Whetherthis is genetically predetermined and/or a consequence of the distress of living with psoriasis remainsto be determined.

Divergent beliefs about psoriasis contribute to psychological distress forpatients and their partners

Richards, H., Fortune, D., Chong, S., Mason, D., Sweeney, S., Griffiths, C.; School of PsychologicalSciences, University of Manchester, UK

Objectives The psychological adjustment of patients with psoriasis has been studied extensively.By comparison, no research has focused on their partners. We examined illness representationsof psoriasis held by patients and their partners and investigated whether divergent beliefs wereassociated with psychological distress.

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Methods Fifty-eight patients with chronic plaque psoriasis and their partners completed a rangeof psychological assessments including beliefs about the condition, anxiety, depression and worry.Patients also completed a self-assessment of psoriasis severity.

Results Patients with psoriasis had significantly higher levels of anxiety, depression and worry thantheir partners (t’s > 2.53, p’s < 0.05). Multiple regression analysis indicated that divergence in patients’and partners’ beliefs about emotional impact of psoriasis and chronicity of timeline accounted for astatistically significant (21.3%) proportion of the variance in depression for partners. Differencesin views on the consequences of having psoriasis and the cyclical nature of the condition were alsosignificantly associated with increased levels of worry in partners.

Conclusions Dissimilarity in particular aspects of illness representations are associated with increasedpsychological distress in particular for the partners of patients with psoriasis. The Results illustrate theimportance of concordance between patients’ and partners’ models of illness in relation to adjustmentand highlight the need to consider and collaborate with both patients and their partners in managingthis challenging condition.

Predicting intentions to quit smoking: The TPB and temporal construal

*Rise, J., Kovac, V.; *Norwegian Institute for Alcohol and Drug Research, Norway

The present paper sets out to examine the predictive power of the theory of planned behaviour (TPB)extended with moral norm and group identity in predicting intentions to quit smoking in 1 monthversus 6 months, respectively, and to explore the mediating role of desires in this context. The dataderives from a sample of daily smoking students (N¼ 156) aged 24.5, and they had been smokingfor 8 years. The TPB predictors were measured in global terms without specifying the context andtime elements. The theoretical components, except for perceived behavioural control, were morestrongly related to 6 months quitting intentions (R2

¼ 0.42) than to 1 month quitting intentions(R2

¼ 0.20). On the other hand, perceived behavioural control was more strongly related to 1month intentions than to 6 months intentions. These results are consistent with the predictionsderiving from temporal construal theory (Trope & Liberman, 2003) that global constructs are morelikely invoked as guides for distant-future behaviours. Furthermore, consistent with Bagozzis ideasthat the TPB predictors provide only reasons for acting, volitive desires partly mediated the effectsof the theoretical predictors on quitting intentions.

Prototypes and adolescent health behaviour: Reasoned action, social reaction,and goal contagion

*Rivis, A., Sheeran, P., Armitage, C.; *University of Derby, UK

Obectives The present study examined (a) the importance of prototypes for young people’shealth risk and health promoting decisions and behaviour, and (b) the processes by which prototypesimpact upon young people’s health-risk and health-promoting behaviours.

Method The study employed a prospective questionnaire survey design. At Time 1, n¼ 271secondary school pupils voluntarily completed measures of Theory of Planned Behaviour(TPB: Ajzen, 1991) and Prototype/Willingness Model (PWM: Gibbons et al., 1998) variables inrelation to 14 health and risk behaviours. Two weeks later (T2) they reported their behaviour(n¼ 136).

Results Hierarchical regression analyses showed that, together with descriptive norms and subjectivenorms, prototype perceptions contributed an additional 14, 13 and 11% to the variance explainedin risk willingness, risk intentions, and healthy intentions, respectively, and an additional 5 and 9%

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to the variance explained in risk and health behaviours, respectively, after variables from the TPB andPWM had been taken into account. Prototype similarity was the most consistent additionalpredictor of health-related decisions and behaviour.

Conclusions The findings (a) highlight the importance of prototypes for adolescents’ health riskand health promoting behaviour, and (b) suggest that prototypes impact upon young people’shealth behaviour via three routes: reasoned action, social reaction and goal contagion.

Behavioural specificity of three types of self-efficacy for exercise

*Rodgers, W., Murray, T., Bell, G., Courneya, V., Harber; *University of Alberta, Edmonton,Canada

Objectives Self-efficacy (Bandura, 1986) has been found to be a robust predictor of exercise and otherhealth behaviours. Many researchers have studied the specificity of self-efficacy to phase of activityadoption (e.g., Schwarzer). Theorists also assert that self-efficacy should be specific to the behaviourof interest. The purpose of this study was to examine the development of task, scheduling and coping(Rodgers & Sullivan, 2002) self-efficacy for two kinds of exercise.

Methods Participants were randomly assigned to a walking activity group (n¼ 44) a fitness centerbased activity group (n¼ 40), or a no activity control group (n¼ 43). Participants completed measuresof task, coping and scheduling self-efficacy for both walking 10,000 steps per day and for traditionalexercise (4�per week at 70% HRR) at baseline and after 3 and 6 months of monitoredactivity. Repeated measures MANOVA with one between subjects factor (group) and two withinsubjects factors (time; type of self-efficacy) analyses were conducted separately for the walkingbehaviour target and the traditional fitness behaviour target.

Results A significant multivariate group� time interaction for traditional fitness behaviourself-efficacy was observed, F(12, 240)¼ 2.74, p< 0.01, Eta2

¼ 0.08, but not for walking. Meansreveal that SE for traditional exercise increased over time in the traditional group.

Conclusions Participation in a supervised traditional exercise program was related to increasesin task, scheduling and coping self-efficacy for traditional exercise, but not walking. Participatingin a supervised walking program had little effect on self-efficacy for traditional exercise.People seem to have similar self-efficacy for walking regardless of type of program. These resultssupport the distinction of the three types of self-efficacy and behavioural specificity of self-efficacyratings.

Patient satisfaction with treatments in chronic low back pain

*Rofail, D., Myers, L.; *MAPI Values Cheshire, UK

Objective Chronic Low Back Pain (CLBP) is the most common form of disability. It is oftenresistant to treatment and has a significant impact on the quality of life of many patients.Therefore, patient satisfaction with treatments for CLBP is an important outcome variable.A systematic literature review was conducted to establish previous research in this field.

Method A systematic search strategy was implemented of the following electronic databases:Medline, Embase, PsycINFO, CINAHL and the Cochrane library. Studies were selected ifsatisfaction data were described in the title or abstract and original data was included. The referencesections of the selected articles were inspected for other relevant articles. In addition, PAIN andSPINE journals (1994–2004) were hand searched. Data extraction included empirical studysummaries, and identification of the instruments used to assess patient satisfaction with treatmentsin CLBP.

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Results The search strategy produced 98 articles. Twelve met all of the inclusion criteria. Resultsindicated there is a lack of research examining patient satisfaction with treatments for CLBP.Available data suggest predominantly positive but some negative attitude towards treatmentsfor CLBP.

Conclusions Further research is warranted in to what constitutes patient satisfaction including astandard operational definition and framework which makes sense of the complex inter-related factors.In addition, a reliable and valid measure to quantify patient satisfaction with treatments for CLBPis required.

Sexual behavior among adolescents: Family, school, and societal factorsthat promote sexual health

*Rosario, M., Schrimshaw, E.; *The City University of New York, USA

Objective Despite declines in adolescent sexual activity, over half of all U.S. youths under age 19have initiated sexual intercourse; rates comparable to those in other developed countries. Thus, themajority of youths are potentially at risk for early sexual initiation, pregnancy, and STIs. As such,the proposed presentation provides an examination of the role that family, schools, and the mediaplay in adolescent sexuality.

Method A comprehensive review of the research literature on the role of family, schools, and themedia in adolescent sexuality.

Results Research has demonstrated that parental attitudes toward adolescent sexuality andcondom use are related to sexual initiation and safer sex practices. Although these attitudes mustbe communicated to adolescents before the initiation of sexual behavior, such parent-child conversa-tions are rare. Parental monitoring of the child’s activities has been found to delay initiation andpromote safer sex. Despite political objections, research demonstrates that comprehensive sexualeducation programs are effective in promoting safer sex, do not increase sexual activity, and in factdelay sexual initiation among adolescents. In contrast, school-based abstinence-only programs haveno effect on delaying sexual initiation. The sexual content of television, music, and magazines popularwith adolescents has been documented; exposure to these media have been found to promote attitudesthat sexual activity is normative and without consequences. However, little research has linked mediato sexual behaviors among adolescents.

Conclusions These findings have profound implications for policy and interventions including theneed to educate and involve parents in discussing sex with their children, the need for comprehensivesex education programs, and for research and monitoring of the media consumption of adolescents.

The impact of religion, spirituality and personal beliefs on illness representations,coping and health outcome in diabetes

*Rowe, J., Hamilton-West, K.; *University of Kent, UK

Objectives There is increasing interest in the role of religion, spirituality and personal life beliefs inadapting to chronic illness (e.g., Fontana, 2003; Narayanasamy, 2002). However, such researchis not typically set within a clear theoretical framework and the underlying mechanisms are uncertain.This study set out to extend the Self Regulatory Model (SRM; Leventhal, Dienfenbach, & Leventhal,1992) by including religion, spirituality, and personal beliefs, thus assessing their impact on illnessrepresentations, coping and health outcomes in a diabetic population.

Method One hundred and forty-six type 1 and type 2 diabetes patients completed baselinequestionnaires assessing religiosity, spirituality, personal beliefs, illness perceptions, coping and

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health (general health perceptions, anxiety and depression). Health outcomes were assessed again fourweeks later.

Results Path analyses revealed significant associations between coping, illness representations andall three health outcomes and coping at least partially mediated the relationship between illness repre-sentations and health. Religiosity, spirituality and personal beliefs were not directly related to healthoutcomes. However, all three were significantly associated with coping and personal beliefssignificantly predicted illness perceptions relating to treatment efficacy.

Conclusion Religion, spirituality and personal beliefs may have important implications for patientswith diabetes, by influencing coping both directly and via illness perceptions. Individual differencesin coping and illness perceptions may also explain variations in physical and psychological health.Results of this study therefore support the influence of life beliefs on adaptation to chronic illnessand suggest that the SRM provides an appropriate framework for examining underlying mechanisms.

Cultural variations in illness perceptions: How lay individuals from differentethnic background understand stress and distress

Rudell, K.; Department of Psychology, Centre for Research on Health Behaviour University of Kent,UK

Objective The development of a new illness perception assessment tool the Bart’s Explanatory ModelInventory (BEMI), consisting of an interview (BEMI-I) and checklists (BEMI-C), allowed to examinecultural variations in lay perceptions and their association with mental state.

Methods A general population sample from three different ethnic groups (Bangladeshi n¼ 79, BlackCaribbean n¼ 85, White British n¼ 97) was interviewed (BEMI-I) about illness, stress and distressand given checklists (BEMI-C) that describe their experienced symptoms, course and consequences,what they attribute their distress to and how they evaluate treatment interventions. A diagnosticmental health interview (CIS-R) was used to examine individuals’ mental state.

Results It was found that significantly higher proportions of individuals from ethnic minorities foundsocial problems to be distressing (�2

¼ 7.448, p< 0.05), attributed distress to spiritual causes(�2

¼ 65.312, p< 0.001) and reported less positive consequences (�2¼ 32.402, p< 0.001).

Bangladeshi said that distress had a long continuous timeline, whereas White British suffer fromshorter (�2

¼ 23.842, p< 0.001), but cyclical forms of distress (�2¼ 28.060, p< 0.001). White

British viewed self-directed treatment as most helpful (�2¼ 26.159, p< 0.001), whereas

Bangladeshi preferred medical (�2¼ 6.597, p< 0.05) and Black Caribbean spiritual interventions

(�2¼ 17.916, p< 0.001). A significant amount of the variance (R2

¼ 0.600, p< 0.001) in mentalstate could be predicted by ethnic background and perceptions.

Discussion Cultural variations in perceptions of stress and distress challenge effective healthservice provision. The finding that severity of their mental state affected individuals’ perceptionshas implications for illness perception research and cognition in general. This paper will introducethe new tool for assessing illness perceptions, highlight the importance of cultural variations inthe experience of health and illness and investigate the influence of mood and mental stateon perceptions.

Illness representations in families with an adolescent suffering from psoriasis

*Salewski, C., Keins, P.; *University of Applied Sciences Magdeburg-Stendal, Germany

Objectives Illness representations have been found to be important for understanding individuals’illness-related behaviour and emotional reactions, but still little is known about the mutual impact

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of family members’ illness representations in families with a chronically ill member. This study aims atanalysing synergetic effects of the illness representations of families with an adolescent member suffer-ing from psoriasis.

Methods Thirty adolescents with psoriasis and their parents filled in questionnaires assessingtheir representations about the adolescents’ illness, their physical and psychological wellbeing,parental and adolescent coping styles. Negative affectivity and family cohesion were assessed ascontrol variables.

Results Illness representations of the family members differed in regards to control, timelineand consequences beliefs. Similarity between family members’ illness representations correlatedwith mothers’ psychological wellbeing, but not with fathers’ or adolescents’ physical and psychologicalwellbeing. Adolescents’ perceived family cohesion was strongly correlated with similarity of thefamily members’ illness representations and physical wellbeing. Similarity between bothparents’ illness representations explained 15 percent of the variance of constructive parental copingbehaviour.

Conclusions Family illness representations have a strong impact on wellbeing and copingbehaviour of parents. Strong correlations between a high similarity in family members’ illness repre-sentations and adolescents’ perception of family cohesion deserve further research: Does highcohesion lead to similar illness representations, or do similar family illness representations causea feeling of closeness? The results suggest that diagnosing both adolescents’ and parental illnessrepresentations could improve the therapeutic strategies for adolescents suffering from psoriasis andcould help to support the whole family system.

Alexithymia and panic disorder trends while attending self-help groups:A longitudinal study on 21 subjects

*Sancassiani, F., Larocca, C., Di Trani, M., Solano, L.; *Dipartimento di Psicologia Dinamica eClinica, Universita degli Studi di Roma ‘‘La Sapienza’’, Italy

Objective The aim of this study has been monitoring alexithymia and Panic Disorder(PD) trends while attending self-help groups, by supposition that Panic Disorder is anaffect regulation disorder: attending a self-help group may improve both alexithymia and panicconditions.

Method The sample is composed by 21 male and female subjects (mean age 39.33� 9.55),members of LIDAP (Italian League against anxiety, Agoraphobia and Panic disorders) self-helpgroups. We assessed the subjects for alexithymia and Panic Disorder with the Toronto AlexithymiaScale-20 items (TAS-20) and with the Panic Disorder Severity Scale-Self Report (PDSS-SR)respectively, at the beginning of the study and, then, every two months. The repeated measuresare 5 totally. At the beginning of the study, the subjects completed also a socio-anagraphicquestionnaire.

Results Alexithymia and panic data show a strong correlation, starting on second measure ( p< 0.05).During time, both alexithymia ( p¼ 0.0004) and panic ( p¼ 0.0004) trends show an overall improve-ment. On fourth measure, corresponding to the summer interruption, alexithymia scores significantlyincrease ( p< 0.05), but panic scores do not.

Conclusions The self-help group, as an ‘‘external regulator’’, may improve panic symptomsand compensate affect regulation deficit as well. Fourth measure data, corresponding tothe summer interruption, show that this affect regulation deficit may represent it self when thegroup is interrupted.

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Quality of life and chronic pain: Analyses and intervention perspectives

*Sancassiani, F., Santoni, W., Incudine, R., Gaspa, P.; *Dipartimento di Psicologia Dinamica eClinica, Universita degli Studi di Roma ‘‘La Sapienza’’, Italy

Objective The aim of this study was to describe socio-demographic and clinical features and toassess the Quality of Life (QoV) of chronic pain patients hypotezising that, in this kind of population,QoV is seriously compromised. Another aim was to assess the possible correlation between pain andpsychological dimensions in QoV evaluation.

Method The experimental sample is composed by 96 male and female chronic pain outpatients ofS. Giovanni-Addolorata Hospital (Rome) Pain Therapy Unit. We assessed the subjects for QoV withthe Italian version of SF-36 Health Survey after the medical examination; we obtained subjectsocio-demographic features by consulting their medical records.

Results SF-36 data allowed to observe a compromission in the experimental sample Quality ofLife when compared to normative Italian sample data. The widest differences concerned physical func-tioning (PF), role-physical and role-emotional limitations (RP; RE) and bodily pain (BP). The Qofreported by younger subjects was better than the one described by older subjects, specially aboutbodily pain (BP) ( p< 0.05), role-emotional limitation (RE) ( p< 0.01), mental health (MH) ( p< 0.05)and vitality (VT) ( p< 0.05). SF-36 Bodily Pain (BP) scale showed significant positive correlations( p< 0.01) with each of every other scales, but the strongest correlations were with QoV psychologicaldimensions: vitality (VT) (r¼ 0.50), mental health (MH) (r¼ 0.50), social functioning (SF) (r¼ 0.47).

Conclusions QoL in chronic pain patients is seriously compromised, but the strong correlationsbetween pain and psychological dimensions in subjects QoV evaluation offer an interesting perspectiveto project a psychological intervention in chronic pain therapy.

Empirical investigations of acceptance commitment therapy in the contextof pain application of Acceptance Commitment Therapy (ACT) to multiple sclerosis patients

*Sanchez Sanchez, L., Luciano Soriano, M.; *University of Almerıa, Spain

Aims In a recent meta-analysis study, Mohr et al. (2004) concluded that there is a consistentassociation between stressful life events and subsequent exacerbation interventions in multiple sclero-sis (MS). This conclusion supports the view that interventions in MS should not only be basedin pharmacological treatment. This study aims to evaluate the efficacy of ACT to intervene inpsychological problems associated to MS, and how this intervention influences the disabilityimprovement.

Method Participants were randomly assigned to receive treatment as usual (informative support) orthe ACT intervention plus treatment as usual. The efficacy of ACT was assessed with severalinstruments: Impact of Event Scale Revised (IES-R), Multiple Sclerosis Impact Scale (MSIS),Questionnaire of Values, Acceptance and Action Questionnaire-Revised (AAQ-R), changes inacts toward values and in frequency/intensity of preoccupations. The influence of psychologicalimprovement on the disability improvement was measured through: Multiple Sclerosis FunctionalComposite (MSFC), Wisconsin Card Sorting Test, Stroop Color and Word Test, Vocabulary Trialof Boston Naming Test, Cubes Trial of WAIS III-R, verbal memory trial of Barcelona Test andMinimental.

Results Within-group analysis: no significant pre-post changes (Wilcoxon). Between-group analysis:significant changes (U-Mann Whitney) in acts toward values ( p< 0.031) and words-colours trial ofStroop Test ( p< 0.034). Within-subject analysis: frecuency/intensity of preoccupations decreased inthe intervention group vs. control group.

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Conclusions There is an improvement in regard to psychological problems and neuropsychologicalprocesses in the ACT group vs. control group. Further research should be done with larger samplesand longer duration of the study, as well as with a better control of the influence of MS characteristics(no. of exacerbation, degree of disability, etc.).

The effects of a genetic information leaflet on public attitudes towards genetic testing

*Sanderson, S., Wardle, J., Michie, S.; *University College, London, UK

Objective There has been debate about whether information about genetic testing providedwithin genetic counseling can be truly ‘‘non-directive’’, yet surprisingly little evaluation of writteninformation materials about genetic testing. The aim of this study was to assess the impact of aseemingly ‘‘neutral’’ information leaflet on attitudes towards genetic testing.

Method A postal survey was completed by 1,024 respondents, half of whom received the geneticsinformation leaflet.

Results The leaflet group reported higher levels of subjective understanding of genetic testing (68%vs. 53%), were more interested in taking a genetic test (81% vs. 77%), and held more positiveattitudes towards genetics than people who did not receive the leaflet. Individuals with higher levelsof educational attainment reported higher levels of understanding of genetic testing than thosewith lower levels of education. The effect of the leaflet on understanding of genetic testing did notvary between demographic groups.

Conclusions Genetics information leaflets may have the intended effect of increasing understanding,but may also influence attitudes towards genetics either as an independent effect or a byproduct ofunderstanding. The fact that the information leaflet did not reduce the educational differencesin understanding suggests that future research should develop more effective ways of targetinginformation towards less educated sectors of the population. As the general public increasinglyaccesses information outside of clinical settings (e.g., on the internet), and as genetic tests becomeincreasingly available outside of clinical settings, it will become more important to understand theimpact of written genetic information materials. Increased awareness that even seemingly-neutralinformation can influence public attitudes is recommended amongst health professionals, researchersand policy informers.

Work engagement and occupational accidents: Are they related?

*Santarem Semedo, C.; *Fundacao Ciencia e Tecnologia, Portugal

Objectives Recent developments on Positive Psychology are trying to change focus from the concernof repairing negative events of life, to the construction of positive traits (Seligman & Csikszentmihalvi,2000). Looking to occupational accidents on this perspective, we would like to answer the followingquestion: workers who haven’t had occupational accidents present higher levels of work engagement(according to Shaufeli et al. (2002), a positive fulfilment related to work, characterised by vigor,dedication and absorption?)?

Methods 183 health professionals from a hospital (physicians, nurses and non qualified health carestaff) constituted our sample. From these, 22 had suffered at least one occupational accident inthe last year. To access engagement, we used the reduced version of Utrecht Work EngagementScale – UWES/R (Schaufeli & Bakker, 2003), composed by 9 items, measuring Vigor, Dedicationand Absorption.

Results Non-accidental workers represent a mean value of 5.47 on Vigor dimension, against 4.78from accidental workers. In what concerns the Dedication dimension, groups presented 5.06

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and 5.64, respectively. Finally, non-accidental workers presented an average level of Absorption of6.97 against 4.57 from those who have accidented. No significant differences between groups werefound.

Conclusions Although the absence of significant differences, it is interesting to see that workerswho did not suffer any occupational accident during the last year, present higher vigor and dedicationand above all, are more absorbed in there work than others, which may eventually contribute to theabsence of accidents.

Moving from one world to another: A model for describing processesleading to the ‘‘illness world’’

Santiago, M.; Lausanne University, Switzerland

The author presents a constructivist and phenomenological model of one’s passage from the ‘‘worldof health’’ to the ‘‘world of serious and/or chronic illness’’, with illustrations drawn from an empiricalstudy on AIDS patients. The model is adapted from the mathematical theory of disasters and gives anaccount of the complexity of the person’s changing world, of the massive disruption in his (her)internal and external environment, as part of those processes that lead from health to illness. Suchprocesses involve a dynamic movement of new adjustment to a world in which both internalinterlocutors (affect, sensations, bodily experiences) and external ones (family, friends, colleagues)are quantitatively and qualitatively modified. These changes are not without cost, both in the subject’sadaptation to the illness and in his (her) re-adaptation to health (such as in recovery or in findingequilibrium). With regard to results, our model shows that, even though one cannot deny the illnessas revealed by biomedical analyses, and even though physicians and their work (which is oftenexhausting and difficult) cannot be criticized either, one should nonetheless emphasize the importanceof differentiating, from a psychological standpoint, the ‘‘illness of the patient’’ from the ‘‘illness of thephysician’’. The illness of the patient is composed of an intricate combination of existentialistic andphysical dimensions, of bodily pain and psychological suffering. Through chronic illness, the patientgradually slides into bodily, subjective, family and social experiences that signal the destruction of his(her) world(s). The subject’s world cannot be rebuilt without giving meaning to these differentdimensions, which explains why some subjects with chronic illness may become attached to it, orwhy some patients may not find compliance acceptable.

An existential model of one’s ‘‘world view of health’’ and ‘‘world view of illness’’

Santiago, M.; Lausanne University, Switzerland

The author presents several guidelines for the operationalization of phenomenologicalcategories involved in processes of health and of serious and/or chronic illness. The relevance ofthis categorization system will be illustrated through an empirical study conducted on womenrequesting in vitro fertilization. Categories dealing with characteristics of ‘‘the world of commonsense views of health’’, such as found in the lived experience of health, are drawn from Schutz’model. They were modified by the author and complemented by characteristics of the world of‘‘experienced reality of illness’’ and characteristics of ‘‘processes of disengagement from the illnessworld’’. Assuming the existence of a process of reconstruction of the world based on ‘‘experiencedreality of illness’’ is in agreement with phenomena described in the literature as coping strategieswhereby the subject behaves in a compliant manner and manages to ‘‘come to terms’’ withhis (her) dramatic experience. We will show how this reconstruction process not only involves the sub-ject but also depends on the encounter experience, the questioning of one’s position in the world,as well as the timing and the decision. The process of adjusting or re-adjusting to the world does

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not conform to some external ethical principle that would advocate adaptation to the medical world as‘‘the right way’’ of being in the world. Adjustments may take very different forms that may not beappreciated by the medical world, such as refusing medical care. For this reason, it is important tostress that this model of world reconstruction is neither right nor wrong, but a moment in the subject’sdecision at the interface between existential decision-making and contextual possibilities.

Using comparison scenarios to increase risk comprehension

*Savadori, L., Pighin, S., Barilli, E., Rumiati, R., Tentori, K.; *Italy

Objective To test the efficacy of a verbal risk ladder technique on the ability of individuals to perceivethe difference between risk levels in the domain of prenatal diagnosis.

Method Three-hundred-sixty individuals answered the questionnaire, each randomly assigned to 1 of9 conditions. The study employed a 3 (risk level) � 3 (scenario) between subjects design. The riskof bearing a child with chromosomal anomaly varied at 3 levels. Each risk level was presentedeither with or without a comparison scenario which could be in 2 forms, each reporting 2 comparisonpoints. The effect of the 2 factors was measured on a series of dependent variables.

Results A 3 (risk level) � 3 (scenario) ANOVA on 2 of the 4 dependent variables (risk perception,more test) confirmed that the scenarios interacted with the level of risk, F(4, 350)¼ 3.210;p¼ 0.013, F(4, 351)¼ 2.552; p¼ 0.039, in the hypothesized way. Worry, instead was not affectedby the manipulation, F(4, 351)¼ 1.400; p¼ 0.233, and the intention to do amniocentesis was directlyinfluenced by the risk level but not by the presence/absence of the scenario.

Conclusions Results showed that when no comparison scenario was provided individual’s perceptionof risk did not varied according to the different risk level. On the contrary, when individuals wereprovided with a comparison scenario, their perception of risk varied according to the risk levels.The infection scenario worked better than the car accident scenario for women (probably due tosemantic relatedness).

Illness perceptions and outcome in patients withChronic Obstructive Pulmonary Disease (COPD)

*Scharloo, M., Kaptein, A., Schlosser, M., Pouwels, H., Bel, E., Rabe, K., Wouters, E.; *PsychologyUnit, Medical Psychology, Leiden University Medical Center, The Netherlands

Objectives This study aims at examining the effects of patients’ illness beliefs (as measured at time 1)on quality of life, medical consumption, and dyspnoea after 1 year (time 2) in patients with COPD.

Methods Questionnaires on illness beliefs (Illness Perception Questionnaire-Revised), and quality oflife (RAND SF-36 Health Survey) were completed twice by 160 patients with COPD (mean age65� 10, FEV1 % pred. 49 � 10). Hospital charts provided information on the number of days inhospital, number of visits to the outpatient clinic and strength of prescribed medication, all in theyear preceding measurement 2. Patients also rated the Medical Research Council (MRC) dyspnoeascale. Partial correlations (controlling for age, time 1 quality of life, and FEV1 % pred.) were usedto examine which illness perceptions correlated with the outcome measures.

Results Stronger emotional response to illness and stronger beliefs in psychological causes(stress, mental attitude, family problems, emotional state, personality) are related to worse qualityof life. Together with stronger identity beliefs and less belief in a chronic timeline, these beliefs arealso related to longer hospital stay.

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Conclusion Improving quality of life and reducing medical consumption and dyspnoea in patientswith chronic obstructive pulmonary disease requires eliciting and discussing patients’ illness beliefs.

Framework convention on tobacco control – could it be effective?

Schoberberger, R.; Center for Pubkic Health, Institute of Social Medicine Medical University ofVienna, Austria

Objectives The Framework Convention on Tobacco Control (WHO) is to protect people fromthe consequences of tobacco consumption and exposure to tobacco smoke. The convention,concerning – among other things – ‘‘price and tax measures’’, ‘‘packaging and labelling of tobaccoproducts’’ ‘‘tobacco advertising, promotion and sponsorship’’, is designed to modify attitudes ofsmokers from consonant to dissonant smokers. The question arises, if such a change in attitude iseffective enough in order to be able successfully to stop smoking.

Methods The aim of the study was to examine whether ex-smokers had different attitudes thansmokers to their risk behaviour and therefore enough motivation to stop smoking. A questionnairesurvey was taken of 307 current smokers (51.5%) and ex-smokers (48.5%). In both groups therewere about 60% men and 40% women.

Results While among current smokers 43% are consonant this was true for only 27.8% of ex-smokersin the period before they quit smoking. There were no significant differences regarding nicotinedependence as assessed by FTND between current smokers (mean score: 3.45) and ex-smokers(mean score: 3.14). But ex-smokers who were successful in their first attempt to stop smokinghad a significantly lower FTND score (2.57) than those who needed more than one attempt(3.73). Nicotine replacement therapy was used by only 8.4% of the ex-smokers who were successfulin their first attempt to quit but by 29.5% of the ex-smokers who tried more than once.

Conclusions A wide variety of tobacco control measures and information promoting contemplation toquit are important to initiate smoking cessation attempts. Smokers with a low degree of nicotinedependence could be motivated by measures of the FCTC and have a good chance to stop smokingby self-help. Smokers with a higher degree of dependence need professional help. This underlinesanother important demand of the FCTC to provide effective measures to promote cessationof tobacco use and adequate treatment for tobacco dependence.

Plan-execution self-efficacy and mastery of action plans: Dynamics inhealth-behavior change

*Scholz, U., Sniehotta, F., Schuz, B., Oeberst, A.; *Freie Universitat, Berlin, Germany

Objectives Self-efficacy and action planning are crucial factors for health behavior change. If per-sonal actions plans are understood as personal tasks individuals set for themselves, persons have acorresponding plan-execution self-efficacy (PESE) for each action plan. This study examined thereciprocal relationship between PESE and the mastery experience of the respective action planfor physical exercise over a six-week period. It was investigated whether PESE preceded masteryof the action plan in the causal ordering and thus emerge as one important factor for the well-proven effectiveness of action plans on behavior change. Furthermore, it was tested whetherPESE was the better predictor for physical exercise at the two-month follow-up than masteryexperience.

Method Participants of the study were 122 persons undergoing cardiac rehabilitation. All participantscompleted a baseline questionnaire during rehabilitation and a follow-up questionnaire 2 months after

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discharge. Plan-execution self-efficacy and mastery of a personal action plan were assessed each weekduring the first 6 weeks after discharge from the rehabilitation center via short weekly questionnaires.

Results Multilevel cross-lagged panel analyses demonstrated that mastery experience was positivelyrelated to the development of PESE, which in turn did not predict subsequent mastery over thesix weeks. Plan-execution self-efficacy assessed at the sixth week after discharge, however, predictedphysical exercise at the two-months follow-up, whereas mastery experience did not.

Conclusions Results indicate that plan-execution self-efficacy develops over time in relation to thecorresponding mastery experience of a personal action plan. The prediction of subsequent exercisebehavior by PESE, in turn, underlines the assumption of a reciprocal relationship between self-efficacyand behavior. Implications for behavior change interventions will be discussed.

Perceived behavioural control and activity limitations in patients with polyneuropathy

*Schroder, C., Johnston, M., van Meeteren, N., Teunissen, L., Notermans, N.; *Rudolf MagnusInstitute of Neuroscience, University Medical Centre, Utrecht, The Netherlands

Objectives To investigate whether perceived behavioural control (PBC) contributes to activitylimitations and if so, PBC mediates the relationship between impairment and activity limitationsin patients with chronic idiopathic axonal polyneuropathy (CIAP; a neuropathy that is progressivelycausing locomotor problems).

Methods Cross sectional study; 55 patients diagnosed with CIAP were assessed on their impairment(muscle strength), activity limitations (shuttle walk test, (SWT), physical component of SF-36 andpatients self reported time ‘ability to walk without resting’), intentions on and PBC over performingactivities. Correlations and multiple hierarchical regression analyses were performed to examineif PBC is a concurrent predictor of the performance of activities, and in self-reported activitylimitations. The possible mediating effect of PBC and intention between impairment and activitylimitation was examined according the methodology of Baron and Kenny (1986).

Results Hierarchical multiple regression analyses showed that PBC, but not intention, significantlyexplained variance in the SWT (R2

¼ 0.09; p< 0.01), and in both self-reported measures of activitylimitation, SF-36 (R2

¼ 0.12; p< 0.01) and in self-reported time ‘ability to walk without resting’(R2

¼ 0.24; p< 0.01). In all three measures of activity (limitations), PBC significantly mediated theeffect of impairment (Sobel test: p< 0.05).

Conclusions Results show that PBC is a concurrent predictor of performance and self-reportedactivity (limitations) in patients with CIAP while intention is not. Additionally, PBC mediates the rela-tion between impairment and activity (limitation). These findings are consistent with the theoreticalmodel we used that integrates the WHO’s International Classification Functioning (ICF) with theTheory of Planned Behaviour. Implications of these findings will be discussed.

Adjustment to cancer in the eight years following diagnosis a longitudinal studycomparing cancer survivors with healthy individuals

Schroevers, M.; University of Leiden, The Netherlands

Objectives The goal of the present study is to gain more insight into the process of long-termadjustment of the large and growing population of cancer survivors. We examined whether cancerhas a long-term impact on functioning, by comparing cancer survivors with healthy references.

Methods Comparisons were made between 206 cancer survivors and 120 similar-agedreferences without cancer from the general population. Comparisons were made at 3 points intime: at 3 months, 5 months, and 8 years after diagnosis. A wide variety of outcome measures was

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assessed including physical functioning, psychological functioning, personal resources (self-esteem,life satisfaction, sense of meaning in life), and social resources (social support, marital satisfaction).These quantitative data was supplemented with a qualitative interview, focusing on specificcancer-related issues and positive consequences of illness.

Results At 8 years after diagnosis, no significant differences between survivors and references werefound in psychological well-being, personal and social resources. However, survivors did report morephysical problems than references. Intriguingly, both survivors and references reported the experienceof positive changes in the past 8 years, with many survivors attributing these changes to the cancerexperience.

Conclusions In the discussion, we address the relative independence of negative and positive out-comes and the role of finding positive meaning in the cancer experience. Psychologicalinterventions should focus on both fostering positive experiences and reducing distress.

How affiliation-motive-congruence and emotional disclosurework together in predicting well-being

*Schuler, J., Job, V.; *University of Zurich, Switzerland

This study aims at bringing together two theoretical explanations for subjective well-being. The firsttheoretical point of view comes from motivational theorists who have provided empirical evidence thatincongruence of implicit motives and explicit motives leads to impairment of well-being. An exampleis the incongruence of implicit and explicit affiliation motives, which we focused on in this study.Although it seems plausible that the incongruence-well-being relationship could be influenced bymotive-congruent behaviour or any other moderator, astonishingly moderator-hypotheses haverarely been examined. The second theoretical point of view comes from emotional disclosure researchthat has demonstrated the beneficial effects of emotional disclosure on well-being. One form ofdisclosing emotions is talking honestly and trustingly to friends or partners about events that happenedin ones life. Simultaneously this behaviour seems to be a prototype of affiliative motivated behaviour.And here is the point we bring both theoretical points of view together: in a correlative study with 52students we measured the implicit affiliation motive (MMG) and the explicit affiliation motive (PRF)and computed motive-incongruence. We tested whether affiliative behaviour, measured by emotionaldisclosure, moderates effects of incongruence on well-being (negative affect, life satisfaction). Maineffects of incongruence as well as of emotional disclosing on well-being were found. Additionally,the moderator hypothesis was supported, indicating that congruence of motives was a necessaryprecondition but not a sufficient factor of well-being. Only when motive congruence and motive-congruent behaviour (emotional disclosing) came together people felt good. Theoretical and practicalimplications of the results were discussed in terms of theories of motivation and emotional-disclosure.

Social support in dyads: Towards a future research agenda from social supportto dyadic coping: More than a change of perspective?

*Schulz, U., Schwarzer, R.; *Preventive Medicine Research Institute, Sausalito, USA

Objectives Social support research has moved from the individual to the dyad as unit of analysis. In asample of cancer patients and their partners the present study investigates patients’ process ofadjustment to cancer by taking spouses’ support provision to the patients, their personal resources,and their own coping into account. A series of analyses is set out to investigate the interdependenceof patient and partner behavior and thus, its effects on coping with cancer.

Methods One month after patients underwent surgery for a cancer of the gastrointestinal tract,they and their spouses reported on their social and personal resources (e.g., self-efficacy), and

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coping with the illness (N¼ 173 couples). Depression, quality of life, and benefit finding were chosento indicate patients’ adjustment six and twelve months after surgery.

Results Beyond patients’ own coping resources, spouses’ support provision and self-efficacycontributed to patients’ adjustment. Resourceful partners were not only able to provide more supportbut also transferred their resources onto the patients as shown by time-lagged effects on copingstrategies, some of which were further linked to benefit finding. Furthermore, patients’ healthcondition and coping abilities (e.g., mobilization of support) influenced spouses’ efforts at providingsupport, illustrating the interdependence within the relationship.

Conclusions The study shows that inclusion of spouses’ reports on their behavior provides valuableinformation for the understanding of coping with severe stressors. Mobilization and transfer of sup-port were characterized by gender and age differences, a result that suggests further fine-grained ana-lysis of couple interactions. The study provides insight into the dynamics of interpersonal copingefforts and points out how tailored interventions may help both partners cope in a stressful situation.

Stage-specific effects of action control on regular preventive dental health behaviour

*Schuz, B., Sniehotta, F., Wiedemann, A., Seemann, R.; *Freie Universitat Berlin, Germany

Objectives Action Control referring to self-regulation via negative feedback loops is regarded highlyvaluable for acting on behavioural intentions by being the proximal predictor of behaviour. It is hypothe-sised that action control is especially beneficial for individuals in the volitional phase of behaviour.Action control has been conceptualised as awareness of individual standards, self-monitoring andself-regulatory effort. This study examined whether action control contributes to the prediction of beha-viour change and whether it was more beneficial in post-intentional than in pre-intentional participants.

Methods Participants of a longitudinal study (N¼ 150) on dental health behaviour (interdentalflossing) indicated their behavioural stage (pre- or post-intentional), behavioural intentions, actioncontrol and dental flossing in three questionnaires during an interval of seven weeks. Hierarchicalregression analyses for pre-and post-intentional participants were conducted to determine whetherpost-intentional participants (as classified with a stage algorithm in the t1 questionnaire) profitedmore from action control than pre-intentional participants.

Results Regression analyses found that action control t2 mediated the influence of t1 intentions andbaseline performance on t3 levels of interdental flossing for post-intentional participants, but not forpre-intentional participants. In post-intentional participants, action control emerged as singlesignificant predictor of behaviour (�¼ 0.36, p< 0.01). However, behaviour prediction was better inpre-than in post-intentional participants (R2

¼ 0.38 compared to R2¼ 0.27).

Conclusions These findings suggest that action control conceptualised as awareness of standards,self-monitoring and self-regulatory effort is an important facilitator of behaviour enactment, overand above the influence of baseline behaviour once an intention is formed. The differences inexplained behaviour variance are interpreted with regard to lower self-regulation problems inpre-intentional participants. Implications for health behaviour change interventions will be discussed.

Controversies in guiding and evaluating health behavior change: Stage models vs. continuummodels identifying effective techniques: The example of physical exercise

Schwarzer, R.; Free University of Berlin, Germany

Objectives Controversies in guiding and evaluating health behavior change: stage models vs.continuum models. This presentation examines the utility and challenges of employing stage

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models to enhance the theoretical explanation of health behavior change, and the intervention efficacyof health promotion strategies.

Methods and Discussion In this presentation, differences between various stage models will bediscussed, empirical evidence (physical exercise, nutrition, dental hygiene, breast self-examination)will be presented, and unresolved issues will be raised. Stage models can be seen as superiorto continuum models only if empirical evidence emerges that attests to the discontinuity betweenstages and to the successful tailoring of interventions to subgroups of individuals who have beenidentified at such stages. Moreover, factors that move people from one stage to another need to bedemonstrated. Authors have argued that the notion of stages might be flawed or circular, in thatthe stages are not genuinely qualitative, but are rather arbitrary distinctions within a continuousprocess. Proposed time frames for distinguishing between different qualitative stages may not beconclusive. One parsimonious model is the Health Action Process Approach (HAPA). It paysparticular attention to postintentional mechanisms, and it conveys an explicit self-regulationperspective. It suggests a distinction between (a) preintentional motivation processes that leadto a behavioral intention, (b) postintentional volition processes that lead to actual healthbehavior. This volition phase can be subdivided into a post-intentional pre-actional phaseand an actional phase. In the three phases, different patterns of social-cognitive predictors shouldemerge.

Conclusions Interventions should be explicitly designed on the basis of continuum and stage models,and their evaluation should allow for a reconsideration of the theory. Thus, it is suggested to providedata that allow for a competitive evaluation. For example, in continuum-based interventions,participants should be assessed with a staging algorithm to judge whether all subgroups benefitfrom the treatment in the same manner.

Do verbal-autonomic response dissociations mediate the relation betweenavoidant coping and pain perception?

*Schwerdtfeger, A., Schmukle, S., Egloff, B.; *Johannes Gutenberg-University Mainz, Germany

Objectives Elevated autonomic stress responses relative to verbal reports of negative affect havebeen discussed to characterize avoidant or repressive individuals. This dissociated response patternhave been referred to as verbal-autonomic response dissociation and might indicate an impairedperception of bodily symptoms necessary to engage in preventive health behaviours. Hence, responsedissociations might lead to the development of diseases because of a disattention to negative feedbackcues that are essential for the prevention of diseases. However, little is known about the behavioralcorrelates of verbal-autonomic response dissociations. Therefore, a study will be presentedthat aims to relate verbal-autonomic response dissociations to the perception of experimentallyinduced pain.

Methods Eighty-five student volunteers underwent a public speaking task and a cold pressor test.Heart rate and negative affect in response to the speaking task were recorded and pain ratings afterthe cold pressor test were obtained. A discrepancy score was calculated for each individual bysubtracting standardized changes in negative affect from standardized changes in heart rate.

Results Response discrepancy was a significant mediator of the relationship between avoidant copingand pain perception, although it was unrelated to expressive indicators of pain (EMG responses ofthe corrugator supercilii).

Conclusions The study provides support for the assumption that a preponderance of autonomicover subjective responsiveness might be indicative of an attenuated perception of bodily symptoms.

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The influence of choice of exercise program on motivation and study completion:A self-determination perspective

*Scime, G., Rodgers, W., Bell, G., Courneya, K., Harber, V.; *University of Alberta, Edmonton,Canada

Objectives The purpose of this study was to examine the initial and long-term influence ofchoice of exercise program on exercise motivation and exercise study completion. According toself-determination theory (Deci & Ryan), individuals who experience more autonomy in their behav-ioural choices should also display greater behavioural persistence and more self-determined motives.

Methods To accomplish this task, participants aged 25–65 years (N¼ 108; n¼ 27 men; n¼ 78women, n¼ 3, missing) were randomized to either a choice or no-choice condition. The no-choicegroup was further randomized to a traditional exercise program carried out at a fitness center, orto a lifestyle walking exercise program. Motivation was assessed at four time-points utilizing theBehavioural Regulation in Exercise Questionnaire (BREQ; Mullen, Markland, & Ingledew, 1997).

Results A Chi-square test showed that participants in the choice condition were more likely tocomplete the exercise study than those in the no-choice condition (�2

¼ 7.713, p< 0.05). Overall,rates of non-completion were 50% higher in the no-choice group. MANOVA on study completers(n¼ 56) supported the hypothesis that those in the choice group would display more self-determinedmotivation over a 4-month period. Specifically, a significant multivariate time by group (choice/no-choice) interaction ( p< 0.01, ES¼ 0.42) was observed. Univariate follow-up analyses revealedthat the choice group had significantly lower extrinsic and significantly higher identified motivationthan the no-choice group after the choice manipulation, with similar trends observed in introjectedand intrinsic motivation respectively.

Conclusions Collectively, these results show that choice of exercise program has a positive effecton self-determined exercise motivation and study completion. The results are consistent with thepropositions of self-determination theory (Deci & Ryan).

Measuring psychodermatological distress: The construction of the Skin Shame Scale (SSS)

*Scott, C., Thompson, A., Kellett, S., Kent, G.; *University of Sheffield, UK

Objectives Shame has been described as being a potentially key moderating emotion in adjustmentto disfigurement. This study aimed to construct a skin specific measure of shame.

Method One hundred and sixty-two patients attending dermatology outpatient clinics sufferingwith psoriasis, eczema or acne participated in a cross sectional study in which the Hospital Anxietyand Depression Scale (HADS: Zigmond & Snaith, 1983), Internalised Shame Scale (ISS: Cook,1994) and a clinician and self perceived index of disease severity and the Skin Shame Scale wereadministered.

Results Exploratory factor analysis reduced the SSS to 24 items, comprising of four factorstermed, affective avoidance, skin pride, stigma and behavioural avoidance. The scale had satisfactoryreliability, consistency and had concurrent validity with the HADS and ISS.

Conclusion This study contributes to the psychodermatological literature in developing a scalebased on psychological theory with promising psychometric qualities. The findings have implicationsfor the psychological understanding of skin distress. However, the psychometric qualities of thescale warrant further investigation.

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Patient delay for potentially malignant oral symptoms

*Scott, S., McGurk, M., Grunfeld, E.; *Institute of Psychiatry, Guy’s Hospital London, UK

Objectives Detecting oral cancer when lesions are small and localised is the most effective meansto reduce mortality and morbidity associated with this disease. Numerous reports suggest thatapproximately 30% of patients delay seeking the advice of a healthcare professional after self-discoveryof symptom(s) of oral cancer. The purpose of this study was to produce a theory-driven assessmentof the cognitive, behavioural and emotional responses following the self-discovery of potentiallymalignant oral symptoms and to provide insight into psychosocial variables associated with delayedhelp-seeking behaviour for symptoms of oral cancer.

Methods Semi-structured interviews were conducted with newly referred patient’s (n¼ 60)presenting with potentially malignant oral symptoms (localised non-recurring ulcer, localisedpersistent oral discomfort, discolouration or a lump/swelling in the oral cavity). Using the Self-regulatory Model (Leventhal, 1970) as a framework, participants were asked about the discoveryof their symptoms, initial interpretations of their symptoms, the reappraisal of these symptominterpretations, coping with symptoms and emotional reactions to their symptoms. Participantswere also asked as to the triggers and barriers to their decision to seek help. ‘Framework analysis’was used to interpret the qualitative data.

Results Preliminary analyses suggest that potentially malignant oral symptoms are rarely attributedto cancer and hence many patients were initially unconcerned about the presence of an oral symptomand treated the symptoms as trivial oral conditions. Triggers to seek help included the persistence ofsymptoms and the inability of patients’ own interpretations to explain the occurrence of symptoms,whereas barriers included the inaccessibility of the health professional, the belief of a natural recoveryand presence of competing priorities.

Conclusions The results of this study will be used to inform the development of an interventionaimed at addressing the problem of delay in seeking help for symptoms of oral cancer.

An exploration of illness beliefs, coping style and self-management behavioursin patients with type 2 diabetes

*Searle, A., Norman, P., Thompson, R., Vedhara, K.; *University of Bristol, UK

Objectives This aim of this work was to explore the relationship between illness beliefs with cognitivemeasures of coping and behavioural measures of coping in patients with type 2 diabetes.

Methods The illness beliefs of patients with type 2 diabetes (N¼ 134) were assessed with an adaptedversion of the IPQ-R. Cognitive coping was assessed with an adapted version of the Medical Modesof Coping Questionnaire (MCMQ) at 0 and 12 months. Patients’ behavioural coping was assessedwith self-report measures of medication and exercise and a food frequency questionnaire.

Results After controlling for demographic and clinical variables stepwise regression analysesdemonstrated that illness beliefs were independent predictors of both coping style and healthbehaviour 12 months later. Perceived consequences predicted ‘confrontational’ coping (�¼ 155,p< 0.05), treatment control predicted ‘avoidance’ coping (�¼�0.217, p< 0.01) and emotionalrepresentations predicted ‘acceptance’ (�¼�0.127, p< 0.05) coping. With regard to health behaviours,perceived consequences predicted fibre (�¼ 0.675, p< 0.001) and fruit and vegetable intake (�¼ 0.107,p< 0.05), cause (own behaviour) predicted saturated fat (�¼ 0.201, p< 0.05), treatment control(�¼ 0.803, p< 0.01) and emotional representations predicted carbohydrate (�¼ 0.689, p< 0.05),treatment control also predicted exercise (�¼ 0.142, p< 0.033) and emotional representations(�¼�0.633, p< 0.001) and illness coherence predicted medication (�¼�0.306, p< 0.05). Further

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analyses also showed that coping style is predictive of patients’ dietary behaviour over and above theinfluence of illness beliefs. For example confrontational coping was the sole predictor of fat(�¼�0.408, p< 0.05) and carbohydrate intake (�¼ 0.518, p< 0.05) after controlling for illness beliefs.

Conclusions Illness beliefs were predictive of both cognitive coping style and actual behaviouralcoping. However, there are theoretical implications regarding the role of illness beliefs and copingstyle in predicting behaviour. The extent that behavioural outcomes are mediated or moderated bycoping style requires further exploration.

Smoking cessation guidance in healthcare settings:Adoption of Minimal Intervention Strategies (MIS)

*Segaar, D., Willemsen, M., Bolman, C., De Vries, H.; *University of Maastricht, The Netherlands

Objectives To asses the determinants of adoption of stepwise smoking cessation protocols (basedon the 5 A’s strategy) in health care settings, such as midwives practices and cardiology wards.

Methods Two cross-sectional studies were performed. Questionnaires were distributed amongall Dutch cardiology wards (N¼ 121) and Dutch midwives practices (N¼ 446). To define determi-nants, the Integrated Model for explaining motivational and behavioural change (I-Change)was used. The I-Change model integrates concepts of various social cognitive models and includesmotivational factors as well as information, awareness and predisposing factors.

Results Seventy-seven ward heads (64%) and 251 midwives (56%) responded. For both groups,adopters had a more positive attitude and higher perceived self-efficacy, and expected more positivesocial norms and support compared to non-adopters. Furthermore, adopters had more awarenessknowledge than non-adopters. The level of risk-perception did not differ between the two groups.Very few differences were found in predisposing factors: a high level of formalization was foundto inhibit adoption in cardiac wards, while this facilitated adoption in midwives practices, and sizeof the ward was an important predictor of adoption in cardiac wards. For midwives practices thepresence of an assistant increased adoption rates. In cardiac wards, smoking behaviour turned outto inhibit adoption of the MIS, such an effect was not found in midwives practices.

Conclusion Motivational factors play an important role in the decision to adopt the MIS in suchdiverse health settings as cardiology wards and midwives practices. Characteristics of the settinghardly influence the effect of motivational factors on adoption. Predisposing factors do not seem toexplain much of the difference between adopters and non-adopters when studying specific settingsand the predisposing factors that were found to predict adoption differed between settings.

Predictors and consequences of health behavior enhancing the individual lifestyle

*Se�k, H., Ziarko, M., Pasikowski, T.; *Institute of Psychology, Mickiewitz University, Poland

Objectives Health promoting behaviors are a part of human action striving to fulfill goals andrealize life tasks with consequences for well-being. The constructed model of processes involved informulating the intention of health behaviors, their planning and implementation also comprisesthe evaluation of health behaviors’ consequences for well-being. Given the developmental, socialand cognitive character of the approach, we have included such predictors as: the goals and tasksof early adulthood, preferred model of health, locus of control, sense of self-efficacy, sense ofcoherence, being an agent in undertaking the intention as well as intention maturity. Thus, themodel focuses on these variables which are significant for supporting the development of an individuallifestyle connected with health. The subjective assessment of the consequences of health behaviors’

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implementation and the level of well-being constitutes an important contribution to the researchconducted so far.

Method The research involved 284 voluntary participants, 148 women and 136 men, aged 18–35,with high school or higher education. A set of rating scales and questionnaires was used to measurehealth enhancing intention, health behavior and well-being as a consequence of healthbehavior. Measures of subjective health concept, self-efficacy, SOC, MHLC, planning of intentionimplementation and sense of agency were used.

Results The Structural Equation Modeling was used to verify the theoretical model partiallyand entirely. It was stated that the necessary factors for a strong intention are: the level of agency,preference for a holistic model of health, the place of health in one’s system of values and social influ-ence. Intention maturity and strong will play the most important role in planning and undertakingof health activity. Health behaviors are evaluated both positively and negatively in terms of anindividual’s well-being, but positive consequences prevail.

Conclusion The results confirmed the validity of the tested model and the significance of subjectpredictors in enhancing health behavior and well-being.

In science we trust? The influence of trust and information presentationon attitudes to gene patenting and cloning

*Senior, V., Barnett, J., Cooper, H.; *University of Surrey, UK

Objectives The public have an increasingly important role to play in determining policydecisions about science. Whilst there have been a number of large scale surveys assessing publicattitudes to modern genetic science, little is known about the way in which characteristics of theperson interact with characteristics of both the information and information source to inform theseattitudes.

Methods Two vignette studies conducted with 245 members of the British general public whovaried in the extent to which they had trust in science and scientists. The first study presentedinformation about the advantages and disadvantages of allowing companies to patent genes and thesecond study presented information about regulations concerning therapeutic and reproductivecloning. Participants then completed a questionnaire including measures of attitudes, ambivalence,trust, and behavioural expectations.

Results Attitudes towards both gene patenting and cloning were related to level of trust in science.As predicted, the group with higher trust in science had more permissive attitudes towardsboth these issues. In relation to gene patenting, attitudes were also related to the type of argumentspresented (one-sided versus two-sided) and the source of the information (an independent source ora source with a vested interest). In the case of cloning, attitudes varied in terms of whetherparticipants were asked to consider the case for therapeutic or reproductive cloning.

Conclusions These findings highlight the role of individual differences and contextual variablesrelating to information presentation in influencing public attitudes to genetic sciences.

Depressed mood and anxiety in heart failure and heart transplant patients

*Sheffield, D., Kidd, T., Hallas, C.; *Staffordshire University, UK

Objective To examine differences in psychosocial factors between heart failure and heart transplantpatients, and to examine changes in psychosocial factors following transplant.

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Methods Thirty-seven Chronic Heart Failure patients aged between twenty years and sixty-sevenyears, and 66 Cardiac Transplant patients aged between nineteen years and seventy-one years,were recruited from a Middlesex hospital. All participants completed questionnaires examiningpsychosocial factors including depressed mood, anxiety, anger, well-being and functional limitations.

Results Initial univariate analysis revealed that heart failure patients reported more sleeplessness/anxiety ( p¼ 0.06), social dysfunction ( p¼ 0.03), depressive symptoms ( p¼ 0.006), sub-clinicalanxiety ( p¼ 0.07) and sub-clinical depression ( p¼ 0.003) than transplant patients. In addition,length of time since transplant was inversely related to sub-clinical anxiety (r¼�0.41, p¼ 0.001)and sub-clinical depression (r¼�0.31, p¼ 0.01).

Conclusions These initial data suggest that transplant patients have reduced depressed mood andanxiety compared to un-transplanted heart failure patients. In addition, levels of depressed moodand anxiety were lowest many years (between seven and nine years) after the transplant.Transplant may have benefits on psychosocial well-being in addition to cardiac improvements.

Using legislation to manage smoking: Ireland’s experience of the smoking ban

Shelley, E.; Department of Health and Children, Ireland

Objectives To assess the impact of the implementation of legislation to ban smoking in workplaces inIreland in March 2004 in relation to (1) feasibility and compliance, and (2) impact on the prevalenceof smoking.

Methods Trends in the prevalence in smoking prior to the introduction of the ban were estimatedusing data from a number of sources. Reports of inspections by the Office for Tobacco Control(OTC) provide information on compliance with the legislation and surveys by the OTC providedata on acceptability and on trends in prevalence.

Results One year after the ban a national survey found that 96% of people believed the law wassuccessful, including 89% of smokers; 98% believed that workplaces were more healthy, including94% of smokers. At that time, compliance was high: 93% in hotels, 99% in restaurants and 90% inlicensed premises. Smoking prevalence had been approximately 30% since the early 1980s; regularor occasional cigarette smoking decreased from 31% in 1998 to 27% in 2002. Prevalence decreasedfrom 25% in August 2003 to 24% in November 2004. Data from the Revenue Commissioners showa decrease in cigarettes ‘retained for use’ in Ireland in 2003 in advance of the ban, probably related tocumulative tobacco taxation and price increases of 44% between 1999 and 2003, as well as decreasingsocial acceptability of the habit.

Conclusions There has been over 90% acceptability ratings and high levels of compliance withlegislation to ban smoking in workplaces in Ireland. Smoking prevalence decreased in advanceof the ban, probably due to increases in taxation. Prevalence has continued to decrease to 24%of adults since the implementation of the ban.

Attitudes of the general public towards genomics

Shepherd, R.; University of Surrey, UK

Advances in genomics in recent years have led to substantial developments in pharmaceuticalsand medicine. However, applications in food and agriculture have met with negative public reac-tions in Europe and future medical applications such as genetic testing, gene therapy and cloningmay also present major issues of public concern. There is a clear need to understand how membersof the public think about and make decisions in this area. Against this background the Economicand Social Research Council commissioned a major project on public attitudes to genomics in the

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UK. Three substantive questions are addressed across this project. (1) What is the impact ofknowledge on attitudes towards genomics? (2) To what degree are attitudes towards genetic tech-nologies coherent with other socio-political attitudes, attitudes towards new non-genetic technolo-gies and with self-interest. (3) How do contextual factors influence ambivalence of attitudestowards genomics? A range of methods has been employed to address the above questions.Initially, a national baseline survey was conducted on over 3000 people in association with theBritish Social Attitudes Survey. This is complemented by an intervention study examining theeffects of information provision with a sub-sample from the original survey, focus groups and inter-views analysed using discourse analysis and other qualitative methods, a textual analysis of repre-sentations of genomics, and a series of experimental ‘‘vignette’’ studies. This paper will presentthe background, rationale and structure for the overall project and how the parts of the projectinter-relate.

Evaluation of the effects of growth hormone treatment on measures ofHealth Related Quality of Life in Children (HRQOL)

*Sheppard, L., Eiser, C., Carney, S., Clarke, S.-A., Wright, N., Davies, H., Ross, R., Wales, J.,Butler, G., Stoner, A., Ryder, M., Urquhart, T.; *Child and Family Research Group, UK

Objectives This study examines HRQOL in children aged 8–16 years with ideopathic oracquired (malignancy) growth hormone deficiency commencing treatment with growth hormoneover a 6 month period.

Methods Twenty-four children (15 males) and their parents participated. Parents completedstandardised measures of child psychological adjustment (including subscales to measure prosocialbehaviour and impact of difficulties on the family) and HRQOL. Children completed a HRQOLmeasure and short-term memory task. Exercise behaviours and fitness levels were evaluated byquestionnaire and the Modified Shuttle Test (MST). Measures were administered pre-GHT andsix months later.

Results Parents reported improved child HRQOL ( p< 0.05) and a reduction of impact of difficulties( p< 0.01) over the six-month period. Children’s fitness levels improved significantly over time(16%; p< 0.01) as measured by the number of shuttle runs achieved on the MST. Children reportedimproved HRQOL but this did not reach significance.

Conclusions GHT is associated with improvements in HRQOL and fitness in children, and areduction of the impact of difficult child behaviour on family life over the first six months.

Causal model of life-skills, exercise, and health condition of college students

*Shimamoto, K., Ishii, M.; *Tokyo Institute of Technology, Japan

The purpose of this study is to examine the causality among 3 factors which indicate exercise, health,and life-skills using the Daily-Life Skills Scale (DLSS; Shimamoto, 2004). DLSS is designed tomeasure life-skills of college students. Participants of the study were 729 Japanese college students(318 males and 411 females) who filled out the DLSS and answered several questions about theirsports interests, amount of physical exercise, and condition of health. In the study, focus was onprimary factors such as self-esteem, intimacy, and educational motivation, which were chosen fromthe DLSS. Four hypotheses were examined. Hypothesis 1 is that sports interests affect the amountof physical exercise. Hypothesis 2 is that physical exercise affects the condition of health.Hypothesis 3 is that physical exercise influences student’s self-esteem, intimacy, and educationalmotivation. Hypothesis 4 is that condition of health also has an impact on these 3 primary factors.

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A covariance structure analysis confirmed the proposed causal model of these 4 hypotheses. Four fitindices of this model indicated appropriate levels (GFI¼ 0.966, AGFI¼ 0.949, CFI¼ 0.954,RMSEA¼ 0.047). The results showed that sport interests affect the amount of physical exercise(beta¼ 0.66, p< 0.001), as in hypothesis 1, and that physical exercise affects the condition ofhealth (beta¼ 0.41, p< 0.001), as in hypothesis 2. But physical exercise had no significant influenceon the 3 primary factors, and condition of health affected self-esteem (beta¼ 0.95, p< 0.001), inti-macy (beta¼ 0.43, p< 0.001), and educational motivation (beta¼ 0.51, p< 0.001), as in hypothesis4. The results of this study suggest that condition of health stands between physical exercise andlife-skills. Therefore, it is important to improve the life-skills of college students that they pay attentionto the condition of their health while participating in athletic or recreational sports.

Development of the perceived promotion and interference scales of physical exercise

*Shimizu, Y., Motonobu, I.; *Obirin University, Japan

Objective The purpose of this study is to develop the perceived promotion scale and interferencescale of physical exercise. To examine how psychological variables influence adoption of physicalexercise, a cross-sectional study was conducted with Japanese university students.

Background Not a few urban residents in Japan who have difficulties to spend time on physicalexercise tend to face chronic diseases. Prior studies report that diabetes and hyperlipemia aredeeply connected with regular physical exercise in daily life. Health, Labour and Welfare Ministryof Japan has standardized the index that prescribed the minimum amount (frequency and intensity)of exercise for prevention of chronic diseases. On the other hand, for many people, it is difficultto spend time to exercise even if they are fully aware of the importance of exercise for their health.

Method The subjects were 637 university students. The mean age of the subjects was 18.33(SD¼ 1.21). In April 2005, the subjects were asked to answer two types of questionnaires (promotionscale and interference scale) developed for this research. Exploratory factor analyses wereconducted with each scale to explore the underlying structure of these scales.

Results Exploratory factor analyses classified perceived promotion scale and interference scaleinto 16 factor structures (8 promotions and 8 interferences). Each of these factors showed acceptableinternal consistency with Cronbach’s alpha values ranging from 0.798 to 0.955.

Conclusion The results of the analyses indicated that both of these scales satisfied the reliabilities.To clarify the validities of these scales, the results of this research will be needed to analyze therelationship between perceived promotion scale and interference scale of physical exercise andphysiological index.

Psychological barriers to cancer screening in German men

*Sieverding, M., Dauven, S.; *Free University of Berlin, Germany

Objectives In Germany, men attend cancer screening less often than women (in 2002: 20 versus50%); this study was designed to elucidate psychological barriers to cancer screening in men.

Methods Four focus groups were conducted with 8 to 10 men each (altogether 37 men,age range from 45 to 65 years), using semistructured open-ended questions. Topics of discussionincluded: emotions and cognitions associated with cancer screening in general, possible reasonsfor the gender difference in adherence to screening, emotions and worries associated with the screen-ing procedure (digital rectal examination), images of the prototypical regular participantof cancer screening, reinforcing factors for screening. The focus groups were audio- and

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video-taped and transcribed verbatim. The word-processing program ATLAS was used for textualinterpretation.

Results The strongest barriers to cancer screening were embarrassment and shame associated withthe cancer screening procedure and fear of a positive result. Men’s attitudes towards their bodyand health, fatalism, irregular contact to physicians, lack of communication about health-relatedissues with other men were identified as additional barriers. Participants also complained about alack of public awareness of men’s health. A number of attitudinal impediments appear to be relatedto the traditional male role, e.g., functional view of the body; denial of disease susceptibility,unwillingness to seek professional counsel or help, or de-evaluation of women’s preventive healthbehaviour.

Conclusions Interventions aiming to increase men’s attendance rates at cancer screenings may benefitfrom taking these male-specific barriers into account. It can be assumed that some of the barriers can’tbe overcome easily because of their connectedness to the male role. The role of peers, wives andphysicians in this process should be analyzed more in detail in further studies.

Anxiety, depression, self-concept and social support in obese patientswith and without binge eating disorder

*Silva, I., Pais-Ribeiro, J., Cardoso, H.; *Universidade Fernando Pessoa, Portugal

Objectives The aim of this study was to analyse the differences in anxiety, depression and self-concept levels, and social support satisfaction in obese patients with and without binge eating disorderdiagnosis.

MethodsParticipants: A cohort of 135 obese patients, 83% of which were females; aged between 16 and 62(M¼ 37.94; SD¼ 11.28); with a body mass index between 30.37 and 100.92 (M¼ 48.96;SD¼ 9.40), 51.5% with binge eating diagnosis was studied.Instruments: Participants answered to the Portuguese version of the Hospital Anxietyand Depression Scale (HADS), to the Satisfaction with Social Support Scale and to the Self-Concept Inventory in the context of a personal interview. Clinical data were collected from medicalregisters after patients’ informed consent.

Results The results suggest that there are no statistically significant differences concerning anxiety,depression and self-concept levels between obese patients with and without binge eating disorderdiagnosis. Nevertheless, they present statistically significant differences regarding satisfaction withfriends (t(132)¼ 2.94; p< 0.01) and family (t(132)¼ 2.43; p< 0.05) social support. Patients sufferingfrom this disorder report lower satisfaction with friends’ (M¼ 0.48, SD¼ 6.48; M¼ 3.68, SD¼ 6.09)and family’s (M¼ 2.20, SD¼ 3.71; M¼ 3.60, SD¼ 2.88) social support.

Conclusion Obese patients with binge eating disorder do not differ from patients without thisdiagnosis concerning anxiety, depression and self-concept levels. However, they report lowersatisfaction with friends’ and family’s social support.

Quality of life and psychological adjustment following heart transplantation

*Sivertsen, B., Relbo, A., Gullestad, L., Andreassen, A., Grov, I., Simonsen, S., Havik, O.;*Department of Clinical Psychology, University of Bergen, Norway

Objectives The purpose of this study was to assess quality of life and psychological adjustment inpatients having undergone heart transplantation.

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Methods The sample consisted of 359 Norwegian heart transplant recipients from the period1983–1999. Data on global quality of life was collected using the The Medical Outcomes StudyShort-form General Health Survey (SF-36). Psychological functioning was assessed using theSymptom Checklist 90-Revised (SCL-90-R) and Beck Depression Inventory (BDI).

Results Heart transplant recipients scored significantly lower on all subscales on the SF-36 comparedto a normative sample. Patients having received a new heart three years ago or more, reportedsignificantly lower quality of life than patients transplanted within the last 2 years. In terms of psycho-logical symptoms, heart transplant recipients reported a heightened level on all subscales of theSCL-90-R, and on the BDI. Level of psychological adjustment was independent from time sincethe surgery.

Conclusions This study demonstrates that both quality of life and psychological adjustmentfollowing transplantation are relatively poor. Especially in terms of quality of life, the patients’condition seems to deteriorate.

Barriers to influenza immunization in an eldely urban population

*Small, R., Foley, M., Soriano, R.; *Department of Community and Preventive Medicine, MountSinai School of Medicine, New York, NY, USA

Objectives In East Harlem, adult hospitalization admission rates for pneumonia and influenzaare 90% higher compared to New York City as a whole. Influenza immunization rates remainbelow the Healthy People 2010 goal of 90% vaccination coverage of the elderly, with lowest immuniza-tion rates among minority populations. This study identified barriers to influenza vaccination in anelderly minority clinic population residing in Harlem and East Harlem, New York City.

Methods This was an observational, cross-sectional survey study. Using a face-to-face survey,patients (n¼ 60) and providers (n¼ 20) were interviewed at an urban geriatric clinic serving over2500 elderly patients annually. Patient survey asked about demographics, general health, andperceived barriers to immunization. Provider survey elicited responses on immunization practices,vaccination management, and perceived barriers to immunization.

Results Overall, 60 interviews were completed with the 70 eligible patients (86%). The subjectpopulation was 55% African American, 37% Hispanic, 8% White/Other. In total, 75% of respondentswere immunized last flu season. The most commonly reported barrier from all patients was concern ofgetting influenza from the vaccine. Of those not immunized, 33% thought they would get the flu fromthe immunization. By ethnicity, 31% of African American patients believed the vaccine caused theflu; 23% of Hispanic patients were concerned about an adverse reaction. Cost and access to carewere not barriers. Synthesized provider responses corroborated patient findings.

Conclusions Despite practice initiatives to improve vaccination rates, immunization rates remainbelow the national objective. Community health care providers must increase awareness of theneed for vaccination, address public misconceptions through patient education, and reduce missedopportunities for vaccination.

Effects of area and family deprivation on risk factors for teenage pregnancyamong 13–15 year-old girls

*Smith, D., Elander, J.; *London Metropolitan University, UK

Objectives Socio-economic deprivation increases teenage pregnancy rates, but less is knownabout the mediation of deprivation effects by specific proximal risk factors like early sexual activity

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and low life expectations. We tested the effects of area and family deprivation on six specificproximal risk factors for teenage pregnancy to help inform the targeting of area-wide and familyinterventions.

Methods Girls from deprived and non-deprived families in deprived and more affluent areaswere compared in a 2� 2 factorial design. The participants were 201 13–15-year-old girls attendingstate secondary schools in Kingston upon Hull and Richmond upon Thames, UK. The dependentvariables were questionnaire measures of early sexual activity, life expectations, knowledgeand beliefs about contraceptives, attitude to abortion, beliefs about love, and use of local sexualhealth services.

Results Area deprivation significantly increased early sexual activity and use of local sexual healthservices, and reduced life expectations and knowledge and beliefs about contraceptives. Familydeprivation also significantly reduced life expectations. There were significant area� family interac-tion effects on early sexual activity and life expectations; living in a deprived area increased earlysexual activity much more markedly among girls in deprived families, and living in a more affluentarea increased life expectations only among girls in non-deprived families.

Conclusions The area� family interactions showed that the effects of family deprivation depend tosome extent on their wider social context, with implications for targeting interventions. Initiativesaiming to reduce early sexual activity should target individually deprived girls living in deprivedareas. To increase life expectations, area-wide interventions in deprived areas would be expected tohave more impact among girls in non-deprived families, and interventions for deprived familieswould be expected to have more impact in more affluent areas, for higher life expectations requiredfavourable area and family circumstances.

Psychological determinants of quality of life in chronic heart failure

*Smith, O., Schiffer, A., Widdershoven, J., Winter, J., Denollet, J.; *Tilburg University,The Netherlands

Objectives To determine the relative importance of psychological determinants of quality of life(QoL) in chronic heart failure (CHF) as compared to CHF severity and functional status.

Methods Ninety-one CHF patients completed a questionnaire both at baseline and at a 6-monthfollow-up. The following psychological determinants were included: depressive symptoms (BDI),vital exhaustion (MQ), and negative affectivity (DS14). The SF36 subscales were used as QoL-measures. Left ventricle ejection fraction and the six minute walking test were used to assess CHFseverity and functional status, respectively.

Results At follow-up, all QoL subscales were predicted by depressive symptoms (�0.20 <�<�0.55,p< 0.05). All subscales, except bodily pain and general health, were predicted by vital exhaustion(�0.20 < �<�0.30, p< 0.05). Negative affectivity (�¼�0.28, p< 0.01) predicted mental health.Bodily pain and vitality were predicted by functional status (0.21 < �< 0.22, p< 0.05). Aftercontrolling for QoL at baseline, QoL subscales at follow-up were predicted by depressive symptoms(�0.26 < �<�0.35, p< 0.05), except for physical functioning and emotional role. Moreover,emotional role was predicted by vital exhaustion (�¼�0.32, p< 0.01), social functioning by negativeaffectivity (�¼�0.18, p< 0.05), bodily pain by CHF severity (�¼ 0.14, p< 0.05), and vitality byfunctional status (�¼ 0.16, p< 0.05).

Conclusions Psychological factors are important predictors of QoL in CHF, above and beyond CHFseverity and functional status. Future large-scale prospective studies should give a more in-depthinsight into the importance of psychological determinants of QoL in CHF.

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Pain as an assault on the self: An interpretative phenomenological analysis ofthe psychological impact of chronic benign back pain

*Smith, J., Osborn, M.; *Birkbeck University of London, UK

Objectives Chronic benign lower back pain can be baffling to the patient because of the lack ofa straightforward and comprehensible medical etiology. This paper presents an in-depth, idiographic,qualitative examination of the psychological effects of chronic pain; in particular the paper isconcerned with the impact of this condition on patients’ sense of self/identity.

Methods Semi-structured interviews were conducted with patients from one pain clinic in thesouth west of England. The resultant transcripts were subjected to interpretative phenomenologicalanalysis (IPA).

Results Three super-ordinate themes emerged: living with an unwelcome self, the social threat tothe self, a self that cannot be understood or controlled. This paper presents the first two of these indetail. Patients struggled to incorporate the pain within their ongoing self-concept; this battle isillustrated in various ways. One of the most powerful messages to come across in participants’accounts was the sense of stigma and self-disgust associated with their pain. Detailed instances areprovided. The importance of the relational context to the experience of pain is also considered.

Conclusion The paper is able to offer detailed, nuanced illustrations of the debilitating impactof chronic pain and thereby makes an important contribution to the theoretical literature. The resultsare considered in relation to relevant extant constructs, including work on illness and identity andshame. The paper also points to the importance of considering this holistic impact of pain onpatients when working with them in the clinic.

Micro-interventions: The use of real-time data and personalized feedbackto augment interventions

Smyth, J.; Dept. of Psychology, Syracuse University, USA

Objectives Ecological momentary assessment [EMA] is a method of collecting ambulatory datafrom participants in their real-life environments, and is often utilized to evaluate the efficacyof interventions by collecting real-time data. This study examined if EMA data collection procedurescould be used to augment a standard intervention by extending it into participants’ naturalenvironments in an ecologically sensitive manner – delivering micro-interventions when someenvironmental contingency (e.g., stress) is reported.

Methods Adult community volunteers (n¼ 90) completed a baseline assessment and a 2-hour stressmanagement course focusing on primary stressor appraisal (reframing skills) and relaxation training.Participants were then randomly assigned to one of three one-week long EMA groups: (1) EMAassessment only, (2) EMA assessment plus random prompting to use stress management skills, or(3) EMA assessment plus targeted prompting (e.g., when stress reports were high) to use stressmanagement skills. EMA assessments included mood, stress, and health behaviors (diet, alcoholuse, smoking, sleep, etc). One week after EMA concluded, participants completed the assessmentpacket a second time.

Results Multi-level random effects models in SAS were used to examine group differences on mood,stress, and health behaviors. There was evidence that all three intervention groups showedimprovement. There were significant group differences in EMA reports of mood, stress, diet, alcoholuse, smoking, and sleep (all p’s < 0.05). In general, the pattern of group contrasts was consistent,with the participants receiving targeted prompting based on concurrent EMA reports reportingmore benefit than the assessment only or random prompting groups.

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Conclusions These data suggest that interventions can be designed to be responsive to concurrentEMA assessments, and that administering such micro-intervention techniques at appropriatemoments (e.g., stress, cravings, etc.) can improve the effectiveness of standard interventions.

Effects of a self-monitoring intervention on action control and oral self-care behavior

*Sniehotta, F., Schuz, B., Wiedemann, A., Seemann, R.; *School of Psychology, Aberdeen, UK

Objectives To test whether a self-monitoring intervention increases dental flossing and investigatethe role of action control conceptualised negative feedback control as a possible mediator.

Methods Single-group intervention study in a pre-post-design with a four-week follow-up with170 students. Measures included TRA variables plus self-efficacy, action planning and an actioncontrol measure, based on awareness of standards, self-monitoring and self-regulatory effort. Afterpre-test, participants received a packet of dental floss, detailed instructions how to use it, and adental-flossing diary, hypothesised to increase action control. After two weeks, the diaries and thedental floss packets were returned. Dental flossing was measured by residual floss, diary entries andself-reports. A follow-up measure was send by post four weeks later. Changes were analysed byrepeated measure ANOVAs and predicted by hierarchical regression analyses.

Results Flossing increased dramatically from baseline to the first week of diary keeping (eta2¼ 0.43),

slightly decreased in the second week (eta2¼ 0.06) and approached the baseline levels at the follow up

measure (all p< 0.01). Subjective norm, self-efficacy, action planning and action control showed timeeffects, with the strongest effects for action control ( p< 0.01, eta2

¼ 0.27). When regressing thechanges in flossing measures onto changes in control measures, only action control was significant,accounting for 25% of the variance in flossing changes. Only participants with high action-controllevels maintained the changes. Overall, action control accounted for variance in flossing over andabove all other measures.

Conclusions Cybernetic models of negative feedback control offer a theoretical explanationfor effects of self-monitoring interventions on behaviour change. An action-control concept basedon this background provides further inside in the process of health-behaviour change. Self-monitoring interventions only lead to sustained effects on behaviour, if action-control routines aremaintained.

No harm done – Results: From the hoorn screening study

*Snoek, F., Adriaanse, M.; *University Medical Centre, Amsterdam, The Netherlands

Objectives To determine the psychological impact of targeted population screening for type 2diabetes, on the short and longer term.

Methods Participants (n¼ 7736) were questioned at the start about perceived risk for and seriousnessof type 2 diabetes (DM-2). Screening algorithm included objective risk score, capillary measurementand Oral Glucose Tolerance Test. Participants were notified of the diagnosis by their GP.An interview study was conducted in persons with and without a positive test result 2 months afternotification. The psychological impact of screening was prospectively determined by questionnaires(DSC-r, WBQ-12; SF-36), self-administered at 2 weeks, 6 and 12 months follow-up by subjectsdetected with DM-2 (n¼ 116) and non-diabetics (n¼ 143). Also by patients diagnosed bythe GP (n¼ 49).

Results Subjects with a family history considered themselves at more risk than those without. Overhalf of the participants (aged 50–75 yrs) confirmed the seriousness of DM-2. Overall, qualitativedata revealed no distress following notification. The procedure was evaluated as non-invasive.

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Longitudinal data showed that screening-detected subjects were burdened more by diabetessymptoms ( p< 0.05) compared to those without DM-2 throughout the first year. Two weeks afternotification no differences were found in well-being or perceived health. At 6 months f-u we foundlower SF-36 Role Physical and Role Emotional scores ( p< 0.05) for screening-detected persons,but not at 12 months f-u. Patients diagnosed in general practice reported higher symptom distressshortly after diagnosis, and consistently worse mental health during the first year comparedto screening-detected patients.

Conclusions Further research is warranted to better understand the lack of emotional responsefollowing the diagnosis type 2 diabetes. It may be that subjects understand the ‘‘glucose concept’’of diabetes, but are less aware of the cardiovascular complications and increased mortality risk.

Determinants of self-reported health in two Czech studies

*Solcova, I., Kebza, V.; *Institute of Psychology, Czech Academy of Sciences, Prague, CzechRepublic

Determinants of self-reported health (SRH) were studied in two Czech population samples. Inthe study I (N¼ 2638) were as independent variables involved: socio-demographic data,hardiness (Personal Views Survey), neuroticism, introversion-extroversion, social desirability(Eysenck Personality Inventory), live events in the past 12 months (Holmes-Rahe SocialAdjustment Scale), and behavioral (e.g., smoking, physical activity, alcohol intake) and nutritionalvariables (e.g., eating of smoked meats, eating of dark meats, eating of salads). The independentvariables were in the study II (N¼ 1322): socio-demographic data, well-being (Satisfaction with lifescale), locus of control (visual analog scale), and self-efficacy (General self-efficacy). A logisticregression analysis has been employed to determine the predictors (method: Enter, criterion:Wald). In the study I appeared as predictors: socioeconomic status represented here by occupation,employment status, and particular behavioral and nutritional factors, namely self-rated physicalactivity, alcohol intake, and eating of salads. The age, socioeconomic status, indexed here by educa-tion, life satisfaction, locus of control, and self-efficacy were determined as predictors in the study II.The authors concluded that self-reported health represents a rather complex phenomenon that is noteasy to capture, despite the employment of the sophisticated statistical methods. The scope ofgeneralization appears to be limited. A meta-analysis of proper studies appears as a possible way todetect the most important determining factors.

Health care employees communication skills: Are there differences betweenself-evaluation and patients’ evaluation?

*Sommaruga, M., Bianchi, L., Zuffi, M., Tramarin, R., Gremigni, P.; *Salvatore MaugeriFoundation, Care and Research Institute, Tradate, Italy

Objectives Patient satisfaction is a reliable marker of the quality of care and poor communication isa common reason for patient dissatisfaction. The purposes of this study were: (1) to evaluate thecommunication skills of health care employees involved in the first contact with the patient frompatients’ perspective; (2) to compare patients’ evaluation and employees’ self-evaluation of thesame skills.

Methods Three hundred twenty eight subjects (50% females, mean age 55� 15 years), referred to theMaugeri Institute, were asked to evaluate the communication skills of 20 health care employeesinvolved in the first contact with the patients (40% front-line employees, 60% nurses and ambulatorytechnicians, 80% females, mean age 39� 6 years) using a 12-item, 5-point Likert format question-naire (Health Care Communication Questionnaire, HCCQ). The employees also filled in the

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HCCQ-employees-form to self evaluate the same skills. One hundred forty eight outpatients (GroupA) were asked to evaluate the skills of front-line employees and 180 patients (Group B) were asked toevaluate the skills of other professionals (nurses and ambulatory technicians). All the questionnaireswere anonymous.

Results Factor analysis of the HCCQ identified two factors: Effective communication skills (9 items)and Hostility (3 items). Using Mann-Whittney comparisons, patients’ evaluation of employees’effective communication skills was higher than employees’ self-evaluation ( p� 0.03). Moreover,according to patients perspective, front-line employees (evaluated by Group A) showed a more hostilebehaviour than nurses and technicians (evaluated by Group B) ( p� 0.005).

Conclusions Results allow to identify specific features of health care service that are less satisfyingfrom patients’ perspective, and to give each employee a profile of his/her communication skills fromdifferent points of view. Such indications are useful to tailor individualized communication trainingfocused on individuals needs.

Waiting for a new heart: Early experience from a prospective multi-site study of medicaland psychological predictors of pre-transplant outcomes

*Spaderna, H., Weidner, G., Krohne, H.; *University of Mainz, Germany

Objectives The aim of this presentation is to introduce a prospective multi-site study examiningmedical and psychosocial predictors of pre-transplantation outcomes among patients newly listedfor heart transplantation (HTX). Due to a lack of donor organs most listed patients have to dealwith long waiting times (averaging 5 months, for some up to 5 years). It has been estimated thatduring this period 20% of patients die and 9% of patients get delisted due to improvement.Psychological variables are strongly related to mortality in cardiac patients with varying diagnoses.However, it is unknown if and to what extent these variables account for differences in outcomesduring waiting time.

Methods As of April 2005, 14 German-speaking HTX-centres have agreed to participate, yieldingapproximately 250 new adult patients per year. Participants will receive standardized psychosocialquestionnaires assessing health behaviours (e.g., nutrition, physical activity) and psychologicalvariables (e.g., depression, social support, perceived stress, and coping styles) at time of listing.Follow-up interviews will be scheduled. Participants will be followed-up for a period of 12 monthswith all changes in waiting list status being recorded. Eurotransplant will provide medical data attime of listing as well as waiting list outcomes (delisting due to improvement or deterioration,transplantation or death). Death of all causes will serve as primary endpoint. It is hypothesised thatbehavioural and psychological variables predict survival and contribute to differences in waiting listevents.

Implications Identification of psychological predictors may be useful to develop interventionsto improve prognosis while waiting for a heart. This could help distribute donor hearts to patientsin most urgent need of them.

Does age make a difference? Structural differences in the effectof social-cognitive variables on physical activity

*Spivak, Y., Renner, B.; *Free University, Berlin, Germany

Objectives Most current health behavior models implicitly assume a high degree of universality.Specifically, it is presumed that health behavior can be predicted on the basis of the social-cognitivevariables regardless of participants’ social-cultural backgrounds or age. However, considering research

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in the field of life span development, structural differences in the interplay of social-cognitive variablesfor different age groups might be expected. Therefore, the main aim of the present study wasto explore structural differences on the basis of the Health Action Process Approach (HAPA) in asample of Korean adults.

Methods Participants (N¼ 619) took part in a longitudinal health screening study with 6 monthsinterval between assessments. Participants filled out questionnaires assessing social-cognitivevariables related to physical activity such as risk perception, outcome-expectancies, perceived self-efficacy, intention, and planning along with frequency of physical activity at both measurementsoccasions.

Results Structural differences in the interplay of social-cognitive variables were foundbetween age groups. The results of structural equation modeling indicated that self-efficacy was theonly predictor of physical activity among young adults. Hence, pointing to a significant mismatchbetween the HAPA model and the empirical data. Conversely, the HAPA model structureshowed a good fit within the older sample. Physical activity at t2 was predicted by intentionand plans (t1) which were in turn predicted by self-efficacy, outcome expectancies, and riskperceptions (t1).

Conclusions The results suggest that younger and older adults might have different motivations forthe involvement in physical activity. Implications for health interventions will be discussed.

Applying ‘thinkaloud’ to health-related quality of life (HrQOL) self-reports:Comprehension, judgement and question-induced error

*Stapley, S., McColl, E., Bond, J.; *Newcastle University, UK

Cognitive Aspects of Survey methodology (CASM) is an important endeavour within health-related quality of life (HrQOL) research. Its impetus is the study of cognitive processes in surveyresponding: comprehension, retrieval, judgement and response (Tourangeau, 1984). Methods suchas ‘thinkaloud’ are used in developing new questionnaires by identifying question problemswith regard to these processes. Equally there may be similar problems with existing instruments,although judgement processes in HrQOL measurement are not well understood generally.Therefore the study of cognition in HrQOL has a key contribution to make to this field.

Objective To investigate the cognitive processes involved in self-reporting of health-related qualityof life (HrQOL).

Methods As part of a case study project, 21 Type 2 diabetes patients enacted both ‘presentperspective’ and ‘when-test’ concurrent thinkalouds. (In a ‘when-test’, respondents self-report as ifit is some future point). Participants completed a selection of items from the ADDQOL(a diabetes-specific measure), the SF-36 (version 2) and the WHOQOL-Brief. Analysis of verbatimtranscripts was aided by reference to question coding taxonomies including the QAS-99,Questionnaire Appraisal System.

Results These included items triggering choices between more than one judgement strategy.Similarly the impact of age and co-morbidity on self-report judgements was observed.Psychological domain items were perceived as ambiguous and tended to evoke general self-perceptions. A key finding was that response categories on the SF-36 (v. 2) Physical Functioningdomain brought about comprehension problems and therefore an erroneous pattern of response forthose items: a phenomenon here termed ‘question-induced error’.

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Conclusions Although ‘thinkaloud’ is controversial, in this study it has provided several usefulinsights. In particular question-induced error may cause misinterpretation of HrQOL outcomes,which has important implications for both intervention and response shift research.

Obesity and psychological health in women

*Stattin, S., Morgenstern, E., Ghaderi, A., Halvarsson-Edlund, K., Ohrvall, M.; *Department ofPublic Health and Caring Sciences, Uppsala University, Sweden

Objectives Obesity is an escalating global epidemic, and results in serious health problems.Research has also shown a higher prevalence of psychiatric disorders and lower psychologicalhealth among populations with obesity. Obesity treatment has high rates of attrition and relapse,which may be accounted for by psychological variables. Even so, psychological problems are rarelytaken into consideration in obesity treatment. Women develop obesity more often than men andalso suffer more socially as well as psychologically. The main aim of this study was to measurepsychological health in terms of psychiatric disorders, mood, quality of life and self-esteem amongSwedish women.

Method Fifty-nine female patients at an obesity treatment clinic completed a battery ofquestionnaires with good to excellent psyhometric properties and were also interviewed individuallyusing the structured clinical interview for DSM-IV.

Results Compared to normal-weight samples, the prevalence of psychiatric disorders was higheramong the obese participants. Lifetime and present major depressive episode, simple phobia,binge-eating disorder and personality disorders were more common among the obese women.Results showed more problematic eating behaviours and eating attitudes, lower self-esteem andlower quality of life, compared to norms for non-psychiatric subjects. Regression analysis showedthat lower scores on measures of quality of life were explained by personality disorders and eatingbehaviours/eating attitudes.

Conclusions These findings suggest that an increased focus on psychological variables is to berecommended in the treatment of obesity.

To drink and to drive: The passengers perspective

*Stefanile, C., Nerini, A., Nocchi, F.; *Department of Psychology, University of Florence, Italy

Objectives The present study intends to investigate an almost unexplored side of the drink anddrive problem: the motivational factors of the intention to perform a risky behavior such as gettinginto a car with a drunk friend.

Methods Four hundred and twenty-six students aged 17–22 (m¼ 18) completed a questionnaire,based on Ajzen’s Theory of Planned Behavior and its following developments, designed to studythe determinants leading to accept a lift from a drunk driver. The data have been subjected to multipleregression analysis.

Results Social norms, perceived behavior control and other determinants such as risk perceptionand self-esteem seem to significatively predict the intention to get into a car with a drunk friend.Other results will be discussed.

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Conclusions Although further research is needed, the present study suggests that a better knowledgeof the passenger perspective may add data to comprehend the drink and drive phenomenon in order toprevent the behavior.

Delay in going to the hospital following a myocardial infarction, failure to attenda cardiac rehabilitation program, and denial-like coping

*Stenstrom, U., Nilsson, A.-K., Ahlund, I., Nyrinder, I., Jonsson, A., Karlsson, J.-E., Jonasson, L.;*School of Health Sciences, Jonkoping University, Jonkoping, Sweden

Objectives This study examines whether patients who exhibited denial-like coping when facedwith a first-time myocardial infarction (MI) tended to also show a delay in going to thehospital and to be less willing to participate in a cardiac rehabilitation program offered to allMI patients.

Methods One hundred and seven consecutively admitted patients, 78 males and 29 females(mean age 59.1 years, SD 7.1), were enrolled in this study. The sample was divided into twogroups depending on whether the patients sought medical help within four hours after they beganexperiencing MI symptoms (non-delayers) or whether they waited longer (delayers). Denial wasmeasured with a short version of the Hackett and Cassem semi-structured interview 3–5 days afterthe patients entered the hospital. Data on participation (attenders) or not (non-attenders) in thecardiac rehabilitation program was also obtained. At the time of this measurement occasion,two patients had died.

Results The delayers (n¼ 49) as well as the non-attenders (n¼ 76) displayed significantly higherdenial scores than the non-delayers and the attenders (means 17.5� 5.9 (SD) vs. 12.9� 4.7 (SD),p< 0.001 and means 16.0� 5.8 (SD) vs. 12.8� 5.0 (SD), p< 0.01). Also, an ANOVA showedsignificant differences in denial scores between (1) attenders/non-delayers, (2) non-attenders/non-delayers, (3) attenders/delayers, (4) non-attenders/delayers. (F(3, 101)¼ 10.8, p< 0.001).A post-hoc comparison (Tukey), indicated that the mean scores for group 4 was significantly differentfrom the scores of the three other groups.

Conclusions The results suggest denial-like coping to increase the health risks of persons potentiallyprone to MI.

Klasse2000 – Factors influencing coverage of a substance abuse preventioncurriculum in elementary schools

Storck, C.; Verein Programm Klasse2000 e. V, Germany

Klasse2000 is the most widely disseminated drug-abuse prevention program aimed at elementaryschool students in Germany. Previous studies have confirmed a positive effect of the Klasse2000program on cigarette smoking onset. To enhance fidelity of implementation teachers cooperatewith external experts, the ‘‘Klasse2000 health providers’’, who have experience with the programand receive essential training. The health providers give two or three interactive lessons per yearwhereas the main part of the curriculum is covered by the teachers. However, with increasingdissemination the program faces new challenges as reports indicate that the newly recruited teachersdo not cover the complete Klasse2000 curriculum. Aim of the current study is to assess the complete-ness of the covered curriculum and to identify factors that influence the amount of coverage, focusingon teacher characteristics and regional differences. Hereto, we analyzed self-reports over three years(response rate¼ 34.6%, n¼ 1517). In these reports, teachers answered questions on the coverage ofthe curriculum, reasons for omitting program modules and personal attitudes towards Klasse2000and school-based prevention in general. During the first year, 66% of the teachers deliver over 75%

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of the curriculum. However, in subsequent years, coverage is significantly lower. Reasons for poorcoverage include lack of time, problems with the curriculum and reassignment of teachers.Moreover, the completeness is associated with teachers’ attitudes towards and experience with theprogram and regional differences indicate that local conditions influence implementation. The resultsshow the need to preserve the teachers’ initial enthusiasm over the four years of intervention and totailor the curriculum to local needs of the different states of Germany. Hereto, an additionalannual meeting between teacher and Klasse2000 health provider was introduced to improvecooperation over time. Initial reports indicate a positive effect of said changes.

Positive affect as a source of resilience in the pain-negative

*Strand, E., Thoresen, M., Finset, A., Zautra, A.; *Dept. of Behavioural Sciences, University of Oslo,Norway

Objectives To test the relationship between pain and negative affect (NA) and to address the impactof Positive affect (PA) in the pain-NA relationship. We asked wheather the stressful impact of chronicpain would be lessened by the presence of positive emotions for patients with rheumatoid arthritis.Vulnerability factors like depression and interpersonal stress to NA were also explored.

Methods Forty-three patients (30 women; mean age 57) were interviewed by telephone once a weekon interpersonal stress, negative affect, positive affect and pain during eight weeks. Depression wasmeasured at baseline. Multilevel modeling (SAS, Proc mixed) was applied to study the within-weekrelationships among the variables.

Results Both weekly pain (�¼ 0.37, p< 0.002), weekly interpersonal stress (�¼ 2.42, p< 0.001),depression (�¼ 0.26, p< 0.01), average perceived stress (�¼ 10.80, p< 0.001) and weekly PA(�¼�0.1, p< 0.01) had a main effect upon NA. There was also a pain�PA interaction effect onNA (�¼�0.05, p< 0.01) indicating a weaker relationship between pain and NA in weeks withmore PA.

Conclusions There was a well established relationship between negative affect and pain. Bothdepression and the person‘s average interpersonal stress seemed to be vulnerability factors to NA.PA are most influential in reducing NA during weeks of higher pain and may be a resilience factor;helping the patients perceiving pain as less distressful than in weeks with less PA.

Exploring discontinuity patterns in the transtheoretical model:Exercise and fruit and vegetable consumption

*Stroebl, V., Ellgring, H.; *University of Wurzburg, Germany

A central assumption of stage models of health behaviour change is that there are qualitativedifferences between the stages of change. These differences should result in non-linear changes intheoretically relevant variables across the stages (‘‘discontinuity patterns’’; Sutton, 2000). The aimof the present study is to investigate discontinuity patterns for self-efficacy, pros and cons acrossthe stages of the transtheoretical model (Prochaska & Velicer, 1997) with respect to exercise as wellas fruit and vegetable consumption. For both behaviours, stage of change, self-efficacy, pros andcons were measured using a questionnaire in a sample of 932 persons (mean age 49 years,SD¼ 8.0; 52% male). To test for discontinuity patterns ANOVA and planned contrasts were used.More than half of the sample reported to exercise regularly (action: 34%; maintenance: 26%) whileonly few participants reported to eat five portions of fruit and vegetable per day (action: 5%,maintenance: 7%). For exercise, 17% were in precontemplation, 15% in contemplation and 8% inpreparation (the respective figures for fruit and vegetable consumption were 40, 29 and 19%).In accordance with other studies the largest increase in pros was between precontemplation and

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contemplation for both behaviours (d¼ 0.64 for exercise resp. d¼ 0.51 for fruit and vegetableconsumption). For the cons, a significant increase was found between precontemplation and contem-plation, followed by a significant decrease between contemplation and preparation for both beha-viours. No significant differences between the stages of action and maintenance were found forself-efficacy, pros and cons in any behaviour. The discontinuity patterns in pros and cons are infavour of a stage model. However, contrary to other studies (Lippke & Plotnikoff, 2004), differencesbetween the stages action and maintenance were not empirically supported. Thus distinguishingbetween those stages might not be justified.

Sense of coherence in an extremely hazardous occupation

Strumpfer, D.; University of Johannesburg, South Africa

Objectives To compare a sample of mine rescue team members whose work makes extreme demandson physical and psychological strengths with a sample of ordinary miners whose work is hazardousyet less demanding; assuming that pro-social and moral aspects of the work of the first samplewould heighten job satisfaction, it was also measured.

Methods A. Antonovsky’s (1987) Sense of Coherence (SOC; both 29- and 13-item forms), J. Block& A. M. Kremen’s (1996) Ego-resiliency and L. R. Goldberg’s (1992) Emotional Stability scaleswere studied as measures of strengths. Job satisfaction was measured by five items from Brayfieldand Rothe’s (1951) scale. Thirty-four rescue team members and 41 ordinary miners were tested;the exceptional sample was not available in large numbers.

Results Coefficients alpha, ranging between 0.73 and 0.92, were acceptable. In a logisticregression analysis only the SOC scales and job satisfaction contributed significantly towardsprediction of group membership. The SOC mean of rescue team members (158) was among thehighest ever reported.

Conclusions The SOC scale and job satisfaction warrant further study in the light of interactionsbetween work and personality. Pending cross-validation on larger samples, the SOC scalescould also contribute to effective selection of rescue team members and in other occupations doingextremely hazardous work.

Predictors of disordered eating among Turkish university students

*Sumer, Z., Pembecioglu, U.; *Middle East Technical University, Turkey

The purpose of the study is twofold: to assess to what extent gender, age, body mass index, weightsatisfaction, body satisfaction, emotion focused coping, and problem focused coping styles predictdisordered eating attitudes of Turkish university students; and to examine the difference betweenfemale and male university students regarding expert preference in case of a weight problem, andimportance of significant other’s opinion regarding their weight. Three instruments – EatingAttitudes Test (EAT-40), Coping Styles Inventory, and a Demographic Data Form were administeredto 525 students from four (3 state, 1 private) universities of Ankara, Turkey. A stepwise multipleregression analysis, and two separate two-way contingency table analyses with chi square wereconducted. The variables found to be most predictive of disordered eating attitudes and enteredthe regression equation were weight satisfaction, gender, emotion focused coping style, age, andbody mass index. Of the five variables, weight satisfaction was significantly negatively related todisordered eating attitudes. Results also indicated that proportions of female students preferringdietician and fitness expert in case of a weight problem were nearly same, whereas male studentspreferred fitness expert, medical doctor and dietician, respectively. Regarding the importance ofsignificant other’s opinion in relation to weight, no significant difference was observed between

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female and male groups. Opposite sex friend’s opinion in relation to weight was found to be the mostimportant source for both female and male students. The role of cultural factors in shaping the atti-tudes toward eating was discussed.

Stage models of health behaviour change stage theories of health behaviour:Introduction, overview and current status

Sutton, S.; Institute of Public Health, University of Cambridge, UK

Objectives To provide an overview of the current status of stage theories in health psychology in orderto set the scene for the presentations that follow.

Methods Based on a recent chapter (Sutton, 2005), a critical review of three theories will bepresented: the transtheoretical model (TTM), the precaution adoption process model (PAPM),and the health action process approach (HAPA).

Result The vast majority of studies on the TTM have employed cross-sectional designs; only ahandful of studies have used strong research designs. Although a cursory glance at the huge literatureon the TTM gives the impression of a large body of mainly positive findings, a closer examinationreveals that there is remarkably little supportive evidence. Fundamental problems with the definitionand measurement of the stages need to be resolved. The stages in the PAPM have greaterface validity and make important distinctions that are not made by the TTM. Only a small numberof studies using this theory have been conducted to date, but these include an important experimentalmatch-mismatch study that supported the theory’s predictions. As tested to date, the HAPAis not a stage theory like the TTM and PAPM but a continuum theory like the theory of plannedbehaviour (TPB).

Conclusions Stage theories are appealing because they seem to capture some of the complexities ofthe process of health behaviour change. However, the more complex structure of stage theoriesmeans that they are more difficult to test and to apply in practice than continuum theories.Wherever possible, future studies should use strong research designs to test predictions from stagetheories.

Experience with breast cancer: Effects on comparative optimism,anxiety, attitudes, and breast self-examination

*Swords, L., Groarke, A.; *University College Dublin, Ireland

Objective To investigate the effects of experience with breast cancer through a family memberor friend on disease-related comparative optimism, anxiety, attitudes, and the regular performanceof breast self-examination.

Method One hundred and fifty eight Irish women aged between 20 and 64 years completed aquestionnaire assessing these variables. Based on whether or not they reported having experiencewith breast cancer and, if so, through whom and to what degree, participants were classified aseither a first degree relative, family/friend high experience, family/friend low experience, or someonewith no experience.

Results Findings indicated that experiencing breast cancer to varying degrees among family andfriends significantly affected women’s comparative optimism and attitudes towards the disease,though not their anxiety or the performance of regular breast self-examination. First-degree relativesof women with breast cancer were less optimistic in their comparative risk appraisals than participantswho had low levels of experience or no experience with the disease. They also expressed more negativeattitudes towards breast cancer than participants with no experience with the disease.

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Conclusions Women who are first-degree relatives have different perceptions of the disease whencompared to individuals who have little or no contact with it. These differences may be due to a varietyof factors, among them experiencing the disease at close range and acknowledging a geneticsusceptibility to it. Implications for further research and health education are discussed.

Life events, stress and quality of life

*Szabo, G., Susanszky, E., Rozsa, S., Kopp, M.; *Semmelweis University, Budapest, Romania

Objectives To study how stressful life events influence the psychological and the physical qualityof life.

Methods The effects of longterm (1–5 years) stressful events were studied in a representativesample of 12640 individuals (Hungarostudy, 2002). The stress inducing events were measured bythe shortened version of the Rahe-Holmes Life Change Unit (LCU) Questionnaire. The qualityof life was measured by various methods including Shortened Beck Depression Inventory,(Shortened Beck) Hopelessness Scale, WHO Wellbeing Score, Shortened Vital ExhaustionQuestionnaire, Disability Score, Illness Intrusiveness Rating Scale, Self-rated Health, Pain RelatedDisability Score. Instead of using the Rahe weighted average we employed a regression model tomeasure the impact of stress inducing events. The participants were asked to rate the impact ofnegative life events. The resulting subjective weights were then compared with the objective weightsof our model.

Results The results of the study gave an unambiguous ranking for the importances of life eventsrelated to health, personal relationships, work/money and meaning in life. Furthermore, we foundthat major life events impact the psychological quality of life by 11% and the physical quality of lifeby 26%. Using the subjective method we found that the individuals of this study had a rather preciseunderstanding of the effects of life events.

Conclusions By studying life events and quality of life we correlated the Rahe-Holmes life events withtheir actual impacts. This investigation also gives the opportunity for testing different real dimensionsof personality in stress management and coping.

Relationships between subjective health evaluation and social integrationamong portuguese patients affected by hardship from health-care centres

*Tap, P., Santos, R., Fonseca, M., Vasconcelos, M.; *Fundation Bissaya-Barreto, European ResearchCentre into Conducts and Institutions, Portugal

The subjective evaluation made by individuals about their own health involves an interpretationof their experience of illness as well as of their living experiences. In this field, dimensions as socialintegration, self-esteem and stress assume special relevance, since they are factors that may influencethat evaluation and people’s adaptation to illness. The purpose of the present paper is to examine therelationship between subjective health evaluation and social integration in 201 patients, from fourteenhealth-care centres in the Central Region of Portugal, living under socio-economic hardship.Participants completed a questionnaire measuring, among other variables, feelings of socialintegration (a ten-item scale, to be answered in likert-format, resulted from the one made by Tap,Sordes & Vasconcelos (2004) for the exploratory research concerning this project), and the evaluationof their own health (based on a scale from 1 to 20, the patient are asked to attribute a scorecorresponding their health state). Participants had a mean age of 44.47 (SD¼ 17.55). Mean scores(standard deviations) on study variables are: feelings of social integration M¼ 31.15 (DP¼ 5.89),out of a maximum score of 50 points; subjective health evaluation M¼ 11.37 (SD¼ 4.75), outof a maximum score of 20 points. Pearson correlations showed that feelings of social integration

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are positively correlated with subjective health evaluation (r¼ 0.332; p¼ 0.01). Results are discussedin terms of the specificity of feelings of social integration and subjective health evaluation. They sug-gest that, among individuals affected by hardship, feeling better integrated plays a role in the way theyexperience and cope with their own state of health.

Exploring the relationship between work and mental healthin male and female hospital consultants

*Taylor, C., Michie, S., Hunter, M., Ramirez, A.; *Institute of Psychiatry, King’s College, London,UK

Objectives To explore the relationship between work (stress and satisfaction) and psychologicaldistress in female hospital consultants compared with male hospital consultants.

Methods A postal survey was sent to 1794 UK hospital consultants from five specialties in 2002:gastroenterology, radiology, surgical, clinical and medical oncology. Psychological distress wasmeasured using the GHQ-12 (total scores and the cut-off >3 were used). Job stress and satisfactionwere measured using a study-specific questionnaire consisting of 36 sources of job stress and 22sources of job satisfaction. Job and demographic variables were also collected.

Results Thousand three hundred and eight (73%) responded to the survey, 251 (19%) were women.Female consultants were more likely to have GHQ scores >3, indicative of psychiatric morbidity(39 vs. 31%, p¼ 0.002) and there was a trend indicative of higher total GHQ scores ( p¼ 0.06).Higher job stress and lower job satisfaction were related to psychological distress for both male andfemale hospital consultants (all p< 0.001). Their job stress levels were similar ( p¼ 0.73), butfemale consultants reported significantly lower job satisfaction ( p< 0.001), particularly in relationto having professional status and esteem ( p¼ 0.001) and deriving intellectual stimulation fromtheir work ( p< 0.001).

Conclusions This study indicates that female consultants have higher rates of psychiatric morbiditythan male consultants, and that lower job satisfaction from particular sources of their work mayaccount for this. The changing shape of the medical workforce across the western world, whichwill result in a majority female workforce, emphasises the importance of exploring this further inorder to inform interventions to reduce distress at work and protect their mental and physicalhealth.

Perceived naturalness and GM acceptance

*Tenbult, P., de Vries, N., Dreezens, E., Martijn, C.; *Maastricht University, The Netherlands

We investigated whether acceptance of genetic modification (GM) of food products is product specificand why GM acceptance differs between certain product categories. In the first study one hundredforty-four undergraduate students filled out a questionnaire in which they had to rate differenttypes of (GM and non-GM) food products with regard to perceived naturalness, healthiness,necessity, tastiness and GM acceptance. In a second study thirty-six undergraduate studentsreplicated the first study. We showed that GM acceptance differs between products and that GMacceptance depends most on how natural the genetically modified product is perceived and not somuch on how natural the conventional product is seen. The more a GM product is seen as lessnatural, the easier it becomes to accept this product. GM products that are processed are moreeasily accepted compared to non-processed GM products because processed products are perceivedas less natural. In a third study we wanted to show that seemingly irrelevant features of a productcan influence the perceived naturalness of a product and its acceptance. One hundred eighty seven

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high school students filled out a questionnaire. They were asked to rate a picture of an apple (attitude,first impression, ambivalence, consistency, fear, acceptance). In the first condition the apple had astem and leaf, in the second condition the stem and leaf were removed. The third and fourthconditions were the same as the first and second conditions, but with the difference that it wasmentioned that the apple was GM. The results showed that the perceived naturalness of a foodproduct can be manipulated by changing seemingly irrelevant features and can consequently influenceGM acceptance. This research is very interesting because it gives insight into how products areevaluated and judged and why.

Coping and social comparison processes in patients with cancer and fibromyalgia

*Terol, M., Neipp, M., Sanchez, P., Pons, N., Lledo, A. Lopez-Roig, S., Pastor, M.;*Health Psychology Department, Miguel Hernandez University, Spain

Social Comparison (SC) could be considered one of the different cognitive coping strategies thatare useful to deal with the illness process (Wood y VanderZee, 1997; Gibbson y Gerard, 1991).

Objective Firstly, to describe the orientation and the use of upward and downward SC dimensions(with better or worse health status of patients) in chronic illnesses and secondly, to identify therelationship between SC with other coping strategies.

Method We interviewed 239 women with cancer or fibromyalgia. We used the following scales: IllnessSC Scale (Vander Zee, Buunk, Sanderman, Botke, & Van den Bergh, 2000); General SC Scale(Gibson y Buunk; 1999) and Coping Strategies Questionnaire (CEA-C Terol, 1999).

Results Women with SC orientation compared themselves with both patients that had better healthstatus (0.26**) and with those that had worse health status (0.22**). To deal with illness, patients whocompared themselves with patients that were worse used Positive Thinkings (0.18**) and WishfulThinking (0.35**). Moreover, patients who compared themselves with patients had better healthstatus used more frequently Seeking Social Support (0.15*) and Think about Advantages (0.16*).

Conclusions Cancer and fibromyalgia patients used quite frequently SC strategies to cope withtheir illness. Different coping strategies were used by patients relied on the type of comparison thatpatients used to deal with their illness.

The relationship between wellness and supportive relationships across the lifespan

*Thomacos, N., McMurray, N.; *Dept of Psychology, University of Melbourne, Australia

Rationale Relationships and their effects on well-being are currently of keen interest to government,researchers and practitioners. While there is a considerable literature about the positive effectsof supportive relationships (most often conceptualised as social support) (e.g., Hatchett, Friend,Symister, & Wadhwa, 1997; Mickelson & Kubzansky, 2003; Rosengren, Wilhelmsen, &Orth-Gomer, 2004), little research has investigated the negative effects of such relationships. Whilesocial support’s impact on individuals’ well-being has been well studied, more recent studies havenoted that supportive relationships are not always perceived as supportive nor are the outcomesalways positive (e.g., Boerner, Reinhardt, Raykov, & Horowitz, 2004; Lincoln, 2003; Rook &Underwood, 2000).

Objective To examine the impact of the positive and the negative effects on relationships across thelifespan.

Method Data was collected from three samples – two community and one university. Measuresincluded: number and nature of participant’s supportive relationships, use and satisfaction withsupportive relationships, attachment style, day-to-day life, and well-being.

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Results The findings demonstrate that well-being (as measured by the absence of anxiety, depression,suicidal ideation and somatic complaints) is better explained by the negative effects of supportiverelationships rather than by the positive effects of such relationships. Furthermore, when factor ana-lysed the negative effects of relationships produced a number of qualitatively different factors fordifferent age groups (young, middle, and older aged). The data also demonstrate quantitative andqualitative change in the use of supportive relationships as well as markedly different appraisalsregarding the negative effects of relationships across the lifespan.

Conclusions These studies confirm that while the effects of social support are generally positive,supportive relationships can also produce negative outcomes. Support needs and appraisals changeover the lifespan, with policy makers and program developers needing to be mindful of these changesin designing and implementing social support interventions and programs.

Longer-term psychological consequences of early detection and treatment of type-2 diabetes

*Thoolen, B., de Ridder, D.; *Dept of Health Psychology, Faculty of Social Science, Utrecht, TheNetherlands

Objectives This study investigates the consequences of early detection of patients with type-2 diabetesin the first few years after diagnosis. Most studies find that screen-detected patients downplay theirillness, generally showing mild and temporary reactions at diagnosis. However, little is knownabout their adjustment in the first years after diagnosis. We assessed the effects of screening fortype-2 diabetes on psychological outcomes over a longer time span.

Methods Two hundred type-2 diabetes patients, detected 4–36 months previously and under eitherintensive medical treatment or care-as-usual since diagnosis, completed a questionnaire. We examinedwhether time since diagnosis and treatment-intensity relate to emotional (e.g., depression – HADS),cognitive (e.g., illness-perceptions – IPQ) and self-management outcomes.

Results Patients showed significantly raised anxiety and depression compared to norm-groups( p< 0.01) and high levels of perceived seriousness and vulnerability. Self-efficacy, motivation andadherence were also high. Taking time since diagnosis into account, anxiety and depression remainedelevated, diabetes-related distress and vulnerability were higher, and self-efficacy was lower amongthose diagnosed longer ago ( p< 0.05). Furthermore, intensively treated patients reported higheranxiety, more diabetes-related distress and lower self-efficacy, regardless of time ( p< 0.05).Self-management behavior was not associated with time or treatment.

Conclusions These findings contradict other studies: patients do not appear to downplay their illnessand continue to report heightened anxiety and depression months after diagnosis. Among thosediagnosed longer ago, vulnerability and distress are actually higher while perceived ability tomanage the disease is lower, perhaps reflecting patients’ confrontation with the realities of their illness.Intensive medical treatment appears to increase this anxiety while it undermines patients’ self-efficacy,without improving adherence. In sum, early detection and treatment of type-2 diabetes may nothave as mild an effect as previously reported.

Women’s responsibility for cervical cancer screening in Bulgaria: Providers’ perceptions

*Todorova, I., Panaiotova, Y., Balabanova, D., Bradley, J.; *Health Psychology Research Center,Bulgaria

Objectives The incidence and mortality from cervical cancer in Bulgaria have risen, which is in sharpcontrast to the steady decline in most countries of Europe. The initiative for cervical cancer screeninghas shifted to providers and clients and depends on their personal knowledge and responsibility.

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To analyze these dynamics in the context of transformation of the health care system, we haveconducted a multi-component study of Health Systems and Psychosocial Aspects of CervicalCancer Screening in Bulgaria, which included interviews with women, providers and keypersonnel. For this paper, we have the objective of understanding how, through their narratives,providers construct women and their responsibility for prevention of cervical cancer.

Method We conducted 50 semi-structured interviews with health care providers inBulgaria. The sample was purposive and aimed to give a representation by gender, training, andlength of work experience. The interviews aimed to determine the provider’s perspectives onhow the cervical cancer screening is currently organized and financed, advantages anddisadvantages of the systems and linkages and responsibility for screening. They were analyzedaccording to the method of constructivist Grounded Theory, supported by Atlas.ti qualitative analysissoftware.

Results The analysis has identified several layers of ambiguity in provider’s constructions of women’sresponsibility for prevention of disease. These include ambiguities within the themes of: responsiblewomen as ‘intelligent’ and ‘cultured’; women as victims of healthcare reform, women as ‘negligent’,‘uncultured’ and ‘resistant’.

Conclusions Identifying providers’ constructions can be informative in clarifying the healthsystems and doctor-patient communication issues that are creating barriers to screening inBulgaria. They can be used in adapting information and health promotion programs to thespecifics of existing doctor-patient relations, in providing recommnedations for changes and willhave implications for healthcare reform.

Psychosocial regulation of immune susceptibility in childhood:The role of maternal stress, child temperament and experience of transition to school

Turner-Cobb, J.; University of Bath, UK

Objectives To investigate psychosocial influences on hypothalamic-pituitary-adrenal (HPA) axisactivity and immune susceptibility to upper respiratory infection (URI). Findings reported are fromtwo longitudinal studies of (i) preschool age; (ii) school transitioning children.

Methods (i) Mother-child dyads (n¼ 67) with pre-school age children (32 boys and 35 girls) assessedat baseline and at six month follow-up. Salivary cortisol was measured at awakening and at 5–6 pm.Mothers’ completed questionnaire data for child temperament, family relations, and maternalwell-being (including job role quality and burnout). (ii) One-hundred-and-five parent-child dyads(53 boys and 52 girls, mean age 4 years), observed over a 12 month period. Awakening and eveningsalivary cortisol levels, parental reports of child behaviour and URI were tracked 6 months beforetransition to reception class and during the first two weeks of school.

Results (i) Cortisol levels in children differed as a function of mothers’ reported levels of well-beingand family expressiveness. Moderating effects of hours in day care and maternal well-being and childtemperament on cortisol levels were found but not for diurnal cortisol change. Child inhibitory controland shyness were predictive of diurnal cortisol decline. (ii) Evening cortisol levels at baselineand during school transition were associated with subsequent severity and duration of URI but notwith infection onset. Evening cortisol levels at school transition were associated with parental reportsof child activity levels and inhibitory control.

Conclusions Maternal stress, child temperament and transition to school are importantpredictors of cortisol reactivity and link to health outcome as shown by the example of URI. Thishas health implications for understanding development of the neuroendocrine system throughoutthe lifespan.

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Design and development of a multidimensional questionnaire to assess adaptationto illness in hemato-oncological patients

*Ulla, S., Arranz, P., Coca, C.; *Dept. of Psychology, Universidad de Castilla La Mancha, Spain

Objective The main objective of this research is addressed to the design and development of asemi-structured interview for the psychosocial assessment of hemato-oncological hospitalised patients.

Methods Three studies were conducted to ensure the reliability of this instrument, including fourmethodological stages: (a) A preliminary design of the first version of the instrument, guided bythe methodological and clinical criteria from a review of the scientific literature; (b) An expert analysisof the reliability of the instrument’s content, including qualitative and quantitative methodology;(c) A pilot study to test the interview structure and detect other possible pitfalls in the data collectingprocess; (d) An extensive assessment of a sample of 168 haemato-oncological patients in a UniversityHospital with the final version of the assessment instrument.

Results The final instrument was divided into two sections. The first one included data about theillness and other medical issues, gathered by the psychologist prior to the patient’s interview. Thissection consisted of 24 items related to the following areas: (a) Hospitalisation data; (b) Medicaldata; (c) Possible psychopathological history; and (d) Conspiracy of silence. The second section con-stituted the actual interview, which included 42 items in the following areas: (a) Socio-demographical;(b) Information about illness; (c) Social support; (d) Perceived well-being; (e) Life events; (f) Personalresources and coping strategies. Qualitative and quantitative reliability analysis were conductedand informed of the accuracy of the instrument to be used as a screening tool for illness adaptationproblems.

Conclusions Patients go through a tough therapeutic process, and sometimes cannot reach theadequate concentration level required by long standardized questionnaires. Therefore is useful tohave a flexible but systematic instrument, which allows the assessment of several psychosocial areasin hospitalised patients. This systematic interview supplies enough information for preventiveintervention and guides the steps to follow in the psychological assessment and intervention.

Adaptation to hemato-oncological illness: Anxiety increases six months after diagnosis

*Ulla, S., Coca, C., Arranz, P.; *Dept. of Psychology, Universidad de Castilla La Mancha, Spain

Objective To analyse the anxiety evolution in the adaptation process to hemato-oncologicalillness. The following indicators to measure adaptation were considered: sadness, anxiety, perceivedwell-being, perceived efforts to face illness, and self efficacy.

Methods A group of 85 hemato-oncological patients was assessed by a semi-structured interview.10-points Likert scales included in the interview assessed the mentioned variables. Mean of age was49.1 years; SD¼ 20.4; range¼ [17–89]. 47.1% were male and 52.9% female. Attending to timepassed from diagnoses we established six categories: less that one week (20%); one week to onemonth (20%); one to six months (31.8%); six months to one year (11.8%); one to two years(5.9%); more than two years (10.6%).

Results Comparing anxiety levels among the different groups, we observed medium-high levels inthe first days after the diagnoses (5.94 in a 10 point scale); then anxiety mean decreased to lowlevels (3.25) in the interval ‘‘one week-one month’’, but increases again significantly in the intervalcomprised between 6 months and one year (7.2) (Chi-square¼ 20.23; p< 0.01). There was norelation observed between anxiety, nor time from diagnoses and the variable prognostic. Therewere not significant relationships between time from diagnoses and the rest of variables. But therewas a significant correlation among the assessed dimensions. Patients with higher anxiety are

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sadder (Rho¼ 0.232; p¼ 0.036) and perceive a higher effort needed to face illness(Rho¼ 0.262; p¼ 0.017); this is also perceived by patients with a lower level of perceivedwell-being (Rho¼�0.372; p¼ 0.001) and these have a lower perception of less efficacy(Rho¼ 0.293; p¼ 0.007).

Conclusions A significative high level of anxiety was observed six months after diagnosis, whichwas not related to a worse prognosis. It could be associated to fears and concerns underlyinghemato-oncological illness process. Psychosocial resources and strategies should be considered withbiological dimensions to maximized adaptation to the illness process.

When do mum and dad need their genes back? Communicating informationabout genetics to children

*Ulph, F., Leong, J., Glazebrook, C., Townsend, E.; *Institute for the study of Genetics, Biorisksand Society Nottingham University, UK

Objectives To examine genetic counsellors’ experiences of communicating information aboutgenetics to children in order to design educational materials for children.

Methods Two hundred and seven members of the Association of Genetic Nurses and Counsellorswere invited to be interviewed. Thirty-three counsellors consented and 20 were interviewed. Theinterviews were transcribed verbatim and analysed using interpretative phenomenological analysis(Smith, 1996).

Results Two superordinate themes were identified:

Internal factors of communication: This included age, verbal ability and maturity all of which areincluded in psychological theories of children’s understanding of illness. Counsellors varied widelyin their perceptions of how these influenced communication.External facilitators of communication: Family communication was of paramount importance andinstrumental in preparing children to receive counselling. Sometimes, however, parents misinformedtheir children which greatly hindered communication. This is related to the influence of science educa-tion in schools as counsellors commented that ‘it’s the parents you are explaining the genetics to ratherthan [the child]’. This finding highlights the uniqueness of communicating information aboutgenetics to children. Educational resources were seen as integral to providing information as they facili-tated discussion and integrated the child into the session. Providing children with information to takeaway with them gave them ownership of the information. Resources appropriate for children howeverwere rare.

Conclusions The factors that genetic counsellors perceive as being most influential in communicatingwith children about genetics are amenable to intervention. Health psychologists possess researchand communication skills which make them uniquely qualified to play a significant role in addressingthis issue.

When it is better to give than to receive: Long-term health effectsof perceived reciprocity in support exchange

*Vaananen, A., Buunk, B., Kivimaki, M., Pentti, J., Vahtera, J.; *Finnish Institute of OccupationalHealth, Finland

The authors examined the relevance of the equity theory and the esteem enhancement theoryin explaining the long-term registered health status of men (n¼ 178) and women (n¼ 575) workingin municipal occupations. Information was gathered on demographics, health behavior, psychosocialfactors in 1990–93, and intimate reciprocity in 1993. The data on subsequent short-term (1–3 days)

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and long-term (>3 days) sickness absences during a 9-year follow-up (1993–2001) were collectedfrom health registers. Perceived underbenefiting (i.e., giving more support than receiving) in intimaterelationships positively affected the subsequent health status of the women, even after varioussignificant covariates were included in the model. In contrast, perceived overbenefiting (i.e., receivingmore support than giving) was associated with a lower level of short-term sickness absences among themen. The findings support the esteem enhancement theory in explaining the registered health statusof employed women in the context of intimate relationships. No support was obtained for theequity theory.

The relationship between self-determined motivation and exercise-related affect

*Vadgama, G., Rodgers, W.; *University of Alberta, Edmonton, Canada

Objectives The purpose of the study was to determine the relationship between motivation asproposed by self-determination theory, exercise-related affect and exercise adherence.

Methods Eighty-eight physically active women (mean age 24.36) participated in a 12-week weighttraining and cardiovascular exercise program. This was a healthy sample with an average bodymass index (BMI) of 24.90. Participants completed the Behavioural Regulation ExerciseQuestionnaire (BREQ) at weeks 1, 6, and 12. Exercise-related affect was assessed before, afterand during three specific 20-minute aerobic exercise sessions using the Positive and Negative AffectScale (PANAS) and Feeling Scale (FS). Adherence was assessed from workout logs and the GodinLeisure Time Exercise Questionnaire (GLTEQ).

Results Significant correlations were found between the BREQ subscales (extrinsic, introjected,identified and intrinsic motivational regulations) and the two measures of affect at all time points.Levels of identified and intrinsic motivation and self-reported exercise all increased over time.More self-determined motives tended to be positively correlated with positive affect. Less self-determined motives were positively correlated with negative affect. The relationship between positiveaffect after exercise, and identified and intrinsic regulation grew stronger over time. Those whoreported more self-determined motives reported more positive affect during exercise at higherintensities. Those who were less self-determined reported more negative affect at higher exerciseintensities. Adherence measured on the GLTEQ was positively predicted by intrinsic regulation atthe beginning (R2

¼ 0.24) and negatively by extrinsic regulation at the end of the exercise program(R2

¼ 12). Also, intrinsic motivation was associated with higher adherence.

Conclusions These findings support the hypotheses of self-determination theory regarding therelationship of self-determined motives to affective experiences. They also show some variation ofinfluence of form of motivation over an exercise program.

Coping styles and quality of life among asthmatic adolescents:The role of severity and gender

*van de Ven, M., Engels, R., van den Eijnden, R.; *Radboud University Nijmegen, The Netherlands

Objectives Hardly any studies have investigated the relationship between coping styles and qualityof life (QOL) in patients with asthma, and, to our knowledge, no studies focused on asthmaticadolescents. Research implicates that asthma impairs QOL in asthmatic teens. The present studyexamines the association between coping and QOL among a large sample of asthmatic adolescentsselected from the general population of Dutch secondary school children. In addition, the role ofseverity and gender on coping and QOL will be studied.

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Methods A total of 553 asthmatic adolescents, aged 12–16, filled out the ‘‘Adolescent AsthmaQuality of Life Questionnaire (AAQOL)’’, and the ‘‘Asthma Specific Coping Scale’’. Linearregression and univariate analyses of variance were conducted to investigate the effects of severityand gender on coping and QOL. The associations between coping and QOL, as well as the moderat-ing role of severity and gender on these associations were tested using Structural EquationModelling (SEM).

Results Asthma severity was positively associated with all coping styles (restricted lifestyle, hidingasthma, positive reappraisal, information seeking, ignoring asthma, worrying about asthma), andnegatively associated with QOL. With regard to gender, boys exhibited higher QOL, whereas girlsscore higher on restrictive lifestyle, information seeking and worrying. SEM analyses showed thatpositive reappraisal was associated with a higher QOL, whereas a restricted lifestyle, hiding asthma,information seeking and worrying were all significantly associated with a lower QOL. Theseassociations were moderated by severity and gender.

Conclusions Adequate coping strategies seem to have beneficial effects on QOL in asthmaticadolescents. These effects are different for girls and boys, and are stronger among adolescentssuffering from more severe asthma.

Organ donation attitudes and intentions to donate amongst Asians and Caucasians

*van den Akker, O., Bhundia, R.; *Aston University, Birmingham, UK

There is an imbalance in relation to organ donation and transplantation supply and demand, withover 5,500 patients on waiting lists and less than 3,000 organs transplanted in the U.K. each year.This imbalance in supply and demand for organs is particularly pronounced among Asian ethnicminority groups. Since 95% of the organ donor pool is Caucasian, Asians are clearly more reluctantto donate organs.

Objectives This study aimed to examine differences between Asian and Caucasian attitudesand intentions to donate organs, altruism, religiosity, traditional values and knowledge across twogenerations.

Methods A sample of 234 participants (mean age¼ 27.71 years) completed self-reported questionnaires, measuring organ donation attitudes, altruism, religiosity and traditionalvalues.

Results MANOVA highlighted differences between Asians and Caucasians and between younger andolder generations on organ donation measures. The younger generation and Asians exhibited lessfavourable organ donation attitudes and were less likely to become donors. ANOVA distinctivelyrepresented Asian Pakistanis as least favourable towards organ donation. Multiple regression elicitedorgan donation attitudes as predictors of potential donors and found altruism, religiosity andtraditional values all contributed towards these attitudes. Altruism overall was the strongest predictor.Religiosity significantly impacted Asian attitudes, but not Caucasians’. All three variables significantlyinfluenced younger generation attitudes; only altruism significantly influenced older generationattitudes. Additionally knowledge of organ donation significantly affected organ donation attitudesand intentions.

Conclusions Aspects of the theory of planned behaviour can successfully be used to predictattitudes and behaviour in organ donation research. In clinical terms, it is suggested thataltruistic behaviours could be encouraged and campaigns to raise public awareness of organdonation needs, particularly for Asians, could be encouraged through ethnic specific routes such asreligious leaders.

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Negative affectivity predicts emotional distress at two months following implantationof a cardioverter defibrillator

*van den Broek, K., van der Voort, P., Denollet, J.; *Tilburg University, The Netherlands

Objective Negative Affectivity (NA) refers to the tendency to experience negative emotions acrosstime/situations. Little is known about the effect of NA on anxiety and depressive symptoms in patientswith cardiac arrythmias.

Methods Respondents (N¼ 85) were patients who were hospitalized for implantation of anImplantable Cardioverter Defibrillator (ICD) between May 2003 and November 2004 in theCatharina Hospital Eindhoven. They filled in the 7-item NA scale of the DS14 before implantation.A median split (cut-off �8) was used to dichotomise the scores on NA. Two months followingimplantation, they filled in the state-scale of the STAI and the BDI to assess anxiety and depressivesymptoms, respectively.

Results Two months post-ICD, 29 (34%) patients reported anxiety (STAI� 39) and 18 (21%)reported depressive symptoms (BDI� 10). High-NA patients more often reported anxiety (51%vs. 18%, p¼ 0.001) and depressive (34% vs. 9%, p¼ 0.005) symptoms compared to low-NA patients,respectively. Logistic regression analysis showed that NA was an independent predictor of anxiety(OR: 4.74; 95%CI: 1.77–12.70, p¼ 0.002) and depressive (OR: 6.37; 95%CI 1.78–22.87,p¼ 0.004) symptoms, adjusting for age and gender.

Conclusions ICD-patients with high NA at baseline are at increased risk to report anxiety anddepressive symptoms at 2 months following implantation. These findings suggest that personalityfactors may optimise risk-stratification in patients with cardiac arrythmias.

Predictors of smoking onset in asthmatic and non-asthmatic adolescents:The value of anticipated emotions

*van den Eijnden, R., van de Ven, M., Engels, R.; *Radboud University, Nijmegen, The Netherlands

Objectives Despite the particularly detrimental health effects of smoking for asthmatics, severalstudies have shown that the prevalence of smoking is just as high or even higher among asthmaticadolescents than among their healthy peers. To gain more insight into underlying mechanisms, thisstudy examined differences in precursors of smoking among asthmatic and non-asthmatic adolescents.An extended version of the Theory of Planned Behaviour was tested. In addition to smoking-specificcognitions, i.e., attitude, perceived social norm, and self-efficacy, the concept of anticipated emotionsregarding smoking was added as a fourth predictor of smoking onset.

Methods A total of 8891 Dutch adolescents, aged 12–16, of which 786 suffer from asthma, wereincluded in a three-wave 2-year longitudinal study. The effects of the four predictors on smokingintention and smoking behaviour were tested cross-sectionally and longitudinally. Multigroup testsin Structural Equation Modelling (SEM) were employed to test for differences in predictorsof smoking in asthmatic and non-asthmatic adolescent.

Results The concept of anticipated emotions was found to be strongly associated with both intentionand onset of smoking, adding a significant proportion of explained variance. When comparingasthmatic with non-asthmatic adolescents, interaction effects were found, indicating that attitude,self-efficacy and anticipated emotions were stronger predictors of smoking intention and behaviourin the asthmatic than in the non-asthmatic group.

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Conclusions Anticipated emotions predict adolescent smoking over and above the factors of the Theoryof Planned Behaviour. Attitude, self-efficacy and anticipated emotions are more predictive of smokingamong asthmatic than among non-asthmatic youngsters. These findings may contribute to the develop-ment of tailored interventions aiming at the prevention of smoking among asthmatic adolescents.

Why and how do patients inform blood relatives about inherited high cholesterol?

*van den Nieuwenhoff, H.; *Maastricht University, The Netherlands

Persons with inherited high cholesterol are prone to (preventable) cardiovascular events at relativelyearly age. About 75% of them are unaware of their predisposition. This unawareness probably ispartly due to inadequate disclosure within affected families, which withholds at-risk relatives fromtest-uptake.

Objectives The present study describes the reasons why index patients (do not) inform blood relativesabout inherited high cholesterol and – if they do – the way they inform them.

Methods Individual in-depth interviews were conducted with 21 persons with inherited highcholesterol. Two independent raters coded the full transcripts, using NVivo software for qualitativeanalysis. The Protection Motivation Theory (Rogers) was applied as a theoretical framework.

Results Index patients generally informed first-degree relatives. They perceived informing as theirduty, because of the potential health benefits for relatives or for the simple reason that their family isalways frank with one another. However, index patients generally did not inform more distant familymembers, even if encouraged to do so by professionals. The main reason was that they did not wantto meddle in the affairs of those distant relatives, which probably is typical for Western cultures.Index patients who did inform relatives frequently communicated a fear appeal message (vulnerabilityand severity information, often partly inaccurate), and rarely communicated the benefits (response effi-cacy) or simplicity of test-uptake or treatment (for personal efficacy). They generally did not tailor themessage to specific characteristics of relatives. In summary, index patients did not motivate relatives toget tested. This also may have been due to the ‘mind-your-own-business-culture’ in Western societies.

Conclusions Detection of inherited high cholesterol is limited by inadequate family disclosure. Evenwith support of professionals, however, disclosure will remain incomplete, for instance because ofcultural preferences.

Psychosocial determinants of sun protective behaviour in Dutch adolescents

*van der Doef, M., Gebhardt, W.; *Leiden University, The Netherlands

Objectives In this study sun protection intention and behaviour of Dutch adolescents wasinvestigated. Two types of sun-protective behaviours (SPB) were discerned: sunscreen use andalternative SPB (e.g., wearing protective clothing, seeking shade). Besides knowledge, attitude,subjective norm, and perceived behavioural control with regard to these SPB, the impact of attitudeand subjective norm with regard to a conflicting goal, i.e., having a suntan, was studied.

Methods A sample of 290 Dutch adolescents (age 12–15) completed a self-report questionnaire.

Results Hierarchical multiple regression analyses revealed that intention and behaviour with regard toeach of the two types of SPB were predicted by a specific set of psychosocial predictors. For alloutcomes, the major predictor was the attitude of the adolescent towards the SPB. Depending onSPB type, subjective norm of parents and friends, and adolescents’ perceived behavioural controlproved predictive of intention and/or behaviour. Furthermore, adolescents’ attitude and subjectivenorm from parents and friends towards a suntanned skin played a role in the prediction of intentionand behaviour. Knowledge proved to be unrelated to the outcomes.

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Conclusions The results indicate that sun screen use and alternative SPB are differentiallydetermined. Besides adolescents’ attitude, subjective norm and perceived behavioural controlwith regard to SPB, adolescents’ own attitude and subjective norm from parents and friendstowards a suntanned skin appear to be of importance. This should be taken into account in designinginterventions to enhance sun protective behaviour in adolescents.

The impact of changes in job demands, job control, and worksite social supporton employee health and well-being

*van der Doef, M., Maes, S.; *Leiden University, The Netherlands

Objectives In this longitudinal study it is examined to which extent employees’ health and well-beingare determined by changes in job demands, job control, and worksite social support. Furthermore,it was postulated that the impact of changes would be dependent on the baseline level and the(mis)fit between actual and desired level of these job characteristics.

Methods A sample of 366 nursing home employees completed a self-report questionnaire atbaseline and one year later. At both measurements, job demands, skill discretion, decisionauthority, and social support from supervisor and colleagues were assessed. At baseline, an analoguequestionnaire was included to measure (mis)fit between actual and desired levels of these job character-istics. At both measurements, job satisfaction, psychological distress and somatic complaints wereassessed.

Results Changes in job characteristics are related to job satisfaction, psychological distress, andsomatic complaints a year later. Favourable changes are associated with higher job satisfaction,and lower levels of psychological distress and somatic complaints, whereas unfavourable changesare related to more unfavourable outcomes. Furthermore, results indicate that the impact ofchanges in job characteristics is partially dependent on baseline job characteristic level andexperienced (mis)fit.

Conclusions Generally, decreases in demands, and increases in job control and social support arerelated to favourable health and well-being outcomes a year later, whereas unfavourable changesare associated with reduced health and well-being. The impact of such changes seems to be partiallydependent on the initial situation and individual preferences with regard to job characteristics. Thesefindings suggest that in terms of health and well-being, certain subgroups of employees may benefitor suffer more from job changes than others.

Eating as an attempt to compensate for impaired ability to dealwith negative emotions

*van der Heijden, P., de Ridder, D., de Wit, J.; *Utrecht University, The Netherlands

Objectives In our study we investigated the relationship between the concept ‘‘emotional eating’’(eating to reduce negative feelings) and ‘‘action orientation’’. This is a personality trait that representsthe ability to self-regulate one’s affect level, and has been shown to predict people’s general copingability. We hypothesize that emotional eating is a compensatory strategy that helps alleviate pervasivenegative affect in low-action-oriented people, and thus allows them to better deal with setbacks andproblems.

Method Eighty subjects – 40 having chronically high anxiety levels (STAI-trait) and 40 controlsubjects – were administered the Action Control Scale (to measure action orientation), and theDutch Eating Behaviour Questionnaire (DEBQ) by van Strien (1986). We examined the relationshipbetween these scales.

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Results There was a large difference in absolute score on the action control scale between the anxiousand the control group ( p¼ 0.001). The anxious group contained almost no high-action-orientedsubjects, thus we merged the two groups to examine the relationship between action orientationand the different scales of the DEBQ. A MANOVA (controlling for BMI) yielded a significantdifference in scores on the emotional eating subscale: low-action-oriented subjects scored higherthan high-action-oriented subjects ( p¼ 0.001). No differences were found between action orientationand the other subscales (external eating, restrained eating) of the DEBQ.

Discussion This study suggests that people who have difficulties in dealing withnegative affect (low action orientation) are more likely to have emotional eating habits: this implicatesthat low-action-oriented people try to compensate for their lack of affect regulation skills byusing external sources of regulation, such as food. This could explain why an (often unhealthy)emotional eating pattern is not easily relinquished without obtaining some other form ofcompensation.

Feeling at risk for familial breast cancer: How accurate is an accurate risk perception?

*van Dijk, S., Otten, W., van Asperen, C., Timmermans, D., Tibben, A., Zoeteweij, M., Silberg, S.,Breuning, M., Kievit, J.; *Leiden University Medical Center, The Netherlands

Objectives The persistent finding of inaccuracy in recalling breast cancer risk, even immediately aftergenetic counselling, has received much concern. However, few studies have assessed how womendescribe their risk in their own words and what the risk information actually means to them. Ourgoal was to address these questions and to assess how verbalisations of the risk and meaning compareto the objective breast cancer risk.

Methods We conducted 123 face-to-face interviews immediately after an (initial) counselling session.N-Vivo software was used to describe the data.

Results The level of accuracy of recall depended strongly on the leniency of the criterion applied.For example the level of verbal accuracy ranged from 25.8% (an exact match with the verbal label)to 98.4% (a more global awareness of having a high versus a low risk). Concerning the significanceof personal risk information, women mentioned a wide variety of risk beliefs, and stress and copingresponses that were associated with their breast cancer risk. In general, women reflected on medicaloptions that were indeed available for them given their risk status.

Conclusions The results indicate that the accuracy of recall might be a limited outcome measure for theeffectiveness of genetic counselling. First, because the level of accuracy of recall seems to depend on howstringent accuracy is defined. Second, accuracy might rather apply to the distress, and risk managementbehaviours that are elicited by the risk information. These beliefs that women hold about their riskstatus, and concomitant levels of stress should play a prominent role in genetic counselling.

Social cognitive prerequisites of planned and preparatory actionsin the context of condom use among young people

*van Empelen, P., Kok, G.; *Universiteit Leiden, The Netherlands

Objectives Social cognitive models, like the TRA/TPB, predict behaviour rather well, withintention being the most proximate predictor. Despite this success, quite a number of people donot act on their intentions. To address this gap, we conducted a study on condom use byadolescents examining preparatory behaviours, behavioural willingness, and TPBþ additionalantecedents for each preparatory behaviour, taking into account the different contexts of casual andsteady sex.

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Methods Written surveys were completed by 399 secondary school students at Time1 and Time 2(3 months after T1). At T1 TPBþ additional concepts were assessed. At T2, preparatory behavioursand condom use was assessed.

Results and Conclusions Condom use with casual and steady sex partners could be predicted fromintentions. In the context of steady sex partners, this relationship was mediated by preparatorybehaviours. This was not the case for condom use in a casual sexual context, but in this contextbehavioural willingness was a very important factor next to intentions, explaining why adolescentsfail to use condoms. These findings suggest that adolescents are rarely prepared and do not anticipatecasual sex. Second we found that a logical sequence of steps (intention – buying condoms – carryingcondoms) could be identified, and that just focusing on intended condom use as the most proximalantecedent of condom use is not enough. Finally, we showed that it is important to not only examineTPB and other social cognitive antecedents (especially descriptive norms) for target behaviour, butalso for preparatory behaviours, because motivational issues may facilitate or hamper thosebehaviours, beyond the decision to use condoms. Our findings support Intervention Mapping,which suggests that in order to change complex health-related behaviour, sequences of sub-behavioursand their unique social-cognitive factors need to be identified.

Cognitive behaviour therapy for multiple sclerosis fatigue

*van Kessel, K., Moss-Morris, R.; *University of Auckland, New Zealand

Objectives Multiple Sclerosis (MS) is an incurable and unpredictable demyelinating disease ofthe central nervous system, with fatigue being one of the more common yet least understoodsymptoms. The exact pathogenesis of MS fatigue remains unclear, but psychological factors suchas unhelpful behaviour and cognitions have been shown to correlate with MS fatigue. The purposeof this study was to investigate the feasibility of a newly designed Cognitive Behavioural Therapy(CBT) programme to treat fatigue in MS.

Design Single subject design with a three month follow-up phase.

Method Six patients with MS fatigue each attended eight individual CBT sessions, which followed amanualised protocol. Treatment consisted of gradual exposure to consistent activity and rest, andcognitive restructuring. Measures included the Chalder Fatigue Scale and the Brief IllnessPerception Questionnaire.

Results Visual inspection of the data showed that substantial improvements in fatigue were reported byall six subjects, and that these improvements were maintained at three month follow-up in foursubjects. Alongside an improvement in fatigue, illness cognitions also appeared to change for mostsubjects. In particular, the extent to which people believed fatigue affected their life reduced, concernabout their fatigue and the emotional impact of their fatigue reduced, while the amount of personal con-trol they felt they had over their fatigue and their understanding of fatigue increased.

Conclusions The findings of this small study tentatively suggest that patients with MS fatigue mightbenefit from a CBT intervention to improve their fatigue. Further research, such as a randomizedcontrol trial, is required to confirm these findings.

A self-help approach to promote sexual health among HIV-positive MSM

*van Kesteren, N., Hospers, H., Kok, G.; *Maastricht University, The Netherlands

Objectives To describe the development of an evidence-based intervention to promote sexual healthamong HIV-positive Men who have Sex with Men (MSM) delivered by HIV-counsellors at HIVoutpatient clinics in the Netherlands.

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Methods We used a five step program-planning framework called Intervention Mapping:(1) formulating proximal program objectives; (2) selecting theoretical methods and practicalstrategies; (3) translating methods into a program; (4) planning for adoption and implementation;and (5) planning for evaluation.

Results In IM Step 1 we specified what HIV-positive MSM should learn in order to promote theirsexual health. Based on theory and additional qualitative and quantitative data, we decided to focuson satisfactory sexual functioning and safer sexual behavior. In specifying health-promotion behaviors,we elaborated on theories of self-regulation as concepts of self-regulation theory afford greaterprecision in understanding what people are doing or need to do to reach health goals. In IM Step 2the program objectives were linked to theoretical methods and translated into practical strategiesthat fit the program objectives. The main theoretical frameworks chosen were self-regulation theoryand cognitive-behavioural therapy. In IM Step 3 program materials were developed and pre-tested:(1) a self-help guide addressing sexual functioning (i.e., sexual dysfunctions) and safersexual behaviour; and (2) a HIV-counsellor’s manual and training in motivational interviewing.The focus of IM Step 4 and 5 was adoption, implementation and evaluation. These steps comprisedseveral tasks, a.o. developing a linkage group to ensure collaboration among several interestgroups and conducting a study to identify determinants of program implementation amongHIV-counsellors.

Conclusion The IM protocol offers a valuable guide to structure the application of theory andempirical evidence in intervention development. The procedures of the IM protocol are not new,but the specification of the planning process represents an innovation for the practice of healthpromotion.

Attitudes about genetic testing for thrombophilia in a large familywith heritable protein C deficiency

*van Korlaar, I., Vossen, C., Rosendaal, F., Bovill, E., Naud, S., Cameron, L., Kaptein, A.; *Unit ofPsychology, Leiden University Medical Center, Leiden, The Netherlands

Objectives The number of genetic risk factors that can be detected through genetic testing isincreasing rapidly. Little research has been done regarding the psychological consequences of knowingthat one is at an increased risk for venous thromboembolism. The aim of this is study was to exploreattitudes of getting a genetic test for protein C deficiency.

Methods Questionnaires about genetic testing attitudes, dispositional anxiety, risk perception, andthrombosis-related worry, were filled in by 192 members of a North-American kindred with a highprevalence of heritable protein C deficiency. A total of 81 subjects (42%) had not been tested forprotein C deficiency before participating in our study, and thus did not know their status whenthey filled in the questionnaires. The other 111 subjects (58%) had been tested prior to participation,and 49 (26%) had protein C deficiency, while 62 (32%) did not.

Results Family members with protein C deficiency perceived a higher risk perception of sufferingvenous thrombosis and scored higher on thrombosis-related worry than family members withoutprotein C deficiency. Participants who were not tested before did not report excessive thrombosis-related worry or risk-perception. All participants reported a high belief in the psychological andhealth benefits of testing, and protein C deficient participants reported low psychological distressfollowing the genetic test. High psychological distress following the test was related to dispositionalanxiety and thrombosis-related worry in participants with protein C deficiency. Participants withoutprotein C deficiency were relieved after finding out they did not have the deficiency.

Conclusions Despite the non-randomisation of the study, findings indicate that in general there arefew negative psychological consequences of knowing that one is at an increased risk for venous

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thromboembolism, except for vulnerable individuals. Furthermore, patients who are still unsure abouttheir status do not worry excessively.

Early detection of cancer: Psychosocial determinants of passive detection behaviourand medical help seeking in an elderly (551) population

*van Osch, L., de Nooijer, J., Lechner, L., Reubsaet, A., de Vries, H.; *Maastricht University,The Netherlands

Objectives Delays in the detection of cancer symptoms and seeking medical help have been foundto be associated with poorer outcomes in various types of cancer. People of advanced age are atincreased risk for developing cancer. This study explores psychosocial determinants of passivedetection behaviour, i.e., attentiveness to cancer symptoms, and medical help-seeking in a sampleof Dutch adults of advanced age.

Method A cross-sectional telephone survey was conducted among 459 respondents aged 55 yearsand older. The survey assessed passive detection behaviour and appropriately timed medicalhelp-seeking with regard to 14 possible cancer symptoms. Various psychosocial determinants, derivedfrom the I-Change Model, were also measured.

Results On average, adequate passive detection behaviour was reported by just over half ofthe respondents (53%) varying from 32 to 68% per symptom. Merely 8% of the respondentsreported adequate detection behaviour for all cancer symptoms. Timely medical help-seekingwas reported by, on average, 74% of the respondents, varying from 23 to 95% for theseparate symptoms. Merely 14% of the respondents indicated that they would timely consult a phy-sician for all cancer symptoms. Correlations between detection behaviour and help-seeking were low(all r� 0.24). Multiple linear regression analyses showed that younger age, being female, knowledgeof cancer symptoms, positive attitude and positive intention were associated with passive detection.Medical help-seeking was associated with lower education, positive attitude, higher self-efficacy andpositive intention.

Conclusions Both passive cancer detection behaviour and adequate medical help-seeking aresub-optimally performed in the high-risk population that was investigated. Different psychosocialdeterminants are of importance in the two behaviours, indicating that educational programs shouldaddress passive detection behaviour and medical help-seeking separately in order to optimisebehavioural change.

The influence of illness script components on physicians’ referral behaviour

*van Schaik, P., Flynn, D., van Wersch, A., Douglass, A., Cann, P.; *School of Social Sciences andLaw (Psychology Subject Group), University of Teesside, UK

Objectives The research aimed to examine the influence of enabling conditions (‘who the patient is’)and consequences (‘signs and symptoms’), as defined by illness script theory, upon ‘generalpractitioners’ (GPs) referral behaviour for common upper and lower gastrointestinal symptoms.

Methods Using a half-factorial design methodology, 16 combinations of five dichotomous patientfactors were embedded in a 3� 2 full-factorial design to create 96 (6� 16) different vignettes.Thirty-two GPs participated and a structured response protocol was used to elicit various aspectsof their referral behaviour. Logistic regression and multiple regression were used to analyse the effectsof illness script components and physician variables on referral behaviour.

Results Results confirmed that both consequences and enabling conditions acted as referral drivers,and several interactions between consequences and enabling conditions were found. Results also

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confirmed that physician factors moderated the effect of enabling conditions, but evidence was alsofound for moderation of consequences. More generally, the use of illness script components wasfound to be influenced by physician factors to a larger extent than previously assumed by illnessscript theory.

Conclusions The current study has demonstrated interaction effects between consequences andenabling conditions in experienced physicians. This confirmed illness script theory by providingsupport for a network of illness script components that act in concert and identifying particular domi-nant links between components. Furthermore, evidence was found for a differentiation in the use ofillness script components in experienced physicians. This differentiation is not predicted by illnessscript theory, but can be interpreted as a confirmation of previous research that has shown awide variability in referral rates between GPs. Overall, illness scripts proved even more malleablethan previously believed, as a function of both individual and environmental physician factors.

Continuation of adolescent smoking after smoking experimentation

*van Zundert, R., Engels, R., van den Eijnden, R.; *Radboud University, Nijmegen, The Netherlands

Objectives The aim of the present study was to determine whether smoking specific cognitions, suchas attitudes, social norms, and self-efficacy predict continuation of smoking after young adolescentshave experimented with smoking. Furthermore, since few studies have yet examined cumulativeeffects of interactions between the cognitive factors, interactions have been examined as well.

Methods From a sample of 1595 students aged 11–15, who were in their first year of secondaryeducation, 397 students had been included. Only those students had been selected who at T1 hadreported to smoke on an experimental basis. During the three-wave 1-year longitudinal study,students filled out questionnaires inquiring current smoking status, and concepts derived from theTheory of Planned Behaviour (TPB), i.e., attitudes towards smoking, perceived social normsregarding smoking, and self-efficacy to resist smoking.

Results Findings from the cross-sectional logistic regression analyses show that pro-smokingattitudes, positive social norms, and low self-efficacy, plus interactions between positive attitudesand norms, were related to smoking at basically all 3 measurements. Moreover, a three-wayinteraction between pro-smoking attitudes, positive norms, and low self-efficacy was related tosmoking at T3. Longitudinally, positive social norms predicted continuation of smoking at T2, andinteractions between pro-smoking attitudes and positive social norms predicted continuation at T3.

Conclusions Although the cognitive constructs of the Theory of Planned Behaviour have beenamply demonstrated to predict smoking initiation, the present findings suggest that cognitive factorsplay less important roles in the process of smoking continuation after experimentation. Moreover,interactions had hitherto been disregarded in examining the TPB factors in relation tosmoking, while the present study demonstrates that they are of significant relevance and are likelyto place youth at accumulated risks for smoking.

Physical symptoms in children: Coping with reactivity, negative affectivityand the role of the parents

*Vanderfaeillie, J., De Fever, F., Vandenplas, Y.; *Orthopsychology, Vrije Universiteit Brussel,Belgium

Objectives We report on the empirical testing of a model inspired on the symptom perceptiontheory and on coping models. In this model reactivity is seen as a stressor and ineffective copingwith it – appraised as a symptom – is assumed to result in physical complaints.

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Methods One hundred and seventy-four children (95 boys and 79 girls aged from 9 to 12) filled upa Coping with Reactivity Inventory, a Questionnaire Physical Symptoms for Children, a NegativeThoughts Questionnaire, a State-Trait Anxiety Inventory for Children and a Illness BehaviourEncouragement Scale (Child form).

Results In a regression analysis coping with reactivity and especially catastrophising predictsa higher symptom reporting. When negative affectivity and anxiety are included into the model,coping with reactivity does not explain the symptom reporting any more. On the contrary,in this new model negative affectivity predicts the symptom reporting. Logistic regressionreveals that illness-encouraging behaviour of the parents explains absenteeism from school.Child factors (negative affectivity and anxiety) and symptom reporting of the child do notcontribute to it.

Conclusions The hypothesis that coping with reactivity results in physical symptoms is not supported.Physical symptoms in school children are the externalisation of negative emotions. The outcome ofthe symptom reporting by children depends on the attitude of the parents.

The symptom perception model tested on children with somatoform symptoms

*Vanderfaeillie, J., De Fever, F., Vandenplas, Y.; *Vrije Universiteit Brussel, Belgium

Objectives The symptom perception theory describes the reporting of somatic sensations asphysical symptoms or as emotional distress in terms of information processing. The model wasoriginally developed to guide the theorising of symptom reporting in adults. In this article wereport on the empirical testing of the model in children with somatoform symptoms.

Methods Data were gathered from 34 children (27 girls, 7 boys) with somatoform symptoms (meanage¼ 10.7; response rate¼ 92%) and a control group (26 girls and 8 boys; mean age¼ 10.2 year).For the purpose of the testing 5 hypotheses are deduced form the model: (1) the children’s compe-tence and their number of symptoms are negatively correlated; (2) children with good and badschool results report more symptoms than children with average results; (3) negative affectivitycorrelates stronger with emotional distress than with physical symptoms; (4) the reporting ofemotional distress and physical symptoms are correlated; (5) illness behaviour is stronger relatedwith the reporting of symptoms than with the reporting of emotional distress.

Results Hypothesis 4 is completely and hypothesis 3 is only partially confirmed. Our datasupport insufficient the use of the symptom perception theory in children with somatoform symptoms.At once is tested if children with somatoform symptoms prefer a specific way of informationprocessing. Neither this hypothesis is confirmed.

Conclusions At this moment the use of the symptom perception theory is not advisable in children.Our sample of children with somatoform symptoms does not use a specific way of informationprocessing. Further research is needed.

Media campaigns to reduce patient delay in seeking care for heart attack symptoms:A psychosocial approach for developing effective messages

*Vecchio, L., Bosio, A., Schweiger, C., Valagussa, F.; *Department of Psychology, University ofMilano-Bicocca, Italy

Objectives The study documents the development of a message for a media campaign aimed atreducing patient delay in seeking care for hearth attack symptoms. Effectiveness of media campaignsin decreasing patients’ delay is controversial. A possible reason is in message contents: most of the

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campaigns make use of messages aimed at increasing symptom awareness and at fostering the rapidityof intervention, inviting people to take responsibility for the decision of seeking help as the first stepof the treatment.

Methods Qualitative research was conducted to explore patients’ representation of hearth attack andthe main factors influencing the delay to a rapid intervention. Sixty-five interviews were conductedto different targets: general population (n¼ 30); survivors of hearth attack (n¼ 10) and their parents(n¼ 10); health workers of emergency services (n¼ 15). Interview protocols were analyzedthrough thematic analysis.

Results Results showed that symptoms knowledge doesn’t represent a problem for the rapidity ofthe intervention: no difficulties in recognizing typical symptoms emerged. Two other obstaclesemerged:

(i) people resistance to recognize having an hearth attack, involving the persistence in astate of uncertainty about how to cope with the problem;

(ii) refusal to take responsibility for the decision of seeking help and the need of profes-sional support to face the threat of such a serious disease (after it’s been recognizedas present).

Conclusions Messages focusing on symptoms appraisal and personal burden of the decision ofmedical help seeking could be self-defeating. Actually, people don’t want to treat personally thisdisease and we can’t ask them to become physician of themselves. A message was developed focusedon a different content, aimed at reducing the uncertainty state, encouraging the rapidity of seekinghelp not as a way to substitute professional intervention but as a manner to protect themselvesbefore the beginning of the treatment.

Chronic caregiver stress and immunity

Vedhara, K.; University of Bristol, UK

Objectives This presentation will review the results of two studies conducted by our groupexamining the effects of chronic caregiver stress on spousal carers of dementia patients. The studiesaimed to:

examine the relationship between caregiver status (i.e., caregiver vs. non-caregiver) and cortisol andimmunity to influenza.examine the effects of a cognitive-behavioural stress management (CBSM) intervention ondistress, cortisol and immunity to influenza.

Methods Study 1: Fifty spousal caregivers and sixty-seven non-caregiving controls were recruited.Assessments of distress, cortisol and immune responses to influenza vaccination were undertaken.Study 2: Forty-three spousal caregivers and twenty-seven non-caregiving controls were recruited.Caregivers were allocated to an 8 week CBSM intervention (N¼ 16), or non-intervention (N¼ 27)group. Assessments of distress and cortisol were undertaken during the intervention period andimmune responses to influenza vaccination were assessed post-intervention.

Results Study 1: Revealed significantly elevated distress and cortisol in caregivers compared withnon-caregivers. Immune responses to the vaccine revealed that significantly fewer carers (16%)generated a clinically appropriate response to the vaccine (i.e., a 4-fold increase in antibody)compared with non-caregivers (39%). Study 2: Elevated distress was observed in both caregivergroups compared with non-caregivers throughout the CBSM period. There were also no between-group differences in cortisol. Immune responses to the vaccine revealed, however, that 50%

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of intervention-carers, 7% of non-intervention carers and 29% of controls produced a clinicallyappropriate response to the vaccination.

Conclusions Chronic distress in elderly caregivers is associated with impaired immunity whichappears amenable to improvement through stress-management.

Outcome evaluation of a sex education intervention for high risk Portuguese women

*Veiga-Costa, E., McIntyre, T.; *University of Minho, Department of Psychology, Braga, Portugal

Objectives The objective of this study is the outcome evaluation of a sex education intervention(1 session HIV Prevention standard information) compared with a control group.

Method Cross-sectional design. Sample: 107 Portuguese women with specific risk criteria for HIVinfection, 16–29 years old, 74 in experimental condition and 33 in control group. Women wererecruited from a youth gynaecological consult in the Portuguese Institute of Youth. Instrumentsand procedure: Instruments were adapted into Portuguese from Women’s Health StudyQuestionnaire (Hobfoll, 2002). The women in the sex education intervention received a one sessionon sex education focused on HIV prevention (Kamb et al., 1998) and those in the control group hadno intervention. Pre and posttest, as well as 3 and 6 months follow up measures were taken usingquestionnaires on condom negotiation self-efficacy, depression, general perceived self-efficacy,perceptions of risk, reasons for not practicing safer-sex, self-esteem, PTSD symptoms, alcohol anddrug use, current safer sex practices (sexual behaviour) and sexual knowledge (transmission andprevention).

Results Statistical analyses show a reduction in depression after the sex education intervention,an increased knowledge of HIV transmission and prevention, as well as an increase inpreventive sexual practices (condom use) when compared with control group. Benefits weremaintained or increased at 3 and 6 month follow up. These results support the use of shorteducational interventions in increasing knowledge as well as safe sex behaviour for young womenat high risk for HIV.

Exposure to worksite wellness-health interventions: Effects on job characteristicsand employee health and wellbeing

*Verhoeven, C., Akerboom, S., van der Doef, M., Maes, S.; *Leiden University, The Netherlands

Objectives A longitudinal study was conducted to study the effectiveness of interventions focusedon working conditions.

Methods All employees of a large hospital in the Netherlands were approached in October 2000(time 1), with questionnaires measuring working conditions (LQWQ), job satisfaction (LQWQ),emotional exhaustion (MBI), anxiety, depression, somatic complaints, sleep (SCL-90) and self-rated health. Based on this initial screening, every organizational unit has been given suggestionsfor improvement of working conditions. A second measurement took place in October 2003(time 2). On the basis of exposure measures an intervention group and a non-intervention groupwere defined.

Results Two exposure measures were used. A first is the supervisor’s report on changes that wereinitiated in his/her organizational unit. The second is employees perception of interventions initiatedin their organizational unit. Effects of interventions were found for working conditions. For thefirst exposure measure positive effects were found on staffing, demands, internal communication

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and developmental possibilities, and a negative effect on physical working conditions. For the secondexposure measure effects were found on: staffing, social support supervisor, information,internal communication, financial rewards and work-home interference. Intervention effects werealso found on outcome measure job satisfaction for the second exposure measure on. No effectswere discovered on the outcomes with the first exposure measure.

Conclusion The LQWQ has proven to be a useful tool to determine suggestions for interventionsfor organizational units. This study proves that interventions can change working conditions andhealth and wellbeing outcome measures.

The effectiveness of personal-relevance information in increasing perceived riskof hepatitis B infection among men who have sex with men

*Vet, R., de Wit, J.; *University Utrecht, The Netherlands

Objective Theory and research on fear arousing health communications suggest that increasingthe personal relevance of a depicted threat enhances persuasion. The present study sought to increasethe personal relevance of health threat messages to promote vaccination against hepatitis B-virus.The aim of the study was to assess the effect of different communication strategies on perceptionsof personal risk of hepatitis B infection among men who have sex with men. Different strategies toinfluence people’s perception of a personal risk are scenario information and prevalence information.The assumption is that presenting information of risk personal relevance will evoke the perceived riskto infection with hepatitis B.

Method In a controlled experimental study the effects of two communication strategieswere compared with two control groups. The participants in the experimental conditions receivedeither a text containing a risk scenario or a text with detailed information about the prevalence ofhepatitis B infection. Participants in the control groups received only basic information orno information at all. After reading the texts participants filled out a questionnairecontaining among others a measure of perceived personal risk. The data for this study were collectedvia the internet.

Results One hundred and eighteen males participated. Age varied from 18 to 63 years with a meanof 37 years. Analysis of variance showed that the manipulation of information established differentlevels of perceived personal risk. The risk scenario resulted in higher levels of perceived personalrisk than did prevalence information or the control conditions.

Conclusions The findings of the present study suggest that a risk scenario is likely to besuccessful in altering perceptions of personal risk. Explanations and implications of this finding willbe discussed.

Smoking status moderates the weight of social-cognitive determinantsof adolescents’ smoking intentions

*Victoir, A., Eertmans, A., Van den Broucke, S., Van den Bergh, O.; *Research Group for Stress,Health and Wellbeing, University of Leuven, Belgium

Objectives To test whether different groups accord different weights to determinants of smokingintentions.

Method We looked at nonsmokers (N¼ 736), occasional smokers (N¼ 199) and daily smokers(N¼ 278), aged 13 to 22 (M 16.1 yrs). In separate-slopes analyses, the variation in weights ofattitudes, self-efficacy, and social influences in the prediction of intentions was tested. The weightof contextually induced cravings was investigated for current smokers as well.

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Results The model showed group-specific predictor weights (Adj. R2¼ 0.72, F35,1106¼ 83.93,

p< 0.001). Nonsmokers’ intentions were linked to ease of refusing to smoke (� �0.06; CI [�0.10,�0.02]) and social influences (� 0.05; CI [0.01; 0.09]). Occasional smokers intended to smokemore if they thought buying/smoking cigarettes is easy (� 0.05; CI [0.01; 0.10]). Daily smokers’intentions were high if they saw few health consequences to smoking (� �0.06; CI[�0.11, �0.02]),if they considered buying/smoking cigarettes easy (� 0.24; CI [0.15; 0.33]), and if social influencesregarding smoking were favourable (� 0.10; CI [0.04; 0.16]). In current smokers (Adj. R2

¼ 0.45,F26,420¼ 15.02, p< 0.001), contexts that elicit a nicotine craving were linked to intentions for dailysmokers (� 27; CI [0.15, 0.39]), but not for occasional smokers.

Conclusions Prevention programmes should reflect the strength of social-cognitive determinants ofintentions in different groups. Refusal skill training may be effective only for nonsmokers.Interventions aimed at daily smokers should incorporate methods that allow smokers to extinguishsituationally induced cravings.

Food marketing for children and obesity

*Vinck, J., Houben, M., Lemaıtre, D.; *Limburgs Universitair Centrum, Health Psychology ResearchGroup, Belgium

Objectives Childhood obesity is a growing problem. Television (TV) viewing has been associatedwith obesity in children and adolescents. This effect may be explained in part by exposure viaTV to advertising for unhealthy foodstuffs. As a follow-up to a study about food marketing to childrenin Europe, conducted by the British Heart Foundation Health Promotion Research Group, this studyaims at examining the amount of exposure of children to (unhealthy) foodstuffs via TV in Flanders.

Method During 4 consecutive weeks, TV programmes of one out of 2 popular channels weremonitored during the hours that children may be supposed to be watching; the two TV channelswere monitored on alternating days. The number and duration of commercials during this periodwere recorded. Percentages of commercials for food and, within this group, for healthy and unhealthyfoodstuffs (the latter defined as containing more than 30% total fat and/or 20% simple carbohydrates)were calculated.

Results During the observation period 1016 commercials were recorded; 274 (27%) of these wereabout foodstuffs. Advertising for unhealthy foodstuffs accounted for almost three quarters of thesefood commercials (198¼ 72%).

Conclusions The finding that about 20% of commercials (and 72% of food commercials) broadcastduring the time that children can be expected to watch TV are about unhealthy food, is consistentwith the hypothesis that food marketing is important in explaining the relation between TV viewingand obesity in children.

Cognitive predictors of GPS’ intentions to recommend smoking cessation servicesto smokers that want to stop smoking

*Vogt, F., Hall, S., Marteau, T.; *King’s College London, Department of Psychology (at Guy’s), UK

Objective Recommending smoking cessation services is of considerable importance to public healthyet many opportunities to do so are missed by primary care physicians. This paper aims to describe theprevalence of GPs’ beliefs about recommending smoking cessation services and to evaluate thedegree to which these beliefs predict GPs’ intentions to recommend smokers to use smoking cessationservices.

Methods A confidential survey of 367 (96% response rate) GPs in England.

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Results Sizable proportions do not intend to recommend all motivated smokers to use Stop SmokingClinics (29%) and one-to-one support (40%). Around 12% see Stop Smoking Clinics as ineffective.One-to-one behavioural support is considered ineffective by 7% of GPs. Fewer than 50% believe thatStop Smoking Clinics and one-to-one support are cost-effective services. Thirty-seven percent believethat few smokers will go the Stop Smoking Clinics and 21% believe few will go to one-to-one support.Multiple regression analyses showed that beliefs explained 41% of variance in intentions to recom-mend group support, and 45% of variance in intentions to recommend one-to-one support. Beliefsabout effectiveness and cost-effectiveness were the strongest independent predictors of intentions.

Conclusions Many GPs do not perceive smoking cessation services to be cost effective, despite thesebeing amongst the most cost-effective health care interventions and at the forefront of the UKgovernment’s plan to reduce premature death and health inequalities. Furthermore, these beliefssignificantly predict GPs intentions to recommend these services. Therefore, addressing these beliefsmay be important if GPs are to encourage more smokers to use smoking cessation services.

Coping with stressful situations: Do optimists receive more social support?

*Vollmann, M., Weber, H., Renner, B.; *University of Greifswald, Germany

Objectives In many studies, optimism was found to be a notable determinant of mental and physicalhealth. The beneficial effects of optimism (as compared to pessimism) on health are assumed to bemediated by an adaptive coping behaviour und the increased receipt of social support. However,only little is known about the social impact of optimism and pessimism. Therefore, the major aimof our research was to examine the social responses to optimistic, pessimistic, and realistic copingbehaviour.

Method First, two stressful target situations, which clearly differed in their perceived controllability,were selected. In the next step, prototypical behaviour patterns (thoughts, feelings, goals, and actions)assigned to optimists, pessimists, and realists in coping with these situations were assessed on the basisof the act frequency approach. Finally, the social responses to these behaviour patterns wereexamined. Participants (N¼ 240) were presented with audiotapes of a target person enacting eitherthe optimistic, pessimistic, or realistic behaviour pattern in response to the stressful situations.

Results Manipulation checks showed that the three behaviour patterns were clearly recognized asoptimistic, pessimistic, or realistic. Participants who listened to optimistic and realistic targetsreported to feel better afterwards than participants who listened to pessimistic targets. Moreover,realistic and optimistic targets were perceived as more competent and more effective than pessimistictargets. However, the willingness to engage in further social interaction and to provide social supportdid not differ for optimistic, realistic, and pessimistic targets.

Conclusion The results support the hypothesis that optimists are evaluated more positively thanpessimists, but they do not support the assumption that optimists receive more social support thanpessimists. Overall, the realistic behaviour pattern received the most positive feedback. This did notaffect, however, the willingness to provide more social support.

Patient experience of neurological rehabilitation

*Wain, H., Kneebone, I., Billings, J.; *Guildford & Waverley NHS Primary Care & University ofKent, UK

Objectives To identify aspects of an in-patient neurological rehabilitation program which areimportant to patients.

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Methods Semi-structured interviews were conducted with 8 past patients of a neurologicalrehabilitation unit. Questions focused on participant’s experiences while in the unit, including thoseaspects they found particularly beneficial and those that were viewed less well. Interviews tookplace in participants’ own homes and lasted approximately 40 minutes. InterpretativePhenomenological Analysis (IPA) was used to explore transcribed data.

Results The major themes identified suggest the importance of maintaining ones locus of controlduring the rehabilitation process. Participants who felt their experience to be particularly beneficialdiscussed their appreciation of the opportunity to control aspects such as their diet and the directionof their therapy. It appeared that when control was reduced or no longer present they became dissa-tisfied with the service. The perception of personal control was supported through the person centredapproach taken by the staff, and the freedom for social interaction fostered generally within the unit.

Conclusions Consistent with well established findings in the psychological literature identifyingpersonal control as important to well-being, individuals facing multiple challenges due to neurologicalillness appear to be more satisfied with services when they exert more control within them.Rehabilitation services should attempt to maximise patient control through as many means aspracticable if they are to maintain satisfaction. Studies investigating patient satisfaction with servicesshould seek information on perceptions of environmental controllability.

Personal dispositions and mortality

*Wainwright, N., Surtees, P., Khaw, K.-T.; *Institute of Public Health, University of Cambridge,UK

Objectives Growing interest in the psychology of positive functioning and resilience is focusing atten-tion on human strengths as determinants of health but evidence is limited on the extent to which con-structs based upon divergent theories may overlap in their importance for health outcome. We nowassess the independent association of selected personal dispositions with mortality.

Methods A population-based cohort study, part of the European Prospective Investigation intoCancer, Norfolk. A total of 20,921 men and women, aged 41–80 years, completed a postal assessmentof measures of hostility, submissiveness, neuroticism, extroversion, sense of coherence (SOC) anda sense of mastery (SOM).

Results A total of 1,331 deaths from all-causes were recorded during follow-up (mean 6 years).Results (rate ratios (95% confidence intervals) for a standard deviation change in scale score afteradjustment for age, sex, prevalent physical disease at baseline and cigarette smoking history) revealedno associations for neuroticism (1.02 (0.97–1.08); high vs. low), hostility (1.04 (0.98–1.10); high vs.low) or submissiveness (1.01 (0.96–1.08); high vs. low). A modest association was observed forextroversion (1.06 (1.00–1.12); low vs. high), and larger associations were observed for SOC (0.86(0.82–0.91); strong vs. weak) and SOM (0.83 (0.78–0.88); strong vs. weak). Only SOC and SOMwere associated with mortality independent of each other and of the other personal dispositionmeasures considered (0.89 (0.83–0.96) and 0.84 (0.78–0.90), respectively).

Conclusions In contrast to measures of hostility, submissiveness, neuroticism and extroversion, copingdispositions represented by either a strong SOC or a strong SOM may confer resilience to the risk ofchronic disease and mortality. Further work is needed to deepen understanding of these relationships.

The psychosocial impact of acne: An altered appearance during adolescence

*Wallace, M., Harcourt, D., Rumsey, N.; *University of the West of England, UK

Objectives To explore the appearance concerns of adolescents who have experienced acne andascertain its impact on cognition, emotion and behaviour.

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Methods Six participants were recruited via the Acne Support Group and a press release fromthe University of the West of England. In depth, semi-structured interviews were conducted withparticipants and analysed using Interpretative Phenomenological Analysis.

Results The experience of acne during adolescence had a profound impact on participants andseveral themes highlighting this emerged from the data. Participants felt repulsed by their acne,leading to feelings of shame and hiding behaviour in public. Ultimately, this translated into reducedsocial interaction and increased isolation. Many spoke of the stigma attached to acne, such as its linkwith being ‘dirty’ and unwashed with the implication that the occurrence is therefore within theircontrol. Intrusive comments, teasing and bullying had resulted in truancy, as had ‘bad skin days’.Participants highlighted the difficulties of experiencing a condition that altered only appearanceand had no ‘medical’ consequences that might induce sympathy or reduce feelings of responsibility.At the same time, participants felt guilty for ‘allowing’ a condition affecting only appearance tohave such a big impact on their lives, highlighting society’s contradictory messages aroundappearance, positioning it as insignificant and superficial, while also locating it as central in termsof value. Experiences with health professionals had been largely unsatisfactory and examples ofinappropriate and insensitive care and support were common.

Conclusions The distress and anxiety resulting from acne is often under-estimated and as thisseems to implicate the care offered by health professionals, should be addressed. Ironically, thefact that acne is not medically ‘serious’ increases psychological vulnerability to it through personaland public perceptions of this condition. Further research is needed to identify factors thatmight increase resiliency for this group during adolescence, when appearance may be of particularconcern.

Physical, sexual and attitudinal correlates of circumcision amongSomalian women living in London

*Walsh, J., Jama, K.; *University of East London, UK

Background The aim of this study was to explore the physical and sexual effects of femalecircumcision, as well as assessing attitudes towards the continuance of the practice.

Method A sample (N¼ 70) of first and second generation Somalian women living in the London areacompleted a multi-sectioned questionnaire assessing both physical and sexual correlates of theircircumcision as well as their thoughts about the future of the practice. The majority had undergonethe most radical form of circumcision (infibulation) at the hands of a traditional midwife. Theirages ranged from 16 to 60 years.

Findings Sixty-six per cent reported problems with micturition (mostly pain), though few had eversought out medical help (<10%). Forty-four per cent reported that they felt their attitudes tosexual activity had been affected, mainly in terms of fear and reduced desire. Thirty-nine per centindicated that, should they have daughters, they would want them circumcised in the future, largelyfor cultural (as opposed to religious) reasons. Interestingly, a clear preference in such cases was shownfor Sunna circumcision, the less radical form. Furthermore, education and marital status moderatedthese findings – less educated and married women showed stronger intentions to continue thepractice. Finally, a small majority (53%) reported wishing, at least occasionally, that they had neverbeen circumcised.

Discussion The results suggest firstly that the health needs of a significant number of women inthis sample are going untreated, and secondly that education may be the means through which thepractice of female circumcision eventually will be discontinued.

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Factor affecting parental decisions to immunize their child with theMeasles Mumps and Rubella (MMR) vaccination

*Walsh, J., Hoare, S.; *National University of Ireland, Galway

Objectives This research investigated the factors that influence decisions about immunizing a childwith the Measles Mumps and Rubella (MMR) vaccination, and assessed the impact of an interventionasking parents to form an action plan on MMR uptake rates.

Methods Participants (N¼ 2,000) were randomly selected from the Health Service Executive (HSE)database on the basis of having an infant due to received their first MMR vaccination and sent thestudy questionnaire containing items on risk assessment, emotional factors, knowledge and attitudestowards the MMR. Following this, parents were sent a letter inviting them to bring their child forthe MMR. Attendance was measured by records sent by GPs to the HSE database. Half of thesample was asked to develop an action plan (i.e., form implementation intentions) for bringingtheir child for the MMR.

Results The response rate to the questionnaire was 56%. Only just over half (55%) of participantshad brought their child to be immunized within three months of receiving the letter of invitation.Attendance was predicted by greater perceived severity and vulnerability to disease, and a reducedsense of responsibility if action (i.e., taking the child for the MMR) resulted in harm (P< 0.05).Ninety seven percent of the experimental group completed the action plan. The formation ofan action plan did not result in an increased uptake of the MMR ( p¼ 0.21).

Conclusions The results suggest that emotional as well risk factors play an important role in parentaldecisions about bringing their child for the MMR vaccination. The formation of an action plansdid not significantly increase the uptake of the MMR. These results have important implicationsfor public health policy makers.

Adult attachment, alexithymia and symptom reporting

*Wearden, A., Lamberton, N., Crook, N., Walsh, V.; *University of Manchester, School ofPsychological Sciences, UK

Objective Adult attachment styles, formed as a result of our childhood experiences with caregivers,are conceptualised as internal representations of relationships which provide working models forrelating to others. Adult attachment style has recently been linked with symptom reporting, health-care utilization, and maladaptive affect regulation strategies. Alexithymia, a deficit in the ability toidentify and describe (but not experience) emotions, may also result from childhood experienceswith caregivers who do not display or discuss their emotions, or who do not deal appropriatelywith the child’s emotions. The present study explored the associations between adult attachment,alexithymia and symptom reporting in a non-clinical population.

Method One hundred and forty two male and female undergraduates, aged 17–44, completedquestionnaire measures of attachment style, alexithymia, self-esteem, positive and negative affectivityand symptom reporting.

Results Fearful and preoccupied attachment styles, negative affectivity and alexithymia were allsignificantly associated with increased symptom reporting while the dismissing attachment style wasnot. Regression analyses showed that the relationship between fearful attachment and symptomreporting was partly, but not fully, mediated by alexithymia and negative affectivity, while thatbetween preoccupied attachment and symptom reporting was mediated mainly by negative affectivity.

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Low self-esteem was associated with symptom reporting only via its association with negativeaffectivity.

Conclusions Fearful and preoccupied attachment styles are both associated with symptom reportingvia a negative model of the self and increased negative affectivity, but alexithymia is an additionalpredictor of symptom reporting in individuals with fearful attachment. This difference is thought tobe linked to the model of other developed in early interactions with caregivers.

Promoting stair use: Single versus multiple stair-riser messages

*Webb, O., Eves, F.; *University of Birmingham, UK

Objective Message banners attached to stair risers have been shown to produce a greater increasein stair use compared to conventional posters. This study sought to establish whether better visibilityor message variety accounts for the superiority of the banner format.

Method The study was conducted in a UK shopping mall with 24-step staircase and adjacentescalators. Two weeks of baseline monitoring were followed by a four-week intervention in whichbanners were fitted to alternate stair risers. For the first two weeks eight banners all featuring asingle message (‘‘Keep fit’’) were interspersed with three banners reading ‘‘Take the stairs’’. In thefinal two weeks the ‘‘Keep fit’’ banners were replaced with eight different messages as used in previousinterventions. Observers recorded the stair/escalator choices of ascending pedestrians, along withdemographic characteristics.

Results In total, 32,597 stair/escalator choices were observed. Stair use rose from 7.0% at baselineto 14.2 and 13.6%, respectively, in the single and multiple message phases. Logistic regressionanalyses confirmed that whilst stair climbing increased significantly between baseline and theintervention period, there was no significant difference between the single and multiple messageconditions.

Conclusions The intervention more than doubled stair use. The switch between message conditionsfailed to induce any further increment, however, indicating that repetition of a single message isas effective as multiple different messages. It appears, therefore, that banners outperform postersdue to enhanced visibility, rather than message variety. Our findings indicate the feasibility ofsimple stair promotion campaigns based around the repetition of a single message. Such interventionswould be easier to devise and cheaper to implement, further enhancing the credibility of stair-riserbanners as a medium for achieving public health gains.

Can lifestyle changes affect the progression of prostate cancer?Results from the prostate cancer lifestyle trial

Weidner, G.; Preventive Medicine Research Institute, California, USA

Objectives The primary purpose of the Prostate Cancer Lifestyle Trial (PCLT) was to assess whetherchanges in specific lifestyle behaviors implicated in the etiology of many chronic diseases (e.g., high fateating patterns, lack of exercise) influence the progression of early stage prostate cancer and qualityof life.

Methods Patient recruitment was limited to men who had chosen not to undergo conventionaltreatment. Ninety-three volunteers with biopsy-proven prostate cancer, serum prostate specificantigen (PSA) 4–10 ng/ml, and Gleason scores <7 were randomly assigned to an experimentalgroup that was asked to make comprehensive lifestyle changes (low-fat vegan diet, moderate aerobicexercise, stress management, group support) or a usual-care control group. Clinical outcomes(e.g., PSA, serum-stimulated LNCaP cell growth, plasma lipid profiles, body weight), quality of life

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(Medical Outcomes Study Short Form-36 Health Status Survey; Perceived Stress Scale; SexualFunction subscale of the UCLA Prostate Cancer Index), and lifestyle behaviors were assessed atbaseline and at the 1 year follow-up.

Results PSA values decreased 4% in the experimental group but increased 6% in the controlgroup ( p< 0.02). Growth of LNCaP prostate cancer cells was inhibited almost eight times moreby serum from the experimental than from the control group (70% vs. 9%, p< 0.001). Changesin serum PSA and in LNCaP cell growth were significantly associated with degree of changein lifestyle ( p< 0.05). Following a healthy lifestyle was also correlated with enhanced quality oflife ( p< 0.05).

Conclusions Improvements in lifestyle may not only affect the clinical progression of early, lowgradeprostate cancer in men but may also contribute to the quality of life in men choosing activesurveillance for early-stage prostate cancer. Implications of these findings for clinical practice willbe discussed.

Effect of oral health education and preventive treatment on well-beingin forensic psychiatric patients

*Werkhoven, Y., Buunk, B., Schaub, R., van der Schans, C., Spreen, M.; *Hanze UniversityGroningen, The Netherlands

Objective The purpose of this study was to evaluate the effect of oral health education and preventivetreatment in forensic psychiatric patients on their perceived quality of life.

Methods Forty forensic psychiatric male patients participated in this study. They all received duringone visit information and instruction concerning oral health and a professional dental cleaning bya dental hygienist. The Oral Health Impact Profile-14 questionnaire was completed prior and3 months after this intervention.

Results Oral health and self-care were generally low. From a fairly low perceived oral health relatedquality of health before the intervention, after the intervention a trend for an improved perceptionof general oral health related quality of life was seen. Significant improvements were seen for thedimensions ‘physical pain’ and ‘handicap’. This means that patients have less painful aching intheir mouth, and they found it more comfortable to eat any foods. In addition the patients felt thatlife in general was more satisfying. Patients with personality disorders reported more improvementthan psychotic vulnerable patients. Oral health and oral health self-care improved, and this benefitedpsychotic vulnerable patients more than patients with personality disorders.

Conclusions The results from this study suggest that professional oral support to improve oralhealth and oral self-care status not only may improve the oral condition, but also the perceived qualityof life of persons with psychiatric disorders.

Trajectories of depression and cannabis consumptiion on youths at risk

Werlen, E.; University of Fribourg, Switzerland

Objectives We were interested to find different trajectories of depression and to describe the resultinggroups in the face of cannabis consumption, age, gender, and other variables on a time frame of24 months.

Methods We used findings of a national secondary prevention program. The subjects had three pointsof measure (N> 500). The mean age of the group is 15.4 (1.6). About 75% of the sample is male.For analysis the Timepath-program of Rogosa and Ghassan (1988) was used. It computes the

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slope for every subject on every variable. The values for the slopes were used together with the valuesfor mood at T0 and T1 to build groups of subjects with similar trajectories.

Results There is a small correlation between depression and cannabis consumption of 0.19( p¼ 0.000) and no association between the slopes of these two measures (�0.01, p¼ 0.857). Thegroup which scored highest on depression at any time had also the highest cannabis consumption,and the group which the lowest depression over time always showed the lowest cannabis consumption.When depression increased, cannabis consumption rose at the same time, but when depressiondecreased cannabis consumption still increased or remained stable at the same level. There aresome differences between the trajectories regarding age, gender, and social starting position.

Conclusions These findings are important for preventive activities. Scoring high in depressioncan be interpreted under certain circumstances to be in danger for high and long lasting cannabis use.

The 4-dimensional stress test: Reliability of HPA, SAM, PNS &psychological reactivity following inhalation of 35% CO2

*Wetherell, M., Crown, A., Kaye, J., Lightman, S., Vedhara, K.; *MRC Health Services ResearchCollaboration, University of Bristol, UK

Objectives In order to understand the pathways by which stress can lead to ill-health, it is necessaryto stimulate the key physiological mechanisms involved in the stress response, e.g., the hypothalamic-pituitary-adrenal (HPA) and sympathetic-adrenal-medullary (SAM) axes. The current study assessedthe reliability of physiological and psychological stress responses following inhalation of carbondioxide (CO2).

Methods Healthy participants (N¼ 24) inhaled a single vital capacity breath of a mixture ofCO2 (35%) and oxygen (65%). Blood pressure and heart rate were recorded for 5 minutes beforeand after the test and blood and saliva samples were taken immediately before and 2, 10, 20 and30 minutes post-inhalation for the measurement of noradrenaline plasma and salivary cortisoland salivary � amylase. In addition, psychosomatic symptoms were recorded immediately beforeand after inhalation. Participants were re-tested using the same procedure 4–6 weeks later.

Results A single inhalation of CO2 elicited increases in blood pressure, noradrenaline, cortisol andpsychosomatic symptoms, but decreases in heart rate. These responses were stable over time althoughcortisol reactivity was reduced. Subsequent analyses of salivary cortisol data revealed that 70% ofthe sample could be reliably classified as either low or high responders (i.e., responder status remainedconsistent across test sessions). These groups differed in terms of their psychological responses tothe stressor.

Conclusions These data indicate that a single inhalation of CO2 induces a psychological stressresponse and simultaneously stimulates the HPA (increases in cortisol), and SAM (increases inblood pressure, and noradrenaline) axes. In addition CO2 also elicited a parasympathetic response(reduction in heart rate). The test is safe and easy to administer and therefore provides a reliablemodel for assessing how individual differences in stress reactivity can lead to ill health.

Including family members in type 2 diabetes research:A qualitative and quantitative approach

*White, P., Smith, S., Hevey, D., O’Dowd, T.; *Department of Public Health and Primary Care,Trinity College Dublin, Ireland

Objectives The purpose of this research was to investigate the usefulness of including family membersin research on the psychological determinants of glycaemic control in type 2 diabetes.

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Methods There were two stages to this research. The first was an exploratory qualitative studyexploring the beliefs, attitudes and perceptions of people with type 2 diabetes and their family mem-bers. Based on these results a second larger quantitative stage was developed. Data was collected fromthose with diabetes (n¼ 153) at a diabetes out-patients clinic, and through postal questionnaires fortheir family members (n¼ 74). The factors examined, as determined by the qualitative resultswere: illness cognitions, coping, well-being, social support, diabetes adherence, treatment satisfactionand diabetes knowledge.

Results From the qualitative study, family members had less information and greater concernsabout diabetes, they tended to perceive diabetes as more serious and as having a greater impact ondaily living than those who actually have the illness. Results from the quantitative data showed thatfamily members perceive diabetes as having more consequences, being more cyclical and as lesscontrollable than those with diabetes. Family members were also less satisfied with the supportthey had and were more distressed about diabetes. Family members of those in good control oftheir diabetes had stronger beliefs that diabetes occurred due to chance and perceived diabetes asless of a long-term illness than family members of those in poor control.

Conclusions Understanding the determinants of glycaemic control in diabetes should includethe people who are part of the social context in which the illness exists. Not only should family mem-bers be included in future research on type 2 diabetes but they should be considered in interventionsto improve glycaemic control.

Eye movements and psycho-social determinants in response to an anti-alcohol campaign

*Whittingham, J., Ruiter, R., Voorwinden, S., Kok, G.; *Maastricht University, The Netherlands

Objectives The present study aimed to demonstrate the merits of evaluating campaign materials ina randomized controlled design.

Methods The tested materials were part of a national campaign launched by the Netherlands Institutefor Health Promotion and Disease Prevention. Purposes of the campaign were raising awarenessand knowledge about misuse of alcohol among students. The present study evaluated effects of theused billboards. Participants were first-year university students, randomly assigned to an experimentalcondition receiving the campaign billboards, an advertisement condition receiving illustrations ofcommercial advertisements on alcoholic beverages, and a control condition receiving no intervention.Self-report questionnaires measuring psychosocial determinants of alcohol use (e.g., risk perception,attitude, and intention) were administered. Also, eye movements were registered in the experimentalcondition. This way, information was gathered about the processing of billboard segments, whichcould guide future decisions on design improvements of the billboards in conjunction with findingsof the experimental study.

Results Analyses showed positive effects on intention to drink less than 6 alcohol consumptionswhile going out in the experimental as compared to the advertisement and control conditions. Also,participants had a higher intention to look for alcohol related information after viewing theexperimental posters, relative to the advertisement and control group. Results of the eye movementanalysis are not analyzed yet, but will be discussed.

Conclusions The purpose of evaluating campaign materials is obtaining a good estimate of the effectsof materials. Appropriate measures and designs are necessary to draw conclusions about effects.Qualitative research lacks important features, for example, opinions are not objective and cannotpredict future effects. Studies with an experimental, quantitative character gain more insight intothe objective effects of materials, and provide concrete useful information for further creativedevelopment of the materials.

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The influence of volitional factors on interdental hygiene: Self-regulatorystrategies and phase-specific self-efficacy

*Wiedemann, A., Schuz, B., Sniehotta, F.; *Free Universitat, Berlin, Germany

Intentions are not sufficient to predict behaviour. To bridge the ‘‘intention-behaviour gap’’(Sheeran, 2002) the Health Action Process Approach (HAPA; Schwarzer, 1992) differentiatesbetween a motivational and a subsequent volitional phase. The motivational phase refers toprocesses of intention formation for health behaviour. During the post-intentional volitionalphase health-related action is planned, initiated and maintained. At this stage, volitional variablessuch as self-regulatory strategies and phase-specific self-efficacy play an important role. It ishypothesised that the HAPA is better suited to predict behaviour change than a motivationalmodel.

Research question The present study aimed in examining the predictive value of action planning,coping planning, action control and phase-specific self-efficacy on interdental hygiene. Additionally,the predictive utility of a volitional model including the aforementioned volitional variables wascompared to a motivational model based on intentions.

Methods Participants (N¼ 139) completed questionnaires at three points of measurement thatcovered motivational variables (risk awareness, situation-outcome-expectancies and task self-efficacyas well as behaviour intentions) and volitional variables (action planning, action control, andphase-specific self-efficacy). Hypotheses were tested using hierarchical regression analyses andexamining differences in R2.

Results Intentions predicted 28% of variance in flossing behaviour. Step-wise inclusion of actioncontrol (�¼ 0.27, p< 0.05) and phase-specific self-efficacy (�¼ 0.26, p< 0.05), and the interactionterm of intention and action planning significantly improved the prediction of flossing behaviourand explained an additional 7% of variance ( p< 0.01).

Conclusions Volitional variables are significant predictors of interdental hygiene. Action planningis particularly crucial for post-intentional participants. Results confirmed the relevance of a differen-tiation between a motivational and a volitional phase in the prediction of dental hygiene. The roleof volitional variables should be emphasized if future intervention studies.

Using comparative data to improve services: A qualitative study of four cancer networks

*Wilkinson, D., Michie, S., Ferlie, E., Addicott, R., McCarthy, M.; *University College, London,UK

Objectives Cancer services in England are coordinated by Cancer Networks, which cover populationsof 1–2 million people. Comparative data, collected routinely by the NHS, constitutes a potentiallysignificant source of information for Cancer Network Teams to identify variations, monitor perfor-mance against national targets, and inform action plans to improve cancer care. The current studysought to assess Network Team perceptions and use of these data, with a view to developing amore useable data set.

Methods Twenty four semi-structured interviews were conducted with members of 4 CancerNetwork Teams, including representatives of patients and carers. Interviewees were asked aboutuses of, and barriers to the use of, 8 national datasets. Interview transcripts were analysed thematicallyusing Interpretative Phenomenological Analysis.

Results Network Team members perceived local data to be more important than national data,and used national data to describe their own services, but rarely compared across Networks.

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Barriers to using national data to monitor or improve performance in the Network includedperceptions that data were not accessible, of uncertain quality, and of limited clinical relevance.Comparative data are rarely provided to patients and carers.

Conclusions Cancer Network Team members indicated low priority for using existing data setsfor comparisons and performance assessment. The perceived and actual accessibility, quality andrelevance of the data must be improved if they are to contribute to developing cancer services.

Exploring the psychosocial antecedents of adolescent smoking usingan extended theory of planned behaviour model

*Wilkinson, D., Abraham, C.; *University College, London, UK

Objectives Using an extended model of the theory of planned behaviour (TPB), thisprospective survey modelled the relationships between key psychosocial antecedents of adolescentsmoking.

Methods Questionnaires were administered, at three time points six months apart, to adolescentsin four co-educational comprehensive schools. Four hundred and ten participants had useablequestionnaires at all three time points. Measures of behaviour-specific cognitions derived from theTPB, as well as salient beliefs, descriptive norms, smoker self-identity, anticipated regret,parental control and parental support, perceived stress, self-esteem, conscientiousness, neuroticism,extraversion, and spending money were included in the model. Relationships between these measuresand smoking status were explored using path-analyses.

Results Predictors at times 1 and 2 collectively explained 63% of the variance in time 3 smoking, andpredictors at time 1 explained 65% of the variance in time 2 smoking. The strongest predictors offuture smoking included previous smoking status, intention, perceived difficulty of smoking(negatively associated), friends’ smoking and behavioural beliefs concerning the social outcomes ofsmoking.

Conclusions Support was found for the predictive utility of the TPB, particularly intention andperceived difficulty of smoking, but the results demonstrated the need to consider additional variablesin explanatory models of adolescent smoking. Previous smoking status was the strongest predictor offuture smoking, and its inclusion in explanatory models is essential if we are to identify predictors ofbehaviour change. Intention, friends’ smoking, perceived difficulty of smoking and behavioural beliefsappear to have an effect on future smoking over and above that of established smoking status, and assuch, may provide the key to changing adolescent smoking behaviour.

Psychosocial adjustment after a first seizure: Processes of losing and regaining control

*Willetts, S., Wilson, S., Sailing, M., Newton, M., Berkovic, S.; *Department of Psychology,University of Melbourne, Australia

Objectives A first seizure in adulthood involves an unexpected and potentially traumatic loss ofcontrol. No previous investigations have studied the immediate processes of psychological adjust-ment following a first seizure. The aim of this study was to examine the impact of a first seizureon a person’s sense of control, and to elucidate psychological processes involved in restoringsubjective control.

Methods This investigation was part of a larger longitudinal qualitative study undertaken at theFirst Seizure Clinic of a hospital with a large Comprehensive Epilepsy Program. Fortypatients were assessed 1- and 3-months after a first seizure using a purpose-developed semi-structuredinterview.

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Results Perceived loss of control was a key theme in the 1-month interview data, with increasedvulnerability, awareness of mortality, fear of seizures and mood disturbance. Patients were classifiedas experiencing either a ‘pervasive’ (n¼ 27) or ‘limited’ (n¼ 13) loss of control. Both groups describedattempts to regain subjective control over the 3-months, for example, by identifying and addressingwhat they believed to be the cause of the seizure (73%), and viewing the seizure as an isolatedevent (52%). More extensive efforts at restoring psychological control (e.g., re-evaluating lifepriorities) were made by the pervasive group (�2

¼ 13.08; p¼ 0.001). Seizure recurrence (n¼ 9)appeared to spark further subjective loss of control, and was associated with ongoing mooddisturbance (55%) and anxiety about seizure recurrence (45%).

Conclusions These findings suggest that the initial 1- to 3-months after a first seizure is acritical period during which most patients spontaneously undertake a process of rebuilding theirperceived sense of control. The findings have clinical implications for the counselling of firstseizure patients.

Type D personality: The case for health related behaviour and impaired social support

*Williams, L., O’Carroll, R., O’Connor, R.; *University of Stirling, UK

Objectives The aim of the current study was to investigate two possible mechanisms that may explainthe link between Type D personality (high Negative Affectivity and high Social Inhibition) andcoronary heart disease (Denollet et al., 1996). It was predicted that (a) Type D individuals wouldengage in more health damaging behaviours and (b) have lower levels of social support thannon-Type D individuals.

Methods Two hundred and four healthy young adults (41 males, 163 females, mean age: 22.2 years)completed measures of Type D personality (DS14), health behaviours (GPHB), social support(SNSS) and neuroticism.

Results Type D individuals reported performing fewer health related behaviours (e.g., eating sensiblyand getting enough exercise) compared to non-Type D individuals ( p< 0.03). Type D individuals alsoreported lower levels of social support than non-Type D individuals ( p< 0.001). Additionally, one ofthe most notable findings was the high number of participants (44%) in this study who met the criteriafor Type D status, this compares to much lower prevalence rates of around 20% found in the generalpopulation in previous studies conducted out with the UK.

Conclusions The results of this study suggest that the link between Type D personality and coronaryheart disease may be explained by Type D individuals performing fewer health related behavioursand experiencing less social support than non-Type D individuals. This is a preliminary cross-sectional study which will be expanded upon in future research by utilising a prospective designto investigate these and other possible mechanisms of effect, within patients who have suffereda myocardial infarction.

Shiftwork, stress and health: The role of morningness-eveningness and shift type

*Willis, T., O’Conner, D., Smith, L.; *University of Leeds, UK

Objectives The study investigated the presence of anticipatory stress in shiftworkers by assessingmood before blocks of different shifts, and explored the role of shift type (e.g., earlys/nights) andmorningness-eveningness in the stress experienced by shiftworkers.

Methods Two hundred eighty-five police staff completed a questionnaire including the job strain andeffort-reward imbalance models, as well as the Composite Scale of Morningness. They also providedinformation concerning general health, affect and stress prior to working three different shift types.

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A second, prospective questionnaire was completed two months later, collecting information onburnout, work-family conflict, and job satisfaction.

Findings Multiple regression analyses demonstrated the job strain and ERI models to be significantpredictors of affect, burnout and general health. A combined model performed little better thanthe ERI alone. In addition, significant interactions were found between shift type (day, afternoon& night) and morning/evening typology. Evening-types reported greater Negative Affect and stress,and reduced Positive Affect and Vigor prior to the day shift. Morning-types showed the reverse:their mood deteriorated with later starting shifts.

Discussion These findings suggest that individual differences variables such as morningness-eveningness, moderate the impact of shift work on general wellbeing. In addition, they indicate thatworkplace interventions to ameliorate shiftwork stress should be tailored to individuals and shifttype. They also provide further support for the strength of the ERI model.

Spouse adjustment to stroke: Depressive versus nondepressive partners

*Wilz, G., von Cramon, D.; *Technical University Berlin, Department of Clinical and HealthPsychology, Germany

Objectives The study investigates the influence of stroke-induced impairments on the developmentof stress-related disorders in the patients’ spouses. The extent of the spouses’ burden as measuredby Beck’s Depression Inventory (BDI), Beck’s Anxiety Inventory (BAI), and Body Complaints(GBB-24) was correlated to the patients’ depression and physical impairments caused by stroke.Besides the patients’ depression and functional impairments, the spouses’ age and gender wereused as predictors.

Methods Data were collected (N¼ 120 couples) upon the patient’s admission to the rehabilitationclinic and again one year later. The Barthel Index and the Patient Competency Rating (PCR) wereused to measure patients’ functional impairments; the Cornell Depression Scale (CDS) to measuredepression. Multiple regression analyses were applied to the data collected upon admission as wellas to the differences between the first and the second measurement.

Results The results confirm the assumption that post stroke depression is associated with stress-related disorders of the spouses. The age of the spouses and functional impairments of the patientsat the time of admission are not related to the spouses’ burden. There was a significant interactionbetween the two predictors ‘‘depression’’ and ‘‘physical impairment’’ and the course of stress-relateddisorders. Spouses of depressive, severely affected patients are therefore particularly susceptible todevelop stress-related disorders.

Conclusions Considering additional findings on effects of depression on the rehabilitative outcomeof patients, this result has salient practical implications. For patients and spouses alike reha-bilitation should focus more on emotional coping with illness and on the treatment of depressivesymptoms.

Correlates of fruit and vegetable consumption among 11 year-oldBelgian-flemish and Dutch school children

*Wind, M., de Bourdeaudhuij, te Velde, S., Klepp, K.-I., Brug, J., Erasmus M.; *Erasmus MC,University Medical Center Roterdam, The Netherlands

Objectives To determine factors influencing the consumption of fruit and vegetables among11-year-old school children in Belgium-Flanders and the Netherlands.

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Methods In total 2448 school children from 98 schools participated in a cross-sectional survey.In order to achieve representative samples, schools were randomly selected in both countries.Consumption of fruit and vegetables and associated personal, social and environmental factorswere measured by means of self-administered school-based written questionnaires. Hierarchicalmultiple regression was conducted to assess correlates of school children’s fruit and vegetablesconsumption. Separate sub-group analyses have been conducted to assess differences in potentialcorrelates according to gender.

Results Percentage of explained variance ranged from 33.7% for fruit and 29.4% for vegetable intake.Only 17.7% of the children ate the 2 pieces of fruit per day that are recommended. Only 1.6% ate atleast 200 grams of vegetables per day. All correlates of school children fruit and vegetable intake wereweak; all standardized beta’s (�) were below 0.20. Multiple regression revealed that bringing fruitto school (�¼ 0.16), modeling behaviour of parents and friends (�¼ 0.14) parents demanding theirchild to eat fruit (�¼ 0.12), knowledge about recommended intake levels (�¼ 0.17), likingfruit (�¼ 0.18) and self-efficacy to eat fruit (�¼ 0.12) were the strongest correlates of fruit intake.The strongest correlates of vegetable intake were gender (�¼ 0.13), parents demanding their childto eat vegetables (�¼ 0.13), parents facilitating to eat vegetables by cutting them for their child(�¼ 0.11) and preferences for vegetables (�¼ 0.16). Subgroup analyses did not result in differentsignificant correlates of intake between boys and girls.

Conclusions Interventions aiming at increasing school children’s fruit and vegetable intake need to betailored to environmental, social and personal influences.

Tackling problems in scoring and scaling the functional limitation profileusing item response theory

*Winter, J., Johnston, M., Sniehotta, F., Pollard, B., Michie, C.; *University of Aberdeen, Scotland, UK

Objectives The Functional Limitation Profile (FLP, UK Sickness Impact Profile) is widely usedto assess activity limitation. However, it retains problems regarding illogical scoring and the lengthof questionnaire. Using Item Response Theory (IRT) provides an alternative approach for tacklingthose problems. IRT models identify discrimination power and difficulty for each item.

Methods The FLP ambulation category was completed by 68 stroke patients (33 men and 35 women)with an average age 69.5 (SD¼ 9.2). The MULTILOG software (Thissen, 1991) was used tofit a two-parameter IRT model estimating discrimination power and difficulty, for each of twelveambulation items.

Results The results showed that seven of the twelve ambulation items significantly discriminate levelsof activity limitations among stroke patients. The five non-discriminating items were discarded.These are items with the highest item weight in the original FLP ambulation category items. Theseven remaining items discriminate among stroke patients between –1.1� below the mean and 0.8�above the mean on the underlying latent disability scale. The highest discrimination informationwas located at the mean 0.0 on the disability scale. Five of the seven discriminating items showedhigh information below the mean, whereas one item above the mean. Furthermore, the difficulty ofeach item is located along the disability scale and correlates significantly with the FLP item weights(r¼ 0.71, p< 0.05).

Conclusions Other researcher provided specific solutions to overcome scoring problems, e.g., usingthe maximum score within each category to define patients by the most severe limitation. UsingIRT methodology can provide a generic solution for tackling problems in illogical scoring.Furthermore, shortened questionnaire can be developed without loosing discrimination power.A challenge for future applied research is the selection of items appropriate for discriminatingin different populations.

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Is the interplay of social-cognitive determinants of activity stage-dependent?An investigation of the Health-Action-Process-Approach in orthopaedicrehabilitation patients

*Winter, J., Lippke, S., Ziegelmann J.; *University of Aberdeen, Scotland, UK

Objectives Rehabilitation treatments aim to support patients in increased activity after discharge.Psychological stages, such as described in the Health-Action-Process-Approach (Schwarzer, 1992;HAPA), explain the initiation and maintenance of regular physical activity by taking into accountthe complex interplay of social-cognitive variables.

It was hypothesised that: (a) Non-Intenders are more likely to start physical activity if they havehigh scores in pros and intention, (b) Intenders are more likely to initiate physical activity if theyhave high scores in self-efficacy, action planning, and social support, (c) Actors will maintain theiractivity if they have low scores in cons as well as high scores in pros, intention, action planning andself-efficacy.

Methods This longitudinal study comprised 510 orthopaedic rehabilitation patients (316 females)aged 19 to 80 years. The HAPA stages, (1) inactive non-intentional, (2) inactive intentional, and(3) active, and social-cognitive variables were assessed at the beginning of rehabilitation. HAPAstages were measured again at a 2-week follow-up. Three multinomial logistic regression modelswere used to investigate the hypotheses.

Results Non-intentional patients were more likely to initiate physical activity if they had higherintention (OR¼ 2.55, p< 0.10) and higher pros (OR¼ 2.44, p< 0.10). Intentional patients startedtheir activity if they perceived more social support (OR¼ 3.68, p< 0.05) and had higher self-efficacy(OR¼ 2.23, p< 0.10). Furthermore, actors were more likely to maintain an active lifestyle if they hadlower cons (OR¼ 2.33, p< 0.10) as well as higher self-efficacy (OR¼ 3.71, p< 0.05) and higher actionplanning (OR¼ 11.49, p< 0.05).

Conclusions The hypotheses were mainly confirmed. More effective interventions should betailored to stage-specific needs at the beginning of rehabilitation. For example, pros can be addressedin order to initiate physical activity, whereas action planning promotes the maintenance of an activelifestyle.

Stress reactivity and vital exhaustion in relation to one’s self-worth system.Investigating elite dancers and musicians

*Wippert, P.-M., Wippert, J., Metzenthin, P., Frey, K.; *Institute for Behavioral Sciences, SwissFederal Institute of Technology, Switzerland

Objectives In the current study, we examine to what extent self-acceptance is associated with stressbehavior and vital exhaustion in demanding occupations.

Methods Information about self-acceptance, stress reactivity and vital exhaustion was gathered ina cross-sectional study. Participants were 72 artists (N¼ 45 dancers; N¼ 27 musicians) from leadingopera houses in Switzerland and Germany. Data was collected using a self-acceptance questionnaire(SA-AA; Bergemann & Johann, 1985), two subscales of the stress reactivity concept, namelyoccupational failure (SRSm) and pre-stress-phase (SRSp) (Schulz, 2004) and the Maastrich vitalexhaustion questionnaire (VE; Appels, 1987). Evaluation took place using parametric statisticaltests for independent samples.

Results A significant difference in their self-worth system is observed between dancers (M¼ 46.2;SD¼ 9.0) and musicians (M¼ 52.0; SD¼ 9.5), with musicians clearly demonstrating a higher levelof self-acceptance (t¼ 2.51; p< 0.01). Negative relationships between self-acceptance and vital

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exhaustion and stress reactivity are found in both groups. All correlations reach significance in thegroup of the dancers (VE: R¼�0.32 p< 0.05; SRSm: R¼�0.53 p< 0.01; SRSp: R¼�0.42p< 0.01), whereas for the musician only one significant association is observed (SRSp: R¼�0.40p< 0.05). Linear regression calculations show that a higher level of self-conception significantly relatesto reduced stress reactivity (SRSm: std. �¼�0.48; p< 0.001; SRSp: std. �¼�0.42; p< 0.001) andlower vital exhaustion (VE: std. �¼�0.34; p< 0.008).

Conclusions Participants demonstrate greater stress reactivity and greater degree of vital exhaustioncorresponding to a lower level of self-worth. The findings expand results of previous investigationson self-worth systems with various measurement parameters and samples (Wust, 2000; N¼ 366,FKK, RSE).

Psychosocial aspects of general practitioner consultation amongdifferent ethnic groups in Germany

*Wittig, U., Merbach, M., Klaiberg, A., Brahler, E.; *Dept. of Medical Psychology and MedicalSociology, Faculty of Medicine, University of Leipzig, Germany

Objectives Subjective complaints, gender and age are often discussed as good predictors of GPconsultation. Aim of the study is to examine the influence of these factors on GP utilization amongdifferent migrant groups is goal of the study.

Methods Two ethnic groups in Germany, 202 Polish Migrants (18–65 years, 146 women) and163 Ethnic German Migrants (18–68 years, 92 women) were asked about their consultations ofGP during the last year, their actual health status and their complaints. Further, they were comparedwith a representative sample of 1897 Germans (18–65 years, 1046 women).

Results 81.1% Polish Migrants, 78.2% Ethnic German Migrants and 79.4% Germans visited thegeneral practitioner in the last year. Bivariate analyzes showed significant correlations betweenconsultation and age, actual health status, subjective complaints in all groups. Multiple linearregression with the independent variables age, gender, subjective complaints, actual health status,education and language skills (only for migrants) and the dependent variable GP consultationshowed significant effects of all variables (R2

¼ 0.23, F¼ 105.32, p< 0.001, df¼ 1755) among theGermans. Gender, actual health status, subjective complaints and German language skills had signif-icant effects in the Ethnic German Migrants (R2

¼ 0.23, F¼ 10.73, p< 0.001, df¼ 144). In the groupof the Polish migrants only age and gender showed a significant effect (R2

¼ 0.06, F¼ 5.66, p< 0.05,df¼ 188).

Conclusion There were no differences in GP utilization among the examined ethnic groups, butthe independent variables influenced the GP consultation differently in several ethnic groups.Reasons and barriers of GP consultation are being discussed.

Distinguishing different types of pain beliefs as a predictor of returnto work following an episode of low back pain

*Wrapson, W., Magnusson, J., Cameron, L.; *Department of Psychology, University of Auckland,New Zealand

Objectives The purpose of this study was to examine the impact of pain beliefs (amongst a numberof other potential predictors) on return to work following an episode of low back pain (LBP).

Methods Two hundred and four compensation claimants, with sickness certification of at least threedays for a new episode of LBP, were recruited from a claims database. Participants filled out a ques-tionnaire shortly after the commencement of sick leave, and those who were currently still off work or

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on work accommodation were requested to complete a follow-up questionnaire at one month regard-ing present work status. A 7-item scale was constructed to measure the impact of pain beliefs on returnto work. Factor analysis of the scale items extracted two factors: (1) beliefs about resuming workduties in the short term, and (2) long term recovery expectations.

Results Preliminary results from regression analyses indicate that a high score on the resumptionof work duties subscale (meaning a return to work at the present time is perceived to be detrimentalto recovery) is significantly associated with participants being off work after 28 days (OR¼ 5.44;95% CI 1.6 to 18). Conversely, a high score on the recovery expectations subscale (signifying theperception of permanent damage to the back) is not associated with being off work after 28 days(OR¼ 1.207; 95% CI 0.524 to 2.776).

Conclusions These findings suggest that beliefs about the short term consequences of LBP aremore likely to impact on a return to work in the acute stage of a back pain episode than beliefsabout the long term consequences of LBP.

Evidence based service development in occupational health psychology

*Wren, B., Hill-Tout, J., Jennings, T., Schwartz, A.; *Royal Free Hampstead NHS Trust, London

Aim The aim of this round table session is to provide an overview of the development of fourdifferent UK occupational health psychology services in order to consider issues raised for psychologyin this new setting including: roles for psychologists in occupational health, developing and evaluatinginterventions, theory-practice links in service development.

Rationale Occupational health psychology is a young specialty and has much to offer organisations,both in terms of enhancing performance, and preventing and addressing problems at a variety oflevels. It is a fruitful area for psychologists to be working in, in order to develop and evaluatepsychological interventions. However there are a number of questions for health psychologists toconsider in developing roles, interventions and possibly services in occupational health settings.The aim of this session is to pose and discuss these questions by considering the dilemmas, challengesand opportunities experienced by four health psychologists while developing very differentoccupational health psychology services.

Objectives To provide an overview of a developing discipline. To describe examples of evidence-based service development in UK healthcare settings. To consider best frameworks to use inoccupational health psychology service development to ensure that health psychologists are commu-nicating with key healthcare stakeholders in an accessible way while also doing evidence-based work.To consider roles for health psychologists in occupational health psychology.

Two types of challenge appraisal and their role in the functioningof patients with myocardial infarction

Wrzesniewski, K.; Faculty of Psychology, Warsaw University, Warsaw, Poland

Objective The aim of the paper is to answer for the question what is the role of the challenge stressappraisal in functioning of patients with myocardial infarction (MI).

Methods The Stress Appraisal Questionnaire, which has a good psychometric characteristic wasused in four independent studies, including one prospective study. A total of 392 MI patients,age 31–60, were studied. The factor analysis and structural modeling were used.

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Results The findings indicate that two types of challenge stress appraisal may be distinguishedin patients after MI: challenge-activity and challenge-passivity. These two type of challenge performdifferent functions. Challenge-activity is related to positive, while challenge-passivity to negativeindicators of functioning after the first heart attack.

Conclusions These important results should be replicated in patients with different diseases.

Selection, optimisation, and compensation in health self-regulation:Interplay with resources and successful aging

*Ziegelmann, J., Lippke, S.; *Free University of Berlin, Germany

Objectives The interplay of successful aging, resource status and self-reported use of exercisespecific strategies of selection, optimisation and compensation (SOC) was investigated in young,middle-aged and older individuals undergoing orthopaedic rehabilitation. In particular, the studyexamined whether effectiveness of SOC use is resource dependent as SOC theory suggests.

Methods As part of a one year longitudinal study, N¼ 373 patients completed questionnairesassessing strategy use, resource status, amount of physical exercise, aging satisfaction, and rehabilita-tion satisfaction. Maintenance of regular physical exercise, aging satisfaction, and rehabilitationsatisfaction including orthopaedic outcome, served as successful aging criteria in this context.

Results A 2 (high vs. low resources)* 2 (high vs. low SOC)* 3 (young vs. middle-aged vs. old)ANOVA revealed main effects for resources and SOC but not for age group regarding the outcomes‘aging satisfaction’ and ‘rehabilitation satisfaction’. In terms of physical exercise an interactioneffect emerged: individuals with lower resources benefited more clearly from SOC strategy use thanindividuals with a high resource status.

Conclusions Results indicate that it whether effectiveness of SOC use is resource dependent or notdepends on the outcome criteria. As no age effects were observed, exercise specific strategies ofSOC and high resources seem to be equally beneficial across all age groups studied. In futureintervention programs aimed at the adoption and maintenance of physical exercise, it may be usefulto assess resource status and enhance the use of exercise specific strategies of selection, optimisationand compensation accordingly.

Phenomenological psychology in caregiving practice

*Zinder, M.; *Universite de Lausanne, Switzerland

Objectives Our presentation demonstrates how phenomenological psychology (PP) opens the wayto defining and setting up practical procedures for basic caregiving – particularly caregiving connectedwith activities of daily living (ADL) – in geriatric psychiatry.

Methods The PP methodology consists of :

. Considering the lifeworld (Husserl, Schutz) as the basis and context of the lived experiences(Erlebnisse) of the subjects being studied,

. Bracketing prejudices and preconceptions concerning the phenomena being observed,

. Observing and describing the spontaneous reactions of subjects in their socio-culturalenvironment,

. From these descriptions, extracting and conceptualizing a typology of the behaviour patternsand subjective experience structures of the observed individuals.

More than 20 (patient-nurse/doctor) caregiving interactions were observed, corresponding to 300hours of observation in a hospital service.

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Results The resources of PP in caregiving procedures intervene at 4 levels:

1. Providing a better definition of basic caregiving through the application of 3 essential properties:insertion of caregiving situations into the socio-cultural lifeworld, resistance of basic caregivingto rationality criteria and the partnership-based relationship between caregiver and patient.

2. Helping caregivers to change from a participative attitude to one of detachment, attention andproviding clear explanations.

3. Proposing a typology of patients’ functioning and their subjective experiences (Zinder, 2003).4. Suggesting a method of rehabilitation consisting of conceptual intervention tools (Zinder, 2003).

Conclusion Our approach is characterized by a dialectical movement between theory and practice.The latter aspect could well develop into specialist expertise.

Are the needs of cancer patients and their carers generic?

*Zinovieff, F., Morrison, V., Coles, A., Cartmell, R.; *School of Psychology, University of Wales/Conwy and Denbighshire NHS Trust, UK

Objectives Although specific need domains of patients with different types of cancer have beenresearched, it is not clear which needs are generic to cancer patients and which needs are more specificto different cancers. Identification and evaluation of areas of potential need for different patientand carer groups will inform clinical need assessment and service provision. Met needs impact directlyon patient satisfaction and quality of life.

Methods A postal questionnaire was completed by 110 patients with a diagnosis of either a haema-tological, colorectal, breast, gynaecological, urological or head and neck cancer. It was also completedby 57 carers of these patients. The questionnaire covered a broad range of items include followingneed domains: Treatment, Information, Practical, Psychological, Interpersonal, Thoughts andExperiences. Each item demanded a Yes/No response followed by a salience rating using a 10 pointLikert scale.

Results The data were ranked by frequency of reported need, and saliency of need, to allow compar-ison across different sites of cancer. Some generic needs were identified e.g., Patients and carersexpressed a need for sincere and open clinicians. Worries about cancer recurring were genericalthough more salient for carers. This is reflected in a high need for information about signs andsymptoms of recurrence. Other needs were more pertinent to specific sites e.g., Haematology patientsand carers express a need to talk with someone outside the family, but neither head and neck patientsnor gynaecology carers report this need.

Conclusions Needs assessment reflecting the most frequent and salient needs of each group will assistthe development of individual care plans by clinicians, thus helping to alleviate distress for patientsand carers alike. Satisfaction with individual health-care programmes affects perceived qualityof life and over-all life satisfaction.

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