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TitleForever Gluten free: exploring the psychosocial impact of living with
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                            CPR 2 describes a study carried out to evaluate clinical supervision groups set up for NHS nurses working in a continuing care unit for older adults.  National initiatives concerning supervision for nurses within the NHS and the available evidence for the effectiveness of this are considered.  The limitations of the methodology and the difficulties experienced in carrying out the evaluation are discussed and blocking factors are considered which might account for difficulties in implementing clinical group supervision for all staff.  Facilitative strategies are drawn from the relevant literature and recommendations are made for future evaluations and implementing supervision into routine clinical practice.
Results        35
The results of binary logistic regression analyses to investigate predictors of general well-being, HRQoL and self-efficacy are presented in tables 8-10.  Reduced scores on Timeline cyclical, Emotional representations, Consequences and older age led to a correct classification of an enhanced general well-being in 74% of the sample.  This means that the lower the scores for Timeline cyclical, Emotional representations and Consequences the more likely it was that participants had higher general well-being scores. In addition the older participants were, the more likely they were to have a higher general well-being score.   Low scores on Consequences, Illness coherence, Emotional representations and Identity led to a correct classification of better HRQoL in 79% of the sample.  This means that the lower the scores for Consequences, Illness coherence, Emotional representations and Identity the more likely for participants to have a higher HRQoL.  In the self-efficacy analysis sex was not entered as no univariate difference had been found (stated previously).  Lower scores for Consequences and Emotional representations were associated with higher self-efficacy scores measured by the PMCSMS as were strong beliefs in Personal control and Illness Coherence (clarity of understanding of CD).  The correct classification rate for this model was 78%.   The independent variables Consequences and Emotional representations were both predictive of all three outcome measures, general well-being, HRQoL and self-efficacy.
Predictors of GFD adherence         Table 11 shows the results of a binary logistic regression analysis to predict high adherence to a gluten-free diet (GFD). Sex was not entered as there was no evidence of a univariate effect (χ2=1.162, P=0.38 Fisher’s Exact).  The most predictive independent variables were older age, strong beliefs in the serious consequences and weak beliefs in the cyclical nature of CD (or conversely beliefs in the chronicity of the condition).  This means that the older participants were and the stronger their beliefs in the seriousness of CD the more likely they were to stick to a GFD.  Furthermore, the weaker participants’ beliefs in the cyclical nature of CD the more likely they were to adhere to a GFD.  The correct classification rate for the model was 86%.  None of the outcome measures, self-efficacy, general well-being and HRQoL were strong predictors of high adherence.
The internal validity of this model was good.  In the omnibus test the coefficients were significant (P= <0.0001) and the significance level in the Hosmer-Lemeshov (Goodness of fit) test was 0.86, above the predefined P-value of 0.05, thus confirming goodness of fit.
	Social Science & Medicine
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	Participant Information Sheet
	Study of Living with Coeliac Disease
	University of Birmingham
	Thank you for agreeing to take part in this survey
	Now please complete the five questionnaires
	beginning with form 1
	Form 1: Living with Coeliac Disease Study
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Form 2: Living with Coeliac Disease Study - Illness Perceptions Questionnaire
	Breathlessness     Yes  No ________________ Yes No
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		The Coeliac Disease Questionnaire CDQ – Health related quality of life index
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	Form 5: Living with Coeliac Disease Study – Information About You
	Thank you for taking the time to complete this survey. Your participation is much appreciated.
Psychology & Health
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expectations: outcome expectation and self-efficacy. Outcome expectation is the belief

that certain behaviours will lead to a particular outcome, and self-efficacy reflects the

belief that one can successfully perform these behaviours to produce the outcome. Self-

efficacy beliefs determine the initial decision to perform a behaviour, the effort to be

expended and persistence in the face of adversity. For example, an individual may believe

that regular exercise will improve his/her future health (high outcome expectancy) but may

reject this strategy as they have a low efficacy expectancy (never having been a regular

exerciser they will not see themselves as able to start regular exercise and will not believe

they have the ability to sustain it). Therefore, generic educational material on diet that

focuses only on improving health outcomes rather than addressing individuals’ confidence

in being able to sustain the diet is unlikely to effectively strengthen their self-management


It has been found that a strong sense of personal efficacy is related to better health,

higher achievement and more social integration (Schwarzer & Fuchs, 1995). In order to

promote individuals’ self-efficacy for managing a long-term health condition, it is

important that clear, precise and specific knowledge and competence in relevant skills are

provided to them to support their own management of their particular condition (Lau-

Walker & Thompson, 2009). In general, people’s self-efficacy beliefs influence the health-

related choices they make, the health related goals they set for themselves and the amount

of effort they use to reach these goals (Wallston, Rothman & Cherrington, 2007). For

example, patients with diabetes who adhere to dietary advice and other self-management

tasks are more likely to report feeling competent to self-manage their diabetes (e.g. Talbot,

Nouwen, Gingras, Gosselin & Audet, 1997). Based on this, it was hypothesised that

adherence to a gluten free diet by individuals with CD would be associated with a strong

sense of self-efficacy. It was also hypothesised that those participants with favourable


Page 64

illness perceptions would have higher levels of perceived self-efficacy to manage their

condition. Although illness perceptions and self-efficacy have been independently

constructed they have a common theme at their core. Each posits that individuals’

personal constructs of their condition and of their ability to cope with that condition are at

the basis of effective self-management. Furthermore, both concepts argue that it is through

an individual’s accumulated experience, rather than personality, that their actions and

perceptions are informed. Both theories acknowledge that individuals interpret the events

that affect them and construct responses and future outcomes from a rational base that is

unique to each individual (Lau-Walker, 2004). In view of the fact that there is

considerable overlap within the two theoretical concepts it seems likely that there will be a

relationship between the components of the two models and more specifically that illness

representations will be predictive of self-efficacy.

This study has three main aims as follows:-

1. To investigate gender differences in quality of life and sense of well-being in adults

with CD in the UK

2. To explore the illness perceptions and self-efficacy beliefs of adults with CD in the


3. To explore the relationship between individuals’ personal sense of control or self-

efficacy and perceptions of illness, and their well-being and quality of life.


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One-Sample Kolmogorov-Smirnov Test



CDQ Total
Score AGE

N 278 274 276 279
Normal Parameters(a,b) Mean 4.83 78.17 152.28 54.0758
Std. Deviation 8.140 15.468 26.493 14.68605
Most Extreme Diffs Absolute .369 .065 .114 .073
Positive .369 .034 .065 .045
Negative -.350 -.065 -.114 -.073
Kolmogorov-Smirnov Z 6.218 1.071 1.902 1.227
Asymp. Sig. (2-tailed) .000 .202 .001 .098

a Test distribution is Normal.
b Calculated from data.


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Psychology & Health

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