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2. Association Between Primary Care Practitioner Empathy and Risk of Cardiovascular Events and All-Cause Mortality Among Patients With Type 2 Diabetes: A Population-Based Prospective Cohort Study

Author

Dambha-Miller, Hajira, Feldman, Adina L., Kinmonth, Ann Louise, and Griffin, Simon J.

Subjects
Empathy -- Health aspects -- Psychological aspects -- Social aspects, General practitioners -- Psychological aspects -- Practice -- Health aspects -- Social aspects, Type 2 diabetes -- Complications and side effects -- Care and treatment -- Patient outcomes -- Risk factors -- Prevention, Patient compliance -- Psychological aspects -- Management -- Health aspects -- Social aspects, Cardiovascular diseases -- Risk factors -- Prevention, Primary health care -- Social aspects -- Health aspects -- Psychological aspects, Company business management, Health, Science and technology
Abstract

PURPOSE To examine the association between primary care practitioner (physician and nurse) empathy and incidence of cardiovascular disease (CVD) events and all-cause mortality among patients with type 2 diabetes. METHODS This was a population-based prospective cohort study of 49 general practices in East Anglia (United Kingdom). The study population included 867 individuals with screen-detected type 2 diabetes who were followed up for an average of 10 years until December 31, 2014 in the Anglo-Danish-Dutch Study of Intensive Treatment in People With Screen Detected Diabetes in Primary Care (ADDITION)-Cambridge trial. Twelve months after diagnosis, patients assessed practitioner empathy and their experiences of diabetes care during the preceding year using the consultation and relational empathy (CARE) measure questionnaire. CARE scores were grouped into tertiles. The main outcome measures were first recorded CVD event (a composite of myocardial infarction, revascularization, nontraumatic amputation, stroke, and fatal CVD event) and all-cause mortality, obtained from electronic searches of the general practitioner record, national registries, and hospital records. Hazard ratios (HRs) were estimated using Cox models adjusted for relevant confounders. The ADDITION-Cambridge trial is registered as ISRCTN86769081. RESULTS Of the 628 participants with a completed CARE score, 120 (19%) experienced a CVD event, and 132 (21%) died during follow up. In the multivariable model, compared with the lowest tertile, higher empathy scores were associated with a lower risk of CVD events (although this did not achieve statistical significance) and a lower risk of all-cause mortality (HRs for the middle and highest tertiles, respectively: 0.49; 95% CI, 0.27-0.88, P = .01 and 0.60; 95% CI, 0.35-1.04, P= .05). CONCLUSIONS Positive patient experiences of practitioner empathy in the year after diagnosis of type 2 diabetes may be associated with beneficial long-term clinical outcomes. Further work is needed to understand which aspects of patient perceptions of empathy might influence health outcomes and how to incorporate this understanding into the education and training of practitioners., INTRODUCTION Empathy is a key health care concept emphasized in policy, codes of practice, national clinical guidance, and medical training. (1,2) It is also a high priority for patients. (3) [...]

Published
2019
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4. Do increases in physical activity encourage positive beliefs about further change in the ProActive cohort?

Author

Hardeman, Wendy, Michie, Susan, Kinmonth, Ann Louise, Sutton, Stephen, and ProActive Project Team

Subjects
Adult, Cohort Studies, Male, Diabetes Mellitus, Type 2, England, Humans, Female, Middle Aged, Sedentary Behavior, Attitude to Health, Exercise
Abstract

Effects of behaviour change on cognitions are rarely examined within the Theory of Planned Behaviour. We tested whether increases in physical activity resulted in more positive beliefs about further change among a cohort of sedentary adults participating in a behavioural intervention trial (ProActive). At baseline, 6 and 12 months, 365 adults completed questionnaires assessing physical activity and cognitions about becoming more active over the coming year. Objective activity was assessed at baseline and 12 months. Participants reporting larger increases in activity were no more positive about making further increases than those reporting less behaviour change (p-values>0.05). Participants with larger increases in objective activity reported weaker perceived control (β=-0.342; p=0.001) and more negative instrumental attitudes (β=-0.230; p=0.017) at 12 months. Participants may have felt that they had changed enough or measures of perceived success may be more sensitive to behaviour change. Alternatively, long measurement intervals may have missed immediate cognitive and affective consequences of behaviour change, or such effects may require participants to consistently self-monitor or receive feedback on performance. Future studies could test the effect of such techniques on physical activity and a wider range of cognitive, affective and physiological consequences, using more frequent measurement intervals.

Published
2023
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22. Bruce Thomas

Author

Kinmonth, Ann Louise and Bain, John

Published
2004

39. Provision of services in primary care for type 2 diabetes: a qualitative study with patients, GPs and nurses

Author

Dambha-Miller, Hajira, Griffin, Simon J., Kinmonth, Ann Louise, and Burt, Jenni

Abstract

Background: there is little evidence on the impact of national pressures on primary care provision for type 2 diabetes from the perspectives of patients and their GPs and nurses.Aim: to explore experiences of primary care provision for people with type 2 diabetes and their respective GPs and nurses. Design and setting: a qualitative interview study in the East of EnglandMethods: semi-structured interviews with people who have type 2 diabetes (n=24) along with their respective GPs and nurses (n=15). Purposive sampling was used to select for heterogeneity in glycaemic control and previous healthcare experiences. Interviews were audio-recorded and analysed thematically. The consolidated criteria for reporting qualitative research were followed.Results: we identified a changing landscape of diabetes provision owing to burgeoning pressures that were presented repeatedly. Patient participants wanted GP-delivered care with continuity. They saw GPs as experts best placed to support them in managing diabetes, but were increasingly receiving nurse-led care. Nurses reported providing most of the in-person care, while GPs remained accountable but increasingly distanced from face-to-face diabetes provision. A reluctant acknowledgement surfaced amongst GPs, nurses and their patients that only minimum care standards could be maintained, with aspirations for high quality provision unlikely to be met.Conclusion: Type 2 diabetes is a tracer condition that reflects many aspects of primary care. Efforts to manage pressures have not been perceived favourably, despite some benefits. Reframing expectations of care, by communicating solutions to both patients and providers so that they are understood, managed and realistic, may be one way forward

Published
2020

40. The importance of affective beliefs and attitudes in the theory of planned behavior: predicting intention to increase physical activity

Author

French, David P., Sutton, Stephen, Hennings, Susie J., Mitchell, Jo, Wareham, Nicholas J., Griffin, Simon, Hardeman, Wendy, and Kinmonth, Ann Louise

Subjects
Behaviorism (Psychology) -- Research, Psychology and mental health, Sociology and social work
Abstract

Standard theory of planned behavior (TPB) questions to elicit salient behavioral beliefs may elicit instrumental consequences of behavior, and overlook affective consequences. Two hundred thirteen English adults (35 to 75 years of age) completed a questionnaire that contained closed measures of TPB constructs, and open-ended questions that asked not only about advantages and disadvantages, but also what respondents would like or enjoy and dislike or hate about being more physically active. Beliefs elicited by affective questions were associated more strongly with a closed affective attitude scale. Beliefs elicited by instrumental questions were associated more strongly with a closed instrumental attitude scale. Closed measures of the standard TPB variables explained 48% of the variance in intention to increase physical activity, while affective attitude explained an additional 11% of the variance. Applications of the TPB should consider affective and not just instrumental determinants of behavior.

Published
2005

44. 9 The University of Cambridge

Author

Berrington, Bob, primary, Perry, John, additional, Oswald, Nigel, additional, Roland, Martin, additional, Benson, John, additional, and Kinmonth, Ann Louise, additional

Published
2011
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