Graduates
Year: 2007
Janaki Amin: Hepatitis B and C associated cancer and mortality: New South Wales, 1990-2002
Supervisors: Professor Matthew Law , Associate Professor Gregory Dore
Joanne Micallef: Natural history of acute hepatitis C virus infection
Supervisors: Associate Professor Gregory Dore, Professor John Kaldor
Heather Proudfoot: DSM-IV alcohol use disorders in Australia: validity, prevalence and treatment seeking
Supervisors: Professor Maree Teesson, Dr Joanne Ross
Jialun Zhou: HIV/AIDS natural history and treatment in the Asia-Pacific region: TREAT Asia HIV observational database
Supervisors: Professor Matthew Law , Associate Professor Gregory Dore
Shelley Bowen: Towards evidence-informed policy and practice - Case studies from Australia
Supervisors: Professor Anthony Zwi, Professor Margaret Whitehead, Associate Professor Peter Sainsbury
Fatemeh H.Nakhaee: Modelling survival following aids in Australia
Supervisors: Professor Matthew Law, Associate Professor Deborah Black
Bibiana Chan: Psychiatry and multicultural health
Supervisors: Professor Maurice Eisenbruch, Professor Gordon Parker, Associate Professor Jan Ritchie
Soufiane Boufous: Reporting injury in older people: epidemiological profile and knowledge gains from data linkage
Supervisors: Professor Caroline Finch, Professor Stephen Lord
http://www.irmrc.unsw.edu.au/Program/boufouss.asp
Rowena Forsyth: Tricky technology, troubled tribes: a video ethnographic study of the impact of information technology on health care professionals' practices and relationships
Supervisors: Professor Rick Iedema, Professor Jeffrey Braithwaite
Christine Jorm: Somebody could die in this place and none of us would know: Medical culture and identity in the era of safety and quality
Supervisors: Professor Jeffrey Braithwaite, Professor Peter Kam
Laura Vogl: Preventing drug misuse in adolescents: the feasibility of introducing a computer based drug prevention package in secondary school
Supervisors: Professor Maree Teesson, Professor Richard Mattick
Cihat Tetik: Relationship between student approaches to learning and clinical reasoning ability
Supervisors: Dr. Peter Harris, Professor Phillip Crowe
Anne Tiedemann: The development of a validated falls risk assessment for use in clinical practice
Supervisors: Professor Stephen Lord, Dr. Raja Salgado
Husna Razee: 'Being a good woman': suffering and distress through the voices of women in the Maldives
Supervisors: Associate Professor Jan Ritchie, Professor Maurice Eisenbruch and Dr. Debbie Long
Annie Lau: The impact of cognitive biases on information searching and decision making
Supervisors: Professor Enrico Coiera, Professor Nigell Lovell
Shirley Schulz-Robinson: Contextualizing implementation of the community health program: a case study of the Hunter region, New South Wales 1974-1989
Supervisors: Associate Professor Anna Whelan, Associate Professor Jan Ritchie
Rosemary Aldrich: Flesh-coloured bandaids: politics, discourse, policy and the health of Aboriginal and Torres Strait Islander peoples 1972-2001
Supervisors: Professor Anthony Zwi, Professor Stephanie Short
Amitai Rotem: Serious rugby football injuries in New South Wales
Supervisors: Professor Anthony Zwi
Vanessa Rose: Sociostructural determinants of diabetes self-management : test of a self-efficay model
Supervisors: Professor Mark Harris, Dr. Maria Theresa Ho
Year: 2006 - Completions
Augustine Asante: Health Resource Allocation and Equity in Ghana.
Supervisors: Professor Anthony Zwi, Dr. Maria Theresa Ho
Heather Hill: Long-term outcomes after seere, traumatic brain injury
Supervisors: Professor Hugh Dickson, Professor Ann Daniel
Jael Wolk: Can government influence the effective development and implementation of hospital admission policy? .
Supervisor: Professor Jeffrey Braithwaite, Professor Peter Baume
Feng Yi Jin: HIV and other sexually transmissible infections in a cohort of HIV negative homosexual men in Sydney
Supervisors: Professor Andrew Grulich, Professor John Kaldor
Joanne Callen: An exploration of the relationship between culture and work practices in the context of clinicians’ use of a computerised test management system
Supervisors: Professor Jeffrey Braithwaite
Adrian Dunlop: Treatment for Vietnamese heroin users with new Opioid pharmacotherapies : Tro Choi Moi ’Playing a new game
Supervisors: Associate Professor Lisa Maher
Abdullah Demirkol: I don’t mind being a diabetic but not every day! : learning to live with a chronic condition
Supervisors: Associate Professor Jan Ritchie, Dr. Philipa Craig
Kathy Petoumenos: Treatment experience and HIV disease proression findgs fromthe Australian HIV observational database
Supervisors: Professor Matthew Law, Professor John Kaldor
Catherine Sharp: Pressure Ulcers
Supervisors: Associate Professor Mary-Louise McLaws, Professor Gabrielle McMullen
Hla Hla Thein: Measuring the health burden of hepatitis C at an individual and population level in Australia
Supervisors: Professor Greg Dore, Professor John Kaldor, Associate Professor Murray Khran
Hien Thi Ho: Culture, risk, and vulnerability to blood-borne viruses among ethnic Vietnamese injecting drug users
Supervisors: Associate Professor Lisa Maher, Dr. Niamh Stephenson, Dr. Nicholas Crofts
Abbas Haghshenas: Negotiating norms, navigating care: the practice of culturally competent care in cardiac rehabilitation
Supervisors: Associate Professor Patricia Davidson, Professor Maurice Eisenbruch, Professor Arie Rotem
Farhad Pourfarzi: The influence of environmental factors on gastric cancer in the Northwest of Iran .
Supervisors: Dr. Anna Whelan, Professor John Kaldor, Professor Rezah Malekzadeh
Year: 2005
Effat Merghati Khoei: Language of Love in Culture of Silence: Iranian women’s sexual understandings and sociocultural context
Supervisors: Juliet Richters, Anna Whelan, Maurice Eisenbruch
I conducted my research in the School of Public Health & Community Medicine. My PhD focus is on women’s health. My research topic is: ‘ Language of Love in Culture of Silence: Iranian women’s sexual understandings and sociocultural context’.
Describe your academic background
In 1990, I received my bachelor degree in midwifery from Iranian Melli University. In 1992, I enrolled in maternal and child health course for my master degree. For my major project I conducted a quantitative study to compare socio–demographic differences of Iranian women in two sexually satisfied and dissatisfied groups.
I started my professional work soon after completing my midwifery course. The main workplace I gained my working experiences were educational and training hospitals as well as public health clinics. I have been facilitator for students of nursing, midwifery and family health in the fieldwork for more that 12 years. In 1996, I became a lecturer in the School of Public Health, Iran University of Medical Sciences. In 2001, I was awarded a scholarship to pursue my PhD in abroad.
How did you hear about research at Medicine UNSW?
At start, I received some information about faculty of medicine from a friend who had done her PhD in this faculty. However, UNSW site was very useful to search for key people and find out their research fields.
What expectations did you have for your candidature?
To fill my knowledge gaps; learn academic skills; become involved in academic activities in the international level; research on a topic that might not be easy to conduct it back at home.
Describe your candidature so far
My PhD journey has been incredibly fruitful and at same time I found it to some degree challenging in terms of teaching and training systems. Culture of language was another huge issue that extremely affected my candidature. I believe, no matter how fluent you can speak a foreign language; the matter is how much do you know about the culture of that language? Sometimes using a word is literally correct but contextually wrong to be used. I spent a lot of time and energy to learn about this culture.
What opportunities regarding your future have you had during your candidature so far?
I have been able to present myself and my research into the world via international conferences, workshops and publication. Learning and having professional skills in the academic level, I believe, will greatly affect my future career.
Positive experiences at UNSW
One of the best experiences I had in this University was learning about how people interact each other that seems to be based on ‘respect’. Making a friendship with the PhD fellows is the best memory I have ever had during my PhD journey. We interact each other without thinking of race, nationality, religion and etc.
Name: Linda Kurti: The delivery of international development assistance by faith-based NGOs.
Supervisor: Dr. Anna Whelan, Professor Anthony Zwi
Name: Neil Donnelly: The use of interrupted time series analysis to evaluate the impact of Pharmaceutical Benefits Scheme policies on drug utilisation in Australia .
Supervisor: Professor Andrea Mant, Professor Wayne Hall
Name: Joanne Kimber: Role of the Sydney Medically Supervised Injecting Centre in reducing injecting drug use-related harm : evaluating accessibility, utilisation, coverage and selected health impacts .
Supervisors: Professor Kate Dolan, Professor Richard Mattick, Associate Professor Louisa Degenhardt
Name: George Alvarez: Interruptive communication patterns in the intensive care unit ward round
Supervisors: Professor Enrico Coiera, Associate Professor Johanna Westbrook
Name: Juliet Ndimwibo Babiyre: Infant feeding practice and adherence to Ugandan infant feeding guidelines among HIV positive and HIV negative mothers .
Supervisors: Assocaite Professor Andrew Grulich, Professor John Kaldor
Name: Katherine Mills: Post traumatic stress disorder among people with heroin dependence .
Supervisors: Associate Professor Maree Teesson, Dr. Joanne Ross
Name: Basema Saddick: The delivery of international development assistance by faith-based NGOs.
Supervisors: Associate Professor Deborah Black, Associate Professor Ann Williamson
Name: Joella Storey: The development, pilot and validation of a multicultural cognitive assessment scale.
Supervisors: Professor Hugh Dickson, Dr. Hans Van der Wall
Name: Chinthaka Balasooriya: The best laid plans : medical students’ responses to new curricula .
Supervisors: Dr. Chris Hughes, Susan Toohey
Name: Joanne Callen: An exploration of the relationship between culture and work practices in the context of clinicians’ use of a computerised test management system
Supervisors: Associate Professor Jeffrey Braithwaite
Name: : Barbara Daly: A crowded house: using an action research approach to address the problem of access block at a tertiary referralhospital :January -July 2003 .
Supervisors: Associate Professor Rick Iedema, Associate Professor Jeffrey Braithwaite
Name: Fleur Hillier: Managing creative and health production processes : issues, similarities and differences.
Supervisors: Assocaite Professor Jeffrey Braithwaite
Name: Yahui Sophie Hsieh: Rethinking quality of care in the context of patient complaints : the response of a hospital organisation to complaints in Taiwan .
Supervisors:Dr. David Thomas, Professor Arie Rotem
Name: Suzanne Polis: Hepatitis B and hepatitis C virus in an antenatal population : an epidemiological study
Supervisors: Professor John Kaldor, Associate Professor Stephen Riordan
Name: Marilyn Rob: Ear, nose and throat surgery among young Australian children
Supervisors: Associate Professor Johanna Westbrook, Professor Richard Taylor
Name: Anna Williamson: The effect of cocaine use on outcomes for the treatment of heroin dependence in Sydney, Australia
Supervisors: Associate Professor Shane Darke, Dr. Joanne Ross
Year: 2004
Paul Thomas: Vertical and horizontal methods of peer learning in clinical examination skills.
Supervisor: Peter Harris
Paul Thomas has completed a Masters in Education upon the subject of peer-learning in clinical medical education. He is continuing to research this topic with a view to improving learning and developing the clinical examination skills that medical students acquire over their training. In the research to date, structured peer-learning has been shown to improve clinical skills and can be demonstrated to be effective in both true peers (dyads, or same level peers) and also if the clinical skills tutoring is undertaken by more advanced students. These improvements were seen in objective assessments specifically in skills such as ophthalmoscopy, and also in summative clinical examinations at the end of year and in the final year examinations.
Opportunities exist for participating in continuation of this research to encourage peer learning, and the amount of participation can suit the individual. Contact A/Prof Thomas (paul.thomas@unsw.edu.au) for details.
David Greenfield: The technologisation of practice in early childhood nursing: Collaborating for innovation and change.
Supervisor: Rick Iedema
There is a need for research to understand change processes and knowledge management in health service organisations, and indeed public sector organisations in general. This PhD research explains how knowledge becomes formulated and thereby mobile, and also how practice has come to be established, visibilised and thereby sustained in a specific context. Exploring practice within a health service organisation, and in particular a public health service organisation, is a particular feature of this research. Using an ethnographic approach, this research explored how the practice of early childhood nursing in the South Western Sydney Area Health Service became a specialised expert undertaking. The research examined how change had occurred, whereby early childhood nursing was refined from being one part of the generalist community nursing practice to being a specialised practice through the increasing technologisation of practice. The technologisation of practice refers to the artefacts, conduct and the processes through which the conceptualisation and enactment of early childhood nursing has become increasingly standardised. Through the technologisation of practice explicit knowledge becomes distributed within the artefacts for practice and tacit knowing becomes distributed across, and is continually enacted by, the collaboration of the practice community. The research demonstrates how collaboration becomes necessitated under pressure of enacting increasingly complex work activities, an outcome being changing practices and extended accountability relationships which enacts discipline while realising expertise.
There are four interrelated aspects to the technologisation of practice. Firstly, the technologisation of practice involves standardising the conceptualisation and enactment of practice through constructing a multi-dimensional practice resource within a community of practice. Secondly, the technologisation of practice involves the mobilisation and refinement of the multi-dimensional practice resource to realise a practice network involving extended relationships of accountability. These relationships of accountability are within a profession and also with other professionals. Thirdly, the technologisation of practice involves the ongoing enactment of accountability in a collaborative community of practice. Fourthly, the technologisation of practice involves the collaborative community assemblage and/or appropriation of further technologies into practice thereby strengthening the local and extended relationships of accountability and expanding the boundaries of practice.
The technologisation of practice is the enactment of a number of mutually enabling practice dualities. The interrelated practice dualities are individual-community, subjective-objective, local-global, formal-informal and governmentality-communal self-governance. Through the enactment of the practice dualities the nursing community pursues expertise while disciplining themselves; by engaging in collaborative interactions and using standardised technologies the community constructs and makes visible their knowing, practice and expertise.
Shalini K. Vinod : A Lung Cancer Patterns of Care Study in the South Western Sydney Area Health Service.
Supervisor: Adrian Bauman
Co-supervisor: Michael Barton
Background: The South Western Sydney Area Health Service
(SWSAHS) contains many areas of socio-economic disadvantage and ethnic diversity. It has a high incidence of lung cancer, which is the leading cause of cancer deaths. The aims of this study were to document lung cancer patterns of care (POC) for SWSAHS residents, compare POC before and after the opening of an oncology centre in SWSAHS and compare POC with other areas in NSW.
Methods: The study population consisted of SWSAHS residents diagnosed with lung cancer in 1993 and 1996. A clinical audit of medical records was performed to extract details on patient demographics, management of lung cancer and outcomes. Collaborating investigators performed identical studies in the Northern Sydney Area Health Service (NSAHS) and the Hunter Area Health Service (HAHS) for lung cancers diagnosed in 1996.
Results: The SWSAHS study population comprised 527 patients. Nine percent did not have a pathological diagnosis. Twelve percent did not see a lung cancer specialist. Twenty-eight percent did not receive any treatment throughout the course of their illness. The median survival was 6.7 months and five-year actuarial survival was 8% (95% CI 6%-10%). Increasing age and poorer performance status were associated with a lower likelihood of obtaining a pathological diagnosis, specialist referral and treatment. Socio-economic factors did not influence POC.
The establishment of an oncology center resulted in more referrals to medical oncologists and palliative care services. Other aspects of POC and survival were similar. Variability in POC was noted between SWSAHS, NSAHS and HAHS. HAHS residents were almost twice as likely not to have pathological confirmation of diagnosis or treatment. Despite this survival was not significantly different.
Conclusions: This study has identified deficiencies in the management of lung cancer. To improve outcomes, referral to specialists and utilisation of treatment, particularly radiotherapy and chemotherapy, needs to be increased. Ageist and nihilistic attitudes need to be overcome. Prospective data collection is necessary to ensure quality of patient care. The formation of national guidelines for the management of lung cancer will play an important role in achieving better outcomes.
Mohammed Mohsin: Is There Equity in Emergency Medical Care? A Descriptive Epidemiological Study of Emergency Department Care in New South Wales Hospitals.
Supervisor: Adrian Bauman
Emergency Departments (EDs) are key entry points into the acute hospital system, working at the interface between the hospital and community. However, in spite of EDs role in the health care system, few studies have comprehensively examined their utilisation and outcomes in Australian hospitals. The main objectives of this study were to document the socio-demographic and clinical characteristics of New South Wales (NSW) ED attenders, and to examine the association of socio-demographic and clinical characteristics with ED outcomes (waiting time, rate of non-urgent visits, walk-out from EDs without being seen by a doctor, unplanned return visits and deaths in EDs). In addition, this study also examined the association of socio-demographic characteristics with private health insurance coverage, and it’s impact on ED outcomes. Bivariate analyses (cross-tabulation, correlation), prevalence ratios and multivariate (multiple regression & logistic regression) analyses were performed to explore the relationship between outcome variables (dependent) and explanatory variables. This study identified that in addition to severity of illness, socio-demographic factors play a significant role in patients’ decision to use EDs, and individuals with certain characteristics waited longer than others to see the doctor, had significantly higher likelihood of having a non-urgent visit, were more likely to leave EDs without being seen by a doctor, had higher rates of unplanned return visits, were more likely to die in ED and less likely to get admitted for further treatment. These variations of ED utilisation and outcome measures by different population subgroups may reflect inequities in access and delivery of ED care. The positive correlation between daily numbers of patients arriving in EDs, with waiting times and rates of walk-out indicate that overcrowding may lead to longer waiting times which may eventually lead to walk-out of patients. The finding of most concern was that after adjusting for socio-demographic characteristics and severity of illness, persons with private health insurance coverage had better access to ED care. The results could help policy makers, health managers, and ED professionals better understand ED users and design strategies to improve the quality and equitable access to ED care. This study also suggest several areas for further research.
Hai Phung: Contribution of social, psychological, geographical and demographical factors to the well-being of mothers and children : an integration of health services research and population data
Supervisors: Adrian Bauman, Robyn Richmond
Zafirul Hussain: Prevalence of type 2 diabetes and associated risk factors in the Kingdom of Tonga and predictive models to identify people with undiagnosed type 2 diabetes and dysglycaemia
Carolyn Day: Understanding the relationship between hepatitis C infection and heroin use in Australia : epidemics, drug markets and methodology
Supervisor: Dr. Kate Dolan
Roberta Chavez: Social capital and self-reported health in two communities of known disadvantage
Supervisors: Elizabeth Harris
Peter McManus: Introduction of the new antidepressants into the Australian community during the 1990s : a drug utilisation study
Supervisors: Andrea Mant
Lucinda Burns: Comorbidity between alcohol use disorders, anxiety and depression
Supervisor: Dr. Maree Teesson
Year: 2003
Jonine Penrose-Wall: Evaluating five models of dissemination of NMHRC Guidelines Depression in Young People for GPs through Divisions of General Practice.</H3>]
Supervisor: Emeritus Professor Ian W Webster AO
The dissemination of evidence-based clinical practice guidelines on mental health had not been done nor studied in Australia prior to this study, undertaken as a MPH by Research. Convening what we called, the National General Practice Guideline Implementation Program over 18 months, linked with the student’s employment operating a national mental health shared care network of Divisions, the study was housed in the Centre for General Practice Integration Studies, UNSW. With support from Professor Mark Harris, the student obtained a series of research grants from the then Commonwealth Mental Health Branch and General Practice Branch. Data were collected during 2001/2 to evaluate 5 models of dissemination designed nationally for local adapting and use by Divisions. The complexity of depression and suicide guideline (NHMRC, 1997) required a national program development framework, the ‘coordinated link-agent’ and ‘enhanced packaged and program development approach’. A Divisions Depression Guideline Dissemination Kit was the key intervention of a total of 10. We also collaborated with Professor Ian Hickie and team, the then director of SPHERE a National Depression Program, SPHERE acting as one model of dissemination.
This study was an important partnership at several levels – between 2 different expert centres (one general practice, the other psychiatry) and between national researchers and mental health program staff in Divisions. It preceded any Government incentive program directly to doctors to increase GP engagement in mental health (eg the Better Outcomes in Mental Health Initiative). It also preceded beyondblue’s other inputs to general practice depression care. Its significance is that it evaluated resource-neutral uptake of a clinically challenging guideline without incentives or funding provided to either Divisions or to GPs.
Offering the program to 123 Divisions we expected to engage 20. In all, 70 Divisions and many other mental health organisations participated (57% of the Division sector). We disseminated 10,000 guidelines: engaging 45 organisations by 7 weeks and 70 by 35 weeks, the majority showing fidelity to the Kit programs. The 5 models were: 1) Education by the Division; 2) Education by an external provider; 3) Clinical Audit; 4) Segmented Formats and 5) Appraisal. Five sub-studies are reported in the thesis: 1) an organisational census on guideline practices by Divisions;
2) a Case Study Database of 3 consecutive interviews of participating Divisions;
3) a Guideline Appraisal study of 9 cohorts of doctors;
4) a Clinical Audit study of 54 doctors involving 1200 patients; and
5) a ‘Segmented Formats’ documentary analysis of Division communications to promote the guideline.
Our census found that prior dissemination by Divisions was administrative not planned programs. Education by the Division, Segmented Formats and Appraisal were the most adopted models. We concluded that Divisions are one appropriate system through which evidence-based mental health guidelines can be implemented if providing 3-6 months to begin effective planning of local programs within existing or new Division commitments. However, barriers remain for complex guidelines, and funded coordinated inputs over the longer term are necessary for practice to match guidelines.
The experience was relevant in public health research and planning terms. It enabled partnerships between medical and non-medical disciplines/workforces around problem solving the application of complex guidelines in challenging settings. We celebrated the initiative through a national Conference of Divisions called: To Their Full Potential: Evidence Based Guideline Uptake in Primary Mental Health Care. Proceedings are housed in the Thesis Appendix. I thoroughly appreciated the opportunity, the input of Professors Ian Webster, Mark Harris and Ian Hickie and that of colleagues at the Centre, School, Divisions and Mental Health Services in all states. It spurred me on to a PhD undertaking at UNSW School of Sociology, also in a suicide-related topic.
Xiao Xia Hu: Improving Quality While Reducing Cost? An Innovation Journey
Supervisor: Jeffrey Braithwaite
Co-supervisor: Anna Whelan
Many innovative ideas have been proposed to manage and improve the quality and cost of clinical care. For many innovations, like Total Quality Management (TQM), the "black box" of implementation process is not well understood. A study was designed to explore how one organisation, Intermountain Health care (IHC), an acute and primary health care provider in the USA, innovates in implementing TQM organisation-wide to improve and manage clinical quality. This study takes a case study approach using multiple research methods. The main methods used comprise interviews with key personnel, assessment of organisational documents and a survey of clinicians' and managers' attitudes and beliefs. The main finding of the research is that innovation implementation at IHC was a journey, not a destination. To implement TQM organization-wide, integrated structures and systems were being instituted. The study also found that supportive environments played a critical role in the journey. While the TQM implementation at IHC resulted in some cost savings and some behavioural changes including clinical practice change, cultural change at the level of values and beliefs had yet to occur. A process-oriented integrative model of clinical service management is proposed. The temporal change processes lead to formation and changes of the ongoing organisational processes, which in turn evaluate and improve the important clinical processes. These processes integrate TQM with other quality improvement approaches, also ensure that quality is part of the dialogue between key stakeholders who are responsible for managing and improving clinical quality and costs.
Year: 2002
Anna Maruyama : Mental Health Problems in Primary Care in the context of general health service in Japan.
Supervisor: Arie Rotem
Mental health problems, particularly the milder forms of depression and anxiety, have a high prevalence across culture and countries. Although 2/3 or more of these patients visit primary care settings, their psychological problems fail to be identified and treated correctly. Thus the impaired functioning of these patients becomes a public health issue. This study used a simple questionnaire which included the GHQ (general health questionnaires) and some other items that cover other important physical symptoms which have been shown to identify a somatic presentation of psychological problems. 33% of 449 patients visiting General Practitioners in Osaka, Japan showed symptoms of depression and anxiety according to the screening instrument. The main risk factors identified were being female, especially being 45 years or older or postmenopausal, and anyone divorced, separated or widowed. Patients’ self rated health status was a good indicator of their psychological wellbeing. Comparison revealed that Japanese subjects scored higher on fatigue and cognitive function items and less on emotional items than Australians. This suggested that Japanese tend to somatasize their mental health problems more than Australians. In addition, some practical suggestions for GP's to enable them to provide better service to their patients for their mental health problems were developed from interviews with the GPs who participated in this study.
Hong-Qiu Wang: A Multivariate Study of Determinants of the Intention to Try Quit Smoking among Adult Male Smokers in three Selected Populations in China
Supervisor: Jeffrey Braithwaite
Co-supervisor: Anna Whelan
A cross-sectional survey of three selected populations in China was conducted to identify the most important factors influencing a smoker's decision to try to quit smoking. A newly developed questionnaire was used and had a good reliability (the test-retest reliabilities for the single-item measures were all over 0.83 and Cronbach’s alphas for the multi-item measures ranged from 0.66 to 0.94). This study is the first attempt to use social-psychological theories developed in Western countries to understand intentions to try to quit in Mainland China.
This study has resulted in a new model of intention to try to quit by firstly integrating a number of major theoretical predictors of health protective behaviors derived from five major theories of health protective behaviors into proximal and distal influences of intentions, and then by incorporating an additional theoretical predictor: immediate incentive as an additional or alternative proximal predictor of intention and testing a number of other variables as potential predictors.
As expected, in the integrated model long-run incentive, outcome expectation and self-efficacy were reliable predictors of intention, with Beta=0.21, 0.11 and 0.53 in the full sample (n=631), p<0.001. Susceptibility, severity and barriers had indirect effects rather than direct effects on intention, mediated by long-run incentive and outcome expectation in the former two and self-efficacy in the latter. The integrated model accounted for 44% of the overall variance in intention. However, incorporation of immediate incentive greatly improved the prediction of intention, with the new model accounting for 74% of the variance in intention in the full sample, and similar amounts in the three sub-samples. In this extended sample, immediate incentive and self-efficacy were the two main direct predictors (Beta=0.76, 0.16 in the full sample, p<0.001) with long-run incentive and outcome expectation being predictors of immediate incentive (Beta=0.24, 0.21 in the full sample, p<0.001). The test of other variables found no clear proximal predictors, but a range of possible distal influences.
The findings of the study may provide useful approaches for anti-smoking education and policy changes in China to encourage more smokers to try to quit. In addition, methodological/theoretical insights will assist future research in this field.
For further information, contact:
Professor Nick Zwar or Associate Professor Mary-Louise McLaws
Higher Degree Coordinators
School of Public Health and Community Medicine
Email: n.zwar@unsw.edu.au m.mclaws@unsw.edu.au