Liz Steed | Queen Mary, University of London (original) (raw)
Papers by Liz Steed
NPJ primary care respiratory medicine, 2015
In chronic obstructive pulmonary disease (COPD), the problem of poor patient participation in stu... more In chronic obstructive pulmonary disease (COPD), the problem of poor patient participation in studies of self-management (SM) and pulmonary rehabilitation (PR) programmes (together referred to as COPD support programmes) is established. Understanding this problem beyond the previously reported socio-demographics and clinical factors is critical. The aim of this study was to explore factors that explain patient participation in studies of COPD support programmes. Thematic 'framework' synthesis was conducted on literature published from 1984 to 1 February 2015. Emergent themes and subthemes were mapped onto the adapted 'attitude-social influence-external barriers' and the 'self-regulation' models to produce analytical themes. Ten out of 12 studies were included: PR (n=9) and SM (n=1). Three descriptive themes with 38 subthemes were mapped onto the models' constructs, and it generated four analytical themes: 'attitude', 'social influences' an...
Diabetes technology & therapeutics, 2008
User acceptability of new health technologies is important in determining their widespread use an... more User acceptability of new health technologies is important in determining their widespread use and adoption. The aim of this current study was twofold: first, to investigate the acceptability of two continuous glucose monitoring devices for people with diabetes; and second, to develop a valid questionnaire measure to assess the acceptability of continuous glucose monitoring devices. Semi-structured interviews were conducted with six people with diabetes who had previously used the GlucoWatchBiographer (Animas Corp., West Chester, PA) or the CGMS continuous glucose monitoring system (Medtronic MiniMed, Northridge, CA) in order to increase understanding of the issues relating to acceptability of, and satisfaction with, the devices. Interview transcripts were analyzed qualitatively using framework analysis. These analyses, together with consultation with researchers and health professionals in the field, provided the foundation for development of a questionnaire measure that was pilote...
Rheumatology (Oxford, England), 2001
Health Technol Assess, 2009
ABSTRACT This groundbreaking book provides a much-needed overview of self-management in chronic p... more ABSTRACT This groundbreaking book provides a much-needed overview of self-management in chronic physical illness. It provides the theoretical and conceptual background to self-management, as well as examining issues related to the delivery of self-management interventions in chronic illness. The chapters systematically review the efficacy and effectiveness of interventions in a range of different chronic conditions, including: asthma, coronary artery disease, heart failure, COPD, hypertension, diabetes, rheumatoid arthritis. Authored by a range of leading international authors, each of them experts in the chronic diseases they discuss, the book is key reading for a wide range of health care professionals dealing with individuals with chronic conditions, including nurses, doctors, physiotherapists, health psychologists and occupational therapists. The book concludes by looking at the future of self-management for chronic illness.
Introduction: Long-term medical conditions (LTCs) cause reduced health-related quality of life an... more Introduction: Long-term medical conditions (LTCs) cause reduced health-related quality of life and considerable health service expenditure. Writing therapy has potential to improve physical and mental health in people with LTCs, but its effectiveness is not established. This project aims to establish the clinical and cost-effectiveness of therapeutic writing in LTCs by systematic review and economic evaluation, and to evaluate context and mechanisms by which it might work, through realist synthesis.
energy expenditure. 'Exercise' refers to planned, structured and repetitive movement to improve o... more energy expenditure. 'Exercise' refers to planned, structured and repetitive movement to improve or maintain one or more components of physical fitness (Chodzko-Zajko et al, 2009). So a person may take little exercise but be physically active with low levels of sedentary behaviour, whereas another might do structured exercises but be habitually inactive and spend long periods sedentary. Thus, the end points of some of the reviewed trials and the methods used to measure those end points require more critical discussion. For example, the authors acknowledge that aerobic exercise tolerance may not reflect aerobic fitness -but neither of those necessarily translates into improved habitual physical activity. The authors acknowledge the challenge of achieving current physical activity guidelines, but do not mention potential end points at the lower end of the physical activity continuum -for example, breaking up sedentary behaviour with light activity -which may be critical in cancer survivors, given recent recognition of the adverse health consequences of high levels of sedentary behaviour in cancer populations (Lynch et al, 2013).
Reviews, 1996
The beneficial effects of regular exercise for people living with or beyond cancer are becoming a... more The beneficial effects of regular exercise for people living with or beyond cancer are becoming apparent. However, how to promote exercise behaviour in sedentary cancer cohorts is not as well understood. A large majority of people living with or recovering from cancer do not meet exercise recommendations. Hence, reviewing the evidence on how to promote and sustain exercise behaviour is important. To assess the effects of interventions to promote exercise behaviour in sedentary people living with and beyond cancer and to address the following questions: Which interventions are most effective in improving aerobic fitness and skeletal muscle strength and endurance? What adverse effects are attributed to different exercise interventions? Which interventions are most effective in improving exercise behaviour amongst patients with different cancers? Which interventions are most likely to promote long-term (12 months or longer) exercise behaviour? What frequency of contact with exercise professionals is associated with increased exercise behaviour? What theoretical basis is most often associated with increased exercise behaviour? What behaviour change techniques are most often associated with increased exercise behaviour? We searched the following electronic databases: Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 8, 2012), MEDLINE, EMBASE, AMED, CINAHL, PsycLIT/PsycINFO, SportDiscus and PEDro from inception to August 2012. We also searched the grey literature, wrote to leading experts in the field, wrote to charities and searched reference lists of other recent systematic reviews. We included only randomised controlled trials (RCTs) that compared an exercise intervention with a usual care approach in sedentary people over the age of 18 with a homogenous primary cancer diagnosis. Two review authors working independently (LB and KH) screened all titles and abstracts to identify studies that might meet the inclusion criteria, or that cannot be safely excluded without assessment of the full text (e.g. when no abstract is available). All eligible papers were formally abstracted by at least two members of the review author team working independently (LB and KH) and using the data collection form. When possible, and if appropriate, we performed a fixed-effect meta-analysis of study outcomes. For continuous outcomes (e.g. cardiorespiratory fitness), we extracted the final value, the standard deviation of the outcome of interest and the number of participants assessed at follow-up in each treatment arm, to estimate standardised mean difference (SMD) between treatment arms. SMD was used, as investigators used heterogeneous methods to assess individual outcomes. If a meta-analysis was not possible or was not appropriate, we synthesised studies as a narrative. Fourteen trials were included in this review, involving a total of 648 participants. Only studies involving breast, prostate or colorectal cancer were identified as eligible. Just six trials incorporated a target level of exercise that could meet current recommendations. Only three trials were identified that attempted to objectively validate independent exercise behaviour with accelerometers or heart rate monitoring. Adherence to exercise interventions, which is crucial for understanding treatment dose, is often poorly reported. It is important to note that the fundamental metrics of exercise behaviour (i.e. frequency, intensity and duration, repetitions, sets and intensity of resistance training), although easy to devise and report, are seldom included in published clinical trials.None of the included trials reported that 75% or greater adherence (the stated primary outcome for this review) of the intervention group met current aerobic exercise recommendations at any given follow-up. Just two trials reported six weeks of resistance exercise behaviour that would meet the guideline recommendations. However, three trials reported adherence of 75% or greater to an aerobic exercise goal that was less than the current guideline recommendation of 150 minutes per week. All three incorporated both supervised and independent exercise components as part of the intervention, and none placed restrictions on the control group in terms of exercise behaviour. These three trials shared programme set goals and the following behaviour change techniques: generalisation of a target behaviour; prompting of self-monitoring of behaviour; and prompting of practise. Despite the uncertainty surrounding adherence in many of the included trials, interventions caused improvements in aerobic exercise tolerance at 8 to 12 weeks (from 7 studies, SMD 0.73, 95% confidence interval (CI) 0.51 to 0.95) in intervention participants compared with controls. At six months, aerobic exercise tolerance was also improved (from 5 studies, SMD 0.70, 95% CI 0.45 to 0.94), but it should be noted that four of the five trials used in this analysis had a high risk of bias, hence…
Psychology, Health & Medicine, 2013
The purpose of this study was to test the extent that constructs from two theoretical models (sel... more The purpose of this study was to test the extent that constructs from two theoretical models (self-regulatory theory and social cognitive theory) mediated change in outcomes following a self-management intervention. One hundred and twenty four individuals with type 2 diabetes who had participated in a randomised controlled trial of a diabetes self-management programme were analysed for the extent that illness beliefs and self-efficacy mediated change in self-management behaviours and illness specific quality of life. Exercise specific self-efficacy significantly mediated change in exercise at three months (B = .03; .01, p < .05) while monitoring specific self-efficacy mediated change in monitoring behaviour at both three (B = .04; .01, p < .01) and nine months follow-up (B = 5.97; 1.01, p < .01). Belief in control over diabetes mediated change in illness specific quality of life at three months (B = -.07; .28, p < .05) and nine months (B = .79; .28, p < .01) follow-ups, as well as change in exercise behaviour at immediately post-intervention (B = -.12; .17, p < .05). Behaviour-specific self-efficacy may have a stronger role in mediating self-management behaviours than illness beliefs; however, belief in control over diabetes may be important to manipulate for change in quality of life. This suggests different theoretical constructs may mediate change dependent on outcome.
Personality and Individual Differences, 1999
The purpose of this study was to investigate the relationship between dispositional optimism, dis... more The purpose of this study was to investigate the relationship between dispositional optimism, dispositional pessimism, repressive coping and trait anxiety. The Marlowe-Crowne scale (MC) and the Bendig version of the Taylor Manifest Anxiety Scale (MAS) were used to select repressor and control groups (N = 143, aged between 18 and 47 years), who subsequently completed a measure of dispositional optimism, the Life Orientation Test (LOT), which consists of two sets of items: optimism and pessimism. Repressors (high MC, low MAS) reported signi®cantly lower pessimism than all other participants. When the pessimism scale was divided into high and low categories, there were signi®cantly more repressors in the low pessimism group than the other low trait anxiety group, low anxious (low MC, low MAS). However, for the optimism scale the opposite pattern of results was found, with signi®cantly more low anxious in the high optimism group than repressors. These results support the assertion that the pessimism and optimism scales of the LOT are not the same construct and should be measured separately. #
Journal of Cystic Fibrosis, 2008
This is the protocol for a review and there is no abstract. The objectives are as follows: Prima... more This is the protocol for a review and there is no abstract. The objectives are as follows:
Primary objective
To assess the effectiveness of health promotion interventions in community pharmacy practice settings on pharmacy workers and
pharmacy clients (including diagnosed patients) when compared to
i) No treatment controls
ii) Usual treatment controls
iii) Other active intervention
Secondary objectives
To assess whether there are differences in effectiveness of health promotion interventions in community pharmacy practice settings on
i) Pharmacy worker
ii) Client (patient)
with regard to:
i) Ethnicity of patients
ii) Country income level (World Bank Group 2009)
iii) Extent of adverse health behaviour (defined according to national guidelines where available)
iv) Type of pharmacy worker delivering the intervention (e.g. pharmacist versus pharmacist technician)
v) Theoretical constructs/components and behaviour change techniques employed in the intervention
vi) Costs of health care
Annals of Thoracic Surgery, 2001
Recently, Tardiff and colleagues have suggested that the presence of the apolipoprotein E, ⑀4 all... more Recently, Tardiff and colleagues have suggested that the presence of the apolipoprotein E, ⑀4 allele was associated with increased likelihood of cognitive decline after coronary artery bypass grafting. The objective of the current study was to replicate this earlier work using an increased sample size. The increased sample also enabled an analysis by individual genotype in cognitive decline after coronary artery bypass grafting.
British Journal of Health Psychology, 1999
To examine the role of the presence of symptoms on illness representations. To examine the succes... more To examine the role of the presence of symptoms on illness representations. To examine the success of the Self-Regulation Model in explaining psychosocial adjustment in patients with atrial brillation (AF).
NPJ primary care respiratory medicine, 2015
In chronic obstructive pulmonary disease (COPD), the problem of poor patient participation in stu... more In chronic obstructive pulmonary disease (COPD), the problem of poor patient participation in studies of self-management (SM) and pulmonary rehabilitation (PR) programmes (together referred to as COPD support programmes) is established. Understanding this problem beyond the previously reported socio-demographics and clinical factors is critical. The aim of this study was to explore factors that explain patient participation in studies of COPD support programmes. Thematic 'framework' synthesis was conducted on literature published from 1984 to 1 February 2015. Emergent themes and subthemes were mapped onto the adapted 'attitude-social influence-external barriers' and the 'self-regulation' models to produce analytical themes. Ten out of 12 studies were included: PR (n=9) and SM (n=1). Three descriptive themes with 38 subthemes were mapped onto the models' constructs, and it generated four analytical themes: 'attitude', 'social influences' an...
Diabetes technology & therapeutics, 2008
User acceptability of new health technologies is important in determining their widespread use an... more User acceptability of new health technologies is important in determining their widespread use and adoption. The aim of this current study was twofold: first, to investigate the acceptability of two continuous glucose monitoring devices for people with diabetes; and second, to develop a valid questionnaire measure to assess the acceptability of continuous glucose monitoring devices. Semi-structured interviews were conducted with six people with diabetes who had previously used the GlucoWatchBiographer (Animas Corp., West Chester, PA) or the CGMS continuous glucose monitoring system (Medtronic MiniMed, Northridge, CA) in order to increase understanding of the issues relating to acceptability of, and satisfaction with, the devices. Interview transcripts were analyzed qualitatively using framework analysis. These analyses, together with consultation with researchers and health professionals in the field, provided the foundation for development of a questionnaire measure that was pilote...
Rheumatology (Oxford, England), 2001
Health Technol Assess, 2009
ABSTRACT This groundbreaking book provides a much-needed overview of self-management in chronic p... more ABSTRACT This groundbreaking book provides a much-needed overview of self-management in chronic physical illness. It provides the theoretical and conceptual background to self-management, as well as examining issues related to the delivery of self-management interventions in chronic illness. The chapters systematically review the efficacy and effectiveness of interventions in a range of different chronic conditions, including: asthma, coronary artery disease, heart failure, COPD, hypertension, diabetes, rheumatoid arthritis. Authored by a range of leading international authors, each of them experts in the chronic diseases they discuss, the book is key reading for a wide range of health care professionals dealing with individuals with chronic conditions, including nurses, doctors, physiotherapists, health psychologists and occupational therapists. The book concludes by looking at the future of self-management for chronic illness.
Introduction: Long-term medical conditions (LTCs) cause reduced health-related quality of life an... more Introduction: Long-term medical conditions (LTCs) cause reduced health-related quality of life and considerable health service expenditure. Writing therapy has potential to improve physical and mental health in people with LTCs, but its effectiveness is not established. This project aims to establish the clinical and cost-effectiveness of therapeutic writing in LTCs by systematic review and economic evaluation, and to evaluate context and mechanisms by which it might work, through realist synthesis.
energy expenditure. 'Exercise' refers to planned, structured and repetitive movement to improve o... more energy expenditure. 'Exercise' refers to planned, structured and repetitive movement to improve or maintain one or more components of physical fitness (Chodzko-Zajko et al, 2009). So a person may take little exercise but be physically active with low levels of sedentary behaviour, whereas another might do structured exercises but be habitually inactive and spend long periods sedentary. Thus, the end points of some of the reviewed trials and the methods used to measure those end points require more critical discussion. For example, the authors acknowledge that aerobic exercise tolerance may not reflect aerobic fitness -but neither of those necessarily translates into improved habitual physical activity. The authors acknowledge the challenge of achieving current physical activity guidelines, but do not mention potential end points at the lower end of the physical activity continuum -for example, breaking up sedentary behaviour with light activity -which may be critical in cancer survivors, given recent recognition of the adverse health consequences of high levels of sedentary behaviour in cancer populations (Lynch et al, 2013).
Reviews, 1996
The beneficial effects of regular exercise for people living with or beyond cancer are becoming a... more The beneficial effects of regular exercise for people living with or beyond cancer are becoming apparent. However, how to promote exercise behaviour in sedentary cancer cohorts is not as well understood. A large majority of people living with or recovering from cancer do not meet exercise recommendations. Hence, reviewing the evidence on how to promote and sustain exercise behaviour is important. To assess the effects of interventions to promote exercise behaviour in sedentary people living with and beyond cancer and to address the following questions: Which interventions are most effective in improving aerobic fitness and skeletal muscle strength and endurance? What adverse effects are attributed to different exercise interventions? Which interventions are most effective in improving exercise behaviour amongst patients with different cancers? Which interventions are most likely to promote long-term (12 months or longer) exercise behaviour? What frequency of contact with exercise professionals is associated with increased exercise behaviour? What theoretical basis is most often associated with increased exercise behaviour? What behaviour change techniques are most often associated with increased exercise behaviour? We searched the following electronic databases: Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 8, 2012), MEDLINE, EMBASE, AMED, CINAHL, PsycLIT/PsycINFO, SportDiscus and PEDro from inception to August 2012. We also searched the grey literature, wrote to leading experts in the field, wrote to charities and searched reference lists of other recent systematic reviews. We included only randomised controlled trials (RCTs) that compared an exercise intervention with a usual care approach in sedentary people over the age of 18 with a homogenous primary cancer diagnosis. Two review authors working independently (LB and KH) screened all titles and abstracts to identify studies that might meet the inclusion criteria, or that cannot be safely excluded without assessment of the full text (e.g. when no abstract is available). All eligible papers were formally abstracted by at least two members of the review author team working independently (LB and KH) and using the data collection form. When possible, and if appropriate, we performed a fixed-effect meta-analysis of study outcomes. For continuous outcomes (e.g. cardiorespiratory fitness), we extracted the final value, the standard deviation of the outcome of interest and the number of participants assessed at follow-up in each treatment arm, to estimate standardised mean difference (SMD) between treatment arms. SMD was used, as investigators used heterogeneous methods to assess individual outcomes. If a meta-analysis was not possible or was not appropriate, we synthesised studies as a narrative. Fourteen trials were included in this review, involving a total of 648 participants. Only studies involving breast, prostate or colorectal cancer were identified as eligible. Just six trials incorporated a target level of exercise that could meet current recommendations. Only three trials were identified that attempted to objectively validate independent exercise behaviour with accelerometers or heart rate monitoring. Adherence to exercise interventions, which is crucial for understanding treatment dose, is often poorly reported. It is important to note that the fundamental metrics of exercise behaviour (i.e. frequency, intensity and duration, repetitions, sets and intensity of resistance training), although easy to devise and report, are seldom included in published clinical trials.None of the included trials reported that 75% or greater adherence (the stated primary outcome for this review) of the intervention group met current aerobic exercise recommendations at any given follow-up. Just two trials reported six weeks of resistance exercise behaviour that would meet the guideline recommendations. However, three trials reported adherence of 75% or greater to an aerobic exercise goal that was less than the current guideline recommendation of 150 minutes per week. All three incorporated both supervised and independent exercise components as part of the intervention, and none placed restrictions on the control group in terms of exercise behaviour. These three trials shared programme set goals and the following behaviour change techniques: generalisation of a target behaviour; prompting of self-monitoring of behaviour; and prompting of practise. Despite the uncertainty surrounding adherence in many of the included trials, interventions caused improvements in aerobic exercise tolerance at 8 to 12 weeks (from 7 studies, SMD 0.73, 95% confidence interval (CI) 0.51 to 0.95) in intervention participants compared with controls. At six months, aerobic exercise tolerance was also improved (from 5 studies, SMD 0.70, 95% CI 0.45 to 0.94), but it should be noted that four of the five trials used in this analysis had a high risk of bias, hence…
Psychology, Health & Medicine, 2013
The purpose of this study was to test the extent that constructs from two theoretical models (sel... more The purpose of this study was to test the extent that constructs from two theoretical models (self-regulatory theory and social cognitive theory) mediated change in outcomes following a self-management intervention. One hundred and twenty four individuals with type 2 diabetes who had participated in a randomised controlled trial of a diabetes self-management programme were analysed for the extent that illness beliefs and self-efficacy mediated change in self-management behaviours and illness specific quality of life. Exercise specific self-efficacy significantly mediated change in exercise at three months (B = .03; .01, p < .05) while monitoring specific self-efficacy mediated change in monitoring behaviour at both three (B = .04; .01, p < .01) and nine months follow-up (B = 5.97; 1.01, p < .01). Belief in control over diabetes mediated change in illness specific quality of life at three months (B = -.07; .28, p < .05) and nine months (B = .79; .28, p < .01) follow-ups, as well as change in exercise behaviour at immediately post-intervention (B = -.12; .17, p < .05). Behaviour-specific self-efficacy may have a stronger role in mediating self-management behaviours than illness beliefs; however, belief in control over diabetes may be important to manipulate for change in quality of life. This suggests different theoretical constructs may mediate change dependent on outcome.
Personality and Individual Differences, 1999
The purpose of this study was to investigate the relationship between dispositional optimism, dis... more The purpose of this study was to investigate the relationship between dispositional optimism, dispositional pessimism, repressive coping and trait anxiety. The Marlowe-Crowne scale (MC) and the Bendig version of the Taylor Manifest Anxiety Scale (MAS) were used to select repressor and control groups (N = 143, aged between 18 and 47 years), who subsequently completed a measure of dispositional optimism, the Life Orientation Test (LOT), which consists of two sets of items: optimism and pessimism. Repressors (high MC, low MAS) reported signi®cantly lower pessimism than all other participants. When the pessimism scale was divided into high and low categories, there were signi®cantly more repressors in the low pessimism group than the other low trait anxiety group, low anxious (low MC, low MAS). However, for the optimism scale the opposite pattern of results was found, with signi®cantly more low anxious in the high optimism group than repressors. These results support the assertion that the pessimism and optimism scales of the LOT are not the same construct and should be measured separately. #
Journal of Cystic Fibrosis, 2008
This is the protocol for a review and there is no abstract. The objectives are as follows: Prima... more This is the protocol for a review and there is no abstract. The objectives are as follows:
Primary objective
To assess the effectiveness of health promotion interventions in community pharmacy practice settings on pharmacy workers and
pharmacy clients (including diagnosed patients) when compared to
i) No treatment controls
ii) Usual treatment controls
iii) Other active intervention
Secondary objectives
To assess whether there are differences in effectiveness of health promotion interventions in community pharmacy practice settings on
i) Pharmacy worker
ii) Client (patient)
with regard to:
i) Ethnicity of patients
ii) Country income level (World Bank Group 2009)
iii) Extent of adverse health behaviour (defined according to national guidelines where available)
iv) Type of pharmacy worker delivering the intervention (e.g. pharmacist versus pharmacist technician)
v) Theoretical constructs/components and behaviour change techniques employed in the intervention
vi) Costs of health care
Annals of Thoracic Surgery, 2001
Recently, Tardiff and colleagues have suggested that the presence of the apolipoprotein E, ⑀4 all... more Recently, Tardiff and colleagues have suggested that the presence of the apolipoprotein E, ⑀4 allele was associated with increased likelihood of cognitive decline after coronary artery bypass grafting. The objective of the current study was to replicate this earlier work using an increased sample size. The increased sample also enabled an analysis by individual genotype in cognitive decline after coronary artery bypass grafting.
British Journal of Health Psychology, 1999
To examine the role of the presence of symptoms on illness representations. To examine the succes... more To examine the role of the presence of symptoms on illness representations. To examine the success of the Self-Regulation Model in explaining psychosocial adjustment in patients with atrial brillation (AF).