Objective To examine patterns of colorectal cancer (CRC) screening uptake over three biennial inv... more Objective To examine patterns of colorectal cancer (CRC) screening uptake over three biennial invitation rounds in the National Health Service (NHS) Bowel Cancer Screening Programme (BCSP) in England. Methods We analysed data from the BCSP's Southern Hub for individuals (n=62 099) aged 60-64 years at the time of first invitation to screening with a follow-up period that allowed for two further biennial invitations. Data on sex, age and a neighbourhood-level measure of socioeconomic deprivation were used in the analysis. Outcomes included uptake of guaiac-based faecal occult blood (gFOB) test screening, inadequate gFOB screening (≥1 test kit(s) returned but failed to complete further gFOB tests needed to reach a conclusive test result), test positivity, compliance with follow-up examinations (usually colonoscopy) and diagnostic outcomes. Results Overall gFOB uptake was 57.4% in the first, 60.9% in the second and 66.2% in third biennial invitation round. This resulted in 70.1% of the initial cohort having responded at least once, 60.7% at least twice and 44.4% three times. Participation in the first round was strongly predictive of participation in the second round ('Previous Responders': 86.6% vs 'Previous Non-Responders': 23.1%). Participation in the third round was highest among 'Consistent Screeners' (94.5%), followed by 'Late Entrants' (78.0%), 'Dropouts' (59.8%) and 'Consistent Non-Responders' (14.6%). Socioeconomic inequalities in uptake were observed across the three rounds, but sex inequalities decreased over rounds. Inadequate gFOB screening was influenced by screening history and socioeconomic deprivation. Screening history was the only significant predictor of follow-up compliance. Conclusions Screening history is associated with overall gFOB uptake, inadequate gFOB screening and follow-up compliance. Socioeconomic deprivation is also consistently associated with lower gFOB uptake and inadequate gFOB screening. Improving regular screening among identified 'at-risk' groups is important for the effectiveness of CRC screening programmes.
From a corporate social responsibility perspective, there are many reasons to promote teleconfere... more From a corporate social responsibility perspective, there are many reasons to promote teleconference use as an alternative to business travel. The present study examines psychosocial and organizational factors relevant to teleconference use. We tested an extended Theory of Planned Behavior model of teleconference use among office workers of four organizations. Results indicate that intention was the strongest direct predictor of teleconference use. Habit and perceived norm, in turn, were the strongest predictors of intention to use teleconference. In contrast, attitude was only weakly predictive and perceived control not predictive at all of intention to use teleconference. We also examined how this model was influenced by the organizational context by comparing organizations from two different regions, and organizations from the private vs. the public sector. Most teleconference-related beliefs differed between regions and organizational sectors. The relevance of specific attitudinal and normative beliefs to the overall attitude and perceived norm also differed between organizational sectors. Implications for practice and future research are discussed.
Substantial energy savings can be achieved by reducing energy use in office buildings. The report... more Substantial energy savings can be achieved by reducing energy use in office buildings. The reported study used a Theory of Planned Behavior (TPB) model extended with perceived habit to explain office energysaving behaviors. One aim was to examine if organizational contextual variability independently predicted office energy-saving behaviors over and above TPB variables and self-reported habit. Another aim was to examine the relative predictive value of TPB variables and habit for energy-saving behaviors between organizational contexts. Survey data on energy-saving behaviors, TPB variables, and habit and number of office mates were collected from office workers of four organizations in the Netherlands. The results indicate that intention was the strongest direct predictor of the behaviors printing smaller and not printing e-mails, whereas habit was the strongest predictor of the behaviors switching off lights and switching off monitors. Of the social-cognitive factors, attitude was the strongest predictor of intentions overall. The effect of perceived norm varied widely between behaviors and subgroups. Number of office mates had a direct, unmediated effect on the behavior switching off lights and a mediated effect via attitude and perceived control. The effect of organizational contextual variability on behavior was entirely mediated through the psychosocial factors for the two 'printing behaviors', but only partially for the two 'switching behaviors'. The relative predictive value of habit and intention differed between organizations. The findings suggest that organizational contextual variability has unconscious influences on some office energy-saving behaviors. Interventions should take variation in the relative importance of cognitive factors and habit between behaviors, and to a lesser extent between organizational contexts, into account.
Objectives Flexible sigmoidoscopy (FS) screening for colorectal cancer will be introduced into th... more Objectives Flexible sigmoidoscopy (FS) screening for colorectal cancer will be introduced into the National Cancer Screening Programmes in England in 2013. Patient-reported outcome measures (PROMs) from trial participants indicate high acceptability and no adverse physical or psychological consequences, but this may not generalize to routine screening in the community. This study examined PROMs in a community-based FS screening programme. Methods Eligible adults aged 58-59 (n ¼ 2016) registered at 34 London general practices were mailed a National Health Service-endorsed invitation to attend FS screening. Pain and side-effects were assessed in a 'morning-after' questionnaire, and satisfaction was assessed in a three-month follow-up questionnaire. Anxiety, self-rated health and colorectal symptoms were assessed at prescreening and follow-up. Results In total, 1020 people attended screening and were included in the current analyses, of whom 913 (90%) returned the morning-after questionnaire, and 674 (66%) the follow-up questionnaire. The prescreening questionnaire had been completed by 751 (74%) of those who attended. The majority (87%) of respondents reported no pain or mild pain, and the most frequent side-effect (wind) was only experienced more than mildly by 16%. Satisfaction was extremely high, with 98% glad they had the test; 97% would encourage a friend to have it. From prescreening to follow-up there were no changes in anxiety or self-rated health, and the number of colorectal symptoms declined. Satisfaction and changes in wellbeing were not moderated by gender, deprivation, ethnicity or screening outcome.
An analysis of individual and organisational determinants of energy-related behaviors in office b... more An analysis of individual and organisational determinants of energy-related behaviors in office buildings and the interplay between the two is presented. Interviews and focus groups were conducted with office workers from four organisations in two Dutch provinces. The results indicate that, overall, work efficiency and productivity was prioritised over energy conservation. In general, self-efficacy was the most salient individual determinant, and social norm the least discussed determinant of current office energy-related behaviors. Nevertheless, both self-efficacy and social norm elements were encountered in employees' proposed strategies to achieve future office energy-saving. Formal and informal aspects of the organisational context were found to equally affect individual determinants and their related behaviors. Facility managers' and general office workers' views differed in a few but important ways. Interorganisational comparisons showed that differences in organisational foci were linked to the relative salience of normative, gain, and hedonic motivations.
A review of empirical studies on proenvironmental behaviors in organizational contexts is present... more A review of empirical studies on proenvironmental behaviors in organizational contexts is presented. Twenty-one studies met the inclusion criteria. Quantitative effect sizes were compared where statistics were available and research designs were comparable. Characteristics of the dependent variable and the targeted organizational (sub)populations were systematically examined. With respect to individualspecific determinants, the results show relatively consistent effects for attitudinal determinants and past behavior. For organization-specific influences, management and physical facilitation were frequently significant. Findings related to other factors are less conclusive. Given the available evidence and feasibility considerations, it is recommended that interventions focus on physical facilitation, tailored persuasive communication, and active engagement of middle management. It is further recommended that future research integrates the analysis of individual and organizational determinants.
Temporal framing has been heralded as a promising strategy to make risks appear more proximal and... more Temporal framing has been heralded as a promising strategy to make risks appear more proximal and concrete and thus counter temporal discounting effects that are often limiting the appeal of long-term benefits of health behaviors. Previous research has shown that temporal framing affects behavioral intention. This study extends on this previous research by examining the effects of temporal framing on behavioral expectations—which are said to better reflect feasibility concerns than intentions—and actual behavior in the context of eating five portions of fruit and vegetables a day. Results show that while temporal framing has effects on behavioral expectations similar to those on behavioral intentions, this effect was not significant for actual behavior.
Objective – To assess the impact of media coverage of the UK Flexible Sigmoidoscopy trial on colo... more Objective – To assess the impact of media coverage of the UK Flexible Sigmoidoscopy trial on colorectal screening uptake in England. Setting – In April 2010, publication of the UK Flexible Sigmoidoscopy (FS) Trial results generated considerable media interest in both FS and colorectal cancer (CRC) generally. Methods – We used routinely collected data from the South of England (excluding London) to analyse return of Faecal Occult Blood test (FOBt) kits within 28 days of the invitation (early uptake) among 60-69 year olds, before (T1, N = 31,229), around the time of (T2, N = 39,571), and one month after (T3, N = 33,430) the FS publicity. Results – FOBt uptake over the whole period was 58.2%, with 38.4% of the kits returned within 28 days (early uptake). Across the three time periods, early uptake was 35.8% at T1, 39.4% at T2, and 39.7% at T3. Multivariate regression controlling for age, gender and socioeconomic status confirmed that uptake was higher if people received the FOBt kit around the time of the media coverage (T2: Odds Ratio [OR] = 1.17, 95% CI = 1.13-1.20), or one month after (T3: OR = 1.18, 95% CI = 1.15-1.22) than before (T1). Sub-group analyses demonstrated that the impact was stronger among previous non-responders than among first-time invitees or previous responders (p< 0.001). Conclusion - Media coverage of the FS Trial appeared to have a small but positive impact on FOBt screening uptake, especially among people who had previously abstained from screening.
This paper's objective is to apply Intervention Mapping, a planning process for the systematic
de... more This paper's objective is to apply Intervention Mapping, a planning process for the systematic development of theory- and evidence-based health promotion interventions, to the development of interventions to promote energy conservation behavior. Intervention Mapping (IM) consists of six steps: Needs assessment, program objectives, methods and applications, program development, planning for program implementation, and planning for program evaluation. Examples from the energy conservation field are provided to illustrate the activities associated with these steps. It is concluded that applying IM in the energy conservation field may help the development of effective behavior change interventions, and thus develop a domain specific knowledge-base for effective intervention design.
Objective To examine patterns of colorectal cancer (CRC) screening uptake over three biennial inv... more Objective To examine patterns of colorectal cancer (CRC) screening uptake over three biennial invitation rounds in the National Health Service (NHS) Bowel Cancer Screening Programme (BCSP) in England. Methods We analysed data from the BCSP's Southern Hub for individuals (n=62 099) aged 60-64 years at the time of first invitation to screening with a follow-up period that allowed for two further biennial invitations. Data on sex, age and a neighbourhood-level measure of socioeconomic deprivation were used in the analysis. Outcomes included uptake of guaiac-based faecal occult blood (gFOB) test screening, inadequate gFOB screening (≥1 test kit(s) returned but failed to complete further gFOB tests needed to reach a conclusive test result), test positivity, compliance with follow-up examinations (usually colonoscopy) and diagnostic outcomes. Results Overall gFOB uptake was 57.4% in the first, 60.9% in the second and 66.2% in third biennial invitation round. This resulted in 70.1% of the initial cohort having responded at least once, 60.7% at least twice and 44.4% three times. Participation in the first round was strongly predictive of participation in the second round ('Previous Responders': 86.6% vs 'Previous Non-Responders': 23.1%). Participation in the third round was highest among 'Consistent Screeners' (94.5%), followed by 'Late Entrants' (78.0%), 'Dropouts' (59.8%) and 'Consistent Non-Responders' (14.6%). Socioeconomic inequalities in uptake were observed across the three rounds, but sex inequalities decreased over rounds. Inadequate gFOB screening was influenced by screening history and socioeconomic deprivation. Screening history was the only significant predictor of follow-up compliance. Conclusions Screening history is associated with overall gFOB uptake, inadequate gFOB screening and follow-up compliance. Socioeconomic deprivation is also consistently associated with lower gFOB uptake and inadequate gFOB screening. Improving regular screening among identified 'at-risk' groups is important for the effectiveness of CRC screening programmes.
From a corporate social responsibility perspective, there are many reasons to promote teleconfere... more From a corporate social responsibility perspective, there are many reasons to promote teleconference use as an alternative to business travel. The present study examines psychosocial and organizational factors relevant to teleconference use. We tested an extended Theory of Planned Behavior model of teleconference use among office workers of four organizations. Results indicate that intention was the strongest direct predictor of teleconference use. Habit and perceived norm, in turn, were the strongest predictors of intention to use teleconference. In contrast, attitude was only weakly predictive and perceived control not predictive at all of intention to use teleconference. We also examined how this model was influenced by the organizational context by comparing organizations from two different regions, and organizations from the private vs. the public sector. Most teleconference-related beliefs differed between regions and organizational sectors. The relevance of specific attitudinal and normative beliefs to the overall attitude and perceived norm also differed between organizational sectors. Implications for practice and future research are discussed.
Substantial energy savings can be achieved by reducing energy use in office buildings. The report... more Substantial energy savings can be achieved by reducing energy use in office buildings. The reported study used a Theory of Planned Behavior (TPB) model extended with perceived habit to explain office energysaving behaviors. One aim was to examine if organizational contextual variability independently predicted office energy-saving behaviors over and above TPB variables and self-reported habit. Another aim was to examine the relative predictive value of TPB variables and habit for energy-saving behaviors between organizational contexts. Survey data on energy-saving behaviors, TPB variables, and habit and number of office mates were collected from office workers of four organizations in the Netherlands. The results indicate that intention was the strongest direct predictor of the behaviors printing smaller and not printing e-mails, whereas habit was the strongest predictor of the behaviors switching off lights and switching off monitors. Of the social-cognitive factors, attitude was the strongest predictor of intentions overall. The effect of perceived norm varied widely between behaviors and subgroups. Number of office mates had a direct, unmediated effect on the behavior switching off lights and a mediated effect via attitude and perceived control. The effect of organizational contextual variability on behavior was entirely mediated through the psychosocial factors for the two 'printing behaviors', but only partially for the two 'switching behaviors'. The relative predictive value of habit and intention differed between organizations. The findings suggest that organizational contextual variability has unconscious influences on some office energy-saving behaviors. Interventions should take variation in the relative importance of cognitive factors and habit between behaviors, and to a lesser extent between organizational contexts, into account.
Objectives Flexible sigmoidoscopy (FS) screening for colorectal cancer will be introduced into th... more Objectives Flexible sigmoidoscopy (FS) screening for colorectal cancer will be introduced into the National Cancer Screening Programmes in England in 2013. Patient-reported outcome measures (PROMs) from trial participants indicate high acceptability and no adverse physical or psychological consequences, but this may not generalize to routine screening in the community. This study examined PROMs in a community-based FS screening programme. Methods Eligible adults aged 58-59 (n ¼ 2016) registered at 34 London general practices were mailed a National Health Service-endorsed invitation to attend FS screening. Pain and side-effects were assessed in a 'morning-after' questionnaire, and satisfaction was assessed in a three-month follow-up questionnaire. Anxiety, self-rated health and colorectal symptoms were assessed at prescreening and follow-up. Results In total, 1020 people attended screening and were included in the current analyses, of whom 913 (90%) returned the morning-after questionnaire, and 674 (66%) the follow-up questionnaire. The prescreening questionnaire had been completed by 751 (74%) of those who attended. The majority (87%) of respondents reported no pain or mild pain, and the most frequent side-effect (wind) was only experienced more than mildly by 16%. Satisfaction was extremely high, with 98% glad they had the test; 97% would encourage a friend to have it. From prescreening to follow-up there were no changes in anxiety or self-rated health, and the number of colorectal symptoms declined. Satisfaction and changes in wellbeing were not moderated by gender, deprivation, ethnicity or screening outcome.
An analysis of individual and organisational determinants of energy-related behaviors in office b... more An analysis of individual and organisational determinants of energy-related behaviors in office buildings and the interplay between the two is presented. Interviews and focus groups were conducted with office workers from four organisations in two Dutch provinces. The results indicate that, overall, work efficiency and productivity was prioritised over energy conservation. In general, self-efficacy was the most salient individual determinant, and social norm the least discussed determinant of current office energy-related behaviors. Nevertheless, both self-efficacy and social norm elements were encountered in employees' proposed strategies to achieve future office energy-saving. Formal and informal aspects of the organisational context were found to equally affect individual determinants and their related behaviors. Facility managers' and general office workers' views differed in a few but important ways. Interorganisational comparisons showed that differences in organisational foci were linked to the relative salience of normative, gain, and hedonic motivations.
A review of empirical studies on proenvironmental behaviors in organizational contexts is present... more A review of empirical studies on proenvironmental behaviors in organizational contexts is presented. Twenty-one studies met the inclusion criteria. Quantitative effect sizes were compared where statistics were available and research designs were comparable. Characteristics of the dependent variable and the targeted organizational (sub)populations were systematically examined. With respect to individualspecific determinants, the results show relatively consistent effects for attitudinal determinants and past behavior. For organization-specific influences, management and physical facilitation were frequently significant. Findings related to other factors are less conclusive. Given the available evidence and feasibility considerations, it is recommended that interventions focus on physical facilitation, tailored persuasive communication, and active engagement of middle management. It is further recommended that future research integrates the analysis of individual and organizational determinants.
Temporal framing has been heralded as a promising strategy to make risks appear more proximal and... more Temporal framing has been heralded as a promising strategy to make risks appear more proximal and concrete and thus counter temporal discounting effects that are often limiting the appeal of long-term benefits of health behaviors. Previous research has shown that temporal framing affects behavioral intention. This study extends on this previous research by examining the effects of temporal framing on behavioral expectations—which are said to better reflect feasibility concerns than intentions—and actual behavior in the context of eating five portions of fruit and vegetables a day. Results show that while temporal framing has effects on behavioral expectations similar to those on behavioral intentions, this effect was not significant for actual behavior.
Objective – To assess the impact of media coverage of the UK Flexible Sigmoidoscopy trial on colo... more Objective – To assess the impact of media coverage of the UK Flexible Sigmoidoscopy trial on colorectal screening uptake in England. Setting – In April 2010, publication of the UK Flexible Sigmoidoscopy (FS) Trial results generated considerable media interest in both FS and colorectal cancer (CRC) generally. Methods – We used routinely collected data from the South of England (excluding London) to analyse return of Faecal Occult Blood test (FOBt) kits within 28 days of the invitation (early uptake) among 60-69 year olds, before (T1, N = 31,229), around the time of (T2, N = 39,571), and one month after (T3, N = 33,430) the FS publicity. Results – FOBt uptake over the whole period was 58.2%, with 38.4% of the kits returned within 28 days (early uptake). Across the three time periods, early uptake was 35.8% at T1, 39.4% at T2, and 39.7% at T3. Multivariate regression controlling for age, gender and socioeconomic status confirmed that uptake was higher if people received the FOBt kit around the time of the media coverage (T2: Odds Ratio [OR] = 1.17, 95% CI = 1.13-1.20), or one month after (T3: OR = 1.18, 95% CI = 1.15-1.22) than before (T1). Sub-group analyses demonstrated that the impact was stronger among previous non-responders than among first-time invitees or previous responders (p< 0.001). Conclusion - Media coverage of the FS Trial appeared to have a small but positive impact on FOBt screening uptake, especially among people who had previously abstained from screening.
This paper's objective is to apply Intervention Mapping, a planning process for the systematic
de... more This paper's objective is to apply Intervention Mapping, a planning process for the systematic development of theory- and evidence-based health promotion interventions, to the development of interventions to promote energy conservation behavior. Intervention Mapping (IM) consists of six steps: Needs assessment, program objectives, methods and applications, program development, planning for program implementation, and planning for program evaluation. Examples from the energy conservation field are provided to illustrate the activities associated with these steps. It is concluded that applying IM in the energy conservation field may help the development of effective behavior change interventions, and thus develop a domain specific knowledge-base for effective intervention design.
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Papers by Siu Hing Lo
Setting – In April 2010, publication of the UK Flexible Sigmoidoscopy (FS) Trial results generated considerable media interest in both FS and colorectal cancer (CRC) generally.
Methods – We used routinely collected data from the South of England (excluding London) to analyse return of Faecal Occult Blood test (FOBt) kits within 28 days of the invitation (early uptake) among 60-69 year olds, before (T1, N = 31,229), around the time of (T2, N = 39,571), and one month after (T3, N = 33,430) the FS publicity.
Results – FOBt uptake over the whole period was 58.2%, with 38.4% of the kits returned within 28 days (early uptake). Across the three time periods, early uptake was 35.8% at T1, 39.4% at T2, and 39.7% at T3. Multivariate regression controlling for age, gender and socioeconomic status confirmed that uptake was higher if people received the FOBt kit around the time of the media coverage (T2: Odds Ratio [OR] = 1.17, 95% CI = 1.13-1.20), or one month after (T3: OR = 1.18, 95% CI = 1.15-1.22) than before (T1). Sub-group analyses demonstrated that the impact was stronger among previous non-responders than among first-time invitees or previous responders (p< 0.001).
Conclusion - Media coverage of the FS Trial appeared to have a small but positive impact on FOBt screening uptake, especially among people who had previously abstained from screening.
development of theory- and evidence-based health promotion interventions, to the development of
interventions to promote energy conservation behavior. Intervention Mapping (IM) consists of six
steps: Needs assessment, program objectives, methods and applications, program development,
planning for program implementation, and planning for program evaluation. Examples from the
energy conservation field are provided to illustrate the activities associated with these steps. It is
concluded that applying IM in the energy conservation field may help the development of effective
behavior change interventions, and thus develop a domain specific knowledge-base for effective
intervention design.
Setting – In April 2010, publication of the UK Flexible Sigmoidoscopy (FS) Trial results generated considerable media interest in both FS and colorectal cancer (CRC) generally.
Methods – We used routinely collected data from the South of England (excluding London) to analyse return of Faecal Occult Blood test (FOBt) kits within 28 days of the invitation (early uptake) among 60-69 year olds, before (T1, N = 31,229), around the time of (T2, N = 39,571), and one month after (T3, N = 33,430) the FS publicity.
Results – FOBt uptake over the whole period was 58.2%, with 38.4% of the kits returned within 28 days (early uptake). Across the three time periods, early uptake was 35.8% at T1, 39.4% at T2, and 39.7% at T3. Multivariate regression controlling for age, gender and socioeconomic status confirmed that uptake was higher if people received the FOBt kit around the time of the media coverage (T2: Odds Ratio [OR] = 1.17, 95% CI = 1.13-1.20), or one month after (T3: OR = 1.18, 95% CI = 1.15-1.22) than before (T1). Sub-group analyses demonstrated that the impact was stronger among previous non-responders than among first-time invitees or previous responders (p< 0.001).
Conclusion - Media coverage of the FS Trial appeared to have a small but positive impact on FOBt screening uptake, especially among people who had previously abstained from screening.
development of theory- and evidence-based health promotion interventions, to the development of
interventions to promote energy conservation behavior. Intervention Mapping (IM) consists of six
steps: Needs assessment, program objectives, methods and applications, program development,
planning for program implementation, and planning for program evaluation. Examples from the
energy conservation field are provided to illustrate the activities associated with these steps. It is
concluded that applying IM in the energy conservation field may help the development of effective
behavior change interventions, and thus develop a domain specific knowledge-base for effective
intervention design.