Delivery Of Advice Research Articles

Comprehensive physiotherapy exercise programme or advice for chronic whiplash (PROMISE): a pragmatic randomised controlled trial

Evidence suggests that brief physiotherapy programmes are as effective for acute whiplash-associated disorders as more comprehensive programmes; however, whether this also holds true for chronic whiplash-associated disorders is unknown. We aimed to estimate the effectiveness of a comprehensive exercise programme delivered by physiotherapists compared with advice in people with a chronic whiplash-associated disorder. PROMISE is a two group, pragmatic randomised controlled trial in patients with chronic (>3 months and <5 years) grade 1 or 2 whiplash-associated disorder. Participants were randomly assigned by a computer-generated randomisation schedule to receive either the comprehensive exercise programme (20 sessions) or advice (one session and telephone support). Sealed opaque envelopes were used to conceal allocation. The primary outcome was pain intensity measured on a 0-10 scale. Outcomes were measured at baseline, 14 weeks, 6 months, and 12 months by a masked assessor. Analysis was by intention to treat, and treatment effects were calculated with linear mixed models. The trial is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12609000825257. 172 participants were allocated to either the comprehensive exercise programme (n=86) or advice group (n=86); 157 (91%) were followed up at 14 weeks, 145 (84%) at 6 months, and 150 (87%) at 12 months. A comprehensive exercise programme was not more effective than advice alone for pain reduction in the participants. At 14 weeks the treatment effect on a 0-10 pain scale was 0·0 (95% CI -0·7 to 0·7), at 6 months 0·2 (-0·5 to 1·0), and at 12 months -0·1 (-0·8 to 0·6). CNS hyperexcitability and symptoms of post-traumatic stress did not modify the effect of treatment. We recorded no serious adverse events. We have shown that simple advice is equally as effective as a more intense and comprehensive physiotherapy exercise programme. The need to identify effective and affordable strategies to prevent and treat acute through to chronic whiplash associated disorders is an important health priority. Future avenues of research might include improving understanding of the mechanisms responsible for persistent pain and disability, investigating the effectiveness and timing of drugs, and study of content and delivery of education and advice. The National Health and Medical Research Council of Australia, Motor Accidents Authority of New South Wales, and Motor Accident Insurance Commission of Queensland.

Implementing health planning in beef suckler and sheep enterprises

In recent years herd and flock health plans have become an integral part of the farm quality assurance systems in the UK. This has helped to shift the focus from a reactive approach to animal health problems to a proactive approach that at its best utilises production data and risk management logic while making best use of the expertise of the veterinary practitioner. One common drawback is that the production of a health plan is seen as a one-off exercise. Another is that the plan does not adopt the basic management concept of plan/do/study/adjust, but is simply a tick box exercise in the quality assurance process. To overcome these drawbacks a more dynamic system is required to provide the framework for analysis of health and productivity as well as the delivery of advice and preventive medicine. Web-based software such as the Animal Health Planning System (AHPS) is specifically designed for beef suckler and sheep enterprises and is a practical aid in the documentation and administration of the health planning process.

Knowledge, Attitudes, and Practices of US Practitioners Who Provide Pre‐Travel Advice

As international travel increases, many health care professionals are being asked to provide pre-travel advice. We designed an anonymous web-based survey to assess the extent to which primary care providers (PCPs) provide travel medicine advice and how their understanding and delivery of itinerary-specific advice and management compare with that of travel medicine specialists. We surveyed randomly selected US PCPs registered in the Pri-Med Institute (now pmiCME) database and US travel medicine specialists from the International Society of Travel Medicine (ISTM), American Society of Tropical Medicine and Hygiene (ASTMH), and Centers for Disease Control and Prevention (CDC) yellow fever (YF) vaccine provider mailing lists. SAS software (SAS Institute, Cary, NC, USA) was used for all analyses. Of 14,932 e-mails sent to valid e-mail addresses, 902 yielded complete or partially completed surveys (6.0% response rate). Eighty percent of respondents personally provided pre-travel advice (95% of travel medicine specialists versus 73% of PCPs). About two thirds of PCPs (68%) providing pre-travel consultations saw <50 travelers per year whereas 30% of travel medicine specialists saw <50 travelers per year. More travel medicine specialists (59%) than PCPs (18%) saw >500 travelers per year. Familiarity with travel-specific vaccines (YF, Japanese encephalitis) and provision of written educational materials increased as volume of travelers increased. Familiarity with antimalarial side effects and malaria resistance patterns, and knowledge scores based on brief pre-travel scenarios were higher in travel medicine specialists, ASTMH or ISTM certificate holders, and respondents who saw more pre-travel patients. Many PCP survey participants provided pre-travel advice, but most saw few travelers. Volume of travelers and holding an ASTMH or ISTM certificate had the greatest influence on knowledge of travel medicine and provision of appropriate advice and recommendations. Creating easily accessible travel medicine education programs for US providers from a wide range of disciplines is needed to improve the management of travelers.

Stepwise advice negotiation in writing center peer tutoring

While the delivery and reception of advice is a practice integral to a wide range of settings, little attention has been given to the detailed practices of advice resistance and how it leads to advice negotiation. Based on 7 hours of videotaped tutoring interactions among 6 tutors and 11 tutees, this conversation analytic study examines the interactional practices of advice negotiation in peer tutoring at an undergraduate writing center. In particular, the study focuses on advice negotiation sequences in which students initially resist tutors’ advice. The findings are in line with the current knowledge that advice resistance is presented and treated as interactionally dispreferred. In addition, the analyses contribute to further specifying the stepwise interactional practices through which advice resistance is produced and managed in a way that it results in successful advice negotiation with the more tailored advice forwarded by the tutor. The study shows how the context of tutoring is a site not only for knowledge development but also for the negotiation of epistemic rights and their interactional management by both participants.

Tobacco Use and Smoking Cessation Practices among Physicians in Developing Countries: A Literature Review (1987–2010)

Physicians have a key role to play in combating tobacco use and reducing the tobacco induced harm to health. However, there is a paucity of information about tobacco-use and cessation among physicians in developing countries. To assess the need for and nature of smoking cessation services among physicians in developing countries, a detailed literature review of studies published in English, between 1987 and 2010 was carried out. The electronic databases Medline and Pub Med were searched for published studies. The findings show that there are regional variations in the current smoking prevalence, quitting intentions, and cessation services among physicians. Smoking prevalence (median) was highest in Central/Eastern Europe (37%), followed by Africa (29%), Central and South America (25%) and Asia (17.5%). There were significant gender differences in smoking prevalence across studies, with higher prevalence among males than females. Smoking at work or in front of patients was commonly practiced by physicians in some countries. Asking about smoking status or advising patients to quit smoking was not common practice among the physicians, especially among smoker physicians. Organized smoking cessation programs for physicians did not exist in all of these regions. This review suggests that while smoking of physicians varies across different developing regions; prevalence rates tend to be higher than among physicians in developed countries. Quitting rates were low among the physicians, and the delivery of advice on quitting smoking was not common across the studies. To promote tobacco control and increase cessation in populations, there is a need to build physicians’ capacity so that they can engage in tobacco use prevention and cessation activities.

Differences in the perceived role of the healthcare provider in delivering vascular health checks: a Q methodology study.

BackgroundThe UK Department of Health introduced the National Health Service (NHS) Health Check Programme in April 2009 in an attempt to improve primary and secondary prevention of cardiovascular disease in the UK population and to reduce health inequalities. Healthcare professionals' attitudes towards giving lifestyle advice will influence how they interact with patients during consultations. We therefore sought to identify the attitudes of primary care healthcare professionals towards the delivery of lifestyle advice in the context of the NHS Health Check Programme.MethodsFifty-two primary care healthcare professionals undertook a Q sort with 36 statements that represented a range of viewpoints about the importance of lifestyle change, medication, giving lifestyle advice in the primary care setting, and the individual, social and material factors that might impact on lifestyle related behaviour change. Sorts were analysed by-person using principal components analysis and varimax rotation.ResultsFive statistically independent factors (accounts) reflected distinct views on the topic. Account 1 was supportive of initiatives like the NHS Health Check, and emphasised the importance of professionals working collaboratively with patients to facilitate lifestyle change. Account 2 expressed views on the potential overuse of statin medication and placed responsibility for lifestyle change with the patient. Account 3 viewed the healthcare professional role to be one of educator, emphasising the provision of information. Account 4 perceived lifestyle change to be difficult for patients and emphasised the need for healthcare professionals to be role models. Account 5 was inconsistent about the value of lifestyle change, or the role of healthcare professionals in promoting it, a finding that may be due to ambivalence about the health check or to lack of engagement with the Q sort task. We found no strong associations between any of the factors and, gender, role, age or ethnicity.ConclusionsOur findings suggest that healthcare professionals hold viewpoints that may influence how they interact with patients during health checks. When implementing programmes like the NHS Health Check, it would be useful to take healthcare professionals’ views into account. Attitudes and beliefs could be explored during training sessions, for example.

Physician advice for smoking cessation.

Healthcare professionals frequently advise people to improve their health by stopping smoking. Such advice may be brief, or part of more intensive interventions. The aims of this review were to assess the effectiveness of advice from physicians in promoting smoking cessation; to compare minimal interventions by physicians with more intensive interventions; to assess the effectiveness of various aids to advice in promoting smoking cessation, and to determine the effect of anti-smoking advice on disease-specific and all-cause mortality. We searched the Cochrane Tobacco Addiction Group trials register in January 2013 for trials of interventions involving physicians. We also searched Latin American databases through BVS (Virtual Library in Health) in February 2013. Randomised trials of smoking cessation advice from a medical practitioner in which abstinence was assessed at least six months after advice was first provided. We extracted data in duplicate on the setting in which advice was given, type of advice given (minimal or intensive), and whether aids to advice were used, the outcome measures, method of randomisation and completeness of follow-up.The main outcome measure was abstinence from smoking after at least six months follow-up. We also considered the effect of advice on mortality where long-term follow-up data were available. We used the most rigorous definition of abstinence in each trial, and biochemically validated rates where available. People lost to follow-up were counted as smokers. Effects were expressed as relative risks. Where possible, we performed meta-analysis using a Mantel-Haenszel fixed-effect model. We identified 42 trials, conducted between 1972 and 2012, including over 31,000 smokers. In some trials, participants were at risk of specified diseases (chest disease, diabetes, ischaemic heart disease), but most were from unselected populations. The most common setting for delivery of advice was primary care. Other settings included hospital wards and outpatient clinics, and industrial clinics.Pooled data from 17 trials of brief advice versus no advice (or usual care) detected a significant increase in the rate of quitting (relative risk (RR) 1.66, 95% confidence interval (CI) 1.42 to 1.94). Amongst 11 trials where the intervention was judged to be more intensive the estimated effect was higher (RR 1.84, 95% CI 1.60 to 2.13) but there was no statistical difference between the intensive and minimal subgroups. Direct comparison of intensive versus minimal advice showed a small advantage of intensive advice (RR 1.37, 95% CI 1.20 to 1.56). Direct comparison also suggested a small benefit of follow-up visits. Only one study determined the effect of smoking advice on mortality. This study found no statistically significant differences in death rates at 20 years follow-up. Simple advice has a small effect on cessation rates. Assuming an unassisted quit rate of 2 to 3%, a brief advice intervention can increase quitting by a further 1 to 3%. Additional components appear to have only a small effect, though there is a small additional benefit of more intensive interventions compared to very brief interventions.

Integrate or Separate - Institutional Design for the Enforcement of Competition Law and Consumer Law

Over the past years several EU Member States decided to integrate their competition authorities with their consumer protection agencies. Most recently, the Netherlands Authority for Consumers and Markets (ACM) has merged the Netherlands Competition Authority (NMa) with the Dutch Consumer Authority (CA) and the Netherlands Independent Post and Telecommunications Authority (OPTA) as from 1st April 2013. On the contrary, some other Member States separate the enforcement of competition law and consumer law. The United Kingdom will abolish the Office of Fair Trading (OFT) and merge its competition and national enforcement functions with the also abolished Competition Commission to form a new Competition and Markets Authority (CMA). The OFT’s consumer law enforcement roles are handed to the National Trading Standards Board which will coordinate consumer law enforcement with local and regional government’s trading standards departments. The CMA will retain consumer enforcement powers for some purposes and have responsibility for national oversight of the effective functioning of markets. These institutional changes are the results of political decisions, based mainly on budgetary concerns. National governments justified these institutional mergers by arguing that consolidated agencies can increase the efficiency and effectiveness of competition oversight and market regulation, enhance the importance of consumer and competition affairs in society, ensure corporate responsibility with regard to consumer interests and streamline administration. Similarly, the separation of institutions was justified by the reduction of complexity in the enforcement landscape, strengthening the effectiveness of law enforcement and achieving more cost-efficient delivery of consumer advice, representation and enforcement. These institutional and procedural changes seem to be experimental rather than programmatic and are instituted without investigating their impact on law enforcement. This paper discusses three different institutional models for separating or integrating the public enforcement of competition law and consumer protection and analyses the synergies and the drawbacks emerging from allocating enforcement powers in one or two public agencies. The aim of the paper is to assess how the allocation of enforcement powers affect law enforcement and map those normative criteria that have to be assessed when the allocation of regulatory powers is decided on. The paper analyses the likely consequences of a certain institutional arrangement for procedural norms such as the proportionality of remedies and the time of intervention and for institutional performance norms such as expertise, administrative efficiency, independence, consumer participation and accountability. This analysis is conducted against the backdrop of the regulatory state in EU law and policy and it extends to examine the impact of EU law and policy on the Member States’ institutional design as well as the EU’s constraining effects on institutional path dependence.

Heath Beliefs of UK South Asians Related to Lifestyle Diseases: A Review of Qualitative Literature

Objective. To review available qualitative evidence in the literature for health beliefs and perceptions specific to UK South Asian adults. Exploring available insight into the social and cultural constructs underlying perceptions related to health behaviours and lifestyle-related disease. Methods. A search of central databases and ethnic minority research groups was augmented by hand-searching of reference lists. For included studies, quality was assessed using a predetermined checklist followed by metaethnography to synthesise the findings, using both reciprocal translation and line-of-argument synthesis to look at factors impacting uptake of health behaviours. Results. A total of 10 papers varying in design and of good quality were included in the review. Cultural and social norms strongly influenced physical activity incidence and motivation as well as the ability to engage in healthy eating practices. Conclusions. These qualitative studies provide insight into approaches to health among UK South Asians in view of their social and cultural norms. Acknowledgement of their approach to lifestyle behaviours may assist acceptability of interventions and delivery of lifestyle advice by health professionals.

P108 Healthcare Professionals Perceptions of Self Management in COPD – Important, Challenging and Misunderstood

IntroductionThere is increasing focus on the importance of self management (SM) within COPD. Literature from other chronic diseases highlights the challenges of implementing SM and the lack of specialist training...

Acts of translation: UK advice agencies and the creation of matters-of-public-concern

Voluntary sector advice agencies have performed an important function in providing free, accessible advice in the UK for many decades. As legal aid is slashed, and ‘austerity’ leaves everyday life for many ever more precarious, their role has never been more essential. Advice agencies provide a dynamic and increasingly significant transition point where the rights, responsibilities and grievances of the individual are brought into dialogue with formal legal structures. Drawing on ideas from the ‘sociology of translation’, this paper sets out to consider the multiple, complex roles these organizations play. They are involved not simply in the delivery of advice to individuals, but in a collective concern that translates personal grievances into matters-of- public-concern. The paper concludes by considering the implications for an emerging research agenda that considers advice organizations as legal actors in a fragmenting world.

The relationships between adult juvenile idiopathic arthritis and employment

The chronicity of juvenile idiopathic arthritis (JIA) into adulthood and attendant potential disability may adversely influence educational attainment and the ability to secure and maintain gainful employment. We undertook this study to investigate the effects of patient- and disease-specific factors on education and employment outcomes in a group of adult patients with JIA. We performed a cross-sectional study of 103 consecutive adults attending a JIA continuity clinic, and patients who consented completed questionnaires relating to educational achievement, employment status, and functional disability (the Health Assessment Questionnaire disability index [HAQ DI]), and, for those who were employed, the rheumatoid arthritis Work Instability Scale. We used the structural equation modeling technique to study key patient and disease variables for employment in adults with JIA. The median age of patients was 24 years (range 17-71 years) with median disease duration of 19 years (range 7-67 years). Functional disability (the mean HAQ DI score) was significantly lower in patients who were employed (P = 0.03) and in those with oligoarticular JIA (t = 2.29, P = 0.02). Educational achievement was not influenced by JIA subtype (F = 1.18, P = 0.33). Educational achievement measured by General Certificate of Secondary Education (GCSE) grades had a positive effect on the type of job achieved in later life (F = 11.63, P = 0.001), with greater success leading to more professional or managerial posts. In the complex structural equation model, job stability was influenced positively by educational achievement measured by GCSE grades and negatively by the HAQ DI score (t = 10.94, P = 6.36 × 10(-16) ). Educational attainment is key to successful employability and is influenced by functional disability rather than by JIA subtype. These findings have implications for choice of occupation and delivery of career advice to aid decision making by young people with JIA.

The impact of the Quality and Outcomes Framework (QOF) on the recording of smoking targets in primary care medical records: cross-sectional analyses from The Health Improvement Network (THIN) database

BackgroundSmoking is a UK public health threat but GPs can be effective in helping patients to quit; consequently, the Quality and Outcomes Framework (QOF) incentivises the recording of smoking status and delivery of cessation advice in patients’ medical records. This study investigates the association between smoking-related QOF targets and such recording, and the factors which influence these clinical activities.MethodsFor 2000 to 2008, using medical records in The Health Improvement Network (THIN) database, the annual proportions of i) patients who had a record of smoking status made in the previous 27 months and ii) current smokers recorded as receiving cessation advice in the previous 15 months were calculated. Then, for all patients at selected points before and after the QOF’s implementation, data on gender, age, Townsend score, and smoking-related morbidity were extracted. Multivariate logistic regression was used to investigate individual-level characteristics associated with the recording of smoking status and cessation advice.ResultsRapid increases in recording smoking status and advice occurred around the QOF’s introduction in April 2004. Subsequently, compliance to targets has been sustained, although rates of increase have slowed. By 2008 64.5% of patients aged 15+ had smoking status documented in the previous 27 months and 50.5% of current smokers had cessation advice recorded in the last 15 months. Adjusted odds ratios show that, both before and after the introduction of the QOF, those with chronic medical conditions, greater social deprivation and women were more likely to have a recent recording of smoking status or cessation advice. Since the QOF’s introduction, the strongest characteristic associated with recording activities was the presence of co-morbidity. An example of this was patients with COPD, who in 2008, were 15.38 (95% CI 13.70-17.27) times and 11.72 (95% CI 10.41-13.21) times more likely to have a record of smoking status and cessation advice, respectively.ConclusionsRates of recording smoking status and cessation advice plateaued after large increases during the QOF’s introduction; however, recording remains most strongly associated with the presence of chronic disease as specified by the QOF, and suggests that incentivised targets have a direct effect on clinical behaviour.

Individual-based primary prevention of cardiovascular disease in Cambodia and Mongolia: early identification and management of hypertension and diabetes mellitus.

BackgroundTo assess the coverage of individual-based primary prevention strategies for cardiovascular disease (CVD) in Cambodia and Mongolia: specifically the early identification of hypertension and diabetes mellitus, major proximate physiological CVD risk factors, and management with pharmaceutical and lifestyle advice interventions.MethodsAnalysis of data collected in national cross-sectional STEPS surveys in 2009 (Mongolia) and 2010 (Cambodia) involving participants aged 25-64 years: 5433 in Cambodia and 4539 in Mongolia.ResultsMongolia has higher prevalence of CVD risk factors than Cambodia --hypertension (36.5% versus 12.3%), diabetes (6.3% versus 3.1%), hypercholesterolemia (8.5% versus 3.2%), and overweight (52.5% versus 15.5%). The difference in tobacco smoking was less notable (32.1% versus 29.4%).Coverage with prior testing for blood glucose in the priority age group 35-64 years remains limited (16.5% in Cambodia and 21.7% in Mongolia). Coverage is higher for hypertension. A large burden of both hypertension and diabetes remains unidentified at current strategies for early identification: only 45.4% (Cambodia) to 65.8% (Mongolia) of all hypertensives and 22.8% (Mongolia) to 50.3% (Cambodia) of all diabetics in the age group 35-64 years had been previously diagnosed.Approximately half of all hypertensives and of all diabetics in both countries were untreated. 7.2% and 12.2% of total hypertensive population and 5.9% and 16.1% of total diabetic population in Cambodia and Mongolia, respectively, were untreated despite being previously diagnosed.Only 24.1% and 28.6% of all hypertensives and 15.9% and 23.9% of all diabetics in Mongolia and Cambodia, respectively were adequately controlled. Estimates suggest deficits in delivery of important advice for lifestyle interventions.ConclusionsMultifaceted strategies are required to improve early identification, initiation of treatment and improving quality of treatment for common CVD risk factors. Periodic population-based surveys including questions on medical and treatment history and the context of testing and treatment can facilitate monitoring of individual-based prevention strategies.

Effects of Brief Advice from Family Physicians on the Readiness to Change of Korean Male At-risk Drinkers

BackgroundThis study examined the effects of the method of delivery of brief advice on the readiness to change in at-risk drinkers.MethodsThe participants were 103 at-risk male drinkers who visited Chungnam National University Hospital for general health examinations. Baseline data on drinking behavior, readiness to change drinking behavior, and sociodemographic characteristics were obtained from a questionnaire. Family physicians gave two minutes of advice by telephone or in-person. The brief advice comprised a simple statement that the patient's drinking exceeded the recommended limits and could lead to alcohol-related problems. It also included advice to moderate one's drinking. One month later, the readiness to change was assessed again by telephone. The improvement in the readiness to change according to each method of delivery was investigated.ResultsInitially, among the 58-patient in-person advice group, 12 patients were in the precontemplation stage, 38 in the contemplation stage, and 8 in the action stage. One month after the advice was given to the patients, the distribution had changed significantly (P < 0.001) to 1, 21, and 36 patients, respectively. Among the 45-patient telephone advice group, 7 patients were in the precontemplation stage, 32 patients were in the contemplation stage, and 6 patients were in the action stage before the advice. The distribution had changed significantly (P < 0.001) to 1, 17, and 27 patients, respectively, 1 month after the advice.ConclusionThese results suggest that brief advice by family physicians is effective in improving the readiness to change of at-risk drinkers, regardless of the delivery method.

Termination of pregnancy for maternal medical indications: Failings in delivery of contraceptive advice?

The majority of therapeutic terminations of pregnancy occur for maternal psychological, social or fetal reasons. Available data on maternal medical indications, rather than social, are sparse. To examine the maternal medical indications for the termination of pregnancy and use of contraception over a ten-year period. A retrospective review of cases of termination of pregnancy performed for maternal indications in an Australian tertiary obstetric referral hospital. Cases from January 2000 to July 2010 inclusive were selected by examination of a termination of pregnancy database at our hospital. From 893 terminations, 104 were performed for maternal indications and had notes available for review: mean maternal age, 28.2 years (SD, 6.6; range, 14-44); median gravidity, 2; and parity, 1; and mean gestational age, 11.5 weeks (SD, 4.6; range, 5-23). Terminations were primarily surgical (n=81 (78.6%)) rather than by induction of labour (n=22 (21.4%)). Frequent maternal indications included psychiatric (n=24 (23.1%)), malignancy (n=17 (16.3%)) and cardiac (n=13 (12.5%)). Information on contraceptive use prior to termination was available in 40 (53%) women known to have disease prior to conception. Contraception was recorded as being in use prior to conception in 19 (47.5%) of these. Following termination, 75 (75.7%) were recorded as using contraception. Contraceptive rates in this at risk group appear to be poor and require attention.

Exploring the limited impact of patient-centred counselling and standardised health messages aimed at improving STI partner notification

The present study set out to explore the limited impact of a randomised controlled trial comparing standardised health messages and patient-centred counselling for improving partner notification by patients with sexually transmitted infections (STIs) at Alexandra Health Centre and University Clinic in South Africa. Using contextual information collected throughout the course of the trial, it was possible to assess whether the proportion of patients asking questions after receiving the standardised health message, and/or the duration of counselling sessions, were associated with the number of patients whose partners subsequently sought treatment at the Health Centrefs pharmacy. By analysing transcribed audio-recordings of standardised health messages and counselling sessions it was also possible to compare what was said during each intervention and to assess the quality of information, advice and problem-solving discussions contained therein. While female STI patients were more likely to ask questions after receiving the standardised health message and were more likely to have longer counselling sessions than male patients, there was little evidence that either events were associated with more than a marginally (p.0.1) significant increase in the number of patients whose partners subsequently sought treatment at the Health Centre. However, partners successfully notified by patients who had received longer counselling sessions were more likely to present for treatment more than a day later, which could indicate that longer counselling sessions encouraged STI patients to contact partners who took time to trace. While patient language appeared to influence the amount of time spent counselling each patient, qualitative analyses of transcribed audio-recordings suggested that the less structured format of counselling sessions undermined the delivery of comprehensive information and advice, even though the counsellors involved often went to some lengths to tailor what was said to suit what they perceived to be each patientfs needs. Indeed, very few of the transcribed counselling sessions contained interactive problem-solving between counsellors and patients, and many counsellors failed to create a non-judgemental atmosphere in which to facilitate problem-solving by STI patients. Since most of the transcribed standardised health messages successfully delivered comprehensive information in a non-judgemental fashion, albeit with little interaction between nurse educator and patient, it may not be surprising that this intervention had a similar impact on partner notification as lay-counselling. Indeed, these findings may explain why a combination of both interventions was required to elicit a significant increase in successful partner notification in the randomised controlled trial. They suggest that counselling may need to include standardised health messages, delivered in a non-judgemental atmosphere, if it is to improve partner notification for STIs; and/or the delivery of healthcare messages in different formats by different health care practitioners may be necessary to elicit a significant change in subsequent health behaviour.

Designing the Recipient

In this paper we consider a collection of conversational practices that arise when a professional is faced with extended resistance to their offered advice. Our data is comprised of telephone calls to a UK child protection helpline. The practices we identify occur repeatedly across our corpus of advice resistance sequences and involve (1) the repackaging of resisted advice in more idiomatic form; (2) the combination of that advice with a tag question that treats the client as able to confirm the reformulated version despite their prior resistance to it; and (3) the dampening of the response requirement by continuing past the tag question, which would normally constitute a transition place for the advice recipient. We also discuss the tension between the contrasting projects of callers and call takers, which can lead to both delivery of advice and the resistance of that advice. In doing this we highlight the way in which advice may function as an element of broader institutional practices. In specifying these practices we draw upon analytic tools employed by conversation analysts, including various features of sequence organization (Schegloff 2007) and turn design (Sacks, Schegloff, and Jefferson 1974). The analysis is intended to contribute to three main areas of research: to the applied topic of managing advice resistance, to the growing literature on understanding institutional practices, and to broader concerns in conversation analytic and discursive psychological literature. These concerns include the status of the “psychological” in interaction and the specification of actions across turns and sequences of talk.

Script proposals: A device for empowering clients in counselling

Much of the research on the delivery of advice by professionals such as physicians, health workers and counsellors, both on the telephone and in face-to-face interaction more generally, has focused on the theme of client resistance and the consequent need for professionals to adopt particular formats to assist in the uptake of the advice. In this article we consider one setting, Kid’s Helpline, the national Australian counselling service for children and young people, where there is an institutional mandate not to give explicit advice in accordance with the values of self-direction and empowerment. The article examines one practice, the use of script proposals by counsellors, which appears to offer a way of providing support which is consistent with these values. Script proposals entail the counsellors packaging their advice as something that the caller might say — at some future time — to a third party such as a friend, teacher, parent or partner, and involve the counsellor adopting the speaking position of the caller in what appears as a rehearsal of a forthcoming strip of interaction. Although the core feature of a script proposal is the counsellor’s use of direct reported speech, they appear to be delivered not so much as exact words to be followed, but as the type of conversation that the client needs to have with the third party. Script proposals, in short, provide models of what to say as well as alluding to how these could be emulated by the client. In their design, script proposals invariably incorporate one or more of the most common rhetorical formats for maximizing the persuasive force of an utterance such as a three-part list or a contrastive pair. Script proposals, moreover, stand in a complex relation to the prior talk and one of their functions appears to be to summarize, respecify or expand upon the client’s own ideas or suggestions for problem solving that have emerged in these preceding sequences.

Translating complex science into life-course health promoting strategies

These days, we are bombarded with nutrition information from diverse sources and of varying quality. There has been a dramatic increase in communication channels, including more television channels with airtime to fill, and the emergence of the Internet and 'new media' such as social networking sites. Part of this culture is to deliver ever changing and novel angles. The background 'noise' that this creates can make delivery of evidence-based advice about healthy eating that generally carries less novelty value, a huge challenge. This paper illustrates ways in which complex scientific information can be translated into meaningful health promoting strategies that can be applied across the life course. The examples used are nutrition in the context of healthy ageing, communicating the concept of energy density in the context of satiety, healthy hydration, health effects of probiotics and resources for use by teachers in the classroom. This selection of examples demonstrates the processes adopted at the British Nutrition Foundation to identify the evidence base for a particular topic and then to communicate this information to various target audiences. The British Nutrition Foundation's approach typically starts with preparation of a detailed review of the evidence, often with the involvement of external expertise, followed by peer review. For much of this work conventional science communication routes are used, but use is also made of the Internet and various forms of new media.