Journal Articles
Published Research
The following is a summary of journal publications by Associate Professor Knowles. Click on the references below for further details.
Journal Articles
2022
Al-Ani, A., GESA IBD Patient Information Materials Working Group (Garg, M. (Chair), Alex, G., An, V., Begun, J., Betlehem, M., Bryant, R., Christensen, B., Clerehan, R., Connor, S.J., Costello, S., D’Souza, B., Day, A., Greene, K., Haar, G., Halmos, E., Hanrahan, T., Harris, H., Healy, K., Knowles, S., Lores, T., Luber, R., Mikocka-Walus, A., O’Connor, M., Rajendran, M., Rentsch C.,, Stockbridge, S., Weldon, J., Winter, C.). (2022). Development of inflammatory bowel disease patient education and medical information sheets: Serving an unmet need. Internal Medicine Journal, 52, 1272–1275.
Abstract:
Inflammatory bowel disease is a chronic gastrointestinal condition that necessitates life-long healthcare engagement and management. Empowering patients with knowledge is fundamental to enhance health literacy, improve health outcomes and facilitate complex decision-making regarding medication and potential surgery. A working group was formed to develop concise, comprehensive patient information sheets to meet this unmet need in the Australian setting.
Evans, S., Olive, L., Dober, M., Knowles, S., Fuller-Tyszkiewicz, M., O, E., Gibson, P., Raven, L., Gearry, R., McCombie, A., van Niekerk, L., Chesterman, S., Romano, D., & Mikocka-Walus, A. (2022). Acceptance commitment therapy (ACT) for psychological distress associated with inflammatory bowel disease (IBD): protocol for a feasibility trial of the ACTforIBD programme. BMJ Open,12(6), e060272.
Article:
Introduction: Inflammatory bowel disease (IBD) involves an abnormal immune response to healthy gut bacteria. When a person develops IBD, their susceptibility to anxiety and/or depression increases. The ACTforIBD programme, specifically designed for people with IBD and comorbid psychological distress, draws on acceptance and commitment therapy (ACT), which promotes acceptance of situations that cannot be solved such as persistent physical symptoms. There are no ACT trials for IBD using an active control group or a telemedicine approach, which is important to improve accessibility, particularly in the context of the ongoing COVID-19 pandemic. The ACTforIBD programme is administered online with a 4-hour therapist involvement per participant only; if successful it can be widely implemented to improve the well-being of many individuals with IBD.
Methods and analysis: Our team have codesigned with consumers the ACTforIBD programme, an 8-week intervention of 1-hour sessions, with the first three sessions and the last session delivered one-to-one by a psychologist, and the other sessions self-directed online. This study aims to evaluate the feasibility and preliminary efficacy of ACTforIBD to reduce psychological distress in patients with IBD. Using a randomised controlled trial, 25 participants will be randomised to ACTforIBD, and 25 patients to an active control condition.
Ethics and dissemination: This protocol has been approved by Deakin University Research Ethics Committee in September 2021 (Ref. 2021-263) and the New Zealand Central Health and Disability Ethics Committee in December 2021 (Ref. 2021 EXP 11384). The results of this research will be published in peer-reviewed journals and shared with various stakeholders, including community members, policy-makers and researchers, through local and international conferences.
URL: https://doi.org/10.1136/bmjopen-2021-060272
Droppert K.M., Knowles, S.R. (2022). The role of pain acceptance, pain catastrophizing, and coping strategies: A validation of the common sense model in females living with fibromyalgia. Journal of Clinical Psychology in Medical Settings, 30(2), 445-452.
Abstract:
This study aimed to examine the extent to which illness beliefs, coping styles, pain acceptance, pain catastrophizing, and psychological distress mediate the relationship between fibromyalgia symptoms and quality of life (QoL) in a female cohort diagnosed with Fibromyalgia (n = 151). Measures used included the Revised Fibromyalgia Impact Questionnaire, Carver Brief COPE scale, Chronic Pain Acceptance Questionnaire Revised, Pain Catastrophizing Scale, Brief Illness Perceptions Questionnaire, Depression and Anxiety Stress Scales, and European Health Interview Survey Quality of Life 8-item Index. Using structural equation modelling, the final model indicated that fibromyalgia symptom severity had a significant direct influence on illness perceptions and psychological distress. In turn, illness perceptions had a significant direct influence on maladaptive coping, pain catastrophizing, pain acceptance, and QoL. Pain catastrophizing and maladaptive coping influenced psychological distress, and in turn distress impacted QoL. Acceptance of pain was found to be influenced by maladaptive coping and in turn acceptance of pain influenced QoL.
URL: https://doi.org/10.1007/s10880-022-09873-w
O'Brien, C. L., Apputhurai, P., Knowles, S. R., Jenkins, Z. M., Ski, C. F., Thompson, D. R., Moore, G., Ward, G., Loh, M., & Castle, D. J. (2022). Initial evaluation of the Optimal Health Program for people with diabetes: 12-month outcomes of a randomised controlled trial. Psychology & Health, 1-21. Advance online publication.
Abstract:
Objective: This study aimed to evaluate if a new Mental health IN DiabeteS Optimal Health Program (MINDS OHP) compared with usual care in adults with Type 1 and Type 2 diabetes would improve psychosocial outcomes including self-efficacy and quality of life.Design and Main Outcome Measures This initial randomised controlled trial evaluated MINDS OHP compared with usual care. Participants were recruited through outpatient clinics and community organisations. The intervention group received nine sessions with assessments over twelve months. Primary outcomes were self-efficacy and quality of life. Secondary outcomes included diabetes distress and anxiety.
Results: There were 51 participants in the control group (mean age = 52) and 55 in the intervention group (mean age = 55). There were significant main effects of time in general self-efficacy, diabetes distress, diabetes self-efficacy, and illness perceptions, however no significant between-group differences in primary or secondary outcomes. Post-hoc analyses revealed MINDS OHP improved diabetes self-efficacy for participants with mild to severe depression and anxiety, with a small effect.
Conclusion: Initial evaluation found MINDS OHP was associated with improved diabetes self-efficacy for adults with diabetes, for people with mild to severe levels of distress, with small effect. Further research is required to explore whether this disease-specific, collaborative care-focused intervention benefits the mental health of people with diabetes.
Möller, S.P., Apputhurai, P., Tye-Din, J.A., & Knowles, S.R. (2022). Longitudinal assessment of the common sense model before and during the COVID-19 pandemic: A large coeliac disease cohort study. Journal of Psychosomatic Research, 153, 110711.
Abstract:
Objective: Psychosocial factors likely play a substantial role in the well-being of those living with coeliac disease, especially during the COVID-19 pandemic, however, little research has examined well-being in this cohort using an integrated socio-cognitive model. This study had two aims: (1) Examine changes in gastrointestinal symptoms, psychosocial factors, and well-being outcomes (i.e., psychological distress, quality of life [QoL]) associated with the pandemic, (2) Examine the interrelationship of these variables across timepoints using the Common Sense Model (CSM).
Methods: 1697 adults with coeliac disease (Time 1, pre-pandemic; 83.1% female, mean age = 55.8, SD = 15.0 years) and 674 follow-up participants (Time 2, pandemic; 82.8% female, mean age = 57.0, SD = 14.4 years) completed an online questionnaire. Hypotheses were tested using repeated measures MANOVA and cross-lagged panel model analyses.
Results: Participants reported improved QoL, and reduced gastrointestinal symptoms, negative illness perceptions and maladaptive coping from pre-pandemic to during the pandemic. There was no significant change in pain catastrophising or psychological distress. Cross-lagged effects showed gastrointestinal symptoms to predict negative illness perceptions, which in turn were predictive of poorer outcomes across all variables except pain catastrophising. Consistent with the CSM, there was a reciprocal relationship between illness perceptions and QoL over time. Maladaptive coping and pain catastrophising demonstrated limited predictive utility.
Conclusion: The COVID-19 pandemic appears to have had a small beneficial effect across several indices of well-being among adults with coeliac disease. Cross-lagged relationships highlight illness perceptions as a predictor of well-being outcomes and a potential target for psychosocial interventions.
URL: https://doi.org/10.1016/j.jpsychores.2021.110711
Lo, B., Barreiro-de Acosta, M., Bernstein, C. N., Burisch, J., Ferreira, N., Gearry, R. B., Mikocka-Walus, A., Mokrowiecka, A., Trindade, I. A., & Knowles, S. R. (2022). Fear of COVID-19 among persons with inflammatory bowel disease as compared to persons with other gastrointestinal conditions. Turkish Journal of Gastroenterology, 33(8), 664-672.
Abstract:
Background: Although several studies have reported the impact of fears relating to coronavirus-19 on several chronic illnesses, there are few studies focused on gastrointestinal conditions. Therefore, the aim of this study was to compare the fear of coronavirus-19 in patients with inflammatory bowel disease to other gastrointestinal conditions and how the fear of COVID-19 manifests across different demographical backgrounds among inflammatory bowel disease respondents.
Methods: Participants with gastrointestinal conditions (age ≥ 18) were recruited from 27 countries. Demographic, clinical, and psychosocial information was collected. An adapted scale for inflammatory bowel disease patients measuring the fear of coronavirus-19 and gastrointestinal-specific fear of coronavirus-19 was used.
Results: In 831 participants (312 inflammatory bowel disease), only significant increases in gastrointestinal-fear of coronavirus-19 were found in between inflammatory bowel disease and other gastrointestinal conditions (mean [standard deviation]: 13.5 [5.5] vs 10.9 [5.0], P < .01). Among inflammatory bowel disease respondents, persons on sick leave had significantly more fear of coronavirus-19 than those employed (median [IQR], 31.0 [28.5-39.5] vs 26.0 [20.0-33.0], P = .035) and significantly more gastrointestinal-fear of coronavirus-19 compared to the employed (18.0 [14.5-22.0] vs 13.0 [9.0-17.0], P = .033) or respondents outside of the labor market (12.0 [7.0-16.0], P = .022). Persons living in a rural setting had significantly more fear of coronavirus-19 compared to persons living in regional setting (29.5 [22.0-37.8] vs 25.0 [20.0-31.3], P = .007) and gastrointestinal-fear of coronavirus-19 (15.0 [11.0-19.8] vs 12.0 [9.0-16.0], P = .02).
Conclusion: Respondents with inflammatory bowel disease are more afraid of coronavirus-19 regarding their disease; especially, persons on sick leave or persons living in a rural setting. This should be taken into consideration to personalize the support that health care providers can offer in mitigating fear related to coronavirus-19.