title: Use of the Theory of Planned Behaviour to assess factors influencing the identification of students at clinical high-risk for psychosis in 16+ Education.
abstract: BACKGROUND
  The longer psychotic disorders are untreated the worse their prognosis. Increasing the awareness of early psychosis by professionals who come into regular contact with young people is one strategy that could reduce treatment delay. As teachers engage with students on a daily basis, their role could be exploited to increase awareness of the early signs of psychosis. This study employed the Theory of Planned Behaviour (TPB) to identify and measure factors that influence identification of students at high-risk (HR) of developing psychosis in 16+ educational institutions.
  
  
  METHODS
  An elicitation phase revealed beliefs underlying teachers' motivations to detect HR students and informed the construction of a preliminary 114-item questionnaire incorporating all constructs outlined in the TPB. To define the determinants of teachers' intention to identify HR students, 75 teachers from secondary and further education institutions in 12 counties surrounding Cambridgeshire completed the questionnaire. A psychometric model of item response theory was used to identify redundant items and produce a reduced questionnaire that would be acceptable to teachers.
  
  
  RESULTS
  The final instrument comprised 73 items and showed acceptable reliability (α  = 0.69-0.81) for all direct measures. Teacher's confidence and control over identification of HR students was low. Although identification of HR students was considered worthwhile, teachers believed that their peers, students and particularly their managers might not approve. Path analysis revealed that direct measures of attitude and PBC significantly predicted intention, but subjective norm did not. PBC was the strongest predictor of intention. Collectively, the direct measures explained 37 % of the variance of intention to identify HR for psychosis.
  
  
  CONCLUSIONS
  This research demonstrated how the TPB can be used to identify and measure factors that influence identification of students at HR of developing psychosis in 16+ educational institutions and confirmed the feasibility, reliability and acceptability of a TPB-based questionnaire for teachers. Consideration of the key determinants of identification in schools will facilitate the design of successful educational intervention strategies with the potential to reduce treatment delays for HR students.
authors.affiliation: CAMEO Early Intervention in Psychosis Service, Cambridgeshire and Peterborough NHS Foundation Trust, Block 7, Ida Darwin Site, Fulbourn Hospital, Fulbourn, Cambridge, CB21 5EE, UK. dr335@medschl.cam.ac.uk.|Department of Psychiatry, University of Cambridge, Cambridge, UK. dr335@medschl.cam.ac.uk.
authors.forename: Debra A
authors.initials: DA
authors.lastname: Russo
authors.affiliation: CAMEO Early Intervention in Psychosis Service, Cambridgeshire and Peterborough NHS Foundation Trust, Block 7, Ida Darwin Site, Fulbourn Hospital, Fulbourn, Cambridge, CB21 5EE, UK. jan.stochl@york.ac.uk.|Department of Psychiatry, University of Cambridge, Cambridge, UK. jan.stochl@york.ac.uk.
authors.forename: Jan
authors.initials: J
authors.lastname: Stochl
authors.affiliation: CAMEO Early Intervention in Psychosis Service, Cambridgeshire and Peterborough NHS Foundation Trust, Block 7, Ida Darwin Site, Fulbourn Hospital, Fulbourn, Cambridge, CB21 5EE, UK. Michelle.Painter@cpft.nhs.uk.
authors.forename: Michelle
authors.initials: M
authors.lastname: Painter
authors.affiliation: CAMEO Early Intervention in Psychosis Service, Cambridgeshire and Peterborough NHS Foundation Trust, Block 7, Ida Darwin Site, Fulbourn Hospital, Fulbourn, Cambridge, CB21 5EE, UK. Gillian.Shelley@cpft.nhs.uk.
authors.forename: Gillian F
authors.initials: GF
authors.lastname: Shelley
authors.affiliation: CAMEO Early Intervention in Psychosis Service, Cambridgeshire and Peterborough NHS Foundation Trust, Block 7, Ida Darwin Site, Fulbourn Hospital, Fulbourn, Cambridge, CB21 5EE, UK. pbj21@cam.ac.uk.|Department of Psychiatry, University of Cambridge, Cambridge, UK. pbj21@cam.ac.uk.|NIHR Collaboration for Leadership in Applied Health Research & Care, Cambridge, UK. pbj21@cam.ac.uk.
authors.forename: Peter B
authors.initials: PB
authors.lastname: Jones
authors.affiliation: CAMEO Early Intervention in Psychosis Service, Cambridgeshire and Peterborough NHS Foundation Trust, Block 7, Ida Darwin Site, Fulbourn Hospital, Fulbourn, Cambridge, CB21 5EE, UK. jp440@cam.ac.uk.|Department of Psychiatry, University of Cambridge, Cambridge, UK. jp440@cam.ac.uk.
authors.forename: Jesus
authors.initials: J
authors.lastname: Perez
mesh_terms: D000328:Adult; D001290:Attitude; D005260:Female; D006801:Humans; D033182:Intention; D008297:Male; D008960:Models, Psychological; D009042:Motivation; D011594:Psychometrics; D011618:Psychotic Disorders; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D012574:Schools; D012649:Self Concept; D013334:Students / Q000523:psychology*; D011795:Surveys and Questionnaires