Showing papers in "British Journal of Health Psychology in 2020"

Daily emotional well-being during the COVID-19 pandemic.

Abstract: The COVID-19 outbreak has become one of the largest public health crises of our time Governments have responded by implementing self-isolation and physical distancing measures that have profoundly impacted daily life throughout the world In this study, we aimed to investigate how people experience the activities, interactions, and settings of their lives during the pandemic The sample (N = 604) was assessed in Ireland on the 25 March 2020, following the closure of schools and non-essential businesses We examined within-person variance in emotional well-being and how people spend their time We found that while most time was spent in the home (74%), time spent outdoors (8%) was associated with markedly raised positive affect and reduced negative emotions Exercising, going for walks, gardening, pursuing hobbies, and taking care of children were the activities associated with the greatest affective benefits Home-schooling children and obtaining information about COVID-19 were ranked lowest of all activities in terms of emotional experience These findings highlight activities that may play a protective role in relation to well-being during the pandemic, the importance of setting limits for exposure to COVID-19-related media coverage, and the need for greater educational supports to facilitate home-schooling during this challenging period

Towards intervention development to increase the uptake of COVID-19 vaccination among those at high risk: Outlining evidence-based and theoretically informed future intervention content

Abstract: Objectives Development of a vaccine against COVID-19 will be key to controlling the pandemic. We need to understand the barriers and facilitators to receiving a future COVID-19 vaccine so that we can provide recommendations for the design of interventions aimed at maximizing public acceptance. Design Cross-sectional UK survey with older adults and patients with chronic respiratory disease. Methods During the UK's early April 2020 'lockdown' period, 527 participants (311 older adults, mean age = 70.4 years; 216 chronic respiratory participants, mean age = 43.8 years) completed an online questionnaire assessing willingness to receive a COVID-19 vaccine, perceptions of COVID-19, and intention to receive influenza and pneumococcal vaccinations. A free text response (n = 502) examined barriers and facilitators to uptake. The Behaviour Change Wheel informed the analysis of these responses, which were coded to the Theoretical Domains Framework (TDF). Behaviour change techniques (BCTs) were identified. Results Eighty-six per cent of respondents want to receive a COVID-19 vaccine. This was positively correlated with the perception that COVID-19 will persist over time, and negatively associated with perceiving the media to have over-exaggerated the risk. The majority of barriers and facilitators were mapped onto the 'beliefs about consequences' TDF domain, with themes relating to personal health, health consequences to others, concerns of vaccine safety, and severity of COVID-19. Conclusions Willingness to receive a COVID-19 vaccination is currently high among high-risk individuals. Mass media interventions aimed at maximizing vaccine uptake should utilize the BCTs of information about health, emotional, social and environmental consequences, and salience of consequences.

Risk factors for psychological distress during the COVID-19 pandemic in Israel: Loneliness, age, gender, and health status play an important role.

Abstract: Objective Research on the psychological toll of the COVID-19 pandemic is being conducted in various countries. This study aimed to examine risk factors for mental health problems among Israeli adults during this crisis. Methods A total of 204 participants took part in the study. They completed self-report questionnaires assessing perceived stress, anxiety, quality of life, and various questions related to quarantine, pre-existing health issues, and worries related to the virus. The study took place during the last two weeks of March 2020. Results The majority of participants reported relatively high levels of perceived stress and corona-related worries, but low levels of anxiety. Female gender, younger age, corona-related loneliness, and pre-existing chronic illness were all related to higher levels of psychological distress and lower levels of quality of life. Conclusions While considering the preliminary nature of these results, the current study highlights risk factors for psychological distress in light of the corona pandemic. Attention should be given to sociodemographic variables that were identified as related to psychological distress, as well as to the important role of loneliness, when screening and treating people during this crisis. More research is needed in order to fully understand the scope and correlates of psychological difficulties during these challenging times.

Exposure to coronavirus news on mainstream media: The role of risk perceptions and depression.

Abstract: Objective: The mainstream media tend to rely on news content that will increase risk perceptions of pandemic outbreaks to stimulate public response and persuade people to comply with preventive behaviours. The objective of this study was to examine associations between exposure to coronavirus disease (COVID-19) news, risk perceptions, and depressive symptoms. Methods: Cross-sectional data were collected from 501 participants who were ≥18 years. Exposure to COVID-19 news was assessed as our exposure variable. We screened for depression (outcome variable) with the Patient Health Questionnaire and examined the roles of risk perceptions. Multiple linear regressions and mediation analysis with 1000 bootstrap resamples were conducted. Results: Participants were 55.29% female, 67.86% White with mean age 32.44 ± 11.94 years. After controlling for sociodemographic and socio-economic factors, news exposure was positively associated with depressive symptoms β = .11; 95% confidence interval (95%CI) = 0.02-0.20. Mediation analysis showed that perceived vulnerability to COVID-19 mediated 34.4% of this relationship (β = .04; 95%CI = 0.01-0.06). Conclusion: Perceived vulnerability to COVID-19 can serve as a pathway through which exposure to COVID-19 news on mainstream media may be associated with depressive symptoms. Based on our findings, we offered recommendations for media-health partnership, practice, and research.

COVID-19-related anxiety predicts somatic symptoms in the UK population.

Abstract: This study aimed to estimate the association between anxiety associated with COVID-19 and somatic symptoms, using data from a large, representative sample (N = 2,025) of the UK adult population. Results showed that moderate to high levels of anxiety associated with COVID-19 were significantly associated with general somatic symptoms and in particular with gastrointestinal and fatigue symptoms. This pattern of associations remained significant after controlling for generalized anxiety disorder (GAD), pre-existing health problems, age, gender, and income. This is the first evidence that anxiety associated with COVID-19 makes a unique contribution to somatization, above and beyond the effect of GAD.

Using an integrated social cognition model to predict COVID-19 preventive behaviours.

Abstract: OBJECTIVES: Rates of novel coronavirus disease 2019 (COVID-19) infections have rapidly increased worldwide and reached pandemic proportions. A suite of preventive behaviours have been recommended to minimize risk of COVID-19 infection in the general population. The present study utilized an integrated social cognition model to explain COVID-19 preventive behaviours in a sample from the Iranian general population. DESIGN: The study adopted a three-wave prospective correlational design. METHODS: Members of the general public (N = 1,718, Mage = 33.34, SD = 15.77, male = 796, female = 922) agreed to participate in the study. Participants completed self-report measures of demographic characteristics, intention, attitude, subjective norm, perceived behavioural control, and action self-efficacy at an initial data collection occasion. One week later, participants completed self-report measures of maintenance self-efficacy, action planning and coping planning, and, a further week later, measures of COVID-19 preventive behaviours. Hypothesized relationships among social cognition constructs and COVID-19 preventive behaviours according to the proposed integrated model were estimated using structural equation modelling. RESULTS: The proposed model fitted the data well according to multiple goodness-of-fit criteria. All proposed relationships among model constructs were statistically significant. The social cognition constructs with the largest effects on COVID-19 preventive behaviours were coping planning (β = .575, p < .001) and action planning (β = .267, p < .001). CONCLUSIONS: Current findings may inform the development of behavioural interventions in health care contexts by identifying intervention targets. In particular, findings suggest targeting change in coping planning and action planning may be most effective in promoting participation in COVID-19 preventive behaviours. Statement of contribution What is already known on this subject? Curbing COVID-19 infections globally is vital to reduce severe cases and deaths in at-risk groups. Preventive behaviours like handwashing and social distancing can stem contagion of the coronavirus. Identifying modifiable correlates of COVID-19 preventive behaviours is needed to inform intervention. What does this study add? An integrated model identified predictors of COVID-19 preventive behaviours in Iranian residents. Prominent predictors were intentions, planning, self-efficacy, and perceived behavioural control. Findings provide insight into potentially modifiable constructs that interventions can target. Research should examine if targeting these factors lead to changes in COVID-19 behaviours over time.

Demographic and health factors associated with pandemic anxiety in the context of COVID-19.

Abstract: Objectives. The mental health consequences of COVID-19 are predicted to have a disproportionate impact on certain groups. We aimed to develop a brief measure, the Pandemic Anxiety Scale, to capture the specific aspects of the pandemic that are provoking anxiety, and explore how these vary by health and demographic factors. Design. Data were from a convenience sample of parents (N = 4,793) and adolescents (N = 698) recruited in the first 6 weeks of lockdown. Methods. Factor analytic and IRT methods were used to validate the new measure in both parent and adolescent samples. Associations between scores on the new measure and age, gender, household income, and physical health status were explored using structural equation modelling (SEM). Results. Two factors were identified in both samples: disease anxiety (e.g., catching, transmitting the virus) and consequence anxiety (e.g., impact on economic prospects); and unique associations with health and demographic factors were observed. Conclusions. Anxieties due to the COVID-19 are multifaceted, and the PAS is a short, reliable, and valid measure of these concerns. These anxieties are differentially associated with demographic, social, and health factors, which should be considered when developing strategies to mitigate the mental health impact of the pandemic.

Looking out for myself: Exploring the relationship between conspiracy mentality, perceived personal risk, and COVID-19 prevention measures.

Abstract: Objectives This research examined how conspiracy mentality may affect compliance with preventive health measures necessary to fight the COVID-19 pandemic, and the underlying motivations to comply. Design and method We conducted two cross-sectional studies (Study 1 N = 762, Study 2 N = 229) on a French population, measuring conspiracy mentality, compliance with preventive health measures, and perceived risks related to COVID-19. We also measured motivations to comply with preventive measures in Study 2. Results We show that people high in conspiracy mentality are likely to engage in non-normative prevention behaviours (Study 1), but are less willing to comply with extreme preventive behaviours that are government-driven (Study 2). However, we demonstrate that a perceived risk to oneself (risk of death) and a motivation to protect oneself can act as a suppressor: Conspiracy mentality is linked with an increase in the perception of risk to oneself, which, in turn, is associated with normative compliance. We also find that perceived risk of death explains the relationship between conspiracy mentality and non-normative prevention behaviours. Conclusions Our studies showcase how people high in conspiracy theorizing may (dis)engage with prevention behaviours, but that perceived risk and motivation to protect oneself could increase these individuals' compliance.

Health psychology and the coronavirus (COVID-19) global pandemic: A call for research.

Abstract: On 11 March 2020, the World Health Organization (WHO) declared COVID-19, a disease caused by coronavirus SARS-CoV-2, a pandemic. At the time of writing, there are significant outbreaks across much of the world with Europe identified as the epicentre. It seems clear that health psychology has an important role to play in understanding how people will respond and cope to the threat of COVID-19 and how they will adhere and adapt to transmission-related behaviours including hand washing and self-isolation. Efforts to control and reduce coronavirus transmission rely on behavioural change and maintenance. In 2010, BJHP published a review of ‘Demographic and attitudinal determinants of protective behaviours during a pandemic’ (Bish &Michie, 2010), finding that communications to promote preventative behaviours should be targeted to specific demographic groups and should focus on raising perceived threat and the effectiveness of behavioural measures to reduce risk. Susan Michie and colleagues have recently written about understanding behaviour and behavioural strategies for reducing COVID-19 transmission (https://blogs.bmj.com/bmj/2020/03/03/behavioural-strategies-for-reducingcovid-19-transmission-in-the-general-population/ and https://blogs.bmj.com/bmj/2020/ 03/11/slowing-down-the-covid-19-outbreak-changing-behaviour-by-understanding-it/) drawing on the COM-Bmodel (Michie et al., 2011) to identify issues of capability, opportunity, and motivation that might impact on behaviours and discussing behavioural strategies to address barriers. Beyond behaviour change, health psychology also has a role in understanding how people might respond to and cope with the threat of a global pandemic and changes to their lives that are made in an effort to reduce that threat. The Economic and Social Research Institute in Dublin has recently produced a working paper on ’Using behavioural science to help fight the coronavirus’ (Lunn et al., 2020 https://www.esri. ie/system/files/publications/WP656.pdf) which in addition to personal hygiene behaviours, considers pro-social behaviours, panic-buying, communication, risk perception, and the impacts of isolation. In 2013, BJHP published the findings of a survey conducted during the H1N1 influenza pandemic in 2009 that indicated the importance of precise and clear information about control measures for reducing anxiety (Taha et al., 2014). Brooks et al. (2020) recently published a rapid review focusing on the psychological impact of quarantine and how best to enable people to cope which reported the importance of clear information, and that voluntary quarantine is ‘associated with less distress and fewer long-term complications’. There is also a need to understand the potential physical and psychosocial impact of COVID-19 on front-line health care staff. Brooks et al. (2018) undertook a systematic review of the factors affecting the psychological well-being of health care workers involved in the severe acute respiratory syndrome (SARS) crisis and recommended that

Coronavirus (COVID-19) in the United Kingdom: A personality-based perspective on concerns and intention to self-isolate.

Abstract: Objectives Public behaviour change is necessary to contain the spread of coronavirus (COVID-19). Based on the reinforcement sensitivity theory (RST) framework, this study presents an examination of individual differences in some relevant psychological factors. Design Cross-sectional psychometric. Methods UK respondents (N = 202) completed a personality questionnaire (RST-PQ), measures of illness attitudes, concerns about the impact of coronavirus on health services and socio-economic infrastructures, personal safety, and likelihood of voluntary self-isolation. Results Respondents most concerned were older, had negative illness attitudes, and scored higher on reward reactivity (RR), indicating the motivation to take positive approach action despite prevailing worry/anxiety. Personal safety concerns were highest in those with negative illness attitudes and higher fight-flight-freeze system (FFFS, reflecting fear/avoidance) scores. Results suggest people are experiencing psychological conflict: between the urge to stay safe (FFFF-related) and the desire to maintain a normal, pleasurable (RR-related) life. Ways of ameliorating conflict may include maladaptive behaviours (panic buying), reflecting reward-related displacement activity. Intended self-isolation related to FFFS, but also low behavioural inhibition system (related to anxiety) scores. Older people reported themselves less likely to self-isolate. Conclusions Interventions need to consider individual differences in psychological factors in behaviour change, and we discuss relevant literature to inform policy makers and communicators. Statement of contribution What is already known on this subject? Reinforcement sensitivity theory (RST) personality systems can influence perception of persuasive health messages. However, there is limited evidence for their direct effects on health concerns and behaviours, and none relating to specific infectious diseases. What does this study add? Reward reactivity (RR) is associated with concern about impact of coronavirus on the NHS and other social infrastructures, indicating the motivation to take positive-approach action despite worry/anxiety. Personal safety concerns are related to fight-flight-freeze system traits (FFFS, reflecting fear/avoidance). Intended self-isolation related to FFFS, but also low behavioural inhibition system (related to anxiety) scores. Older people reported themselves less likely to self-isolate. Results suggest psychological conflict: between the urge to stay safe (FFFF-related) and the desire to maintain a normal, pleasurable life (RR-related). Ways of ameliorating conflict may include maladaptive behaviours (panic buying), reflecting reward-related displacement activity.

Reasoned and implicit processes in heavy episodic drinking: An integrated dual-process model.

Abstract: Objectives University students commonly engage in heavy episodic drinking (HED), which contributes to injury risk, deleterious educational outcomes, and economic costs. Identification of the determinants of this risky behaviour may provide formative evidence on which to base effective interventions to curb HED in this population. Drawing from theories of social cognition and dual-process models, this study tested key hypotheses relating to reasoned and implicit pathways to action for HED in a sample of Australian university students who drink alcohol. Design A two-wave correlational design was adopted. Methods Students (N = 204) completed self-reported constructs from social cognition theories with respect to HED at an initial time point (T1): attitude, subjective norm, perceived behavioural control, intentions, habit, past behaviour, and implicit alcohol identity. Four weeks later (T2), students self-reported their HED behaviour and habit. Results An initial path model indicated attitude and subjective norm predicted intentions, and intentions and implicit alcohol identity predicted HED. Inclusion of past behaviour and habit revealed direct effects of these on HED. Effects of T1 habit on HED were indirect through T2 habit, and there were indirect effects of past behaviour on HED through habit at both time points and the social cognition constructs. Direct effects of intentions and implicit alcohol identity, and indirect effects of attitude and subjective norm, on HED, were attenuated by the inclusion of past behaviour and habit. Conclusion Results indicate that university students' HED tends to be governed by non-conscious, automatic processes than conscious, intentional processes. Statement of contribution What is already known on this subject? Social cognitive factors are associated with risky alcohol consumption behaviours. Dual-process models are being used to explain health behaviours, such as heavy episodic drinking (HED). What does this study add? Past HED behaviour and HED habits have direct and indirect effects on students' HED behaviour. Past behaviour and habit attenuate the effects of intentions and implicit alcohol identity on HED.

Capability, opportunity, and motivation to enact hygienic practices in the early stages of the COVID-19 outbreak in the United Kingdom.

Abstract: Objectives The COVID‐19 pandemic is one of the greatest global health threats facing humanity in recent memory. This study aimed to explore influences on hygienic practices, a set of key transmission behaviours, in relation to the Capability, Opportunity, Motivation‐Behaviour (COM‐B) model of behaviour change (Michie et al., 2011). Design Data from the first wave of a longitudinal survey study were used, launched in the early stages of the UK COVID‐19 pandemic. Methods Participants were 2025 adults aged 18 and older, representative of the UK population, recruited by a survey company from a panel of research participants. Participants self‐reported motivation, capability, and opportunity to enact hygienic practices during the COVID‐19 outbreak. Results Using regression models, we found that all three COM‐B components significantly predicted good hygienic practices, with motivation having the greatest influence on behaviour. Breaking this down further, the subscales psychological capability, social opportunity, and reflective motivation positively influenced behaviour. Reflective motivation was largely driving behaviour, with those highest in reflective motivation scoring 51% more on the measure of hygienic practices compared with those with the lowest scores. Conclusions Our findings have clear implications for the design of behaviour change interventions to promote hygienic practices. Interventions should focus on increasing and maintaining motivation to act and include elements that promote and maintain social support and knowledge of COVID‐19 transmission. Groups in particular need of targeting for interventions to increase hygienic practices are males and those living in cities and suburbs.

Understanding face mask use to prevent coronavirus and other illnesses: Development of a multidimensional face mask perceptions scale.

Abstract: Face masks are an avenue to curb the spread of coronavirus, but few people in Western societies wear face masks. Social scientists have rarely studied face mask wearing, leaving little guidance for methods to encourage these behaviours. In the current article, we provide an approach to address this issue by developing the 32-item and 8-dimension Face Mask Perceptions Scale (FMPS). We begin by developing an over-representative item list in a qualitative study, wherein participants' responses are used to develop items to ensure content relevance. This item list is then reduced via exploratory factor analysis in a second study, and the eight dimensions of the scale are supported. We also support the validity of the FMPS, as the scale significantly relates to both face mask wearing and health perceptions. We lastly confirm the factor structure of the FMPS in a third study via confirmatory factor analysis. From these efforts, we identify an avenue that social scientists can aid in preventing coronavirus and illness more broadly - by studying face mask perceptions and behaviours.

How can use of the Theoretical Domains Framework be optimized in qualitative research? A rapid systematic review.

Abstract: Purpose The Theoretical Domains Framework (TDF) is an integrative framework which can facilitate comprehensive assessment of behavioural determinants in qualitative studies However, studies can become entirely deductive if they adhere rigidly to the provided guidance and may thus overlook important factors This review identified the number of TDF-related qualitative publications employing health care professional (HCP) or patient/public samples (stage 1) and investigated the specific methods used and impact on findings in research involving patient/public populations, with consideration of how TDF use could be optimized in such studies (stage 2) Methods A rapid systematic review of TDF-based qualitative studies was conducted Studies were included in stage 1 that had (1) used qualitative methods of both data collection and analysis and (2) used the TDF to inform data collection and/or analysis Stage 2 included studies from stage 1 that employed patient/public populations and explored influences of behaviour These studies were coded for instances of TDF use with respect to data collection, analysis, and reporting of findings Results In stage 1, 186 TDF-based qualitative studies were identified (HCP = 123; patient/public = 43; both = 20) Thirty-eight of these were eligible for inclusion in stage 2 Many of these studies used the TDF in a highly structured way within data collection, and the majority used a deductive approach to analysis Most studies presented findings confined to TDF domains, with no non-TDF material presented Conclusions Rigid operationalization of the TDF in qualitative studies may result in determinants being overlooked We propose recommendations for flexible use of the TDF in order to optimize its use in exploratory qualitative research

Reducing SARS-CoV-2 transmission in the UK: A behavioural science approach to identifying options for increasing adherence to social distancing and shielding vulnerable people.

Abstract: PURPOSE: To describe and discuss a systematic method for producing a very rapid response (3 days) to a UK government policy question in the context of reducing SARS-CoV-2 transmission. METHODS: A group of behavioural and social scientists advising the UK government on COVID-19 contributed to the analysis and writing of advice through the Government Office for Science. The question was as follows: What are the options for increasing adherence to social distancing (staying at home except for essential journeys and work) and shielding vulnerable people (keeping them at home and away from others)? This was prior to social distancing legislation being implemented. The first two authors produced a draft, based on analysis of the current government guidance and the application of the Behaviour Change Wheel (BCW) framework to identify and evaluate the options. RESULTS: For promoting social distancing, 10 options were identified for improving adherence. They covered improvements in ways of achieving the BCW intervention types of education, persuasion, incentivization, and coercion. For promoting shielding of vulnerable people, four options were identified covering the BCW intervention types of incentivization, coercion, and enablement. CONCLUSIONS: Responding to policymakers very rapidly as has been necessary during the COVID-19 pandemic can be facilitated by using a framework to structure the thinking and reporting of multidisciplinary academics and policymakers.

The coronavirus (COVID-19) fatality risk perception of US adult residents in March and April 2020.

Abstract: The study compares empirical results on the coronavirus SARS-CoV-2 (causing COVID-19) fatality risk perception of US adult residents stratified for age, gender, and race in mid-March 2020 (N1 = 1,182) and mid-April 2020 (N2 = 953). While the fatality risk perception has increased from March 2020 to April 2020, our findings suggest that many US adult residents severely underestimated their absolute and relative fatality risk (i.e., differentiated for subgroups defined by pre-existing medical conditions and age) at both time points compared to current epidemiological figures. These results are worrying because risk perception, as our study indicates, relates to actual or intended health-protective behaviour that can reduce SARS-CoV-2 transmission rates.

Acceptability, reliability, and validity of a brief measure of capabilities, opportunities, and motivations ("COM-B")

Abstract: Objectives The Capabilities, Opportunities, Motivations, Behaviour (COM‐B) model is being used extensively to inform intervention design, but there is no standard measure with which to test the predictive validity of COM or to assess the impact of interventions on COM. We describe the development, reliability, validity, and acceptability of a generic 6‐item self‐evaluation COM questionnaire. Design and methods The questionnaire was formulated by behaviour change experts. Acceptability was tested in two independent samples of health care professionals (N = 13 and N = 85, respectively) and a sample of people with low socio‐economic status (N = 214). Acceptability (missing data analyses and user feedback), reliability (test–retest reliability and Bland–Altman plots) and validity (floor and ceiling effects, Pearson's correlation coefficient [r], exploratory factor analysis [EFA], and confirmatory factor analysis [CFA] were tested using a national survey of 1,387 health care professionals. Results The questionnaire demonstrated acceptability (missing data for individual items: 5.9–7.7% at baseline and 18.1–32.5% at follow‐up), reliability (ICCs .554–.833), and validity (floor effects 0.6–5.5% and ceiling effects 4.1–22.9%; pairwise correlations rs significantly <1.0). The regression models accounted for between 21 and 47% of the variance in behaviour. CFA (three‐factor model) demonstrated a good model fit, (χ2[6] = 7.34, p = .29, RMSEA = .02, CFI = .99, TLI = .99, BIC = 13,510.420, AIC = 13,428.067). Conclusions The novel six‐item questionnaire shows evidence of acceptability, validity, and reliability for self‐evaluating capabilities, opportunities, and motivations. Future research should aim to use this tool in different populations to obtain further support for its reliability and validity.

Longitudinal associations between family identification, loneliness, depression, and sleep quality.

Abstract: Objectives The prevalence of depression and loneliness is increasing in Western nations, and both have been shown to cause poor sleep quality, with evidence suggesting that loneliness also predicts depression. The Social Cure perspective can shed light on these relationships and thus informs the present study. Specifically, it was hypothesized that the extent of participants' identification with a significant social group, their family, would positively predict sleep quality and that this relationship would be mediated by loneliness and depression. Design A two-lave longitudinal online survey was used. Methods Participants completed an online survey at T1 (N = 387) and 1 year later at T2 (N = 122) assessing the extent to which they identified with their family. Their loneliness, depressive symptomology, and sleep quality/insomnia severity were also measured. Results Consistent with predictions, cross-sectional and longitudinal serial mediation models indicated that family identification was a negative predictor of loneliness, which in turn was a positive predictor of depression, which predicted poor sleep quality/insomnia. Conclusions This is the first Social Cure study to explore the mediated relationship between social identification and sleep quality. As well as advancing the Social Cure perspective, these results have implications for how health professionals understand, prevent, and treat sleep problems. Statement of contribution What is already known on this subject? The prevalence of depression and loneliness is increasing in Western nations, and both have been shown to cause poor sleep quality. Weak social networks have been shown to predict restless sleep over time, and that depressed mood mediates this relationship. What does this study add? Family identification negatively predicted poor sleep quality cross-sectionally. Depression and loneliness positively predicted poor sleep quality over time. Depression and loneliness mediated the family identification-sleep quality relationship over time.

The psychosocial impact of facial palsy: A systematic review.

Abstract: Purpose Facial palsy is a condition which can lead to significant changes in facial function and appearance. People with facial palsy often report psychosocial difficulties, including withdrawal from social activities, anxiety, negative body image, and low mood. This paper aimed to review all published research investigating the psychosocial impact of facial palsy on adults. Methods A systematic search of MEDLINE, CINAHL, EMBASE, PsycINFO, and AMED databases was performed. The quality of included studies was assessed, and data were extracted with regard to characteristics of participants; study methodology and design; outcome measures used; and psychosocial outcomes. Results Twenty-seven studies met inclusion criteria. A high proportion of people with facial palsy reported clinically significant levels of anxiety and depression, with greater difficulties typically reported by females, compared to males. Other difficulties consistently reported include low quality of life, poor social function, and high levels of appearance-related distress. Objective severity of facial palsy was consistently shown to not be associated with anxiety or depression, with psychological factors instead likely mediating the relationship between the severity of facial palsy and psychosocial well-being. Conclusions Irrespective of objective symptom severity, facial palsy has the potential to have a significant impact on psychosocial well-being and quality of life. The various methodological limitations of the included studies are discussed, along with clinical implications, including the need for greater access to psychological screening and interventions for people with facial palsy.

Developing quality fidelity and engagement measures for complex health interventions.

Abstract: Objectives To understand whether interventions are effective, we need to know whether the interventions are delivered as planned (with fidelity) and engaged with. To measure fidelity and engagement effectively, high-quality measures are needed. We outline a five-step method which can be used to develop quality measures of fidelity and engagement for complex health interventions. We provide examples from a fidelity study conducted within an evaluation of an intervention aimed to increase independence in dementia. Methods We propose five steps that can be systematically used to develop fidelity checklists for researchers, providers, and participants to measure fidelity and engagement. These steps include the following: (1) reviewing previous measures, (2) analysing intervention components and developing a framework outlining the content of the intervention, (3) developing fidelity checklists and coding guidelines, (4) obtaining feedback about the content and wording of checklists and guidelines, and (5) piloting and refining checklists and coding guidelines to assess and improve reliability. Results Three fidelity checklists that can be used reliably were developed to measure fidelity of and engagement with, the Promoting Independence in Dementia (PRIDE) intervention. As these measures were designed to be used by researchers, providers, and participants, we developed two versions of the checklists: one for participants and one for researchers and providers. Conclusions The five steps that we propose can be used to develop psychometrically robust and implementable measures of fidelity and engagement for complex health interventions that can be used by different target audiences. By considering quality when developing measures, we can be more confident in the interpretation of intervention outcomes drawn from fidelity and engagement studies. Statement of contribution What is already known on the subject? Fidelity and engagement can be measured using a range of methods, such as observation and self-report. Studies seldom report psychometric and implementation qualities of fidelity measures. What does this study add? A method for developing fidelity and engagement measures for complex health interventions. Guidance on how to consider quality when developing fidelity and engagement measures.

COVID-19: Concerns and behaviours in Croatia.

Abstract: OBJECTIVES: The COVID-19 pandemic has created uncertainty that has heightened fear and worry worldwide, thus elevating the potential for a growth in anxiety. This study aims to examine changes in levels of COVID-19 concern and safety behaviours among persons living in Croatia during the period in which the first COVID-19 case was identified and when the country recorded its first fatality. These changes were examined with respect to gender and family circumstances. DESIGN: The repeated cross-sectional data were conducted over two time points over the 3 weeks (N1 = 888; N2 = 966). METHODS: Participants completed online questionnaire regarding various COVID-19 concerns and safety behaviours aimed at disease prevention. RESULTS: Findings demonstrate dramatic increase in concern and safety behaviours among participants during the 3 weeks between the first identified case and the first fatality. The results suggest that parents, and mothers especially, represent the most concerned group, regardless of age. People with chronic health conditions also expressed greater concern and safety behaviour than healthy participants, but with small effect size. CONCLUSION: These findings highlight the importance of developing clear guidelines for alleviating the negative effects on mental health through effective communication strategies that minimize fear and emphasize positive behavioural change. Statement of contribution What is already known on this subject? In times of pandemic, people react with elevated levels of anxiety and some will adjust their behaviours in order to protect themselves as well as their family and friends. Some of the measures introduced to protect the spread of the COVID-19 disease have induced an atmosphere of fear, which in turn can lead to an increase in maladaptive anxiety and a greater burden on mental health. What does this study add? By conducting the research in two waves representing two critical time points in the developing COVID-19 situation in Croatia, we were able to trace a large increase in anxiety levels and safety behaviours among the general population. There is a discordance between those who are at most risk from serious consequences of the disease and those who are at greatest risk for maladaptive anxiety. Parents, and mothers in particular, represent the most concerned group, regardless of age. Lockdown measures have allowed us to ensure the safety of those vulnerable for serious COVID-19 illness. Now, we must focus on preserving the mental health of our whole community.

Reasoned action approach and compliance with recommended behaviours to prevent the transmission of the SARS-CoV-2 virus in the UK

Abstract: Objectives To examine associations between demographics, people's beliefs, and compliance with behaviours recommended by the UK government to prevent the transmission of the SARS-CoV-2 virus that causes COVID-19. Design A two-wave online survey conducted one week apart during the national lockdown (April, 2020). Measures A sample of 477 UK residents completed baseline measures from the reasoned action approach (experiential attitudes, instrumental attitudes, injunctive norms, descriptive norms, capacity, autonomy, and intention) and perceived susceptibility for each of the following recommended behaviours: limiting leaving home, keeping at least 2 m away from other people when outside and when inside shops, not visiting or meeting friends or other family members, and washing hands when returning home. Self-reported compliance with each of the recommended behaviours was assessed one week later. Results Rates of full compliance with the recommended behaviours ranged from 31% (keeping at least 2 m away from other people when inside shops) to 68% (not visiting or meeting friends or other family members). Capacity was a significant predictor of compliance with each of the five recommended behaviours. Increasing age and intentions were also predictive of compliance with three of the behaviours. Conclusions Interventions to increase compliance with the recommended behaviours to prevent the transmission of the SARS-CoV-2 virus, especially those relating to social distancing, need to bolster people's intentions and perceptions of capacity. This may be achieved through media-based information campaigns as well as environmental changes to make compliance with such measures easier. Such interventions should particularly target younger adults.

Development and validation of a 6-item Revised UCLA Loneliness Scale (RULS-6) using Rasch analysis.

Abstract: Objective The UCLA Loneliness Scale, containing 20 items, is one of the commonly used loneliness scales. Some shorter versions have been developed using factor analysis. The study aimed to shorten the UCLA Loneliness Scale using Rasch and factor analysis methods and test the psychometric properties of the new scale. Methods The full sample of the study included 719 respondents, divided into three subsamples (205, 324, and 190 for samples 1-3, respectively). The original, 20-item Revised UCLA Loneliness Scale (R-ULS) was shortened using 205 students (sample 1); the shortened scale was then validated for construct and concurrent validity with 324 students (sample 2) and 190 clinical participants (sample 3). Confirmatory factor analysis and Rasch analysis were used for construct validity. Convergent, discriminant, and concurrent validity were assessed by exploring the correlation with other psychological measurements. Results In sample 1, the R-ULS was shortened to a 6-item scale (RULS-6) that fits the Rasch model. The RULS-6 met the criteria of unidimensionality and local independence without differential item functioning due to age and sex, and good targeting the clinical sample. Person Separation Index (PSI) reflected that reliability from the Rasch perspective was acceptable. However, collapsing categories 2 (sometime) and 3 (rarely) may be required in a clinical sample. When tested in samples 2 and 3, the RULS-6 fits the Rasch measurement model. Convergent and discriminant validity were demonstrated with interpersonal problems and attachment scales. As expected, a positive correlation was found between RULS-6 and anxiety, depression subscale, interpersonal difficulties, and somatization subscales denoting concurrent validity. Cronbach's alpha of the RULS-6 was good (.83). Conclusion Using Rasch analysis, the proposed RULS-6 constituted a 70% reduction of the number of original items, yet preserved the psychometric properties in independent samples of students and psychiatric outpatients. Statement of contribution What is already known on this subject? The UCLA Loneliness Scale is a common instrument used to gauge loneliness levels. The 20-item revised scale (R-ULS) has acceptable psychometric properties but its construct varies. Due to the length of the questionnaire, administration of R-ULS is not always practical. Short versions vary in items and were developed with classic test theory (e.g., factor analysis). Rasch analysis - providing more accuracy based on measurement theory - could be used instead. What does this study add? Using a Rasch analysis approach, a 6-item scale of loneliness (RULS-6) was created. The RULS-6 was tested in student and clinical samples, meeting Rasch measurement model criteria. The RULS-6 showed promising psychometrics to be used in both non-clinical and clinical samples.

Environmental and psychological variables influencing reactions to the COVID-19 outbreak

Abstract: Objective The COVID-19 outbreak in Italy caused a major health emergency and high uncertainty. We studied how media outlets, risk perception, state anxiety, and emotion regulation impacted peoples' reactions and undertaking of protective behaviours aimed at reducing the spread of the virus. Design Data were collected in two cross-sectional waves (N = 992 at T1; N = 1031 at T2): at the beginning of the outbreak and once the national lockdown was imposed. Methods Participants completed online surveys on their perception of the COVID-19 outbreak. Moreover, they were asked to self-report on their emotion regulation, state anxiety, and protective behaviours. Results Media exposure and wave predicted risk perception. An interaction between wave, risk perception, and emotion regulation predicted the number of protective behaviours people undertook. Specifically, in the second wave, the number of protective behaviours was predicted by risk perception only among those who were ineffective at regulating emotions. Instead, effective regulators undertook the same number of behaviours regardless of their level of risk perception. In the second wave, we also found that the risk perception by emotion interaction predicting protective behaviours was mediated by state anxiety. Conclusions The present study provides important insights on how people experienced the early stages of the outbreak. This information could prove valuable in the coming months to understand who might have been more impacted by the stress caused by the COVID-19 pandemic and the consequent restrictive measures.

Preferences for scarce medical resource allocation: Differences between experts and the general public and implications for the COVID-19 pandemic.

Abstract: This study concerns what lay people believe is the best way to allocate scarce medical resources A sample of 515 individuals completed a short questionnaire asking them to rank-order eight different ethical positions with respect to the allocation of scarce resources They showed a strong preference for the 'saves most lives' and 'sickest first' options, with 'reciprocity' and a 'lottery' being least favoured There was a reasonable degree of unanimity amongst respondents and comparatively few correlations with individual difference factors such as demography The preference results are compared to expert recommendations (Emanuel et al, 2020, N Engl J Med, 382, 2049) made in light of the current coronavirus pandemic, and differences are highlighted Implications for scare medical resource allocations are discussed, and limitations of the study acknowledged

Women's experience of social media breastfeeding support and its impact on extended breastfeeding success: A social cognitive perspective.

Abstract: Objective This paper investigates the experiences of women using a social media Facebook group for breastfeeding support and attempts to explore whether it has aided in extended breastfeeding success. In addition, it aims to explore the value of social cognitive theory (SCT) in explaining these experiences. Design Exploratory, deductive approach. Methods Qualitative, audio-recorded, semi-structured interviews were conducted from eight women who were members of a private Facebook group'. Data were analysed using theoretical thematic analysis, and SCT was used as a theoretical lens through which the data were interrogated. Results A number of themes were identified from the women's experiences, with analysis uncovering the superordinate theme 'increased self-efficacy' which provided an understanding of how the group impacted women's experiences and aided them in breastfeeding success. The sub-themes of education, accessibility, online community, normalization, and extended goals provided a more detailed understanding of how self-efficacy was increased through group membership. Conclusion The symbiotic relationship between members of a social media group facilitates greater breastfeeding success and a longer duration of breastfeeding through the central concept of the SCT: reciprocal determinism. Therefore, it is posited that the SCT is a suitable theory of behaviour change which can potentially be used to develop interventions aiming to increase breastfeeding rates and duration.

'Barbed wire wrapped around my feet': Metaphor use in chronic pain.

Abstract: Objectives As there is no objective test for pain, sufferers rely on language to communicate their pain experience. Pain description frequently takes the form of metaphor; however, there has been limited research in this area. This study thus sought to extend previous findings on metaphor use in specific pain subgroups to a larger, heterogeneous chronic pain sample, utilizing a systematic method of metaphor analysis. Design Conceptual metaphor theory was utilized to explore the metaphors used by those with chronic pain via qualitative methodology. Methods An anonymous online survey was conducted which asked for the descriptions and metaphors people use to describe their pain. Systematic metaphor analysis was used to classify and analyse the metaphors used into specific metaphor source domains. Results Participants who reported chronic pain completed the survey (N = 247, age 19-78, M = 43.69). Seven overarching metaphor source domains were found. These were coded as Causes of Physical Damage, Common Pain Experiences, Electricity, Insects, Rigidity, Bodily Misperception, and Death and Mortality. Conclusions Participants utilized a wide variety of metaphors to describe their pain. The most common descriptions couched chronic pain in terms of physical damage. A better understanding of pain metaphors may have implications for improved health care communication and provide targets for clinical interventions.

Classism and dehumanization in chronic pain: A qualitative study of nurses’ inferences about women of different socio‐economic status

Abstract: Objectives Class-based dehumanization in health is poorly investigated. Beliefs about social class are often shared across cultures, with people of lower socio-economic status (SES) being typically dehumanized. This study specifically examined how nurses' perceptions of pain patients' SES were associated with (more or less) dehumanizing inferences about their pain and different treatment recommendations. Design Sequential mixed methods including Similitude Analysis (statistical analysis of qualitative data) and a Thematic Analysis. Fifty female nurses watched short videos of two white women of different SES (low vs. middle) and similar levels of pain behaviours. Afterwards, nurses were asked to complete (1) a Free Association Task (associating characteristics and a profession to the women) and (2) a Story-Completion Task (writing a story describing women's lives, pain, and recommending treatments). Data were analysed with Similitude and Thematic Analysis. Results The women's SES was recognized, linked to distinct professions, and associated with distinct inferences. The middle-SES woman was depicted with both Uniquely Human (e.g., autonomous) and Human Nature (e.g., communicative) traits, positive future prospects, and competence to self-manage pain. The low-SES woman was associated with Human Nature traits (hard-working) but denied Uniquely Human traits associated with competence; she was imagined as passive towards pain, with poor future prospects and referred to psychoeducation. Conclusion Findings reveal the role of class-based cultural belief systems in pain care, showing how nurses' recognition of low SES is associated with dehumanizing inferences and recommendations, which may contribute to reproducing pain care disparities. Theoretical implications of these findings for social and health psychology are drawn. Statement of contribution What is already known on the subject? • Psychosocial research on health and pain care disparities has paid more attention to the role of race/racism and gender/sexism than the role of social class/classism; Belief systems about social class are shared across cultures; people from lower SES are often dehumanized by being denied competence, civility, and self-determination; Class-based dehumanization may influence the relational and technical aspects of clinical encounters but little is still known about these processes. What does this study add? Drawing upon a mixed-methods approach, this study provides novel findings on class-based dehumanization inferences made by female nurses on female chronic pain patients; Nurses perceived the lower SES patient with fewer Uniquely Human traits, that is, less competent, with more pain-related disability, and recommended her more psychoeducation. Class-based dehumanization processes may contribute to reproducing pain care disparities and may prove to be important targets for intervention development.

Health and health belief factors associated with screening and help-seeking behaviours for breast cancer: A systematic review and meta-analysis of the European evidence.

Abstract: PURPOSE The aim of this systematic review was to identify health or health belief factors associated with mammography attendance or with self-initiated medical help-seeking for breast cancer symptoms among women in Europe. METHODS Five databases were searched for articles published between 2005 and 2018. Meta-analyses were conducted for 13 factors related to screening attendance and two factors associated with help-seeking behaviour. Where there were too few studies to include in the meta-analysis, a narrative synthesis was undertaken. RESULTS Sixty-five studies were included. Never having had cervical screening (d = -.72, p < .001) and higher perceived barriers to mammography (d = -.40, p < .001) were associated with lower levels of screening attendance. Possessing health insurance (d = .49, p < .001), greater perceived benefits (d = .31, p < .001) and motivation (d = .36, p = .003) towards screening, and higher perceived seriousness (d = .24, p = .019) and susceptibility (d = .20, p = .024) towards breast cancer were associated with a higher level of screening attendance. Presenting with a non-lump symptom was associated with a longer time to presentation (d = .32, p < .001). The narrative synthesis revealed that previous benign breast disease was associated with a higher level of screening attendance but with a longer time to presentation. CONCLUSIONS The review identified key similarities in factors associated with screening and help-seeking behaviours which offer scope for combined interventions aimed at women that target both behaviours. Furthermore, the review highlighted that fewer studies have focused on help-seeking behaviour, despite two thirds of breast cancer cases being self-detected. Future research should further examine predictors of help-seeking behaviour including a focus on modifiable factors, such as BMI, and physical activity.

Translating a walking intervention for health professional delivery within primary care: A mixed-methods treatment fidelity assessment

Abstract: Objectives: Existing fidelity studies of physical activity interventions are limited in methodological quality and rigour, particularly those delivered by health care providers in clinical settings. The present study aimed to enhance and assess the fidelity of a walking intervention delivered by health care providers within general practice in line with the NIH Behavior Change Consortium treatment fidelity framework. Design: Two practice nurses and six health care assistants delivered a theory-based walking intervention to 63 patients in their own practices. A cross-sectional mixed-methods study assessed fidelity related to treatment delivery and treatment receipt, from the perspectives of health care providers and patients. Methods: All providers received training and demonstrated delivery competence prior to the trial. Delivery of intervention content was coded from audio-recordings using a standardized checklist. Qualitative interviews with 12 patients were conducted to assess patient perspectives of treatment receipt and analysed using framework analysis. Results: Overall, 78% of intervention components were delivered as per the protocol (range 36-91%), with greater fidelity for components requiring active engagement from patients (e.g., completion of worksheets). The qualitative data highlighted differences in patients' comprehension of specific intervention components. Understanding of, and engagement with, motivational components aimed at improving self-efficacy was poorer than for volitional planning components. Conclusions: High levels of fidelity of delivery were demonstrated. However, patient-, provider-, and component-level factors impacted on treatment delivery and receipt. We recommend that methods for the enhancement and assessment of treatment fidelity are consistently implemented to enhance the rigour of physical activity intervention research. Statement of contribution What is already known on this subject? Physical activity interventions delivered within primary care by health professionals have so far demonstrated limited impact on behaviour change initiation and maintenance. Treatment fidelity enhancement and assessment strategies can support the successful translation of behaviour change interventions into real-life settings. Few studies have examined treatment fidelity within the context of physical activity interventions, particularly within clinical settings, and existing fidelity studies are limited by methodological quality and rigour. What does this study add? High levels of fidelity were found for a physical activity intervention delivered in primary care. Patient-, provider-, and component-level factors may impact on treatment delivery and receipt. The implementation of best practice fidelity recommendations can support near-optimal fidelity.