Showing papers in "British Journal of Health Psychology in 2021"

Resilience during uncertainty? Greater social connectedness during COVID-19 lockdown is associated with reduced distress and fatigue.

Abstract: Background Social connections are crucial for our health and well-being. This is especially true during times of high uncertainty and distress, such as during the COVID-19 lockdown. This period was characterized by unprecedented physical distancing (often communicated as social distancing) measures resulting in significant changes to people's usual social lives. Given the potential effects of this disruption on people's well-being, it is crucial to identify factors which are associated with negative health outcomes, and conversely, those that promote resilience during times of adversity. Aims We examined the relationship between individuals' levels of social connectedness during lockdown and self-reported stress, worry, and fatigue. Method Survey data were collected from 981 individuals in a representative sample of Austrian citizens. Data collection occurred during the last week of a six-week nationwide lockdown due to the COVID-19 pandemic. The final sample consisted of 902 participants. Participants were asked to complete validated questionnaires to assess levels of social connectedness as well as measures of perceived stress, worry-both general and COVID-19 specific-and symptoms of fatigue during the previous two weeks. Results Our results demonstrate that greater social connectedness during the lockdown period was associated with lower levels of perceived stress, as well as general and COVID-19-specific worries. Furthermore, we found a negative relationship between fatigue and social connectedness, which was mediated by feelings of stress, general worries, and COVID-19-specific worries-respectively, indicating that individuals with smaller network sizes, who were highly distressed during the pandemic, were also likely to report feeling more fatigued. Conclusion Our findings highlight the important role that social connections play in promoting resilience by buffering against negative physical and mental health outcomes, particularly in times of adversity in times of adversity.

Compliance without fear: Individual-level protective behaviour during the first wave of the COVID-19 pandemic.

Abstract: OBJECTIVES: The outbreak of the COVID-19 pandemic required rapid public compliance with advice from health authorities. Here, we ask who was most likely to do so during the first wave of the pandemic. DESIGN: Quota-sampled cross-sectional and panel data from eight Western democracies (Denmark, France, Germany, Hungary, Italy, Sweden, the United Kingdom, and the United States). METHODS: We fielded online public opinion surveys to 26,508 citizens between 19 March and 16 May. The surveys included questions about protective behaviour, perceptions of the pandemic (threat and self-efficacy), as well as broader attitudes towards society (institutional and interpersonal trust). We employ multilevel and fixed-effects regression models to analyse the relationship between these variables. RESULTS: Consistent with prior research on epidemics, perceptions of threat turn out as culturally uniform determinants of both avoidant and preventive forms of protective behaviour. On this basis, authorities could foster compliance by appealing to fear of COVID-19, but there may be normative and practical limits to such a strategy. Instead, we find that another major source of compliance is a sense of self-efficacy. Using individual-level panel data, we find evidence that self-efficacy is amendable to change and exerts an effect on protective behaviour. Furthermore, the effects of fear are small among those who feel efficacious, creating a path to compliance without fear. In contrast, two other major candidates for facilitating compliance from the social sciences, interpersonal trust and institutional trust, have surprisingly little motivational power during the first wave of the COVID-19 pandemic. CONCLUSIONS: To address future waves of the pandemic, health authorities should thus focus on facilitating self-efficacy in the public.

Explaining the rise and fall of psychological distress during the COVID-19 crisis in the United States: Longitudinal evidence from the Understanding America Study.

Abstract: Objectives It has been shown that psychological distress rose rapidly as the COVID-19 pandemic emerged and then recovered to pre-crisis levels as social lockdown restrictions were eased in the United States. The aim of the current study was to investigate psychosocial and behavioural factors that may explain the rise and fall of distress during the initial months of the COVID-19 crisis. Design This study examined six waves of longitudinal nationally representative data from the Understanding America Study (UAS) collected between March and June 2020 (N = 7,138, observations = 34,125). Methods Mediation analysis was used to identify whether changes in distress (PHQ-4) during the COVID-19 pandemic were explained by the following factors: perceived infection risk and risk of death, perceived financial risks, lifestyle changes resulting from the virus, perceived discrimination related to the virus, and changes in substance use and employment status. Results All mediating factors played a role in explaining changes in distress and together accounted for 70% of the increase in distress between 10-18 March and 1-14 April and 46.4% of the decline in distress between 1-14 April and early June 2020. Changes in perceived health risks were most important in explaining changes in distress followed by changes in lifestyle and the perceived financial risks associated with COVID-19. Conclusions This study provides longitudinal population-based evidence detailing the mediating factors explaining changes in distress during the COVID-19 crisis. Perceived health risks associated with the virus may play a key role in explaining rising and falling levels of psychological distress during the COVID-19 pandemic.

Health behaviour change during the UK COVID-19 lockdown: Findings from the first wave of the C-19 health behaviour and well-being daily tracker study.

Abstract: OBJECTIVES: To provide baseline cohort descriptives and assess change in health behaviours since the UK COVID-19 lockdown. DESIGN: A prospective cohort (N = 1,044) of people recruited online, purposively targeting vulnerable populations. METHODS: After a baseline survey (April 2020), participants completed 3 months of daily ecological momentary assessments (EMA). Dietary, physical activity, alcohol, smoking, vaping and substance use behaviours collected retrospectively for the pre-COVID-19 period were compared with daily EMA surveys over the first 30 days during early lockdown. Predictors of behaviour change were assessed using multivariable regression models. RESULTS: 30% of the cohort had a COVID-19 at risk health condition, 37% were classed as deprived and 6% self-reported a mental health condition. Relative to pre-pandemic levels, participants ate almost one portion of fruit and vegetables less per day (vegetables mean difference -0.33, 95% CI -0.40, -0.25; fruit -0.57, 95% CI -0.64, -0.50), but showed no change in high sugar portions per day (-0.03, 95% CI -0.12, 0.06). Participants spent half a day less per week doing ≥30 min of moderate to vigorous physical activity (-0.57, 95% CI -0.73, -0.40) but slightly increased days of strength training (0.21, 95% CI 0.09, 0.34), increased alcohol intake (AUDIT-C score change 0.25, 95% CI 0.13, 0.37), though did not change smoking, vaping or substance use behaviour. Worsening health behaviour change was associated with being younger, female and higher body mass index. CONCLUSIONS: The cohort reported worsening health behaviours during early lockdown. Longer term changes will be investigated using further waves of data collection.

Determinants of physical activity among adults in the United Kingdom during the COVID-19 pandemic: The DUK-COVID study.

Abstract: Objectives This study examined the impact of the COVID-19 lockdown on the physical activity (PA) of UK adults and potential motivational determinants of such behaviour. Design and methods A survey was conducted with 1,521 UK adults recruited through Prolific.co in early June 2020. Along with demographic information, questions assessed current PA, changes in PA modalities (i.e., overall, around the home, for transport, in the workplace, in the local neighbourhood, at recreation/sport facilities) related to the lockdown, and beliefs about capabilities, opportunities, and motivations according to the COM-B model. A series of logistic regressions were constructed to examine associations between shifts in the PA modalities and the COM-B components. Results The majority of respondents (57%) had either maintained or increased their levels of PA during the COVID-19 lockdown. However, the proportion meeting PA guidelines (31%) was low and engagement in sedentary-related behaviour for both work and leisure increased substantially during the lockdown. The components of the COM-B model were associated with shifts in PA. In particular, physical opportunity (odds ratios ranging from 1.14 to 1.20) and reflective motivation (odds ratios ranging from 1.11 to 1.25) appeared to be the most consistent predictors of behaviour. Conclusions If UK adults believed they had the physical opportunity and were motivated, they were more likely to have maintained or increased their PA during the COVID-19 lockdown. However, the majority of adults are not meeting the UK guidelines on PA and the prevalence of PA is substantially lower than national surveys prior to the pandemic. Statement of contribution What is already known on this subject? The COVID-19 pandemic has significantly disrupted the daily routines of citizens globally. Engagement in physical activity appears to have declined as a result of the requirement to self-isolate and stay in place. The COM-B model of behaviour change is a useful framework for identifying the correlates and determinants of behaviour. What does this study add? Though most UK adults maintained or increased their engagement in physical activity during the COVID-19 pandemic, the majority did not meet recommended guidelines. Reflective processes and physical opportunity were the primary predictors of change in physical activity.

Stockpiling in the time of COVID-19.

Abstract: Objectives Consistent with behaviour observed in prior crises, individuals are stockpiling supplies during the novel coronavirus (COVID-19) pandemic. The goal of this study was to describe stockpiling behaviour in response to COVID-19 and investigate individual predictors of stockpiling. Methods Workers (N = 363, 54.72% male, 44.65% female, 0.63% other; Mage = 38.41, SD = 12.48, range = 18-78) were recruited from Amazon's Mechanical Turk and completed a survey about their stockpiling of 13 items, as well as behaviours and opinions surrounding the COVID-19 pandemic and their political affiliation. Results Participants stockpiled, on average, approximately 6 items, and toilet paper was the item most commonly procured. Approximately 25% of the sample acquired a gun or other weapon in response to the pandemic and approximately 20% of participants stockpiled gold or other precious metals. Stockpiling was more commonly observed among individuals who were more conservative, worried more about the pandemic, and social distanced less. Conclusions Individual, societal, and ideological implications are discussed.

Efficacy information influences intention to take COVID-19 vaccine.

Abstract: Objectives A successful response to the COVID-19 pandemic requires achieving high levels of vaccine uptake. We tested whether directly contrasting the high efficacy of COVID-19 vaccines with the lower efficacy of the annual flu vaccine would increase intentions to take a COVID-19 vaccine. Design A pre-registered online study of 481 participants compared four information conditions: (1) no information; (2) COVID-19 Vaccine Information Only; and COVID-19 Vaccine Information combined with flu vaccine information suggesting either (3) 60% efficacy or (4) 40% efficacy; we measured COVID-19 and flu vaccine intentions along with several other vaccine-related variables. Methods The Prolific platform was used to recruit 481 UK participants (64% female; aged between 18 and 85 years) who had been pre-screened to have intermediate levels of vaccine hesitancy. After reading a short text (~200 words) about COVID-19 vaccines, participants were asked about their vaccination intentions. Results Providing information about the safety and efficacy of the new COVID-19 vaccines resulted in vaccination intentions that were, on average, 0.39 standard deviations (SDs) higher than those in the no information condition; providing the same COVID vaccine efficacy information in the context of information about flu vaccine efficacy resulted in a further significant increase in vaccination intentions that were 0.68 SD higher than those in the no information condition. This positive contrast effect for the COVID-19 vaccine was not associated with reduced flu vaccine intentions. Conclusions Vaccination intentions can be strengthened through a simple messaging intervention that utilizes context effects to increase perceived response efficacy.

Psychological, social, and situational factors associated with COVID-19 vaccination intentions: A study of UK key workers and non-key workers.

Abstract: OBJECTIVES: Vaccine hesitancy is a growing concern and threat to public health. This research will begin to examine the relative influence of relevant psychological, social, and situational factors on intent to engage with a hypothetical COVID-19 vaccine among key workers and non-key workers. DESIGN: Cross-sectional. METHODS: The study utilized a sample of UK adults who completed the 1-month follow-up of The COVID-19 Psychological Wellbeing Study during April/May 2020 and indicated having not been previously diagnosed with COVID-19 (key workers n = 584; not key workers n = 1,021). These groups were compared in relation to their intentions to vaccinate, perceived risk of infection, and symptom severity. Binary logistic regression was used to examine predictors of vaccine hesitancy. RESULTS: Overall, 74.2% of the sample (76.2% key workers, 73.1% non-key workers) indicated they would accept a COVID-19 vaccine in future. Key workers (in particular health and social care workers) had a higher perceived risk of becoming infected in the coming months. For key workers, being female and perceiving oneself as having relatively low infection risk in the next 6 months was associated with increased likelihood of vaccine hesitancy. For non-key workers, however, being aged 25-54, having a low or average income and not knowing someone diagnosed with COVID-19 were associated with hesitancy. CONCLUSIONS: The proportion of individuals willing to accept a vaccine is encouraging but there is much room for improvement. Given the unique predictors of vaccine hesitancy in each group, public health campaigns may benefit from targeted messaging.

Evolution of physical activity habits after a context change: The case of COVID-19 lockdown.

Abstract: OBJECTIVE: Habits, defined as well-learned associations between cues and behaviours, are essential for health-related behaviours, including physical activity (PA) Despite the sensitivity of habits to context changes, little remains known about the influence of a context change on the interplay between PA habits and behaviours We investigated the evolution of PA habits amidst the spring COVID-19 lockdown, a major context change Moreover, we examined the association of PA behaviours and autonomous motivation with this evolution DESIGN: Three-wave observational longitudinal design METHODS: PA habits, behaviours, and autonomous motivation were collected through online surveys in 283 French and Swiss participants Variables were self-reported with reference to three time-points: before-, mid-, and end-lockdown RESULTS: Mixed effect modelling revealed a decrease in PA habits from before- to mid-lockdown, especially among individuals with strong before-lockdown habits Path analysis showed that before-lockdown PA habits were not associated with mid-lockdown PA behaviours (s = -02, p = 837), while mid-lockdown PA habits were positively related to end-lockdown PA behaviours (s = 23, p = 021) Autonomous motivation was directly associated with PA habits (ps 072) CONCLUSION: PA habits were altered, and their influence on PA behaviours was impeded during the COVID-19 lockdown Engagement in PA behaviours and autonomous motivation helped in counteracting PA habits disruption

Chronic pain in the time of COVID-19: Stress aftermath and central sensitization.

Abstract: Objectives The COVID-19 crisis is a significant stressor worldwide. The physical and emotional condition of individuals with pain sensitization syndromes who are experiencing the pandemic may worsen. This study investigated the contribution of life changes due to the coronavirus to emotional distress in individuals with a diagnosis of chronic central sensitization pain and tested whether the associations between level of pain and sensitization were independent of or mediated by emotional distress. Methods Spanish individuals with chronic pain (N = 362) completed an online survey on direct or indirect exposure to the consequences of COVID-19, pain intensity, and emotional distress. They also completed central sensitization questionnaires. Results An association was found between changes in daily routines and pain intensity, emotional distress, and sensitization scores. Correlations were found between emotional distress, sensitization, and pain intensity. Significant predictors of emotional distress were age, difficulty in receiving medical care, changes in daily routines, and diminished social support. Emotional distress did not mediate the association between sensitization and pain intensity. Conclusion Due to the COVID-19 situation, individuals with central sensitization pain syndromes may be at higher risk of developing psychological distress. Interdisciplinary interventions involving psychologists are urgently needed to provide this population with appropriate health care.

Determinants of protective behaviours during a nationwide lockdown in the wake of the COVID-19 pandemic.

Abstract: OBJECTIVES: Without pharmaceutical measures available, endorsement of protective behaviours, such as hygiene behaviours, social distancing, and adherence to recommended behaviours in case of symptoms is of key importance to curb the ongoing COVID-19 pandemic. Based on an extended version of the protection motivation theory, this study examined the role of perceived risks to oneself and to others, self-efficacy, response efficacy, and perceived social norms for intentions to and the endorsement of several protective behaviours and alternative behaviours known to be ineffective. Further, it was hypothesised that effects of risk perceptions depended on high levels of self-efficacy. DESIGN: Data were collected by telephone at the beginning of the lockdown in Switzerland with a large sample (N = 1,009) representative of the adult Swiss population. METHODS: All predictors (self-efficacy, response efficacy, perceived social norms, intentions) but risk perceptions were assessed for hygiene behaviours, social distancing, adherence to recommended behaviours in case of symptoms, and alternative measures known to be ineffective. RESULTS: Across all analyses of intentions for and endorsement of protective and alternative behaviours, response efficacy and self-efficacy emerged as the most important predictors. Social norms were mainly related to intentions, but not to behaviours. The different risk perceptions were rarely and inconsistently related to intentions and behaviours. No consistent pattern of interactions between self-efficacy and risk perceptions emerged. CONCLUSION: This study demonstrates that even in the face of a pandemic of an unknown virus, the resources (self-efficacy, response efficacy) rather than the risk perceptions have the potential to promote protective behaviours.

Pro-vaccination subjective norms moderate the relationship between conspiracy mentality and vaccination intentions.

Abstract: This research was funded by a grant of the Deutsche Forschungsgemeinschaft (DFG, #SA800/17-1) awarded to Kai Sassenberg and Matthew J. Hornsey.

Habit formation following routine-based versus time-based cue planning: A randomized controlled trial

Abstract: OBJECTIVES: Habit formation has been identified as one of the key determinants of behaviour change. To initiate habit formation, self-regulation interventions can support individuals to form a cue-behaviour plan and to repeatedly enact the plan in the same context. This randomized controlled trial aimed to model habit formation of an everyday nutrition behaviour and examined whether habit formation and plan enactment differ when individuals plan to enact their behaviour in response to a routine-based versus time-based cue. DESIGN: Following a baseline assessment, N = 192 adults (aged 18-77 years) were randomly assigned to a routine-based cue or a time-based cue planning intervention, in which they selected an everyday nutrition behaviour and linked it to a daily routine or a time cue. METHODS: Participants responded to daily questionnaires over 84 days assessing plan enactment and the behaviour's automaticity (as an indicator of habit formation). Multilevel models with days nested in participants were fitted. RESULTS: As indicated by asymptotic curves, it took a median of 59 days for participants who successfully formed habits to reach peak automaticity. Group-level analyses revealed that both routine-based and time-based cue planning led to increases in automaticity and plan enactment, but no between-condition differences were found. Repeated plan enactment was a key predictor for automaticity. CONCLUSIONS: Linking one's nutrition behaviour to a daily routine or a specific time was similarly effective for habit formation. Interventions should encourage persons to repeatedly carry out their planned behaviour in response to the planned cue to facilitate habit formation.

Longitudinal associations of meaning in life and psychosocial adjustment to the COVID-19 outbreak in China

Abstract: Objective Literature suggests that 'meaning in life' may be a mental strength that enables individuals to function healthily and adaptively in the face of stress events. Therefore, this study aims to examine the longitudinal associations between meaning in life and psychosocial adjustment to the COVID-19 outbreak among Chinese people. Methods A prospective design was adopted. 154 Chinese college students (Mean age = 20.41 ± 1.45 years) completed two waves of the assessment. Participants reported their meaning in life before the outbreak (Time 1) and their psychosocial adjustment 7 weeks later after the outbreak had occurred (Time 2). Results Participants' meaning in life at Time 1 was positively related to life satisfaction and negatively related to depression, anxiety, stress, and negative emotions at Time 2. Additionally, levels of meaning in life at Time 1 were positively associated to COVID-19-related behavioural engagement - prosocial behaviour and information addiction at Time 2. Individuals' perceptions of the outbreak and status of self-quarantine did not moderate these relationships. Conclusion Findings suggest that individuals' prior level of meaning in life may help them maintain a healthy psychosocial adjustment during disease outbreak, though cautions regarding the possibility to render an addiction to information about the outbreak are warranted.

Mental health of Italian adults during COVID-19 pandemic.

Abstract: OBJECTIVES: On 31 January 2020, a new type of coronavirus was first confirmed in Italy and spread rapidly across the country leading to a national lockdown. The aim of this pilot study was to explore the impact of the public health emergency due to COVID-19 on individual's mental health among 299 Italian adults after a month of home isolation due to COVID-19. DESIGN: Cross-sectional study design. Adults of the general population were invited to a voluntary online health survey. METHODS: Hierarchical multiple regressions were used to examine diverse psycho-social and stressful contextual factors associated with symptoms of psychopathology. RESULTS: Results indicated that females reported higher symptoms of depression, anxiety and circadian rhythm dysregulation, than males. Age and the capacity to adapt to a new environment and to cope with illness were negatively associated with all symptoms of psychopathology. Conversely, engaging in verbally aggressive behaviours and having experienced stressful events related to COVID-19 were positively related to psychopathological symptoms. Finally, social support was negatively associated with depressive symptoms, and substance use during the past months was related to circadian rhythm dysregulation. CONCLUSIONS: The findings of this study raise particular concern about psychological well-being considering the negative associations between stressful events during the COVID-19 pandemic, symptoms of psychological distress, and perceived social support. These results have possible significant clinical implications.

Parallel worlds and personified pain: A mixed-methods analysis of pain metaphor use by women with endometriosis

Abstract: Objectives Endometriosis is a long-term condition in which endometrial-like tissue grows outside of the womb, causing intense chronic pain. Previous work has demonstrated the physical and emotional impact on women who live with endometriosis, and metaphors can play an influential role in communicating the experience of pain, but there exists little understanding of the role and impact of such language for women with endometriosis. Design A qualitative, semi-structured interview design. Methods Conceptual Metaphor Theory (CMT) and Interpretative Phenomenological Analysis (IPA) were utilized in a mixed-methods study to examine the prevalence, types, and meaning of metaphors and metaphor use as a health communication strategy. Twenty-one women aged between 23 and 53 years (mean age 36.1 years) with endometriosis took part in audio-recorded interviews. Results The women reported experiencing symptoms for an average of 11 years before receiving a formal diagnosis of endometriosis, and the mean age of diagnosis was 27.6 years. Seven distinct conceptual metaphors were identified in 221 metaphorical expressions used across all participants, with most common ones referring to pain as physical properties of elements such as temperature and pressure, physical damage, and an external attacker. IPA revealed three themes pertaining to the feeling of vulnerability and helplessness, pain being incomprehensible, and a drive to manage and conceal pain simultaneously. Conclusions This study demonstrates the power of language in facilitating understanding and empathy in the listener, alongside the challenge of communicating endometriosis pain to others. Imagery-based techniques may assist in adaptation to, interpretation, and acceptance of pain to reduce pain-related distress.

Hedonic and eudaimonic well-being during the COVID-19 lockdown in Italy: The role of stigma and appraisals.

Abstract: OBJECTIVES: This study examines perceived and anticipated stigma towards infected people, threat and impact appraisals of the COVID-19 pandemic as well as distressing personal experiences related to the virus in order to determine the extent to which they directly and indirectly predict hedonic and eudaimonic well-being. Investigated experiences included exposure to COVID-19-related news, having being in close proximity to people with a COVID-19 diagnosis or with COVID-19-like symptoms, having being sick or having suffered COVID-19-like symptoms, having tested negative for COVID-19. METHODS: Adults from northern Italy (n = 326; M age = 29.86) provided cross-sectional data through an online survey during the nationwide lockdown period. Structural equation modelling analyses were conducted. RESULTS: Perceived and anticipated stigma, exposure to COVID-19 news, perceived threat and impact on material resources access were negatively and indirectly related to both hedonic and eudaimonic well-being via perceived COVID-19 psychological impact which served as a mediator. Perceived stigma was also directly and negatively related to hedonic and eudaimonic well-being, whereas having tested negative for COVID diagnosis was positively and directly associated with eudaimonic well-being. CONCLUSIONS: COVID-19-related stigma and appraisals can impair positive feelings about life as well as the pursuit of self-realization and the search for meaning in life. The findings highlight the importance of developing psychological preventive and rehabilitative interventions to help people cope with these risk factors.

Ready Exerciser One: Effects of music and virtual reality on cycle ergometer exercise

Abstract: Objectives: Physical inactivity remains a major global health concern and researchers have been encouraged to explore the role of technology in the promotion of physical activity. Technologies that deliver audio-visual stimuli are frequently applied in the exercise domain. However, there is a paucity of research that examines the efficacy of modern virtual reality (VR) technology in this context. We investigated the effects of VR and music on affective, perceptual, enjoyment, and cardiac responses to aerobic-type exercise. Design: A fully counterbalanced, within-subjects design was employed. Methods: A convenience sample of recreationally active adult volunteers (N = 24) completed a 12-min protocol during which they exercised under music, VR, VR-with-music, and control conditions. Results: Analyses indicated a Condition × Time interaction for affective valence and perceived activation. Moreover, a main effect of condition emerged for state attention and perceived enjoyment. The VR and VR-with-music conditions elicited the most positive affective valence, highest levels of perceived activation, greatest number of dissociative thoughts, and most exercise enjoyment. Differences between these two conditions were negligible across the breadth of dependent variables. Conclusions: The present findings illustrate the efficacy of modern VR technology in the exercise context, applied both with and without musical accompaniment. Additional research is required to assess the degree to which the findings are replicable among sedentary or ageing segments of the population. Given the emerging support pertaining to a positive relationship between affective responses and exercise adherence, VR technology should be considered as a means by which to promote an enjoyable exercise experience.

Investigating which behaviour change techniques work for whom in which contexts delivered by what means: Proposal for an international collaboratory of Centres for Understanding Behaviour Change (CUBiC).

Abstract: PURPOSE: Behaviour change techniques are fundamental to the development of any behaviour change intervention, but surprisingly little is known about their properties. Key questions include when, why, how, in which contexts, for which behaviours, in what combinations, compared with what, and for whom behaviour change techniques are typically effective. The aims of the present paper are to: (1) articulate the scope of the challenge in understanding the properties of behaviour change techniques, (2) propose means by which to tackle this problem, and (3) call scientists to action. METHODS: Iterative consensus (O'Connor et al., 2020, Br. J. Psychol., e12468) was used to elicit and distil the judgements of experts on how best to tackle the problem of understanding the nature and operation of behaviour change techniques. RESULTS: We propose a worldwide network of 'Centres for Understanding Behaviour Change' (CUBiC) simultaneously undertaking research to establish what are the single and combined properties of behaviour change techniques across multiple behaviours and populations. We additionally provide a first attempt to systematize an approach that CUBiC could use to understand behaviour change techniques and to begin to harness the efforts of researchers worldwide. CONCLUSION: Better understanding of behaviour change techniques is vital for improving behaviour change interventions to tackle global problems such as obesity and recovery from COVID-19. The CUBiC proposal is just one of many possible solutions to the problems that the world faces and is a call to action for scientists to work collaboratively to gain deeper understanding of the underpinnings of behaviour change interventions.

'Oh no, not a group!' The factors that lonely or isolated people report as barriers to joining groups for health and well-being.

Abstract: Objectives: Belonging to groups can significantly affect people’s health and well-being for the better (‘the social cure’) or worse (‘the social curse’). Encouraging people to join groups is a central component of the Social Prescribing movement; however, not everyone who might benefit from Social Prescribing aspires to participating in groups. This study aims to identify what barriers are preventing people from experiencing the associated health and well-being benefits of group belonging. Method: Semi-structured interviews analysed using reflexive thematic analysis. Participants were 11 white British people (aged 48-86), 1 male and 10 female, recruited by a charity partner of a Social Prescribing project. Results: The themes derived from the interviews are as follows: (1) ‘The dread, the fear of being in a group’: When groups do not meet needs; (2) ‘I can remember as quite a young child backing out of things’: Accumulative barriers over the lifetime, and (3) ‘I’m singing away and feeling terribly miserable’: the challenges of fitting in with others in groups. The themes reflect how people can feel deterred from social interaction, which interferes with their ability to derive a sense of belonging or shared identity associated with the ‘social cure’. Conclusions: A key challenge for Social Prescribing is to meet the social needs of people disinclined to join groups; groups can be detrimental to health and well-being if there are barriers to integration. Alternative ways of structuring groups or activities may be more effective and can still avail of the belonging and identity associated with ‘the social cure’.

Using behavioural theory to understand adherence to behaviours that reduce transmission of COVID-19; evidence from the CHARIS representative national study.

Abstract: OBJECTIVES: To examine the ability of four models of behaviour, namely, Protection Motivation Theory (PMT), the Common Sense Self-Regulation Model (CS-SRM), and Social Cognitive Theory and the Reasoned Action Approach (SCT and RAA) to understand adherence to transmission-reducing behaviours (TRBs) advised by national governments for suppression of SARS-CoV2. DESIGN: A series of six cross-sectional telephone surveys of a random representative sample of adults living in Scotland. METHODS: Self-reported adherence to three TRBs (physical distancing, wearing a face covering and handwashing), PMT, CS-SRM, and SCT/RAA constructs, and sociodemographic variables were measured each week for 6 weeks (n = ~500 p/w; third June-15th July) via a 15 min telephone survey. RESULTS: Adherence was high ('Always' or 'Most times') throughout for physical distancing and handwashing, and, when mandated, for wearing a face covering. Older people were more adherent to all TRBs. Constructs from all three models predicted all three TRBs. Intention and self-efficacy (SCT/RAA) were the only beliefs to predict to all three TRBs each week and for all groups equally; intention was the strongest predictor. The predictive utility of PMT and CS-SRM varied by TRB and by group. Of note was the observation that several illness beliefs were associated with adherence only for those who believed they had not had COVID-19. CONCLUSIONS: The CHARIS project has identified beliefs about specific behaviours, the illness and the risks associated with lower adherence rates that might be addressed in national interventions. It confirms previous findings that some groups show lower levels of adherence and might be specially targeted.

Therapists' perceptions of barriers and facilitators to uptake and engagement with therapy in long-term conditions.

Abstract: Objective Improving Access to Psychological Therapies (IAPT) services in England have established a long-term condition (LTC) pathway in recent years, meaning that LTC therapies are now delivered via varied modes and by professionals with varied experiences. To gain insight into how this new pathway is functioning in practice, this study aimed to explore therapists' perceptions of barriers and facilitators to uptake and engagement with therapy in LTCs. Design A qualitative design was employed using semi-structured interviews. Methods Fifteen therapists were recruited from IAPT and physical health care settings. Interviews were first analysed using inductive thematic analysis. A deductive approach was then taken to map themes onto Normalisation Process Theory constructs (coherence, cognitive participation, collective action, reflective monitoring) to guide steps towards improving implementation. Results Four key themes highlighted patient, therapist, and service-level factors related to uptake and engagement: Working flexibly with barriers within the National Health Service context; Acceptability of 'embedded' versus 'separate' psychological care; Confidence in working with people with LTCs; and Navigating implementation of online therapies. Therapists recognized the need for tailored LTC therapies, though opinions about online therapies varied. Therapists expressed commitment to flexibly adapting their practice to suit patient needs, but felt their flexibility was limited by system and service constraints. Conclusion Barriers to uptake and engagement need to be addressed to optimize LTC pathways. Findings demonstrated the importance of offering flexible, tailored therapy to people with LTCs, and equipping staff and services with adequate training and resources to improve functioning of LTC pathways in practice.

Living with persistent insomnia after cancer: a qualitative analysis of impact and management

Abstract: Objectives To conduct a qualitative exploration of the lived experience of insomnia disorder and its management amongst a sample of mixed-diagnoses cancer survivors. Methods Twenty-seven cancer survivors with persistent insomnia were recruited to this qualitative study following completion of treatment for breast (12), prostate (7), colorectal (7), and gynaecological (1) cancers. Eleven males and 16 females (mean age 62 years), who met DSM-5 criteria for insomnia disorder, contributed to one of four focus group discussions, designed to explore the lived experience of persistent insomnia and its management within cancer care services. Results Poor sleep was a persistently troubling complaint for participants, long after the completion of active cancer treatment. The impact of insomnia was significant for all participants, with six key domains emerging as those most affected: temperament, sociability, physical well-being, cognitive functioning, relationships, and psychological well-being. In terms of insomnia management, participants frequently resorted to unfruitful self-management strategies, due to the lack of professional insomnia expertise within cancer care settings. Three main themes emerged in relation to insomnia management: self-management, seeking professional intervention, and a lack of focus on sleep. A lack of clinician understanding of the importance of sleep health and the poor availability of evidence-based insomnia interventions, such as cognitive behavioural therapy for insomnia (CBT-i), were highlighted as important gaps in cancer care. Conclusions Insomnia was found to have a detrimental and pervasive impact on cancer survivors' quality of life, which persisted long into survivorship. There is an absence of professional attention to sleep throughout the cancer care trajectory, contributing to its prevalence, persistence, and impact. In order to break this cycle, sleep health should be integrated as a key aspect of cancer treatment and rehabilitation, much like maintaining a healthy diet and appropriate levels of physical activity.

How do we harness adolescent values in designing health behaviour change interventions? A qualitative study

Abstract: Objectives Adolescent health behaviours do not support optimal development. Adolescents are reportedly difficult to engage in health behaviour improvement initiatives. Little is known about what adolescents value in relation to diet and physical activity or how best to target these in health interventions. This study explored adolescents' values in relation to diet and physical activity and how these values can inform health intervention design. Design Qualitative semi-structured interviews explored adolescents' lives, what they thought about diet and physical activity and what might support them to improve their health behaviours. Methods A total of 13 group interviews were conducted with 54 adolescents aged 13-14 years, of whom 49% were girls and 95% identified as White British. Participants were recruited from a non-selective secondary school in a large southern UK city. Inductive thematic analysis was used to identify key adolescent values. Results Adolescents valued being with their friends, doing what they enjoyed and were good at; being healthy was important to them but only if achievable without compromising other things that are important to them. The need to be healthy was not aligned with adolescents' basic psychological needs, nor their strongly held priorities and values. Conclusions Health is not a motivating factor for adolescents; therefore, interventions designed solely to improve health are unlikely to engage them. Instead, interventions that align with the values and priorities specified by adolescents are more likely to be effective in supporting them to eat well and be more active.

Habits and self-efficacy moderate the effects of intentions and planning on physical activity.

Abstract: Objectives Behavioural intentions as well as action planning can facilitate the adoption and maintenance of physical activity under certain conditions The present study examined levels of plan-specific self-efficacy and habit strength as possible conditions that may modify this relationship Design As a secondary analysis of a larger randomized trial to improve physical activity, n = 225 recipients of a planning intervention were followed up at five measurement points over one year Methods Two-level models were fit Within-person levels, that is, fluctuations of intention and action planning around person means, were modelled to predict self-reported moderate-to-vigorous physical activity Moreover, between-person, that is, average person, levels of self-efficacy and habit strength were specified as putative moderators of this relationship Results The within-person intention-activity relationship was moderated by between-person levels of habit strength, yielding a compensatory effect: higher-than-usual intention predicted physical activity only when average activity habit levels were low The within-person planning-activity relationship was moderated by between-person levels of self-efficacy, yielding a synergistic effect: higher-than-usual planning combined with high average self-efficacy resulted in highest physical activity levels Conclusion Higher-than-usual intention may only be required in the presence of low activity habits Moreover, high self-efficacy seems to be required to translate higher-than-usual action planning into augmented physical activity because self-efficacious individuals may invest more efforts to enact their plans

Psychosocial needs of adolescents and young adults with eczema: A secondary analysis of qualitative data to inform a behaviour change intervention.

Abstract: Objectives: This study aimed to explore adolescents and young adults’ experiences of symptoms related to their eczema in order to determine their psychosocial needs. Design: A secondary qualitative analysis of two data sources collected through semi‐structured interviews for two different projects, SKINS project and Eczema Care Online project. Methods: In total, there were 28 transcripts with adolescents and young adults with eczema having a mean age of 19.5 years available to analyse. Interview data were collected from face‐to‐face interviews that were recorded and transcribed. Inductive thematic analysis explored data about symptoms and organized according to psychosocial needs. Results: Adolescents and young adults with eczema experience both visible symptoms (such as flaky, dry, and inflamed skin) and invisible symptoms (such as itch, pain, exhaustion, and mental distress) that elicit different psychosocial needs. These psychosocial needs are to (i) be understood; (ii) be perceived as normal; and (iii) receive emotional support. Interviewees described a struggle between wanting their peers and family to understand but take their eczema seriously whilst not wanting to stand out and instead to be perceived as ‘normal’, which they would define as being perceived as other adolescents. This has implications on behaviours, such as seeking support, avoiding going out, hiding their skin, as well as emotional implications, such as social isolation and feeling anxious and low. Conclusions: Having a better understanding of young people’s experiences and psychosocial needs will provide a framework on how best to support adolescents and young adults when managing symptoms related to eczema.

The influence of context stability on physical activity and sedentary behaviour habit and behaviour: An ecological momentary assessment study.

Abstract: Objectives This study used ecological momentary assessment (EMA) to empirically test the theoretical propositions that habit for and level of physical activity (PA) and sedentary behaviour (SB) should be associated with degree of context stability of those behaviours. Design Older adults (N = 104) completed a 10-day EMA protocol and continuous accelerometer monitoring. Methods As part of the EMA protocol older adults answered 6 EMA prompts per day to assess current behaviour as well as social and physical contexts of behaviour. Temporal context was determined via time stamps of EMA questionnaires. Context stability was calculated as the reversed entropy scores of the contexts (physical, social, temporal, behavioural [i.e., type]) of PA and SB weighted for total frequency of context prompts. Habit for PA and SB (operationalized as self-reported behavioural automaticity) was assessed via baseline questionnaire. An ActivPAL monitor was worn to assess average daily time spent in moderate-vigorous PA (MVPA), light PA, and SB, and number of sit-to-stand transitions. Results More stable physical contexts for physical activity predicted more MVPA (β = 10.22) and more stable social contexts for sitting predicted more SB (β = 1.36). More variety of time people tended to report engaging in SB, the more SB engaged in (β = -13.76). No context stability scores predicted light PA, sit-to-stand transitions, or habit. Conclusions Although context stability was related to behaviour, this did not appear to be explained by habit, as habit did not differ by the degree of context stability surrounding bouts of PA or SB.

What makes one feel eustress or distress in quarantine? An analysis from conservation of resources (COR) theory.

Abstract: Objective Health quarantines produce serious deterioration in psychological health, which becomes more affected the longer the quarantine lasts. According to the Conservation of Resources theory from Hobfoll (1989, American Psychologist, 44, 513), those people who have a good supply of resources will be able to cope better with the adversities and will show less distress. The objective of this research is to identify what are the resources that, in a situation of confinement under the threat of COVID-19, predict eustress or well-being, and the loss or lack of which resources predict distress or discomfort. Design and method A total of 839 people complete an online questionnaire during the first week of COVID-19 confinement in Spain. The sample is weighted to obtain a distribution that is similar to the Spanish population. Using multiple linear regression analysis, factors are identified that are associated with eustress and distress based on the Conservation of Resources theory. Results A model is identified that explains 55% of the variance of eustress consisting mostly of personal resources, with vitality as the recourse having the most weight. The factors that explain distress (18.9% of the variance) are those related to work (employment situation, work satisfaction, and time devoted to work) and conditions in the home (space). Conclusions The models that predict eustress and distress are completely different. Based on these results, a series of recommendations are proposed aimed at increasing eustress and reducing distress in a situation of confinement. Additionally, proposals are offered for future research.

Holding a stigmatizing attitude at the start of the COVID-19 outbreak: A cross-sectional survey.

Abstract: Objectives To identify the prevalence of a stigmatizing attitude towards people of Chinese origin at the start of the COVID-19 outbreak in the UK population and investigate factors associated with holding the stigmatizing attitude. Design Online cross-sectional survey conducted 10-13 February 2020 (n = 2006, people aged 16 years or over and living in the UK). Methods We asked participants to what extent they agreed it was best to avoid areas heavily populated by Chinese people because of the COVID-19 outbreak. Survey materials also asked about: worry, perceived risk, knowledge, information receipt, perception of government response to COVID-19, and personal characteristics. We ran binary logistic regressions to investigate associations between holding a stigmatizing attitude, personal characteristics, and psychological and contextual factors. Results 26.1% people (95% CI 24.2-28.0%, n = 524/2006) agreed it was best to avoid areas heavily populated by Chinese people. Holding a stigmatizing attitude was associated with greater worry about COVID-19, greater perceived risk of COVID-19, and poorer knowledge about COVID-19. Conclusions At the start of the COVID-19 pandemic, a large percentage of the UK public endorsed avoiding areas in the UK heavily populated by people of Chinese origin. This attitude was associated with greater worry about, and perceived risk of, the COVID-19 outbreak as well as poorer knowledge about COVID-19. At the start of future novel infectious disease outbreaks, proactive communications from official sources should provide context and facts to reduce uncertainty and challenge stigmatizing attitudes, to minimize harms to affected communities.