Influences of decisions to attend a national diabetes prevention programme from people living in a socioeconomically deprived area.

AIMS: To explore key influences of decisions in participants from a socioeconomically deprived area to attend the Healthier You: NHS Diabetes Prevention Programme (NHSDPP). The NHSDPP is a lifestyle behaviour change programme for adults with prediabetes living in England. METHODS: Semi-structured interviews were conducted with 35 participants who had attended the initial assessment, but not yet started the NHSDPP; 23 were classified as "attenders," 12 as "non-attenders" after they were interviewed based on whether they had attended the first NHSDPP session or not. Transcribed interviews were analysed using inductive thematic analysis. RESULTS: Seven themes were derived from the data. The results demonstrate how understanding type 2 diabetes, making lifestyle changes, comparing themselves with others, having support and certain self-perceptions can all affect individuals' motivation to attend a diabetes prevention programme. Accessibility and practicalities also influenced both motivation and attendance. CONCLUSIONS: This study identified a range of different influences on decisions to attend a diabetes prevention programme, which programme organisers and healthcare professionals should consider to maximise attendance. Initial communication from general practitioners (GPs) and initial assessments are key points where people's beliefs and understanding could be explored.

Normative misperceptions of unhealthy snacking amongst 11- to 12-year-old secondary school students.

Younger adolescents are at an age where they have increasing control of their diet, and where peers become an important social reference for acceptable and normative dietary behaviours. These normative perceptions are often inaccurate and can lead to the development of unhealthy eating practices; although, the role of normative misperceptions of peers' unhealthy snacking behaviours in younger adolescents' personal snacking behaviours is not clear. The current study was a cross-sectional analysis of baseline data from a social norms-based healthy eating intervention sampling two secondary schools in deprived areas of England. Students aged 11-12 years (n = 252) completed self-report measures of their demographic characteristics and personal behaviours, attitudes, intentions, and normative perceptions (descriptive and injunctive norms), relating to unhealthy snacking. Results indicated students overestimated peers' daily unhealthy snacks consumption by approximately 3.2 portions, misperceived peers to have more positive attitudes towards unhealthy snacking and more negative attitudes towards reducing snacking. The greater these misperceptions of peers' behaviours and attitudes, the more likely students were to consume unhealthy snacks and have positive attitudes about unhealthy snacking. Girls had a stronger intention to reduce their snacking behaviours if they had more positive attitudes to reducing snacking behaviours and misperceived peers to also have a positive attitude. In summary, 11- to 12-year-olds misperceive the snacking behaviour and attitudes of their peers, and such normative misperceptions are associated with students' own snacking behaviours and attitudes. Interventions which challenge these misperceptions may assist in reducing the social acceptability of unhealthy snacking and in reducing unhealthy snacking amongst young adolescents.

An in-school social norms approach intervention for reducing unhealthy snacking behaviours amongst 11-12-year-olds.

OBJECTIVES: Adolescents tend to overestimate the extent of peers' unhealthy snacking consumption and such misperceptions have been associated with increased personal unhealthy snacking. This study aims to test whether a Social Norms Approach (SNA) intervention which challenges these misperceptions of peers' unhealthy snacking will have a positive effect on students' personal unhealthy snacking behaviours, related attitudes, and behavioural intentions. DESIGN: A quasi-experimental study tested the effectiveness of an in-school SNA intervention (n = 163) compared to a control condition (n = 95) among 11-12-year-old students. METHOD: Both conditions received healthy eating information, while students in the SNA intervention received additional normative feedback (outlining the discrepancies between perceived and actual unhealthy snacking of the majority based on baseline data) delivered through an interactive poster-making session. Students completed self-reported measures of personal unhealthy snacking, related-attitudes, behavioural intentions, and normative perceptions (descriptive and injunctive) at baseline, post-intervention, and at a 3-month follow-up. RESULTS: Students who received SNA feedback were significantly less likely to overestimate peers' unhealthy snacking attitudes post-intervention (F(1,232) = 16.405, p < .001), and at 3-month follow-up consumed fewer unhealthy snacks (F(1,232) = 6.133, p = .014) and had less positive attitudes towards unhealthy snacking (F(1,198) = 8.779, p = .003). The changes in personal snacking attitudes at 3-month follow-up were mediated by changes in normative misperceptions about peers' unhealthy snacking attitudes post-intervention, which indicated that the reductions in normative misperceptions following SNA messages mediated the effect of the intervention. CONCLUSION: The results indicate that in-school SNA interventions which challenge normative misperceptions constitute a promising strategy for reducing unhealthy snacking in young adolescents.

A social norms approach intervention to address misperceptions of anti-vaccine conspiracy beliefs amongst UK parents.

Anti-vaccine conspiracy beliefs among parents can reduce vaccination intentions. Parents' beliefs in anti-vaccine conspiracy theories are also related to their perceptions of other parents' conspiracy beliefs. Further, research has shown that parents hold misperceptions of anti-vaccine conspiracy belief norms: UK parents over-estimate the anti-vaccine conspiracy beliefs of other parents. The present study tested the effectiveness of a Social Norms Approach intervention, which corrects misperceptions using normative feedback, to reduce UK parents' anti-vaccine conspiracy beliefs and increase vaccination intentions. At baseline, 202 UK parents of young children reported their personal belief in anti-vaccine conspiracy theories, future intentions to vaccinate, and their perceptions of other UK parents' beliefs and intentions. Participants were then randomly assigned to a normative feedback condition (n = 89) or an assessment-only control condition (n = 113). The normative feedback compared participants' personal anti-vaccine conspiracy beliefs and perceptions of other UK parents' beliefs with actual normative belief levels. Parents receiving the normative feedback showed significantly reduced personal belief in anti-vaccine conspiracy beliefs at immediate post-test. As hypothesised, changes in normative perceptions of anti-vaccine conspiracy beliefs mediated the effect of the intervention. The intervention, did not directly increase vaccination intentions, however mediation analysis showed that the normative feedback increased perceptions of other parents' vaccination intentions, which in turn increased personal vaccination intentions. No significant effects remained after a six-week follow-up. The current research demonstrates the potential utility of Social Norms Approach interventions for correcting misperceptions and reducing anti-vaccine conspiracy beliefs among UK parents. Further research could explore utilising a top-up intervention to maintain the efficacy.

What behavior change techniques are associated with effective interventions to reduce screen time in 0-5 year olds? A narrative systematic review.

Screen time has been linked to obesity in young children. Therefore, this systematic review aims to investigate which Behavior Change Techniques (BCTs) are associated with the effectiveness of interventions to reduce screen time in 0-5 year olds. Seven databases were searched, including PsycInfo, PubMed, and Medline. Grey literature searches were conducted. Inclusion criteria were interventions reporting pre- and post- outcomes with the primary objective of reducing screen time in 0-5 year olds. Studies were quality assessed using the Effective Public Health Practice Project criteria. Data extracted included participant characteristics, intervention characteristics and screen time outcomes. The BCT Taxonomy was used to extract BCTs. Interventions were categorised as "very", "quite" or "non" promising based on effect sizes. BCTs were deemed promising if they were in twice as many very/quite promising interventions as non-promising interventions. Seven randomised controlled trials were included, involving 642 participants between 2.5 and 5.0 years old. One very promising, four quite promising, and two non-promising interventions were identified. Screen time decreased by 25-39 min per day in very/quite promising interventions. Eleven BCTs were deemed promising, including "behavior substitution" and "information about social and environmental consequences". This review identified eleven promising BCTs, which should be incorporated into future screen time interventions with young children. However, most included studies were of weak quality and limited by the populations targeted. Therefore, future methodologically rigorous interventions targeting at-risk populations with higher screen time, such as those of a low socioeconomic status and children with a high BMI, should be prioritized.

A systematic review of recruitment strategies and behaviour change techniques in group-based diabetes prevention programmes focusing on uptake and retention.

BACKGROUND: Many countries worldwide have developed diabetes prevention programmes (DPPs) that involve lifestyle modification. Research has shown that uptake and retention of DPPs are important and by exploring recruitment strategies and behaviour change techniques (BCTs) used, factors that are most effective in promoting uptake and retention can be identified. OBJECTIVES: This review aims to identify recruitment strategies of group-based DPPs that are associated with high uptake and common BCTs associated with high retention. METHODS: Papers were identified with a systematic literature search. Programmes that were predominantly group-based and involved lifestyle modification and in which uptake and/or retention could be determined, were included. Intervention details were extracted, recruitment strategies and BCTs identified, and response, uptake and retention rates were calculated. RESULTS: A range of recruitment strategies were used making it difficult to discern associations with uptake rates. For BCTs, all programmes used a credible source, 81% used instruction on how to perform a behaviour and 71% used goal setting (behaviour). BCTs more commonly found in high retention programmes included problem-solving, demonstrating the behaviour, using behavioural practice and reducing negative emotions. CONCLUSIONS: Recommendations include that DPPs incorporate BCTs like problem-solving and demonstrating the behaviour to maximise retention.

"Living in a foreign country": experiences of staff-patient communication in inpatient stroke settings for people with post-stroke aphasia and those supporting them.

Purpose: Staff-patient communication in in-patient stroke settings is viewed as challenging for stroke survivors with aphasia and those supporting them. This study sought to explore these experiences from the perspectives of stroke survivors, their carers and healthcare professionals.Methods: A qualitative study where stroke survivors with aphasia, carers and healthcare professionals were interviewed (audio-recorded) one-to-one or via focus group. Stroke survivors were at least 6 months post-stroke and had a self-reported mild to moderate level of post-stroke aphasia. Transcripts for each group were analysed separately using inductive thematic analysis; followed by an integrative analysis.Results: Six stroke survivors with aphasia, 10 carers, and six healthcare professionals were recruited. Three overarching themes were identified: "being in a foreign country", "finding a voice", and "you're just a number". A dynamic model of communication is proposed offering a framework for understanding the relationships between "the context", "the people" and "the interactions".Conclusions: Communication was viewed as important but challenging by all three groups. To maximise staff-patient interactions in the future, attention needs to be paid to: the psychosocial needs of stroke survivors and their carers, ongoing staff training and support for the healthcare professionals supporting them, and the provision of an aphasia-friendly and a communicatively stimulating ward environment.Implications for RehabilitationEffective staff-patient communication is viewed as fundamental to stroke rehabilitation but challenging by patients with aphasia, their carers and the healthcare professionals supporting them.To maximise staff-patient communication three key areas must be considered and targeted: those involved/affected by staff-patient communication ("the people"), factors within the "hospital context", and "the interactions" between "the people".Tailoring and being consistent with communication and care is paramount to avoid repeated negative communication encounters which can result in disengagement from care.Stroke rehabilitation which currently focuses on the physical fails to address the psychological/emotional and social needs of the patients and those supporting them.

Delivering in-school interventions to improve dietary behaviours amongst 11- to 16-year-olds: A systematic review.

Childhood obesity is a global health concern, which has both short- and long-term health consequences for the individual, and is a potential burden on health care services and the wider economy. The school environment is a setting where changes can be applied to dietary behaviours, as schools have direct and intensive contact with children. This systematic review evaluated school-based interventions designed to improve dietary behaviours among adolescents (11- to 16-year-olds). The aims were to review types of interventions delivered, dietary behaviours targeted, and interventions' effectiveness in improving dietary behaviour and associated intervention components. Twenty-nine school-based interventional studies with this population were identified for review. The data were synthesized by identifying and comparing individual studies' results, intervention components, and characteristics. Interventions appeared more effective when they involved peers, used educational media to deliver health messages, increased availability of healthy foods in school, and incorporated computer-based individualized feedback with normative information on eating behaviours. A limitation of the review was the lack of description in certain reviewed studies and the nonfeasibility of conducting a meta-analysis owing to study heterogeneity. Future interventions with this population could consider including the aforementioned components, gender-specific feedback, and both short- and long-term follow-ups as change may not be apparent immediately and to determine if changes are sustained.

Offenders' perceptions of the UK prison smoking ban.

PURPOSE: Despite overall reductions in levels of smoking in the UK, rates of offender smoking remain high. In 2016, it was announced that prisons in England and Wales would gradually introduce a smoking ban. The purpose of this paper is to explore offenders' perceptions around the upcoming smoking ban. DESIGN/METHODOLOGY/APPROACH: A total of eight focus groups were conducted in four prisons across the North of England. Both smoking and non-smoking offenders participated in the focus groups, and thematic analysis was used to explore the findings. FINDINGS: Themes generated from the data were "freedom and rights", "the prison environment" and "guiding support". Participants discussed how the smoking ban was viewed as a punishment and restricted their freedom, with perceptions as to why the ban was being implemented centring around others trying to control them. Participants expressed concerns around the financial implications of the smoking ban on already stretched prison resources. Participants also recommended improving the nicotine replacement therapy on offer, and increasing the range of leisure activities within the prison to prepare for the smoking ban. ORIGINALITY/VALUE: Overall, it was apparent that participants' awareness of the smoking ban was generally poor. It is recommended that offenders need to be made more aware of the smoking cessation support they will receive and given the opportunity to ask questions about the smoking ban. Increasing offenders' awareness of the ban may reduce stress associated with a perceived lack of choice around their smoking behaviours.

Diabetes and healthy eating: a systematic review of the literature.

PURPOSE: The purpose of this study is to review the literature on healthy eating interventions within diabetes care. DATA SOURCES: The databases PubMed, Cumulative Index to Nursing and Allied Health Literature, and PsycINFO were searched for the terms healthy eating or dietary and intervention and diabetes in the abstracts. In addition, electronic searches of the contents of Diabetes, Clinical Diabetes, Diabetes Care, Diabetes Spectrum, and Diabetic Medicine were conducted. STUDY SELECTION: Articles were included in the review if the participants were diagnosed with type 1 or type 2 diabetes, results from an intervention to promote dietary change were reported, measurements were taken from 2 time points (preintervention and postintervention), at least 1 outcome measured eating behavior, and the articles had been published between 1990 and the present date. DATA EXTRACTION: Data were extracted from the 23 studies found to be eligible. Studies were compared in terms of sample types and sizes, duration, and type and content of intervention. DATA SYNTHESIS: Comparisons were made between the characteristics of those studies that produced a statistically significant result and those that did not, for the different outcome measures. CONCLUSIONS: For studies measuring the outcomes of weight, fat intake, saturated fat intake, and carbohydrates, there was a tendency for successful interventions to include an exercise dimension and group work. Some outcomes had a tendency to show significant changes in studies of longer duration (eg, serum cholesterol), whereas others were more likely to show significant changes in studies of shorter duration (eg, weight, fiber), suggesting that certain outcomes may be more difficult to maintain. Future research would benefit by ensuring that sample sizes are adequate to give sufficient power, and interventions should be designed that focus on the maintenance in addition to the initiation of eating behavior change.

Promoting children's fruit and vegetable consumption: interventions using the Theory of Planned Behaviour as a framework.

OBJECTIVE: This study compared a motivational intervention based on the Theory of Planned Behaviour (TPB) with a volitional intervention based on implementation intentions. DESIGN: The study employed a quantitative longitudinal questionnaire design involving two waves of data collection. METHOD: Participants (N=198) were randomly allocated to a control group or one of two intervention groups. TPB variables, and fruit and vegetable consumption were assessed at the beginning of the study (time 1) and 2 weeks later (time 2). Experimental group A formed an implementation intention, about how, when and where they could eat five portions a day, whilst experimental group B stated ways they could overcome motivational barriers to eating five portions a day. RESULTS: Both interventions were found to increase fruit and vegetable consumption significantly, although only the volitional intervention demonstrated a significant increase in fruit and vegetable consumption over the control intervention. CONCLUSIONS: The present study found support for two interventions in increasing fruit and vegetable consumption in children. These findings are encouraging regarding the use of these types of interventions within schools to improve children's eating behaviour.

Assessing interventions to increase compliance to patching treatment in children with amblyopia: a systematic review and meta-analysis.

BACKGROUND/AIMS: Amblyopia is the most common condition affecting visual acuity in childhood. Left untreated it will not resolve itself, leading to increased risk of blindness. Occluding the good eye with a patch is a highly effective treatment if carried out before age 7 years but compliance is a major problem. This systematic review addresses the question: How effective are existing interventions at increasing compliance to patching treatment in children with amblyopia? METHODS: Electronic searches were carried out in June 2014 and updated in April 2015 to identify studies reporting primary data on interventions to increase patching compliance. Data screening, extraction and quality ratings were performed independently by two researchers. RESULTS: Nine papers were included. Interventions including an educational element (5 studies) significantly increased patching compliance and had higher quality ratings than interventions that changed aspects of the patching regime (3 studies) or involved supervised occlusion (1 study). Meta-analysis was conducted on four studies and indicated that overall interventions involving an educational element have a significant small effect r=0.249, p<0.001. CONCLUSIONS: Interventions to increase patching compliance should include educational elements. High quality research is needed to further assess the effectiveness of specific elements of educational interventions and additional behaviour change techniques.

Moderating role of attitudinal ambivalence within the theory of planned behaviour.

The present study examined the moderating role of attitudinal ambivalence within the theory of planned behaviour (TPB). Attitude, subjective norm, perceived behavioural control (PBC), behavioural intentions and self-reported behaviour were assessed in relation to 20 healthy eating behaviours in a prospective questionnaire design in 232 members of the general public in the UK. Between-participants univariate and multivariate analyses indicated attitude-behaviour and PBC-behaviour relationships to be weaker in higher ambivalence compared to lower ambivalence respondents. These effects were confirmed in within-participants analyses. The findings are discussed in terms of the role of ambivalence in furthering our understanding of relationships in the TPB.

Patients' and practitioners' views on health behaviour change: a qualitative study.

OBJECTIVE: This study was designed to examine patients' and health professionals' perspectives on lifestyle behaviour change and to inform the development of a lifestyle behaviour change intervention to be used in primary care. DESIGN: Focus groups were conducted with seven patients and 13 health professionals where they were asked to discuss lifestyle behaviour change in relation to the design and development phase of a tailored lifestyle behaviour change intervention package. RESULTS: An inductive thematic analysis of transcripts suggested a range of issues that are relevant to the development and implementation of lifestyle change interventions such as time, lack of resources and starting interventions too late, as well as personal circumstances and the continuous effort that behaviour change requires. They were interpreted as two superordinate themes of 'internal and external influences on behaviour change' and 'behaviour change initiation and maintenance'. The results are discussed in relation to the implications they may have for researchers and health service commissioners designing interventions and practitioners implementing lifestyle change interventions in primary care. CONCLUSION: Many factors are involved in patients' and health care professionals' understanding of interventions and lifestyle behaviour change. These should be taken into consideration when designing interventions based on behaviour change theories.

The experiences and understandings of obesity: families' decisions to attend a childhood obesity intervention.

OBJECTIVES: This study investigated the families' experiences of a childhood obesity intervention and sought to understand factors that influence attendance and lifestyle behaviours. DESIGN: Eleven semi-structured interviews were conducted and analysed using Interpretative Phenomenological Analysis. RESULTS: Four themes emerged highlighting the differences and similarities between attendees and non-attendees perceptions of childhood obesity, perceptions of the intervention, practical barriers and overcoming hurdles to attending and, availability and suitability of local facilities. CONCLUSIONS: The findings relate to identity and health communication. For some families attending an obesity intervention may challenge social and individual identities, which may have an impact on subsequent behavioural decisions. Those who attend the obesity intervention may experience a shift in identity, which may or may not initially be perceived as a positive outcome. Public Health and those involved in treatment interventions should aim to bridge the gap between people's in-group identities and those associated with particular lifestyle behaviours. In order to be effective, services must meet the needs of their clients and address any preconceived negative perceptions by carefully considering how health information is presented, how it is understood and most importantly how identity may affect motivation to engage in, and sustain, new behaviours.

Determinants of older adults' intentions to vaccinate against influenza: a theoretical application.

BACKGROUND: Despite many government initiatives, uptake of the trivalent influenza vaccine among the older adult population still remains suboptimal. If immunization rates are to be optimized, new approaches for identifying the determinants that facilitate or inhibit influenza vaccination decision making in this population are necessary. METHODS: An extension of the theory of planned behaviour (TPB) provided the theoretical framework for the development of a multi-item questionnaire. One hundred and ninety-three white, independent living and city dwelling men (n =77) and women (n = 116), completed the measure. The main outcomes of interest were future vaccination intentions. RESULTS: Overall, the TPB predicted 48.2% of older adults' intentions to vaccinate next influenza season. Receiving the vaccine in the past and anticipating feelings of regret (the impact of missing a vaccination opportunity) contributed to increments of 10.7 and 13.7%, respectively, in explaining this intentional behaviour. CONCLUSION: Utility of theoretical frameworks is a useful resource tool for understanding the rationale behind the facilitating and inhibitory determinants of older adults' vaccination decision-making processes. The implications of this research are discussed with a view towards future directions for maximizing influenza vaccination uptake initiatives using theoretically driven applications.