To contemplate or not to contemplate evaluating a preliminary intervention proposal in an outpatient setting: the contemplation therapy group.

PURPOSE: The concept for the contemplation group intervention was derived from motivational interviewing (MI) to support people suffering from an eating disorder who are reluctant to engage with treatment. This evaluation focuses on the contemplation group run by the eating disorder services in the Cardiff and Vale area between 2012 and 2016 to investigate the outcomes for participants and implications for working with people suffering from an eating disorder who are ambivalent about change. METHOD: Quantitative measures were used to assess eating disorder symptomatology, motivation to change and location within the stages of change model. A brief qualitative evaluation of client experiences was also included. RESULTS: While dropout was high, a number of patients displayed increased readiness for treatment at the end of the group or even started to engage in change-focussed therapy. Participants who completed the group described it as challenging but helpful. CONCLUSIONS: This evaluation shows that explorative contemplation of their ambivalence towards their eating disorder and treatment was helpful for the participants of the group and supported them in achieving more clarity and decisiveness regarding whether to engage in treatment or not. Further research is needed to evaluate long-term outcomes for patients who feel ambivalent towards treatment, and to explore what interventions can be used to help them. EVIDENCE LEVEL: Level IV: Evidence obtained from multiple time series with or without the intervention.

Telephone helplines as a source of support for eating disorders: Service user, carer, and health professional perspectives.

Access to care for eating disorders can be problematic for numerous reasons including lack of understanding and delays with treatment referrals. Previous research has highlighted the benefits of telephone helplines as an accessible source of support for those who may not wish to access face-to-face support or to fill a gap for those waiting for treatment. This study aimed to gain an insight into the perspectives of those who may use or refer others to a telephone helpline in order to identify the requirements of such a service. Triangulation of service user, carer and health professionals' perspectives resulted in identification of themes relating to the type of support, delivery and practicalities of a helpline. The findings indicated that telephone helplines may offer numerous benefits for individuals with an eating disorder, whether accessed as a first step, alongside treatment or as an extension of this support when in recovery. Additionally helplines may provide an opportunity for carers to access information and discuss their own experiences, while supporting their loved one. Raising awareness of these services is important to encourage those affected by an eating disorder to access and make the most of this type of support. These findings offer an insight into the key requirements for new and existing service development with regard to both the type of support and the method of communication required by individuals with eating disorders.

Cognitive Behaviour Therapy for Bulimia Nervosa and Eating Disorders Not Otherwise Specified: Translation from Randomized Controlled Trial to a Clinical Setting.

BACKGROUND: Enhanced Cognitive Behaviour Therapy (CBT-E) (Fairburn, Cooper and Shafran, 2003) was developed as a treatment approach for eating disorders focusing on both core psychopathology and additional maintenance mechanisms. AIMS: To evaluate treatment outcomes associated with CBT-E in a NHS Eating Disorders Service for adults with bulimia and atypical eating disorders and to make comparisons with a previously published randomized controlled trial (Fairburn et al., 2009) and "real world" evaluation (Byrne, Fursland, Allen and Watson, 2011). METHOD: Participants were referred to the eating disorder service between 2002 and 2011. They were aged between 18-65 years, registered with a General Practitioner within the catchment area, and had experienced symptoms fulfilling criteria for BN or EDNOS for a minimum of 6 months. RESULTS: CBT-E was commenced by 272 patients, with 135 completing treatment. Overall, treatment was associated with significant improvements in eating disorder and associated psychopathology, for both treatment completers and the intention to treat sample. CONCLUSIONS: Findings support dissemination of CBT-E in this context, with significant improvements in eating disorder psychopathology. Improvements to global EDE-Q scores were higher for treatment completers and lower for the intention to treat sample, compared to previous studies (Fairburn et al., 2009; Byrne et al., 2011). Level of attrition was found at 40.8% and non-completion of treatment was associated with higher levels of anxiety. Potential explanations for these findings are discussed.

Perceived barriers to, and benefits of physical activity among British military veterans that are wounded, injured, and/or sick: a Behaviour Change Wheel perspective.

PURPOSE: Many British military veterans that are wounded, injured, and/or sick (WIS) face significant physical, psychological and social challenges following discharge from the military. There is increasing evidence to support the application and benefit of physical activity for veterans that are WIS. Understanding engagement in physical activity is therefore imperative so that physical activity interventions and initiatives can be designed effectively, and their benefits optimised. Therefore, the aim of this study is to identify the perceived barriers to, and benefits of physical activity among veterans that are WIS. MATERIALS AND METHODS: Nine semi-structured interviews were conducted to explore perceived barriers to, and benefits of physical activity amongst veterans that are WIS. A thematic analysis was conducted, and themes mapped to the Behaviour Change Wheel's capability, opportunity, motivation-behaviour (COM-B) model. RESULTS: Perceptions related to physical capability, psychological capability, physical opportunity and reflective motivation were predominant barriers to engagement in physical activity. As well providing opportunities to socialise, the perceived benefits of engagement in physical activity seemed to mirror the perceived barriers, suggesting a reciprocal relationship. CONCLUSIONS: Using the Behaviour Change Wheel, incentivisation, education, persuasion, enablement and environmental restructuring were identified as potentially beneficial intervention functions when seeking to increase levels of physical activity among veterans that are WIS living within the United Kingdom.IMPLICATIONS FOR REHABILITATIONUK-based veterans that are wounded, injured, and/or sick (WIS) often face significant challenges with respect to physical, mental, and social well-being.Perceived barriers, in the form of limited opportunities and a self-perceived lack of capability impact on levels of motivation and are viewed as obstacles to becoming physically active by veterans that are WIS.Providing education and complementary incentives may help reduce the extent of perceived barriers in veterans that are WIS.Approaches that allow veterans that are WIS to socialise while developing self-efficacy will likely increase physical activity engagement.

A service evaluation specifying the active components of a functional restorative programme to promote management of persistent non-specific low back pain.

BACKGROUND: Functional Restorative Programmes (FRP) for persistent non-specific lower back pain have been shown to be effective, but they often lack sufficient detailed reporting of the intervention components to allow for accurate replication. OBJECTIVES: This study used the Behaviour Change Technique Taxonomy (v1) (BCTi) [1] to identify the main components of one such programme and interviewed patients to identify the most effective programme components and areas for improvement. DESIGN: A mixed methods design was used. METHODS: Intervention data were coded using the BCT Taxonomy (v1) to identify the BCTs utilised. Following this, semi-structured interviews with nine patients evaluated the BCTs included using thematic analysis and identified possible techniques for inclusion in future developments of the programme. RESULTS: Forty-one different BCTs were identified in the coding phase with frequency of occurrence in the programme ranging from forty-nine to one. Four main themes emerged from the interviews: Social Support, Shaping Knowledge, Repetition and Substitution and Changes in Mindset. CONCLUSION: The results of this study identify the key ingredients in a programme for persistent, non-specific lower back pain, which facilitates the replication of this intervention and identified areas patients appreciated most as well as areas for improvement.

Identifying management practices that drive production-line workers' engagement through qualitative analysis.

INTRODUCTION: Engagement research - most often defined by a worker's psychological state of vigor, dedication, and absorption - pays little attention to production-line workers. This study therefore explores factors that drive workers' engagement with health and safety (H&S) in a production-line context as well as their perception of managerial influence Furthermore, the study adds to the body of research by exploring H&S engagement concepts through the use of qualitative research methods. METHOD: 38 semi-structured interviews were conducted and analyzed through template analysis to identify themes that promote and hinder engagement. RESULTS: The main engagement drivers were found to be: (a) the displayed safety focus of the company in organizational and social aspects; (b) the quality of the communication approach with respect to quality, consistency and direction; and (c) the environment encompassing the relationship between workers and supervisors and peers as well as the psychological environment. Notably, a trusting relationship between supervisors and workers appeared to be the most influential driver in determining engaged H&S behavior. Discussion and impact in industry: The study highlights factors that could be adapted to improve engagement and consequently enhance H&S approaches. Originality: The study reported in this paper offers a unique insight into individual production workers' perceived drivers of H&S engagement using Qualitative Analysis. Practical applications: The study identified the important role that supervisors play in workers' H&S engagement levels and what skills they need to employ to enhance workers' engagement in general and in the context of H&S behavior and performance. Furthermore, the importance of psychological and sociological factors in safety approaches are highlighted and were found to be key for creating safer workplaces.

Perceptions of social support and eating disorder characteristics.

Poor social support is a risk factor for the development of eating disorders (Ghaderi, 2003). We designed this study to investigate the relationship between social support and eating disorder symptomatology among a female, nonclinical population. The work is of international interest because disordered eating behavior is common across many nations. The results of this research should help build a better understanding of the links between social support and participants at risk of developing an eating disorder. In this study, family support was not correlated with disordered eating, but satisfaction with social support was.

Positive Influence of Role Ambiguity on JD-R Motivational Process: The Moderating Effect of Performance Recognition.

Most previous research has shown the negative influence of role ambiguity on employes' motivational process. This has led to role ambiguity being perceived as a main hindrance demand in the workplace, with a negative effect on the Job Demands Resources (JD-R) model's motivational process. Recent theories propose that job demands can be perceived by employes as a challenge, rather than a hindrance. However, there is little evidence on which elements of the organizational context shape this perception. The objective of this study is to elucidate the possible effect of performance recognition from the team leader on employes' interpretation of role ambiguity as a hindrance or a challenge. Data were obtained from 706 employes of a multinational company headquartered in Almería, Spain. Results confirmed that performance recognition moderates the effects of role ambiguity: specifically, performance recognition changes the effect of role ambiguity on engagement from negative to positive and reduces role ambiguity's negative influence on extra-role behaviors.

Adolescents' perceptions and experiences of family meals.

Benefits of family meals include diet quality, social interaction and wellbeing, yet previous research indicates only one in four adolescents eats a meal with their family every day. This study identified factors relating to the frequency and importance of family meals. A focus group conducted with seven adolescents was analysed thematically. The themes and findings of past research were used to develop a Family Meals Questionnaire (FMQ), completed by 76 adolescents. Regular engagement in healthy family meals eaten around the table was reported, with the majority of participants reporting that their meals included a variety of foods and portions of vegetables. Frequency of family meals was associated with increased family togetherness for both males and females. The nutritional value of meals was found to be most important to females, whereas the impact of family meals on mood was more salient for males. Findings suggest that the views and behaviour of other family members may influence adolescents' enjoyment and perceptions of the importance of family meals, and therefore impact on their frequency. These findings may inform the development of future interventions aimed at increasing adolescent engagement in family meals by adopting a family systems approach to improve the frequency and experience of family meals.

The Eating Disorder Inventory: a test of the factor structure and internal consistency in a nonclinical sample.

My objective was to investigate the factor structure and internal consistency of the Eating Disorder Inventory (EDI) among a nonclinical sample. Previous research has indicated that although the EDI appears to be psychometrically sound when used with a clinical sample, the relevance of the measure for a nonclinical population is uncertain. Six hundred forty-seven female university students, average age of 23.3 years, completed a questionnaire including the EDI. I found that the factor structure was supported when items from just five subscales of the EDI were included in the analysis, but when items pertaining to all eight subscales were analysed the factor structure was not supported. The current results cast doubt on the factor structure and internal consistency of the EDI when used with a nonclinical sample, unless just five subscales (drive for thinness, perfectionism, bulimia, interpersonal distrust, and maturity fears) are included. More research is needed to clarify the implications of these findings.

Outcomes of pregnancies diagnosed with Klinefelter syndrome: the possible influence of health professionals.

OBJECTIVE: To describe the association between the outcomes of pregnancies diagnosed with Klinefelter syndrome (KS) and the specialty of the health professional providing pre- and post-diagnostic counselling. METHOD: Data were extracted from the case notes of the 111 cases of KS diagnosed prenatally between 1986 and 1997 in eight geographical regions in five European countries. The data extracted included: outcome of pregnancy, maternal age, social class, parity, gestational age at diagnosis, year of diagnosis and specialties of the health professionals conducting pre- and post-diagnosis consultations. RESULTS: The overall termination rate was 44% (49/111: 95% confidence interval: 35 to 54). Using multivariable logistic regression analysis, the only significant predictor of continuation of the pregnancy was the specialties of the health professionals conducting post-diagnosis counselling: the affected pregnancy was more likely to continue when post-diagnosis counselling involved only a genetics specialist (relative risk: 2.42 (1.14 to 5.92)). CONCLUSION: There is an association between whether or not a woman terminates a pregnancy affected by an unfamiliar fetal anomaly and the professional background of the health professional providing post-diagnostic counselling. The causal nature of this association remains to be determined.