Facing the Emotional Barriers to Colorectal Cancer Screening. The Roles of Reappraisal and Situation Selection.

BACKGROUND: Disgust, embarrassment, and fear can hinder the attendance of colorectal cancer (CRC) screening. However, individuals can respond to these emotions differently. The present study tested whether reappraising a negative stimulus versus avoiding a negative stimulus is associated with age; whether these two emotion regulation strategies (reappraisal and situation selection) moderate the effects of disgust, embarrassment and fear on CRC screening intention; and the efficacy of a message based on participants' preferred emotion regulation strategy. METHODS: We recruited 483 Italian participants (aged 40-84 years) through snowball sampling. Participants were randomly assigned to one of four conditions differing for a message promoting CRC screening with an affective lever, a cognitive lever, both levers or none. Key variables included emotion regulation strategies, emotional barriers and intention to get screened. RESULTS: The preference for reappraisal over situation selection increased with age. Reappraisal neutralized the effect of disgust on CRC screening intention. The combined message with both affective and cognitive levers increased CRC screening intention (b = 0.27, ß = 0.11, SE = 0.13 p = .049), whereas reading the message based only on the affective (b = 0.16, ß = 0.06, SE = 0.14 p = .258) or the cognitive (b = 0.22, ß = 0.09, SE = 0.14 p = .107) lever was not effective. CONCLUSIONS: Communication campaigns should support the activation of a reappraisal strategy of emotion control, and messages promoting CRC screening should highlight both the instrumental (i.e., early detection) and affective (i.e., peace of mind) benefits of attendance.

Emotions and Narrative Reappraisal Strategies of Users of Breast Cancer Screening: Reconstructing the Past, Passing Through the Present, and Predicting Emotions.

Emotional forecasting, meaning how a person anticipates feeling as a consequence of their choices, drives healthcare decision-making. Research, however, suggests that people often do not fully anticipate or otherwise grasp the future emotional impacts of their decisions. Emotional reappraisal strategies, such as putting emotions into words and sharing emotions with others, may mitigate potential undesirable effects of emotions on decision-making. The use of such strategies is important for consequential decisions, such as obtaining timely mammography screening for breast cancer, whereby earlier diagnosis may impact the success of treatment. In this study, we explored the use of emotional reappraisal strategies for decision-making regarding breast cancer screening attendance among women aged 50-69 years. Data were collected through semi-structured interviews following mammography with a reflexive thematic methodological approach employed for analysis. Results shed light on how participants' emotional response narratives were reconstructed before the mammography, felt during the mammography, and forecasted while awaiting the results. Future research should consider how individuals experience and manage their emotions as they access breast screening services.

Public cancer screening services and participation: What meanings in users' narratives to promote engagement?

Despite the effectiveness of cancer screening (CS) in providing timely diagnoses and early treatments, the participation of citizens remains very low in particular in Southern Italy. This study aims to investigate the meanings that intervene in the relationship between the individual and their active participation in CSs within public healthcare. A total of 101 ad hoc semi-structured interviews were collected with CS users in public service of Campania Region, Italy. The interviews were analyzed through a qualitative-quantitative methodology by T-Lab software. A cluster analysis and multiple matching analysis were conducted. Findings show five clusters: prevention as a sensory and emotional burden; prevention as a strategy to manage the hereditary risk of death; individual's internal demand for health; the times and places of prevention; and the concreteness of doing prevention; and two factors: from the risk of disease diagnosis to preventive measures and from external healthcare settings to internal self-care settings. Findings shed light on how to construct better well-being promotion strategies and foster a subjective health and prevention demand accounting for the continuous experiences of those participating in CSs to encourage greater citizen engagement.

Only the best for my kids: An extended TPB model to understand mothers' use of food labels.

Despite the evidence that mothers' food purchasing behavior impacts the quality of children's diet, few studies have explored psycho-social factors influencing how mothers choose the food to buy for their children. To fill this gap, this study tested an extended Theory of Planned Behavior (TPB) model to predict mothers' tendency to seek information on food labels before purchasing food for children. Participants included 311 Italian mothers who completed a self-report questionnaire measuring their information-seeking behavior, TPB variables, anticipated regret and healthy-eater identity. Results from a Multiple Correspondence Analysis showed that mothers' information-seeking behavior involved a continuum of choices ranging from selecting conventional or prepackaged foods to choosing to read the food label before making a purchase. Besides, a Partial Least Squares-Structural Equation Modeling analysis showed that information-seeking behavior was positively predicted by intention (ß = 0.309, p < 0.001) and healthy-eater identity (ß = 0.195, p < 0.001). In turn, intention was positively affected by attitude (ß = 0.208, p < 0.001), subjective norms (ß = 0.155, p < 0.01), perceived behavioral control (ß = 0.124, p < 0.05), anticipated regret (ß = 0.193, p < 0.001), and healthy-eater identity (ß = 0.191, p < 0.001). These findings emphasize that future initiatives could usefully target attitude, anticipated regret and self-identity to encourage mothers' informed food choices for their children.

Factors promoting breast, cervical and colorectal cancer screenings participation: A systematic review.

OBJECTIVE: The present study aims at systematically reviewing research conducted on factors promoting breast, cervical and colorectal cancer screenings participation. METHODS: A literature search in MEDLINE/PubMed and PsycInfo from January 2017 to October 2021 was performed. Data extraction, researchers' full agreement and the inclusion criteria produced 102 eligible studies. Data were narratively synthesized and critically interpreted. RESULTS: Multiple factors favoring or hindering breast, cervical and colorectal cancer screenings were identified and summarized as factors operating at the individual level (background information, individual characteristics, emotions related to screening procedure and to cancer, knowledge and awareness), at the relational level (relationships with healthcare staff, significant others, community members), and at the healthcare system level (systems barriers/policy, lack of staff). A critical appraisal of studies revealed a fragmentation in the literature, with a compartmentalization of studies by type of cancer screening, country and specific populations of destination. CONCLUSIONS: Overall findings indicated that greater integration of research results obtained independently for each cancer diagnosis and within the different countries/populations could foster a more comprehensive understanding of factors potentially enhancing the participation in breast, cervical and colorectal cancer screenings worldwide. This review, which is grounded in the current context of globalization and superdiversification in population, can help to enhance a better integration between research and practices, by supporting the development of more effective and inclusive evidence-based interventions and health-promotion campaigns worldwide. Research and practical implications are highlighted and discussed.

Finally, the chance to eat healthily: Longitudinal study about food consumption during and after the first COVID-19 lockdown in Italy.

With the COVID-19 outbreak, structural constraints and social psychological factors changed the dietary habits of many people. This two-wave longitudinal study performed in Italy aimed to explore people's perceptions of changes in healthy and unhealthy food consumption before and during the first lockdown and the possible persistence of such changes after its official end, as a function of the number of people cohabiting, negative emotion activation, and individual eating styles. A total of 728 Italian adults completed self-reported food consumption measures and related psychological variables at both time points. In the lockdown period, participants reported an increase in healthy food consumption and involvement in cooking and a decrease in the consumption of junk food. This general pattern was stronger for both young and restrained eaters. The intensity of negative emotions and the number of cohabitants were not associated with the examined behaviour. In the post-lockdown period, the new consumption pattern acquired during the confinement was partially discontinued: participants cut down their healthy food consumption as well as their involvement in food preparation, but they continued to reduce their junk food intake. These results suggest that people's food consumption patterns can easily improve when the situation is favourable (e.g., more time and opportunities for cooking healthy meals) and offer an interesting theoretical contribution to understanding the factors useful in promoting healthy eating, in the event of a future outbreak.

Promoting water intake. The persuasiveness of a messaging intervention based on anticipated negative affective reactions and self-monitoring.

The present research focused on water intake (WI) in young adults. Study 1 (N = 272) was a correlational study and showed affective attitude, perceived behavioural control, past behaviour and anticipated negative affective reactions (ANAR) to predict WI intentions. It also showed intentions, instrumental attitude, perceived behavioural control, and past behaviour to predict WI prospectively. In addition, ANAR moderates the relationship between intention and future water intake (WI). Study 2 (N = 197) was an experimental study and showed that daily text messages targeting ANAR plus a self-monitoring manipulation increased WI immediately after the intervention although this effect did not persist one month later. Mediation analysis indicated the intervention impacted WI via sequentially changing ANAR and intention.

Psychosocial Factors Influencing Parents' Acceptance of COVID-19 Vaccination for Their Children: An Italian Cross-Sectional Study.

Vaccine hesitancy poses a significant threat to the health of individuals across all age groups, which has been exacerbated by the COVID-19 pandemic. In this cross-sectional study, an extension of the Theory of Planned Behavior (TPB) was applied to investigate psychosocial variables predicting intention to vaccinate children under 12 against COVID-19 in a sample of 420 Italian parents (Mean age = 40.4, SD = 5.9; Women = 78.1%). Hierarchical regression analysis revealed that, among the TPB variables, cognitive attitude, descriptive norms, and perceived behavioral control significantly predicted parents' vaccination intention. Furthermore, including trust in the institutions' ability to manage the vaccination campaign in the model significantly increased the explained variance in intention. These findings suggest that campaigns promoting childhood COVID-19 vaccination should not only emphasize the safety and effectiveness of vaccines for children but also focus on reducing barriers to vaccination. Additionally, attention should be given to enhancing the perception that this behavior is widespread among other parents, thus leveraging the power of social influence. Finally, and not less important, significant efforts should be directed toward building and reinforcing trust in the system of actors promoting and managing the COVID-19 vaccination campaign.

Testing an extended theory of planned behaviour in predicting Covid-19 vaccination intention over the course of the pandemic: A three-wave repeated cross-sectional study.

Background: Mass vaccination against Covid-19 has been recognised as the most effective strategy for overcoming the pandemic emergency and remains crucial in the ongoing efforts to mitigate the impact of the virus. The present study aimed to test the efficacy of an extended Theory of Planned Behaviour (TPB) model in predicting vaccination intention in three different phases of the pandemic. Understanding how psychological drivers of vaccine acceptance may have changed throughout the pandemic is essential for informing public health strategies and addressing vaccine hesitancy, even in the current post-pandemic context. Methods: Using a repeated cross-sectional survey, we tested the hypothesised extended TPB model (intention, attitude, subjective norms, perceived behavioural control, anticipated affective reactions, risk perception, trust in science, trust in institutions and religiosity) across three independent samples: before (T1: November-December 2020; N = 657), during (T2: March-May 2021; N = 818), and after (T3: February-March 2022; N = 605) the start of the vaccination campaign in Italy. Results: Results indicated significant differences between the time points in all investigated variables, pointing to a general trend of improvement in vaccine acceptability levels at T2 compared to T1, and a worsening at T3 compared to the other two time points. Interestingly, net of these differences, a multi-group Structural Equation Modeling analysis supported the invariance, across time, of the structural relationships examined within the extended TPB. Conclusion: Findings demonstrated the efficacy of the TPB in predicting Covid-19 vaccination intention at different stages of the pandemic, suggesting that the model, in its extended version, represents a valuable framework for designing interventions aimed at promoting vaccine acceptance.

Integrating the theory of planned behavior and the self-determination theory to promote Mediterranean diet adherence: A randomized controlled trial.

The Mediterranean diet (MD) is one of the healthiest and most sustainable food regimes. Nevertheless, MD diffusion is still limited, emphasizing the need to understand the psychosocial factors that could predict and promote its adoption. Starting from an integrated model of Theory of Planned Behavior (TPB) and Self-Determination Theory (SDT), the present randomized controlled trial investigated the effect of manipulating motivation (autonomous vs. controlled) on intention and MD adherence behavior. Participants included 726 Italian adults randomly allocated to one of three conditions: autonomous motivation manipulation, controlled motivation manipulation, and control group. TPB variables were measured immediately after manipulation (T1), while MD adherence was evaluated 2 weeks later (T2). Results from multivariate analyses of variance highlighted that participants in the autonomous motivation condition reported higher intention and a more favorable cognitive attitude than control group participants. However, no change in behavior was found. Moreover, a path analysis with mediation effect showed that the impact of autonomous motivation condition versus control group on intention was mediated by cognitive attitude. Findings support the integration of TPB and SDT to encourage intention to adhere to the MD, also suggesting that prompting autonomous motivation may help to promote a greater diffusion of this healthy and sustainable dietary pattern.

No more than "half prevention": A qualitative study on psychosocial determinants of Covid-19 vaccination acceptance.

Vaccine hesitancy represents a major barrier to achieving Covid-19 vaccination coverage, including in Italy, where the vaccination rates suggest that Covid-19 vaccination has not been fully integrated into people's routine immunization schedules. While quantitative studies have generated ample data on factors influencing vaccination decisions, rarely was an overall picture of people's actual views and experiences with Covid-19 vaccines provided. To address this gap, this qualitative study aimed to explore, from a psychosocial perspective, the relationships between perceptions of Covid-19 vaccines, traditional vaccines, and general approaches to prevention. Following a Grounded Theory approach, we interviewed 25 Italian adults from different socioeconomic and working backgrounds. Findings revealed that, despite a generally positive attitude towards Covid-19 vaccines, they were often regarded as providing only partial protection-a "half prevention"-against the disease rather than a definitive preventive measure. In this sense, a gap emerged between the overall notion of prevention and the specific representations associated with Covid-19 vaccines. Therefore, to increase vaccination acceptance, interventions should prioritize the reduction of such a gap by promoting the idea that vaccination against Covid is, in all respects, a safe and effective preventive tool. This requires fostering a credible knowledge system and building trustful relationships among community members and stakeholders involved in the vaccination campaign, including general practitioners, healthcare professionals, and political authorities.

Users' Experience of Public Cancer Screening Services: Qualitative Research Findings and Implications for Public Health System.

Following the One Health approach, designing multidimensional strategies to orient healthcare in promoting health and preventive processes has become paramount. In particular, in the prevention domain, cancer screening attendance is still unsatisfactory in many populations and requires specific consideration. To this end, following a research-intervention logic, this study aims to investigate the experiences and meanings that users of public cancer screening services associate with prevention, particularly participation in the screenings. The experiences of 103 users (96 females; Mage = 54.0; SD = 1.24) of public cancer screening programs in the Campania region (Italy) were collected through interviews. The data collected were analysed following the Grounded Theory Methodology, supported by the software Atlas.ti 8.0. The text material was organised into eight macro-categories: Health and Body; Relationship with Cancer and Diseases; Health Facilities and Health Providers; The Affective Determinants of Cancer Screening Participation; Partners and Children; Physical Sensations and Emotions in the Course of Action; Protective Actions; Promotion and Dissemination. The core category was named Family and Familiarity. Respondents perceived prevention as an act of care for the family and themselves. Our findings support a shift from the idea of taking care of personal health as an individual matter toward considering it as a community issue, according to which resistance to act is overcome for and through the presence of loved ones. The results of this study contribute to a deeper understanding of the perspectives of southern Italian users on participation in cancer screening, and provide important insights to guide future actions to promote these public programmes based primarily on the emerging theme of family and familiarity related to screening programs.

Exploring the psychosocial impact of the Covid-19 pandemic on women's perinatal experiences and wellbeing: A qualitative study.

OBJECTIVE: While many studies have investigated the clinical impact of the Covid-19 pandemic on pregnant women's mental health, little attention has been paid to the exploration of women's experiences during the perinatal period from a psychosocial perspective in the Italian context. Thus, the present study aimed to explore the psychosocial changes associated with the pandemic in the perinatal context. METHODS: Twenty-one Italian women who gave birth between March and November 2020 took part in this research by participating in semi-structured interviews, exploring their childbirth experiences. Our data were analysed using a Grounded Theory approach. RESULTS: Our findings revealed the enhanced importance of social support as a protective factor against uncertainties, which strongly characterised all phases of the perinatal period during the pandemic. Such uncertainties were mainly linked to the discontinuity in intrapartum care, as well as to concerns of being infected with Covid-19 combined with other pregnancy-specific worries. The main sources of social support were represented by loved ones - most of all partners - along with health care staff and peer networks. CONCLUSIONS: Our results suggest the importance of implementing evidence-based policies and interventions to improve women's wellbeing in the perinatal period during the pandemic, as well as of guaranteeing intrapartum care continuity and the presence of social support.

Clinical and psychosocial constructs for breast, cervical, and colorectal cancer screening participation: A systematic review.

Research has identified a wide range of psychosocial factors associated to choosing to engage in ongoing cancer screenings. Nevertheless, a systematic review of the theoretical frameworks and constructs underpinning studies on breast, cervical, and colorectal cancer screening participation has yet to be conducted. As part of the action-research project "Miriade," the present study aims to identifying the main theoretical frameworks and constructs adopted in the literature over the past five years to explain cancer screening participation. According to the PRISMA guidelines, a search of the MEDLINE/PubMed and PsycINFO databases was made. Empirical studies conducted from 2017 to 2021 were included. The following keywords were used: breast OR cervical OR colorectal screening AND adhesion OR participation OR engagement AND theoretical framework OR conceptual framework OR theory. Overall, 24 articles met the inclusion criteria. Each theoretical framework highlighted clinical and psychosocial constructs of cancer screening participation, focusing on the individuals (psycho-emotional functioning and skills plan) and/or the health services perspectives. Findings from the present study acknowledge the plurality of the theoretical frameworks and constructs adopted to predict or promote breast, cervical, and colorectal cancer screening adhesion and the need for new research efforts to improve the effectiveness of cancer screening promotion interventions.

Understanding the psychosocial determinants of Italian parents' intentions not to vaccinate their children: an extended theory of planned behaviour model.

OBJECTIVE: This study aimed to identify the psychosocial factors involved in Italian parents' intentions not to vaccinate their children. For this purpose, we used an extended version of the Theory of Planned Behaviour, which included both proximal and distal factors influencing intention not to vaccinate children. DESIGN: Participants included 447 Italian parents, each completed an online questionnaire, which measured intention not to vaccinate children, attitude toward not vaccinating, subjective norms, perceived behavioural control, anticipated regret, negative attitude toward vaccines, risk perception, trust in healthcare institutions, trust in science and religious morality. RESULTS: Results showed that attitude toward not vaccinating was strongly associated with intention not to vaccinate children. Furthermore, attitude toward not vaccinating was associated with negative attitude toward vaccines, which in turn was affected by all the distal factors considered (risk perception, trust in healthcare institutions, trust in science, religious morality). Finally, negative attitude toward vaccines fully mediated the effect of the distal factors on attitude toward not vaccinating children. CONCLUSION: These findings provide support for the validity of the proposed extended TPB model in explaining parents' intention not to vaccinate children. Theoretical and practical implications, in terms of understanding and promoting vaccination behaviour, are discussed.

The Mediating Roles of Attitude Toward COVID-19 Vaccination, Trust in Science and Trust in Government in the Relationship Between Anti-vaccine Conspiracy Beliefs and Vaccination Intention.

Since the outbreak of COVID-19, many conspiracy theories have spread widely, which has the potential to reduce adherence to recommended preventive measures. Specifically, anti-vaccine conspiracy beliefs can have a strong negative impact on COVID-19 vaccination attitude and intention. The present study aimed to clarify how such beliefs can reduce vaccination intention, exploring the possible mediating roles of attitude toward vaccination, trust in science, and trust in government, among a sample of 822 unvaccinated Italian adults (Women = 67.4%; M age = 38.1). Path analysis showed that anti-vaccine conspiracy beliefs influenced intention to get vaccinated both directly and indirectly through the mediating effects of attitude, trust in science, and trust in government. In particular, the simple mediating effect of attitude was the strongest one, followed by the serial mediating effect of trust in science and attitude itself. Findings provide insights into the design of interventions aimed at reducing misinformation and subsequent vaccine hesitancy.

Tumblr Facts: Antecedents of Self-Disclosure across Different Social Networking Sites.

Previous research investigating antecedents of online self-disclosure pointed out two perspectives: social compensation and enhancement hypotheses, showing controversial findings. Furthermore, most contributions have focused on social networking sites (SNSs) considered mainstream, like Facebook and Instagram, and such results are often considered universally valid for all SNSs. Tumblr is a less-studied SNS with peculiar features­such as anonymity, higher control over the presentation of personal aspects, supportive communities­that could particularly lead individuals to self-disclose. As prior contributions highlighted that the features and affordances could define how a medium will be used, this paper aims to investigate the antecedents of online self-disclosure on Tumblr and other mainstream SNSs. We run a survey on 559 Tumblr users (aged 13−70; M = 28.86; SD = 12.34). T-test showed that Tumblr users have a higher willingness to self-disclose on Tumblr compared to another SNSs (t = 22.44, p < 0.001). A path analysis model confirmed the predictive role of some psychological variables on self-disclosure on Tumblr but not on mainstream SNSs. In particular, self-disclosure on Tumblr was predicted by self-esteem, negative emotionality, and preference for online social interactions, which was in turn predicted by social anxiety. These findings partially supported both social compensation and enhancement hypotheses, indicating that the phenomenon is more complex than expected.

The Relationship between Healthcare Providers and Preventive Practices: Narratives on Access to Cancer Screening.

Cancer screening programs are public health interventions beneficial to early diagnoses and timely treatments. Despite the investment of health policies in this area, many people in the recommended age groups do not participate. While the literature is mainly focused on obstacles and factors enabling access to health services, a gap from the point of view of the target population concerns healthcare providers. Within the "Miriade" research-action project, this study aims to explore the dimensions that mediate the relationship between healthcare providers and preventive practices through the narrations of 52 referents and healthcare providers involved in breast, cervical and colorectal cancer screening. We conducted ad hoc narrative interviews and used theory-driven analysis based on Penchansky and Thomas' conceptualization and Saurman's integration of six dimensions of healthcare access: affordability, availability, accessibility, accommodation, acceptability and awareness. The results show that 21 thematic categories were representative of the access dimensions, and 5 thematic categories were not; thus, we have classified the latter as the dimension of affection. The results suggest trajectories through which psychological clinical intervention might be constructed concerning health, shared health decisions and access to cancer screening.

Anticipating pride or regret? Effects of anticipated affect focused persuasive messages on intention to get vaccinated against COVID-19.

Understanding the factors that increase intention to receive COVID-19 vaccines is essential to maximise the vaccination campaign effectiveness. The present experimental study evaluated the effect of exposure to messages targeting cognitive attitude plus anticipated positive (pride) or negative (regret) affective reactions on intention to get vaccinated. Participants included 484 Italian adults randomly allocated to one of four conditions: 1) cognitive attitude message; 2) cognitive attitude plus positive affect message; 3) cognitive attitude plus negative affect message; 4) control condition (no message). Results showed that participants in the second condition reported greater intention to get vaccinated against COVID-19 compared with those in the control condition. Parallel mediation analysis indicated that the effect of the second condition on intention was fully mediated by cognitive attitude and anticipated positive affect. These findings suggest that future campaigns aimed at promoting COVID-19 vaccination intention could usefully target both cognitive attitude and anticipated positive affect.