Remote consultations in primary care: Patient experiences and suggestions for improvement.

The use of Remote Consultations (RCs) in primary care expanded rapidly during the Covid-19 pandemic: their ongoing use highlights a need to improve experiences of them. We interviewed 17 adults in the UK, including a sub-sample of five people with a First Language other than English (FLotE). Interpretative Phenomenological Analysis identified five major themes: (1) RCs are convenient, but they require appropriate technology and appropriate conditions of use; (2) even those with good general eHealth literacy and connectivity may struggle with systems that are not user-friendly; (3) greater reliance on verbal communication was experience as limiting empathy, and also made RCs more difficult for people with a FLotE; (4) RCs are considered inappropriate for complex conditions, or those with major psychological components; (5) continuity of care is important, but is often lacking. Overall, interviewees emphasised the need for more user-friendly processes, and greater attention to patients' preferences for consultation type.

Condom Use Beliefs Differ According to Regulatory Focus: A Mixed-Methods Study in Portugal and Spain.

Reports worldwide have been showing increasing rates of sexually transmitted infections (STIs) and condomless sex in recent years. Research has identified several individual and situational variables that can determine the decision to use condoms or forgo their use. We argue that such a decision can also be shaped by motives related to pleasure and safety (i.e., regulatory focus in sexuality). Using open ended questions, we asked 742 Portuguese and Spanish adults to indicate situations and reasons that could inform the decision making process with casual partners and the functions/attributes related to condoms. Using thematic analyses, we coded the drivers of condomless sex and condom use into themes and subthemes, and computed their frequencies. Using quantitative measures, we also asked participants to indicate their condom use expectancies and perceived barriers. Comparing participants according to regulatory focus revealed some differences. Pleasure promotion participants were more likely to consider that condom use decision making is driven by unexpectedness, pleasure, and intimacy pursuit, attached more pleasure reduction functions to condoms, expected more negative outcomes in condom use, and endorsed more sensation and partner barriers in condom use. In contrast, disease prevention participants were more likely to consider that condom use decision making is driven by adequate sexual education, responsibility, and behavioral control, and attached more health protective functions to condoms. These differences can inform the development of tailored intervention and awareness campaigns aimed at helping people to use condoms more consistently with casual partners and to avoid behaviors that put them at risk of STI transmission.

Prevent2Protect Project: Regulatory Focus Differences in Sexual Health Knowledge and Practices.

The way people perceive risks and make decisions about their health is regulated by two motivational systems-prevention of harm or promotion of pleasure. People more focused on prevention strive to avoid negative outcomes and enact more health-protective behaviors. In contrast, people more focused on promotion strive to attain positive outcomes and take more risks with their health. Building upon recent evidence extending this framework to sexual behaviors and health, we conducted a pre-registered online survey ( OSF ) with Portuguese and Spanish adults (N = 742; Mage = 31.42, SD = 9.16) to examine whether self-reported STI knowledge and sexual health practices differ based on predominant regulatory focus. This study was part of the Prevent2Protect project ( OSF ). Results showed that prevention-focused participants had heard about more STIs and retrieved more of their knowledge from scientific sources but had been tested for fewer STIs in the past. In contrast, promotion-focused participants indicated they had specific knowledge about more STIs, retrieved more of their knowledge from medical and peer sources, and had been tested for more STIs in the past. They also reported more frequent STI testing, using free testing facilities or asking their family practice doctor to get tested, more routine sexual health check-ups, and more use of other contraceptive methods, such as birth control pills. These results remained unchanged after controlling for demographic differences. Overall, our findings showed that different motives in sexuality shape sexual health knowledge and sexual health practices.

Calling time on responsible drinking: A qualitative study of perceptions of information on alcohol product labels.

OBJECTIVES: This study aimed to explore (a) how people interpret responsible drinking messages on alcohol product labels, and (b) the acceptability of including health information on labels. DESIGN: Qualitative interviews. METHODS: Face-to-face semi-structured interviews were conducted with 20 people aged 21-63; 18 were classified risky drinkers using AUDIT-C. They were shown three sets of alcohol product labels: one including three responsible drinking messages (drink responsibly), one with three positively worded health messages (drinking less reduces risks) and one with three negatively worded health messages (drinking more increases risks). Health messages included information about cancer, liver and heart disease. RESULTS: Thematic analysis identified three themes: ambiguity about alcohol labelling; identifying oneself as responsible; and acceptability of enhanced product labelling. Participants were critical of responsible drinking messages and wary of conflicting health information in the media. They positioned themselves as responsible, knowledgeable drinkers and distanced themselves from problem drinkers. They did not appear to support the inclusion of health information on labels; however, novel information was considered more impactful. CONCLUSIONS: Responsible drinking messages were seen by our sample as an alcohol industry ploy. Although health messages about cancer were seen as potentially impactful, the ability of consumers to position themselves as unproblematic drinkers means that they may not see the information on the label as relevant to themselves. Understanding factors that increase the personal relevance of messages is needed, alongside an exploration of a wider range of methods for alcohol health communication.

Messages focused on the effect of alcohol on the immune system boosted intention to adhere to alcohol intake guidelines during Covid-19 lockdown.

Objective: Research shows that personal relevance may affect the impact of alcohol-related health information. This study explored alcohol consumption during the UK Covid-19 lockdown, and whether a message emphasising the effect of alcohol on the immune system was more effective in altering intentions to follow low-risk drinking guidelines than other messages about the effects of alcohol on health.Methods & Measures: From April to June 2020, 953 drinkers completed an online questionnaire, and were randomly allocated to exposure to a control condition or one of three messages emphasising the impact of alcohol on: the immune system; mental health; or physical health. Outcome variables were: concern about alcohol intake, and intention to adhere to low-risk drinking guidelines.Results: Pre-post ANCOVAs revealed that participants in the immunity message group had significantly stronger intention to adhere to low-risk guidelines than the control group (after controlling for initial intention). Concern for the effect of alcohol on health was not significantly affected.Conclusion: During Covid-19 lockdown, a message emphasising the impact of alcohol on the immune-system had a greater effect on intention to observe low-risk drinking guidelines than other messages. Contextually relevant messages could be used for alcohol health campaigns and for improving alcohol labelling.

"It's Not Just in My Head, and It's Not Just Irrelevant": Autistic Negotiations of Menopausal Transitions.

Physical and psychological changes during menopause can be especially tumultuous for autistic people: difficulties with sensory sensitivity and daily functioning may be exacerbated. Through individual interviews, we examined the language used by seven peri- or post-menopausal autistic people to construct their experiences, and to consider the implications for their wellbeing and identities. Our analysis, which utilised thematic decomposition, yielded three discursive themes. The theme "Uncertainty about Changes" addressed how limited awareness and understanding of menopause combined with difficulties recognising internal states. However, with "Growing Self-Awareness and Self-Care", some participants made conscious efforts to resist negative societal constructions of both autism and menopause. The theme "Navigating Support Options" addressed the interpersonal and systemic barriers participants faced when seeking support. There is a need for accessible information for autistic people experiencing menopause, and greater professional awareness.

Beyond "Meat Free Monday": A mixed method study of giving up eating meat.

Increasing numbers of people are vegan, vegetarian, or reducing meat consumption. There has also been growth in campaigns such as Meat Free Monday (MFM) that encourage and support reduced meat consumption. We conducted a mixed-method exploration of the behaviour and beliefs associated with reducing or eliminating meat consumption. An online questionnaire was completed by an opportunistic sample of 655 people aged 18-82 who were registered on the MFM website, and were meat eaters at the time of registering. The key focus of quantitative analyses was comparisons between three groups: those who described themselves as "omnivores" who ate all meat at the time of completing the survey, those who ate only some meat, and those who had stopped eating meat since registering for MFM. The qualitative component entailed Interpretative Phenomenological Analysis of in-depth interviews with 18 people who had completed the questionnaire. The quantitative data revealed that people who had stopped eating meat since engaging with the MFM campaign had more positive attitudes toward being vegetarian or vegan, had been engaged with MFM for a longer time, and had used more elements of the MFM website. The qualitative data illustrated that individuals understood and appreciated MFM's aim of supporting people to make an initial change and then considering expanding on this. Interviewees highlighted the value and importance of campaign materials that helped them to turn their beliefs and motivation into enduring behaviour change. The observed associations between longer engagement with the campaign and greater behaviour change suggest that MFM and similar campaigns will maximise their impact if they can maintain people's active engagement: that this will necessitate deeper understanding of the forms of support and advice are most wanted and most effective.

Understanding Motivation to Adhere to Guidelines for Alcohol Intake, Physical Activity, and Fruit and Vegetable Intake Among U.K. University Students.

BACKGROUND: To encourage people to lead healthier lifestyles, governments in many countries publish guidelines for alcohol intake, physical activity (PA), and fruit and vegetable (FV) intake. However, there is a need for better understanding of whether people understand such guidelines, consider them useful, and adhere to them. University students are a group worthy of attention because although they are less likely than older adults to exceed U.K. weekly alcohol intake guidelines or to be inactive, they are also less likely to meet FV consumption targets. Furthermore, because behavior during youth predicts adult behavior, it is important to identify influences on healthier behavior. METHOD: An online survey was completed by 559 U.K. university students. Key outcome variables were knowledge of guidelines, motivation to adhere to them, and adherence to them. RESULTS: A total of 72% adhered to guidelines for alcohol intake, 58% for PA, and 20% for FV intake. Students generally had poor or moderate knowledge of guidelines, perceived them as only moderately useful, and were only moderately motivated to adhere to them. Greater motivation to adhere to guidelines was not significantly related to more accurate knowledge. However, it was related to greater familiarity, and perceiving guidelines as useful and realistic, and greater conscientiousness. DISCUSSION: There is a need to ensure that students understand the U.K. guidelines for alcohol intake, PA, and FV intake. However, simply increasing knowledge may not lead to greater adherence to the guidelines: There is also a need to focus on improving perceptions of how useful and realistic they are.

Short- and Longer-Term Benefits of Temporary Alcohol Abstinence During 'Dry January' Are Not Also Observed Among Adult Drinkers in the General Population: Prospective Cohort Study.

AIMS: The alcohol abstinence challenge 'Dry January' continues to grow, but there is a lack of knowledge of how Dry January participants compare to the general population. There is also a need to determine whether benefits experienced by Dry January participants are unique to that group or are also observed among other people. METHODS: We conducted a prospective cohort study using online questionnaires in early January, February and August 2019. We compared 1192 Dry January participants and 1549 adult drinkers who did not attempt to abstain from alcohol. Key outcomes were self-rated physical health, psychological well-being (Warwick-Edinburgh Mental Well-Being Scale), control over drinking (Drink Refusal Self-Efficacy Scale (DRSE)) and alcohol intake (Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) subscale). Baseline differences in demographic and alcohol consumption variables were included as covariates in between-group analyses. RESULTS: Dry January participants had higher SES, poorer well-being, higher AUDIT-C scores and less control over their drinking than the general population. Beneficial changes in health, WEMWBS, DRSE and AUDIT-C observed among people completing Dry January were not observed among other adult drinkers. CONCLUSIONS: Dry January appears to attract people who are heavier drinkers than the general population and who are more concerned about their alcohol intake. Completion of Dry January is associated with short- and longer-term benefits to well-being that are not observed in the general population.

Temporary abstinence during Dry January: predictors of success; impact on well-being and self-efficacy.

Background: Temporary alcohol abstinence conveys physiological benefits. Less well-known are its effects on well-being and general self-efficacy (GSE), and how use of support during alcohol abstinence challenges affects success rates.Methods: In this study, 4232 adults participating in 'Dry January' completed a baseline questionnaire and a 1-month follow-up questionnaire. Key follow-up variables related to whether respondents completed the abstinence challenge, their use of support provided by Dry January, and changes in well-being and GSE. Analyses also examined whether well-being and GSE explained variance in the likelihood of completing Dry January not accounted for by other variables known to be associated with successful attempts at Dry January.Results: Participation in Dry January was associated with increases in well-being and GSE among all respondents: these changes were larger among people who successfully completed the challenge. In multivariate analysis, greater use of email support was a significant independent correlate of completing Dry January.Conclusions: This paper adds to growing evidence that support provided through organised abstinence challenges is associated with changes in beliefs linked to harmful drinking. However, there is a need for further research to help us to understand what forms of support are most effective for different drinkers.

Resilience-based alcohol education: developing an intervention, evaluating feasibility and barriers to implementation using mixed-methods.

Alcohol education must ensure that young people have appropriate information, motivation and skills. This article describes the fifth phase in a program of intervention development based on principles of social marketing and intervention mapping. The aim was to enhance drink refusal self-efficacy (DRSE) and help develop skills for non-drinking or moderate drinking. We conducted a mixed-methods feasibility trial that measured intervention effects among 277 UK secondary school students aged 14-16, and used qualitative methods to explore four teachers' experiences of delivering the intervention. The intervention did not produce the desired changes in DRSE or alcohol use, but nor did it increase alcohol use. In the qualitative process evaluation, time constraints, pressure to prioritize other topics, awkwardness and embarrassment were identified as barriers to fidelitous delivery. A more intense and/or more prolonged intervention delivered with greater fidelity may have produced the desired changes in DRSE and alcohol use. This study illustrates how principles of social marketing and intervention mapping can aid development of resilience-based education designed to help students develop skills to drink moderately, or not drink. It also highlights the need to consider the constraints of micro-social (school) and macro-social (societal) cultures when designing alcohol education.

Employees' Perspectives on the Facilitators and Barriers to Engaging With Digital Mental Health Interventions in the Workplace: Qualitative Study.

BACKGROUND: Prevalence rates of work-related stress, depression, and anxiety are high, resulting in reduced productivity and increased absenteeism. There is evidence that these conditions can be successfully treated in the workplace, but take-up of psychological treatments among workers is low. Digital mental health interventions delivered in the workplace may be one way to address this imbalance, but although there is evidence that digital mental health is effective at treating stress, depression, and anxiety in the workplace, uptake of and engagement with these interventions remains a concern. Additionally, there is little research on the appropriateness of the workplace for delivering these interventions or on what the facilitators and barriers to engagement with digital mental health interventions in an occupational setting might be. OBJECTIVE: The aim of this research was to get a better understanding of the facilitators and barriers to engaging with digital mental health interventions in the workplace. METHODS: Semistructured interviews were held with 18 participants who had access to an occupational digital mental health intervention as part of a randomized controlled trial. The interviews were transcribed, and thematic analysis was used to develop an understanding of the data. RESULTS: Digital mental health interventions were described by interviewees as convenient, flexible, and anonymous; these attributes were seen as being both facilitators and barriers to engagement in a workplace setting. Convenience and flexibility could increase the opportunities to engage with digital mental health, but in a workplace setting they could also result in difficulty in prioritizing time and ensuring a temporal and spatial separation between work and therapy. The anonymity of the Internet could encourage use, but that benefit may be lost for people who work in open-plan offices. Other facilitators to engagement included interactive and interesting content and design features such as progress trackers and reminders to log in. The main barrier to engagement was the lack of time. The perfect digital mental health intervention was described as a website that combined a short interactive course that was accessed alongside time-unlimited information and advice that was regularly updated and could be dipped in and out of. Participants also wanted access to e-coaching support. CONCLUSIONS: Occupational digital mental health interventions may have an important role in delivering health care support to employees. Although the advantages of digital mental health interventions are clear, they do not always fully translate to interventions delivered in an occupational setting and further work is required to identify ways of minimizing potential barriers to access and engagement. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02729987; https://clinicaltrials.gov/ct2/show/NCT02729987?term=NCT02729987& rank=1 (Archived at WebCite at http://www.webcitation.org/6wZJge9rt).

Benefits and drawbacks of social non-drinking identified by British university students.

INTRODUCTION AND AIMS: Promoting the benefits of not drinking alcohol during social occasions where other peers may be drinking ('social non-drinking') may support more moderate drinking among young people. We analysed free-text responses from university students to gauge the frequency/focus of identified benefits of, and drawbacks to, social non-drinking. We also assessed whether/how identified benefits and drawbacks were associated with recent drinking behaviour and psychological correlates of harmful drinking. DESIGN AND METHODS: Secondary data analyses were conducted on 511 free-text responses provided by students participating in a health intervention. Template analysis was used to identify potential benefits of social non-drinking. Links between responses relating to social non-drinking and behavioural/psychological measures were assessed. RESULTS: 46.2% of female students and 42.0% of male students had engaged in social non-drinking in the previous week. Overarching benefits of social non-drinking included: improved physical and psychological health; increased self-esteem/agency; a higher quality social life and having a more stable/productive life. Hostility/ambivalence to social non-drinking was evident in 26.6% of responses. Among women only, endorsing higher self-esteem and agency as a benefit of social non-drinking was associated with increased intention to heed government drinking recommendations (ß = 0.10, P = 0.036). DISCUSSION AND CONCLUSIONS: Focus on social non-drinking may help encourage more moderate drinking among young people by articulating positives of social non-drinking while raising awareness of a changing normative context in which non-drinking is increasingly more common among young people.

"It Takes a Man to Put Me on the Bottom": Gay Men's Experiences of Masculinity and Anal Intercourse.

In anal intercourse between gay men, men who are typically insertive ("tops") are often perceived as, and may identify as, more masculine than those who are typically receptive ("bottoms"). "Versatile" men, who may adopt either position, may be perceived as more gender balanced and may transcend the gender-role stereotypes associated with self-labeling as top or bottom. The aim of this study was to explore how gay men's beliefs about masculinity were associated with their beliefs about the gendered nature of sexual self-labels and their behavior in anal intercourse. Individual semistructured interviews were undertaken with 17 UK-based gay men. Interpretative phenomenological analysis (IPA) identified that perceptions of tops and bottoms as gendered social identities varied depending on the extent to which gay men subscribed to the mandates of hegemonic masculinity, the dominant masculinity in Western society. The findings also suggested that some gay men differentiated between top and bottom as social identities and topping and bottoming as gendered behaviors. This had implications for gay men's behaviors in anal intercourse. It is suggested that future efforts to engage with gay men about their sexual behavior should account for their beliefs regarding the gender-role stereotypes associated with gay sexual self-labels.

The growth of 'Dry January': promoting participation and the benefits of participation.

This article explores contributors to the rapid growth of the annual UK alcohol abstinence challenge 'Dry January' and the benefits of registration. Evidence from four sources is presented: (i) registrations via the Dry January website, (ii) surveys of population-representative samples of drinkers, (iii) surveys of Dry January registrants and (iv) surveys of a control group of drinkers who wanted to change to their drinking behaviour but had not registered for Dry January. The data revealed that Dry January registrations increased 15-fold in 4 years. Participants reported that encouragement received from Dry January helped them to avoid drinking. Comparisons of Dry January registrants to the control group suggest that registering for Dry January reduced problematic drinking and enhanced the capacity to refuse alcohol. The four sources of data suggest that 'social contagion' and 'diffusion' have aided the growth of the awareness, appeal and practice of Dry January.

Tobacco smoking and sexual difficulties among Australian adults: a cross-sectional study.

Background Few studies have examined smoking and female sexual difficulties. The aim of this study was to investigate the association between current tobacco smoking and sexual difficulties in Australian men and women. METHODS: Data for this study came from the Second Australian Study of Health and Relationships (2012-13), which includes a representative sample of 18427 sexually active Australian adults (aged 16-69 years). The main study and outcome measures were tobacco smoking and sexual difficulties. A multiple logistic regression analysis was conducted to adjust for potential confounders. RESULTS: Male heavy smokers (>20 cigarettes per day) were significantly more likely than non-smokers to have trouble keeping an erection [adjusted odds ratio (AOR) 4.14, 95% confidence interval (CI) 1.87-9.20; P<0.0001], lack interest in having sex (AOR 2.18, 95% CI 1.20-3.97; P=0.011), have anxiety about performance (AOR 2.46, 95% CI 1.24-4.86; P=0.010) and be unable to come to orgasm (AOR=2.81, 95% CI 1.23-6.42; P=0.015). Female smokers were also significantly more likely than non-smokers to not find sex pleasurable (AOR 1.48, 95% CI 1.05-2.07; P=0.025); and light female smokers were significantly more likely than non-smokers to be unable to come to orgasm (AOR=1.44, 95% CI 1.05-1.98; P=0.025). CONCLUSIONS: Current tobacco smoking was associated with sexual difficulties in both men and women. For women, even light smoking was associated with not finding sex pleasurable and being unable to come to orgasm.

A Profile of Pornography Users in Australia: Findings From the Second Australian Study of Health and Relationships.

There are societal concerns that looking at pornography has adverse consequences among those exposed. However, looking at sexually explicit material could have educative and relationship benefits. This article identifies factors associated with looking at pornography ever or within the past 12 months for men and women in Australia, and the extent to which reporting an "addiction" to pornography is associated with reported bad effects. Data from the Second Australian Study of Health and Relationships (ASHR2) were used: computer-assisted telephone interviews (CASIs) completed by a representative sample of 9,963 men and 10,131 women aged 16 to 69 years from all Australian states and territories, with an overall participation rate of 66%. Most men (84%) and half of the women (54%) had ever looked at pornographic material. Three-quarters of these men (76%) and more than one-third of these women (41%) had looked at pornographic material in the past year. Very few respondents reported that they were addicted to pornography (men 4%, women 1%), and of those who said they were addicted about half also reported that using pornography had had a bad effect on them. Looking at pornographic material appears to be reasonably common in Australia, with adverse effects reported by a small minority.

University students' beliefs about unit-based guidelines: A qualitative study.

UK government guidance for alcohol consumption is expressed in 'units' of alcohol. This study employed semi-structured interviews to explore university students' knowledge of, attitudes towards, and use of unit-based guidelines. Thematic analysis revealed that participants were not motivated to adhere to unit-based guidelines and that they lacked the skills required to apply them to reduce their own drinking. Instead, interviewees used individual strategies to monitor their drinking. The results suggest that public health interventions should include provision of information, efforts to motivate young people to change their behaviour and strategies to develop skills for managing alcohol consumption.

Differences Between Landline and Mobile Phone Users in Sexual Behavior Research.

This study investigated differences between the demographic characteristics, participation rates (i.e., agreeing to respond to questions about sexual behavior), and sexual behaviors of landline and mobile phone samples in Australia. A nationally representative sample of Australians aged 18 years and over was recruited via random digit dialing in December 2011 to collect data via computer-assisted telephone interviews. A total of 1012 people (370 men, 642 women) completed a landline interview and 1002 (524 men, 478 women) completed a mobile phone interview. Results revealed that telephone user status was significantly related to all demographic variables: gender, age, educational attainment, area of residence, country of birth, household composition, and current ongoing relationship status. In unadjusted analyses, telephone status was also associated with women's participation rates, participants' number of other-sex sexual partners in the previous year, and women's lifetime sexual experience. However, after controlling for significant demographic factors, telephone status was only independently related to women's participation rates. Post hoc analyses showed that significant, between-group differences for all other sexual behavior outcomes could be explained by demographic covariates. Results also suggested that telephone status may be associated with participation bias in research on sexual behavior. Taken together, these findings highlight the importance of sampling both landline and mobile phone users to improve the representativeness of sexual behavior data collected via telephone interviews.