Satisfaction with remote consultations in primary care during COVID-19: a population survey of UK adults.

BACKGROUND: Mode of access to primary care changed during the COVID-19 pandemic; remote consultations became more widespread. With remote consultations likely to continue in UK primary care, it is important to understand people's perceptions of remote consultations and identify potential resulting inequalities. AIM: To assess satisfaction with remote GP consultations in the UK during the COVID-19 pandemic and identify demographic variation in satisfaction levels. DESIGN AND SETTING: A cross-sectional survey from the second phase of a large UK-based study, which was conducted during the COVID-19 pandemic. METHOD: In total, 1426 adults who self-reported having sought help from their doctor in the past 6 months completed an online questionnaire (February to March 2021). Items included satisfaction with remote consultations and demographic variables. Associations were analysed using multivariable regression. RESULTS: A novel six-item scale of satisfaction with remote GP consultations had good psychometric properties. Participants with higher levels of education had significantly greater satisfaction with remote consultations than participants with mid-level qualifications (B = -0.82, 95% confidence interval [CI] = -1.41 to -0.23) or those with low or no qualifications (B = -1.65, 95% CI = -2.29 to -1.02). People living in Wales reported significantly higher satisfaction compared with those living in Scotland (B = -1.94, 95% CI = -3.11 to -0.78), although caution is warranted due to small group numbers. CONCLUSION: These findings can inform the use and adaptation of remote consultations in primary care. Adults with lower educational levels may need additional support to improve their experience and ensure equitable care via remote consultations.

Health behaviour change among UK adults during the pandemic: findings from the COVID-19 cancer attitudes and behaviours study.

BACKGROUND: COVID-19 related lockdowns may have affected engagement in health behaviours among the UK adult population. This prospective observational study assessed socio-demographic patterning in attempts to change and maintain a range of health behaviours and changes between two time points during the pandemic. METHODS: Adults aged 18 years and over (n = 4,978) were recruited using Dynata (an online market research platform) and the HealthWise Wales platform, supplemented through social media advertising. Online surveys were conducted in August/September 2020 when lockdown restrictions eased in the UK following the first major UK lockdown (survey phase 1) and in February/March 2021 during a further national lockdown (survey phase 2). Measures derived from the Cancer Awareness Measure included self-reported attempts to reduce alcohol consumption, increase fruit/vegetable consumption, increase physical activity, lose weight and reduce/stop smoking. Multivariable logistic regressions were used to assess individual health behaviour change attempts over time, adjusted for age, sex, ethnicity, employment and education. RESULTS: Around half of participants in survey phase 1 reported trying to increase physical activity (n = 2607, 52.4%), increase fruit/vegetables (n = 2445, 49.1%) and lose weight (n = 2413, 48.5%), with 19.0% (n = 948) trying to reduce alcohol consumption among people who drink. Among the 738 participants who smoked, 51.5% (n = 380) were trying to reduce and 27.4% (n = 202) to stop smoking completely. Most behaviour change attempts were more common among women, younger adults and minority ethnic group participants. Efforts to reduce smoking (aOR: 0.98, 95% CI: 0.82-1.17) and stop smoking (aOR: 0.98, 95% CI: 0.80-1.20) did not differ significantly in phase 2 compared to phase 1. Similarly, changes over time in attempts to improve other health behaviours were not statistically significant: physical activity (aOR: 1.07; 95% CI: 0.99-1.16); weight loss (aOR: 0.95; 95% CI: 0.90-1.00); fruit/vegetable intake (aOR: 0.98, 95% CI: 0.91-1.06) and alcohol use (aOR: 1.32, 95% CI: 0.92-1.91). CONCLUSION: A substantial proportion of participants reported attempts to change health behaviours in the initial survey phase. However, the lack of change observed over time indicated that overall motivation to engage in healthy behaviours was sustained among the UK adult population, from a period shortly after the first lockdown toward the end of the second prolonged lockdown.

Intentions to participate in cervical and colorectal cancer screening during the COVID-19 pandemic: A mixed-methods study.

Worldwide, cancer screening faced significant disruption in 2020 due to the COVID-19 pandemic. If this has led to changes in public attitudes towards screening and reduced intention to participate, there is a risk of long-term adverse impact on cancer outcomes. In this study, we examined previous participation and future intentions to take part in cervical and colorectal cancer (CRC) screening following the first national lockdown in the UK. Overall, 7543 adults were recruited to a cross-sectional online survey in August-September 2020. Logistic regression analyses were used to identify correlates of strong screening intentions among 2319 participants eligible for cervical screening and 2502 eligible for home-based CRC screening. Qualitative interviews were conducted with a sub-sample of 30 participants. Verbatim transcripts were analysed thematically. Of those eligible, 74% of survey participants intended to attend cervical screening and 84% intended to complete home-based CRC screening when next invited. Thirty percent and 19% of the cervical and CRC samples respectively said they were less likely to attend a cancer screening appointment now than before the pandemic. Previous non-participation was the strongest predictor of low intentions for cervical (aOR 26.31, 95% CI: 17.61-39.30) and CRC (aOR 67.68, 95% CI: 33.91-135.06) screening. Interview participants expressed concerns about visiting healthcare settings but were keen to participate when screening programmes resumed. Intentions to participate in future screening were high and strongly associated with previous engagement in both programmes. As screening services recover, it will be important to monitor participation and to ensure people feel safe to attend.

Cancer symptom experience and help-seeking behaviour during the COVID-19 pandemic in the UK: a cross-sectional population survey.

OBJECTIVES: To understand self-reported potential cancer symptom help-seeking behaviours and attitudes during the first 6 months (March-August 2020) of the UK COVID-19 pandemic. DESIGN: UK population-based survey conducted during August and September 2020. Correlates of help-seeking behaviour were modelled using logistic regression in participants reporting potential cancer symptoms during the previous 6 months. Qualitative telephone interviews with a purposeful subsample of participants, analysed thematically. SETTING: Online UK wide survey. PARTICIPANTS: 7543 adults recruited via Cancer Research UK online panel provider (Dynata) and HealthWise Wales (a national register of 'research ready' participants) supplemented with social media (Facebook and Twitter) recruitment. 30 participants were also interviewed. MAIN OUTCOME MEASURES: Survey measures included experiences of 15 potential cancer symptoms, help-seeking behaviour, barriers and prompts to help-seeking. RESULTS: Of 3025 (40.1%) participants who experienced a potential cancer symptom, 44.8% (1355/3025) had not contacted their general practitioner (GP). Odds of help-seeking were higher among participants with disability (adjusted OR (aOR)=1.38, 95% CI 1.11 to 1.71) and who experienced more symptoms (aOR=1.68, 95% CI 1.56 to 1.82), and lower among those who perceived COVID-19 as the cause of symptom(s) (aOR=0.36, 95% CI 0.25 to 0.52). Barriers included worries about wasting the doctor's time (1158/7543, 15.4%), putting strain on healthcare services (945, 12.6%) and not wanting to make a fuss (907, 12.0%). Interviewees reported reluctance to contact the GP due to concerns about COVID-19 and fear of attending hospitals, and described putting their health concerns on hold. CONCLUSIONS: Many people avoided healthcare services despite experiencing potential cancer symptoms during the COVID-19 pandemic. Alongside current help-seeking campaigns, well-timed and appropriate nationally coordinated campaigns should signal that services are open safely for those with unusual or persistent symptoms. TRIAL REGISTRATION NUMBER: ISRCTN17782018.

The mediating role of comorbid conditions in the association between type 2 diabetes and cognition: A cross-sectional observational study using the UK Biobank cohort.

AIMS: Using the UK Biobank cohort, a large sample of middle aged and older adults in the UK, the present study aimed to examine the cross-sectional association between type 2 diabetes and cognition and to assess the hypothesised mediating role of common comorbid conditions, whilst controlling for important demographic and lifestyle factors. METHODS: Using regression models and general structural equation models, we examined the cross-sectional association between type 2 diabetes status and: fluid intelligence; reaction time; visual memory; digit span and prospective memory; and the hypothesised mediating role of common comorbid conditions: visceral obesity; sleep problems; macrovascular problems; respiratory problems; cancer and depressive symptoms in 47,468 participants from the UK Biobank cohort, of whom 1,831 have type 2 diabetes. We controlled for ethnicity, sex, age, deprivation, smoking status, alcohol consumption, physical activity levels and use of diabetes medication. RESULTS: Participants with type 2 diabetes had a significantly shorter digit span, b = -0.14, CIs [-0.27, -0.11] than those without type 2 diabetes. Those with type 2 diabetes did not differ from those without type 2 diabetes on fluid intelligence, reaction time, visual memory and prospective memory. The associations that do exist between type 2 diabetes and cognition are consistently mediated via macrovascular problems, depressive symptoms, and to a lesser extent visceral obesity. Respiratory problems, sleep disturbances and cancer did not mediate the association between type 2 diabetes status and measures of cognition. CONCLUSIONS: Comorbid conditions explain some of the observed association between type 2 diabetes and cognitive deficits. This suggests that prevention, management or treatment of these comorbid conditions may be important to reduce the likelihood of cognitive decline. Treatment studies with long follow-ups are needed to examine this.

User Experiences of a Smartphone-Based Attentive Eating App and Their Association With Diet and Weight Loss Outcomes: Thematic and Exploratory Analyses From a Randomized Controlled Trial.

BACKGROUND: Short-term laboratory studies suggest that eating attentively can reduce food intake. However, in a recent randomized controlled trial we found no evidence that using an attentive eating smartphone app outside of the laboratory had an effect on energy intake or weight loss over 8 weeks. OBJECTIVE: This research examined trial participants' experiences of using an attentive eating smartphone app and whether app usage was associated with energy intake and weight loss outcomes over 8 weeks. METHODS: We conducted thematic analysis of semistructured interviews (N=38) among participants in the attentive eating smartphone app group of the trial who completed the 8-week assessment. Linear regression models examined the associations between energy intake and weight loss outcomes at 8 weeks and app usage. RESULTS: Participants reported several barriers and facilitators to using the smartphone app, including repetition of app content, social setting, motivation, and habitual use of the app. Participants believed that using the app had some beneficial effects on their eating behavior and diet. Exploratory analyses indicated that more frequent recording of eating episodes in the app was associated with lower body weight (B=-0.02, P=.004) and greater self-reported energy intake (B=5.98, P=.01) at 8 weeks, but not body fat percentage or taste-test energy intake. Total audio clip plays, gallery views, and percentage of food entries recorded using an image were not significantly associated with energy intake or weight. CONCLUSIONS: Frequent recording of eating episodes in a smartphone app was associated with greater weight loss. There are barriers and facilitators to frequent use of an attentive eating smartphone app that may be useful to address when designing dietary behavior change smartphone apps. TRIAL REGISTRATION: ClinicalTrials.gov NCT03602001; https://clinicaltrials.gov/ct2/show/NCT03602001; Open Science Framework DOI 10.17605/osf.io/btzhw; https://osf.io/btzhw/.

Hypothesis awareness as a demand characteristic in laboratory-based eating behaviour research: An experimental study.

Demand characteristics are thought to undermine the validity of psychological research, but the extent to which participant awareness of study hypotheses affects laboratory-measured eating behaviour studies has received limited attention. Participants (N = 84) attended two laboratory sessions in which food intake was measured. In session 1 baseline food intake was measured. In session 2 participants were allocated to either a 'hypothesis aware' or 'hypothesis unaware' condition. Participants were led to believe in the 'hypothesis aware' condition that they were expected to increase their food intake in session 2 relative to session 1. Participants in the 'hypothesis unaware' condition were not provided with hypothesis information. Contrary to our pre-registered predictions, the experimental manipulation of hypothesis awareness did not affect session 2 food intake. However, the manipulation was less effective than anticipated as some participants did not appear to believe the hypothesis information provided. Post-hoc exploratory analyses revealed that participants who believed the study hypothesis was that their food intake would increase in session 2 ate more in session 2 than participants who did not believe this was the study hypothesis. Further confirmatory research is required to understand the causal effect that participant awareness of study hypotheses has on laboratory measured eating behaviour.

A smartphone based attentive eating intervention for energy intake and weight loss: results from a randomised controlled trial.

BACKGROUND: Laboratory studies suggest that eating more 'attentively' (e.g. attending to food being eaten and recalling eating episodes) can reduce food intake among participants with both healthy weight and overweight. The aim of this trial was to assess whether a smartphone application that encourages a more attentive eating style reduces energy intake and promotes weight loss. METHODS: In an open-label, single centre, parallel groups, individually randomised controlled trial, 107 adults with overweight/obesity in Merseyside, UK used an attentive eating smartphone application along with standard dietary advice (intervention group) or standard dietary advice only (control group) for 8 weeks. The primary outcomes were change in body weight at 8 weeks and energy intake at 4 and 8 weeks. Additional outcomes included self-reported eating behaviours measured at 8 weeks. Differences between groups were assessed with linear regression (adjusted) using multiple imputation for missing data. Study protocol registered prospectively at ( https://doi.org/10.17605/osf.io/btzhw ). RESULTS: There was no significant difference between the intervention and control group in weight lost at 8 weeks, or change in self-reported 24 h or objective taste-test energy intake at 4 or 8 weeks. Mean weight loss in the intervention group (n = 53) was 1.2 kg and 1.1 kg in the control group (n = 54), adjusted difference of - 0.10 (- 1.6 to 1.3) kg. Self-reported eating behaviours at 8 weeks also did not differ across groups. The intervention was largely used as intended and a per protocol analysis confined to participants in the intervention group that used the attentive eating smartphone application regularly and as intended also showed no effect on energy intake or weight loss. CONCLUSIONS: A smartphone based attentive eating intervention and standard dietary advice did not result in reduced energy intake or greater weight loss at 4 or 8 week follow-up than standard dietary advice alone. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03602001 . Registered retrospectively on 26th July 2018. Prospectively registered on the Open Science Framework on 11th August 2017.

Focused attention during eating enhanced memory for meal satiety but did not reduce later snack intake in men: A randomised within-subjects laboratory experiment.

Attending to food being eaten ('attentive eating') may reduce later overeating. However, evidence in support of this comes primarily from studies in women. The aims of the current study were to investigate the effect that attentive eating has on later food intake in men and examine potential underlying mechanisms. Using a within-subjects design, 34 men (BMI M = 23.73 kg/m2, SD = 2.93; age M = 29.15, SD = 11.99) consumed a fixed lunchtime meal on two study days. On one study day participants were instructed to pay attention to the sensory properties of the meal as they ate (focused attention condition), and on the other study day participants ate lunch normally. Three hours after each lunchtime session, ad libitum consumption of snack food was measured, and measures of memory for the earlier lunchtime meal were completed. Participants remembered the lunch to be significantly more satiating in the focused attention condition compared to the control condition. However, focused attention did not significantly affect later ad libitum snack intake or other measures of meal memory. Further research is needed to understand when focused attention influences subsequent food intake before this approach can be used effectively to reduce food intake.

(Over)eating out at major UK restaurant chains: observational study of energy content of main meals.

OBJECTIVES: To examine the energy content of main meals served in major UK restaurant chains and compare the energy content of meals in fast food and "full service" restaurant chains. DESIGN: Observational study. SETTING: Menu and nutritional information provided by major UK restaurant chains. MAIN OUTCOME MEASURES: Mean energy content of meals, proportion of meals meeting public health recommendations for energy consumption (≤600 kcal), and proportion of meals with excessive energy content (≥1000 kcal). RESULTS: Main meals from 27 restaurant chains (21 full service; 6 fast food) were sampled. The mean energy content of all eligible restaurant meals (13 396 in total) was 977 (95% confidence interval 973 to 983) kcal. The percentage of all meals that met public health recommendations for energy content was low (9%; n=1226) and smaller than the percentage of meals with an excessive energy content (47%; 6251). Compared with fast food restaurants, full service restaurants offered significantly more excessively calorific main meals, fewer main meals meeting public health recommendations, and on average 268 (103 to 433) kcal more in main meals. CONCLUSIONS: The energy content of a large number of main meals in major UK restaurant chains is excessive, and only a minority meet public health recommendations. Although the poor nutritional quality of fast food meals has been well documented, the energy content of full service restaurant meals in the UK tends to be higher and is a cause for concern. REGISTRATION: Study protocol and analysis strategy pre-registered on Open Science Framework (https://osf.io/w5h8q/).

Remembered Meal Satisfaction, Satiety, and Later Snack Food Intake: A Laboratory Study.

It is well established that the satiety providing effects of food can influence meal size and a disparate area of research suggests that memory regarding recent eating informs food intake. Here we examined whether remembered meal satisfaction (encompassing memory for meal liking and satiety) can be manipulated in the laboratory and whether this influences later food intake. Participants (N = 128, body mass index mean = 23.46kg/m², standard deviation = 4.70) consumed a fixed lunch and then rehearsed the satisfying or dissatisfying aspects of the meal, or a neutral experience (control), in order to manipulate memory for meal satisfaction. Three hours later participants completed a bogus taste-test to measure food intake and meal memory measures. There was no evidence that memory for general satisfaction with the meal was affected by the rehearsal condition. However, in the dissatisfying rehearsal condition, participants remembered being less satisfied with the satiety-providing effects of the lunch meal than in the satisfying and neutral rehearsal conditions. Snack food consumption did not differ across conditions and there was a small negative correlation between how satiating participants remembered their earlier meal to be and later snack food intake (r = -0.16, p = 0.07). The present study did not produce evidence that memory relating to meal satiety affects later food intake but further research is warranted.

Does working memory training improve dietary self-care in type 2 diabetes mellitus? Results of a double blind randomised controlled trial.

AIMS: Controlling food intake despite adequate knowledge remains a struggle for many people with type 2 diabetes. The present study investigated whether working memory training can reduce food intake and improve glycaemic control. It also examined training effects on cognition, food cravings, and dietary self-efficacy and self-care. METHODS: In a double-blind multicentre parallel-group randomised controlled trial, adults with type 2 diabetes mellitus were randomly allocated to receive 25 sessions of either active (n = 45) or control (n = 36) working memory training. Assessments at baseline, post-training and 3-month follow-up measured cognition, food intake (primary outcomes), glycaemic control (HbA1c) and cholesterol (secondary outcomes). Semi-structured interviews assessed participants' experiences of the training. RESULTS: Intention-to-treat ANOVAs (N = 81) showed improved non-trained updating ability in active compared to control training from pre-test (active M = 34.37, control M = 32.79) to post-test (active M = 31.35, control M = 33.53) and follow-up (active M = 31.81, control M = 32.65; η2 = 0.05). There were no overall effects of training on other measures of cognition, food intake, HbA1c, cholesterol, food cravings and dietary self-efficacy and self-care. In post-hoc analyses, those high in dietary restraint in the active training group showed a greater reduction in fat intake pre to post-test compared to controls. Interviews revealed issues around acceptability and performance of the training. CONCLUSIONS: Transfer of working memory training effects to non-trained behaviour were limited, but do suggest that training may reduce fat intake in those who are already motivated to do so. TRIAL REGISTRATION: Current Controlled Trials ISRCTN22806944.

No effect of focused attention whilst eating on later snack food intake: Two laboratory experiments.

Focusing attention on food during a meal has been shown to reduce later snack consumption. We report the results of two studies that aimed to replicate this effect and to elucidate the underlying mechanisms. We hypothesised that focused attention during a lunchtime meal would improve visual memory and/or memory for the satiating effects of the meal, and that this would reduce later food intake. In Study 1, participants (N = 108, 52.8% female, BMI M = 25.75 kg/m2) were randomly allocated to eat a fixed lunchtime meal while listening to instructions that encouraged them to pay attention to the sensory properties of the meal (focused attention condition), or to one of two control conditions. To determine whether the effect of focused attention on later food intake is influenced by meal satisfaction, in a second study, participants (N = 147, 100% female, BMI M = 25.15 kg/m2) were given either a satisfying or dissatisfying lunch. In both studies, after 3 h participants ate snack food ad libitum and completed assessments of their memory for the recent lunch. In both studies there was no effect of focused attention on later food intake. In Study 2, the effect of focused attention on later food intake was not moderated by meal satisfaction. In both studies focused attention did not improve memory for the lunch meal. The present studies failed to replicate the effect of focused attention on later food intake and this may be because focused attention did not improve memory for the lunchtime meal. Further research should examine the conditions under which attention during eating influences memory encoding and food intake.

The role of working memory sub-components in food choice and dieting success.

Evidence suggests a role for self-reported working memory (WM) in self-reported food intake, but it is not known which WM sub-components are involved. It is also important to consider how individual differences in dietary restraint and disinhibition influence WM and the impact of this on food choice. The current study assessed the relationship between WM sub-components and food choice, using computerised measures of WM sub-components and a direct assessment of food intake. The role of dieting success (measured by restraint and disinhibition) as a distal predictor of food choice that influences food choices via WM, and the role of WM more generally in dieting success were investigated. Female undergraduate students (N = 117, mean age: 18.9 years, mean BMI: 21.6 kg/m2) completed computer tasks assessing three components of WM (updating, phonological loop and visuospatial sketchpad) and a snack food taste-test. Greater visuospatial WM span was associated with a higher (lower) percentage of food intake that was low (high) energy dense. It was also found that unsuccessful dieters (high restraint, high disinhibition) had poorer visuospatial WM span and consumed a lower (higher) percentage of low (high) energy dense food. Visuospatial WM span significantly mediated the relationship between dieting success and percentage of low energy dense food intake. Further, dietary restraint was associated with poorer updating ability, irrespective of disinhibition. These findings suggest that better visuospatial WM is associated with a greater (reduced) preference for low (high) energy dense foods, and that deficits in visuospatial WM may undermine dieting attempts. Future work should assess whether the ability to deal with food cravings mediates the relationship between visuospatial WM and dieting success and investigate how WM may influence the mechanisms underlying behavioural control.