Cultural challenges for adapting behavioral intervention frameworks: A critical examination from a cultural psychology perspective.

We introduce the bias and equivalence framework to highlight how concepts, methods, and tools from cultural psychology can contribute to successful cultural adaptation and implementation of behavioral interventions. To situate our contribution, we provide a review of recent cultural adaptation research and existing frameworks. We identified 68 different frameworks that have been cited when reporting cultural adaptations and highlight three major adaptation dimensions that can be used to differentiate adaptations. Regarding effectiveness, we found an average effect size of zr = 0.24 (95%CI 0.20, 0.29) in 24 meta-analyses published since 2014, but also substantive differences across domains and unclear effects of the extent of cultural adaptations. To advance cultural adaptation efforts, we outline a framework that integrates key steps from previous cultural adaptation frameworks and highlight how cultural bias and equivalence considerations in conjunction with community engagement help a) in the diagnosis of behavioral or psychological problems, b) identification of possible interventions, c) the selection of specific mechanisms of behavior change, d) the specification and documentation of dose effects and thresholds for diagnosis, e) entry and exit points within intervention programs, and f) cost-benefit-sustainability discussions. We provide guiding questions that may help researchers when adapting interventions to novel cultural contexts.

Introducing 'Ngaruroro', a New Model for Understanding Maori Wellbeing.

Indigenous peoples around the world are revitalising their ancestral beliefs, practices, and languages, including traditional understandings of health and wellbeing. In the Aotearoa (New Zealand) context, a number of ground-breaking Maori health- and wellbeing-related models have emerged, each with their own scope and applications. We sought in our qualitative studies to explore and identify several key sources of wellbeing for Maori individuals. Nine interviews were conducted with members of Maori communities to identify key themes of Maori wellbeing. We performed a Reflexive Thematic Analysis on these data and then conducted a further fifteen interviews to revise, refine, and reposition the previously generated themes. The Ngaruroro model describes wellbeing as the embodied and active process of being well in relation with one's (1) here tangata (social and familial ties), (2) te taiao (the environment), and (3) taonga tuku iho (cultural treasures) while doing what one can to make lifestyle choices that are conducive to the health of one's (4) tinana (body) and (5) wairua (spirit) while cultivating a balanced (6) ngakau (inner-system), fulfilling (7) matea (core needs) and exercising your (8) mana (authority). These themes illustrate that Maori wellbeing is dynamic, interconnected, and holistic.

Electronic health record time-tracking provides real-time data to measure and benchmark dietitian productivity.

BACKGROUND: Traditional methods for benchmarking dietitian productivity are time-consuming and fail to accurately measure the total time spent providing nutrition care. An electronic health record (EHR)-based tool that allows for daily tracking of both face-to-face and patient care coordination time for dietitians was created. We assessed whether it provided consistent, continuous measurement of time and productivity. METHODS: This tool was created in an independent paediatric academic healthcare system in the USA. Time spent by dietitians in face-to-face settings and care coordination were tracked. Changes in time spent between the years 2013-2016 versus 2018-2019 were also analysed. RESULTS: The outpatient dietitian spent a mean total of 66.4 min per patient (37.8 ± 6.0 min in face-to-face care and 28.6 ± 5.2 min in care coordination). The total times and fractions spent on face-to-face and care coordination time varied by specialty. Comparison of the two periods of time revealed 75% more productivity on average of dietitians in different outpatient settings after including care coordination tracking. In addition, dietitians were more likely to document time spent in 5-min increments after the institution of this methodology as opposed to 15-min increments. CONCLUSIONS: An EHR-based tool that facilitates the documentation of both face-to-face time and patient care coordination time is feasible and enables consistent, continuous measurement of time and productivity. The real-time data from this tool can be used to support adequate dietitian staffing and be used to create a multicentre database to measure the actual time dietitians need to provide care and generate consistent staffing benchmarks.

Experimentally induced changes in authoritarian submission as a response to threat.

Authoritarianism is best conceptualised by three attitudinal clusters: Aggression, Submission, and Conventionalism. Once considered a fixed characteristic, recent observational research has demonstrated how the dimension of submission can fluctuate in response to COVID-19 threat as a means of maintaining collective security. However, this effect has not been investigated with other forms of threat, nor has it been supported experimentally. In the present study, we sought to test observational findings by priming 300 participants with either a COVID-19 threat, a domestic terrorism threat, or a non-threatening control. Levels of authoritarianism were tested before and after presentation of a prime and then the difference between the two measures could be compared between prime conditions. Results from a Bayesian multivariate regression analysis informed by observational findings suggested that participants who experienced the COVID-19 or terrorism primes reported higher levels of authoritarian submission after the prime compared to before the prime, relative to those who experienced the neutral control prime. In contrast, the aggression subfactor did not seem to elicit any change in response to threat, and the conventionalism subfactor showed a response only to the terrorism prime. We concluded that two different forms of societal threat could elicit changes in specific dimensions of authoritarianism over a very short time span. We caution against the common practice of treating authoritarianism as a unidimensional construct without careful consideration.

Effects of vaping on uptake and cessation of smoking: Longitudinal analysis in Aotearoa New Zealand adults.

INTRODUCTION: Globally, the use of vapes, or e-cigarettes, is increasing. While vaping is less harmful than smoking and may help smokers to quit, there is also the possibility that vaping may lead to smoking. The current study aimed to determine the prevalence of vaping and smoking in Aotearoa New Zealand and explore longitudinal pathways between smoking status and vape use. METHOD: Data related to smoking and vaping status was analysed from Times 10, 11 and 12 across 2018-2020 of the New Zealand Attitudes and Values study, a large, representative, multi-wave study of adults living in New Zealand. Weighted descriptive analyses were used to determine prevalence rates of vaping and smoking and a generalised linear modelling approach was used to examine the likelihood of changing to, or taking up, the other behaviour in the transition between time points. RESULTS: Broadly, the prevalence of smoking was found to be decreasing over time while the prevalence of vaping was increasing. Despite these general trends, no differences were observed in the likelihood of transitioning from smoking to vaping or from vaping to smoking, indicating that either pathway was equally as likely. DISCUSSION AND CONCLUSIONS: The current findings demonstrate that vaping appeared to be just as likely to have a gateway effect to smoking as it was to have a cessation effect. This highlights the need for greater consideration regarding vaping-related policies and restrictions.

High Risk or Risky Highs: Understanding the Links Between Alcohol and Cannabis Use on the Transition From Suicidal Ideation to Attempts in Australian Men.

Alcohol and cannabis use are consistently associated with greater risk of suicide, particularly among men and in higher-income countries (e.g., Australia). Adult data (n = 7,464) from waves 1 and 2 of Ten to Men: The Australian Longitudinal Study on Male Health were used to explore whether alcohol and/or cannabis use increased the longitudinal risk of a suicide attempt among suicidal ideators. Cannabis use was associated with increased risk of transitioning from suicidal ideation to making a suicide attempt; no association was found for alcohol. Broadly, these findings indicate that greater cannabis but not alcohol use may increase risk of transitioning to making a suicide attempt among those who are thinking about suicide.

The Maori Cultural Embeddedness Scale (MaCES): Initial evidence of structural validity.

OBJECTIVES: The purpose of this article is to introduce a self-report measure of cultural embeddedness for Maori (Maori Cultural Embeddedness Scale [MaCES]), which builds on theoretical and qualitative research on the concept. METHOD: A total of 548 adults who self-identified as Maori responded to 49 items that were designed to measure aspects of Maori Cultural Values, Beliefs, and Practices. The data were analyzed using confirmatory factor analysis, and invariance was tested through multigroup confirmatory factor analysis. RESULTS: A total of six items were pruned from the measure for having low loadings on the latent factor, having ambiguous wording, and/or measuring contentious concepts. The remaining 43 items fit the data well when organized by three primary factors (i.e., Values, Beliefs, and Practices), further split into secondary subfactors. We also found that this nuanced subfactor model was invariant to sole/mixed identification as Maori, as well as growing up in urban or rural settings. We found evidence of structural validity for the MaCES, but ongoing validation, including convergent and divergent comparisons to other scales, is required in future work. CONCLUSIONS: The MaCES is a theoretically derived and statistically sound measure that offers significant research potential for exploring the various ways that embeddedness in Maori culture informs differential outcomes. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Evaluation of the English Version of the Fear of COVID-19 Scale and Its Relationship with Behavior Change and Political Beliefs.

The COVID-19 pandemic has many individuals around the world fearing for their lives. The constant news coverage, rapid transmission, and relatively high mortality rate, make fearfulness a natural response. To assess the fear of COVID-19, the Fear of COVID-19 Scale (FCV-19S) was developed. The primary aim of the present study was to conduct the first psychometric assessment and validation of the English version of the FCV-19S. Two samples were collected in New Zealand. Sample 1 comprised 1624 participants of which 1397 completed all questions and were used in the analyses. Sample 2 comprised 1111 participants of which 1023 completed all questions and were used in the analyses. Several psychometric tests were conducted to ascertain the scale's reliability and validity. Across both samples, the FCV-19S had high internal consistency. Consistent with the earlier validation studies, the FCV-19S displayed a moderately strong relationship with the perceived infectability and germ aversion subscales of the perceived vulnerability to disease scale (PVDS). Furthermore, FCV-19S scores were negatively correlated with the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) scores. With respect to the motivating role of fear, there was a significant relationship between FCV-19S scores and adherence to the lockdown rules that were implemented in New Zealand. Finally, consistent with recent reports on the politicization of the COVID-19 pandemic, an exploratory question found that participants who rated themselves as more conservative tended to report lower FCV-19S scores. The English version of the COVID-19S is a sound unidimensional scale with robust psychometric properties and can be used with confidence among English-speaking populations.

A combined web based intervention and ecological momentary intervention for reducing alcohol use among incoming first-year university students: Results from a three-arm randomised controlled trial.

BACKGROUND: The transition from high school to university is associated with increased alcohol use and harm. Web-based interventions (WBIs) and ecological momentary interventions (EMIs) are two methods that have had some success in reducing alcohol use among university students and may be particularly effective if implemented during the transition to university. The aim of the current study was to investigate the effectiveness of a combined WBI and EMI to reduce alcohol use among incoming university students. METHODS: Incoming first-year students (n = 783, in 2018 and 2019) were randomized into either a WBI + EMI, WBI-only, or an assessment-only condition. All participants completed online questionnaires before university, after their first and second semester, and reported their alcohol use fortnightly throughout their first year. Those in the WBI + EMI and WBI conditions received online feedback about their drinking (i.e., the WBI) immediately following the pre-university survey. Those in the WBI + EMI were also sent eight EMI messages to their mobile phones during Orientation Week and six EMI messages across the academic year aimed at reducing alcohol harm. RESULTS: There were no significant differences between the conditions in Orientation Week drinking, academic year drinking (both "typical" semester or fortnightly drinking), or alcohol-related harms. CONCLUSION: A WBI + EMI intervention aimed at the transition to university did not reduce university students' alcohol use. The transition, however, continues to be a period of serious harm where students drink more than any other period.

Why So Serious? An Attempt to Mitigate the Short-Term Harmful Effects of the Film Joker on Prejudice toward People with Mental Illness.

The media perpetuates many harmful stereotypes about people with mental illness. In two studies, we demonstrate the impact of negative media portrayals of mental illness on prejudice and attempt to mitigate these negative effects. Specifically, in Study 1, participants watched the movie Joker, a recent film which associates mental illness with violent behavior, or a control film (Terminator). Participants completed the Prejudice towards People with Mental Illness (PPMI) scale before and after viewing their respective films. The PPMI consists of four dimensions: fear/avoidance (i.e., wanting to avoid people with mental illness), malevolence (i.e., viewing people with mental illness as inferior), authoritarianism (i.e., preference for control over people with mental illness), and unpredictability (i.e., the behavior of people with mental illness is unreliable). We hypothesized that participants who watched the film Joker would display an increase in their fear/avoidance of people with mental illness and their support for authoritarian approaches to their treatment. Consistent with these hypotheses, participants who viewed Joker displayed a significant increase in the fear/avoidance and authoritarian subscales of the PPMI, relative to participants that watched Terminator. In Study 2, in an attempt to mitigate the impact of Joker on prejudice towards people with mental illness, directly after the film we displayed educational and counter-stereotypical statements on-screen that challenged the view that people with mental illness are violent. A control group viewed Joker without these statements. Identical to Study 1, all participants completed the PPMI scale before and after viewing the film. We hypothesized that participants who viewed Joker with the statements would display lower prejudice relative to the control condition. Unfortunately, participants in the experimental and control conditions displayed a comparable increase in prejudice. Together, these studies confirm the negative effect of media portrayals of mental illness (as depicted in Joker) and demonstrate that these effects are not easily mitigated.

Lung Cancer Attracts Greater Stigma than Other Cancer Types in Aotearoa New Zealand.

Background: Lung cancer is the leading cause of cancer death in Aotearoa New Zealand, killing over 1,700 people each year. Despite the burden of lung cancer in Aotearoa New Zealand, the popular press has referred to it as the cancer type that no one talks about. Here, we investigate one factor that may contribute to this state of affairs: lung cancer stigma. Methods: Participants were university students and members of the general public. University students were recruited via an online experiment participation system in 2021. Members of the public were recruited via social media. All participants completed the Cancer Stigma Scale (CSS) for one of five cancer types (lung, cervical, breast, skin, or bowel). The CSS is a 25-item scale with six subscales: awkwardness, avoidance, severity, policy opposition, personal responsibility, and financial discrimination. Results: The mean age of participants was 24.3 (Standard Deviation = 10.4). Data from each subscale were submitted to an analysis of covariance (ANCOVA), with cancer type as a between-participant factor (5: lung, cervical, breast, skin, or bowel) and stigma as the dependent variable. Relative to most other cancer types, people were more likely to avoid someone with lung cancer, view interacting with someone with lung cancer as more awkward, and view people with lung cancer as being responsible for their condition. Conclusion: The Health Research Council of New Zealand recently funded the very first trial of lung cancer screening in Aotearoa New Zealand. The current study suggests that addressing stigma will be essential for the success of such programs, with stigma likely influencing those who engage in such trials.

Left-wing support of authoritarian submission to protect against societal threat.

New Zealand's Prime Minister, Jacinda Ardern, adopted a "go hard, go early" approach to eliminate COVID-19. Although Ardern and her Labour party are considered left-leaning, the policies implemented during the pandemic (e.g., police roadblocks) have the hallmarks of Right-Wing Authoritarianism (RWA). RWA is characterized by three attitudinal clusters (authoritarian aggression, submission, and conventionalism). The uniqueness of the clusters, and whether they react to environmental change, has been debated. Here, in the context of the pandemic, we investigate the relationship between political orientation and RWA. Specifically, we measured political orientation, support for New Zealand's major political parties, and RWA among 1,430 adult community members. A multivariate Bayesian model demonstrated that, in the middle of a pandemic, both left-leaning and right-leaning individuals endorsed items tapping authoritarian submission. In contrast to authoritarian submission, and demonstrating the multidimensional nature of RWA, we observed the typical relationships between political orientation and authoritarian aggression and conventionalism was observed.

Indigenous people in Aotearoa New Zealand are overrepresented in cannabis convictions.

BACKGROUND: Previous work has demonstrated that cannabis laws have had a disproportionate impact on Maori, the Indigenous people of Aotearoa New Zealand. In 2019, the New Zealand Government amended cannabis laws, providing police with the power to determine whether a therapeutic or health-centred approach would be more beneficial than a conviction. In the current study, we use population level data to assess whether this law change has ameliorated the bias in cannabis convictions for Maori. METHODS: Data were drawn from the Integrated Data Infrastructure (IDI), a large government database hosted by Aotearoa New Zealand's national statistics office. In the IDI, we selected individuals who (1) were between 18 and 65, (2) were Maori or Pakeha (New Zealanders of European descent) and, (3) had any cannabis charges that proceeded to the courts. RESULTS: Maori ethnicity was a significant predictor of the odds of receiving a cannabis conviction for Maori males (Odds: 1.56), with a marginally significant effect for Maori females (Odds: 1.57). Further, for Maori, there was no reduction in the number of cannabis charges before vs. after the amendment to cannabis laws. CONCLUSION: The current study demonstrates that the bias in cannabis convictions for Maori remain. Given this, the New Zealand Government must follow other countries around the world and move forward on cannabis law reform.

Does the Fear of Missing Out Moderate the Relationship Between Social Networking Use and Affect? A Daily Diary Study.

Social networking site (SNS) use is common and speculation about the negative impact of SNS use on mental health and psychological well-being is a recurring theme in scientific debates. The evidence for this link, however, is inconclusive. The Fear of Missing Out (FoMO) may assist in understanding the mixed evidence, as individuals who experience FoMO are more driven to keep up with what is happening to avoid missing out. We used a 2-week daily diary study of 408 university students to measure the daily associations between SNS use and negative and positive affect and whether FoMO moderated these associations. Multi-level Bayesian regression analyses revealed that 1) greater SNS use was associated with reductions in successive positive affect, but not increases in negative affect and 2) FoMO moderated the influence of SNS use such that increases in successive negative affect occurred only in those individuals high in trait FoMO.

Methodological and conceptual complexities of assessing relationships between single-occasion CRP inflammation and daily affect.

Inflammation is commonly implicated in sustained levels of depressed mood, chiefly with concurrent measures. There is a dearth of research on understanding how mood-inflammation relationships change on a day-to-day timescale. Determining how inflammation and mood may fluctuate and interact with each other is imperative to determining which pathways may lead to a depressed mood due to inflammation, and, more broadly, which factors induce inflammation in the first place. Therefore, we explored a means of elucidating the nature of mood-inflammation relationships using daily measures of mood and a single time-point measure of inflammation, C-Reactive Protein (CRP). We predicted that the relationship between affect and this measure of inflammation would be time-invariant because of evidence suggesting factors contributing to inflammation are persistent over time, such as obesity or poor gut-microbiome health. Our sample consisted of 1397 young adult participants who completed daily surveys for thirteen days and provided a blood sample for CRP measurement once at the conclusion of the study. A Bayesian multivariate regression model was performed to determine how daily levels of positive and negative mood could be predicted by this single time-point measure of inflammation. As part of our analysis, we sought to control for two key moderators, BMI and physical activity. Results indicated that moderate levels of inflammation were not associated with poor mood when the individual exercised. We also determined that high BMI participants exhibited a greater impact of inflammation on their mood relative to low BMI participants. However, contrary to our primary prediction that this mood-inflammation relationship would be time-invariant, we did indeed find that the relationship was time-variant. This result indicated that research examining associations involving inflammation daily will be required to understand which causative factors may contribute to fluctuations of a mood-inflammation relationship on a daily basis.

A Longitudinal Study of Mental Wellbeing in Students in Aotearoa New Zealand Who Transitioned Into PhD Study.

Journal editorials, career features, and the popular press commonly talk of a graduate student mental health crisis. To date, studies on graduate student mental health have employed cross-sectional designs, limiting any causal conclusions regarding the relationship between entry into graduate study and mental health. Here, we draw on data from a longitudinal study of undergraduate students in Aotearoa New Zealand, allowing us to compare participants who did, and did not, transition into PhD study following the completion of their undergraduate degree. Using multilevel Bayesian regression, we identified a difference in mental wellbeing between those who entered PhD study and those who did not. This difference, however, was largely due to those not entering PhD study displaying an increase in mental wellbeing. Participants that entered PhD study displayed a small decrease in mental wellbeing, with the posterior distribution of the simple effect heavily overlapping zero. This latter finding was orders of magnitude smaller than one might expect based on previous cross-sectional research and provides an important message; that a marked drop in mental health is not an inevitable consequence of entering graduate study.

Taking a Break from Social Media Improves Wellbeing Through Sleep Quality.

As social media use has increased in prevalence, so have concerns that social media may be detrimental to mental health and wellbeing. The primary aim of the current study was to investigate whether limiting social media use leads to increases in wellbeing. A secondary aim was to assess whether sleep quality contributed to the hypothesized relationship between social media use and wellbeing. One hundred and thirty-two individuals participated in the current study, with half the participants limiting their use of Facebook, Instagram, and Snapchat for 1 week. Social media use was monitored by having participants email screen shots of their battery usage, which included information on the level of usage for Facebook, Instagram, and Snapchat. Relative to a control group that did not limit social media use, taking a break from social media led to a small improvement in wellbeing. This improvement, at least in part, appears to be due to changes in sleep quality.

Identifying profiles of affective change: An ecological momentary assessment of flourishers.

The broaden-and-build theory of positive emotion suggests that higher levels of positive affect promote an independently measurable state of high psychological well-being termed flourishing. Levels of self-perceived flourishing have been shown to be influenced by past affect, and there is some indication that flourishing may influence future affect. Our study addressed 2 questions: (a) whether a person-centered latent profile analysis based on momentary affective dynamics (intercept, stability, and variability) would identify the expected flourishing profile and (b) whether this profile would exhibit predicted bidirectional relationships between affective experience and self-reported flourishing status. A sample of 1,152 early adults reported momentary positive and negative affect 4 times a day and daily self-perceived flourishing for 13 days. Latent profile analysis identified 3 affective profiles: a positive profile, a mixed profile, and a negative profile. Our results indicate that distinct groups of people can be identified by their affective profiles and that momentary affect predicts changes in future self-perceptions of flourishing. However, we failed to find support for the view that self-perceptions of flourishing reliably predicted changes in levels of future affect. Thus, we only provide mixed support for the broaden-and-build theory and failed to support a key inference of the framework, a bidirectional relationship between experienced affect and self-perceptions of flourishing (at least on the scale of daily momentary change). (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Monitoring the sentiment of cannabis-related tweets in the lead up to New Zealand's cannabis referendum.

INTRODUCTION AND AIMS: In October 2020, New Zealanders will vote on whether cannabis should be legalised for recreational use. With this in mind, the aim of the present study is to gauge the views and opinions of the New Zealand population on cannabis via tweets. To achieve this, we conducted a sentiment analysis of all historic cannabis-related tweets and referendum-specific tweets written in New Zealand. DESIGN AND METHODS: We used a Twitter-sponsored commercial platform to access all historic cannabis-related tweets written in New Zealand and used search terms to remove non-cannabis-related terms. Next, we used the platform's machine learning function to code the sentiment of tweets (i.e. positive/pro-cannabis, negative/anti-cannabis or neutral). RESULTS: Between July 2009 and August 2020, 304 760 cannabis-related tweets were written in New Zealand. Overall, the tweets were predominantly positive (62.0%) and there was a higher proportion of positive tweets written in 2020 (65.3%) compared to negative or neutral tweets. Similarly, for referendum-specific tweets, the 2020 data reveal a generally positive view of cannabis (53.5%). DISCUSSION AND CONCLUSIONS: Both cannabis-related, and referendum-specific tweets, suggest that Twitter users in New Zealand have a generally positive view of cannabis. Given the nature of Twitter, the current method will allow us to study whether views toward cannabis change as the referendum nears and capture any late swings in pro- or anti-cannabis sentiment (abcd-lab.shinyapps.io/cannabis_sentiment/).