'Beyond the Scale': A Qualitative Exploration of the Impact of Weight Stigma Experienced by Patients With Obesity in General Practice.

OBJECTIVE: Obesity is a complex, chronic, relapsing disease that requires an individualised approach to treatment. However, weight stigma (WS) experienced in healthcare settings poses a significant barrier to achieving person-centred care for obesity. Understanding the experiences of people living with obesity (PwO) can inform interventions to reduce WS and optimise patient outcomes. This study explores how patients with obesity perceive WS in general practice settings; its impact on their psychological well-being and health behaviours, and the patients suggestions for mitigating it. METHODS: In-depth semistructured interviews were conducted with 11 PwO who had experienced WS in general practice settings in Ireland. The interviews were conducted online via Zoom between May and August 2023; interviews lasted between 31 and 63 min (M = 34.36 min). Interviews were audio-recorded, transcribed verbatim and analysed using inductive reflexive thematic analysis. RESULTS: Three overarching themes specific to participants' experience of WS in general practice were generated: (1) shame, blame and 'failure'; (2) eat less, move more-the go-to treatment; (3) worthiness tied to compliance. A fourth theme: (4) the desire for a considered approach, outlines the participants' suggestions for reducing WS by improving the quality of patient-provider interactions in general practice. CONCLUSION: The findings call for a paradigm shift in the management of obesity in general practice: emphasising training for GPs in weight-sensitive communication and promoting respectful, collaborative, and individualised care to reduce WS and improve outcomes for people with obesity. PATIENT OR PUBLIC CONTRIBUTION: PPI collaborators played an active and equal role in shaping the research, contributing to the development of the research questions, refining the interview schedule, identifying key themes in the data, and granting final approval to the submitted and published version of the study.

Awareness, Understanding and HIV Stigma in Response to Undetectable = Untransmittable Messages: Findings from a Nationally Representative Sample in the United Kingdom.

'Undetectable = Untransmittable', or 'U = U', is a message which communicates the scientific consensus that people living with HIV who maintain an undetectable viral load cannot sexually transmit HIV to others. This research aimed to empirically test whether a protection-framed U = U message is more effective at decreasing HIV stigma and increasing perceived accuracy of U = U than a risk-framed message. A nationally representative UK sample (N = 707) completed an online experiment. Participants viewed one of two U = U messages (protection-framed or risk-framed) and completed an online questionnaire. No evidence of a difference in HIV stigma at post-test or in perceived accuracy of U = U was found between the two message frame conditions. A minority of participants were aware of U = U prior to participation. Post-intervention, the majority of participants rated U = U as at least somewhat accurate. Higher understanding of U = U was associated with lower post-test stigma following a protection-framed message. Following a brief intervention, among a sample predominantly unaware of U = U previously, there was an overall favourable rating of U = U. No evidence was found for an effect of message framing on HIV stigma or perceived accuracy of U = U, but participants who completed a pre-test measure of stigma rated U = U as less accurate.

Lessons learned from a pandemic: implications for a combined exercise and educational programme for medical students.

BACKGROUND: The 'MED-WELL' programme is a combined exercise and educational intervention designed to promote well-being among medical students and educate students about prescribing exercise as medicine in clinical practice. Due to COVID-19 public health restrictions of social distancing the 'MED-WELL' programme was offered online instead of in-person in 2021. The aim of this study is to compare the experiences of participants in the 'MED-WELL' programme online to those that previously participated in the same programme in-person to understand the student experience and optimize programme delivery. METHODS: Purposive sampling was used to recruit 20 participants to a qualitative study using semi-structured interviews. Ten study participants took part in the 'MED-WELL' programme when it was offered in-person, and the other ten study participants took part in the programme when it was offered online. All interviews were audio-recorded and transcribed using Microsoft Teams. A combined inductive and deductive approach was used for analysis. An inductive thematic analysis was utilized to categorize data into higher order codes, themes, and overarching themes. The theory of online learning provided the theoretical framework for a deductive approach. RESULTS: Analysis of the data produced five overarching themes: 'student-student', 'student-teacher', 'student-content', 'student-environment', and 'effects of a pandemic'. The first four themes detail distinct types of interaction that participants had with various entities of the 'MED-WELL' programme and the effects that these interactions had on participant experiences. 'Effects of a pandemic' refers to the context of delivering the 'MED-WELL' programme online during a pandemic and how this mode of delivery influenced participants and the programme. CONCLUSIONS: Optimizing the 'MED-WELL' programme relies on an understanding of how participants interact with different entities of the programme and are motivated to attend and engage. Participants tended to favour an in-person mode of delivery, however certain advantages of delivering the programme online were also identified. The findings from this study can be used to inform similar experiential and educational exercise interventions, and may help plan for potential future restrictions on in-person educational and exercise-based programmes.

New self-management technologies for the treatment of hypertension: general practitioners' perspectives.

Background: Digital health interventions, such as those that can be delivered via smartphone applications (apps) or wireless blood pressure monitors, offer a new, scalable and potentially cost-effective way to improve hypertension self-management. In Ireland, as is common in the UK, the majority of hypertension management occurs in general practice. Therefore, it is crucial to investigate how general practitioners (GPs) feel about and engage with the growth of these new methods of self-management of blood pressure. Aim: To explore GPs' perspectives of self-management technology to support medication adherence and blood pressure control in patients with hypertension. Design and setting: This was a qualitative interview study based in the West of Ireland. Ten GPs who were purposively sampled participated in semi-structured interviews. Thematic analysis was carried out on the data. Results: Three major themes were identified: current reach and future potential, empowerment and responsibility. Conclusions: GPs could see the benefit of using these technologies, such as more accurate blood pressure data and potential to engage patients in self-management. Concerns relating to the increased workload associated with a potentially unmanageable quantity of information and an increase in healthcare use among the 'worried well' also emerged strongly from the data.

Comparing the effects of an acute bout of physical exercise with an acute bout of interactive mental and physical exercise on electrophysiology and executive functioning in younger and older adults.

BACKGROUND: Physical exercise has been shown to improve cognitive and neural functioning in older adults. AIMS AND METHODS: The current study compared the effects of an acute bout of physical exercise with a bout of interactive mental and physical exercise (i.e., "exergaming") on executive (Stroop) task performance and event-related potential (ERP) amplitudes in younger and older adults. RESULTS: Results revealed enhanced executive task performance in younger and older adults after exercise, with no differences in performance between exercise conditions. Stroop (RT) performance in older adults improved more than in younger adults from pre- to post-exercise. A significant increase in EEG amplitude from pre- to post-exercise was found at the Cz site from 320 to 700 ms post-stimulus for both younger and older adults, with older adults demonstrating a larger Stroop interference effect. While younger adults exhibited overall greater EEG amplitudes than older adults, they showed no differences between congruent and incongruent trials (i.e., minimal interference). Compared to peers with higher BMI (body mass index), older adults with lower BMI showed a greater reduction in Stroop interference effects from pre- to post-exercise. DISCUSSION AND CONCLUSIONS: The beneficial effects of an acute bout of physical exercise on cognitive and neural functioning in younger and older adults were confirmed, with no difference between standard exercise and exergaming. Findings suggest that BMI, sometimes used as a proxy for fitness level, may modulate benefits that older adults derive from an acute bout of exercise. Findings have implications for future research that seeks to investigate unique effects of exergaming when compared to standard physical exercise.

Cancer-related fatigue in post-treatment cancer survivors: application of the common sense model of illness representations.

BACKGROUND: Cancer-related fatigue (CrF) is a common and disruptive symptom that may be experienced during and after cancer. Research into the subjective experience of fatigue in this group is required. The common sense model of self-regulation of health and illness (SRM) addresses personal beliefs or mental representations-whether medically sound or unsubstantiated- that a person holds about a health issue. The current study assesses if the SRM could be used as a theoretical framework for organizing the experiences of people with CrF, with a view to identifying methods to address fatigue in cancer survivors. METHOD: Four focus groups were held with a total of 18 cancer survivors who reported they experienced 'significant fatigue or reduced energy.' A thematic analysis was conducted within the framework of the SRM. RESULTS: Findings were aligned with the SRM, with participants discussing fatigue with reference to representation, coping, and appraisal of symptoms. In particular, the wider social context of CrF was frequently addressed. Perceived inadequacies in support available to those with lingering fatigue after the completion of cancer treatment were highlighted by the participants. CONCLUSION: This study explored the subjective experience of fatigue after cancer using the SRM. CrF should be approached as a complex psychosocial issue and considered from the patient perspective to facilitate better understanding and management of symptoms. The SRM is an applicable framework for identifying modifiable factors that could lead to improved coping with CrF in post-treatment cancer survivors.

Correlates of psychological distress immediately following colposcopy.

OBJECTIVE: Women are at risk for prolonged psychological distress following attendance at colposcopy for cervical abnormalities, with potentially negative consequences. Little is presently known about the correlates of post-colposcopy distress. The present study aimed to extend knowledge of correlates of post-colposcopy anxiety and negative affect, and identify women at risk for elevated psychological distress. METHODS: Psychosocial data (demographic variables, anxiety, negative affect, and pain) were collected using validated questionnaires from 164 women attending colposcopy for the first time immediately prior to their colposcopy examination and immediately following it. Two separate logistic regressions were conducted to identify key factors that may be useful targets for preventing post-colposcopy distress and to determine which factors exert the biggest influence and therefore may be targeted in future intervention studies. RESULTS: Pre-colposcopy state anxiety, pain experienced during colposcopy, and trait anxiety emerged as independent predictors of post-colposcopy state anxiety, accounting for 36% of the variance. Pre-colposcopy negative affect, pain experienced during colposcopy, trait anxiety, and referral smear grade were independent predictors of post-colposcopy negative affect, explaining 32% of variance. CONCLUSIONS: Whether or not women underwent punch biopsy or treatment did not influence post-colposcopy distress levels; however, pain experienced during colposcopy remains a risk for continued psychological distress. Trait anxiety may be an important variable to consider in future studies, as women high in trait anxiety may represent a particularly vulnerable subgroup of women referred for colposcopy, at greater risk for negative psychosocial consequences associated with colposcopy, and to be targeted for interventions to reduce psychological distress.

Factors that influence general practitioners' obesity-related clinical practices and determinants of behavior to target to promote best practice in obesity care: A qualitative exploration.

Introduction: General practitioners (GPs) have been identified as pivotal in the identification and initiation of treatment for obesity, yet effective obesity management remains challenging in general practice. Despite the growing prevalence of obesity and the central role of GPs, there is a dearth of research exploring their experiences and challenges in managing the disease. Objective: This study aimed to understand these challenges by exploring GPs' experiences and to identify factors influencing their obesity management practices to inform the development of targeted intervention strategies. Method: In-depth interviews were conducted with 10 GPs. Data were analyzed using abductive thematic analysis underpinned by the theoretical domains framework (TDF). Findings were mapped to the behavior change wheel (BCW) and the behavior change taxonomy to identify potential future intervention strategies. Findings: Participants described multiple barriers to effective obesity management, including knowledge gaps, lack of training, patient factors, and systemic challenges. Key themes identified were the need for increased support, improved patient engagement, and system-level changes. Conclusion: This study offers valuable insights into the challenges GPs encounter when managing obesity in general practice. Application of the TDF and BCW frameworks identified complex interactions between knowledge, beliefs, and environmental factors influencing GP behavior. These findings highlight key areas for targeted interventions to enhance obesity care and drive best practice.

A qualitative exploration of participants' perspectives and experiences of novel digital health infrastructure to enhance patient care in remote communities within the Home Health Project.

The Home Health Project, set on Clare Island, five kilometres off the Irish Atlantic coast, is a pilot exploration of ways in which various forms of technology can be utilised to improve healthcare for individuals living in isolated communities. The integration of digital health technologies presents enormous potential to revolutionise the accessibility of healthcare systems for those living in remote communities, allowing patient care to function outside of traditional healthcare settings. This study aims to explore the personal experiences and perspectives of participants who are using digital technologies in the delivery of their healthcare as part of the Home Health Project. Individual semi-structured interviews were conducted with nine members of the Clare Island community participating in the Home Health Project. Interviews took place in-person, in June 2023. Interviews were audio-recorded and transcribed verbatim. The data were analysed inductively using reflexive thematic analysis. To identify determinants of engagement with the Home Health Project, the data was then deductively coded to the Theoretical Domains Framework (TDF) and organised into themes. Seven of the possible 14 TDF domains were supported by the interview data as influences on engagement with the Project: Knowledge, Beliefs about capabilities, Optimism, Intentions, Environmental context and resources, Social influences and Emotion. Overall, participants evaluated the Home Health Project as being of high quality which contributed to self-reported increases in health literacy, autonomy, and feeling well supported in having their health concerns addressed. There was some apprehension related to data protection, coupled with a desire for extended training to address aspects of digital illiteracy. Future iterations can capitalise on the findings of this study by refining the technologies to reflect tailored health information, personalised to the individual user.

Perspectives of People with Stroke, Caregivers and Healthcare Professionals on an Adaptive mHealth Intervention for Physical Activity in the Prevention of Secondary Stroke: A Qualitative Study.

Introduction: Engaging in regular physical activity (PA) is associated with lower mortality following stroke, and PA reduces the chance of recurrent stroke. Despite recent guidelines to optimise PA following stroke, people with stroke are known to be less active than their age-matched counterparts. Given the heterogenous nature of stroke, adaptive PA interventions are recommended for people with stroke. Empirical data is lacking on adaptive PA or behavioural change interventions following stroke. Suggested strategies in the prevention of stroke recommend the use of mobile health (mHealth) interventions in the primary prevention of stroke. A structured stakeholder consultation process is key to successful implementation of complex interventions. This paper reports the findings of our consultation process to inform the development of an adaptive mHealth PA. Methods: We used a qualitative study design to explore the perspectives of key stakeholders on the development of an adaptive PA intervention delivered via mHealth post-stroke. Healthcare workers, carers and people with stroke participated in semi-structured one-to-one or focus group interviews. A reflexive thematic analysis was undertaken on transcribed interviews; key themes and sub-themes were developed using coding and summarised by two researchers, then reviewed by the full research team. Results: Twenty-eight stakeholders were interviewed and three main themes were identified; Key feature of a mHealth intervention, delivering a mHealth intervention, Challenges to development and use. There was widespread agreement across stakeholder groups that an adaptive mHealth PA intervention following stroke would be beneficial to people with stroke, following discharge from acute care. Conclusion: Our consultation supports the development of an adaptive PA programme that addresses specific impairments that can hinder exercise participation after stroke.

Sequential multiple assignment randomised trial to develop an adaptive mobile health intervention to increase physical activity in people poststroke in the community setting in Ireland: TAPAS trial protocol.

INTRODUCTION: Stroke is the second-leading cause of death and disability globally. Participation in physical activity (PA) is a cornerstone of secondary prevention in stroke care. Given the heterogeneous nature of stroke, PA interventions that are adaptive to individual performance are recommended. Mobile health (mHealth) has been identified as a potential approach to supporting PA poststroke. To this end, we aim to use a Sequential Multiple Assignment Randomised Trial (SMART) design to develop an adaptive, user-informed mHealth intervention to improve PA poststroke. METHODS AND ANALYSIS: The components included in the 12-week intervention are based on empirical evidence and behavioural change theory and will include treatments to increase participation in Structured Exercise and Lifestyle or a combination of both. 117 participants will be randomly assigned to one of the two treatment components. At 6 weeks postinitial randomisation, participants will be classified as responders or non-responders based on participants' change in step count. Non-responders to the initial treatment will be randomly assigned to a different treatment allocation. The primary outcome will be PA (steps/day), feasibility and secondary clinical and cost outcomes will also be included. A SMART design will be used to evaluate the optimum adaptive PA intervention among community-dwelling, ambulatory people poststroke. ETHICS AND DISSEMINATION: Ethical approval has been granted by the Health Service Executive Mid-Western Ethics Committee (REC Ref: 026/2022). The findings will be submitted for publication and presented at relevant national and international academic conferences TRIALS REGISTRATION NUMBER: NCT05606770.

Matching intra-procedural information with coping style reduces psychophysiological arousal in women undergoing colposcopy.

This study assessed the combined effects of coping style and intra-procedural information on indices of distress (physiological measures, observed distress, self-report measures of anxiety and affect) among a group of patients undergoing colposcopy. High and low monitors were exposed to one of three interventions: high information (live video feed of colposcopy); low information (complete audiovisual distraction); and control. Results revealed a 2 (monitoring style) × 3 (information level) × 2 (time) interaction for systolic blood pressure (SBP), F(2, 111) = 3.55, p = .032. Among low monitors, patients in the low-information group exhibited significant SBP reductions during colposcopy, while those in the high-information group exhibited SBP increases. Among high monitors, patients in the high-information and control groups exhibited SBP reductions. Further, significant differences in observed signs of distress were found between groups with high monitors in the low-information group faring best overall, F(2, 111) = 4.41, p = .014. These findings indicate that tailoring information to suit individual coping style may maximize the apparent efficacy of interventions aimed at reducing stress during medical examinations.

Exploring the content of the STAND-VR intervention: A qualitative interview study.

Prolonged sedentary behaviour has been identified as a potential independent contributor to a number of chronic conditions as well as mortality. The integration of digital technology into health behaviour change interventions has been shown to contribute to increases in physical activity levels, reductions in time spent sedentary, reductions in systolic blood pressure and improvements physical functioning. Recent evidence suggests that older adults could be motivated to adopt a technology such as immersive virtual reality (IVR) due to the added agency it can potentially afford them in their lives through physical and social activities offered in IVR. To date, little research has attempted to integrate health behaviour change content into an immersive virtual environment. This study aimed to qualitatively explore older adults' perspectives on the content of a novel intervention, STAND-VR, and how it could be integrated into an immersive virtual environment. This study was reported using the COREQ guidelines. Twelve participants aged between 60 and 91 years took part. Semi-structured interviews were conducted and analysed. Reflexive thematic analysis was the chosen method of analysis. Three themes were developed, "Immersive Virtual Reality: The Cover versus the Contents", "Ironing Out the (Behavioural) Details" and, "When Two Worlds Collide". These themes offer insights into how retired and non-working adults perceived IVR before and after use, how they would like to learn how to use IVR, the content and people they would like to interact with and finally, their beliefs about their sedentary activity and using IVR. These findings will contribute to future work which aims to design IVR experiences that are more accessible to retired and non-working adults, offering greater agency to take part in activities that reduce sedentary behaviour and improve associated health outcomes and, importantly, offer further opportunity to take part in activities they can ascribe greater meaning to.

Assessing the physiological effect of non-driving-related task performance and task modality in conditionally automated driving systems: A systematic review and meta-analysis.

In conditionally automated driving, the driver is free to disengage from controlling the vehicle, but they are expected to resume driving in response to certain situations or events that the system is not equipped to respond to. As the level of vehicle automation increases, drivers often engage in non-driving-related tasks (NDRTs), defined as any secondary task unrelated to the primary task of driving. This engagement can have a detrimental effect on the driver's situation awareness and attentional resources. NDRTs with resource demands that overlap with the driving task, such as visual or manual tasks, may be particularly deleterious. Therefore, monitoring the driver's state is an important safety feature for conditionally automated vehicles, and physiological measures constitute a promising means of doing this. The present systematic review and meta-analysis synthesises findings from 32 studies concerning the effect of NDRTs on drivers' physiological responses, in addition to the effect of NDRTs with a visual or a manual modality. Evidence was found that NDRT engagement led to higher physiological arousal, indicated by increased heart rate, electrodermal activity and a decrease in heart rate variability. There was mixed evidence for an effect of both visual and manual NDRT modalities on all physiological measures. Understanding the relationship between task performance and arousal during automated driving is of critical importance to the development of driver monitoring systems and improving the safety of this technology.

Assessing the physiological effect of non-driving-related task performance in conditionally automated driving systems: A systematic review and meta-analysis protocol.

Background: Level 3 automated driving systems involve the continuous performance of the driving task by artificial intelligence within set environmental conditions, such as a straight highway. The driver's role in Level 3 is to resume responsibility of the driving task in response to any departure from these conditions. As automation increases, a driver's attention may divert towards non-driving-related tasks (NDRTs), making transitions of control between the system and user more challenging. Safety features such as physiological monitoring thus become important with increasing vehicle automation. However, to date there has been no attempt to synthesise the evidence for the effect of NDRT engagement on drivers' physiological responses in Level 3 automation. Methods: A comprehensive search of the electronic databases MEDLINE, EMBASE, Web of Science, PsycINFO, and IEEE Explore will be conducted. Empirical studies assessing the effect of NDRT engagement on at least one physiological parameter during Level 3 automation, in comparison with a control group or baseline condition will be included. Screening will take place in two stages, and the process will be outlined within a PRISMA flow diagram. Relevant physiological data will be extracted from studies and analysed using a series of meta-analyses by outcome. A risk of bias assessment will also be completed on the sample. Conclusion: This review will be the first to appraise the evidence for the physiological effect of NDRT engagement during Level 3 automation, and will have implications for future empirical research and the development of driver state monitoring systems.

Weight stigma experienced by patients with obesity in healthcare settings: A qualitative evidence synthesis.

Weight stigma research is largely focused on quantifiable outcomes with inadequate representation of the perspectives of those that are affected by it. This study offers a comprehensive systematic review and synthesis of weight stigma experienced in healthcare settings, from the perspective of patients living with obesity. A total of 1340 studies was screened, of which 32 were included in the final synthesis. Thematic synthesis generated three overarching analytical themes: (1) verbal and non-verbal communication of stigma, (2) weight stigma impacts the provision of care, and (3) weight stigma and systemic barriers to healthcare. The first theme relates to the communication of weight stigma perceived by patients within patient-provider interactions. The second theme describes the patients' perceptions of how weight stigma impacts upon care provision. The third theme highlighted the perceived systemic barriers faced by patients when negotiating the healthcare system. Patient suggestions to reduce weight stigma in healthcare settings are also presented. Weight stigma experienced within interpersonal interactions migrates to the provision of care, mediates gaining equitable access to services, and perpetuates a poor systemic infrastructure to support the needs of patients with obesity. A non-collaborative approach to practice and treatment renders patients feeling they have no control over their own healthcare requirements.

Dysplasia severity, but not experiences during colposcopy, predicts adherence to follow-up colposcopy.

OBJECTIVE: Patient adherence with treatment recommendations is an essential factor for the effectiveness of cervical cancer screening programs. Psychological factors may play a role in patient adherence to cervical cancer screening. The present study aimed to extend knowledge of women's adherence to follow-up colposcopy, by examining possible predictive biopsychosocial variables measured at colposcopy and objective attendance rates from patients' medical files. METHODS: Baseline data on psychosocial factors (e.g. demographic variables, state anxiety, and pain) were collected from 141 women prior to undergoing colposcopy for the first time (M age = 29.63, SD = 8.39). Experiences of colposcopy and adherence to follow-up (within two years) were assessed subsequently. RESULTS: There were no associations between adherence and demographic variables. Women with severe dysplasia were more likely to adhere to follow-up colposcopy than women with other histology grades. Women who did not attend for follow-up reported significantly greater state anxiety and pain unpleasantness following colposcopy than women who did attend. A multivariate logistic regression analysis revealed that the psychological experiences of colposcopy did not predict adherence status. However, dysplasia severity made a significant contribution to the model. The odds of adhering to colposcopy for patients with severe dysplasia were 3.57 times higher than for patients with normal histology, and 4.35 times higher than for patients with moderate dysplasia (p = 0.005). CONCLUSIONS: Colposcopy-related experiences do not appear to be strong predictors of adherence, but women with dysplasia grades other than 'severe' should be targeted for follow-up recommendations and advice.

The psychological and behavioural correlates of COVID-19 vaccine hesitancy and resistance in Ireland and the UK.

BACKGROUND: The successful control of the COVID-19 pandemic depends largely on the acceptance and uptake of a COVID-19 vaccine among the public. Thus, formative research aiming to understand and determine the causes of weak and/or positive vaccination intentions is vital in order to ensure the success of future and current vaccination programmes through the provision of effective, evidence-based health messaging. METHODS: A cross-sectional survey was completed by a sample of Irish (N = 500) and UK (N = 579) citizens using the online platform 'Qualtrics'. Participants completed a questionnaire battery comprised of health, attitudes/beliefs, influences, and behavioural intention measures. Demographic information was also assessed. RESULTS: Results highlighted similar rates of vaccine intention among both samples; where a total of 76.8% Irish respondents, and 73.7% of UK respondents indicated that they intended to be immunized if the government advised them to take the COVID-19 vaccine. Overall, 23.2% of Irish respondents reported being vaccine hesitant or vaccine resistant, while a rate of 26.3% of UK respondents reported vaccine hesitancy or resistance. Univariate analysis highlighted that both gender and age played a significant role in vaccine intention, with women under age 30 reporting higher rate of vaccine hesitancy. Multivariate analysis revealed that significant correlates of vaccine acceptance included peer influence, GP influence, civic responsibility, perceived benefit, and positive vaccination attitudes. Those who reported vaccine resistance and hesitancy were more likely to have less positive vaccination attitudes and perceive higher vaccination risk. DISCUSSION: The current sociodemographic and psychological profiles of vaccine resistant and hesitant individuals provide a useful resource for informing health practitioners in the UK and Ireland with the means of enhancing pro-vaccine attitudes and promoting vaccination uptake. The current research shows indications of associations between distrust in the vaccine itself and vaccine hesitancy and resistance. Thus, to effectively design and deliver public health messages that ensures the success of vaccination uptake, it is likely that governments and public health officials will need to take actions to garner trust in the safety of the vaccine itself. Additionally, campaigns to decrease hesitancy and resistance in the COVID-19 vaccine may benefit in targeting altruism to increase willingness to get vaccinated against COVID-19.

Examining the Impact of an mHealth Behavior Change Intervention With a Brief In-Person Component for Cancer Survivors With Overweight or Obesity: Randomized Controlled Trial.

BACKGROUND: Cancer survivorship in Ireland is increasing in both frequency and longevity. However, a significant proportion of cancer survivors do not reach the recommended physical activity levels and have overweight. This has implications for both physical and psychological health, including an increased risk of subsequent and secondary cancers. Mobile health (mHealth) interventions demonstrate potential for positive health behavior change, but there is little evidence for the efficacy of mobile technology in improving health outcomes in cancer survivors with overweight or obesity. OBJECTIVE: This study aims to investigate whether a personalized mHealth behavior change intervention improves physical and psychological health outcomes in cancer survivors with overweight or obesity. METHODS: A sample of 123 cancer survivors (BMI≥25 kg/m2) was randomly assigned to the standard care control (n=61) or intervention (n=62) condition. Group allocation was unblinded. The intervention group attended a 4-hour tailored lifestyle education and information session with physiotherapists, a dietician, and a clinical psychologist to support self-management of health behavior. Over the following 12 weeks, participants engaged in personalized goal setting to incrementally increase physical activity (with feedback and review of goals through SMS text messaging contact with the research team). Direct measures of physical activity were collected using a Fitbit accelerometer. Data on anthropometric, functional exercise capacity, dietary behavior, and psychological measures were collected at face-to-face assessments in a single hospital site at baseline (T0), 12 weeks (T1; intervention end), and 24 weeks (T2; follow-up). RESULTS: The rate of attrition was 21% (13/61) for the control condition and 14% (9/62) for the intervention condition. Using intent-to-treat analysis, significant reductions in BMI (F2,242=4.149; P=.02; ηp2=0.033) and waist circumference (F2,242=3.342; P=.04; ηp2=0.027) were observed in the intervention group. Over the 24-week study, BMI was reduced by 0.52 in the intervention condition, relative to a nonsignificant reduction of 0.11 in the control arm. Waist circumference was reduced by 3.02 cm in the intervention condition relative to 1.82 cm in the control condition. Physical activity level was significantly higher in the intervention group on 8 of the 12 weeks of the intervention phase and on 5 of the 12 weeks of the follow-up period, accounting for up to 2500 additional steps per day (mean 2032, SD 270). CONCLUSIONS: The results demonstrate that for cancer survivors with a BMI≥25 kg/m2, lifestyle education and personalized goal setting using mobile technology can yield significant changes in clinically relevant health indicators. Further research is needed to elucidate the mechanisms of behavior change and explore the capacity for mHealth interventions to improve broader health and well-being outcomes in the growing population of cancer survivors. TRIAL REGISTRATION: ISRCTN Registry ISRCTN18676721; https://www.isrctn.com/ISRCTN18676721. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/13214.

Acceptability of a Mobile Health Behavior Change Intervention for Cancer Survivors With Obesity or Overweight: Nested Mixed Methods Study Within a Randomized Controlled Trial.

BACKGROUND: A significant proportion of cancer survivors have overweight or obesity. Although this has negative implications for health, weight management is not a standard component of oncology aftercare. Mobile health (mHealth) technology, in combination with behavior change techniques (BCTs), has the potential to support positive lifestyle changes. Few studies have been carried out with cancer survivors; therefore, the acceptability of these tools and techniques requires further investigation. OBJECTIVE: The aim of this study is to examine the acceptability of a behavior change intervention using mHealth for cancer survivors with a BMI of 25 or more and to gather constructive feedback from participants. METHODS: The intervention consisted of educational sessions and an 8-week physical activity goal setting intervention delivered using mobile technology (ie, Fitbit activity monitor plus SMS contact). In the context of a two-arm randomized controlled trial, semistructured interviews were conducted to assess the retrospective acceptability of the intervention from the perspective of the recipients. The theoretical framework for the acceptability of health care interventions was used to inform a topic guide. The interviews were transcribed and analyzed using thematic analysis. A quantitative survey was also conducted to determine the acceptability of the intervention. A total of 13 participants were interviewed, and 36 participants completed the quantitative survey. RESULTS: The results strongly support the acceptability of the intervention. The majority of the survey respondents held a positive attitude toward the intervention (35/36, 97%). In qualitative reports, many of the intervention components were enjoyed and the mHealth components (ie, Fitbit and goal setting through text message contact) were rated especially positively. Responses were mixed as to whether the burden of participating in the intervention was high (6/36, 17%) or low (5/36, 14%). Participants perceived the intervention as having high efficacy in improving health and well-being (34/36, 94%). Most respondents said that they understood how the intervention works (35/36, 97%), and qualitative data show that participants' understanding of the aim of the intervention was broader than weight management and focused more on moving on psychologically from cancer. CONCLUSIONS: On the basis of the coherence of responses with theorized aspects of intervention acceptability, we are confident that this intervention using mHealth and BCTs is acceptable to cancer survivors with obesity or overweight. Participants made several recommendations concerning the additional provision of social support. Future studies are needed to assess the feasibility of delivery in clinical practice and the acceptability of the intervention to those delivering the intervention. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/13214.