Self-Acceptance and Purpose in Life Are Mechanisms Linking Adverse Childhood Experiences to Mortality Risk.

OBJECTIVE: Adverse childhood experiences (ACEs) are associated with an increased risk of premature mortality, but it is not clear why. Individuals with ACEs tend to have lower self-acceptance and purpose in life, which may be pathways between ACEs and risk of premature mortality. As such, we tested whether purpose and self-acceptance are mechanisms that link ACEs to mortality risk. METHODS: We used the Midlife in the United States Survey ( N = 6218; mean [standard deviation] = 46.89 [12.94] years) to test whether these factors were indirect pathways between ACEs and mortality hazards over 24 years of follow-up. We used a comprehensive ACE measure that included 20 possible childhood adversities including emotional and physical abuse, household instability, socioeconomic climate, and ill health. RESULTS: ACEs significantly increased mortality risk (hazard ratio = 1.028, 95% confidence interval = 1.008-1.047, p = .006). Self-acceptance and purpose accounted for an estimated 15% and 4% of the ACEs-mortality relation, respectively. These effects withstood a range of adjustments and sensitivity analyses. CONCLUSIONS: ACEs may affect mortality risk partially through lower self-acceptance and purpose during adulthood. Given that self-acceptance and purpose may change through intervention, these factors may be useful targets for individuals with ACEs that could lead to a longer life.

Effectiveness of physical activity interventions for overweight and obesity during pregnancy: a systematic review of the content of behaviour change interventions.

BACKGROUND: Behaviour change techniques (BCTs) employed within PA intervention for pregnant women with a healthy body mass index (BMI) have been previously identified, however, these BCTS may differ for other weight profiles during pregnancy. The aim of this current review was to identify and summarise the evidence for effectiveness of PA interventions on PA levels for pregnant women with overweight and obesity, with an emphasis on the BCTs employed. METHODS: A systematic review and meta-analysis of PA intervention studies using the PRISMA statement was conducted. Searches were conducted of eight databases in January 2019. Strict inclusion/exclusion criteria were employed. The validity of each included study was assessed using the Cochrane Collaboration's tool for assessing risk of bias. The primary outcome measure was change in PA levels, subjectively or objectively measured, with physical fitness as a secondary outcome. All intervention descriptions were double coded by two authors using Michie's et al's BCT taxonomy V1. Meta-analyses using random effect models assessed the intervention effects on PA. Other PA outcomes were summarised in a narrative synthesis. RESULTS: From 8389 studies, 19 met the inclusion criteria 13 of which were suitable for inclusion in a meta-analysis. The remaining 6 studies were described narratively due to insufficient data and different outcome measures reported. In the meta-analysis, comparing interventions to a control group, significant increases were found in the intervention group for metabolic equivalent (SMD 0.39 [0.14, 0.64], Z = 3.08 P = 0.002) and physical fitness (VO2 max) (SMD 0.55 [0.34, 0.75], Z = 5.20 P = < 0.001). Of the other six, five studies reported an increase in PA for the intervention group versus the control with the other study reporting a significant decrease for women in their 3rd trimester (p = 0.002). 'Self-monitoring of behaviour' was the most frequently used BCTs (76.5%), with 'social support' being newly identified for this pregnant population with overweight or obesity. CONCLUSIONS: This review identified a slight increase in PA for pregnant women with overweight and obesity participating in interventions. However, due to the high risk of bias of the included studies, the results should be interpreted with caution. PA measures should be carefully selected so that studies can be meaningfully compared and standardised taxonomies should be used so that BCTs can be accurately assessed.

Exploring non-participation in colorectal cancer screening: A systematic review of qualitative studies.

INTRODUCTION: Worldwide, colorectal cancer is a major public health issue. Despite the existence of screening programmes in many countries, global uptake remains low. This meta-ethnography aimed to analyse qualitative literature to explore attitudes towards colorectal cancer screening and reasons for non-participation in eligible people that do not participate when invited. METHODS: Systematic searches were conducted in five databases in May 2021. Critical appraisal of included studies was performed using the CASP checklist for qualitative studies. FINDINGS: Thirteen studies were included. Three main themes and eight sub-themes were developed across studies: (1) Differences in motivation, with non-participants expressing a lack of knowledge and varying levels of intention to participate but not feeling screening was personally necessary; (2) Active aversion to screening expressed by fear, discomfort, disgust or not wanting to know; and (3) Contextual barriers of the healthcare system such as practical constraints or poor relationships with healthcare professionals. CONCLUSION: Findings suggest multiple pathways to non-participation including ambivalence, aversion to the process and consequences of screening or lack of support. Persuasive messages and prompts to action to target ambivalence, reassurance regarding the screening procedures to target negative reactions, and increased support from healthcare professionals may be beneficial in increasing screening uptake.

Goal-setting in diabetes self-management: A systematic review and meta-analysis examining content and effectiveness of goal-setting interventions.

BACKGROUND: Goal-setting is recommended and widely used within diabetes self-management programmes. However, empirical evidence around its effectiveness lacks clarity. This review aims to evaluate the effectiveness of goal-setting interventions on diabetes outcomes and to determine which behaviour change techniques (BCTs) are frequently used within these interventions. METHODS: A systematic search identified 14 studies, describing 12 interventions targeting diabetic-control which incorporated goal-setting as the main intervention strategy. Study characteristics, outcome measures and effect sizes of the included studies were extracted and checked by two authors. The BCT taxonomy v1 was used to identify intervention content. Meta-analyses were conducted to assess intervention effects on the primary outcome of average blood glucose levels (HbA1c) and on body-weight. Psycho-social and behavioural outcomes were summarised in narrative syntheses. RESULTS: Significant post-intervention improvements in HbA1C were found (-.22, 95% CI, -.40, -.04) across studies. No other main effects were identified. The BCT 'goal-setting (behaviour)' was most frequently implemented and was identified in 84% of the interventions. CONCLUSIONS: Goal-setting interventions appear to be associated with reduced HbA1C levels. However, the low numbers of studies identified and the risk biases across studies suggest more research is needed to further explore goal-setting BCTs in diabetes self-management.

Prioritising target behaviours for research in diabetes: Using the nominal group technique to achieve consensus from key stakeholders.

PLAIN ENGLISH SUMMARY: The behaviour of people with diabetes (e.g. taking medication) and the behaviour of doctors and other healthcare professionals (e.g. checking patients' blood sugar) are important. Our research group wanted to select one patient behaviour and one healthcare professional behaviour as topics to research in Ireland. Patients and healthcare professionals are not usually asked to help decide on research topics. In this study, we wanted to bring together patients, healthcare professionals and policy makers to help us decide on the most important target behaviours for research in diabetes in Ireland. We worked with 24 participants, including people with diabetes, diabetes healthcare professionals and policy makers. First, participants suggested behaviours they thought were important to target for research in diabetes. Participants then attended a meeting and ranked which of the behaviours were the most important and discussed the results of the rankings as a group. We identified the most highly ranked patient and healthcare professional behaviours. The top ranked behaviour for people with Type 1 diabetes was to 'take insulin as required' and for people with Type 2 diabetes was to 'attend and engage with structured education programmes'. 'Engage in collaborative goal setting with patients' was the top ranked behaviour for healthcare professionals. Our study shows it is possible for researchers to work with people with diabetes, healthcare professionals and policy makers to decide on research topics. The top ranked behaviours will now be researched by our group in Ireland. ABSTRACT: Background Working with patients, healthcare providers, and policy makers to prioritise research topics may enhance the relevance of research and increase the likelihood of translating research findings into practice. The aim of the present study was to work with key stakeholders to identify, and achieve consensus on, the most important target behaviours for research in diabetes in Ireland. Methods Twenty-four participants, including people with diabetes, diabetes healthcare professionals and policy makers, took part in a nominal group technique consensus process. Through an online survey, participants generated lists of important target behaviours in three areas: managing Type 1 diabetes, managing Type 2 diabetes and preventing Type 2 diabetes. Participants then attended a research prioritisation meeting and ranked target behaviours in two rounds, with group discussion between ranking rounds. For each of the three key areas, the six top ranked behaviours relevant to people with diabetes and healthcare professionals were identified. Results In most cases, the most highly ranked behaviour was the same for Ranking 1 and Ranking 2 and consensus increased in relation to endorsement of top ranked behaviours. However, some behaviours did change position between rankings. The top behaviour relevant to people with Type 1 diabetes was 'taking insulin as required' and for people with Type 2 diabetes was 'attending and engaging with structured education programmes'. 'Engage in collaborative goal setting with patients' was the top ranked behaviour relevant to healthcare professionals for managing both Type 1 and Type 2 diabetes. For preventing Type 2 diabetes, 'engage in healthy behaviours as a family' was the highest ranked population behaviour and 'attend and engage with behaviour change training' was the highest ranked professional behaviour. Conclusions It is possible to work with a diverse group of stakeholders to inform the diabetes research agenda. The priorities identified were co-produced by key stakeholders, including patients, healthcare professionals and policy makers, and will inform the development of a programme of behavioural research in diabetes in Ireland. The study also provides a worked example of a research prioritisation process using the nominal group technique, and identified limitations, which may be useful for other researchers.