Attitudes, subjective norms and perceived behavioural control factors influencing Canadian secondary school students' milk and milk alternatives consumption.

OBJECTIVE: The research objectives were to evaluate factors that influence Canadian secondary school students' milk and milk alternatives (MMA) consumption and to explore associations through age and gender lenses. DESIGN: A qualitative design was used, consisting of semi-structured interviews and photo-elicitation methods. Analysis was guided by the Theory of Planned Behaviour (TPB). Deductive and inductive thematic analyses were used to generate themes, charting data based on attributes such as gender and age. SETTING: Interviews were held virtually or via telephone. PARTICIPANTS: Participants were twenty-eight high school students from Ontario, Canada, diverse in terms of gender and age. RESULTS: Both desirable and undesirable beliefs about the health outcomes of consuming MMA were commonly discussed. These included health benefits such as strong bones, muscular strength, and growth, and health consequences like unwanted skin conditions, weight gain, and diseases. While boys and girls associated MMA consumption with muscular strength, boys predominantly considered this favourable, while girls discussed outcomes like unwanted skin conditions and weight gain more often. Adolescents' perspectives on taste/perceived enjoyment, environmentally friendly choices and animal welfare also influenced their MMA preferences. Parental influences were most cited among social factors, which appeared to be stronger during early adolescence. Factors involving cost, time and accessibility affected adolescents' beliefs about how difficult it was to consume MMA. CONCLUSIONS: Recommendations for shifting attitudes towards MMA are provided to address unfavourable beliefs towards these products. Interventions to increase MMA consumption among adolescents should include parents and address cost barriers.

The effects of attitudes, norms, and perceived control on the adaptation of elderly individuals and individuals with chronic health conditions to heatwaves.

BACKGROUND: In this study, the theory of planned behaviour (TPB) was used to examine the determinants of the heat protection intentions and actions of elderly individuals and individuals with chronic health conditions. This is an important topic as understanding the motivations for adapting behaviours to heatwaves can inform the design of warning systems and awareness campaigns by public health authorities to mitigate the adverse effects of weather hazards on health. METHODS: Three phone surveys were conducted in 2015 and 2016 to collect data on a large sample of individuals with increased vulnerability to heatwaves in the city of Longueuil, Canada. Prospective and panel fixed effects logit models for ordinal variables were used to analyse the factors that influenced heat protection intentions and actions. RESULTS: Attitudes, norms, and perceived control have positive effects on intentions to adopt heatwave protection actions and intentions on the effective adoption of these preventive measures. The hypothesis according to which perceived control moderates the effect of attitudes and norms on intentions is rejected. In addition, the results suggest that elderly individuals are less likely than individuals in other age groups to adopt heat protection actions. Health conditions related to vulnerability to hot weather do not seem to significantly improve the adoption of heat protection behaviours. CONCLUSIONS: The adoption of heatwave protection actions can be improved by public health interventions that influence attitudes and social norms related to heat protection behaviours and facilitate their adoption.

Stakeholder perspectives on the barriers and facilitators of engagement in healthy lifestyle behaviours in underrepresented adolescents: a focus group study from the European SEEDS project.

BACKGROUND: Obesity in adolescence has increased in the last decades. Adolescents fail to meet the recommended guidelines for physical activity (PA) and healthy diet. Adolescents with a low socioeconomic status (SES) particularly seem to have fewer healthy lifestyle behaviours. The European Science Engagement to Empower aDolescentS (SEEDS) project used an extreme citizen science approach to develop and implement healthy lifestyle behaviour interventions in high schools. As part of this project, key stakeholders were invited to reflect on the intentions of adolescents to engage in healthy lifestyle behaviours. The aim of this study was to gain stakeholder insights into the barriers and facilitators to healthy lifestyle behaviours of adolescents from low SES areas and on the possible role of these stakeholders in facilitating healthy lifestyle behaviours. METHODS: Six semi-structured focus groups were conducted in four European countries with 28 stakeholders from different settings (schools, community, and government), like teachers, policy advisors and youth workers. The theoretical framework of focus groups was based on the Theory of Planned Behaviour. The main questions of the focus groups were centred on PA and healthy diet. The focus groups were qualitatively analysed in NVivo using thematic analysis to identify topics and themes. RESULTS: According to stakeholders, adolescents have sufficient understanding of the importance of PA and a healthy diet, but nevertheless engage in unhealthy behaviour. Parents were mentioned as important facilitators for engaging adolescents in healthy lifestyle behaviours. Stakeholders listed lack of knowledge, time, and financial resources as barriers for adolescents from low SES families to engage in healthy lifestyle behaviours. The school environment was listed as an important facilitator of adolescents' healthy lifestyle changes, but stakeholders acknowledged that current school days, curriculum and buildings are not designed to promote healthy lifestyle behaviours. External support and collaboration with community and governmental stakeholders was seen as potentially beneficial to improve healthy lifestyle behaviours. CONCLUSIONS: This study shows the variety of barriers adolescents from low SES areas face, and the need for a broader collaboration between key stakeholders to facilitate healthy lifestyle behaviours. Schools are regarded specifically as important facilitators. Currently, the school environment entails various barriers. However, when addressing those, schools can increase opportunities for healthy lifestyle behaviours of adolescents from low SES areas. TRIAL REGISTRATION: This study is registered in ClinicalTrials.gov on 12/08/2021: NCT05002049.

Adults' beliefs related to reducing red meat consumption: An exploratory study in the province of Quebec, Canada.

A significant consumption of red meat is associated with various issues (e.g. public health, sustainability, animal welfare). This exploratory study aims to identify the perceived advantages and disadvantages, perceived approval and disapproval by important others, and perceived barriers and facilitators pertaining to reducing red meat consumption among adults. An online questionnaire based on the Theory of Planned Behaviour was used to elicit the salient beliefs of 55 red meat eaters living in the province of Quebec (Canada). A content analysis performed by two independent coders revealed that the predominant themes (modal beliefs) included health, environment, saving money, food preferences, social influence, perceptions of the alternatives of meat, and efforts related to change. This study can inform the development of interventions aimed at promoting the reduction of red meat consumption.

Predicting nurses' safety compliance behaviour in a developing economy, using the theory of planned behaviour: A configurational approach.

AIM: The study's main objective was to use a fuzzy set qualitative comparative analysis to identify the configuration of recipes that predict nurses' safety compliance behaviour. DESIGN: A cross-sectional design. METHODS: A survey was used where questionnaires were collected from 285 nurses across four primary healthcare hospitals within the Ashanti Region, Ghana. The data collection happened between June 1 to August 2, 2022. A fuzzy set qualitative comparative analysis was used to identify the recipes of psychological factors that determine nurses' safety compliance behaviour. RESULTS: Results from the study suggest that the necessary configurations that explained nurses' safety compliance behaviour came from the presence of subjective norm, attitude, perceived behavioural control, perceived organizational support and negation of intention. The result highlights the need for safety protocols to be conscious of the interplay between nurses' assessment of self, social clues and perception of management care and support since such psychological factors must be considered concurrently to achieve the optimal safety compliance behaviour among nurses. CONCLUSION: A health and safety protocol that fails to recognize the importance of psychological antecedents on subordinates' safety compliance behaviour could limit the safety policy's usefulness in bringing the appropriate behavioural change in nurses. IMPACT: To date, no study has combined the antecedents of theory planned behaviour with perceived organizational support and cue to action to assess how they collectively predict nurses' safety compliance behaviour. Findings from the study suggest that nurses in primary health facilities inform their safety compliance behaviour by assessing self-capabilities, social signals from superiors and colleagues and perception of management support. Hospital administrators and nursing managers in sub-Saharan Africa may rely on these psychological forces to persuade nurses to develop positive safety compliance behaviour at the health facility. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution.

What Determines Healthcare Workers to Seek Professional Psychological Support? A Cross-Sectional Study.

AIM: Although healthcare workers often experience significant mental health challenges, their willingness to seek professional psychological help remains relatively low. However, the factors associated with healthcare workers' psychological help-seeking remain unclear. This study aims to identify the determinants of professional psychological help-seeking intention among healthcare workers based on the theory of planned behaviour. DESIGN: Cross-sectional study. METHODS: A questionnaire, incorporating demographic information and latent variable items, was developed and employed on 403 healthcare workers through online and offline surveys from December 2022 to January 2023 using convenience sampling. Structural equation modelling was applied to test the research hypotheses. RESULTS: The model explained 46.9% of the variance in help-seeking intention. Subjective norm had the strongest total association with help-seeking intention. Attitude towards help-seeking behaviour, subjective norm and perceived behavioural control were directly positively related to help-seeking intention. Moreover, self-stigma, public stigma, perceived barriers and perceived risk were indirectly associated with help-seeking intention mediated by attitude towards the behaviour and perceived behavioural control. Of the four constructs, public stigma showed the most significant indirect relation to behavioural intention. CONCLUSION: Healthcare workers' intention to seek psychological support is associated with multiple interacting factors, particularly subjective norm and public stigma. Targeted interventions addressing individual and systemic barriers are essential to create a supportive environment for healthcare workers to access mental health services. IMPACT: This study identified key barriers and facilitators to healthcare workers seeking psychological support, which can assist authorities in enhancing mental health services and implementing tailored intervention strategies, thereby promoting help-seeking behaviour among healthcare workers. Moreover, our research reinforces the applicability of the theory of planned behaviour in explaining healthcare workers' intention to seek professional psychological support. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Fostering sustainable consumer behaviour: Unravelling the determinants of repair intentions for smart appliances.

Consumer demand for repair services is vital for prolonging product lifespan, yet factors influencing the repair intention for smart appliances remain unclear. Addressing this gap, we propose an extended theory of planned behaviour, incorporating four additional constructs: environmental knowledge, cost of repair, financial benefit, and data security. We collected data from 383 participants in the United Kingdom, which we analysed using a partial least squares approach. Results reveal that the cost of repair, perceived behavioural control, attitude, and financial benefit directly impact repair intention, while subjective norms do not. Environmental knowledge indirectly influences repair intention through attitude mediation, and data security's impact is not moderated by attitude. This extended theory offers a theoretical foundation for future related studies, providing insights for repair providers, environmental NGOs, and policymakers. Our findings can inform interventions promoting repair behaviour and guide policies incentivising consumers, thus increasing the demand for repair services.

Identifying key beliefs underlying QR code check-in and compliance behaviours in the COVID-19 pandemic.

ISSUE ADDRESSED: The implementation of quick response (QR) code check-in compliance behaviour during the COVID-19 pandemic featured in infection control strategies in several global jurisdictions, but was of particular interest in the Australian context, where it became mandated on a nationwide scale. We aimed to identify the salient beliefs people hold toward complying with the QR code check-in using a Theory of Planned Behaviour belief-based framework. METHODS: An elicitation study using open-ended questions (Queensland; N = 93, Mage = 4.77 years, SD = 13.62 and Victoria; N = 76, Mage = 44.92 years, SD = 11.63) and a prospective correlational study using a two-wave online survey (Queensland; N = 290, Mage = 38.99, 46.6% female and Victoria; N = 290, Mage = 38.27, 53.4% female) were conducted. RESULTS: Qualitative data were coded through an iterative content analysis, while quantitative data were analysed using linear multiple regression. Behavioural, normative and control beliefs were associated with intention and behaviour in both samples. Variation in beliefs across the states also were observed. CONCLUSIONS: Across both samples, beliefs in positive outcomes consistently exhibited stronger associations with both intention and behaviour than the reported negative outcomes. Distinct differences emerged between the two samples in terms of regression effects. SO WHAT?: Results indicate individual experience may affect the beliefs which guide behaviour, supporting the potential efficacy of health promotion campaigns tapping into context specific beliefs and experiences if QR code check-in is to be implemented as an infection control measure in future.

Municipal solid waste management instruments that influence the use of the refuse as fuel in developing countries: A critical review.

Landfills are the destination of most of the refuse generated whereas composting, material recycling, and Waste-to-Energy (WtE) technologies are not commonly employed in developing countries. However, the destination for energy purposes could be supplied with this refuse, improving the viability of energy use. Thus, this article raises some questions to identify aspects that could encourage its use as refuse-derived fuel (RDF) in these countries. Among them, does environmental education affect the municipal solid waste (MSW) source separation with emphasis on a destination? Can selective collection and extended producer responsibility (EPR) affect the MSW for energy recovery? Is there competition between the recycling market and the energy market for RDF? A systematic review of the literature was conducted to gather data and provide answers to such questions. This enabled to observe that EPR, selective collect expansion and source separation influence the quantity and quality of waste sent for energy use. Both internal and external factors impact on source separation. Additionally, there is evidence to support that despite several studies showing their technical, economic, environmental and social viability, the methods of energy usage of the refuse still need to improve their deployment in developing countries. In addition to identifying the main research gaps to be filled in future studies, the article also identified the instruments of MSW management that are to be applied in developing countries to divert recyclable and organic waste from landfill.

Discussing the possibility of fertility treatment being unsuccessful as part of routine care offered at clinics: patients' experiences, willingness, and preferences.

STUDY QUESTION: Are patients willing to discuss the possibility of treatment being unsuccessful as part of routine care offered at clinics, and what are the factors associated with this willingness? SUMMARY ANSWER: Nine in every 10 patients are willing to discuss this possibility as part of routine care, with willingness being associated with higher perceived benefits, lower barriers, and stronger positive attitudes towards it. WHAT IS KNOWN ALREADY: Fifty-eight percent of patients who complete up to three cycles of IVF/ICSI in the UK do not achieve a live birth. Offering psychosocial care for unsuccessful fertility treatment (PCUFT), defined as assistance and guidance on the implications of treatment being unsuccessful, could reduce the psychosocial distress patients experience when it happens, and promote positive adjustment to this loss. Research shows 56% of patients are willing to plan for an unsuccessful cycle, but little is known about their willingness and preferences towards discussing the possibility of definitive unsuccessful treatment. STUDY DESIGN, SIZE, DURATION: The study was of cross-sectional design, comprising a theoretically driven and patient-centred bilingual (English, Portuguese) mixed-methods online survey. The survey was disseminated via social media (April 2021-January 2022). Eligibility criteria included being aged 18 or older, waiting to or undergoing an IVF/ICSI cycle, or having completed a cycle within the previous 6 months without achieving a pregnancy. Out of 651 people accessing the survey, 451 (69.3%) consented to participate. From these, 100 did not complete 50% of the survey questions, nine did not report on the primary outcome variable (willingness), and 342 completed the survey (completion rate 75.8%, 338 women). PARTICIPANTS/MATERIALS, SETTING, METHODS: The survey was informed by the Health Belief Model (HBM) and Theory of Planned Behaviour (TPB). Quantitative questions covered sociodemographic characteristics and treatment history. Quantitative and qualitative questions gathered data on past experiences, willingness, and preferences (with whom, what, how and when) to receive PCUFT, as well as theory-informed factors hypothesized to be associated with patients' willingness to receive it. Descriptive and inferential statistics were used on quantitative data about PCUFT experiences, willingness, and preferences, and thematic analysis was applied to textual data. Two logistic regressions were used to investigate the factors associated with patients' willingness. MAIN RESULTS AND THE ROLE OF CHANCE: Participants were, on average, 36 years old and most resided in Portugal (59.9%) and the UK (38.0%). The majority (97.1%) were in a relationship for around 10 years, and 86.3% were childless. Participants were undergoing treatment for, on average, 2 years [SD = 2.11, range: 0-12 years], with most (71.8%) having completed at least one IVF/ICSI cycle in the past, almost all (93.5%) without success. Around one-third (34.9%) reported having received PCUFT. Thematic analysis showed participants received it mainly from their consultant. The main topic discussed was patients' low prognosis, with the emphasis being put on achieving a positive outcome. Almost all participants (93.3%) would like to receive PCUFT. Reported preferences indicated that 78.6% wanted to receive it from a psychologist/psychiatrist/counsellor, mostly in case of a bad prognosis (79.4%), emotional distress (73.5%), or difficulties in accepting the possibility of treatment being unsuccessful (71.2%). The preferred time to receive PCUFT was before initiating the first cycle (73.3%), while the preferred format was in an individual (mean = 6.37, SD = 1.17; in 1-7 scale) or couple (mean = 6.34, SD = 1.24; in 1-7 scale) session. Thematic analysis showed participants would like PCUFT to provide an overview of treatment and all possible outcomes tailored to each patient's circumstances and to encompass psychosocial support, mainly focused on coping strategies to process loss and sustain hope towards the future. Willingness to receive PCUFT was associated with higher perceived benefit of building psychosocial resources and coping strategies (odds ratios (ORs) 3.40, 95% CI 1.23-9.38), lower perceived barrier of triggering negative emotions (OR 0.49, 95% CI 0.24-0.98), and stronger positive attitudes about PCUFT being beneficial and useful (OR 3.32, 95% CI 2.12-5.20). LIMITATIONS, REASONS FOR CAUTION: Self-selected sample, mainly composed of female patients who had not yet achieved their parenthood goals. The small number of participants unwilling to receive PCUFT reduced statistical power. The primary outcome variable was intentions, and research shows a moderate association between intentions and actual behaviour. WIDER IMPLICATIONS OF THE FINDINGS: Fertility clinics should provide patients with early opportunities to discuss the possibility of their treatment being unsuccessful as part of routine care. PCUFT should focus on minimizing suffering associated with grief and loss by reassuring patients they can cope with any treatment outcome, promoting coping resources, and signposting to additional support. STUDY FUNDING/COMPETING INTEREST(S): M.S.-L. holds a doctoral fellowship from the Portuguese Foundation for Science and Technology, I.P. [Fundação para a Ciência e a Tecnologia] (FCT; SFRH/BD/144429/2019). R.C. holds a post-doctoral fellowship supported by the European Social Fund (ESF) and FCT (SFRH/BPD/117597/2016). The EPIUnit, ITR and CIPsi (PSI/01662) are also financed by FCT through the Portuguese State Budget, in the scope of the projects UIDB/04750/2020, LA/P/0064/2020 and UIDB/PSI/01662/2020, respectively. Dr Gameiro reports consultancy fees from TMRW Life Sciences and Ferring Pharmaceuticals A/S, speaker fees from Access Fertility, SONA-Pharm LLC, Meridiano Congress International and Gedeon Richter, grants from Merck Serono Ltd, an affiliate of Merck KgaA, Darmstadt, Germany. TRIAL REGISTRATION NUMBER: N/A.

Adolescent sleep duration: associations with social-cognitive determinants and the mediating role of sleep hygiene practices.

Insufficient sleep duration among adolescents is a widespread public health problem. Gaining better insight into social-cognitive determinants associated with adolescent sleep duration is necessary for developing effective preventive interventions to support healthy sleep. This study aimed to explore whether social-cognitive determinants regarding sufficient sleep duration were associated with sleep duration, and if these associations were mediated by collective sleep hygiene practices. Furthermore, we examined these associations for social-cognitive determinants related to not using media before bedtime and doing relaxing activities and considered whether these associations were mediated by specific sleep hygiene practices. Data were collected amongst second- and third-grade adolescents from 10 Dutch high schools. A total of 878 adolescents (mean [SD] age 13.3 [0.71] years) completed data on sleep duration, social-cognitive determinants of the Theory of Planned Behaviour (i.e., attitude, subjective norms from parents, subjective norms from peers, perceived behavioural control, intention), and sleep hygiene practices. Single- and multivariable path models were constructed and mediation by sleep hygiene practices was analysed by Monte Carlo simulation. All social-cognitive determinants except for subjective norms from peers were associated with longer sleep duration (p < 0.01). Sleep hygiene practices mediated all associations between social-cognitive determinants and sleep duration (mediation ranging from 16% to 72%). Although some of the significant associations and mediation disappeared in the multivariable model, behavioural arousal was the strongest mediator, but collective sleep hygiene practices and cognitive/emotional arousal also explained parts of the associations. The findings indicate that social-cognitive factors should not be overlooked when targeting adolescent sleep duration.

Opportunities for improved indicator-based HIV testing in the hospital setting: a structural equation model analysis.

Indicator condition (IC)-guided HIV testing, i.e., testing when diagnosing a condition associated with HIV, is a feasible and cost-effective testing strategy to identify undiagnosed individuals. Assessing determinants for IC-guided testing may identify opportunities for improvement. A survey study based on the Theory of Planned Behaviour (TPB) was conducted among 163 hospital physicians from five specialties in Amsterdam, the Netherlands. Structural equation models were used to determine the association between the TPB domains (i.e., attitude, belief, norms, self-efficacy and behavioural control) and (1) the intention to test as a mediator for HIV testing behaviour (intentional model) and (2) actual HIV testing behaviour (direct model). Both models accounted for the effect of guideline recommendations. Behaviour scored lower than intention on a five-point scale (mean score of 2.8, SD = 1.6 versus 3.8, SD = 1.1; p<0.0001). The direct model had a better fit than the intentional model based on fit statistics. Discrepancies between the determinants most important for intention versus those for behaviour led to the following recommendations: interventions to improve IC-guided testing in hospitals should primarily focus on implementation of guideline recommendations, followed by improving physicians' attitude towards IC-guided HIV testing and self-efficacy, as these were the most important correlates of actual HIV testing behaviour.

Application of the Theory of Planned Behaviour to inform development of a Dissemination and Implementation science training for nutrition practitioners.

OBJECTIVE: To determine nutrition practitioners' attitudes, behavioural control and normative beliefs to best inform the development and formulation of a nutrition-specific Dissemination and Implementation (D&I) science training. DESIGN: A cross-sectional survey aimed to assess Theory of Planned Behaviour (TPB) constructs and intention to use D&I science. A validated TPB questionnaire assessed constructs including perceived behavioural control, subjective, injunctive and descriptive normative beliefs, attitudes and intention to use D&I science. For analysis, Spearman's ρ, Kruskal-Wallis and Steel-Dwass tests were conducted for quantitative variables. SETTING: Online, 26-item Qualtrics survey. PARTICIPANTS: Cross-sectional sample of members (n 70) affiliated with the Society for Nutrition Education and Behaviour listserv. RESULTS: The major finding from this study was a significant positive correlation between perceived behavioural control score and intention (r = 0·315, P = 0·0119). CONCLUSIONS: D&I training interventions could formulate learning and teaching strategies to target perceived behavioural control (self-efficacy, knowledge and ability) to enhance intention. For example, application and experience-based learning techniques trainings could be strategies to increase knowledge and abilities.

Effect of educational intervention based on theory of planned behaviour on promoting preventive behaviours of oral cancer in rural women.

BACKGROUND: Oral cancer has created an alarming situation around the world, and being the 16th most common cancer worldwide, it has become a global concern. The present study aimed to investigate the effect of educational intervention based on a theory of planned behavior (TPB) on promoting preventive behaviors of oral cancer in rural women. METHODS: This quasi-experimental study was conducted on 120 female hookah users referring to rural health centers in Fasa and Shiraz city, Fars province, Iran. The subjects were divided into experimental and control groups by simple random sampling. The educational intervention for the experimental group consisted of 8 training sessions of 50 min. Both groups completed a questionnaire including demographic characteristics and constructs of TPB before and four months after the educational intervention. Data were analyzed using SPSS 22 software through independent t-test, chi-square, and paired t-test (p = 0.05). RESULTS: The mean age of the experimental and control group subjects were 41.12 ± 8.86 and 40.63 ± 9.62 years, respectively (p = 0.185). The mean age of onset of hookah use in the experimental and control group was 24.16 ± 9.50 and 23.35 ± 9.44 years, respectively (p = 0.182). Also, before the educational intervention, there was a significant difference between the experimental and control groups in terms of knowledge (p < 0.189), attitude (p < 0.122), perceived behavioral control (p < 0.142), subjective norms (p < 0.236), behavioral intention (p < 0.126), oral cancer prevention behaviors (p < 0.108) and nicotine dependence (p < 0.218); however, four months after the educational intervention, there was a significant increase in the experimental group in all variables except nicotine dependence (p < 0.005). CONCLUSION: Due to the alarming situation of oral cancer and the prevalence of hookah use among women, educational programs based on TPB could effectively prevent hookah use and oral cancer.

Exploring the influence of behavioural, normative and control beliefs on intentions to adhere to public health guidelines during the COVID-19 pandemic: a qualitative interview based study.

BACKGROUND: Perceived severity and susceptibility of disease are predictors of individual behaviour during health crises. Little is known about how individual beliefs influence intentions to adhere to public health guidelines during periods of health crises, and how access to and consumption of information influence these intentions. This study investigated behavioural beliefs, normative beliefs, and control beliefs, and their influence on behavioural intentions to adhere to public health guidelines during the COVID-19 pandemic. METHODS: Participants were recruited from a related COVID-19 study conducted by our team, and through snowball sampling in subsequent. Using a maximum variation sampling technique, we recruited a diverse group of participants representing six major regions in Canada. Participants took part in one-on-one semi-structured interviews from February 2021 to May 2021. Data were analyzed independently in duplicate by thematic analysis. The Theory of Planned Behaviour (TPB) was the conceptual framework used to organize dominant themes. RESULTS: We conducted a total of 60 individual interviews (137 eligible individuals contacted, 43.8% response rate) and identified six themes organized according to the three constructs of behavioural, normative and control beliefs as described in the TPB: (1) Behavioural: My "New Normal," Individual Rights and Perceived Pandemic Severity, Fatigue with COVID-19, (2) Normative: COVID-19 Collective, (3) Control: Practicality of Public Health Guidelines, and (6) Conflicting Public Health Messages. Most (n = 43, 71.7%) participants perceived individuals in their geographic community to be following public health guidelines adequately. Several participants (n = 15, 25.0%) commented on the unequal impact of restrictions based on socioeconomic factors (i.e., class, race, age). CONCLUSION: Individual perceptions of risk, loss of control, access to resources (i.e., childcare), and societal expectations, shaped intentions to engage in disease preventative behaviours (i.e., social distancing) during the COVID-19 pandemic.

Web-based need-supportive parenting program to promote physical activity in secondary school students: a randomized controlled pilot trial.

BACKGROUND: Current global trend of insufficient physical activity (PA) among children and adolescents highlights the necessity of finding effective ways to promote PA in childhood. Self-determination theory (SDT) has demonstrated efficacy as a conceptual framework for developing interventions aimed at promoting diverse health behaviours. Parents have potential to influence children's health behaviours to a great extent, which could be enhanced from an online, self-paced training to gain knowledge on how to support children's intrinsic motivation towards particular health behaviour. In this pilot study, we developed and tested an online SDT-informed need-supportive training for parents, enabling them to interact with their children in a way to support their intrinsic motivation towards leisure-time physical activity. METHODS: Sixty eight students (Mage = 12.5 ± 0.72) and one parent for each child were randomly assigned to the 6-week intervention condition or control condition. Students completed psychological measures (i.e., perceptions of parents' need-supportive behaviours, basic psychological need satisfaction and frustration, autonomous and controlled forms of motivation, as well as social cognition beliefs towards leisure-time PA) and self-reported PA pre-intervention, post-intervention, and one-month after the intervention. Repeated measures ANOVAs were conducted to test the effects of the intervention condition and time. RESULTS: While a statistically significant intervention effect on children's leisure-time PA was not found, students in the intervention group reported higher, albeit marginal, perceptions of intrinsic motivation (F(2, 84) = 3.095, p = 0.050) and lower perceptions of introjected regulation (F(2, 88) = 3.107, p = 0.050) and autonomy frustration (F(2, 84) = 2.987, p = 0.056) at follow-up. Contrary to expectations, children in the control group demonstrated higher perceptions of intention (F(2, 84) = 4.838, p = 0.010) and effort (F(2, 80) = 3.473, p = 0.036) towards leisure-time physical activity at follow-up. No significant changes were found in perceptions of need-supportive behaviour from parents, attitude, and perceived behavioural control. CONCLUSIONS: Our pilot study highlights the importance of parental training and the potential for SDT-informed interventions to support children's intrinsic motivation towards physical activity. Further research is needed to test the intervention in other domains and combine interventions in several domains to have the highest impact. TRIAL REGISTRATION: This pilot study is part of preparation for the main study, prospectively registered in ISRCTN registry as ISRCTN78373974 (15.12.2022). The current stage of the main study is 'recruiting'.

Patient satisfaction and behavioural intention in using the home medication delivery service in an ambulatory oncology centre.

BACKGROUND: The COVID-19 pandemic has increased usage of medication delivery service (MDS) significantly. MDS improves adherence to medication and clinical outcomes. OBJECTIVES: To study behavioral change factors that affect adoption of MDS, determine existing patient satisfaction level, and make recommendations to improve MDS adoption. METHODS: A single-institution, cross-sectional survey was conducted at the outpatient pharmacy of the largest ambulatory cancer centre in Singapore. The survey consisted of sections on demographics, Theory of Planned Behavior constructs and patient satisfaction questions. Descriptive analysis and logistic regression were used. RESULTS: A total of 881 patients responded. Respondents were mostly Chinese, female and subsidized patients, with a mean age of 62.4 years old. MDS use is strongly predicted by favourable attitude (OR 3.54, 95%CI 2.64-4.75; p < 0.001) and subjective norm (OR 3.07, 95%CI 2.30-4.09; p < 0.001) towards its use and greater perceived behavioral control (OR 2.48; 95%CI 1.86-3.30; p < 0.001). Being ill or frail has been identified as facilitators, while absence of face-to-face consultation and cost of delivery were barriers to the adoption of MDS. Encouragingly, the satisfaction level of our existing patients was generally high (80.2, SD16.7). Recommendation to improve MDS adoption targets facilitators and barriers identified and aims to further elevate patient satisfaction level. Establishment of a centralised pharmacy for MDS together with a call centre would be essential in the long run. CONCLUSIONS: MDS is becoming increasingly important, in line with our national strategy. Implementation of suggested short-term and long-term measures will encourage its use.

Determining acceptance and perceptions of chemotherapy dose banding in an ambulatory cancer centre.

INTRODUCTION: Despite the advantages of dose banding (DB) and numerous plans to adopt this practice, uptake of DB is still poor. As opinions of healthcare professionals were deemed essential in DB's acceptance, this study surveyed key stakeholders to determine the acceptance, facilitators, and barriers of DB in chemotherapy to improve its implementation. METHODS: A cross-sectional study at the National Cancer Centre Singapore, involving physicians, nurses, and pharmacy staff, was conducted in February 2022. The Theory of Planned Behaviour was adapted to design a survey questionnaire to obtain the acceptance, facilitators, and barriers of DB. Additional questions on maximum acceptable dose variance and essential criteria for selecting drugs for DB were included. RESULTS: A total of 93 participants responded, with a mean 9.75 ± 7.37 years of clinical experience. Less than half have heard of DB while few had prior experience. Drug cost was the top selection criteria for DB, followed by toxicity, therapeutic index, frequency of use and drug wastage. Acceptance rate of DB was 41.9%, with majority agreeing to use DB in various drugs but to determine patient suitability before usage. Being greatly affected by subjective norms, having a positive outlook for DB's impacts, and no effect on toxicity significantly influenced acceptance. CONCLUSION: Prior to implementing DB at the institutional level, educational training addressing concerns over toxicity, and providing technological support can help improve acceptance. Future studies can involve patients' perspectives and more institutions for greater diversity in opinions.

Psychosocial Predictors of Colorectal Cancer Screening Intention: An Experiment on the Invitation Letter.

BACKGROUND: In Italy, attendance rates for colorectal cancer (CRC) screening are suboptimal. The present work analysed cognitive and emotional predictors of CRC screening intention and tested an intervention on a real invitation letter to improve CRC screening intention, both directly and in interaction with the predictors of our model. METHODS: Our model included variables from the theory of planned behaviour and the emotional barriers to bowel screening scale. We applied six changes to an invitation letter used in Italy to avoid the repetition of words like 'faeces', 'blood', or 'occult' and reduce the prompting of disgust. The 228 participants were randomly assigned to a between-participants design (original letter vs. manipulated letter). RESULTS: Disgust hindered CRC screening intention, while embarrassment, fear, and subjective norms (i.e., perception of the social pressures to attend CRC screening) were not associated with intention to screen. More positive attitudes towards CRC screening were associated with a higher intention to screen. The positive association between perceived behavioural control and CRC screening intention was stronger for participants who read the letter with fewer (vs. more) references to bodily waste. Letter manipulation did not affect intention to screen. CONCLUSIONS: The disgust associated with faecal matter is a critical factor in determining CRC screening attendance, and it should be acknowledged as such in public policies. Until new screening tests avoiding the activation of this emotional reaction are concretely available, public campaigns should improve CRC screening participation by boosting both positive attitudes towards screening and patients' perceived behavioural control.

Do British and Chinese adolescents snack for different reasons? A cross-country study using the Theory of Planned Behaviour and eating styles.

Snacking is prevalent in adolescents and can have significant health impacts, but there is considerable individual and cross-country variation in determinants on adolescent snacking. The present study examined the role of eating styles (i.e. restrained eating, emotional eating, external eating, mindful eating) and the constructs of an extended Theory of Planned Behaviour (TPB) (i.e. attitudes, subjective norms, perceived behavioural control, habit strength) in predicting adolescent snacking, and the moderating effects of country. A survey was completed by adolescents aged 16-19 years from China (N = 182; mean age = 16.13, SD = 0.87) and England (N = 96; mean age = 17.04, SD = 0.74). Compared to British adolescents, Chinese adolescents showed higher restrained eating (p = .009), lower external eating (p = .004), less positive attitudes (p < .001) and subjective norms (p = .007) to, and less strong habit strength (p = .005) for unhealthy snacking. Mindful eating significantly predicted lower consumption of unhealthy snacks (p = .008) and beverages (p = .001), while restrained eating predicted higher consumption of fruit (p < .001) and vegetables (p < .001), regardless of country. Country showed significant moderating effects of TPB constructs on unhealthy beverages (p = .008) and fruit (p < .001) consumption, and effects on unhealthy snack (p = .023) and vegetable (p = .015) consumption approaching significance. Subjective norms predicted unhealthy snacking frequency regardless of country (p = .001). Habit strength predicted consumption of beverages (p < .001) and fruit (p < .001) only in English adolescents. Mindful eating may be a positive intervention approach to help reduce adolescent unhealthy snacking. TPB-based snacking interventions should carefully consider the country context. Acknowledging country-specific determinants of snacking are recommended.