Professor Jane Ogden

Whilst ‘brain fog’ is mostly considered a biological problem little is understood about an individual’s experience. This qualitative study explored women’s experiences of brain fog focusing on those at the start (aged 18-25; n=10) and end (aged 45-60; n=10) of their reproductive journey. Descriptive thematic analysis described three themes: i) ‘daily disruptions’ describing cognitive dysfunctions and the main triggers; ii) ‘the cycle of impact’ with a focus on women’s emotional experiences and how these can exacerbate brain fog; iii) ‘taking control’ highlighting the use of self-care, physical prompts, and Hormonal Replacement Therapy (HRT) to manage brain fog. Transcending these themes was the notion of ‘crisis of identity’ illustrating the negative impact of brain fog on the women’s sense of self with some older women describing acceptance and finding it less challenging.  Brain fog is much more than a biological phenomenon and has broader implications for a woman’s sense of self.  

Whilst a substantial body of evidence supports the benefits of exercise for physical and mental health, the overfocus on the benefits of exercise could result in harmful behaviours in some individuals. Conceptualised as a behavioural addiction, research often dichotomises the behaviour through a medical diagnostic model. The present qualitative study explored the meaning of problematic behaviour from the exerciser's perspective. Nineteen UK-based frequent exercisers were interviewed regarding their experiences. Thematic analysis described three themes: 'relentlessly pushing the limits' of their personal best and comparing to others; 'an enabling community' which could promote problematic behaviours; and 'the complexity of the ideal body' focussing on perceptions of weight maintenance. Transcending these themes was the notion of 'rationalising choices'. The results indicate that participants felt that the benefits outweighed the costs, encouraging them to continue, even when causing harm. These findings support the notion of problematic exercise as a continuum, rather than dichotomous.

ObjectiveSocial support is mostly seen as a positive resource for many health outcomes. However, some research indicates that weight loss may disrupt the equilibrium of relationships and highlights the potential for a more negative form of social support. This qualitative study aimed to explore bariatric surgery (BS) patients' perceptions of the way in which their current or previous partner supported them throughout their BS journey.DesignBS patients (N = 30) participated in semi-structured interviews.MethodsThe data were analysed using an inductive approach to reflexive thematic analysis.ResultsFour themes were derived from the data. While two themes reflected social support as a form of caring (Mutual Investment and Positive Reinforcements), the other two themes indicated aspects of sabotage (Feeder Behaviours and Negative Reactions to Weight Loss Attempts and Successes). Transcending these themes was the notion of Bariatric Surgery as an Opportunity or Threat to the Relationship.ConclusionsSome patients perceived social support as a positive resource in BS success involving Mutual Investment from their partners and being offered Positive Reinforcements for changes in their weight status and wellbeing. Some, however, described more negative aspects of support which had undermined their BS goals, either unintentionally or intentionally, through acts of sabotage including Feeder Behaviours and Negative Reactions to Weight Loss Attempts and Successes. Future research should develop interventions to help prepare the partners of those undergoing BS for the changes to both their partner's weight status and the dynamics of their relationship.

Abstract Positive psychology interventions increase well-being and some health outcomes. In this experimental study, we assessed three positive psychology interventions (nostalgia, gratitude, and best possible self (BPS) as a means to manage weight, diet and activity and increase body esteem. Participants ( n = 178) who had gained weight during the pandemic were randomly assigned to one of four interventions: nostalgia, gratitude, BPS, or control. Participants completed pre- and post-intervention measures of behavioural intentions and body esteem, as well as outcome measures of body compassion and affect. The results showed significant differences by intervention for intention to lose weight, intention to diet, intention to exercise, body kindness, and positive and negative affect. The BPS intervention increased intention to lose weight, whereas the gratitude intervention increased intention to exercise, aspects of body compassion, positive affect, but reduced the intention to lose weight and negative affect. Overall, positive psychology interventions promote body compassion and positive health behaviour intentions and therefore may have the potential to help manage weight.

Health Psychology is essential reading for all students and researchers of health psychology. Organized into four sections, the 6th edition is structured with a clear emphasis on theory and evidence throughout. This textbook maintains its popular and balanced approach between the biomedical and psychosocial model, while strengthening its focus on critical thinking and behaviour change.

This study explored how women made sense of their recovery from Anorexia Nervosa (AN). Semi-structured telephone interviews were carried out with fifteen women who had received a diagnosis of AN and defined themselves as either recovered or in recovery. Data were analysed using interpretative phenomenological analysis (IPA). The women described their experiences in terms of three broad areas; being anorexic; the process of change; and being recovered. Transcending these themes was a series of dichotomies involving splits between their mind and body, AN behaviour and cognitions and their rational and irrational side. Further, they indicated that recovery reflects the time when these many different components of their selves are no longer divided and that this was often facilitated through therapy and close relationships which enabled them to find non bodily means to express their distress. Therapy should therefore aim to facilitate a sense of becoming 'whole' again. © 2011 John Wiley & Sons, Ltd and Eating Disorders Association.

Malignant melanoma (MM) is mainly attributable to UV exposure and research indicates that maladaptive sun safe beliefs and behaviour need to be changed in order to help reduce MM prevalence in the most at risk subset of the UK population; fair skinned young women. Sun safety interventions which are personalised and appearance-based have been found effective at improving sun safe beliefs and behaviour. To date, no research has explored whether the effectiveness of these interventions can be improved by varying both their format of presentation and temporal framing. In this experimental study UK fair skinned young women (n=65) aged between 16 and 25 rated their sun safe beliefs and behavioural cognitions after being exposed to personalised appearance-based information which varied in terms of format (text vs visual) and temporal framing (immediate vs future). Their sun safe behaviour was also observed. The visual format used the Aprilage® digital sun aging programme. The results showed that following the visual format intervention participants had significantly lower perceptions of the skin’s ability to heal, and higher levels of observed sun safe behaviour in the form of taking a sunscreen sample and a sun safety educational leaflet compared to those who received the text intervention. No significant effect of temporal framing was found. The results suggest that a visual, personalised, appearance-based intervention may be an effective form of sun safety promotion for young women in the UK.

The current study aimed to examine the role of binge eating (BE) in explaining weight loss in patients undergoing laparoscopic adjustable gastric banding (LAGB) for severe obesity. Participants were 49 patients (13 males and 36 females) who completed questionnaires two weeks prior and three and six months after their operation. Predictor measures of weight loss included pre and postoperative BE and changes in BE following surgery. A decrease in BE as a consequence of having surgery was able to significantly predict postoperative weight loss. Many surgical services currently screen patients for BE at baseline to identify those most suitable for surgery. This study suggests that this process may be redundant as the results indicate that it is not the presence of BE pre- or post-operatively which are predictive of treatment-induced weight loss, but whether patients' BE behaviours decrease or persist in response to surgery. Future research therefore should seek to identify predictors of decreased BE following surgery in order to enhance candidate selection and improve the efficacy of this form of obesity management. © 2012 Elsevier Ltd.

Nineteen heterosexual couples completed questionnaires concerning their own and their partner's body size. Although women reported higher levels of body dissatisfaction, both men and women reported being dissatisfied with their body parts. Further, the results showed comparability within couples for ratings of the male partner's body size but consistent differences for ratings of the female partner's body size. In addition, both partners reported most dissatisfaction with the female partner's body size. It is suggested that a sexual partner's beliefs may play a greater role in the development of men's body dissatisfaction and that the female body may have become a legitimate source of criticism for both men and women. The implications for the social context on self-perception are discussed.

Abstract Purpose - To evaluate an online ‘teachable moment’ intervention to promote healthy eating for overweight and food intolerance symptoms. Design/methodology/approach – The study involves a 2 x 2 factorial design with two conditions: group (weight loss vs food intolerance) and condition (intervention vs control). The intervention aimed to generate a ‘teachable moment’ by providing knowledge regarding the relationship between food and the problem (overweight or food intolerance), focusing on the negative aspects of the problem, creating a behavioural model, and encouraging hope and reinvention. Participants receiving the intervention (n = 22) completed measures of dietary behaviour and either weight or food intolerance symptoms before receiving the intervention and again one month later. Control participants (n = 20) provided measures but did not receive the intervention. Findings - There were no significant reductions in weight or food intolerance symptoms. However, compared to control participants, participants in the intervention conditions reported greater intentions to eat healthily (p = .01) and improved healthy eating behaviour over time, following both an intention-to-treat (p = .046) and explanatory analysis (p = .042). Practical implications - Encouraging individuals to perceive their everyday situation as a time for change and adopt healthier behaviour early on, may prevent future diet-related medical events. This has benefits for both the individual and for health care costs. Originality/value - A quick and easy to administer online ‘teachable moment’ intervention improves dietary behaviour and can be minimally adapted to suit individuals with differing health needs.

Objective To develop a clinic for patients who believe they have a food intolerance that could be administered by practice nurses with minimal experience of dietary change or food intolerance. Methods The clinic consisted of 1 week baseline, 2 weeks healthy eating plan (HE), 2 weeks wheat and dairy free plan (WD). Patients were discharged after the HE plan if their symptoms had improved, otherwise they continued onto the WD plan. Following training 4 nurses ran 4 clinics across the UK. Results 281 patients with perceived food intolerance were recruited. The most common symptoms were bowel symptoms, tiredness, stomach symptoms, and headaches. Of those who completed the programme (n=150), the majority were discharged after the HE plan as their symptoms had improved (n=106, 70.6%). A third also completed the WD plan (n=44, 29%). Symptoms, mood and quality of life improved significantly by the end of the intervention. WD showed added value as symptoms showed further improvement. Conclusion There was a need for the clinic although not on a full time basis. Symptoms improved following both the HE and WD plans. Practice implications A simple dietary based intervention may help relieve symptoms in those who believe they have a food intolerance.

Our original paper (Ward & Ogden, 1994 ) explored women's experiences of vaginismus and argued that it should be conceptualised as a psychosocial rather than just a psychosexual problem. This commentary describes the background to the study and highlights what contribution we feel it made to the literature in the context of recent developments.

Eating behaviour is influenced by both cognitions and triggers in the environment. The potential difference between a ‘snack’ and a ‘meal’ illustrates these factors and the way in which they interact, particularly in terms of the label used to describe food and the way it is presented. To date no research has specifically explored the independent and combined impact of label and presentation on eating behaviour. Using a preload / taste test design this experimental study evaluated the impact of label (‘snack’ vs. ‘meal’) and place (‘snack’ vs. ‘meal’) of a preload on changes in desire to eat and subsequent food intake. Eighty female participants consumed a pasta preload which labelled as either a ‘snack’ or a ‘meal’ and presented as either a ‘snack’ (standing and eating from a container) or a ‘meal’ (eating at a table from a plate), generating four conditions. The results showed main effects of label and place with participants consuming significantly more sweet mass at the taste test when the preload had been labelled a ‘snack’ and more total mass and calories when the preload had been presented as a ‘snack’. No label by place interactions were found. The results also showed a combined effect of both label and place with those who had eaten the preload both labelled and presented as a ‘snack’ consuming significantly more in terms of nearly all measures of food intake than those in the other conditions. To conclude, label and presentation influence subsequent food intake both independently and combined which is pertinent given the increase in ‘snacking’ in contemporary culture

Background Due to the increased prevalence of obesity GPs now have a key role in managing obese patients. Aim To explore GPs' views about treating patients with obesity. Setting An inner London primary care trust Design of study A qualitative study using semi-structured interviews. Method Twenty-one GPs working in an inner London primary care trust were interviewed about recent obese patients and obesity in general. An interpretative phenomenological approach was used for data analysis. Results GPs primarily believed that obesity was the responsibility of the patient, rather than a medical problem requiring a medical solution. They also believed that in contrast to this, obese patients wanted to hand responsibility over to their doctor. This contradiction created conflict for the GPs, which was exacerbated by a sense that existing treatment options were ineffective. Further, this conflict was perceived as potentially detrimental to the doctor-patient relationship. GPs described a range of strategies that they used to maintain a good relationship including offering anti-obesity drugs, in which they had little faith, as a means of meeting patients' expectations; listening to the patients' problems, despite not having a solution to them; and offering an understanding of the problems associated with being overweight. Conclusion GPs believe that although patients want them to take responsibility for their weight problems, obesity is not within the GP's professional domain. Until more effective interventions have been developed GPs may remain unconvinced that obesity is a problem requiring their clinical expertise and may continue to resist any government pressure to accept obesity as part of their workload.

This study explored the role of life events in triggering both weight loss and weight gain and assessed whether a number of variables differentiated between these two types of weight change. Members of a slimming club (n = 538) completed an online questionnaire concerning two events, which had caused either weight loss or weight gain. They then described the event and its impact in terms of a number of variables. The majority of participants could describe a time when a life event had resulted in both weight loss and weight gain including relationship problems, pregnancy, illness and death of someone close. Compared with the weight gain event, the weight loss event was perceived as more positive, less negative, more controllable and more predictable than the weight gain event. Further, in terms of sustaining conditions, the weight loss event was perceived as reducing the choice over food and the function of eating and as increasing the choice over exercise and the function of this behaviour. To conclude, life events are related to weight change and the direction of this change can be explained both by the perceived nature of the event and its impact upon choice and function of eating and exercise.

Media images of stereotypically attractive women are often cited as contributory factors in body size distortion and body dissatisfaction. In fact, recent research suggests that acute exposure to such images may exacerbate body distortion in women with eating disorders. The present study examined the effects of acute exposure to images of stereotypical attraction (thin pictures) compared to images of overweight individuals (fat pictures) in both men and women. Twenty men and 20 women completed measures of body satisfaction before and after viewing images of either thin or overweight individuals matched for the subject's gender. The results suggested that subjects of both gender reported feeling less satisfied with their bodies as measured by rating scales (e.g. feeling fat, feeling attractive), body silhouettes and body size estimation, after viewing the thin pictures and showed improved body satisfaction after viewing the overweight pictures. The results also suggested that this response was greater in the female than in the male subjects for some of the measures (e.g. feeling fat, feeling toned) and was unrelated to levels of restrained eating. The results are discussed in terms of the role of the media in determining body image and the possible use of such images in clinical practice.

To assess the impact of distraction on subsequent eating, 60 females consumed a cereal bar while watching TV, walking or talking, and their subsequent desire to eat and food intake were assessed. No effects were found for desire to eat. But while those higher in restrained eating consumed less overall and fewer calories after watching TV or talking, they consumed more overall and more calories (specifically five times more chocolate) if the cereal bar was eaten while walking. 'Eating on the go' may disinhibit restrained eaters either as a form of distraction or by offering a justification to overeat.

This qualitative study interviewed heterosexual men (n=12) who had experienced a difficult relationship with a woman defined as ‘emotionally difficult, but without the presence of physical abuse’. Thematic analysis described three main themes: meaning of difficult relationships; immediate impact; longer-term impact and two higher order themes: gendered standards; power imbalance. Transcending these themes was men’s normalisation of their experiences. Overall, men experienced controlling, shouting and blocking behaviours which had immediate and longer-term negative effects. They also described how these relationships were underpinned by double standards of behaviour and a power imbalance. Further, they showed a tendency to normalise these experiences which reduces their status as a victim and makes their partner’s behaviour more acceptable. Accordingly, as the literature has been reluctant to accept men as victims, so are the men themselves.

Lockdown policies brought on by the COVID-19 pandemic pose a threat to well-being. This study examined the effectiveness of three positive psychology interventions, with different time-orientations, on well-being as well as predictors of well-being during lockdown. Participants (n=216) completed measures of lockdown characteristics, attachment orientation, and emotion regulation, were then randomly allocated to one of four interventions; nostalgia (past), gratitude (present), best possible self (BPS; future) or control (recalling a TV show), and completed outcome measures of well-being and affect. Results showed that BPS resulted in higher positive affect and that both BPS and gratitude resulted in higher social connectedness than the nostalgia intervention. Further, greater well-being during lockdown was predicted by greater attachment security, greater emotion regulation, and more social interactions. In sum, focusing on the present or future during lockdown is more effective for well-being than focusing on the past, which alongside trait characteristics predict well-being under lockdown.

Antimicrobial resistance (AMR) is a pressing threat to public and animal health. There is evidence that antimicrobial prescribing and stewardship behaviors by veterinarians (vets) are influenced by non-clinical factors, such as psychological, social, and environmental factors. This study explored the role of context, beliefs, and values on vets' antimicrobial prescribing decisions. UK-based practicing farm vets ( = 97) were recruited to an online study. Using an experimental vignette methodology, vets were randomly assigned across four conditions, to examine the effects of different contexts (pressure on farm economics, the farmer, or the vet-farmer relationship, compared to a control condition) on vets' likelihood of prescribing antibiotics. Vets' beliefs about different groups' responsibility for causing and preventing AMR and vets' values were also measured. Key findings were that context alone, values, and beliefs about groups' responsibilities for causing AMR were not predictive of vets' likelihood of prescribing antibiotics. However, vets' beliefs about groups' responsibilities for preventing AMR were predictive of an increased likelihood of prescribing antibiotics, when vets were exposed to the experimental condition of the vignette in which the vet-farmer relationship was under pressure. Farm vets also believed that different groups have different levels of responsibility for causing and preventing AMR. Results should be interpreted cautiously, given the smaller than planned for sample size, and the possibility for both false negatives and false positives. Further research is needed to explore how these findings could inform antimicrobial stewardship interventions in veterinary medicine.

Objective: Established risk factors for jet lag are mostly physiological including circadian preference, age, gender, the number of flight zones crossed and to some extent direction of travel. Some research has also highlighted a role for psychosocial factors including sleep, diet and ‘circadian’ health behaviours and illness cognitions although this remains relatively untested. The aim of this study was to evaluate the role of sleep, diet and illness cognitions in predicting perceived jet lag amongst long-haul crew. Design: 60 long-haul crew took part in a longitudinal study. Profile characteristics (including chronotype), preparation strategies (sleep, eating and ‘circadian’ behaviours) and illness cognitions were measured at baseline (before a trip). Main outcome measures: Subjective jet lag (unidimensional and multidimensional) was measured on the crews’ second day off (post-trip). Results: Hierarchical regression analyses showed that unidimensional jet lag was predicted by the belief in a cyclical timeline whereas multidimensional jet lag was predicted by multidimensional jet lag at baseline and to a lesser extent by identity. No role was found for profile characteristics and preparation strategies. Conclusion: Illness cognitions partly explain the experience of perceived jet lag in long-haul cabin crew indicating that jet lag is in part a psycho-social construct, not just a biological one.

The notion of nudge effects was investigated in two field experiments which focused on influencing customers’ purchases by manipulating the location and availability of food in a University canteen setting. Study 1 manipulated the location of fruit and confectionary. Study 2 restricted the types of bread (i.e. brown only not white) that customers could choose for their sandwiches. The results of the Study1 showed that the fruit sales increased when positioned away from the checkouts. The majority of interviewed customers bought fruit intentionally but those who bought confectionary did it on impulse. In the Study 2, a restricted choice of baguettes did not reduce sales, with customers simply buying more brown baguettes. This increase did not persist after the intervention. Simple changes in the location and availability of food items can nudge the customers’ purchases towards the choice of healthier options. There may be different processes that guide the purchase of fruit (intention/deliberation) and confectionary (impulse/reflex).

Qualitative studies have highlighted the complexity of patient models of health. The present quantitative study aimed to compare general practitioners' (GPs) and patients' models of health. A questionnaire consisting of 27 'markers of health' was completed by 472 patients (response rate 78.8%) and 64 GPs (response rate 71 %). The results showed that GPs and patients were comparable in their ratings of those markers relating to arousal, such as sleep, sex drive and energy and infections, such as neck glands and having lots of colds. However, in the main GPs and patients were consistently different. In particular, the patients showed a higher rating for those markers relating to digestion (e.g. appetite, bloatedness), bodily fluids (e.g. the colour and smell of urine, regularity of bowels), the condition of the tongue, hair and complexion and for more traditional medical markers (e.g. heart beat, body weight). In contrast, GPs reported higher ratings for mood and emotions. To conclude, patients appeared to hold much more diverse models of health than GPs and reported greater endorsement for markers consistent with both a humoral and medical approach to health. These results suggest that GPs and patients do not have a shared understanding of health, which has implications for the effectiveness of primary care consultations. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.

Boarding school can create attachment issues and may contribute to eating related problems including disordered eating. This chapter reports the findings from interviews with 17 women who describe their experiences of boarding school and how these had a negative impact on their eating behaviour. The analysis indicates that while pre-existing issues such as negative family body-related scripts and the need for weight control may set the scene, elements of boarding school can exacerbate these problems. In particular, intense feelings of abandonment when sent away to school can compound the drive to use food as a form of comfort; body image criticism can be exacerbated by constant scrutiny and always being watched by friends at school; the competitive nature of boarding school can make achieving the perfect body a goal while paradoxically making food a means through which to gain status and popularity; and the rules, rigidity and control imposed upon food by the school structure can make food the ideal forum for rebellion which seemed to backfire as these women grew older. The findings illustrate that while not the only cause of disordered eating, boarding school certainly seems to play a key contributory role.

A number of models of behaviour have been applied to contraception use including subjective expected utility theory and social cognition models. Whilst correlates of contraception use have been identified, the limitations of these models include their failure to consider either contextual factors or changes in contraception use over time. Researchers have called for integrated and dynamic models of contraception use, which can be related to the changing contraception use of individual women and can also be readily operationalised to explore within and between subject differences in contraception use. The present study therefore used a qualitative methodology to explore women's contraceptive histories and to enable women to define the issues from their perspectives, resulting in a model of contraception use that is firmly located within the context of their own lives and allows an investigation of the factors and processes involved in changes in contraception use/ non-use over time. This model conceptualises the predictors of contraception use in terms of the meaning and importance of a range of social goals, perceptions of vulnerability and constraints on or facilitators of contraception. Further the dynamic nature of these factors is described and it is illustrated how these core components vary over time according to situation, experience, and new information. The paper outlines the relevance of the findings for different models of decision-making processes and highlights the way that the model addresses the limitations of previous approaches.

Background: Emerging research highlights how, due to demographic changes in horse owner populations in Western soci eties, complex owner -horse relationships are leading to inappropriate horse care, including over -nutrition, which in turn can lead to laminitis. Farriers, due to their regular visits, may be in a position to support owners in dealing with this problem. Objectives: This study explored whether UK farriers have a role in working with horse owners to support horse welfare and prevent laminitis. Study design : Grounded theory analysis, a qualitative methodology. Methods: Semi -structured interviews were conducted with 12 farriers and 11 horse owners. The interviews were transcribed verbatim and systematically analysed using an inductive coding approach. Results: The analysis of the farrier and horse owner interview data revealed farriers and horse owners undertake a contracting process leading to either a task -focussed or holistic - care -focussed approach. Either approach can be satisfactory, but the evidence from this study suggests that when horses are at risk of laminitis, a task -focussed approach misses important opportunities to prevent it. Main limitations : This analysis , based on a small sample of participants, was not able to identify the frequency of farriers or horse owners orientating towards different approaches in a way that can be generalised to a wider population. However, the power of grounded theory lies in its inductive design to develop new theory, which can be subsequently tested. Conclusions: Farriers are in a perfect position to support horse owners to prevent laminitis through providing feedback, guidance and advice. However, not all farriers adopt this role and it is not necessary in all contexts. The evidence presented in this study has implications for equine veterinarians and welfare officers in educating horse owners about the value of holistic -care -focussed farriery .

The relationship between eating style, attitudes towards food and food intake was investigated in 846 British adolescent schoolchildren. Eating style was assessed with the Dutch Eating Behaviour Questionnaire, attitudes towards food with a series of specially prepared questions, and food intake with a diet history taken by a dietitian. The results showed that restraint, external and emotional eating were associated with very different profiles of attitudes and behaviour. Restrained subjects had a higher body weight, more negative attitudes towards food, a lower likelihood of overeating and a lower overall energy intake. External eaters had a lower body weight, positive attitudes to food, and reported a higher energy intake. Emotional eaters fell in between in some ways, with some signs of situational loss of control combined with a negative attitude towards overeating. While external eating appeared to be attenuated by restraint, emotional eating was enhanced by it. The implications of these eating styles for later patterns of eating and weight are discussed.

Research shows that the attitudes of children and adolescents towards bullying are influenced by the school environment and their peer groups. Given the increased vulnerability to bullying for autistic children, this study explored whether neurotypical children’s attitudes towards bullying and autism varied according to school exposure and personal contact with autistic people. Survey data were collected at the beginning and end of the school year from 775 children aged 11-12, from six schools: three with specialist centres for autism and three without. Participants read vignettes depicting bullying scenarios then completed measures of their attitudes in relation to the vignette and towards autism. Children from centre schools showed a greater increase in prosocial emotions towards bullying. For children from non-centre schools, an interaction showed a decrease in prosocial emotions except in response to social exclusion of an autistic child. Increases in personal contact showed a greater increase in positive attitudes towards autistic people. Explanations draw on theories of inter-group contact and social-moral reasoning. Results highlight the need for contact both at a personal level and through attending a school with an inclusive autism provision to increase understanding, improve attitudes towards autism and reduce tolerance for bullying.

There have been many approaches to understanding contraception use including social cognition models which have been criticised for their individualistic approach and their static nature. The present quantitative study developed and refined a contextual and dynamic model of contraception use that was derived using qualitative research. This model conceptualizes the predictors of contraception use in terms of the meaning and importance of a range of social goals, perceptions of vulnerability, and constraints on or facilitators of contraception use each of which changes over time. The present study operationalized this model in relation to emergency contraception and explored differences between users and non-users and between episodes of use and non-use. In terms of users and non-users, the results showed that the users of emergency contraception showed a more positive view of an emergency contraception user, perceived greater support from their partner for emergency contraception use, rated themselves more at risk of pregnancy, and felt more confident about asking for emergency contraception. In terms of use and non-use, use was related to an increased belief about the risk of pregnancy, increased partner support, increased concern about health care professionals and the side-effects of the drug, and a more positive identity of an emergency contraception. The study has helped to develop and refine the model and has identified some key factors that are specifically relevant to emergency contraception use in a sample of women in education in and around London.

Food intolerance is one of medicine's modern enigmas. Its etiology and mechanism are unclear and the subject of constant debate, while estimates of its prevalence vary widely from 2% to over 20% of the population. Using interpretive phenomenonological analysis, this study explored the phenomenon of food intolerance in primary care from the general practitioner's (GP) perspective. Semi-structured interviews were carried out with 17 GPs from around the UK. Food intolerance was primarily conceptualised as a spectrum of clinical importance with medical conditions arranged in three hierarchies; the certainty that the GP would have in making a diagnosis, the authenticity of the patients' experience, and the threat posed to physical health. Since some conditions within the spectrum had a medical name that was used in preference to the term ‘food intolerance’, food intolerance essentially became a ‘dustbin diagnosis’, focused at just one end of the spectrum and viewed with scepticism. The scepticism about food intolerance as a specific condition influenced the GPs' perceptions of patients and of the patients' underlying problems. This was, however, tempered by an element of awareness of the limitations of modern medicine. Rather than risk damaging the doctor–patient relationship, the GPs chose, despite their scepticism, to negotiate mutually acceptable ground with patients and with patients' beliefs. As a result, whether due to a placebo effect, secondary benefit, or as a biophysical result of excluding a food from the diet, the GPs acknowledged both personal and therapeutic benefit in working with the patients' belief in food intolerance and with behaviours associated with the beliefs.

Background Providing choice in health care is part of an ongoing policy initiative. Aim To explore how people understand choice in healthcare provision. Design of study A qualitative study using semi-structured interviews. Setting South East England. Method Twenty-two people were interviewed about the issue of choice in general, and choice in healthcare in particular. Data were analysed using template analysis. Results Participants discussed choice in the NHS within the context of the GP consultation. Four main themes about choice were identified: positive aspects of choice; the appearance of choice; unwanted choice; and the role of information in choice. Participants valued choice in principle, and having choice was seen as positive. However, the provision of choice options was not always associated with the possibility of meaningful choice. Participants expressed that in some instances they were given the appearance rather than the substance of choice. Making - as opposed to having - choice was often unwanted and considered as indicative of erosion in trust in the GP. Information was seen as a necessary, but not sufficient, prerequisite of informed choice. Conclusion People value having choices rather than making choices but are concerned about choice provision for its own sake rather than choice that is available in a meaningful way. Health care policy that recommends an increase in choice per se may be met with scepticism which could ultimately undermine, rather than promote, the doctor-patient relationship.

Purpose: Prisons offer a public health opportunity to access a group with multiple and complex needs and return them to the community with improved health. However, prisons are not conducive to optimal health and there are few frameworks to guide efforts. This study aims to generate insights into health literacy across a young adult prison population, specifically examining the level of limitations, barriers and characteristics associated with these limitations. Design/methodology/approach: The study took place in a single prison in England for young adult men aged 18–21 years old. A mixed-methods design was adopted with 104 young men completing a quantitative survey and qualitative semi-structured interviews with 37 young men.Findings72% (n = 75) of young men scored as limited in their health literacy. Barriers included structural restrictions, limited access to formal support and social and natural disruptions. No demographic characteristics or smoking intentions/behaviours predicted limited health literacy, but characteristics of the prison were predictive. Physical problems (sleep, nausea, tiredness and headaches), mental health and well-being (anxiety, depression and affect) and somatisation problems were also predictive of limitations. Practical implications: Prison healthcare services and commissioners should undertake regular health literacy needs assessments to support developments in reducing barriers to healthcare and increasing health improvement efforts. Action also requires greater political will and investment to consider broader action on the wider determinants of (prison) health. Originality/value:The study provides a framework to understand and guide prison health efforts and highlights attention needed at the level of governments, prison leaders and their health systems.

This experimental study explored whether the physical symptoms of cold, pain and itchiness could be generated by visual cues, whether they varied in the ease with which they could be generated and whether they were related to negative affect. Participants were randomly allocated by group to watch one of three videos relating to cold (e.g. ice, snow, wind), pain (e.g. sporting injuries, tattoos) or itchiness (e.g. head lice, scratching). They then rated their self-reported symptoms of cold, pain and itchiness as well as their negative affect (depression and anxiety). The researcher recorded their observed behaviour relating to these symptoms. The results showed that the interventions were successful and that all three symptoms could be generated by the visual cues in terms of both self-report and observed behaviour. In addition, the pain video generated higher levels of anxiety and depression than the other two videos. Further, the degree of itchiness was related to the degree of anxiety. This symptom onset process also showed variability between symptoms with self-reported cold symptoms being greater than either pain or itchy symptoms. The results show that physical symptoms can be generated by visual cues indicating that psychological factors are not only involved in symptom perception but also in symptom onset.

Purpose: Ex-service personnel face numerous and significant problems upon discharge from the forces. The purpose of this paper is to explore experiences of the transition from military to civilian life and to identify some of the barriers and facilitators to re-employment. Design/methodology/approach: In-depth interviews were carried out with 11 ex-servicemen who had previously served in the UK armed forces and analysed using interpretative phenomenological analysis (IPA). Findings: Participants described their experiences in terms of three broad themes: characteristics of a military life; loss as experienced upon return to civilian life; and the attempt to bridge the gap between these two lives. Transcending these themes was the notion of identity, illustrating that the transition from military to civilian life can be viewed as a shift in sense of self from soldier to civilian. Research limitations/implications: The current study only recruited male ex-service personnel and therefore the findings may not accurately represent the experiences of female service leavers. Practical implications: The military needs to ensure that not only is support provided for all service personnel, but that it goes beyond basic vocational advice. Although the needs of ex-service personnel are defined by factors other than unemployment, such as trauma or the sudden loss of security, they do relate back to unemployment in some capacity. Methodological changes to the discharge process could help this population to achieve a more continuous trajectory rather than a fragmented one. Originality/value: The present study has provided further insight into the identity experiences of ex-service personnel along their journey from soldier to civilian. Breakwell's Identity Process Theory provided a valuable framework for understanding the experiences of ex-service personnel. © Emerald Group Publishing Limited.

Interviews with 11 participants who had suffered a range of traumas five or more years ago were analysed using thematic analysis to explore the impact of a negative event and the mechanisms involved in subsequent changes and adjustment. Participants described a sense of mortality reflected in a feeling that life was fragile as though the intellectual knowledge of their future death had been turned into an emotional reality, which had offered them opportunity to make changes across a number of life domains. For some, however, these changes were hindered through ongoing issues such as physical and psychological symptoms and legal action. The final theme reflected a process of recalibration and many described achieving a state of relative contentment. Transcending these themes were a series of mechanisms facilitating change including downward comparisons to friends and abstract others, active remembering involving forced reflection, self-talk and reading diaries, shifting priorities and a focus on the positives and lowered expectations. Overall, it is suggested that growth following trauma is achieved through a shift in the object of comparison whether it be others or themselves as either in an alternative life trajectory or even death. This may result in a greater appreciation of life, but rather than being achieved through growth in one's sense of self per se it reflects a generalised lowering of expectations and growth in comparison to a new lowered set of points of comparison.

This study investigates the lived experience of inflammatory bowel disease with the aim of examining the process of adapting to life with inflammatory bowel disease. Adaptation is often referred to as the desirable outcome in chronic illnesses such as inflammatory bowel disease; yet little is known as to how this is achieved. A total of 10 Crohn's and 12 ulcerative colitis patients recruited from online support networks participated in individual, semi-structured interviews. The study has identified the notion of a 'new normal' as central to adaptation, whereby patients seek to recover a sense of normality by finding an equilibrium between their lives before and after diagnosis.

Antimicrobial resistance (AMR) is a global health burden. Although a complex and multi-faceted problem, inappropriate antibiotic use has repeatedly been identified as one of the main drivers of the acceleration and spread of AMR. Behaviours associated with antibiotic prescription and use have been extensively investigated in human medicine, and in the livestock sector of veterinary medicine. There is now a growing interest in the factors that drive inappropriate antibiotic use in companion animal medicine, as the significance of antimicrobial use in this sector is being recognised. Additionally, the possibility of an alternative antimicrobial, phage therapy, being implemented into companion animal medicine is explored in this study. Interviews revealed complexities in the vet-owner relationship including conflicting perceptions of responsibility regarding antibiotic prescription and use, distrust of vets’ intentions and misconception of clients’ needs. A need for alternative antimicrobials was evident, as all vets were able to report difficulties finding antibiotics to treat infections as a common occurrence. Questionnaire results indicated that vets and pet owners are open to the use of phage therapy in companion animals. This study shows that an alternative antimicrobial such as phage therapy could be accepted into companion animal medicine in the UK, however, effective communication between vets and pet owners is vital if antibiotic use is to be reduced and new antimicrobials successfully implemented.

The present qualitative study aims to explore the experiences of dieters who successfully maintain their weight loss with a focus on the transition in perception of self from their heaviest to their current reduced weight. Ten successful women from a slimming club who had lost at least 10 per cent of their weight for a minimum of one year participated in the study. The results showed an identity shift from a previous restrained self towards a liberated individual, regarding their social interactions, dietary habits, emotional regulation and self-appraisal. The results are discussed in terms of the process of reinvention and the impact of stigma on an obese person’s self-identity.

This study explored whether breast scarring following a lumpectomy generated negative judgements using an experimental between subjects factorial design. Eight images of women varying in terms of breast scarring (present vs. absent), beauty (average vs. high) and celebrity (as a proxy for familiarity; present vs. absent) were rated by 232 participants. The results showed that scarring resulted in lower ratings of attractiveness and self esteem and higher ratings of femininity. Scarred celebrities were judged as particularly unattractive. Women's assumption that they will be judged more harshly following breast cancer surgery maybe reflected in the actual ratings of others.

Objective: Whilst much research has addressed patients’ expectations and experiences of cancer treatment little research has explored the association between these factors. The current qualitative study aimed to explore patients’ beliefs about the relationship between their expectations of cancer treatment and their subsequent experiences. Design: Qualitative semi-structured interviews were conducted with sixteen individuals who had received cancer treatment. Results: Data were analysed using thematic analysis and illustrated that cancer treatment was experienced as a challenge that could be understood in terms of two themes: ‘investing in treatment’ reflecting trust in treatment and health care professionals and a sense that treatment was a necessary evil and ‘encountering tensions or disconnects’ illustrating the mismatch between expectations and experiences with patient reporting feeling unprepared, pleasantly surprised or shock. Transcending these themes was the notion of ‘searching for stability and certainty’ in terms of a desire for normality and a shift in focus between treatment process and outcome. Overall, disconnects were apparent between participants’ expectations and experiences. However, due to their trust in treatment, participants were able to shift their focus between the treatment itself and future outcomes, to regain a sense of certainty. Conclusion: Patients describe a complex relationship between expectations and experiences and are able to shift their focus between process and outcome to cope with the challenges they face.

A variety of services are available for those who experience problems with their gambling, though understanding about the effectiveness of and mechanisms behind these interventions remains limited. Insight into how users of these interventions experience them is limited further still. This is therefore an exploratory study of 10 problem gamblers' experiences of the various interventions available to them, with a focus on their reasons for using them and their insights into the costs and benefits of each approach. The results described three main themes: (1) "degrees of investment" which illustrated the factors affecting investment in different interventions, highlighting the importance of the shared experience; (2) "social comparison" which highlighted how comparing one's own gambling experience to that of others (both positively and negatively) bolstered recovery goals; and (3) "what works" whereby participants unpacked what they felt was effective for them and why, such as personalisation. Transcending these themes was the perception that "experience is expertise" and that due to their lived experience gamblers should be considered the experts on recovery over and above "trained professionals". Overall, Gamblers Anonymous emerged as the most positive intervention as it facilitated participants' sense of investment, encouraged positive social comparison, was deemed to be most effective and also epitomized the focus on "experience is expertise" as the groups are run by members rather than qualified practitioners. Therefore, not only does GA involve gamblers helping each other, but provides the context for physical connection, personalisation (through being listening and responded to individually) and support through social media.

Despite efforts, attempts to induce successful long term weight loss remain a problem in obesity research, with the majority of those who lose weight unable to control or sustain the loss. It is accepted that in order to bring about more successful approaches to weight management, it is vital to determine the psychosocial factors that underpin weight control capability. Previous research has demonstrated that successful weight maintainers and less successful overweight individuals display different patterns of weight control behaviours (1). The present study aims to explore weight control practices and help-seeking behaviours in an overweight sample from 8 European countries. Data were collected as part of the EU project DiOGenes – a pan-European project which aims to refine understanding of the individual genetic, dietary and behavioural factors influencing weight control, and how these factors interact. Participants of a pan-European dietary intervention trial (n ~ 700) completed a set of online questionnaires relating to their weight control practices and help-seeking behaviours before entering the trial such as use of antiobesity medication, commercial products and help from health professionals. Objective weight measurements were recorded at baseline as well as self-reported weight control history. The results of this investigation will be presented, focussing on inter country differences in weight control behaviours. Differences in weight control behaviours and baseline weight status and previous weight history will be explored.

With its primary focus on the psychology of eating from a social, health, and clinical perspective, the second edition of The Psychology of Eating: From Healthy to Disordered Behavior presents an overview of the latest research into a wide range of eating-related behaviors •Features the most up-to-date research relating to eating behavior •Integrates psychological knowledge with several other disciplines •Written in a lively, accessible style •Supplemented with illustrations and maps to make literature more approachable

Purpose The aim of this study is to explore the role of attachment styles in obesity. Material and Methods The present study explored differences in insecure attachment styles between an obese sample waiting for bariatric surgery (n = 195) and an age, sex and height matched normal weight control group (n = 195). It then explored the role of attachment styles in predicting change in BMI 1 year post bariatric surgery (n = 143). Results The bariatric group reported significantly higher levels of anxious attachment and lower levels of avoidant attachment than the control non-obese group. Baseline attachment styles did not, however, predict change in BMI post surgery. Conclusion Attachment style is different in those that are already obese from those who are not. Attachment was not related to weight loss post surgery.

Most current approaches to obesity management involve dietary interventions designed to change and reduce the amount of food consumed. Research indicates, however, that although such interventions can induce weight loss in the short term longer term changes in weight, which are required if the individual’s health is to improve, are much more difficult to sustain. This paper will explore the complex reasons behind why we eat and the many roles that food plays in our lives. It will then explore current dietary and alternative interventions for obesity and assess what we can learn from them to improve obesity management.

Research suggests a link between being in care and eating problems. The present study compared the eating behaviour of looked after young people and their non-looked after peers with a focus on the role of their perceived early childhood attachments. Looked after young people completed questionnaires about their perceived and unresolved attachment to their main caregiver during early childhood (aged 0 to 5), their level of picky eating and food disgust and the meanings they ascribed to food. They then nominated a non-looked after friend to complete the same measures. The results showed that looked after young people reported poorer scores on all aspects of early childhood attachments and were more likely to be picky eaters' and to find food disgusting. Further, they rated food as less embedded with meanings relating to sexuality, family life, a treat and social interaction. In addition, although care status independently predicted picky eating, food disgust and a belief that food was central to family life and social interaction, unresolved attachment was a better predictor of these variables. Unresolved attachment also significantly predicted a belief that food was a means to take control over one's life. Being brought up in care is associated with eating problems and a less engaged approach to food. Poor attachment is a powerful explanation of this association. Carers and other professionals are key to the development of trusting relationships with looked after young people. Such secure attachments with carers and other professionals may enable looked after young people to foster a more positive relationship with food.

Animals are considered key contributors to the development and spread of antimicrobial resistance (AMR). However, little is known about the existing AMR interventions in the animal sector. This scoping review examines the existing evidence on AMR interventions aimed at livestock, animal health professionals (AHPs), and farmers, while reviewing their impact, limitations, gaps, and lessons for future use. The scoping review was conducted following guidelines from the PRISMA-ScR checklist. The databases, Web of Science, Scopus, PubMed, and international organisations’ websites (WHO, FAO, WOAH) were searched for articles reporting interventions targeting livestock, farmers, and AHPs. Interventions were categorised based on seven pre-defined primary measures including: change in antimicrobial use (AMU) practices; change in the uptake of antimicrobial stewardship (AMS); change in development of AMR; change in knowledge of appropriate AMU practices, AMR, and AMS; change in attitudes and perceptions concerning AMU, AMR, and AMS; and surveillance strategies. In total, ninety three sources were included: 66 studies, 20 reports, and 7 webpages. The reviewed interventions focused mostly on AMU practices (22/90), AMS uptake (8/90), and reduction of bacterial or resistant strains (30/90). Changes in knowledge (14/90) and attitude (1/90) were less frequently assessed and were often implicit. Most interventions were conducted within a select country (83/90) and 7/90 were at a global level. Only 19% (16/83) of interventions were implemented in low- and middle-income countries (LMICs) and most were at herd level with many self-reporting changes. Most of the interventions that focused on surveillance strategies (30/83) were implemented in high-income countries (62/83). Only one study investigated the financial implications of the intervention. The study findings provide an overview of existing AMR interventions and insights into the gaps which can be addressed to guide future interventions and research. A focus on developing, implementing and evaluating interventions in LMICs coupled with the use of objective outcome measures (e.g., measurable outcomes vs. self-reporting) will improve our understanding of the impact of interventions in these settings. Finally, assessing the financial benefits of interventions is necessary to inform feasibility and to encourage uptake of interventions aimed at reducing AMR in the animal health sector.

This article analyses research exploring medication adherence, help-seeking behaviour, screening and behaviour change to argue that all interventions have the potential for both benefit and harm. Accordingly, health psychology may have inadvertently contributed to psychological harms (e.g. lead times, anxiety, risk compensation and rebound effects); medical harms (e.g. medication side effects, unnecessary procedures) and social harms (e.g. financial costs, increased consultations rates). Such harms may result from medicalisation or pharmaceuticalisation. Or, they may reflect the ways in which we manage probabilities and an optimistic bias that emphasises benefit over cost.

Whilst the treatment and prevention of overweight and obesity-related disease is managed by restricting daily energy intake, long-term adherence to dietary strategies appears unsustainable. Time-restricted eating (TRE) aims to position energy intake in an eating window under 12 h per day and offers an alternative behavioral intervention, which can aid weight management and improve cardiometabolic health. Adherence to previous TRE protocols is estimated at between 63 and 100%, although the accuracy of reporting is unclear. This study therefore aimed to provide an objective, subjective, and qualitative overview of adherence to a prescribed TRE protocol, and to identify any potential barriers affecting adherence. Adherence after 5 weeks of TRE was estimated at ~63% based on continuous glucose monitoring data when compared with time-stamped diet diaries. Subjective participant responses reported adherence at an average of ~61% per week. Barriers to adopting TRE, including work schedules, social events, and family life, were identified by participants during qualitative interviews. The findings of this study suggest that the development of personalized TRE protocols may help to navigate the barriers to adherence leading to improved health-related outcomes.

Background. Falls in older people decrease quality of life and increase mortality. There is littleresearch on perceptions of the cause of a fall and their influence on health outcomes. Method.A survey (N¼196) of older people hospitalised after a fall recorded attributions for the causeof the fall. A follow-up survey at 6 months measured functional limitation, anxiety anddepression. Findings. of the participants, 44.3% saw their fall as due to their character, 15.6%due to their behaviour, and 40.1% due to external factors. A hopelessness explanatory stylewas found in 21.1% of participants. Perceiving age as the cause of the fall predicted (p5.06)higher levels of depression at 6 months, while having hopelessness explanatory stylesignificantly predicted higher functional limitation (p¼.001). Discussion. Causal attributionsof fall events impact on physical and mental health outcomes, offering a route forpsychological intervention to reframe the meaning attached to a fall.

Objective: Patients’ expectations of cancer treatment could impact on their treatment experiences. Research in this area tends to focus on a particular aspect of expectations, and no suitable measure exists to explore patients’ expectations and experiences of treatment.  Methods: The current study developed and validated two new, matched, measures: The Expectations of Cancer Treatment Questionnaire (EXPECT-CTQ) and the Experiences of Cancer Treatment (EXPER-CTQ). Items were generated using the previous expectations literature, alongside findings from qualitative interviews, and refined with assistance from cancer patients and a wider pool of researchers. A sample of 200 cancer patients completed the measures, and factor analysis was performed to validate the EXPECT-CTQ, resulting in a 39-item measure with subscales assessing treatment efficacy, physical side-effects, psychological side-effects, and the impact of treatment on daily life, social life and self-care. The EXPER-CTQ was matched to the EXPECT-CTQ, excluding the treatment efficacy subscale, resulting in a 36-item measure. Reliability analyses were conducted on both measures with good results (α > 0.6). Analyses of the expectations-experiences relationship encompassing a broad range of expectations showed that expectations are positively associated with experiences of cancer treatment.  Conclusion: These two new measures are suitable for use in future research exploring both expectations and experiences of treatment for cancer and the implications of gaps between these constructs.

This study first aimed to provide additional validation for a new tool to measure Feeder Motivations and Behaviour. Second, it aimed to evaluate how feeder motivations and behaviour are enacted within romantic relationships and whether this reflects a reciprocal or linear dynamic. Participants completed the Feeder Questionnaire composed of six motivational subscales (affection; waste avoidance; status; hunger avoidance; offloading; manners) and one subscale to measure feeder behaviour, measures of eating behaviour (restrained, emotional and external eating) and their BMI. Participants were analysed as individuals (n=190) and within couples as dyads (n=76 couples).  In terms of validation of the measure, analysis using the non-dyadic data showed good internal reliability for all subscales and moderate correlations between feeder behaviour and motivations and measures of eating behaviour.  In terms of couple dynamics, dyadic data analysis indicated evidence for reciprocity within couples for BMI, feeder behaviour and feeder motivations relating to waste avoidance, affection, manners and status but not for hunger avoidance or offloading.  Dyadic analysis also indicated evidence for a more linear relationship with one participant’s feeder behaviour and motivations relating to their partner’s emotional and external eating. This study therefore provides further support for the usefulness of the Feeder Questionnaire.  The study also indicates that feeder behaviour is complex within couples and may function in a reciprocal way but also with one partner’s behaviour impacting upon their partner in a more linear fashion. 

ObjectiveExploration of the factors that influence hospital doctors’ antibiotic prescribing decisions when treating children with respiratory symptoms in UK emergency departments.MethodsA qualitative study using semistructured interviews based on a critical incident technique with 21 physicians of different grades and specialties that treat children in the UK. Interviews were audio-recorded then transcribed verbatim and analysed using thematic analysis.ResultsFour themes were identified. These themes illustrate factors which influence clinician prescribing. The three principal themes were authorities, pressures and risk. The fourth transcending theme that ran through all themes was clinician awareness and complicity (‘knowing but still doing’).ConclusionsHospital doctors prescribe antibiotics even when they know they should not. This appears to be due to the influence of those in charge or external pressures experienced while weighing up the immediate and longer term risks but clinicians do this with full insight into their actions. These findings have implications for invested parties seeking to develop future antimicrobial stewardship programmes. It is recommended that stewardship interventions acknowledge and target these themes which may in turn facilitate behaviour change and antimicrobial prescribing practice in emergency departments.

Whilst much research has explored the possible causes and consequences of gambling, Gamblers Anonymous (GA) - one of the most accessed forms of support for gamblers - has been largely overlooked and, to date, only a few studies have explored how members experience this programme. Core to GA is the social interaction between members. From March 2020, however, the COVID-19 pandemic forced GA to move their meetings online. The present qualitative study therefore explored how GA members experienced these online meetings in the absence of actual face to face interactions with others. Individual telephone or video call interviews (n = 21) were carried out with members of GA in the UK and analysed using Thematic Analysis. The results described three main themes: (1) 'practicalities of GA in lockdown', which highlighted the practical benefits of online meetings such as more opportunity to attend different meetings, which in turn expanded participants' perspectives and social networks; (2) 'the importance of relationships in GA', reflecting strong and enduring social networks that were created, maintained, and strengthened by feelings of solidarity; and (3) 'therapeutic elements of the meetings', such as psychological contract making which helped participants to stay abstinent. Transcending these themes was a tension between individual versus group identity with interviewees reporting a shift to focusing more on their own needs rather than those of the group. Overall, whilst still providing a lifeline during COVID-19 and offering some practical benefits, the online GA meetings were not able to completely replicate the value individuals gained from face to face meetings. This transition also resulted in disruptions both to group dynamics and to individual interactions within each group, ultimately resulting in participants behaving more individualistically and less collectively than in face-to-face meetings.

There is an evidence-base in human and small animal veterinary healthcare contexts which understands how practitioners engage in partnership working with patients and owners to support adherence to treatment/care plans. However, as yet, it is believed there is no similar evidence-base for how practitioners in equine healthcare contexts work with equine owners. It is argued that this is essential for understanding complex equine practitioner-owner interaction involving the prevention and management of laminitis. The aim of this study was to explore farrier-client interaction where risk management for an equine recovering from laminitis was being undertaken. A case report method involved a microlevel analysis of farrier-client consultation. The consultation was video-recorded and analysed using a conversation analysis approach to identify the linguistic and paralinguistic features of the interaction. These were compared with conversation analyses in other healthcare contexts to identify the actions being accomplished within the consultation. The analysis identified a number of joint actions, including managing epistemic stance (or knowledge rights) and deploying the animal’s presence to navigate problem sequences which supported progression of the consultation through a three-stage model involving ‘team-’, ‘option-’ and ‘decision-‘ talk, known to be associated with partnership working in human healthcare contexts. The study highlights the importance of developing an empirical evidence-base in equine practice for how practitioners engage with owners based on a microlevel analysis of real-world interactions. It is argued this evidence-base is necessary in supporting effective practitioner training in partnership working with clients to promote their adherence to treatment/care plans.

Research indicates a role for both social support and belonging in addiction recovery, however little is known about the role of these constructs in the recovery from problem gambling, and whether they relate to the effectiveness of mutual aid groups such as Gamblers Anonymous. The aim of this study was therefore to explore the relationship between social support and belonging, and to assess the role of demographics (including group membership of GA), social support and/or belongingness in predicting gambling addiction recovery in terms of gambling urges and quality of life. Using a cross sectional design, participants identifying as having problem gambling (n = 60) completed an online questionnaire with two independent variables (Social Support and Belonging), two dependent variables (Gambling Urges and Quality of Life) to assess gambling addiction recovery and measures of GA membership. The results showed no significant association between gender, age, ethnicity, education or employment status and gambling urges or quality of life. Membership to GA, and length of membership were significantly associated with gambling recovery indicating that being a member of GA and longer membership was associated with lower gambling urges and higher quality of life. Further, the results showed a high but not perfect correlation between social support and belonging (r(58) = .81, p = < .01). A regression analysis showed that although there was a significant correlation between social support and belongingness, they played different roles in gambling addiction recovery. Social support alone predicted higher quality of life, but not a reduction in gambling urges; belonging (along with being a member of GA) predicted a reduction in gambling urges, but not an increase in quality of life. Social support and belonging have a differential impact on aspects of gambling addiction, and should be considered as different constructs. In particular, whilst the process underpinning reduced gambling urges is membership of GA and the sense of belonging it provides its members, social support per se is a better predictor of quality of life. These findings have implications for the development of treatment for problem gamblers in the future.

Purpose Media images of unrealistic beauty have been identified as a determinant of women's body dissatisfaction. This experimental study aims to explore whether the negative impact of such images could be reduced by a one-time educational intervention consisting of a presentation and discussion, teaching women to be critical of media images. Design/methodology/approach Female psychology students (n=176) from a university in the UK were randomly assigned to the control or intervention group and completed measures of body dissatisfaction after being challenged by images of the perfect female body. Follow up data were collected four weeks later. Findings The results suggested that the intervention had no immediate buffering effect on body dissatisfaction but participants in the intervention group showed a long-term improvement for confidence, attractiveness and body-parts dissatisfaction. Practical implications This one-time intervention could be used to protect young women against the detrimental impact of media images in the longer term. Originality/value This study provides an evidence base for the use of an educational intervention for young people in schools and colleges.

The present study examined the experience of vaginismus in 89 sufferers and ex-sufferers using quantitative and qualitative methodologies. The results provide insights into the effects of vaginismus on the sufferers' self perception and on their relationships with important others. It is suggested that vaginismus should not be regarded as a psychosexual problem but as a psychosocial experience in which defences have been created to protect the self, and that the vaginal spasm is only one of the many effects of this defence.

Background. Research in general practice emphasizes the importance of matched models, beliefs and vocabulary in the consultation. Objective. The present study aimed to explore the impact of matched and unmatched vocabulary on patient satisfaction with consultations. Methods. The study took place in one inner city general practice. Patients (n = 62) were randomized to either matched or unmatched vocabulary consultations when consulting for problems relating to sexual or bodily function or anatomy. Matched consultations required the doctor to use the same vocabulary as the patient. Unmatched consultations required the doctor to use medical vocabulary. Completed questionnaires were received from 60 patients. The main outcome measure was patient satisfaction (using the Medical Interview Satisfaction Scale). This assesses total satisfaction and has four subscales: distress relief; communication comfort; rapport; and compliance intent. Doctor satisfaction with the consultation was also assessed. Results. The results showed that the two groups were comparable for demographic variables and doctor satisfaction. However, patients in the matched consultation group had significantly higher total satisfaction scores and higher ratings of rapport, communication comfort, distress relief and compliance intent than those in the unmatched group. Conclusion. The results indicate that a doctor's choice of vocabulary affects patient satisfaction immediately after a general practice consultation and that using the same vocabulary as the patient can improve patient outcomes.

This study explored long-term consequences of obesity surgery. Interpretative phenomenological analysis was used to analyse transcripts of 10 interviews with patients who underwent surgery 8 or more years ago. Experiences were described under three broad themes: eating behaviours, relationship with food and quality of life. Although patients described variability within these themes, describing different patterns of change, analysis revealed associations between themes and outcomes. In particular, those who reported successful weight loss also described the functionalization of food, the development of new coping strategies and a process of positive reinvention creating a new sense of self.

Prisons are an important setting to reach an underserved group and reduce health inequalities. This study describes a co-design approach to developing a health promotion leaflet for young men in prison with the aim to evaluate the effects of the leaflet on behaviours in the wider prison population. We successfully co-designed a leaflet with a group of young men in a prison through a series of workshops. The leaflet was evaluated through a cluster randomised controlled trial, where it was distributed to young men in half the wings in the prison (with the other half as a control wings) and followed-up a week later with a short evaluation survey across all the wings. Although the leaflet was rated as highly acceptable with some significant shifts in attitudes, there were no significant differences in behaviours between the leaflet and control groups. Free text responses from participants highlighted the material and social constraints in adopting healthy behaviours, including the challenges of being locked up for long periods, limited opportunities to take-up healthy activities and choices, and restrictions to personal finances and support. The study highlights the value in the co-design approach but wider structural and policy support is required to create health promoting environments.

Objective GPs sometimes use euphemisms rather than medical terms. The present study aimed to explore the relative impact of using the term ‘obese’ compared to GPs’ preferred euphemism on patients’ beliefs about the problem. Methods A cross sectional survey followed by an experimental study was used with two conditions: the term ‘obese’ versus the GPs’ preferred euphemism. In the cross sectional survey, GPs’ (n = 19) described their preferred use of term. In the experimental study, patients (n = 449) from one General Practice in West London then completed a set of ratings about their beliefs following a vignette using either the term ‘obese’ or the GPs’ preferred euphemism. Results The first stage of the study showed that GPs avoided using the term ‘obese’ and preferred to use a euphemism. The most commonly used euphemism was ‘your weight may be damaging your health’. The second stage showed that the term ‘obese’ made patients believe that the problem had more serious consequences and made them feel more anxious and upset than when the same symptoms were labelled using the euphemism. When analysed according to the patient's own BMI, however, the results showed that the term ‘obese’ had a greater emotional impact than the euphemism only on patients who were not obese; obese patients found the euphemism more upsetting. Conclusion GPs avoid using the term ‘obese’ for fear of upsetting patients. This term, whilst making the problem appear more serious is only more upsetting for non-obese patients. Practice implications GPs choice of term therefore needs to reflect whether they want the patients to be upset or whether they want them to accept the seriousness of their problem.

Objective: To examine the effect of questionnaire context on self-reported illness cognition. Design: A single-item measure of the perceived impact of lower urinary tract symptoms (LUTS) was embedded twice in a questionnaire battery completed by community-dwelling middle-aged males (N = 1,790). The impact measure was placed in two distinct questionnaire contexts; at the end of a general somatic symptoms questionnaire, and following an illness-specific symptoms questionnaire. The order of the two questionnaire contexts was counter-balanced in a random sub-sample. Main Outcome Measures: An established single-item measure of the perceived impact of LUTS. Results: Concordance between the two single-item measures was moderate. Scores on a single-item measure of impact were significantly lower when assessed immediately following the completion of a LUTS-specific questionnaire than when assessed following the completion of a general symptoms questionnaire. There was no evidence of order effects. The observed effect was moderated by the severity of LUTS such that the difference in perceived impact scores between contexts (where general symptoms context > illness-specific context) increased as urinary symptoms increased. Conclusion: Questionnaire context systematically influenced responses on self-report measures of illness impact. The magnitude of the context effect was largest in the highest quintile of LUTS severity, a difference of >0.5 on a scale with a range of 3. These findings may have implications for situations where patient reported outcome measures are used to evaluate healthcare interventions or inform treatment decisions.

Background Stress has become an increasingly common presentation in general practice. This may relate to an increase in stress in people's lives or a change in the meaning of stress and its conceptualisation as a legitimate problem for the GP. Aim, To explore patients' beliefs about stress, their association with help-seeking behaviour, and to examine differences by ethnic group. Design of study Gross-sectional survey of general practice patients attending to see their GP. Setting An inner-city London practice. Method Consecutive general practice patients completed a questionnaire, which involved rating a series of symptoms for the extent to which they were associated with stress and describing their help-seeking behaviour. In total, 548 patients completed the questionnaire. Most patients described themselves as black Caribbean (n = 163), black African (n = 48), or white British In = 187). Results The symptoms most frequently associated with stress were sleeping problems, feeling depressed, feeling panicky, having high blood pressure and feeling anxious; feeling ashamed, experiencing indigestion, having diarrhoea, feeling hot or cold, and suffering from constipation were least commonly associated to stress. This model of stress did not vary by ethnic group. Ethnic group differences were found for the association between the model of stress and help-seeking behaviour. Although white British patients consistently reported that the more a symptom was seen as indicative of stress, the more likely they would be to visit the doctor for that symptom, this association was not found for either black Caribbean or black African patients. Conclusions The belief that stress-related symptoms are a legitimate problem for the GP is not universal and varies according to ethnic group. Stress is used by different patients in different ways and offers a variable pathway to the doctor.

Much research has addressed behavior change but has tended to focus on short term changes. This study aimed to explore the mechanisms behind sustained changes in behavior and involved qualitative interviews with 34 `success stories' who had either lost weight through changes in diet and exercise (n = 24) or stopped smoking (n = 10) and had maintained this change for at least 3 years. The results showed that the majority described how their sustained behavior change had been triggered by a significant life crisis relating to their health, relationships or salient milestones. This initial change was then translated into sustained change if three sustaining conditions were met: the function of the unhealthy behavior was disrupted, the individual perceived that their choice over carrying out the unhealthy behavior had been reduced and they adhered to a behavioral model of their problem. Further, these conditions functioned by enabling a process of reinvention with participants showing a shift in identity toward a new healthier self. The results are discussed in terms of self-regulation and the establishment of a new post-crisis healthier equilibrium.

Whilst the consequences of weight bias and weight bias internalisation (WBI) have been explored, less is known about the factors contributing to their development. Some research has explored the role of social exposure in weight bias and WBI but has been limited in its definition of exposure and focused solely on western countries. The present study therefore aimed to assess the role of social exposure defined in terms of both population and personal exposure in predicting weight bias and WBI, in an international sample. Participants (N = 1041) from 33 countries, aged 18-85 years completed online measures of demographics, weight bias, WBI, and population and personal social exposure. Population exposure was defined using national obesity prevalence data from the World Health Organisation to classify countries as low (obesity rates ≤19.9%; n = 162), medium (20.0-29.9%; n = 672) or high prevalence (≥30%; n = 192). Personal exposure was defined in terms of personal contact and health and attractiveness normalisation. Using regression analysis, greater weight bias was significantly predicted by being younger, male, less educated, and personal exposure in terms of normalisation beliefs that thinner body types are healthier and more attractive, greater daily exposure and overall exposure to thinner friends. The strongest predictors of weight bias (adj R  = 13%) were gender (β = -0.24, p 

A repeated measures cohort study was conducted to investigate the impact of attending a day treatment programme on physical and psychological state, and to assess which baseline factors predicted level of recovery. Physical and psychological outcomes of treatment were analysed for 116 patients admitted to the treatment programme between 1996 and 2006 and were found to be in line with previous day care evaluations, with the majority of patients showing improvements on all measures. A multiple regression analysis revealed several factors to be predictive of treatment outcomes including patient demographics, comorbidities and traumatic life events. In particular, those patients who benefited most from the treatment had a lower body mass index at admission, stayed longer at the unit, were older, less likely to have other physical and psychiatric comorbidities, particularly obsessive compulsive disorder or a history of sexual abuse, and whose most predominant eating disorder problem was characterised by low weight.

Purpose This experimental study seeks to explore the impact of media images on women's body dissatisfaction and to assess whether this impact could be reduced by an educational intervention describing the power of air-brushing. Design/methodology/approach The study involved a 2×2 factorial design with two conditions: picture (thin vs fatter) and air-brushing intervention (present vs absent). A total of 200 women completed measures of body dissatisfaction before and after viewing the experimental information. Findings The results showed that women felt consistently more dissatisfied with their bodies after viewing thin pictures and more satisfied after viewing fatter pictures. In addition, the air-brushing intervention reduced the detrimental effect of viewing the thinner pictures but had no effect on the benefits of viewing the fatter pictures. Originality/value Media images may have a role to play in body dissatisfaction in women. But a simple intervention focusing on air-brushing can facilitate a more critical perspective and thus provide a buffer against the influence of media images.

This paper aimed to investigate which parents use which types of parenting control practices to manage their children's diets and to assess the impact of these practices on children's dietary patterns and their BMI. A cross-sectional survey of 518 parents with children aged 4–7 years was carried out in 18 primary schools across the South of England. Measures included aspects of parental control practices and the child's diet. Results showed that older parents with a lower BMI and who were stay at home parents used more “snack overt control”, “snack covert control” and “meal covert control” and those with more education used more covert control strategies. In contrast, male, non-white parents with younger children used more “pressure to eat”. In terms of the children's diet, the results showed links between parental and child demographics and aspects of unhealthy and healthy food intake. In addition, links were also found for parental control practices. For example, eating more unhealthy snacks was related to less covert control and more pressure to eat, eating fruit and vegetables was related to higher levels of both overt and covert control over meals and less pressure to eat and being neophobic was related to less covert control over meals and more pressure to eat. The children's BMIs were unrelated to any variables measured in the study

Objective: Jet lag is common place amongst long haul cabin crew. Timed food has been shown to reset the circadian rhythm in rodents. Implementation intentions have been used to change eating behaviour. Meal times could therefore be used as a countermeasure to reduce jet lag and improve alertness in long-haul cabin crew through forming an implementation intention to improve the regularity of meals on days off. Design: 60 long-haul crew took part in a randomized controlled trial, with two conditions: forming an implementation intention to eat regular meals on days off versus no implementation intention. Pre-intervention measurements were taken at baseline (before a long-haul trip) and post-intervention measures were taken on the first and second days off post-trip. Main outcome measures: Subjective jet lag (unidimensional and multidimensional) and objective alertness (Psychomotor Vigilance Task (PVT)). Results: Mixed ANOVA showed a significant condition x time interaction for unidimensional jet lag but not for multidimensional jet lag and objective alertness. In particular, the formation of an implementation intention to alter meal times resulted in a reduction of unidimensional jet lag. Conclusion: Implementation intentions can be used to alleviate jet lag in long-haul crew through promoting a change in meal times.

Objective To explore general practitioners (GPs’) beliefs about the causes and solutions to obesity, to compare them to those held by a lay sample and to assess the role of beliefs about causes in explaining beliefs about solutions. Methods Questionnaires regarding the causes and solutions to obesity were completed by GPs (n = 73) and a lay sample (n = 311). Results GPs generally believe that obesity is caused by psychological and behavioural factors and are ambivalent about the effectiveness of the majority of available solutions. When compared to a lay population, GPs show a greater endorsement of behavioural, structural, social and psychological causes of obesity whereas the lay population prefer a more biological model of causality. The present study also provides some evidence for the origins of such beliefs about solutions and indicates consistency between GPs’ beliefs about solutions and causes. For example, GPs endorse a medical solution if they believe obesity is caused by biological factors and endorse policy change as a solution if they believe it is caused by social factors. The lay sample did not show such consistency in their beliefs. Conclusions GPs believe that obesity does not belong within the medical domain. They hold a coherent model in terms of beliefs about causes and solutions which may limit their perspective on what constitutes a suitable solution to this ever common problem. Practice implications If GPs are to take responsibility for the management of obesity they should be encouraged either to change their beliefs or to consider whether solutions need always address causality.

Unlike various countries and organisations, including the World Health Organisation and the European Parliament, the United Kingdom does not formally recognise obesity as a disease. This report presents the discussion on the potential impact of defining obesity as a disease on the patient, the healthcare system, the economy, and the wider society. A group of speakers from a wide range of disciplines came together to debate the topic bringing their knowledge and expertise from backgrounds in medicine, psychology, economics, and politics as well as the experience of people living with obesity. The aim of their debate was not to decide whether obesity should be classified as a disease but rather to explore what the implications of doing so would be, what the gaps in the available data are, as well as to provide up-to-date information on the topic from experts in the field. There were four topics where speakers presented their viewpoints, each one including a question-and-answer section for debate. The first one focused on the impact that the recognition of obesity could have on people living with obesity regarding the change in their behaviour, either positive and empowering or more stigmatising. During the second one, the impact of defining obesity as a disease on the National Health Service and the wider economy was discussed. The primary outcome was the need for more robust data as the one available does not represent the actual cost of obesity. The third topic was related to the policy implications regarding treatment provision, focusing on the public's power to influence policy. Finally, the last issue discussed, included the implications of public health actions, highlighting the importance of the government's actions and private stakeholders. The speakers agreed that no matter where they stand on this debate, the goal is common: to provide a healthcare system that supports and protects the patients, strategies that protect the economy and broader society, and policies that reduce stigma and promote health equity. Many questions are left to be answered regarding how these goals can be achieved. However, this discussion has set a good foundation providing evidence that can be used by the public, clinicians, and policymakers to make that happen.

The aim of this study is to explore the experiences of young women undergoing weight loss surgery in relation to quality of life and health behaviour issues with a focus on reproductive health. This is in light of the increasing numbers of women who have unsuccessfully tried conventional weight loss approaches and are now opting for surgical interventions in order to gain control of their weight and better assimilate into society. Weight loss operations refer to a collection of permanent and reversible surgical techniques collectively known as Bariatric Surgery (“BS”), which have been demonstrated to be an effective and viable treatment to sustain weight-loss in the severely obese. These operations are unique in that they also have a positive influence on other medical conditions and aid long-term health, including resolving menstrual irregularities leading to improved female fertility. In recent years there has been an increase in women aged 18-25 years who have undergone BS. This age bracket correlates with the natural ‘peak’ in fertility and inevitably leads to some early post-surgery pregnancies with an increase in the risk of adverse health issues for both mother and (foetal development) child. Seven women (aged 18-25 years) responded via an on-line tool to share their experiences of undergoing BS, in one to one recorded interviews conducted via Skype. All had undergone surgery within the private sector and were 6-24 months post-surgery at the time of the interview. Thematic framework was used to analysis and understand the personal narratives and identify semantic themes. The participants described their experiences in terms of three broad themes i) identifying a problem, ii) seeking help and iii) reality check. Transcending these themes was the ‘cost’ which linked with the Subjective Expected Utility (SEU) Theory being the theoretical framework underpinning this study, based on the decision making model of behaviour (Edward 1954). The majority of the participants described feeling optimistic after-surgery, however this was balanced against various costs (trade-offs) of positive/negative experiences and outcomes with a realisation for some that psychological issues still needed to be addressed. These findings provide an insight to the physical and psychological experiences of young women who have undergone BS and offer awareness for health care professional and prospective participants considering/preparing to undergo BS.

This paper aimed to develop a reliable measurement tool to evaluate the meanings of food that could be used in both practice and research and to examine possible gender differences. A new meaning of food questionnaire (MOF) was refined across two studies (study 1, n = 451 and study 2, n = 170). The final questionnaire consisted of 25 items and 8 reliable subscales: food and sex, emotional regulation, treat, guilt, social interaction, control over life, control over food, family. The new Meaning of Food (MOF) questionnaire could be used in both research and clinical practice to profile patients and explore predictors of eating behaviour. Copyright © 2011 John Wiley & Sons, Ltd and Eating Disorders Association.

University can be a time of identity shift and transition for many and for some, the worries of adolescence can start to subside. aims: this qualitative study explored the lessons those in their final year at University would say to their younger selves using a novel photograph prompted think-aloud method. Final year University students (n = 42; aged 20–24) were asked to look at a photograph of themselves in their mid-teens and think-aloud about the lessons learned since this time. the transcripts were analysed using thematic analysis and described three main themes: 'create a safe space' to ensure a positive environment around you; 'look around you and take perspective' involving looking outwards to realise that things could be worse; 'look inwards and trust yourself' by listening to your feelings. transcending these themes was the value of learning to 'be patient and accept change' and an overarching lesson to 'pay attention to what matters'. the lessons University students would give their younger selves involved regulating both their internal and external world, being patient and paying attention to aspects of the world that enhance wellbeing. these lessons provide an insider's voice which is both relatable and inspiring for other young people. Further, they illustrate the application of a novel photograph prompted think-aloud method which could be used to elicit lessons learned from a wealth of life stages and reflections of recovery after both physical and mental health problems.

The present study evaluated community nurses’attributions for a case patient's heart attack and their recommendations for treatment Eighty-nine district nurses and health visitors completed a set of rating scales following a case vignette describing a patient who had suffered a heart attack and prior to which had either adopted a healthy lifestyle (n=47) or had maintained unhealthy behaviours (n= 42) The results suggest that subjects in the unhealthy-behaviour condition rated the case patient as less likely to follow advice, more responsible for his/her condition and rated the heart attack as more preventable In addition, the results suggest that subjects were more likely to offer recommendations for behavioural change to the unhealthy case patient and that these recommendations were significantly related to internal attributions of patient responsibility The results are discussed in terms of theories of health professionals’beliefs and behaviours

Many organisations avoid disease-based labels such as 'diabetic' or 'epileptic' as they are believed to be detrimental to a patient's beliefs about their condition and may generate stigma. The aim of this study was to examine the impact of the term 'a diabetic' compared with the term 'a person with diabetes' on the beliefs of participants who either did or did not have the condition. The study used an experimental design and was in two parts, with study cohorts derived from Diabetes UK websites and the University of Surrey website. Part 1 evaluated the impact of the two terms - 'a diabetic' and 'a person with diabetes' - on participants who had diabetes, in relation to their beliefs about the condition, using the Revised Illness Perception Questionnaire. Part 2 measured the impact of these two terms on participants without diabetes in relation to their positive and negative stereotypes of the condition. Data were gathered for 92 participants with diabetes (Part 1) and for 99 participants without diabetes (Part 2). The results showed no significant differences between the term 'a diabetic' compared with the term 'a person with diabetes' on either the beliefs of people with diabetes or the stereotypical attitudes of people without diabetes. In conclusion, the results suggest that the two terms are not as different as has been sometimes assumed. © 2013 FEND. Published by John Wiley & Sons, Ltd.

Why is feeding a child so difficult? This book answers a question that many parents find themselves asking on a daily basis. Hunger is a basic biological drive and eating should be an easy part of family life. But too often, it is not. Based on 30 years of research into eating behaviour and 21 years being a mother, Jane Ogden offers straightforward advice about how to encourage children to develop a healthy, unproblematic approach to eating from birth through to young adulthood. The book describes current theory and research and turns these into practical tips for use in everyday family life. It covers how children learn to like food, how habits are formed and can be changed, what children should be eating and how this can be helped to happen without making food into an issue. She discusses common problems that parents face such as picky eating, undereating, overeating, obesity, body image issues and eating disorders and how to deal with a child who thinks they are fat. She also provides practical tips and solutions and some simple ways to feed a family a healthy diet. With insightful advice about one of the most complicated adventures in parenting this guide is a must have for any parent who wants their child’s relationship with food to thrive.

Objective: To evaluate the effectiveness of a print-based intervention supported by Internet tools at improving physical activity in cancer survivors compared to a standard letter recommendation. Pre-diagnosis physical activity and self-efficacy were hypothesised to predict physical activity improvement. Study design: Waiting list randomised control trial and cost-consequence analysis. Methods: Adult cancer survivors who could become physically active without prior medical approval were randomised to receive either a print-based intervention supported by Internet tools (intervention, n=104) or a standard letter recommendation (control, n=103). Physical activity was assessed at 12-weeks with maintenance assessed at 24-weeks in the intervention arm. A number-needed-to-treat was calculated and a cost-consequence analysis completed. Results: Participants in receipt of a print-based intervention supported by Internet tools improved their physical activity by 36.9% over 12-weeks compared to 9.1% in the control arm. Physical activity was maintained at 24-weeks in the intervention arm. Six-point-two-nine cancer survivors needed to receive the intervention for one to improve physical activity over a standard letter recommendation. Intervention delivery cost £8.19 per person. Pre-diagnosis physical activity and self-efficacy did not predict physical activity improvement. Conclusion: A print-based intervention supported by Internet tools offers a promising low-cost means to intervene to improve physical activity in cancer survivors.

Over recent years, it has become increasingly clear that health-related quality of life (HRQoL) is an important outcome for assessing the effectiveness of bariatric surgery. HRQoL can be measured using unidimensional tools to assess factors such as mobility, mood, self-esteem, or eating behavior and multidimensional tools which assess health status in the broadest sense. This chapter will present these different measurement tools and also describe a number of tools which have been developed specific to bariatric surgery. It will then evaluate the pros and cons of each tool and consider the issues relevant for identifying the best tool for any given situation. The chapter will then provide an overview of the existing evidence for the impact of bariatric surgery on the quality of life and broader psychosocial outcomes. There is no single measure of HRQoL that meets all research or clinical needs for bariatric surgery. The choice of measure should not only take into account the evidence base for each tool together with its content validity but also the definition of HRQoL being used, the function of the measure being used, and the practicalities of the data collection process.

It is becoming increasingly common to enable a woman to see her ambulatory hysteroscopy procedure on a monitor. However, there is only limited evidence on the potential impact of seeing or not seeing the procedure on patient mood, perception of pain, and patient–physician interaction. This randomized controlled trial compared the effects of seeing or not seeing the screen during an outpatient hysteroscopy procedure on patient’s experience. At two outpatient clinics, 157 women scheduled for a hysteroscopy procedure were randomized either to see the screen (n = 81) or not to see the screen (n = 76). Before and after the procedure, the patients completed questionnaires to evaluate various parameters of their experience (mood, pain perception, illness cognitions, and communication with the health professional). After the initial study, the analysis was repeated using a local anesthetic to control for the potential impact of this covariate on the experience of the patients for whom this was measured [screen on(n = 51) and screen off (n = 54)].The data showed that seeing the screen or not had no effect on changes in mood, perception of pain, several parameters of illness cognitions, and patient–physician communication with respect to patient involvement, affect and information giving. Women who did not see the screen, however, had greater confidence in the effectiveness of their treatment and reported that the health professional was more receptive to their views during the consultation. After adjustment for the use of a local anesthetic, anxiety was decreased more after the procedure in women who did not see the screen.The investigators conclude from these findings that viewing the procedure is not beneficial to the patient and may be detrimental to patient–physician communication.

Bariatric surgery is currently the most effective form of obesity management for those whose BMI is greater than 40 (or 35 with co morbidities). A minority of patients, however, either do not show the desired loss of excess weight or show weight regain by follow up. Research highlights some of the reasons for this variability, most of which centres on the absence of any psychological support with patients describing how although surgery fixes their body, psychological issues relating to dietary control, self esteem, coping and emotional eating remain neglected.The present study aims to evaluate the impact of a health psychology led bariatric rehabilitation service (BRS) on patient health outcomes. The bariatric rehabilitation service will provide information, support and mentoring pre and post surgery and will address psychological issues such as dietary control, self esteem, coping and emotional eating. The package reflects the rehabilitation services now common place for patients post heart attack and stroke which have been shown to improve patient health outcomes.

Health education highlights the role of fear and knowledge as a means to improve women's use of contraception. This paper explores the ways in which contraception use is more complex than this and argues for a central role of beliefs, aspects of the situation and negotiation in determining whether or not a woman decides to use contraception and which form of contraception is best for her. In terms of beliefs, research highlights the role of a range of beliefs about the costs and benefits of each form of contraception, the risk of pregnancy and STDs and people's feelings of competency at using contraception. Contraception use however, arises out of the sexual situation, which involves an interaction between people. This situation can result in emotions such as anxiety and embarrassment and is often associated with high levels of arousal, which may be exacerbated by drugs or alcohol. At such times using contraception may not always be high priority. Finally, contraception use involves communication and negotiation both between sexual partners and with health professionals. Research indicates that whilst people are prepared to become intimate with each other physically, discussing contraception can be embarrassing, leading to non-use if either partner is less than determined. Furthermore, contact with health professionals such as the GP, pharmacist or nurse may also feel uncomfortable and be a barrier to seeking help. Contraception use is therefore the result of a complex set of cognitions and emotions, which are not sufficiently addressed by knowledge and education. It is suggested that such factors should be given more attention within health education if contraception use is to increase. Further it is argued that whilst health professionals may aim to encourage 'best case' contraception use, a compromise approach such as the use of emergency contraception is always worth pursuing. © 2005 Elsevier Ltd. All rights reserved.

Samaritan listening volunteers provide emotional support to people in distress or suicidal. Samaritans’ has high volunteer turnover, which may be due to burnout. This study evaluated the role of demographic and psychosocial factors in predicting Samaritans listening volunteers’ burnout and health status. Samaritans’ listening volunteers (n=216) from seven branches across UK completed an online survey to assess their levels of burnout (emotional exhaustion, depersonalisation, personal accomplishment), subjective health status, coping, empathy and social support. Overall, listeners showed low levels of burnout and good health. Regression analysis revealed that higher emotional exhaustion was predicted by younger age and avoidant coping style; higher depersonalisation was predicted by lower empathy fantasy and higher avoidant coping style; lower personal accomplishment scores were predicted by higher empathy personal distress and worse health status was predicted by more hours per week spent on listening duties, lower social support and higher avoidant coping style. Overall, different factors influenced different facets of burnout. However, higher use of avoidant coping style consistently predicted higher burnout and worse health status, suggesting avoidant coping is an important target for intervention.

The existing literature on parental control and children's diets is confusing. The present paper reports two studies to explore an expanded conceptualisation of parental control with a focus on overt control which 'can be detected by the child' and covert control which 'cannot be detected by the child'. In study 1, 297 parents of children aged between 4 and 11 completed a measure of overt control and covert control alongside ratings of their child's snacking behaviour as a means to assess who uses either overt or covert control and how these aspects of parental control relate to a child's snacking behaviour. The results showed that lighter parents and those with children perceived as heavier were more likely to use covert control and those from a higher social class were more likely to use overt control. Further, whilst greater covert control predicted a decreased intake of unhealthy snacks, greater overt control predicted an increased intake of healthy snacks. In study 2, 61 parents completed the same measure of overt and covert control alongside the three control subscales of the Child Feeding Questionnaire [Birch, L.L., Fisher, J.O., Grimm-Thomas, Markey, C.N., Sawyer, R. (2001). Confirmatory factor analysis of the Child Feeding Questionnaire: A measure of parental attitudes, beliefs and practices about child feeding and obesity proneness. Appetite, 36, 201-210] to assess degrees of overlap between these measures. The results showed that although these five measures of control were all positively correlated, the correlations between the new and existing measures indicated a maximum of 21% shared variance suggesting that covert and overt control are conceptually and statistically separate from existing measures of control. To conclude, overt and covert control may be a useful expansion of existing ways to measure and conceptualise parental control. Further, these constructs may differentially relate to snacking behaviour which may help to explain some of the confusion in the literature.

Children with autism are more likely to be socially excluded than their neurotypical peers. Since the majority of children with autism attend mainstream schools, interventions are needed to improve the attitudes and behaviours of their peers. Many studies highlight the influence of contact on positive attitudes and reduced discrimination. Group music-making provides an ideal opportunity for positive contact to occur in the classroom. This study evaluated the impact of music-based contact with autistic peers on the attitudes, emotions and behaviours of neurotypical children. Changes in those with autism were also assessed. Neurotypical participants (n=55) aged 10-11 years took part in an eleven-week music programme designed to increase social interaction, which either did or did not include contact with autistic children (n=10). Measures of attitudes, emotions and behaviours were assessed at baseline and follow up. In response to a hypothetical scenario depicting social exclusion of a child with autism, neurotypical participants in the contact group showed a greater increase in prosocial emotions and a greater decrease in tendency to be a victim than those in the no-contact group. Participants with autism also showed a 19.7% decrease in victimisation. Implications of group music-making for tackling social exclusion of children with autism are discussed.

Diet and healthDiet influences health through a variety of pathways. This chapter will explore the nature of a healthy diet, how diet affects health and the theoretical perspectives which have been used to understand eating behaviour.A healthy dietAlthough the nature of a good diet has changed dramatically over the years, there is currently a consensus amongst nutritionists as to what constitutes a healthy diet (DOH, 1991). Current recommendations according to food groups are as follows:Fruit and vegetables: A wide variety of fruit and vegetables should be eaten and preferably five or more servings should be eaten per day.Bread, pasta, other cereals and potatoes: Plenty of complex carbohydrate foods should be eaten, preferably those high in fibre.Meat, fish and alternatives: Moderate amounts of meat, fish and alternatives should be eaten and it is recommended that the low fat varieties are chosen.Milk and dairy products: These should be eaten in moderation and the low fat alternatives should be chosen where possible.Fatty and sugary foods: Food such as crisps, sweets and sugary drinks should be eaten infrequently and in small amounts.Other recommendations for a healthy diet include a moderate intake of alcohol (a maximum of 3–4 units per day for men and 2–3 units per day for women); the consumption of fluoridated water where possible; a limited salt intake of 6 g per day; eating unsaturated fats from olive oil and oily fish rather than saturated fats from butter and margarine and consuming complex carbohydrates (e.g. bread and pasta) rather than simple carbohydrates (e.g. sugar).

This study compared the impact of different forms of distraction on eating behaviour with a focus on the mechanisms behind this association and the link between the amount consumed and changes in the desire to eat. Participants (n=81) were randomly allocated to four conditions: driving, television viewing, social interaction or being alone in which they took part in a taste test. Measures of the desire to eat (i.e. Hunger, fullness, motivation to eat) were assessed before and after the intervention. The results showed that those watching television consumed more than the social or driving conditions. Food intake was associated with a decreased desire to eat for those eating alone, but was unrelated to changes in the desire to eat for those driving. Watching television also created a decrease in the desire to eat commensurate with food intake whereas social eating resulted in the reverse relationship. The results are discussed in terms an expanded model of mindless eating and it is argued that eating more requires not only distraction away from the symptom of hunger but also sufficient cognitive capacity left to attend to the process of eating.

This chapter asks ‘who is the late twentieth-century self?’ and argues that the construction of this individual is reflected in the increasing interest in a range of eating-related behaviours; the emphasis on such behaviours increases as eating becomes the ideal vehicle to control this new self-controlling, reflexive and intra-active self. The emphasis on either the presence or absence of self-control is also found in the use of escape theory to explain disinhibition. This perspective has been applied to both the overeating characteristic of dieters and the more extreme form of binge eating found in bulimics and describes overeating as a consequence of ‘a motivated shift to low levels of self awareness’. Examination of psychological theories of diet suggests a shift in their model of the individual from a passive responder to external events, to one who interacts with these events to a late twentieth-century individual who is reflexive and intra-active.

Background. Previous studies have suggested that the attitudes of health professionals towards people with disability may be as negative as those of society. Further, even positive attitudes may not always be reflected in the health professional's behaviour. Objective. The aim of this study was to examine GPs' (registrars and trainers) consultations with people who have congenital disabilities and to explore incidents when their attitudes were either matched or not matched with their behaviour. Methods. A purposeful sample of 19 registrars and trainers participated in a semi-structured interview using the critical incident technique. Subjects were asked to describe encounters from their professional life with a person with a congenital disability, when they either had or had not been able to behave as they wished. Results. The results indicated that matching or non-matching between attitudes and behaviour was related to three main themes: aspects of the patient such as their appearance, ease of communication and autonomy; aspects of the GP including their management of personal, expert and professional boundaries and the historical context of the consultation including the GP's personal and professional experience, the familiarity between the GP and the patient and the patient's previous experiences of care. Conclusion. The critical incident technique was found to be a useful tool to gain access into this complex and problematic area and the results raise many issues pertinent to the planning of learning opportunities for both undergraduates and postgraduates.

Overview For centuries health professionals have recognised that psychology can be a consequence of being ill and we know that a diagnosis of cancer or diabetes can make people anxious or depressed. This course, however, will draw upon health psychology, public health and community psychology to emphasise how psychology can also contribute to the cause, progression, experience and outcomes of any physical illness. This course will highlight the many roles that psychology plays in physical illness from i) being and staying well and the role of health behaviours and behaviour change; ii) becoming ill with a focus on illness beliefs, symptom perception, help seeking and communication with health professionals; iii) being ill in terms of stress, pain and chronic illnesses such as obesity, coronary heart disease and cancer; iv) the role of gender on health; and v) health outcomes in terms of quality of life and longevity.

This study explored the predictors of weight loss following orlistat with a focus on both baseline variables and changes in beliefs and behaviours occurring over the course of taking the drug. Patients (n = 566) prescribed orlistat completed a questionnaire at baseline and after 6 months concerning their weight, beliefs and behaviours. By 6 months the majority had lost some weight and showed improvements in diet. Many had also stopped taking the drug and a large minority reported using it flexibly as a lifestyle drug. Those who lost most weight showed a decrease in beliefs in a medical solution, a decrease in unhealthy eating, an increased belief in treatment control and an increased belief that the unpleasant consequences are both due to their eating behaviour and just part of the drug. When taken with fatty food orlistat causes symptoms such as anal leakage and oily stools. These may encourage some patients to focus on the behavioural aspects of their weight problem thus promoting the dietary changes needed for both short and longer term weight loss. When prescribing orlistat, clinicians should encourage patients to see the consequences as an education as a means to promote the effectiveness of this form of medical management.

The present study compared the modelling and control theories of parental influence on children's eating attitudes and behaviour with a focus on snack foods. Matched questionnaires describing reported snack intake, eating motivations and body dissatisfaction were completed by 112 parent/child pairs. Parents completed additional items relating to control in terms of attempts to control their child's food intake and using food as a tool for controlling behaviour. The results showed significant correlations between parent and child for reported snack intake, eating motivations and body dissatisfaction, indicating an important role for modelling. Parents were then divided according to their control scores. Children whose parents indicated greater attempts to control their child's diets reported higher intakes of both healthy and unhealthy snack foods. In addition, those children whose parents indicated a greater use of food as a means to control their child's behaviour reported higher levels of body dissatisfaction. The results provide some support for both the modelling and control theories of parental influence. However, whereas modelling appears to have a consistent impact, parental control has a differential impact depending upon whether this control is focused on the child's diet or on other aspects of their behaviour. To conclude, a positive parental role model may be a better method for improving a child's diet than attempts at dietary control.

Purpose: To compare the effectiveness of audiovisual and relaxation-based intraoperative interventions for their impact on intraoperative pain and anxiety. Design: Systematic review and meta-analysis. Methods: The following databases were searched for articles published between 1990 and January 2014: MEDLINE, PsychINFO, CINAHL, and Web of Science. Twenty randomized trials meeting the following inclusion criteria were included; adult participants undergoing elective outpatient surgery under local anesthetic using a form of distraction-based intraoperative intervention for the management of anxiety and pain. Finding: Thirty percent of studies reviewed found that intraoperative interventions improved patient experience in comparison to treatment as usual, 20% of studies were inconclusive, and 50% of studies found that interventions during surgery provided no benefit. Conclusions: Both relaxation-based and audiovisual interventions were found to be efficacious for pain and anxiety management during surgery under local anesthetic. This review indicates that relaxation-based interventions could be more effective than audiovisual interventions for managing intraoperative anxiety.

Eight homeless people were interviewed about their experiences of health and social services. Three themes emerged: responsibility, identity, and feeling trapped. Although some felt they were responsible for their own situation and avoided help, most turned to formal channels for help, but professionals were often seen as offering unwanted labels and as being rule bound. In contrast, peers were considered more understanding but colluded with their problems. Participants also expressed feeling trapped within the homeless system. Therefore, by locating responsibility for change with others, they were left feeling stigmatized, but by turning to their peers, their situation remained the same.

The Psychological Impact of Boarding School is a collection of research-based essays answering a range of questions about boarding school and its long-term impact.Through a combination of original in-depth first-person narratives as well as larger scale surveys, this book aims to fill gaps in current boarding school research and present new findings. Topics addressed include gender differences, eating behaviours, loneliness, mental health and relationships, the differences between younger and older boarders, and ex-boarder experiences of therapy. The research results highlight a key role in the age that children start boarding, the way that long-term psychological influences of friendships formed at school, and the larger role that parent and family relationships play in the psychological lives of boarders. Through these findings, the book ultimately challenges the current understanding of 'boarding school syndrome', proposing a move beyond the term and its concept.The book will appeal to psychologists, psychoanalysts, counsellors, academics, teachers, current and ex-boarders as well as parents and guardians interested in the impact of boarding schools from either a professional or a personal perspective.

This experimental study investigated the role of BMI on the impact of weight bias versus body positivity terminology on behavioural intentions and beliefs about obesity. Participants (n=332) were randomly allocated to two conditions to receive a vignette depicting an image of a person with obesity using either weight bias (n=164) or body positivity (n=168) terminology. Participants were divided into 3 groups based upon their BMI category (normal weight n=173; overweight n=92; obese n=64). They then completed measures of behavioural intentions, obesity illness beliefs and fat phobia. Although there were several differences in beliefs by BMI group, the results showed no differences between weight bias or body positivity terminology on any measures. There were, however, significant BMI group by condition interactions for beliefs about obesity relating to personal control and treatment control. Post hoc tests showed that weight bias resulted in reduced personal control in the obese BMI group compared to other participants. Weight bias also resulted in higher personal control over obesity in normal weight individuals compared to body positivity. People with obesity reported higher treatment control when exposed to weight bias compared to overweight participants, whereas normal weight participants reported greater treatment control when exposed to body positivity compared to both other groups. To conclude, the impact of weight bias and body positivity information is not universal and varies according to the BMI of the audience and the outcome being measured; whereas people of normal weight may benefit from weight bias there is no evidence that obese people benefit from body positivity. Implications for the prevention and treatment of obesity are discussed.

Research indicates a role for attention in the perception of hunger and food intake. The present experimental study aimed to explore the impact of attention to food cues through either active or passive food preparation, versus attention away from food cues through a non-food distraction task on eating behaviour using a preload / taste test design. Female participants (n=80) were randomly allocated to one of four conditions: active food preparation (making a wrap); passive video preparation (watching video of researcher making a wrap); distraction (a non-food colouring task); no time control. Measures of desire to eat (hunger, fullness, motivation) were taken before and after the interventions. Food intake was measured in terms of mass of wrap consumed and snacks consumed at a subsequent taste test. The results showed greater wrap consumption for active and passive food preparation and the control groups compared to the distraction intervention. Further, the results showed that active food preparation resulted in increased hunger and motivation to eat and that passive food preparation resulted in increased motivation to eat. No changes were found following distraction. To conclude, attention to food cues through both active and passive food preparation can increase both food intake and the desire to eat. The implications for promoting changes in eating behaviour are discussed.

Although much research has investigated the drivers of inappropriate antimicrobial prescribing in human medicine, equivalent research in veterinary medicine is in its infancy. This qualitative study used a critical incident approach to explore farm veterinarians' (vets) and farmers' beliefs about antimicrobial use and antimicrobial stewardship. Semi-structured interviews were conducted with 13 vets and 12 farmers in the UK, who worked mostly with beef cattle, dairy cattle and sheep, but a minority also worked with pigs or poultry. An inductive thematic analysis was conducted to explore how vets and farmers understood their responsibilities toward stewardship and antimicrobial resistance (AMR) and to identify key similarities and differences between the professions. The analysis generated four themes: “A shared conflict between ideals and behaviour,” “Barriers to stewardship: the vets' perspective,” “Barriers to stewardship: the farmers' perspective,” and “A shared ambivalence: ownership vs. other-blaming.” Vets and farmers demonstrated good understanding of stewardship but their treatment decisions are not always aligned to stewardship principles. Various barriers to improving antimicrobial stewardship were discussed by vets and farmers, but they placed differing emphasis on specific barriers. Faced with these barriers and an awareness that antimicrobial usage is not always aligned to stewardship principles, vets and farmers expressed frustration and a sense of ambivalence toward stewardship, and also engaged in other-blaming for the problem of AMR. In conclusion, vets and farmers in this study seem motivated to be antimicrobial stewards but feel challenged by the day-to-day reality of their jobs; they experience ambivalence toward their responsibilities for AMR, which may negatively impact their motivation to always act as antimicrobial stewards. Successfully tackling AMR will require change at the individual-, group-, and societal-level. Future interventions to improve antimicrobial usage in livestock farming could be situated within a social ecological framework, where other-blaming between professions is seen as a result of the interplay between psychological and contextual factors. Other-blaming could be reduced using a social identity approach; a common ingroup identity could be created by encouraging vets and farmers to focus on their common goal, namely a shared desire to promote animal welfare through optimal antimicrobial stewardship.

How do social scientists create facts? What strategies do they use to construct knowledge? How does social science make sense of the individual? Critical studies of both medical and scientific knowledge have been conducted but social science knowledge remains relatively unquestioned. Addressing this question, Health and the Construction of the Individual, originally published in 2002, is a social study of social science. Jane Ogden focuses particularly on constructions of the individual in health-related psychology and sociology. She explores how social science texts construct social science facts using the strategies of theory, methodology, measurement, and rhetorical boundaries and argues that the individual is not only constructed through the dissemination of social science knowledge but through the mechanics of its production. The results provide a unique insight into the transformation of the individual as an ever-changing self, from both a historical and social constructionist perspective. This title will make fascinating reading for health psychologists, medical sociologists, social constructionists and all students and researchers interested in gaining a greater understanding of the premises underlying social science.

Objective: We are all born and we all have a conception and birth story. Whilst quantitative research highlights the impact of conception and birth on health outcomes, little is known about how people make sense of their own conception and birth stories. Methods: 10 participants took part in a qualitative interview to explore their conception and birth stories and how they have made sense of them. Results: Thematic analysis described three major themes relating to; i) ‘shaping their sense of self’ including feelings of ‘luck’, an appreciation for being alive and changes to their self-identity; ii) ‘changing family relationships’, and how their stories had influenced their views of parents and siblings; iii) ‘feelings about becoming a parent in the future’ including their expectations of their own future births and conception experiences. Transcending these themes was the notion of ‘valence of the story’ which illustrated that how a story was told and whether this was with humour or fear could change the impact of this story. Conclusion: Conception and birth stories may become ingrained into family narratives but they are also ingrained into who we become and even negative events can be ingrained in a more positive way if told with humour rather than fear. 

The recent rise in body dissatisfaction and weight bias has led to a call to the media to increase the diversity of their imagery, in efforts to challenge the thin-ideal. Therefore, this study aimed to evaluate the effects of both body diversity and thin-ideal interventions on health outcomes. Female participants (n = 160) were randomly allocated into an intervention group: body diversity; thin-ideal; control. They completed measures of body satisfaction, body compassion, internalisation of the thin-ideal, weight bias and behavioural intentions at baseline and post-intervention. The results showed significant differences between groups for weight bias and intentions to eat healthily. Specifically, those in the body diversity intervention group reported a greater reduction in weight bias compared to the other conditions. Further, those in the thin-ideal intervention group reported a greater increase in intentions to eat healthily compared to the other conditions. There were no differences between groups for body satisfaction, body compassion, internalisation of the thin-ideal and behavioural intentions to exercise and manage weight. In conclusion, exposure to body diversity images reduced weight bias whereas exposure to the thin-ideal promoted intentions towards healthy eating. These findings therefore offer empirical evidence for the impact of using different types of imagery to change different health outcomes.

Symptom perception is complex and influenced by a number of psychological factors. Further, a number of problems relating to symptom perception have been identified including poor interoception and a reduced ability to recognise bodily signals and alexithymia reflecting an impaired ability to identify and describe emotional symptoms. In addition, research indicates that some individuals may have difficulty distinguishing between internal signals and demonstrate an ‘Interoceptive Crossover’ of emotions and physical symptoms. To date, research in this area is sparse. The current study therefore aimed to explore the incidence and nature of Interoceptive Crossover. 239 individuals completed an online survey and reported their experiences of perceived similarity between a range of emotions (e.g., Sad, Happy, Afraid and Calm) and physical symptoms (e.g., Stomach Pain, Fatigue/Tiredness, Headache and Abnormal Heartbeat) to assess the incidence and nature of Interoceptive Crossover. Some individuals demonstrated crossover between emotions and physical symptoms. Some crossovers were more unsurprising and reported by greater proportion of the sample, such as Afraid and Abnormal Heartbeat (74.5%); Sad and Fatigue (29.4%) and Afraid and Shortness of Breath (58.5%). Other crossovers were less prevalent in the sample and more unexpected such as Satisfied with Headache (1.2%); Bored with Back Pain (5.95%) and Happy and Back Pain (0.4%). Some individuals demonstrate Interoceptive Crossover of emotions and physical symptoms. Some crossovers are more prevalent whilst others are rare and unexpected. This phenomena needs to be explored in more depth and with relation to other constructs such as alexithymia and interoception.

Antimicrobial resistance (AMR) is a profound threat to human and animal health. Antimicrobial prescribing behaviours are influenced by psychological factors such as knowledge, beliefs, and emotions. As future antimicrobial prescribers, it is important to understand beliefs about AMR and stewardship among veterinary (vet) students. This cross-sectional online survey assessed vet students' self-reported behavior, knowledge, and beliefs in specific relation to antibiotic resistance (ABR) and antibiotic usage. Participants were early years (first- and second-year; n = 460) and later-years (third- and fourth-year; n = 113) undergraduate vet students from three UK universities. Self-reported antibiotic-related behaviors were responsible among most students. Knowledge about ABR and stewardship was moderate among early years students and good among later years students. Vet students typically believed that vets had less responsibility for both causing and preventing ABR than other groups (animal owners, human medics, and the public). This study offers evidence that vet students (along with other groups) tend to lay greater responsibility for ABR/AMR outside of their own profession, which may impact their future prescribing behaviors. It is vital that AMR and antimicrobial stewardship are embedded across veterinary curricula, and that the One Health nature of the challenge posed by AMR is emphasized to encourage shared responsibility across all stakeholder groups, thereby helping to reduce 'other-blaming' for AMR.

Background Bariatric and Metabolic Surgery (BMS) is a popular weight loss intervention worldwide, yet few scientific studies have examined variations in preoperative practices globally. This study aimed to capture global variations in preoperative practices concerning patients planned for BMS. Methods A 41-item questionnaire-based survey was designed and the survey link was freely distributed on social and scientific media platforms, email groups and circulated through personal connections of authors. The survey included eight parts: basic information; criteria for BMS; preoperative nutritional screening; preoperative weight loss; preoperative diets for liver size reduction; preoperative glycemic control; other laboratory investigations and preparations; decision making, education, and consents. Descriptive statistics were used to analyse data and graphs were used for representation where applicable. Results Six hundred thirty-four bariatric healthcare professionals from 76 countries/regions completed the survey. Of these, n = 310 (48.9%) were from public hospitals, n = 466 (73.5%) were surgeons, and the rest were multidisciplinary professionals. More than half of respondents reported using local society/association guidelines in their practice (n = 310, 61.6%). The great majority of respondents routinely recommend nutritional screening preoperatively (n = 385, 77.5%), mandatory preoperative diets for liver size reduction (n = 220, 53.1%), routine screening for T2DM (n = 371, 90.7%), and mandate a glycemic control target before BMS in patients with T2DM (n = 203, 55.6%). However, less than half (n = 183, 43.9%) recommend mandatory preoperative weight loss to all patients. Most respondents (n = 296, 77.1%) recommend psychological intervention before surgery for patients diagnosed with psychological conditions. Variations were also identified in laboratory investigations and optimisation; and in the aspects of decision making, education and consent. Conclusions This survey identified significant global variations in preoperative practices concerning patients seeking primary BMS. Our findings could facilitate future research for the determination of best practice in these areas of variations, and consensus-building to guide clinical practice while we wait for that evidence to emerge.

Buruli ulcer (BU) is a skin infection caused by Mycobacterium ulcerans and a neglected tropicaldisease of the skin (skin NTD). Antibiotic treatments are available but, to be effective in theabsence of surgery, BU must be detected at its earliest stages (an innocuous-looking lumpunder the skin) and adherence to prescribed drugs must be high. This study aimed to developmultisensory medical illustrations of BU to support communication with at-risk communities. Weused a Think Aloud method to explore community health workers’ (n¼6) experiences of BUwith a focus on the role of their five senses, since these non-medical disease experts are familiarwith the day-to-day challenges presented by BU. Thematic analysis of the transcripts identifiedthree key themes relating to ‘Detection,’ ‘Help Seeking,’ and ‘Adherence’ with a transcendingtheme ‘Senses as key facilitators of health care’. New medical illustrations, for which we coin thephrase “5D illustrations” (signifying the contribution of the five senses) were then developed toreflect these themes. The senses therefore facilitated an enriched narrative enabling the productionof relevant and useful visuals for health communication. The medical artist communitycould utilise sensory experiences to create dynamic medical illustrations for use in practice.

Although recent work has encouraged doctors to express their uncertainty to patients as a means to improve communication the potential impact of this on patients remains unclear. The present study first explored the impact of the way in which uncertainty was expressed (behaviourally versus verbally) on doctor's and patient's beliefs about patient confidence. Second the study examined the role of the patient's personal characteristics and knowledge of their doctor as a means to address the broader context. Matched questionnaires were completed by GPs (n = 66, response rate = 92%) and patients (n = 550, response rate = 88%) from practices in the south-east of England. The results showed that the majority of GPs and patients viewed verbal expressions of uncertainty such as 'Let's see what happens' as the most potentially damaging to patient confidence and both GPs and patients believed that asking a nurse for advice would have a detrimental effect. In contrast, behaviours such as using a book or computer were seen as benign or even beneficial activities. When compared directly, GPs and patients agreed about behavioural expressions of uncertainty, but the patients rated the verbal expressions as more detrimental to their confidence than anticipated by the doctors. In terms of the context, patients who indicated that both verbal and behavioural expressions of uncertainty would have the most detrimental impact upon their confidence were younger, lower class and had known their GP for less time. To conclude, patients' reactions to uncertainty occur within the context of the patient's own background and experience, however, some consistent responses can be found. In particular, whilst behavioural expressions of uncertainty may have a positive impact upon patient confidence, verbal expressions have a consistently detrimental effect which is underestimated by GPs. (C) 2002 Published by Elsevier Science Ireland Ltd.

Background Current policy advocates individual choice across a number of domains, including healthcare provision. Aim To develop a new tool for measuring people's beliefs about the value of choice in the context of healthcare provision. Design of study Cross-sectional survey. Setting Four general practices in South East England. Method Nine items relating to health and general domains, derived from in-depth interviews with 22 participants, were collated into a questionnaire. This formed the measurement tool called the Choice Questionnaire (ChQ), which was completed by 823 consecutive patients (response rate = 81.2%). Results Principal components analysis resulted in two factors: having choices (for example, `I like to know all the possible ways in which I could be treated') and making choices (for example, `I am happy for the doctor to make decisions for me'). These two constructs showed good internal consistency. One item was deleted, resulting in the 8-item ChQ. Beliefs about choice in health and general domains were not discrete. The vast majority of participants endorsed having choices as positive. In contrast, beliefs about the value of making choice were more mixed. A greater endorsement of both these aspects of choice was related to higher educational status. Conclusion Results from this study indicate that choice can be usefully conceptualised as consisting of two separate constructs: having choices and making choices. The 8-item ChQ has an interpretable factor structure and has been shown to be reliable. It could be used in research to assess beliefs about the value of choice or in the clinical setting to establish whether a patient would prefer to be provided with options or to be managed in a more paternalistic way.

Research indicates that parental control and parental modelling are key factors in shaping a child's eating behaviour. To date, however, little is known about how these factors influence a child's diet once they have left home. This prospective study evaluated the extent to which a parent's own behaviour and their use of control over food whilst their child was still living at home predicted their child's relationship with food once they had begun to live independently. Parent/child dyads (n=93) took part in the study. Parents completed baseline measures of parental control practices (overt control, covert control and pressure to eat), their own diet (unhealthy snacks, unhealthy meals, healthy foods) and eating behaviours (emotional, uncontrolled and restrained eating). At one year follow up, once their child had left home, the child completed measures of their own diet and eating behaviours. The results showed a clear role for modelling with concordance between a child's intake of unhealthy snacks and emotional eating and their parents' own reports of these behaviours. Furthermore, the child's intake of healthy foods was also predicted by their parent's behaviour although there was both concordance and discordance between parents and their children. No role for parental control was found for any measure of diet or eating behaviour. It is concluded that a parent's own behaviour rather than parental control has a stronger longer lasting influence once a child has left home and that although this mostly involves a child copying their parent's behaviour (action) at times it also involves the opposite (reaction).

Adults ( n = 25) completed online free text boxes about their self-harming behaviour. Thematic analysis identified three dominant themes: ‘managing the private self’, ‘managing the public self’ and ‘moving on’. Transcending these themes was the notion of thresholds of change. Self-harm enables people to manage both their private and public selves. When thresholds of change are surpassed, the public self communicates a need for help. Self-harm exists within a precarious balance of well-being and can be a form of self-care. Help seeking is instigated when this balance is disrupted and continued if it offers a better form of self-management than the individual’s own self-harming behaviour.

Objectives: Research illustrates that people hold beliefs about the causes and solutions to illness. This study aimed to assess the consistency in these beliefs in terms of their variation according to type of problem and whether they are consistent with each other. Further, the study aimed to assess whether they are open to change and whether changing beliefs about cause resulted in a subsequent shift in beliefs about solutions. Design: Experimental factorial 3 (problem) × 2 (manipulated cause) design using vignettes. Methods: Two hundred seventy-nine participants rated their beliefs about the cause and solution of one of three problems (depression, obesity and sleep problems) following a vignette which described the causes as either psychological or biomedical. Results: Beliefs about causes and solutions varied according to type of problem indicating that beliefs are illness specific. The results also showed that people hold beliefs about causes and solutions which are consistent with each other as an endorsement of a psychological cause was consistently reflected in a belief that a psychological solution was most appropriate and effective. A similar pattern was seen for beliefs about biomedical causes and solutions. Finally, the results showed that beliefs were open to manipulation and that a shift in beliefs about causes resulted in a parallel shift in beliefs about solutions.Conclusions: People hold beliefs about causes and solution which vary according to type of problem. However, they are always consistent with each other and a shift in one set of beliefs results in a significant shift in the other set.

Objective It is well established that exercise and lifestyle behaviours improve men's health outcomes from prostate cancer. With 3.8 million men living with the disease worldwide, the challenge is creating accessible intervention approaches that lead to sustainable lifestyle changes. We carried out a phase II feasibility study of a lifestyle intervention delivered by nine community pharmacies in the United Kingdom to inform a larger efficacy study. Qualitative interviews explored how men experienced the intervention, and these data are presented here. Methods Community pharmacies delivered a multicomponent lifestyle intervention to 116 men with prostate cancer. The intervention included a health, strength, and fitness assessment, immediate feedback, lifestyle prescription with telephone support, and reassessment 12 weeks later. Three months after receiving the intervention, 33 participants took part in semistructured telephone interviews. Results Our framework analysis identified how a teachable moment can be created by a community pharmacy intervention. There was evidence of this when men's self‐perception was challenged and coupled to a positive interaction with a pharmacist. Our findings highlight the social context of behaviour change with men identifying how their lifestyle choices were negotiated within their household. There was a ripple effect as lifestyle behaviours made a positive impact on friends and family. Conclusions The teachable moment is not a serendipitous opportunity but can be created by an intervention. Our study adds insight into how community pharmacists can support cancer survivors to make positive lifestyle behaviour changes and suggests a role for doing rather than just telling.

Research indicates that an unhealthy diet is a risk factor for the development of a range of chronic conditions, including obesity, cancer, diabetes and coronary heart disease. Dietary habits formed in childhood persist into adulthood. Previous research on dietary habits has focused on families with young children. This qualitative study extends the literature by exploring how mothers manage their teenage children's diets. Semi-structured interviews were carried out with l5 British mothers who had at least one child aged 13–16 years. The data were analysed using interpretative phenomenological analysis. Five themes emerged: achieving gold standard, coping with obstacles, using strategies, resolving conflict and support. The participants were determined to achieve the gold standard (of nutrition) for their children and used a range of strategies to implement it. Mothers developed ways to cope with obstacles that undermined the gold standard. They were keen to resolve conflicts that were generated in the process. Some mothers received a degree of support in achieving the gold standard. The mothers felt that the strong presence of fast food and confectionary in the external environment was the biggest threat to the maintenance of their children's healthy eating. Participants were highly motivated to achieve the gold standard, as it was central to the notion of being a good mother. Being a good mother was a vital component of their self-identity.

This study aimed to explore the impact of the size of a post-operative dressing and the subsequent visibility of the wound on recovery from laparoscopic cholecystectomy (LC). A randomised controlled trial was conducted. Fourty-one patients (8 men and 33 women, mean age = 44 years) scheduled for LC were included. Participants were randomly assigned to receive either small gauze dressings (n = 19) or large gauze dressings (n = 22) which were directly applied on post-operative incisions. Patients' mood, psychological well-being, illness cognitions, and pain and recovery were assessed at three time points: baseline, immediately after the procedure and then two weeks later. The findings suggest that the management of post-surgical incisions influences patients' interpretation of their illness which in turn has an impact upon the process of recovery from LC. This implies that visual information available to patients after the procedure through the cognitive and emotional mechanisms involved in their processing can alter the process of convalescence from LC.

Background. Recent qualitative research indicates that life events can enhance behaviour change maintenance. if a number of sustaining conditions are met. This study aimed to quantitatively test this theory in the context of weight loss maintenance. Method. Based upon their weight histories participants were classified as either successful (n = 431) or unsuccessful (n = 592) dieters and all completed questionnaires relating to life events, choice, the function of eating and exercise and the model of their weight problem. Findings. Successful dieters reported a higher number of life events than unsuccessful dieters particularly for events such as "clothes did not fit me", "doctor's recommendation" and "reached my heaviest weight". Successful participants also indicated reduced choice over their previous unhealthy diet, more choice over their exercise behaviours and more benefits from the new healthy behaviours. They were also less likely to attribute their previous increased weight to any medical and psychological factors. This was accompanied by a belief about the effectiveness of behavioural solutions to their weight problem. Discussion. Life events can promote behaviour change for some individuals. This change is facilitated by a reduction in choice and disruption of function over the unhealthy behaviours, and a belief that behavioural solutions will be effective.

ObjectivesExisting research has established the importance of appearance concerns for individuals with cancer and identified appearance as an important factor in dying with dignity. No research, however, has explored in depth the role of appearance in the experiences of individuals who have incurable cancer. This research aims to explore patients’ experiences and perspectives in relation to the role of appearance issues in adults with incurable cancer.MethodsSemi-structured interviews were conducted with 24 adults with incurable cancer (20 women, 4 men; mean age 54.5, SD 11.32).ResultsThematic analysis generated three themes: ‘Identity: Embodying Cancer’, ‘Communication: Wearing your illness’ and ‘Support: Holistic Care’. Appearance was felt to be an important element of identity, which was often dominated by cancer, leading to feelings of separation from the participant’s previous self. Appearance changes also influenced the way in which individuals communicated with their external world, forcing discussion of their diagnosis, and increasing focus on their cancer, with participants having to manage the emotional impact of this on loved ones, as well as the impact on their legacy. Finally, participants highlighted the positive impact of appearance-related support in their well-being and identified peer connections and refocusing on the self as key elements of such support.ConclusionsAppearance changes play an important role in the experiences of individuals with incurable cancer with regards to both identity and communication and challenged participants’ ability to maintain normalcy. Further psychosocial support relating to appearance concerns was considered necessary to promote dignity and provide truly holistic patient care.

The interaction between time of day and energy intake, termed chrono-nutrition, has received considerable recent interest. One aspect of chrono-nutrition with potential to benefit long-term cardio-metabolic health is time-restricted feeding (TRF). Current support for TRF primarily derives from animal research, although recent small-scale human studies indicate possible translational benefit. Whether free-living humans, however, can incorporate TRF into their daily lives is poorly understood. This study reports data from participants (n = 608) who completed an online questionnaire to investigate daily routine, likelihood of TRF incorporation within work vs free-days, and key considerations influencing TRF uptake. The majority of participants reported a typical daily feeding window (time between first and last energy intake) of between 10 and 14 h on workdays and free days, 62.7 and 65.5% respectively. Likelihood of adherence to TRF declined with an increase in the proposed restriction of the feeding window by 0.5 to 4-h per day. We then examined data from participants with a typical daily feeding window of 12+ h on workdays (n = 221) and free-days (n = 223) to investigate the likelihood of using TRF, and the most important considerations in making this decision. Of these participants, (n = 132) on workdays and (n = 125) on free days would likely reduce their feeding window by 3-h. Multiple regression analysis revealed that key considerations determining the likelihood of adopting TRF were: cost, time availability, and perceived health benefits (on workdays); wake time, bed time, time availability, motivation to change and perceived health benefits (on free-days). These data provide novel information regarding public attitudes towards TRF and highlight important aspects to be considered when translating controlled laboratory studies to public dietary advice.

There is an evidence base in human and small animal veterinary health care contexts which understands how practitioners engage in partnership working with patients and owners to support adherence to treatment/care plans. However, as yet, it is believed there is no similar evidence base for how practitioners in equine health care contexts work with equine owners. It is argued that this is essential for understanding complex equine practitioner-owner interaction involving the prevention and management of laminitis. The aim of this study was to explore farrier-client interaction where risk management for an equine recovering from laminitis was being undertaken. A case report method involved a microlevel analysis of a farrier-client consultation. The consultation was video-recorded and analyzed using a conversation analysis approach to identify the linguistic and paralinguistic features of the interaction. These were compared with conversation analyses in other health care contexts to identify the actions being accomplished within the consultation. The analysis identified a number of joint actions, including managing epistemic stance (or knowledge rights) and deploying the animal's presence to navigate problem sequences which supported progression of the consultation through a three-stage model involving "team-", "option-", and "decision-" talk, known to be associated with partnership working in human health care contexts. The study highlights the importance of developing an empirical evidence base in equine practice for how practitioners engage with owners based on a microlevel analysis of real-world interactions. It is argued this evidence base is necessary in supporting effective practitioner training in partnership working with clients to promote their adherence to treatment/care plans.

Background: Weight management interventions involving behaviour change often utilise face to face interventions which include evidence based behaviour change strategies yet are costly and time intensive. In contrast, digital interventions cost less and have a wider reach yet tend to lack an evidence base and are less effective. Aims: The present study therefore aimed to develop an evidence based behaviour change low cost app for weight management and to provide a preliminary analysis of its effectiveness. Methods: The Ladle app was developed through evidence review and feedback from health care professionals and patients and consists of a 12 week course focusing on 6 habits and weight loss facilitated through 36 audio psychological lessons and 12 lessons specifically on the 6 habits. Each lesson was between 2-5 minutes (approx. 168 minutes of lessons). It was evaluated in terms of completion rate, weight loss, adoption of the 6 habits and participant feedback. Results: The results showed a completion rate of 44%, that 52% of Completers showed weight loss of at least 5%, 79% showed weight loss of at least 3%, the median % weight lost was -5% and the median weight loss was -3.8kg. Further, by the end of 12 weeks the majority (>80%) of participants had adopted 4 of the 6 habits for at least 5 days a week and nearly half (45%) had adopted the remaining 2 habits for at least 4 days out of 7. Feedback comments were mainly positive (n=80) focusing mostly on the content of the lessons. Some comments were neutral (n=56) and involved a statement of commitment or a description of a challenge and a minority were negative (n=23) describing some technical issues which were addressed as the evaluation progressed. Conclusion: The new Ladle app offers an evidenced based alternative to more intensive face to face interventions. On preliminary analysis it would seem to have lower completion rates than some more intensive interventions but comparable effectiveness for weight loss. It can also improve habits and is less time-intensive and costly to deliver. Participant feedback was generally positive.

Interviews were carried out with 10 men and women who had undergone weight-loss surgery (WLS) up to 10 years ago and felt that it had failed. Seven had had a further successful procedure. Data were analysed using Interpretative Phenomenological Analysis. Weight regain following surgery was explained in terms of either the mechanics of the operation or with participants describing ways to ‘cheat’ as food continued to be used for emotional regulation. Everyone spoke of how surgery neglected their mind. Following the second successful surgery, participants described changes in both their eating behaviour and cognitions emphasising how their mind had been brought ‘in gear’ through the investment of two invasive procedures. Transcending all accounts was the mind/body relationship and the issue of control with attributions for both failed and successful surgery shifting from the self to the surgical mechanism as the participants negotiated the pathway between self-blame and responsibility and utilised conflicting frameworks in which the mind and body were either divided or united. Whereas failed surgery is characterised by a battle for control, successful surgery involves handing control over to their restricted stomachs or considering WLS as a tool to be worked with.

Long-haul cabin crew regularly report misalignment between their circadian phase and the external world (i.e. jet lag). The extent to which changes in circadian phase relate to reported levels of jet lag remains unclear. The main aim of the present study was first to evaluate the relationship between objective (circadian phase) and subjective jet lag and second to explore the relative role of both subjective and objective psycho-behavioural factors in predicting the subjective experience of jet lag. Twenty-eight long-haul cabin crew completed questionnaires measuring diurnal preference, trip characteristics and subjective jet lag as a single and as a multidi-mensional measure. Sleep was monitored using actigraphy and urinary melatonin peak time was measured, at baseline (T1), e.g. before a long-haul trip and post-trip on the crew's first recovery day (T2). Subjective jet lag was also measured at both time points. At T1, later circadian phase related to increased unidimensional jet lag, however, a post-trip discrepancy was found between objective and subjective uni-and multidimensional jet lag measured at T2 and change from T1 to T2. After controlling for direction and size of circadian phase, increased uni-and multidimensional subjective jet lag was predicted by depressed mood states. The regression models including phase, diurnal preference, departure time on the outbound sector and arousal levels accounted for 28% of the variance in unidimensional jet lag and 53% of the variance in multidimensional jet lag. It was concluded that there is a discordance between objective and subjective jet lag post-trip. Further, subjective jet lag in long-haul cabin crew is better explained by mood impairment than circadian phase. The results are discussed with reference to the gap between subjective and objective jet lag and the role of psychology rather than just biology in the jet lag experience. The implications for improving health and safety in the workplace, through a better understanding of the role of human factors in the management of jet lag, are discussed.

Objective. The aim of the present study was to examine patients' views about the relative impact and function of lay and medical diagnoses for stomach and throat problems. Methods. A questionnaire survey was carried out among 900 consecutive patients attending nine general practices across England. A total of 740 questionnaires were completed (response rate: 82.2%). Each participant rated a series of statements describing the impact upon the patient and the function for the doctor following both a stomach and a throat problem case scenario involving either a lay (stomach upset/sore throat) or medical (gastroenteritis/tonsillitis) label. Results. The results showed consistent differences between the lay and medical labels for both stomach and throat problems in terms of their impact upon the patient and their function for the doctor. In particular, the medical labels were rated as beneficial for the patient in terms of validating the sick role and improving their confidence in the doctor. In contrast, the lay labels resulted in a greater sense of ownership of the problem which could be associated with unwanted responsibility and blame. In addition, the medical labels were seen to provide the doctor with a greater sense of professionalism, as giving them a clearer role in the consultation and to imply less blame on the part of the patient. 'Stomach upset' was also seen as a more pragmatic label than 'gastroenteritis'. Conclusion. Although much current prescriptive literature in general practice advocates the use of lay language in the consultation as a means to promote better doctor-patient partnerships, the issue of diagnosis is more complex than this. Patients attribute greater benefits to the use of medical labels for themselves and state that such medical labels are of greater benefit to the doctor.

Objectives To describe contraceptive risk and compensatory behaviour, using condoms or emergency contraception (EC), in young people in education aged 16-24 years. Design Cross-sectional study. Subjects A total of 1135 students aged 16-24 years. Setting Educational establishments in and around London, UK. Results Seventy-six percent of women and 55% of men reported having experienced sex either without contraception or when a condom split or came off. Most participants (or their sexual partners) who reported such risks had compensated by using EC at least once (72% women, 55% men) but only a minority had compensated on each occasion of risk (37% women and 22% men). Of the oral contraceptives users the majority (83%) had experienced a pill 'problem' and the majority of these participants had compensated for such problems by using condoms (79%). Fewer than half of the women who experienced pill problems (45%) compensated by using condoms on each occasion. Less than a quarter (23%) of those who experienced pill problems but did not compensate by using condoms ever compensated by using EC. Conclusions This study demonstrates high levels of primary contraceptive risk and low levels of consistent compensatory condom or EC use. The findings suggest that there would be large increases in EC use and repeated use if all primary contraceptive risks were followed by compensatory action. Interventions to increase contraceptive use should focus not only on initiation of contraception use but acknowledge that risks do happen and promote both continuing use and compensatory behaviour.

Purpose: Previous research demonstrates a consistent association between the media and body and eating related issues in children. Recent research has highlighted a role for ‘fat talk’ to describe discourses around body size and food. One key source of media information is Disney animation films, yet to date no research has explored the verbal content of this genre. Design/ methods / aims: The present study used a content analysis to examine fat talk in Disney animation films (1937-2021; n = 53) with a focus on the frequency of fat talk, changes over time, and differences between the genders and heroic statuses of the givers and receivers of fat talk. Fat talk was defined as relating to both body size and food and could be either positive or negative. Findings: Results revealed that there was more negative than positive fat talk per film; no significant changes over time; males were the givers of significantly more positive and negative fat talk than females and were also the receivers of more negative fat talk; good characters were the givers and receivers of more positive and negative fat talk, and more self-directed negative fat talk than bad characters. Originality: Disney animation films may not be as benign as often thought. Practical implications: The results are discussed in terms of possible legislation and parenting interventions to minimise the harm of this genre on young children.

Research suggests a link between being in care and eating problems. The present study compared the eating behaviour of looked after young people and their non-looked after peers with a focus on the role of their perceived early childhood attachments. Looked-after young people completed questionnaires about their perceived and unresolved attachment to their main caregiver during early childhood (aged 0 to 5), their level of picky eating and food disgust and the meanings they ascribed to food. They then nominated a non-looked after friend to complete the same measures. The results showed that looked-after young people reported poorer scores on all aspects of early childhood attachments and were more like to be ‘picky eaters’ and to find food disgusting. Further, they rated food as less embedded with meanings relating to sexuality, family life, a treat and social interaction. In addition, although care status independently predicted picky eating, food disgust and a belief that food was central to family life and social interaction, unresolved attachment was a better predictor of these variables. Further, unresolved attachment also significantly predicted a belief that food was a means to take control over one’s life. Being brought up in care is associated with eating problems and a less engaged approach to food. Poor attachment is a powerful explanation of this association. Carers and other professionals are key to the development of trusting relationships with looked after young people. Such secure attachments with carers and other professionals may enable looked after young people to foster a more positive relationship with food.

Purpose of review: Whilst research indicates the positive impact of social support across a number of health domains, including weight management, not all social support is beneficial. Findings: This paper reviews the evidence for both positive and negative social support in the context of behavioural interventions and surgery for obesity. It then presents a new model of negative social support focusing on sabotage (‘active and intentional undermining of another person’s weight goals’), feeding behaviour (‘explicit over feeding of someone when they are not hungry or wishing not to eat’) and collusion (‘passive and benign negative social support to avoid conflict’) which can be conceptualized within the context of relationships as systems and the mechanisms of homeostasis. Summary: There is increasing evidence for the negative impact of social support. This new model could form the basis of further research and the development of interventions for family, friends and partners to maximise weight loss outcomes.  

There have been many approaches to understanding contraception use including social cognition models which have been criticised for their individualistic approach and their static nature. The present quantitative study developed and refined a contextual and dynamic model of contraception use that was derived using qualitative research. This model conceptualizes the predictors of contraception use in terms of the meaning and importance of a range of social goals, perceptions of vulnerability, and constraints on or facilitators of contraception use each of which changes over time. The present study operationalized this model in relation to emergency contraception and explored differences between users and non-users and between episodes of use and non-use. In terms of users and non-users, the results showed that the users of emergency contraception showed a more positive view of an emergency contraception user, perceived greater support from their partner for emergency contraception use, rated themselves more at risk of pregnancy, and felt more confident about asking for emergency contraception. In terms of use and non-use, use was related to an increased belief about the risk of pregnancy, increased partner support, increased concern about health care professionals and the side-effects of the drug, and a more positive identity of an emergency contraception. The study has helped to develop and refine the model and has identified some key factors that are specifically relevant to emergency contraception use in a sample of women in education in and around London.

Research teams have argued that some bariatric patients require psychological input pre- and post-surgery and that weight loss surgery should only be undertaken by a multidisciplinary team (MDT) that can provide psychological support. To date, no guidelines exist for the provision of psychological support pre- and post-bariatric surgery. The authors were approached by British Obesity Metabolic Surgery Society (BOMSS) in September 2017 to produce guidelines for the provision of psychological support for patients pre- and post-bariatric surgery. These guidelines were developed using seven stages: (a) review of evidence base; (b) expert input; (c) feedback from BOMSS delegates; (d) feedback from the special interest group; (e) service user feedback; (f) presentation to BOMSS council; and (g) presentation to the Association for the Study of Obesity. The guidelines describe two stepped care service models for the delivery of psychological support pre-surgery and 6 to 9 months post-surgery involving online resources, group workshops and one-to-one with a clinical psychologist. They are founded upon the following principles: (a) a living document to be modified over time; (b) flexible and pragmatic; (c) advisory not prescriptive; (d) broad based content; (e) skills based delivery. These guidelines are feasible for use across all services and should minimize patient risk and maximize patient health outcomes.

Purpose The purpose of this paper is to evaluate the impact on stress and work-related outcomes of an app-delivered mindfulness-based program (MBP; Headspace®) offered to employees in a UK higher education (HE) institution. Design/methodology/approach Using a randomized waitlist control trial design, participants were randomly allocated to be offered a mindfulness-based program (MBP) immediately for 2 months or after a waiting list period of 2 months (WLC). Data were analyzed using Intention to Treat (ITT; MBP n = 62; WLC n = 63); with supplementary analysis restricting to those who completed all measures; (MBP n = 45; WLC n = 56) and then further restricting the MBP group to those who completed at least foundation level 1 of the app; (MBP n = 31; WLC n = 56). Findings The ITT analysis showed significant increases in several aspects of mindfulness and a significant reduction in perceived stress but no significant effects for work-related outcomes. Analysis restricted to MBP participants who completed the app foundation course showed a similar pattern but in addition showed significant increases in work-life balance and the emotional aspect of job engagement. Practical implications The offer of the Headspace® app in the HE sector may result in reduced perceived stress. If improvements in work-related outcomes are also to be seen, then users need to be encouraged to complete a minimum level of practice. Originality/value Effect size estimates for stress and work-related outcomes of an app-delivered MBP contribute to the evolving picture of MBPs in the workplace.

This study aimed to explore experiences of learning, friendships and bullying of boys with autism attending specialist and mainstream schools, and those of their parents. Semi-structured interviews were conducted with 11 boys with autism, aged 11 – 17 years, and 9 of their mothers. Thematic analysis identified four key themes relating to experiences of friendships and bullying, risk factors, protective factors and outcomes. Overall, the findings indicated that five of the 11 participants had been subjected to bullying, particularly those in mainstream schools (four out of six). Further, if risk factors relating to autism or the school culture were not mediated by protective factors such as self-esteem or supportive friends, various negative outcomes were identified as more likely including mental health issues and effects on learning and relationships. Therefore, although not inevitable, mainstream settings may increase the likelihood of negative experiences as they have fewer resources to protect children against the risk of bullying.

To date little is known about the experiences of girls with autism, or how they live with and manage their autism. This qualitative study explored experiences of learning, friendships and bullying of girls with autism. Semi-structured interviews were conducted with 11 girls with autism, aged 11-17years, and one parent of each girl. Thematic analysis identified key themes relating to motivation to have friends, challenges for girls with autism and the notion that many girls tend to mask their autism, which had both positive and negative consequences. Overall, the girls were motivated to have friends, but often encountered social difficulties and were sometimes targeted for bullying. Findings pointed to the need for interventions such as staff training and programmes to support the social interaction of girls with autism based on their specific perceptions of friendship.

Background: Research has shown that doctor's make judgements about patients on the basis of their demographic characteristics. Little is known about how patients judge their doctors. Aim: The present study aimed to explore the impact of a doctor's ethnicity, age and gender on patients' judgements in the setting of a general practice consultation. Methods: The study involved an experimental factorial design using vignettes with patients receiving one of eight photos of a doctor who varied in terms of ethnic group (Asian versus White), age (older versus younger) and gender (male versus female). Six general practices in South West London took part and 309 patients (response rate = 77%) rated the doctor in terms of the expected behaviour of the doctor, the expected behaviour of the patient and the patient ease with the doctor. Results: The results showed that in terms of the impact of ethnic group, the Asian doctor and White doctor received comparable ratings for most questions; however, the Asian doctor was rated as being more likely to explore emotional aspects of health than the White doctor. Differences for age and gender were more profound. In particular, both the younger doctor and the female doctor were judged to have a better personal manner, better technical skills, better explanation skills, to be more likely to explore emotional aspects of health and empower the patient. Patients also stated that they were more likely to have faith in their diagnoses, advice and to comply with treatment and preferred both the younger and female doctors for a physical examination. In addition, younger doctors were deemed to be more likely to refer a patient to see a hospital specialist and female doctors were seen to be more likely to suggest complementary therapy. Conclusion: A doctor's age and gender have a stronger impact on a patient's judgements than their ethnicity.

Empirical articles published between 1997 and 2001 from 4 health psychology journals that tested or applied 1 or more social cognition models (theory of reasoned action, theory of planned behavior, health belief model, and protection motivation theory; N = 47) were scrutinized for their pragmatic and conceptual basis. In terms of their pragmatic basis, these 4 models were useful for guiding research. The analysis of their conceptual basis was less positive. First, these models do not enable the generation of hypotheses because their constructs are unspecific; they therefore cannot be tested. Second, they focus on analytic truths rather than synthetic ones, and the conclusions resulting from their application are often true by definition rather than by observation. Finally, they may create and change both cognitions and behavior rather than describe them.

Objectives: Leg ulcers are known to have a profound effect on patient quality of life; however, the influence of different treatment approaches is unclear. This review aims to evaluate the comparative impact of conservative treatments and superficial venous surgery, for venous leg ulcers, on patient Quality of Life. Data sources: Three electronic databases (PsycInfo, Medline, and CINAHL), and reference lists of relevant articles, were searched. Two-hundred and nine articles were initially identified, and sixteen articles were included in the review. Results: The results lend cautious support to the suggestion that all treatment has a positive effect on quality of life, regardless of type, whilst wound status also appears to be an important factor. Conclusions: Some evidence suggests that surgical treatment methods may lead to greater improvements in patient quality of life than compression bandaging alone; however, future research may focus on the psychological mechanisms underlying such changes.

This is an accessible and comprehensive guide to all the major topics of health psychology, including a new chapter on women's health.

Research exploring weight bias and weight bias internalisation (WBI) is grounded upon a number of core measures. This study aimed to evaluate whether operationalisations of these measures matched their conceptualisations in the literature. A ‘closed card-sorting task’ methodology was used whereby participants sorted items from the most commonly used measures into pre-defined categories, reflecting weight bias and non-weight bias domains. Findings indicated a high degree of congruence between WBI conceptualisations and operationalisations. However, there was less congruence between weight bias conceptualisations and operationalisations, with scale-items largely being sorted into non-weight bias domains. Recommendations for scale modifications and developments are made, and a new amalgamated weight bias scale (AWBS) is presented.

Objectives To explore young women's accounts of their use and non-use of emergency contraception. Design Qualitative study using in-depth interviews. Participants 30 women aged 16-25; participants from socially deprived inner city areas were specifically included. Setting Community, service, and educational settings in the London area. Results Young women's accounts of their non-use of emergency contraception principally concerned evaluations of the risk conferred by different contraceptive behaviours, their evaluations of themselves in needing emergency contraception, and personal difficulties in asking for emergency contraception. Conclusions The attitudes and concerns of young women, especially those from disadvantaged backgrounds, may make them less able or willing than others to take advantage of recent increases in access to emergency contraception. Interventions that aim to increase the use of emergency contraception need to address the factors that influence young women's non-use of emergency contraception.

This audit was based in general practice and examined 49 consecutive referrals to a UK trained traditional Chinese acupuncturist. It aimed to assess the type of patients referred to an acupuncturist, subsequent changes in health status, whether the effectiveness of acupuncture was related to the type of presenting problem and to examine which factors were predictive of the success of acupuncture. The referred patients had a wide variety of conditions which were categorised as to whether or not there was empirical evidence from trials of responsiveness to acupuncture (evidence based vs non evidence based). Patients completed measures of their health status prior to treatment and at two and six month follow ups. In addition, the referring GP’s beliefs about the prognosis of the problem and the therapist’s and patient’s expectations of success were measured at baseline. The results showed that referred patients reported poorer health status than a historical sample of general practice patients and that they showed significant improvements in all aspects of health status following acupuncture. In particular, patients showed improved energy, pain, emotional reactions, sleep and reduced social isolation at two months which were maintained at six months. Physical mobility was improved at six months. In addition, the results indicated that the best predictors of effectiveness were the therapist’s and patient’s expectations of success at baseline. Effectiveness was not related to the category of condition (evidence based or not) nor to the GP’s expectations about the prognosis of the condition. The results are discussed in terms of implications for the role of acupuncture in General Practice and selectively targeting patients who would be responsive to such an approach.

Our objective was to examine patients' experiences of taking orlistat as a means to explore adherence and behavior change.

Humor is considered a coping strategy that is associated with well-being and positive self-esteem. The role of humor in relation to body image and eating behaviors has rarely been investigated. This cross-sectional study (  = 216) examined the relationship between general coping humor and humor styles targeting the self, namely self-enhancing and self-defeating humor, and body image and eating behaviors. Results showed that adaptive self-enhancing humor was associated with body appreciation and compassion, whilst maladaptive self-defeating humor was related to body criticism, drive for thinness, and emotional eating. General coping humor played almost no role. We also examined humor clusters and found that body appreciation and body kindness were higher in self-enhancers than self-defeaters and higher in humor endorsers than humor deniers. Further, self-defeaters reported more body criticism and emotional eating than self-enhancers, and emotional eating was higher in humor deniers than humor endorsers. This study shows that humor referring to the self is key in the understanding of body image and eating behaviors. Whilst the use of self-enhancing humor can have positive effects on body image, self-defeating humor can play a detrimental role.

Having become an academic 30 years ago due to the love of ideas and debate, and having spent most of those 30 years not doing this, I have welcomed the chance to think again and before I respond want to thank my commentators for engaging in this process so fully! My call to celebrate variability and critique of the Behaviour Change Technique Taxonomy (BCTT) and the Behaviour Change Wheel (BCW)has not gone without criticism and within these commentaries authors have argued for the benefits of systematisation and consensual frameworks (Johnston, 2016), the feasibility of being innovative within a process of description and prescription (Albarracin & Glassman, 2016), the usefulness of coding and mapping (Abraham, 2016; Peters and Kok, 2016), and the absence of any clear alternative approach to improving behaviour change interventions (Teixeira, 2016). Yet across these very disparate viewpoints three tensions within health psychology have been highlighted which I think remain central to the debate about systematisation. In this response I will briefly discuss these tensions and their implications.

Objective: A quasi-longitudinal design was used to explore how changes in the home environment reflect body weight and eating behavours in three generations of women across two non-Mediterranean (UK and Australia) and two Mediterranean countries (Greece and Malta). Method: A within- and between-subjects design was used. The within-subjects factor was generation (daughters, mothers and grandmothers). The between-subjects factor was nationality (Mediterranean (Malta, n=135 and Greece, n=106) vs non-Mediterranean (UK, n=120 and Australia, n=96). Body Mass Index (BMI), eating behaviour and aspects of the home environment were assessed using questionnaires for family triads. Results: There were consistent differences by generation in terms of BMI, eating behaviour and most aspects of the home environment, with daughters being lighter but reporting less healthy diets in terms of drinks, snacks, meals and food preparation than either their mothers or grandmothers and a lower endorsement of parental control over food, a lower belief in controlling forms of parenting and a lower belief in the mothers’ autonomy over their daughter. Further, those from Mediterranean countries were heavier and reported poorer diets and a stricter approach to the home environment. The results also indicate that a shift between the generations was more marked in Mediterranean countries with more pronounced differences occurring between daughters, their mothers and grandmothers. Conclusion: Increased weight may be associated with a less managed home environment and poorer eating behaviours which are particularly apparent in those from Mediterranean countries where daughters may be reacting against their more controlling family culture.

Objective: A waiting list randomised control trial has shown the Move More Pack, a print-based intervention supported by Internet tools, to improve physical activity levels in cancer survivors; however, one-third do not improve from the intervention. The objective of this process evaluation is to understand intervention use, the mechanisms of impact, the perceived benefits, and the contextual factors influencing these, identifying for whom it is a useful resource. Methods: A mixed methods process evaluation, based on guidance from the UK Medical Research Council, including 181 questionnaire responses on intervention use and physical activity improvement over 12-weeks, 56 open text responses and 17 semi-structured interviews. Results: The Move More Pack was suggested to be most useful when delivered towards the start of the cancer journey to those with a positive attitude to fighting cancer but with a low level of physical activity, capitalising on a teachable moment. It was suggested that healthcare professionals could support the effective distribution of the Move More Pack. The intervention’s printed components were more popular and well used than the Internet tools. The printed intervention components were positively correlated with physical activity improvement but the Internet tools were not. Females were more likely to use the intervention’s printed components than males. Cancer survivors using the intervention reflected that they had increased confidence and motivation for physical activity and other lifestyle behaviours. Conclusion: The Move More Pack should be offered by healthcare professionals, during cancer treatment, when health is salient, to those with a positive attitude to fighting cancer but with low levels of physical activity. Use of the intervention’s printed components are more likely to improve physical activity than the Internet tools and are more likely to be used by females. The use of Internet tools to support physical activity improvement in cancer survivors requires further investigation.

Two promising strategies to manage eating behaviour are Intuitive Eating (IE; following hunger) and Pinned Eating (PE; ignoring hunger / eating at specific times of the day). This study compared IE and PE on behavioural markers. Participants (n=56) were randomly assigned to IE (n=28) or PE (n=28) and given instructions to follow for one week. Drive to eat, behaviour, behavioural intentions and self-efficacy were measured at baseline and follow up. Participants also evaluated their specific intervention. Comparable changes over time were found for both conditions for many measures. Significant condition by time interactions were found for healthy snacking, total self efficacy and self efficacy for weight loss: those following IE showed an increase in each of these outcomes compared to those following PE who showed no change. The IE group found their intervention more useful than those following PE. Further research is needed to build on these preliminary findings.

There is general support among teachers for inclusion of children with special educational needs, but many lack the confidence and knowledge to support autistic pupils. This can have an adverse effect on their education. Previous studies have explored the attitudes of teachers towards inclusion, but less is known about the experiences of teachers from contrasting school settings regarding autistic pupils. Semi-structured interviews were conducted with twelve teachers from mainstream and special schools. Questions explored the school provision for autistic pupils, including strategies relating to their learning, friendships, bullying and general inclusion. Thematic analysis identified themes describing teachers' challenges supporting autistic children, strategies they adopt to facilitate achievement and the influence of factors such as staff training/expertise, educational ideology, attitudes and the physical environment. Overall, it is argued that, besides the structural differences between mainstream and special schools, there remain a number of additional factors impacting teachers' sense of self-efficacy. These are discussed in relation to recent research perspectives advocating an inclusive educational pedagogy.

Primary care literature emphasises the importance of agreement and shared models in the consultation. This study compared general practitioners' (GPs') and patients' models of obesity. Questionnaires concerning beliefs about the causes, consequences and solutions to obesity were completed by 89 general practitioners (GPs) and 599 patients from practices across UK. In terms of causes, the results showed that the patients were more likely to attribute obesity to a gland/hormone problem, slow metabolism and stress than the GPs, whereas the GPs were more likely to blame eating too much. In terms of consequences, the patients rated difficulty getting to work more highly whereas the GPs regarded diabetes as more important. For the solutions to obesity. the two groups reported similar beliefs for a range of methods, but whereas the patients rated the GP and a counsellor as more helpful. the GPs rated the obese person themselves more highly. It is argued that patients show a self serving model of obesity by blaming internal uncontrollable factors for causing obesity yet expecting external factors to solve it. In contrast, GPs show a victim blaming model by attributing both cause and the solution to internal controllable factors. Such differing models have implications regarding the form of intervention likely to be used in primary care and indicate that whereas patients would prefer a more professional based approach. GPs would prefer a more patient-led one. Further. the results suggest that even if an intervention could be negotiated, success rates would be low as either the patient or the GP would be acting in contradiction to their beliefs about the nature of obesity. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.

This study explored the experiences of newly arrived and settled Eritrean immigrants currently in the UK. Semi-structured interviews were carried out with 10 newly arrived (< 1 year) and 10 settled (> 7 years) participants, recruited through an Eritrean café and using snowball sampling. Thematic analysis identified three themes: 1) Wanting freedom, expectations of the UK and the desire for safety, 2) Integration and becoming part of the British community, 3) Personal development, which involved growth and aspirations. Transcending these themes was the notion of balance, and the co-existence of past and present. It is argued that Eritreans in the UK wish to become part of British community whilst at the same time remembering and celebrating their Eritrean culture. This is explained within the context of a dual identity and it is argued that rather than being a hindrance, a dual rather than single identity facilitates the process of integration.

The present study provides experimental evidence for the effects of cognitive restraint on sensitivity to internal and external cues of hunger. The design involved four experimental conditions. In each condition the subjects were given either a high calorie or a low calorie early morning drink, and either correctly or incorrectly told its calorie content. The subjects, 10 restrained and 10 nonrestrained normal weight women, then rated their subjective hunger and satiety responses and had a test meal. All subjects reported lower sensations of hunger and higher sensations of fullness after the high calorie drink than the low calorie drink, indicating sensitivity to internal cues. However, the restrained eaters' ratings of hunger were also influenced by the believed content of the drink, indicating sensitivity to external cues. The implications of the results are analysed in terms of current theories of restrained eating and their relevance to further research into pathological eating regulation is discussed.

Research has shown that Instagram imagery can affect women's body image. However, it remains unclear how Instagram images are perceived, and which type of images can have a positive impact on body image. In this study (N = 170), we examined whether exposure to body positive and humorous parody (vs. body ideal) imagery would be perceived as critiques of thin body ideals, would elicit photo-based activity in the form of "likes", and would positively affect women's body image. Results showed that both body positivity and humorous parody images elicited more "likes" and were perceived as critiquing thin body standards more than body ideal images. Moreover, women's body satisfaction and positive mood were higher after exposure to body positivity and humorous parody compared to exposure to body ideal images. Women exposed to humorous parody also reported a lower drive for thinness. These findings demonstrate that both body positivity and humorous parody can be considered critiques that improve body image.

Objective: Social support is mostly seen as a positive resource for many health outcomes. However, some research indicates that weight loss may disrupt the equilibrium of relationships and highlights the potential for a more negative form of social support. This qualitative study aimed to explore bariatric surgery (BS) patients’ perceptions of the way in which their current or previous partner supported them throughout their BS journey.Design: BS patients (N=30) participated in remote qualitative semi-structured interviews. Methods: The data were analysed using an inductive approach to reflexive thematic analysis. At the time of this study, patients had undergone BS a mean of 5.1 years ago. Results: Four themes were derived from the data. While two themes reflected social support as a form of caring (Mutual Investment and Positive Reinforcements),the other two themes indicated aspects of sabotage (Feeder Behaviours and Negative Reactions to Weight Loss Attempts and Successes). Transcending these themes was the notion of Bariatric Surgery as an Opportunity or Threat to the Relationship.Conclusions: Some patients perceived social support as a positive resource for achieving optimal clinical response post-BS. This was characterised by Mutual Investment from their partners and being offered Positive Reinforcements for changes in their weight status and wellbeing. Some, however, described more negative aspects of support which had undermined their BS goals, either unintentionally or intentionally, through acts of sabotage including Feeder Behaviours and Negative Reactions to Weight Loss Attempts and Successes. Future research should develop interventions to help prepare the partners of those undergoing BS for the changes to both their partner’s weight status and the dynamics of their relationship.

Background General Practitioners (GPs) play a key role in the diagnosis and management of eating disorders (EDs). Aim To explore GPs’ experiences of managing patients with eating disorders (EDs). Design & setting A qualitative study utilising remote semi-structured interviews. Method Fourteen GPs were interviewed about their experiences of supporting patients with EDs. The interviews were recorded, transcribed and analysed using thematic analysis. Results The analysis described four themes: i) ‘Continuity of care’ addressing the GPs relationship with patients and family, patients transitions across life stages and geographical areas and patient non-attendance; ii) ‘The role of guidance’ focusing on guidelines and protocols, referrals and specialist professionals as points of contact; iii) ‘Structural barriers’ including waiting times, lack of resources, referral criteria and relationships between services; iv) ‘Confidence and skills’ reflecting professional and personal experience in EDs, previous training and training needs. Transcending these themes was the notion of the ‘Limits to the care’ GPs can provide due to professional boundaries and the emotional impact of managing patients with EDs. Conclusion This study found that whilst GPs want to help patients with EDs many limits remain to the care they can provide due to both internal and external factors. Funding is required for training and accessible specialist ED support and greater clarity is needed regarding referral processes if ED management in Primary Care is to be optimised.

Purpose: To explore how individuals with overweight and obesity living in the UK respond to the public health and media messaging surrounding COVID-19 and obesity. Design: Qualitative interview study with a think-aloud protocol. 10 participants self-reported to have overweight, obesity, or as actively trying to lose weight were recruited through social media, were asked to think-aloud whilst exposed to four sets of public health and media materials describing the link between COVID-19 and obesity. Interviews were conducted over zoom, recorded and transcribed verbatim. Findings: Three primary themes were identified through thematic analysis: ‘flawed messaging’, ‘COVID-19 as a teachable moment’, and ‘barriers to change’. Transcending these themes was the notion of balance. Whilst the messaging around COVID-19 and obesity was deemed problematic, for some it was a teachable moment to facilitate change when their future self and physical health was prioritised. Yet, when focusing on their mental health in the present participants felt more overwhelmed by the barriers and were less likely to take the opportunity to change. Originality: This study offers a novel and useful insight into how the public health and media messaging concerning COVID-19 risk and obesity is perceived by those with overweight and obesity. Practical implications: Findings hold implications for public health messaging, highlighting the need for balance between being educational and informative but also supportive, so as to achieve maximum efficacy.

Orlistat is currently the only prescribed form of pharmacological management for obesity and functions by reducing the amount of fat absorbed from food eaten. Although frequently prescribed, there is marked variability in outcomes. A total of 10 participants' experiences of gaining weight after taking orlistat were analysed using thematic analysis. Participants attributed their failed weight loss to mechanisms of the medication, emphasised a medical model of obesity with barriers to their weight loss and other weight-loss methods which had also failed. Overall, their weight gain was considered an inevitable part of their self-identity, reflecting their self-fulfilling prophecy of being a perpetual dieter.

In the prison context, the Illicit Economy (IE) refers to trade that is forbidden by law or by prison rules which mostly includes either goods ranging from canteen items to classified drugs, New Psychoactive Substances (NPS), prescribed medications, alcohol and mobile phones or services such as money lending and gambling. Although the IE may have some positive impact on prison life by engaging prisoners in an activity that rewards the seller and meets a buyer’s need, or by filling idle hours and keeping prisoners calm, reports suggest that the IE can lead to debt, intimidation, violence and disruptive behaviour. 1,2,3,4,5 This study explored prisoners’ experiences of the illicit economy (IE) and developed a new measure of biddability to predict involvement in the IE; the BIDSCALE.

Two naturalistic experiments are reported exploring the impact of parental restriction on children's diets. For study 1, 53 parents gave 75. g of chocolate coins to their child over a weekend. For study 2, 86 parents were recruited prior to the 2. week Easter break when their children would be receiving chocolate Easter eggs. For both studies, parents were randomly allocated to either the non-restriction or restriction conditions and rated their child's preoccupation with the target food and other sweet foods (demanding and eating) at the start and end of the interventions. Perceived and actual food intake was assessed. Children in the restriction conditions consumed fewer chocolate coins and Easter eggs. All children showed decreased preoccupation with chocolate coins or Easter eggs over the course of the studies yet by the end the restriction group were more preoccupied with the target food. In contrast, all children showed an increased preoccupation with other sweet foods as the studies progressed which was greater in the non-restriction group for the chocolate coins study. Overall, restriction resulted in reduced intake but relative increased preoccupation with the food being restricted. Non-restriction resulted in a greater preoccupation with other sweet foods once the target foods had been consumed. © 2012.

BACKGROUND: The purpose of the present study is to evaluate the impact of a health psychology-led bariatric rehabilitation service (BRS) on patient weight loss following bariatric surgery at 1 year. METHODS: A single-site open-randomised parallel group control trial based at St. Richard's Hospital in Chichester in the UK. Patients (n = 162) were recruited immediately prior to Roux-en-Y gastric bypass and randomly allocated to receive either treatment as usual (n = 80) or the BRS (n = 82). The BRS involved three 50-min one-to-one sessions with a health psychologist and provided information, support and mentoring pre and post surgery addressing psychological issues such as dietary control, self esteem, coping and emotional eating. Weight loss was assessed at 1 year. The key outcome variable was BMI and change in BMI. RESULTS: Follow-up weight was available for 145 patients. Intention-to-treat analysis (n = 162) using last measured weights showed that mean change in BMI by 1 year post surgery was -16.49. There was no significant difference between the two groups (control group = -16.37, 95 % CI = 15.15-17.57; intervention = -16.6, 95 % CI = 15.42-17.81; η p (2) = 0.001). Similarly, explanatory analysis (n = 145) showed a mean change in BMI of -17.17. The difference between the two groups was not significant (control group = -16.9, 95 % CI = 15.78-18.18; intervention = -17.35, 95 % CI = 18.5-16.16; η p (2) = 0.001). CONCLUSIONS: Psychological support pre and post bariatric surgery had no impact on weight loss as measured by BMI and change in BMI by 1 year. It is argued that psychological support should be targeted to patients who start to demonstrate weight regain at a later stage. TRIAL REGISTRATION: ClinicalTrials.gov NCT01264120.

Likert scales relating to quality of life were completed by the homeless (N = 75); first year students (N = 301) and a town population (N = 72). Participants also completed free text questions. The scale and free text data were often contradictory and the results highlighted three processes to account for these disparities: i) frame of reference: current salient issues influenced how questions were interpreted; ii) within-subject comparisons: ratings were based on expectations given past experiences; iii) time frame: those with more stable circumstances showed habituation to their level of deprivation. Likert scale data should be understood within the context of how ratings are made.

Whilst overeating is often influenced by others in an implicit way, people may also explicitly encourage others to overeat. This has been labelled being “a Feeder” but to date, this more deliberate trait remains neglected. This study aimed to conceptualize being “a Feeder” in terms of motivations and behaviour and to operationalize this construct with a new measurement tool through five stages with three discrete samples. Using the definition of a Feeder as “someone who offers others food even when they are not hungry” a preliminary qualitative study (n = 5) clarified the behaviour of a Feeder and revealed six motivations for such feeder behaviour. These six motivational dimensions and the feeder behaviours were operationalized with individual items and the psychometric properties of the scale were assessed using two independent samples (n = 116; n = 113). The final 27‐item measure consisted of six motivational factors (affection; waste avoidance; status; hunger avoidance; offloading; manners) and one behaviour factor, all with good internal consistency (α  ≥ .7). The two samples were then merged (n = 229) to describe motivations and behaviour and to assess the association between them. The best predictors of feeder behaviour were love, offloading, manners and status. This new Feeder questionnaire has a strong factor structure and good internal consistency and could be used for further research or clinical practice.

There is an overweight/obesity crisis in both human and companion animal populations globally. Veterinarians have an ethical obligation to protect animal welfare and, therefore, have a duty to intervene by supporting their clients in changing care plans to mitigate and prevent pet overweight/obesity. Currently, there is limited evidence in veterinary contexts for when and howthis can be done effectively. In contrast, a more comprehensive body of literature has been developed on how human healthcare practitioners `make every contact count' (MECC). This review begins by briefly exploring the cross-species multifactorial causes of overweight/obesity, before considering the literature regarding whether veterinarians reliably address overweight/obesity and the obstacles they encounter. The review then explores the evidence from human healthcare contexts in terms of how person-centred and health `coaching-style' MECC interventions have supported weight management in adult and child populations and the barriers practitioners face when implementing these interventions. The final section interprets this literature to provide a fresh `lens' through which veterinarians' concerns can be understood. Recommendations are made for enhancing veterinarians' capacity to develop the knowledge and skills needed for successful outcomes when MECC. Opportunities for developing local multi-stakeholder/agency teams taking a `one health' approach are considered.

Background: Physical activity can improve many common side effects of cancer treatment as well as improve physical function and quality of life (QOL). In addition, physical activity can improve survival rate and reduce cancer recurrence. Despite these benefits, only 23% of cancer survivors in England are active to recommended levels. Cancer survivors are interested in lifestyle behavior change. Home-based interventions offer a promising means for changing physical activity behavior. Prediagnosis levels of physical activity and self-efficacy have been reported to be predictors of physical activity behavior change. The Move More Pack, which has undergone revision, is a printed resource with supporting Internet-based tools that aims to increase the physical activity of cancer survivors in the United Kingdom. The revised Move More Pack is underpinned by the theory of planned behavior and the social cognitive theory. Objective: The aim of this proposed study was to investigate the effect of the revised Move More Pack, supported by Internet-based tools, on physical activity, self-efficacy, and health-related QOL (HRQOL) of cancer survivors in the United Kingdom. Methods: This study is a two-arm waiting list randomized control trial with embedded process evaluation. A sample of 99 participants per arm will be recruited by invitation through an email database of cancer survivors held by UK charity Macmillan Cancer Support and an advert placed on the Macmillan Cancer Support Facebook page. Each participant is randomized to receive brief physical activity information and the UK guidelines for physical activity, or brief physical activity information and the revised Move More Pack with supporting Internet-based tools. The intervention and control arm will be followed up at 12 weeks to identify changes in self-reported physical activity, self-efficacy, and HRQOL based on Web-based questionnaires. The control arm will receive the revised Move More Pack at 12 weeks with follow-up at 24 weeks. The intervention arm is followed up at 24 weeks to determine maintenance of reported changes. Subgroup analyses will be completed based on participants' prediagnosis level of physical activity and baseline self-efficacy as possible predictors of positive changes. Use of each component of the revised Move More Pack will be assessed using a 4-point Likert scale. Semistructured phone interviews will evaluate the use and perceived usefulness of the revised Move More Pack. Results: Participant recruitment started in March 2017. Projected completion of this study is October 2018. Conclusions: This study's findings will identify if the proposed low-cost broad reach intervention improves physical activity, self-efficacy, and the HRQOL of cancer survivors. The process evaluation is designed to contextualize the use and perceived usefulness of the revised Move More Pack, help augment its efficient distribution, and identify potential improvements to its design.

Medically unexplained symptoms such as headache, tiredness and stomach problems are common amongst children and research highlights the potential importance of the family environment in their development and maintenance. The present qualitative study aimed to explore how mothers make sense and manage their child's unexplained recurrent somatic symptoms. Mothers (n=13) with children with headaches, tiredness or stomach problems were interviewed. Transcripts were analysed using thematic analysis. Three main areas emerged relating to "making sense of the symptom", "impact of the symptom" and "strategies for coping". Transcending these areas were three core issues relating to managing ambiguity, authenticity and responsibility. In particular, more ambiguous symptoms were associated with making uncontrollable causal attributions that removed responsibility away from the family. Further, even though the mothers reported coping strategies that may have exacerbated their child's symptoms these were defended in ways to minimise their own potential influence on the symptom and to emphasise its authenticity. In conclusion, mothers perceptions and behaviours may be counterproductive in the longer term but function in the more immediate term by facilitating a protective relationship with their child. © 2012 Copyright Taylor and Francis Group, LLC.

Background :  Whilst bariatric surgery remains the most effective form of weight management, some patients show less than optimal weight loss. This study evaluated the impact of focusing on the investment patients have made in surgery to improve health outcomes. Methods :  The study used a randomised control trial design with patients allocated either to the control or investment intervention group. Patients were recruited from University College Hospital, London and half were randomly allocated to the intervention arm and described the investment they had made in their operation just before surgery then 3 and 6 months post-surgery. The primary outcomes were patient’s weight, body mass index (BMI) and HbA1c at 12 months.  Secondary psychological outcomes were also assessed at baseline and 12 months. Results: By one year post-operation for 141 patients the mean change in weight was 35.2kg, for BMI it was 12.7 and for HbA1c it was 0.65.  At one year follow up there was no significant difference between groups for weight loss (kg and BMI) using both ITT analysis and explanatory analysis. Using explanatory analysis (n=119) a significant difference in HbA1c change was found with those in the control group showing a greater improvement in their blood sugars than those in the intervention group (5.44 vs 5.41; p=0.03).  Response rates for psychological outcomes were low (n=73).  No differences were found for most psychological outcomes, however, those in the intervention group reported lower levels of imposed control than those in the control group by 12 months.  Conclusions: Highlighting the patients’ investment pre and post bariatric surgery had no impact on weight loss as measured by kg or BMI 1 year later. Furthermore, no changes were found for most psychological outcomes. Some detrimental impacts were found however relating to HBA1c and perceptions of control.  ClinicalTrials.gov registration: NCT02045628

Although texts recommend the generation of rich data from interviews, no empirical evidence base exists for achieving this. This study aimed to operationalise richness and to assess which components of the interview (for example, topic, interviewee, question) were predictive. A total of 400 interview questions and their corresponding responses were selected from 10 qualitative studies in the area of health identified from university colleagues and the UK Data Archive database. The analysis used the text analysis program, Linguistic Inquiry and Word Count, and additional rating scales. Richness was operationalised along five dimensions. ‘Length of response’ was predicted by a personal, less specific or positive topic, not being a layperson, later questions, open or double questions; ‘personal richness’ was predicted by being a healthy participant and questions about the past and future; ‘analytical responses’ were predicted by a personal or less specific topic, not being a layperson, later questions, questions relating to insight and causation; ‘action responses’ were predicted by a less specific topic, not being a layperson, being healthy, later and open questions. The model for ‘descriptive richness’ was not significant. Overall, open questions, located later on and framed in the present or past tense, tended to be most predictive of richness. This could inform improvements in interview technique.

This qualitative study explored the childhood experiences of growing up with a sibling with Developmental Coordination Disorder (DCD) to offer an ‘outsider’s’ view of this condition. Ten individuals who had grown up with a sibling with DCD were interviewed about their experiences. Data were analysed using Thematic Analysis. Analysis described three main themes: i)‘witnessing the challenges for their sibling with DCD’ ii) ‘experiencing the impact on the family’; iii) ‘a vacuum of knowledge’. Not all experiences were negative and transcending these themes was the notion ‘resolution and finding benefit’ highlighting access to support, being more empathic and resilient, becoming a role model for others and finding success. Participants play witness to their sibling’s experiences which can often be negative sometimes impacted by a vacuum of knowledge but they also describe how a diagnosis of DCD comes with some benefits which are discussed in the context of ‘posttraumatic growth’.

Background: This paper reports the findings from an interview study conducted with people who had attended a specialist food intolerance clinic running in four general practices in the UK. The aims of the interviews were to investigate the experiential accounts and meaning-making of people who had reported symptom improvement whilst attending the clinic. Methods: Semi-structured interviews were conducted with 10 participants following clinic attendance. Interviews were analysed using Interpretative Phenomenological Analysis. Findings: Analyses revealed five key themes: ‘reported expectations of clinic intervention’, ‘reported symptom changes’, ‘reported implications of symptom change for personal social and emotional life’, ‘accounts of processes of change’ and ‘adherence and non-adherence to dietary regime’. Discussion: Participants reported attending the food intolerance clinic to search for an explanation for the cause of their symptoms. The clinic seemed to work by helping participants to identify food related culprits thus bringing into line their beliefs about causes and solutions to their problem.

Research indicates a key role for parenting in a daughter's relationship with food and body shape. One possible mechanism for this translational process is through scripts. The present study used a dyadic design to investigate the relationship between caregivers and daughters' scripts regarding food and body shape. Caregivers (n = 40) and their daughters (n = 40) rated word lists of their current and childhood scripts and caregivers completed an additional measure of their parenting scripts. Non-dyadic analysis showed consistent correlations between daughters' current scripts and their recollections of childhood scripts, and several (but less consistent) correlations between caregivers' current scripts, their own childhood scripts and the scripts they had used as a parent. Dyadic analysis showed consistent correlations between the daughter's current scripts relating to negative eating and both positive and negative body scripts and their caregiver's parenting scripts, and between the daughter's current scripts relating to positive and negative eating and body looking positive and their caregiver's current scripts. No associations were found between the daughter's current scripts and the caregiver's childhood scripts. The results indicate that whilst daughters' current scripts relating to food and body shape are often concordant to those reported by their caregivers, they are more closely linked to what they remember from their childhoods. Further, they suggest that those scripts which do transfer between generations may be more related to body size and negative eating than food per se. Finally, the results suggest that scripts do not inevitably pass across the generations possibly due to parents choosing not to repeat the errors of their own parents or due to the role of factors other than just parenting in creating the scripts we hold.

How do social scientists create facts? What strategies do they use to construct knowledge? How does social science make sense of the individual? Critical studies of both medical and scientific knowledge have been conducted but social science knowledge remains relatively unquestioned.Addressing this question, Health and the Construction of the Individual, originally published in 2002, is a social study of social science. Jane Ogden focuses particularly on constructions of the individual in health-related psychology and sociology. She explores how social science texts construct social science facts using the strategies of theory, methodology, measurement, and rhetorical boundaries and argues that the individual is not only constructed through the dissemination of social science knowledge but through the mechanics of its production. The results provide a unique insight into the transformation of the individual as an ever-changing self, from both a historical and social constructionist perspective.This title will make fascinating reading for health psychologists, medical sociologists, social constructionists and all students and researchers interested in gaining a greater understanding of the premises underlying social science.

Background: Obesity surgery has been shown to result not only in sustained weight loss, but also in improvements in psychological morbidity and quality of life. The present study aimed to explore the mechanisms behind the success of surgery and to examine how it might bring about such changes in patients' health status. Methods: Both quantitative and qualitative methods were used. A questionnaire was completed by patients who had undergone bariatric surgery in the past 4 years (n=22) and a matched-group of waiting list controls (n=39). In depth interviews were then carried out with 15 surgical patients. Results: The quantitative study showed that the surgical group weighed less, had more negative experiences of eating and yet reported improved subjective health status using a range of validated tools. The qualitative study provided some insights into this improved health status, with the surgical patients reporting improved energy and self-esteem. The patients also reported a fundamental shift in their relationship with food. In particular, they described changes in their eating behavior and stated that they had a new experience of fullness and a reduction in their hunger. Furthermore, they described how food now had a reduced role in their lives and that the operation had made them feel more in control of their food intake. Conclusion: Post-surgical improvements in health status may not only be a result of the non-specific consequences of surgery brought about by weight loss, but also a result of the specific impact of the surgical procedure itself. By enforcing a reduction in the amount of food that can be eaten, restrictive surgery seems to generate changes in the individuals' relationship to food and may help to re-establish a perception of control over eating behavior.[PUBLICATION ABSTRACT]

Examination of theories in health psychology over the twentieth century reveals parallel shifts in models describing the subject of psychology and a consistent realignment between this subject and the environment. A similar reconfiguration of the individual can also be seen within medical and health care discourses about risks to health. These changes are discussed in terms of the interrelationship between theory (the discipline of health psychology), the theory's subject (the individual) and methodology.

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Psychology focuses on what people believe and how they behave; health psychology explores how these beliefs and behaviours relate to health and illness. This chapter focuses on the beliefs that individuals have about health and illness and how these beliefs relate to their health behaviours and subsequently their health status. Part 1 explores the contribution of psychology to studying health and illness, describing the background to psychology and highlighting the importance of beliefs concerning health and illness on the part of laypeople and health professionals. Pain is used as an example of the role of psychology in the experience of illness. Part 2 describes the models that have been developed within health psychology, in particular focusing on the structured models of health beliefs and the self-regulatory model of illness behaviour. Finally, the case study on diet, eating habits and obesity explores in depth how psychological theories can be applied to a topical health issue.

Anecdotal evidence indicates a difference between doctors' health seeking behaviours for their patients and for themselves. This difference remains untested. This study aimed to assess any differences between the first-line treatment options GPs would accept for themselves and those they would advise their patients. A postal questionnaire was completed by 286 GPs based in two west London Health Authorities (response rate 51.4%) asking them to score the treatment options of 6 common symptoms for both themselves and their patients in terms of over the counter (OTC) remedies, prescriptions, referrals and complementary therapies. The results showed that GPs differentiated between themselves and their patients in terms of OTC remedies for indigestion and depression, prescriptions for indigestion, hypertension, depression and 'tired all the time' (TATT); referrals for indigestion, hypertension, low back pain and TATT; and complementary therapy for depression. GPs may be prepared to cross the boundary be treated the same as their patients if the symptoms are relatively uncontroversial. Stigmatised problems and those with clinical guidelines, however, seem to result in a 'do as I say not as I do' approach to health care. (C) 2004 Elsevier Ireland Ltd. All rights reserved.

Sexual contact between psychological therapists and their clients is regarded as highly damaging, both to the clients and to the professions, and regulatory bodies impose increasingly severe sanctions upon those practitioners who are disciplined. The present study captured therapists' accounts of sexual boundary violations through interpretative phenomenological analysis of interviews with three disciplined practitioners about their relationships with clients and former clients. The results highlighted two key themes relating to (i) therapists' efforts to neutralize the power imbalances between themselves and the clients by minimizing the clients' mental health problems, stressing the conventionality of the relationships and not testing the appropriateness of the relationship with their supervisors, and (ii) a shifting identity of the therapist between hero, victim, perpetrator, which permeated their accounts as the relationship moved from success to failure. In order for a sexual boundary violation to occur, the therapist needed to generate a sense of equivalent status between themselves and the client. As the relationships failed, the therapists' accounts of the clients shifted and the inequality of the relationship re-emerged. The results are discussed in terms of implicit theories and the implications for both training and supervision in the prevention of sexual boundary violations. Copyright © 2011 John Wiley & Sons, Ltd. Key Practitioner Message: In accounting for their sexual boundary violations, this small sample of therapists minimized the power imbalances between themselves and their clients. Minimizing the client's mental health problems; stressing the conventionality of the relationship; stressing the therapist's own needs-all contributed to the neutralization of the client's patient status. A relationship with a client that we are not willing to discuss with our supervisor should be a cause for concern. © 2011 John Wiley & Sons, Ltd.

Evidence relating to dietary change is contradictory, as some studies document a lack of dietary change while other studies report a degree of success in the implementation and maintenance of long-term dietary change. The present cross-sectional survey aimed to establish the prevalence of dietary change in a community sample, with a focus on four mechanisms of dietary change: two mechanisms within an active path (accumulation of evidence and trigger to action) and two mechanisms within a passive path (imposed change and seamless change) across participants' lifespan (N = 404). The results indicated that minor dietary change occurred frequently in the lives of 99% of participants. Those described as involving the active path illustrated a reliance on different, self-regulatory styles. In contrast, passive path changes reflected participants' flexible adaptation to the external environment and evolving personal health needs. Both, the changes within active and passive paths, occurred with almost equal frequency across participants' lifespan. Further, while weight loss in the past year tended to be attributed to conscious effort, weight gains were blamed on the obesogenic environment.

Although weight loss surgery (WLS) is currently the most effective management approach for those with a Body Mass Index greater than 40, many patients are left with excess skin and a sense that they are aesthetically worse than they were before. This in-depth qualitative study explored patients' (n = 7) experiences of having plastic surgery post WLS. Thematic analysis revealed three broad themes; (i) a journey which involved investing time, energy and money; (ii) goals such as health, improved body esteem, choice and a desire to feel normal; (iii) barriers to achieving these goals including shame, guilt and self-criticism. Transcending these themes was a gradual recognition that their problems should not be treated with a surgical approach alone but were more psychological in nature, which emerged through shifting expectations that could never be met and an acknowledgement that their physical shape was not the key cause of a negative sense of self. Accordingly, by the end of their surgical journey they began to question whether they had set out on the wrong journey with the wrong goals in mind which is discussed in the context of social comparisons and the need for coherence between beliefs about causes and solutions. © 2014 © 2014 Taylor & Francis.

The patient-practitioner relationship is fundamental to rehabilitation practice and patients' health and wellbeing. Dissonance between patients who have had bariatric surgery and health care practitioners about what supportive care and good outcomes are can undermine care. To address the mechanisms of this process, we conducted an Interpersonal Process Recall study. We interviewed patients (11), video recorded consultations (10), conducted video-assisted individual interviews with patients (10) and practitioners (11) and a dyadic data analysis. We identified relational states and shifts in the clinical encounter 2-3 years post-surgery, described in themes: a) Playing by the Book - Making it Easier for Each Other, b) Down the Blind Alley - Giving up on Each Other, and c) Opposite Poles - Towards and Away from Each Other. The post-surgery consultations facilitated responsibility for health and self-care but did not invite dialogues about the psychosocial burdens of living with obesity and undergoing bariatric surgery. Patients and practitioners tried to avoid creating conflict, which in turn seemed to foster distance, rather than human connection. This limits the encounter's benefit to both parties, leaving them frustrated and less willing to either meet again or take any gains into their future lives. IMPLICATIONS FOR REHABILITATION Illness evokes feelings of stress and uncertainty and is experienced very differently from the perspective of patients and health care practitioners (HCPs), who encounter each other in a field fraught with tension. Bodily changes and difficult emotions related to food and eating are to be expected when undergoing bariatric surgery, and to explicitly "notice, name and validate" emotions can promote the patient's capacity to sustain self-care, lifestyle change, weight loss and health gains. Making interpersonal connection and interaction between patient and HCP the centre of bariatric aftercare can enhance engagement in and outcomes of the post-surgery clinical encounter

Background Although obesity surgery is currently the most effective method for achieving weight loss, not all patients lose the desired amount of weight and some show weight regain. Previous research shows that successful weight loss may be associated with the amount of investment the patient feels that they have made in their operation. For example, those who feel that it has taken more time and effort to organise, has cost more money, has been more disruptive to their lives and has caused pain are more likely to lose weight after their operation. Therefore, it seems as if the greater the sense of investment, the greater the motivation to make the operation a success. The present study aims to build on these findings by encouraging weight loss surgery patients to focus on the investment they have made, thus making their investment more salient to them and a means to improve weight loss outcomes. Methods The study involves an open randomised parallel group control trial with patients allocated either to the control or investment intervention group. Using third party blinded randomization, half the patients will be asked to rate and describe the investment they have made in their operation just before surgery then 3 and 6 months after surgery. All patients will record their weight, beliefs about food, intentions to change and actual eating and exercise behaviour at baseline then 3, 6 and 12 months follow up. Patients will be recruited from the bariatric surgery pre-assessment clinic at University College Hospital, London. The primary outcome is to explore the impact of the investment based intervention on patient’s weight and BMI, with secondary outcomes of patients’ beliefs about foods, behavioural intentions and diet and exercise behaviours. Discussion It is predicted that the investment intervention will improve excess weight loss post-surgery, together with beliefs about food, intentions to change and actual change in diet and exercise behaviour. This has cost implications for the NHS and other healthcare providers as improved effectiveness of bariatric surgery reduces the health costs of obese patients in the longer term and this simple, easy to administer and low cost intervention could become routine practice for bariatric patients.

Objective: A minority of patients show sub-optimal outcomes after weight loss surgery. Research has identified predictors of poor outcomes focusing on the patients’ perspective. No research has explored surgeons’ accounts. Design: Ten bariatric surgeons were interviewed using a critical incident approach to explore their explanations for sub-optimal outcomes in the context of a real-life case. Data were analysed using thematic analysis. Results: Three main themes were developed: ‘Challenges to success’ highlighting the role of psychosocial issues, poor adherence and patient non-disclosure; ‘Ideal world solutions’ describing who should identify and address psychosocial issues and ‘Real world compromise’ reflecting the impact of limited resources and weighing up risk between carrying out versus not carrying out surgery. Transcending these themes was the notion of ‘responsibility’ with surgeons balancing the role of the patient, themselves and the health care system. Conclusion: Some surgeons concluded that if they had known before surgery what they know now, they may not have operated. All emphasised that they could only know what was disclosed by the patient, that they were not convinced that not operating would have resulted in better outcomes in the longer term and many felt that they were ‘damned one way or the other’.

A systematic review, meta-analysis and meta-regression were conducted to evaluate the effectiveness of behavioural weight management programmes and examine how programme characteristics affect mean weight loss. Randomized controlled trials of multicomponent behavioural weight management programmes in overweight and obese adults were included. References were obtained through systematic searches of electronic databases (conducted November 2012), screening reference lists and contacting experts. Two reviewers extracted data and evaluated risk of bias. Thirty-seven studies, representing over 16,000 participants, were included. The pooled mean difference in weight loss at 12 months was -2.8 kg (95% confidence interval [CI] -3.6 to -2.1, P < 0.001). I(2) indicated that 93% of the variability in outcome was due to differences in programme effectiveness. Meta-analysis showed no evidence that supervised physical activity sessions (mean difference 1.1 kg, 95% CI -2.65 to 4.79, P = 0.08), more frequent contact (mean difference -0.3 kg, 95% CI -0.7 to 0.2, P = 0.25) or in-person contact (mean difference 0.0 kg, 95% CI -1.8 to 1.8, P = 0.06) were related to programme effectiveness at 12 months. In meta-regression, calorie counting (-3.3 kg, 95% CI -4.6 to -2.0, P = 0.027), contact with a dietitian (-1.5 kg, 95% CI -2.9 to -0.2, P < 0.001) and use of behaviour change techniques that compare participants' behaviour with others (-1.5 kg, 95% CI -2.9 to -0.1, P = 0.032) were associated with greater weight loss. There was no evidence that other programme characteristics were associated with programme effectiveness. Most but not all behavioural weight management programmes are effective. Programmes that support participants to count calories or include a dietitian may be more effective, but the programme characteristics explaining success are mainly unknown.

The present study examined the experience of vaginismus in 89 sufferers and ex-sufferers using quantitative and qualitative methodologies. The results provide insights into the effects of vaginismus on the sufferers' self-perception and on their relationships with important others. It is suggested that vaginismus should not be regarded as a psychosexual problem but as a psychosocial experience in which defences have been created to protect the self, and that the vaginal spasm is only one of the many effects of this defence.

Purpose: Due to resource limitations, psychological support for bariatric patients needs to be targeted to those most in need. This study aimed to evaluate the resource implications of a brief triage tool to identify and support those most at risk from poorer outcomes Materials and methods: A four stage process was used involving: Expert consensus; the selection of appropriate measures; A patient cohort over two years; A resource analysis Results: Three key psychological contra-indications for bariatric surgery were identified by expert psychologists (n=45) as alcohol and drug dependency and suicidality. Next, existing validated measures were selected based upon the literature to form the Bariatric Triage Tool (BTT) consisting of the AUDIT, DAST-10 and SBQ-R. Consecutive patients at one UK bariatric clinic then completed the BTT for 2 years (n=484). Of these under a fifth were identified as at risk (n=85; 17.6%) and referred for an in depth one to one assessment with a bariatric psychologist. Of these 7 (1.4%) were referred to their GP for further psychological support and removed from the surgical pathway. Finally, resource implications were evaluated and indicated that the BTT saved both money (between £15 and £105 per patient depending on the metric) and time (just under one hour per patient) which could be used to target those patients most in need of psychological support Conclusion: The BTT is a brief, easy to self-administer tool that could be used to identify those most at risk and ensure that psychological support is targeted to those most in need

Within any discipline there is always a degree of variability. For medicine it takes the form of Health Professional’s behaviour, for education it’s the style and content of the classroom and for health psychology it can be found in patient’s behaviour, our theories and our practice. Over recent years attempts have been made to reduce this variability through the use of the Behaviour Change Technique Taxonomy, the COM-B and the Behaviour Change Wheel. This paper argues that although the call for better descriptions of what we do are useful for clarity and replication this systematisation may be neither feasible nor desirable. In particular, it is suggested that the gaps inherent in the translational process from protocol to behaviour will limit the effectiveness of reducing patient variability, that theory variability is necessary for the health and well being of a discipline and that practice variability is central to the professional status of our practitioners. It is therefore argued that we should celebrate rather than remove this variability in order for our discipline to thrive and for us to remain as professionals rather than technicians.

This study investigated how intensivists make decisions regarding withholding and withdrawing treatment for patients at the end of their lives. This involved completing in-depth interviews from two sites of the South of England, United Kingdom by twelve intensivists. The data collected by these intensivists were analysed using thematic analysis. This resulted in the identification of three themes: intensivists’ role, treatment effectiveness, and patients’ best interest. Transcending these were two overarching themes relating to the balance between quantity and quality of life, and the intensivists’ sense of responsibility versus burden. The results are considered in terms of making sense of death and the role of beliefs in the decision-making process.

Much research has explored the interaction between doctor and patient in the consultation and patient centredness has generally emerged as the preferred mode of consultation style. The present study aimed to examine and compare general practitioners' (GPs) and patients' beliefs about the importance of the different aspects of patient centred behaviour in a consultation. Matched questionnaires were completed by 410 patients (response rate = 76.5%) and 64 GPs (response rate = 85.3%) from practices around London concerning aspects of patient centredness operationalised in terms of doctor receptiveness, patient involvement, the affective content of the relationship and information giving. The results showed that GPs and patients showed similar beliefs about involving the patient in decision making, aspects of doctor receptiveness and the importance of the patient's own feelings in the consultation. However, GPs believed that it was less important to focus only on the patient's main problem, and more important to acknowledge their own feelings and avoid medical language. Further, GPs rated doctor receptiveness and the affective content of the relationship overall as more important for a good consultation than the patients. The patients also consistently rated information giving as more important than the GPs. To conclude, GPs rated the doctor receptiveness and affective components of patient centredness as more important than patients whereas patients showed greater endorsement of information indicating that although patient centredness may currently be the preferred style of consultation, doctors and patients prefer different aspects of this behaviour. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved.

Substantial research in symptom perception demonstrates symptoms are influenced by a wide range of psychological factors. However, there is limited understanding of the broader milieu of bodily states within which symptoms exist, including emotions, sensations and "pre-symptoms". Furthermore, little is known about how bodily states are experienced and translated into symptoms. Semi-structured interviews with 12 participants explored how individuals experience, describe and understand their bodily states in addition to how bodily states are translated into symptoms and how this transition was experienced. Thematic Analysis described four main themes in relation to; i) "The qualia of bodily states", individuals' description and understanding of how bodily states "feel"; ii) "Attending to bodily states", how attention to bodily states could differ between individuals and in certain contexts; iii) "Becoming symptoms", understanding of normality and its deviations and finding meaning could play a role in transition of states to symptoms; iv)"Reifying symptoms", how individuals communicated, verbally and non-verbally, abstract lived experience of bodily states to the self and others. A transcending theme, "A series of thresholds" encompassed how bodily states surpass a threshold to become a symptom and the involvement of individual differences such as attention, emotions, expectations and finding meaning. Symptoms may arise when a bodily state surpasses a series of thresholds which may be lowered or raised. There is a critical need to consolidate understanding of bodily states and symptoms within a research context and for greater appreciation of the nuanced, complex and varied nature of bodily states beyond "symptoms".

Background. Although consultations have increased in length, patients still express dissatisfaction with how much time they spend with their doctor. Objectives. This study aimed to explore aspects of consultation time and to examine the correlates of patients' desire for more time. Methods. A quantitative cross-sectional design was used. General practice patients from eight UK practices (n = 294) completed a questionnaire following a consultation regarding their satisfaction with the consultation, their beliefs about how long the consultation lasted (perceived time) and how long they would have preferred it to last (preferred time). The actual consultation length (real time) was recorded by the doctor. Results. The majority of patients underestimated how long the consultation took, and a large minority stated that they would have preferred more time. When controlling for both real time and perceived time, a preference for more time was correlated with a dissatisfaction with the emotional aspects of the consultation and a lower intention to comply with the doctors recommendations. It was unrelated to satisfaction with the information giving and examination components of the consultation. Conclusion. Patients' dissatisfaction with consultation length could be managed by making consultations longer. Alternatively, it could also be managed by changing how a given time is spent. In particular, a doctor who listens and tries to understand their patient may make the patient feel more satisfied with the consultation length and subsequently more motivated to follow any recommendations for change.

Abstract. Media sexualization of women may lead to objectification and poor well-being.  To explore the more ‘in the moment’ and spontaneous responses to sexualized images men (n = 19) and women (n = 20) from Greece/Cyprus and the UK completed a qualitative think aloud task whilst exploring images of women in a male-directed magazine. Using thematic analysis, four themes emerged: What they see; Sense of celebration; Feeling insulted; Harmful consequences. Transcending these themes was the notion of choice/ownership.  These themes were then further coded to explore differences between men and women and by culture (Greece / Cyprus vs. UK). Whilst men and women described what they saw as positive, negative or with moral judgement, women were also more likely to either celebrate women’s sexualized images and seeing them as empowering and justified, or felt insulted and angry, perceiving the media as objectifying women and described possible harmful consequences. This tended to be underpinned by whether the women in the images were perceived to have choice/ownership over their actions. If women observers imputed no choice/ownership to the women in the images, such images were considered insulting whereas a sense of choice/ownership gave them a sense of empowerment. No clear differences by culture were observed.

Background: Polycystic Ovary Syndrome (PCOS) is associated with well-being. Many women report dissatisfaction with the diagnostic process. Aim: This study assessed the impact of aspects of the diagnostic consultation on subsequent well-being. Design and setting: A retrospective community survey. Methods: Females with PCOS (n=146) completed measures of aspects of the diagnostic consultation (consultation satisfaction, language used in terms of framing and focus) and current well-being (body esteem, quality of life).  Results: Most diagnoses took place in Primary Care. The majority showed a medium degree of satisfaction with the consultation. Most diagnoses were framed using a neutral term ‘raised’ but many used the more judgemental term ‘abnormal’. The majority focused on taking oral contraception and weight management.  Poorer body esteem (body dissatisfaction and dieting behaviour) and poorer quality of life (self-identity, concerns about fertility, physical health, hirsutism and overall quality of life) were predicted by lower communication comfort during the diagnostic consultation and greater use of the word ‘raised’. Greater use of the word ‘irregular’ predicted greater concerns about fertility, greater focus on fertility predicted greater concerns about physical health and greater focus on appearance predicted greater concerns about hirsutism. Conclusion: How a diagnosis of PCOS is delivered can impact subsequent well-being. The diagnostic consultation may take a few minutes, yet how these minutes are managed, what words are used, and how this makes the patient feel may change how the patient makes sense of their condition and influence the impact of the condition on their well-being for the longer term.  

Social media, and particularly posting ‘selfies’ have become fully incorporated into young people’s lives. Research indicates that posting selfies may impact upon self esteem and that feedback in the form of ‘likes’ may change how young people feel about themselves. To date, however, most research has been cross sectional or qualitative limiting conclusions about causality. Further, it has taken place in non naturalistic environments, with no longer term follow up and limited outcome variables. This experimental study explored the impact of posting selfies and receiving feedback (‘likes’) on Instagram on broader aspects of the psychological well-being of young people. Participants (n = 59) aged 16-25 were randomly allocated to one of three conditions for a 7-day intervention (no selfie-posting; posting selfies without feedback; posting selfies with feedback) and completed measures at baseline, after the intervention and at one week follow up. ‘Likes’ were delivered through an app. The intervention had no impact on self-esteem or mood. Posting no selfies resulted in a greater improvement in appearance satisfaction over the study compared to posting selfies (regardless of feedback). In contrast, posting selfies with feedback resulted in a greater improvement in face satisfaction during the intervention although this dropped back to baseline by follow up. To conclude the impact of selfies may vary depending upon which outcome variable is measured and when.

Research indicates that brief 2-min positive psychology interventions (PPIs) increase well-being during COVID-19 lockdowns. The present study extended this to assess the effectiveness over two-weeks. Participants (  = 150) were randomly allocated to one of three PPIs; nostalgia, gratitude, best possible self (BPS), or control. The interventions were slightly adapted for the lockdown and were completed three times, every seven days over two-weeks. Well-being measures were completed immediately after the first intervention (T1), after the next two interventions (T2-T3) and at one-week follow-up (T4) (but no baseline measure of well-being was taken). At T1, participants in the nostalgia, gratitude, and BPS intervention had higher self-esteem than those in the control intervention. At T1 and T2, participants in the gratitude and BPS intervention reported higher social connectedness than participants in the nostalgia and control intervention. Then at follow-up (T4), participants in the nostalgia, gratitude, and BPS intervention had lower fear of COVID-19 than those in the control intervention. Overall, the results show the benefits of nostalgia, gratitude and optimism, compared to the control, during lockdown. The online version contains supplementary material available at 10.1007/s10902-022-00513-6.

Objective To undergo the preliminary development of a new measure of patient adaptation to Inflammatory Bowel Disease (IBD): A-IBD. Design Based on a prior conceptualisation of adaptation, a 40-item scale was generated and completed by 304 people diagnosed with IBD. Main outcome measures Psychometric analysis of the measure. Association with the Brief Illness Perception Questionnaire (Brief IPQ) and the Inflammatory Bowel Disease Questionnaire (IBDQ). Results The 18-item scale consisted of four subscales (patient identity, person identity, acceptance, expectations). Weak to moderate correlations were found between subscales of the A-IBD and the Brief IPQ and IBDQ. Conclusion The A-IBD shows potential for assessing adaptation. Further analysis could confirm its usefulness.

Background  The introduction of patient screens for outpatient procedures is becoming increasingly common. To date, the impact on the patient of viewing the screen remains unknown. Objectives  To explore how viewing the screen during a hysteroscopy procedure affects the patient’s experience. Setting  The outpatient clinics at the Royal Surrey Hospital in Guildford and the Royal Infirmary in Bradford. Design  A randomised control trial. Sample  Women undergoing a hysteroscopy procedure were randomly allocated to see the screen (n = 81) or not to see the screen (n = 76). Methods  A quantitative study with measures taken before and after the intervention. Main outcome measures  Pain perception, mood, illness cognitions, communication. Results  Seeing the screen or not had no impact on several measures of pain perception, mood, illness cognitions or communication. However, women who did not see the screen were more optimistic about the effectiveness of their treatment and felt that the health professional was more receptive to them during the consultation compared with those who saw the screen. After controlling for the use of a local anaesthetic, those who did not see the screen also reported a greater decrease in anxiety after the procedure. However, those who saw the screen described pain more positively (i.e. in terms of comfort, reassurance or encouragement) compared with those who did not see the screen. Conclusion  Viewing the screen does not benefit the patient and may interfere with the patient–physician interaction.

Research indicates that eating related problems, body weight and eating habits often start in childhood and track through to adulthood. To date, however, little is known about how children conceptualise food and the factors involved in their decision making processes. This qualitative study aimed to explore children's understanding of food and how this influences their food related decisions. Children (n = 27) aged 9–10 took part in a think-aloud study and voiced their thoughts whilst making different meals and snacks using pictures of food. Data were analysed using thematic analysis which described 3 core themes: i) drivers of food decisions (hunger, health, liking, emotions, availability) ii) sources of these drivers (parents, peers, routine); iii) polarised reasoning whereby food was often dichotomised as good or bad. Transcending these themes was the degree of deliberation whereby children showed decision making as automatic, considered or sanctioned. Finally, overarching their accounts was the notion of the transitioning child with children illustrating the shift between being a passive child whose decisions were made for them and an active child with autonomy and agency. The results illustrate the ways in which children begin to internalise the messages of others as they grow older which they incorporate into their own schema. These messages in turn form part of their heuristic system which enable less sanctioned decisions as children take ownership of their own eating behaviour. The results are discussed in terms of the implications for decision making and a framework for developing interventions.

Objective: As weight loss in primary care remains minimal, Health Professionals are advised to medically manage obesity-related risk factors including blood pressure and cholesterol. This experimental study evaluated the impact of medically managing risk factors on obese patients’ motivation to change their behaviour. Methods: A vignette study with two arms: successful medical management (ie risk factors have improved) vs failed medical management (ie no change) set in three General Practices in the South of England. Overweight and obese patients (n=170) patients rated their behavioural intentions and beliefs after reading a vignette describing an overweight patient who had received either successful or failed medical management of their risk factors (blood pressure and cholesterol). Results: Following successful medical management overweight and obese patients reported increased intentions to lose weight and a greater understanding of their condition. Conclusion: Medical management may change patient’s understanding of their weight problem and motivate them to lose weight. Practice implications: Successful management relating to improvements in blood pressure and cholesterol may offer renewed hope and motivate obese patients to change their behaviour. This could be used as a teachable moment to encourage patients to see that obesity need not be an inevitable part of their lives.

This study explored the predictors of weight loss following orlistat with a focus on both baseline variables and changes in beliefs and behaviours occurring over the course of taking the drug. Patients ( = 5 6 6 ) prescribed orlistat completed a questionnaire at baseline and after 6 months concerning their weight, beliefs and behaviours. By 6 months the majority had lost some weight and showed improvements in diet. Many had also stopped taking the drug and a large minority reported using it flexibly as a lifestyle drug. Those who lost most weight showed a decrease in beliefs in a medical solution, a decrease in unhealthy eating, an increased belief in treatment control and an increased belief that the unpleasant consequences are both due to their eating behaviour and just part of the drug. When taken with fatty food orlistat causes symptoms such as anal leakage and oily stools. These may encourage some patients to focus on the behavioural aspects of their weight problem thus promoting the dietary changes needed for both short and longer term weight loss. When prescribing orlistat, clinicians should encourage patients to see the consequences as an education as a means to promote the effectiveness of this form of medical management.

There has recently been an increased call for the use of more diverse images by the media as a means to promote body satisfaction. The present experimental study evaluated the impact of body diversity images and whether these could act as a buffer against thin-ideal norms. Female participants (n=106, aged 16-30 years) completed measures of body compassion, body and face satisfaction before and after random allocation to images reflecting one of three interventions: control, body diversity and thin-ideal. Attitudes towards thin-ideal images were also assessed. The results showed significant differences between groups for overall body compassion, the body compassion subtype of body kindness, body satisfaction and face satisfaction with those viewing the body diversity images reporting higher scores after exposure compared to the other two groups. Those in the body diversity group also displayed more negative attitudes towards thin-ideal images compared to controls. There were no differences between the groups for body compassion subtypes relating to common humanity, motivated action and body criticism or positive attitudes to the thin-ideal images. In sum, exposure to body diversity images had a positive impact on body kindness and overall body compassion and body satisfaction providing experimental support for the use of diversity images as a buffer against thin-deals.

Aims: To study tobacco advertising in the United Kingdom between 1950-2003 and to evaluate the role of the cigarette box in advertising. Method: Tobacco company advertisements (n=204) were coded for content and meanings used to promote the product. Results: There was a significant shift over time from cigarettes being displayed to the cigarette box only. Changes in advertising and the meanings evoked were unrelated to changes in smoking behaviour. Conclusions: It is argued that the cigarette box has absorbed the meanings associated with smoking and has become an effective vehicle for advertising. It is also argued that this can only be minimised with plain packaging.

Doctors often use a range of euphemisms as a means to facilitate communication in the consultation. The present experimental study aimed to assess whether GPS use or avoid the term 'heart failure' and to evaluate the relative impact of the term 'heart failure' Versus their preferred euphemism on patients' belief's about the illness. This two part study involved a cross sectional Survey of GPs and all experimental Study of patients' beliefs and was based oil one General Practice in a semi-rural area of the UK. For the first part, 42 GPs completed a questionnaire about their preferred terms to describe symptoms of heart failure. The results showed that GPs rated the majority of euphemisms as preferable to the term 'heart failure'. Their preferred euphemism was 'fluid oil your lungs as your heart is not pumping hard enough'. For the second part, 447 patients completed ratings of their beliefs about a condition, which was described its either 'heart failure' or the GPs' preferred euphemism. Patients who received the condition described as 'heart failure' believed that the illness would have more serious consequences for their life. that the problem would be more variable over time and that it would last for longer and reported feeling more anxious and depressed than those who received the condition described using the euphemism. GPs are encouraged to be open with their patients and to respect their experience. The choice of language, therefore, presents a dilemma for doctors. The term 'heart failure' may be in line with the Current climate of openness but may evoke a more negative response from the patient. In contrast, a euphemism may be less open but more protective of the patients experience. This study suggests that the area of heart failure may be one where GPs may chose to compromise openness for the sake of the patient's experience and that this fear of upsetting the patient is well founded. (c) 2004 Elsevier Ireland Ltd. All rights reserved.

This qualitative Think Aloud study explored how Black women (n=32) processed information from a White or Black fashion magazine. Comments to the ‘White’ magazine were characterised by rejection, being critical of the media and ambivalence, whereas they responded to the ‘Black’ magazine with celebration, identification and a search for depth. Transcending these themes was their self identity of being a Black woman which was brought to the fore either by a sense of exclusion (White magazine) or engagement (Black magazine). Such an identity provides resilience against media thin ideals by minimising the processes of social comparison and internalisation.

The present qualitative study aimed to explore how people experience their obesity and to explore the impact of this on their motivations to lose weight. Participants (n = 46) were either currently obese or had been obese and were interviewed about their experiences. Participants described the impact of obesity on aspects of their self-identity and used language such as "ugly", "freak", "hate", "blob", and "disgust" which reflected the pervasively negative impact of their weight. They highlighted a complex and often contradictory relationship with food and described how such negative experiences were created out of the dynamic between their obesity and a stigmatising social context. Some, however, suggested that such stigma could also have positive consequences by promoting and encouraging behaviour change. Many obese people, therefore, experience their weight in profoundly negative ways as a result of existing within a social context which stigmatises their condition. The results are discussed in terms of the costs and benefits of stigma and a balance between support, tolerance, and collusion in promoting weight loss.

Prisons provide an important public health opportunity to improve the health of a hard-to-reach population. However, the prison as a place for health promotion requires greater attention. Using De Certeau’s concept of tactics, semi-structured interviews with 35 young men who had screened as low on an anxiety and depression scale, illustrate how they stitch together discrete tactics to navigate the prison system and mitigate the risks to their health and wellbeing. These involve a process of being vigilant to the cracks in the system whilst appropriating objects and seeking out spaces of comfort. Understanding imprisonment in this nuanced approach provides greater insights into the interplay of health and place with the potential to inform context-relevant practice and policy.

Most quantitative research considers miscarriage a trigger to grief, anxiety and depression. The present qualitative study involved in depth interviews with a heterogeneous sample of 13 women who had experienced a miscarriage up to five weeks previously. The women described their experiences using a range of themes which were conceptualised into three stages: turmoil, adjustment and resolution. For the majority, the turmoil stage was characterised. by feelings of being unprepared and negative emotions. Some women who had had an unwanted pregnancy described their shock at the physical trauma of miscarriage but described the experience as a relief. The women then described a period of adjustment involving social comparisons, sharing and a search for meaning. The latter included a focus on causality which left a minority, particularly those who had had previous miscarriages, feeling frustrated with the absence of a satisfactory medical explanation. The final resolution stage was characterised by a decline in negative emotions, a belief by some that the miscarriage was a learning experience and the integration of the experience into their lives. This resolution seemed more positive for those with children and more negative if the miscarriage was not their first. Rather than being a trigger to psychological morbidity a miscarriage should be conceptualised as a process involving the stages of turmoil, adjustment and resolution. Miscarriage could also be considered a pivotal point in the lives of many women resulting in the reassessment of both their past and future experiences.