Dr Sarah Golding

•During Covid-19 people visited a wide range of nearby places to get away from everyday demands, without needing to travel.•People engaged with a wide range of activities in those places, but many activities were place dependent.•All place visits benefitted hedonic and eudemonic wellbeing, but outdoor activities were more beneficial than indoor activities.•Place and activity choices varied between people. Younger people and those living in urban areas visited less outdoor places.•To support wellbeing for all it is important to identify the variety of nearby places people visit and manage access and provision of such places. Being able to get away from everyday stressors and demands, even if close to home and just for a few minutes, is important for wellbeing. During the Covid-19 lockdown periods, people’s ability to get away changed significantly. An increase in visits to nearby natural places is well documented. Little is known about other types of places people visited to get away. An online UK survey was conducted in 2020 (N = 850) investigating what places people visited to get away during the pandemic, what they did in those places, how place and activity choices were related to each other and to demographic variables, and to recalled hedonic and eudaimonic wellbeing during those visits. Participants visited a rich array of places and engaged in a variety of activities that supported their hedonic and eudaimonic wellbeing needs. Responses were grouped into four types of places (at home outdoors, at home indoors, away from home outdoors, and away from home indoors) and seven activity types (cognitive, walks, nature engagement, social activities, technology use, relaxing, and exercise). Place and activity choices were strongly linked. Visiting outdoor places was most beneficial for wellbeing (and most common), especially when it involved mindful engagement with nature (bird watching, gardening) or exercise. Staying indoors, engaging with technologies (computers, television) was least beneficial and more common among those with no degree or job, living in urban areas, and identifying as male. The findings demonstrate the importance of understanding place-activity interactions to support the wellbeing benefits derived from visits to places to get away.

It is widely understood that nature engagement benefits human wellbeing. Such benefits have been found for real as well as virtual engagements. However, little is known about the role of nature-based videos in social media on wellbeing. With Covid-19 restrictions limiting people's direct engagement with natural environments, this study critically examined people's reactions to nature videos posted on Facebook during the first UK Covid-19 lockdown in 2020. Data consisted of comments on videos containing highlights from the British Broadcasting Corporation's (BBC) Springwatch 2020 television series, and from a UK television presenter and naturalist's (Chris Packham) livestream videos, posted on Facebook from March to July 2020. Looking at the quantitative profile of a range of videos (i.e., views, likes and shares) and a detailed analysis of the 143,265 comments using thematic analysis, 3 major themes were generated: (1) engaging with nature via social media is emotionally complicated, (2) cognitive and reflective reactions are generated from social media nature engagement, and (3) engagement with nature-based social media as a mechanism for coping with stress during Covid-19. These findings inform understanding of how nature-related social media content and associated commentary have supported wellbeing 2 throughout the ongoing pandemic and their importance as a means of continued support for wellbeing.

Organisations have implemented intensive home-based teleworking in response to global COVID-19 lockdowns and other pandemic-related restrictions. Financial pressures are driving organisations to continue intensive teleworking after the pandemic. Understanding employees’ teleworking inclinations post COVID-19, and how these inclinations are influenced by different factors, is important to ensure any future, more permanent changes to teleworking policies are sustainable for both employees and organisations. This study, therefore, investigated the relationships between the context of home-based teleworking during the pandemic (pandemic-teleworking conditions), productivity perceptions during home-based teleworking, and employees’ future teleworking inclinations (FTI) beyond the pandemic. Specifically, the study examined whether pandemic-teleworking conditions related to the job, and the physical and social environments at home, influenced employees’ FTI, and if perceptions of improved or reduced productivity mediated these relationships. Data were collected during April and May 2020 with a cross-sectional online survey of teleworkers ( n = 184) in Germany, Switzerland, the United Kingdom, and other countries during the first COVID-19 lockdowns. Reported FTI were mixed. Most participants (61%) reported wanting to telework more post-pandemic compared to before the pandemic; however, 18% wanted to telework less. Hierarchical multiple regression analysis revealed that some teleworking conditions (job demands and work privacy fit) were positively associated with FTI. Other teleworking conditions (specifically, job change, job control, home office adequacy, and childcare) were not associated with FTI. Perceived changes in productivity mediated the relationship between work privacy fit and FTI. Findings highlight the role of work privacy fit and job demands in influencing pandemic productivity perceptions and teleworking inclinations post-pandemic. Results raise questions about the suitability and sustainability of home-based teleworking for all staff. As organisations plan to increase the proportion of teleworking post-pandemic, this study suggests there is a need to support employees who perceived their productivity to be poor while home-working during the pandemic.

Background: During national lockdowns in response to the COVID-19 pandemic, previously office-based workers who transitioned to home-based teleworking faced additional demands (e.g., childcare, inadequate homeworking spaces) likely resulting in poor work privacy fit. Previous office research suggests poor work privacy fit is associated with lower wellbeing and higher work fatigue. Emerging evidence suggests a relationship between childcare duties during pandemic teleworking and work fatigue. In addition to psychosocial working conditions (job demand, job control, and job change management), which are acknowledged predictors of work fatigue, this poses a significant threat to occupational health during pandemic teleworking. However, the relative effects of aspects of the psychosocial environment (job demands and resources), the home office environment (including privacy fit), and the social environment (childcare) on work fatigue as well as their interactions are under-explored.Objective: This study examined the relationships between the psychosocial, environmental, and social working conditions of teleworking during the first COVID-19 lockdown and work fatigue. Specifically, the study examined teleworkers’ physical work environment (e.g., if and how home office space is shared, crowding, and noise perceptions) as predictors of privacy fit and the relationship between privacy fit, childcare, psychosocial working conditions (job demand, job control, and job change management), and work fatigue. Work privacy fit was hypothesized to mediate the relationship between childcare and work fatigue.Methods: An online cross-sectional survey was conducted with teleworkers (n = 300) during the first COVID-19 lockdown in April and May 2020; most participants were in Germany, Switzerland, and the United Kingdom.Results: Path analysis was used to examine the hypothesized relationships. Privacy fit was lower for those reporting greater levels of noise in home-working spaces and those feeling crowded at home. Work fatigue was lower amongst those with greater privacy fit and higher amongst those with high levels of job demand. An indirect relationship was observed between childcare and work fatigue with privacy fit mediating this relationship.Conclusion: The influence of privacy fit has so far been largely neglected in research on teleworking, especially during the pandemic. However, its contribution to workers’ wellbeing should be acknowledged in occupational health strategies.

This systematic review and intervention content analysis used behavioural science frameworks to characterise content and function of interventions targeting supermarket shoppers' purchasing behaviour, and explore if coherence between content and function was linked to intervention effectiveness. Study eligibility: in-store interventions (physical supermarkets) with control conditions, targeting objectively measured food and/or non-alcoholic drink purchases, published in English (no date restrictions). Eleven electronic databases were searched; reference lists of systematic reviews were hand-searched. Methodological quality was assessed using the GATE checklist. A content analysis was performed to characterise intervention content and function, and theoretical coherence between these, using the Behaviour Change Wheel, Behaviour Change Techniques Taxonomy, and Typology of Interventions in Proximal Physical Micro-Environments (TIPPME). Forty-six articles (49 interventions) met inclusion criteria; 26 articles (32 interventions) were included in the content analysis. Twenty behaviour change techniques (BCTs), and four TIPPME intervention types were identified; three BCTs ('Prompts/cues', 'Material incentive', and 'Material reward') were more common in effective interventions. Nineteen interventions solely employed theoretically appropriate BCTs. Theoretical coherence between BCTs and intervention functions was more common in effective interventions. Effective interventions included price promotions and/or in-store merchandising. Future research should explore the effect of specific BCTs using factorial study designs. PROSPERO Registration: CRD42017071065.

Navigating the Guiding Principles: The Guiding Principles are intended to act both as a guide to core ACCESS activity (in a non-prescriptive way) and as inspiration for the wider Environmental Social Science research, policy and practice communities. We anticipate the Guiding Principles will be developed over time as we receive input from others and reflect upon and learn from our own experiences within ACCESS. These pages – which are not intended to be exhaustive in terms of resources and encouraged actions – have 5 main sections: 1. An Introduction to ACCESS’s three Guiding Principles: Environmental Sustainability (ES); Equality, Diversity and Inclusion (EDI); and Knowledge Co-Production (KCP) 2. An outline of the Core Elements of each of the three Guiding Principles 3. Principles into Practice – a guide through the process of how and when to operationalise and incorporate ES, EDI, and KCP considerations into your ACCESS activities 4. Signposts to Further Resources for each of the three Guiding Principles 5. Activity Matrices – an outline of how the Guiding Principles can be applied to key activities that colleagues and partners undertake across ACCESS, with a range of suggested considerations and encouraged actions for each principle. We have identified nine key activities or areas of work to specifically address (although the focus on these key work areas does not preclude the Guiding Principles from being applied to other activities conducted across ACCESS). These core work areas are: I. Internal meetings II. Workshops and Events III. Communication 5 IV. Working Groups V. Recruitment (employees; participants at ‘applied for’ events) VI. Flex Fund Administration VII. Externally-facing training VIII. People development within ACCESS IX. Research Activities

During June 2022, ACCESS held its first Annual Assembly. The Assembly had several objectives, including bringing together a range of partners from different sectors, providing an opportunity for networking early in the project, and enabling discussions around the aims of ACCESS. The Assembly also provided an early opportunity for the Guiding Principles Team to 1) embed principles of Environmental Sustainability, Knowledge Co-Production, and EDI within the Assembly, and 2) use the event as a reflection and benchmarking moment early in the life of ACCESS to inform the ongoing development of the Guiding Principles Charter.

A key objective of ACCESS is to ‘contribute to scoping future transformative social science and interdisciplinary research within the area of climate and environment that draws on diverse stakeholder perspectives to ensure strategic research outcomes that make a difference’. As part of this objective ACCESS has provided input into the Economic and Social Research Council’s (ESRC) environmental priorities. This report presents the outcomes of two horizon scanning or scoping projects carried out by the ACCESS team for the ESRC in the spring and summer of 2022. Alongside other scoping activities organised by ESRC, these ACCESS activities helped shape a call for research funding published by ESRC early 2023, focusing on a place theme. Phase I ‘Net Zero, Environment, biodiversity and climate change’ is a priority area within ESRC’s three-year Delivery Plan for 2022 (in draft at the time of Phase I but now published). On 5 May 2022, ESRC presented to ESRC Council on plans and priorities within this thematic area. ACCESS provided input to help ESRC develop the thematic priorities. This was done by drawing on key themes drawn from a rapid review of existing citizen assemblies and a short survey among ACCESS experts. A report was presented to ESRC in March 2022, which resulted in the reordering of the thematic priorities, some rewording of the text and the addition of a potential cross-cutting theme. Phase II Following feedback from Council and confirmation of spending review allocations, ESRC aimed to refine ideas through wider consultation with the academic community and stakeholders to further develop the core themes of the research programmes. ACCESS was asked to provide further input to assist with the refinement of the place-based research theme that was taken forward. ACCESS developed a short survey and carried out a focus group discussion with key stakeholders. Phase II activities highlighted the key importance and challenges of co-production in research on place-based solutions. Amongst others. it suggested research should address important issues around social inequalities, consider place-based approaches at different scales, support novel methods to generate new data and be based on well-designed co-production approaches to produce usable tangible outcomes and support new ways of thinking and doing.

Exposure to natural environments has been shown to have beneficial effects on mood. Rumination is a thinking style associated with negative mood, and sometimes depression, and is characterized by repetitive, intrusive thoughts, often with a negative emotional element. This study investigated whether exposure to nature, operationalized using photographs presented as a slideshow, could aid reduction in levels of state rumination. An experimental, within-between (Time x Condition) participant design was used; participants (n = 58) undertook a presentation task designed to induce rumination and influence mood. Participants were then randomly allocated to either: watch a slideshow of a natural environment, watch a slideshow of an urban environment, or wait patiently with no distractions. Data were collected at baseline, after the presentation, and after the slideshow. Environmental exposure had no effect on levels of rumination or negative mood, but did have a significant effect on levels of positive mood, ‘being away’, and ‘fascination’. Positive mood declined in those who saw the urban slideshow, but remained the same in those who saw the nature slideshow, whilst levels of being away and fascination were highest in those who saw the nature slideshow. This study extends previous restorative environment research by exploring the effects of nature on rumination.

Despite successful efforts to reduce Meticillin Resistant Staphylococcus aureus bloodstream infections (BSI) and Clostridium difficile infection, Gram-negative BSI (GNBSI) have continued to increase in England. Public Health England (PHE) and NHS Improvement (NHSI) were tasked by the Minister for Health to lead the development of tools and resources to support healthcare workers to reduce these infections. To work with commissioners and providers of healthcare to collaboratively develop resources to support whole health economies to reduce GNBSI using a combination of behavioural insights and quality improvement methods. We took a unique approach to develop these tools and resources using a combination of behavioural insights, quality improvement and front-line collaboration to ensure the tools and resources were designed around the needs of those who would use them. The approach taken was a stepwise iterative process in two distinct phases: a development phase and a testing phase. Both phases used a combination of behavioural insights, human factors, quality improvement and co-production methods to engage stakeholders in co-designing resources that would support them in their work to reduce GNBSI. During the development phase, feedback from workshops and stakeholder reviews indicated that tools needed to be reduced, simplified, and communicated clearly. Stakeholders wanted tools that could be used by a cross-system group and indicated that leadership was key to ensuring resources were adopted to drive improvements. The final tools were published on the NHS Improvement GNBSI hub. This electronic platform had 30,000 visits between May 2017 and October 2018.

Background. The study objective was to investigate and synthesize available evidence relating to the psychological health of Emergency Dispatch Centre (EDC) operatives, and to identify key stressors experienced by EDC operatives. Methods. Eight electronic databases (Embase, PubMed, Medline, CINAHL, PsycInfo, PsycArticles, The Psychology and Behavioural Sciences Collection, and Google Scholar) were searched. All study designs were included, and no date limits were set. Studies were included if they were published in English, and explored the psychological health of any EDC operatives, across fire, police, and emergency medical services. Studies were excluded if they related solely to other emergency workers, such as police officers or paramedics. Methodological quality of included studies was assessed using checklists adapted from the Critical Appraisal Skills Programme. A narrative synthesis was conducted, using thematic analysis. Results. A total of 16 articles were included in the review. Two overarching themes were identified during the narrative synthesis: `Organisational and Operational Factors' and `Interactions with Others'. Stressors identified included being exposed to traumatic calls, lacking control over high workload, and working in under-resourced and pres- sured environments. Lack of support from management and providing an emotionally demanding service were additional sources of stress. Peer support and social support from friends and family were helpful in managing work-related stress. Discussion. EDC operatives experience stress as a result of their work, which appears to be related to negative psychological health outcomes. Future research should explore the long-term effects of this stress, and the potential for workplace interventions to alleviate the negative impacts on psychological health.

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.

Background: The demand for organ donation is increasing worldwide. One possible way of increasing the pool of potential posthumous donors is to encourage more members of the general public to join an organ donor registry. Objective: A systematic review was conducted to investigate the effectiveness of psychological interventions designed to increase the number of individuals in the community who register as organ donors. Methods: PsycINFO and PubMed databases were searched. No date limits were set. Randomized and non-randomized controlled trials exploring the effects of community-based interventions on organ donor registration rates were included. Methodological quality was assessed using the ‘Quality Assessment Tool for Quantitative Studies’. Results: 24 studies met the inclusion criteria; 19 studies found a positive intervention effect on registration. Only eight studies were assessed as having reasonable methodological robustness. A narrative synthesis was conducted. Factors influencing registration rates include providing an immediate registration opportunity and using brief interventions to challenge misconceptions and concerns about organ donation. Discussion: Community based interventions can be effective at increasing organ donor registrations amongst the general public. Factors that may increase effectiveness include brief interventions to address concerns, and providing an immediate registration opportunity. Particular consideration should be paid to the fidelity of intervention delivery.

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.

Research shows that gardens are important for wellbeing. To examine garden use and wellbeing during the first Covid-19 lockdown, a sample of 850 UK respondents were asked to recall their experiences and use of their home gardens between March and May 2020. Key findings include: • Gardens were used frequently during the lockdown, with around 60% visiting their garden at least once a day. • Gardens were used more frequently than other natural environments during lockdown. • More frequent garden visits were associated with better wellbeing. • But more than 1 in 10 either had no access to a garden, or found it difficult to access one. • Ethnic minorities and those with a low household income were more likely to have no garden access or find access difficult. • Younger respondents were more likely to have difficult or no garden access than older respondents, with those under 47 years of age reporting the greatest difficulties. • The more nature in the garden, the greater the wellbeing of respondents. • Certain aspects of nature were particularly associated with improved wellbeing: natural sounds and smells, and animals, birds and insects. • Respondents did multiple activities in their gardens, with 43% gardening, 27% spending time resting, sitting and lying down, 21% reading, 14% watching and feeding nature, 13% listening to music, radio and podcasts, and 11% enjoying the weather.

Benign prostatic hyperplasia (BPH) is a common condition amongst older men and is associated with lower urinary tract symptoms and erectile dysfunction; these symptoms can be burdensome and negatively affect quality of life. Various surgical and pharmaceutical treatment options exist but there is a paucity of qualitative research exploring men's decision-making when seeking BPH treatment. This study qualitatively explored men's experience of living with BPH and seeking treatment for BPH. Twenty men (aged 52-75) were recruited from outpatient urology clinics at a hospital trust in Southern England. Data were collected using semi-structured interviews (via video or telephone call) and were audio-recorded; transcripts were analysed using thematic analysis. Four themes were generated: 'Impacts are about more than just physical symptoms', 'The path towards treatment', 'The process of information gathering' and 'Navigating hopes, fears and uncertainty'. Results indicate most men appear to seek treatment for BPH following a gradual, and sometimes lengthy, period of deterioration in symptoms; for some men, however, treatment seeking follows an acute episode of sudden or severe symptoms. The decision to proceed with surgical or minimally invasive treatment options appears to be dependent on men reaching a tipping point; they no longer perceive their symptoms as tolerable and feel their ability to cope with symptoms is reduced. Men each bring their own set of concerns and preferences about side effects and risk-benefit profiles of different treatments. Clinicians need to be sensitive to these individual differences and incorporate them into shared decision-making for choosing between treatment options for BPH.

Objective Most current Misophonia scales are not validated, do not include both emotional and physiological responses to triggers, and/or focus only on auditory triggers. This research aimed to develop and validate a measure of the magnitude of the Misophonic response that addressed these omissions. Method Three studies were carried out with individuals with self-diagnosed Misophonia. In study 1, expert opinion and participants commented on initial items to determine both face and content validity. In study 2, scale structure, reliability, and convergent and discriminant validity were determined using correlations, principal component analysis (PCA), and reliability analysis. In study 3, factor structure was confirmed in another sample of participants using confirmatory factor analysis (CFA). Results The final 22-item scale assesses the magnitude of responses to triggers across any sensory modality. There are three subscales (emotional, physiological, and participation in life), with three additional items measuring frequency of triggers, avoidance of triggers, and time taken to recover from the triggers. The final scale showed suitable discriminant and convergent validity, with good internal consistency (Cronbach's alphas range 0.77 to 0.89). The three-component solution extracted using PCA explained 53.97% of variance, with all items loading between 0.45 and 0.84. The structure was confirmed with CFA (χ2 = 269.01, p < .001; CFI = 0.96; TLI = 0.96 and RMSEA = 0.045 (CI 0.037–0.053). Conclusion The Misophonia Response Scale, which is valid and reliable, will facilitate understanding of Misophonia as it is short and easy to use for self-report in research.

Online supermarket platforms present an opportunity for encouraging healthier consumer purchases. A parallel, double-blind randomised controlled trial tested whether promoting healthier products (e.g. lower fat and lower calorie) on the Sainsbury's online supermarket platform would increase purchases of those products. Participants were Nectar loyalty membership scheme cardholders who shopped online with Sainsbury's between 20th September and 10th October 2017. Intervention arm customers saw advertisement banners and recipe ingredient lists containing healthier versions of the products presented in control arm banners and ingredient lists. The primary outcome measure was purchases of healthier products. Additional outcome measures were banner clicks, purchases of standard products, overall purchases and energy (kcal) purchased. Sample sizes were small due to customers navigating the website differently than expected. The intervention encouraged purchases of some promoted healthier products (spaghetti [B = 2.10, p < 0.001], spaghetti sauce [B = 2.06, p < 0.001], spaghetti cheese [B = 2.45, p = 0.001], sour cream [B = 2.52, p < 0.001], fajita wraps [B = 2.10, p < 0.001], fajita cheese [B = 1.19, p < 0.001], bakery aisle products (B = 3.05, p = 0.003) and cola aisle products [B = 0.97, p < 0.002]) but not others (spaghetti mince, or products in the yogurt and ice cream aisles). There was little evidence of effects on banner clicks and energy purchased. Small sample sizes may affect the robustness of these findings. We discuss the benefits of collaborating to share expertise and implement a trial in a live commercial environment, alongside key learnings for future collaborative research in similar contexts.

In the United Kingdom, blanket antibiotic dry cow therapy (BDCT) is commonly prescribed. An alternate strategy is selective dry cow therapy (SDCT) whereby a teat sealant is given instead of an antibiotic to cows with a low probability of infection. Switching from BDCT to SDCT can significantly reduce antibiotic use. The aims of this study were to explore how veterinarians (vets) rationalized their prescribing decisions for mammary treatments at drying off, and the barriers and motivators they perceived to implementing SDCT. Face-to-face interviews were conducted with 20 purposively recruited vets from 6 practices in England, United Kingdom. The data were analyzed qualitatively using an inductive thematic analysis. The majority of participants stated a personal preference for SDCT because it constitutes more responsible antibiotic use. On the majority of farms, the prescribing decision was taken by a senior veterinarian and BDCT was prescribed. Less experienced vets expressed a desire to be more involved in the decision-making process. The first theme, prioritizing responsible antimicrobial prescribing, encapsulated the difficulties vets expressed engaging with farmers, conflicts of interest, and vets’ determination to take action. The second theme, the effect of a vet's experience on their ability to influence farmers, focused on the specific challenges faced by less experienced vets and the importance of vets being both trusted by farmers and being knowledgeable. The third theme, vets’ perceptions about the risk and complexity of implementing SDCT, revealed markedly different levels of concern and fears about adverse outcomes with teat sealants versus antibiotics. The results also showed differences in perceptions about how difficult SDCT is to implement in practice. The last theme, vets’ suggestions for facilitating the introduction of SDCT, was wide ranging and provided useful insight from a veterinary perspective into ways to facilitate SDCT. Initiatives that seek to alter vets’ perceptions of the risks associated with switching to using SDCT are likely to prove useful in facilitating change. Our results also suggest that it is vital for senior vets to take a leading role in facilitating farms to implement SDCT. Less experienced colleagues may benefit from more help from senior vets to gain the trust of farmers and to become involved more quickly in herd-level preventive medicine. Vets must work together and take a united approach to reduce antimicrobial use.

Breastfeeding has many known benefits, but rates vary globally. We propose two main reasons why psychological theory and interventions have not been successful to date in explaining breastfeeding behaviours. Specifically, prior research underestimates the importance of (1) specific emotions and (2) wider injunctive influences (i.e., societal and moral norms about what women feel they ought to be doing) in the breastfeeding experience. Therefore, we conducted a systematic review of quantitative, qualitative, and mixed-methods studies that explored whether injunctive norms and/ or specific emotions are associated with breastfeeding behaviours (i.e., intentions, initiation and duration). Seventy-two papers were included in this review; data were extracted and quality appraisals conducted for all included studies. A meta-analysis of effect sizes was performed with the quantitative data. A convergent qualitative synthesis of the data was conducted, resulting in the following line of argument: Breastfeeding is a social behaviour and not a personal/individual behaviour. From this line of argument, three themes with associated sub-themes were developed, highlighting the importance of both specific emotions and injunctive norms on breastfeeding behaviours. These influences are discussed in relation to both theoretical and practical implications, as well as future research.

Understanding antibiotic prescription patterns and non-clinical factors influencing antibiotic use is essential for implementing strategies to promote appropriate antibiotic use. There is, however, limited research exploring these issues with Ecuadorian veterinarians. Therefore, a questionnaire was developed and applied cross-sectionally to veterinarians (n = 173) from two professional organizations to explore the antibiotic prescription patterns and non-clinical factors (e.g., attitudes and perceptions) influencing antibiotic use, and to identify strategies to reduce antibiotic use. The response rate was 78.4%. Responses were compared between veterinarians working mainly on cattle and poultry farms using Mann-Whitney U tests. The most important attitudes, beliefs and perceptions towards antimicrobial resistance (AMR) and antibiotic use were identified with the Relative Importance Index (RII). Veterinarians showed high awareness of AMR and its implications for public health, as well as the necessity of reducing antibiotic use. However, some veterinarians appear to underestimate the potential contribution of veterinary antibiotic use on AMR in humans. Veterinarians self-reported high prescription (> 20%) of antibiotics for cattle and poultry that are critically important for human medicine, such as 3rd and 4th generation cephalosporins, polymyxins and quinolones. Further, antibiotic therapy was not tailored to disease type. Cattle and poultry veterinarians perceived similar barriers to increasing antibiotic stewardship including: poor biosecurity measures, animal confinement, low feed quality, farmers’ behaviors (such as stopping antibiotic treatment, storing antibiotics on farms, buying antibiotics in veterinary supply stores), and sales agents’ roles as non-professional prescribers of antibiotics. Overall, veterinarians were broadly supportive (>90%) of most strategies to promote appropriate antibiotic use. They saw more merit in improving biosecurity of farms and implementing educational programs for farmers and veterinarians. This study provides insight into the complexity of antibiotic use on Ecuadorian farms and the need for holistic strategies in a One Health context, to achieve antibiotic stewardship. •Ecuadorian veterinarians were aware of AMR and its implication for public health.•Over 20% of veterinarians’ prescriptions were for clinically important antibiotics.•Perceived barriers to appropriate use include farmer attitude and poor biosecurity.•Cattle and poultry veterinarians were supportive of proposed stewardship strategies.•Collaborative strategies are needed for antibiotic stewardship on Ecuadorian farms.

Antimicrobial resistance (AMR) represents a major threat to public and animal health, and inappropriate antimicrobial prescribing by doctors and vets is an important contributing factor to increasing rates of AMR. This study used vignettes, which are an under-utilised method in veterinary medicine research, to examine differences between farm vets' ideal' antibiotic prescribing and their 'real-world' experiences of antibiotic prescribing. Vets attending the British Cattle Veterinary Association Annual Congress (n = 16) were presented with seven clinical scenarios relating to ailments in cattle and were asked to consider how likely they would be to prescribe antibiotics in each scenario, once in an 'ideal, text-book' situation, and once in a 'real -world' situation. Across all seven scenarios, participants reported being more likely to prescribe antibiotics in the 'real -world' situation compared to the 'ideal, text-book' situation. These results, based on the vignettes, support the hypothesis that farm vets' everyday patterns of antibiotic prescribing are different from their ideals for antibiotic prescribing. It is recommended that further research is required to better understand how non -clinical factors influence vets' prescribing decisions, in order to develop effective antimicrobial stewardship interventions that can help support vets to more frequently prescribe in line with stewardship ideals.

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.