Publications by authors named "Madelynne A Arden"

34 Publications

Learning from previous lockdown measures and minimising harmful biopsychosocial consequences as they end: A systematic review.

J Glob Health 2021 May 22;11:05008. Epub 2021 May 22.

Manchester Centre for Health Psychology, The University of Manchester, Manchester, UK.

Background: Infectious outbreaks, most recently coronavirus disease 2019 (COVID-19), have required pervasive public health strategies, termed lockdown measures, including quarantine, social distancing, and closure of workplaces and educational establishments. Although evidence analysing immediate effects is expanding, repercussions following lockdown measures remain poorly understood. This systematic review aims to analyse biopsychosocial consequences after lockdown measures end according to short, medium, and long-term impacts.

Methods: PubMed, Ovid MEDLINE, Embase, PsycInfo, Web of Science, and Scopus databases were searched from inception to January 12, 2021. Reference lists were manually reviewed. Eligible studies analysed biopsychosocial functioning after lockdown measures secondary to recent infectious outbreaks ended. Lockdown measures were defined as quarantine, isolation, workplace or educational closures, social or physical distancing, and national or local closure of public institutions deemed non-essential. Studies exclusively researching outcomes during lockdown measures, examined infectious participants, or analysed lockdown measures not pertaining to an infectious outbreak were excluded. Two independent reviewers extracted data and assessed bias with a third resolving discrepancies. Data was extracted from published reports with further information requested from authors where necessary. The mixed methods appraisal tool assessed study quality, languages were restricted to English, German, Italian, and French and narrative synthesis was applied.

Results: Of 5149 identified studies, 40 were eligible for inclusion. Psychological distress, economic repercussions, social, biological, and behavioural ramifications were observed. Short to medium-term effects comprised reactions relating to early trauma processing whereas medium to long-term repercussions manifested in maladaptive behaviours and mental health deterioration. Increased alcohol intake, stigmatisation, and economic effects were also identified consequences. High-risk groups included health care workers, children, elderly, inpatients, those with pre-existing psychiatric diagnoses, and socially isolated individuals.

Conclusions: Supporting vulnerable groups and offering education, workplace modifications, financial, and social assistance may mitigate negative repercussions. Establishing a rapid and comprehensive evidence base appraising the efficacy of such interventions and identifying areas for development is essential. This review was limited by study heterogeneity and lack of randomisation in available literature. Given the unprecedented nature and progression of COVID-19, the relevance of previous outcomes remains uncertain.

Protocol Registration: PROSPERO registration CRD42020181134.
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http://dx.doi.org/10.7189/jogh.11.05008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8141332PMC
May 2021

The impact of COVID-19 on health behaviour, well-being, and long-term physical health.

Br J Health Psychol 2021 05 31;26(2):259-270. Epub 2021 Mar 31.

Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.

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http://dx.doi.org/10.1111/bjhp.12520DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8250322PMC
May 2021

The development of a theory and evidence-based intervention to aid implementation of exercise into the prostate cancer care pathway with a focus on healthcare professional behaviour, the STAMINA trial.

BMC Health Serv Res 2021 Mar 25;21(1):273. Epub 2021 Mar 25.

Institute for Population Health Sciences, Queen Mary, University of London, London, UK.

Background: Twice-weekly supervised aerobic and resistance exercise for 12 weeks reduces fatigue and improves quality of life in men on Androgen Deprivation Therapy for prostate cancer. Despite the National Institute for Health and Care Excellence (NICE) proposing this as standard of care, it does not routinely take place in practice. Healthcare professionals are in a prime position to deliver and integrate these recommendations. A change in the behaviour of clinical teams is therefore required. In this paper, we describe the development of a training package for healthcare professionals using theory and evidence to promote delivery of such recommendations as standard care.

Methods: The intervention development process was guided by the Medical Research Council guidance for complex interventions and the Behaviour Change Wheel. Target behaviours were identified from the literature and thirty-five prostate cancer care healthcare professionals (including oncologists, consultant urologists, clinical nurse specialists, physiotherapists, general practitioners and commissioners) were interviewed to understand influences on these behaviours. The Theoretical Domains Framework was used to identify theoretical constructs for change. Behaviour change techniques were selected based on theory and evidence and were translated into intervention content. The intervention was refined with the input of stakeholders including healthcare professionals, patients, and exercise professionals in the form of rehearsal deliveries, focus groups and a workshop.

Results: Seven modifiable healthcare professional target behaviours were identified to support the delivery of the NICE recommendations including identifying eligible patients suitable for exercise, recommending exercise, providing information, exercise referral, providing support and interpret and feedback on progress. Ten domains from the Theoretical Domain's Framework were identified as necessary for change, including improving knowledge and skills, addressing beliefs about consequences, and targeting social influences. These were targeted through twenty-two behaviour change techniques delivered in a half-day, interactive training package. Based on initial feedback from stakeholders, the intervention was refined in preparation for evaluation.

Conclusions: We designed an intervention based on theory, evidence, and stakeholder feedback to promote and support the delivery of NICE recommendations. Future work will aim to test this training package in a multi-centre randomised trial. If proven effective, the development and training package will provide a template for replication in other clinical populations, where exercise has proven efficacy but is insufficiently implemented.
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http://dx.doi.org/10.1186/s12913-021-06266-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7992804PMC
March 2021

Feasibility study for supporting medication adherence for adults with cystic fibrosis: mixed-methods process evaluation.

BMJ Open 2020 10 27;10(10):e039089. Epub 2020 Oct 27.

School of Health and Related Research, University of Sheffield, Sheffield, UK.

Objectives: To undertake a process evaluation of an adherence support intervention for people with cystic fibrosis (PWCF), to assess its feasibility and acceptability.

Setting: Two UK cystic fibrosis (CF) units.

Participants: Fourteen adult PWCF; three professionals delivering adherence support ('interventionists'); five multi-disciplinary CF team members.

Interventions: Nebuliser with data recording and transfer capability, linked to a software platform, and strategies to support adherence to nebulised treatments facilitated by interventionists over 5 months (± 1 month).

Primary And Secondary Measures: Feasibility and acceptability of the intervention, assessed through semistructured interviews, questionnaires, fidelity assessments and click analytics.

Results: Interventionists were complimentary about the intervention and training. Key barriers to intervention feasibility and acceptability were identified. Interventionists had difficulty finding clinic space and time in normal working hours to conduct review visits. As a result, fewer than expected intervention visits were conducted and interviews indicated this may explain low adherence in some intervention arm participants. Adherence levels appeared to be >100% for some patients, due to inaccurate prescription data, particularly in patients with complex treatment regimens. Flatlines in adherence data at the start of the study were linked to device connectivity problems. Content and delivery quality fidelity were 100% and 60%-92%, respectively, indicating that interventionists needed to focus more on intervention 'active ingredients' during sessions.

Conclusions: The process evaluation led to 14 key changes to intervention procedures to overcome barriers to intervention success. With the identified changes, it is feasible and acceptable to support medication adherence with this intervention.

Trial Registration Number: ISRCTN13076797; Results.
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http://dx.doi.org/10.1136/bmjopen-2020-039089DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7592300PMC
October 2020

The vital role of health psychology in the response to COVID-19.

Br J Health Psychol 2020 11;25(4):831-838

Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.

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http://dx.doi.org/10.1111/bjhp.12484DOI Listing
November 2020

Mechanisms of Action of a Web-Based Intervention With Health Professional Support to Increase Adherence to Nebulizer Treatments in Adults With Cystic Fibrosis: Qualitative Interview Study.

J Med Internet Res 2020 10 6;22(10):e16782. Epub 2020 Oct 6.

Sheffield Adult CF Centre, Sheffield Teaching Hospitals, Sheffield, United Kingdom.

Background: Adherence to nebulizer treatments in adults with cystic fibrosis (CF) is often low. A new complex intervention to help adults with CF increase their adherence to nebulizer treatments was tested in a pilot randomized controlled trial (RCT) in 2 UK CF centers. Patients used a nebulizer with electronic monitoring capabilities that transferred data automatically to a digital platform (CFHealthHub) to monitor adherence over time and to a tailored website to display graphs of adherence data and educational and problem-solving information about adherence. A trained interventionist helped patients identify ways to increase their adherence.

Objective: This study aims to explore the mechanisms of action underpinning the intervention.

Methods: A qualitative interview study was conducted concurrently with a pilot RCT. In total, 25 semistructured interviews were conducted with 3 interventionists at 2 time points, 14 patients in the intervention arm of the trial, and 5 members of the multidisciplinary teams offering wider care to patients. A framework approach was used for the analysis.

Results: The intervention was informed by a theoretical framework of behavior change. There was evidence of the expected behavior change mechanisms of action. There was also evidence of additional mechanisms of action associated with effective telehealth interventions for self-management support: relationships, visibility, and fit. Patients described how building a relationship with the interventionist through face-to-face visits with someone who cared about them and their progress helped them to consider ways of increasing adherence to medication. Rather than seeing the visibility of adherence data to clinicians as problematic, patients found this motivating, particularly if they received praise about progress made. The intervention was tailored to individuals, but there were challenges in how the intervention fitted into some patients' busy lives when delivered through a desktop computer.

Conclusions: The mechanisms of action associated with effective telehealth interventions for self-management operated within this new intervention. The intervention was modified to strengthen mechanisms of action based on these findings, for example, delivery through an app accessed via mobile phones and then tested in an RCT in 19 UK CF centers.

Trial Registration: International Standard Randomized Controlled Trial Number 13076797; http://www.isrctn.com/ISRCTN13076797.
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http://dx.doi.org/10.2196/16782DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7576463PMC
October 2020

Health psychology and the coronavirus (COVID-19) global pandemic: A call for research.

Br J Health Psychol 2020 05 30;25(2):231-232. Epub 2020 Mar 30.

Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.

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http://dx.doi.org/10.1111/bjhp.12414DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7228384PMC
May 2020

Enhancing the quality and transparency of qualitative research methods in health psychology.

Br J Health Psychol 2019 11;24(4):739-745

Centre for Behavioural Science and Applied Psychology, Sheffield Hallam University, UK.

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http://dx.doi.org/10.1111/bjhp.12393DOI Listing
November 2019

When Is Forgetting Not Forgetting? A Discursive Analysis of Differences in Forgetting Talk Between Adults With Cystic Fibrosis With Different Levels of Adherence to Nebulizer Treatments.

Qual Health Res 2019 12 13;29(14):2119-2131. Epub 2019 Jul 13.

Sheffield Teaching Hospitals, Sheffield, United Kingdom.

Forgetting is often cited as a reason why people struggle to adhere to treatments for chronic conditions. Interventions have tried to improve forgetting behavior using reminders. We used a discursive psychological approach to explore differences in how high and low adherers constructed forgetting their nebulizer treatments for cystic fibrosis. Interviews were conducted with 18 adults from a cystic fibrosis center in the United Kingdom. High adherers constructed forgetting treatments as occasional lapses in automaticity and temporary lapses in memory that they found easy to repair. Low adherers utilized forgetting to normalize more consistent nonadherence to treatments. However, it is important to contextualize forgetting as a discursive resource that helped these participants to negotiate moral discourses around adherence to treatment that reminder interventions cannot address; we therefore recommend a more behavioral, patient-focused, theory-driven approach to intervention development.
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http://dx.doi.org/10.1177/1049732319856580DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7322938PMC
December 2019

Supporting medication adherence for adults with cystic fibrosis: a randomised feasibility study.

BMC Pulm Med 2019 Apr 11;19(1):77. Epub 2019 Apr 11.

Sheffield Adult Cystic Fibrosis Unit Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK.

Background: Preventative medication reduces hospitalisations in people with cystic fibrosis (PWCF) but adherence is poor. We assessed the feasibility of a randomised controlled trial of a complex intervention, which combines display of real time adherence data and behaviour change techniques.

Methods: Design: Pilot, open-label, parallel-group RCT with concurrent semi-structured interviews.

Participants: PWCF at two Cystic Fibrosis (CF) units. Eligible: aged 16 or older; on the CF registry. Ineligible: post-lung transplant or on the active list; unable to consent; using dry powder inhalers.

Interventions: Central randomisation on a 1:1 allocation to: (1) intervention, linking nebuliser use with data recording and transfer capability to a software platform, and behavioural strategies to support self-management delivered by trained interventionists (n = 32); or, (2) control, typically face-to-face meetings every 3 months with CF team (n = 32).

Outcomes: RCT feasibility defined as: recruitment of ≥ 48 participants (75% of target) in four months (pilot primary outcome); valid exacerbation data available for ≥ 85% of those randomised (future RCT primary outcome); change in % medication adherence; FEV percent predicted (key secondaries in future RCT); and perceptions of trial procedures, in semi-structured interviews with intervention (n = 14) and control (n = 5) participants, interventionists (n = 3) and CF team members (n = 5).

Results: The pilot trial recruited to target, randomising 33 to intervention and 31 to control in the four-month period, June-September 2016. At study completion (30th April 2017), 60 (94%; Intervention = 32, Control =28) participants contributed good quality exacerbation data (intervention: 35 exacerbations; control: 25 exacerbation). The mean change in adherence and baseline-adjusted FEV percent predicted were higher in the intervention arm by 10% (95% CI: -5.2 to 25.2) and 5% (95% CI -2 to 12%) respectively. Five serious adverse events occurred, none related to the intervention. The mean change in adherence was 10% (95% CI: -5.2 to 25.2), greater in the intervention arm. Interventionists delivered insufficient numbers of review sessions due to concentration on participant recruitment. This left interventionists insufficient time for key intervention procedures. A total of 10 key changes that were made to RCT procedures are summarised.

Conclusions: With improved research processes and lower monthly participant recruitment targets, a full-scale trial is feasible.

Trial Registration: ISRCTN13076797 . Prospectively registered on 07/06/2016.
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http://dx.doi.org/10.1186/s12890-019-0834-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6458785PMC
April 2019

Adherence to medication in adults with Cystic Fibrosis: An investigation using objective adherence data and the Theoretical Domains Framework.

Br J Health Psychol 2019 05 1;24(2):357-380. Epub 2019 Mar 1.

School of Health and Related Research (ScHARR), University of Sheffield, UK.

Objectives: Adherence to nebulizer treatment in adults with Cystic Fibrosis (CF) is poor, and interventions are needed. This research aimed to identify the factors affecting nebulizer adherence using the Theoretical Domains Framework (TDF) and to compare these for participants with different levels of adherence.

Design: Data-prompted interviews using the TDF.

Methods: Eighteen semi-structured interviews were conducted with adults with CF during which objectively measured adherence data were discussed. Framework analysis was used to code the data into TDF domains, and inductive qualitative content analysis was used to code different beliefs and experiences. Aspects of the TDF that differed between participants with different adherence levels were explored.

Results: Factors influencing adherence to treatment included all 14 domains of the TDF, 10 of which appeared to vary by adherence level: Skills; Memory and decision-making; and Behavioural regulation; Environmental context and resources; Social influences; Beliefs about consequences; Beliefs about capability; Reinforcement; Social role and identify; Intentions; Optimism; and Emotions.

Conclusions: This study is the first to use objectively measured adherence data in a data-prompted interview using the TDF framework to systematically assess the full range of factors potentially influencing adherence. The results highlighted that interventions need to consider issues of capability, opportunity, and motivation. Interventions that challenge dysfunctional beliefs about adherence and which support the development of routines or habits and problem-solving may be particularly useful for adults with CF. Statement of contribution What is already known? Adherence to medication in adults with cystic fibrosis is poor. Previous research has identified a range of contributing factors in relation to subjective reports of adherence. There is a wide discrepancy between self-reported adherence and objectively measured adherence. What this study adds A data-prompted interview using objectively measured adherence data enabled the systematic assessment of potential factors that could be targeted in an intervention to increase adherence. There were some differences in the factors that were identified by high and low adherers. There is not one-size fits all intervention for adherence to medication in cystic fibrosis.
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http://dx.doi.org/10.1111/bjhp.12357DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6519271PMC
May 2019

Role of habit in treatment adherence among adults with cystic fibrosis.

Thorax 2019 02 9;74(2):197-199. Epub 2018 Jun 9.

School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.

Among adults with cystic fibrosis (CF), medication adherence is low and reasons for low adherence are poorly understood. Our previous exploratory study showed that stronger 'habit' (ie, automatically experiencing an urge to use a nebuliser) was associated with higher nebuliser adherence. We performed a secondary analysis of pilot trial data (n=61) to replicate the earlier study and determine whether habit-adherence association exists in other cohorts of adults with CF. In this study, high adherers also reported stronger habit compared with low adherers. Habit may be a promising target for self-management interventions. TRIAL REGISTRATION NUMBER: ACtiF pilot, ISRCTN13076797.
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http://dx.doi.org/10.1136/thoraxjnl-2017-211453DOI Listing
February 2019

Enhancing the effectiveness of alcohol warning labels with a self-affirming implementation intention.

Health Psychol 2016 Oct 9;35(10):1159-63. Epub 2016 Jun 9.

Department of Psychology, Sociology and Politics, Sheffield Hallam University.

Objective: Excess alcohol consumption extorts significant social and economic costs that are increasing despite the presence of mandatory warning labels on packaged alcoholic beverages. We used a novel approach by adding a brief statement based on self-affirmation theory to alcohol warning labels.

Method: In two studies (N = 85 and N = 58), we randomized regular wine drinkers recruited from university campuses to complete a wine-pouring task with bottles that had standard labeling or bottles that added a self-affirming implementation intention to the standard labeling. Alcohol consumption, behavioral intention, and self-efficacy were measured premanipulation; message acceptance was measured postmanipulation; and alcohol consumption, behavioral intention, and self-efficacy were measured again at follow-up.

Results: In both studies, the self-affirming implementation intention significantly reduced subsequent alcohol consumption (ds = 0.70 and 0.91, respectively). However, message acceptance, behavioral intention, and self-efficacy did not significantly mediate the observed effects.

Conclusions: Self-affirming implementation intentions augmented the effect of alcohol warning labels to reduce subsequent alcohol consumption, but-consistent with the broader self-affirmation literature-it was not clear what mediated the effects. Further research is required to examine the effects of self-affirming implementation intentions on other kinds of public health-related labeling. (PsycINFO Database Record
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http://dx.doi.org/10.1037/hea0000376DOI Listing
October 2016

What women really think about gestational weight management: A thematic analysis of posts made in online parenting forums.

Pregnancy Hypertens 2014 Jul 9;4(3):231. Epub 2014 Jul 9.

Department of Psychology, Sheffield Hallam University, United Kingdom.

Traditional research methods may not assess true beliefs and views of sensitive topics such as obesity because the research situation tends to promote particular responses based on the perceived expectations of the researcher and pressure to be 'politically correct'. The publication of the NICE guidance on weight management in pregnancy in 2010, and the subsequent press coverage of it, provided a stimulus for discussion of gestational weight management on UK-based online parenting forums. A systematic search identified 21 UK parenting forums on which 400 posts referring to guidance on weight management in pregnancy were made by 202 women in the two-week period following the publication of the guidance. These posts were analysed thematically resulting in the identification of three main themes: (i) Perceived control/responsibility (ii) Risk perception (iii) Confused messages. Women differed in their perceptions of the level of control that people had over being overweight with some women reporting feeling guilty and experiencing significant obesity stigma. Information about the risks of overweight and obesity in pregnancy were difficult messages for women to hear, and for health professionals to deliver and they used a range of strategies to downplay their personal risk. Women reported being confused by the messages that they received. Health messages need to be delivered sensitively to women, and health professionals need support and training to do this. Risk information should always be accompanied with advice and support to help women to manage their weight in pregnancy.
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http://dx.doi.org/10.1016/j.preghy.2014.03.007DOI Listing
July 2014

Maternal Obesity Management Using Mobile Technology: A Feasibility Study to Evaluate a Text Messaging Based Complex Intervention during Pregnancy.

J Obes 2015 16;2015:814830. Epub 2015 Apr 16.

Doncaster and Bassetlaw Hospitals NHS Foundation Trust, Armthorpe Road, Doncaster DN2 5LT, UK.

Background: Maternal obesity and excessive gestational weight gain (GWG) are on the rise with negative impact on pregnancy and birth outcomes. Research into managing GWG using accessible technology is limited. The maternal obesity management using mobile technology (MOMTech) study aimed at evaluating the feasibility of text messaging based complex intervention designed to support obese women (BMI ≥ 30) with healthier lifestyles and limit GWG.

Methods: Participants received two daily text messages, supported by four appointments with healthy lifestyle midwife, diet and activity goal setting, and self-monitoring diaries. The comparison group were obese mothers who declined to participate but consented for their routinely collected data to be used for comparison. Postnatal interviews and focus groups with participants and the comparison group explored the intervention's acceptability and suggested improvements.

Results: Fourteen women completed the study which did not allow statistical analyses. However, participants had lower mean GWG than the comparison group (6.65 kg versus 9.74 kg) and few (28% versus 50%) exceeded the Institute of Medicine's upper limit of 9 kg GWG for obese women.

Conclusions: MOMTech was feasible within clinical setting and acceptable intervention to support women to limit GWG. Before further trials, slight modifications are planned to recruitment, text messages, and the logistics of consultation visits.
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http://dx.doi.org/10.1155/2015/814830DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4415456PMC
April 2016

Evidence that a very brief psychological intervention boosts weight loss in a weight loss program.

Behav Ther 2014 Sep 18;45(5):700-7. Epub 2014 Apr 18.

Sheffield Hallam University.

Reducing morbidity and mortality associated with being overweight is a crucial public health goal. The aim of the present research was to test the efficacy of a very brief psychological intervention (a volitional help sheet) that could be used as an adjunct to standard weight loss programs to support increased weight loss in an overweight sample. Seventy-two overweight participants currently participating in a weight loss program were randomly allocated to either an intervention (volitional help sheet) condition or a control (distracter task) condition. The main outcome measure was weight at 1-month follow-up. Participants in both conditions lost significant amounts of weight, but those in the intervention condition lost significantly more than those in the control condition (d=0.66). The findings support the efficacy of the volitional help sheet to promote additional weight loss in an overweight sample engaged in a weight loss program. The volitional help sheet therefore represents a very brief, low-cost intervention that could be used to supplement ongoing weight-loss programs.
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http://dx.doi.org/10.1016/j.beth.2014.04.001DOI Listing
September 2014

Responses to gestational weight management guidance: a thematic analysis of comments made by women in online parenting forums.

BMC Pregnancy Childbirth 2014 Jun 30;14:216. Epub 2014 Jun 30.

Centre for Health and Social Care Research, Sheffield Hallam University, Collegiate Crescent, Sheffield, UK.

Background: The National Institute for Health and Clinical Excellence (NICE) published guidance on weight management in pregnancy in July 2010 (NICE public health guidance 27: 2010), and this received considerable press coverage across a range of media. This offered an opportunity to examine how gestational weight management guidance was received by UK women.

Methods: A thematic analysis was conducted of 400 posts made in UK-based parenting internet forums in the week following the publication of the NICE guidance. This allowed us to examine the naturally occurring comments from 202 women who posted about the guidance on public forums.

Results: Three main themes were identified and explored: i) Perceived control/responsibility ii) Risk perception iii) Confused messages.

Conclusions: Women differed in their perceptions of the level of control that they had over being overweight with some feeling responsible and motivated to maintain a healthy lifestyle. Others felt there were multiple factors influencing their weight issues beyond their control. There were reports of feeling guilty about the impact of weight on the growing baby and experiencing significant obesity stigma from the public and health professionals. Information about the risks of overweight and obesity in pregnancy were difficult messages for women to hear, and for health professionals to deliver. Women reported being confused by the messages that they received. Health messages need to be delivered sensitively to women, and health professionals need support and training to do this. Risk information should always be accompanied with clear advice and support to help women to manage their weight in pregnancy.
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http://dx.doi.org/10.1186/1471-2393-14-216DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4091654PMC
June 2014

Experiences of baby-led weaning: trust, control and renegotiation.

Matern Child Nutr 2015 Oct 13;11(4):829-44. Epub 2014 Feb 13.

Department of Psychology, Sociology and Politics, Sheffield Hallam University, Sheffield, S10 2BP, UK.

Baby-led weaning (BLW) is an approach to introducing solid foods that relies on the presence of self-feeding skills and is increasing in popularity in the UK and New Zealand. This study aimed to investigate the reported experiences and feelings of mothers using a BLW approach in order to better understand the experiences of the mother and infant, the benefits and challenges of the approach, and the beliefs that underpin these experiences. Fifteen UK mothers were interviewed over the course of a series of five emails using a semi-structured approach. The email transcripts were anonymised and analysed using thematic analysis. There were four main themes identified from the analysis: (1) trusting the child; (2) parental control and responsibility; (3) precious milk; and (4) renegotiating BLW. The themes identified reflect a range of ideals and pressures that this group of mothers tried to negotiate in order to provide their infants with a positive and healthy introduction to solid foods. One of the key issues of potential concern is the timing at which some of the children ingested complementary foods. Although complementary foods were made available to the infants at 6 months of age, in many cases they were not ingested until much later. These findings have potentially important implications for mother's decision-making, health professional policy and practice, and future research.
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http://dx.doi.org/10.1111/mcn.12106DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6860235PMC
October 2015

A brief psychological intervention that reduces adolescent alcohol consumption.

J Consult Clin Psychol 2014 Jun 3;82(3):546-50. Epub 2014 Feb 3.

School of Psychology, University of Sussex.

Objective: Alcohol consumption in adolescence is associated with problem drinking in later life, and there is a need to develop evidence-based interventions to reduce adolescent alcohol consumption. The aims of the present study were to test the ability of a very brief intervention based on self-affirmation theory to reduce alcohol consumption in a sample of adolescents and to examine potential mediators of the effects.

Method: 67 adolescents were randomly allocated either to form a self-affirming implementation intention or to complete a distractor task. All participants were exposed to a threatening message concerning the health risks of alcohol consumption. The main outcome measure was subsequent alcohol intake, but message processing (operationalized as perceived threat and message derogation), behavioral intention, and self-efficacy were also measured as potential mediators.

Results: The intervention produced a significant decrease in alcohol consumption: Participants in the self-affirming implementation intention condition consumed 2.48 fewer grams of pure alcohol per day at the end of the study than adolescents who completed the distractor task. The effect was not mediated by perceived threat, message derogation, behavioral intention, or self-efficacy.

Conclusions: The findings provide support for the efficacy of the self-affirming implementation intention for promoting health behavior change and extend previous research by testing an adolescent sample and observing longer term effects. Further research is needed to find out what mediates the effects of self-affirming implementation intentions on health behavior change.
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http://dx.doi.org/10.1037/a0035802DOI Listing
June 2014

Graphic imagery is not sufficient for increased attention to cigarette warnings: the role of text captions.

Addiction 2013 Apr 19;108(4):820-5. Epub 2012 Nov 19.

Department of Psychology, Sociology and Politics, Sheffield Hallam University, Sheffield, UK.

Aims: The present study aims to assess the extent to which attention to UK cigarette warnings is attributable to the graphic nature of the content.

Design: A visual dot probe task was utilised, with the warnings serving as critical stimuli that were manipulated for the presence of graphic versus neutral image content, and the accompanying text caption. This mixed design yielded image content (graphic versus neutrally-matched images) and presence (versus absence) of text caption as within subjects variables and smoking status as a between-participants variable.

Setting: The experiment took place within the laboratories of a UK university.

Participants: Eighty-six psychology undergraduates (51% smokers, 69% female), predominantly of Caucasian ethnicity took part.

Measurements: Reaction times towards probes replacing graphic images relative to probes replacing neutral images were utilised to create an index of attentional bias.

Findings: Bias scores (M = 10.20 ± 2.56) highlighted that the graphic image content of the warnings elicited attentional biases (relative to neutral images) for smokers. This only occurred in the presence of an accompanying text caption [t (43) = 3.950, P < 0.001] as opposed to when no caption was present [t (43) = 0.029, P = 0.977]. Non-smokers showed no biases in both instances.

Conclusions: Graphic imagery on cigarette packets increases attentional capture, but only when accompanied by a text message about health risks.
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http://dx.doi.org/10.1111/add.12008DOI Listing
April 2013

A volitional help sheet to reduce alcohol consumption in the general population: a field experiment.

Prev Sci 2012 Dec;13(6):635-43

School of Psychological Sciences, University of Manchester, Coupland Street, Oxford Road, Manchester M13 9PL, UK.

Volitional help sheets (VHS) have been shown to be effective in changing health behavior, but not yet alcohol consumption in a general population. The aim of the present research was to test the ability of VHS to reduce alcohol consumption against an active control condition, a "standard" self-generated implementation intention condition, and forming a single implementation intention using the VHS. Sixty-nine participants were randomly allocated to one of four conditions: active control, VHS: single implementation intention, VHS: multiple implementation intentions and self-generated implementation intention. The main outcome measure was alcohol intake, assessed using a version of the timeline follow-back technique. Subsequent alcohol consumption decreased by more than 0.5 standard units (8 grams) per day in each of the experimental conditions (ps < 0.05), but increased marginally (0.05 units/day) in the active control condition. There were no significant differences in cognition or behavior between the three experimental conditions. The findings support the efficacy of a new VHS to reduce alcohol consumption. Further research is needed to identify alternative means by which people may form implementation intentions.
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http://dx.doi.org/10.1007/s11121-012-0291-4DOI Listing
December 2012

A volitional help sheet to reduce binge drinking in students: a randomized exploratory trial.

Alcohol Alcohol 2012 Mar-Apr;47(2):156-9. Epub 2012 Jan 17.

Health Psychology Research Group, Department of Psychology, Sociology and Politics, Faculty of Development & Society, Sheffield Hallam University, Collegiate Crescent Campus, Sheffield, S10 2BP, UK.

Aims: This study tested the ability of a volitional help sheet (VHS) to decrease binge drinking in UK students.

Methods: Fifty-six participants were randomly allocated to one of three conditions: control, active control or VHS as part of a questionnaire-based study.

Results: There were significant decreases in units of alcohol consumed and self-reported binge drinking frequency in the VHS condition, but not in either of the control conditions.

Conclusions: The findings support use of the VHS to help people to reduce their alcohol consumption and binge drinking.
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http://dx.doi.org/10.1093/alcalc/agr164DOI Listing
June 2012

Maternal obesity support services: a qualitative study of the perspectives of women and midwives.

BMC Pregnancy Childbirth 2011 Oct 8;11:69. Epub 2011 Oct 8.

Faculty of Health and Wellbeing, Sheffield Hallam University, Collegiate Crescent, Sheffield, S10 2BP, UK.

Background: Twenty percent of pregnant women in the UK are obese (BMI ≥ 30 kg/m2), reflecting the growing public health challenge of obesity in the 21st century. Obesity increases the risk of adverse outcomes during pregnancy and birth and has significant cost implications for maternity services. Gestational weight management strategies are a high priority; however the evidence for effective, feasible and acceptable weight control interventions is limited and inconclusive. This qualitative study explored the experiences and perceptions of pregnant women and midwives regarding existing support for weight management in pregnancy and their ideas for service development.

Methods: A purposive sample of 6 women and 7 midwives from Doncaster, UK, participated in two separate focus groups. Transcripts were analysed thematically.

Results: Two overarching themes were identified, 'Explanations for obesity and weight management' and 'Best care for pregnant women'. 'Explanations' included a lack of knowledge about weight, diet and exercise during pregnancy; self-talk messages which excused overeating; difficulties maintaining motivation for a healthy lifestyle; the importance of social support; stigmatisation; and sensitivity surrounding communication about obesity between midwives and their clients. 'Best care' suggested that weight management required care which was consistent and continuous, supportive and non-judgemental, and which created opportunities for interaction and mutual support between obese pregnant women.

Conclusions: Women need unambiguous advice regarding healthy lifestyles, diet and exercise in pregnancy to address a lack of knowledge and a tendency towards unhelpful self-talk messages. Midwives expressed difficulties in communicating with their clients about their weight, given awareness that obesity is a sensitive and potentially stigmatising issue. This indicates more could be done to educate and support them in their work with obese pregnant women. Motivation and social support were strong explanatory themes for obesity and weight management, suggesting that interventions should focus on motivational strategies and social support facilitation.
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http://dx.doi.org/10.1186/1471-2393-11-69DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3198957PMC
October 2011

Evidence that self-affirmation reduces alcohol consumption: randomized exploratory trial with a new, brief means of self-affirming.

Health Psychol 2011 Sep;30(5):633-41

Department of Psychology, University of Sheffield, WesternBank, Sheffield S10 2TP, United Kingdom.

Objective: To test the ability of a new, brief means of affirming the self (the "self-affirming implementation intention") to decrease alcohol consumption against a standard means of self-affirmation (the self-affirming "kindness" questionnaire) and an active control condition; to test whether self-affirmation effects can be sustained beyond the experimental session; and to examine potential moderators of the effects.

Method: Two hundred seventy-eight participants were randomly allocated to one of three conditions: control questionnaire, self-affirming questionnaire, and self-affirming implementation intention. All participants were exposed to a threatening health message, designed to inform them about the health risks associated with consuming alcohol.

Main Outcome Measures: The main outcome measure was subsequent alcohol intake.

Results: There were significant public health gains and statistically significant decreases (>1 unit/day) in alcohol consumption in the two experimental conditions but not in the control condition. At the end of the study, participants in the control condition were consuming 2.31 units of alcohol per day; people in the self-affirming questionnaire condition were consuming 1.52 units of alcohol per day; and people in the self-affirming implementation intention condition were consuming 1.53 units of alcohol per day. There were no significant differences between the self-affirming questionnaire and self-affirming implementation intention, and adherence did not moderate the effects. Self-affirmation also improved message processing, increased perceived threat, and led to lower message derogation.

Conclusions: The findings support the efficacy of a new, brief self-affirmation manipulation to enhance the effectiveness of health risk information over time. Further research is needed to identify mediators of the effects of self-affirmation on health behavior change.
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http://dx.doi.org/10.1037/a0023738DOI Listing
September 2011

Improving adolescent contraceptive use: evaluation of a theory-driven classroom-based intervention.

Psychol Health Med 2011 Mar;16(2):141-55

Department of Psychology and ARC-HLI, Coventry University, Coventry, UK.

The aim of the research was to evaluate the impact of intervention materials, designed to enhance self-efficacy and anticipated regret, on contraceptive behaviour and antecedents of contraceptive use in a sample of adolescents. It was hypothesised that materials designed to enhance self-efficacy and anticipated regret would lead to improvements in outcome measures compared with controls. A 4(intervention condition) × 3(time) mixed design was used to assess the impact of intervention materials. Participants (N = 414) were recruited from five secondary schools in the north of England. They were assigned to an active control group, an anticipated regret (AR) manipulation, a self-efficacy (SE) manipulation or both AR and SE manipulations. Outcome measures included psychological antecedents of contraceptive behaviour change, intentions and behaviour. Multivariate analysis of variance (MANOVA) revealed increases across several outcome measures over time (F[14,287] = 8.99, P < 0.001, η(p)(2) = 0.305) including intentions, but these did not differ by condition (F[42,852] = 1.35, P = 0.07, η(p)(2) = 0.062). There was evidence that the questionnaires may have caused reactivity in participants. Amongst sexually active participants with relatively low levels of intention to use contraception at the outset, increases in several outcome measures including intention and behaviour were observed (F[3,35] = 10.359, P < 0.001, η(p)(2) = 0.47). Findings support the potential for effective delivery of behaviour change theory-driven interventions in classroom settings. The possibility that the questionnaires may have acted as a form of intervention contributes to recent discussion of this issue in the literature, and the findings also strengthen the case for post-decisional and behavioural skills interventions to enhance behaviour amongst those already motivated to use contraception.
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http://dx.doi.org/10.1080/13548506.2010.525791DOI Listing
March 2011

Conflicting influences on UK mothers' decisions to introduce solid foods to their infants.

Matern Child Nutr 2010 Apr;6(2):159-73

Psychology Research Group, Faculty of Development & Society, Sheffield Hallam University, Collegiate Crescent, Sheffield S10 2 BP, UK.

Adherence to recommendations to wait until 6 months to introduce solid foods into infants' diets is very poor. An in-depth understanding of the factors involved in this decision is essential if health practitioners are to offer suitable advice and health education. A cross-sectional electronic questionnaire study was conducted with 105 mothers recruited via UK-based Internet parenting discussion forums. Ratings of variables important in making the decision to introduce solid foods were analyzed using factor analysis and multiple regression. Open-ended questions were analyzed qualitatively using content analysis. In this sample of educated women, later weaning was found to be associated with a focus on the importance of the recommendations and a perception that health visitor advice and support was poor. Earlier weaning was associated with a focus on the importance of putative weaning signs from the baby. Qualitative analysis revealed a number of conflicting influences on the decision about when to give solid foods: recommendations, guidelines and advice, signs from the baby, beliefs about solids and maternal considerations. The conflict that some mothers experience in deciding when to give their babies solid food between the rigid recommendations, more tailored guidance from health professionals and their perceptions of putative weaning signs from their infants poses a particular problem for those attempting to provide clear and helpful health education information. Future research must assess the extent to which this conflict is prevalent in the general population, and investigate the salience and utility of different health education messages to promote good infant health.
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http://dx.doi.org/10.1111/j.1740-8709.2009.00194.xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6860783PMC
April 2010

A volitional help sheet to increase physical activity in people with low socioeconomic status: A randomised exploratory trial.

Psychol Health 2010 Dec;25(10):1129-45

Centre for Research in Social Attitudes, Department of Psychology, University of Sheffield, Sheffield, S10 2TP, United Kingdom.

Volitional help sheets use Gollwitzer's (1993) concept of implementation intentions as a vehicle to change behaviour using Prochaska and DiClemente's (1983) processes of change. The present study designed and tested a volitional help sheet to increase physical activity in a group with low socioeconomic status (low-SES). Sixty-eight people (33 women, 35 men; mean age 27) with low-SES were randomly allocated to either an experimental group or a control group. Both groups received a questionnaire and a volitional help sheet; the only difference between the experimental and control groups was that the former were given explicit instructions to link occasions on which they were tempted not to be physically active with appropriate behavioural responses (processes of change). Physical activity (Metabolic Equivalent minutes per week) was the main outcome measure; behavioural intention and self-efficacy were the secondary outcome measures. The findings revealed significant increase in physical activity in the experimental condition, relative to the control condition, F (1, 66) = 7.28, p < 0.01, η2(10) = 0.10, but no differences for social cognitive variables. Furthermore, the participants who were most responsive to the intervention engaged in more than three times the physical activity at baseline than those who received the intervention but did not subsequently change. The findings provide further support for volitional help sheets to change health behaviour and extend them to a group with low-SES. Further work is required to refine this intervention tool.
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http://dx.doi.org/10.1080/08870440903121638DOI Listing
December 2010

How useful are the stages of change for targeting interventions? Randomized test of a brief intervention to reduce smoking.

Health Psychol 2008 Nov;27(6):789-98

Centre for Research in Social Attitudes, Department of Psychology, University of Sheffield, Western Barnk, Sheffield S10 2TP, United Kingdom.

Objective: To see whether the stages of change are useful for targeting a brief intervention to reduce smoking based on implementation intentions. A second objective was to rule out demand characteristics as an alternative explanation for the findings of intervention studies based on the transtheoretical model and implementation intentions.

Design: Participants (N = 350) were randomized to a passive control condition (questionnaire only), active control condition (questionnaire plus instruction to plan to quit), or experimental condition (questionnaire, plan to quit, form an implementation intention). Their behavior and psychosocial orientation to quit were measured at baseline and at 2-month follow-up.

Main Outcome Measures: Theory of planned behavior variables, nicotine dependence, and quitting.

Results: Significantly more people quit smoking in the experimental condition than in the control conditions, and the planning instructions changed intention to quit and perceived control over quitting, but not behavior. Stage of change moderated these effects such that implementation intentions worked best for individuals who were in the preparation stage at baseline.

Conclusion: Harnessing both motivational and volitional processes seems to enhance the effectiveness of smoking cessation programs, although further work is required to clarify inconsistencies in the literature using the stages of change.
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http://dx.doi.org/10.1037/0278-6133.27.6.789DOI Listing
November 2008

Predicting and explaining transtheoretical model stage transitions in relation to condom-carrying behaviour.

Br J Health Psychol 2008 Nov;13(Pt 4):719-35

Health Psychology Research Group, Sheffield Hallam University, Sheffield, UK.

Objectives: The stages of change component of the transtheoretical model have been applied to safe sex behaviours in cross-sectional analyses, but have not yet been subject to prospective analysis. It was predicted that: (a) cross-sectional analyses would demonstrate good discrimination between the stages of change; (b) prospective analyses would allow for the identification of predictors of stage transitions; and (c) implementation intentions would explain progression from the preparation stage.

Design: This study employed an experimental longitudinal design. Participants were randomly assigned to the experimental (implementation intention) or control conditions and completed questionnaires at baseline and at 2-month follow-up.

Methods: Five hundred and twenty-five adolescents who were broadly representative of the UK population completed questionnaires at baseline and follow-up (N=393) measuring: demographic variables; stage of change; theory of planned behaviour constructs; anticipated regret; and moral norm in relation to condom-carrying behaviour. The experimental condition completed a self-generated implementation intention to carry condoms at the end of the baseline questionnaire.

Results: Discriminant function analyses indicated that the stages of change could be accurately discriminated from one another cross-sectionally and that, longitudinally, the measured variables were able to predict transitions between most stages. Implementation intentions caused people to progress from the preparation stage.

Conclusions: Transitions between most stages were reliably predicted, thereby providing potential targets for intervention. The brief implementation intention intervention was effective and could easily be utilized and expanded to encompass a broader range of sexual health behaviours.
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http://dx.doi.org/10.1348/135910707X249589DOI Listing
November 2008
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