Publications by authors named "Mark Conner"

164 Publications

Do socio-structural factors moderate the effects of health cognitions on COVID-19 protection behaviours?

Soc Sci Med 2021 09 23;285:114261. Epub 2021 Jul 23.

University of Sheffield, UK.

Objective: Adherence to protection behaviours remains key to curbing the spread of the SARS-CoV-2 virus that causes COVID-19, but there are substantial differences in individual adherence to recommendations according to socio-structural factors. To better understand such differences, the current research examines whether relationships between health cognitions based on the Reasoned Action Approach (RAA) and eight COVID-19 protection behaviours vary as a function of participant-level socio-structural factors.

Methods: Within-person design with behaviours nested within participants in a two-wave online survey (one week delay) conducted during the UK national lockdown in April 2020. A UK representative sample of 477 adults completed baseline measures from the RAA plus perceived susceptibility and past behaviour for eight protection behaviours, and self-reported behaviour one week later. Moderated hierarchical linear models with cross-level interactions were used to test moderation of health cognitions by socio-structural factors (sex, age, ethnicity, deprivation).

Results: Sex, ethnicity and deprivation moderated the effects of health cognitions on protection intentions and behaviour. For example, the effects of injunctive norms on intentions were stronger in men compared to women. Importantly, intention was a weaker predictor of behaviour in more compared to less deprived groups. In addition, there was evidence that perceived autonomy was a stronger predictor of behaviour in more deprived groups.

Conclusion: Socio-structural variables affect how health cognitions relate to recommended COVID-19 protection behaviours. As a result, behavioural interventions based on social-cognitive theories might be less effective in participants from disadvantaged backgrounds.
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http://dx.doi.org/10.1016/j.socscimed.2021.114261DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8299154PMC
September 2021

Development and randomized controlled trial of an animated film aimed at reducing behaviours for acquiring antibiotics.

JAC Antimicrob Resist 2021 Jun 17;3(2):dlab083. Epub 2021 Jun 17.

Leeds Teaching Hospitals NHS Trust, Leeds, UK.

Background: Antimicrobial resistance (AMR) is a global health crisis but reducing antibiotic use can help. Some antibiotic use is driven by patient demand.

Objectives: To develop an intervention to discourage antibiotic-seeking behaviour in adults.

Methods: Literature reviewed to identify behaviours for acquiring antibiotics among adults in the community. Behaviour change wheel approach was used to select the target behaviour and behaviour change techniques. An intervention in the form of a short animated film was developed and its potential impact evaluated in a randomized, controlled, online questionnaire study.

Results: Asking a general medical/dental practitioner for antibiotics was identified as the target behaviour. A short stop-motion animated film was chosen to deliver several behaviour-change techniques. Education and persuasion were delivered around information about the normal microbial flora, its importance for health, the negative effect of antibiotics, and about AMR. 417 UK-based individuals completed the questionnaire; median age 34.5 years, 71% female, 91% white ethnicity. 3.8% of participants viewing the test film intended to ask for antibiotics compared with 7.9% viewing the control film. Test film viewers had significantly higher knowledge scores. At 6 week follow up, knowledge scores remained significantly different, while most attitude and intention scores were not different.

Conclusions: Some patients continue to ask for antibiotics. The film increased knowledge and reduced intentions to ask for antibiotics. At 6 weeks, knowledge gains remained but intentions not to ask for antibiotics had waned. Evaluation in the clinical environment, probably at the point of care, is needed to see if antibiotic prescribing can be impacted.
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http://dx.doi.org/10.1093/jacamr/dlab083DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8251327PMC
June 2021

Understanding the psychosocial determinants of Italian parents' intentions not to vaccinate their children: an extended theory of planned behaviour model.

Psychol Health 2021 Jun 27:1-21. Epub 2021 Jun 27.

School of Psychology, University of Leeds, Leeds, UK.

Objective: This study aimed to identify the psychosocial factors involved in Italian parents' intentions not to vaccinate their children. For this purpose, we used an extended version of the Theory of Planned Behaviour, which included both proximal and distal factors influencing intention not to vaccinate children.

Design: Participants included 447 Italian parents, each completed an online questionnaire, which measured intention not to vaccinate children, attitude toward not vaccinating, subjective norms, perceived behavioural control, anticipated regret, negative attitude toward vaccines, risk perception, trust in healthcare institutions, trust in science and religious morality.

Results: Results showed that attitude toward not vaccinating was strongly associated with intention not to vaccinate children. Furthermore, attitude toward not vaccinating was associated with negative attitude toward vaccines, which in turn was affected by all the distal factors considered (risk perception, trust in healthcare institutions, trust in science, religious morality). Finally, negative attitude toward vaccines fully mediated the effect of the distal factors on attitude toward not vaccinating children.

Conclusion: These findings provide support for the validity of the proposed extended TPB model in explaining parents' intention not to vaccinate children. Theoretical and practical implications, in terms of understanding and promoting vaccination behaviour, are discussed.
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http://dx.doi.org/10.1080/08870446.2021.1936522DOI Listing
June 2021

Attitude stability as a moderator of the relationships between cognitive and affective attitudes and behaviour.

Br J Soc Psychol 2021 Jun 12. Epub 2021 Jun 12.

University of Sheffield, UK.

Temporal stability is assumed to be an important basis for attitudes being strong predictors of behaviour, but this notion has been little tested. The current research reports tests of temporal stability in moderating the attitude-behaviour relationship, specifically in relation to cognitive attitude (i.e., evaluation implied by cognitions about an attitude object) and affective attitude (i.e., evaluation implied by feelings about the attitude object). In three prospective studies (Study 1: physical activity, N = 909; Study 2: multiple health behaviours, N = 281; Study 3: smoking initiation, N = 3,371), temporal stability is shown to moderate the cognitive and affective attitudes to subsequent behaviour relationship in two-, three-, and four-wave designs utilizing between- (Studies 1 and 3) and within-participants (Study 2) analyses and controlling for past behaviour. Effects were more consistent for affective attitudes (when affective and cognitive attitudes were considered simultaneously and past behaviour controlled). Moderation effects were attenuated, but remained significant, in three- and four-wave compared with two-wave designs. The findings underline the role of temporal stability as an indicator of strength and confirm the relative importance of affective over cognitive (components of) attitudes for predicting behaviour.
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http://dx.doi.org/10.1111/bjso.12473DOI Listing
June 2021

Promoting physical activity through text messages: the impact of attitude and goal priority messages.

Health Psychol Behav Med 2021 Mar 1;9(1):165-181. Epub 2021 Mar 1.

Department of Psychology, University of Leeds, Leeds, UK.

Introduction: Many young adults demonstrate insufficient rates of physical activity (PA) to yield health benefits. The study tested the effectiveness of a text messaging intervention targeting key psychological determinants and PA.

Methods: Participants received either attitude messages, goal priority messages, a combination of these, or generic PA information (control). After confirming that groups were matched at baseline, a 2 (attitude: yes vs. no) by 2 (goal priority: yes vs. no) by 2 (time: immediately post-intervention, four weeks post-intervention) randomized control trial tested main and interactive effects.

Results: Results showed participants that received attitude messages had significantly more positive attitudes, intentions and rates of PA. Mediational analyses showed the influence of attitude messages on PA to be fully mediated through the serial path via attitude and intention. There were no other main or interactive effects.

Conclusion: The study provides support for using attitudinal messages delivered via text messaging to influence key psychological determinants and PA.
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http://dx.doi.org/10.1080/21642850.2021.1891073DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8158195PMC
March 2021

What factors are most influential in increasing cervical cancer screening attendance? An online study of UK-based women.

Health Psychol Behav Med 2020 Aug 7;8(1):314-328. Epub 2020 Aug 7.

School of Psychology, University of Leeds, Leeds, UK.

: Cervical cancer is the fourth most commonly occurring cancer in women worldwide. The UK has one of the highest cervical screening rates in Europe, yet attendance has been decreasing. This study aimed to identify barriers and facilitators to screening attendance and assess the perceived importance of these factors. : 194 women living in the UK were recruited via an online research recruitment website to an online survey. Most participants ( = 128, 66.0%) were currently up-to-date with cervical screening, 66 participants (34.0%) had never been screened, or were overdue for screening. Participants identified barriers and facilitators to cervical screening attendance via free-text responses and were also asked to rate a list of factors as most to least influential over decision making. Results were analysed using thematic content analysis and ratings analysed using multivariable analyses. : The most commonly reported barriers were: Pain/discomfort; Embarrassment; and Time. These were also rated as most influential for decision making. The most commonly reported facilitators were: Ease of making appointments; Peace of mind; and Fear of cancer/preventing serious illness. While importance rating of barriers did not differ by previous screening behaviour, ratings of some facilitators significantly differed. Up-to-date women rated believing screening is potentially life-saving and part of personal responsibility as significantly more important than overdue/never screened women. : This study confirmed that factors which encourage screening are key to the decision of whether to attend screening. Women suggested several improvements that might make attending easier and improve uptake, including flexibility of screening locations to fit around work hours and childcare arrangements. Psychological facilitators included the peace of mind that screening brings and the belief that cervical cancer screening is potentially life-saving. Public health interventions should target factors which facilitate screening and how these interplay with barriers in order to improve uptake.
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http://dx.doi.org/10.1080/21642850.2020.1798239DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8114340PMC
August 2020

Stress and eating behaviours in healthy adults: a systematic review and meta-analysis.

Health Psychol Rev 2021 May 24:1-25. Epub 2021 May 24.

School of Psychology, University of Leeds, Leeds, LS2 9JT, UK.

Stress leads to detrimental health outcomes through direct biological and indirect behavioural changes. Stress can lead to disruption to normal eating behaviours, although the strength of these associations is unknown. This is the first meta-analysis to determine the strength of the stress-eating relationship in healthy adults and to explore the impact of potential moderators. Studies included had a clearly defined measure of stress (i.e., any noxious event or episode in one's environment with the exclusion of emotional distress) that was linked to non-disordered eating. Key terms were searched in Medline, PsycInfo and Ovid databases (23,104 studies identified). 54 studies (combined = 119,820) were retained in the meta-analysis. A small, positive effect size was found for the stress-overall food intake relationship ( 0.114). Stress was associated with increased consumption of unhealthy foods (0.116) but decreased consumption of healthy foods ( -0.111). Only one significant moderator (restraint on stress-unhealthy eating) was identified. This meta-analysis identified the magnitude of the effect of stress on eating behaviour outcomes. Significant heterogeneity was observed that was not explained by the moderators examined. Further research on moderators of the stress-eating relationship is required and should distinguish effects for healthy versus unhealthy eating.
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http://dx.doi.org/10.1080/17437199.2021.1923406DOI Listing
May 2021

Exploring the effects of daily hassles and uplifts on eating behaviour in young adults: The role of daily cortisol levels.

Psychoneuroendocrinology 2021 Jul 20;129:105231. Epub 2021 Apr 20.

School of Psychology, University of Leeds, UK. Electronic address:

Existing stress-eating research has shown that daily hassles are associated with increases in food intake and that cortisol reactivity to stress has been found to influence the stress-eating relationship. However, the moderating effects of daily cortisol levels (e.g., the cortisol awakening response, CAR) remain unknown. Moreover, recent evidence has shown that daily uplifts, as well as daily hassles, are important in understanding daily influences on eating behaviour. Therefore, in the same study, the current investigation explored the effects of daily hassles and uplifts on eating behaviour and whether these relationships were moderated by mean daily cortisol levels in young female adults. Forty-nine female participants (M age: 19.13 years) recorded the daily hassles and uplifts that they experienced over a 4-day period, together with the between-meal snacks they consumed each day, using an online daily diary. Cortisol samples were provided daily immediately upon waking, at +30 min and +12 h. Mean CAR and mean cortisol levels were calculated across the 4 days. Using multi-level modeling, daily hassles and uplifts were both significantly associated with greater unhealthy snacking. Daily uplifts, but not daily hassles, were also associated with lower healthy snack intake. Higher levels of mean CAR were associated with lower daily healthy snack intake. Moreover, the effects of daily uplifts on healthy snacking were found to be moderated by mean daily cortisol levels, such that participants with the highest levels of mean cortisol consumed less healthy snacks on days when they experienced uplifts. The current study provides novel evidence that mean daily cortisol levels, as well as daily hassles and uplifts, are implicated in daily snack consumption in young female adults. The role of hypothalamic-pituitary adrenal axis activity should be explored further in the context of the daily hassles/uplifts and eating behaviours relationship, in men and in individuals from lower socio-economic status and minority groups.
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http://dx.doi.org/10.1016/j.psyneuen.2021.105231DOI Listing
July 2021

Work-family conflict and dangerous driving behaviours: The mediating role of affect.

Stress Health 2021 Jan 12. Epub 2021 Jan 12.

School of Psychology, University of Leeds, Leeds, UK.

This study examined the under-studied relationship between work-family conflict and dangerous driving behaviours in a sample of employees, and job-related affect as a mediator of this relationship. The sample consisted of 476 Malaysian drivers (44.7% male; 55.3% female) aged 19-60 years. The participants completed scales measuring bidirectional work family conflict (work interference with family[ WIF]; family interference with work [FIW]), job-related negative affect, dangerous driving behaviours and socio-demographics. The data were analysed using structural equation modelling. Our findings indicate that dangerous driving was predicted by FIW, but not WIF. As predicted, job-related negative affect fully mediated the relationship between WIF and dangerous driving. Furthermore, the effect of FIW on dangerous driving behaviours was partially due to negative affect at work. Mediation path was conditional upon gender, suggesting the indirect effects of the relationship between FIW and dangerous driving behaviours via job affect occurs in males but not females. The findings of this study may be useful as a starting point for both applied and theoretical investigations of the role of the psychological effects of juggling work and family responsibilities and affect in traffic safety.
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http://dx.doi.org/10.1002/smi.3026DOI Listing
January 2021

Phase III Randomized Controlled Trial of eRAPID: eHealth Intervention During Chemotherapy.

J Clin Oncol 2021 03 8;39(7):734-747. Epub 2021 Jan 8.

Leeds Institute of Medical Research at St James's, University of Leeds, St James's University Hospital, Leeds, United Kingdom.

Purpose: Electronic patient self-Reporting of Adverse-events: Patient Information and aDvice (eRAPID) is an online eHealth system for patients to self-report symptoms during cancer treatment. It provides automated severity-dependent patient advice guiding self-management or medical contact and displays the reports in electronic patient records. This trial evaluated the impact of eRAPID on symptom control, healthcare use, patient self-efficacy, and quality of life (QOL) in a patient population treated predominantly with curative intent.

Methods: Patients with colorectal, breast, or gynecological cancers commencing chemotherapy were randomly assigned to usual care (UC) or the addition of eRAPID (weekly online symptom reporting for 18 weeks). Primary outcome was symptom control (Functional Assessment of Cancer Therapy-General, Physical Well-Being subscale [FACT-PWB]) assessed at 6, 12, and 18 weeks. Secondary outcomes were processes of care (admissions or chemotherapy delivery), patient self-efficacy, and global quality of life (Functional Assessment of Cancer Therapy-General, EQ5D-VAS, and EORTC QLQ-C30 summary score). Multivariable mixed-effects repeated-measures models were used for analyses. Trial registration: ISRCTN88520246.

Results: Participants were 508 consenting patients (73.6% of 690 eligible) and 55 health professionals. eRAPID compared to UC showed improved physical well-being at 6 ( = .028) and 12 ( = .039) weeks and no difference at 18 weeks (primary end point) ( = .69). Fewer eRAPID patients (47%) had clinically meaningful physical well-being deterioration than UC (56%) at 12 weeks. Subgroup analysis found benefit in the nonmetastatic group at 6 weeks ( = .0426), but not in metastatic disease. There were no differences for admissions or chemotherapy delivery. At 18 weeks, patients using eRAPID reported better self-efficacy ( = .007) and better health on EQ5D-VAS ( = .009). Average patient compliance with weekly symptom reporting was 64.7%. Patient adherence was associated with clinician's data use and improved FACT-PWB at 12 weeks.

Conclusion: Real-time monitoring with electronic patient-reported outcomes improved physical well-being (6 and 12 weeks) and self-efficacy (18 weeks) in a patient population predominantly treated with curative intent, without increasing hospital workload.
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http://dx.doi.org/10.1200/JCO.20.02015DOI Listing
March 2021

Association between age at first reported e-cigarette use and subsequent regular e-cigarette, ever cigarette and regular cigarette use.

Addiction 2021 07 12;116(7):1839-1847. Epub 2021 Jan 12.

Department of Health Sciences, University of York, York, UK.

Background And Aims: Association of electronic cigarette use and subsequent smoking has received considerable attention, although age of first use has not. This study tested differences in regular (e-cigarettes, cigarettes) and ever (cigarettes) use between e-cigarette user groups: early versus never users, late versus never users, early versus late users and effects of controlling for covariates.

Design: Prospective study with 12- and 24-month follow-up of e-cigarette/cigarette ever/regular use with data from an intervention.

Setting: Forty-five schools in England (Staffordshire and Yorkshire).

Participants: Never smokers (3289 13-14-year-olds) who were part of a cluster randomized controlled trial.

Measurements: The sample was divided into groups of e-cigarette users: early users (at 13-14 years), late users (at 14-15 years) and never users (at 13-14 and 14-15 years). Dependent variables were self-reported regular e-cigarette and cigarette use and ever cigarette use at 15-16 years. Covariates were assessed.

Findings: Early and late users compared with never users were significantly more likely to be regular e-cigarette users [early: odds ratio (OR) = 9.42, 95% confidence interval (CI) = 5.38, 16.49, P < 0.001; late: OR = 6.89, 95% CI = 4.11, 11.54, P < 0.001], ever cigarette users (early: OR = 7.96, 95% CI = 6.02, 10.53, P < 0.001; late: OR = 5.13, 95% CI = 3.85, 6.84, P < 0.001) and regular cigarette users (early: OR = 7.80, 95% CI = 3.99, 15.27, P < 0.001; late: OR = 4.34, 95% CI = 1.93, 9.77, P < 0.001) at age 15-16 years. Late users compared with early users had significantly lower rates of ever use of cigarettes at 15-16 years (OR = 0.48, 95% CI = 0.35, 0.66, P < 0.001), although this difference was non-significant at 12 months after first use of e-cigarettes (OR = 0.89, 95% CI = 0.64, 1.25, P = 0.498). Controlling for covariates did not change the findings.

Conclusions: Adolescents in England who report using e-cigarettes at age 13-14 years have higher rates of subsequently initiating cigarette use than adolescents who report using e-cigarettes at age 14-15 years, a difference that may be attributable to a longer period of time to initiate cigarette use in former group.
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http://dx.doi.org/10.1111/add.15386DOI Listing
July 2021

Affective Determinants of Physical Activity: A Conceptual Framework and Narrative Review.

Front Psychol 2020 1;11:568331. Epub 2020 Dec 1.

Department of Behavioral and Social Sciences, Department of Psychiatry and Human Behavior, School of Public Health, Brown University, Providence, RI, United States.

The literature on affective determinants of physical activity (PA) is growing rapidly. The present paper aims to provide greater clarity regarding the definition and distinctions among the various affect-related constructs that have been examined in relation to PA. Affective constructs are organized according to the Affect and Health Behavior Framework (AHBF), including: (1) (e.g., how one feels in response to PA behavior) to PA; (2) (e.g., how one feels throughout the day, unrelated to the target behavior); (3) (e.g., affective associations, implicit attitudes, remembered affect, anticipated affective response, and affective judgments); and (4) (e.g., intrinsic motivation, fear, and hedonic motivation). After defining each category of affective construct, we provide examples of relevant research showing how each construct may relate to PA behavior. We conclude each section with a discussion of future directions for research.
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http://dx.doi.org/10.3389/fpsyg.2020.568331DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7735992PMC
December 2020

Unhealthy eating and academic stress: The moderating effect of eating style and BMI.

Health Psychol Open 2020 Jul-Dec;7(2):2055102920975274. Epub 2020 Nov 30.

University of Leeds, UK.

This study aimed to evaluate the relationship between stress and unhealthy eating among undergraduate students, considering the moderation effects of BMI, eating style, and nationality. A total of 748 Italian and French students completed self-report measures of academic stress, emotional eating, restrained eating, BMI, and unhealthy eating intake. Results showed that academic stress increased unhealthy food consumption in Italian students, whereas it reduced junk food consumption in French students. Negative emotional eating and BMI moderated, respectively, the impact of academic stress on sweet food intake and snacking. Finally, no clear support was found for the moderation role of restrained eating.
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http://dx.doi.org/10.1177/2055102920975274DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7708726PMC
November 2020

Cluster randomized controlled trial of volitional and motivational interventions to improve bowel cancer screening uptake: A population-level study.

Soc Sci Med 2020 11 2;265:113496. Epub 2020 Nov 2.

School of Psychology, University of Leeds, Leeds, UK. Electronic address:

Objectives: Colorectal cancer (CRC) is a leading cause of cancer death worldwide, although effective uptake of bowel cancer screening is below 60% in England. This trial investigated the influence of volitional and motivational interventions and their combination on increasing guaiac fecal occult blood testing (gFOBT) screening uptake.

Method: In total, 34,633 participants were recruited (via North-East of England bowel cancer screening hub) into a 2×2 factorial cluster randomized controlled trial. Social norm-based motivational intervention (SNA); Implementation intention-based Volitional Help Sheet (VHS); Combined intervention (SNA+VHS); Treatment as usual control. Screening rate (gFOBT kit return rate within 8 weeks of invitation) was the primary outcome.

Results: Screening kits were returned by 60% of participants (N=20,847/34,633). A substantial imbalance was observed in participant characteristics, participants in the combined intervention group were younger and more likely to be first time invitees. Adjusted analyses found insufficient evidence that any of the interventions were different to control (Combined: OR = 1.18, 95% CI 0.97-1.44; SNA alone: OR=0.93; 95% CI: 0.76-1.15; VHS alone OR= 0.88; 95% CI: 0.75-1.03). Subgroup analyses demonstrated a significant beneficial effect of the combined intervention in the youngest age group compared to control (OR = 1.27; 95% CI: 1.05-1.54).

Conclusions: The study did not support any benefit of either VHS or SNA interventions alone on bowel cancer screening uptake. The combined SNA+VHS intervention was significantly different from control only in the youngest age group in adjusted analyses. However, the magnitude of effect in the youngest age group suggests that further testing of VHS plus SNA interventions in carefully targeted populations may be warranted.
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http://dx.doi.org/10.1016/j.socscimed.2020.113496DOI Listing
November 2020

Investigating which behaviour change techniques work for whom in which contexts delivered by what means: Proposal for an international collaboratory of Centres for Understanding Behaviour Change (CUBiC).

Br J Health Psychol 2021 02 20;26(1):1-14. Epub 2020 Oct 20.

University of Manchester, UK.

Purpose: Behaviour change techniques are fundamental to the development of any behaviour change intervention, but surprisingly little is known about their properties. Key questions include when, why, how, in which contexts, for which behaviours, in what combinations, compared with what, and for whom behaviour change techniques are typically effective. The aims of the present paper are to: (1) articulate the scope of the challenge in understanding the properties of behaviour change techniques, (2) propose means by which to tackle this problem, and (3) call scientists to action.

Methods: Iterative consensus (O'Connor et al., 2020, Br. J. Psychol., e12468) was used to elicit and distil the judgements of experts on how best to tackle the problem of understanding the nature and operation of behaviour change techniques.

Results: We propose a worldwide network of 'Centres for Understanding Behaviour Change' (CUBiC) simultaneously undertaking research to establish what are the single and combined properties of behaviour change techniques across multiple behaviours and populations. We additionally provide a first attempt to systematize an approach that CUBiC could use to understand behaviour change techniques and to begin to harness the efforts of researchers worldwide.

Conclusion: Better understanding of behaviour change techniques is vital for improving behaviour change interventions to tackle global problems such as obesity and recovery from COVID-19. The CUBiC proposal is just one of many possible solutions to the problems that the world faces and is a call to action for scientists to work collaboratively to gain deeper understanding of the underpinnings of behaviour change interventions.
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http://dx.doi.org/10.1111/bjhp.12479DOI Listing
February 2021

Predicting long-term healthy eating behaviour: understanding the role of cognitive and affective attitudes.

Psychol Health 2021 Oct 15;36(10):1165-1181. Epub 2020 Oct 15.

Psychology, University of Sheffield, Sheffield, UK.

Objectives: There are few tests of the ability of cognitive and affective attitudes to predict long-term performance of health behaviours. We assessed relationships between cognitive and affective attitudes and healthy eating behaviour over periods of 4, 6 and 10 years. A prospective survey measuring cognitive and affective attitudes at baseline (T1) and 6 years (T2), and self-report healthy eating behaviour at baseline (T1), 6 (T2) and 10 (T3) years later in a sample of UK adults recruited through General Practice ( = 285). When considered simultaneously, affective attitude (T1 and T2) predicted healthy eating behaviour cross-sectionally (at T1 and T2) and prospectively (over 4 [T2-T3], 6 [T1-T2] and 10 [T1-T3] years) whereas cognitive attitude did not. Stability of affective attitude (T1-T2) moderated the affective attitude-behaviour relationship in some (T1-T2, T1-T3), but not all (T2-T3), prospective analyses. Change in affective attitude, but not cognitive attitude (T1-T2), predicted change in behaviour over 6 (T1-T2) and 10 (T1-T3) years. The findings indicate that affective attitudes can be significant predictors of healthy eating behaviour over prolonged time periods suggesting they may be useful targets for interventions designed to produce long-term change in eating behaviour.
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http://dx.doi.org/10.1080/08870446.2020.1832675DOI Listing
October 2021

Reasoned action approach and compliance with recommended behaviours to prevent the transmission of the SARS-CoV-2 virus in the UK.

Br J Health Psychol 2020 11 2;25(4):1006-1019. Epub 2020 Oct 2.

School of Psychology, University of Leeds, UK.

Objectives: To examine associations between demographics, people's beliefs, and compliance with behaviours recommended by the UK government to prevent the transmission of the SARS-CoV-2 virus that causes COVID-19.

Design: A two-wave online survey conducted one week apart during the national lockdown (April, 2020).

Measures: A sample of 477 UK residents completed baseline measures from the reasoned action approach (experiential attitudes, instrumental attitudes, injunctive norms, descriptive norms, capacity, autonomy, and intention) and perceived susceptibility for each of the following recommended behaviours: limiting leaving home, keeping at least 2 m away from other people when outside and when inside shops, not visiting or meeting friends or other family members, and washing hands when returning home. Self-reported compliance with each of the recommended behaviours was assessed one week later.

Results: Rates of full compliance with the recommended behaviours ranged from 31% (keeping at least 2 m away from other people when inside shops) to 68% (not visiting or meeting friends or other family members). Capacity was a significant predictor of compliance with each of the five recommended behaviours. Increasing age and intentions were also predictive of compliance with three of the behaviours.

Conclusions: Interventions to increase compliance with the recommended behaviours to prevent the transmission of the SARS-CoV-2 virus, especially those relating to social distancing, need to bolster people's intentions and perceptions of capacity. This may be achieved through media-based information campaigns as well as environmental changes to make compliance with such measures easier. Such interventions should particularly target younger adults.
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http://dx.doi.org/10.1111/bjhp.12474DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7536976PMC
November 2020

Using Messages Targeting Psychological versus Physical Health Benefits to Promote Walking Behaviour: A Randomised Controlled Trial.

Appl Psychol Health Well Being 2021 02 17;13(1):152-173. Epub 2020 Sep 17.

University of Leeds, UK.

Background: This study aimed to test the efficacy of a messaging intervention targeting psychological or physical benefits plus goal setting and self-monitoring strategies to promote walking activity in the university context.

Methods: Two hundred and thirty university students from the University of Naples Federico II were randomly allocated to one of four conditions: physical health messages + self-monitoring, psychological health (well-being) messages + self-monitoring, self-monitoring, and no messages. All three intervention conditions were exposed to goal setting (doing at least 7,000 steps a day) and participants were required to monitor their daily progress through the specific step counting app. Participants' walking activity and related psychological variables were assessed at T1 and T2. We ran ANCOVAs and mediation analysis to test our research questions and hypotheses. Analyses were based on the N = 156 who completed all measures at both time points.

Results: Participants in the three experimental (message) conditions reported improvement in psychological variables and behaviour. In particular, the messages focused on the physical health benefits, combined with self-monitoring, were the most effective.

Conclusions: Our study provides new information on the factors that could be usefully targeted to promote walking activity (i.e. intention, past behaviour, action control, and persuasive messages on the physical benefits of walking).
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http://dx.doi.org/10.1111/aphw.12224DOI Listing
February 2021

Cognitive-Affective Inconsistency and Ambivalence: Impact on the Overall Attitude-Behavior Relationship.

Pers Soc Psychol Bull 2021 04 4;47(4):673-687. Epub 2020 Aug 4.

University of Amsterdam, The Netherlands.

This research explored whether overall attitude is a stronger predictor of behavior when underlying cognitive-affective inconsistency or ambivalence is low versus high. Across three prospective studies in different behaviors and populations (Study 1: eating a low-fat diet, = 136 adults, eating five fruit and vegetables per day, = 135 adults; Study 2: smoking initiation, = 4,933 adolescents; and Study 3: physical activity, = 909 adults) we tested cognitive-affective inconsistency and ambivalence individually and simultaneously as moderators of the overall attitude-behavior relationship. Across studies, more similar effects were observed for inconsistency compared with ambivalence (in both individual and simultaneous analyses). Meta-analysis across studies supported this conclusion with both cognitive-affective inconsistency and ambivalence being significant moderators when considered on their own, but only inconsistency being significant when tested simultaneously. The reported studies highlight the importance of cognitive-affective inconsistency as a determinant of the strength of overall attitude.
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http://dx.doi.org/10.1177/0146167220945900DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7961742PMC
April 2021

Exploring the effects of daily hassles on eating behaviour in children: The role of cortisol reactivity.

Psychoneuroendocrinology 2020 07 24;117:104692. Epub 2020 Apr 24.

School of Psychology, University of Leeds, Leeds, UK. Electronic address:

It is well established that stress is positively associated with unhealthy eating behaviours and that cortisol reactivity to stress has been found to influence the stress-eating relationship in adults. However, there is a paucity of research that has explored the daily stress-cortisol-eating relationship amongst children. Therefore, the current study aimed to explore whether the experience of daily stressors was associated with an increase in between-meal snack consumption in children over 7 days. Individual cortisol reactivity to stress in the laboratory was explored as a potential moderator of the stress-eating relationship in the real world. Twenty 8-11 year old children completed the Trier Social Stress Test (for children, TSST-C) during which 4 salivary cortisol samples were taken. Participants subsequently completed a 7-day diary that recorded daily hassles (stressors) and between-meal snack consumption. Using multi-level modelling, the results showed there were no effects of daily hassles or mood on snack consumption. However, there were cross-level interactions, such that individuals who had higher cortisol reactivity to stress in the laboratory were found to consume more total and unhealthy snacks in naturalistic settings on days with high hassles and more negative mood compared to those who exhibited low and moderate cortisol reactivity to stress. This exploratory study provides novel evidence that cortisol reactivity to stress is an important moderator of stress-eating relationship in children and that daily diary approaches are feasible in studies investigating stress and eating in children aged 8-11 years old.
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http://dx.doi.org/10.1016/j.psyneuen.2020.104692DOI Listing
July 2020

Changing Sedentary Behavior in the Office: A Randomised Controlled Trial Comparing the Effect of Affective, Instrumental, and Self-Regulatory Messaging on Sitting.

Appl Psychol Health Well Being 2020 11 19;12(3):687-702. Epub 2020 May 19.

University of Victoria, Victoria, BC, Canada.

Background: Although avoiding sedentary behavior has many health benefits, adults often sit for long periods at work. The purpose of this study was to compare affective attitude, instrumental attitude, and self-regulation messaging interventions on sitting in the workplace.

Methods: Using a cluster randomised controlled trial design, participants (N = 116) were assigned (by workplace) to: (a) instrumental, (b) affective, (c) self-regulation, or (d) control (nutrition information) groups. Measurements were taken online at baseline, 4 weeks, 8 weeks, and 12 weeks post-baseline. The interventions comprised three presentations delivered following baseline, week 4, and week 8 assessments. The primary outcome was self-reported average hours of sitting per day at work (registered trial number: NCT04082624).

Results: Controlling for baseline sitting, overall, the affective group sat for less time than the instrumental and self-regulation groups. Also, at week 4, the affective group sat for less time than the instrumental and self-regulation groups and, at week 8, the affective group sat for less time than the self-regulation and control groups. There were no differences between the groups at week 12.

Conclusions: This investigation showed that workplace interventions targeting affective attitude can lead to less sitting time in the short term. Future research should explore additional strategies to minimise sedentary behavior in the long term.
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http://dx.doi.org/10.1111/aphw.12202DOI Listing
November 2020

Promoting colorectal cancer screening: a systematic review and meta-analysis of randomised controlled trials of interventions to increase uptake.

Health Psychol Rev 2020 May 13:1-24. Epub 2020 May 13.

School of Psychology, University of Leeds, Leeds, UK.

Colorectal cancer (CRC) represents a global public health concern. CRC screening is associated with significant reductions in CRC incidence and mortality, however, uptake is suboptimal. This systematic review and meta-analysis of randomised controlled trials explored the effectiveness of interventions designed to increase screening uptake, plus the impact of various moderators. Data from 102 studies including 1.94 million participants were analysed. Results showed significant benefit of all interventions combined (OR, 1.49, 95% CI: 1.43, 1.56,  < 0.001). The effects were similar in studies using objective versus self-reported uptake measures and lower in studies judged to be at high risk of bias. Moderator analyses indicated significant effects for aspects of behaviour (effects lower for studies on non-endoscopic procedures), and intervention (effects higher for studies conducted in community settings, in healthcare systems that are not free, and that use reminders, health-professional providers, paper materials supplemented with in-person or phone contact, but avoid remote contact). Interventions that included behaviour change techniques targeting social support (unspecified or practical), instructions or demonstration of the behaviour, and that added objects to the environment produced stronger effects. The way in which findings can inform interventions to improve CRC screening uptake is discussed.
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http://dx.doi.org/10.1080/17437199.2020.1760726DOI Listing
May 2020

Exploring the effects of positive and negative emotions on eating behaviours in children and young adults.

Psychol Health Med 2021 04 7;26(4):457-466. Epub 2020 May 7.

School of Psychology, University of Leeds, Leeds, UK.

It is well established that stress can elicit change in a range of eating behaviours, however, less is known about these effects in children and young adults. In addition, there is a growing interest in investigating the role of positive as well as negative emotions as triggers of food intake in children. Therefore, the current study aimed to explore the relationship between positive and negative emotions and eating behaviour in children (aged 9-10 years old) and young adults together with the moderating effects of eating styles (emotional and external eating). A questionnaire design was used to investigate the effects of positive and negative emotions on snacking responses in children and young adults (children, , young adults, ). Eating styles were assessed using the Dutch Eating Behaviour Questionnaire. We found that children reported wanting to eat more snacks in response to positive emotions, while young adults reported wanting to eat more snacks in response to negative emotions. Emotional and external eating styles moderated the positive and negative emotions - eating response relationship. Future research should include both positive and negative emotions when examining the influence of stress and emotions on eating, particularly when exploring the triggers of food intake amongst children.
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http://dx.doi.org/10.1080/13548506.2020.1761553DOI Listing
April 2021

Can Routinely Collected, Patient-Reported Wellness Predict National Early Warning Scores? A Multilevel Modeling Approach.

J Patient Saf 2020 Feb 21. Epub 2020 Feb 21.

School of Psychology, University of Leeds, Leeds, United Kingdom.

Objective: Measures exist to improve early recognition of and response to deteriorating patients in hospital. However, management of critical illness remains a problem globally; in the United Kingdom, 7% of the deaths reported to National Reporting and Learning System from acute hospitals in 2015 related to failure to recognize or respond to deterioration. The current study explored whether routinely recording patient-reported wellness is associated with objective measures of physiology to support early recognition of hospitalized deteriorating patients.

Methods: A prospective observation study design was used. Nurses on four inpatient wards were invited to participate and record patient-reported wellness during every routine observation (where possible) using an electronic observation system. Linear multilevel modeling was used to examine the relationship between patient-reported wellness, and national early warning scores (NEWS), and whether patient-reported wellness predicted subsequent NEWS.

Results: A significant positive relationship was found between patient-reported wellness and NEWS recorded at the next observation while controlling for baseline NEWS (β = 0.180, P = 0.033). A significant positive relationship between patient-reported wellness and NEWS (β = 0.229, P = 0.005) recorded during an observation 24 hours later while controlling for baseline NEWS was also found. Patient-reported wellness added to the predictive model for subsequent NEWS.

Conclusions: The preliminary findings suggest that patient-reported wellness may predict subsequent improvement or decline in their condition as indicated by objective measurements of physiology (NEWS). Routinely recording patient-reported wellness during observation shows promise for supporting the early recognition of clinical deterioration in practice, although confirmation in larger-scale studies is required.
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http://dx.doi.org/10.1097/PTS.0000000000000672DOI Listing
February 2020

Involving patients in recognising clinical deterioration in hospital using the Patient Wellness Questionnaire: A mixed-methods study.

J Res Nurs 2020 Feb 25;25(1):68-86. Epub 2019 Sep 25.

Professor, Psychology of Healthcare, Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK.

Background: Measures exist to improve early recognition of, and response to deteriorating patients in hospital. Despite these, 7% of the deaths reported to the National Reporting and Learning System from acute hospitals in 2015 related to a failure to recognise or respond to deterioration. Interventions have been developed that allow patients and relatives to escalate patient deterioration to a critical care outreach team. However, there is not a strong evidence base for the clinical effectiveness of these interventions, or patients' ability to recognise deterioration.

Aims: The aims of this study were as follows. (a) To identify methods of involving patients in recognising deterioration in hospital, generated by health professionals. (b) To develop and evaluate an identified method of patient involvement in practice, and explore its feasibility and acceptability from the perspectives of patients.

Methods: The study used a mixed-methods design. A measure to capture patient-reported wellness during observation was developed (Patient Wellness Questionnaire) through focus group discussion with health professionals and patients, and piloted on inpatient wards.

Results: There was limited uptake where patients were asked to record ratings of their wellness using the Patient Wellness Questionnaire themselves. However, where the researcher asked patients about their wellness using the Patient Wellness Questionnaire and recorded their responses during observation, this was acceptable to most patients.

Conclusions: This study has developed a measure that can be used to routinely collect patient-reported wellness during observation in hospital and may potentially improve early detection of deterioration.
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http://dx.doi.org/10.1177/1744987119867744DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7932225PMC
February 2020

Conceptualizing and intervening on affective determinants of health behaviour.

Psychol Health 2019 11;34(11):1267-1281

Psychology, Institute of Psychological Sciences, University of Leeds , Leeds , UK.

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http://dx.doi.org/10.1080/08870446.2019.1675659DOI Listing
November 2019

Feel good now or regret it later? The respective roles of affective attitudes and anticipated affective reactions for explaining health-promoting and health risk behavioral intentions.

J Appl Soc Psychol 2019 Jun 1;49(6):331-348. Epub 2019 Mar 1.

School of Psychology, University of Leeds, Leeds, United Kingdom.

Evidence supporting the incorporation of affective constructs, such as affective attitudes and anticipated regret, into theoretical models of health behavior has been mounting in recent years; however, the role of positive anticipated affective reactions (e.g., pride) has been largely unexplored. The purpose of the present investigation was to assess how affective attitudes and anticipated affective reactions (both pride and regret for performing a behavior or not) may provide distinct utility for understanding intentions to perform health-promoting and health risk behaviors over and above cognitive attitudes and other established theoretical constructs from the theory of planned behavior (TPB). Participants ( = 210) were recruited via Amazon's Mechanical Turk to complete a one-time online battery assessing TPB and affective constructs. Self-reported intentions served as the main outcome measure, and hierarchical linear modeling was used to examine the effects of TPB and affective constructs across behaviors. Controlling for TPB constructs, more positive affective attitudes and greater anticipated regret, but not anticipated pride, predicted intentions to engage in future health behaviors. Anticipated affective reactions contributed explanatory variance for intentions to perform health risk behaviors, but anticipated pride and regret were not associated with intentions to perform health risk behaviors. Contributions made via the inclusion of both positively and negatively valence anticipated affective reactions for both action and inaction (performing a behavior or not) across a range of health promoting and health risk behaviors are discussed, as well as implications for future intervention work.
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http://dx.doi.org/10.1111/jasp.12584DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6738954PMC
June 2019

Health behaviour: cancer screening, blood and organ donation, and opioid (mis)use.

Psychol Health 2019 09;34(9):1029-1035

University of Sheffield.

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http://dx.doi.org/10.1080/08870446.2019.1649408DOI Listing
September 2019

Setting Realistic Health Goals: Antecedents and Consequences.

Ann Behav Med 2019 11;53(12):1020-1031

Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, NC, USA.

Background: People often fail to translate their intentions into health behaviors.

Purpose: The present research examined a new potential moderator of intention-behavior relations, namely, how realistic or unrealistic are respective goal intentions. Goal realism was defined as the degree to which intentions are aligned with expectations (i.e., predicted performance).

Methods: A validation study (N = 81) examined our novel goal realism measure. Study 1 (N = 246) tested goal importance, fantasy proneness, and pathways thinking as predictors of realistic goal setting using a cross-sectional questionnaire design. Moderation of the intention-behavior relation was tested in prospective surveys of cervical cancer screening (Study 2, N = 854), physical activity (Study 3, N = 237), and performance of a suite of 15 health behaviors (Study 4, N = 378).

Results: The validation study offered preliminary evidence concerning the convergent and predictive validity of the goal realism measure. Study 1 showed that goal importance, fantasy proneness, and pathways thinking interacted to predict how realistic were intentions to perform 11 health behaviors. In Study 2, realistic intentions better predicted women's attendance for cervical cancer screening compared with unrealistic intentions. Study 3 confirmed this finding for a frequently performed behavior (physical activity). In Study 4, multilevel modeling of longitudinal data for 15 health behaviors again revealed a significant goal realism × intention interaction. Greater realism was associated with improved prediction of behavior by intention. The interaction term remained significant even when past behavior, perceived behavioral control, and other predictors were taken into account.

Conclusions: The present findings offer new insights into the factors that lead to more realistic intentions and demonstrate that goal realism influences how effectively intentions are translated into action.
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http://dx.doi.org/10.1093/abm/kaz012DOI Listing
November 2019

A systematic review and meta-analysis of the executive function-health behaviour relationship.

Health Psychol Behav Med 2019 Jul 9;7(1):253-268. Epub 2019 Jul 9.

School of Psychology, University of Leeds, Leeds, UK.

Objective: This study provides the first comprehensive meta-analysis of the relationship between executive function (EF) and performance of health behaviours in healthy populations.

Method: Electronic databases (MEDLINE, Embase, PsycINFO, Web of Science) were searched, and forward and backward citation tracking was undertaken to identify articles investigating the relationship between EF and health behaviour. Studies were eligible if they examined the direct correlational relationship between EF and health behaviour in healthy populations, were available in English and published in peer-reviewed journals in any year.

Results: Sixty-one articles covering 65 tests were included in a random effects meta-analysis. Several moderators were assessed, including: the type, and addictiveness of the health behaviour; the type of EF measure; study design, and sample characteristics. Overall EF had a significant, but small correlation with health behaviour; EF was significantly positively associated with health-protective behaviours and significantly negatively associated with health-damaging behaviours. There was considerable heterogeneity in the observed effect sizes, but this was not explained by the examined moderators.

Conclusions: Although the meta-analysis indicates a significant effect for EF on health behaviour, effect size is small. Due to the complex nature of EF, more research is required to further elucidate the relationship between EF and health behaviour in its entire conceptualization.
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http://dx.doi.org/10.1080/21642850.2019.1637740DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8114370PMC
July 2019
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