North Yorkshire County Council

Appearance-related content is ubiquitous across highly visual social media platforms, in both imagery and text. The present study aims to explore the content of text-based interactions initiated by self-images on Instagram. Seventeen adolescent girls from the UK (Age M = 15.12; SD = 1.80; Range = 12-18) provided data from their most recent Instagram posts (up to 10 posts) as part of one-to-one interviews. This included images (n = 85), captions (n = 85), direct comments on images (n = 630) and participants' first replies to direct comments (n = 459). An inductive-deductive content analysis was used to analyse Instagram data, and a template analysis was used to analyse the interview data to aid with the interpretation of the content. Analyses showed positive appearance-related compliments were highly prevalent on Instagram posts (79.2 % of comments) and were considered the norm. Compliments tended to focus on general, rather than specific appearance qualities. Girls tended to respond to compliments using likes, gratitude, or affectionate expressions. The findings highlight the role of self-objectification and self-presentation strategies in dictating the norms of adolescent girls' text-based interactions on Instagram. Implications and directions for future research are discussed.

Abstract Introduction Diagnostic delay for endometriosis is a well-established phenomenon. Despite this, little is known about where in the health care system these delays occur or why they occur. Our review is the first attempt to synthesise and analyse this evidence. Methods A systematic scoping review with a pre-specified protocol was used to incorporate the global mixed methods literature on diagnostic delay for endometriosis. Four databases (PubMed, MEDLINE, EMBASE, PsychINFO) were searched from inception to September 2023 with a search strategy designed specifically for each. Results The search yielded 367 studies, 22 of which met the inclusion criteria. A third of studies has been published since 2020 and 65% were from high income countries. Six were qualitative and 16 were quantitative studies. The average age of onset of endometriosis was 14 years for adolescents and 20 for adults. On average, the diagnostic delay reported for endometriosis across the included studies was 6.6 years (range 1.5 to 11.3 years) but this masked the very wide differences reported between countries such as a 0.5-year delay in Brazil to a 27-year delay in the UK. Discussion Health system barriers included access to private healthcare for those with limited finance, physical access for those using public health systems and a general lack of knowledge amongst patients and health care professionals. Women often reported feeling unheard by health professionals. Considering the impact on individuals and the health system, addressing diagnostic delay for endometriosis must remain a priority for researchers, health care providers and policy makers.### Competing Interest StatementThe authors have declared no competing interest.### Funding StatementWe thank our employers for supporting this work. JF received support from Harrogate Borough Council, AMJ received support from the University of York and AW received support from York St John University.### Author DeclarationsI confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.YesI confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.YesI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).YesI have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.YesAll data produced in the present work are contained in the manuscript.

Background:The use of behavioural science and behaviour change within local authorities and public health has supported healthful change; as evidenced by its importance and contribution to reducing harm during the COVID-19 pandemic. It can provide valuable information to enable the creation of evidence-based intervention strategies, co-created with the people they are aimed at, in an effective and efficient manner.Aim:This study aimed to use the COM-B model to understand the Capability, Opportunity and Motivation of performing a constellation of eight COVID-19 disease prevention behaviours related to the slogans of 'Hands, Face, Space, Fresh Air'; 'Find, Isolate, Test, (FIT), and Vaccinate' in those employed in workplaces identified as high risk for transmission of the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) to support intervention development.Methods:This qualitative study recruited twenty-three participants (16 female, 7 male), who were interviewed from three environments (schools, care homes, warehouses) across three local authorities. Semi-structured interviews were analysed using thematic analysis.Findings:Ten core themes were identified inductively; (1) knowledge and skills, (2) regulating the behaviour, (3) willingness to act, (4) necessity and concerns, (5) emotional impact, (6) conducive environment, (7) societal influence, (8) no longer united against COVID-19, (9) credible leadership, and (10) inconsistent adherence to COVID-19 prevention behaviours. Themes were then deductively mapped to the COM-B model of behaviour change and the theoretical domains framework and a logic model using the behaviour change wheel (BCW) was produced to inform intervention design.Conclusion:This study offers a novel approach to analysis that has included eight behaviours within a single thematic analysis and COM-B diagnosis. This will enable local authorities to direct limited resources to overarching priorities. Of key importance, was the need for supportive and credible leadership, alongside developing interventions collaboratively with the target audience. COVID-19 has had an emotional toll on those interviewed, however, promoting the value of disease prevention behaviours, over and above their costs, can facilitate behaviour. Developing knowledge and skills, through education, training, marketing and modelling can further facilitate behaviour. This supports guidance produced by the British Psychological Society COVID-19 behavioural science and disease prevention taskforce.