Strong evidence supports the integration of physical activity (PA) promotion in psychotherapy. As mental healthcare practitioners with expertise in behaviour change, psychologists are well-placed to promote PA as an adjunctive psychological intervention. This scoping review aimed to systematically synthesise evidence on psychologists' PA promotion practices, including their knowledge, confidence and past training on promoting PA. This scoping review mapped psychologists' barriers and facilitators to the 14 domains of the Theoretical Domains Framework. Systematic searches were conducted, with 11 studies meeting the inclusion criteria. Among the studies measuring the frequency of psychologists' PA promotion (n = 9), most (67%) reported that >50% of psychologists promote PA with clients. Studies reporting on psychologists' PA promotion training experiences (n=4) found that almost two-thirds of psychologists have not received any formal training in PA promotion. The domains most identified as barriers to PA promotion were 'social influences' and 'skills', whilst the domains most identified as facilitators to PA promotion were 'beliefs about consequences' and 'beliefs about capabilities'. Given that PA promotion in psychotherapy is an effective intervention, but psychologists lack formal training in this area, tailored training may benefit psychologists' capabilities and clinical practice to promote PA safely and effectively.
Cultural Competency Interventions (CCIs) for healthcare providers are employed to promote equitable healthcare for ethnic minority population(s). This systematic review assesses the effect of CCIs in modifying providers' behaviour, their impact on patient outcomes and the Behaviour Change Techniques (BCTs) employed using BCT-Taxonomy. Databases, including PubMed, PsycINFO and Web of Science, were searched up to December 2025 with no language restrictions for all studies of CCIs where change in provider behaviour was the main outcome. Of 8,405 records identified, 158 full texts were reviewed and 19 studies met the inclusion criteria. Fifteen studies reported a positive effect on the providers' behaviour. 'Feedback on behaviour', 'Information about social and environmental consequences' and 'Framing or reframing' were the BCTs most frequently deployed in the most effective interventions. The review indicated positive behavioural changes in providers following CCI. However, the field lacks studies where provider behaviour was measured objectively along with measurement of patient outcomes.PROSPERO registration: CRD42024575957.
In this review, we aimed to investigate the rates with which individuals fail versus achieve their goals in physical activity programmes. We conducted a systematic review and meta-analysis of 89 randomised controlled trials (N = 10,219 individuals) identified via a search of APA PsycINFO, MEDLINE, and SPORTDiscus until 5th September 2024. We conducted primary analysis with data from 30 studies with low risk of bias (N = 4,204 individuals), and complementary sensitivity analyses with the remaining studies judged to have some concerns and high risk of bias. Primary analyses found that the majority of participants failed to achieve their goals at each timepoint (range = 57.9%-77.0%), and that rates of achievement declined over time. Sensitivity analyses supported these findings, with the exception that achievement rates during interventions were significantly higher (p < .01) in studies with some concerns and high risk of bias. In studies with low risk of bias, achievement was higher among individuals with cardiac health issues and Type 2 diabetes, and lower when goals were prescribed (rather than self-set or collaboratively-set). These findings highlight the need for programmes to incorporate strategies for maximising achievement and minimising failure to support adoption and maintenance of physical activity.
Pain is a universal human experience and the most common reason to seek medical care. Although women report more frequent and disabling pains than men, their pains are more often underassessed and undertreated in clinical encounters. Understanding the 'whens' and 'whys' of this gender paradox is vital to promote pain care equity and efficiency. Yet, the atheoretical and descriptive nature of most studies on provider gender biases in pain care is stalling the research field. To overcome this gap, we first propose the novel Gender Biases in Pain Care Model, which conceptualises the contextual nature of gender biases in pain care. It is an interaction-based socioecological model that integrates assumptions of gender-related theories and dual process models of person perception and stereotyping. Second, we conduct a theory-driven review of current evidence addressing the model's theoretical contentions. Sixty-six articles (8 reviews and 58 primary studies), mostly published in 2010-2024, were included. Although findings provide preliminary support for the model's four contentions, important empirical gaps are still unaddressed. We discuss how this model is a steppingstone to the generation of novel research questions and testable hypotheses that may fill current knowledge gaps and contribute to the development of equitable pain practices and policies.
INTRODUCTION:Long COVID involves a variety of persistent symptoms after initial SARS-CoV-2 infection, affects multiple functional areas and requires multidisciplinary treatment. OBJECTIVE:This study aimed to explore the available evidence about psychological interventions for individuals with long COVID and their effectiveness in reducing some prevalent symptoms, such as fatigue, anxiety or depression, among others, and improving patient quality of life. METHODOLOGY:A systematic review and meta-analysis were conducted following the PRISMA 2020 guidelines. Two independent reviewers performed study selection and data extraction using Web of Science, Scopus, and PubMed databases prior to March 2024. Data synthesis was performed via random-effects meta-analysis, with heterogeneity assessed using the I2 statistic. RESULTS:Of the 1041 articles obtained, 19 were included in the systematic review and 14 in the meta-analysis. Results showed significant reductions in symptoms of anxiety [SMD = -0.64 (95% CI: -1.18 to -0.10)], depression [SMD = -0.41 (95% CI: -0.73 to -0.10)] and fatigue [SMD = -1.37 (95% CI: -2.48 to -0.26)]. Significant improvements were only registered in self-perceived health-related quality of life [SMD = 7.59 (95% CI: 3.70-11.48)]. CONCLUSION:Results showed improvements in anxiety, depression or fatigue, highlighting the potential role of psychological interventions in patient recovery.
Individuals with mental health difficulties face a higher risk of chronic disease than the general population, partly due to greater prevalence of health risk behaviours such as smoking, alcohol and drug use, physical inactivity, and poor diet. Preventive care aims to reduce this burden by addressing these modifiable behaviours. However, implementing preventive care in mental health settings is challenging due to numerous barriers. This scoping review explored healthcare professionals' perspectives on barriers and enablers to delivering preventive care, using the Theoretical Domains Framework (TDF). Four databases (Medline All, PsycINFO, CINAHL, EMBASE) and reference lists were searched. Eligible studies included qualitative, quantitative, and mixed-methods articles in English reporting healthcare professionals' perspectives on delivering preventive care for these modifiable behaviours. Forty-one studies were included. Barriers were identified across all fourteen TDF domains, 24 studies identified barriers relating to 'Social Influences' and 16 studies identified barriers relating to 'Beliefs about Consequences'. Enablers mapped to eleven domains, with four studies reporting enablers relating to 'Social Influences' and four studies reporting enablers relating to 'Knowledge.' Findings highlight the need for tailored, multilevel strategies to address barriers, strengthen implementation, and improve health outcomes for people with mental health difficulties.
This systematic review aimed to synthesise studies evaluating the effectiveness of volitional healp sheet (VHS) interventions in changing health behaviours, behavioural outcomes and behaviour-related cognitions. Controlled or uncontrolled VHS-based intervention studies targeting health behaviour change were included. Effect sizes were estimated using random effects meta-analyses as standardised mean differences (SMD), mean differences (MD) and odds ratios (OR) with 95% confidence intervals (CI). Twenty-seven studies met inclusion criteria; including 25 randomised trials. Interventions targeted health risk behaviours (e.g., alcohol consumption), health promoting behaviours (e.g., physical activity), and behaviour-related outcomes (i.e., weight). Overall, VHS interventions led to significant changes in health behaviours (SMD 0.22, 95% CI, 0.13, 0.30), and non-significant effects on cancer screening OR 0.93 (95% CI, 0.81, 1.07) and weight change (MD - 1.20 kg, 95% CI, - 2.79-0.38). The VHS led to significant changes in intentions (SMD 0.29, 95% CI, 0.08, 0.49; 6 comparisons, n = 770); self-efficacy (SMD 0.31, 95% CI, 0.15, 0.46) and self-regulatory effort (SMD 0.27, 95% CI, 0.03-0.51). Subgroup analysis found no difference for in-person vs remote delivery (P = 0.06) or behavioural categories (P = 0.23). The VHS is a scalable intervention for behaviour change with the potential to support small changes in some health-related behaviours.
The purpose of this state-of-the-art review of reviews was to unify, describe and appraise the relationship between physical activity (PA) and social psychological constructs, using the social dimensions of health behavior (SDHB) framework, which represents a taxonomy of 10 social dimensions applicable to health behaviors. Eligible reviews were published in a peer-reviewed journal in English, included a review in which PA was operationalized as a focal predictor or outcome variable and with data also reported on at least one social construct reported in the results, and published between 2010 and July 2025. Literature searches were completed in August 2025 using seven common databases. The search yielded 54 reviews. We identified limited evidence for reviews of experimental research. Reviews of observational quantitative studies showed associations between PA with injunctive norm, perceived social support, and attachment ties with meta-analysis point estimates in the small, positive effect size range. Reviews of qualitative studies revealed positive associations with PA that covered the entire SDHB framework, yet most were conducted on specific populations so generalizability was not clear. The findings show domains in need of further examination to address gaps in knowledge, opportunities for theoretical integration, and highlight key social dimensions important in PA promotion.
Many societal challenges, for example in the health and sustainability domain, involve human behaviour. The problem is often that unhealthy or environmentally harmful behaviours are perceived as more attractive than their healthy and pro-environmental alternatives, and that experiences with new healthy or pro-environmental behaviours are not always immediately pleasant. Here, we take a value-based decision making perspective and present a new psychological model of behaviour change. First, we adapt the existing Value-based Choice Model of self-control to better align with the behaviour change domain by, for example, mapping key concepts of this domain (e.g., attitudes, goals) onto our model. Second, whereas the endpoint of other models of behaviour change is the choice for a specific behaviour, the Value and Experience-based Model of Behaviour Change (VEM-BC) incorporates an experiential component. Specifically, it acknowledges the crucial importance of affective experiences during behaviour execution for long-term behaviour change. One central recommendation of the VEM-BC is, therefore, that interventions should aim at creating positive experiences with the desired target behaviour. By integrating insights from different research areas such as decision making, reinforcement learning, affective processing, self-control, and behaviour change, the VEM-BC offers a unified perspective and generates novel predictions for promoting lasting behaviour change.
Background Thyroid hormone replacement therapy (THRT) is the lifelong treatment for hypothyroidism, yet persistent non-resolution of the condition necessitates indefinite adherence and systematic evidence on facilitators, barriers, and targeted interventions to optimize medication adherence in THRT remains limited. Objectives This mixed-methods systematic review aimed to: 1) identify influential barriers and facilitators of THRT adherence using the Capability, Opportunity, Motivation-Behavior (COM-B) model and Theoretical Domains Framework (TDF); and 2) map potential and effective behavior change techniques (BCTs) to the TDF domains corresponding to the identified barriers. Methods Ten databases were searched from inception to November 2024 and then updated in November 2025. Study quality was assessed using the Mixed Methods Appraisal Tool (MMAT). For purpose 1: the COM-B model and TDF, were used to code barriers and facilitators extracted from primary studies to one or more of the 14 domains of TDF, then identify the key barriers and ranked the top five influential TDF domains using three criteria. For purpose 2: the potential BCTs were recommended to target key barriers identified in TDF domains. Results The 44 studies were included and mapped to 14 domains of TDF. Top five influential TDF to medication adherence were environmental context and resources (e.g., inconvenient administration times), social influences (e.g., family support), knowledge (e.g., lack of disease/medication knowledge), belief about consequences (e.g., concerns about side effects), and social/professional role and identity (e.g., older age as a facilitator). Twenty-seven potentially effective BCTs were identified from the included studies and the most frequently used BCTs to target five key TDF domains were social support from their partners, multilevel care intervention and effective physician communication. Conclusion This review highlights multifaceted barriers of medication adherence in patients receiving THRT and proposes theory-informed strategies to address them. Future research should validate these strategies in real-world settings and explore contextual adaptations for diverse populations.
This review establishes the extent to which the behaviour change technique (BCT) Graded Tasks is effective in increasing physical activity. Databases, including PubMed, Cochrane and PsycINFO, were searched (October 2024) for randomised control trials of Graded Tasks interventions with adult physical activity change as the main outcome. Graded Tasks were always delivered alongside BCTs 'goal setting (behaviour)' and 'action planning'. Of the 53 identified studies (N = 10,060), 39 were included in a random effects meta-analysis, indicating a significant, medium effect of Graded Tasks interventions in increasing physical activity (N = 4190, g = 0.61, CI 95% 0.42-0.81, p < .001, I2 = 83%). Prevention-based interventions (g = 0.78, CI 95% 0.43-1.12, p < .001, I2 = 90%) had larger effects than treatment-based interventions (g = 0.38, CI 95% 0.23-0.53, p < .001, I2 = 34). The number of Graded Task increments explained significant variability in physical activity change (R2 = 0.47, β = 0.68, p < .001). GRADE certainty of evidence was rated low. Graded Tasks, in conjunction with other BCTs, are effective for increasing physical activity, particularly for prevention. The included studies did, however, show high heterogeneity and potential publication bias. PROSPERO registration: CRD42022347300.
Timely breast and cervical cancer screening greatly reduce mortality, yet uptake remains sub-optimal, and intervention effectiveness varies across populations and settings. This systematic review applies the Intervention Ladder framework to classify interventions by their level of intrusiveness and assess their effectiveness in increasing uptake. Five databases (PubMed, Web of Science, EMBASE, Cochrane Library, SCOPUS) were searched for articles published from 2004 to October 2024, using terms related to cancer screening, uptake, and behavioural interventions. Studies were included if they were randomised or cluster-randomised trials targeting under-screened women (never screened, overdue, or non-responders). Of 2,981 records identified, 240 full-texts were reviewed and 91 trials met inclusion criteria. Due to high heterogeneity in intervention types, populations, and outcome reporting, a narrative synthesis was conducted. Screening uptake was summarised as percentage-point change. Results showed that low-intensity strategies that support individual autonomy, such as mailed reminders or self-sampling kits, were consistently effective. In contrast, more intrusive interventions were infrequently implemented and showed no clear added benefit. These findings highlight the value of ethically proportionate, accessible strategies to enhance participation in cancer screening.
Living with and managing Gestational Diabetes Mellitus (GDM) can be a significant burden for women. Previous research suggests that family support, particularly from partners, can substantially influence women's experiences of GDM. This review synthesised qualitative research examining the influence of partner support on women's experiences of living with and managing GDM. A systematic search was conducted across MEDLINE, EMBASE, PsycINFO, CINAHL, Cochrane, and ProQuest. Sixty-two articles were included, and themes were developed using Thomas and Harden's (2008) thematic synthesis approach. Confidence in the findings was assessed using the GRADE-CERQual approach. Three key themes were generated: (1) the spectrum of dyadic experiences in GDM, highlighting varying forms of partner support, including practical, emotional, and indirect support; (2) aligning partner support with women's needs, emphasising the importance of matching support with individual preferences; and (3) partner support is experienced within dyads, families, and cultural contexts, demonstrating how cultural norms shape partner involvement. Supportive partners positively influenced coping and management, while overbearing or inadequate support increased burden. Cultural expectations around support affected how support was perceived and provided. Most findings were rated as moderate confidence. Healthcare strategies could focus on education, open communication, and culturally tailored support to optimise partner involvement.
Caring for a child with a chronic health condition (CC) involves numerous challenges, which may have multiplied during the COVID-19 pandemic. Therefore, this meta-analysis aimed (1) to quantify the prevalence of clinically elevated anxiety, depression, general stress, and parenting stress symptoms in afflicted parents, (2) to examine potential moderator variables, and (3) to compare the outcomes between parents of children with and without CCs. A systematic literature search was conducted across four databases (PsycInfo, PubMed, CENTRAL, PSYNdex). A total of 79 studies were included. The pooled prevalence estimates of clinically elevated anxiety, depression, general and parenting stress symptoms were 31.04%, 27.37%, 64.27%, and 26.70%, respectively. Significant moderators were identified only for anxiety symptoms, namely geopolitical region, child CC, and child age. Anxiety and depression, but not general and parenting stress, were significantly higher in parents of children with than without CCs. Compared to published data from before the pandemic, prevalence rates of clinically elevated anxiety and depression symptoms decreased, while stress levels no longer differed between parents of children with and without CCs. We hypothesise that parents of children with CCs experienced some beneficial effects during the COVID-19 pandemic and had already acquired resilience to buffer its psychosocial impact.
Stress regulation is commonly conceptualised as behavioural responses to external stressors, often overlooking the perceptual processes shaping individual experience. This framing obscures the dynamic, hierarchical, and personally meaningful nature of regulation. In this paper, we introduce a unifying framework grounded in Perceptual Control Theory, proposing that the psychophysiology of stress is best understood as the control of perception rather than behaviour. Stress arises from a mismatch between current perceptions and internally held reference values - the desired states individuals strive to maintain. Within a hierarchical control system, these values are dynamically modified through experience. We argue that goal conflict - where simultaneous reference values cannot be satisfied, leading to persistent error - is the primary source of acute and chronic stress. Reorganisation, an adaptive process of structural change within the hierarchy, serves as the mechanism for resolving such conflict by revising reference values or creating new control systems. This perspective explains individual differences by focusing on controlled perceptions rather than standardised coping strategies. By formalising stress regulation as perceptual control, this approach bridges biological, psychological, and social dimensions. It offers a foundation for personalised interventions that target what individuals value most, rather than prescribing one-size-fits-all solutions.
BACKGROUND:This preregistered systematic review and meta-analysis aimed to comprehensively assess the effectiveness of psychosocial interventions on health outcomes in pediatric patients undergoing treatment for cancer. METHODS:A systematic literature search was conducted across multiple databases. The review included studies reporting samples with children and/or adolescents undergoing cancer treatment, focusing on randomised controlled trials of psychosocial interventions with a quantified health outcome. A three-level meta-analytic approach was utilised. RESULTS:A total of 74 studies (total N = 4526), providing 204 effect sizes, was eligible. The summary effect estimate was of medium size and nominally significant (Hedges g = 0.46, 95% CI [0.33-0.59]). Subgroup analyses revealed significant differences for health outcome and publication year only. Physiological outcomes showed a smaller effect (g = 0.14, 95% CI [-0.16-0.43]), and more recent publications showed larger effect sizes. DISCUSSION:This research synthesis provides evidence supporting the impact of psychosocial interventions on health outcomes in pediatric oncology and hematology patients. Despite variations in study quality and heterogeneity of the primary literature corpus, psychosocial care emerged as beneficial across a diverse range of contexts.
Fidelity is an important but under-addressed aspect of health behaviour change intervention research. Consensus is lacking regarding terminology, definitions, and conceptualisations. Fidelity frameworks and models can help people address fidelity in a structured way and ensure clarity and consistency of terminology, but they are underutilised to date. We aimed to identify and describe existing fidelity frameworks/models and compare these in terms of fidelity constructs included. We conducted a scoping review using a pre-specified search, dual independent screening, and data extraction. We analysed data using basic descriptive statistics and qualitative content analysis. We identified 20 fidelity frameworks/models. All frameworks/models included constructs relating to intervention delivery. All frameworks/models also included additional constructs; however, there was a lack of consensus across these, and whether they are components or moderators of fidelity. For health behaviour change researchers wishing to address fidelity, selecting a comprehensive framework/model that facilitates consideration of multiple constructs and that aligns with their intended purpose and context may be beneficial. Fidelity is a multi-faceted concept of which delivery is an important, but not the only, construct. Findings will help researchers consider fidelity in greater depth, apply and refine existing frameworks/models, and improve how fidelity is addressed in future behavioural interventions.
The aim of the study was to systematically retrieve and analyse current published literature and grey literature regarding the impact of community-based outdoor physical activity (PA) interventions on quantitative and qualitative measures of health and wellbeing in adults and children. A systematic review of seven databases was undertaken in February-April 2022 and September 2024. Overall, 57 outdoor community-based PA intervention studies were included. Meta-analysis results revealed a small-to-moderate positive effect for green exercise (GE) on measures of general health and mental health from pre-to-post intervention, with some evidence of greater benefits on overall health and PA compared to no exercise engagement. Quantitative and qualitative data synthesis indicated positive effects on mental wellbeing and PA engagement when interventions lasted 45 -90 minutes over 6 -13 weeks, with the greatest benefits displayed after walking and multi-activity interventions. A content analysis of qualitative findings emphasises the importance of social opportunities for GE uptake and adherence, and recommended developing low-cost, accessible, fun, and varied exercise opportunities in collaboration with community stakeholders. This comprehensive and robust evidence synthesis demonstrates the positive impact of GE engagement on mental wellbeing and PA, offering novel guidance for the creation, application, and promotion of community-based GE projects.
This study aims to investigate the effectiveness of text message-delivered health behaviours intervention on HbA1c change among adults with T2DM, and to identify key moderators including intervention features, message characteristics, target behaviours, and the usage of behaviour change techniques (BCTs). We systematically reviewed 37 randomised controlled trials published between 2016 and 2025, involving 8,971 participants. Changes in HbA1c and health behaviours were analysed using the standardised mean difference. The meta-analysis revealed a significant reduction in HbA1c (g = -0.32, 95% CI = -0.46 to - 0.18). Meta-regression also found that the intervention significantly improved health behaviours, which in turn predicted a significant reduction in HbA1c levels. Subsequent subgroup analyses revealed that studies with a shorter duration (≤6 months) demonstrated a larger effect size in reducing HbA1c. Notably, interventions employing specific BCTs including 'body changes' (g = -0.643), 'habit formation' (g = -0.624), 'credible source' (g = -0.513), 'self-monitoring of outcomes of behaviours' (g = -0.377), and "instruction on how to perform the behaviour' (g = -0.354) were significantly associated with greater HbA1c reductions. These effects were particularly pronounced in trials focused on physical activity, healthy eating, and medication adherence. Conclusions suggest that text message-delivered health behavior interventions should be tailored to specific target behavior and incorporate these high-impact BCTs to comprehensively improve diabetes management.
This systematic review of prospective studies examined whether psychological stress-conceptualised as cumulative stressful life events or perceived stress-is associated with cancer incidence. It was pre-registered in PROSPERO (IDCRD42020175681) and conducted following PRISMA guidelines. Methodological quality was assessed using the NIH Tool for Observational Studies, and the certainty of evidence was assessed using the GRADE tool. Hazard ratios were synthesised using random-effects meta-analyses. Nineteen studies were included, evaluating the effect of stressful life events (k=6) and/or perceived stress (k=15) on overall (k=3), breast (k=10), prostate (k=3), colorectal (k=2) and endometrial (k=1) cancer. Neither stressful life events nor perceived stress was consistently associated with cancer risk. Conflicting results emerged for perceived stress, including both protective and detrimental effects, particularly for breast and colorectal cancer. Most studies employed non-validated stress measures (k=12), assessed stress only once (k=17), and did not examine its impact comprehensively (k=11). The certainty of evidence was graded as very low. This review found no consistent evidence linking psychological stress to cancer risk. More high-quality prospective studies using comprehensive and validated measures of psychological stress and exploring potential moderators can help advance knowledge on the role of psychological stress in cancer incidence.
