PurposeA total of 478,000 children in England are reported to live with a parent who uses substances. The presence of a stable non-substance using caregiver within the family has been found to be one protective factor for children (Velleman and Templeton, 2016), yet there is a lack of research examining how to intervene with non-substance using parents/caregivers. This study aims to co-produce an intervention for non-substance using parents/caregivers and their children.Design/methodology/approachThis study had three phases: interviews with practitioners, exploring their perceptions of whom non-substance using parents/caregivers seek support from, the type of support needs they had and what influenced their decision-making; interviews with parents/caregivers to examine their support needs and experiences of help seeking; and co-production workshops with parents/caregivers and practitioners to discuss the findings and design of an intervention.FindingsParents/caregivers reported experiencing challenges in talking to their child(ren) about the other parent/caregiver's substance use. They highlighted the importance of a structured intervention to support them to initiate conversations with children about how parental substance use impacted the child and wider family in a way that parents/caregivers felt was age-appropriate and sensitive and supported them in their caregiving role to children.Research limitations/implicationsA limitation of this study relates to the participation of parents/caregivers who were not in receipt of support services. Recruitment was predominantly via specialist carer support organisations, and although this often presented an opportunity to talk with parents/caregivers who were open to the idea of discussing parental substance use, the authors are mindful of the differing view that parents who were not in receipt of support may have expressed about the potential of an intervention.Practical implicationsThis study highlights the often-overlooked impact of parental substance use on parents/caregivers who do not use substances and often manage dual roles as caregiver to a child and their partner/ex-partner or family member who uses substances. In particular, it seeks to emphasise the impact on parents/caregivers parenting and acknowledge the challenge of managing their own emotions whilst maintaining stability for the child.Social implicationsThis research suggests characteristics of an intervention that could be used to support family relationships when talking to children about the impact of parental substance use. It attempts to create space for families to convey that it is ok for children to talk about how this impacts upon their lives.Originality/valueThere is a lack of research examining how to intervene with non-substance using parents or other caregivers to support them in their parent/caregiver role. This study suggests ways for parents/caregivers to provide emotional support to their child(ren) impacted by parental substance use.

​ Abstract Background Individual heat protection depends on conditional behaviours that are activated when risk cues cross meaningful thresholds. Unlike Ultraviolet (UV) protection - where decades of preventive communication have ingrained clear behavioural triggers - heat guidance still offers vague cues that rarely specify when protective action is required. Methods We conducted a population-representative vignette experiment in Germany (n = 2,003). Using days sampled from actual past weather forecasts in an ecologically valid weather-app format as cues we investigate when and how people decide to protect themselves against both heat and UV exposure. Using composite behavioural indices, weighted regression, LASSO feature selection and spline-based exposure-response models, we identified the cues that drive protective behaviour and the presence of threshold responses. Findings Heat-protective behaviour displayed no population-level threshold, rising only gradually. Participants consistently relied on the maximum air temperature, not the perceived temperature that better reflects thermos-physiological heat stress and includes more climate parameters. In contrast, UV protection showed a sharp behavioural threshold at UVI 7-8, aligned with WHO messaging. Interpretation These findings reveal a critical gap: existing heat communication fails to provide effective behavioural cues. Establishing clear, actionable heat thresholds and actions is essential to improve public readiness for escalating heat extremes. Funding For this project there was no dedicated funding available.

Abstract Background Children with special health care needs (CSHCN) often rely on cross-sectoral care networks involving medical, therapeutic, educational, and social services. However, key dimensions of integrated care, including cross-sectoral communication and attention to family impact, remain challenging. Understanding factors that shape caregiver-reported experience of integrated care can inform program development to strengthen integrated care. We aimed (1) to quantify caregiver-reported experience of integrated care and (2) to examine associations between dimensions of caregiver-reported experience of integrated care and sociodemographic, health- and network-related correlates. Methods We analyzed cross-sectional data from the nationwide PART-CHILD cohort. Caregivers of CSHCN with predominantly neurological, developmental, and behavioral conditions were recruited in specialized outpatient facilities in Germany and completed questionnaires. Caregiver-reported experience of integrated care was assessed using the German Pediatric Integrated Care Survey, yielding composite scores for Team quality and communication and Attention to family impact . Associations with sociodemographic characteristics, reason for seeking care, unmet needs, and care network size were examined using multivariable linear regression models. Results Caregivers of CSHCN ( n = 459) reported moderate Team quality and communication (mean 4.1 ± 1.1) and low Attention to family impact (2.3 ± 1.1). Higher unmet needs were associated with lower Team quality and communication (1−4 unmet needs: β = −0.28, 95% CI: −0.52 to − 0.04; ≥5 unmet needs: β = −0.83, 95% CI: −1.28 to − 0.38; reference: none). Cognitive impairment (β = 0.36, 95% CI: 0.03 to 0.69; reference: physical impairment) and larger care networks (4 − 5 providers: β = 0.33, 95% CI: 0.08 to 0.58; 6 − 10 providers: β = 0.38, 95% CI: 0.07 to 0.70; reference: 2–3 providers) were associated with higher Attention to family impact . Conclusion Strengthening integrated care for CSHCN may require greater attention to family-level concerns, which were rated low in this sample. The association between unmet needs and Team quality and communication suggests a close link between perceived integration and needs-based service delivery. Correlates of Attention to family impact , including impairment type and care network size, warrant further investigation and may help identify target groups for interventions to strengthen family-centered services. Trial registration The study was prospectively registered in the German Clinical Trials Register on 16 November 2018 (ID: DRKS00015054).

BACKGROUND:Lower-grade gliomas (LGG) are a subgroup of primary brain tumours. People with LGG often live long-term with wide-ranging symptoms and impairments (e.g., seizures, cognitive impairment) and uncertainty about their disease progression. Self-management interventions can improve quality-of-life (QoL) in cancer survivors; however, adaptability, acceptability, and feasibility of existing interventions for people with LGG is unclear. AIMS:Co-design, with multiple stakeholders, an early prototype supported self-management intervention for people with LGG. METHODS:Co-design activities followed two sequential phases. Phase one comprised three semi-structured interview sets with people with LGG, caregivers, and healthcare professionals (HCP). Desired support and design preferences were inductively identified and mapped to the TIDieR checklist; this informed a paper prototype outline. Phase two comprised four discussion groups with people with brain tumours, caregivers, and HCPs, and a survey. These activities considered the prototype design, feasibility, and acceptability. A preliminary intervention logic model was developed from Phases one and two, evidence and self-management theory. RESULTS:Early co-design findings indicate preference for a blend of online and face-to-face access to information and support with consideration given to technology literacy and accessibility. A support 'toolkit' was desired for advice, signposting, and support, with the option for caregivers to access intervention content, where appropriate. To improve QoL, the intervention needs to improve symptom knowledge and self-efficacy for symptom management, and support psychological adjustment and independence. CONCLUSIONS:This groundwork, involving multiple stakeholders, will help ensure intervention acceptability, feasibility and effectiveness. There is scope for wider applicability to other brain tumour groups.

OBJECTIVE:Low-dose aspirin is proven to reduce the incidence of pre-eclampsia, yet adherence remains low. This systematic review synthesises qualitative evidence on barriers and facilitators to low-dose aspirin adherence in pregnancy and uses a co-production approach to develop an explanatory model of this complex behaviour. The overall aim is to contribute to the development of a theory of adherence, targeting this health issue. METHODS:Data sources: A search of electronic databases (Medline, Web of Science, CINAHL, PsycINFO, Embase, Scopus, Open Grey, Google Scholar, Prospero), charity and professional organisations' archives was conducted using predefined terms. Citation searching was also performed. Searches were not time-limited or language-specific and completed in November 2024. ELIGIBILITY CRITERIA:Studies, which included qualitative data on low-dose aspirin determinants of adherence in pregnancy were included. STUDY APPRAISAL AND SYNTHESIS METHODS:Quality was assessed using the Critical Appraisal Skills Programme checklist. A meta-ethnography approach with reciprocal translation and line-of-argument synthesis was used. The co-production approach was utilised to streamline future intervention development by engaging key stakeholders in evidence synthesis, enabling them to translate evidence into action, support implementation and overcome the subjectivity inherent in meta-ethnography. Co-production activities followed the nominal group technique and structured discussions. RESULTS:Out of 3757 items identified through systematic searches of published studies and grey literature, six studies were included in the review. No studies were excluded based on quality. Four 3rd-order constructs with a total of 10 sub-themes were identified: informational gap, verbal and non-verbal health system communication, personal assets and autonomous control. In an explanatory model, we demonstrate that women are advised to take low-dose aspirin in a context of lack of information and misconceptions (informational gap) with patchy and inconsistent messages from the health care system. Women ultimately control their decision about the use of low-dose aspirin, however, the arrival at a decision depends on the utilisation of individual assets (unique personal or social characteristics inherited or acquired). CONCLUSIONS:Improving the quality and delivery of information for women and their support networks can reduce the strain on personal resources and make this essential preventive treatment more accessible and equitable. PATIENT OR PUBLIC CONTRIBUTION:A group consisting of representatives from two national charities and a service user worked alongside an academic team, contributing to all aspects of this work, including formulating the research question, participating in the selection of the search terms, conducting screening of the abstracts, data extraction, quality assessment, synthesis, drafting a graphic representation and this manuscript.

Background As climate change increases the frequency and intensity of extreme heat, effective interventions are needed to reduce heat-related mortality, morbidity, and demand for emergency services. We systematically reviewed the effectiveness of interventions to reduce adverse health outcomes during periods of high temperature. Methods We searched PubMed, Embase, Web of Science, and Google Scholar from inception to 09.02.2026, and grey literature. Randomised and nonrandomised intervention studies assessing the effect of heat-protection interventions on mortality, morbidity and emergency demand in the general population or in heat-vulnerable groups were included. Risk of bias was assessed with the JBI checklist. Following a pre-registered protocol which was co-produced with an international expert panel (CRD420251020849), we conducted a systematic review and random-effects meta-analysis where studies were sufficiently comparable; otherwise, findings were synthesised narratively. Findings Of 32,149 records screened, 49 studies were included. Most studies evaluated complex interventions, particularly heat-health action plans (HHAP; n=18) and heat warning systems (HWS=12). Fewer studies assessed urban and building planning measures, education and awareness campaigns, community interventions, occupational interventions, and emergency preparedness measures. Mortality was the most frequently reported outcome. In meta-analysis of pre–post studies, HHAP implementation was associated with reduced mortality risk (RR=0·93 [95% CI 0·89; 0·99], p < 0 ·05). Evidence for HWS alone was inconsistent. Three studies suggested that air conditioning in public institutions was associated with lower mortality risk than no air conditioning. Evidence for other interventions was limited or inconsistent. Interpretation Comprehensive heat–health action plans appear to reduce heat-related mortality, but evidence for warning systems alone and other intervention types remains limited or inconsistent. More rigorous evaluations are needed, particularly for morbidity, emergency service demand, and implementation in low-resource settings.

Childhood obesity is a major health concern and a public health priority. Parents play a key role in addressing childhood obesity, and one possible solution could be directly informing parents about their child’s weight status, encouraging them to change behaviour. The MapMe intervention has been developed as a tool to improve parental acknowledgement and understanding of childhood obesity. A three-arm cluster randomised trial was delivered within England’s mandatory National Child Measurement Programme as part of the MapMe2 study. Building on the original MapMe trial, it assessed the effect of two versions MapMe intervention on weight in children aged 4–5 and 10–11 years. The aim of this study was to conduct a within-trial cost-utility analysis (CUA) using the MapMe2 trial data to estimate the potential cost-effectiveness of two versions of the MapMe intervention (a ‘Web Only’ version and a ‘Web Boost’ version) compared to a control group. The CUA was carried out from an NHS perspective over a one-year time horizon. In the base case, the primary outcome was child health-related quality of life measured by the CHU-9D. The inclusion of out-of-pocket costs and an alternative measure of health-related quality of life (the WAItE) were conducted as sensitivity analyses. Results were expressed as incremental cost per Quality Adjusted Life Year (QALY) gained. The results indicated that the ‘Web Only’ and ‘Web Boost’ intervention versions were more likely to be cost-effective than the control. This conclusion held true even when including parental out-of-pocket expenses for weight management and physical activity, and when using a condition-specific health-related quality of life measure. However, given the small sample size in the sub-study, the results from this study should be treated with a high degree of caution. Future analysis should focus on estimating the cost-effectiveness of public health interventions such as MapMe over a longer time horizon, given that full costs and benefits are unlikely to be captured in the short time frame of trials such as MapMe2.

Changes in the food system are key for attaining the Sustainable Development Goals. This viewpoint i) contends that, alongside structural changes to the food production and distribution systems, the next years are decisive to foster individual behavior change for sustainable healthy diets, especially in high-income countries; ii) provides a set of behavior change techniques that can contribute to the design of individual interventions aimed at that dietary change; iii) highlights the main weaknesses of previous eating behavior interventions and suggest how they may be overcome, notably by addressing potential negative spillovers and trade-offs; and iv) provides an actionable definition of sustainable healthy diets for designing behavior change interventions. This viewpoint offers a relevant starting point for the design of future interventions targeting individual behavioral change for sustainable healthy diets from a holistic and multi-disciplinary perspective.

Sickness absence has become a focal issue in labour market debate across high income economies- Specifically, accessible telemedical sick leave procedure is politically cited as a driver of opportunistic absenteeism. However, empirical evidence on the prevalence of such behaviours and their underlying mechanisms remains limited as traditional questionnaires on sensitive behaviours are prone to social desirability bias (SDB). We estimate the prevalence and predictors of voluntary absenteeism in this large, population-based pre-registered study (N = 1964) with an indirect questioning technique designed to circumvent SDB responding. We find that self-reported voluntary absenteeism doubles when measured indirectly (34.6%) compared to directly (18.6%). Psychosocial workplace factors - burnout, role conflict, and low work engagement - emerge as consistent predictors along with injunctive social norms (p’s < 0.05). Uncertainty about telemedical access was associated with reduced odds of voluntary absenteeism compared to having access (OR = 0.58, p = .003), while no effect was found for no access. Findings challenge dominant narratives attributing telemedical-sick leave to opportunistic misuse. Rather voluntary absenteeism is better understood as a function of workplace conditions and employee well-being rather than procedural access to certification. Policy efforts should focus on improving workplace conditions over simplistic reforms of sick leave certification procedures.

Well-designed effective interventions promoting sustainable diets are urgently needed to benefit both human and planetary health. This study evaluated the feasibility, acceptability, and potential impact of a pilot blended digital intervention aimed at promoting sustainable diets. We conducted a series of ABA n-of-1 trials with baseline, intervention, and follow-up phases over the course of a year, involving twelve participants. The intervention included text messages, and individualized online feedback sessions. Quantitative data on diet composition was collected daily for 15 weeks distributed over the year. Qualitative data was collected through interviews at the end of each phase. Results showed high feasibility and acceptability: 100% retention rate, 75% attendance at all feedback sessions, and an average response rate of 86% to the dietary questionnaires. The intervention had a positive and significant effect on the overall diet composition. Specifically, 92% of the participants significantly increased their daily fruit and vegetable consumption, and 58% significantly reduced their intake of red and processed meat as well as ultra-processed foods. Participants also reported reducing food waste, choosing minimally packaged and in-season foods, and prioritizing fair-sourced food. The study demonstrates the potential of digital interventions to effectively promote sustainable dietary behaviors and offers insights for future large-scale implementations. Upcoming iterations should involve a more diverse population, particularly less motivated individuals and with more diverse socioeconomic status. International Registered Report Identifier (IRRID): PRR1-10.2196/41443

OBJECTIVES:Parental underdetection of child underweight and overweight/obesity may negatively affect children's longer-term health. We examined psychological/behavioural mechanisms of a very low-intensity intervention to improve acknowledgement and understanding of child weight after feedback from a school-based weight monitoring programme. DESIGN:This sub-study was nested within a larger 3-arm cluster-RCT (1:1:1; N = 57,300). Parents in all groups received written postal feedback on their child's weight classification. Intervention participants received an enhanced feedback letter with computer-generated photorealistic images depicting children of different weight classifications, and access to a website about supporting healthy weight, once (intervention one) or twice (intervention two; repeated 6 months after first 'dose'). METHODS:A quantitative process and outcome evaluation using baseline and 12-month BMI z-scores of an opt-in sub-sample of 502 children aged 4-5 and 10-11. Children completed dietary reports, used accelerometers (MVPA), and self-reported self-esteem; 10-11-year-olds also self-reported quality of life and dietary restraint. Parents reported perceptions of child's weight classification, and their intentions, self-efficacy, action planning and coping planning for child physical activity, dietary intake; parents of 4-5-year-olds reported their child's quality of life. RESULTS:Neither intervention differentially improved parental acknowledgement or understanding of weight classification at follow-up, although parents in all groups reported better acknowledgement after receiving feedback. The interventions did not affect behavioural/psychological determinants, weight outcomes, children's self-esteem, dietary restraint or quality of life. CONCLUSIONS:The interventions neither improved parental acknowledgement of child weight, child BMI z-scores and their psychological/behavioural determinants, nor worsened psycho-social sequelae.

BACKGROUND:Low levels of physical activity (PA), more prevalent among those with low education, require effective interventions. Fewer trials have tested interventions to decrease sedentary behavior (SB). No school-based interventions have shown lasting effects on PA or SB in vocational schools. PURPOSE:To examine whether the Let's Move It intervention has effects on behavioral and clinical outcomes among vocational students after 2 and 14 months. METHODS:A cluster randomized trial in 6 school units in vocational education in Finland (N = 1112) (mean age 18.5 years, range 15-46). The multi-component intervention targeted in-class activity opportunities (eg, teacher-led activity breaks, equipment in classrooms), and students' motivation and self-regulation (eg, 6 group sessions, à 45-60 min, during the intensive intervention period of 2 months). Valid (≥ 4 days, ≥ 10 h/day) accelerometer data were obtained from 741 students at baseline, 521 (70.3%) at 2 months, and 406 (54.8%) at 14 months. RESULTS:No evidence of a significant intervention effect on the co-primary outcomes (moderate-to-vigorous PA, SB, breaks in SB) was found. Participants in the intervention arm reduced their total daily SB time by 32 min (95% CI, -43.2 to -20.8) on weekdays, compared with the control arm's reduction of 8.6 (95% CI, -19.5 to 2.3) and engaged in more accelerometer-measured light PA during school time. Few differences were found in secondary outcomes. The fidelity of intervention delivery was relatively good. CONCLUSIONS:This school-based intervention did not affect leisure-time activity. Despite a positive outcome on school-time light PA, more comprehensive or intensive environmental changes may be needed to meaningfully improve vocational students' total activity.

Objectives: Behaviour change theories have extensively been used in health behaviour change interventions and their programme theories. However, they are rarely evaluated in randomized field studies. The Let's Move It intervention targeted various psychosocial constructs to increase adolescents' physical activity. A theory-based process evaluation aiming to illuminate the trial findings as well as to test the programme theory used is conducted. Specifically, we investigate whether the intervention influenced the theorized determinants of change immediately post-intervention and after 1 year, and whether these determinants were associated with changes in physical activity. Design: A cluster-randomized controlled trial (n = 1166). Methods: We measured theorized determinants with self-report, and physical activity (PA) with accelerometry and self-report. The effects are evaluated with repeated measures ANOVA and regression models. Results: No changes were detected in most theorized determinants but intervention arm reported higher enactment of behaviour change techniques used during intervention immediately post-intervention and lower descriptive norms for PA throughout. Autonomous motivation was associated with PA immediately post-intervention. Conclusions: The lack of intervention effects may be due to many factors, for example insensitive measures, ceiling effects. However, reporting these null effects advances understanding of behaviour change processes. We introduce methodologic possibilities for future intervention programme theory evaluation efforts.

Die Covid-19-Pandemie hat den Bedarf an hochauflösender Evidenz zu sozialen und kontextuellen Bedingungen sowie den gesundheitlichen Folgen solcher Ausnahmesituationen deutlich gemacht. Mit der PULS(Populationsbasierte Umfrage zur Lebenssituation und Sozialen Gesundheit)-Studie soll deshalb eine agile und responsive Echtzeitkohorte etabliert werden. In einem ersten Schritt sollen die Determinanten der Studienteilnahme analysiert werden. Qualitative Studie im Zeitraum 16.12.2024–14.02.2025 mit 7 leitfadengestützten Fokusgruppen mit jeweils 4–7 Teilnehmenden (insg. 22 männlich, 17 weiblich, 2 nonbinär). Aussagen wurden entlang der 14 Domänen des „Theoretical Domains Framework“ deduktiv codiert. Die Teilnehmenden betonten vor allem die Wichtigkeit verschiedener Aspekte, die den Domänen Verstärkung, Erwartungen über Auswirkungen und Umweltbedingungen/Ressourcen sowie Ziele und Überzeugungen über Fähigkeiten zuzuordnen sind. Dabei wurden die einzelnen Aspekte nicht isoliert betrachtet, sondern gegeneinander abgewogen. So waren Teilnehmende beispielsweise eher bereit, zeitliche Ressourcen zu investieren, wenn sie ihren Beitrag zum Gemeinwohl als besonders relevant empfanden – etwa weil ihre persönlichen Ziele mit den politischen und gesellschaftlichen Implikationen der Studie übereinstimmten. Die Teilnahme an einer agilen und langfristig angelegten Kohortenstudie wird unter bestimmten Bedingungen als akzeptabel und umsetzbar eingeschätzt. Insbesondere der wahrgenommene Einfluss auf Gesellschaft und Politik sowie die Aussicht auf eine wirksame Translation wissenschaftlicher Erkenntnisse in politische Maßnahmen können Schlüsselanreize für Bürger:innen sein, die den persönlichen Ressourceneinsatz aufwiegen. Die Ergebnisse haben nicht nur Bedeutung für die Implementierung der PULS-Studie, sondern auch für anschließende Translationsvorhaben.

Premature death in patients with xeroderma pigmentosum (XP) is most commonly due to metastatic skin cancer. In total, 80% of the skin cancers in XP are on the face, head and neck. So rigorous ultraviolet protection, especially of the face, is crucial in managing patients with XP. We recently developed a new methodology for the accurate estimation of the daily dose of ultraviolet (UV) reaching the skin of the face over a prolonged period. We then used this to study photoprotection behaviour in detail over a 3-week period in 36 patients with XP in the UK. We identified a wide range of UV protection behaviours (i.e. daily UV dose to the face), with around 35% of adult patients with XP protecting significantly worse than the rest. We then found that their poor photoprotection correlated closely with nine variables, seven of them potentially reversible psychological or social factors. We went on to design a personalized behaviour change intervention (‘XPAND’) to target these psychological factors that correlated with poor photoprotection (i.e. high daily UV dose to the face). It consists of seven one-to-one sessions delivered by a nurse or psychologist. We tested the efficacy of this intervention in 16 patients with XP with poor photoprotection, in a randomized controlled trial. The design was a two-arm parallel-group randomized control trial with a delayed-intervention control arm who received XPAND the following year. The primary endpoint was mean daily UV dose to the face during a 3-week period in June or July following XPAND (or no intervention in the control group). Sixteen patients were randomized. There were sufficient data for primary outcome analysis in 13 of them. The XPAND group (n = 8) had a lower mean daily UV dose to the face than the control group (P < 0.001). The delayed-intervention control group also had a lower mean daily dose to the face after the intervention than before, although not at a statistically significant level. Secondary endpoints were also analysed. Health economic analysis was carried out and showed that XPAND was a potentially cost-effective treatment, as it would reduce long-term treatment costs associated with UV exposure. This small randomized controlled trial has shown that XPAND is effective at improving UV protection in poorly protecting patients with XP, and should be incorporated into the clinical management of XP.

BACKGROUND:The COVID-19 pandemic has highlighted the need for high-resolution evidence on the social and contextual conditions as well as health outcomes of such emergency events. The PULS (Populationsbasierte Umfrage zur Lebenssituation und Sozialen Gesundheit, i.e., Population-Based Survey on Living Conditions and Social Health) study aims to provide such evidence with an agile and responsive real-time cohort. Here, we examine the determinants of participation in such a study. METHODS:A qualitative study using seven semi-structured focus groups (between 16 December 2024 and 14 February 2025), each with 4 to 7 participants (total of 22 men, 17 women, 2 non-binary individuals; diverse backgrounds). Statements were deductively coded along the 14 domains of the Theoretical Domains Framework. RESULTS:Participants primarily emphasized the importance of various aspects associated with the domains of Reinforcement, Beliefs about Consequences, Environmental Context and Resources, and Goals, and Beliefs about Capabilities. However, participants did not only mention distinct aspects but also weighed them against each other. For example, participants were more willing to invest resources such as time if the resulting political and social implications of the study aligned with their personal goals, thus demonstrating a subjective contribution to the common good. DISCUSSION:Participation in an agile, responsive, and long-term cohort study is viewed acceptable and feasible under certain conditions. The perceived impact on society and politics as well as the translation of research into policy seem to be key incentives for citizens and can outweigh personally invested resources. These results have implications not only for the implementation of the PULS study but also for the related translation pathways.

Introduction: The environmental impact of on-site conferences, with air travel as the primary contributor to greenhouse gas emissions, has prompted a surge in research in recent years. The objective of this report is to raise awareness and stimulate transformation in the organisation of meetings of the European Health Psychology Society (EHPS).Methods: We conducted estimations of travel-related CO2eq emissions of EHPS conferences in 2019, 2022, and 2023, and performed projections for 2024 and 2025. Additionally, we developed hypothetical scenarios for selected European cities as centroids for future conferences.Results: EHPS conferences with an online option result in significant reductions in CO2eq emissions when compared to on-site only conferences. The selected European locations of these conferences enable more delegates to choose alternative forms of transportation instead of flying, such as trains, cars or buses, and consequently lead to significantly lower CO2eq emissions.Discussion: The principal avenues for curbing travel-related emissions while maintaining on-site attendance are the provision of hybrid conferences with enhanced online participation and the optimisation of venue locations.

BACKGROUND:Poor adherence to photoprotection in xeroderma pigmentosum (XP) increases morbidity and shortens lifespan due to skin cancers. OBJECTIVES:To test a highly personalized intervention (XPAND) to reduce the dose of ultraviolet radiation (UVR) reaching the face in adults with XP, designed using known psychosocial determinants of poor photoprotection. METHODS:A two-arm parallel group randomized controlled trial, including patients with suboptimal photoprotection to receive XPAND or a delayed-intervention control arm that received XPAND the following year. XPAND comprises seven 1 : 1 sessions targeting photoprotection barriers (e.g. misconceptions about UVR) supported by personalized text messages, activity sheets and educational materials incorporating behaviour change techniques. The primary outcome, mean daily UVR dose to face across 21 days in June-July 2018, was calculated by combining UVR exposure at the wrist with a face photoprotection activity diary. Secondary outcomes were UVR dose to face across 21 days in August 2018, time spent outside, photoprotective measures used outside, mood, automaticity and confidence to photoprotect. Financial costs and quality-adjusted life years (QALYs) were calculated. RESULTS:Sixteen patients were randomized; 13 provided sufficient data for primary outcome analysis. The XPAND group (n = 8) had lower mean daily UVR dose to face [0.03 standard error of difference (SED) (SD 0.02)] compared with controls (n = 7) [0.43 SED (SD 0.17)] (adjusted difference = -0.25, P < 0.001, Hedge's g = 2.21) at the June 2018 assessment. No significant between-group differences were observed in time spent outside, photoprotection outside, mood or confidence. The delayed-intervention control showed improvements in UVR dose to face (adjusted difference = -0.05; Hedge's g = -0.1), time outside (adjusted difference = -69.9; Hedge's g = -0.28) and photoprotection (adjusted difference = -0.23, Hedge's g = 0.45) after receiving XPAND (June 2019 assessment). XPAND was associated with lower treatment costs [-£2642; 95% confidence interval (CI) -£8715 to £3873] and fewer QALYs (-0.0141; 95% CI -0.0369 to 0.0028). CONCLUSIONS:XPAND was associated with a lower UVR dose to face in patients with XP and was cost-effective.

Patients presenting to emergency departments (EDs) following an episode of self-harm are at risk of future suicide. There are few evidence-based interventions for self-harm in the ED context in England. This study sought to assess the feasibility of a trial of a newly developed brief psychological intervention, the Assured approach. This approach consisted of an enhanced psychosocial assessment, collaborative safety planning and three rapid solution-focussed follow-up sessions. Phase 1 was a feasibility study, and phase 2 was an internal pilot trial of a cluster randomised controlled trial to assess whether progression to a full-scale trial was warranted. In phase 1, patients were recruited and allocated to a study arm, the Assured arm or treatment as usual, depending on the allocation of their assessing practitioner, in four EDs in England. They were invited to research assessments after consent and at 6 months. Phase 2 was the internal pilot of a cluster randomised controlled trial conducted in six EDs in England. Practitioners were randomised to deliver the Assured approach or treatment as usual. Patients were recruited and allocated to a study arm depending on the allocation of their assessing practitioner. They were invited to complete research assessments after consent and at 3, 9 and 18 months. Sixty-one patients were recruited into the Assured (n = 46) and treatment as usual (n = 15) arms in phase 1. Findings showed we could recruit and follow up patients over a 6-month period. The research procedures were acceptable to patients and practitioners, and the intervention was delivered with acceptable fidelity to the intervention manual. Forty-seven patients were recruited into the phase 2 internal pilot trial, falling substantially short of our target of 491 in the stop-go criteria, indicating that the trial was not feasible in its current design. The feasibility study indicated that both the intervention and research processes were acceptable. However, the internal pilot trial revealed substantial challenges in recruiting patients and delivering the intervention in the ED context. Adaptations to the trial design and intervention are proposed to enable the Assured approach to be tested in a future trial, to improve care for this underserved population. ISRCTN16003313, 04/02/2020; ISRCTN13472559, 18/11/2021.