Background: UK sexual health surveillance data shows a recent rise in sexually transmitted infections [STIs] among women in the 45+ age group. However, current government policies and services that aim to reduce STIs are not typically tailored for the specific needs of this population. Further, the existing evidence base of condom use interventions for older women is restricted to one study from the USA. Aims: Using an extended two-component TPB, the aims of this study were to: (1) determine the significant independent predictors of ‘at-risk’ online older women’s condom use intentions; and (2) identify the key beliefs underlying the significant independent TPB predictors. Methods: A cross-sectional online survey was employed. 109 UK-based sexually active single women that were 45+ years and looking for a new sexual partner(s) were recruited through Facebook adverts. Participants completed measures of direct and belief-based (established via an elicitation study) two-component TPB constructs, anticipated regret, moral norm, self-identity, future time perspective, and past behaviour. A three-step hierarchical regression analysis was conducted for the first aim, while correlational analyses were undertaken for the second aim. Findings: The extended two-component TPB accounted for 78% of the variance in condom use intention. Experiential attitude, injunctive norm, perceived behavioural control - capacity, anticipated regret, and self-identity emerged as significant independent predictors. A total of seven key beliefs (one behavioural, one normative, and five control) were identified. Discussion: This study addresses a gap in the literature and provides guidance for the development of condom use interventions for ‘at-risk’ online older women.

Background: Research suggests that social justice cognitions can affect health. Specifically, perceived injustice, defined as loss and blame/unfairness in relation to injury, is consistently associated with poor pain outcomes. Little is known about who is most likely to be affected by injustice, thus needing intervention, although evidence indicates that strong just-world believers are most threatened by underserved outcomes, a central ingredient of perceived injustice. The present study investigated the relationship between the just-world belief and perceived injustice in an experimental pain context. Methods: A between-groups experimental design was adopted. Following the completion of just-world belief and state anxiety scales and the cold pressor task, 114 healthy participants were interviewed about either an experienced injustice or the characteristics of their home (control condition), before repeating the cold pressor task. Pain and anxiety measures were completed following each cold pressor task. Repeated measures analyses of covariance were used to analyse the data. Findings: Opposing the hypotheses, no differences were found on pain and anxiety between the two interview conditions and individuals with a strong just-world belief did not report higher pain and anxiety levels following a recalled injustice. However, within the recalled injustice condition, unfairness ratings associated with a past or present injustice were associated with significantly increased pain and anxiety. Discussion: Overall, the findings support previous research on the adverse effects of a perceived injustice and extend them to suggest these effects may occur for a resolved or unresolved injustice that is unrelated to pain, thus carrying implications for intervention development.

Health-related research suggests the belief in a just world can act as a personal resource that protects against the adverse effects of pain and illness. However, currently, little is known about how this belief, particularly in relation to one's own life, might influence pain. Consistent with the suggestions of previous research, the present study undertook a secondary data analysis to investigate pain catastrophizing as a mediator of the relationship between the personal just world belief and chronic pain outcomes in a sample of chronic pain support group attendees. Partially supporting the hypotheses, catastrophizing was negatively correlated with the personal just world belief and mediated the relationship between this belief and pain and disability, but not distress. Suggestions for future research and intervention development are made.

BACKGROUND:A growing field of investigation into social justice cognitions and pain suggests perceived injustice has a negative impact on pain, but little is known about individual variation in the impact of a perceived injustice. One published study found that individuals with a strong rather than a weak just-world belief reported greater pain from the cold pressor task after experiencing a perceived injustice, but an overt measure of perceived unfairness is needed to investigate this relationship.METHODS:Following the completion of just-world belief and state anxiety scales, and the cold pressor task, 114 healthy participants were interviewed about either an experienced injustice or the characteristics of their home, before repeating the cold pressor task. Pain and anxiety measures were completed following each cold pressor task.RESULTS:Opposing the hypotheses, no differences were found on pain and anxiety between the two interview conditions, and individuals with a strong just-world belief did not report higher pain and anxiety levels following a recalled injustice. However, within the recalled injustice condition, unfairness ratings were associated with significantly increased pain and anxiety.CONCLUSIONS:Recalled personal injustice unrelated to one's current pain experience had a negative impact on pain and anxiety associated with the cold pressor task. These findings indicate that intervention development should be cognizant of the role of everyday injustices and not just those related to pain, on the pain experience. WHAT DOES THIS STUDY ADD?: This study shows that, independent of just-world beliefs, perceived unfairness associated with a recalled injustice unrelated to pain has a negative impact on the experience of acute pain.

This systematic review collates, examines and syntheses condom use interventions for middle-aged and older adults. Associations between effectiveness and theoretical basis, behaviour change techniques, mode of delivery and treatment fidelity were explored. Five interventions were included; one was effective. Compared to interventions with non-significant findings, the effective telephone-administered intervention used theory to a greater extent, had a higher number of behaviour change techniques and employed more treatment fidelity strategies. There is a need to develop theory-based interventions targeting condom use among this population and evaluate these in randomised controlled trials that are rigorously designed and reported. Health psychologists have a key role in this endeavour.

Background: Noroviruses are a leading cause of outbreaks globally and the most common cause of service disruption due to ward closures. Temporary suspension of visiting (TSV) is increasingly a recommended public health measure to reduce exposure, transmission and impact during norovirus outbreaks; however, preventing patient-visitor contact may contravene the ethos of person-centred care, and public acceptability of this measure is not known.Aim: To investigate the acceptability of TSV during norovirus outbreaks from the perspectives of patients, visitors and the wider public.Methods: Cross-sectional survey of patients (N = 153), visitors (N = 175) and the public (N = 224) in three diverse areas in Scotland. Health Belief Model constructs were applied to understand ratings of acceptability of TSV during norovirus outbreaks, and to determine associations between these levels and various predictor variables.Findings: The majority (84.6%) of respondents indicated that the possible benefits of TSV are greater than the possible disadvantages. Conversely, the majority (70%) of respondents disagreed that TSV is wrong as it ignores people's rights to have contact with family and friends'. The majority (81.6%) of respondents agreed that TSV would be more acceptable if exceptions were made for seriously ill or dying patients. Correlational analysis demonstrated that overall acceptability was positively related to perceived severity (r = 0.65), identified benefits (r = 0.54) and implementing additional communication strategies (r = 0.60); acceptability was negatively related to potential barriers (r = -0.49).Conclusions: There is greater service user and public support for the use of TSV than concerns around impinging upon patients' rights to have visitors. TSV should be considered as an acceptable infection control measure that could be implemented consistently during norovirus outbreaks. Crown Copyright (C) 2016 Published by Elsevier Ltd on behalf of the Healthcare Infection Society.

Associations of sexual identity with a range of sexual and sexual health behaviours were investigated amongst men who have sex with men (MSM). Data from 1816 MSM recruited from 4 Celtic nations (Scotland, Wales, Northern Ireland and the Republic of Ireland) were collected via a cross-sectional online survey advertised via social media. About 18.3% were non-gay identified MSM (NGI-MSM). In the last year, 30% of NGI-MSM reported high-risk unprotected anal intercourse and 45% reported never having had an sexually transmitted infection (STI) test. When compared to MSM who were gay identified (GI-MSM), NGI-MSM were more likely to be older, have a female partner, fewer sex partners, fewer anal sex partners, STI diagnoses and less likely to be HIV positive, more likely to never use the gay scene and be geographically further from a gay venue. NGI-MSM were also less likely to report STI and HIV testing behaviours. The findings highlight variations in risk by sexual identities, and unmet sexual health needs amongst NGI-MSM across Celtic nations. Innovative research is required regarding the utility of social media for reaching populations of MSM and developing interventions which target the heterogeneity of MSM and their specific sexual health needs.

Rates of HIV testing are increasing among men who have sex with men (MSM) in Scotland and the UK. However, it remains vital to encourage MSM to test for HIV. The aim of the current study was to determine which factors discriminated among three groups of MSM: those tested for HIV within the previous year, those who had tested over one year previously, and those who had never tested. Cross-sectional data were collected using self-report, anonymous questionnaires from MSM frequenting gay venues in Glasgow, Scotland, during July 2010 (N = 822, response rate 62.6%). Those who identified themselves as HIV positive (n = 38), did not normally reside in Scotland (n = 88), and did not provide information on HIV testing (n = 13), were excluded (139 excluded, leaving N = 683). Around 57% (n = 391) had tested for HIV within the previous year, 23% (n = 155) had tested over one year previously and 20% (n = 137) had never tested. Compared with those tested within the previous year, those tested over one year previously and those never tested had greater fear of a positive-HIV test result, a weaker norm for HIV testing, and were more likely to have had no anal sex partners at all within the previous year. Those tested over one year previously were significantly older than both other groups (who were more likely to be under 25 years of age). Unprotected anal intercourse (UAI) did not discriminate among the HIV testing groups. The results highlight the need to promote HIV testing in Scotland among those under 25 years and over 45 years, those with high fear of testing, and those whose sexual behaviour puts them at risk. Interventions to increase HIV testing should promote positive norms and challenge the fear of a positive result.

AIMS AND OBJECTIVES:To explore the patient experience and acceptability of methicillin-resistant Staphylococcus aureus screening of inpatient admissions to acute hospital settings.BACKGROUND:Prevention of healthcare-associated infections such as methicillin-resistant Staphylococcus aureus is a major patient safety concern internationally. Screening of patients for methicillin-resistant Staphylococcus aureus colonisation is becoming a routine aspect of hospital admission; however, evidence of the patient experience and acceptability of methicillin-resistant Staphylococcus aureus screening is limited.DESIGN:A mixed-methods study set in six acute care hospitals in three Scottish regions.METHODS:Data collection involved postdischarge self-report survey of patients who had been screened (n = 54) and qualitative patient interviews (n = 10). Theoretical constructs derived from the Health Belief Model and Theory of Planned Behaviour used in analysis.RESULTS:Findings indicated that methicillin-resistant Staphylococcus aureus screening was broadly acceptable to patients. The experience of screening did not appear to be problematic; responses demonstrate that screening provided reassurance and generated confidence that health organisations were tackling healthcare-associated infections. Patients were less positive regarding the provision of information, the possibility of refusing a screen and the consequences of a positive test result. Furthermore, there were indications that patients wanted to be told the results of the screen and strong support for screening of hospital staff.CONCLUSIONS:Analysis of constructs from our theoretical frameworks provides evidence that attitudes were largely positive; responses indicate a belief in the beneficial impact of methicillin-resistant Staphylococcus aureus screening for patients and the wider community. However, it is important that health professionals continually assess the patient experience of 'routine' aspects of health care such as MRSA screening.RELEVANCE TO CLINICAL PRACTICE:The findings from this study suggest that while methicillin-resistant Staphylococcus aureus screening is generally acceptable to patients as a regular patient safety initiative, to enhance the quality of the patient experience, clinicians should consider the timing, content and effectiveness of information provision.

A growing field of investigation suggests that social justice appraisals have implications for adjustment to chronic pain conditions. One strand of research indicates that the ability to perceive justice in one’s own life and in the world can confer benefits on the experience of pain in experimental and support group environments. This study extended previous research to investigate the role of justice beliefs in a clinical environment, where adjustment to pain can be particularly problematic, in order to learn more about the circumstances under which these beliefs are more or less adaptive in the pain experience. In total 123 pain clinic attendees completed self-report measures of personal and general just-world beliefs, acceptance of pain (activity engagement/pain willingness), pain severity; disability and depression. Somewhat contrary to expectations, correlation analyses revealed that the personal but not the general just world-belief was weakly associated with lower depression scores, and both beliefs were unrelated to disability and pain intensity. In hierarchical regression analyses the general just-world belief did not interact with pain intensity and disability in their relationship with depression, but activity engagement interacted with the personal just-world belief in its relationship with pain intensity, such that the personal just-world belief was associated with less pain when activity engagement was high. Overall, although largely non-significant, the results are nonetheless informative as their inconsistency with previous research findings indicates that unidentified mediator or moderator variables may be relevant in the relationship between justworld beliefs and pain, identifying opportunities to take this work forward.

The UK and USA guidelines recommend at least annual HIV testing for men who have sex with men (MSM), with more frequent testing for those at risk. Although measures of risk and regularity of HIV testing are essential for evaluating interventions, these are not yet standardised across the UK.1 Risk criteria could include recent unprotected anal intercourse (UAI), a high number of partners, unknown partners and recent sexually transmitted infection (STI).2 From self-report data collected in Glasgow with a bar-based sample (excluding non-Scottish …

BACKGROUND:This paper explores the exposure and impact of a Scottish mass media campaign: Make Your Position Clear. It ran from October 2009 to July 2010, targeted gay men and other men who have sex with men (MSM), and had two key aims: to promote regular sexual health and HIV testing every 6 months, and to promote the use of appropriate condoms and water-based lubricant with each episode of anal intercourse.METHODS:A cross-sectional survey (anonymous and self-report) was conducted 10 months after the campaign was launched (July 2010). Men were recruited from commercial venues. Outcome measures included use of lubricant, testing for sexually transmitted infections and HIV, and intentions to seek HIV testing within the following six months. Linear-by-linear chi-square analysis and binary logistic regressions were conducted to explore the associations between the outcome measures and campaign exposure.RESULTS:The total sample was 822 men (62.6% response rate). Men self-identifying as HIV positive were excluded from the analysis (n=38). Binary logistic analysis indicated that those with mid or high campaign exposure were more likely to have been tested for HIV in the previous six months when adjusted for age, area of residence and use of the "gay scene" (AOR=1.96, 95% CI=1.26 to 3.06, p=.003), but were not more likely to be tested for STIs (AOR=1.37, 95% CI=0.88 to 2.16, p=.167). When adjusted for previous HIV testing, those with mid or high campaign exposure were not more likely to indicate intention to be tested for HIV in the following six months (AOR=1.30, 95% CI=0.73 to 2.32, p=.367). Those with no campaign exposure were less likely than those with low exposure to have used appropriate lubricant with anal sex partners in the previous year (AOR=0.42, 95% CI=0.23 to 0.77, p=.005).CONCLUSIONS:The campaign had demonstrable reach. The analysis showed partial support for the role of mass media campaigns in improving sexual health outcomes. This suggests that a role for mass media campaigns remains within combination HIV prevention.

BACKGROUND:Smoking in people with mental health problems (MHPs) is an important public health concern as rates are two to three times higher than in the general population. While a strong evidence base exists to encourage and support smoking cessation in the wider population, there is limited evidence to guide the tailoring of interventions for people with MHPs, including minimal understanding of their needs. This paper presents findings from theoretically-driven formative research which explored the barriers and facilitators to smoking cessation in people with MHPs. The aim, guided by the MRC Framework for the development and evaluation of complex interventions, was to gather evidence to inform the design and content of smoking cessation interventions for this client group.METHODS:Following a review of the empirical and theoretical literature, and taking a critical realist perspective, a qualitative approach was used to gather data from key stakeholders, including people with enduring MHPs (n = 27) and professionals who have regular contact with this client group (n = 54).RESULTS:There was a strong social norm for smoking in participants with MHPs and most were heavily addicted to nicotine. They acknowledged that their physical health would improve if they stopped smoking and their disposable income would increase; however, more important was the expectation that, if they attempted to stop smoking, their anxiety levels would increase, they would lose an important coping resource, they would have given up something they found pleasurable and, most importantly, their mental health would deteriorate. Barriers to smoking cessation therefore outweighed potential facilitators and, as a consequence, impacted negatively on levels of motivation and self-efficacy. The potential for professionals to encourage cessation attempts was apparent; however, they often failed to raise the issue of smoking/cessation as they believed it would damage their relationship with clients. The professionals' own smoking status also appeared to influence their health promoting role.CONCLUSIONS:Many opportunities to encourage and support smoking cessation in people with MHPs are currently missed. The increased understanding provided by our study findings and literature review have been used to shape recommendations for the content of tailored smoking cessation interventions for this client group.

Objectives This paper examines changes in barriers to HIV testing amongst gay men. We compared data collected in 2000 and 2010 to assess changes in HIV testing behaviours, in community-level perceptions of barriers to HIV testing, and in the relative contributions of barrier measures. Methods Cross-sectional surveys were conducted within the commercial gay scene in Glasgow with good response rates (78% and 62%) using a form of time and location sampling. Results Major changes in HIV testing behaviours were observed between 2000 and 2010 (30.6% increase in testing within previous year). At the community level, the perceived benefits of testing [t (1284)?=?8.46; P?<?0.001] and the norm for HIV testing [t (1236)?=?11.62; P?<?0.001] increased; however, other perceived barriers did not change (fear of a positive result, clinic-related barriers and attitudes to sex with HIV-positive men). Multinomial logistic regression showed that fear of a positive test result remained a key barrier to HIV testing; however, a significant fear x year of survey interaction indicated that fear played a lesser role in differentiating those who had never been tested from those who had been tested in 2010 than it had in 2000. Conclusions These findings suggest the partial normalization of HIV testing. While some barriers have reduced, other key barriers remain important. Interventions should be designed and evaluated that attend to both the biomedical and the psychosocial aspects of HIV testing (e.g. the meaning of positive test results, the sexual exclusion of positive men, and HIV-related stigma).