Impaired inhibition of emotional material is an important cognitive component of depression. The current aim was to determine if participants with major depression (MDD) and/or subclinical depression (dysphoria) exhibit impaired inhibition of sad faces on a face-word variant of the Stroop task. Study 1: patients with MDD (n=28) and healthy controls (n=32) were presented with positive and negative words superimposed across happy, sad, and neutral faces. Study 2: dysphoric (n=23) and non-dysphoric (n=35) participants were presented with positive and negative words superimposed across happy and sad faces (shown upright and inverted). Participants were told to ignore the faces and categorise the words. Patients with MDD experienced greater interference from sad faces than did the controls. Healthy controls experienced greater interference from happy than sad faces, whereas interference levels from happy and sad faces did not differ in patients with MDD. Dysphoric participants experienced greater interference from sad faces than did non-dysphoric participants, and from sad faces than happy. The amount of interference from happy and sad faces did not differ in the non-dysphoric participants. Clinical and subclinical depression are linked to impaired inhibition of sad faces, which might represent a risk factor for depression and a potential target for intervention.

BACKGROUND:Uptake of colorectal cancer screening is suboptimal. The TEMPO trial evaluated the impact of two evidence-based, theory-informed, and co-designed behavioural interventions on uptake of faecal immunochemical test (FIT) colorectal screening. METHODS:TEMPO was a 2 × 4 factorial, eight-arm, randomised controlled trial embedded in the nationwide Scottish Bowel Screening Programme. All 40 000 consecutive adults (aged 50-74 years) eligible for colorectal screening were allocated to one of eight groups using block randomisation: (1) standard invitation; (2) 1-week suggested FIT return deadline; (3) 2-week deadline; (4) 4-week deadline; (5) problem-solving planning tool (no deadline); (6) planning tool plus 1-week deadline; (7) planning tool plus 2-week deadline; (8) planning tool plus 4-week deadline. The primary outcome was the proportion of FITs returned correctly completed to be tested by the colorectal screening laboratory providing a positive or negative result, within 3 months of the FIT being mailed to a person. The trial is registered with clinicaltrials.gov, NCT05408169. FINDINGS:From June 19 to July 3, 2022, 5000 participants were randomly assigned per group, with no loss to follow-up. 266 participants met the exclusion criteria; 39 734 (19 909 [50·1%] female and 19 825 [49·9%] male; mean age 61·2 [SD 7·3] years) were included in the analysis. The control group (no deadline, and no planning tool) had a 3-month FIT return rate of 66·0% (3275 of 4965). The highest return rate was seen with a 2-week deadline without the planning tool (3376 [68·0%] of 4964; difference vs control of 2·0% [95% CI 0·2 to 3·9]). The lowest return rate was seen when the planning tool was given without a deadline (3134 [63·2%] of 4958; difference vs control of -2·8% [-4·7 to -0·8]). The primary analysis, assuming independent effects of the two interventions, suggested a clear positive effect of giving a deadline (adjusted odds ratio [aOR] 1·13 [1·08 to 1·19]; p<0·0001), and no effect for use of a planning tool (aOR 0·98 [0·94 to 1·02]; p=0·34), though this was complicated by an interaction between the two interventions (pinteraction=0·0041); among those who were given a deadline, there was no evidence that receiving a planning tool had any effect (aOR 1·02 [0·97 to 1·07]; p=0·53), but in the absence of a deadline, giving the planning tool appeared detrimental (aOR 0·88 [0·81 to 0·96]; p=0·0030). In the absence of the planning tool, there was little evidence that the use of a deadline had any effect on return rates at 3 months. However, secondary analyses indicated that the use of deadlines boosted earlier return rates (within 1, 2, and 4 weeks, particularly around the time of the deadline), and reduced the need to issue a reminder letter after 6 weeks, with no evidence that the planning tool had any positive impact, and without evidence of interactions between interventions. INTERPRETATION:Adding a single sentence suggesting a deadline for FIT return in the invitation letter to FIT colorectal screening resulted in more timely FIT return and reduced the need to issue reminder letters. This is a highly cost-effective intervention that could be easily implemented in routine practice. A planning tool had no positive effect on FIT return. FUNDING:Scottish Government and Cancer Research UK.

Abstract Background People with Inflammatory Bowel Disease (IBD) have an increased risk of depression and self-harm. Participants in IBD research trials often disclose severe depression symptoms, including thoughts of self-harm and suicidal ideation, in validated self-administered questionnaires such as the Patient Health Questionnaire-9 (PHQ-9). However, there is no standard protocol for responding to such disclosure in research trials and the opportunity to support people at risk is potentially missed. We developed and evaluated a risk assessment protocol for the IBD-BOOST randomised controlled trial (ISRCTN71618461). Methods Participants completed the PHQ-9 scale at baseline, six-month and 12-month follow-up. Responding to item 9: ‘Thoughts that you would be better off dead or of hurting yourself in some way’, if a participant indicated ‘More than half the days’ or ‘Nearly every day’, the trial database automatically alerted the research team to risk assess the participant. Trial risk assessors, trained in the protocol, contacted participants by telephone, completed the risk assessment protocol (Figure 1) and signposted participants to appropriate professional services. Risk assessments were completed at the first occurrence of a PHQ-9 item 9 response. Risk assessments were reviewed by the Chief Investigator and summarised to trial governing committees. Results 780 participants were randomised. Overall, there were 58 PHQ-9 risk alerts during the trial (baseline, six- or 12-month follow-up), 41 of which were new alerts and required risk assessment. One participant declined assessment so 40 risk assessments were completed. 24 participants were assessed as low-risk and 16 participants as medium-risk, with 12 declaring previous suicide attempts. No participants were rated as high-risk. The mean time for the risk assessment phone call was 14 minutes (range 5-36 minutes) and total time spent on calls was approximately nine hours. Trial participants who received a risk assessment expressed appreciation for being contacted and all except two wished to receive information about professional support services. In a focus group, trial risk assessors reported positive experiences of conducting the risk assessment with suggestions for improvement, which resulted in minor modifications to the protocol. Conclusion Our evaluation demonstrated that it was viable for a research trial team to successfully conduct a risk-assessment protocol for trial participants reporting thoughts of self-harm, with training and support from senior colleagues. Resources are required for training and delivery, but it is not unduly onerous. Trial participants appeared to find completing the assessment acceptable. The revised protocol will be made available for researchers to use.

Background Participants in research trials often disclose severe depression symptoms, including thoughts of self-harm and suicidal ideation, in validated self-administered questionnaires such as the Patient Health Questionnaire (PHQ-9). However, there is no standard protocol for responding to such disclosure, and the opportunity to support people at risk is potentially missed. We developed and evaluated a risk assessment protocol for the IBD-BOOST randomised controlled trial (ISRCTN71618461 09/09/2019). Methods Participants completed the PHQ-9 at baseline and 6-month and 12-month follow-ups. The trial database automatically alerted the research team to risk assess participants. Trial researchers, trained in the protocol, contacted participants by telephone, completed the risk assessment, and signposted participants to appropriate professional services. Results Seven hundred eighty participants were randomised in the trial; 41 required risk assessment. One participant declined assessment, so 40 risk assessments were completed. Twenty-four participants were assessed as low-risk and 16 participants as medium-risk, with 12 declaring previous suicide attempts. None were rated as high-risk. Trial participants expressed appreciation for being contacted, and all except two wished to receive information about professional support services. Trial risk assessors reported positive experiences of conducting the risk assessment with suggestions for improvement, which resulted in minor modifications to the protocol. Discussion Our evaluation demonstrated that it was viable for a research trial team to successfully conduct a risk-assessment protocol for trial participants reporting thoughts of self-harm, with training and support from senior colleagues. Resources are required for training and delivery, but it is not unduly onerous. Trial participants appeared to find completing the assessment acceptable.

BACKGROUND:Adherence to physical activity (PA) recommendations during pregnancy is low. A common reason for low adherence is concern of harm to mother and/or baby. The Necessity-Concerns Framework (NCF), is a well-established framework in medicine adherence, however it has not been used to explore adherence to antenatal PA. This study aims to explore (1) what influences pregnant women's PA in the context of the NCF; and (2) if the NCF is an appropriate framework to understand antenatal PA engagement.METHODS:Semi-structured interviews were conducted with 18 pregnant women in the UK and Ireland (mean gestation 27 weeks). Interviews explored beliefs, experiences, perceived necessities and concerns about PA. Interviews were transcribed verbatim and analysed using thematic framework analysis.RESULTS:Five themes were identified as influential to antenatal PA: (1) Perceived benefits and necessity of PA, (2) Concerns regarding antenatal PA, (3) Balancing the necessity and concern, (4) Barriers to antenatal PA, (5) Facilitators of antenatal PA. Women described a number of perceived necessities and concerns regarding antenatal PA. These necessities and concerns were described as being consciously balanced, supporting the NCF. However, a number of additional influences (for example, feelings of nausea and lack of advice and knowledge) seemed to impact antenatal PA engagement before women could consider their perceived necessities and concerns around antenatal PA.CONCLUSIONS:The Necessity Concerns Framework is a useful framework to help explain how and why women engage with antenatal PA, more specifically why women do and do not engage in antenatal PA at different times during their pregnancy. However, there are a number of other interpersonal and intrapersonal influences on antenatal PA (e.g. physical symptoms, motivation and time), suggesting the NCF alone may be too simplistic to understand and influence complex behaviour such as antenatal PA.

This paper describes the development process of the ‘SKIP IT’ text messaging intervention to promote smoking cessation during pregnancy. Smoking during pregnancy is a major risk to mother and infant health. Pregnant women who smoke are more likely to experience complications during pregnancy, and babies born to women who smoke are likely to experience ongoing health needs. Previous interventions for reducing smoking in pregnant women have shown limited effectiveness. The objective was to develop an effective intervention to promote smoking cessation during pregnancy by examining the complex set of needs for facilitating positive behaviour change. This included engaging with clinicians and the target group of pregnant smokers to ensure the intervention is feasible and acceptable. Due to the linear nature of this development methods and results are presented together. Step 1: Literature review methods A series of literature reviews were carried to explore existing psychological theory relating to smoking cessation during pregnancy. The result was six ‘elements’ that, if achieved, are likely to increase the likelihood of a successful quit attempt: Step 2: Qualitative interviews Qualitative interviews were conducted with key stakeholder groups. The setting for this qualitative work was one large maternity unit in Scotland. Evidence supporting each of the ‘elements’ developed from the literature review was present. Step 3: Intervention development Evidence from the literature reviews and qualitative interviews was collated and a prototype intervention was developed based on storytelling and images. The final intervention consisted of frequent text messages sent to participants from a fictional character, ‘Megan’, who was designed as a coping model. Images corresponding to the current size of the fetus were sent weekly. Step 4: Alpha testing The intervention underwent alpha testing where the intervention was taken to a wider stakeholder group for feedback. The writing group refined the intervention to reflect changes to current smoking cessation technology, including e-cigarettes and extended the intervention to be delivered up to 6 weeks post-birth. Step 5: Focus groups and user feedback Qualitative user testing was carried out the two health boards. The views of the target group were used to develop an intervention that was demonstrated to be feasible in practice and both acceptable and engaging for participants. Step 6: Refining texts and coding Text messages were refined based on the user feedback. The final text messages were coded for the presence of Behavioural Change Techniques (BCTs) by two coders. We have developed a narrative and image-based intervention delivering by text message with the aim of supporting smoking cessation in pregnant women. Importantly, the intervention is rooted in an in-depth understanding of the target group, and their needs. Trials registration ClinicalTrials.gov Protocol ID: RMS2119.

INTRODUCTION:Screening can reduce deaths from colorectal cancer (CRC). Despite high levels of public enthusiasm, participation rates in population CRC screening programmes internationally remain persistently below target levels. Simple behavioural interventions such as completion goals and planning tools may support participation among those inclined to be screened but who fail to act on their intentions. This study aims to evaluate the impact of: (a) a suggested deadline for return of the test; (b) a planning tool and (c) the combination of a deadline and planning tool on return of faecal immunochemical tests (FITs) for CRC screening. METHODS AND ANALYSIS:A randomised controlled trial of 40 000 adults invited to participate in the Scottish Bowel Screening Programme will assess the individual and combined impact of the interventions. Trial delivery will be integrated into the existing CRC screening process. The Scottish Bowel Screening Programme mails FITs to people aged 50-74 with brief instructions for completion and return. Participants will be randomised to one of eight groups: (1) no intervention; (2) suggested deadline (1 week); (3) suggested deadline (2 weeks); (4) suggested deadline (4 weeks); (5) planning tool; (6) planning tool plus suggested deadline (1 week); (7) planning tool plus suggested deadline (2 weeks); (8) planning tool plus suggested deadline (4 weeks). The primary outcome is return of the correctly completed FIT at 3 months. To understand the cognitive and behavioural mechanisms and to explore the acceptability of both interventions, we will survey (n=2000) and interview (n=40) a subgroup of trial participants. ETHICS AND DISSEMINATION:The study has been approved by the National Health Service South Central-Hampshire B Research Ethics Committee (ref. 19/SC/0369). The findings will be disseminated through conference presentations and publication in peer-reviewed journals. Participants can request a summary of the results. TRIAL REGISTRATION NUMBER:clinicaltrials.govNCT05408169.

Abstract Background The ActWELL randomised controlled trial assessed the effectiveness of a weight management programme delivered by volunteer lifestyle coaches (LCs) in women attending breast clinics. The intervention focused on caloric intake and physical activity, utilising behavioural change techniques including a weight awareness plan (WAP). The current work is a secondary analysis of the ActWELL data and aims to examine the response to the weight self‐awareness plan (used as part of the intervention programme). Methods The LCs invited participants (n = 279) to undertake an implementation intention discussion to formulate a self‐weighing (SW) plan. Bodyweight scales were offered, and recording books provided. The physical activity component of the intervention focused on a walking plan assessed by accelerometers. The LCs contacted participants by telephone monthly and provided personalised feedback. Mann–Whitney tests and chi‐squared analysis were used to examine the effect of SW on weight change. A qualitative evaluation utilising semi‐structured interviews was also undertaken. Results Most participants (96.4%) agreed to set a weekly SW goal and 76 (27%) requested scales. At 12 months, 226 (81%) returned for follow up. The median (interquartile range) weight change for those who self‐ reported at least one weight (n = 211) was −2.3 kg (−5.0 to 0.0) compared to −1.2 kg (−5.0 to 0.03) in those who did not (n = 14). Participants who reported weights on more than eight occasions (39%) were significantly more likely (p = 0.012) to achieve 5% weight loss compared to those who weighed less often. Low numbers of accelerometers were returned that did not allow for significance testing. Qualitative data (n = 24) indicated that many participants found the WAP helpful and motivating. Conclusions Greater adherence to the WAP initiated by volunteer coaches is associated with achieving 5% weight loss.

Introduction: Worldwide, colorectal cancer is a major public health issue. Despite the existence of screening programmes in many countries, global uptake remains low. This meta-ethnography aimed to analyse qualitative literature to explore attitudes towards colorectal cancer screening and reasons for non-participation in eligible people that do not participate when invited.Methods: Systematic searches were conducted in five databases in May 2021. Critical appraisal of included studies was performed using the CASP checklist for qualitative studies.Findings: Thirteen studies were included. Three main themes and eight sub-themes were developed across studies: (1) Differences in motivation, with non-participants expressing a lack of knowledge and varying levels of intention to participate but not feeling screening was personally necessary; (2) Active aversion to screening expressed by fear, discomfort, disgust or not wanting to know; and (3) Contextual barriers of the healthcare system such as practical constraints or poor relationships with healthcare professionals. Conclusion: Findings suggest multiple pathways to non-participation including ambivalence, aversion to the process and consequences of screening or lack of support. Persuasive messages and prompts to action to target ambivalence, reassurance regarding the screening procedures to target negative reactions, and increased support from healthcare professionals may be beneficial in increasing screening uptake.

Childhood trauma has been found to have serious negative consequences for mental and physical health. However, the precise mechanisms through which trauma influences health outcomes are unclear. Childhood trauma-related disruptions to sleep in adulthood represent an important potential mechanism. Two 7-day multilevel studies investigated the effects of childhood trauma on daily sleep outcomes and stress-related variables and whether the effects of trauma on sleep outcomes were mediated through these stress-related variables (or vice versa). Participants completed the Childhood Trauma Questionnaire before a 7-day online daily diary study. Measures of daily stress, perseverative cognition, and sleep were completed daily. Multi-level modelling found that higher levels of childhood neglect were associated with poorer daily sleep quality, shorter sleep duration, longer sleep onset latency, and higher daily stress and rumination levels. Higher childhood abuse was associated with shorter sleep duration, greater morning tiredness, and higher levels of daily stress, rumination, and worry. Childhood trauma was found also to have bidirectional, indirect effects on sleep quality and morning tiredness through daily stress-related variables. The current findings suggest that interventions aimed at mitigating the negative effects of childhood trauma should also incorporate components that target modifiable risk factors, such as sleep, stress, worry, and rumination.

Rationale: Family, and sometimes longstanding friends, have considerable influence over organ donation, through agreeing or disagreeing to the donation of a deceased individual's organs. To date, most research has been undertaken within opt-in systems. Objective: This study advances on previous research by assessing next-of-kin approval under opt-out legislation. We tested whether next-of-kin approval varies when the deceased is a registered donor (opted-in), registered non-donor (opted-out) or has not registered a decision under an opt-out policy (deemed consent). We also tested if the deceased's wishes influenced next-of-kin approval through relatives anticipating regret for not donating and feelings of uncertainty. Finally, we assessed whether next-of-kin's own beliefs about organ donation influ-enced whether they followed the deceased's wishes.Methods: Participants (N = 848) living in a country with opt-out legislation (Wales, UK) were asked to imagine a relative had died under an opt-out system and decided if their relatives' organs should be donated. Participants were randomly allocated to imagine the deceased had either (i) opted-in, (ii) opted-out or (iii) not registered a decision (deemed consent). The outcome variable was next-of-kin approval, with uncertainty and anticipated regret as potential mediators and next-of-kin's beliefs about organ donation as moderators.Results: Next-of-kin approval was lower when the deceased had opted-out than under deemed consent. This was due to next-of-kin anticipating more regret for not donating under deemed consent than opt-out. Further analyses revealed the deceased's wishes influence next-of-kin approval, via anticipated regret, when next-of-kin did not hold negative beliefs about organ donation.Conclusions: The deceased's wishes were less likely to be followed when next-of-kin had negative beliefs towards donation. Developing large-scale campaigns to improve these beliefs in the general public should make people more likely to follow the deceased's wishes. As a result, these campaigns should improve the availability of donor organs.

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Chief Scientist Office Background Atrial fibrillation (AF) related stroke risk can be reduced with oral anticoagulants (OACs). OACs need to be taken once or twice a day to maintain effectiveness but non-adherence remains a challenge mHealth applications are one way to support patients to take medication. Purpose We aimed to co-design an mHealth intervention to increase medication adherence to OACs in patients with AF. Methods We recruited individuals with AF via British Heart Foundation social media advertisement and using established contacts from the Scottish AF survey to take part in a series of remote and in-person workshops. These were 1) an initial patient experience session, gathering personal stories to contextualise the intervention 2) an interactive session, using existing mHealth AF applications identified via scoping review, and 3) a pilot session of the co-designed mobile app prototype. Data were collected using flipchart, post-it notes and researcher field notes, with emphasis placed on the use of direct quotations and storytelling. Development work was overseen by a steering group including clinicians, digital health experts, and four AF patient representatives. Results Eleven patients (7 males) aged 35-80 years took part. Six participants were diagnosed with AF within the last five years and eight had one or more co-morbidities. Number of daily medications ranged from 0-12, with 8/11 (72%) of participants taking OACs. Experience with smartphone use varied and only two reported using a smartphone to manage their own health. We developed a prototype mHealth app, MyAFNurse. The talking avatar-based app increases accessibility regardless of user health literacy level. It incorporates behaviour change techniques including a medication tracker and reminders, information about AF, advice on when and where to seek help, and a quiz to test knowledge. Conclusions A robust co-design process developed an avatar-based mHealth app that incorporates behaviour change techniques which will be evaluated in a feasibility trial.

The COVID-19 pandemic has been associated with psychological distress. In addition to physical effects including fatigue and cognitive impairment, contracting COVID-19 itself may also be related to subsequent negative mental health outcomes. The present study reports data from a longitudinal, national survey of the UK adult population investigating whether contracting suspected or confirmed COVID-19 at the early stages of the pandemic (March–May 2020) was associated with poorer mental health outcomes in May/June 2020, October/November 2020 and June/July 2021. A quota survey design and a sampling frame that permitted recruitment of a national sample (n = 3077) were utilised. Experience of contracting COVID-19 during the first UK lockdown was assessed along with levels of depression, anxiety, mental wellbeing and loneliness. Around 9% of participants reported contracting COVID-19 in March/May 2020 (waves 1–3) with just under 13% of the overall sample reporting COVID-19 at any one of the first three time points. Compared to those without probable COVID-19 infection, participants with probable COVID-19 had poorer mental health outcomes at follow-up with these effects lasting up to 13 months (e.g., May/June 2020:OR depression = 1.70, p < 0.001; OR anxiety = 1.61, p = 0.002; Oct/Nov 2020, OR depression = 1.82, p < 0.001; OR anxiety 1.56, p = 0.013; June/July 2021, OR depression = 2.01, p < 0.001; OR anxiety = 1.67, p = 0.008). Having a pre-existing mental health condition was also associated with greater odds of having probable COVID-19 during the study (OR = 1.31, p = 0.016). The current study demonstrates that contracting probable COVID-19 at the early stage of the pandemic was related to long-lasting associations with mental health and the relationship between mental health status and probable COVID-19 is bidirectional.

ObjectivesColorectal cancer (CRC) screening uptake in Scotland is 56%. This study examined whether psychological factors were associated with CRC screening uptake.DesignCross-sectional observational study.SettingThis study used data from the Healthy AGeing In Scotland (HAGIS) pilot study, a study designed to be representative of Scottish adults aged 50 years and older.Participants908 (505 female) Scottish adults aged 50–80 years (mean age=65.85, SD=8.23), who took part in the HAGIS study (2016–2017).Primary and secondary outcome measuresSelf-reported participation in CRC screening was the outcome measure. Logistic regression was used to test whether scores on measures of health literacy, cognitive ability, risk aversion, time preference (eg, present oriented or future oriented) and personality were associated with CRC screening when these psychological factors were entered individually and simultaneously in the same model.ResultsControlling for age, age-squared, sex, living arrangement, and sex*living arrangement, a one-point increase in risk aversion (OR=0.66, 95% CI 0.51 to 0.85) and present orientation (OR=0.86, 95% CI 0.80 to 0.94) was associated with reduced odds of screening. Higher scores on health literacy (OR per one-point increase=1.20, 95% CI 1.09 to 1.31), cognitive ability (OR per SD increase=1.51, 95% CI 1.25 to 1.81) and the intellect personality trait (OR per one-point increase=1.05, 95% CI 1.01 to 1.09) were associated with increased odds of screening. Higher risk aversion was the only psychological variable that was associated with CRC screening participation when all psychological variables were entered in the same model and remained associated with CRC screening when additionally adjusting for deprivation and education. A backward elimination model retained two psychological variables as correlates of CRC screening: risk aversion and cognitive ability.ConclusionIndividuals who are more risk averse are less likely to participate in free, home CRC screening.

Information seeking has generally been seen as an adaptive response to the COVID-19 pandemic. However, it may also result in negative outcomes on mental health. The present study tests whether reporting COVID-related information seeking throughout the pandemic is associated with subsequently poorer mental health outcomes. A quota-based, non-probability-sampling methodology was used to recruit a nationally representative sample. COVID-related information seeking was assessed at six waves along with symptoms of depression, anxiety, mental wellbeing and loneliness (N = 1945). Hierarchical linear modelling was used to assess the relationship between COVID-related information seeking and mental health outcomes. Information seeking was found to reduce over time. Overall, women, older and higher socioeconomic group individuals reported higher levels of information seeking. At waves 1-4 (March-June 2020) the majority of participants reported that they sought information on Covid 1-5 times per day, this decreased to less than once per day in waves 5 and 6 (July -November 2020). Higher levels of information seeking were associated with poorer mental health outcomes, particularly clinically significant levels of anxiety. Use of a non-probability sampling method may have been a study limitation, nevertheless, reducing or managing information seeking behaviour may be one method to reduce anxiety during pandemics and other public health crises.

Although medical mistrust (MM) may be an impediment to public health interventions, no MM scale has been validated across countries and the assessment of MM has not been explored using item response theory, which allows generalisation beyond the sampled data. We aimed to determine the dimensionality of a brief MM measure across four countries through Mokken analysis and Graded Response Modelling. Analysis of 1468 participants from UK (n = 1179), Ireland (n = 191), India (n = 49) and Malaysia (n = 49) demonstrated that MM items formed a hierarchical, unidimensional measure, which is very informative about high levels of MM. Possible item reduction and scoring changes were also demonstrated. This study demonstrates that this brief MM measure is suitable for international studies as it is unidimensional across countries, cross cultural, and shows that minor adjustments will not impact on the assessment of MM when using these items.

Objective Colorectal screening using faecal immunochemical tests (FITs) can save lives if the people invited participate. In Scotland, most people intend to complete a FIT but this is not reflected in uptake rates. Planning interventions can bridge this intention-behaviour gap. To develop a tool supporting people willing to do colorectal screening with planning to complete a FIT, this study aimed to identify frequently experienced barriers and solutions to these barriers.Design This is a cross-sectional study.Setting Participants were recruited through the Scottish Bowel Screening Programme to complete a mailed questionnaire.Participants The study included 2387 participants who had completed a FIT (mean age 65 years, 40% female) and 359 participants who had not completed a FIT but were inclined to do so (mean age 63 years, 39% female).Outcome measures The questionnaire assessed frequency of endorsement of colorectal screening barriers and solutions.Results Participants who had not completed a FIT endorsed significantly more barriers than those who had completed a FIT, when demographic, health and behavioural covariates were held constant (F(1,2053)=13.40, p<0.001, partial η2=0.01). Participants who completed a FIT endorsed significantly more solutions than those who did not (U=301 585.50, z=−3.21, p<0.001, r=0.06). This difference became insignificant when covariates were controlled. Participants agreed on the most common barriers and solutions regardless of screening history. Barriers included procrastination, forgetting, fear of the test result, screening anxiety, disgust and low self-efficacy. Solutions included hand-washing, doing the FIT in private, reading the FIT instructions, benefit of early detection, feelings of responsibility, high self-efficacy and seeing oneself as a person who looks after one’s health.Conclusion This survey identified six barriers and seven solutions as key content to include in the development of a planning tool for colorectal screening using the FIT. Participatory research is required to codesign an engaging and accessible planning tool.

Objective: Smoking during pregnancy causes risks to mother and infant health. We investigated the feasibility and likely success of SKIP-IT, a narrative and picture-based smoking cessation intervention delivered via text messages.Methods: A feasibility and pilot trial. We aimed to recruit 70 pregnant women who smoked, randomised to usual care alone, or usual care and the SKIP-IT intervention, between 12 weeks of pregnancy and 6 weeks post due-date. Outcomes assessed were recruitment, retention, acceptability of, and engagement with the intervention, smoking behaviour, intentions, perceived risk, and self-efficacy. Results: Of 312 women initially approached by smoking cessation services only 54 (17%) agreed to be contacted by the research team. Twenty were then either ineligible or uncontactable and 28 (82%) participated. Most women reported texts to be entertaining and helpful. The proportion of women not smoking at follow-up was lower in the intervention group, but numbers were too small to draw conclusions about effectiveness.Conclusion: The intervention was acceptable, but difficulty in making initial and follow-up contacts meant our methods were unfeasible for a larger trial. Practice implications: Digital Storytelling interventions could help women quit smoking, but further research is required to identify alternative methods for studies with pregnant women who smoke.Crown Copyright (c) 2022 Published by Elsevier B.V. CC_BY_NC_ND_4.0