Background Research suggests that individuals with a mental health diagnosis often engage in social media to access support for their diagnosis. However, there is a lack of information on online usage in those diagnosed with borderline personality disorder (BPD). Furthermore, there is little research using qualitative interviews to examine the use of social media, such as YouTube, for psychological support. Purpose The aim of the present study was to explore experiences of YouTube in individuals diagnosed with borderline personality disorder, including its impact on their offline lives. Methods Six participants were recruited on social media; all those who contacted the researcher and met inclusion criteria were interviewed. Semi-structured interviews were used, lasting between 40 and 60 min. Data were transcribed verbatim and analysed using interpretive phenomenological analysis. Findings The analysis produced two global themes: ‘YouTube as a form of self-help’ and ‘YouTube transforming the self’. Limitations All the participants were female, limiting transferability of the findings. Originality This paper is the first to show that YouTube could be used in addition to regular support to initiate recovery for those with BPD. It could provide them with a way to reduce self-stigma, enhance self-awareness and learn coping techniques.

Risky alcohol consumption behaviours remain commonplace, representing a major threat to health and safety, and are especially evidenced by young university students. Consequently, new interventions targeting this high-risk group are required. The current study investigated young male university students’ experiences of a personalised, appearance-based, facial morphing, safer drinking intervention. Twenty-five male student participants were recruited, aged 18–34 years. Inductive thematic analysis of data gathered whilst participants were immersed in the intervention, and thereby exposed to alcohol-aged images of their own faces, produced four primary themes: alcohol as a threat to appearance and health, motivations to protect appearance, motivational aspects of the intervention, and proposed improvements and applications. The results of the current study suggested that participants expressed intentions towards healthier consumption/maintenance of already non-risky intake, supporting the potential of the facial-morphing appearance-based approach to address risky alcohol consumption, even in high-risk groups.

Background NHS Health Check (NHSHC) is a national cardiovascular disease (CVD) risk identification and management programme. However, evidence suggests a limited understanding of the most used metric to communicate CVD risk with patients (10-year percentage risk). This study used novel application of video-stimulated recall interviews to understand patient perceptions and understanding of CVD risk following an NHSHC that used one of two different CVD risk calculators.Methods Qualitative, semi-structured video-stimulated recall interviews were conducted with patients (n = 40) who had attended an NHSHC using either the QRISK2 10-year risk calculator (n = 19) or JBS3 lifetime CVD risk calculator (n = 21). Interviews were transcribed and analysed using reflexive thematic analysis.Results Analysis resulted in the development of four themes: variability in understanding, relief about personal risk, perceived changeability of CVD risk, and positive impact of visual displays. The first three themes were evident across the two patient groups, regardless of risk calculator; the latter related to JBS3 only. Patients felt relieved about their CVD risk, yet there were differences in understanding between calculators. Heart age within JBS3 prompted more accessible risk appraisal, yet mixed understanding was evident for both calculators. Event-free survival age also resulted in misunderstanding. QRISK2 patients tended to question the ability for CVD risk to change, while risk manipulation through JBS3 facilitated this understanding. Displaying information visually also appeared to enhance understanding.Conclusions Effective communication of CVD risk within NHSHC remains challenging, and lifetime risk metrics still lead to mixed levels of understanding in patients. However, visual presentation of information, alongside risk manipulation during NHSHCs can help to increase understanding and prompt risk-reducing lifestyle changes.Trial registration ISRCTN10443908. Registered 7th February 2017.

Research on age-progression facial morphing interventions for smoking cessation has not investigated the effect of different instructions for intervention delivery. The objective of this pilot study was to investigate the influence of two instruction types used to deliver the intervention on efficacy of the intervention. Women were recruited and randomly allocated to an age-progression intervention session with (i) neutral instructions; (ii) instructions designed to reassure; or (iii) a condition that controlled for participant engagement (“control”). The conditions were delivered in a one-time procedure, after which primary (quitting intentions) and secondary (cigarettes/week, quit attempts) outcomes were measured immediately post-intervention, and at 1 and 3 months. Seventy-two women (M = 25.7; SD = 0.9) were recruited and randomly allocated to condition (Neutral n = 27, Reassuring n = 22, Control n = 23). Quitting intentions were higher in the Reassuring versus Control arm (3 months post-intervention, F = 4.37, p = 0.016, 95

ABSTRACT This article uses discursive approaches to examine the utility and functions of language in public health, focusing on social constructions of e-cigarettes. Due to the ambiguity surrounding the use of e-cigarettes, understanding may be negotiated collaboratively through co-construction in talk. Ten participants, three men and seven women aged 26–47 years, took part in two focus groups in Manchester, UK, where they discussed e-cigarettes. Data were analysed using blended discourse analysis, with a view to identifying dominant repertoires used by speakers. Participants drew from two discursive frameworks to communicate perceptions of e-cigarettes: (1) uncertainty and risk and (2) the social acceptability and stigma spectrum. The ambiguity surrounding e-cigarettes was reflected in the linguistic devices used in talk. This article demonstrates the value of drawing on discourse analysis to better understand the impact of health-related communication by providing insight into how existing messages are interpreted, co-constructed, and assigned meaning through shared interactions.

Abstract Background As part of a multifaceted approach to patient and public involvement and engagement (PPIE), alongside traditional methods, a closed Facebook group was established to facilitate PPIE feedback on various aspects of a project that used video‐recording to examine risk communication in NHS Health Checks between June 2017 and July 2019. Objective To explore the process and impact of conducting PPIE through a closed Facebook group and to identify the associated benefits and challenges. Methods Supported by reflections and information from project meetings used to document how this engagement informed the project, we describe the creation and maintenance of the Facebook Group and how feedback from the group members was obtained. Facebook data were used to investigate levels and types of engagement in the closed Facebook group. We reflect on the challenges of using this method of engaging the public in health research. Results A total of 289 people joined the ‘Risk Communication of Cardiovascular disease in NHS Health Checks’ PPIE closed Facebook group. They provided feedback, which was used to inform aspects of the study, including participant‐facing documents, recruitment, camera position and how the methodology being used (video‐recorded Health Checks and follow‐up interviews) would be received by the public. Discussion Using a closed Facebook group to facilitate PPIE offered a flexible approach for both researchers and participants, enabled a more inclusive method to PPIE (compared with traditional methods) and allowed rapid feedback. Challenges included maintaining the group, which was more labour intensive than anticipated and managing members' expectations. Suggestions for best practice include clear communication about the purpose of the group, assigning a group co‐ordinator to be the main point of contact for the group, and a research team who can dedicate the time necessary to maintain the group. Conclusion The use of a closed Facebook group can facilitate effective PPIE. Its flexibility can be beneficial for researchers, patients and public who wish to engage in the research process. Dedicated time for sustained group engagement is important. Patient or Public Contribution Patient representatives were engaged with the development of the research described in this paper and a patient representative reviewed the manuscript.

There has been a significant increase in research into body image in men, women and children in the last 20 years. This editorial reviews definitions of the concept of body image, and considers potential health consequences of lowered body satisfaction and increased body concern. The articles that form this Special Issue are contextualized within contemporary research literature around relevant themes. These include sociocultural influences, gender, effects of weight and appearance and perceptual factors. Implications of findings for health psychologists involved in designing health promotion interventions are discussed.

Objective. This study was designed to investigate UK smokers' accounts of impacts of COVID-19 on their smoking, to develop implications for supporting smoking cessation. Design. One hundred and thirty-two smokers aged 19-52 years (mean age 25 years), recruited through an advert distributed through social media and a dedicated Twitter page, completed an anonymous online questionnaire. Main Outcome Measures. Smokers produced written accounts of how COVID-19 had impacted their smoking. Responses were of unlimited length and completed online 22(nd) May-22(nd) June 2020 during UK COVID-19 lockdown. Results. Inductive thematic analysis generated three themes: i) increased smoking as a coping mechanism to deal with anxiety, boredom, stress, and anger in COVID-19 lockdown; ii) lockdown as enabling quitting through lifting social barriers and enabling a focus on health benefits; and iii) no change, avoiding Government/media COVID-19 information due to disbelief, lack of trust, and perceptions of bias. Conclusions. Results demonstrate a need for credible public health messaging on COVID-19 risk aimed at smokers. Implications for supporting smoking cessation are discussed, including maintaining quitting in those "social smokers" who quit during lockdown, and support on stress-management and emotion regulation in those who use smoking as a way to cope with stress, anger, and boredom.

Objective This study aimed to explore E-cigarette (EC) accounts from a small sample of UK adults with varied smoking/EC experiences. This was to contribute to existing knowledge of adult perceptions and understand the factors that encourage or deter use to inform health messaging aimed at professionals, policy makers and the general public. Design Twelve participants, five men and seven women aged 23-55 years (mean age 32.43) with mixed smoking/EC backgrounds took part in face-to-face interviews, analysed using semantic-level inductive thematic analysis. Results The analysis identified three key themes. Social influence (1) relates to the understanding of the social representations of ECs. Representation and knowledge (2) captures the impact of varied EC related communication on perception. Aspects of addiction (3) conveys aspects of nicotine addiction and how this influences EC use. Conclusion ECs were generally perceived as more socially acceptable than cigarettes by non-smokers, although there were varying levels of acceptability depending on the type of EC device used. There was also unanimity concerning uncertainty surrounding the devices. Behavioural/sensory elements and personal enjoyment of ECs were consistent elements that encouraged or deterred use. Although non-smokers/vapers did not use the devices, they expressed similar apprehensions to those who did.

Objectives:Appearance-related interventions to promote healthy behaviour have been found effective to communicate health risks. The current study aimed to explore women smokers' experiences of age-progression software showing the effects of smoking on the face.Methods:A qualitative design was implemented, utilizing both individual interviews and focus groups within a critical realist framework. Fifteen, 19-52 year-old women smokers were administered an age-progression intervention. All participants responded to the intervention, engaged in semi-structured interviews, and were invited back to attend one of three focus groups. Data were analysed using inductive thematic analysis.Results:Four main themes were identified: Health versus Appearance, Shock Reaction, Perceived Susceptibility, and Intention to Quit. Participants found the intervention useful, voicing need for a comprehensive approach that includes both appearance and health. Despite increases in appearance-based apps which could diminish impact, women's accounts of shock induced by the aged smoking-morphed images were similar to previous work conducted more than ten years previously.Conclusions:The study provides novel insights in how women smokers currently perceive, and react to, an age-progression intervention for smoking cessation.Innovation:Findings emphasise the implementation of this intervention type accompanied by health information in a range of patient settings.

This study explored smokers' and non-smokers' accounts of E-cigarettes. A total of 51 UK-based participants, 20 men and 31 women, responded to open-ended questions online. Inductive thematic analysis identified that the factors that influence E-cigarette behaviour and opinion in adult smokers and non-smokers are related to social context, informative sources, practical aspects and health implications. Participants presented varying accounts of E-cigarettes, suggesting that individual narratives regarding E-cigarettes are multi-faceted. This is important information for health professionals and policy makers tasked with advising on E-cigarette use.

It has been suggested that smoking and age are associated with higher vulnerability to Covid-19. While threat of Covid-19 may reduce or stop smoking, increased stress due to lockdown could increase smoking behaviour. This study aimed to investigate changes in smoking behaviour in relation to age, Covid-19-related threat and subjective perceived stress during the UK lockdown. A cross-sectional study was performed. Online adverts were used to recruit UK residents who smoked combustible tobacco any time from January 2020. A questionnaire measured demographic information, smoking behaviour pre- and during-lockdown, perceived subjective stress (PSS), and Covid-19 related threat. Data were collected from a total of 145 participants (58% women, 39% men, 3% non-binary; mean age: 26 years, SD = 7.7), during UK lockdown between 22nd May and 22nd June 2020. Independent of stress and Covid-19-related threat, smoking was reduced in those aged less than 30 years. In participants aged 30 and above, increases in smoking behaviour were associated with higher PSS. The results highlight the relevance of the different stages of life on the relationship between stress, threat, and smoking behaviour. Greater emphasis should be placed on stress reduction for adult smokers aged 30 and above to enable smoking cessation.

BACKGROUND:The NHS Health Check is a national cardiovascular disease prevention programme. There is a lack of evidence on how health checks are conducted, how cardiovascular disease risk is communicated to foster risk-reducing intentions or behaviour, and the impact on communication of using different cardiovascular disease risk calculators. OBJECTIVES:RIsk COmmunication in Health Check (RICO) study aimed to explore practitioner and patient understanding of cardiovascular disease risk, the associated advice or treatment offered by the practitioner, and the response of the patients in health checks supported by either the QRISK®2 or the JBS3 lifetime risk calculator. DESIGN:This was a qualitative study with quantitative process evaluation. SETTING:Twelve general practices in the West Midlands of England, stratified on deprivation of the local area (bottom 50% vs. top 50%), and with matched pairs randomly allocated to use QRISK2 or JBS3 during health checks. PARTICIPANTS:A total of 173 patients eligible for NHS Health Check and 15 practitioners. INTERVENTIONS:The health check was delivered using either the QRISK2 10-year risk calculator (usual practice) or the JBS3 lifetime risk calculator, with heart age, event-free survival age and risk score manipulation (intervention). RESULTS:Video-recorded health checks were analysed quantitatively (n = 173; JBS3, n = 100; QRISK2, n = 73) and qualitatively (n = 128; n = 64 per group), and video-stimulated recall interviews were undertaken with 40 patients and 15 practitioners, with 10 in-depth case studies. The duration of the health check varied (6.8-38 minutes), but most health checks were short (60% lasting < 20 minutes), with little cardiovascular disease risk discussion (average < 2 minutes). The use of JBS3 was associated with more cardiovascular disease risk discussion and fewer practitioner-dominated consultations than the use of QRISK2. Heart age and visual representations of risk, as used in JBS3, appeared to be better understood by patients than 10-year risk (QRISK2) and, as a result, the use of JBS3 was more likely to lead to discussion of risk factors and their management. Event-free survival age was not well understood by practitioners or patients. However, a lack of effective cardiovascular disease risk discussion in both groups increased the likelihood of a maladaptive coping response (i.e. no risk-reducing behaviour change). In both groups, practitioners often missed opportunities to check patient understanding and to tailor information on cardiovascular disease risk and its management during health checks, confirming apparent practitioner verbal dominance. LIMITATIONS:The main limitations were under-recruitment in some general practices and the resulting imbalance between groups. CONCLUSIONS:Communication of cardiovascular disease risk during health checks was brief, particularly when using QRISK2. Patient understanding of and responses to cardiovascular disease risk information were limited. Practitioners need to better engage patients in discussion of and action-planning for their cardiovascular disease risk to reduce misunderstandings. The use of heart age, visual representation of risk and risk score manipulation was generally seen to be a useful way of doing this. Future work could focus on more fundamental issues of practitioner training and time allocation within health check consultations. TRIAL REGISTRATION:Current Controlled Trials ISRCTN10443908. FUNDING:This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 50. See the NIHR Journals Library website for further project information.

AbstractBackground and aimsAssociation of electronic cigarette use and subsequent smoking has received considerable attention, although age of first use has not. This study tested differences in regular (e‐cigarettes, cigarettes) and ever (cigarettes) use between e‐cigarette user groups: early versus never users, late versus never users, early versus late users and effects of controlling for covariates.DesignProspective study with 12‐ and 24‐month follow‐up of e‐cigarette/cigarette ever/regular use with data from an intervention.SettingForty‐five schools in England (Staffordshire and Yorkshire).ParticipantsNever smokers (3289 13–14‐year‐olds) who were part of a cluster randomized controlled trial.MeasurementsThe sample was divided into groups of e‐cigarette users: early users (at 13–14 years), late users (at 14–15 years) and never users (at 13–14 and 14–15 years). Dependent variables were self‐reported regular e‐cigarette and cigarette use and ever cigarette use at 15–16 years. Covariates were assessed.FindingsEarly and late users compared with never users were significantly more likely to be regular e‐cigarette users [early: odds ratio (OR) = 9.42, 95% confidence interval (CI) = 5.38, 16.49, P < 0.001; late: OR = 6.89, 95% CI = 4.11, 11.54, P < 0.001], ever cigarette users (early: OR = 7.96, 95% CI = 6.02, 10.53, P < 0.001; late: OR = 5.13, 95% CI = 3.85, 6.84, P < 0.001) and regular cigarette users (early: OR = 7.80, 95% CI = 3.99, 15.27, P < 0.001; late: OR = 4.34, 95% CI = 1.93, 9.77, P < 0.001) at age 15–16 years. Late users compared with early users had significantly lower rates of ever use of cigarettes at 15–16 years (OR = 0.48, 95% CI = 0.35, 0.66, P < 0.001), although this difference was non‐significant at 12 months after first use of e‐cigarettes (OR = 0.89, 95% CI = 0.64, 1.25, P = 0.498). Controlling for covariates did not change the findings.ConclusionsAdolescents in England who report using e‐cigarettes at age 13–14 years have higher rates of subsequently initiating cigarette use than adolescents who report using e‐cigarettes at age 14–15 years, a difference that may be attributable to a longer period of time to initiate cigarette use in former group.

Relatively little is known about the factors that mediate the relationship between high body mass index (BMI) and reduced body satisfaction. This is the first study to investigate whether availability of well-fitting clothes mediates this relationship. Eighty-five women with an age range of 18–81 years were 3D body scanned and weighed and measured at Time 1, and number of retailers stocking their sizes (determined through body scans) was calculated. At Time 2, they completed an online body satisfaction measure. Body satisfaction at Time 2 was predicted by both BMI and availability of well-fitting clothes in UK retailers at Time 1, with the two factors explaining 27% of the variance in body satisfaction. Availability of clothes size partially mediated the relationship between BMI and body satisfaction. Results suggest that the clothing retail sector might contribute to reducing body dissatisfaction by providing a wider range of choices for all sizes of consumer.

BACKGROUND:NHS Health Check (NHSHC) is a national programme to identify and manage cardiovascular disease (CVD) risk. Practitioners delivering the programme should be competent in discussing CVD risk, but there is evidence of limited understanding of the recommended 10-year percentage CVD risk scores. Lifetime CVD risk calculators might improve understanding and communication of risk.AIM:To explore practitioner understanding, perceptions, and experiences of CVD risk communication in NHSHCs when using two different CVD risk calculators.DESIGN & SETTING:Qualitative video-stimulated recall (VSR) study with NHSHC practitioners in the West Midlands.METHOD:VSR interviews were conducted with practitioners who delivered NHSHCs using either the QRISK2 10-year risk calculator (n = 7) or JBS3 lifetime CVD risk calculator (n = 8). Data were analysed using reflexive thematic analysis.RESULTS:In total, nine healthcare assistants (HCAs) and six general practice nurses (GPNs) were interviewed. There was limited understanding and confidence of 10-year risk, which was used to guide clinical decisions through determining low-, medium-, or high-risk thresholds, rather than as a risk communication tool. Potential benefits of some JBS3 functions were evident, particularly heart age, risk manipulation, and visual presentation of risk.CONCLUSION:There is a gap between the expectation and reality of practitioners' understanding, competencies, and training in CVD risk communication for NHSHCs. Practitioners would welcome heart age and risk manipulation functions of JBS3 to promote patient understanding of CVD risk, but there is a more fundamental need for practitioner training in CVD risk communication.

Endometriosis is a condition which affects around 1–2% of women worldwide and has profound effects on their everyday lives. Previous research has tended to focus on physical symptoms (such as chronic pain); how women manage changes to their identity and relationships as a result of endometriosis has received less attention. This paper discusses qualitative data examining how women negotiate changes to identity while living with endometriosis, in a social context where women are expected to minimise their symptoms and conform to feminine role expectations. We conducted thematic analysis of 34 replies to an online survey seeking qualitative text responses. The women identified disruptions to personal identity as a result of living with endometriosis. They talked about not feeling like themselves (Theme 1) and about reactions from medical and social connections prompting feelings that they were going “mad” (Theme 2). Participants also expressed feeling as though they were a burden to loved ones (Theme 3), which often resulted in self-silencing (Theme 4). Findings are discussed in the context of Western expectations of women’s roles in social relationships and suggest that professionals who support women with endometriosis should be aware of strategies such as self-silencing which may reduce effective self-care.

This study investigates how men’s body image develops over time. A total of 14 men aged between 45 and 67 years completed in-depth interviews where they discussed their body image since childhood, prompted in some cases by photographs of themselves at different ages that they brought to the interviews. Transcripts were analysed using inductive thematic analysis. From the participants’ accounts, it was evident that body concerns did not steadily improve or worsen, but waxed and waned over time. Results are discussed in relation to understanding changing body concerns in men’s lives, and the implications of these for future research and practice.