BackgroundThe Cancer Research UK Cancer Awareness Measure (CRUK CAM) was introduced in 2008 as the first psychometrically validated survey of public attitudes, awareness and behaviours across cancer prevention, screening and early diagnosis. CRUK regularly collects CAM data in the UK to inform strategic planning. The measure has been modified over time in response to changes in the research, policy and practice landscape. Our aim is to revalidate the most recent CAM ‘Plus’ (CAM+) to ensure the measure remains accurate, reliable, valid, and relevant over time.MethodsThere will be four phases, running from 2023 to 2026, with the CAM + being revised after each phase. Phase 1 will start by auditing the CAM + against a behaviour change framework, i.e., the COM-B, postulating that to engage in a Behaviour (B), a person must have the Capability (C) and Opportunity (O) to exhibit that behaviour, as well as the Motivation (M) to demonstrate it at a specific moment. This phase will also include (a) scoping literature reviews; (b) a face validity assessment, to check CRUK and scientific evidence needs and identify gaps in the survey; and, (c) a readability assessment using the Hemingway App to check for long complex sentences. Phase 2 will focus on content validity, using two stages of cognitive interviews with members of the public to assess comprehension and clarity. The first stage will use a ‘Think Aloud’ methodology to identify potential problem areas; while the second stage will use the four-stage model of cognitive interviewing to understand how people comprehend, retrieve, judge, and respond to questions. In Phase 3, we will conduct exploratory and confirmatory factor analysis to inform further refinements to the measure. In Phase 4, we will assess: (a) construct validity, by comparing responses of cancer experts and non-cancer experts; (b) reliability, using the test–retest approach; and (c) responsiveness, using sensitivity to change to questions in CAM+, following a brief intervention. Throughout the revalidation process we will be adhering to the standards set out in the COSMIN guidelines.

University years are an important transitional time for young adults. Recently, an increasing number of students have reported mental health problems. The increasing numbers are an international phenomenon. Qualitative research on mental health promotion for students is, however, scarce. The aim of this study is to explore students’ descriptions of experiences in their student life that are beneficial to mental health. A Norwegian project named “In my experience” collected descriptions, through the web-based tool Sensemaker, from students about experiences that have had an impact on their student life. This study explores the descriptions of experiences beneficial to students’ mental health that the students categorized as having had a positive or very positive impact on their student life. A total of 171 descriptions from students aged 18–29 were analyzed using thematic analysis. Two main themes were identified: becoming a student, which consisted of descriptions about the feeling of a new life as a student, and being a student, which described experiences with managing student life that were beneficial for mental health. Experiences such as being welcomed, being included, belonging to a social group, finding one’s own identity, maturing, and developing were all highlighted in the descriptions. Student societies and other forms of civic engagement and being accepted and included in an academic community were fundamental. A limitation of the study was the relatively low number of male participants, and further research on male students’ descriptions about beneficial experiences is needed.

Background: Health behavior consultations support self-management if delivered by skilled practitioners. We summarize here the results of a collaborative training intervention program delivered to health and care practitioners working in a remote-island context. The program was designed to build confidence in the implementation of communication and behavior change skills and to sustain their use in work settings. The setting for the behavior change training program was the South Atlantic island of St. Helena, a remote low-middle-income country which has a population with high levels of obesity and a prevalence of long-term conditions. Objectives: We aimed to increase knowledge, confidence, and implementation of behavior change techniques (BCTs) and communication skills of health and social care staff through delivering and evaluating training using the MAP (Motivation, Action, Prompt) behavior change framework. A successful training intervention could ultimately improve self-management and patient health outcomes. Methods: Co-production with onsite representatives adapted the program for local delivery. A two-day training program was delivered face-to-face to 32 multidisciplinary staff. Pre- and post-intervention and 18-month follow-up evaluation assessed reactions, learning and implementation using multiple methods, including participant feedback and primary care patient reports. Results: Positive reactions to training and significant improvement in confidence, perceived importance, intention to use and implementation of BCTs and communication skills immediately post-training and at long-term follow-up were observed. Patient reports suggested some techniques became routinely used. Methodological difficulties arose due to staff retention and disruption through the COVID-19 pandemic. Conclusions: The delivery of health behavior change training can be effective in remote contexts with sustainable impacts on healthcare. There are challenges working in this context including staff continuity and technological reliability.

Background: Social prescribing programmes across the United Kingdom were obliged to adapt and change as a result of COVID‐19. However, as we emerge from the pandemic and only now begin to witness the extent to which service users and providers continue to be affected, is it realistic to expect social prescribing services to meet the increasing demands placed upon them? How might schemes manage to deliver effectively against a backlog of referrals, escalating mental health issues and growing health inequalities across the population? This paper explores the challenges faced by service providers and service users of social prescribing programmes during the global pandemic. Drawing from primary and secondary research, the discussion considers how the implementation of one social prescribing programme was impacted by COVID‐19, how service providers responded, how service users were affected and, finally, what questions have been raised for the development and delivery of social prescribing in a postpandemic landscape. Methods: Using the reach, effectiveness, adoption, implementation and maintenance (RE‐AIM) framework, this discrete qualitative case study sits within the wider evaluation of Community Connect, London Borough of Bexley’s social prescribing programme. To investigate the impacts upon the programme through the key domains of implementation, maintenance and effectiveness, data were collected between April 2020 and November 2022. One reflexive discussion group and 26 semistructured interviews were conducted with a purposive sample of stakeholders, including social prescribers ( n = 6), service users ( n = 12), service provider organisations ( n = 6), volunteer telephone befrienders ( n = 6) and service commissioners ( n = 2). Framework analysis was subsequently used to code and analyse the resulting qualitative data. Results: Following a period of programme interruption, Community Connect adapted to remote delivery in support of both existing and new service users. Service users experiencing multimorbidity, combined with mental health problems, loneliness and isolation were adversely affected physically, emotionally and socially. Volunteers likewise reported feelings of isolation and uselessness, motivating them to support those in need. An interim ‘telephone befriending’ intervention engendered feelings of self‐worth and reduced social isolation, having a positive impact on mental wellbeing. However, social prescribers experienced challenges in working from home, while attempting to build relationships with new referrals and/or providing meaningful support to digitally excluded individuals. Limited capacity meant many service users experienced intermittent contact with social prescribers, while few were offered consistent support in managing worsening health and/or mental health conditions. In addition, restricted access to voluntary service provider organisations adversely affected all areas of the programme. Those living in deprived circumstances and/or with complex health needs experienced negative impacts upon their long‐term conditions, housing or finances. Many service users now report finding themselves in an escalating state of crisis, while Community Connect and all linked services attempt to address the continuing challenges resulting from COVID‐19 and the current economic crisis. Conclusions: Social prescribing offered valuable support to certain individuals during the first phase of the pandemic but remote contact had limited impact for service users with complex health and/or social needs. Continuing and increasing pressures placed upon social prescribing and voluntary services have resulted in negative outcomes. Findings highlight the vulnerability of social prescribing’s implementation and efficacy when voluntary service organisations and other linked services are disrupted by unforeseen global events.

Young women who are not in education, employment, or training (NEET) experience poorer health and social outcomes compared to non-NEET young women and to NEET young men, especially in deprived areas with intersecting inequalities. The evidence on effective public health approaches is scarce. Interventions that target hope, which NEET young women notably lack, offer a promising theory-driven and intuitive means to prevent mental health problems and improve social outcomes. Hope can be defined as a goal-focused mindset comprising self-agency (motivation and self-belief) and pathways (identifying routes to achieving goals). Hope is implicated in a variety of evidence-based psychosocial interventions for young people, but is not directly targeted by existing prevention programmes for NEET populations. The current study used a phased qualitative research design and participatory methods to model a hope-focused intervention for NEET young women. Phase 1 investigated population needs and intervention parameters through semi-structured interviews with 28 key informants living or working in disadvantaged coastal communities in South-East England. The sample comprised eight NEET young women, four family members, and 16 practitioners from relevant support organisations. Phase 2 refined intervention parameters and outcomes through co-design sessions with four NEET young women, followed by a theory of change workshop with 10 practitioners. The resulting intervention model is articulated as a mentor-supported, in-person psychosocial intervention that builds hope by enhancing positive sense of self and time spent in meaningful activities, before explicitly teaching the skills needed to identify, set, and pursue personally meaningful goals.

INTRODUCTION:In low- and middle-income countries (LMICs), the persistent lack of access and high inappropriate use of antibiotics, which are fuelled by gender-related factors, continue to facilitate antimicrobial resistance. This in turn reduces the capacity to treat infectious diseases. However, there is a lack of clarity on the nature and extent of the available evidence on gender influence on access to antibiotics and antibiotic use behaviour. This proposed study will systematically review the available literature to map out the scope of evidence on gender differences and, importantly, the related factors influencing antibiotic use and access to antibiotics in LMICs. METHODS AND ANALYSIS:This scoping review will be conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for scoping reviews. Major databases (MEDLINE, PsycINFO and CINAHL) will be searched via the EBCOhost and Web of Science platforms for peer-reviewed articles. Title and abstract screening, as well as full paper review, will be conducted by a single reviewer, with 20% of identified citations reviewed independently by two other reviewers. A predefined excel spreadsheet will be used for data extraction and analysis. Findings will be presented thematically in a narrative summary and tables. ETHICS AND DISSEMINATION:Obtaining ethics approval is not required for this study. The findings will contribute to understanding gender health inequalities and areas for further research on strategies to incorporate gender considerations in antimicrobial stewardship efforts in LMICs. The study findings will be disseminated through presentations in seminars, scientific conferences and publications in peer-reviewed journals.

BACKGROUND:Parkinson's Disease (PD) is associated with considerable carer burden, but there has been little qualitative research on the support needs of carers of People with Parkinson's (PwP).METHODS:Semi-structured in-depth interviews with carers of PwP in 11 European countries.RESULTS:Interviews with 36 carers of PwP were analysed. At the time of diagnosis, carers often felt that they had a role in helping get a diagnosis and then in dealing with the impact of the diagnosis on the family. Information on medication was seen as particularly important for carers, and many of the carers felt that their informational needs differed from that of the PwPs. Many of the carers also felt that they needed to be present at all appointments to request referrals or ask for medication changes. Carers of those in the later stages of the disease often reported feeling isolated and not having any time for themselves.CONCLUSIONS:The involvement of carers should be addressed more actively in the management of Parkinson's.

Background A 2018 review of the English primary care pay-for-performance scheme, the Quality and Outcomes Framework, suggested that it should evolve to better support holistic, patient-centred care and leadership for quality improvement (QI). From 2019, as part of the vision of change, financially incentivised QI cycles (initially in prescribing safety and end-of-life care), were introduced into the scheme. Objectives To conduct a rapid evaluation of general practice staff attitudes, experiences and plans in relation to the implementation of the first two QI modules. This study was commissioned by NHS England and will inform development of the QI programme. Methods Semistructured telephone interviews were conducted with 25 practice managers from a range of practices across England. Interviews were audio recorded with consent and transcribed verbatim. Anonymised data were reflexively thematically analysed using the framework method of analysis to identify common themes across the interviews. Results Participants reported broadly favourable views of incentivised QI, suggesting the prescribing safety module was easier to implement than the end-of-life module. Additional staff time needed and challenges of reviewing activities with other practices were reported as concerns. Some highlighted that local flexibility and influence on subject matter may improve the effectiveness of QI. Several questioned the choices of topic, recognising greater need and potential for improving quality of care in other clinical areas. Conclusion Practices supported the idea of financial incentivisation of QI, however, it will be important to ensure that focus on QI cycles in specific clinical areas does not have unintended effects. A key issue will be keeping up momentum with the introduction of new modules each year which are time consuming to carry out for time poor General Practitioners (GPs)/practices.

Health psychology is at the forefront of developing and disseminating evidence, theories, and methods that have improved the understanding of health behaviour change. However, current dissemination approaches may be insufficient for promoting broader application and impact of this evidence to benefit the health of patients and the public. Nevertheless, behaviour change theory/methods typically directed towards health behaviours are now used in implementation science to understand and support behaviour change in individuals at different health system levels whose own behaviour impacts delivering evidence-based health behaviour change interventions. Despite contributing to implementation science, health psychology is perhaps doing less to draw from it. A redoubled focus on implementation science in health psychology could provide novel prospects for enhancing the impact of health behaviour change evidence. We report a Health Psychology Review-specific review-of-reviews of trials of health behaviour change interventions published from inception to April 2020. We identified 34 reviews and assessed whether implementation readiness of behaviour change interventions was discussed. We then narratively review how implementation science has integrated theory/methods from health psychology and related discipline. Finally, we demonstrate how greater synergy between implementation science and health psychology could promote greater follow-through on advances made in the science of health behaviour change.

Background Individual behaviour changes, such as hand hygiene and physical distancing, are required on a population scale to reduce transmission of infectious diseases such as COVID-19. However, little is known about effective methods of communicating risk reducing information, and how populations might respond. Objective To synthesise evidence relating to what (1) characterises effective public health messages for managing risk and preventing infectious disease and (2) influences people's responses to messages. Design A rapid systematic review was conducted. Protocol is published on Prospero CRD42020188704. Data sources Electronic databases were searched: Ovid Medline, Ovid PsycINFO and Healthevidence.org, and grey literature (PsyarXiv, OSF Preprints) up to May 2020. Study selection All study designs that (1) evaluated public health messaging interventions targeted at adults and (2) concerned a communicable disease spread via primary route of transmission of respiratory and/or touch were included. Outcomes included preventative behaviours, perceptions/awareness and intentions. Non-English language papers were excluded. Synthesis Due to high heterogeneity studies were synthesised narratively focusing on determinants of intentions in the absence of measured adherence/preventative behaviours. Themes were developed independently by two researchers and discussed within team to reach consensus. Recommendations were translated from narrative synthesis to provide evidence-based methods in providing effective messaging. Results Sixty-eight eligible papers were identified. Characteristics of effective messaging include delivery by credible sources, community engagement, increasing awareness/knowledge, mapping to stage of epidemic/pandemic. To influence intent effectively, public health messages need to be acceptable, increase understanding/perceptions of health threat and perceived susceptibility. Discussion There are four key recommendations: (1) engage communities in development of messaging, (2) address uncertainty immediately and with transparency, (3) focus on unifying messages from sources and (4) frame messages aimed at increasing understanding, social responsibility and personal control. Embedding principles of behavioural science into public health messaging is an important step towards more effective health-risk communication during epidemics/pandemics.

We write to express our concern about a paper you recently published in your newly established journal. The paper examines the association of a non-modifiable measure, IQ, and its relationship to adult body mass index (BMI). We are academics, health professionals, health psychologistsandlayexpertsinweightstigmaanddiscrimination,pub-lic health, patient advocacy and risk communication. We believe the contents of this paper are likely to cause unjustifiable harm to people in bigger bodies, some of whom may not be in a position to raise their concerns with the authors or yourselves. We further assert that there arenumerousethicalandmethodologicalissuesthatshouldbebrought to your attention, which limit the applicability of the results. This paper goes against the stated aims and the scope of your jour-nal.First,yourjournalstatesthatyou“advocatetheprinciplesofsound science publishing” and that “if the science is reliable and sound, you will publish.” Yet this paper suffers a number of methodological flaws and, in particular, breaches two ethical principles, namely, beneficence andjusticethatsignificantlydetractfromthesoundnessofthescience. Aswedemonstratebelow,onthisoccasionyourjournalhasnotupheld good scientific principles. Second, you state that your journal “exam-ines clinical and scientific aspects of lifestyle medicine and its incorpo-ration into clinical practice.” This suggests that you are interested in research that identifies potentially modifiable risk factors that might be addressed in clinical practice in a way that is beneficial to people. IQ is neither a "lifestyle" choice nor a modifiable variable (as noted by the authors themselves).

Older people's health and care needs are changing. Increasing numbers live with the combined effects of age-related chronic illness or disability, social isolation and/or poor mental health. Social prescribing has potential to benefit older people by helping those with social, emotional or practical needs to access relevant services and resources within the local community. However, researchers have highlighted limitations with the existing evidence-base, while clinicians express concerns about the quality of onward referral services, liability and upfront investment required. The current article provides a critical review of evidence on social prescribing, drawing on the RE-AIM Framework (Glasgow et al., 1999) to identify questions that will need to be addressed in order to inform both the design and delivery of services and the evolving research agenda around social prescribing. We emphasise the need for researchers and planners to work together to develop a more robust evidence-base, advancing understanding of the impacts of social prescribing (on individuals, services and communities), factors associated with variation in outcomes and strategies needed to implement effective and sustainable programmes. We also call on policymakers to recognise the need for investment in allied initiatives to address barriers to engagement in social prescribing programmes, provide targeted support for carers and improve access to older adult mental health services. We conclude that social prescribing has potential to support older people's health and wellbeing, but this potential will only be realised through strategic alignment of research, local level implementation and national policy and investment.

Salisbury’s article raises important points about the widespread rollout of social prescribing.1 Linking people with services that could help tackle problems that contribute to reduced wellbeing seems sensible, but the approach rests on several problematic assumptions. A recent systematic review2 concluded that current evidence on social prescribing is insufficient to judge either success or value for money. Of the 15 …

Objective: To describe the experience of being diagnosed and living with mild to moderate Parkinson’s disease (PD).Method: Semi-structured in-depth interviews with people with Parkinson’s (PwP) in 11 European countries.Results: Interviews with 60 PwP (52% male) with a mean age of 63 (SD 8.1) years and a disease duration of 9.6 (SD 6.9) years were analysed. PwP often delayed help-seeking due to lack of awareness of symptoms and there was sometimes a delay in specialist referral. The diagnosis typically came as a “shock”, making PwP unable to absorb all the information, but having a diagnosis for the symptoms was sometimes described as a “relief”. Prompt referral to a specialist, a clear and sensitively communicated diagnosis with reassurance about prognosis and a follow-up appointment with a PD nurse or other healthcare professionals a short interval after diagnosis were all positively viewed. Many reported worries and negative experiences with medications and wished for more time and information before initiating these. Reactions from family, friends and work colleagues when communicating the diagnosis were typically positive. During ongoing care, longer appointments with specialists and provision of information from healthcare professionals, patient organisations and self-help groups were considered important to many PwPs and helped them feel as if they could “take control” and manage their disease more effectively.Conclusions: Taking into account these findings has the potential to improve the experiences of PwP through improved communication, tailoring of appointments and information provision including self-help approaches.

Aim We aimed to evaluate a pilot service to facilitate discharge of patients with stable long-term mental health needs from secondary to primary care. Background Patients with stable long-term mental health conditions are often not discharged from secondary mental health services when no longer needed due to insufficient systems and processes to enable safe, effective, recovery-focussed treatment and support. The Primary Care Mental Health Specialist (PCMHS) Service was developed to address this gap; new PCMHS posts were introduced to act as a conduit for patients being discharged from secondary care and a single point of referral back into secondary care, should it be required. The two-year pilot, across six Clinical Commissioning Groups in South East England, began in March 2013. Methods Interviews were conducted with all PCMHS employed in the pilot service (n=13) and a sample of service users (n=12). The views of professionals working alongside the service, including GPs, Psychiatrists and Mental Health Nurses, were captured using a brief online questionnaire (n=50). Time and Activity Recording Sheets were used to capture data required for economic analysis. Findings Our findings indicate that the service is working well from the perspective of patients; staff employed within the service and professionals working alongside the service. Patients described the service as a ‘safety net’ they could fall back on in case of difficulties, whereas staff used the analogy of a ‘bridge’ to describe the way the service improved communication and collaboration between the various professionals and organisations involved in the patient’s care. Improvements in well-being were seen to result from increased support for those transitioning from secondary to primary care, a more pro-active approach to relapse prevention and increased engagement in daily activities. Each PCMHS covered 36 patients in a one-month period, with a unit cost of £73.01 per patient.

A recent primary school initiative encouraged pupils to run or walk a mile each day. Andy Fairhurst and Sarah Hotham of the Centre for Health Services Studies, University of Kent, highlight the importance of encouraging children to explore a full range of social and physical activities, building foundations for continued physical activity in later life.[Image omitted: See PDF.]In 2015, media attention focussed on a Scottish primary school where the introduction of a 'Daily Mile' saw pupils run or walk a mile, taking around 15 min each day.[1] The benefits claimed by the school and media included that obesity had been eliminated and that educational attainment and concentration had been improved.[2],[3] The simplicity and replicability of the concept has caught the attention of the health and education sector, and over the last year, there have been moves to reproduce the programme across England.Why not the Daily Mile?The Daily Mile falls short of where primary school physical activity needs to be. While an additional 15 min or more per day of activity will contribute to achieving the recommended daily minimum of 60 min of moderate to vigorous intensity physical activity in children,[4] the Daily Mile is an overly simplistic contribution to energy expenditure that misses opportunities to develop a range of physical and social skills. Furthermore, it is a potential contributor to the issues underpinning physical inactivity later in life.It also fails to address what children want from physical activity. Children have an inherent interest in physical activity-based play and a strong belief in its value, with the main reasons for positive attitudes towards physical activity identified as fun and enjoyment, being with friends and the sense of belonging to a team.[5] It is unlikely that an enforced mile run will engender these feelings in every child.The worst case scenario is that the Daily Mile is setting up a generation for a lifetime of inactivity. Low levels of participation after leaving primary school are often due to negative experiences of primary school sport and physical activity, particularly in girls.[6] Reasons cited for children and young people not wanting to participate in physical activity in primary school include getting cold and wet,[7] and boredom;[5] both commensurate with a compulsory year-round outdoor run in school uniform.The Current State of Primary School Physical EducationThe excitement with which the Daily Mile has been received is a tacit admission that there is a lack of structured physical activity in primary schools. Physical education (PE) lessons in England last an average of 108 min, well below the daily recommended levels of physical activity.[8] Outside classes and break times provide an opportunity for free play, but for children who are already disengaged with physical activity, this time is usually spent sedentary.[9]There is also a variation in quality of primary school PE delivery. Initial Teacher Training allocates a maximum of 12 h to physical education, meaning primary teachers do not feel confident or safe delivering PE lessons.[10] Furthermore, many teachers start with preconceived views of PE, usually shaped from their own negative school experiences, which are difficult or impossible to change.[10]Building the Foundations of a Sporting FutureThe benefits of the Daily Mile claimed are not exclusive to a mile's walk or run, but are the widely reported benefits of physical activity. If schools are to commit time to physical activity, could it be better spent promoting physical literacy, movement skills and leadership as well expending energy?Physical literacy is the foundation of PE and school sport and describes the range of motor skills, flexibility, agility, co-ordination, confidence and motivation required to take part in physical activity or sport. …

This powerpoint presentation was designed to accompany a train the trainer workshop linked to a postural care training programme. POSTED is a training programme designed to improve understanding, knowledge and confidence in parents, teachers and teaching assistants responsible for the postural care needs of children with physical disabilities. This powerpoint explain the aims of the training and why this was developed, the structure of the training programme and the role of the therapist and introduces tools and resources. The powerpoint was originally designed for use in research commissioned by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (grant reference number PB‐PG‐ 0110‐21045). When using/referring to this powerpoint please acknowledge authorship as appropriate. Details of the study can be found in the following publication. Hotham, S., Hamilton-West, K., Hutton, E., King, A. and Abbott, N. (2017) A study in to the effectiveness of a postural care training programme aimed at improving knowledge, understanding, and confidence in parents and school staff. Child: Care, Health and Development. ISSN 0305-1862.