Behavioural Interventions for Obese Adults with Additional Risk Factors for Morbidity : Systematic Review of Effects on Behaviour, Weight and Disease Risk Factors

Peer reviewedPostprin

Coping among Students: Development and validation of an exploratory measure

Students is a very specific population according to their manner to cope with stress. A coping questionnaire for students was developed and administered to 1100 French students at the beginning of the term (T1). Principal Component Analysis of responses, followed by varimax rotations, yielded three factors accounting for 50.5% of the total variance. Factors were identified as seeking social support, avoidance/emotion-focused coping and festive-addictive coping. Associations were observed between scores on these factors and a general coping scale (WCC-R), personal variables measured at the same time (T1), neuroticism, self-esteem, substance use, and four stress factors, as well as variables measured at the end of the term (T2), somatic symptoms, depressive symptoms, eating disorders, and life satisfaction. It would be very interesting to develop the students' personal competencies, so that they are learning how to adopt functional strategies of coping rather than of the harmful kind

Is being resolute better than being pragmatic when it comes to breastfeeding? Longitudinal qualitative study investigating experiences of women intending to breastfeed using the Theoretical Domains Framework

Background  In the UK, initiating then discontinuing breastfeeding before two weeks post-partum is common. The aim of this longitudinal qualitative study was to explore which psychosocial factors may influence discontinuation.  Methods  A sample of 10 pregnant women intending to breastfeed were recruited. A longitudinal qualitative design was used to capture views prior to and two weeks following birth. Semi-structured interviews were conducted underpinned by the Theoretical Domains Framework to explore a comprehensive list of psychosocial factors.  Results  Four women discontinued breastfeeding at the time of the second interview. Pre partum differences were identified between maintainers and discontinuers; discontinuers appeared to have stronger intentions to breastfeed based on their self-determination, self-confidence and perception of fewer barriers to breastfeeding. Post partum, discontinuers highlighted how they felt physically unable to carry on; their feeding experiences elicited negative emotions and pain. Negative emotions appeared to be exacerbated by original breastfeeding beliefs and advice given by healthcare professionals.  Conclusions  The women in this study who discontinued breastfeeding showed less cognitive flexibility which appeared to exacerbate post partum emotional distress when they encountered difficulties. Women with strong intentions and self-determination might benefit from support in anticipating potential barriers and identifying ways of overcoming them

Do more specific plans help you lose weight? Examining the relationship between plan specificity, weight loss goals, and plan content in the context of a weight management programme

Objectives: The conditions under which planning for behaviour change is most effective are not fully understood. In the context of a weight management intervention, we examined the interrelationship between plan specificity, type of behaviour planned (diet vs. exercise) and weight loss goals.  Design: Prospective design and content analysis of plans formed by participants of a 10-week weight management programme.  Methods: Participants (n=239) formulated two plans, for dietary and exercise behaviours respectively. Plans were rated for specificity by examining the number of plan components. Weight loss goals were assessed by asking how much weight participants intend to lose. Weight was measured objectively each of the 10 weeks. Changes in BMI over time and the interactions between plan specificity, and weight loss goals, for all plans and separately for diet and exercise, were estimated using linear mixed models.  Results: Plan specificity was unrelated to weight loss, but interacted with weight loss goals in predicting linear change in BMI (t= -2.48): More specific plans were associated with higher decreases in weight in participants with high weight loss goals. Separate interaction tests for plans formulated for diet and exercise change showed that more specific dietary plans, but not exercise ones, were associated with higher decreases in weight in participants with high weight loss goals (t= -2.21).  Conclusions: Within a population that is highly motivated to lose weight, the combination of high weight loss goals and formulating detailed plans for changing dietary behaviours may be most effective in supporting weight loss

Participants' perspectives on making and maintaining behavioural changes in a lifestyle intervention for type 2 diabetes prevention: A qualitative study using the theory domain framework

Objectives: In a qualitative substudy, we sought to elicit participants' perspectives of their behavioural change and maintenance of new behaviours towards intervention optimisation. Setting: The intervention was delivered in leisure and community settings in a local authority, which according to the UK government statistics ranks as 1 of the 10 most socioeconomically deprived areas in England. Participants: We recruited 218 adults aged 40-65 years at elevated risk of type 2 diabetes (Finnish Diabetes Risk Score≥11) to the intervention. Follow-up at 12 months was completed by 134 (62%). We recruited 15 participants, purposively sampled for physical activity increase, to the qualitative substudy. Intervention: Lifestyle intervention can prevent type 2 diabetes, but translation to service provision remains challenging. The ‘New life, New you' intervention aimed to promote physical activity, healthy eating and weight loss, and included supervised group physical activity sessions. Behavioural change and weight loss at 12-month follow-up were encouraging. Design: We conducted 15 individual semistructured interviews. The Framework approach, with a comparison of emerging themes, was used in analysis of the transcribed data and complemented by the Theory Domains Framework. Results: Themes emerging from the data were grouped as perceptions that promoted initiating, enacting and maintaining behavioural change. The data were then categorised in accordance with the Theory Domains Framework: intentions and goals; reinforcement; knowledge; social role and identity; social influences; skills and beliefs about capabilities; behavioural regulation, memory, emotion, attention and decision processes and environmental context and resources. Participant perceptions of intervention features that facilitated behavioural change processes were then similarly analysed. Conclusions: Social influences, reference to social role and identity (eg, peer support), and intentions and goals (eg, to lose weight) were dominant themes across the three phases of behavioural change. Reinforcement, regulation and decision processes were more evident in the maintenance phase. The socioeconomic status of participants was reflected in the environmental context and resource theme. Analysis of phases and theoretical domains of behavioural change added depth and utility to inform intervention optimisation. We will develop the intervention with improved peer support and explicit monitoring of the behavioural change techniques used, prior to a definitive trial

Perspectives of UK Pakistani women on their behaviour change to prevent type 2 diabetes: Qualitative study using the theory domain framework

Background: Type 2 diabetes (T2D) is a debilitating disease, highly prevalent in UK South Asians, and preventable by lifestyle intervention. The ‘New life, New you' (NLNY) physical activity (PA) and dietary intervention for T2D prevention was culturally adapted to better engage minority ethnic populations and tested for feasibility. Objectives: To investigate Pakistani female participants' perspectives of their behaviour change and of salient intervention features. Setting: A community-based 8-week programme of group delivered PA sessions with behavioural counselling and dietary advice, culturally adapted for ethnic minority populations, in an area of socioeconomic deprivation. Participants to NLNY were recruited through screening events in community venues across the town. Participants: Interviews were conducted with 20 Pakistani female NLNY participants, aged 26-45 (mean 33.5) years, from different parts of town. Results: Within the a priori Theoretical Domains Framework (intentions and goals, reinforcement, knowledge, nature of the activity, social role and identity, social influences, capabilities and skills, regulation and decision, emotion and environment), we identified the importance of social factors relating to participants' own PA and dietary behaviour change. We also identified cross-cutting themes as collateral benefits of the intervention including participants' ‘psychological health'; ‘responsibility' (for others' health, especially family members included in the new PA and diet regimes) and ‘inclusion' (an ethos of accommodating differences). Conclusions:  Our findings suggest that culturally adapted interventions for Pakistani women at risk of T2D, delivered via group PA sessions with counselling and dietary advice, may encourage their PA and dietary behaviour change, and have collateral health and social benefits. The NLNY intervention appeared to be acceptable. We plan to evaluate recruitment, retention and likely effect of the intervention on participant behaviour prior to definitive evaluation

Investigating midwives' barriers and facilitators to multiple health promotion practice behaviours: a qualitative study using the theoretical domains framework

Background In addition to their more traditional clinical role, midwives are expected to perform various health promotion practice behaviours (HePPBes) such as informing pregnant women about the benefits of physical activity during pregnancy and asking women about their alcohol consumption. There is evidence to suggest several barriers exist to performing HePPBes. The aim of the study was to investigate the barriers and facilitators midwives perceive to undertaking HePPBes. Methods The research compromised of two studies. Study 1: midwives based in a community setting (N = 11) took part in semi-structured interviews underpinned by the theoretical domains framework (TDF). Interviews were analysed using a direct content analysis approach to identify important barriers or facilitators to undertaking HePPBes. Study 2: midwives (N = 505) completed an online questionnaire assessing views on their HePPBes including free text responses (n = 61) which were coded into TDF domains. Study 2 confirmed and supplemented the barriers and facilitators identified in study 1. Results Midwives’ perceived a multitude of barriers and facilitators to carrying out HePPBes. Key barriers were requirements to perform an increasing amount of HePPBes on top of existing clinical work load, midwives’ cognitive resources, the quality of relationships with pregnant women, a lack of continuity of care and difficulty accessing appropriate training. Key facilitators included midwives’ motivation to support pregnant women to address their health. Study 1 highlighted strategies that midwives use to overcome the barriers they face in carrying out their HePPBes. Conclusions Despite high levels of motivation to carry out their health promotion practice, midwives perceive numerous barriers to carrying out these tasks in a timely and effective manner. Interventions that support midwives by addressing key barriers and facilitators to help pregnant women address their health behaviours are urgently needed

Identifying the determinants of adjuvant hormonal therapy medication taking behaviour in women with stages I-III breast cancer: A systematic review and meta-analysis

Objective: This systematic review and meta-analysis aimed to identify the modifiable determinants of adjuvant hormonal therapy medication taking behaviour (MTB) in women with stage I-III breast cancer in clinical practice settings. Methods: We searched PubMed EMBASE, PsycINFO and CINAHL for articles investigating determinants of adjuvant hormonal therapy. Potentially modifiable determinants were identified and mapped to the 14 domains of the Theoretical Domains Framework (TDF), an integrative framework of theories of behavioural change. Meta-analysis was used to calculate pooled odds ratios for selected determinants. Results: Potentially modifiable determinants were identified in 42 studies and mapped to 9 TDF domains. In meta-analysis treatment side-effects (Domain: Beliefs about Capabilities) and follow-up care with a general practitioner (vs. oncologist) (Social Influences) were significantly negatively associated with persistence (p<0.001) and number of medications (Behaviour Regulation) was significantly positively associated with persistence (p<0.003). Studies did not examine several domains (including Beliefs about Consequences, Intentions, Goals, Social Identity, Emotion and Knowledge) which have been reported to influence MTB in other disease groups. Conclusions: There is some evidence that the domains Beliefs about Capabilities, Behaviour Regulation and Social Influences influence hormonal therapy MTB. Practice implications: Further research is needed to develop effective interventions to improve hormonal therapy MTB

Examining dietary self-talk content and context for discretionary snacking behaviour: a qualitative interview study

Background: Consuming discretionary snack foods high in calories, salt, sugar or fat in between regular meals can have a negative impact on weight management and health. Despite the intention to refrain from discretionary snacking, individuals often report feeling tempted by snack foods. A cognitive process to resolve food choice related tension may be dietary self-talk which is one’s inner speech around dietary choice. This study aimed to understand the content and context of dietary self-talk before consuming discretionary snack foods. Methods: Qualitative semi-structured interviews based on Think-Aloud methods were conducted remotely. Participants answered open-ended questions and were presented with a list of 37 dietary self-talk items. Interview transcripts were analyzed thematically. Results: Interviews (n = 18, age: 19–54 years, 9 men, 9 women) confirmed the frequent use of dietary self-talk with all 37 content items endorsed. Reported use was highest for the self-talk items: ‘It is a special occasion’; ‘I did physical activity/exercise today’; and ‘I am hungry’. Three new items were developed, eight items were refined. Identified key contextual themes were: ‘reward’, ‘social’, ‘convenience’, ‘automaticity’, and ‘hunger’. Conclusions: This study lists 40 reasons people use to allow themselves to consume discretionary snack foods and identifies contextual factors of dietary-self talk. All participants reported using dietary self-talk, with variation in content, frequency and degree of automaticity. Recognising and changing dietary self-talk may be a promising intervention target for changing discretionary snacking behaviour

Urban-rural variations in quality-of-life in breast cancer survivors prescribed endocrine therapy

The number of breast cancer survivors has increased as a result of rising incidence and increased survival. Research has revealed significant urban–rural variation in clinical aspects of breast cancer but evidence in the area of survivorship is limited. We aimed to investigate whether quality of life (QoL) and treatment-related symptoms vary between urban and rural breast cancer survivors prescribed endocrine therapy. Women with a diagnosis of stages I–III breast cancer prescribed endocrine therapy were identified from the National Cancer Registry Ireland and invited to complete a postal survey (N= 1606; response rate = 66%). A composite measure of urban–rural classification was created using settlement size, population density and proximity to treatment hospital. QoL was measured using the Functional Assessment of Cancer Therapy (FACT-G) and an endocrine subscale. The association between urban–rural residence/status and QoL and endocrine symptoms was assessed using linear regression with adjustment for socio-demographic and clinical covariates. In multivariable analysis, rural survivors had a statistically significant higher overall QoL (β = 3.81, standard error (SE) 1.30,p< 0.01), emotional QoL (β = 0.70, SE 0.21,p< 0.01) and experienced a lower symptom burden (β = 1.76, SE 0.65,p< 0.01) than urban survivors. QoL in breast cancer survivors is not simply about proximity and access to healthcare services but may include individual and community level psychosocial factors