A social norms and identity approach to increasing fruit and vegetable intake of undergraduate students in the United Kingdom

The funding for open access was supported by the University of St Andrews.This study investigated the influence of descriptive norm messages that either communicated that university students eat a sufficient amount of fruit and vegetable (F&V) or that they do not, on F&V consumption, and whether or not any effects are moderated by student identification. An online 2 (Norm: ‘Sufficient’/‘Insufficient’) x 2 (Identification: ‘Low’/‘High’) experimental design was employed. Infographics containing ‘sufficient’/‘insufficient’ F&V intake descriptive norms were presented. An identification manipulation was employed to create ‘high’/‘low’ student identifiers. F&V intake intentions were assessed after the manipulations; self-reported F&V intake was reported at 2 days post-intervention. UK undergraduate students (N=180) reported intake intentions, of which 112 (62%) completed the behavioral follow-up. Participants were predominantly white female students from Scottish universities, mean age 20.4 (±1.6) years. Baseline mean F&V consumption was high (4.5±2.8). There were no significant main effects of Norm or Identification manipulations on F&V intentions and intake. Significant norm×identification interactions were revealed for fruit intake intentions and vegetable intake at follow-up, indicating half portion differences (~40g) between groups. Ironic effects were observed for ‘high’ identifiers, who neither intended to, nor acted in accordance with group norms; ‘low’ student identifiers intended to and followed group norms, whereby the ‘sufficient’/‘low’ group intended to consume significantly more fruit portions, and consumed more vegetables than the ‘insufficient’/‘low’ group. Given the half-portion differences between groups resulting from the norm×identification interactions, future research on a larger sample of young adults with low F&V intake is warranted to further explore the conditions under which moderating effects of identification are observed and the underlying mechanisms.Publisher PDFPeer reviewe

Information seeking behaviours and uncertainty around accessing primary care in the changing landscape of the COVID-19 pandemic : a qualitative study

This work was funded by Medical Research Scotland.Background The COVID-19 pandemic has and will continue to have a disproportionate effect on the most vulnerable. Public health messaging has been vital to regulate the impact of the pandemic. However, messages intended to slow the transmission of the virus may also cause harm. Understanding the areas where public health messaging could be improved may help reduce this harm. Aim To explore and understand health communication issues faced by those most likely to be impacted by the COVID-19 pandemic. Design & setting A qualitative study using online surveys. The area of focus was Fife, a local authority in Scotland, UK. Method Two consecutive surveys were conducted. Survey 1: N=19 support workers and Facebook group moderators, focussing on key issues faced by service users, as well as examples of good practice. Survey 2: N=34 community members, focussing on issues regarding access to and communication around access to primary care. Results Survey one found broad issues around communication and access to primary care services. Survey two emphasised key issues in accessing primary care, including, (a) the lengthy process of making appointments, (b) feeling like a burden for wanting to be seen, (c) a lack of confidence in remote triaging and consultations, and (d) not knowing what to expect prior to getting an appointment. Conclusion Clear issues regarding access to primary care were identified. Our new understanding of these issues will inform a co-creation process designed to develop clear, actionable and effective public health messages centred on improving access to primary care.Publisher PDFPeer reviewe

Increasing uptake to a lung cancer screening programme : Building with communities through co-design

Acknowledgements We would like to acknowledge the contribution of Dr Neil Arnott and all other organisations/individuals who helped engage participants. Funding This work was funded by the Chief Scientist Ofce (COBELT co-design study)Peer reviewedPublisher PD

Communication skills training for the radiotherapy team to manage cancer patients’ emotional concerns : a systematic review

Funding: Breast Cancer Now, grant number 2017MayPR898.Objectives: Many cancer patients experience high levels of anxiety and concern during radiotherapy, often with long-lasting effects on their well-being. This systematic review aims to describe and determine the effectiveness of communication skills training (CST) for the radiotherapy team (RT) to improve conversations in this setting and to support patients with emotional concerns. Design: Systematic review. Interventions: CST for RT members. Data sources: On 17 April 2018, databases Medline, Embase, Scopus and PsycNET were searched. Eligibility criteria, Population, Intervention, Comparison, Outcome(PICO): Quantitative and/or qualitative articles were included that evaluate the effect of a CST for RT members (vs no CST) on communication behaviours and patients’ emotional concerns. Data extraction and synthesis: Articles were appraised using the mixed-methods appraisal tool, and a narrative synthesis was performed. Results: Of the nine included articles, five were randomised controlled trials, three were mixed-methods and one used repeated measurements. Four of the five different CST programmes managed to increase emotional communicative behaviour from the RT, and all studies measuring patient communicative behaviour found an improvement in at least one of the hypothesised outcomes. Two studies examining patient anxiety and concerns found a positive effect of the CST, although one found a negative effect; two other studies without a positive effect on mood made use of both empathic CST and tools. Conclusions: There are promising indications that CST can be successfully introduced to improve emotional conversations between RT members and patients. With the right support, the RT can play an important role to help patients cope with their emotional concerns. Future work is necessary to confirm initial promising results and to ensure the learnt communication skills are sustained.Publisher PDFPeer reviewe

Development, acceptability and feasibility of a communication skills training package for therapeutic radiographers to reduce fear of recurrence development in breast cancer patients (FORECAST2)

The study is funded by Breast Cancer Now (reference number: 2017MayPr898).Background: Many patients who have been treated for breast cancer experience high levels of fear that the cancer will return. The FORECAST pilot study showed that for a third of the patients, fears of cancer recurrence (FCR) increase during radiotherapy treatment and that conversations with their therapeutic radiographer at the weekly review meetings might help patients manage these concerns. This study aims to develop a communication skills training package (KEW, for ‘Know’, ‘Encourage’, and ‘Warm-up’) for therapeutic radiographers based on the findings of the FORECAST pilot study and on active input from patients and radiographers. This package will be piloted in a single centre to evaluate its acceptability and to prepare for a multi-centre clinical trial. Methods: The study consists of three phases. In the first phase, patient representatives and therapeutic radiographers participate in Experience-Based Co-Design to identify ways to improve communication during the radiotherapy review. In the second phase, various stakeholders, including members of the Society of Radiographers and of national patient representation groups are consulted to develop a storyboard for the production of the communication training package. In the third phase, the acceptability and feasibility of the training is evaluated through observations, recruitment rates and follow-up discussions; a fidelity measure is designed; and potential benefits are observed, with patients’ fear of cancer recurrence (FCR7) as the primary outcome. Secondary outcomes include a short daily measure of recurrence (FCR3), patients’ positive and negative affect (PANAS), perceived empathy from the radiographer (CARE), satisfaction with the review meetings (RISS) and health-related quality of life (EQ-5D-3L). Discussion: To date there has been limited research on how communication between therapeutic radiographers and patients during review appointments can help to manage patients’ recurrence fears during radiotherapy treatment. A collaborative and participatory approach to the development of a communication skills training will ensure that it is optimally targeted to the needs and preferences of both patients and radiographers. Targeting recurrence fears through communication at this stage, when patients are still in regular contact with healthcare providers, has the potential to reduce the need for complex interventions post-treatment.Publisher PDFPeer reviewe

The extent and effects of patient involvement in pictogram design for written drug information : a short systematic review

This short review provides insight into the extent and effectiveness of patient involvement in the design and evaluation of pictograms to support patient drug information. Pubmed, CINAHL, Cochrane Library, Embase, PsycINFO, Academic Search Premier and Web of Science were searched systematically; the 73 included articles were evaluated with the MMAT. We see that, usually, non-patient end-users are involved in the design of pharmaceutical pictograms - patients are more commonly involved in the final evaluation of pictogram success. Repeated involvement of (non-)patients aids the design of effective pharmaceutical pictograms, although there is limited evidence for such effects on patient perception of drug information or health behaviour.Publisher PDFPeer reviewe

Low literacy and written drug information : information-seeking, leaflet evaluation and preferences, and roles for images

Background Low-literate patients are at risk to misinterpret written drug information. For the (co-) design of targeted patient information, it is key to involve this group in determining their communication barriers and information needs. Objective To gain insight into how people with low literacy use and evaluate written drug information, and to identify ways in which they feel the patient leaflet can be improved, and in particular how images could be used. Setting Food banks and an education institution for Dutch language training in the Netherlands. Method Semi-structured focus groups and individual interviews were held with low-literate participants (n = 45). The thematic framework approach was used for analysis to identify themes in the data. Main outcome measure Low-literate people’s experience with patient information leaflets, ideas for improvements, and perceptions on possible uses for visuals. Results Patient information leaflets were considered discouraging to use, and information difficult to find and understand. Many rely on alternative information sources. The leaflet should be shorter, and improved in terms of organisation, legibility and readability. Participants thought images could increase the leaflet’s appeal, help ask questions, provide an overview, help understand textual information, aid recall, reassure, and even lead to increased confidence, empowerment and feeling of safety. Conclusion Already at the stages of paying attention to the leaflet and maintaining interest in the message, low-literate patients experience barriers in the communication process through written drug information. Short, structured, visual/textual explanations can lower the motivational threshold to use the leaflet, improve understanding, and empower the low-literate target group.Publisher PDFPeer reviewe

Pharmaceutical pictograms for low-literate patients : understanding, risk of false confidence, and evidence-based design strategies

Objective: This study aims to (1) evaluate ten pharmaceutical pictograms for low-literate patients on understandability, (2) assess the risk of false confidence in understanding, and (3) identify how the design can be improved to increase understandability. Methods: Interviews were conducted with n=197 pharmacy visitors in the Netherlands. Additional qualitative discussions were held with n=30 adequately and n=25 low-literate participants (assessed with REALM-D). Qualitative data were analysed using the Thematic Framework approach. Results: Half of the pictograms reached 67% understanding (31.0%-98.5%); two did in the low-literate group. Three pictograms showed a risk for false confidence. Pictograms appeared to be most effective when people were familiar with their visual elements and messages. Conclusion: Low-literate people have more difficulty understanding pictograms than people with adequate literacy. While the risk of false confidence is low, for critical safety information, 67% understanding might not be sufficient. Design strategies for pharmaceutical pictograms should focus on familiarity, simplicity, and showing the intake and effect of medicine. Practice implications: Health professionals should go over the meaning of pictograms when providing drug information to patients to increase patients' familiarity with the message and to ensure that all pictograms are sufficiently understood.PostprintPeer reviewe