Health Psychology and Behavioral Medicine: an Open Access Journal

Background Smartphone Addiction (SA) is a rising global behavioral issue among adolescents. Extant studies rarely explore interventions to lower the risk of SA and increase resilience for adolescents. Objective To investigate the feasibility of the study protocol designed with a cluster-RCT and examine the preliminary effect of the first 4-week group mindfulness-based cognitive program (MBCP) on Smartphone Addiction risk and resilience in young adolescents. Methods A quasi-experimental approach was used. Two primary schools were randomly allocated into two study groups. 23 and 28 aged 10–11 adolescents were recruited for waitlist control and intervention groups, respectively. Intervention group received the first 4 weeks of the MBCP. The risk of Smartphone Addiction was measured by Smartphone Addiction Scale-Short Version. Smartphone behavior was evaluated by daily time spent on smartphone and frequency of using smartphone functions. Resilience was evaluated by Connor-Davidson Resilience Scale. Data was collected before intervention (T0) and after the fourth session (week 4,T1). Results Attrition rate, participation rate, and compliance with daily home practice were 10.7%, 80%, and 64%, respectively. There were no significant differences in outcome variables between groups. In within-group comparison, the posttest resilience score was significantly greater than that of the pretest in intervention group (Z = -2.37, p = 0.02), with a moderate effect size (d) of 0.52. No significant within-group differences were found for all smartphone behavioral outcomes (p > 0.05). However, the within-group effect size (d) of total smartphone addiction score in the intervention(I) group was larger than that of the control(C) (dI =−0.13; dC = 0.06). It gives clue to the potential influence of mindfulness practice on adolescents' smartphone behavior. Discussion and conclusions The preliminary findings suggest that MBCP may be a potential intervention to manage smartphone addiction problems in young adolescents in Hong Kong's school context. Further refinement of intervention protocol to boost parents' participation and compliance with daily practice is needed to ensure practice adherence.

Episodic future thinking (EFT), an intervention in which participants vividly imagine their future, has been explored as a cognitive intervention to reduce delay discounting and decrease engagement in harmful health behaviors. In these studies, participants generate text descriptions of personally meaningful future events. The content of these text descriptions, or cues, is heterogeneous and can vary along several dimensions (e.g. references to health, celebrations, family; vividness; emotional valence). However, little work has quantified this heterogeneity or potential importance for EFT’s efficacy. To better understand the potential impact of EFT content in the context of health behavior change (e.g. diet) among people with or at risk for obesity and related conditions, we used data from 19 prior EFT studies, including 1705 participants (mean body mass index = 33.1) who generated 9714 cues. We used natural language processing to classify EFT content and examined whether EFT content moderated effects on delay discounting. Cues most commonly involved recreation, food, and spending time with family, and least commonly involved references to health and self-improvement. Cues were generally classified as highly vivid, episodic, and positively valent (consistent with the intervention’s design). In multivariate regression with model selection, EFT content did not significantly moderate the effect of the episodic thinking intervention. Thus, we find no evidence that any of the content characteristics we examined were important moderators of the efficacy of EFT in reducing delay discounting. This suggests that EFT’s efficacy is robust against variability in these characteristics. However, note that in all studies, EFT methods were designed to generate high levels of vividness, episodicity, and emotional valence, potentially resulting in a ceiling effect in these content areas. Moreover, EFT content was not experimentally manipulated, limiting causal inference. Future studies should experimentally examine these and other content characteristics and evaluate their possible role in EFT’s efficacy.

Objective Endometriosis, a chronic condition affecting 10-15% of women of reproductive age, often leads to psychological distress (PD), including depression and anxiety. This study examined how body image and self-criticism mediate the relationship between endometriosis and PD, comparing Israeli women to those from English-speaking countries, and explored the moderating role of cultural background. Methods A cross-sectional survey was conducted with 437 women from Israel and English-speaking countries. Participants completed questionnaires to evaluate depression symptoms, anxiety, self-criticism, and body appreciation. Data were analyzed using multivariate MANOVA and moderated mediation models. Results Women with endometriosis showed higher PD, with significant differences by cultural background. Israeli participants reported higher depression and anxiety. The mediation model showed that body image and self-criticism were significant mediators in the endometriosis-PD link, a process consistent across cultural groups. However, the direct effect of endometriosis on PD was stronger among Israeli women. Conclusion Our findings highlight the impact of cultural context on PD on women with endometriosis, emphasizing body image and self-criticism as intervention targets. This study underscores the importance of culturally sensitive support for mental health in endometriosis, with implications for clinical practice and public health strategies.

Introduction Rates of depression, burnout, and anxiety among nurses are high. Improving sleep quality may mitigate psychological distress, but research on effective sleep interventions for nurses is limited. This pilot study explored the preliminary effects of the Somni© sleep quality kit on sleep, stress, and psychological health among nurses using continuous physiologic data from the Oura ring©. Methods A prospective pilot trial was conducted with 25 nurses. Participants wore the Oura ring© for eight weeks to collect data on heart rate variability (HRV) and sleep. The Somni© sleep kit, containing evidence-based sleep aids, was introduced from weeks 4-8. Participants completed surveys at baseline, 4, and 8 weeks to assess sleep quality, stress, burnout, and depressive symptoms. Data were analyzed using paired t-tests and linear mixed-effect models. Results The sample was predominantly White (64%), non-Hispanic (88%), and female (84%). Lavender spray and white noise machines were the most frequently used sleep aids. Self-reported sleep latency significantly decreased (p = 0.03), with a trend toward improved sleep quality. No significant changes were observed in physiologic metrics or depressive symptoms. Effect sizes ranged from moderate to small, with the greatest improvement in sleep latency. Discussion The Somni© sleep kit showed potential for improving self-reported sleep quality and sleep latency, especially through non-pharmacologic interventions. While the results were mixed, this study supports the feasibility of using wearable devices to track sleep and stress in nurses. Future research should include larger samples and investigate the long-term effects of sleep interventions on nurses’ mental health.

Background: Fatigue is a common long-term problem after illnesses affecting the brain, having substantial impact on work ability, social activities, and quality of life. Treatment has been requested in the healthcare and by patients. The aim of this randomized pilot study is to evaluate a new Brain Fatigue and Mindfulness program (BF-M) for participants suffering from long-term fatigue after an acquired brain injury or Multiple Sclerosis. BF-M consists of six biweekly group meetings. Meditation is practiced, knowledge is imparted about fatigue and participants have time to share and discuss common issues. Methods: A mixed method research design is used with quantitative and qualitative methods. Sixteen participants completed BF-M and 16 controls on waitlist responded to questionnaires before and after the intervention. Results: After the program, the BF-M group had a significant reduction in BF and anxiety compared to the controls. The analysis of 13 interviews with BF-M participants suggested that: (1) BF-M became a space for the participants to exchange and share experiences associated with BF; (2) the participants felt more understood and less alone; and (3) they learned how to better understand and live with brain fatigue. Conclusions: This study showed that BF-M may reduce brain fatigue and help participants to better manage their difficulties. Based on this pilot study, we suggest that BF-M may be considered as a rehabilitation option for brain fatigue. However, more confirmatory research with larger and different patient groups is needed.

Background: Adolescents with inflammatory bowel disease (IBD) are faced with the complexities of acquiring self-management behaviours at a time when they are also navigating developmental challenges associated with adolescence. To date, limited treatment adherence interventions exist to support adolescents with IBD. Aim: To explore the experience and support needs of adolescents with IBD to facilitate optimum treatment adherence. Method: Thirty-three semi-structured interviews were conducted with adolescents with IBD (n = 12), parents of adolescents with IBD (n = 13) and healthcare professionals who support adolescents with IBD (n = 8). Adolescents and parents completed a creative task to prioritise adherence barriers and adherence intervention strategies. Results: The analysis generated three key themes: (1) striving for normality, (2) taking responsibility for IBD management and (3) seeking supportive environments. Living with IBD was often perceived as living a limited life, as adolescents had to manage their symptoms, which resulted in feelings of difference and stigmatisation. To manage their IBD, adolescents were required to develop treatment routines and communicate their health needs. Parents wanted to protect their child from the burden of living with IBD. Synthesis of findings with a creative mapping task generated seven priorities for intervention. Discussion: Adolescents discussed the complexity behind their adherence behaviours and the formation of treatment perceptions. The adherence barriers identified within this research can be utilised to develop a treatment adherence intervention that is effective for adolescents with IBD.

Background Although there have been many studies on laughter and health, few studies have clarified the effects of laughter on optimism and pessimism, as well as anxiety. The purpose of the study was to evaluate the effects of viewing a comedy live performance on optimism, pessimism, and anxiety, sAA as a stress marker, and examine the relationship between laughter attitude and optimism, pessimism and stress marker and clarify significant factors that contribute to optimism. Methods In this pre – post study, we evaluated the effects on attendees of laughter elicited by a comedy live performance (CLP). The participants were 110 volunteers aged 18–64 years. Participants attended a two-hour CLP by four famous Japanese comedians (Sisonnu, Tonikaku Akarui Yasumura, Mouchugakusei, and Panther) and completed pre – and post-event questionnaires that included items from the Japanese Optimism and Pessimism Scale (JOPS), State-Trait Anxiety Inventory (STAI), the Laughter Attitude Scale (LAS) and Salivary alpha-amylase (sAA). Results The valid response rate was 101. Participants’ optimism was higher, and pessimism, anxiety and sAA were lower, after attending the CLP. α-amylase was significantly lower in more people before and after CLP. Factors contributing to optimism were strongly influenced by the degree to which people made them laugh, as well as pessimism, anxiety, and forced laughter. Conclusion The personal factors contributing most strongly to optimism were ‘A state that makes you laugh,’ as well as pessimism, anxiety, and a low level of ‘Forced Laughter.’ Attending a two-hour CLP increased optimism and decreased stress level, pessimism and anxiety, these effects were more pronounced in those who laughed regularly in their everyday lives.

Background: Digital health interventions have the potential to improve health at a large scale globally by improving access to healthcare services and health-related information, but they tend to benefit more affluent and privileged groups more than those less privileged. Methods: In this narrative review, we describe how this ‘digital health divide’ can manifest across three different levels reflecting inequalities in access, skills and benefits or outcomes (i.e. the first, second, and tertiary digital divide). We also discuss four key causes of this digital divide: (i)) digital health literacy as a fundamental determinant; (ii) other personal, social, community, and societal level determinants; (iii) how technology and intervention development contribute to; and (iv) how current research practice exacerbates the digital health divide by developing a biased evidence base. Finally, we formulate implications for research, policy, and practice. Results: Specific recommendations for research include to keep digital health interventions and measurement instruments up to date with fastpaced technological changes, and to involve diverse populations in digital intervention development and evaluation research. For policy and practice, examples of recommendations are to insist on inclusive and accessible design of health technology and to ensure support for digital health intervention enactment prioritises those most vulnerable to the digital divide. Conclusion: We conclude by highlighting the importance of addressing the digital health divide to ensure that as digital technologies' inevitable presence grows, it does not leave those who could benefit most from innovative health technology behind.

Introduction We present a unique multi-country, two-wave dataset of 42,417 survey responses drawn from nationally representative samples of citizens from the G-7 countries: Canada, France, Germany, Italy, Japan, UK, and USA. This data note outlines the motivation and methodology of the survey instrument and describes the measures contained in the dataset. We highlight areas for future research. Methods We fielded an online survey over two waves (January 27 to February 26 [n = 24,303] and wave 2 from March 6 to May 12 [n = 18,114]) measuring a range of demographic, social, political, and psychological variables. Samples were nationally representative by age, education, gender, and subnational region. Each wave included of three experiments (one conjoint and two between-subjects) to facilitate randomised evaluation of behavioural health policies promoting the uptake of COVID-19 booster vaccinations. Results The dataset has produced two peer-reviewed publications at the time of writing ([Banerjee, S., John, P., Nyhan, B., Hunter, A., Koenig, R., Lee-Whiting, B., Loewen, P. J., McAndrews, J., & Savani, M. M. (2024). Thinking about default enrollment lowers vaccination intentions and public support in G7 countries. PNAS Nexus, 3(4), pgae093]; [Koenig, R., Savani, M. M., Lee-Whiting, B., McAndrews, J., Banerjee, S., Hunter, A., John, P., Loewen, P. J., & Nyhan, B. (2024). Public support for more stringent vaccine policies increases with vaccine effectiveness. Scientific Reports, 14(1), 1748]). A summary report is posted online (https://www.thebritishacademy.ac.uk/publications/overcoming-barriers-to-vaccination-by-empowering-citizens-to-make-deliberate-choices/). Additional research outputs are currently under preparation. Discussion Our dataset combines observational and experimental data on behavioural health policies, offering numerous insights. First, the dataset's extensive size and geographical diversity enables comparative analysis of public health issues involving social, political, and behavioural factors. Second, the dataset is suited to advanced statistical methods that can explore heterogeneity in the uptake of behavioural health policies, such as vaccine nudges. Third, the timing of the data collection, coinciding with the rise of the Omicron variant, provides valuable insights into why some previously vaccinated individuals might hesitate to receive additional doses, potentially improving our understanding of the COVID-19 pandemic and possible responses to pandemics and other public health emergencies in the future.

Introduction Colorectal cancer (CRC) is a growing public health concern in Malaysia influenced by a complex interplay of ecological, biological, and social (EBS) factors. Despite its increasing incidence, limited research has explored how these factors interact to shape CRC risk in the Malaysian context, especially from the perspectives of affected individuals. This study explores Malaysians’ perceptions and experiences regarding CRC risk within the EBS framework. Methods A qualitative case study approach involved in-depth interviews with twelve Malaysians aged 35–75 who had undergone colonoscopy at a university hospital. All interviews were recorded and transcribed. Data were collected until saturation was achieved. The transcripts were coded and analysed using ATLAS.ti software. The data were analysed using thematic analysis. Results Findings revealed key themes related to ecological factors in the physical activity environment, which included the sub-themes of type, facilitators, barriers to physical activity, and food sources. The biological factors theme revealed that a family history of CRC influences experience and perception. The subthemes of social factors were sociocultural customs, misconceptions, food preparation methods, CRC-related foods, and food affordability. Conclusion The findings highlighted the multifactorial nature of CRC risk. Understanding the aspects of EBS supports the development of targeted public health interventions to address modifiable CRC risk factors and promote prevention and early CRC detection in the Malaysian context.

Introduction Seasonal and within-week variation has been documented in relation to body weight change and self-weighing; however, less is known regarding how patterns of self-monitoring dietary intake vary over time. Methods The current study conducted secondary data analysis from a larger weight management trial to examine within-week and within-year patterns of dietary self-monitoring in 446 adults with obesity (mean ± SD age = 49.5 ± 11.4 years, BMI = 35.7 ± 4.0 kg/m²) enrolled in a 16-week behavioral weight loss program (with start dates staggered throughout the year). Generalized mixed models were used to characterize within-week and within-year patterns in adherence to dietary self-monitoring and to examine potential moderators (i.e. age and gender). Results There was significant variation in self-monitoring adherence and caloric intake across days of the week, ps < .001, with the lowest adherence and greatest intake observed on Thursdays through Sundays. Moreover, there was significant variation by calendar month, ps < .001, with the lowest adherence and highest intake in October, November, and December. Age moderated the associations between day of the week and caloric intake and between calendar month and self-monitoring adherence/caloric intake; gender moderated the associations between calendar month and self-monitoring adherence/caloric intake. Discussion Results demonstrate differences in dietary self-monitoring adherence and caloric intake within-week and within-year, with effects moderated by age and gender. Taken together with research demonstrating that additional support may improve adherence to self-monitoring during high-risk times (e.g. holiday seasons), future research should replicate these findings and identify additional predictors of self-monitoring adherence, supporting the development of novel, individually- and contextually-adaptable interventions.

Background Individuals who undergo metabolic and bariatric surgery are at increased risk for an alcohol use disorder. Clarity on the relationships between mood, food, and alcohol use could inform interventions to reduce alcohol use and mitigate risk of alcohol use disorders after metabolic and bariatric surgery (MBS). Methods Twenty patients who underwent MBS at a single health care system and reported engaging in post-operative alcohol use were recruited. Participants were between 6 months and 3 years post-operative and reported consuming alcohol at least 2–3 times per month. Participants engaged in a 1-hour semi-structured interview about factors influencing post-operative mood, eating behaviors, and alcohol use. All interviews were recorded, transcribed, and coded by two independent raters. Results Statements by participants were deductively coded within different themes: (1) changes in mood, (2) changes in eating patterns, and (3) unintended alcohol use and eating. Participants reported positive changes in mood and eating behaviors following MBS, but also indicated potential for negative mood states and new eating patterns. They also suggested that mood was a driver of both eating and alcohol use, including unintended (i.e. unplanned) eating and unintended alcohol use. However, most did not consume food and alcohol at the same time. Discussion Food and alcohol may be used as a coping strategy for mood, though they are not often consumed together. There is currently a lack of post-operative interventions to reduce alcohol use and findings suggest that interventions could simultaneously target mood, unintended eating, and alcohol use.

Introduction The aim of this study was to investigate how the dynamics of the social environment impacted the alcohol consumption of individuals who self-identified as heavy drinkers. Methods A mixed methods approach including N-of-1 study with daily Ecological Momentary Assessment (EMA) followed by a social network egonet interview. Qualitative data was analysed using deductive and inductive approaches. The main quantitative outcomes were a number of social contacts and the supportiveness of social networks. Results Fifteen participants provided sufficient EMA data regarding social contact and six of these took part in the egonet interviews. EMA respondents reported 10.8 social contacts on average and rated approximately half of their networks as positive supports; approximately 10% of each respondents’ networks were perceived as ‘drinking a lot’. Interview data illustrated the influence of peer and family networks; stress; motivation levels; and coping strategies within the context of the social world. EMA and egonet methods proved feasible with this specific population demonstrating the utility of innovative approaches to study dynamic social contexts related to substance use. Discussion Respondents either drew upon their social resources and implemented strategies to support behaviour change or experienced social strain and poor mental health in the absence of supportive social strategies. Future research should explore how social networks can impact maintaining non-drinking status and accessing supports. Mixed methods research combining N-of-1, EMA, and egonets can provide novel insights into social dynamics.

Background Physical activity (PA) provides maternal and fetal health benefits, but only 27.5% of Canadian pregnant women meet PA recommendations. Theory-based interventions like the theory of planned behavior (TPB) are useful in explaining what drives behavior. The first objective of this study was to validate the TPB model to predict prenatal moderate-to-vigorous physical activity (MVPA), including testing of the novel interaction between intention and perceived behavioral control (PBC). The second objective was to identify which specific beliefs predict intention toward prenatal MVPA to support intervention. Method We used a prospective correlational design. Healthy pregnant women completed two electronic questionnaires: at baseline, to assess TPB constructs, and one month later, to assess MVPA practice. Structural equation modeling was conducted with Latent Moderated Structural Equations. The interaction was interpreted with the pick-a-point method and the Johnson-Neyman graphical method. Results The sample consists of 193 women (Mage = 31.2±3.6). Results indicate that prenatal MVPA at one month was marginally predicted by intention (β = 0.149; p < 0.10) and PBC (β = 0.322; p < 0.05, MVPA R2 = 20%), but when their interaction was added to the model, MVPA R² increased to 44%. Specifically, the relationship between intention and MVPA is stronger when PBC is high (0.5 standard deviation over the mean). In the full model including the interaction, attitude (β = 0.59; p < 0.001), subjective norm (β = 0.20; p < 0.01) and PBC (β = 0.26; p < 0.05) all made a significant contribution to predicting MVPA intention (R2 = 88%). Finally, the following beliefs displayed significant indirect paths toward the intention of being physically active: behavioral beliefs: unlikely to be more tired and likely feel better mentally; normative beliefs: approval from friends and from mother/father; and control beliefs: being tired and missing social support. Conclusion Interventions aiming to promote regular MVPA during pregnancy should prioritized the six significant beliefs identified to significantly predict intention toward prenatal MVPA.

This paper reports on human rights violation of trans women in Umlazi township in South Africa. Violation of trans women’s human rights happens in several countries regardless of their constitutional stance regarding LGBTQI policies. Although South Africa was the first country to outlaw discrimination based on sexual orientation with its democratic Constitution of 1996, it is not an exception to these violations of transgender people’s human rights. This paper presents human rights violations experienced by trans women’s in Umlazi township in South African. The study was qualitative in nature utilising an interpretative phenomenological analysis design. Data was collected through semi-structured interviews from eight criterion purposively selected trans women from Umlazi township. Data was analysed guided by an interpretative analytics framework. Two key themes emerged from the study: the types of human rights violations and their sources. The findings indicated that trans women experience several types of human rights violations, including violations of their right to safety, freedom of expression, access to employment, and the right to human dignity. The sources of these human rights violations for trans women include cis-normative infrastructure, transphobic communities, and transphobic public officials. Understanding these experiences is crucial in developing measures to conscientize communities, foster tolerance and promoting social inclusivity of transgender people in society. The findings provide insights that can facilitate positive changes in how communities perceive transgender persons.

Young adult women have unique barriers to exercise, but assessing the psychological and behavioral strategies of women who overcome these barriers may be beneficial for informing future exercise programs. This study assessed differences in motives and self-regulation by type (aerobic or muscle-strengthening) and frequency of exercise, along with preferences for exercise amongst young adult women who exercise regularly. Methods A survey assessed exercise frequency (International Physical Activity Questionnaire), intensity (Borg’s scale), type, and social and physical preferences. The Exercise Motivations Inventory-2 measured motivators for exercise and the Physical Activity Self-Regulation Scale measured self-regulation. Characteristics and preferences for exercise were examined using descriptives and frequencies. MANOVAs assessed differences in motivators and self-regulation by frequency of exercise, and regression analyses assessed differences in exercise predictors by type. Results The sample consisted of 269 women ages 18–34 (66.5% White), of whom 80.3% met the national guidelines for aerobic exercise, 78.4% met the guidelines for muscle-strengthening exercise, and 32.3% identified resistance exercise as their preferred type of exercise. Weight management and self-regulation (p = .021, R² = .073) were the strongest predictors of aerobic exercise. Positive health, strength and endurance, and self-regulation (p = .023, R² = .161) were predictors of muscle-strengthening exercise. Women who participated in high amounts of aerobic exercise were motivated by interpersonal factors while psychological factors motivated high frequency of muscle-strengthening exercise. Conclusions Programs for young adult women should consider incorporating resistance exercise as this study shows it may evoke motivation that could lead to regular participation. Self-regulation strategies were associated with adherence to both aerobic and muscle-strengthening exercises, highlighting the potential importance for inclusion in future interventions.

Background Bardet-Biedl syndrome (BBS) is a rare disorder involving a complex combination of eye and kidney diseases, obesity and learning difficulties. To better understand the roles of family caregivers, this study sought to explore parents’ experiences of supporting adult children with BBS. Method This study included 17 parents of adult children with BBS. Semi-structured interviews were used as the research method. The generated data were interpreted using a reflexive thematic analysis, which employed a phenomenological and hermeneutical approach. Result Four themes were identified – namely, worries and expectations for the child's future, advocate and companion, in the power of the health and support system, and sources of support and coping. The findings indicate that the parents’ everyday lives are affected in many ways by caring for adult children with BBS. Conclusion This study highlights the various roles and responsibilities of parents of adult children with BBS, including advocating for health services and attempting to fill gaps in care and social relationships. Hence, the findings of this study provide valuable insights for health professionals and support systems, helping to identify key areas for future initiatives aimed at better addressing the needs of adults with BBS and their parents.

Objective Huntington’s disease (HD) is a rare neurodegenerative condition characterised by progressive symptoms affecting motricity, cognition, neuropsychiatric function and behaviour. HD develops during a period of life in which many live in partnership and have children. HD impacts all family members through its cognitive and psychological symptoms, mid-life onset, long disease trajectory and genetic risk. The aim of the study was to explore how parents without HD experience and manage parenthood when their partner is affected by HD. Methods Qualitative interviews with 14 caregivers were analysed using reflexive thematic analysis. Results Three main themes with corresponding subthemes were identified, followed by an underlying theme: Genetic risk: An underlying layer of complexity. The first theme, Balancing competing demands, describes the challenges involved when attempting to attend to conflicting needs within the family. Theme 2, Needing a shoulder to lean on, covers participants’ feelings of loneliness and their need to be seen by others, whereas Theme 3, Restoring and building strength, encompasses coping strategies used by caregivers to protect themselves and their children from potential negative experiences. The underlying theme describes how the genetic aspect of the disease permeates the participants’ experiences across all other themes. Conclusion Support providers may be unaware of the extensive repercussions HD can have on a family. Acknowledging the central role of partners without HD and their risk of psychological distress is crucial. Exhausted partners may struggle to support their children, which may lead to childhoods overshadowed by HD. For family members to prioritise their own needs, tailored support must be set in place for parents with HD.

Introduction Aspirin is increasingly recommended for colorectal cancer prevention for people with Lynch syndrome, who are at higher risk. Before starting aspirin, patients should be reviewed by a healthcare professional for contraindications. We conducted interviews to explore the views of people with Lynch syndrome and healthcare professionals on aspirin for cancer prevention. While open data sharing is increasingly implemented for quantitative research, it is less likely to be adopted for qualitative data. We aimed to create and share a qualitative dataset of the interview transcripts in a restricted access repository. Methods We interviewed 15 people with Lynch syndrome and 23 healthcare professionals. Healthcare professionals included general practitioners (GPs), community pharmacists, genetic counsellors, and specialist hospital clinicians (e.g. genetics, gastroenterology). The interview schedule was informed by the Theoretical Domains Framework. Interviews were conducted over video or telephone. Results Participants could consent to their anonymised interview transcript being deposited in a restricted repository, with access limited to people using the data for non-commercial research, learning or teaching purposes. Those who did not consent could still participate in the interview. Several transcripts were removed due to identifiability concerns. In total, we deposited 12 transcripts with people with Lynch syndrome, and 8 transcripts with GPs. Discussion To safeguard participants’ identities, we fully anonymised the dataset. While this acted to protect participants’ identities, it also potentially reduced its usability due to the removal of rich contextual detail. When sharing qualitative data, it is important to balance confidentiality with data reusability.

Introduction There is accumulating evidence of ineffective decision-making between birthing individuals and healthcare providers during childbirth. While research syntheses have demonstrated that negative birth experiences are associated with postpartum mental health, primary quantitative studies linking specific decision-making measures and mental health outcomes have not been synthesised. The present study aims to fill this gap in order to provide hands-on evidence on how to further improve perinatal care. Methods A systematic literature search using Bolean logic was conducted. A final set of 34 publications from 14 different countries could be included in our meta-analysis. Measures of intrapartum decision-making were consolidated into four key domains: information, respect, control, and involvement. We conducted multi-level meta-analyses to assess the overall relationship of intra-partum decision-making and mental-health outcomes, as well as the specific correlations associated with each decision-making domain. Results Our analysisrevealed that less effective intrapartum decision-making is associated with more postpartum overall mental health problems (r = -.25), depression (r = -.19), and posttraumatic stress disorder (r = -.29). More precisely, while all domains of intrapartum decision-making (information: r = -.22, involvement: r = -.23, respect: r = -.28, control: r = -.25) were associated with postpartum overall psychopathology, only information (r = -.18), respect (r = -.25), and control (r = -.12) were associated with depression, and only involvement (r = -.31), respect (r = -.32), and control (r = -.25) were associated with posttraumatic stress disorder. A higher percentange of planned cesarean sections in a sample and longer time lags between birth and post-effect measurement were identified as moderating variables. Conclusions Ineffective decision-making is a significant contributing factor to the development of adverse postpartum mental health problems outcomes. Implications for practice concern establishing numerous antenatal care contacts as a standard to enhance birth preparedness for both birthing individuals and providers. Additionally, measuring the experience of intrapartum decision-making as an indicator of quality of care as a default to monitor, analyse, and improve decision-making and to facilitate accountability systems.

Background Sunburn and intermittent sun exposure elevate melanoma skin cancer risk. Sun protection behaviours, including limiting sun exposure, seeking shade, wearing protective gear, and using sunscreen, help mitigate excessive sun exposure. Smartphone apps present a promising platform to enhance these behaviours. Objective Part 1 aimed to analyse and evaluate the content of mobile apps that encourage sun protection behaviours, focusing on features, and behaviour change techniques (BCTs). Part 2 explored user preferences and usability post-initial use and two weeks later. Results Part 1 identified 1294 apps; after applying exclusion criteria, 87 apps were downloaded, with 48 included for analysis. The apps presented opportunities for enhancement in their theoretical and evidence basis, and visualisations use (e.g. UV-index). The apps mapped across a total of 12 BCTs (M = 1.71, SD = 1.07; range = 0–5). The most frequently identified BCTs were ‘instruction on how to perform behaviour’ (65%), ‘information about health consequences’ (29%), and ‘prompts/cues’ (27%). In Part 2, participants favoured features supporting knowledge and ease of use. Participants expressed a preference for apps that are free of paid features, advertisements, and external purchases. Tailored advice (e.g. location, skin type) was deemed crucial, particularly for initial exposure. Proactive features integrating behavioural, personal, and contextual information for adaptive and just-in-time sun protection advice were seen as essential for sustaining engagement. Conclusions Sun protection apps emphasizing knowledge, ease of use, tailored advice, and proactive features are likely to encourage sustained engagement. Suggestions for optimising current and future sun protection apps are provided.

Background Psychologists play a crucial role in providing essential psychological aid to individuals navigating the challenges posed by the COVID-19 pandemic. However, studies focusing on the mental health of psychologists during the COVID-19 pandemic remain scarce. This study investigates the interaction between coping strategies and psychological distress among a group of Indonesian psychologists. Methods This longitudinal study was conducted over two-time points in 2021, with data collected from April 29 to June 23 and again from September 1 to October 23. A total of ninety-seven psychologists, predominantly female (91 out of 97), participated. The data was collected through an online survey, where participants completed the Indonesian version of the Depression, Anxiety, and Stress Scale-21 (DASS-21) and the Brief COPE questionnaire. Multiple regression analysis was used to perform cross-lag analyses on the data. Results The findings revealed that adaptive coping strategies were strong predictors of continued use of adaptive coping strategies six months later, while existing psychological distress strongly predicted future distress. Notably, maladaptive coping strategies demonstrated a similar pattern, predicting the continued use of maladaptive coping techniques over time, but they were also consistently associated with psychological distress across both time points, though they did not significantly predict future psychological distress. Discussion These findings shed light on the dynamic nature of coping strategies and psychological distress among psychologists, presenting significant implications for their support systems and mental health during the challenges posed by the pandemic. Future studies should focus on how psychologists can reduce maladaptive coping strategies to be better equipped to handle very stressful situations such as a pandemic. Additionally, researchers should explore effective interventions and programs that can be implemented to enhance adaptive coping mechanisms, ultimately improving overall psychological resilience and well-being during crises.

Despite mounting evidence of a robust relation between discrimination and poor pain outcomes in people of color (POC) with chronic pain, little is known about everyday discrimination’s role in increasing the risk of opioid misuse and its potential interactive effects. This study aimed to evaluate the potential moderating effect of everyday discrimination on the relationship between chronic pain severity and the risk of opioid misuse among POC with chronic pain. Everyday discrimination was assessed using the 9-item Everyday Discrimination Scale (EDS), while the risk of opioid misuse was measured with the 14-item Screener and Opioid Assessment for Patients with Pain (SOAPP). Using a racially diverse sample of 348 individuals with chronic pain, ranging in age from 20 to 75 years old (M = 28.56), this study investigated these relationships through path analysis conducted in Mplus, controlling for age, sex, and social class. The results showed that high levels of everyday discrimination placed POC patients at a higher risk of opioid misuse when they experienced more severe pain. When chronic physical pain was accompanied by chronic social pain stemming from discrimination, POC patients reported a significantly higher risk of opioid misuse. Discrimination may intensify pain severity, potentially necessitating a higher dose and/or longer-term opioid treatment and, thus, increasing the risk of opioid misuse among POC. The integration of routine assessments of patients’ experiences of discrimination could strengthen the ecological validity of pain assessment and treatment. Where feasible, clinicians might consider exploring the experiences of discrimination among POC patients as part of a holistic approach to pain management, and when indicated, facilitate referrals to psychosocial services to address both social and physical aspects of pain.