A randomised controlled trial of volitional and motivational interventions to improve cervical cancer screening uptake.

OBJECTIVE: Cervical cancer is the fourth most common cancer to occur in women worldwide. In the UK, the NHS cervical screening programme invites eligible individuals to take part in screening every 3-5 years. At present, around 70% of individuals attend screening when invited. The present study aimed to test the effectiveness of a volitional and a motivational intervention alone and in combination on screening uptake at 16-week follow up. METHODS: 14,536 participants were recruited from the list of eligible participants invited for screening in Yorkshire, Humber and the North East regions of England in December 2021. They were randomised to a social norm-based motivational intervention (SNA); implementation intention-based Volitional Help Sheet (VHS); combined intervention (SNA + VHS); or treatment as usual control. The primary outcome was screening uptake measured via patient screening records at 16 weeks. RESULTS: Of the 14,466 participants with eligible data for analysis, 5793 (40.0%) attended for cervical cancer screening in the 16 weeks after the intervention mailing. Both age and deprivation influenced screening uptake, with lower uptake in the youngest individuals and those from more deprived areas. Compared to control, there was no evidence of any benefit from the VHS implementation intervention alone (Adj.OR = 0.99, 95% CI 0.90 to 1.10), the SNA motivational intervention alone (Adj.OR = 0.89; 95% CI: 0.80 to 0.99), or the combined intervention (Adj.OR = 0.96, 95% CI 0.86 to 1.06). CONCLUSION: The study did not support any benefit of either VHS or SNA interventions alone or in combination on cervical cancer screening uptake. It did demonstrate alarmingly low levels of screening uptake at 16 weeks which were well below the average rate. Future research needs to urgently investigate and understand the barriers to uptake following on from the COVID-19 pandemic.

Probable COVID-19 infection is associated with subsequent poorer mental health and greater loneliness in the UK COVID-19 Mental Health and Wellbeing study.

The COVID-19 pandemic has been associated with psychological distress. In addition to physical effects including fatigue and cognitive impairment, contracting COVID-19 itself may also be related to subsequent negative mental health outcomes. The present study reports data from a longitudinal, national survey of the UK adult population investigating whether contracting suspected or confirmed COVID-19 at the early stages of the pandemic (March-May 2020) was associated with poorer mental health outcomes in May/June 2020, October/November 2020 and June/July 2021. A quota survey design and a sampling frame that permitted recruitment of a national sample (n = 3077) were utilised. Experience of contracting COVID-19 during the first UK lockdown was assessed along with levels of depression, anxiety, mental wellbeing and loneliness. Around 9% of participants reported contracting COVID-19 in March/May 2020 (waves 1-3) with just under 13% of the overall sample reporting COVID-19 at any one of the first three time points. Compared to those without probable COVID-19 infection, participants with probable COVID-19 had poorer mental health outcomes at follow-up with these effects lasting up to 13 months (e.g., May/June 2020:ORdepression = 1.70, p < 0.001; ORanxiety = 1.61, p = 0.002; Oct/Nov 2020, ORdepression = 1.82, p < 0.001; ORanxiety 1.56, p = 0.013; June/July 2021, ORdepression = 2.01, p < 0.001; ORanxiety = 1.67, p = 0.008). Having a pre-existing mental health condition was also associated with greater odds of having probable COVID-19 during the study (OR = 1.31, p = 0.016). The current study demonstrates that contracting probable COVID-19 at the early stage of the pandemic was related to long-lasting associations with mental health and the relationship between mental health status and probable COVID-19 is bidirectional.

Information seeking, mental health and loneliness: Longitudinal analyses of adults in the UK COVID-19 mental health and wellbeing study.

Information seeking has generally been seen as an adaptive response to the COVID-19 pandemic. However, it may also result in negative outcomes on mental health. The present study tests whether reporting COVID-related information seeking throughout the pandemic is associated with subsequently poorer mental health outcomes. A quota-based, non-probability-sampling methodology was used to recruit a nationally representative sample. COVID-related information seeking was assessed at six waves along with symptoms of depression, anxiety, mental wellbeing and loneliness (N = 1945). Hierarchical linear modelling was used to assess the relationship between COVID-related information seeking and mental health outcomes. Information seeking was found to reduce over time. Overall, women, older and higher socioeconomic group individuals reported higher levels of information seeking. At waves 1-4 (March-June 2020) the majority of participants reported that they sought information on Covid 1-5 times per day, this decreased to less than once per day in waves 5 and 6 (July-November 2020). Higher levels of information seeking were associated with poorer mental health outcomes, particularly clinically significant levels of anxiety. Use of a non-probability sampling method may have been a study limitation, nevertheless, reducing or managing information seeking behaviour may be one method to reduce anxiety during pandemics and other public health crises.

Information seeking, mental health and loneliness: Longitudinal analyses of adults in the UK COVID-19 Mental Health & Wellbeing study

Information-seeking has generally been seen as an adaptive response to the COVID-19 pandemic. However, it may also result in negative outcomes on mental health. The present study tests whether reporting COVID-related information-seeking throughout the pandemic is associated with subsequently poorer mental health outcomes. A quota-based, non-probability-sampling methodology was used to recruit a nationally representative sample. COVID-related information-seeking was assessed at six waves along with symptoms of depression, anxiety, mental wellbeing and loneliness (N = 1945). Hierarchical linear modelling was used to assess the relationship between COVID-related information-seeking and mental health outcomes. Information-seeking was found to reduce over time. Overall, women, older and higher socioeconomic group individuals reported higher levels of information-seeking. At waves 1-4 (March-June 2020) the majority of participants reported that they sought information on Covid 1-5 times per day, this decreased to less than once per day in waves 5 and 6 (July-November 2020). Higher levels of information-seeking were associated with poorer mental health outcomes, particularly clinically significant levels of anxiety. Use of a non-probability sampling method may have been a study limitation, nevertheless, reducing or managing information-seeking behaviour may be one method to reduce anxiety during pandemics and other public health crises.

Does Temporal Stability Moderate Reasoned Action Approach Relations With Covid-19 Preventive Behaviors?

BACKGROUND: Preventive behaviors continue to play an important role in reducing the spread of the SARS-CoV-2 virus. PURPOSE: This study aimed to apply the reasoned action approach (RAA) to predict Covid-19 preventive intentions and behavior and to test whether temporal stability moderates relations between RAA constructs and behavior. METHODS: A representative sample of UK adults (N = 603) completed measures of RAA variables (i.e., experiential attitudes, instrumental attitudes, injunctive norms, descriptive norms, capacity, autonomy and intention) in relation to six Covid-19 preventive behaviors (i.e., wearing face coverings, social distancing, hand sanitizing, avoiding the three Cs [closed spaces, crowded places, and close contacts], cleaning surfaces, and coughing/sneezing etiquette) at baseline (December 2020) and after 1 month. Self-reported behavior was assessed at baseline and after 1 and 2 months. RESULTS: The RAA was predictive of Covid-19 preventive intentions at time 1 and time 2; instrumental attitudes, descriptive norms, and capability were the strongest predictors at each time point. The RAA also predicted subsequent behavior across time points with intention, descriptive norms, and capability the strongest/most consistent predictors. Temporal stability moderated a number of RAA-behavior relationships including those for intention, descriptive norms, and capability. In each case, the relationships became stronger as temporal stability increased. CONCLUSIONS: Health cognitions as outlined in the RAA provide appropriate targets for interventions to promote Covid-19 preventive intentions and behavior. Moreover, given that continued performance of Covid-19 preventive behaviors is crucial for reducing transmission of the SARS-CoV-2 virus, the results highlight the need for consistent messaging from governments and public health organizations to promote positive intentions and maintain preventive behavior.

Do socio-structural factors moderate the effects of health cognitions on COVID-19 protection behaviours?

OBJECTIVE: Adherence to protection behaviours remains key to curbing the spread of the SARS-CoV-2 virus that causes COVID-19, but there are substantial differences in individual adherence to recommendations according to socio-structural factors. To better understand such differences, the current research examines whether relationships between health cognitions based on the Reasoned Action Approach (RAA) and eight COVID-19 protection behaviours vary as a function of participant-level socio-structural factors. METHODS: Within-person design with behaviours nested within participants in a two-wave online survey (one week delay) conducted during the UK national lockdown in April 2020. A UK representative sample of 477 adults completed baseline measures from the RAA plus perceived susceptibility and past behaviour for eight protection behaviours, and self-reported behaviour one week later. Moderated hierarchical linear models with cross-level interactions were used to test moderation of health cognitions by socio-structural factors (sex, age, ethnicity, deprivation). RESULTS: Sex, ethnicity and deprivation moderated the effects of health cognitions on protection intentions and behaviour. For example, the effects of injunctive norms on intentions were stronger in men compared to women. Importantly, intention was a weaker predictor of behaviour in more compared to less deprived groups. In addition, there was evidence that perceived autonomy was a stronger predictor of behaviour in more deprived groups. CONCLUSION: Socio-structural variables affect how health cognitions relate to recommended COVID-19 protection behaviours. As a result, behavioural interventions based on social-cognitive theories might be less effective in participants from disadvantaged backgrounds.

Reasoned action approach and compliance with recommended behaviours to prevent the transmission of the SARS-CoV-2 virus in the UK.

OBJECTIVES: To examine associations between demographics, people's beliefs, and compliance with behaviours recommended by the UK government to prevent the transmission of the SARS-CoV-2 virus that causes COVID-19. DESIGN: A two-wave online survey conducted one week apart during the national lockdown (April, 2020). MEASURES: A sample of 477 UK residents completed baseline measures from the reasoned action approach (experiential attitudes, instrumental attitudes, injunctive norms, descriptive norms, capacity, autonomy, and intention) and perceived susceptibility for each of the following recommended behaviours: limiting leaving home, keeping at least 2 m away from other people when outside and when inside shops, not visiting or meeting friends or other family members, and washing hands when returning home. Self-reported compliance with each of the recommended behaviours was assessed one week later. RESULTS: Rates of full compliance with the recommended behaviours ranged from 31% (keeping at least 2 m away from other people when inside shops) to 68% (not visiting or meeting friends or other family members). Capacity was a significant predictor of compliance with each of the five recommended behaviours. Increasing age and intentions were also predictive of compliance with three of the behaviours. CONCLUSIONS: Interventions to increase compliance with the recommended behaviours to prevent the transmission of the SARS-CoV-2 virus, especially those relating to social distancing, need to bolster people's intentions and perceptions of capacity. This may be achieved through media-based information campaigns as well as environmental changes to make compliance with such measures easier. Such interventions should particularly target younger adults.