Using the COM-B framework to elucidate facilitators and barriers to COVID-19 vaccine uptake in pregnant women: a qualitative study.

Since April 2021, COVID-19 vaccines have been recommended for pregnant women. Despite this, COVID-19 vaccine uptake in this group is low compared to the non-pregnant population of childbearing age. Our aim was to understand barriers and facilitators to COVID-19 vaccine uptake among pregnant women in Northern Ireland using the COM-B framework, and so to make recommendations for public health interventions. The COM-B proposes that human behaviour is influenced by the extent to which a person has the capability, opportunity, and motivation to enact that behaviour. Understanding the factors underpinning behaviour through this lens helps discern what needs to change to change behaviour, therefore supporting the development of targeted interventions.This study consisted of eight semi-structured interviews with new/expectant mothers who did not receive a COVID-19 vaccine dose while pregnant since April 2021, and a focus group with five participants who received at least one COVID-19 vaccine dose while pregnant. Interview and focus group data were analysed using semi-deductive reflexive thematic analysis framed by a subtle realist approach. The COM-B was used to categorise codes and subthemes were developed within each COM-B construct.Within Psychological Capability, subthemes captured the need for consistent and reliable COVID-19 vaccine information and access to balanced and jargon-free, risk-benefit information that is tailored to the pregnant individual. The behaviour/opinions of family, friends, and local healthcare providers had a powerful influence on COVID-19 vaccine decisions (Social Opportunity). Integrating the COVID-19 vaccine as part of routine antenatal pathways was believed to support access and sense of familiarity (Physical Opportunity). Participants valued health autonomy, however experienced internal conflict driven by concerns about long-term side effects for their baby (Reflective Motivation). Feelings of fear, lack of empathy from healthcare providers, and anticipated guilt commonly underpinned indecision as to whether to get the vaccine (Automatic Motivation).Our study highlighted that the choice to accept a vaccine during pregnancy generates internal conflict and worry. Several participants cited their concern was primarily around the safety for their baby. Healthcare professionals (HCPs) play a significant part when it comes to decision making about COVID-19 vaccines among pregnant women. HCPs and pregnant women should be involved in the development of interventions to improve the delivery and communication of information.

Tackling diabetes as a team: co-designing healthcare interventions to engage couples living with type 1 diabetes.

AIMS: Couples living with Type 1 diabetes: co-designing interventions to support them. METHODS: This is a qualitative study comprising two phases. Phase I represents the exploratory phase, consisting of semi-structured interviews with persons with Type 1 diabetes (N = 16) and partners (N = 6). In the second phase, co-design principles guided workshops with healthcare professionals, persons with Type 1 diabetes, and partners (N = 7) to facilitate discussion of the key themes identified and solutions to engage couples living with Type 1 diabetes in diabetes care. RESULT: The key themes identified from phase I as priorities to target in future interventions were: (i) Emotional impact of diabetes and (ii) Partners' involvement. Priority (i) captures the impact the emotional burden of diabetes management produces within couples' relationship. Priority (ii) captures the request from partners to be more involved in diabetes management. Characteristics of the interventions suggested during the co-design phase II focused on engaging patients and partners via a counseling point in healthcare settings and tailored help for couples' psychological support needs. CONCLUSIONS: Couples value pro-active intervention and support from their diabetes team or primary care for both the partners to live well with Type 1 diabetes.

Facilitators and barriers to social distancing for young people during the COVID-19 pandemic.

BACKGROUND: Social (or physical) distancing is an important transmission-prevention behaviour that has been endorsed to minimize COVID-19 transmission. This qualitative study explores the facilitators of and barriers to social distancing for young people during the COVID-19 pandemic, with recognition that young people represent a unique demographic group, with differing psychosocial needs and experiences to other age cohorts. METHODS: Qualitative data was collected as part of a larger Qualtrics survey between July 28th 2020 and August 24th 2020. Eligible participants were young people living on the Island of Ireland, aged 16-25 years. The survey design was underpinned by the Capability, Opportunity, and Motivation model of behaviour change (COM-B). Semi-inductive thematic analysis was used to analyse comments collected via three free-text survey items. The COM-B model provided a thematic framework to organise subthemes extracted. RESULTS: A total of N = 477 young people completed the survey, of which N = 347 provided comments for at least one of three free-text survey items. The majority of respondents lived in Northern Ireland (96%), the average age was 21 years, and most respondents were female (73%) and were students (81%). Key barriers identified included lack of environmental support for social distancing (lack of physical Opportunity to social distance), observing other people not social distancing (lack of social Opportunities supporting social distancing), and missing physical interaction from others (relating to the dissuading influence of automatic Motivational factors i.e. the influence of loneliness). Key facilitators included presence of clear and consistent environmental cues and availability of space to support social distancing (increasing physical Opportunity to social distance), increasing awareness and perceived consequences of risk of transmission (enhancing reflective Motivational factors i.e. perceived benefits (versus costs) of social distancing), and increasing opportunities to observe others' adhering to guidelines (increasing social Opportunities supporting social distancing). CONCLUSIONS: These findings suggest that the actions and endorsement of peers and the physical design of environments have a key role in influencing social distancing behaviour among young people living in NI. The COM-B factors identified in this study can inform the development of tailored interventions using models such as the Behaviour Change Wheel. The findings of this study suggest that intervention functions based on peer modelling and physical environmental restructuring and enablement should be priortitised, however it is imperative that interventions are co-designed with young people to foster collaboration and empowerment.

"If it is not made easy for me, I will just not bother". A qualitative exploration of the barriers and facilitators to recycling plastics.

Despite significant investment to increase recycling facilities and kerbside collection of waste materials, plastic packaging is frequently discarded as litter, resulting in significant environmental harm. This research uses qualitative methods to explore the contextual and psychological factors that influence plastic waste disposal behaviour from the perspectives of consumers. This research also reports key results from a brief online survey exploring consumer perspectives toward plastics and plastic recycling. A total of N = 18 adults living in Northern Ireland (NI) participated in a semi-structured interview and N = 756 adults living in NI took part in an online survey. Interview data was analysed via a semi-directed content analysis approach, using the COM-B behaviour change model as a guiding framework. Survey data underwent descriptive and frequency analysis. Collectively, the findings suggest that environmental concern exists among consumers generally, but there is a degree of ambivalence toward recycling that reflects a gap between intentions to recycle and actual recycling behaviour. Plastic recycling behaviour is hindered by three common barriers: 1. confusion and uncertainty about which plastic materials can be recycled (exacerbated by the abundance of plastic products available) 2. perceiving plastic recycling to be less of a personal priority in daily life 3. perceiving that local government and manufacturers have a responsibility to make plastic recycling easier. As recycling is simply not a priority for many individuals, efforts should instead be placed on providing greater scaffolding to make the process of recycling less tedious, confusing, and more habitual. Visual cues on product packing and recycling resources can address ambiguity about which plastic materials can/cannot be recycled and increasing opportunities to recycle (via consistent availability of recycling bins) can reduce the physical burden of accessing recycling resources. Such interventions, based on environmental restructuring and enablement, may increase motivations to recycle by reducing the cognitive and physical burden of recycling, supporting healthier recycling habits.

'Using humanity to change systems' - understanding the work of online feedback moderation: A case study of Care Opinion Scotland.

OBJECTIVE: To gain a deeper understanding of online patient feedback moderation through the organisation of Care Opinion in Scotland. METHODS: An ethnographic study, initially using in-person participant observations, switching to remote methods due to the pandemic. This involved the use of remote observations and interviews. Interviews were carried out with the whole Scottish team (n = 8). RESULTS: Our results identify three major themes of work found in online patient feedback moderation. The first is process work, where moderators make decisions on how to edit and publish stories. The second is emotional labour from working with healthcare experiences and with NHS staff. The third is the brokering/mediation role of Care Opinion, where they must manage the relationships between authors, subscribing healthcare providers and Scottish Government. Our results also capture that these different themes are not independent and can at times influence the others. CONCLUSION: Our results build on previous literature on Care Opinion and provide novel insights into the emotional and brokering/mediation work they undertake. Care Opinion holds a unique position, where they must balance the interests of the key stakeholders. Care Opinion holds the power to amplify authors' voices but the power to make changes to services lies with NHS staff and services. Online moderation work is complex, and moderators require support to carry out their work especially given the emotional impact. Further research is planned to understand how patient stories are used by NHS Scotland, and the emotional labour involved with stories, from both the author and NHS staff perspective.

Psychological, social, and situational factors associated with COVID-19 vaccination intentions: A study of UK key workers and non-key workers.

OBJECTIVES: Vaccine hesitancy is a growing concern and threat to public health. This research will begin to examine the relative influence of relevant psychological, social, and situational factors on intent to engage with a hypothetical COVID-19 vaccine among key workers and non-key workers. DESIGN: Cross-sectional. METHODS: The study utilized a sample of UK adults who completed the 1-month follow-up of The COVID-19 Psychological Wellbeing Study during April/May 2020 and indicated having not been previously diagnosed with COVID-19 (key workers n = 584; not key workers n = 1,021). These groups were compared in relation to their intentions to vaccinate, perceived risk of infection, and symptom severity. Binary logistic regression was used to examine predictors of vaccine hesitancy. RESULTS: Overall, 74.2% of the sample (76.2% key workers, 73.1% non-key workers) indicated they would accept a COVID-19 vaccine in future. Key workers (in particular health and social care workers) had a higher perceived risk of becoming infected in the coming months. For key workers, being female and perceiving oneself as having relatively low infection risk in the next 6 months was associated with increased likelihood of vaccine hesitancy. For non-key workers, however, being aged 25-54, having a low or average income and not knowing someone diagnosed with COVID-19 were associated with hesitancy. CONCLUSIONS: The proportion of individuals willing to accept a vaccine is encouraging but there is much room for improvement. Given the unique predictors of vaccine hesitancy in each group, public health campaigns may benefit from targeted messaging.

COVID-19 vaccine uptake and hesitancy survey in Northern Ireland and Republic of Ireland: Applying the theory of planned behaviour.

The Coronavirus Disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) first appeared in Wuhan, China in late 2019 and since then has caused unprecedented economic and social disruption as well as presenting a major challenge to public health. Despite mass progress in COVID-19 vaccination uptake, vaccine hesitancy or anti-vax information has been reported that can delay public acceptance of a vaccine. An online cross-sectional survey (n = 439) assessed COVID-19 vaccine uptake and hesitancy in adults in Northern Ireland and the Republic of Ireland. Participants completed an adapted version of the Theory of Planned Behaviour Vaccine Questionnaire, the Vaccine Attitudes Scale (VAX), Vaccine Confidence Scale, and questions on previous experience of COVID-19. Results showed that 66.7% of the sample intended to get a vaccination as soon as possible, 27.15% reported they will get a vaccine when others get theirs and when it is clear there are no side effects. 6.15% had no intention of getting a vaccine. Overall, there is a high mean intention (M = 6.12) and confidence to get a COVID-19 vaccine. There was low vaccine hesitancy (M = 2.49) as measured by the VAX scale. A further analysis of the sub factors of the VAX showed there is uncertainty and mistrust of side effects for children. The finding demonstrate that the Theory of Planned Behaviour can be useful in making recommendations for public health considerations when encouraging vaccine uptake and reducing vaccine hesitancy.

Connection, constraint, and coping: A qualitative study of experiences of loneliness during the COVID-19 lockdown in the UK.

The COVID-19 pandemic has necessitated physical distancing which is expected to continue in some form for the foreseeable future. Physical distancing policies have increased reliance on digital forms of social connection and there are widespread concerns about social isolation and mental health in this context. This qualitative study sought to understand how loneliness was experienced during physical distancing in the initial national UK COVID-19 lockdown. Eight individuals who reported feeling lonely during the initial lockdown were interviewed in May 2020. Interviews were analysed using reflexive thematic analysis. Four main themes were identified: (1) Loss of in-person interaction causing loneliness, (2) Constrained freedom, (3) Challenging emotions, and (4) Coping with loneliness. The loss of in-person interaction contributed to feelings of loneliness and digital interaction was viewed as an insufficient alternative. Social freedom could be constrained by distancing policies and by social contacts, contributing to strained personal relationships and feelings of frustration as part of loneliness. Fluctuations in mood and difficult emotions were experienced alongside loneliness, and distraction and seeking reconnection were commonly reported methods of coping, although they were less accessible. These findings indicate that physical distancing measures can impact loneliness due to the limitations they impose on in-person social contact and the perceived insufficiency of digital contact as a substitute.

Examining temporal interactions between loneliness and depressive symptoms and the mediating role of emotion regulation difficulties among UK residents during the COVID-19 lockdown: Longitudinal results from the COVID-19 psychological wellbeing study.

BACKGROUND: Longitudinal studies examining the temporal association between mental health outcomes during the COVID-19 outbreak are needed. It is important to determine how relationships between key outcomes, specifically loneliness and depressive symptoms, manifest over a brief timeframe and in a pandemic context. METHOD: Data was gathered over 4 months (March - June 2020) using an online survey with three repeated measures at monthly intervals (N = 1958; 69.8% females; Age 18-87 years, M = 37.01, SD = 12.81). Associations between loneliness, depression symptoms, and emotion regulation difficulty were tested using Pearson's product moment correlations, and descriptive statistics were calculated for all study variables. Cross-lagged structural equation modelling was used to examine the temporal relationships between variables. RESULTS: The longitudinal association between loneliness and depressive symptoms was reciprocal. Loneliness predicted higher depressive symptoms one month later, and depressive symptoms predicted higher loneliness one month later. The relationship was not mediated by emotion regulation difficulties. Emotion regulation difficulties and depressive symptoms were also reciprocally related over time. LIMITATIONS: Limitations include the reliance on self-report data and the non-representative sample. There was no pre-pandemic assessment limiting the conclusions that can be drawn regarding the mental health impact of the COVID-19 crisis. CONCLUSIONS: Loneliness should be considered an important feature of case conceptualisation for depression during this time. Clinical efforts to improve mental health during the pandemic could focus on interventions that target either loneliness, depression, or both. Potential approaches include increasing physical activity or low-intensity cognitive therapies delivered remotely.

Understanding the lived experiences of healthcare professionals during the COVID-19 pandemic: an interpretative phenomenological analysis.

Background: Little research has examined the impact of working within the context of COVID-19 on UK healthcare professionals (HCPs) mental health and well-being, despite previous pandemic findings indicating that HCPs are particularly vulnerable to suffering PTSD and other mental health difficulties due to the nature of healthcare work. Specifically, it appears that no research has employed qualitative methodologies to explore the effects of working amidst COVID-19 on mental health for HCPs in the UK. Objective: To qualitatively examining the lived experiences of HCPs in Northern Ireland, working during the early stages of the pandemic and lockdown period (14.04.20 and 29.04.20). Method: Interpretative phenomenological analysis (IPA) was used to explore the experiences of healthcare professionals, who were working during the COVID-19 outbreak. Ten HCPs were recruited via a social media campaign and snowball sampling. All interviews were conducted via telephone and transcribed verbatim. Results: Three superordinate themes with subordinate themes were elicited through the analysis. Theme one centred on specific challenges of HCPs working during the pandemic, such as redeployment, isolation from loved ones, infection concerns, lack of PPE and impact on patient interpersonal care. Theme two offered insights into the mental health and wellbeing of HCPs, while many experienced feelings of fear, sadness and hypervigilance, all also demonstrated a marked resilience. Finally, many felt undervalued and misunderstood, and wished to press upon the general public seriousness of the disease. Conclusion: To the authors' knowledge this is the first study to explore in depth, the unique experiences of frontline HCPs in Northern Ireland, offering a detailed account of the challenges confronted in these unprecedented circumstances and highlighting support needs within this cohort.

Antecedentes: Pocas investigaciones han examinado el impacto de trabajar en el contexto COVID-19 en la salud mental y bienestar de los profesionales de salud del Reino Unido (HCPs por sus siglas en inglés), a pesar que los hallazgos de pandemias previas señalan que los HCPs son particularmente vulnerables a sufrir TEPT y otras dificultades de salud mental debido a la naturaleza del trabajo sanitario. Específicamente, pareciera que ninguna investigación ha utilizado metodologías cualitativas para explorar los efectos de trabajar en medio de COVID-19 en la salud mental de los HCPs en el Reino Unido.Objetivo: Examinar cualitativamente las experiencias vividas de los HCPs en Irlanda del Norte, trabajando durante las primeras etapas de la pandemia y el periodo de confinamiento (14.04.20 y 29.04.20).Método: Se utilizó un Análisis fenomenológico interpretativo (IPA por sus siglas en inglés) para explorar las experiencias de los profesionales de la salud, que estuvieron trabajando durante el brote de COVID-19. Fueron reclutados diez HCPs a través de una campaña por medios sociales y un muestreo de bola de nieve. Todas las entrevistas se realizaron por teléfono y se transcribieron literalmente.Resultados: A través del análisis se obtuvieron tres temas superiores con temas subordinados. El tema uno se centró en los desafíos específicos de los HCPs que trabajaban durante la pandemia, como el redespliegue, estar aislados de los seres queridos, preocupaciones de infectarse, falta de EPP y el impacto en la atención interpersonal del paciente. El tema dos ofreció concientización sobre la salud mental y bienestar de los HCPs, aunque muchos experimentaron sentimientos de miedo, tristeza e hipervigilancia, todos también demostraron una marcada resiliencia. Finalmente, muchos se sintieron subvalorados y poco comprendidos y desearon presionar al público en general sobre la gravedad de la enfermedad.Conclusión: Según el conocimiento de los autores, este es el primer estudio que explora en profundidad, las experiencias únicas de los HCPS de primera línea en Irlanda del Norte, ofreciendo un recuento detallado de los desafíos enfrentados en estas circunstancias sin precedentes y destaca las necesidades de apoyo dentro de esta cohorte.

Loneliness in the UK during the COVID-19 pandemic: Cross-sectional results from the COVID-19 Psychological Wellbeing Study.

OBJECTIVES: Loneliness is a significant public health issue. The COVID-19 pandemic has resulted in lockdown measures limiting social contact. The UK public are worried about the impact of these measures on mental health outcomes. Understanding the prevalence and predictors of loneliness at this time is a priority issue for research. METHOD: The study employed a cross-sectional online survey design. Baseline data collected between March 23rd and April 24th 2020 from UK adults in the COVID-19 Psychological Wellbeing Study were analysed (N = 1964, 18-87 years, M = 37.11, SD = 12.86, 70% female). Logistic regression analysis examined the influence of sociodemographic, social, health and COVID-19 specific factors on loneliness. RESULTS: The prevalence of loneliness was 27% (530/1964). Risk factors for loneliness were younger age group (OR: 4.67-5.31), being separated or divorced (OR: 2.29), scores meeting clinical criteria for depression (OR: 1.74), greater emotion regulation difficulties (OR: 1.04), and poor quality sleep due to the COVID-19 crisis (OR: 1.30). Higher levels of social support (OR: 0.92), being married/co-habiting (OR: 0.35) and living with a greater number of adults (OR: 0.87) were protective factors. CONCLUSIONS: Rates of loneliness during the initial phase of lockdown were high. Risk factors were not specific to the COVID-19 crisis. Findings suggest that supportive interventions to reduce loneliness should prioritise younger people and those with mental health symptoms. Improving emotion regulation and sleep quality, and increasing social support may be optimal initial targets to reduce the impact of COVID-19 regulations on mental health outcomes.

Are young adults appreciating the health promotion messages on diet and exercise?

AIM: This study aims to determine if current health promotion messages relating to diet and physical activity are sufficiently targeted towards young adults. In addition, we examine what elements of these messages might be improved to ensure they encourage improved diet and exercise behaviours within this underserved group. SUBJECT AND METHODS: Using qualitative methods, five focus group discussions (FGDs) and two semi-structured in-depth interviews were conducted among 19 young adults in Aberdeen City. An appropriate topic guide was developed for this purpose. After obtaining consent, all FGDs and interviews were audio-recorded and transcribed verbatim. A thematic analysis was conducted that allowed for emerging themes to be identified from the data. Links between themes were established and key quotes identified. RESULTS: Five major themes emerged: (1) exposure to health messages over time; (2) chains of healthy or unhealthy behaviours; (3) perceptions and attitudes towards health messages; (4) facilitators and barriers; (5) improving the usability of health messages. CONCLUSIONS: The results demonstrate that young adults did not find current health promotion messages engaging. These messages did not support them in overcoming their perceived barriers, nor were they suitably formatted or located for them. There were suggestions from young adults on how to improve these messages including using social media, presenting messages in more usable forms, and working with larger corporations to make these messages more effective. Tailoring these messages specifically for young adults could improve their diet and exercise behaviours, thereby helping to reduce future obesity levels and co-morbidities within Scotland.

Managing Type 2 diabetes as a couple: The influence of partners' beliefs on diabetes distress over time.

AIMS: Partners and spouses have an important role in supporting healthy self-care in adults with Type 2 diabetes. While evidence has shown that the beliefs held by people with diabetes influence emotional wellbeing, little is known about the long-term impact of partners' illness beliefs on diabetes distress. METHODS: Persons with Type 2 diabetes (pwt2d) and their partners completed a questionnaire at baseline (N = 75 couples) and 12 months later (N = 45 couples). Measures included demographic/clinical parameters, the Revised Illness Perception questionnaire, and the Diabetes Distress Scale. A repeated measures ANOVA was used to examine change in measures over time. Multiple regression and moderation analysis were used to explore the indirect influence of partners beliefs on diabetes distress at baseline and follow-up. RESULTS: Illness perceptions and diabetes distress in pwt2d and partners did not change overtime. Partners' beliefs about the controllability, chronicity, and predictability of symptoms of diabetes moderated the relationship between the corresponding pwt2d beliefs and diabetes distress. These indirect effects were observed across both time points. CONCLUSIONS: Conflicting illness perceptions about the controllability and chronicity of diabetes, and congruous negative perceptions about diabetes symptoms among couples sustain distress overtime. Targeting the beliefs of couples to improve communication and understanding may reduce diabetes distress.

Exploring the effectiveness of couples interventions for adults living with a chronic physical illness: A systematic review.

OBJECTIVE: Partners have a significant role in a person's ability to adjust to a chronic physical illness, which warrants their inclusion in couples interventions. However to deliver more specific, tailored support it is necessary to explore which types of couples interventions are most effective across certain chronic illness populations and outcomes. METHODS: Five databases were searched using selected terms. Thirty-five articles met the eligibility criteria for inclusion. RESULTS: The majority of studies were from the US, and most interventions targeted cancer populations. Couples interventions fell into two categories according to therapeutic approach; Cognitive Behavioural Skills Training (CBST) and Relationship Counselling (RC). When compared with a patient-only intervention or controls, CBST interventions effectively targeted behavioural, physical/somatic and cognitive outcomes, while RC more effectively targeted interpersonal outcomes. CONCLUSION: Couples interventions can be more effective than patient-only interventions or controls across various patient and partner outcomes. Couples interventions tend to favour a skills-based or a relationship-based approach, which strongly influences the types outcomes effectively targeted. PRACTICE IMPLICATIONS: Our findings suggest it could be therapeutically useful to integrate these two approaches to more holistically support couples living with chronic illness. We also identify the need to target understudied illness groups and ethnicities.

Illness perception clusters and relationship quality are associated with diabetes distress in adults with Type 2 diabetes.

This report aims to augment what is already known about emotional distress in Type 2 diabetes, by assessing the predictive value of illness perception clusters and relationship quality on four subcategories of Diabetes Distress.162 individuals with Type 2 diabetes responded to a postal questionnaire assessing demographics, depression, diabetes distress, illness perceptions and relationship quality. Long-term blood glucose was retrieved from participants' General Practitioner. Three illness perception clusters emerged from the data, capturing three subgroups of participants sharing similar illness perception schemas. Regression analyses were performed across each diabetes distress subscale, with demographics, illness perception clusters, and relationship variables entered into three blocks. Covariates explained 51.1% of the variance in emotional burden, 41% of the variance in regimen-related distress, 20% of the variance in interpersonal distress, and 8.6% of the variance in physician-related distress. Cluster membership was strongly associated with emotional burden, regimen-related distress, and to a lesser degree interpersonal distress, but was not associated with physician-related distress. Relationship quality most strongly predicted regimen-related distress. Illness perception schemas and interpersonal issues influence emotional adjustment in diabetes. This study provides direction for the content of a novel approach to identifying and reducing diabetes distress in people with Type 2 diabetes.

Diabetes distress: understanding the hidden struggles of living with diabetes and exploring intervention strategies.

Diabetes distress is a rational emotional response to the threat of a life-changing illness. Distinct from depression, it is conceptually rooted in the demands of diabetes management and is a product of emotional adjustment. Diabetes distress has been found to be significantly associated with glycated haemoglobin (HbA1c) level and the likelihood of an individual adopting self-care behaviours. The lack of perceived support from family, friends and healthcare professionals significantly contributes to elevated diabetes distress, and this issue tends to be overlooked when designing interventions. Pioneering large-scale research, DAWN2, gives voices to the families of those with diabetes and reaffirms the need to consider psychosocial factors in routine diabetes care. Structured diabetes education programmes are the most widely used in helping individuals cope with diabetes, but they tend not to include the psychological or interpersonal aspects of diabetes management in their curricula. The need for health practitioners, irrespective of background, to demonstrate an understanding of diabetes distress and to actively engage in discussion with individuals struggling to cope with diabetes is emphasised.

SenseCam: a wearable camera that stimulates and rehabilitates autobiographical memory.

SenseCam is a wearable digital camera that captures an electronic record of the wearer's day. It does this by automatically recording a series of still images through its wide-angle lens, and simultaneously capturing a log of data from a number of built-in electronic sensors. Subsequently reviewing a sequence of images appears to provide a powerful autobiographical memory cue. A preliminary evaluation of SenseCam with a patient diagnosed with severe memory impairment was extremely positive; periodic review of images of events recorded by SenseCam resulted in significant recall of those events. Following this, a great deal of work has been undertaken to explore this phenomenon and there are early indications that SenseCam technology may be beneficial to a variety of patients with physical and mental health problems, and is valuable as a tool for investigating normal memory through behavioural and neuroimaging means. Elsewhere, it is becoming clear that judicious use of SenseCam could significantly impact the study of human behaviour. Meanwhile, research and development of the technology itself continues with the aim of providing robust hardware and software tools to meet the needs of clinicians, patients, carers, and researchers. In this paper we describe the history of SenseCam, and the design and operation of the SenseCam device and the associated viewing software, and we discuss some of the ongoing research questions being addressed with the help of SenseCam.