The impact of accredited social health activists in India on uptake of modern contraception: A nationally representative multilevel modelling study.

The government of India introduced the Accredited Social Health Activist (ASHA) programme in 2006 to connect marginalised communities to the health system. ASHAs are mandated to increase the uptake of modern contraception through the doorstep provision of services. There is currently no evidence on the impact of ASHAs on the uptake of contraception at the national level. This paper examines the impact of ASHAs on the uptake of modern contraception using nationally representative National and Family Health Survey data collected in 2019-21 in India. A multilevel logistic regression analysis was performed to determine the effect of contact with ASHAs on the uptake of modern contraception, controlling for regional variability and socio-demographic variables. The data provide strong evidence that ASHAs have succeeded in increasing modern contraceptive use. Women exposed to ASHAs had twice the odds of being current users of modern contraception compared to those with no contact, even after controlling for household and individual characteristics. However, only 28.1% of women nationally reported recent contact with ASHA workers. The ASHA programme should remain central to the strategy of the government of India and should be strengthened to achieve universal access to modern contraception and meet sustainable development goals by 2030.

Working memory load impairs tacit coordination but not inter-brain EEG synchronization.

Coordinating actions with others is thought to require Theory of Mind (ToM): the ability to take perspective by attributing underlying intentions and beliefs to observed behavior. However, researchers have yet to establish a causal role for specific cognitive processes in coordinated action. Since working memory load impairs ToM in single-participant paradigms, we tested whether load manipulation affects two-person coordination. We used EEG to measure P3, an assessment of working memory encoding, as well as inter-brain synchronization (IBS), which is thought to capture mutual adjustment of behavior and mental states during coordinated action. In a computerized coordination task, dyads were presented with novel abstract images and tried selecting the same image, with selections shown at the end of each trial. High working memory load was implemented by a concurrent n-back task. Compared with a low-load control condition, high load significantly diminished coordination performance and P3 amplitude. A significant relationship between P3 and performance was found. Load did not affect IBS, nor did IBS affect performance. These findings suggest a causal role for working memory in two-person coordination, adding to a growing body of evidence challenging earlier claims that social alignment is domain-specific and does not require executive control in adults.

Effect of health-care professionals' weight status on patient satisfaction and recalled advice: a prospective cohort study.

Background: Research has demonstrated that healthcare professionals are not immune to weight stigma attitudes, with evidence showing that people living with overweight or obesity may experience direct and indirect stigma and discrimination. This can impact the quality of care provided and impact patients' engagement in healthcare. Despite this, there is a paucity of research examining patient attitudes towards healthcare professionals living with overweight or obesity, which can also hold implications for the patient-practitioner relationship. Thus, this study examined whether healthcare professionals' weight status impacts patient satisfaction and recalled advice. Methods: In this prospective cohort study, using an experimental design, 237 participants (113 women, 125 men) aged 32 ± 8.92 with a body mass index of 25.87 ± 6.79 kg m2 were recruited through a participant pooling service (ProlificTM), word of mouth, and social media. The majority of participants were from the UK: 119, followed by participants from the USA: 65, Czechia: 16, Canada: 11, and other countries (N = 26). Participants completed an online experiment consisting of questionnaires assessing satisfaction with healthcare professionals and recalled advice after exposure to one of eight conditions assessing the impact of healthcare professional weight status (lower weight or obesity), gender (woman or man) and profession (psychologist or dietitian). A novel approach to creating the stimuli was used to exposure participants to healthcare professionals of different weight status. All of the participants responded to the experiment hosted on Qualtrics™ in the period from June 8, 2016 to July 5, 2017. Study hypotheses were examined using linear regression with dummy variables and follow up post-hoc analysis to estimate marginal means with adjustment for planned comparisons. Findings: The only statistically significant result was a difference with a small effect in patient satisfaction, where satisfaction was significantly higher in healthcare professional who was a women living with obesity compared to healthcare professional who was a man living with obesity (estimate = -0.30; SE = 0.08; df = 229; ωₚ2 = 0.05; CI = -0.49 to -0.11; p < 0.001), and healthcare professional who was a women living with lower weight compared to healthcare professional who was a man living with lower weight (estimate = -0.21; SE = 0.08; df = 229; CI = -0.39 to -0.02; ωₚ2 = 0.02; p = 0.02). There were no statistically significant differences in satisfaction of healthcare professionals and recall of advice in the lower weight compared to obesity conditions. Interpretation: This study has used novel experimental stimuli to examine weight stigma towards healthcare professionals which is vastly under-researched and holds implications for the patient-practitioner relationship. Our findings showed statistically significant differences and a small effect where satisfaction with healthcare professionals both living with obesity and with a lower weight were higher when the healthcare professional was a woman compared to man. This research should act as a stimulus for further research that aims to examine the impact of healthcare professional gender on patient responses, satisfaction and engagement, and weight stigma from patients towards healthcare professionals. Funding: Sheffield Hallam University.

Breaking the silence around academic harassment.

It is time to hold every member of the scientific community responsible and 'response able' in addressing/reporting academic harassment. Stop applauding academic stars on the podium prior to checking what is happening underneath!

The need for the development of discipline-specific approaches to address academic bullying.

Background: It is now well-documented that academic bullying, mainly driven by power differences, affects all disciplines and academic people with various positions (from students to senior faculty) of all levels of experience. Our aim is to probe whether academic bullying, in its specific forms, manifests differently across disciplines. Methods: We analyzed discipline-specific data from our global survey on academic bullying, which was collected since November 2019. The survey was a cross-sectional global study that was administered via Qualtrics. It reflects responses from 2122 individuals whose participation was solicited through various means including advertisements in Science and Nature magazines and the American Chemical Society. Findings: The main finding is that academic bullying does not affect all scientific fields equally. Our cross-sectional global survey of targets of academic bullying indicates that bullying behavior depended strongly on the scientific discipline. Specifically, our comparison of the three major scientific categories, including Applied Sciences, Natural Sciences, and Social Sciences revealed significant differences (p < 0.05) in four (out of ten) of the contextual behaviors. Further comparison of the bullying behavior among specific disciplines (e.g., Chemistry, Engineering, Life Sciences, Neuroscience, and Social Sciences) revealed significant differences (p < 0.05) in five of the contextual behaviors. We also noticed that, among the top five disciplines analyzed, respondents in Engineering experienced the highest rate of bullying behaviors. Interpretation: The variation in contextual bullying behavior across disciplines suggests the need for specific and nuanced training, monitoring, and actions by stakeholders in addressing academic bullying in a context-specific manner. Funding: None.

Harassment as a consequence and cause of inequality in academia: A narrative review.

A growing body of literature suggests that over the past 30 years, policies aimed at tackling harassment in academia have had little discernable effect. How can this impasse be overcome to make the higher education sector a safe space for everyone? We combine the areas of harassment and inequality, intersectionality, policy-practice gaps, gender sensitive medicine, as well as corruption and whistleblower processes to identify lacunae and offer recommendations for how to apply our recommendations in practice. We have been searching the most influential, relevant, and recent literature on harassment and inequality in our respective fields of expertise. By studying conceptual overlaps between the different fields, we were able to create insights that go beyond the insights of the most recent reviews. Our synthesis results in three concrete recommendations. First, harassment and inequality are mutually reinforcing. Failure to adequately tackle harassment contributes to perpetuating and reproducing inequality. Further, the intersectional nature of inequality has to be acknowledged and acted upon. Second, enforcing anti-harassment policies should be a top priority for universities, funders, and policymakers. Third, sexual harassment should be treated as institutional-level integrity failure. The higher education sector should now focus on enforcing existing anti-harassment policies by holding universities accountable for their effective implementation - or risk being complicit in maintaining and reproducing inequality. Funding: We have received no funding for this research.

Women Academics' Intersectional Experiences of Policy Ineffectiveness in the European Context.

Despite policy efforts targeted at making universities more inclusive and equitable, academia is still rife with harassment and bullying, and opportunities are far from equal for everyone. The present preregistered survey research (N = 91) aimed to explore whether an intersectional approach can be useful to examine the tangible effects of policy ineffectiveness, even when legislative and ideologic constraints limit the possibility to conduct a full-fledged intersectional analysis. Policy ineffectiveness was operationalized as experiences of harassment, discrimination, institutional resistance to gender equality, and retaliation against reporters of misconduct in universities. Policy ineffectiveness was negatively related to women academics' inclination to pursue an academic career. This relationship was mediated by lower levels of psychological safety associated with policy ineffectiveness. Importantly, women academics who differ from the majority on multiple dimensions show a stronger and more negative relationship between policy ineffectiveness and psychological safety. The study further shows that self-report measures are useful to uncover intersectional privilege afforded to overrepresented groups in academia. The study discusses the benefits of intersectional approaches for designing and implementing effective policies to tackle harassment and inequality in academia, even when the available methodologies are constrained by legislation and ideology. Overall, self-report measurement can have an important function for signalling areas that warrant further intersectional inquiry to ensure that policies serve everyone.

Exploring Responses to Body Weight Criticism: Defensive Avoidance When Weight Is Seen as Controllable.

In Western society, weight moralization is reflected in the belief that weight is controllable across the weight spectrum. However, the effect of holding such beliefs is unclear. We therefore propose that these beliefs affect people differently depending on their BMI. When confronted with negative, self-related feedback, people's coping strategies are often reflected in the ways they relate to their self. We examine three such self-to-self relations (i.e., reassured, inadequate, and hated self). Extending prior research, we predict that weight controllability beliefs are related to positive self-to-self relations for adults with a low, and to negative self-to-self relations for adults with a high BMI. Accordingly, we expected that weight controllability beliefs would be associated with defensive avoidance among people with a high, but not with a low BMI. We tested our hypotheses in a sample of 348 adults who participated in an online survey. Weight controllability beliefs were associated with increased defensive avoidance in people with high BMI, and with decreased defensive avoidance in adults with a low BMI. Forms of self-to-self relating fully mediated this association, demonstrating positive effects on adults with a low, and negative effects on adults with a high BMI. Additionally, in an open ending section, we found seven social settings that deprive people from satisfying their need to belong and to be accepted due to their weight. We discuss our findings against a call for a less moralized public discourse about overweight and obesity that is particularly relevant in the context of the current COVID-19 pandemic.

The Impact of Workplace Health Promotion Programs Emphasizing Individual Responsibility on Weight Stigma and Discrimination.

Over time, there has been a steady increase of workplace health promotion programs that aim to promote employees' health and fitness. Previous research has focused on such program's effectiveness, cost-savings, and barriers to engaging in workplace health promotion. The present research focuses on a downside of workplace health promotion programs that to date has not been examined before, namely the possibility that they, due to a focus on individual responsibility for one's health, inadvertently facilitate stigmatization and discrimination of people with overweight in the workplace. Study 1 shows that the presence of workplace health promotion programs is associated with increased attributions of weight controllability. Study 2 experimentally demonstrates that workplace health promotion programs emphasizing individual rather than organizational responsibility elicit weight stigma. Study 3, which was pre-registered, showed that workplace health promotion programs emphasizing individual responsibility induced weight-based discrimination in the context of promotion decisions in the workplace. Moreover, focusing on people with obesity who frequently experience weight stigma and discrimination, Study 3 showed that workplace health promotion programs highlighting individual responsibility induced employees with obesity to feel individually responsible for their health, but at the same time made them perceive weight as less controllable. Together, our research identifies workplace health promotion programs as potent catalysts of weight stigma and weight-based discrimination, especially when they emphasize individual responsibility for health outcomes. As such, we offer valuable insights for organizations who aim to design and implement workplace health promotion programs in an inclusive, non-discriminatory way that benefits all employees.

Weight Bias Internalization: The Maladaptive Effects of Moral Condemnation on Intrinsic Motivation.

Weight stigma typically focuses on suggestions that people with overweight and obesity are incompetent and immoral. Integrating so far unconnected lines of research, the current research presents two studies that examine the motivational relevance of these aspects of weight stigma. Specifically, we tested the proposition that people with overweight and obesity respond differently to the public viewing them as incompetent compared to immoral, as these aspects of weight stigma differ in reparability. We expect that threats to competence are more acceptable and thus related to a constructive response that is more effective in losing weight in the long-run. By contrast, we propose that threats to morality elicit an acute urge to defend one's moral image, thereby prompting responses that are more visible to the social environment, but potentially less effective for losing weight. Study 1 experimentally compared exposure to weight stigma focused on morality vs. weight stigma focused on competence in a sample of adults with overweight and obesity (N = 122; M BMI = 31.89, SD BMI = 4.39). We found that when exposed to weight stigma focused on morality, people with overweight and obesity respond by defending their moral social-image but that this is less effective for encouraging weight loss, while exposure to weight stigma focused on competence led to an increased likelihood of engagement in weight loss behaviors. Complementing and extending the findings, Study 2 (N = 348, M BMI = 26.78, SD BMI = 6.78) tested the notion that internalized weight bias predominantly revolves around moral concerns, and thus will lead to less self-determined behavioral regulation. We found strong support for the moral core of weight bias internalization. In line with our predictions, greater weight bias internalization was associated less self-determined and more other-determined regulation of dieting and exercising. This suggests that weight bias internalization operates as a facilitator of maladaptive behavioral regulation following weight stigma, contributing to lower psychological functioning and well-being of people with overweight and obesity. The current research presents novel findings about the underlying mechanisms of weight stigma and weight bias internalization and identifies strategies to avoid maladaptive and facilitate adaptive health behaviors.

Linking Self-Construal to Creativity: The Role of Approach Motivation and Cognitive Flexibility.

While some evidence has linked the way individuals define themselves in relation to others (independent versus interdependent self-construal) to creativity, little is known about the underlying mechanism in explaining why and how self-construal influences creativity. Integrating approach-avoidance motivation theory and the dual pathway to creativity model, this research focuses on the motivational and cognitive mechanisms that transfer the effects of self-construal on creativity. Specifically, we expect that independent self-construal is a driver of creativity because it facilitates individuals' approach motivation, which in turn increases flexible information processing. To test the three-stage mediation model, one experiment and one survey study were conducted. In Study 1, in a sample of 231 Dutch students, self-construal was manipulated by a story-writing task; approach-avoidance motivation, cognitive flexibility, and creativity were measured. In Study 2, self-construal, approach (and avoidance) motivation, cognitive flexibility, and creativity were all measured in a second sample of Dutch students (N = 146). The results of two studies supported the three-stage mediation model, showing that approach motivation and cognitive flexibility together mediated the effects of self-construal on creativity. Limitations and implications for future research are discussed.

Moralized Health-Related Persuasion Undermines Social Cohesion.

Integrating theory and research on persuasion, moralization, and intergroup relations, the present research aims to highlight the far-reaching impact of health-related persuasion on society. I propose that governments' health-related persuasion leads to the emergence of new social norms, and in particular moral norms. Importantly, moral norms provide strong behavioral imperatives and are seen as binding for group members. This suggests that moralized persuasion has a strong potential to divide society along the lines of citizens who conform to and citizens who deviate from health-related moral norms. Thus, departing from the traditional focus on targets of persuasion, the present research focuses on those holding a moralized view on health and lifestyle. Key aspects of social cohesion as defined by the OECD (2011) have been tested across four studies. The main hypothesis tested is that those conforming to the norm (e.g., non-smokers, normal weight people, people with healthy lifestyles) will stigmatize those deviating from the norm (e.g., smokers, overweight people, people with unhealthy lifestyles). Flowing from stigmatization, less inclusion, lower solidarity with and greater endorsement of unequal treatment of those deviating from the moral norm are predicted. Four survey studies (total N = 1568) examining the proposed associations among non-smokers, normal weight people, and employees with healthy lifestyles are presented. The studies provide unanimous support for the hypothesis, with meta-analysis providing further support for the reliability of the findings. Consistent across studies, social cohesion indicators were negatively affected by health moralization through stigmatization of those deviating from health-related moral norms. Findings highlight an under-acknowledged potential of moralized health-related persuasion to divide society, thereby undermining cohesion and the achievement of important societal goals. In the discussion, limitations and relevant routes for future research are highlighted. Recommendations are derived for policy makers, institutions, employers, and individuals.