'It has been the hardest decision of my life': a mixed-methods study of pregnant women's COVID-19 vaccination hesitancy.

OBJECTIVE: To explore psychological factors influencing decision-making regarding COVID-19 vaccination among pregnant women. DESIGN: Cross-sectional mixed-methods online survey comprising sociodemographic factors, health beliefs, trust and anticipated regret, and open-ended qualitative questions. Pregnant respondents living in the UK or Ireland (n = 191) completed the online survey during June and July 2021. MAIN OUTCOME MEASURES: Intention to vaccinate against COVID-19 during pregnancy, with response options yes (vaccine accepting), no (vaccine resistant), unsure (vaccine hesitant). Qualitative questions about perceived benefits and risks of COVID-19 vaccination during pregnancy. RESULTS: Multivariate analysis of correlates of vaccine hesitancy and resistance revealed independent associations for perceived barriers to the COVID-19 vaccine, anticipated regret, and social influences. Most respondents described making a decision regarding COVID-19 vaccination in the absence of satisfactory information or guidance from a health care professional. Vaccine hesitant and resistant respondents reported significantly greater barriers to the COVID-19 vaccination than vaccine accepting respondents. Concerns about the vaccine focussed on the speed of its development and roll-out and lack of evidence regarding its safe use in pregnancy. CONCLUSION: Participants who did not intend to be vaccinated against COVID-19 in pregnancy focused on vaccine fears as opposed to virus fears. Results indicate that pregnant women need balanced vaccine information and unequivocal health care provider recommendation to aid maternal vaccination decision-making.

Attitudes to reducing cervical screening frequency among UK women: A qualitative analysis.

OBJECTIVE: Cervical cancer remains a significant health threat amongst women globally despite most cervical cancers being preventable through screening and Human Papilloma Virus (HPV) vaccination. With the introduction of HPV testing and vaccination, evidence suggests that the frequency of cervical screening for women can be reduced. However, there is limited evidence on women's attitudes to possible changes to the cervical screening programme. This study explored attitudes, perceptions and beliefs of women in the United Kingdom (UK) regarding potential changes to the National Cervical Screening Programme. METHOD: Forty-four women were interviewed between November 2018 and March 2019. Reflexive thematic analysis was used to identify key themes. RESULTS: Most participants were opposed to any reduction in cervical screening frequency. Reasons included perceptions that disease would develop undetected, disempowerment, increased anxiety, reduced motivation to attend, and inefficient use of health care resources. Women perceived that they were ill-informed about the reasons for the proposed change, and that access to evidence for the basis of proposed changes may persuade them to accept reduced screening frequency. Women believed that cervical screening is a test for cancer and that HPV vaccination does not provide reliable protection against cervical cancer. These beliefs suggest that women's perception that they require more information about the basis for reduced screening frequency is correct. CONCLUSION: Any changes to cervical screening frequency need to ensure public support and trust through a robust public health initiative clearly identifying the rationale for any changes.

"A lot can happen in five years": Women's attitudes to extending cervical screening intervals.

OBJECTIVE: Evidence suggests that cervical screening intervals can be extended and lifetime cervical screening for human papillomavirus (HPV)-vaccinated women could be reduced. This study examines UK women's attitudes to extending screening intervals and assesses associations between knowledge, risk perception and HPV vaccination status, and acceptability of changes. METHODS: Using a convenience sampling strategy, an anonymous mixed-methods online survey was used and data recorded from 647 women (mean age = 28.63, SD = 8.69). RESULTS: Across the full sample, 46.1% of women indicated they would wait 5 years for their next cervical screening, while 60.2% of HPV-vaccinated women would be unwilling to have as few as three cervical screens in a lifetime. Multivariate analysis revealed those who are regular screened, those who intend to attend when invited, and those who perceive greater personal risk of cervical cancer are less likely to accept a 5-year screening interval. Qualitative findings relating to benefits of extending intervals included convenience of less tests, less physical discomfort, and psychological distress. Concerns identified included the likelihood of developing illness, increased psychological distress relating to what may be happening in the body, and worries about increased risk of cervical cancer. CONCLUSION: Women need clear and specific information about HPV timelines, their relationship with cancer risk, and the rationale for extending screening intervals.

The psychological and behavioural correlates of COVID-19 vaccine hesitancy and resistance in Ireland and the UK.

BACKGROUND: The successful control of the COVID-19 pandemic depends largely on the acceptance and uptake of a COVID-19 vaccine among the public. Thus, formative research aiming to understand and determine the causes of weak and/or positive vaccination intentions is vital in order to ensure the success of future and current vaccination programmes through the provision of effective, evidence-based health messaging. METHODS: A cross-sectional survey was completed by a sample of Irish (N = 500) and UK (N = 579) citizens using the online platform 'Qualtrics'. Participants completed a questionnaire battery comprised of health, attitudes/beliefs, influences, and behavioural intention measures. Demographic information was also assessed. RESULTS: Results highlighted similar rates of vaccine intention among both samples; where a total of 76.8% Irish respondents, and 73.7% of UK respondents indicated that they intended to be immunized if the government advised them to take the COVID-19 vaccine. Overall, 23.2% of Irish respondents reported being vaccine hesitant or vaccine resistant, while a rate of 26.3% of UK respondents reported vaccine hesitancy or resistance. Univariate analysis highlighted that both gender and age played a significant role in vaccine intention, with women under age 30 reporting higher rate of vaccine hesitancy. Multivariate analysis revealed that significant correlates of vaccine acceptance included peer influence, GP influence, civic responsibility, perceived benefit, and positive vaccination attitudes. Those who reported vaccine resistance and hesitancy were more likely to have less positive vaccination attitudes and perceive higher vaccination risk. DISCUSSION: The current sociodemographic and psychological profiles of vaccine resistant and hesitant individuals provide a useful resource for informing health practitioners in the UK and Ireland with the means of enhancing pro-vaccine attitudes and promoting vaccination uptake. The current research shows indications of associations between distrust in the vaccine itself and vaccine hesitancy and resistance. Thus, to effectively design and deliver public health messages that ensures the success of vaccination uptake, it is likely that governments and public health officials will need to take actions to garner trust in the safety of the vaccine itself. Additionally, campaigns to decrease hesitancy and resistance in the COVID-19 vaccine may benefit in targeting altruism to increase willingness to get vaccinated against COVID-19.

The impact of sitting time and physical activity on mental health during COVID-19 lockdown.

Objective: The primary aim of this study was to investigate the association between physical activity (PA) and sitting time on adults' mental health (i.e., depression, anxiety and wellbeing) and the influence of mediators and confounders. Methods: An online survey was disseminated in the UK between May and June 2020. A total of 284 participants (33.5 ± 12.4 years) self-reported their PA, sitting time and mental health through validated questionnaires. Results: Multiple stepwise regression analysis revealed that being of younger age, female, on a lower income, with one or more comorbid health conditions, with a previous diagnosis of mood disorder and increased sitting time independently correlated with higher depression scores (F (13,219) = 12.31, p < 0.001), and explained 42% of the variance. Similar results were found for wellbeing where socio-demographic, health outcomes and sitting time influenced the subjective wellbeing (F (14,218) = 5.77, p < 0.001, 27% variance), although only socio-demographic and health outcomes contributed to the variation in anxiety score (F (13,219) = 7.84, p < 0.001, 32% variance). PA did not explain variation when sitting time was taken into account in any of the models. Combined analysis revealed that participants with lower sedentary time (< 8 h) and with both low or moderate and high PA presented a significantly lower depression score [low PA: (B = -2.7, 95% CI -4.88, -0.52); moderate and high PA (B = -2.7, -4.88, -0.52)]. Conclusion: Sitting time was strongly associated with adverse mental health during COVID-19 lockdown and should be considered in future public health recommendations.

A comparison of open-label and deceptive placebo analgesia in a healthy sample.

OBJECTIVES: A small number of studies have supported the efficacy of open-label placebos (OLPs) in reducing pain. However, research comparing the effectiveness of OLPs with deceptive placebos (DPs) is limited, and the relative impact on pain tolerance versus intensity are not yet understood. This study therefore, examined the effectiveness of a nasal placebo administered openly and deceptively on pain intensity and tolerance during a cold pressor test (CPT). METHOD: 75 healthy participants were allocated to one of three groups; OLP (n = 25), DP (n = 26) and no-treatment (NT; n = 24). A pre-test post-test design was used, with all participants completing a baseline and post-treatment CPT, following placebo administration in the treatment groups. RESULTS: A one-way ANCOVA revealed significant differences between groups for pain intensity, with planned contrasts revealing that this effect was driven by an increase in pain intensity scores for the NT group within the post treatment CPT, which was not evident in the OLP and DP groups. There were no significant differences between groups for changes in pain tolerance. CONCLUSION: The increase in pain intensity reported within the post-treatment CPT in the NT group was not apparent in either the OLP or DP groups, with no significant differences between OLP and DP effectiveness. These findings suggest that deception may not be necessary for effective placebo treatment and have implications for the management of pain.

Help-Seeking for Mental Health Issues in Professional Rugby League Players.

BACKGROUND: Despite the prevalence and negative consequences of mental health issues among elite athletes, studies suggest many do not seek professional help. Understanding barriers and facilitators to help-seeking is imperative to reduce the burden of mental health symptoms and disorders. AIMS: This study aimed to elucidate factors associated with actual help-seeking behavior in professional rugby football league (RFL) players in England and one club in France. DESIGN: A mixed-methods cross-sectional online survey design was used, and completed by 167 professional RFL players. METHODS: The survey consisted of measures of mental health, perceived psychological stress, athletic identity, knowledge of player welfare, and actual help-seeking. Additionally, one open-ended question allowed free-text comments about barriers to help-seeking. RESULTS: Those who had sought help reported significantly higher psychological stress compared to those who had not sought help. Help-seeking was associated with better mental health literacy and higher perceived psychological stress in a multivariate analysis. The qualitative analysis revealed a number of perceived barriers to help-seeking, of which lower mental health literacy and stigma were the most prominent. CONCLUSION: In one of the first studies to examine actual help-seeking behavior, professional rugby players who had sought help for mental health and personal issues were characterized by having greater mental health literacy and experiencing greater psychological stress. Players also identified feelings of embarrassment, pride, fear and shame act as barriers to seeking help for mental health issues. These results suggest focusing on increasing mental health literacy and reducing stigma may increase help-seeking behavior for mental health symptoms.

Awareness and knowledge of human papilloma virus in UK women aged 25 years and over: Results from a cross-sectional internet-based survey.

OBJECTIVE: The expanding use of human papilloma virus (HPV) testing within cervical screening requires an evaluation of public understanding of HPV. This study aimed to explore HPV awareness and knowledge using a previously psychometrically validated measure in a sample of UK women aged 25 years and over. METHODS: An anonymous web-based cross-sectional survey design was used, and responses were recorded for 246 women (mean age = 37.59, SD = 9.20). RESULTS: Findings indicated limits to women's understanding of HPV, its transmission, treatment and link with cancer. The mean HPV knowledge score was 9.35 (4.43), and the mean HPV testing score was 3.34 (1.91). Multivariate analyses revealed that information seeking following cervical screening and being a student is associated with higher HPV knowledge and that having a positive HPV test result and having university education is associated with higher HPV testing knowledge. CONCLUSIONS: These results highlight that there is a lack of knowledge and misunderstanding relating to HPV and its link with cancer in adult women in the UK. The findings suggest that public health HPV information campaigns are urgently needed, especially with a drop in UK cervical screening attendance rates, and with the upcoming change to HPV primary testing within the UK NHS cervical screening programme.

Adult report of childhood imaginary companions and adversity relates to concurrent prodromal psychosis symptoms.

Hallucination and dissociation have been found to be associated with imaginary friend play in childhood (CIC). Past studies have not investigated how this play relates to adult prodromal symptoms or how childhood adversity mediates the relationship. CIC play was examined in 278 participants, 18-24 years. CIC status predicted prodromal symptoms of hallucination only, whereas childhood adversity predicted all other symptoms. Mediation analysis found CIC's relation to hallucination symptoms was partially mediated by childhood adversity. Findings fit with views that CIC are a positive childhood experience which may convert to a negative developmental trajectory through the impact of childhood adversity.

Evaluating service user pedagogy in UK higher education: Validating the Huddersfield Service User Pedagogy Scale.

BACKGROUND: There is global recognition that the inclusion of service users in the education of health and social care students in higher education can lead to more compassionate professional identities which will enable better decision making. However, to date there is no systematic tool to explore learning and service user involvement in the curriculum. OBJECTIVES: To generate and validate a psychometric instrument which will allow educators to evaluate service user pedagogy. DESIGN: Construction and validation of a new scale. PARTICIPANTS AND SETTINGS: 365 undergraduate students from health and social care departments in two universities. RESULTS: A two correlated factor scale. Factor 1 - perceived presence of service users in the taught curriculum and factor 2 - professionals and service users working together (correlation between factor 1 and factor 2 - r = 0.32). CONCLUSIONS: The Huddersfield Service User Pedagogy Scale provides a valid instrument for educators to evaluate student learning. In addition, the tool can contribute to student reflections on their shifting professional identities as they progress through their studies.

Gender differences and correlates of extreme dieting behaviours in US adolescents.

This article examined correlates of and gender differences in extreme dieting behaviours among 15,425 US adolescents from the 2011 Youth Risk Behavior Survey. Suicidal thoughts and plans and binge drinking were related to extreme dieting behaviours in females, but not in males. Suicide attempts, daily smoking and marijuana use were related to extreme dieting behaviours in males, but not females. Results suggest extreme dieting behaviours are associated with a range of negative psychosocial factors and substance use behaviours, and that these differ for boys and girls. Additional research is required to elucidate these relationships, and these results provide a focus for future research, prevention and intervention efforts.

Correlates of psychological distress immediately following colposcopy.

OBJECTIVE: Women are at risk for prolonged psychological distress following attendance at colposcopy for cervical abnormalities, with potentially negative consequences. Little is presently known about the correlates of post-colposcopy distress. The present study aimed to extend knowledge of correlates of post-colposcopy anxiety and negative affect, and identify women at risk for elevated psychological distress. METHODS: Psychosocial data (demographic variables, anxiety, negative affect, and pain) were collected using validated questionnaires from 164 women attending colposcopy for the first time immediately prior to their colposcopy examination and immediately following it. Two separate logistic regressions were conducted to identify key factors that may be useful targets for preventing post-colposcopy distress and to determine which factors exert the biggest influence and therefore may be targeted in future intervention studies. RESULTS: Pre-colposcopy state anxiety, pain experienced during colposcopy, and trait anxiety emerged as independent predictors of post-colposcopy state anxiety, accounting for 36% of the variance. Pre-colposcopy negative affect, pain experienced during colposcopy, trait anxiety, and referral smear grade were independent predictors of post-colposcopy negative affect, explaining 32% of variance. CONCLUSIONS: Whether or not women underwent punch biopsy or treatment did not influence post-colposcopy distress levels; however, pain experienced during colposcopy remains a risk for continued psychological distress. Trait anxiety may be an important variable to consider in future studies, as women high in trait anxiety may represent a particularly vulnerable subgroup of women referred for colposcopy, at greater risk for negative psychosocial consequences associated with colposcopy, and to be targeted for interventions to reduce psychological distress.