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.

Eat now or later: self-control as an overlapping cognitive mechanism of depression and obesity.

While overlapping neurobiological mechanisms are known, relatively little is known about how "self-control" and cognitive affective processing of rewards may also influence the bi-directional risk between obesity and depression. The objective of this study was to identify the extent to which "self-control," measured using a delay discounting task is co-related to BMI and Depression diagnostic thresholds. A within-subjects counterbalanced design was used in which 92 participants (Mean ± SD: BMI = 27.9 ± 3.5, HAMD = 14.7 ± 7.7) completed a series of clinical diagnostic, survey, and demographic questionnaires in a behavioral health laboratory setting. For the delay discounting task, participants chose between one large delayed reward and one successively smaller immediate reward for four food types (dessert, fried food, fruit, and vegetable). Results showed that delay discounting scores were predictive of BMI and depression with lower delay discounting scores associated with higher BMI and HAMD for the dessert (HAMD scores (ß = -.197, p = .013), BMI (ß = -.239, p < .001)) and fried food (HAMD scores (ß = -.328, p = .001), BMI (ß = -.166, p = .027)). Clinical significance was further evident when HAMD and BMI scores were converted to diagnostic thresholds. Only depression and/or atypical depressive symptoms were related to delay discounting scores with the fruit and vegetable. Thus, reduced cognitive affective self-control for impulsive food choices-particularly for "comfort foods" high in fat and sugar-appears to be a shared cognitive mechanism for both conditions perhaps contributing to the high prevalence of co-morbid mood disorders and weight gain.