Analysis of the components of cancer risk perception and links with intention and behaviour: A UK-based study

Risk perception refers to how individuals interpret their susceptibility to threats, and has been hypothesised as an important predictor of intentions and behaviour in many theories of health behaviour change. However, its components, optimal measurement, and effects are not yet fully understood. The TRIRISK model, developed in the US, conceptualises risk perception as deliberative, affective and experiential components. In this study, we aimed to assess the replicability of the TRIRISK model in a UK sample by confirmatory factor analysis (CFA), explore the inherent factor structure of risk perception in the UK sample by exploratory factor analysis (EFA), and assess the associations of EFA-based factors with intentions to change behaviour and subsequent behaviour change. Data were derived from an online randomised controlled trial assessing cancer risk perception using the TRIRISK instrument and intention and lifestyle measures before and after communication of cancer risk. In the CFA analysis, the TRIRISK model of risk perception did not provide a good fit for the UK data. A revised model developed using EFA consisted of two separate “numerical” and “self-reflective” factors of deliberative risk perception, and a third factor combining affective with a subset of experiential items. This model provided a better fit to the data when cross-validated. Using multivariable regression analysis, we found that the self-reflective and affective-experiential factors of the model identified in this study were reliable predictors of intentions to prevent cancer. There were no associations of any of the risk perception factors with behaviour change. This study confirms that risk perception is clearly a multidimensional construct, having identified self-reflective risk perception as a new distinct component with predictive validity for intention. Furthermore, we highlight the practical implications of our findings for the design of interventions incorporating risk perception aimed at behaviour change in the context of cancer prevention.

Rejecting and retaining aspects of selfhood: Constructing desistance from abuse as a ‘masculine’ endeavour

Evaluative studies of men who have attended domestic violence perpetrator programmes have, thus far, paid attention to the question of what they are expected to desist from. This is entirely appropriate. However, the question of what they are expected to achieve, or ‘become’, is less clearly articulated, indeed often overlooked. Based on a series of interviews with men who had completed perpetrator programmes, the narratives explored in this articles suggest that their abusive behaviour was underpinned by fears about how to ‘perform masculinity’ satisfactorily in the past. Consequentially, the programme experience was perceived as threatening or as ‘feminising’. However, the accounts of these men suggest that in desisting from abusive behaviour, issues of identity and processes of behaviour change remain profoundly gendered. Indeed, committing to desistance is perceived as something of an ‘heroic struggle’ in which qualities associated with being a ‘proper man’ are harnessed and utilised in the process.

Understanding the Experience of Service Users in an Integrated Care Programme for Obesity and Mental Health: A Qualitative Investigation of Total Wellbeing Luton

Obesity is a complex public health issue with multiple contributing factors. The emphasis on joined care has led to the development and implementation of a number of integrated care interventions targeting obesity and mental health. The purpose of this study was to examine user experience in an integrated care programme for obesity and mental health in Luton, UK. Semi-structured interviews were conducted with a purposeful sample of service users (N = 14). Interview transcripts were analysed using thematic analysis. Analysis of the interviews identified six main themes for understanding service users’ experiences of integrated care: (1) ‘A user-centered system’, (2) ‘Supports behaviour change’, (3) ‘Valued social support’, (4) ‘Communication is key’, (5) ‘Flexible referral process’, and (6) ‘Positive impact on life’. These themes describe how the service is operated, evidence perceived value service users place on social support in behavior change intervention, and address which service areas work well and which require improvement. The findings of these interviews have offered a significant contribution to understanding what service users value the most in an integrated healthcare setting. Service users value ongoing support and being listened to by healthcare professionals, as well as the camaraderie and knowledge acquisition to support their own behaviour change and promote self-regulation following their participation in the programme.

Conceptualising Four Categories of Behaviours: Implications for Implementation Strategies to Achieve Behaviour Change

Background: Effectiveness of implementation strategies is influenced by the extent to which they are based on appropriate theories concerning the behaviours that the strategies intend to impact. Effectiveness may be limited simply because the strategies are based on theories that are limited in scope or are derived from partially inaccurate assumptions about the behaviours in question. It may therefore be important to combine insights from various theories to cover the range of influences on the behaviours that will be changed.Aim: This article aims to explore concepts, theories and empirical findings from different disciplines to categorise four types of behaviours and discuss the implications for implementation strategies attempting to change these behaviours.Influences on behaviours: Multilevel influences on behaviours are dichotomized into individual-level and collective-level influences, and behaviours that are guided by conscious cognitive processes are distinguished from those that rely on non-conscious processing. Combining the two dimensions (levels and cognitive modes) creates a 2 x 2 conceptual map consisting of four categories of behaviours. Explicitly conceptualising the levels and cognitive modes is crucial because different implementation strategies are required depending on the characteristics of the behaviours involved in the practise that needs to be changed.Conclusion: The 2 x 2 conceptual map can be used to consider and reflect on the nature of the behaviours that need to be changed, thus providing guidance on the type of theory, model or framework that might be most relevant for understanding and facilitating behaviour change.

The effectiveness of behaviour change interventions delivered by non-dental health workers in promoting children’s oral health: A systematic review and meta-analysis

Objectives Dental caries is the most common preventable childhood condition. Non-dental professionals and health workers are often well placed to support parents in adopting positive oral health behaviours for their children. The aim of this study was to determine the effectiveness of behaviour change interventions and their individual component behaviour change techniques (BCTs), that were delivered by non-dental professionals and health workers. Methods A systematic search of Ovid MEDLINE, PubMed, CINAHL, Cochrane Library, Web of Science, TRoPHI and PROQUEST from inception until March 2021 was conducted. Randomised controlled trials and quasi-experimental studies for improving oral health outcomes in children were included. Quality assessment was carried out using Cochrane Risk of Bias tool and ROBINS-I tool. Publication bias was assessed using funnel plots and Egger’s regression intercept. Effect sizes were estimated as standardised mean difference (SMD) and odds ratio/risk ratio for proportions. Meta-analyses were performed for studies reporting mean decayed, missing, filled surfaces (dmfs) and mean decayed, missing, filled, teeth (dmft) indices. Behaviour change technique coding was performed using behaviour change technique taxonomy v1 (BCTTv1). Results Out of the 9,101 records retrieved, 36 studies were included with 28 showing a significant effect either in clinical and/or behavioural/knowledge outcomes. Most studies (n = 21) were of poor methodological quality. The pooled SMD for caries experience showed statistically significant result for caries prevention at surface level -0.15 (95% CI -0.25, -0.04) and at the tooth level -0.24 (95% CI -0.42, -0.07). In 28 effective interventions, 27 individual BCTs were identified and the most frequently used were: “Instructions on how to perform the behaviour” and “Information about health consequences”. Conclusion There is low quality of evidence suggesting non-dental professionals and health workers may help improve oral health outcomes for children. To confirm these findings, further high-quality studies incorporating a variety of BCTs in their interventions for adoption of good oral health behaviours are needed.

Effects of Environmental Enrichment on Dog Behaviour: Pilot Study

Environmental enrichment (EE) can be used to enhance the environment of various animals. The aim of this pilot study was to determine the effects of seven EE activities (Bonding, Bubble machine, Conspecific play, Interactive toy, Playhouse, Stuffed food toy and Tug play) on dog behaviour, pre- and post-EE for dogs housed in an office environment during training as part of an assistance dog training programme. EE activities resulted in a significant increase in the frequency of relaxation behaviours (p < 0.01) and a significant reduction in alert (p < 0.01) and stress behaviours (p = 0.02). Results suggest various benefits of the different activities with Conspecific Play and Playhouse activities having the greatest overall positive behaviour change when compared to the other activities. The food-based EE activities (Interactive toy and Stuffed food toy) had the least behaviour change of all the activities provided. Findings will be of interest to pet owners, animal rescue centres, dog trainers and working dog organisations.

A systematic review of behaviour change techniques used in interventions to increase physical activity among breast cancer survivors

Background Despite evidence that physical activity (PA) can help reduce recurrence and mortality, many breast cancer survivors are less active than recommended levels. The aim of this systematic review is to advance our understanding of which behaviour change techniques (BCTs) have been used in interventions promoting breast cancer survivors’ PA and to evaluate their potential to increase PA. Methods A systematic search was conducted in five databases (Medline; PsycInfo; Embase; CINAHL and Scopus) for studies published between 2005 and 2019. Following a rigorous screening process, 27 studies were retained. These were reviewed and analysed for quality, coded for BCTs (k = 0.65) and interventions categorised according to their potential to increase PA using an established methodology. Results The majority of studies were moderate quality (64%). Demonstration on how to perform the behaviour was the most commonly used BCT (n = 23). Adding objects to the environment, (pedometer or accelerometer) was the BCT with the highest potential to increase PA. This was followed by, goal setting and self-monitoring of behaviour. A theory-based approach to evaluation was used in only 59% (n = 16) of the studies. Conclusions The results of this review inform which BCTs have the potential to increase PA for breast cancer survivors and inform intervention development. Future research, is encouraged to properly report intervention procedures around dose and frequency of intervention components to allow for review and replication.