Bernadette Egan

Dr Bernadette Egan


Senior Research Fellow/Deputy Director NIHR Research Design Service South-East
BSc (University College Cork) PhD (University College Cork)
+44 (0)1483 688686
30 AD 04

Academic and research departments

School of Biosciences and Medicine.

Biography

Biography

Bernadette Egan graduated with a 1st Class honours degree in Biochemistry from University College Cork (UCC) in 1982, where she subsequently obtained her PhD. She then joined the Microbiology Department at the University of Surrey as a postdoctoral fellow, working on a number of projects in the area food microbiology. After a career break Dr Egan held a Daphne Jackson fellowship in the School of Biomedical and Life Sciences (SBLS) at the University of Surrey (2000-2002), and then worked briefly with Professor Sibel Roller, establishing web based information systems on natural antimicrobials.

Bernadette joined the Food, Consumer Behaviour and Health Research Centre, in the University of Surrey's Department of Psychology in November 2002 where she has worked as a Research Fellow on a range of projects funded by organisations including the Food Standards Agency and the EU. She has also been involved in a number of applied health research projects in conjunction with Professor Heather Gage.

Bernadette is the Academic Lead at Surrey for the NIHR Research Design Service, which is part of the Research Design Service-South East. She was a member of the team that coordinated the University of Surrey's application for an Athena Swan Bronze award and is currently on the self-assessment team in the School of Psychology applying for a Silver Award.

Research interests

Bernadette's research interests are primarily public health-related (food safety, food choice, behavioural nutrition). She works with consumers, professionals (e.g. teachers) and other stakeholders to investigate food-related attitudes, beliefs and behaviour using both qualitative and quantitative methods. Bernadette also has extensive experience in developing study protocols and in the collection, analysis and reporting of data.

Research collaborations

  • Plant Food Supplements: Levels of Intake, Benefit and Risk Assessment - PlantLIBRA (European Union; June 2010 to May 2014)
  • The Effect of Diet on the Mental performance of Children - NutriMENTHE (European Union; March 2008 to February 2013)
  • Early Nutrition programming - long term follow up of efficacy and safety trials and integrated epidemiological, genetic, animal, consumer and economic research - EARNEST (European Union; April 2005 to March 2010)
  • European Food Information Resource Network - EuroFIR (European Union; 5 years from January 2005)
  • Getting food safety and food hygiene messages into schools (Food Standards Agency; March 2004 to November 2005)
  • Evaluation of UK food hygiene and safety training (Food Standards Agency; August 2002 to March 2004)

My publications

Publications

Lada Timotijevic, Carys Banks, Patrice Rusconi, Bernadette Egan, Matthew Peacock, Ellen Seiss, Morro Touray, Heather Gage, C. Pellicano, G. Spalletta, F. Assogna, M. Giglio, A. Marcante, G. Gentile, I. Cikajilo, D. Gatsios, S. Konitsiotis, D. Fotiadis (2020)Designing a mHealth Clinical Decision Support System for Parkinson’s Disease: A Theoretically Grounded User Needs Approach, In: BMC Medical Informatics and Decision Making2034 BMC (Springer Nature)
Background: Despite the established evidence and theoretical advances explaining human judgments under uncertainty, developments of mobile health (mHealth) Clinical Decision Support Systems (CDSS) have not explicitly applied the psychology of decision making to the study of user needs. We report on a user needs approach to develop a prototype of a mHealth CDSS for Parkinson’s Disease (PD), which is theoretically grounded in the psychological literature about expert decision making and judgement under uncertainty. Methods: A suite of user needs studies was conducted in 4 European countries (Greece, Italy, Slovenia, the UK) prior to the development of PD_Manager, a mHealth-based CDSS designed for Parkinson’s Disease, using wireless technology. Study 1 undertook Hierarchical Task Analysis (HTA) including elicitation of user needs, cognitive demands and perceived risks/benefits (ethical considerations) associated with the proposed CDSS, through structured interviews of prescribing clinicians (N=47). Study 2 carried out computational modelling of prescribing clinicians’ (N=12) decision strategies based on social judgment theory. Study 3 was a vignette study of prescribing clinicians’ (N=18) willingness to change treatment based on either self-reported symptoms data, devices-generated symptoms data or combinations of both. Results: Study 1 indicated that system development should move away from the traditional silos of ‘motor’ and ‘non-motor’ symptom evaluations and suggest that presenting data on symptoms according to goal-based domains would be the most beneficial approach, the most important being patients’ overall Quality of Life (QoL). The computational modelling in Study 2 extrapolated different factor combinations when making judgements about different questions. Study 3 indicated that the clinicians were equally likely to change the care plan based on information about the change in the patient’s condition from the patient’s self-report and the wearable devices. 3 Conclusions: Based on our approach, we could formulate the following principles of mHealth design: 1) enabling shared decision making between the clinician, patient and the carer; 2) flexibility that accounts for diagnostic and treatment variation among clinicians; 3) monitoring of information integration from multiple sources. Our approach highlighted the central importance of the patient-clinician relationship in clinical decision making and the relevance of theoretical as opposed to algorithm (technology)-based modelling of human judgment.
Charo Hodgkins, Bernadette Egan, Matthew Peacock, Naomi Klepacz, Krista Miklavec, Igor Pravst, Jure Pohar, Azucena Gracia, Andrea Groeppel-Klein, Mike Rayner, Monique Raats (2019)Understanding How Consumers Categorise Health Related Claims on Foods: A Consumer-Derived Typology of Health-Related Claims, In: Nutrients11(3) MDPI
The Nutrition and Health Claims Regulation (NHCR) EC No 1924/2006 aims to provide an appropriate level of consumer protection whilst supporting future innovation and fair competition within the EU food industry. However, consumers’ interpretation of health claims is less well understood. There is a lack of evidence on the extent to which consumers are able to understand claims defined by this regulatory framework. Utilising the Multiple Sort Procedure (MSP), a study was performed (N = 100 participants across five countries: Germany, the Netherlands, Slovenia, Spain and the United Kingdom) to facilitate development of a framework of health-related claims encompassing dimensions derived from consumers. Our results provide useful insight into how consumers make sense of these claims and how claims may be optimised to enhance appropriate consumer understanding. They suggest consumers may not consciously differentiate between a nutrition claim and a health claim in the way that regulatory experts do and provide insight into where this might occur. A consumer-derived typology of health-related claims based on three key dimensions is proposed: (1) Familiarity with the nutrient, substance or food stated in the claim; (2) statement type in terms of simplicity/complexity; (3) relevance of the claim, either personally or for a stated population group.
Sarah Golding, Clare Horsfield, Annette Davies, Mary Egan, Martyn Jones, Mary Raleigh, Patricia Schofield, Allison Squires, Kath Start, Tom Quinn, Mark Cropley (2017)Exploring the psychological health of emergency dispatch centre operatives: a systematic review and narrative synthesis, In: PeerJ5 PeerJ

Background. The study objective was to investigate and synthesize available evidence relating to the psychological health of Emergency Dispatch Centre (EDC) operatives, and to identify key stressors experienced by EDC operatives.

Methods. Eight electronic databases (Embase, PubMed, Medline, CINAHL, PsycInfo, PsycArticles, The Psychology and Behavioural Sciences Collection, and Google Scholar) were searched. All study designs were included, and no date limits were set. Studies were included if they were published in English, and explored the psychological health of any EDC operatives, across fire, police, and emergency medical services. Studies were excluded if they related solely to other emergency workers, such as police officers or paramedics. Methodological quality of included studies was assessed using checklists adapted from the Critical Appraisal Skills Programme. A narrative synthesis was conducted, using thematic analysis.

Results. A total of 16 articles were included in the review. Two overarching themes were identified during the narrative synthesis: `Organisational and Operational Factors' and `Interactions with Others'. Stressors identified included being exposed to traumatic calls, lacking control over high workload, and working in under-resourced and pres- sured environments. Lack of support from management and providing an emotionally demanding service were additional sources of stress. Peer support and social support from friends and family were helpful in managing work-related stress.

Discussion. EDC operatives experience stress as a result of their work, which appears to be related to negative psychological health outcomes. Future research should explore the long-term effects of this stress, and the potential for workplace interventions to alleviate the negative impacts on psychological health.

MB Egan, A Fragodt, MM Raats (2006)The importance of harmonising and sustaining food composition data across Europe, In: Nutrition Bulletin31(4)pp. 349-353
Food composition data are essential for a wide variety of activities, including public health nutrition, research, food labelling and government policy. Food composition data play a particularly important role in four sectors in Europe, namely health, trade regulation and legislation, agriculture and the environment. The need to continue the harmonisation of food composition data already achieved through European collaboration can be clearly identified and evidenced. Harmonisation is not exclusively a technical issue, but also entails creating durable and sustainable structures to maintain the viability of food composition data. These and related issues are currently being addressed by the EuroFIR Network of Excellence (project number FP6-513944, http://www.eurofir.net). © 2006 British Nutrition Foundation.
A Garcia-Alvarez, R Mila-Villarroel, L Ribas-Barba, MB Egan, M Badea, FM Maggi, M Salmenhaara, P Restani, L Serra-Majem (2016)Usage of Plant Food Supplements (PFS) for weight control in six European countries: results from the PlantLIBRA PFS Consumer Survey 2011-2012, In: BMC Complementary and Alternative Medicine BioMed Central
Background: Obesity is increasing worldwide and weight-control strategies, including the consumption of plant food supplements (PFS), are proliferating. This article identifies the herbal ingredients in PFS consumed for weight control and by overweight/obese dieters in six European countries, and explores the relationship between their consumption and their self-reported BMI. Methods: Data used were a subset from the PlantLIBRA PFS Consumer Survey 2011-2012, a retrospective survey of 2359 PFS consumers. The survey used a bespoke frequency-of-PFS-usage questionnaire. Analyses were performed in two consumer subsamples of 1) respondents taking the products for “body weight reasons”, and 2) “dieters for overweight/obesity”, to identify the herbal ingredients consumed for these reasons. The relationship between the 5 most consumed herbal ingredients and self-reported BMI in groups 1 and 2 is explored by comparing BMI proportions of consumers vs. non-consumers (using Chi-squared test). Results: 252 PFS (8.8 %) were consumed for “body weight reasons” (by 240 PFS consumers); 112 PFS consumers (4.8 %) were “dieting for overweight/obesity”. Spain is the country where consuming herbal ingredients for body weight control and dieting were most popular. Artichoke was the most consumed herbal ingredient. Considering only the 5 top products consumed by those who responded “body weight”, when using the total survey sample, a greater proportion of BMI ≥ 25 was observed among consumers of PFS containing artichoke and green tea as compared to non-consumers (58.4 % vs. 49.1 % and 63.2 % vs. 49.7 % respectively). Considering only the 5 top products consumed by “dieters” and using only the “dieters” sample, a lower proportion of BMI ≥ 25 was observed among pineapple-containing PFS consumers (38.5 % vs. 81.5 %); however, when using the entire survey sample, a greater proportion of BMI ≥ 25 was observed among artichoke-containing PFS consumers (58.4 % vs. 49.1 %).Conclusions: A comparison of results among the scarce publications evaluating the use of weight-loss supplements at the population level is limited. Nevertheless every hint is important in finding out which are the self-treatment strategies used by overweight/obese individuals in European countries. Although limited by a small sample size, our study represents a first attempt at analysing such data in six EU countries. Our findings should encourage the conduction of further studies on this topic, long-term and large sample-sized studies, ideally conducted in the general population.
Matthew Peacock, Mihaela Badea, Flavia Bruno, Lada Timotijevic, Martina Laccisaglia, Charo Hodgkins, Monique Raats, Bernadette Egan (2019)Herbal supplements in the print media: communicating benefits and risks, In: BMC Complementary and Alternative Medicine19196pp. 1-14 BMC

Background

The rise in use of food supplements based on botanical ingredients (herbal supplements) is depicted as part of a trend empowering consumers to manage their day-to-day health needs, which presupposes access to clear and accurate information to make effective choices. Evidence regarding herbal supplement efficacy is extremely variable so recent regulations eliminating unsubstantiated claims about potential effects leave producers able to provide very little information about their products. Medical practitioners are rarely educated about herbal supplements and most users learn about them via word-of-mouth, allowing dangerous misconceptions to thrive, chief among them the assumption that natural products are inherently safe. Print media is prolific among the information channels still able to freely discuss herbal supplements.

Method

This study thematically analyses how 76 newspaper/magazine articles from the UK, Romania and Italy portray the potential risks and benefits of herbal supplements.

Results

Most articles referenced both risks and benefits and were factually accurate but often lacked context and impartiality. More telling was how the risks and benefits were framed in service of a chosen narrative, the paucity of authoritative information allowing journalists leeway to recontextualise herbal supplements in ways that serviced the goals and values of their specific publications and readerships.

Conclusion

Providing sufficient information to empower consumers should not be the responsibility of print media, instead an accessible source of objective information is required.

Bernadette Egan, Heather Gage, J Hood, Karen Poole, C McDowell, G Maguire, L Storey (2012)Availability of CAM for people with cancer in the British NHS: the results of a national survey, In: Complementary Therapies in Clinical Practice18(2)pp. 75-80 Elsevier
This study assessed access to Complementary and Alternative Medicine (CAM) therapies for people with cancer within the British National Health Service. CAM units were identified through an internet search in 2009. A total of 142 units, providing 62 different therapies, were identified: 105 (74.0%) England; 23 (16.2%) Scotland; 7 (4.9%) each in Wales and Northern Ireland. Most units provide a small number of therapies (median 4, range 1–20), and focus on complementary, rather than alternative approaches. Counselling is the most widely provided therapy (available at 82.4% of identified units), followed by reflexology (62.0%), aromatherapy (59.1%), reiki (43.0%), massage (42.2%). CAM units per million of the population varied between countries (England: 2.2; Wales: 2.3; Scotland: 4.8; Northern Ireland: 5.0), and within countries. Better publicity for CAM units, greater integration of units in conventional cancer treatment centres may help improve access to CAMs.
MB Egan, MM Raats, SM Grubb, A Eves, ML Lumbers, MS Dean, MR Adams (2007)A review of food safety and food hygiene training studies in the commercial sector, In: Food Control18(10)pp. 1180-1190
This review summarises the methods and results of studies conducted worldwide on the effectiveness of food safety and food hygiene training in the commercial sector of the food industry. In particular it focuses on those studies that have tried to evaluate the effectiveness of such training. Forty-six studies of food hygiene training are included which used some outcome measure to assess the effectiveness of training. The short-term nature and variety of measures used limited the majority of studies. The need for the development of evaluation criteria of effectiveness of food hygiene training is discussed. (c) 2006 Elsevier Ltd. All rights reserved.
MB Egan, A Fragodt, M Raats, C Hodgkins, M Lumbers (2007)The importance of harmonizing food composition data across Europe, In: European Journal of Clinical Nutrition61(7)pp. 813-821
Objective: To examine the role of food composition data in Europe in four sectors, namely health, trade regulation and legislation, agriculture and the environment. Results: The need for further harmonization of data across Europe is clearly identified and evidenced from a number of previous successful European collaborations. Conclusions: Data on the nutritional composition of foods are essential for a broad spectrum of activities, including public health nutrition, research, the food industry and government policy development and implementation. With the expansion of the European Union and the concomitant increase in cross border trade and cooperation harmonizing food composition data becomes a more important issue than ever. Harmonization is not solely a technical issue, but also involves creating durable and sustainable structures to maintain the viability of the data. These are some of the issues currently being addressed by the European Food Information Resource Network of Excellence.
Heather Gage, MM Raats, P Williams, B Egan, V Jakobik, K Laitinen, E Martin-Bautista, M Schmid, J von Rosen-von Hoewel, C Campoy, T Decsi, J Morgan, B Koletzko (2011)Developmental origins of health and disease: the views of first-time mothers in 5 European countries on the importance of nutritional influences in the first year of life., In: American Journal of Clinical Nutrition94(6S)pp. 2018S-2024S American Society for Nutrition
Background: The programming concept suggests that poor early nutrition causes an array of medical problems later in life. Public health messages about the implications of programming may not be reaching parents and influencing infant feeding behaviors. Objective: The views of new mothers were sought about the extent to which lifelong health is influenced by diet as an infant, rather than by genetic predispositions or lifestyles and behaviors. Design: A questionnaire survey of first-time mothers was undertaken in 5 European countries. Results: A convenience sample of 2071 mothers from England (438), Finland (426), Germany (414), Hungary (389), and Spain (404) self-completed the questionnaire. High proportions of mothers agreed that how an infant is fed affects his or her health over the first year (95.8%) and in subsequent years (88.5%), but the effect of infant feeding decisions on the development of long-term conditions was the least-cited underlying reason. Diet as an infant was rated an extremely/very important influence on adult health by 64% of mothers, equivalent to environmental pollution (63%), but by fewer mothers than were diet and physical activity in childhood/adolescence (79%, 84%) and adulthood (81%, 83%), genetics/inheritance (70%), and exposure to cigarette smoke (81%). Inter- and intracountry differences were observed. Conclusions: Mothers in this study consider diet as an infant to be a less important influence on lifelong health than many lifestyle, behavioral, and environmental factors and genetics. Further dissemination of the implications of programming to consumers may be warranted.
Adrian P. Banks, Bernadette Egan, Charo E. Hodgkins, Matthew Peacock, Monique M. Raats (2018)The role of causal models and beliefs in interpreting health claims, In: British Journal of Health Psychology23(4)pp. 933-948 Wiley

Objective: Health claims on food packaging are regulated to inform and protect consumers, however many consumers do not accurately interpret the meaning of the claims. Whilst research has shown different types of misinterpretation, it is not clear how those interpretations are formed. The aim of this study is to elicit the causal beliefs and causal models about food and health held by consumers, i.e. their understanding of the causal relationships between nutrients, health outcomes and the causal pathways connecting them, and investigate how well this knowledge explains the variation in inferences they draw about health benefits from health claims.

Method: 400 participants from Germany, the Netherlands, Spain, Slovenia, and the UK were presented with 7 authorised health claims and drew inferences about the health benefits of consuming nutrients specified in the claim. Then their personal causal models of health were elicited along with their belief in the truth and familiarity with the claims.

Results: The strength of inferences about health benefits that participants drew from the claims were predicted independently by the strength of the relevant causal pathways within the causal model, and belief in the truth of the claim, but not familiarity with the claim. Participants drew inferences about overall health benefits of the nutrients by extrapolating from their causal models of health.

Conclusion: Consumers’ interpretation of claims is associated with their belief in the claim and their causal models of health. This prior knowledge is used to interpret the claim and draw inferences about overall health benefits that go beyond the information in the claim. Therefore efforts to improve consumers’ understanding and interpretation of health claims must address both their wider causal models of health and their knowledge of specific claims.

A Garcia-Alvarez, Mary Egan, S de Klein, L Dima, FM Maggi, M Isoniemi, L Ribas-Barba, Monique Raats, EM Meissner, M Badea, F Bruno, M Salmenhaara, R Mila-Villarroel, V Knaze, Charo Hodgkins, A Marculescu, L Uusitalo, P Restani, L Serra-Majem (2014)Usage of Plant Food Supplements across Six European Countries: Findings from the PlantLIBRA Consumer Survey, In: PLoS ONE9(3) Public Library of Science

Background The popularity of botanical products is on the rise in Europe, with consumers using them to complement their diets or to maintain health, and products are taken in many different forms (e.g. teas, juices, herbal medicinal products, plant food supplements (PFS)). However there is a scarcity of data on the usage of such products at European level.

Objective To provide an overview of the characteristics and usage patterns of PFS consumers in six European countries.

Design Data on PFS usage were collected in a cross-sectional, retrospective survey of PFS consumers using a bespoke frequency of PFS usage questionnaire.

Subjects/setting A total sample of 2359 adult PFS consumers from Finland, Germany, Italy, Romania, Spain and the United Kingdom.

Data analyses Descriptive analyses were conducted, with all data stratified by gender, age, and country. Absolute frequencies, percentages and 95% confidence intervals are reported.

Results Overall, an estimated 18.8% of screened survey respondents used at least one PFS. Characteristics of PFS consumers included being older, well-educated, never having smoked and self-reporting health status as “good or very good”. Across countries, 491 different botanicals were identified in the PFS products used, with Ginkgo biloba (Ginkgo), Oenothera biennis (Evening primrose) and Cynara scolymus (Artichoke) being most frequently reported; the most popular dose forms were capsules and pills/tablets. Most consumers used one product and half of all users took single-botanical products. Some results varied across countries.

Conclusions The PlantLIBRA consumer survey is unique in reporting on usage patterns of PFS consumers in six European countries. The survey highlights the complexity of measuring the intake of such products, particularly at pan-European level. Incorporating measures of the intake of botanicals in national dietary surveys would provide much-needed data for comprehensive risk and benefit assessments at the European level.

Naomi Klepacz, RA Nash, Mary Egan, Monique Raats, Charo Hodgkins (2015)When Is an Image a Health Claim? A False-Recollection Method to Detect Implicit Inferences About Products’ Health Benefits, In: Health Psychology35(8)pp. 898-907 American Psychological Association
Objective: Images on food and dietary supplement packaging might lead people to infer (appropriately or inappropriately) certain health benefits of those products. Research on this issue largely involves direct questions, which could (a) elicit inferences that would not be made unprompted, and (b) fail to capture inferences made implicitly. Using a novel memory-based method, in the present research, we explored whether packaging imagery elicits health inferences without prompting, and the extent to which these inferences are made implicitly. Method: In 3 experiments, participants saw fictional product packages accompanied by written claims. Some packages contained an image that implied a health-related function (e.g., a brain), and some contained no image. Participants studied these packages and claims, and subsequently their memories for seen and unseen claims were tested. Results: When a health image was featured on a package, participants often subsequently recognized health claims that— despite being implied by the image—were not truly presented. In Experiment 2, these recognition errors persisted despite an explicit warning against treating the images as informative. In Experiment 3, these findings were replicated in a large consumer sample from 5 European countries, and with a cued-recall test. Conclusion: These findings confirm that images can act as health claims, by leading people to infer health benefits without prompting. These inferences appear often to be implicit, and could therefore be highly pervasive. The data underscore the importance of regulating imagery on product packaging; memory-based methods represent innovative ways to measure how leading (or misleading) specific images can be.