Dr Naomi Klepacz

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.

Background: Patients with malignant pleural mesothelioma (MPM) have a life limiting illness and a short prognosis and experience many debilitating symptoms from early on in the illness. Innovations such as remote symptom monitoring are needed to enable patients to maintain wellbeing and to manage symptoms in a proactive and timely manner. The Advanced Symptom Management System (ASyMS) has been successfully used to monitor symptoms associated with cancer. Objective: To determine the feasibility and acceptability of using an Advanced Symptom Management System (ASyMS) adapted for use by patients with malignant pleural mesothelioma and called: ASyMSmeso enabling the remote monitoring of symptoms using a smartphone. Methods: This was a mixed methods study using Patient Reported Outcome Measures (PROMs) at key time points over a period of 2-3 months with 18 patients. The Sheffield Profile for Assessment and Referral for Care (SPARC); Technology Acceptance Model Measure for e-health (TAM); and the Lung Cancer Symptom Scale-Mesothelioma (LCSS-meso) were the PROMs used in the study. Patients were also asked to complete a daily symptom questionnaire on a smartphone throughout the study. At the end of the study semi-structured interviews with 11 health professionals, 8 patients and 3 carers about their experience of using ASyMSmeso were conducted. Results: Eighteen patients with MPM agreed to participate in the study (33.3% response rate). The completion rates of study PROMs were high (97.2%-100%) and for completion of the daily symptom questionnaire were also high at 88.5% There were no significant changes in quality of life, as measured by LCSS-meso. There were statistically significant improvements from the SPARC domain: psychological need (P=0.049), and in the “Usefulness” domain of the Technology Acceptance Model (P=0.022). End of study interviews identified that both patients and clinicians found the system quick and easy to use. For patients in particular the system provided reassurance about symptom experience and the feeling of being listened to. The clinicians largely viewed the system as feasible and acceptable and areas that were mentioned included the early management of symptoms, connectivity between patients and clinicians leading to enhanced communication. Conclusions: This study demonstrates that remote monitoring and management of symptoms of people with MPM using a mobile phone is feasible and acceptable. The evidence supports future trials using remote symptom monitoring to support patients with MPM at home.

Background The need for a better understanding of food consumption behaviour within its behavioural context has sparked the interest of nutrition researchers for user-documented food consumption data collected outside the research context using publicly available nutrition apps. The study aims to characterize the scientific, technical, legal and ethical features of this data in order to identify the opportunities and challenges associated with using this data for nutrition research. Method A search for apps collecting food consumption data was conducted in October 2016 against UK Google Play and iTunes storefronts. 176 apps were selected based on user ratings and English language support. Publicly available information from the app stores and app-related websites was investigated and relevant data extracted and summarized. Our focus was on characteristics related to scientific relevance, data management and legal and ethical governance of user-documented food consumption data. Results Food diaries are the most common form of data collection, allowing for multiple inputs including generic food items, packaged products, or images. Standards and procedures for compiling food databases used for estimating energy and nutrient intakes remain largely undisclosed. Food consumption data is interlinked with various types of contextual data related to behavioural motivation, physical activity, health, and fitness. While exchange of data between apps is common practise, the majority of apps lack technical documentation regarding data export. There is a similar lack of documentation regarding the implemented terms of use and privacy policies. While users are usually the owners of their data, vendors are granted irrevocable and royalty free licenses to commercially exploit the data. Conclusion Due to its magnitude, diversity, and interconnectedness, user-documented food consumption data offers promising opportunities for a better understanding of habitual food consumption behaviour and its determinants. Non-standardized or non-documented food data compilation procedures, data exchange protocols and formats, terms of use and privacy statements, however, limit possibilities to integrate, process and share user-documented food consumption data. An ongoing research effort is required, to keep pace with the technical advancements of food consumption apps, their evolving data networks and the legal and ethical regulations related to protecting app users and their personal data.

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.

Images on dietary supplement packaging can help identify the products' supposed function. However, research shows that these images can also lead people to infer additional health benefits of consuming the products. The present research investigated the extent to which front-of-pack imagery affects people's perceptions of the health risks and benefits of fictional products. In three randomized experiments, participants saw fictitious dietary supplement packages. Some of the packages included a health-related image (e.g. a heart), whereas others did not. Participants were asked to infer the products' intended purpose and then to rate the perceived risks and benefits of consuming the product. In Experiment 1 (N = 546), the inclusion of a health-related image increased the perceived benefits of consuming the product, with minimal effect on the perceived risks. This finding was replicated in Experiment 2 (N = 164), but was contingent on whether each product's assumed health function was confirmed or disconfirmed. In Experiment 3 (N = 306), which used a pre-registered design and analysis plan, the inclusion of a health-related image increased the perceived benefits and decreased the perceived risks of consuming the product. Again, these effects were contingent on whether the assumed health functions were confirmed or disconfirmed. These findings indicate that health-related imagery could lead consumers to infer additional health properties from non-diagnostic information featured on a product's packaging, perhaps as a consequence of increased processing fluency. This research underscores the importance of regulating the use of imagery in health marketing, to protect consumers from the effects of potentially misleading claims.

Antimicrobial resistance is of growing concern in human and animal health. The aim of this study was to raise awareness and perception of risk of infection-related behaviours during routine preparation for veterinary surgery. We took a multi-disciplinary and multi-method approach to 'make visible, the invisible' by illustrating how microbial contamination can be spread during the preparation process for surgical procedures. The design-led visualization approach enhanced inter-disciplinary team and workshop participant contributions during the co-development of an innovative digital tool to support training for veterinary practitioners and students. After experiencing the intervention, 92% of 51 participants agreed to change their behaviour and stated an intention to implement an infection control behaviour that aligned with training objectives. The 3D graphics enhanced the delivery of training content by making difficult and abstract contamination concepts easy to understand. A similar approach could be taken for human health applications.

A better understanding of food-related behaviour and its determinants can be achieved through harmonisation and linking of the various data-sources and knowledge platforms. We describe the key decision-making in the development of a prototype of the Determinants and Intake Platform (DI Platform), a data platform that aims to harmonise and link data on consumer food behaviour. It will be part of the Food Nutrition Health Research Infrastructure (FNH-RI) that will facilitate health, social and food sciences. The decision-making was based on the evidence of user needs and data characteristics that guided the specification of the key building blocks of the DI Platform. Eight studies were carried out, including consumer online survey; interview studies of key DI Platform stakeholders; desk research and workshops. Consumers were most willing to share data with universities, then industry and government. Trust, risk perception and altruism predicted willingness to share. For most other stakeholders non-proprietary data was most likely to be shared. Lack of data standards, and incentives for sharing were the main barriers for sharing data among the key stakeholders. The value of various data types would hugely increase if linked with other sources. Finding the right balance between optimizing data sharing and minimizing ethical and legal risks was considered a key challenge. The development of DI Platform is based on careful balancing of the user, technical, business, legal and ethical requirements, following the FAIR principles and the need for financial sustainability, technical flexibility, transparency and multi-layered organisational governance. •There is a need to better support science on food intake and its determinants (DI).•DI Platform links consumer, business, science-generated data on food consumption.•Decision-making is based on evaluations of user needs and data characteristics.•The final design balances user, technology, business and governance requirements.•DI Platform supports the Food Nutrition Health Research Infrastructure initiative.

Background Nurses, midwives and paramedics are the largest collective group of clinical staff in the NHS and have some of the highest prevalence of psychological ill-health. Existing literature tends to be profession-specific and focused on individual interventions that place responsibility for good psychological health with nurses, midwives and paramedics themselves. Aim To improve understanding of how, why and in what contexts nurses, midwives and paramedics experience work-related psychological ill-health; and determine which high-quality interventions can be implemented to minimise psychological ill-health in these professions. Methods Realist synthesis methodology consistent with RAMESES reporting guidelines. Data sources First round database searching in MEDLINE ALL (via Ovid), CINAHL (via EBSCO) and HMIC (via Ovid), was undertaken between February-March 2021, followed by supplementary searching strategies (e.g., hand searching, expert solicitation of key papers). Reverse chronology screening was applied, aimed at retaining 30 relevant papers in each profession. Round two database searches (December 2021) targeted COVID-19-specific literature and literature reviews. No date limits were applied. Results We built on 7 key reports and included 75 papers in the first round (26 Nursing, 26 Midwifery, 23 Paramedic) plus 44 expert solicitation papers, 29 literature reviews and 49 COVID-19 focused articles in the second round. Through the realist synthesis we surfaced 14 key tensions in the literature and identified five key findings, supported by 26 Context Mechanism and Outcome configurations (CMOcs). The key findings identified that: 1) Interventions are fragmented, individual-focused and insufficiently recognise cumulative chronic stressors; 2) It is difficult to promote staff psychological wellness where there is a blame culture; 3) The needs of the system often override staff wellbeing at work (‘serve & sacrifice’); 4) There are unintended personal costs of upholding and implementing values at work; and 5) It is challenging to design, identify and implement interventions to work optimally for diverse staff groups with diverse and interacting stressors. Conclusions Our realist synthesis strongly suggests the need to improve the systemic working conditions and the working lives of nurses, midwives and paramedics to improve their psychological wellbeing. Individual, one-off psychological interventions are unlikely to succeed alone. Psychological ill-health is highly prevalent in these staff groups (and can be chronic and cumulative as well as acute) and should be anticipated and prepared for, indeed normalised and expected. Healthcare organisations need to: 1) rebalance the working environment to enable healthcare professionals to recover and thrive; 2) invest in multi-level systems approaches to promoting staff psychological wellbeing; and use an organisational diagnostic framework such as the NHS England and NHS Improvement Health and Wellbeing framework to self-assess and implement a systems approach to staff wellbeing. Future work Future research should implement, refine and evaluate systemic interventional strategies. Interventions and evaluations should be co-designed with frontline staff and staff experts by experience, and tailored where possible to local, organisational and workforce needs. Limitations The literature was not equivalent in size and quality across the three professions and we did not carry out citation searches using hand searching and stakeholder / expert suggestions to augment our sample.

This paper critiques the opportunities afforded by immersive experience technology to create stimulating, innovative living environments for long-term residents of care homes for the elderly. We identify the ways in which virtual mobility can facilitate reconnection with recreational environments. Specifically, the project examines the potential of two assistive and immersive experiences; virtual reality (VR) and multisensory stimulation environments (MSSE). Findings identify three main areas of knowledge contribution. First, the introduction of VR and MSSE facilitated participants re-engagement and sharing of past experiences as they recalled past family holidays, day trips or everyday practices. Secondly, the combination of the hardware of the VR and MSSE technology with the physical objects of the sensory trays created alternative, multisensual ways of engaging with the experiences presented to participants. Lastly, the clear preference for the MSSE experience over the VR experience highlighted the importance of social interaction and exchange for participants.