Dr Sarah-Jane Stewart

Molecular diagnostic tests may improve antibiotic prescribing by enabling earlier tailoring of antimicrobial therapy. However, clinicians' trust and acceptance of these tests will determine their application in practice. To examine ICU prescribers' views on the application of molecular diagnostics in patients with suspected hospital-acquired and ventilator-associated pneumonia (HAP/VAP). Sixty-three ICU clinicians from five UK hospitals completed a cross-sectional questionnaire between May 2020 and July 2020 assessing attitudes towards using molecular diagnostics to inform initial agent choice and to help stop broad-spectrum antibiotics early. Attitudes towards using molecular diagnostics to inform initial treatment choices and to stop broad-spectrum antibiotics early were nuanced. Most (83%) were positive about molecular diagnostics, agreeing that using results to inform broad-spectrum antibiotic prescribing is good practice. However, many (58%) believed sick patients are often too unstable to risk stopping broad-spectrum antibiotics based on a negative result. Positive attitudes towards the application of molecular diagnostics to improve antibiotic stewardship were juxtapositioned against the perceived need to initiate and maintain broad-spectrum antibiotics to protect unstable patients.

Minority stress-in the form of experiences of prejudice and discrimination-can have negative consequences on individuals in same-sex relationships. However, little is known about the ways in which members of same-sex couples make meaning of minority stress, especially in the context of newly formed relationships that may be most vulnerable to minority stressors. The present study draws upon emerging understandings of couple-level minority stress to investigate the ways in which newly formed same-sex couples make meaning of their minority stress experiences jointly as a couple. A narrative analysis was conducted using data from dyadic interviews with 40 same-sex couples who had been together for at least 6 months but less than 3 years. Analyses highlighted six distinct narrative strategies used by couples when making-meaning of their minority stress experiences: "minority stress made couples stronger," "minority stress contaminates positive experiences," "minority stress is not a big deal," "couples resign in the face of minority stress," "minority stress is worse than expected." and "couples hope minority stress experiences will get better." These findings not only provide valuable evidence for couple-level minority stress constructs, but crucially give a nuanced insight into how same-sex couples that are in the early stages of relationship development, mike meaning of their minority stress experiences. Findings have important implications for the design and implementation of effective clinical and counseling interventions aimed at reducing negative outcomes among individuals in same-sex relationships, and the potential for relationship dissolution resulting from minority stress experiences.

Nonadherence to medicines is a global problem compromising health and economic outcomes for individuals and society. This article outlines how adherence is defined and measured, and examines the impact, prevalence and determinants of nonadherence. It also discusses how a psychosocial perspective can inform the development of interventions to optimise adherence and presents a series of recommendations for future research to overcome common limitations associated with the medication nonadherence literature. Nonadherence is best understood in terms of the interactions between an individual and a specific disease/treatment, within a social and environmental context. Adherence is a product of motivation and ability. Motivation comprises conscious decision-making processes but also from more 'instinctive', intuitive and habitual processes. Ability comprises the physical and psychological skills needed to adhere. Both motivation and ability are influenced by environmental and social factors which influence the opportunity to adhere as well as triggers or cues to actions which may be internal (e.g. experiencing symptoms) or external (e.g. receiving a reminder). Systematic reviews of adherence interventions show that effective solutions are elusive, partly because few have a strong theoretical basis. Adherence support targeted at the level of individuals will be more effective if it is tailored to address the specific perceptions (e.g. beliefs about illness and treatment) and practicalities (e.g. capability and resources) influencing individuals' motivation and ability to adhere.

Background: Breast cancer is the most common cancer in women worldwide. Approximately 80% of breast cancers are oestrogen receptor positive (ER+). Patients treated surgically are usually recommended adjuvant endocrine therapy (AET) for 5–10 years. AET significantly reduces recurrence, but up to 50% of women do not take it as prescribed. Objective: To co-design and develop an intervention to support AET adherence and improve health-related quality-of-life (QoL) in women with breast cancer. Methods: Design and development of the HT&Me intervention took a person-based approach and was guided by the Medical Research Council framework for complex interventions, based on evidence and underpinned by theory. Literature reviews, behavioural analysis, and extensive key stakeholder involvement informed ‘guiding principles’ and the intervention logic model. Using co-design principles, a prototype intervention was developed and refined. Results: The blended tailored HT&Me intervention supports women to self-manage their AET. It comprises initial and follow-up consultations with a trained nurse, supported with an animation video, a web-app and ongoing motivational ‘nudge’ messages. It addresses perceptual (e.g. doubts about necessity, treatment concerns) and practical (e.g. forgetting) barriers to adherence and provides information, support and behaviour change techniques to improve QoL. Iterative patient feedback maximised feasibility, acceptability, and likelihood of maintaining adherence; health professional feedback maximised likelihood of scalability. Conclusions: HT&Me has been systematically and rigorously developed to promote AET adherence and improve QoL, and is complemented with a logic model documenting hypothesized mechanisms of action. An ongoing feasibility trial will inform a future randomised control trial of effectiveness and cost-effectiveness.

Rapid molecular diagnostic tests improve antimicrobial stewardship (AMS) by facilitating earlier refinement of antimicrobial therapy. The INHALE trial tested the application of the BioFire FilmArray Pneumonia Panel (Pneumonia Panel) for antibiotic prescribing for hospital-acquired and ventilator-associated pneumonias (HAP/VAP) in UK intensive care units (ICUs). We report a behavioral study embedded within the INHALE trial examining clinicians’ perceptions of using these tests. Semi-structured interviews were conducted with 20 ICU clinicians after using the Pneumonia Panel to manage suspected HAP/VAP. Thematic analysis identified factors reinforcing perceptions of the necessity to modify antibiotic prescribing in accordance with test results and doubts/concerns about doing so. While most acknowledged the importance of AMS, the test’s impact on prescribing decisions was limited. Concerns about potential consequences of undertreatment to the patient and prescriber were often more salient than AMS, sometimes leading to “just-in-case” antibiotic prescriptions. Test results indicating a broad-spectrum antibiotic were unnecessary often failed to influence clinicians to avoid an initial prescription or de-escalate antibiotics early as they considered their use to be necessary to protect the patient and themselves, “erring on the side of caution.” Some clinicians described cases where antibiotics would be prescribed for a sick patient regardless of test results because, in their opinion, it fits with the clinical picture—“treating the patient, not the result.” Our findings illustrate a tension between prescribing guidelines and clinicians’ “mindlines,” characterized by previous experiences. This highlights the need for a “technology plus” approach, recognizing the challenges clinicians face when applying technological solutions to patient care.IMPORTANCERapid molecular diagnostic tests for pathogens and resistance genes may improve antibiotic-prescribing decisions and stewardship. However, clinicians’ desire to protect their patients with antibiotics often overrides more distal concerns about possible resistance selection, limiting the application of these tests in practice. Findings underscore the challenge of changing prescribing decisions based on technical results or guidelines, highlighting factors such as clinicians’ previous experience and “knowledge in practice” as more proximal drivers of these decisions. Implementation strategies for technological solutions to antimicrobial resistance must be “behaviorally intelligent,” recognizing the challenges facing clinicians when making “life or death” prescribing decisions.CLINICAL TRIALSThis study is registered with ISRCTN as ISRCTN16483855.

This study aimed to explore how individuals with obesity, who have a positive body image (an accepting and favourable view of the body), maintain this positive image in the face of weight stigma. A qualitative methodology was used to explore the experiences of 16 individuals (11 women; 5 men) using one-to-one semi-structured interviews. Four themes were developed using Thematic Analysis: Experiences of stigma, Self-evaluative cognitive strategies, Social Behavioural strategies, and What Helps? Themes included strategies that reflect self-affirmation, defensive self-protection, and social support. The results also included strategies not found in previous research, such as confronting the source of the stigmatization. Moreover, no negative strategies, such as eating or self-harm, were reported. In addition, the participants spoke of the positive effect of social support but did not report seeking this support, which suggests that perceived social support may be more useful than enacted support.

Purpose: To explore how individuals with overweight and obesity living in the UK respond to the public health and media messaging surrounding COVID-19 and obesity. Design: Qualitative interview study with a think-aloud protocol. 10 participants self-reported to have overweight, obesity, or as actively trying to lose weight were recruited through social media, were asked to think-aloud whilst exposed to four sets of public health and media materials describing the link between COVID-19 and obesity. Interviews were conducted over zoom, recorded and transcribed verbatim. Findings: Three primary themes were identified through thematic analysis: ‘flawed messaging’, ‘COVID-19 as a teachable moment’, and ‘barriers to change’. Transcending these themes was the notion of balance. Whilst the messaging around COVID-19 and obesity was deemed problematic, for some it was a teachable moment to facilitate change when their future self and physical health was prioritised. Yet, when focusing on their mental health in the present participants felt more overwhelmed by the barriers and were less likely to take the opportunity to change. Originality: This study offers a novel and useful insight into how the public health and media messaging concerning COVID-19 risk and obesity is perceived by those with overweight and obesity. Practical implications: Findings hold implications for public health messaging, highlighting the need for balance between being educational and informative but also supportive, so as to achieve maximum efficacy.

Research exploring weight bias and weight bias internalisation (WBI) is grounded upon a number of core measures. This study aimed to evaluate whether operationalisations of these measures matched their conceptualisations in the literature. A ‘closed card-sorting task’ methodology was used whereby participants sorted items from the most commonly used measures into pre-defined categories, reflecting weight bias and non-weight bias domains. Findings indicated a high degree of congruence between WBI conceptualisations and operationalisations. However, there was less congruence between weight bias conceptualisations and operationalisations, with scale-items largely being sorted into non-weight bias domains. Recommendations for scale modifications and developments are made, and a new amalgamated weight bias scale (AWBS) is presented.

This experimental study investigated the role of BMI on the impact of weight bias versus body positivity terminology on behavioural intentions and beliefs about obesity. Participants (n=332) were randomly allocated to two conditions to receive a vignette depicting an image of a person with obesity using either weight bias (n=164) or body positivity (n=168) terminology. Participants were divided into 3 groups based upon their BMI category (normal weight n=173; overweight n=92; obese n=64). They then completed measures of behavioural intentions, obesity illness beliefs and fat phobia. Although there were several differences in beliefs by BMI group, the results showed no differences between weight bias or body positivity terminology on any measures. There were, however, significant BMI group by condition interactions for beliefs about obesity relating to personal control and treatment control. Post hoc tests showed that weight bias resulted in reduced personal control in the obese BMI group compared to other participants. Weight bias also resulted in higher personal control over obesity in normal weight individuals compared to body positivity. People with obesity reported higher treatment control when exposed to weight bias compared to overweight participants, whereas normal weight participants reported greater treatment control when exposed to body positivity compared to both other groups. To conclude, the impact of weight bias and body positivity information is not universal and varies according to the BMI of the audience and the outcome being measured; whereas people of normal weight may benefit from weight bias there is no evidence that obese people benefit from body positivity. Implications for the prevention and treatment of obesity are discussed.

Whilst the consequences of weight bias and weight bias internalisation (WBI) have been explored, less is known about the factors contributing to their development. Some research has explored the role of social exposure in weight bias and WBI but has been limited in its definition of exposure and focused solely on western countries. The present study therefore aimed to assess the role of social exposure defined in terms of both population and personal exposure in predicting weight bias and WBI, in an international sample. Participants (N = 1041) from 33 countries, aged 18-85 years completed online measures of demographics, weight bias, WBI, and population and personal social exposure. Population exposure was defined using national obesity prevalence data from the World Health Organisation to classify countries as low (obesity rates ≤19.9%; n = 162), medium (20.0-29.9%; n = 672) or high prevalence (≥30%; n = 192). Personal exposure was defined in terms of personal contact and health and attractiveness normalisation. Using regression analysis, greater weight bias was significantly predicted by being younger, male, less educated, and personal exposure in terms of normalisation beliefs that thinner body types are healthier and more attractive, greater daily exposure and overall exposure to thinner friends. The strongest predictors of weight bias (adj R  = 13%) were gender (β = -0.24, p 

The recent rise in body dissatisfaction and weight bias has led to a call to the media to increase the diversity of their imagery, in efforts to challenge the thin-ideal. Therefore, this study aimed to evaluate the effects of both body diversity and thin-ideal interventions on health outcomes. Female participants (n = 160) were randomly allocated into an intervention group: body diversity; thin-ideal; control. They completed measures of body satisfaction, body compassion, internalisation of the thin-ideal, weight bias and behavioural intentions at baseline and post-intervention. The results showed significant differences between groups for weight bias and intentions to eat healthily. Specifically, those in the body diversity intervention group reported a greater reduction in weight bias compared to the other conditions. Further, those in the thin-ideal intervention group reported a greater increase in intentions to eat healthily compared to the other conditions. There were no differences between groups for body satisfaction, body compassion, internalisation of the thin-ideal and behavioural intentions to exercise and manage weight. In conclusion, exposure to body diversity images reduced weight bias whereas exposure to the thin-ideal promoted intentions towards healthy eating. These findings therefore offer empirical evidence for the impact of using different types of imagery to change different health outcomes.

Whilst overeating is often influenced by others in an implicit way, people may also explicitly encourage others to overeat. This has been labelled being “a Feeder” but to date, this more deliberate trait remains neglected. This study aimed to conceptualize being “a Feeder” in terms of motivations and behaviour and to operationalize this construct with a new measurement tool through five stages with three discrete samples. Using the definition of a Feeder as “someone who offers others food even when they are not hungry” a preliminary qualitative study (n = 5) clarified the behaviour of a Feeder and revealed six motivations for such feeder behaviour. These six motivational dimensions and the feeder behaviours were operationalized with individual items and the psychometric properties of the scale were assessed using two independent samples (n = 116; n = 113). The final 27‐item measure consisted of six motivational factors (affection; waste avoidance; status; hunger avoidance; offloading; manners) and one behaviour factor, all with good internal consistency (α  ≥ .7). The two samples were then merged (n = 229) to describe motivations and behaviour and to assess the association between them. The best predictors of feeder behaviour were love, offloading, manners and status. This new Feeder questionnaire has a strong factor structure and good internal consistency and could be used for further research or clinical practice.