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During the COVID-19 pandemic, the United Kingdom implemented physical distancing measures to minimize viral transmission, which may have adversely impacted health and wellbeing. Evidence suggests that social support may be key to mitigating against adverse health impacts of such measures, particularly when such social support is identity-based. In this longitudinal study, we examined the role of social identity and perceived social support in mental and physical health outcomes during the COVID-19 pandemic. Participants completed a survey at 4 time points during the first year of the pandemic: May/June 2020 (T1; N = 443); September/October 2020 (T2; N = 235); December 2020/January 2021 (T3; N = 243); and April 2021 (T4; N = 206). Results showed that at each time point, social support was predicted by identification with multiple groups before COVID-19, identity continuity, and identification with communities. Higher identity continuity and identification with communities both predicted greater mental and physical health at the same time point, mediated by perceived social support. Interestingly, higher identity continuity and identification with communities predicted higher social support at the same time point, which in turn predicted worse mental and physical health outcomes at the subsequent time point. Findings are discussed in relation to the context of the first year of the pandemic and the changing nature of societal restrictions across the four survey time points.

BackgroundHealthcare workers (HCWs) are frontline responders to emergency infectious disease outbreaks such as COVID-19. To avoid the rapid spread of disease, adherence to protective measures is paramount. We investigated rates of correct use of personal protective equipment (PPE), hand hygiene and physical distancing in UK HCWs who had been to their workplace at the start of the COVID-19 pandemic and factors associated with adherence.MethodsWe used an online cross-sectional survey of 1035 UK healthcare professionals (data collected 12–16 June 2020). We excluded those who had not been to their workplace in the previous 6 weeks, leaving us with a sample size of 831. Respondents were asked about their use of PPE, hand hygiene and physical distancing in the workplace. Frequency of uptake was reported descriptively; adjusted logistic regressions were used to separately investigate factors associated with adherence to use of PPE, maintaining good hand hygiene and physical distancing from colleagues.ResultsAdherence to personal protective measures was suboptimal (PPE use: 80.0%, 95% CI 77.3 to 82.8; hand hygiene: 67.8%, 95% CI 64.6 to 71.0; coming into close contact with colleagues: 74.7%, 95% CI 71.7 to 77.7). Adherence to PPE use was associated with having received training about health and safety in the workplace for COVID-19, greater perceived social pressure to adopt the behaviour and availability of PPE. Non-adherence was associated with fatalism about COVID-19 and greater perceived difficulty of adopting protective measures. Workplace design using markings to facilitate distancing was associated with adherence to physical distancing.ConclusionsUptake of personal protective behaviours among UK HCWs at the start of the pandemic was variable. Factors associated with adherence provide insight into ways to support HCWs to adopt personal protective behaviours, such as ensuring that adequate PPE is available and designing workplaces to facilitate physical distancing.

Background As of March 2020, the UK public were instructed to work from home and as a result, nearly half of those in employment did so during the following month. Pre-pandemic, around 5% of workers chose to work from home; it was often seen as advantageous, for example due to eliminating commuting time and increasing flexibility. However, homeworking also had negative connotations, for example, blurred boundaries between work and home life due to a sense of constant connectivity to the workplace. Therefore, understanding the psychological impact of working from home in an enforced and prolonged manner due to the COVID-19 pandemic is important. Therefore, this review sought to establish the impact of working from home in terms of mental health and productivity. Methods In January 2022, literature searches were conducted across four electronic databases: Medline, Embase, PsycInfo and Web of Science. In February 2022 grey literature searches were conducted using Google Advanced Search, NHS Evidence; Gov.uk Publications; and the British Library directory of online doctoral theses. Published and unpublished literature which collected data after March 2020, included participants who experienced working from home for at least some of their working hours, and detailed the impact of homeworking in relation to mental health or productivity were included. Results In total 6,906 citations were screened and 25 papers from electronic databases were included. Grey literature searching resulted in two additional papers. Therefore, 27 studies were included in this review. Findings suggest the impact of homeworking on mental health and productivity varies considerably, suggesting a complex relationship, with many factors having an influence on the relationship. Conclusion We found that there was no clear consensus as to the impact of working from home on mental health or productivity. However, there are indications that those who start homeworking for the first time during a pandemic are at risk of poor productivity, as are those who experience poor mental health. Suggestions for future research are suggested.

IntroductionAntimicrobial stewardship (AMS) strategies, such as intravenous-to-oral switch (IVOS), promote optimal antimicrobial use, contributing to safer and more effective patient care and tackling antimicrobial resistance (AMR).AimThis study aimed to achieve nationwide multidisciplinary expert consensus on antimicrobial IVOS criteria for timely switch in hospitalised adult patients and to design an IVOS decision aid to operationalise agreed IVOS criteria in the hospital setting.MethodA 4-step Delphi process was chosen to achieve expert consensus on IVOS criteria and decision aid; it included Step One) Pilot/1stround questionnaire, Step Two) Virtual meeting, Step Three) 2ndround questionnaire and Step 4) Workshop. This study follows the Appraisal of Guidelines for Research and Evaluation II instrument checklist.ResultsStep One questionnaire of 42 IVOS criteria had 24 respondents, 15 of whom participated in Step Two, where 37 criteria were accepted for the next step. Step Three had 242 respondents (England n=195, Northern Ireland n=18, Scotland n=18, Wales n=11); 27 criteria were accepted. Step Four had 48 survey respondents and 33 workshop participants; where consensus was achieved for 24 criteria and comments received on a proposed IVOS decision aid. Research recommendations include the use of evidence-based standardised IVOS criteria.Discussion and ConclusionThis study achieved nationwide expert consensus on antimicrobial IVOS criteria for timely switch in the hospitalised adult population. For criteria operationalisation, an IVOS decision aid was developed. Further research is required to provide clinical validation of the consensus IVOS criteria and to expand this work into the paediatric and international settings.

IntroductionHot and cold weather events are increasingly becoming a global burden resulting in premature and preventable morbidity and mortality, particularly in vulnerable groups such as older people and people with chronic health conditions. However, risk perception regarding weather is generally poor among vulnerable groups which often acts as a barrier to the uptake of critical health-protective behaviours. A more cohesive understanding of determinants of risk perception is needed to inform public health risk communication and behaviour change interventions that promote protective health behaviours. This scoping literature review aimed to understand factors influencing perception of personal health risks in vulnerable groups as a result of exposure to hot and cold weather events.MethodsA five-stage scoping review framework was followed. Searches were run across Medline, PsychInfo, Web of Science and EMBASE. Papers were included if they provided rationale for risk perceptions in vulnerable groups in indoor/domestic environments and focussed on samples from OECD countries.ResultsIn total, 13 out of 15,554 papers met the full inclusion criteria. The majority of papers focused on hot weather events: one study exclusively examined cold weather events and one study addressed both cold and hot weather events. Included papers focused on older adults aged 65+ years. The papers identified eight factors that were associated with older adults' personal health risk perception of hot and cold weather events: (1) Knowledge of the relationship between hot/cold weather and health risks, (2) presence of comorbidities, (3) age and self-identity, (4) perceived weather severity, (5) Beliefs associated with regional climate, (6) past experience with weather, (7) misconceptions of effectiveness of protective behaviours, and (8) external locus of control.ConclusionsFuture research should explore risk communication methods by implementing the identified risk perception determinants from this review into health protection interventions targeting older adults. Further understanding is needed regarding risk perceptions in non-elderly vulnerable groups, for examples individuals with chronic diseases or disabilities.

Seasonal changes in the measured CO2 levels at four schools are herein presented through a set of indoor air quality metrics that were gathered during the height of the COVID-19 pandemic in the UK. Data from non-intrusive environmental monitoring units were remotely collected throughout 2021 from 36 naturally ventilated classrooms at two primary schools and two secondary schools in England. Measurements were analysed to assess the indoor CO2 concentration and temperature. Relative to UK school air quality guidance, the CO2 levels within classrooms remained relatively low during periods of warmer weather, with elevated CO2 levels being evident during the colder seasons, indicating lower levels of per person ventilation during these colder periods. However, CO2 data from the cold period during the latter part of 2021, imply that the per person classroom ventilation levels were significantly lower than those achieved during a similarly cold weather period during the early part of the year. Given that the classroom architecture and usage remained unchanged, this finding suggests that changes in the ventilation behaviours within the classrooms may have altered, and raises questions as to what may have given rise to such change, in a year when, messaging and public concerns regarding COVID-19 varied within the UK. Significant variations were observed when contrasting data, both between schools, and between classrooms within the same school building; suggesting that work is required to understand and catalogue the existing ventilation provisions and architecture within UK classrooms, and that more work is required to ascertain the effects of classroom ventilation behaviours.

A lesson identified from the COVID-19 pandemic is that we need to extend existing best practice for intervention development by establishing better methods of rapidly coproducing public health interventions and messaging to support all population groups to protect themselves and their communities, together with better methods of rapidly evaluating interventions to determine which are acceptable and effective. This paper describes the Agile Co-production and Evaluation (ACE) framework, which is intended to provide a focus for investigating new ways of rapidly developing effective interventions and messaging by combining co-production methods with large-scale testing and/or real-world evaluation. We briefly review some of the participatory, qualitative and quantitative methods that could potentially be combined and propose a research agenda to further develop, refine and validate packages of methods in a variety of public health contexts to determine which combinations are feasible, cost-effective and achieve the goal of improving health and reducing health inequalities.

We examined whether varying information about long COVID would affect expectations about the illness.In October 2021, we conducted a 2 (Illness Description: long COVID vs. ongoing COVID-19 recovery) × 2 (Symptom Uncertainty: uncertainty emphasized vs. not emphasized) × 2 (Efficacy of Support: enhanced vs. basic support) between-subjects randomized online experimental study. Participants (We ran a series of 2 × 2 × 2 ANOVAs on the outcome variables. We found a main effect of illness description: individuals reported longer symptom duration and less illness coherence when the illness was described as long COVID (compared to ongoing COVID-19 recovery). There was a main effect of symptom uncertainty: when uncertainty was emphasized, participants reported longer expected symptom duration (p.001), less treatment control (Communications around long COVID should avoid emphasizing symptom uncertainty and aim to provide people with access to additional support and information on how they can facilitate their recovery. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

IntroductionCulturally appropriate interventions to promote COVID-19 health protective measures among Black and South Asian communities in the UK are needed. We aim to carry out a preliminary evaluation of an intervention to reduce risk of COVID-19 comprising a short film and electronic leaflet.Methods and analysisThis mixed methods study comprises (1) a focus group to understand how people from the relevant communities interpret and understand the intervention’s messages, (2) a before-and-after questionnaire study examining the extent to which the intervention changes intentions and confidence to carry out COVID-19 protective behaviours and (3) a further qualitative study exploring the views of Black and South Asian people of the intervention and the experiences of health professionals offering the intervention. Participants will be recruited through general practices. Data collection will be carried out in the community.Ethics and disseminationThe study received Health Research Authority approval in June 2021 (Research Ethics Committee Reference 21/LO/0452). All participants provided informed consent. As well as publishing the findings in peer-reviewed journals, we will disseminate the findings through the UK Health Security Agency, NHS England and the Office for Health Improvement and Disparities and ensure culturally appropriate messaging for participants and other members of the target groups.

The ability of the public to remain psychologically resilient in the face of public health emergencies and disasters (such as the COVID-19 pandemic) is a key factor in the effectiveness of a national response to such events. Community resilience and social capital are often perceived as beneficial and ensuring that a community is socially and psychologically resilient may aid emergency response and recovery. This review presents a synthesis of literature which answers the following research questions: How are community resilience and social capital quantified in research?; What is the impact of community resilience on mental wellbeing?; What is the impact of infectious disease outbreaks, disasters and emergencies on community resilience and social capital?; and, What types of interventions enhance community resilience and social capital? A scoping review procedure was followed. Searches were run across Medline, PsycInfo, and EMBASE, with search terms covering community resilience or social capital, public health emergencies, and mental health. 26 papers met the inclusion criteria. The majority of retained papers originated in the USA, used a survey methodology to collect data, and involved a natural disaster. There was no common method of measuring community resilience or social capital. The association between community resilience and social capital with mental health was regarded as positive in most cases. However, we found that community resilience, and social capital, were initially negatively impacted by public health emergencies and enhanced by social group activities. Several key recommendations are proposed based on the outcomes from the review, which include: the need for a standardised and validated approach to measuring community resilience or social capital; that there should be enhanced effort to improve preparedness to public health emergencies in communities by gauging current levels of community resilience and social capital; that community resilience and social capital should be bolstered if areas are at risk of disasters or public health emergencies; the need to ensure that suitable short-term support is provided to communities with high resilience in the immediate aftermath of a public health emergency or disaster; the importance of conducting robust evaluation of community resilience initiatives deployed during the COVID-19 pandemic.

BackgroundStaff working in intensive care units (ICUs) have faced significant challenges during the COVID-19 pandemic which have the potential to adversely affect their mental health.AimsTo identify the rates of probable mental health disorder in staff working in ICUs in nine English hospitals during June and July 2020.MethodsAn anonymized brief web-based survey comprising standardized questionnaires examining depression, anxiety symptoms, symptoms of post-traumatic stress disorder (PTSD), well-being and alcohol use was administered to staff.ResultsSeven hundred and nine participants completed the surveys comprising 291 (41%) doctors, 344 (49%) nurses and 74 (10%) other healthcare staff. Over half (59%) reported good well-being; however, 45% met the threshold for probable clinical significance on at least one of the following measures: severe depression (6%), PTSD (40%), severe anxiety (11%) or problem drinking (7%). Thirteen per cent of respondents reported frequent thoughts of being better off dead, or of hurting themselves in the past 2 weeks. Within the sample used in this study, we found that doctors reported better mental health than nurses across a range of measures.ConclusionsWe found substantial rates of probable mental health disorders, and thoughts of self-harm, amongst ICU staff; these difficulties were especially prevalent in nurses. Whilst further work is needed to better understand the real level of clinical need amongst ICU staff, these results indicate the need for a national strategy to protect the mental health, and decrease the risk of functional impairment, of ICU staff whilst they carry out their essential work during COVID-19.

Background COVID-19 vaccines remain central to the UK government’s plan for tackling the COVID-19 pandemic. Average uptake of 3 doses in the United Kingdom stood at 66.7% as of March 2022; however, this rate varies across localities. Understanding the views of groups who have low vaccine uptake is crucial to guide efforts to improve vaccine uptake. Objective This study aims to understand the public’s attitudes toward COVID-19 vaccines in Nottinghamshire, United Kingdom. Methods A qualitative thematic analysis of social media posts from Nottinghamshire-based profiles and data sources was conducted. A manual search strategy was used to search the Nottingham Post website and local Facebook and Twitter accounts from September 2021 to October 2021. Only comments in the public domain and in English were included in the analysis. Results A total of 3508 comments from 1238 users on COVID-19 vaccine posts by 10 different local organizations were analyzed, and 6 overarching themes were identified: trust in the vaccines, often characterized by a lack of trust in vaccine information, information sources including the media, and the government; beliefs about safety including doubts about the speed of development and approval process, the severity of side effects, and belief that the ingredients are harmful; belief that the vaccines are not effective as people can still become infected and spread the virus and that the vaccines may increase transmission through shedding; belief that the vaccines are not necessary due to low perceived risk of death and severe outcomes and use of other protective measures such as natural immunity, ventilation, testing, face coverings, and self-isolation; individual rights and freedoms to be able to choose to be vaccinated or not without judgement or discrimination; and barriers to physical access. Conclusions The findings revealed a wide range of beliefs and attitudes toward COVID-19 vaccination. Implications for the vaccine program in Nottinghamshire include communication strategies delivered by trusted sources to address the gaps in knowledge identified while acknowledging some negatives such as side effects alongside emphasizing the benefits. These strategies should avoid perpetuating myths and avoid using scare tactics when addressing risk perceptions. Accessibility should also be considered with a review of current vaccination site locations, opening hours, and transport links. Additional research may benefit from using qualitative interviews or focus groups to further probe on the themes identified and explore the acceptability of the recommended interventions.

Climate change requires urgent action; however, it can be challenging to identify individual-level behaviours that should be prioritised for maximum impact. The study aimed to prioritise climate change mitigation behaviours according to their impacts on climate change and public health, and to identify associated barriers and facilitators—exploring the impact of observed behaviour shifts associated with COVID-19 in the UK. A three-round Delphi study and expert workshop were conducted: An expert panel rated mitigation behaviours impacted by COVID-19 in relation to their importance regarding health impacts and climate change mitigation using a five-point Likert scale. Consensus on the importance of target behaviours was determined by interquartile ranges. In total, seven target behaviours were prioritised: installing double/triple glazing; installing cavity wall insulation; installing solid wall insulation; moving away from meat/emission heavy diets; reducing the number of cars per household; walking shorter journeys; and reducing day/weekend leisure car journeys. Barriers related to the costs associated with performing behaviours and a lack of complementary policy-regulated subsidies. The target behaviours are consistent with recommendations from previous research. To ensure public uptake, interventions should address behavioural facilitators and barriers, dovetail climate change mitigation with health co-benefits and account for the long-term impacts of COVID-19 on these behaviours.

Objectives Infectious disease outbreaks can be distressing for everyone, especially those deemed to be particularly vulnerable such as pregnant women, who have been named a high-risk group in the current COVID-19 pandemic. This paper aimed to summarise existing literature on the psychological impact of infectious disease outbreaks on women who were pregnant at the time of the outbreak. Study design The design of this study is a rapid review. Methods Five databases were searched for relevant literature, and main findings were extracted. Results Thirteen articles were included in the review. The following themes were identified: negative emotional states; living with uncertainty; concerns about infection; concerns about and uptake of prophylaxis or treatment; disrupted routines; non-pharmaceutical protective behaviours; social support; financial and occupational concerns; disrupted expectations of birth, prenatal care and postnatal care and sources of information. Conclusions Pregnant women have unique needs during infectious disease outbreaks and could benefit from up-to-date, consistent information and guidance; appropriate support and advice from healthcare professionals, particularly with regards to the risks and benefits of prophylaxis and treatment; virtual support groups and designating locations or staff specifically for pregnant women., Highlights • Pregnant women may be particularly susceptible to distress during pandemics. • Infection fears and prophylaxis concerns may exacerbate distress. • Disrupted routines, financial concerns and uncertainty are also stressors. • Disrupted expectations of birth and related healthcare may be distressing. • Pregnant women may benefit from clear information/guidance and support groups.

BACKGROUND COVID-19 vaccines remain central to the UK government’s plan for tackling the COVID-19 pandemic. Average uptake of 3 doses in the United Kingdom stood at 66.7% as of March 2022; however, this rate varies across localities. Understanding the views of groups who have low vaccine uptake is crucial to guide efforts to improve vaccine uptake. OBJECTIVE This study aims to understand the public’s attitudes toward COVID-19 vaccines in Nottinghamshire, United Kingdom. METHODS A qualitative thematic analysis of social media posts from Nottinghamshire-based profiles and data sources was conducted. A manual search strategy was used to search the Nottingham Post website and local Facebook and Twitter accounts from September 2021 to October 2021. Only comments in the public domain and in English were included in the analysis. RESULTS A total of 3508 comments from 1238 users on COVID-19 vaccine posts by 10 different local organizations were analyzed, and 6 overarching themes were identified: trust in the vaccines, often characterized by a lack of trust in vaccine information, information sources including the media, and the government; beliefs about safety including doubts about the speed of development and approval process, the severity of side effects, and belief that the ingredients are harmful; belief that the vaccines are not effective as people can still become infected and spread the virus and that the vaccines may increase transmission through shedding; belief that the vaccines are not necessary due to low perceived risk of death and severe outcomes and use of other protective measures such as natural immunity, ventilation, testing, face coverings, and self-isolation; individual rights and freedoms to be able to choose to be vaccinated or not without judgement or discrimination; and barriers to physical access. CONCLUSIONS The findings revealed a wide range of beliefs and attitudes toward COVID-19 vaccination. Implications for the vaccine program in Nottinghamshire include communication strategies delivered by trusted sources to address the gaps in knowledge identified while acknowledging some negatives such as side effects alongside emphasizing the benefits. These strategies should avoid perpetuating myths and avoid using scare tactics when addressing risk perceptions. Accessibility should also be considered with a review of current vaccination site locations, opening hours, and transport links. Additional research may benefit from using qualitative interviews or focus groups to further probe on the themes identified and explore the acceptability of the recommended interventions.

ObjectivesIndividuals who receive a negative lateral flow coronavirus test result may misunderstand it as meaning ‘no risk of infectiousness’, giving false reassurance. This experiment tested the impact of adding information to negative test result messages about residual risk and the need to continue protective behaviours.Design.4 (residual risk) × 2 (post-test result behaviours) between-subjects design.Setting.Online.Participants1200 adults from a representative UK sample recruited via Prolific (12–15 March 2021).InterventionsParticipants were randomly allocated to one of eight messages. Residual risk messages were: (1) ‘Your coronavirus test result is negative’ (control); (2) message 1 plus ‘It’s likely you were not infectious when the test was done’ (current NHS Test & Trace (T&T); (3) message 2 plus ‘But there is still a chance you may be infectious’ (elaborated NHS T&T); and (4) message 3 plus infographic depicting residual risk (elaborated NHS T&T+infographic). Each message contained either no additional information or information about the need to continue following guidelines and protective behaviours.Outcome measures(1) Proportion understanding residual risk of infectiousness and (2) likelihood of engaging in protective behaviours (scales 1–7).ResultsThe control message decreased understanding relative to the current NHS T&T message: 54% versus 71% (Adjusted Odds Ratio (AOR)=0.56 95% CI 0.34 to 0.95, p=0.030). Understanding increased with the elaborated NHS T&T (89%; AOR=3.25 95% CI 1.64 to 6.42, p=0.001) and elaborated NHS T&T+infographic (91%; AOR=5.16 95% CI 2.47 to 10.82, p2(1)=0.18, p=0.669), being high (M=6.4, SD=0.9) across the sample.ConclusionsA considerable proportion of participants misunderstood the residual risk following a negative test result. The addition of a single sentence (‘But there is still a chance you may be infectious’) to current NHS T&T wording increased understanding of residual risk.Trial registration numberOSF: https://osf.io/byfz3/

ObjectivesWe examined whether providing different types of information about Long COVID would affect expectations about the illness.DesignA 2 (Illness description: Long COVID vs ongoing COVID-19 recovery) x 2 (Illness uncertainty: uncertainty emphasised vs uncertainty not emphasised) x 2 (Efficacy of support: enhanced support vs basic support) between-subjects randomised online experimental study.SettingThe online platform Prolific, collected in October 2021.ParticipantsA representative sample of 1110 members of the public in the UK.InterventionsParticipants were presented with a scenario describing a positive COVID-19 test result and then presented with one of eight scenarios describing a Long COVID diagnosis.Primary and Secondary Outcome MeasuresVarious outcome measures relating to illness expectations were captured including: symptom severity, symptom duration, quality of life, personal control, treatment control and illness coherence.ResultsWe ran a series of 2 × 2 × 2 ANOVAs on the outcome variables. We found a main effect of illness description: individuals reported longer symptom duration and less illness coherence when the illness was described as Long COVID (compared to ongoing COVID-19 recovery). There was a main effect of illness uncertainty: when uncertainty was emphasised, participants reported longer expected symptom duration, less treatment control, and less illness coherence than when uncertainty was not emphasised. There was also a main effect of efficacy of support: participants reported higher personal control and higher treatment control when support was enhanced (compared to basic support). We also found an interaction between illness description and efficacy of support: when support was enhanced, participants reported less illness coherence for Long COVID (compared to ongoing COVID-19 recovery).ConclusionsCommunications around Long COVID should not emphasise symptom uncertainty and should provide people with information on how they can facilitate their recovery and where they can access additional support. The findings also suggest that use of the term ongoing COVID-19 recovery, where possible, may reduce negative expectations associated with the illness.Strengths and Limitations of this studyThis is one of the first experimental designed studies to assess the impact of different types of communication about Long COVID.Participants were a UK representative sample, although these findings are not necessarily applicable to all population groups (i.e., ethnic minorities).This study is one of the first applications of the IPQ-R in a hypothetical, online experiment, with high reliability.This was an online experiment, with hypothetical scenarios and participants with no experience of COVID-19 or Long COVID, therefore outcomes may be different in a real-world context.

Vaccination is vital to protect the public against COVID-19. The aim of this systematic review is to identify and evaluate the effectiveness of interventions to increase COVID-19 vaccine uptake. We searched a range of databases (Embase, Medline, Psychology & Behavioral Science, PsycInfo, Web of Science and NIH Preprints Portfolio) from March 2020 to July 2021 for studies which reported primary quantitative or qualitative research on interventions to increase COVID-19 vaccine uptake. Outcome measures included vaccination uptake and reported intention to vaccinate. Reviews, position papers, conference abstracts, protocol papers and papers not in English were excluded. The NHLBI quality assessment was used to assess risk of bias. In total, 39 studies across 33 papers met the inclusion criteria. A total of 28 were assessed as good quality. They included interventions relating to communication content, communication delivery, communication presentation, policy or vaccination delivery, with 7 measuring vaccination uptake and 32 measuring vaccination intention. A narrative synthesis was conducted, which highlighted that there is reasonable evidence from studies investigating real behaviour suggesting that personalising communications and sending booking reminders via text message increases vaccine uptake. Findings on vaccination intention are mixed but suggest that communicating uncertainty about the vaccine does not decrease intention, whereas making vaccination mandatory could have a negative impact. Although much of the research used experimental designs, very few measured real behavioural outcomes. Understanding which interventions are most effective amongst vaccine-hesitant populations and in the context of booster vaccinations will be important as vaccine roll outs continue across the world.

BackgroundThe COVID-19 pandemic generated a surge of critically ill patients greater than the NHS’ capacity. Additionally, there have been multiple well-documented impacts associated with the national COVID-19 pandemic surge on ICU workers, including an increased prevalence of mental health disorders on a scale potentially sufficient to impair high-quality care delivery.AimTo identify prevalence of probable mental health disorders and functional impairment. As well as establish demographic and professional predictors of probable mental health disorders and functional impairment in ICU staff between November 2020 to April 2021.MethodsEnglish ICU staff were surveyed before, during and after the winter 2020/2021 surge using a survey which comprised of validated measures of mental health.Results6080 surveys were completed, by nurses (57.5%), doctors (27.9%), and other healthcare staff (14.5%). Reporting probable mental health disorders increased from 51% (prior to), to 64% (during) and then dropped to 46% (after). Younger, less experienced and nursing staff were most likely to report probable mental health disorders. Additionally, during and after the winter, over 50% of participants met threshold criteria for functional impairment. Staff who reported probable post-traumatic stress disorder, anxiety or depression were more likely to meet threshold criteria for functional impairment.ConclusionsThe winter of 2020/2021 was associated with an increase in poor mental health outcomes and functional impairment during a period of peak caseload. These effects are likely to impact on patient care outcomes and the longer-term resilience of the healthcare workforce.

BackgroundLarge-scale vaccination is fundamental to combatting COVID-19. In March 2021, the UK’s vaccination programme had delivered vaccines to large proportions of older and more vulnerable population groups; however, there was concern that uptake would be lower among young people. This research was designed to elicit the preferences of 18-29-year-olds with respect to key delivery characteristics.MethodsFrom 25 March - 2 April 2021, an online sample of 2,021 UK adults aged 18-29 years participated in a Discrete Choice Experiment. Participants made six choices, each between two SMS invitations to get vaccinated; each choice also had an opt-out. Each invitation had four attributes (1 x 5 levels, 3 x 3 levels): delivery mode, appointment timing, proximity, and SMS sender. These were systematically varied according to a d-optimal fractional factorial design. Order of presentation was randomised for each participant. Responses were analysed using a mixed logit model.ResultsThe logit model revealed a large alternative-specific constant (β = 1.385, SE = 0.067, p ConclusionsThe results indicated that the existing configuration of the UK’s mass vaccination programme was well-placed to deliver vaccines to 18-29-year-olds; however, some adjustments might enhance acceptance. Local pharmacies were not preferred; long travel times were a disincentive but close proximity (0-15 minutes from one’s premises) was not necessary; and either the ‘NHS’ or ‘Your GP’ would serve as adequate invitation sources. This research informed COVID-19 policy in the UK, and contributes to a wider body of Discrete Choice Experiment evidence on citizens’ preferences, requirements and predicted behaviours regarding COVID-19.

ObjectivesIndividuals who receive a negative lateral flow coronavirus (Covid-19) test result may misunderstand it as meaning ‘no risk of infectiousness’, giving false reassurance. This experiment tested the impact of adding information to negative test result messages about (a) residual risk and (b) need to continue protective behaviours.Design4 (residual risk) × 2 (post-test result behaviours) between-subjects design.SettingOnline.Participants1200 adults from a representative UK sample recruited via Prolific (12-15 March 2021).InterventionsParticipants were randomly allocated to one of eight messages. Residual risk messages were: 1) ‘Your coronavirus test result is negative’ (control); 2) Message 1 plus ‘It’s likely you were not infectious when the test was done’ (Current NHS Test & Trace); 3) Message 2 plus ‘But there is still a chance you may be infectious’ (Elaborated NHS T&T); 4) Message 3 plus infographic depicting residual risk (Elaborated NHS T&T + infographic). Each message contained either no additional information or information about behaviour, i.e. the need to continue following guidelines and protective behaviours.Outcome measures(i) proportion understanding residual risk of infectiousness and (ii) likelihood of engaging in protective behaviours (score range 0-7).ResultsThe control message decreased understanding relative to the current NHS T&T message: 54% vs 71% (AOR=0.37 95% CI [0.22, 0.61], pppF(1,1192)=0.43, p=.513), being high (M=6.4, SD=0.9) across the sample.ConclusionsThe addition of a single sentence (‘But there is still a chance you may be infectious’) to current NHS Test & Trace wording increased understanding of the residual risk of infection.Trial registrationOpen Science Framework: https://osf.io/byfz3/

Background Large-scale vaccination is fundamental to combatting COVID-19. In March 2021, the UK’s vaccination programme had delivered vaccines to large proportions of older and more vulnerable population groups; however, there was concern that uptake would be lower among young people. This research was designed to elicit the preferences of 18–29-year-olds regarding key delivery characteristics and assess the influence of these on intentions to get vaccinated, to inform planning for this cohort. Methods From 25 March to 2 April 2021, an online sample of 2012 UK adults aged 18–29 years participated in a Discrete Choice Experiment. Participants made six choices, each involving two SMS invitations to book a vaccination appointment and an opt-out. Invitations had four attributes (1 × 5 levels, 3 × 3 levels): delivery mode, appointment timing, proximity, and sender. These were systematically varied according to a d-optimal design. Responses were analysed using a mixed logit model. Results The main effects logit model revealed a large alternative-specific constant (β = 1.385, SE = 0.067, p p p p p = 0.028). Conclusions The results indicated that the existing configuration of the UK’s vaccination programme was well-placed to deliver vaccines to 18–29-year-olds; however, some adjustments might enhance acceptance. Local pharmacies were not preferred; long travel times were a disincentive but close proximity (0–15 min from one’s premises) was not necessary; and either the ‘NHS’ or ‘Your GP’ would serve as adequate invitation sources. This research informed COVID-19 policy in the UK, and contributes to a wider body of Discrete Choice Experiment evidence on citizens’ preferences, requirements and predicted behaviours regarding COVID-19.

Mathematical modelling is an important public health tool for aiding understanding the spread of respiratory infectious diseases, such as influenza or COVID-19, and for quantifying the effects of behavioural interventions. However, such models rarely explicitly appeals to theories of human behaviour to justify model assumptions. Here we propose a novel mathematical model of disease transmission via fomites (luggage trays) at airport security screening during an outbreak. Our model incorporates the self-protective behaviour of using hand sanitiser gel in line with the extended parallel processing model (EPPM) of behaviour.We find that changing model assumptions of human behaviour in line with the EPPM gives qualitatively different results on the optimal placement of hand sanitiser gels within an airport compared to the model with naive behavioural assumptions. Specifically, that it is preferable to place hand sanitiser gels after luggage screening in most scenarios, however in situations where individuals perceive high threat and low efficacy this strategy may need to be reviewed. This model demonstrates how existing behavioural theories can be incorporated into mathematical models of infectious disease.

Background: Experiencing a potentially traumatic event can put individuals at risk for both short-term and long-term mental health problems. While many psychological interventions exist for those who have experienced potentially traumatic events, there remains controversy about the best ways to support them. Objective: This review explores the effect of brief psychoeducational interventions after potentially traumatic experiences on adult recipients’ mental health, attitudes towards mental health, and trauma-related knowledge, as well as the perceived acceptability of psychoeducation. Methods: Four electronic databases were searched for relevant published literature. Results: Ten papers were included in the review. There was no evidence that psychoeducation was any more effective in terms of reducing mental health symptoms than other interventions or no intervention at all. There was some evidence that psychoeducation improved attitudes towards and knowledge of mental health immediately post-intervention; one study examined whether these improvements were sustained over the long term and found that they were not. However, psychoeducation was generally highly regarded by participants. Conclusions: This review did not find sufficient evidence to support routine use of brief psychoeducation as a stand-alone intervention., HIGHLIGHTS Brief single-session psychoeducation interventions delivered within a month of experiencing a potentially traumatic event do not appear to have a significant impact on mental health.

Observing the world on a global scale can help us understand better the context of problems that engage us all. In this paper, we propose a data-driven global observatory that puts together the different perspectives of media, science, statistics and sensing over heterogeneous data sources and text mining algorithms. We also discuss the implementation of this global observatory in the context of epidemic intelligence, monitoring the impact of the COVID-19 pandemic, and in the context of climate change, with a specific focus on water resource management. We will also discuss the value of this global solution in local contexts and priorities.

ObjectivesTo understand the experiences of those who underwent supported isolation as part of the response to the COVID-19 pandemic, after returning to the UK from Wuhan, China.DesignWe used semi-structured interviews to capture participants’ experiences and perceptions of supported isolation.SettingTelephone interviews carried out within approximately one month of an individual leaving supported isolation.Participants26 people who underwent supported isolation at either Arrowe Park Hospital (n = 18) or Kents Hill Park Conference Centre (n = 8) after being repatriated from Wuhan in January – February 2020.ResultsParticipants were willing to undergo supported isolation because they understood that it would protect themselves and others. Positive treatment by staff was fundamental to participants’ willingness to comply with isolation procedures. Despite the high level of compliance, participants expressed some uncertainty about what the process would involve.ConclusionsAs hotel quarantine is introduced across the UK for international arrivals, our findings suggest that those in charge should: communicate effectively before, during and after quarantine, emphasising why quarantine is important and how it will protect others; avoid enforcement and focus on supporting and promoting voluntary compliance; facilitate shared social experiences for those in quarantine; and ensure all necessary supplies are provided. Doing so will increase adherence and reduce any negative effects on wellbeing.

BackgroundIntensive Care Unit (ICU), anaesthetic and theatres staff have faced significant challenges during the COVID-19 pandemic which have the potential to adversely affect their mental healthAimsTo identify the rates of probable mental health disorder in ICU and anaesthetic staff in six English hospitals during June and July 2020MethodsAn anonymised brief web-based survey comprising standardised questionnaires examining depression, anxiety symptoms, symptoms of Post Traumatic Stress Disorder (PTSD), wellbeing and alcohol use was administered to staff.Results709 participants completed the surveys comprising 291 (41%) doctors, 344 (48.5%) nurses, and 74 (10.4%) other healthcare staff. Over half (58.8%) reported good wellbeing, however 45.4% met the threshold for probable clinical significance on at least one of the following measures: severe depression (6.3%), PTSD (39.5%), severe anxiety (11.3%) or problem drinking (7.2%). 13.4% of respondents reported frequent thoughts of being better off dead, or of hurting themselves in the past two weeks. We found that doctors consistently reported better mental health than nurses.ConclusionsWe found substantial rates of probable mental health disorders, and thoughts of self-harm, amongst ICU staff; these difficulties were especially prevalent in nurses. These results indicate the need for a national strategy to protect the mental health, and decrease the risk of functional impairment, of ICU staff whilst they carry out their essential work during COVID-19.Occ Med Statements: article should contain 3 statements (each max of 3 bullets of max 50 words each)What is already known about this subjectIntensive care unit (ICU) staff are regularly exposed to traumatic situations as part of their jobPrevious studies have shown them to be at risk of psychological and moral distressLittle is known about the mental health of ICU staff during the current pandemicWhat this study addsAlmost half of ICU staff report symptoms consistent with a probable diagnosis of post traumatic stress disorder, severe depression or anxiety or problem drinkingAround 1 in 7 ICU staff report recent thoughts of self-harm or of wanting to be better off deadNursing staff are more likely to report higher levels of distress than doctors or other clinical staffWhat impact this may have on practice or policyHealthcare managers need to prioritise staff mental health support and timely access to evidence based treatments for ICU staffSupervisors and managers should be aware that a substantial proportion of ICU staff may perform less well because of their current poor state of mental healthMore work is needed to understand whether the high levels of mental health symptoms identified in this study are truly indicative of high levels of clinical need for mental healthcare

Healthcare workers (HCWs) are frontline responders to emergency infectious disease outbreaks such as COVID-19. We investigated factors associated with adherence to personal protective behaviours in UK HCWs during the COVID-19 pandemic using an online cross-sectional survey of 1035 healthcare professionals in the UK. Data were collected between 12th and 16th June 2020. Adjusted logistic regressions were used to separately investigate factors associated with adherence to use of personal protective equipment, maintaining good hand hygiene, and physical distancing from colleagues. Adherence to personal protective measures was suboptimal (PPE use: 80.0%, 95% CI [77.3 to 82.8], hand hygiene: 67.8%, 95% CI [64.6 to 71.0], coming into close contact with colleagues: 74.7%, 95% CI [71.7 to 77.7]). Adherence to PPE use was associated with having adequate PPE resources, receiving training during the pandemic, lower perceived fatalism from COVID-19, higher perceived social norms and higher perceived effectiveness of PPE. Adherence to physical distancing was associated with one’s workplace being designed, using markings to facilitate physical distancing and receiving training during the pandemic. There were few associations with adherence to hand hygiene. Findings indicate HCWs should receive training on personal protective behaviours to decrease fatalism over contracting COVID-19 and increase perceived effectiveness of protective measures.

Background In some organizations, traumatic events via direct or indirect exposure are routine experiences. The National Institute for Health and Care Excellence reviews (2005; 2018) of post-traumatic stress disorder management in primary and secondary care did not address early interventions for trauma within emergency response organizations. Aims This scoping review was designed to identify research which evaluates the use of early interventions in emergency and other high-risk organizations following exposure to primary or secondary trauma and to report on the effectiveness of the early intervention models in common use. Methods A scoping review was conducted to examine early interventions for workers exposed to trauma, including emergency response, military, and humanitarian aid. Relevant data were extracted from the included studies and the outcomes were assessed using meta-ethnography. Results Fifty studies of mixed quality met the inclusion criteria for this review. A synthesis of study outcomes found that early interventions help emergency responders to manage post-incident trauma when they are delivered in a manner that (a) respects distinct organizational culture, (b) is supported by organizations and senior management, and (c) harnesses existing social cohesion and peer support systems within teams. Conclusion This review demonstrates that early interventions support emergency responders following exposure to trauma when these are tailored to the needs of the population, are supported by the host organization, and harness existing social cohesion and peer support processes within a team or unit. A number of recommendations for the delivery and evaluation of early interventions for psychological trauma in emergency response organizations were made.

Introduction The MIDAS (Meaningful Integration of Data Analytics and Services) project is developing a big data platform to maximize the use of health & social care data. The goal is to link data sources to support senior managers & policy makers in delivering services. The project includes 4 case studies, in 4 countries. As part of the evaluation, we need to understand the perspectives of the users, developers, and senior managers involved, and to see how these change over time. We employ Q-methodology, an objective mixed method for the study of human perspectives, to do this. In this paper we describe the use of bootstrap methods, and visualizations to assist in the execution and interpretation of the first round of our Q study. Methods A concourse of 36 items was developed from the literature, a logic model for the project, and a series of semi-structured interviews with project participants. Sixteen people (3 female, and 13 male) took part in the Q study, six developers, five managers, two health professionals, and 3 others. The 36 statements on the concourse were ranked online, by each participant, using the HTMLQ software, in order of their agreement with each statement. These are then subjected to a form of factor analysis, but by person, not by statement, using the qmethod package in R. For each Q-sort 1,000 bootstrap replications were done, using sampling with replacement. A range of visualisations were prepared, using ggplot2. Results Visualizations of bias and variability showed modest levels of both, suggesting that the Q-method model fitted well. Interactive visualizations of the factors, and respondents, were done. These showed distinct clusters of respondents, with divergent perspectives on the project. These assisted in making final decisions, both on the number of factors to report on, and the interpretation of those factors. Further use of advance visualisations is recommended for future Q-studies. Funded by the European commission under contract 727721 Key messages Q methodology is useful across many areas of public health, and is a valuable way of studying individual perspectives. Modern statistical visualisation tools can enhance the interpretation of Q methodology studies.

Objectives(1) To understand the experiences and perceptions of those who underwent supported isolation, particularly in relation to factors that were associated with improved compliance and well-being; (2) to inform recommendations for the management of similar supported isolation procedures.DesignWe carried out a qualitative study using semistructured interviews to capture participants’ experiences and perceptions of supported isolation. Data were analysed using the framework approach, a type of thematic analysis that is commonly used in research that has implications for policy.SettingTelephone interviews carried out within approximately 1 month of an individual leaving supported isolation.Participants26 people who underwent supported isolation at either Arrowe Park Hospital (n=18) or Kents Hill Park Conference Centre (n=8) after being repatriated from Wuhan in January to February 2020.ResultsSix key themes were identified: factors affecting compliance with supported isolation; risk perceptions around catching COVID-19; management of supported isolation; communication with those outside supported isolation; relationship with others in supported isolation; and feelings on leaving supported isolation. Participants were willing to undergo supported isolation because they understood that it would protect themselves and others. Positive treatment by staff was fundamental to participants’ willingness to comply with isolation procedures. Despite the high level of compliance, participants expressed some uncertainty about what the process would involve.ConclusionsAs hotel quarantine is introduced across the UK for international arrivals, our findings suggest that those in charge should: communicate effectively before, during and after quarantine, emphasising why quarantine is important and how it will protect others; avoid coercion if possible and focus on supporting and promoting voluntary compliance; facilitate shared social experiences for those in quarantine; and ensure all necessary supplies are provided. Doing so is likely to increase adherence and reduce any negative effects on well-being.

Background Repeat chlamydia infections are common, and the risk of receiving complications increases with the number of lifetime infections. However, retesting rates in the UK remain low and interventions to increase retesting have had variable effects. In order to change behaviour (e.g., to increase retesting), behavioural-science theoretical models may help identify influential factors. One such model, the COM-B Model proposes behaviour results from an interaction between capability, opportunity and motivation. The aim of this study was to identify theoretically-based demographic and psychosocial factors associated with retesting behaviour and intentions to retest amongst those previously diagnosed with chlamydia. Methods An online questionnaire was developed, based on a comprehensive literature review and expert and lay consultation. Participants were 263 young people (16–24 years) in the UK who had been diagnosed with chlamydia (via healthcare settings or online platforms). In addition to demographic questions, each measure was representative of COM-B components: susceptibility and severity, fear, stigma, shame, knowledge, social support, social norms, perceived advantages/disadvantages of retesting. Results 35% had not retested, the most common reason for which was unawareness of the need to retest (31%). In those who had not retested, moral norms, injunctive norms, and STI knowledge significantly predicted intentions to retest (F[1,53]=6.20,p=0.016,R2 =0.45,AdjR2=0.42). Retesters were slightly older and more likely to have had other STIs. The most common location of retest was a sexual health clinic (57%), followed by general practice (14%) and online services (11%). Multivariable regression demonstrated that social norms (injunctive, descriptive, and moral) significantly predicted having retested (F[1,171]=7.44, p=0.007,R2 =0.12,AdjR2=0.10]. Conclusion This research has identified potential targets for public health campaigns aimed at eliminating STIs. Specifically, future interventions should focus on social (e.g., social approval one expects from others for engaging in a responsible sexual health action) and psychological (awareness and education) to increase retesting rates. Disclosure No significant relationships.

In the event of a hazardous chemical release incident in the UK, affected members of the public would undergo improvised and interim forms of decontamination (the “Initial Operational Response” (IOR)). To enable members of the public to take recommended actions quickly, the Home Office and National Chemical, Biological, Radiological and Nuclear Centre have developed the “Remove, Remove, Remove” pre-incident information campaign. This is designed to raise awareness amongst a broad range of people with a public safety role, as well as members of the general public. The paper aims to discuss these issues.,Public perceptions of the utility of “Remove, Remove, Remove” pre-incident information materials were assessed using focus group discussions and questionnaires.,Perceptions of the “Remove, Remove, Remove” campaign poster were generally positive, and the groups agreed that releasing this type of information prior to an incident occurring is a positive step. There was consensus that the poster contains useful information, and that members of the public would benefit from receiving this information prior to a chemical incident occurring.,The findings from this study have been used to inform the development of the “Remove, Remove, Remove” materials. These materials have been disseminated to all emergency services in the UK to further embed IOR principles, as well as to crowd safety professionals.

Background Behavioural science can play a critical role in combatting the effects of an infectious disease outbreak or public health emergency, such as the COVID-19 pandemic. The current paper presents a synthesis of review literature discussing the application of behaviour change theories within an infectious disease and emergency response context, with a view to informing infectious disease modelling, research and public health practice. Methods A scoping review procedure was adopted for the searches. Searches were run on PubMed, PsychInfo and Medline with search terms covering four major categories: behaviour, emergency response (e.g., infectious disease, preparedness, mass emergency), theoretical models, and reviews. Three further top-up reviews was also conducted using Google Scholar. Papers were included if they presented a review of theoretical models as applied to understanding preventative health behaviours in the context of emergency preparedness and response, and/or infectious disease outbreaks. Results Thirteen papers were included in the final synthesis. Across the reviews, several theories of behaviour change were identified as more commonly cited within this context, specifically, Health Belief Model, Theory of Planned Behaviour, and Protection Motivation Theory, with support (although not universal) for their effectiveness in this context. Furthermore, the application of these theories in previous primary research within this context was found to be patchy, and so further work is required to systematically incorporate and test behaviour change models within public health emergency research and interventions. Conclusion Overall, this review identifies a range of more commonly applied theories with broad support for their use within an infectious disease and emergency response context. The Discussion section details several key recommendations to help researchers, practitioners, and infectious disease modellers to incorporate these theories into their work. Specifically, researchers and practitioners should base future research and practice on a systematic application of theories, beginning with those reported herein. Furthermore, infectious disease modellers should consult the theories reported herein to ensure that the full range of relevant constructs (cognitive, emotional and social) are incorporated into their models. In all cases, consultation with behavioural scientists throughout these processes is strongly recommended to ensure the appropriate application of theory.

Background Despite the substantial personal and economic consequences of mental ill-health, and the relationship between mental ill-health and poor management provision, further work is needed to provide a robust evaluation of employment interventions to address mental ill-health in the workplace. Aims To provide a pilot service evaluation of a UK organization's mental health awareness for managers' training provision. Methods Participants were 93 employees at a UK-based organization who attended one of the three different types of, independently facilitated, half-day training courses designed to raise managers' awareness and understanding of mental health. All participants were asked to complete three questionnaires (one prior to the training session, one immediately following the training session and one 3 months after the training session). Each questionnaire contained six questions concerning participants' awareness of mental ill-health, and their confidence in dealing with mental ill-health among employees. Results Participants reported feeling more aware of mental ill-health at work and more confident in their ability to address mental ill-health among their employees after attending mental health awareness for managers' training. Conclusions Although further work is needed to explore the efficacy of different types of training, the results of our pilot evaluation alongside the extant literature suggest that workplace interventions can have positive implications for good mental health.

UNSTRUCTURED Established methods for collecting surveillance data and attitudinal or behaviour data during a pandemic are limited by issues including cost, timeliness and reliability. This paper presents the outcomes of a rapid evidence review exploring the potential utility of online data, and particularly social media data, for contributing to both outbreak detection and the assessment of influenza-related health behaviours and sentiments. Three literature reviews, including one systematised review, contributed to this rapid evidence review. The systematised review search was conducted on PubMed and Google Scholar. From an initial total of 787 papers found through the search, 54 relevant articles were identified and included in the synthesis. These papers were combined with our initial narrative reviews to form the rapid evidence review and subsequent literature synthesis. Overall, the literature suggests that online data do have a role to play in both surveillance and understanding public responses and concerns during large-scale infectious disease outbreaks. However, given the relative infancy of work in this area, more research is needed – particularly around evaluating the validity and reliability of these approaches – before complex online data can be used with confidence to inform public health decision-making.

Background Given the importance of person to person transmission in the spread of infectious diseases, it is critically important to ensure that human behaviour with respect to infection prevention is appropriately represented within infectious disease models. This paper presents a large scale scoping review regarding the incorporation of infection prevention behaviour in infectious disease models. The outcomes of this review are contextualised within the psychological literature concerning health behaviour and behaviour change, resulting in a series of key recommendations for the incorporation of human behaviour in future infectious disease models. Methods The search strategy focused on terms relating to behaviour, infectious disease and mathematical modelling. The selection criteria were developed iteratively to focus on original research articles that present an infectious disease model with human-human spread, in which individuals’ self-protective health behaviour varied endogenously within the model. Data extracted included: the behaviour that is modelled; how this behaviour is modelled; any theoretical background for the modelling of behaviour, and; any behavioural data used to parameterise the models. Results Forty-two papers from an initial total of 2987 were retained for inclusion in the final review. All of these papers were published between 2002 and 2015. Many of the included papers employed a multiple, linked models to incorporate infection prevention behaviour. Both cognitive constructs (e.g., perceived risk) and, to a lesser extent, social constructs (e.g., social norms) were identified in the included papers. However, only five papers made explicit reference to psychological health behaviour change theories. Finally, just under half of the included papers incorporated behavioural data in their modelling. Conclusions By contextualising the review outcomes within the psychological literature on health behaviour and behaviour change, three key recommendations for future behavioural modelling are made. First, modellers should consult with the psychological literature on health behaviour/ behaviour change when developing new models. Second, modellers interested in exploring the relationship between behaviour and disease spread should draw on social psychological literature to increase the complexity of the social world represented within infectious disease models. Finally, greater use of context-specific behavioural data (e.g., survey data, observational data) is recommended to parameterise models. Electronic supplementary material The online version of this article (10.1186/s12889-018-5223-1) contains supplementary material, which is available to authorized users.

Highlights • To our knowledge, this is a first joint examination of general UK H1N1 self and parental vaccination. • Data collected during the Flu Watch study (798 adults, 85 children) were analysed. • Vaccine concerns and perceived H1N1 risk predicted self and parental vaccination. • Addressing these issues in future could influence self and parental vaccination., During the 2009 H1N1 pandemic, UK uptake of the pandemic influenza vaccine was very low. Furthermore, attitudes governing UK vaccination uptake during a pandemic are poorly characterised. To the best of our knowledge, there is no published research explicitly considering predictors of both adult self-vaccination and decisions regarding whether or not to vaccinate one’s children among the UK population during the H1N1 pandemic. We therefore aimed to identify predictors of both self-vaccination decisions and parental vaccination decisions using data collected during the H1N1 pandemic as part of the Flu Watch cohort study. Data were analysed separately for 798 adults and 85 children: exploratory factor analysis facilitated reduction of 16 items on attitudes to pandemic vaccine into a smaller number of factors. Single variable analyses with vaccine uptake as the outcome were used to identify variables that were predictive of vaccination in children and adults. Potential predictors were: attitudinal factors created by data reduction, age group, sex, region, deprivation, ethnicity, chronic condition, vocation, healthcare-related occupation and previous influenza vaccination. Consistent with previous literature concerning adult self-vaccination decisions, we found that vaccine efficacy/safety and perceived risk of pandemic influenza were significant predictors of both self-vaccination decisions and parental vaccination decisions. This study provides the first systematic attempt to understand both the predictors of self and parental vaccination uptake among the UK general population during the H1N1 pandemic. Our findings indicate that concerns about vaccine safety, and vaccine effectiveness may be a barrier to increased uptake for both self and parental vaccination.

Social connections are essential to health and well-being. However, when pursing social acceptance, people may sometimes engage in behavior that is detrimental to their health. Using a multi-time-point design, we examined whether the structure of an emerging network of students in an academic summer school program correlated with their physical health and mental well-being. Participants who were more central in the network typically experienced greater symptoms of illness (e.g., cold/flu symptoms), engaged in riskier health behaviors (e.g., binge drinking), and had higher physiological reactivity to a stressor. At the same time, they were happier, felt more efficacious, and perceived less stress in response to a strenuous math task. These outcomes suggest that social ties in an emerging network are associated with better mental well-being, but also with poorer physical health and health behaviors.

Two studies examined the effects of social identity concerns on the moral justification of torture. British and American nationals read a media report concerning the torture of a terrorist suspect that they were led to believe had been perpetrated either by members of their own nation's security services or by another nation's security services. When the torture was perpetrated by the ingroup, participants described it as more morally justified than when the torture was perpetrated by the other nation's security services. This effect was mediated by participants' decreased empathy for the ingroup's torture victim (Study 1), as well as increased victim blame and perceiving the perpetrators as prototypical of their national group (Study 2). We consider how social identity concerns enable moral justification of harm doing.

PurposeEffective interprofessional working is widely claimed to enhance service delivery, user satisfaction, and most importantly, clinical outcomes. Achieving this position is proving difficult. Research suggests that strategies to enhance interprofessional collaboration should begin at the earliest possible opportunity to prevent negative stereotypes from developing. This project was an attempt to develop effective interprofessional education (IPE) across staff groups who work in the mental health arena (mental health nursing students and clinical psychology trainees).Design/methodology/approachParticipants were whole cohorts of undergraduate mental health nursing students (n=11) in their second year of training (at the commencement of their “branch” programme), and trainees on the doctorate in clinical psychology (n=10) at the start of their first year of training. IPE sessions were facilitated by mental health nursing and clinical psychology academic staff and clinicians. Activities included creative group work and problem‐based learning. Seven sessions were delivered across over a 2 year period.FindingsQualitative and quantitative data from this two year project showed an increase in positive attitudes towards professionals from each profession over a two year period, though no overall improvement. Qualitative analysis of participant comments provided more encouraging support for improvement in attitudes, within the theme areas of teamwork and collaboration, professional identity, and roles and responsibilities. Overall, the project provided important information on building positive attitudes within the mental health workforce, while identifying challenges that need to be anticipated and addressed.Originality/valueFew studies have explored IPE in mental health contexts, especially in the pre‐qualification arena.

In the event of an incident involving the release of a hazardous chemical, first responders may decide to initiate emergency decontamination in order to remove any contaminant from affected casualties. Recent initiatives such as the UK Home Office-led Initial Operational Response Programme have introduced new evidence-based decontamination protocols that reduce the time taken to initiate the decontamination process, including an increased emphasis on rapidly removing contaminated clothing (disrobe), and the use of improvised dry decontamination methods. The current study used a series of focus groups to examine public perceptions of different decontamination interventions and responder management strategies. Results revealed that a decontamination shower was perceived to be more effective than dry decontamination methods and that a management strategy that included effective responder communication resulted in increased willingness to comply with the need for decontamination. This study demonstrates that public understanding and acceptance of novel decontamination methods such as dry decontamination may present additional challenges for first responders. Increased emphasis on effective communication during decontamination is needed. Furthermore, provision of information during the focus group study resulted in an increase in participants' knowledge and confidence in taking recommended decontamination actions, which was maintained three months after the study. The longitudinal nature of these effects suggest that it may be possible to increase public awareness about actions to take during chemical incidents by developing pre-incident public education; however, further research is needed to examine this more fully.

Researchers who study perspective taking are generally optimistic about the potential for interventions to improve intergroup perceptions. The current research provides new insight into the conditions that frame the intergroup outcomes of perspective taking. The results show that the effects of perspective taking are not always positive but depend on perspective takers’ degree of identification with the in-group. In two experiments, we demonstrated that adopting the perspective of an out-group member can have damaging effects on intergroup perceptions among group members who are highly identified with the in-group. Specifically, compared with less committed members, those who identified highly with the in-group used a greater number of negative traits to describe the out-group following perspective taking. Such perspective taking also led participants with high in-group identification to judge the out-group less favorably. Understanding how social identity concerns frame the outcome of perspective taking is crucial to its effective employment in intergroup-relations programs.