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BackgroundChildhood eczema is often poorly controlled owing to underuse of emollients and topical corticosteroids (TCS). Parents/carers report practical and psychosocial barriers to managing their child’s eczema, including child resistance. Online interventions could potentially support parents/carers; however, rigorous research developing such interventions has been limited.AimTo develop an online behavioural intervention to help parents/carers manage and co-manage their child’s eczema.Design and settingIntervention development using a theory-, evidence-, and person-based approach (PBA) with qualitative research.MethodA systematic review and qualitative synthesis of studies (n = 32) and interviews with parents/carers (n = 30) were used to identify barriers and facilitators to effective eczema management, and a prototype intervention was developed. Think-aloud interviews with parents/carers (n = 25) were then used to optimise the intervention to increase its acceptability and feasibility.ResultsQualitative research identified that parents/carers had concerns about using emollients and TCS, incomplete knowledge and skills around managing eczema, and reluctance to transitioning to co-managing eczema with their child. Think-aloud interviews highlighted that, while experienced parents/carers felt they knew how to manage eczema, some information about how to use treatments was still new. Techniques for addressing barriers included providing a rationale explaining how emollients and TCS work, demonstrating how to use treatments, and highlighting that the intervention provided new, up-to-date information.ConclusionParents/carers need support in effectively managing and co-managing their child’s eczema. The key output of this research is Eczema Care Online for Families, an online intervention for parents/carers of children with eczema, which is being evaluated in a randomised trial.

Background Eczema can have a considerable impact on quality of life. Treatments can improve this, but management is complex. Barriers to eczema self‐management may be impacted upon by environmental context, such as the COVID‐19 pandemic. Objectives To explore experiences of eczema, self‐management, and accessing healthcare and advice during the COVID‐19 pandemic among young people with eczema and parents/carers of children with eczema. Methods Qualitative semi‐structured interviews were carried out with 36 participants recruited from general practices as part of randomised controlled trials of online eczema resources. Results Changes to everyday life—Periods of staying at home due to the pandemic alter the burden of eczema, with reports of an improved routine and application of topical treatments for many, but difficulties with handwashing for others. Parents/carers reported improved eczema control due to closures of educational settings. Young people reported higher stress that may have triggered eczema flare‐ups. Changes to access to advice and treatment—There was a reluctance to seek medical appointments in a non‐emergency situation. Participants reported a lack of trust in the outcome of telephone consultations because health professionals were unable to see or feel the skin. Delays or difficulties when obtaining appointments and treatments caused frustration. Access to an online eczema resource was reported to have extra value in the context of the pandemic. Conclusion Changes to lifestyle and access to healthcare during the pandemic have affected eczema and self‐management. Healthcare settings may want to consider providing extra reassurance around remote consultations., This interview study explored experiences of eczema, self‐management, and accessing healthcare and advice during the covid‐19 pandemic among young people with eczema and parents/carers of children with eczema. Both groups reported how changes to their lifestyle and access to healthcare during the pandemic affected eczema and self‐management. Healthcare services should provide extra reassurance around remote consultations and advice on how to deal with things during the pandemic that might trigger eczema, such as increased handwashing.

ObjectiveTo systematically review and synthesise qualitative research exploring parents/carers’ experiences of seeking online information and support for long-term physical childhood conditions.DesignSystematic review and thematic synthesis of qualitative research.Data sourcesMedline, CINAHL, Embase, PsycINFO and the International Bibliography of the Social Sciences were searched from inception to September 2019. We used thematic synthesis to analyse findings.Eligibility criteriaPrimary research papers presenting qualitative data collection and analysis, focusing on parents/carers’ experiences of seeking health information and support from online resources for long-term physical childhood health conditions. No language restrictions were placed.Results23 studies from seven countries met inclusion criteria and were included in the synthesis. Included studies presented data collected through interviews/focus groups with 559 parents/carers; free-text surveys and essays with 26 parents/carers and 2407 messages from online support groups. Parents/carers developed a variety of strategies to obtain information and support online, based on personal preferences, appraisal of trustworthiness, perceived needs and previous experiences online. Many parents sought the benefits of online information and support, which included reassurance and validation from online communities, and feeling they had greater knowledge about their children’s conditions. Some concerns and perceived risks were discussed, which often stemmed from prior unsatisfactory experiences of seeking information and support online, consultations with health professionals and seeing distressing stories online.ConclusionMost parents/carers were successful in obtaining information and support online. Many continued to share experiences with other parents/carers online. The need for information was particularly apparent early after diagnosis of the condition, whereas the need for peer support continued. The potential concerns and perceived risks with information and support online were especially apparent among parents/carers of children with life-limiting long-term conditions. Findings may be useful for health professionals to facilitate discussions regarding use of online resources, and researchers designing online health resources for parents/carers.PROSPERO registration numberCRD42018096009.

BackgroundIrritable bowel syndrome (IBS) is common and often negatively affects quality of life. Patients frequently perceive medical interventions as inadequate and seek support from other sources, including online discussion forums.AimTo explore online discussion forum topics posted by people with IBS.Design & settingA qualitative study exploring three UK-based online discussion forums.MethodA scoping review identified UK-based discussion forums with high activity and frequent use, which did not require a password/registration to view posts (two IBS-specific and one general health forum). Internal search functions were used to identify and export relevant discussion threads relating to managing IBS. Inductive thematic analysis of exported discussions was undertaken.ResultsAnalysis identified two main overarching themes from 122 relevant discussion threads: 1) sharing information and practical advice about lifestyle changes; and 2) receiving emotional support. The most prevalent topics were lifestyle changes, including diet, using oral preparations (for example, supplements or probiotics), and physical activity. Dietary changes were usually considered positive, and most hopeful for potentially alleviating symptoms. Emotional support was also regularly offered with expressions of empathy, kindness, and gratitude, and a sense of users feeling less alone. Some discussions raised concern around potentially inappropriate symptomatic reassurance, and negative or conflicting advice.ConclusionOnline forums seem, generally, to be a positive experience for those posting, but include potential risks of misinformation. Most posts focus on symptomatic relief through lifestyle change and/or emotional support. Clinicians could gain a better understanding of patients’ ideas, concerns, and expectations of IBS diagnosis and management by asking about patient-acquired online forum information.

There is little information about how diet influences the health of childhood acute lymphoblastic leukemia (cALL) survivors. This study explores the associations between diet quality indices, cardiometabolic health indicators and inflammatory biomarkers among cALL survivors. Participants were part of the PETALE study (n = 241, median age: 21.7 years). Adherence to 6 dietary scores and caloric intake from ultra-processed foods were calculated. Multivariate logistirac regressions, Student t-tests and Mann-Whitney tests were performed. We found that 88% of adults and 46% of children adhered poorly to the Mediterranean diet, 36.9% had poor adherence to the World Health Organisation (WHO) recommendations and 76.3% had a diet to be improved according to the HEI-2015 score. On average, ultra-processed foods accounted for 51% of total energy intake. Low HDL-C was associated with a more inflammatory diet (E-DIITM score) and higher intake of ultra-processed foods. A greater E-DII score was associated with elevated insulin resistance (HOMA-IR), and consumption of ultra-processed foods was correlated with high triglycerides. Circulating levels of TNF-&alpha, adiponectin and IL-6 were influenced by diet quality indices, while CRP and leptin were not. In conclusion, survivors of cALL have poor adherence to dietary recommendations, adversely affecting their cardiometabolic health.

Background: The number of qualitative studies on eczema has increased rapidly in recent years. Systematically reviewing these can provide greater understandings of people’s perceptions of eczema and eczema treatments. Objectives: We sought to systematically review and thematically synthesise qualitative studies exploring views and experiences of people with eczema and parents/carers of children with eczema. Methods: We searched MEDLINE, PsycINFO, CINAHL and EMBASE from the earliest date available to February 2019. We selected papers focusing on views and experiences of eczema, eczema treatments, and barriers/facilitators to eczema self-management. We excluded papers focusing on health service provision models or health professionals’ views. Results: We synthesised 39 papers (reporting 32 studies) from 13 countries. We developed four analytical themes: 1) Eczema not viewed as long-term condition, 2) Significant psychosocial impact not acknowledged by others, 3) Hesitancy (patient/carer uncertainty) about eczema treatments and 4) Insufficient information and advice. Our findings suggest people with eczema and their carers experience frustration at having to manage a condition that is often seen by others as mundane but has significant psychosocial impact and is difficult to manage due to concerns about, and burden of, treatment. This frustration can be exacerbated by experiences of conflicting and/or insufficient information and advice from health professionals, family and others. Conclusions: Effective self-management of eczema could be supported by addressing beliefs and concerns about treatments; seeking positive ways to promote a ‘control not cure’ message; acknowledging psychosocial impacts of eczema and treatment burden; and providing clear consistent advice or signposting towards reliable information.

Survivors of childhood acute lymphoblastic leukemia (cALL) are at high risk of developing dyslipidemia, including low HDL-cholesterol (HDL-C). This study aimed to examine the associations between food/nutrient intake and the levels of HDL-C in a cohort of children and young adult survivors of cALL. Eligible participants (n = 241) were survivors of cALL (49.4% boys, median age: 21.7 years old) recruited as part of the PETALE study. Nutritional data were collected using a validated food frequency questionnaire. Fasting blood was used to determine participants&rsquo, lipid profile. Multivariable logistic regression models were fitted to evaluate the associations between intakes of macro- and micronutrients and food groups and plasma lipids. We found that 41.3% of cALL survivors had at least one abnormal lipid value. Specifically, 12.2% had high triglycerides, 17.4% high LDL-cholesterol, and 23.1% low HDL-C. Low HDL-C was inversely associated with high intake (third vs. first tertile) of several nutrients: proteins (OR: 0.27, 95% CI: 0.08&ndash, 0.92), zinc (OR: 0.26, 95% CI: 0.08&ndash, 0.84), copper (OR: 0.34, 95% CI: 0.12&ndash, 0.99), selenium (OR: 0.17, 95% CI: 0.05&ndash, 0.59), niacin (OR: 0.25, 95% CI: 0.08&ndash, 0.84), riboflavin (OR: 0.31, 95% CI: 0.12&ndash, 0.76) and vitamin B12 (OR: 0.35, 95% CI: 0.13&ndash, 0.90). High meat consumption was also inversely associated (OR: 0.28, 95% CI: 0.09&ndash, 0.83) with low HDL-C while fast food was positively associated (OR: 2.41, 95% CI: 1.03&ndash, 5.63) with low HDL-C. The role of nutrition in the development of dyslipidemia after cancer treatment needs further investigation.

Background: Survivors of childhood acute lymphoblastic leukemia (cALL) are at high risk of developing dyslipidemia (high LDL-cholesterol, high triglycerides, or low HDL-cholesterol). Studies showed that, similarly to the general population, cALL survivors do not respect dietary guidelines. However, whether nutritional intakes affect the lipid profile of this high-risk population remains unknown. This study aims to examine the associations between macro- and micronutrients and the presence of dyslipidemia in children and young adult survivors of cALL. Methods: Participants (n=247) survivors of cALL were recruited as part of the PETALE study at Sainte-Justine University Health Center (49.4% boys; median age: 21.7 yrs, range: 8.5-41.0 yrs; median time since diagnosis: 15.2 yrs, range: 5.4-28.2 yrs). Nutritional data were collected using a validated food frequency questionnaire (FFQ) comprising 190 items. Fasting blood was used to determine participants’ lipid profile by enzymatic reactions. Multivariable logistic regression models were fitted to evaluate the associations between intakes of macro- and micronutrients and dyslipidemia. The model included the following covariables: body mass index, age at diagnosis, age at diagnosis2, sex, and total energy intake. Results: Despite their young age, 41.3% of cALL survivors had dyslipidemia defined by having at least one abnormal lipid value. Specifically, 12.2% had high triglycerides and 17.4% high LDL-cholesterol and 23.1% low HDL-cholesterol. Our analysis revealed that having low HDL-cholesterol was associated with higher intakes in several nutrients (3rd vs. 1st tertile). They were proteins [odd ratio (OR): 0.27, 95%CI: 0.08-0.92, P Conclusion: Our study shows the potential protective role of specific macro- and micronutrients on HDL-cholesterol levels in cALL survivors. These results stress the importance of deepening our understanding of the impact of nutrition in the development of dyslipidemia after cancer treatment. Nutritional strategies could be a valuable approach to prevent long-term cardiometabolic complications in cALL survivors. Citation Format: Sophia Morel, Devendra Amre, Emma Teasdale, Caroline Laverdière, Daniel Sinnett, Emile Levy, Valérie Marcil. Nutritional intakes are associated with HDL-cholesterol levels in survivors of childhood acute lymphoblastic leukemia [abstract]. In: Proceedings of the AACR Special Conference on the Advances in Pediatric Cancer Research; 2019 Sep 17-20; Montreal, QC, Canada. Philadelphia (PA): AACR; Cancer Res 2020;80(14 Suppl):Abstract nr B66.

Background Cellulitis is a common painful infection of the skin and underlying tissues that recurs in approximately one-third of cases. The only proven strategy to reduce the risk of recurrence is long-term, low-dose antibiotics. Given current concerns about antibiotic resistance and the pressure to reduce antibiotic prescribing, other prevention strategies are needed. Objectives To explore patients' views about cellulitis and different ways of preventing recurrent episodes. Methods Adults aged ≥ 18 years with a history of first-episode or recurrent cellulitis were invited through primary care, hospitals and advertising to complete a survey, take part in an interview or both. Results Thirty interviews were conducted between August 2016 and July 2017. Two hundred and forty surveys were completed (response rate 17%). Triangulation of quantitative and qualitative data showed that people who have had cellulitis have wide-ranging beliefs about what can cause cellulitis and are often unaware of risk of recurrence or potential strategies to prevent recurrence. Enhanced foot hygiene, applying emollients daily, exercise and losing weight were more popular potential strategies than the use of compression stockings or long-term antibiotics. Participants expressed caution about long-term oral antibiotics, particularly those who had experienced only one episode of cellulitis. Conclusions People who have had cellulitis are keen to know about possible ways to prevent further episodes. Enhanced foot hygiene, applying emollients daily, exercise and losing weight were generally viewed to be more acceptable, feasible strategies than compression or antibiotics, but further research is needed to explore uptake and effectiveness in practice.

BackgroundCellulitis is a painful infection of the skin and underlying tissues, commonly affecting the lower leg. Approximately one-third of people experience recurrence. Patients’ ability to recover from cellulitis or prevent recurrence is likely to be influenced by their understanding of the condition.AimTo explore patients’ perceptions of cellulitis, and their information needs.Design and settingMixed-methods study comprising semi-structured, face-to-face interviews and a cross-sectional survey, recruiting through primary and secondary care, and advertising.MethodAdults aged ≥18 years with a history of cellulitis were invited to take part in a survey, qualitative interview, or both.ResultsIn all, 30 interviews were conducted between August 2016 and July 2017. Qualitative data highlighted a low awareness of cellulitis before the first episode, uncertainty about when it had been diagnosed, concern/surprise at the severity of cellulitis, and a perceived insufficient information provision. People were surprised that they had never heard of cellulitis and that they had not received advice or leaflets giving self-care information. Some sought information from the internet and found this confusing.A total of 240 surveys were completed (response rate 17%). These showed that, although many participants had received information on the treatment of cellulitis (60.0%, n = 144), they often reported receiving no information about causes (60.8%, n = 146) or prevention of recurrence (73.3%, n = 176).ConclusionThere is a need to provide information for people with cellulitis, particularly in regard to naming their condition, the management of acute episodes, and how to reduce the risk of recurrences.

Summary Background Many children suffer with skin diseases but to date most dermatological research has been done ‘on’ rather than ‘with’ children; in this study we actively sought the experiences of children and young people. Atopic eczema (AE) is a chronic, itchy, inflammatory skin condition that affects around 20% of children and can impact on the health and wellbeing of children and their families. The role of specialist clothing in the management of AE is poorly understood. Objectives The aim of this study, which was nested in a randomized controlled trial, was to qualitatively examine child participants’ experiences of using silk garments for the treatment of AE. Methods Eighteen children aged 5–15 years, who took part in the CLOTHing for the relief of Eczema Symptoms (CLOTHES) trial, participated in age‐appropriate individual interviews or focus groups. Results Thematic analysis generated four themes directly related to the silk garments: (i) expectations of the garments; (ii) wearing the garments; (iii) asking if the garments helped; and (iv) thoughts about the garments. The conclusions from this nested qualitative study are that there was some limited improvement in eczema for some children but that the hoped‐for ‘miracle cure’ did not transpire. A mixed picture of knowledge, beliefs and experiences of using the silk garments emerged. Conclusions Engaging children in the evaluation of the garments provided first‐hand nuanced insights that enhanced understanding of the CLOTHES study as a whole. This nested study demonstrates that children can and indeed want to be engaged in dermatological research in meaningful ways that add to our understanding of treatment options., What's already known about this topic? Eczema affects around 20% of children and can have a detrimental effect on the child and their family.Adherence with topical treatments is often poor and can lead to treatment failure.Although children are often end‐users of eczema treatments, they are rarely engaged in research involving these products beyond completing questionnaires. What does this study add? Children and young people can be meaningfully engaged in dermatology research and add new dimensions of understanding that would not be gained by proxy data.Children told us about their expectations of the garments and their views once they had worn them.The added value of child data lies in enhancing understanding of reasons for adherence and nonadherence, in facilitating interpretation of the trial results, and in ensuring selected objective outcome measures include factors important to children. What are the clinical implications of the work? This study illustrates the need to communicate effectively with children and young people to ascertain their thoughts and beliefs about treatment regimens and assess the likelihood of adherence. Linked Comment: Teasdale. Br J Dermatol 2018; 178:25–26. Plain language summary available online Respond to this article

SummaryBackground Childhood eczema is very common and can have substantial impact on quality of life. One of the main treatments is topical-corticosteroids, but these are often under-used by parents/carers for reasons that include concerns about safety. Objectives To explore understandings and concerns about topical-corticosteroids amongst parents/carers of children with eczema who had posted messages in online forums. Methods A qualitative study of messages and their resultant discussions about topical-corticosteroids for childhood eczema posted by parents/carers on two UK-based discussion forums. Results Ninety-five forum users involved in 27 discussions relating to topical-corticosteroid use in childhood eczema were identified dating from 2003–2015. Analysis of discussions highlighted three themes: 1) diverse beliefs about the use of topical-corticosteroids, 2) uncertainty and confusion about using/applying topical corticosteroids, 3) seeking to resolve conflicting advice received offline and advice on navigating health services. People expressed a general sense of cautiousness about topical-corticosteroids, wide-ranging concerns and considerable confusion, for instance about potency or safe duration of use. They sought advice from other forum users who they perceived as having experiential expertise. Some posts attempted to reassure that topical-corticosteroids were safe if used correctly, but overall the discussions seemed likely to amplify existing concerns. Conclusions Given the prevalence of concerns and uncertainties about topical-corticosteroids, signposting parents/carers of children with eczema towards detailed, credible information about how to use topical-corticosteroids safely would be beneficial. In the absence of such information, parents/carers are likely to turn to online discussion forums where, although much useful support and advice can be found, the credibility of advice cannot be assured. This article is protected by copyright. All rights reserved.

Aim To evaluate the feasibility of training sufficient radiographers to deliver an intervention to promote early presentation of breast cancer to all older women attending for their final routine mammogram within the NHS Breast Screening Programme. If the Promoting Early Presentation (PEP) intervention is demonstrated to be cost-effective, it may be implemented across the NHS requiring at least four radiographers per screening service to deliver the intervention. Methods A pilot study in a single breast screening service was conducted to assess the feasibility of training sufficient radiographers to meet this objective. Quantitative and qualitative methods were used to evaluate the impact of training on participating radiographers and the screening service. Competency to deliver the intervention was assessed at key points during training according to quality criteria based on delivery of the key messages and style of delivery. Confidence to deliver the intervention was assessed using a self-report measure before and after training. Radiographers' experiences of training were elicited in face-to-face qualitative interviews. Results Seven of eight radiographers who were released to undertake the training achieved the required level of competency to deliver the intervention within four months. All improved over time in their confidence to deliver the key messages of the intervention. The qualitative analysis revealed the benefits and challenges of training from the perspective of the radiographers. Conclusion It was feasible and acceptable to train sufficient radiographers to deliver the PEP Intervention. The training package will be streamlined to improve efficiency for large implementation trials and clinical practice across the NHS.

Objectives. Behavioural responses to influenza pandemics can significantly influence the impact on public health. Protection motivation theory (PMT) provides a framework for understanding how people respond to health threats such as pandemics. The main aim of this study was to model the relative contribution of the components of PMT (threat and coping appraisal) to intentions to perform two behaviours recommended by the UK government in a pandemic: stay at home when ill and keep going to work when well. Design. A 2× 2 factorial design was used to test the effect of scenarios describing pandemic severity (low vs. high threat) and advice messages (standard government advice vs. theory-based advice) on measures of threat and coping appraisal, and intentions to carry out the two recommended behaviours. Methods. A web-based survey designed to assess threat appraisal, coping appraisal, and behavioural intentions was completed by 883 adults (December 2009-January 2010) drawn from University College London staff and the local community. Structural equation modelling was used to test the PMT framework. Results. Perceived pandemic severity influenced threat and coping appraisals and intentions. Structural equation modelling revealed that coping appraisal (i.e., perceptions of the costs, benefits, and feasibility of the recommended behaviours) was the principal predictor of variability in intentions for both behaviours and for both pandemic scenarios. Conclusions. Coping appraisals appear to be an important, and hitherto underresearched, predictor of how people may behave in pandemics, and our findings provide encouraging preliminary evidence that it may be possible to change these perceptions. ©2011 The British Psychological Society.

BackgroundCellulitis is a common painful infection of the skin and underlying tissues that recurs in approximately a third of cases. Patients’ ability to recover from cellulitis or prevent recurrence is likely to be influenced by their understanding of the condition.AimTo explore patients’ perceptions of cellulitis and their information needs.MethodMixed methods study comprising semi-structured, face-to-face interviews and cross-sectional survey, recruiting through primary care, secondary care and advertising. Adults aged 18 or over with a history of cellulitis (first or recurrent) were invited to complete a survey, take part in an interview or both. Qualitative data was analysed thematically.ResultsThirty interviews were conducted between August 2016 and July 2017. Qualitative data revealed low prior awareness of cellulitis, uncertainty around diagnosis, concern/surprise at the severity of cellulitis, and perceived insufficient information provision. People were surprised they had never heard of the condition and that they had not received advice or leaflets giving self-care information. Some sought information from the internet and found this bewildering. Two hundred and forty surveys were completed (response rate 17%). These showed that, while most people received information on the treatment of cellulitis (60.0%, n = 144), they reported receiving no information about causes (60.8%, n = 146) or prevention of recurrence (73.3%, n = 176).ConclusionThere is a need for provision of basic information for people with cellulitis, particularly being informed of the name of their condition, how to manage acute episodes, and how to reduce risk of recurrence.

Objectives Vitiligo is a relatively common autoimmune condition causing loss of skin pigment. Around 1 in 100 people in the UK develop vitiligo. It can have a significant impact on quality of life for many of those affected. How people access information and help for vitiligo may influence how they manage such impact. We aimed to explore people’s views and experiences of seeking health information and help for vitiligo.Design Qualitative analysis of free-text responses to four open-ended questions in an online survey.Setting Online survey conducted in the UK between February and March 2016.Participants A survey link was emailed to 675 members of The Vitiligo Society, a UK-based charity providing information and support for people with vitiligo. One hundred and sixty-one members responded to the survey (24%).Results Many participants wrote extensive free text, often reporting frustration with help-seeking. They perceived general practitioners (GP) as their primary source of advice but felt that GPs had low awareness of available treatments. Where GPs appeared sympathetic or signposted towards further information this was appreciated, even where people felt their GP had not seemed knowledgeable. Many felt that vitiligo was dismissed by health professionals including GPs and dermatologists as ‘cosmetic’, which upset those who experienced substantial impact. Participants expressed concerns about the credibility of online information on vitiligo and the need for reliable, detailed information, as well as a desire for support with managing its psychosocial impact.Conclusions Information and help-seeking needs of people with vitiligo currently appear to be poorly met, even among members of The Vitiligo Society, who are likely to have received more information than others. People with vitiligo would welcome greater health professional awareness of available vitiligo treatments. Acknowledging the psychosocial impacts of vitiligo and signposting towards credible information are also welcomed.

Background: Poor symptom control is common in asthma. Breathing training exercises may be an effective adjunct to medication; it is therefore important to understand facilitators and barriers to uptake of breathing training exercises. Aims: To gain insight into patients' perceptions of breathing training exercises designed to help control asthma symptoms. Methods: Semi-structured think-aloud interviews were conducted with 29 people with asthma about their views of a booklet on breathing training exercises. Results: Thematic analysis showed breathing training exercises were seen as acceptable in principle because they were viewed as nonpharmacological, holistic, unobtrusive, and likely to increase patient confidence in managing symptoms. Anticipated disadvantages included the time required and perceived irrelevance for those with well-controlled asthma. These views were influenced by prior experience of changing breathing, wanting to self-manage asthma, negative views of medication, and perceived asthma control/severity. Anticipated barriers to carrying out the exercises included difficulties with nose breathing, remembering to do them, and persevering with them. Anticipated facilitators included monitoring tools and social support. Conclusions: The idea of breathing training was viewed positively as an acceptable non-pharmacological treatment that patients can do discreetly to help them breathe more easily and reduce their reliance on medication. Uptake of breathing training may be greater among those who perceive their asthma as severe and/or have negative views of medication. To enhance uptake, it might be helpful to present breathing training exercises as holistic skills that can also benefit those with mild symptoms. © 2013 Primary Care Respiratory Society UK. All rights reserved.

Behavioural responses to influenza pandemics can significantly influence the impact on public health. Protection motivation theory (PMT) provides a framework for understanding how people respond to health threats such as pandemics. The main aim of this study was to model the relative contribution of the components of PMT (threat and coping appraisal) to intentions to perform two behaviours recommended by the UK government in a pandemic: stay at home when ill and keep going to work when well.A 2×2 factorial design was used to test the effect of scenarios describing pandemic severity (low vs. high threat) and advice messages (standard government advice vs. theory-based advice) on measures of threat and coping appraisal, and intentions to carry out the two recommended behaviours.A web-based survey designed to assess threat appraisal, coping appraisal, and behavioural intentions was completed by 883 adults (December 2009-January 2010) drawn from University College London staff and the local community. Structural equation modelling was used to test the PMT framework.Perceived pandemic severity influenced threat and coping appraisals and intentions. Structural equation modelling revealed that coping appraisal (i.e., perceptions of the costs, benefits, and feasibility of the recommended behaviours) was the principal predictor of variability in intentions for both behaviours and for both pandemic scenarios.Coping appraisals appear to be an important, and hitherto underresearched, predictor of how people may behave in pandemics, and our findings provide encouraging preliminary evidence that it may be possible to change these perceptions.

This mixed methods study informed the development of our web-based intervention to reduce the risk of transmission of respiratory infections. Two qualitative studies examined 28 users’ responses to website materials, and elicited additional beliefs. A questionnaire study ( N = 129) tested key intervention assumptions: that hand-washing is considered the most feasible preventive behaviour; behavioural determinants were related to behavioural intentions; beliefs related to hand-washing intentions and behaviour. Thematic analysis of the qualitative data revealed important issues, such as the belief that catching minor infections is beneficial to the immune system. The questionnaire results confirmed our assumptions, including hand-washing as the appropriate target behaviour.

Summary There is little research exploring nurses’ experiences of, and attitudes towards, the chemotherapy administration process. There is also limited work investigating practitioners’ educational preparation for this aspect of cancer nursing. The aim of this study was to describe nurses’ experiences, attitudes and educational preparation for the chemotherapy administration process. A postal survey was conducted across 26 London hospitals providing cancer services. A survey questionnaire was sent to all 526 nurses who administered chemotherapy in these hospitals, of whom 257 replied (response rate 49%). Nearly all nurses (n ¼ 244, 95%) reported being frightened, scared and anxious when initially working with chemotherapy. Of these 221(86%) stated they became more confident with experience, when supported by knowledgeable role models and following chemotherapy education. Over 80% (n ¼ 206) of the sample had received some form of education, whilst 241 nurses (94%) thought they could benefit from more. Nurses reported they were often or always worried about extravasation (n ¼ 113, 44%), anaphylactic reactions (n ¼ 95, 37%), and other nurses’ education and knowledge deficits (n ¼ 118, 46%). Overall, nurses’ attitudes towards chemotherapy were neither negative nor positive. Findings highlight the value of formal educational preparation in chemotherapy prior to undertaking this aspect of nursing. Positive role models for novice practitioners would appear important and role models themselves require continued professional development. Wide variations in educational preparation and practice exist and a co-ordinated education and training strategy for chemotherapy practice is warranted to underpin safe and effective practice in this area. & 2008 Elsevier Ltd. All rights reserved.

Background Non-pharmaceutical public health interventions may provide simple, low-cost, effective ways of minimising the transmission and impact of acute respiratory infections in pandemic and non-pandemic contexts. Understanding what influences the uptake of non-pharmaceutical interventions such as hand and respiratory hygiene, mask wearing and social distancing could help to inform the development of effective public health advice messages. The aim of this synthesis was to explore public perceptions of non-pharmaceutical interventions that aim to reduce the transmission of acute respiratory infections. Methods Five online databases (MEDLINE, PsycINFO, CINAHL, EMBASE and Web of Science) were systematically searched. Reference lists of articles were also examined. We selected papers that used a qualitative research design to explore perceptions and beliefs about non-pharmaceutical interventions to reduce transmission of acute respiratory infections. We excluded papers that only explored how health professionals or children viewed non-pharmaceutical respiratory infection control. Three authors performed data extraction and assessment of study quality. Thematic analysis and components of meta-ethnography were adopted to synthesise findings. Results Seventeen articles from 16 studies in 9 countries were identified and reviewed. Seven key themes were identified: perceived benefits of non-pharmaceutical interventions, perceived disadvantages of non-pharmaceutical interventions, personal and cultural beliefs about infection transmission, diagnostic uncertainty in emerging respiratory infections, perceived vulnerability to infection, anxiety about emerging respiratory infections and communications about emerging respiratory infections. The synthesis showed that some aspects of non-pharmaceutical respiratory infection control (particularly hand and respiratory hygiene) were viewed as familiar and socially responsible actions to take. There was ambivalence about adopting isolation and personal distancing behaviours in some contexts due to their perceived adverse impact and potential to attract social stigma. Common perceived barriers included beliefs about infection transmission, personal vulnerability to respiratory infection and concerns about self-diagnosis in emerging respiratory infections. Conclusions People actively evaluate non-pharmaceutical interventions in terms of their perceived necessity, efficacy, acceptability, and feasibility. To enhance uptake, it will be necessary to address key barriers, such as beliefs about infection transmission, rejection of personal risk of infection and concern about the potential costs and stigma associated with some interventions.