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BACKGROUND: Vietnamese medical students believe becoming “strong” drinkers is important for their future career working as doctor. However, it is unclear if this is a temporary behaviour associated with life as a student, or a phenomenon associated with the transition to working as a medical practitioner. OBJECTIVE: This study explored changes in alcohol-related perceptions and behaviour among Vietnamese early career doctors working after graduation. METHODS: In-depth interviews were conducted with 15 Vietnamese early career doctors in Hanoi city. Thematic analysis was used to analyse the qualitative data. RESULTS: Vietnamese early career doctors perceived binge drinking as common among doctors, especially male doctors, surgeons, and preventive medicine doctors. This perception was different from when they were medical students because, at that time, they believed doctors would not drink alcohol at hazardous levels. Additionally, Vietnamese early career doctors’ drinking behaviour changed in the frequency and quantity of alcohol consumption after graduation due to peer pressure, job stress, working collaborations, and working environment. CONCLUSIONS: Vietnamese early career doctors changed their alcohol-related perceptions and behaviour after graduation. Gender, mental health (stress), factors related to the working environment, and the role of professional relationships should be considered in strategies to reduce risky alcohol consumption among Vietnamese early career doctors.

Objective To examine the disposition outcomes and disposition intentions of elective egg freezers (EEFs) toward their surplus frozen oocytes and the psychosocial determinants underlying these. Design A systematic review and meta-analysis. Setting Not applicable. Patient(s) Actual EEFs (women with oocytes in storage), potential EEFs (women investigating elective oocyte cryopreservation or about to freeze their oocytes), and women of reproductive age (women in the community aged ≥18 years). Intervention(s) A systematic review was undertaken and electronically searched MEDLINE, Embase, and PsycINFO on the Ovid platform for conference abstracts and peer-reviewed articles, published in English after January 1, 2010. A search strategy combined synonyms for oocyte, cryopreservation, donation, disposition, elective, and attitude. Eligible studies assessed disposition outcomes (how an oocyte was disposed of) and disposition intentions (how women intend to dispose of an oocyte) and/or the psychosocial determinants underlying disposition outcomes and intentions. The Joanna Briggs Institute Prevalence Tool was used to assess the risk of bias. A meta-analysis using random effects was applied to pool proportions of women with similar disposition intentions toward their oocytes. Main Outcome Measure(s) Disposition outcomes and intentions toward surplus frozen oocytes: donate to research; donate to others; discard; unsure. Psychosocial determinants (beliefs, attitudes, barriers, and facilitators) of disposition outcomes and intentions. Result(s) A total of 3,560 records were identified, of which 22 (17 studies) met the inclusion criteria (8 studies from Europe, 7 from North America, and 2 from Asia). No studies reported on past oocyte disposition outcomes. Seventeen studies reported on the future disposition intentions of 5,446 women. Only 2 of the 17 studies reported on the psychosocial determinants of oocyte disposition intentions. There was substantial heterogeneity in the pooled results, which was likely a result of the significant variation in methodology. Actual EEFs were included in eight studies (n = 873), of whom 53% (95% confidence interval [CI], 44–63; I2, 87%) would donate surplus oocytes to research, 31% (95% CI, 23–40; I2, 72%) were unsure, 26% (95% CI, 17–38; I2, 92%) would donate to others, and 12% (95% CI, 6–21; I2, 88%) would discard their eggs. Psychosocial determinants: One study reported that 50% of these women were aware of friends and/or family having difficulty conceiving, which may have contributed to their willingness to donate to others. Potential EEFs were included in 4 studies (n = 645), of whom 38% (95% CI, 28–50; I2, 84%) would donate to research, 32% (95% CI, 17–51; I2, 91%) would donate to others, 29% (95% CI, 17–44; I2, 89%) would discard, and 7% (95% CI, 1–27; I2, 77%) were unsure. Psychosocial determinants: No studies. Women of reproductive age were included in 5 studies (n = 3,933), of whom 59% (95% CI, 48–70; I2, 97%) would donate to research and 46% (95% CI, 35–57; I2, 98%) would donate to others. “Unsure” and “discard” were not provided as response options. Psychosocial determinants: One study reported that the facilitators for donation to others included a family member or friend in need, to help others create a family, financial gain, to further science, and control or input over the selection of recipients. Barriers for donation included fear of having a biological child they do not know or who is raised by someone they know. Conclusion(s) No studies reported on the disposition outcomes of past EEFs. Disposition intentions varied across the three groups; however, “donating to research” was the most common disposition preference. Notably, the second disposition preference for one-third of actual EEFs was “unsure” and for one-third of potential EEFs was “donate to others.” There were limited studies for actual and potential EEFs, and only two studies that explored the psychosocial determinants of oocyte disposition intentions. Additionally, these data suggest that disposition decisions change as women progress on their egg freezing journey, highlighting the importance of ongoing contact with the fertility team as intentions may change over time. More research is needed to understand the psychosocial determinants of oocyte disposition decisions so fertility clinics can provide EEFs with the support and information they need to make informed decisions about their stored eggs and reduce the level of uncertainty reported among EEFs and the potential risk of psychological distress and regret. Clinical Trial Registration Number PROSPERO 2020: CRD42020202733

Worldwide, smartphone use is a major contributing factor to road crash among young drivers. While young drivers may be aware of their heightened crash risk and the legal penalties associated with this behaviour, young drivers continue to engage with their smartphones. The development of novel interventions targeting this behaviour is therefore crucial. The current 2 × 2 between groups experimental study (N = 153, 107F, 43 M, 1 other) investigated the concept of cognitive dissonance in relation to smartphone use among young drivers aged 17–25 years (Mage = 20.66 SD = 2.26). Specifically, it applied the induced hypocrisy paradigm to this context. The induced hypocrisy paradigm elicits cognitive dissonance by asking participants to both advocate for the desired behaviour and identify their engagement in the undesired behaviour. Participants are then motivated to change their behaviour to reduce the feelings of dissonance. The current study investigated the efficacy of both the traditional in-person methodology with a new online methodology. Analyses (e.g., ANCOVA) found that the online conditions were more effective than the in-person groups at eliciting dissonance and that the intervention conditions were more effective in reducing both intention and change in behaviour (from pre- to post-intervention) than the control groups. The intervention groups were also more likely to take/request a flyer about driver distraction. While more research is needed to corroborate these findings, these initial results suggest that cognitive dissonance occurs when young drivers use their smartphones and that the induced hypocrisy paradigm may be an effective intervention. In particular, this study’s findings suggest that an online version of the induced hypocrisy paradigm has merit and may form part of future cost-effective, mass interventions.

Background Readmission after percutaneous coronary intervention is common in the early postdischarge period, often linked to limited opportunity for education and preparation for self-care. Attending a nurse-led clinic within 30 d after discharge has the potential to enhance health outcomes. Objective The aim of the study was to synthesise the available literature on the effectiveness of nurse-led clinics, during early discharge (up to 30 d), for patients who have undergone percutaneous coronary intervention. Review method used A systematic review of randomised and quasi-randomised controlled trials was undertaken. Data sources The databases included PubMed, OVID, CINAHL, EMBASE, the Cochrane Library, SCOPUS, and ProQuest. Review methods Databases were searched up to November 2018. Two independent reviewers assessed studies using the Cochrane risk-of-bias tool. Results Of 2970 articles screened, only four studies, representing 244 participants, met the review inclusion criteria. Three of these studies had low to moderate risk of bias, with the other study unclear. Interventions comprised physical assessments and individualised education. Reported outcomes included quality of life, medication adherence, cardiac rehabilitation attendance, and psychological symptoms. Statistical pooling was not feasible owing to heterogeneity across interventions, outcome measures, and study reporting. Small improvements in quality of life and some self-management behaviours were reported, but these changes were not sustained over time. Conclusions This review has identified an important gap in the research examining the effectiveness of early postdischarge nurse-led support after percutaneous coronary intervention on outcomes for patients and health services. More robust research with sufficiently powered sample sizes and clearly defined interventions, comparison groups, and outcomes is recommended to determine effectiveness of nurse-led clinics in the early discharge period.

Given the predominance of the theory of planned behaviour (TPB) to represent the psychological determinants underlying people’s charitable decisions, the present study synthesised the model’s key relationships, using meta-analysis, and tested the predictive utility of the model for charitable giving encompassing donations of blood, organs, time, and money. Given its relevance to altruistic decisions, the impact of moral norm was assessed also. A systematic literature review identified 117 samples (from 104 studies) examining donation intentions and/or prospective behaviour using TPB measures. The sample-weighted average effects for all associations were moderate-to-strong with perceived behavioural control (PBC) most strongly associated with intention (r+ = 0.562), followed by moral norm (r+ = 0.537), attitude (r+ = 0.507), and subjective norm (r+ = 0.472). Intention (r+ = 0.424) showed stronger associations with prospective behaviour than PBC (r+ = 0.301). The standard TPB predictors explained 44% of variance in intention (52% including moral norm). Intention and PBC explained 19% of variance in behaviour. A number of TPB associations showed differences when analysed for moderator variables such as length of follow-up for prospective behaviour and type of target behaviour. Stronger associations were found for the (subjective and moral) norm-intention associations among some of the different types of giving behaviours, especially for donating organs and time. Overall, the large proportion of variance explained by the TPB predictors especially for intention highlights those cognitions associated with people’s plans to give, informative for charities reliant on people’s propensity to give.

Objective To examine the psychosocial factors that influence Australian women’s intentions to freeze their eggs. Design Initially, a qualitative elicitation study followed by a larger-scale quantitative study. Setting Both studies were conducted online. Patients A total of 234 Australian women 25−43 years of age, who identifed as heterosexual, had no children, were open to the idea of having children, were currently not pregnant, and did not have a diagnosis of medical infertility. Intervention None. Main Outcome Measure(s) Intentions and willingness of women to freeze their eggs. Result(s) Hierarchical multiple regression analyses showed that after accounting for demographic variables, there was strong support for the psychosocial predictors of attitude, pressure from others, and control perceptions as predictors of women’s intentions to freeze their eggs. Of the additional variables, cognitive bias (influence of the media) was significant, and the final model accounted for 52.7% of variance in women’s intentions to freeze their eggs. Conclusion(s) This study was the first to predict women’s intentions to freeze their eggs using a well-established decision-making model, the theory of planned behavior. Messages designed to develop a positive attitude toward egg freezing, and to encourage an increased perception of personal control of the egg freezing process, as well as approval from others, could support women to investigate egg freezing, in consultation with appropriate medical advice, as an option when faced with possible future infertility. Effective strategies broaden fertility options for women faced with age-related fertility decline, maximize women’s chances of a successful pregnancy, and, critically, prevent the often substantial psychological distress associated with involuntary childlessness.

Aim To identify and analyse the cultural attitudes, beliefs and practices of internationally educated nurses towards end-of-life care in the context of cancer. Background Cultural heritage shape beliefs and practices about cancer and end of life, which complicates nursing care delivery. While previous studies centred on diverse patients' perspectives and cultural competence of healthcare professionals, little analysis available focusing on the cultural attitudes and beliefs of care providers from diverse backgrounds. Design Mixed methods systematic review. Data sources CINAHL, MEDLINE, Embase, PsychINFO and Scopus were searched between January and March 2020. No date limit was applied. Review methods Quality appraisal was conducted using the mixed-method appraisal tool. Convergent segregated synthesis was undertaken. Findings were thematically synthesised with the final synthesis presented narratively. Results Seven studies were included: three qualitative, two quantitative and two mixed methods. None of the studies focused on the end-of-life care experiences of IENs in the context of cancer. One study reported views on cancer, with all studies analysing the cultural attitudes, beliefs and practices of internationally educated nurses towards end-of-life care. Three main themes were identified: the philosophy of care, approaches to care and perceptions of death and dying. Conclusion The distinct gap in research on understanding the cultural attitudes and beliefs of internationally educated nurses in end-of-life care in the context of cancer demands further research. Several aspects of end-of-life care were in conflict with internationally educated nurses' cultural attitudes, beliefs and practices. As these nurses are integral in achieving culturally competent care, further understanding of this phenomenon is required to advance the delivery of culturally sensitive care to patients. Impact Stakeholders, including the nursing workforce, need to play an active role in providing a culturally inclusive workplace. Support measures are necessary to reduce the impact of cultural conflicts experienced by internationally educated nurses.

The present study examined psychological, spiritual, physical/leisure and social self-care behaviours among psychologists using a major model of predicting human behaviour, the theory of planned behaviour (TPB). The study used a mixed method approach with two stages of data collection. Psychologists (N = 200) completed an online questionnaire assessing TPB constructs (attitude, subjective norm, perceived behavioural control and intention) and additional constructs of action planning, coping planning, peer and supervisor norms and organizational climate. Two weeks later, participants (n = 110) completed a follow-up questionnaire assessing their self-care behaviour. Results indicated general support for the standard TPB constructs in predicting self-care intentions for psychologists and the additional construct of action planning mediated the intention-behaviour relationship across most self-care dimensions. Findings from the current research provide further understanding of the factors influencing self-care engagement among psychologists and can be used to inform development of strategies to foster greater engagement in self-care behaviour.

This paper describes an innovative approach combining a content analysis of commentary and images on a Facebook page with a thematic analysis of the subjective experience expressed in interviews of those impacted by the text and images. Interview participants were asked about their perceptions of the representation of the muscularity-focused identity on social media, including the specific Facebook page. Content analysis of the Facebook page comments showed that very muscular male images attracted predominantly negative feedback from the public, a trend supported by the interview participants. Thematic analysis of the interviews indicated that a negative social media representation and commentary can affect young men's self-esteem and increase body concern. Some men represented on the Page found it humorous, which could serve as a form of bonding for the muscularity-focused online community. Other young men acknowledged how harmful such negative feedback can be on their self-evaluations and body image, consistent with the sociocultural framework whereby negative representations can lead to increased body dissatisfaction.

Objective Radiotherapy for gynaecological cancer is associated with multiple adverse effects. This randomised controlled trial evaluated the impact of a combined nurse- and peer-led psycho-educational intervention on psychological distress, preparation for treatment, quality of life, psychosexual function, unmet needs and vaginal stenosis. Methods Eligible women had a confirmed diagnosis of gynaecological cancer, scheduled to receive radiotherapy with curative intent, aged ≥18 years, and able to read and write English. Participants randomly assigned one-to-one to either four nurse-led consultations plus four peer-led telephone sessions, or to usual care. Participants completed study measures at baseline, immediately before first radiotherapy (FU1), and four weeks (FU2), three (FU3), six (FU4), and 12 months (FU5) post radiotherapy. The primary outcomes were psychological distress at FU1 and FU2 measured by the Hospital Anxiety and Depression Scale. Results Of 840 eligible participants, 625 were approached and 319 (51%) consented; 158 assigned to intervention, 160 to usual care with 1 withdrawing before randomisation. Between-groups differences for primary outcomes were trivial- and small-sized, (both p > 0.05). Notable effects on secondary outcomes favouring the intervention at FU2 included preparation for treatment (sensory/psychological concerns, d = 0.57; and procedural concerns, d = 0.52) and specific needs domains (sexuality needs, d = 0.38; and health system and information needs, d = 0.41). Conclusions There was no evidence that a nurse- and peer-led intervention had a beneficial effect on psychological distress compared to usual care. However, improved treatment readiness and lower health system and sexuality needs indicate the intervention may have addressed outcomes known to be important to this population.

BackgroundEvidence-based clinical practice guidelines recommend discussion by a multidisciplinary team (MDT) to review and plan the management of patients for a variety of cancers. However, not all patients diagnosed with cancer are presented at an MDT.Objectives(1) To identify the factors (barriers and enablers) influencing presentation of all patients to, and the perceived value of, MDT meetings in the management of patients with pancreatic cancer and; (2) to identify potential interventions that could overcome modifiable barriers and enhance enablers using the theoretical domains framework (TDF).MethodsSemistructured interviews were conducted with radiologists, surgeons, medical and radiation oncologists, gastroenterologists, palliative care specialists and nurse specialists based in New South Wales and Victoria, Australia. Interviews were conducted either in person or via videoconferencing. All interviews were recorded, transcribed verbatim, deidentified and data were thematically coded according to the 12 domains explored within the TDF. Common belief statements were generated to compare the variation between participant responses.ResultsIn total, 29 specialists were interviewed over a 4-month period. Twenty-two themes and 40 belief statements relevant to all the TDF domains were generated. Key enablers influencing MDT practices included a strong organisational focus (social/professional role and identity), beliefs about the benefits of an MDT discussion (beliefs about consequences), the use of technology, for example, videoconferencing (environmental context and resources), the motivation to provide good quality care (motivation and goals) and collegiality (social influences). Barriers included: absence of palliative care representation (skills), the number of MDT meetings (environmental context and resources), the cumulative cost of staff time (beliefs about consequences), the lack of capacity to discuss all patients within the allotted time (beliefs about capabilities) and reduced confidence to participate in discussions (social influences).ConclusionsThe internal and external organisational structures surrounding MDT meetings ideally need to be strengthened with the development of agreed evidence-based protocols and referral pathways, a focus on resource allocation and capabilities, and a culture that fosters widespread collaboration for all stages of pancreatic cancer.

Coaching is increasingly being used in the health sector, with staff and patients. Despite this increase there is only a small body of empirical evidence that demonstrates the effectiveness of coaching in health care settings.Objectives:This study evaluated the effectiveness of a workplace coaching programme (WCP) aimed at enhancing the work behaviours and well-being of 17 managers in a large Australian teaching hospital.Design:A within-group, pre-post test study design was used.Methods:The WCP consisted of needs-based workshops and group and individual coaching over a six-month period. Positive social science provided the theoretical underpinning for the WCP, and this was applied through an integrated solution-focused, cognitive-behavioural methodology. A questionnaire was used to collect data at two time points. Data was analysed using the Wilcoxon Sign Rank Test.Results:Participation in coaching was associated with significantly enhanced proactivity, core performance, goal-attainment, self-insight, motivation, positive affect, and autonomy. Significant effects on self-reflection, negative affect and psychological well-being were not found.Conclusion:The study provides preliminary evidence in favour of workplace coaching as an effective approach for facilitating work effectiveness. Further research utilising larger sample sizes and controlled study designs is warranted.

Objective: Increasing numbers of young Australian men are training and dieting to attain high muscle mass and low body fat and using steroids and performance and image enhancing drugs to expedite this process. This study explored men's identification with a muscularity-centred subculture and what contributes to the pursuit of masculine body image defined by muscularity. Method: Participants were 14 young men who (a) weight-trained >3 times per week, (b) used bodybuilding supplements daily, and (c) used/had used steroids/other performance and image enhancing drugs. Results: Interview analysis identified precipitating (e.g., low self-confidence), perpetuating (e.g., social media pressures), and resultant factors related to strict regime adherence, including simultaneous recreational drug use. This range of influences gives support to a sociocultural framework for explaining the development and maintenance of striving for a muscular ideal among this cohort. Conclusions: Understanding the factors contributing to the attainment of a muscularity-defined masculine body image is important given the risky health behaviours young men may engage in to reach this ideal.

Background The aim of this systematic review is to examine patient-reported outcome measures (PROMs), their attributes and application in patients with pancreatic cancer (PC). Method A systematic literature search was undertaken of articles published to June 2018 to identify PROMs applied in primary studies in PC. Characteristics of the included studies and PROMs were described with identified scales grouped into five domains. The psychometric properties of the identified PROMs were further assessed for reliability and validity among patients with PC. Results From 1688 studies screened, 170 were included. Almost half (48%) were conducted in patients with unresectable PC; the majority of these (68%) were evaluated in randomized controlled trials. Median questionnaire completion rates fell below 10% of the original cohort within 12 months in patients with unresectable PC compared to 75% in patients with resectable PC. Seventy PROMs were identified, 32 measuring unidimensional parameters (e.g. pain) and 35 measuring multidimensional (e.g. quality of life) constructs. Only five (7%) PROMs were disease-specific and 13 (19%) were validated in patients with PC. Fifty scales were grouped into 19 physical, 9 psychological, 6 psychiatric, 9 social and 7 other domains. Conclusion Three multidimensional PROMs, the: (i) FACT-HEP in unresectable PC; (ii) QLQ-PAN26 (in conjunction with its core QLQ-C30 PROM) in resectable PC; and (iii) MDASI-GI are recommended as instruments to capture quality of life in patients with PC. Summarised scales and psychometric evaluation provide a framework to choose PROMs for scales not captured by the recommended PROMs.

ObjectiveThe current study was informed by the belief basis of Ajzen’s (1991) Theory of Planned Behavior (TPB) to identify the important behavioral (advantages and disadvantages), normative (important referents) and control (barriers and facilitators) beliefs associated with the key recommended prevention and management behaviors for adults in Iran diagnosed with Type 2 diabetes (T2D).MethodsA cross-sectional study was conducted. A total of 115 adults diagnosed with T2D completed a questionnaire examining behavioral, normative and control beliefs and intention in relation to the three diabetes management behaviors including low fat food consumption, carbohydrate counting and physical activity. For each behavior, intention was considered as dependent variable; beliefs were independent variables. Analyses involved three multivariate one-way analysis of variance (MANOVAs).ResultsThe findings for carbohydrate counting and physical activity suggested behavioral and control beliefs as differentiating high from low intenders to perform the behavior. For carbohydrate counting, behavioral beliefs such as weight control, improving one’s health, feeling good and controlling diabetic complications differed significantly between low and high intenders. For physical activity, feeling good, controlling blood sugar and tiredness were among behavioral beliefs differentiating low and high intenders. Medical advice from professionals and greater knowledge were identified as facilitators of carbohydrate counting. High costs were identified as a key barrier preventing individuals from engaging in physical activity. Spouse was the single significant referent influencing carbohydrate counting.Conclusions & ImplicationsIdentifying the underlying beliefs of key diabetes management behaviors can assist in the design of tailored educational interventions for individuals with T2D.

Purpose: To summarise what is currently known about the psychosocial morbidity, experiences, and needs of people with cancer and their informal caregivers, who live in rural or regional areas of developed countries. Methods: Eligible studies dating from August 2010 until May 2021 were identified through several online databases, including MEDLINE, EMBASE, PsychINFO, and RURAL (Rural and Remote Health Database). Results were reported according to the PRISMA guidelines and the protocol was registered on PROSPERO (CRD42020171764). Results: Sixty-five studies were included in this review, including 20 qualitative studies, 41 quantitative studies, and 4 mixed methods studies. Qualitative research demonstrated that many unique psychosocial needs of rural people remain unmet, particularly relating to finances, travel, and accessing care. However, most (9/19) quantitative studies that compared rural and urban groups reported no significant differences in psychosocial needs, morbidity, or quality of life (QOL). Five quantitative studies reported poorer psychosocial outcomes (social and emotional functioning) in urban cancer survivors, while three highlighted poorer outcomes (physical functioning, role functioning, and self-reported mental health outcomes) in the rural group. Conclusion: Recent research shows that rural people affected by cancer have unique unmet psychosocial needs relating to rurality. However, there was little evidence that rural cancer survivors report greater unmet needs than their urban counterparts. This contrasts to the findings from a 2011 systematic review that found rural survivors consistently reported worse psychosocial outcomes. More population-based research is needed to establish whether uniquely rural unmet needs are due to general or cancer-specific factors. Refereed/Peer-reviewed

Background New parents face increased risks of emotional distress and relationship dissatisfaction. Digital interventions increase support access, but few preventive programs are optimized for both parents. Objective This study aims to conduct the first randomized controlled trial on universal self-guided digital programs to support positive perinatal adjustment of both mothers and fathers. Effects of childcare information (Baby Care) and information plus an interactive program (Baby Steps Wellbeing) were compared from the third trimester baseline to 3 and 6 months subsequently. Methods The study recruited 388 co-parenting male-female adult couples expecting their first single child (26-38 weeks’ gestation), using web-based registration. Most (337/388, 86.8%) were obtained from prenatal hospital classes. Couples’ randomization was automated and stratified by Edinburgh Postnatal Depression Scale (EPDS) scores (50% couples scored high if either mother >7, father >5). All assessments were web-based self-reports: the EPDS and psychosocial quality of life were primary outcomes; relationship satisfaction, social support, and self-efficacy for parenting and support provision were secondary. Linear mixed models provided intention-to-treat analyses, with linear and quadratic effects for time and random intercepts for participants and couples. Results Selection criteria were met by 63.9% (248/388) of couples, who were all randomized. Most participants were married (400/496, 80.6%), tertiary educated (324/496, 65.3%), employed full time (407/496, 82%), and born in Australia (337/496, 67.9%). Their mean age was 32.2 years, and average gestation was 30.8 weeks. Using an EPDS cutoff score of 13, 6.9% (18/248) of men, and 16.1% (40/248) of women screened positive for depression at some time during the 6 months. Retention of both partners was 80.6% (201/248) at the 6-month assessments, and satisfaction with both programs was strong (92% ≥50). Only 37.3% (185/496) of participants accessed their program more than once, with higher rates for mothers (133/248, 53.6%) than fathers (52/248, 20.9%; P Conclusions Three secondary outcomes showed differential benefits from Baby Steps Wellbeing, but for one (parenting self-efficacy), the effect only occurred for mothers, perhaps reflecting their greater program use. Increased engagement will be needed for more definitive testing of the potential benefits of Baby StepsWellbeing for perinatal adjustment. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12614001256662; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=367277

There is a perception that traditional masculine ideals, usually thought deleterious for men's health outcomes, are no longer as relevant for younger social generations such as Millennials as they are for older social generations such as Baby Boomers. Yet, in Australia, there remains a disparity between younger men's and women's health outcomes and use of health services. Conformity to traditional masculinity is often cited as a barrier to men's positive health behaviours but conceptualisation of the construct is contested. We analysed a selected secondary dataset (n = 14,917) of Australian males aged between 15 and 55 years from Ten to Men: The Australian Longitudinal Study on Male Health. We examined the role of conformity to traditional masculine norms in predicting likelihood of regular primary and preventative health services use for different social generations. Analyses included mediated regression and adjusted logistic regression. Conformity to ten of the eleven specific traditional masculine norms predicted likelihood of increased or decreased regular health service use depending on the generation and health service type. Specific traditional masculine norms play a complex role in men's use of distinct health service types for different generations of Australian males. Practitioners wishing to increase men's engagement with health services should consider gender-sensitive approaches that leverage specific masculine norms relevant to the age cohort to drive positive outcomes in men's health.

Purpose The purpose of this paper is to investigate the role of masculine identity in generating value destruction and diminished well-being in a preventative health service. Design/methodology/approach This research used five focus groups with 39 Australian men aged between 50 and 74 years. Men’s participation in the National Bowel Cancer Screening Program informed the sample frame. In total, 12 Jungian male archetypes were used to identify different masculine identities. Findings Thematic analysis of the data revealed three themes of masculinity that explain why men destroy value by avoiding the use of a preventative health services including: rejection of the service reduces consumer disempowerment and emasculation, active rejection of resources creates positive agency and suppressing negative self-conscious emotions protects the self. Research limitations/implications Limitations include the single context of bowel cancer screening. Future research could investigate value destruction in other preventative health contexts such as testicular cancer screening, sexual health screening and drug abuse. Practical implications Practical implications include fostering consumer empowerment when accessing services, developing consumer resources to create positive agency and boosting positive self-conscious emotions by promoting positive social norms. Originality/value This research is the first known study to explore how value is destroyed in men’s preventative health using the perspective of gender identity. This research also is the first to explore value destruction as an emotion regulation strategy.

Background Research indicates that young women are being exposed to increasing pressures to remove pubic hair from their bodies, which has the potential for both negative physical and psychological consequences. Women’s personal choice and reasoning for partaking in pubic hair removal is influenced by broader social influences; however, there is little theory-based research drawing from established decision-making models investigating the underlying processes that lead young women to engage in pubic hair removal practices. Based on the Theory of Planned Behaviour, it was hypothesised that 1) attitude, subjective norm, and perceived behavioural control would predict intention to remove pubic hair; 2) additional variables (prototype similarity and favourability) from the Prototype Willingness Model would significantly predict intention to remove pubic hair; 3) feminist values would significantly predict decreased intention to remove pubic hair; and 4) intention and perceived behavioural control would predict future self-reported removal of pubic hair. Method The current study included a sample of 270 young women (17–25 years old), who completed an online survey and a follow up survey 4 weeks later (N = 96). Results Attitudes, perceived behavioural control, and similarity to prototypical pubic hair removers were significant predictors of intention to remove pubic hair. Intention was significantly positively associated and feminist values were significantly negatively associated with actual pubic hair removal. Conclusions These findings align with Theory of Planned Behaviour propositions. Furthermore, the expansion of the model highlights how broader social images impact on young women when deciding whether to engage in a behaviour that is intimately associated with their body image.

Alcohol is a commonly used substance among Vietnamese medical students, especially males. Vietnamese male medical students drink more alcohol, report more intentions to binge drink, and experience more alcohol-related problems than females. As medical students' alcohol consumption may influence their attitudes and medical practice relating to alcohol counseling and prevention, research about the cultural and drinking norms underlying the drinking behavior of Vietnamese male medical students is warranted. This study aims to explore the norms underlying drinking behavior of Vietnamese male medical students. A qualitative study including 32 in-depth interviews with Vietnamese male medical students at a medical university. Thematic analysis was used to analyze the data. This study found Vietnamese male medical students considered alcohol consumption as a way to show their masculinity and become accepted by groups. Given these beliefs and adherence to norms, they followed rules to force others to consume more alcohol or be intoxicated in drinking occasions among medical students. This study showed the importance of gender and group norms in influencing Vietnamese male medical students' alcohol consumption. These norms should be considered in future research and interventions addressing alcohol use among this target population.

The prognostic value of patient-reported outcomes (PROs) has been determined in some cancers, but a focussed review in colorectal cancer (CRC) has not yet been conducted. We systematically reviewed PRO predictors of CRC patient survival. We searched four electronic databases (from inception to May 2018), reference lists and professional organisations to identify studies reporting pre-treatment PRO predictors of overall survival (OS) or progression-free survival (PFS) in CRC identified through univariate or multivariate models. Two reviewers independently applied inclusion criteria and extracted data on study characteristics, median and 1-year survival rates, PROs assessed and model results. In 25 of 27 studies (n = 12,544), at least one PRO was significantly associated with survival. Physical functioning, fatigue, pain and appetite loss predicted OS more often than other PROs in metastatic disease (19/27 studies). One study explored PRO predictors in early-stage CRC, finding emotional well-being and mood predicted OS. In mixed-stage samples (7/27 studies), physical functioning predicted OS more often than other PROs. Few studies modelled PFS, for which few PROs had predictive value. Physical and psychological functioning, pain, fatigue and appetite loss had prognostic significance above and beyond clinical predictors in CRC. Routine monitoring of these PROs may allow earlier detection and amelioration of problems, which may improve quality of life and perhaps extend survival. More research is needed to determine prognostic value of PROs in early-stage CRC, and prognostic significance of changes in PRO scores.

Background Hospitalisation for percutaneous coronary intervention (PCI) in Australia is reducing. Patients who undergo PCI may be discharged home without a post-discharge health management plan, referral for secondary prevention, or understand their chronic condition. Subsequently, negative psychological symptoms such as anxiety and depression may be experienced in the post-discharge period. Objectives This study assessed the effectiveness of a nurse-led clinic on patients' cardiac self-efficacy and negative psychological symptoms of anxiety and depression 1-week post-PCI discharge. Methods One-hundred and eighty-eight potential participants were screened, and 33 participants were block-randomised to study groups. The nurse-led clinic used a person-centred approach and delivered tailored education, health assessment, and post-discharge support. In Phase 1, the Cardiac Self-efficacy Scale and State-Trait Anxiety Inventory measured primary outcomes, while the Cardiac Depression Scale was used to measure secondary outcomes. Phase 2 evaluated participants' experiences and healthcare professionals' perceptions of the intervention through semi-structured interviews. Results In Phase 1, intervention group participants did not show improvements in mental health indicators compared to standard care group participants, except for a moderate reduction in anxiety levels (d = 0.50). Phase 2 qualitative findings; however, highlighted the benefits of the nurse-led clinic. Conclusions Overall, findings suggest that nurse-led clinics may be valuable to reduce anxiety and act as a supportive measure in the early post-discharge period until commencement of a secondary prevention program. Further research with a more powered sample is needed to determine the significance of the findings.

This study used an extended Theory of Planned Behaviour (TPB; Ajzen, 1985) incorporating moral norm and descriptive norm, to examine the beliefs, intentions, and behaviours associated with altruistic driving. This study was conducted among Australian drivers aged 17 years and older. A formative consultation (N = 9) was conducted in which participants identified two specific altruistic driving behaviours; namely, letting another driver have a car space and giving way to another driver to enter their lane, in addition to the salient behavioural, normative, and control beliefs underlying the performance of altruistic driving behaviours in general. Following this consultation, a quantitative study was conducted with an initial (Time 1) and follow-up questionnaire (Time 2) explored individuals’ intentions and behaviours associated with the performance of general, and the two specific, altruistic driving behaviours. The regression analyses from Time 1 (N = 237) provided support for the extended TPB in predicting individuals’ intention to engage in altruistic driving. At Time 2, the regression analyses revealed intention significantly predicted general altruistic driving behaviours (N = 124), letting another driver have a car space (n = 63), and giving way to another driver to enter a lane (n = 114). Furthermore, the analysis of the TPB beliefs found two beliefs to underlie the performance of general altruistic driving behaviours, namely ‘maintain traffic flow’ as an advantage associated with the behaviour being more likely to be performed, and ‘time constraints’ serving as a barrier to prevent drivers from performing the behaviour. Overall, this preliminary investigation offers insights into avenues for future road safety campaigns aimed at encouraging drivers to be more altruistic on the roads.

Background Pancreatic cancer (PC) remains a highly fatal disease. There is a gap in the literature on the of quality care on survival in a real-world population. Objectives This study: (1) assessed compliance with a consensus set of quality indicators (QIs); and (2) evaluated the association between compliance with these QIs and survival. Methods Data were collected on a core set of quality indicators by the Upper Gastrointestinal Cancer Registry (UGICR) for patients diagnosed with PC between 1 January 2016 and 31 December 2019. Univariable and multivariable Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% CIs for the association between survival and patient characteristics, hospital characteristics and QIs, stratified by resectability. A multivariable analysis tested the relationship between significant patient and hospital characteristics, patient cluster effects within hospitals and survival. Results 1061 patients were eligible for this study with 52% male, 71% over the age of 65, 23% potentially resectable and 51% with metastatic disease at diagnosis. 52% received some form of cancer directed treatment. Significant association with improved survival were: (1) in the potentially resectable group having adjuvant chemotherapy administered following surgery or a reason documented (HR, 0.29; 95 CI, 0.19-0.46); (2) in the locally advanced group included having chemotherapy ± chemoradiation, or a reason documented for not undergoing treatment (HR, 0.38; 95 CI, 0.25-0.58) and (3) in the metastatic disease group included having documented ECOG at presentation and/or American society of Anaesthesiologists (ASA) performance status at a diagnostic procedure (HR, 0.65; 95 CI, 0.47-0.89), being seen by a medical oncologist and/or a radiation oncologist in the absence of treatment (HR, 0.48; 95 CI, 0.31-0.77), and having disease management discussed at an MDT meeting (HR, 0.79; 95 CI, 0.64-0.96). Conclusion Capture of a concise data set has enabled quality of care to be assessed and an analysis of factors associated with improved survival identified.

ObjectiveInformal family caregivers play a crucial role in cancer care. Effective caregiver involvement in cancer care can improve both patient and caregiver outcomes. Despite this, interventions improving the caregiver involvement are sparse. This protocol describes a randomised controlled trial evaluating the combined effectiveness of novel online caregiver communication education modules for: (1) oncology clinicians (eTRIO) and (2) patients with cancer and caregivers (eTRIO-pc).Methods and analysisThirty medical/radiation/surgical oncology or haematology doctors and nurses will be randomly allocated to either intervention (eTRIO) or control (an Australian State Government Health website on caregivers) education conditions. Following completion of education, each clinician will recruit nine patient–caregiver pairs, who will be allocated to the same condition as their recruiting clinician. Eligibility includes any new adult patient diagnosed with any type/stage cancer attending consultations with a caregiver. Approximately 270 patient–caregiver pairs will be recruited. The primary outcome is caregiver self-efficacy in triadic (clinician–patient–caregiver) communication. Patient and clinician self-efficacy in triadic communication are secondary outcomes. Additional secondary outcomes for clinicians include preferences for caregiver involvement, perceived module usability/acceptability, analysis of module use, satisfaction with the module, knowledge of strategies and feedback interviews. Secondary outcomes for caregivers and patients include preferences for caregiver involvement, satisfaction with clinician communication, distress, quality of life, healthcare expenditure, perceived module usability/acceptability and analysis of module use. A subset of patients and caregivers will complete feedback interviews. Secondary outcomes for caregivers include preparedness for caregiving, patient–caregiver communication and caring experience. Assessments will be conducted at baseline, and 1 week, 12 weeks and 26 weeks post-intervention.Ethics and disseminationEthical approval has been received by the Sydney Local Health District Human Research Ethics Committee (REGIS project ID number: 2019/PID09787), with site-specific approval from each recruitment site. Protocol V.7 (dated 1 September 2020) is currently approved and reported in this manuscript. Findings will be disseminated via presentations and peer-reviewed publications. Engagement with clinicians, media, government, consumers and peak cancer groups will facilitate widespread dissemination and long-term availability of the educational modules.Trial registration numberACTRN12619001507178.

Background Cigarette smoking in people with cancer is associated with negative treatment-related outcomes including increased treatment toxicity and complications, medication side effects, decreased performance status and morbidity. Evidence-based smoking cessation care is not routinely provided to patients with cancer. The purpose of this study is to determine the effectiveness of a smoking cessation implementation intervention on abstinence from smoking in people diagnosed with cancer. Methods A stepped wedge cluster randomised design will be used. All sites begin in the control condition providing treatment as usual. In a randomly generated order, sites will move to the intervention condition. Based on the Theoretical Domains Framework, implementation of Care to Quit will include (i) building the capability and motivation of a critical mass of key clinical staff and identifying champions; and (ii) identifying and implementing cessation care models/pathways. Two thousand one hundred sixty patients with cancer (diagnosed in the prior six months), aged 18+, who report recent combustible tobacco use (past 90 days or in the 30 days prior to cancer diagnosis) and are accessing anti-cancer therapy, will be recruited at nine sites. Assessments will be conducted at baseline and 7-month follow-up. The primary outcome will be 6-month abstinence from smoking. Secondary outcomes include biochemical verification of abstinence from smoking, duration of quit attempts, tobacco consumption, nicotine dependence, provision and receipt of smoking cessation care, mental health and quality of life and cost effectiveness of the intervention. Discussion This study will implement best practice smoking cessation care in cancer centres and has the potential for wide dissemination. Trial registration The trial is registered with ANZCTR (www.anzctr.org.au): ACTRN (ACTRN12621000154808) prior to the accrual of the first participant and will be updated regularly as per registry guidelines.

Many young donors (i.e., young people who wish to donate organs upon death) are unaware of the need for family discussion to increase the likelihood of family consent for donation. They have low motivation to discuss and have not notified family of their wishes. We addressed a gap in existing research by developing and piloting six persuasive message appeals targeted specifically at young donors to encourage family discussion about donation. Young donors, who were Australian residents (7 females, 2 males) aged 21-25 years (M = 23.00; SD = 1.73), participated in qualitative interviews. Participants commented on their reactions to each message appeal, message effectiveness, and preferred appeals. Responses to message appeals were mixed. Mixed reactions were reflected in preferences for solely positive appeals or both positive and negative. Some participants felt negative emotional appeals were more impactful and memorable. Reactions to the provision of strategies to aid actual discussion (i.e., what to say, when to discuss, reminder prompts) in messages were guided by young donors’ views of family discussion as either ‘no big deal’ or requiring preparation. Participants believed that including scenarios in which a person makes a donation decision for themselves or a loved one was thought provoking, motivating, and clearly conveyed the impact of the choice not to discuss on others. The four preferred message appeals included equal numbers of messages with positive and negative framing, high and low/no strategy, and individual vs. other perspective. Future piloting of these message appeals with a larger audience of young donors will determine message effectiveness in encouraging family discussion.