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Wales has been committed to receiving asylum seekers and resettling refugees in towns and cities, and these numbers are increasing on a yearly basis. However, many people seeking asylum feel disempowered by the disabling policies of the Home Office, leading to social and economic hardship for this population. This qualitative study aimed to capture the voices of this under-served group through in-depth, semi structured interviews to gain contextual understanding of the social and psychological challenges experienced by people seeking asylum in Wales. The findings suggest that many asylum seekers and refugees relied on their social support networks to compensate for the limited welfare offered to them by the asylum system. Changes to the asylum process and policies are needed for Wales to achieve its goal of ensuring that people seeking asylum are supported to rebuild their lives and make a full contribution to the Welsh society., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Attentional bias modification (ABM) is a novel cognitive-based treatment that may help individuals reduce overeating by decreasing food processing bias and food cravings. However, most empirical studies have evaluated the short-term effects of ABM in populations that have body mass indexes that are within healthy ranges; therefore, the extent to which this training method can influence eating behavior in individuals who are overweight or obese remains unclear. This systematic review explored the efficacy of ABM as a tool to support weight management for individuals who are overweight or obese. Ten studies met the inclusion criteria for the review. The findings reveal that although training is effective at manipulating attentional bias to food cues, there is limited evidence that training significantly impacted appetite and eating behaviors or led to maintained weight loss., (© 2024 The Author. Obesity Reviews published by John Wiley & Sons Ltd on behalf of World Obesity Federation.)

Background: It is difficult to recognize vitamin B12 deficiency and to evaluate the effect of B12 treatment due to a broad range of variable clinical symptoms overlapping with other diseases and diagnostic biomarkers that quickly normalize during treatment. This poses a risk of delay in diagnosis and a challenge to uniformly monitor the effect of B12 treatment. There is a need for a new clinical outcome measure suitable for clinical practice and clinical evaluation studies., Objective: To develop a Patient-Reported Outcome Measure (PROM) which measures the severity of vitamin B12 deficiency symptoms., Methods: The B12 PROM was developed by (1) gathering input from experts and literature review to define a construct and develop a conceptual model, (2) processing input from health care providers, scientists, and patients to develop items and response options, and (3) improving items based on the feedback from laypersons, test interviews, semi-structured cognitive interviews with patients, and forward and backward translation (ENG-NL)., Results: The B12 PROM includes 62 items grouped into 8 categories of symptoms related to vitamin B12 deficiency (General, Senses, Thinking, In limbs and/or face, Movement, Emotions, Mouth & Abdomen, Urinary tract & Reproductive organs). Cognitive interviews demonstrated good comprehensibility and comprehensiveness., Conclusions: This study is the first step in the development of a disease-specific PROM for vitamin B12 deficiency to measure the burden of symptoms. Further validation and reliability testing are necessary before the PROM can be applied in clinical practice and research., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Pernicious anemia (PA) is a type of macrocytic anemia caused by autoimmune gastritis. To facilitate timely diagnosis and treatment of PA there is a pressing need for improved understanding among Healthcare providers of the condition's symptoms and diagnostic criteria., Objective: This systematic review aims to extend existing clinical knowledge on the presentation of PA by determining which symptoms and clinical complications are reported in published adult case studies., Methods: Relevant studies were identified through electronic searches of PsycINFO, Embase, and MEDLINE, via OvidSP. During data extraction symptoms were categorized according to the International Classification of Diseases and were grouped based on frequency., Results: Symptoms were documented for 103 adults with a diagnosis of PA; the most frequent symptoms were fatigue (55%), loss of sensation in limbs (32%), excessive weight loss (27%), and a sore tongue (23%)., Conclusions: This review highlights the diverse symptomology of adults who are diagnosed with PA. Most symptoms documented in case studies are consistent with the core signs of B 12 and folate deficiencies. Research is needed to identify if there are common clusters of PA symptoms that can be used as prompts for diagnostic testing in patients with suspected B 12 deficiency., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objectives: Migraine is considered a chronic health condition that impacts both quality of life and psychological wellbeing. People with migraines use a range of management strategies, which include pharmacological and non-pharmacological treatments. The aim of this study was to explore individuals' experiences and perceptions of migraines and its treatment using the Common-Sense Model (CSM) of Illness Representations., Methods: Semi-structured, one-to-one interviews were conducted with eleven individuals with a history of migraine to explore their experiences and perceptions of migraine and its treatment. Participants were recruited from across the United Kingdom via convenience sampling using social media advertisement. Interviews were recorded, transcribed verbatim, and qualitative data were analysed using theoretical framework analysis using the CSM., Results: The three dimensions of the CSM were mapped on to the qualitative data. These were: (i) Cognitive representations of migraine, within five domains: (a) identity of migraine, (b) perceived causes, (c) perceived timeline, (d) perceived control/cure, and (e) perceived consequences; (ii) Emotional representations of migraine relating to (a) migraine specific emotions and (b) emotional representation of the impact of migraine; and (iii) Coping/self-management behaviours, namely (a) self-medicating behaviours and (b) care-seeking behaviours. No incongruous data were found; therefore, no further thematic analysis was required., Conclusion: This is the first study to apply the CSM to migraine for framework analysis of qualitative data in this way. The findings illustrate the emotional impact of migraine and the range of illness perceptions associated with appropriate self-management. The data will be used to design a questionnaire for quantitative studies to investigate the extent to which these perceptions are generalizable to the wider population of people who experience migraines., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Royal Pharmaceutical Society.)

Whilst chronic fatigue syndrome (CFS) has been widely researched amongst women, studies investigating how men experience a CFS diagnosis is limited. This study utilised an interpretative phenomenological approach to interview five men who have a medical diagnosis of CFS. Six themes emerged to demonstrate the participants' experiences prior to, during and after obtaining their CFS diagnosis. Findings revealed that participants were initially reluctant to accept their condition, confounded by their perception that symptoms compromised their sense of masculinity. They also felt that healthcare professionals had limited recognition of CFS leading them to seek social support and legitimisation from other sources. The struggle to come to terms with a different lifestyle and sense of masculinity prevailed. Such knowledge could be effectively utilised by researchers, practitioners and employers to facilitate an increased understanding of male accounts of the condition and more bespoke interventions where required., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Pharmacy professionals are well-placed to provide medication adherence support to patients. The Capability, Opportunity, Motivation-Behaviour (COM-B) and Theoretical Domains Framework (TDF) are two complementary models previously applied to medication-taking behaviour. Understanding the patient-specific barriers and facilitators to adherence using psychological frameworks from the early stages of pharmacy education enables the design and delivery of effective interventions., Objectives: To examine whether a novel 'mock medicine' learning activity enabled students to experience the range of barriers and facilitators to medication adherence using the COM-B and TDF., Methods: A mock medicine activity was conducted with students at pharmacy schools in three universities in the UK, Norway, and Australia over one week. Percentage adherence was calculated for five dosing regimens; theoretical framework analysis was applied to map reflective statements from student logs to COM-B and TDF., Results: A total of 349 students (52.6%) returned completed logs, with high overall mean adherence (83.5%, range 0-100%). Analysis of the 277 (79.4%) students who provided reflective statements included barriers and facilitators that mapped onto one (9%), two (29%) or all three (62%) of the COM-B components and all fourteen TDF domains (overall mean = 4.04; Uni 1 = 3.72; Uni 2 = 4.50; Uni 3 = 4.38; range 1-8). Most frequently mapped domains were ' Environmental context and resources ' ( n  = 199; 72%), ' Skills ' ( n  = 186; 67%), ' Memory, attention and decision-making ' (184; 66%) and ' Beliefs about capabilities ' ( n  = 175; 63%)., Conclusions: This is the first study to utilise both COM-B and TDF to analyse a proxy measure of medication adherence in pharmacy education. Data mapping demonstrated that students experienced similar issues to patients when prescribed a short course of medication. Importantly, all the factors influencing medication-taking reported by students were captured by these two psychological frameworks. Future educational strategies will involve students in the mapping exercise to gain hands-on experience of using these psychological constructs in practice., Competing Interests: The authors have no competing interests to declare., (© 2023 The Authors.)

Background: Patient medication adherence in Parkinson's Disease (PD) is often suboptimal. This may lead to poor symptom management, greater disease burden, decreased quality of life and increased healthcare costs. Use of psychological theory such as the Theoretical Domains Framework (TDF) has effectively captured barriers and facilitators to medication adherence in other long-term conditions. Applying this framework to medication adherence in PD could provide a better understanding of the challenges to inform the development of effective interventions., Objectives: The aim of the study was to apply the TDF to determine the barriers and facilitators to medication adherence in people with PD., Methodology: This qualitative study employed online interviews to explore medication adherence in a small group of people with PD recruited via Parkinson's UK and social media. A semi-structured interview schedule was designed informed by the 14 TDF domains. All interviews were audio-recorded, transcribed verbatim and mapped to the TDF using Framework Analysis., Results: Twelve participants diagnosed with PD were interviewed, 11 of whom were currently taking prescribed medication plus another self-medicating with Vitamin B1. All TDF domains were evident in the data. Predominant facilitators were Domains 1 - Knowledge , 6 - Social Influence , and 12 - Beliefs about Consequences and barriers were 7 - Reinforcement , 10 - Memory, Attention and Decision Processes , and 11 - Environmental Context and Resources . Other themes were not related to medication adherence., Conclusion: In this small group, all data relating to the barriers and facilitators for medication adherence in PD were successfully mapped onto the TDF. This indicates the utility of the framework for determining and structuring the factors to consider when providing medication support for this patient population in an accessible and coherent way. Further quantitative studies are needed to determine the extent to which these factors can be generalised to other PD patients., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

Illness and medication beliefs have shown to predict COVID-19 vaccination behaviour in the general population, but this relationship has yet to be demonstrated in healthcare staff. This research aimed to explore the potential explanatory value of illness and medication beliefs on the COVID-19 vaccination uptake of a sample of patient-facing healthcare workers (HCWs). A web-based questionnaire-measuring beliefs about vaccinations (the BMQ), perceptions of COVID-19 (the BIPQ), vaccine hesitancy, and vaccine uptake-was targeted to HCWs via social media platforms between May-July 2022. Open text responses allowed participants to provide explanations for any delay in vaccine uptake. A total of 91 participants completed the questionnaire. Most respondents (77.1%, n = 64) had received three doses of the COVID-19 vaccination, and vaccination uptake (number of doses received) was predicted by Vaccine Concerns, Vaccine Hesitancy, and their Necessity-Concerns Differential score. Vaccine Hesitancy was predicted by Necessity, Concerns, and Overuse scores, as well as Necessity-Concerns Differential scores. Delay in Vaccine Uptake could only be predicted for Dose 3 (Booster). Qualitative data revealed that hesitant respondents were "unable to take time off work" for vaccination and that some had concerns over vaccine safety. In conclusion, illness and medication beliefs have potential value in predicting vaccine hesitancy and uptake in healthcare workers. Interventions to improve vaccination uptake in this population should address concerns about vaccine safety and releasing staff for vaccination booster appointments should be prioritised. Future research should further investigate the relationship between illness and medication beliefs and COVID-19 vaccine uptake in a larger sample of healthcare workers.

Public perceptions of pandemic viral threats and government policies can influence adherence to containment, delay, and mitigation policies such as physical distancing, hygienic practices, use of physical barriers, uptake of testing, contact tracing, and vaccination programs. The UK COVID-19 Public Experiences (COPE) study aims to identify determinants of health behaviour using the Capability, Opportunity, Motivation (COM-B) model using a longitudinal mixed-methods approach. Here, we provide a detailed description of the demographic and self-reported health characteristics of the COPE cohort at baseline assessment, an overview of data collected, and plans for follow-up of the cohort. The COPE baseline survey was completed by 11,113 UK adult residents (18+ years of age). Baseline data collection started on the 13th of March 2020 (10-days before the introduction of the first national COVID-19 lockdown in the UK) and finished on the 13th of April 2020. Participants were recruited via the HealthWise Wales (HWW) research registry and through social media snowballing and advertising (Facebook®, Twitter®, Instagram®). Participants were predominantly female (69%), over 50 years of age (68%), identified as white (98%), and were living with their partner (68%). A large proportion (67%) had a college/university level education, and half reported a pre-existing health condition (50%). Initial follow-up plans for the cohort included in-depth surveys at 3-months and 12-months after the first UK national lockdown to assess short and medium-term effects of the pandemic on health behaviour and subjective health and well-being. Additional consent will be sought from participants at follow-up for data linkage and surveys at 18 and 24-months after the initial UK national lockdown. A large non-random sample was recruited to the COPE cohort during the early stages of the COVID-19 pandemic, which will enable longitudinal analysis of the determinants of health behaviour and changes in subjective health and well-being over the course of the pandemic., Competing Interests: The authors have declared that no competing interests exist.

Background: Functional Restorative Programmes (FRP) for persistent non-specific lower back pain have been shown to be effective, but they often lack sufficient detailed reporting of the intervention components to allow for accurate replication., Objectives: This study used the Behaviour Change Technique Taxonomy (v1) (BCTi) [1] to identify the main components of one such programme and interviewed patients to identify the most effective programme components and areas for improvement., Design: A mixed methods design was used., Methods: Intervention data were coded using the BCT Taxonomy (v1) to identify the BCTs utilised. Following this, semi-structured interviews with nine patients evaluated the BCTs included using thematic analysis and identified possible techniques for inclusion in future developments of the programme., Results: Forty-one different BCTs were identified in the coding phase with frequency of occurrence in the programme ranging from forty-nine to one. Four main themes emerged from the interviews: Social Support, Shaping Knowledge, Repetition and Substitution and Changes in Mindset., Conclusion: The results of this study identify the key ingredients in a programme for persistent, non-specific lower back pain, which facilitates the replication of this intervention and identified areas patients appreciated most as well as areas for improvement., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Pernicious anemia (PA) is a chronic condition that is usually treated using B 12 injections. Due to the pandemic, many patients were prescribed an alternative oral B 12 treatment. There is limited evidence that this is effective at managing symptoms of PA. The aim of this study was to document treatment changes across the United Kingdom and the impact on patient experience. An online survey explored how the treatment of PA has been managed during the early stages of the pandemic; responses were analyzed for a subsample of participants receiving prescribed B 12 injections and where changes in treatment applied (n = 329) using content analysis. The most common reported change was the suspension of injections, with oral B 12 being offered as an alternative treatment. Patients were concerned about the long-term impact that changes would have on their condition management, and many stated that they were dissatisfied with the level of care received. Those who were supported by health care providers to continue their usual treatment reported experiencing improved health and well-being. This study highlights the major impact of treatment changes on patient health outcomes and the need to further support health care professionals with PA management during and beyond the pandemic., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2021.)

Objectives: Pernicious anemia (PA) is a chronic condition caused by vitamin B12 deficiency. This is a qualitative study using interpretative phenomenological analysis (IPA), which aimed to explore the patients lived experience of diagnosis and treatment., Methods: Eleven semistructured interviews were conducted in PA patients; these covered participants' diagnostic and treatment journeys, the responses of others to their diagnosis, and the role health professionals have played in their medical care. Interviews were analyzed for recurrent themes using IPA., Results: Three superordinate themes were identified: "The struggle to achieve a diagnosis," "The significance of a diagnosis," and "Battling for sufficient treatment." Participants were dissatisfied with their medical care due to diagnostic delay, insufficient treatment, and poor relationships with their health professionals. Many experienced, anticipated, and internalized stigma, which led to a reduced quality of life and withdrawal from the medical profession., Discussion: Participants' interactions with their health professionals hindered their adaptation to their condition; this affected their psychological and physical well-being. Increased clinician awareness of stigma in the PA population symptoms and effective patient-centered communication is required., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2019.)

The Three Factors Eating Questionnaire's measure of disinhibited eating is a robust predictor of long-term weight gain. This experiment explored if disinhibited eaters display attentional bias to food cues. Participants (N = 45) completed a visual dot probe task which measured responses to food (energy dense and low energy foods) and neutral cues. Picture pairs were displayed either for a 100 ms or 2000 ms duration. All participants displayed attentional bias for energy dense food items. Indices of attentional bias were largest in disinhibited eaters. Attentional bias in disinhibited eaters appeared to be underpinned by facilitated attention., (Copyright © 2016 Elsevier Ltd. All rights reserved.)