Helping pregnant women quit smoking: sharing best practice from the UK

By Felix Naughton, University of East Anglia, UK

 Between 25-50% of female smokers quit smoking after they discover they are pregnant. But why do the remainder continue to smoke throughout their pregnancy?

 Do they not know that smoking during pregnancy is harmful? They usually do. One of our UK studies, that included pregnant women both motivated and unmotivated to quit, found 99% agreed to some degree with the statement ‘smoking during pregnancy can cause serious harm to my baby’ with around 75% agreeing very much or extremely. Yet less than 10% of them were abstinent 12 weeks later. While making a quit attempt is more likely among those with strong ‘harm beliefs’ about smoking in pregnancy, it does not appear to increase the chances of success. 


Improving the delivery of brief alcohol advice in primary care: views from both sides of the consultation table

By Amy O’Donnell, Newcastle University, UK

Levels of drinking have fallen recently in some parts of Europe, particularly amongst young people. However, excessive alcohol consumption remains a major risk factor for poor health and early death. Providing simple brief advice to those identified as heavy drinkers can help reduce the amount of alcohol people consume, especially when delivered by primary care clinicians such as general practitioners (GPs) or nurses. Alcohol brief advice involves a short, evidence-based, structured conversation that aims to motivate and support a patient to consider a change in their drinking behaviour to reduce their risk of harm. We still haven’t fully identified the key ingredients of these conversations, but providing personalised feedback on a patient’s alcohol consumption, and encouraging them to self-monitor their drinking, seem to be particularly effective parts of the package.


Staying well while staying at home

By Dr Federica Picariello and Professor Rona Moss-Morris, King’s College London, the UK.

Within weeks around the world, daily life dramatically changed, and uncertainty seized our future in the wake of the COVID-19 pandemic. Beyond the immediate and urgent need to slow down the spread of COVID-19 through rapid and widespread behavioural change (i.e., self-isolation, social distancing, and quarantine), the impact on mental and physical wellbeing needs to be considered to allow early intervention and mitigate the longer-term consequences.


How to maintain health behaviours long term?

By Dominika Kwasnicka, SWPS University, Poland and University of Melbourne, Australia

The ultimate goal of health promotion programmes is to promote long-lasting change and health care professionals can play a role and help patients to improve their health outcomes and maintaining behaviour change. We know that health behaviour change is difficult to initiate and it can be even more challenging to maintain in the long term. One big question in health psychology is why maintenance is so difficult. 


Stop being an ostrich! The benefits of helping people to monitor their progress

By Thomas L. Webb, Department of Psychology, The University of Sheffield, the UK

How are you getting on with your goal to reduce the amount of sugar that you eat and lose 10kg? Chances are that you don’t really know – or even want to know. In situations like these, people tend to behave like ostriches and bury their heads in the sand, intentionally avoiding or rejecting information that would help them to monitor their goal progress. Research on this “ostrich problem” suggests that people often do not keep track of their progress (e.g., step on weighing scales, read the packets of food that they buy), in part, because doing so can make them feel bad about themselves – e.g., they realise that they weigh more than hoped and that they still consume too much sugar. However, theory and evidence suggest that keeping track of progress helps people to identify discrepancies between their current and desired states that warrant action. The implication is that avoiding monitoring makes it difficult to identify the need to act and the most appropriate way to do so. The ostrich problem therefore represents an opportunity for healthcare professionals (and others) to help people to monitor their progress and capitalise on the benefits of so doing. Perhaps not surprisingly then, we found good evidence that prompting people to monitor their progress helps people to achieve goals across a range of domains.


Insights from behavioural science for the COVID-19 pandemic

By Shane Timmons, Economic and Social Research Institute, Ireland

Governments worldwide have mobilised to try to control the spread of the novel coronavirus, but the behaviour of individuals will be vital to their success. We – the Behavioural Research Unit at the Economic and Social Research Institute in Dublin – are working with Ireland’s Department of Health to inform their response to the COVID-19 pandemic. As part of this work, we’ve reviewed over 100 scientific papers and have begun testing ways to best communicate with the public, with lessons relevant for health psychology practitioners. In our review, we focus on literature relevant for three areas that have formed the basis for public health messaging in multiple countries: hand hygiene, face touching and isolation. We also address broader literatures on how to motivate helpful behaviour and communicate effectively in a crisis. 


The importance of assessing clients’ coping strategies

By Nadia Garnefski and Vivian Kraaij, Department of Clinical Psychology, Leiden University, The Netherlands

Rob has just heard that he has HIV (negative event). He thinks that he is the one to blame for this (self-blame) and he avoids seeing his friends (withdrawal). The situation makes him sad. When sitting at home, he cannot stop thinking about his feelings (rumination) and believes that what has happened to him is a complete disaster (catastrophizing). Because he feels sad, he has little energy. As a result, he withdraws even more. This makes him even sadder. In this way, Rob is drawn into a downward spiral.


Are your clients being defensive? If so, self-affirmation may help.

Peter Harris and Ian Hadden, The Self-Affirmation Research Group, School of Psychology, University of Sussex, UK

Have you ever been reluctant to face up to something you’d rather ignore? Maybe your fondness for something bad for you that you eat too often or your tendency to avoid health check-ups? Well, you’re not alone. Most of us think we are generally quite sensible and competent people. So, being told that something we do is not really sensible or competent can be quite challenging. As a result, we can be pretty skilled at resisting messages we’d prefer not to hear.


Becoming your better self as reason for changing behavior

By Winifred Gebhardt, Leiden University, The Netherlands

About nine years ago, I became a vegetarian overnight. In a novel I was reading, the main character explained how he could not eat anything “in which at some time a heart had been beating”. Like a thunderbolt these few words sunk in. I realized that this was exactly how I felt. I stopped eating meat and fish instantly, and I have not had any problem sticking to this new diet ever since. The new behavior perfectly fitted the “person I am”. 

Conversely, in the past I used to jog regularly and could easily run seven kilometers. However, I never regarded myself as a “sporty person”, and whenever a barrier occurred such as being ill, I lapsed into being a couch potato. I now no longer try to “be sporty” but do try to walk whenever I can during the day. I consider myself an “active person”. 


N-of-1 studies: What can we learn by studying a single case?

By Marie Johnston and Derek Johnston, University of Aberdeen, Scotland

Practitioners frequently want the answer to a problem which concerns one person, one health care team, one hospital or one region etc.  For example, it may be important to know how often an obese man snacks, when and where he snacks and if stress makes it worse.   Or you may wish to find out how often members of the healthcare team omit hand hygiene, if it is worse when they are under-staffed and if ward adverts improve it.  Or you may be investigating sources of clinical errors to check if they are more common on some wards or for some grades of staff.  Or, at a policy level, it might be valuable to investigate whether a new regulation, such as a smoking ban in public places has affected smoking rates.

You might try to answer these questions by asking people what they think or remember but it would be better to ask or observe at the critical  times and places to avoid problems of bias and forgetting. Recent technological advances such as digital monitoring using smartphones make it easier to track what is going on in real time and an n-of-1 study might allow you to answer your question.

N-of-1 studies are possible when the problem can be assessed repeatedly to look at change over time.  Then one can describe the problem and examine whether it is better or worse under some conditions.  Or one may introduce a new intervention or treatment and assess whether it is having the proposed effect.

The simplest evaluation of the data collected is the observation of trends on a graph as in the illustrations below.  This is an essential step in any n-of-1 analysis and can be sufficient. Additionally, there are methods of statistical analyses for n-of-1 studies.  More complex methods continue to be developed (e.g., methods for assessing dynamic change ).