Charlotte Emma Hilton

Despite the clear utility and transferability, National Health Service (NHS) quality improvement initiatives have yet to benefit fully from what is already known within health psychology. Thus far, evidence from established, seminal behaviour change theory and practice have been ignored in favour of newly developed models and frameworks. Further, whilst there is a growing interest in what is commonly referred to as ‘human factors’ of change and improvement, there is scant transferability of known psychologically informed implementation skills into routine NHS Improvement practice. The science and practice of healthcare improvement is growing, and the behaviour change aspect is critical to sustainable outcomes. Therefore, this paper offers practical guidance on how seminal psychological behaviour change theory and motivational interviewing (a person-centred skills-based approach specifically developed to support people through change) can be combined to better address individual and organisational change within a healthcare improvement context.

The growing trend in the use of the Internet and social media as a method of self-managing illness presents a critical opportunity to better understand the role of pro-anorexia (pro-ana) websites for eating disorders. Therefore, 155 pro-ana website messages regarding criticism that the site was responsible for developing anorexia were inductively thematically analysed. The analysis revealed five main themes: eating disorders are mental illnesses and websites do not cause mental illness, pro-ana websites and eating disorders are more than wanting to be thin (with sub-theme residents and visitors), eating disorders develop regardless of pro-ana websites, pro-ana sites do not cause eating disorders but they may trigger or encourage them (with sub-theme the problem is the user, not the site) and pro-ana sites provide support. Pro-ana websites and online communities present clinicians with complex treatment challenges. Collaborative, therapeutic consultations about pro-ana website use may help to establish how and when accessing them may hinder the treatment process.

Despite the growth in theoretical understandings of health behaviour and standardised approaches to health interventions (e.g. behaviour change taxonomies), health psychology has paid comparatively less attention to the importance of the implementation processes – ‘how to’ rather than ‘what to’ of such interventions. The clinical and interpersonal skills that often reflect these implementation processes are poorly defined within the health psychology literature. The level of proficiency in such skills expected of Health and Care Professions Council registered practitioner health psychologists is unclear and poorly documented within the UK training requirements. This article explores the potential impact of this and offers some pragmatic solutions.

Aims and objectives: To report the findings from a unique analysis of naturally occurring data regarding self‐harm behaviour generated through the global social media site, Twitter.Background: Self‐harm behaviours are of global concern for health and social care practice. However, little is known about the experiences of those who harm and the attitudes of the general public towards such behaviours. A deeper, richer and more organic understanding of this is vital to informing global approaches to supporting individuals through treatment and recovery.Design: Exploratory, qualitative design.Methods: Three hundred and sixty‐two Twitter messages were subject to inductive thematic analysis.Results: Five themes were identified: (1) celebrity influence, (2) self‐harm is not a joke (with subthemes of you wouldn't laugh if you loved me and you think it's funny, I think it's cruel), (3) support for and from others, (4) eating disorders and self‐harm and (5) videos and personal stories.Conclusions: The findings indicate that self‐harm behaviour continues to be largely misunderstood by the general public and is often the source of ridicule which may contribute to delays in accessing treatment. Whilst Twitter may also provide a source of valuable support for those who self‐harm, the sense of community, relatedness and understanding generated by such support may contribute to normalising self‐harm and perpetuating the behaviours.Relevance to clinical practice: Our understanding of the complexity of and aetiology and most effective treatment options for self‐harm behaviours is still unclear. The findings demonstrate that there is a critical opportunity to conduct further qualitative research to better understand self‐harm and to use these valuable and internationally relevant data to support the development of effective public education campaigns and personally tailored treatment options.

There is a growing need to assess the psychological outcomes of exercise referral and the National Institute of Health and Care Excellence has called for the routine assessment of life-quality. However, a quality of life scale specific to the requirements of exercise referral is currently unavailable. Therefore, the aim of this study was to produce a quality of life measure for this purpose. The Exercise Referral Quality of Life Scale is a 22-item measure comprising three domains: mental and physical health, injury pain and illness and physical activity facilitators. Exploratory factor analysis determined the initial factor structure and was subsequently confirmed by confirmatory factor analysis. Additional scale properties were also assessed. The scale contributes to the global need for improved consistent psychological outcome assessment of exercise referral.