. BACKGROUND
. Globally, obesity is a growing crisis. Despite obesity being preventable, over a quarter of the UK adult population is currently considered clinically obese (typically body mass index ≥35 kg/m<sup>2</sup>). Access to treatment for people with severe obesity is limited by long wait times and local availability. Online and group-based interventions provide means of increasing the accessibility of obesity prevention and treatment services. However, there has been no prior review of the effectiveness of group-based interventions delivered online for people with severe obesity.
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.
. OBJECTIVE
. The purpose of this systematic review protocol is to provide an evaluation of the effectiveness and usability of different types of online, group-based interventions for people with severe obesity.
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.
. METHODS
. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) and the Population, Intervention, Comparator, Outcome, and Study (PICOS) frameworks were used to structure this review. The review will systematically search 7 databases: MEDLINE, Embase, the Cumulative Index of Nursing and Allied Health Literature, APA PsycNet, Web of Science, CENTRAL, and the ProQuest Dissertations and Theses databases. Two authors (MM-I and LB) will independently screen the titles and abstracts of identified articles, select studies for inclusion based on the eligibility criteria, and extract data into a standardized form. Any disagreements will be discussed and resolved by a third reviewer (EM) if necessary. Risk of bias will be assessed using the Cochrane Collaboration Risk of Bias 2 tool and a descriptive analysis will be used to evaluate effectiveness and usability.
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.
. RESULTS
. The systematic review has not yet been started. It is expected to be completed and submitted for publication by December 2021.
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.
. CONCLUSIONS
. This systematic review will summarize the effectiveness and usability of online, group-based interventions for people with obesity. It will identify the types of online delivery that have the strongest support to help inform the development of more useful and engaging interventions for people with severe obesity.
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.
. CLINICALTRIAL
. National Institute for Health Research, PROSPERO. CRD42021227101; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021227101
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. INTERNATIONAL REGISTERED REPORT
. PRR1-10.2196/26619
.

Abstract
. Background
. Approximately 15 million people in the UK live with obesity, around 5 million of whom have severe obesity (body mass index (BMI) ≥35kg/m2). Having severe obesity markedly compromises health, well-being and quality of life, and substantially reduces life expectancy. These adverse outcomes are prevented or ameliorated by weight loss, for which sustained behavioural change is the cornerstone of treatment. Although NHS specialist ‘Tier 3’ Weight Management Services (T3WMS) support people with severe obesity, using individual and group-based treatment, the current evidence on optimal intervention design and outcomes is limited. Due to heterogeneity of severe obesity, there is a need to tailor treatment to address individual needs. Despite this heterogeneity, there are good reasons to suspect that a structured group-based behavioural intervention may be more effective and cost-effective for the treatment of severe obesity compared to usual care. The aims of this study are to test the feasibility of establishing and delivering a multi-centre randomised controlled clinical trial to compare a group-based behavioural intervention versus usual care in people with severe obesity.
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. Methods
. This feasibility randomised controlled study is a partially clustered multi-centre trial of PROGROUP (a novel group-based behavioural intervention) versus usual care. Adults ≥18 years of age who have been newly referred to and accepted by NHS T3WMS will be eligible if they have a BMI ≥40, or ≥35 kg/m2 with comorbidity, are suitable for group-based care and are willing to be randomised. Exclusion criteria are participation in another weight management study, planned bariatric surgery during the trial, and unwillingness or inability to attend group sessions. Outcome assessors will be blinded to treatment allocation and success of blinding will be evaluated. Clinical measures will be collected at baseline, 6 and 12 months post-randomisation. Secondary outcome measures will be self-reported and collected remotely. Process and economic evaluations will be conducted.
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. Discussion
. This randomised feasibility study has been designed to test all the required research procedures and additionally explore three key issues; the feasibility of implementing a complex trial at participating NHS T3WMS, training the multidisciplinary healthcare teams in a standard intervention, and the acceptability of a group intervention for these particularly complex patients.
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. Trial registration
. ISRCTN number 22088800.
.

ObjectivesTo conduct a systematic review and synthesise qualitative research of electronic risk assessment tools (eRATs) in primary care, examining how they affect the communication and understanding of diagnostic risk and uncertainty. eRATs are computer-based algorithms designed to help clinicians avoid missing important diagnoses, pick up possible symptoms early and facilitate shared decision-making.DesignSystematic search, using predefined criteria of the published literature and synthesis of the qualitative data, using Thematic Synthesis. Database searches on 27 November 2019 were of MEDLINE, Embase, CINAHL and Web of Science, and a secondary search of the references of included articles. Included studies were those involving electronic risk assessment or decision support, pertaining to diagnosis in primary care, where qualitative data were presented. Non-empirical studies and non-English language studies were excluded. 5971 unique studies were identified of which 441 underwent full-text review. 26 studies were included for data extraction. A further two were found from citation searches. Quality appraisal was via the CASP (Critical Appraisal Skills Program) tool. Data extraction was via line by line coding. A thematic synthesis was performed.SettingPrimary care.ResultseRATs included differential diagnosis suggestion tools, tools which produce a future risk of disease development or recurrence or calculate a risk of current undiagnosed disease. Analytical themes were developed to describe separate aspects of the clinical consultation where risk and uncertainty are both central and altered via the use of an eRAT: ‘Novel risk’, ‘Risk refinement’, ‘Autonomy’, ‘Communication’, ‘Fear’ and ‘Mistrust’.ConclusioneRATs may improve the understanding and communication of risk in the primary care consultation. The themes of ‘Fear’ and ‘Mistrust’ could represent potential challenges with eRATs.Trial registration numberCRD219446.

OBJECTIVES: Parent carers of children with special educational needs or disability are at risk of poorer mental and physical health. In response to these needs, we codeveloped the 'Healthy Parent Carers' (HPC) programme. This study examined the views and experiences of participants in the HPC feasibility trial to inform programme refinement. INTERVENTION, SETTING AND PARTICIPANTS: HPC is a peer-led group-based intervention (supported by online materials) for primary carers of disabled children, encouraging behaviours linked with health and well-being. It was delivered by two lead and six assistant peer facilitators in six community sites (one lead and one assistant per group) in South West England over six or 12 sessions. Control participants had online materials only. The trial involved 47 intervention and 45 control parent carers (97% female and 97% white) and eight facilitators (one male). DESIGN: a preplanned mixed methods process evaluation using questionnaires and checklists (during and after the intervention), qualitative interviews with participants after intervention (n=18) and a focus group with facilitators after trial. RESULTS: HPC was highly acceptable to participants and facilitators and experiences were very positive. Participants reported that the programme increased awareness of what parent carers could and could not change and their self-efficacy to engage in health-promoting behaviours. The intended mechanisms of action (social identification and peer support) matched participants' expectations and experiences. Control participants found the online-only programme flexible but isolating, as there were no opportunities to share ideas and problem solve with peers, the key function of the programme. Areas for improvement were identified for programme content, facilitator training and delivery. CONCLUSION: HPC was acceptable, well received and offers considerable potential to improve the health of parent carers. Under the pandemic, the challenge going forward is how best to maintain reach and fidelity to function while delivering a more virtual programme. TRIAL REGISTRATION NUMBER: ISRCTN151144652.

Community groups are commonly used as a mode of delivery of interventions for promoting health and well-being. Research has demonstrated that developing a sense of shared social identity with other group members is a key mechanism through which the health benefits of group membership are realized. However, there is little understanding of how shared social identity emerges within these therapeutic settings. Understanding the emergence of shared social identity may help researchers optimize interventions and improve health outcomes. Group-based singing activities encourage coordination and a shared experience, and are a potential platform for the development of shared social identity. We use the “Singing for People with Aphasia” (SPA) group intervention to explore whether group cohesiveness, as a behavioral proxy for shared social identity, can be observed and tracked across the intervention. Video recordings of group sessions from three separate programmes were rated according to the degree of cohesiveness exhibited by the group. For all treatment groups, the final group session evidenced reliably higher levels of cohesiveness than the first session (t values ranged from 4.27 to 7.07; all p values < 0.003). As well as providing confidence in the design and fidelity of this group-based singing intervention in terms of its capacity to build shared social identity, this evaluation highlighted the value of observational methods for the analysis of shared social identity in the context of group-based singing interventions.

Objectives: Pilot feasibility randomised controlled trial (RCT) for the ‘Singing groups for People with Aphasia’ (SPA) intervention to assess: (1) the acceptability and feasibility of participant recruitment, randomisation and allocation concealment; (2) retention rates; (3) variance of continuous outcome measures; (4) outcome measure completion and participant burden; (5) fidelity of intervention delivery; (6) SPA intervention costs; (7) acceptability and feasibility of trial and intervention to participants and others involved.
Design: a two-group, assessor-blinded, randomised controlled external pilot trial with parallel mixed methods process evaluation and economic evaluation.
Setting: Three community-based cohorts in the South-West of England.
Participants: Eligible participants with post-stroke aphasia were randomised 1:1 to SPA or control.
Intervention: the manualised SPA intervention was delivered over 10 weekly singing group sessions, led by a music facilitator and assisted by an individual with post-stroke aphasia. The intervention was developed using the Information-Motivation-Behavioural skills model of behaviour change and targeted psychosocial outcomes. Control and intervention participants all received an aphasia information resource pack.
Outcome measures: Collected at baseline, 3 and 6 months post-randomisation, candidate primary outcomes were measured (well-being, quality of life and social participation) as well as additional clinical outcomes. Feasibility, acceptability and process outcomes included recruitment and retention rates, and measurement burden; and trial experiences were explored in qualitative interviews.
Results: of 87 individuals screened, 42 participants were recruited and 41 randomised (SPA=20, Control=21); 36 participants (SPA=17, Control=19) completed 3-month follow-up, 34 (SPA=18, Control=16) completed 6-month follow-up. Recruitment and retention (83%) were acceptable for a definitive RCT, and participants did not find the study requirements burdensome. High fidelity of the intervention delivery was shown by high attendance rates and facilitator adherence to the manual, and participants found SPA acceptable. Sample size estimates for a definitive RCT and primary/secondary outcomes were identified.
Conclusions: the SPA pilot RCT fulfilled its objectives, and demonstrated that a definitive RCT of the intervention would be both feasible and acceptable.

BACKGROUND: Globally, obesity is a growing crisis. Despite obesity being preventable, over a quarter of the UK adult population is currently considered clinically obese (typically body mass index ≥35 kg/m2). Access to treatment for people with severe obesity is limited by long wait times and local availability. Online and group-based interventions provide means of increasing the accessibility of obesity prevention and treatment services. However, there has been no prior review of the effectiveness of group-based interventions delivered online for people with severe obesity. OBJECTIVE: the purpose of this systematic review protocol is to provide an evaluation of the effectiveness and usability of different types of online, group-based interventions for people with severe obesity. METHODS: the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) and the Population, Intervention, Comparator, Outcome, and Study (PICOS) frameworks were used to structure this review. The review will systematically search 7 databases: MEDLINE, Embase, the Cumulative Index of Nursing and Allied Health Literature, APA PsycNet, Web of Science, CENTRAL, and the ProQuest Dissertations and Theses databases. Two authors (MM-I and LB) will independently screen the titles and abstracts of identified articles, select studies for inclusion based on the eligibility criteria, and extract data into a standardized form. Any disagreements will be discussed and resolved by a third reviewer (EM) if necessary. Risk of bias will be assessed using the Cochrane Collaboration Risk of Bias 2 tool and a descriptive analysis will be used to evaluate effectiveness and usability. RESULTS: the systematic review has not yet been started. It is expected to be completed and submitted for publication by December 2021. CONCLUSIONS: This systematic review will summarize the effectiveness and usability of online, group-based interventions for people with obesity. It will identify the types of online delivery that have the strongest support to help inform the development of more useful and engaging interventions for people with severe obesity. TRIAL REGISTRATION: National Institute for Health Research, PROSPERO CRD42021227101; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021227101. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/26619.

Groups are regularly used to deliver healthcare services, including the management of obesity, and there is growing evidence that patients' experiences of such groups fundamentally shape treatment effects. This study investigated factors related to patients' shared social identity formed within the context of a treatment group for the management of severe obesity. A cross-sectional survey was administered to patients registered with a UK medical obesity service and enrolled on a group-based education and support programme. Patients (N = 78; MBMI = 48 on entry to the service) completed measures of group demographics (e.g. group membership continuity) and psychosocial variables (e.g. past experiences of weight discrimination) and reported their social identification with the treatment group. The results showed that patients identified with the treatment group to the extent that there was continuity in membership across the programme and they perceived themselves more centrally in terms of their weight status. Weight centrality was negatively associated with external social support and positively associated with experiences of weight discrimination. Group continuity was positively correlated with session attendance frequency. Patients presenting to clinical treatment services with severe obesity often do so after sustained weight loss failure and exposure to negative societal experiences. This study highlights that providing a treatment environment wherein these experiences can be shared with other patients may provide common ground for development of a new, positive social identity that can structure programme engagement and progression.

OBJECTIVES: Although many health interventions are delivered in groups, it is unclear how group context can be best used to promote health-related behaviour change and what change processes are most helpful to participants. This study explored participants' experiences of attending type 2 diabetes prevention and management programme, and their perceptions of how group participation influenced changes in diet and physical activity. DESIGN: Qualitative. METHODS: Semi-structured telephone interviews were conducted with 20 participants (twelve men) from nine groups in the Norfolk Diabetes Prevention Study. Interviews were audio-recorded, transcribed verbatim, and analysed using thematic analysis in NVivo. RESULTS: Participants benefited from individual change processes, including information provision, structuring and prioritizing health goals, action planning, self-monitoring, and receiving feedback. They also benefited from group processes, including having a common purpose, sharing experiences, making social comparisons, monitoring and accountability, and providing and receiving social support in the groups. Participants' engagement with, and benefits from, the groups were enhanced when there was a supportive group context (i.e. group cohesion, homogeneous group composition, and a positive group atmosphere). Optimal facilitation to develop an appropriate group context and initiate effective change processes necessitated good facilitator interpersonal and professional skills, credibility and empathy, and effective group facilitation methods. Participants reported developing a sense of responsibility and making behaviour changes that resulted in improvements in health outcomes and weight loss. CONCLUSIONS: This study highlights the role of individual and group processes in facilitating health-promoting behaviour change, and the importance of group context and optimal facilitation in promoting engagement with the programme. Statement of contribution What is already known on this subject? Many health interventions, including programmes to help prevent or manage diabetes and facilitate weight loss, are delivered in groups. Such group-based behaviour-change interventions are often effective in facilitating psychological and behaviour change. There is considerable research and theory on individual change processes and techniques, but less is known about which change processes and techniques facilitate behaviour change in group settings. What does this study add? This study contributes to our understanding of how participating in group-based health programmes may enhance or impede individual behaviour change. It identified individual (intrapersonal) and group (interpersonal, facilitated through group interaction) change processes that were valued by group participants. The findings also show how these change processes may be affected by the group context. A diagram summarizes the identified themes helping to understand interactions between these key processes occurring in groups. The study offers an insight into participants' views on, and experiences of, attending a group-based diabetes prevention and management programme. Thus, it helps better understand how the intervention might have helped them (or not) and what processes may have influenced intervention outcomes. Key practical recommendations for designing and delivering group-based behaviour-change interventions are presented, which may be used to improve future group-based health interventions.

Research on choirs and other forms of group singing has been conducted for several decades and there has been a recent focus on the potential health and well-being benefits, particularly in amateur singers. Experimental, quantitative, and qualitative studies show evidence of a range of biopsychosocial and well-being benefits to singers; however, there are many challenges to rigor and replicability. To support the advances of research into group singing, the authors met and discussed theoretical and methodological issues to be addressed in future studies. The authors are from five countries and represent the following disciplinary perspectives: music psychology, music therapy, community music, clinical psychology, educational and developmental psychology, evolutionary psychology, health psychology, social psychology, and public health. This article summarizes our collective thoughts in relation to the priority questions for future group singing research, theoretical frameworks, potential solutions for design and ethical challenges, quantitative measures, qualitative methods, and whether there is scope for a benchmarking set of measures across singing projects. With eight key recommendations, the article sets an agenda for best practice research on group singing.

Background
Theories and meta-analyses have elucidated individual-level mechanisms of action in behaviour change interventions. Although group-based interventions are commonly used to support health-related behaviour change, such interventions rarely consider theory and research (e.g. from social psychology) on how group-level mechanisms can also influence personal change.

Objectives
The aim was to enhance understanding of mechanisms of action in group-based behaviour change interventions. The objectives were to (1) develop a potentially generalisable framework of change processes in groups, (2) test the framework by analysing group session recordings to identify examples illustrating group processes and facilitation techniques and (3) explore links between group-level mechanisms and outcomes.

Data sources
In this mixed-methods study, the research team reviewed literature, conducted consultations and analysed secondary data (i.e. delivery materials and 46 audio-recordings of group sessions) from three group-based weight loss interventions targeting diet and physical activity: ‘Living Well Taking Control’ (LWTC), ‘Skills for weight loss Maintenance’ and ‘Waste the Waist’. Quantitative LWTC programme data on participant characteristics, attendance and outcomes (primarily weight loss) were also used.

Methods
Objectives were addressed in three stages. In stage 1, a framework of change processes in groups was developed by reviewing literature on groups (including theories, taxonomies of types of change techniques, qualitative studies and measures of group processes), analysing transcripts of 10 diverse group sessions and consulting with four group participants, four facilitators and 31 researchers. In stage 2, the framework was applied in analysing 28 further group sessions. In stage 3, group-level descriptive analyses of available quantitative data from 67 groups and in-depth qualitative analyses of two groups for which comprehensive quantitative and qualitative data were available were conducted to illustrate mixed-methods approaches for exploring links between group processes and outcomes.

Results
Stage 1 resulted in development of the ‘Mechanisms of Action in Group-based Interventions’ (MAGI) framework and definitions, encompassing group intervention design features, facilitation techniques, group dynamic and development processes, interpersonal change processes, selective intrapersonal change processes operating in groups, and contextual factors. In stage 2, a coding schema was developed, refined and applied to identify examples of framework components in group sessions, confirming the content validity of the framework for weight loss interventions. Stage 3 demonstrated considerable variability in group characteristics and outcomes and illustrated how the framework could be applied in integrating group-level qualitative and quantitative data to generate and test hypotheses about links between group mechanisms and outcomes (e.g. to identify features of more or less successful groups).

Limitations
The framework and examples were primarily derived from research on weight loss interventions, and may require adaptations/additions to ensure applicability to other types of groups. The mixed-methods analyses were limited by the availability and quality of the secondary data.

Conclusions
This study identified, defined, categorised into a framework and provided examples of group-level mechanisms that may influence behaviour change.

Future work
The framework and mixed-methods approaches developed provide a resource for designers, facilitators and evaluators to underpin future research on, and delivery of, group-based interventions.

Funding
This project was funded by the Efficacy and Mechanism Evaluation programme, a Medical Research Council and National Institute for Health Research partnership.

Abstract
. Background
. Parent carers of disabled children are at increased risk of mental and physical health problems. They often experience challenges to maintaining good health which have implications for their well-being and their ability to care for their children. In response to these needs, researchers and parent carers developed the Healthy Parent Carers (HPC) programme. It is a peer-led, group-based intervention that promotes behaviours associated with health and well-being. The aims of this trial are to assess the acceptability of the HPC programme and the feasibility of its delivery in the community and to assess the feasibility and acceptability of the design of the definitive trial to evaluate the programme’s effectiveness and cost-effectiveness.
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. Methods
. We will establish six research sites and train facilitators to deliver the manualised intervention. Parent carers of children with special educational needs and disabilities will be individually randomised, stratified by group delivery site, to either take part in a group programme and online resources (intervention) or to receive access to the online resources only (control). Measures of mental health; well-being; health-related quality of life; health behaviours; patient activation; protective factors such as resilience, social connections, and practical support; and use of health care, social care, and wider societal resources will be collected before randomisation (baseline), immediately post-intervention, and 6 months later. Recruitment of participants, adherence to the programme, and the dose received will be assessed. Group sessions will be audio-recorded to evaluate the fidelity of delivery and participant engagement. Participants’ and facilitators’ feedback on the programme content and delivery, their experience, and the acceptability of the outcome measures and trial design will be collected through feedback forms, interviews, and focus groups.
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. Discussion
. This trial will assess whether the programme delivery and evaluative trial design are feasible, to inform whether to progress to a definitive randomised controlled trial to test the effectiveness and cost-effectiveness of the Healthy Parent Carers programme.
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. Trial registration
. ISRCTN, ISRCTN151144652, registered on 25 October 2018; ClinicalTrials.gov, NCT03705221, registered on 15 October 2018.
.

Group-based interventions are widely used to promote health-related behaviour change. While processes operating in groups have been extensively described, it remains unclear how behaviour change is generated in group-based health-related behaviour-change interventions. Understanding how such interventions facilitate change is important to guide intervention design and process evaluations. We employed a mixed-methods approach to identify, map and define change processes operating in group-based behaviour-change interventions. We reviewed multidisciplinary literature on group dynamics, taxonomies of change technique categories, and measures of group processes. Using weight-loss groups as an exemplar, we also reviewed qualitative studies of participants’ experiences and coded transcripts of 38 group sessions from three weight-loss interventions. Finally, we consulted group participants, facilitators and researchers about our developing synthesis of findings. The resulting ‘Mechanisms of Action in Group-based Interventions’ (MAGI) framework comprises six overarching categories: (1) group intervention design features, (2) facilitation techniques, (3) group dynamic and development processes, (4) inter-personal change processes, (5) selective intra-personal change processes operating in groups, and (6) contextual influences. The framework provides theoretical explanations of how change occurs in group-based behaviour-change interventions and can be applied to optimise their design and delivery, and to guide evaluation, facilitator training and further research.

Obesity stigma largely remains a socially acceptable bias with harmful outcomes for its victims. While many accounts have been put forward to explain the bias, the role of obesity etiology beliefs has received little scrutiny. The research examined the effect that beliefs about the psychological etiology of obesity have on the expression of obesity stigma and the mechanisms underpinning this effect. Participants (N = 463) were asked to evaluate a target person with obesity after reading one of three possible etiologies: psychological, genetic, or behavioral. The presentation of a psychological etiology of obesity elicited less prejudice compared to behavioral causes but greater prejudice compared to genetic causes; observed differences were found to be a function of the agency ascribed to the target’s obesity and empathy expressed for the target. The findings highlight the impact that communicating obesity in terms of psychological causes can have for the expression of obesity stigma.

BACKGROUND: Many weight-loss interventions are delivered in groups but evidence on their effectiveness, and characteristics associated with effectiveness, is limited. We synthesised evidence on (1) design and delivery of group-based weight-loss interventions; (2) effectiveness; and (3) associations between intervention characteristics, change techniques, and effectiveness. METHODS: Five online databases were searched to May 2017 for randomised controlled trials (RCTs) of group-based diet and/or physical activity interventions for overweight/obese adults (BMI ≥ 25). Intervention characteristics were synthesised narratively. Mean differences (MD) in weight loss were calculated using a random-effects meta-analysis, and sub-group analyses were conducted to identify moderators of effectiveness. RESULTS: Forty-seven RCTs reporting 60 evaluations of group-based interventions were included. MD in weight loss between intervention and control groups was -3.49 [95% CI -4.15, -2.84], -3.44 [-4.23, -2.85], and -2.56 kg [-3.79, -1.33] at follow-ups closest to 6, 12, and 24 months, respectively. Explicitly targeting weight loss, men-only groups providing feedback and dietary goals were significantly associated with greater effectiveness (p <. 05). CONCLUSIONS: Diet and physical activity interventions delivered in groups are effective in promoting clinically meaningful weight loss at 12 months. Intervention design and effectiveness vary considerably between studies, and evidence on what optimises the effectiveness of group-based weight-loss interventions remains limited.

Addressing problems associated with malnutrition in care home residents has been prioritized by researchers and decision-makers. This review aimed to better understand factors that may contribute to malnutrition by examining the attitudes, perceptions and experiences of mealtimes among care home residents and staff. Five databases were searched from inception to November 2015: Medline, Embase, PsychINFO, AMED, and the Cochrane Database. Forward and backward citation checking of included articles was conducted. Titles, abstracts, and full texts were screened independently by two reviewers and quality was assessed using the Wallace criteria. Thematic analysis of extracted data was undertaken. Fifteen studies were included in the review, encompassing the views and opinions of a total of 580 participants set in nine different countries. Four main themes were identified: (1) organizational and staff support, (2) resident agency, (3) mealtime culture, and (4) meal quality and enjoyment. Organizational and staff support was an over-arching theme, impacting all aspects of the mealtime experience. Mealtimes are a pivotal part of care home life, providing structure to the day and generating opportunities for conversation and companionship. Enhancing the mealtime experience for care home residents needs to take account of the complex needs of residents while also creating an environment in which individual care can be provided in a communal setting. PROSPERO Registration: CRD42015025890.

BACKGROUND: Many interventions aim to alleviate well-documented problems of malnutrition in residential care homes and improve residents' health and wellbeing. Despite some positive findings, little is known about how and why mealtime interventions might be effective, and in particular, what effects residents' experiences of mealtimes have on health outcomes. The aim of this study was to gain an insight into these experiences and explore some of the issues that may impact on residents' enjoyment of meals, and resulting health and wellbeing. METHODS: Semi-structured interviews were conducted with eleven residents from four care homes in the South West UK. Thematic analysis was used to derive content and meaning from transcribed interviews. Interviews were supplemented by researcher observations of mealtimes. RESULTS: the dining experience was a focal point for participants' broader experiences of residing in a care home. Three themes pertaining to residents' experiences were identified: (1) Emotional and psychological connections with other residents; (2) managing competing interests with limited resources; and (3) familiarity and routine. CONCLUSION: Mealtimes are a mainstay of life in a care home through which residents' experiences are characterised, exemplified and magnified. Understanding how residents interact with one another, accommodating their preferences and encouraging autonomy may enhance their mealtime experiences. It may also help to ease the transition from independent-living to life in care, which can be particularly stressful for some residents, and improve health and wellbeing over the long-term.

BACKGROUND: Children with disabilities are often the target of prejudice from their peers. The effects of prejudice include harmful health consequences. The Contact Hypothesis has previously shown to promote positive attitudes towards a range of social groups. OBJECTIVE: to conduct a systematic review and meta-analysis on the effectiveness of school-based interventions for improving children's attitudes towards disability through contact with people with disabilities. METHODS: a comprehensive search was conducted across multiple databases. Studies were included if it evaluated an intervention that aimed to improve children's attitudes towards disability and involved either direct (in-person) or indirect (e.g. extended) contact with people with disabilities. Data were synthesised in a meta-analysis. RESULTS: Twelve studies met the inclusion criteria. of these, 11 found significant effects: six used direct contact, two used extended contact, two used parasocial (media-based) contact and one used guided imagined contact. One parasocial contact intervention found no significant effects. Three meta-analyses showed direct contact (d = 0.55, 95% CI 0.20 to 0.90) and extended contact (d = 0.61, 95% CI 0.15 to 1.07) improved children's attitudes; there was no evidence for parasocial contact (d = 0.20, 95% CI -0.01 to 1.40). CONCLUSIONS: Direct, extended, and guided imagined contact interventions are effective in improving children's attitudes towards disability; there was no evidence for parasocial contact.

OBJECTIVES: People with obesity experience a range of physical and psychological ill-health outcomes. This study examined patients' experiences of a group-based programme for the management of morbid obesity delivered within the UK National Health Service. The focus of the study was on the emerging dynamic of the group and patients' perceptions of its impact on health outcomes. DESIGN: a qualitative interview study was conducted and involved patients recruited from a Tier 3 bariatric service in South West England. Verbatim transcripts were analysed using thematic analysis. METHODS: Twenty patients (12 females) with a BMI ≥ 35 kg/m2 participated in a semi-structured one-to-one interview. Participants had been registered with the bariatric service for at least 6 months. None of the participants had had bariatric surgery. RESULTS: Most participants felt that they had benefited from participating in the group programme and talked about the group as a resource for lifestyle change. Participants' narratives centred on the emergence of a sense of self based upon their participation in the group: establishing psychological connections to other patients, or shared social identity, was regarded as a key mechanism through which the programme's educational material was accessed, and underpinned the experience of social support within the group. Through interaction with other patients, involving the sharing of personal experiences and challenges, participants came to experience their weight 'problem' through a collective lens that they felt empowered them to initiate and sustain individual lifestyle change. DISCUSSION: Bariatric care groups have the potential to support lifestyle change and weight loss and may help address the psychological needs of patients. Nurturing a sense of shared social identity amongst patients with morbid obesity should be a core aim of the care pathway and may provide the foundation for successful translation of dietetic content in group programmes. Statement of contribution What is already known on this subject? Services for people with obesity who require specialist care are often supported by group-based bariatric programmes. There are no specific guidelines for the organization of bariatric groups beyond the recommendation for lifestyle interventions delivered by a multidisciplinary care team. Research with other health conditions suggests that the psychological connections formed between participants in bariatric programmes may play an important role in structuring programme effectiveness. What does this study add? Establishing psychological connections with other patients underpins bariatric patients' group experience. Shared social identity structures behaviour change in patients on bariatric programmes. Nurturing shared social identity should be a core aim of the bariatric care pathway.

Many older adults experience what is clinically recognised as frailty but little is known about the perceptions of, and attitudes regarding, being frail. This qualitative study explored adults' perceptions of frailty and their beliefs concerning its progression and consequences. Twenty-nine participants aged 66-98 with varying degrees of frailty, residing either in their homes or institutional settings, participated in semi-structured interviews. Verbatim transcripts were analysed using a Grounded Theory approach. Self-identifying as 'frail' was perceived by participants to be strongly related to their own levels of health and engagement in social and physical activity. Being labelled by others as 'old and frail' contributed to the development of a frailty identity by encouraging attitudinal and behavioural confirmation of it, including a loss of interest in participating in social and physical activities, poor physical health and increased stigmatisation. Using both individual and social context, different strategies were used to resist self-identification. The study provides insights into older adults' perceptions and attitudes regarding frailty, including the development of a frailty identity and its relationship with activity levels and health. The implications of these findings for future research and practice are discussed.

PURPOSE: to explore the association between children's self-reported contact with people with disabilities and attitudes towards them, as well the potential mediating influence of anxiety about interacting with people with disabilities and empathy for them. METHOD: 1881 children, aged 7-16 years, from 20 schools in South West England completed a survey assessing their contact with people with disabilities and their attitudes towards them. Anxiety about interacting with people with disabilities and empathy towards them were examined as potential mediators. Gender, school year, perceived similarity between people with and without disabilities, proportion of children with additional needs at the school and socioeconomic status (SES) were assessed as moderators. A random effects ("multilevel") regression model was used to test the contact-attitude association and moderation, and path analysis was used to test for mediation. RESULTS: Participants with more self-reported contact reported more positive attitudes towards disability (p 

Objectives: the study sought to identify key design features that could be used to create a new framework for group-based health interventions. We designed and tested the first session of a group intervention for stroke survivors with aphasia which was aimed at nurturing new psychological connections between group members.
Setting: the intervention session, a participant focus group and interviews with intervention facilitators were held in a local community music centre in the South West of England.
Participants: a convenience sample of ten community-dwelling people with post-stroke aphasia participated in the session. Severity of aphasia was not considered for inclusion.
Intervention: Participants took part in a 90-minute group singing session which involved singing songs from a specially-prepared song book. Musical accompaniment was provided by the facilitators.
Primary and secondary outcome measures: Participants and group facilitators reported their experiences of participating in the session, with a focus on activities within the session related to the intervention aims. Researcher observations of the session were also made.
Results: Two themes emerged from the analysis, concerning experiences of the session (“developing a sense of group belonging”) and perceptions of its design and delivery (“creating the conditions for engagement”). Participants described an emerging sense of shared social identity as a member of the intervention group and identified fixed (e.g. group size, session breaks) and flexible (e.g. facilitator responsiveness) features of the session which contributed to this emergence. Facilitator interviews and researcher observations corroborated and expanded participant reports.
Conclusions: Engagement with health intervention content may be enhanced in group settings when intervention participants begin to establish positive and meaningful psychological connections with other group members. Understanding and actively nurturing these connections should be a core feature of a general framework for the design and delivery of group interventions.

Many older people perceive ageing negatively, describing it in terms of poor or declining health and functioning. These perceptions may be related to older adults' health. The aim of this review was to synthesise existing research on the relationship between older adults' perceptions of ageing and their health and functioning. A systematic search was conducted of five electronic databases (ASSIA, CINAHL, IBSS, MEDLINE and PsycINFO). Citations within identified reports were also searched. Observational studies were included if they included perceptions of ageing and health-related measures involving participants aged 60 years and older. Study selection, data extraction and quality appraisal were conducted using predefined criteria. Twenty-eight reports met the criteria for inclusion. Older adults' perceptions of ageing were assessed with a variety of measures. Perceptions were related to health and functioning across seven health domains: memory and cognitive performance, physical and physiological performance, medical conditions and outcomes, disability, care-seeking, self-rated health, quality of life and death. How ageing is perceived by older adults is related to their health and functioning in multiple domains. However, higher quality and longitudinal studies are needed to further investigate this relationship.

Background: Published descriptions of group-based behaviour-change interventions (GB-BCIs) often omit design and delivery features specific to the group setting. This impedes the ability to compare behaviour-change interventions, synthesise evidence on their effectiveness and replicate effective interventions. The aim of this study was to develop a checklist of elements that should be described to ensure adequate reporting of GB-BCIs. Methods: a range of characteristics needed to replicate GB-BCIs were extracted from the literature and precisely defined. An abbreviated checklist and a coder manual were developed, pilot tested and refined. The final checklist and coder manual were used to identify the presence or absence of specified reporting elements in 30 published descriptions of GB-BCIs by two independent coders. Reliability of coding was assessed. Results: the checklist comprises 26 essential reporting elements, covering intervention design, intervention content, participant characteristics, and facilitator characteristics. Inter-rater reliability for identification of reporting elements was high (95 % agreement, Mean AC1 = 0.89). Conclusion: the checklist is a practical tool that can be used, alongside other reporting guidelines, to ensure comprehensive description and to assess reporting quality of GB-BCIs. It can also be helpful for designing group-based health interventions.

We examined the effects of making salient different norm referents on young people's dietary orientation. Participants were exposed to a referent who was either of similar age to themselves or older before reporting their normative beliefs, attitudes and intentions concerning dietary behavior. As predicted, exposure to the older referent was associated with stronger perceptions that eating five portions of fruit and vegetables each day was normative. Compared to those exposed to the same-age referent, participants exposed to the older referent reported more positive attitudes towards eating "five-a-day" and stronger intentions to do so over the coming week. Referent salience was also associated with a behavioral outcome, with those participants exposed to the older referent more likely to take a piece of fruit upon completion of the study (OR: 4.97, 95% CI: 1.39-17.82). The implications of these findings for norms-based interventions for changing dietary behavior are discussed.

Aim: the aim of this review was to systematically review and synthesize observational evidence of associations between children's naturally varying contact with people with disabilities and their attitudes towards disability. Method: a comprehensive search was conducted across multiple databases. Studies were included if they measured children's contact with people with disabilities and their attitudes towards disability. Qualitative research and studies that experimentally varied the amount of contact children had were excluded. Data were synthesized in a narrative review. Results: There were 35 studies that met the inclusion criteria: 22 of these reported a statistically significant association between contact with people with disabilities and more positive attitudes towards disability; two studies reported a negative association between contact and attitudes; and 11 studies reported no association. Incomplete reporting of the methods and results across studies limited the conclusions that could be drawn. Interpretation: Studies identified in this review generally indicate that children's contact with people with disabilities is associated with more positive attitudes towards disability. There is a need for more rigorous research to examine the effect of children's contact with people with disabilities on their attitudes towards disability. © 2013 Mac Keith Press.

Researchers who study perspective taking are generally optimistic about the potential for interventions to improve intergroup perceptions. The current research provides new insight into the conditions that frame the intergroup outcomes of perspective taking. The results show that the effects of perspective taking are not always positive but depend on perspective takers' degree of identification with the in-group. In two experiments, we demonstrated that adopting the perspective of an out-group member can have damaging effects on intergroup perceptions among group members who are highly identified with the in-group. Specifically, compared with less committed members, those who identified highly with the in-group used a greater number of negative traits to describe the out-group following perspective taking. Such perspective taking also led participants with high in-group identification to judge the out-group less favorably. Understanding how social identity concerns frame the outcome of perspective taking is crucial to its effective employment in intergroup-relations programs.

Two studies examined the effects of self-categorization on people's orientation towards health. In Study 1, making salient a social identity which did not advocate a positive orientation towards health led group members to report weaker intentions to engage in health promotion behaviours in the future than did making salient a social identity which had a more positive health orientation. Study 2 showed that orientation towards health is influenced by the intergroup comparative context in which social identity is made salient. When social identity was made salient via an upward intergroup social comparison, participants' evaluation of the in-group's health was more negative, but their commitment to performing health promotion behaviours in the future was stronger, compared to when that same identity was made salient via a downward intergroup comparison. The findings are discussed in relation to the emerging debate concerning the impact of social group processes on health.

Two studies investigated the extent to which empathizing with a single member of a stigmatized group can yield positive attitudes toward other stigmatized groups. Participants read a scenario in which a member of a socially stigmatized group described the experiences of group membership. Participants then reported their attitudes toward the target group and a second group. Both studies revealed a generalization effect such that experiencing empathy for the target was associated with more positive attitudes, both toward the target group and the second group. Study 2 demonstrated that this generalization effect is confined to those groups located within the same superordinate category. Implications of these findings for attempts to structure people's orientation to stigmatized groups are discussed. © 2010 Copyright the Authors. Journal compilation © 2010 Wiley Periodicals, Inc.

Three experiments (N=370) investigated the effects of social categorization on the experience of empathy. In Experiment 1, university students reported their empathy for, and intentions to help, a student who described a distressful experience. As predicted, participants reported stronger empathy and helping intentions when the student belonged to an ingroup compared to an outgroup university. Experiments 2 and 3 demonstrated that stronger empathy for outgroup members was experienced following the activation of an ingroup norm that prescribed the experience of this emotion. Activating this norm also led to the expression of more positive attitudes towards the outgroup (Experiment 3), and empathy fully mediated this effect. These findings indicate that like other emotions, empathy is influenced by social categorization processes.

The cross-cultural generalizability of the social physique anxiety scale (SPAS) was evaluated using confirmatory factor analysis (CFA) in five European nations: Britain, Estonia, Spain, Sweden, and Turkey. Motl and Conroy's (2000) methods were used to develop modified versions of the scale within each sample based on the original 12-item version. Pending the satisfactory fit of the CFAs of the modified models within each sample, it was expected that the measurement parameters and mean values of these models would be equivalent across samples in multisample CFAs. An eight-item version of the SPAS exhibited a good fit with data from the British, Estonian, and Swedish samples, and a seven-item version fitted the data well in the Spanish and Turkish samples. The eliminated items were also influenced by a method effect associated with the item wording. Multisample analyses revealed that factor loadings were equivalent across samples. Tests of latent means revealed that British and Spanish participants reported the highest levels of SPA, with Estonian participants reporting the lowest. Results indicate that the SPAS is generalizable across these cultures, although subtle variations existed in the Spanish and Turkish samples. Researchers are advised to follow these procedures to develop a valid version of the SPAS appropriate for their sample. © 2007 Blackwell Munksgaard.

Two studies tested the hypothesis that responses to within-group criticism are influenced by perceptions of a critic's prior adherence to ingroup norms. Participants responded to criticism which originated from ingroup members who either had previously adhered to or deviated from a group norm. Across both studies, criticising the ingroup yielded more negative group evaluations for antinormative members than it did for normative members. Participants also reported highest levels of sensitivity overall to communication (whether critical or praising of the ingroup) which came from antinormative members. Mediational analyses (Study 2) indicated that these effects were driven by perceptions of whether the communication violated a group expectation, and also perceptions of the critic's identification with the group. Study 1 also provided evidence that reactions to criticism are made in response to social identity concerns: the effects of prior norm adherence were observed only in participants who were highly identified with the ingroup. The research integrates previous work on group deviance and responses to criticism by elaborating the conditions under which criticism originating from within a group is most and least likely to be tolerated by its members. Copyright © 2007 John Wiley & Sons, Ltd.

Recent research has successfully applied social identity theory to demonstrate how individuals use music as a basis for intergroup differentiation. The current study investigated how music might also be used to encourage the development of positive intergroup attitudes. Participants (N = 97) were allocated to one of two experimentally created social groups and then led to believe that the groups had similar or different musical preferences. They then evaluated each group and reported their perceptions concerning how they expected their own group to be evaluated by the other group. Participants who believed the groups had similar musical preferences reported more positive intergroup attitudes relative to a control group; they also expected to be evaluated more positively by members of the other group. However, positive intergroup perceptions were also reported by those who believed the two groups had different musical preferences. The implications of these findings for theory and practice are discussed.

This study applied a social identity perspective to the study of adolescent self-concept and social development. British adolescents aged 14-15 years (N=114) completed a questionnaire which asked them to: (i) rate their degree of identification with a school-based friendship group; (ii) complete a measure of multi-dimensional self-concept; and (iii) report their experiences of a variety of personal, relational and socio-institutional (e.g. achieving economic independence) developmental tasks. Compared to low identifiers, participants who were highly identified with a friendship group reported highest levels of self-esteem; and these differences were most marked in non-academic domains of self. High identifiers also displayed higher levels of general self-esteem and reported more positive experiences of personal and relational developmental tasks. The discussion focuses on the potential benefits to understanding of social developmental processes that can be derived from a consideration of adolescents' subjective appraisals of their peer relations.

This study investigated the intergroup perceptions of 2 social groups. English adolescents aged 14-15 years were asked to make causal attributions for various positive and negative behaviors performed by members of an in-group and an out-group. In the first condition (n = 45), participants rated members of their own peer group and members of a peer group to which they did not belong. Participants in the second condition (n = 45) rated English adolescents and members of a national out-group (either France or Germany). Results showed that participants in both conditions reported perceptions that were biased towards the formation of a favorable in-group evaluation. However, the relationship between intergroup discrimination and identification with the in-group was in the expected direction for participants in the peer group condition only. This observation is explained in terms of the potential level of identity threat posed by the prevalent intergroup context.

Previous research into intergroup attribution has addressed mainly the behavior of groups to which members are ascribed (e.g. gender, race). The attribution processes of groups of which membership is achieved (e.g. friendship groups) is less well understood, and the current study sought to address this. Fifty-five undergraduate participants were asked to explain the positive and negative behavior of a member of the in-group and a member of the out-group. As predicted, the participants attributed an in-group member's positive behavior more, and their negative behavior less, to internal, global, and specific causes than they did the corresponding behavior of an out-group member. There was also evidence that the participants employed a strategy of out-group derogation in their attributions: they made a higher internality rating for an out-group member's negative behavior than they did for that person's positive behavior. It is proposed that the current study's use of achieved groups maximized participants' levels of group identification, and that this in turn motivated behavioral strategies aimed at protecting that identity.

Several studies indicate that mood can influence the likelihood of an individual demonstrating instances of helping behavior, and one previous laboratory study has indicated that music can be used to bring about manipulations of mood to such an end. To investigate this in a naturalistic setting, 646 users of a university gym were played either uplifting or annoying music while they worked out. Upon completion of their workout, they were asked to either sign a petition in support of a fictitious sporting charity (i.e. a low-cost task) or to distribute leaflets on their behalf (i.e. a high-cost task). Responses to the petition-signing measure indicated a ceiling effect with almost all participants offering to help. However, consistent with previous research on mood and helping behavior, uplifting music led to participants offering to help more on the high-cost, leaflet-distributing task than did annoying music. © 2004 Sage Publications.

This study investigated processes by which adolescents form positive evaluations of their peer groups. One-hundred and fifteen male and female adolescents aged 14-15 years made a series of comparisons between their own peer group (the ingroup) and a group of which they were not a member (the outgroup). In line with the predictions of social identity theory (Tajfel and Turner, 1979), participants behaved consistently in ways which favoured the ingroup: Compared to the outgroup, the ingroup was associated to a greater extent with positive characteristics (e.g. being fun, nice, and honest) and to a lesser extent with negative characteristics (e.g. being ignorant; unfriendly, and boring). Their responses were also related to levels of identification with the ingroup: at higher levels of identification participants reported more favourable evaluations of their groups. These findings extend earlier research and show how the benefits derived from group membership in adolescence are in part realised through intergroup processes.

The authors investigated the intergroup processes of male adolescents within the context of social identity theory (SIT; H. Tajfel, 1978; H. Tajfel & J. C. Turner, 1979). The participants were English male adolescents (age = 14-15 years). They estimated in-group and out-group musical preferences and evaluated the in-group and out-group along a series of scales. The results showed in-group favoritism effects along the musical preference and evaluative dimensions. The participants reported greater liking for the in-group. Compared with the out-group, they associated the in-group more with positively stereotyped music and less with negatively stereotyped music. Compared with the out-group, they rated the in-group as more fun, more masculine, more sporty, less boring, less snobbish, and less weird. The participants with lower levels of self-esteem showed greater differentiation between groups and greater derogation of the out-group. The results supported the predictions of SIT and demonstrated the applicability of SIT for the study of adolescent behavior.

Social identity theory (SIT) was used to investigate the effects of social categorization on adolescents' intergroup behaviour. One hundred and forty-nine male adolescents aged 14-15 years made comparisons between an ingroup and an outgroup along a series of dimensions. Participants displayed consistent ingroup-favouring behaviour in their ratings: the ingroup was associated to a greater extent than the outgroup with positively valued dimensions, and to a lesser extent with negatively valued dimensions. Those participants who demonstrated the most discrimination reported highest levels of ingroup identification. The utility of applying predictions from SIT to the study of adolescence is discussed.

This study investigated the degree to which English and American adolescents report similar reasons for listening to music. A questionnaire was completed by 245 participants (mean age = 15 27 years), on which they indicated how much each of 11 potential reasons for listening to music applied to them. Factor analysis revealed three factors which accounted for 60.3% of the variance in responses. These factors were interpreted as listening to music for reasons of "selfactualisation", to "fulfil emotional needs", and to "fulfil social needs". Whilst analysis of the factor scores did reveal some individual differences between responses of participants in each culture, overall there were no significant multivariate or univariate main effects of nationality. This suggests that the English and American adolescents' reasons for listening to music may similarly be explained by the same factors. © 2000 by the Society for Research in Psychology of Music and Music Education.