Presentation 1: Health Psychology Services Australia: Scoping effective health psychology interventions to address chronic disease

Aim: This presentation will outline the symposia and introduce Health Psychology Services Australia and the work it is doing to scope effective health psychology interventions to address chronic disease.

Method: A brief review will be provided of the evidence for the effectiveness of health psychology interventions using the categorization of universal, selective and indicated prevention. An historical and background overview will be provided of Health Psychology Services Australia (HPSA).

Results: The lack of dissemination of effective health psychology interventions led to the decision to form HPSA, initially as a sub-committee of the College of Health Psychologists. HPSA has designed and implemented a psychological pain management training program for health service staff. In 2018 the decision was made to scope further interventions to address chronic disease. Following (1) the introduction paper, this symposia will present three further papers to: (2) present a rapid review of effective health psychology interventions to address chronic disease; (3) provide examples of effective health psychology universal interventions to prevent chronic disease risk factors at a population level; and (4) overview effective health psychology selective intervention to reduce chronic disease risk factors in high-risk groups and provide a case-study of an Australian program.

Conclusion: The three following presentations will be introduced.

Presentation 2: A rapid literature review of health psychology interventions to address chronic disease in Australia.

Aim: This presentation will outline a rapid literature review of health psychology interventions to address chronic disease that was completed in 2018 to guide the planning for Health Psychology Services Australia (HPSA).

Design: Literature search using rapid (time-limited) search methods.

Method: The first component of the search sought to identify areas of high burden for Australian health that were showing stable or upward trends. The second component of the search sought to identify health psychology interventions that had evidence for effectiveness in addressing chronic disease problems.

Results: Chronic disease was identified as an area of high burden for Australian population health that is currently showing stable or upward trends. A number of health psychology interventions were identified that have evidence for their effectiveness in addressing chronic disease problems.

Conclusion: There appears to be promising opportunities for HPSA to assist program developers to increase their implementation of health psychology interventions that have evidence for their effectiveness in addressing chronic disease problems.

Presentation 3: Effective universal health psychology interventions to prevent chronic disease

Aim: This presentation will outline effective universal health psychology interventions that are available to prevent chronic disease risk factors at a population level.

Method: An overview of Cochrane reviews will be presented followed by a selective summary of specific Australian evidence-based programs.

Results: School, community, family and individual health psychology programs with evidence for addressing risk factors for obesity and chronic disease in childhood, adolescence and adulthood will be summarised. The use of community coalition strategies (such as Communities That Care) to integrate effective programs into community prevention strategies will be outlined.

Conclusion: There is potential for HPSA to assist developers to disseminate universal health psychology programs to prevent obesity and chronic disease at a whole-population level.

Presentation 4: Evidence-based health psychology interventions targeting selective groups with high levels of chronic disease risk factors: A case-study of the Good Life Club project for type 2 diabetes

Aim: This presentation will overview the field of evidence-informed health psychology interventions targeting selective groups with high levels of chronic disease risk factors. A case study will be presented of the Good Life Club project for type 2 diabetes.

Method: A brief review will first be provided of the cost-benefit of health psychology interventions for selective groups with high levels of chronic disease risk factors. The components and structure of the health professional health psychology training program and the methodological design of the intervention program for older adults with a diagnosis of type 2 diabetes and a co-morbidity of heart disease will be outlined.

Results: The Washington State Institute for Public Policy review of the cost-benefit of group-based health psychology interventions for selective people with high levels of diabetes risk factors included 8 randomised trials and reported a cost-benefit of $USD13,737 per client. The evaluation of the Australian GLC also showed significant benefits in improved diabetes management. Based on intention to treat data at 18 month follow-up, 39% of GLC clients had well-managed diabetes compared to just 30% at baseline (Relative Risk of advancing to well-managed diabetes =1.28 [95% Confidence Interval 1.04 to 1.58] compared to usual care). The cost-benefit was estimated at $AUD16,000 per client.

Conclusion: The positive evaluation and cost-benefit findings for the GLC are within the range of published meta analyses of health psychology interventions targeting selective groups with high levels of chronic disease risk factors. Presentation 2 outlined that chronic disease risk factors remain poorly managed in Australia. Together these findings suggest a case for HPSA to further encourage the dissemination of health psychology interventions to assist selective groups to manage high levels of chronic disease risk factors.

Presentation 5: Discussion: HPSA scoping of effective health psychology interventions to address chronic disease

Aim: This presentation will overview and discuss the symposia papers.

Method: Integrated reflections on the implications for understanding of the evidence for and the requirement to disseminate effective health psychology interventions to address chronic disease.

Results: The presentations reveal evidence that chronic disease is not currently well managed in Australia. There is evidence that effective health psychology interventions are available to improve prevention and management of chronic disease in Australia.

Conclusion: Based on the available evidence HPSA I concert with the APS should seek to encourage the dissemination of effective health psychology interventions to improve prevention and management of chronic disease in Australia.

Aim: To improve understanding of the psychosocial factors that influence dietary adherence in the restrictive dietary patterns of weight loss, vegetarian, vegan, gluten-free, and paleo, three questions were explored, 1) the psychosocial profile, 2) the social and psychological variables related to better dietary adherence in general, and 3) the social and psychological variables related to better dietary adherence for each of the dietary groups.

Design: A cross-sectional survey design was used to broadly explore the key social and psychological factors that were identified in previous research as being associated with dietary pattern adherence.

Method: Three hundred and ninety-nine community members and university students (82.7% female) participated in this study. Participants were recruited to complete an online survey titled “Understanding your eating choices” through online sources and word of mouth. The survey measures covered the areas of eating behaviours (e.g., food cravings), mental health (e.g., eating disorder symptoms), social factors (e.g., social identification) and dietary adherence (subjective and measured adherence).

Results: Results revealed significant differences amongst the groups in their psychosocial profile. The weight loss group tended to score lower than all the other groups on measures of wellbeing, healthy eating behaviour and attitudes, as well as self-control. By contrast, people following a vegetarian, vegan, and especially a paleo diet had a profile of psychological strength, especially in terms of healthy eating behaviors and attitudes, even compared to controls. Of the variables, social identification (group identity) was most strongly related to dietary adherence.

Conclusion: This study was the first to comparatively explore the psychosocial and diet adherence profile of a number of restrictive dietary groups, and has provided insight into the role of diet group identity in dietary adherence.

Background: With almost half of Australian 5-year-olds reportedly experiencing dental caries, poor oral health early in life is a major public health issue. Parental involvement in their children’s oral hygiene practices is crucial to improving oral health in young children. It is therefore necessary to identify the psychological factors associated with parental-supervised oral hygiene behaviour, to accurately inform future interventions aimed at promoting this health behaviour.

Aims/objectives: This systematic and meta-analytic review aimed to identify all social-cognitive factors associated with the oral hygiene behaviour of children aged 2-6 years.

Method: Relevant peer-reviewed articles were identified in PsycINFO, Web of Science, Scopus, Embase, and PubMed databases. A study was eligible for inclusion when it reported an association between a social-cognitive factor and an oral hygiene behaviour of a child aged 2-6 years varying from self-reports (e.g., toothbrushing frequency) to clinical measurements (e.g., plaque and gingival indices as proxy measures of behaviour). Article quality was assessed using a modified Newcastle-Ottawa Scale. Meta-analyses were conducted when there were at least four independent effect sizes (k>3).

Results: Of the 5468 identified articles, 20 publications addressing four social-cognitive constructs were found to be eligible for meta-analysis. Weak positive weighted average correlations (r+) were observed between oral health behaviour and attitudes (k = 9, r+ = .122), self-efficacy (k = 9, r+ = .386), and intention (k = 4, r+ = .345). No association was found between oral health behaviour and sense of coherence (k = 4, r+ = .078).

Conclusion: Current findings indicate self-efficacy, attitudes, and intention as potential social-cognitive determinants of parental-supervised oral hygiene behaviour. Further research is needed to explore the influence of additional social-cognitive constructs that have shown to be important determinants of parents’ behaviour for their young children’s oral hygiene practices, for example self-regulatory factors such as planning and action control. Identifying the key social-cognitive factors influencing parents’ behaviours for their young children’s oral health can better inform future intervention studies aimed at improving this important health issue in young children.

Aim: Previous experimental research indicates that women exposed to idealised media images are more frequently dissatisfied with their bodies. Adolescents may be particularly vulnerable to the impact of idealized images in the media. The present study aimed to examine the impact of different forms of social media imagery on adolescent females. Specifically, it was predicted that viewing idealised media images (thin-ideal and fitspiration) would lead to greater body dissatisfaction and negative mood than viewing control images. It was also predicted that this effect would be mediated by state appearance comparisons and moderated by trait appearance comparisons.

Design: The study utilised a between groups experimental design with three levels of the independent variable, image type (thin-ideal, fitspiration, travel control). The dependent variables were state body dissatisfaction and negative mood. State social comparison was tested as a mediator of these relationships and trait social comparison as a moderator.

Method: Participants were 60 female high school students (Year’s 8-12; aged 12-18) who were recruited from a private high school in Queensland. They ranged in age from 12-18, and on average were 15.25 years old (SD = 1.27). They were randomly assigned to one of the three images conditions and completed the study during class time. Planned comparisons were used to examine differences between specific groups. Mediation analyses were conducted using PROCESS, and moderation analyses were conducted using hierarchical regression.

Results: In comparison to the control images, exposure to the idealised images led to greater negative mood, but not body dissatisfaction. There was no difference in body dissatisfaction or negative mood between participants who viewed the thin-ideal images or participants who viewed the fitspiration images. State appearance comparison mediated the relationship between image condition and negative mood. Trait appearance comparisons moderated the effect for body dissatisfaction.

Conclusion: Overall, idealised media images depicting the ‘perfect body’ can play an adverse role in the mood and body image of adolescents. Appearance comparisons are important to consider in this context.

Aim: The aim of the study was to examine compensatory health beliefs, i.e., that energy intake can be compensated for by energy expenditure or vice versa. Specifically, we examined the influence of unhealthy food consumption on compensatory beliefs, and the subsequent enactment of compensatory behaviour, namely physical activity.

Design: A between-groups, experimental design was conducted.

Method: Participants were 100 female undergraduate students (M(age) = 20.41 years) who were randomly assigned to consume either healthy or unhealthy foods that were similar in nutritional value (calories, sugar, carbohydrates and fat). Participants rated the perceived healthiness of the foods consumed, and completed a measure of state compensation. They were then given the choice to engage in either a physical activity (exercise on a treadmill) or a sedentary activity (play a game on an iPad). Exercise behaviour (distance travelled) and perceived exertion were examined for participants who selected the physical activity. Chi-square analysis was used to compare the percentage of participants who selected the physical or sedentary activity between the two food type (healthy, unhealthy) conditions. Independent samples t-tests were used to examine the influence of food type on exercise behaviour, perceived exertion and state compensatory beliefs. The SPSS macro PROCESS was used to test whether perceived healthiness of the foods mediated the effect of food type on activity type.

Results: A significantly higher proportion of participants in the unhealthy food condition selected to engage in the physical activity (76%) as opposed to the sedentary activity (24%). However, the food type consumed did not influence actual exercise behaviour or perceived exertion. Participants who consumed the unhealthy food reported significantly higher state compensatory health beliefs, however, they did not emerge as a mediator. Yet, perceived healthiness of the foods consumed did mediate the effects of food type on activity type.

Conclusion: The findings provide evidence to indicate a compensatory link governing the relationship between food consumption and physical activity via perceived healthiness. This enhanced understanding of the relationship between energy consumption and expenditure is important in the development of effective strategies to improve health.

Aim: People receiving peritoneal dialysis (PD) for end-stage kidney disease experience markedly poorer quality of life than healthy individuals. Gastrointestinal (GI) symptoms are common and associated with poor psychosocial wellbeing among this cohort. The mind-gut axis represents one possible explanatory mechanism for this relationship. The aim of this study was to explore the perspectives, attitudes and experiences of people with end-stage kidney disease undergoing PD, with a particular focus on the links between diet, gastrointestinal health and psychosocial wellbeing. This study posed the question: What are the psychosocial consequences of PD, the renal diet and gastrointestinal symptoms in people with end-stage kidney disease?

Design: A qualitative study design was employed to elicit rich and detailed information of people’s experiences and perceptions of how dialysis and GI symptoms contribute to quality of life issues in end-stage kidney disease.

Method: Ten people receiving automated PD (5 females, 5 males) aged 31 to 77 years (Mean age = 59.3, SD = 15.67) were recruited from a Renal Unit at a public hospital in South Australia. Purposive sampling was used. One-on-one qualitative interviews were audio recorded and transcribed verbatim. Transcripts were analysed thematically.

Results: A central theme of Autonomy represented participants’ experiences of the psychosocial consequences of PD, GI symptoms and dietary changes. This overarched two main themes 1) Loss of Autonomy (Sub-themes: Interference to Daily Life (Dialysis process and sleep, Impacts on relationships), Powerlessness, Frustration, Food Aversion and Restriction (Friendships and social life, Impacts on partner)) and 2) Attempts to Gain Autonomy (Sub-themes: Coping Well, Pragmatism, and Maintaining Normality). A related sub-theme of Partner as a Carer was evident as part of Loss of Autonomy.

Conclusion: GI symptoms and diet and fluid restrictions have psychosocial consequences resulting in multiple losses of autonomy for people receiving automated PD, who employ strategies to attempt to regain autonomy in the face of these interconnected issues. This should be actively addressed in clinical care through dietary education and symptom management advice that aims enhance patient autonomy within the confines of dialysis therapy, and thus reduce its overall impacts on psychosocial wellbeing.

Aim: With high rates of equality, extensive parental leave and financial remuneration, free child care and accessible social supports such as free community play centres, Sweden offers an ideal backdrop against which to consider parenting and psychological wellbeing. The research aim was to investigate the Nordic regions’ systems, procedures and approach to motherhood, career and parenting stress. Specifically, the insights outlined in this paper stem from empirical observational research conducted from extensive fieldwork in Sweden. The first author was expecting her second child and thus the presentation provides insights from her lived experience of Sweden’s support systems.

Design: To research the mechanisms and experiences of postpartum support in Sweden methods included ethnographic data collection, reflection, participant observation and semi-structured interviews.

Method: The first author spent time in schooling environments, at people’s homes, in public spaces and in the hospital setting. Semi-structured interviews were conducted with maternal and child health care professionals, some of whom were also parents, as well as working parents, to understand in more depth the experiences of postpartum support systems.

Results: Preliminary results indicate that whilst there are individual differences in postpartum experiences, there are broader societal structural needs that must be considered. In particular, this paper outlines the experiences of professionals and parents in Sweden and asks what this means for postpartum support for women and their families and communities, more broadly, particularly in the context of Sweden’s rates of postnatal depression, which are on par with those in Australia.

Conclusion: Sweden’s parental support structures and policy in regard to employment equality and shared parenting are seen as ‘best practice’. With rates of postnatal depression at levels similar to those of countries with less well-developed government support structures in place, further research is clearly implicated, to identify strategies that may improve support and correspondingly decrease the incidence of postnatal depression.