Behavioural Sciences Contribution to Suppressing Transmission of Covid-19 in the UK: A Systematic Literature Review

Demoralization: A concept analysis through a scoping review methodology

Background

Demoralization is a complex construct comprising of several clinical phenomena that has gained increasing interest in clinical practice and research; however, the concept needs to be sufficiently specified and clearly described. A concept analysis of demoralization is necessary to integrate previous research findings and establish the scientific foundation for future intervention research.

Aim

To analyze the concept of demoralization in terms of its antecedents, attributes, consequences, and empirical referents in health.

Methods

A concept analysis was performed using the Joanna Briggs Institute guidelines scoping review method and mapping information through the Walker and Avant concept analysis framework. Electronic databases, including PubMed, The Cochrane Library, Embase, PsycINFO, and Web of Science, were searched until September 15, 2024. The grey literature and other minor non-indexed publications were also reviewed.

Results

A total of 106 articles were included in the review. Antecedents included medical illness, symptom burden, low social support and coping difficulties. Attributes were identified as follows: dysphoria, disheartenment, helplessness, hopelessness, loss of meaning and purpose, and sense of failure. Consequences included poor quality of life, depression, anxiety, suicidal ideation and desire to die. The concept of demoralization was illustrated through a model case, one exhibiting borderline criterion and another displaying challenge.

Conclusion

This scoping review clarifies the clinical definition of demoralization, distinguishing it from common language usage and from other emotional symptoms frequently experienced by patients.

Implications for Practice

The identified attributes of demoralization play vital roles in health assessments and should guide nurses in providing appropriate patient care early on. Interventions should address the concept's antecedents and consequences.

Falsification of home rapid antigen lateral flow tests during the COVID-19 pandemic

During the COVID-19 pandemic, lateral flow tests (LFTs) were used to regulate access to work, education, social activities, and travel. However, falsification of home LFT results was a concern. Falsification of test results during an ongoing pandemic is a sensitive issue. Consequently, respondents may not answer truthfully to questions about LFT falsification behaviours (FBs) when asked directly. Indirect questioning techniques such as the Extended Crosswise model (ECWM) can provide more reliable prevalence estimates of sensitive behaviors than direct questioning. Here we report the prevalence of LFT FBs in a representative sample in England (n = 1577) using direct questioning (DQ) and the ECWM. We examine the role of demographic and psychological variables as predictors of LFT FBs. We show that the prevalence estimates of the FBs in the DQ condition were significantly lower than the ECWM estimates, e.g., reporting a negative result without conducting a test: 5.7% DQ vs 18.4% ECWM. Moral norms, subjective norms, anticipated regret, perception of risk to self, and trust in government predicted some of the FBs. Indirect questioning techniques can help provide more realistic and higher quality data about compliance with behavioural regulations to government and public health agencies.