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Emily McBride and Joseph Chilcot conceived and drafted the article. All authors contributed to the final version and approved the submission. The COVID-19 pandemic has led to substantial changes in population behaviour and health-related outcomes. Approximately 10% of people who test positive for COVID-19 experience long-term health effects lasting for more than 12 weeks post-infection, including persistent physical, neuropsychological, and mental health-related symptoms (termed Long COVID; Office for National Statistics, 2020). Although outcomes are improving due to better understanding of COVID-19 and clinical advancements, a significant proportion of people with severe disease require hospitalization and experience substantially impaired quality of life (Dennis, McGovern, Vollmer, Brooks et al., 2020; Cabarkapa, Nadjidai, Murgier, LeRoy, Robles, Kilpela, Mokdad, Marks, Stroup, Puterman et al., 2020). Furthermore, the combined impact of multiple preventative healthy behaviours appears to further attenuate mortality risk (Ford, Bergmann, Boeing, Li, Williams et al., 2020). Since the vaccine was rolled out across England in priority populations, preliminary data have shown lower vaccination rates among ethnic minority groups (those with Black ethnicity displaying lowest rates), people living in areas of higher deprivation, and those with severe mental illness or learning disabilities (MacKenna et al., 2021). Data from a large study of 22,374 UK adults found that one third reported changes to quantities of food consumed through the first lockdown period. Subgroups of the population were found to persistently eat more, whilst others reported eating less (particularly those who were already underweight; Herle, Smith, Bu, Steptoe, McAtamney et al., 2021). Barriers to weight management have, for example, included reports of lower motivation to eat healthily and lower control over eating (Robinson et al., 2021). An online UK survey of 9,190 adults found that a quarter reported lower levels of physical activity since COVID-19 (Rogers et al., 2020). Vulnerable populations reported engaging in around half a day less of 30 min of moderate-to-vigorous physical activity each week through the first lockdown period (Naughton et al., 2021). Another UK survey found that 57% had either maintained or increased their levels of physical activity during lockdown. However, only a third met recommended physical activity guidelines of 150 min of moderate-to-vigorous physical activity per week (Spence et al., 2021). Changes in physical activity were found to be associated with components of the COM-B model (Michie, van Stralen, Katzmarzyk, Church, Craig, Brierley, Chater, Smith, Rees et al., 2020). For example, bowel, breast, and cervical cancer screening programmes in the United Kingdom were temporarily paused or have been operating a reduced service at different stages of the pandemic. By September 2020, an estimated 3 million people in the United Kingdom were overdue for screening (Cancer Research UK, 2020). The numbers urgently referred to secondary care with suspected cancer symptoms had also starkly declined at the height of the pandemic; though figures are now improving, they are still lower than before the pandemic. This was largely due to fewer people visiting their GP with suspected cancer symptoms but also because many GPs were reluctant to risk sending people to hospitals (Cancer Research UK, 2020). Furthermore, there have been reductions in patient engagement across general health services such as visits to Accidents and Emergency (Thornton, 2020). Some reasons reported for non-attendance have included fear of COVID-19 infection, not wanting to burden the health system, and practical barriers (Jo's Cervical Cancer Trust, 2020; NHS England, 2020). Increased prevalence of sleep disorders through COVID-19 has been highlighted in the research literature across different countries. Studies have examined the effect on sleep of SARS-CoV-2 infection and explored confounders related to isolation, quarantine, anxiety, stress, or financial losses (Partinen, 2021). It is thought that symptoms of insomnia could be related to psychosocial factors and the impact of confinement (Altena et al., 2020). A large UK study found poor quality sleep was associated with the occurrence of adverse events through the pandemic. Adverse events included, for example, illness with COVID-19, financial difficulty, loss of paid work, problems with sourcing medicine, difficulties accessing food, and perceived threats to personal safety (Wright, Steptoe, Lades, Laffan, Daly, McElroy et al., 2020; Pierce et al., 2020). Data in both the United Kingdom and the United States suggest that symptoms of psychological distress have increased during the pandemic, with people aged between 18 and 24 years showing the greatest deterioration (McGinty, Presskreischer, Han, Pierce et al., 2020). Whilst increased psychological distress is a normal and understandable response for many given these challenging circumstances, the consequences and impact of COVID-19 provide significant risk factors for clinically relevant anxiety and depression (Holmes et al., 2020). Increased prevalence of social isolation and loneliness (MQ: Transforming Mental Health Power, 2020; Raisi-Estabragh et al., 2020). As has been highlighted in various Government reports and the recent COVID-19 Marmot Review, there is particular concern around rapidly widening health and social inequalities (Marmot, Allen, Goldbatt, Herd, UK Government, 2020). Several COVID-19 and wider research studies have already shown that socio-economic status, ethnicity, gender, age, and education are predictive of poorer health behaviours and health-related outcomes (Bann et al., 2020; Marteau, Rutter, McBride et al., 2020). There is a wealth of established behaviour change techniques and interventions targeting health behaviours such as physical activity and healthy eating (Howlett, Trivedi, Troop, Michie, Ashford, et al., 2011; Rhodes, Boudreau, Josefsson, tobacco smoking (Michie, Hyder, Walia, Roberts, Kerr, and alcohol consumption (Michie et al., 2012). Strategies to increase engagement with preventative health services, such as cancer screening, have been considered extensively (Camilloni et al., 2013; Sabatino et al., 2012; Tsipa et al., 2020). Similar principles can be carried forward and integrated with the proliferating and emerging COVID-19 literature to design context-specific tailored behaviour change and psychological interventions. These can also be used to inform the development of potential services or treatments for Long COVID. Importantly, in tandem with evidence-based practice, nationally recommended inclusivity and diversity frameworks such as ‘The INCLUDE Ethnicity Framework’ should be used to guide research design and intervention testing (Trial Forge; Witham et al., 2020). Guidelines produced by networks such as ‘EQUATOR’ can be used to promote transparent and accurate reporting of health research (EQUATOR Network). Patient and public involvement, which adopt representative sampling and ensure inclusion from high-risk and underserved groups, will also be key to improving intervention quality and acceptability (Greenhalgh et al., 2019; Holmes et al., 2019). Long-term disease prevention and detection strategies should be prioritized now that most of the UK have been living under policy restrictions for over a year, and the COVID-19 vaccine is rolling out nationally. Cost-effective and evidence-based interventions that support the uptake of healthy behaviours and promote engagement with preventative health services are needed to offset indirect consequences of COVID-19 on disease prevention and mental well-being. Emphasis should be placed on ensuring future research and intervention development align to meet the needs of high-risk groups and underserved populations, to help reduce widening health and social inequalities.
McBride et al. (Wed,) studied this question.