Background: The COVID-19 pandemic requires massive and rapid behavior change. The Health Action Process Approach (HAPA) describes personal determinants that play a key role in behavior change. This study investigated whether these determinants are associated with adherence to physical distancing measures to prevent the spread of COVID-19 (i.e. keeping 1.5 m physical distance and staying at home). Decreased psychosocial well-being and lack of social support were explored as barriers to adherence. Methods: Two cross-sectional surveys were conducted among adults in Belgium. The first survey (N = 2,379; March 2020) focused on adherence to physical distancing measures. The second survey (N = 805; April 2020) focused on difficulty with, and perseverance in, adhering to these measures. Linear regression models were fitted to examine associations with HAPA determinants, psychosocial well-being, and social support. Results: Self-efficacy, outcome expectancies, intention, action planning, and coping planning were related to adhering to, difficulty with, and perseverance in, adhering to physical distancing measures. Decreased psychosocial well-being and lack of social support were related to more difficulties with adhering to physical distancing and lower perseverance. Conclusions: Health action process approach determinants are associated with adherence to physical distancing measures. Future work could design HAPAbased interventions to support people in adhering to these measures.

Conflict of interest statement: there are no conflicts of interest that may arise as a result of the research presented in this article.

To limit the spread of COVID-19, many countries, including Belgium, have installed physical distancing measures. Yet, adherence to these newly installed behavioral measures has been described as challenging and effortful. Based on the Health Action Process Approach (HAPA) model, this study performed an in-depth evaluation of when, why, and how people deviated from the physical distancing measures.An online mixed-method study was conducted among Belgian adults (N = 2055) in the beginning of May 2020. Participants were recruited via an open call through email and social media platforms, using snowball sampling. Conditions wherein people deviated from the physical distancing measures were assessed by means of an open-ended question. HAPA determinants were assessed in a quantitative way.Half of the sample reported to deviate from the measures. Further, deviation from the measures was associated with each determinant outlined by the HAPA. Findings highlight that many people deviated from the measures because of their need for social contact. The majority of the people who deviated from the measures stated that they carefully weighed the risks of their behavior.Need for social contact pushed people to deviate from physical distancing measures in a deliberate manner. Potential areas for future interventions aimed at promoting adherence to physical distancing measures and enhancing psychosocial wellbeing are discussed.

Background: In line with research highlighting the role of observer appraisals in understanding individuals' pain experience, recent work has demonstrated the effects of parental child-and self-oriented injustice appraisals on child pain-related outcomes. However, research on parental injustice appraisals is in its infancy and lacks a valid and context-specific operationalization of what parental injustice appraisals of child pain precisely entail. The current study presents an in-depth qualitative analysis of parental child-and self-oriented appraisals of injustice in the context of their child's chronic pain. Methods: Twenty-one mothers of children living with chronic pain participated in one of five focus group interviews conducted in Ghent (Belgium), Glasgow (Scotland) and Indianapolis (USA). Results: The interviews were subjected to interpretative phenomenological analysis, which revealed three key justice-related themes, labelled 'You shouldn't be in this much pain', 'The problem's probably with the mother' and 'At least it's not cancer'. Maternal injustice appraisals focused mainly on the child rather than the self and reflected various perceived barriers to their efforts to provide quality of life for their child. A fourth theme labelled 'Not everybody gets a healthy child' reflected maternal strategies to effectively cope with the child's condition and the associated appraisals of injustice. Conclusions: The current findings attest to the relevance of (child-and self-oriented) injustice in the parental experience of caring for a child with chronic pain and provides insight into the specific content and scope of these appraisals. As such, this study provides valuable insights to further research in this area. Significance: The current study presents an in-depth qualitative analysis of parental appraisals of injustice in the context of their child's chronic pain condition. The findings provide valuable insights into the phenomenology of this construct and may inform future research and assessment methods. Furthermore, the themes reported in this study may contribute to clinical practice, as they may raise awareness of parental concerns regarding their child's pain management. | 1933 BAERT ET Al. 1 | INTRODUCTION The experience of pain is common in childhood and is usually temporary. However, a considerable proportion of children report chronic, long-term pain that has a significant impact on their everyday lives (e.g. impaired functioning, school absence and general distress) (

Patients with Functional Somatic Syndromes (FSS) often display troubled relationships with health care providers, psychotherapists, and significant others. Research shows that patients' history of trauma, attachment disturbances, and mentalization deficits may result in the emergence of maladaptive interpersonal patterns, which may later contribute to the onset and maintenance of FSS, "doctor-hopping," and dropout in psychotherapy. As the nature and therapeutic consequences of such maladaptive interpersonal patterns in FSS cannot be understood sufficiently by quantitative methods alone, there is a need for in-depth qualitative research. To address this issue, we conducted a metasynthesis of 23 published case studies of patients with FSS from various psychotherapeutic orientations. Results show that patients with FSS from our sample perceived others as unreliable, i.e., unavailable, overcontrolling, and overprotective. To adapt to such unreliable others, patients attempted to please and to control them. Patients also suppressed their emotional awareness and expression. Although alexithymia could also play a role, the primary reason for emotional avoidance seemed to be interpersonal in nature, i.e., patients were avoiding negative emotions in order to please and control the unreliable others. The onset and worsening of FSS were associated with both interpersonal and physical triggers. Showing signs of physical or emotional distress lead to more rejection, overcontrol, and overprotection from unreliable others, which could create a "vicious circle." Our results suggest that offering a more interpersonal perspective on emotion regulation difficulties would be beneficial for patients with FSS, counselors, psychotherapists, and other health care professionals.