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In January 2021, we assessed the implications of temporary regulations in the United Kingdom allowing pubs and restaurants to operate on a takeaway basis without instigating a change of use. Local authorities (LAs) across the North‐East of England were unaware of any data regarding the take‐up of these regulations, partially due to ongoing capacity issues; participants also raised health concerns around takeaway use increasing significantly. One year on, we repeated the study aiming to understand the impact of these regulations on the policy and practice of key professional groups. Specifically, we wanted to understand if LAs were still struggling with staff capacity to address the regulations, whether professionals still had public health trepidations, and if any unexpected changes had occurred across the local food environment because of the pandemic. We conversed with 16 public health professionals, planners and environmental health officers across seven LAs throughout the North‐East of England via focus groups and interviews. Data collated were analysed via an inductive and semantic, reflexive‐thematic approach. Through analysis of the data, three themes were generated and are discussed throughout: popular online delivery services as a mediator to increased takeaway usage; potential long‐term health implications and challenges; continued uncertainty regarding the temporary regulations. This paper highlights important changes to local food environments, which public health professionals should be aware of, so they are better equipped to tackle health inequalities across urban and sub‐urban areas. [ABSTRACT FROM AUTHOR]

Despite a history of critique, concentrated discussion and improved assessment processes, neglect continues to be a major challenge for child protection services. This paper draws on findings from a government‐commissioned analysis of 'serious case reviews' (SCRs) in England, arising from incidents of serious child abuse in 2017–2019. There were 235 cases, for which 166 final reports were available. Alongside a quantitative analysis of the whole cohort, we undertook an in‐depth qualitative analysis of 12 cases involving neglect. A key challenge in responding to neglect in its different forms is that it can be so widespread amongst families that practitioners no longer notice its severity or chronicity – it becomes normalised. In this paper we explore two dimensions of the 'paradox of neglect' where it seems to be everywhere and nowhere simultaneously. The first is that neglect is so closely bound up with the prevalence of poverty that little action is taken to address it. The second is that the overwhelming nature of neglect can blind practitioners to other forms of maltreatment that may also be present within a family. Practitioners, now more than ever, need to recognise the dimensions of this paradox to protect children from neglect. [ABSTRACT FROM AUTHOR]

This paper explores the explanatory models of mental challenges among Black Africans in England. It argues that understanding these models is critical for providing culturally appropriate care to this population. The study employed qualitative methodology, and interpretative phenomenological analysis (IPA). Twelve mental health service users who are living in England and self‐identified as first or second‐generation Black Africans were purposively selected. The data were gathered using face‐to‐face semistructured interviews. Data were manually analysed in accordance with IPA concepts of searching for common, unique and idiosyncratic themes across transcripts. The findings revealed three themes Black Africans associated to their explanatory model of mental health challenges: complexities of migration, African‐centred worldview and negative life experiences. To help alleviate the Eurocentric nature of mental health practice in England, it is hoped that this explanatory model will become an integral part of mental health practice in England and around the world. [ABSTRACT FROM AUTHOR]

Background: Globally, it is estimated that one in three adults live with two or more long‐term conditions (multiple long‐term conditions, MLTCs), that require self‐management. People who experience socioeconomic deprivation face significant health inequalities due to a range of interrelated characteristics that lead to a lack of resources and opportunities. Previous research with underserved populations indicate low levels of trust towards primary care providers and potential barriers for developing patient‐healthcare professional relationships. The purpose of this paper is to explore the barriers and facilitators to self‐managing MLTCs, amongst people who experience socioeconomic deprivation. Methods: Semistructured one‐to‐one interviews with adults (n = 28) living in London and Sheffield, United Kingdom with MLTCs who are experiencing socioeconomic deprivation. Participants were recruited through general practices, community channels and social media. Data were analysed in NVivo using reflexive thematic analysis methods. Findings: Four analytical themes were developed: (1) challenges in accessing healthcare services, financial assistance, and cultural awareness; (2) empowerment and disempowerment through technology, including digital exclusion, and use of technology; (3) impact and causes of exclusion on self‐management, including social isolation, area‐based and economic exclusion, and health‐related stigma and (4) adapting self‐management strategies, including cost‐effective, and culturally/lifestyle appropriate strategies. Conclusions: Future health interventions and services need to be developed with consideration of the combined complexities of managing MLTCs while experiencing socioeconomic deprivation. Increased awareness in practitioners and commissioners of the complexities surrounding the lives of people experiencing socioeconomic deprivation, and the need for targeted strategies to promote self‐management of MLTCs are of great importance. Patient or Public Contribution: A patient advisory group contributed to all stages of the study, including providing important feedback on study documents (topic guides and recruitment materials), as well as providing critical insights surrounding the interpretation of interview data. [ABSTRACT FROM AUTHOR]

Background: Despite strong evidence supporting the expansion of midwife‐led unit provision, as a result of optimal maternal and perinatal outcomes, cost‐effectiveness, and positive service user and staff experiences, scaling‐up has been slow. Systemic barriers associated with gender, professional, economic, cultural, and social factors continue to constrain the expansion of midwifery as a public health intervention globally. This article aimed to explore relationships and trust as key components of a well‐functioning freestanding midwifery unit (FMU). Method(s): A critical realist ethnographic study of an FMU located in East London, England, was conducted over a period of 15 months. Recruitment of the 82 participants was purposive. Data collection included participant observation and semi‐structured interviews, and data were analyzed thematically along with relevant local guidelines and documents. Results: Twelve themes emerged. Relationships and Trust were identified as a core theme. The other 11 themes were grouped into six families, three of which: Ownership, Autonomy, and Continuous Learning; Team Spirit, Interdependency, and Power Relations; and Salutogenesis will be covered in this paper. The remaining three families: Friendly Environment; Having Time and Mindfulness; and Social Capital, will be covered in a separate paper. Conclusions: A relationship‐based model of care was crucial for both the functioning of the FMU and service users' satisfaction and may offer a compelling response to high levels of stress and burnout among midwives. [ABSTRACT FROM AUTHOR]

The professed aim of any social welfare or legal intervention in family life is often to bring about "better outcomes for the children." But there is considerable ambiguity about "outcomes," and the term is far too often used in far too simplistic a way. This paper draws on empirical research into the outcomes of care proceedings for a randomly selected sample of 616 children in England and Wales, about half starting proceedings in 2009–2010 and the others in 2014–2015. The paper considers the challenges of achieving and assessing "good outcomes" for the children. Outcomes are complex and fluid for all children, whatever the court order. One has to assess the progress of the children in the light of their individual needs and in the context of "normal" child development, and in terms of the legal provisions and policy expectations. A core paradox is that some of the most uncertain outcomes are for children who remain with or return to their parents; yet law and policy require that first consideration is given to this option. Greater transparency about the uncertainty of outcomes is a necessary step towards better understanding the risks and potential benefits of care proceedings. [ABSTRACT FROM AUTHOR]

The aim of this paper was to explore the experiences of perceived prejudices faced in England by Black African mental health nurses. Purposive sampling was used to identify five nurses from sub‐Saharan Africa. They were interviewed using face‐to‐face semi‐structured interviews. Data were analysed using interpretative phenomenological analysis (IPA). The findings were reported under two superordinate themes: Judging a book by its cover and opportunities. The findings showed that Black African nurses experience deep‐rooted discrimination and marginalisation. Aside from that, because of their ethnicity and the fact that they speak English as a second language, they face discrimination and have difficulty achieving leadership roles. These findings provide key stakeholders, such as nursing trade unions and professional associations, as well as NHS employers, with the opportunity to act to counter hegemony in the NHS and recognise that discriminatory and racially related barriers hinder Black African nurses from reaching their full professional potential. [ABSTRACT FROM AUTHOR]

This paper examines the impact of disruptions to the organisation and delivery of healthcare services and efforts to re‐order care through emotion management during the COVID‐19 pandemic in the UK. Framing care as an affective practice, studying healthcare workers' (HCWs) experiences enables better understanding of how interactions between staff, patients and families changed as a result of the pandemic. Using a rapid qualitative research methodology, we conducted interviews with frontline HCWs in two London hospitals during the peak of the first wave of the pandemic and sourced public accounts of HCWs' experiences of the pandemic from social media (YouTube and Twitter). We conducted framework analysis to identify key factors disrupting caring interactions. Fear of infection and the barriers of physical distancing acted to separate staff from patients and families, requiring new affective practices to repair connections. Witnessing suffering was distressing for staff, and providing a 'good death' for patients and communicating care to families was harder. In addition to caring for patients and families, HCWs cared for each other. Infection control measures were important for limiting the spread of COVID‐19 but disrupted connections that were integral to care, generating new work to re‐order interactions. [ABSTRACT FROM AUTHOR]

While many evidence-based tools and measures exist to support child protection practice, in the United Kingdom, there is little evidence of their routine use in casework. This paper reports on a qualitative study exploring the use of such tools with children and families receiving statutory social care services. Fifteen social workers working in child safeguarding teams in two local authorities in Southeast England agreed to incorporate the use of outcome measures into their casework over a 6-month period. Qualitative data were collected through monthly action learning workshops held separately in each local authority. The results showed how the impact of using the measures was shaped by a combination of institutional factors, practice context and the dynamics of casework. Outcome measures were found to have benefits as well as limitations with respect to partnership working, assessment and decision-making and overall social work practice. Implications are discussed for the prospects of enhancing the use of evidence-based tools in statutory social work with children and families. [ABSTRACT FROM AUTHOR]

Background: Geographical and cultural differences have been shown to affect public attitudes towards stuttering. However, increasingly for many individuals in the world one's birthplace culture (or home culture) and culture in their local geographical environment (or host culture) are not the same. Aims: The effects of home culture and host culture in shaping the attitudes towards stuttering among students with British, Arab and Chinese home cultures attending one British university were explored. The effects of host culture were investigated by considering the time lived in the UK for Arab and Chinese students. Methods & Procedures: The study used a descriptive survey design that included a standardized self‐delivered questionnaire: the Public Opinion Survey of Human Attributes—Stuttering (POSHA‐S). Purposive sampling was carried out thorough volunteer mailing lists, student societies and personal contact. The final sample of 156 university students included 51 British, 52 Arab and 53 Chinese students. Outcomes & Results: Overall stuttering score (OSS), which is indicative of attitudes towards stuttering, was highest for British participants (mean = 30) and lowest for Chinese participants (mean = 13), with Arab participants falling in the middle (mean = 21). The differences in attitudes between the three groups were statistically significant, suggesting that home culture is a contributor to attitudes towards stuttering. A post‐hoc item analysis of the POSHA‐S revealed numerous specific differences in attitudes towards stuttering between the three groups, including differences in the attribution of the aetiology of stuttering, their role in helping people who stutter (PWS) and sympathy toward PWS. Time lived in the UK—a proxy measure for the role of host culture—did not significantly influence the attitudes of Arab and Chinese respondents. Conclusions & Implications: To varying degrees, all three groups had evidence of stereotypical stuttering attitudes. Nevertheless, given similar ages and student status in the same university, observed respondent differences confirm previous research documenting geographical influences on stuttering attitudes in Western versus East Asian and Middle Eastern samples. The study also provides evidence that home culture was influential in shaping attitudes towards stuttering, but host culture was not a significant contributor. What this paper addsWhat is already known on the subjectPublic stereotypical beliefs towards stuttering are found across the world and hinder the quality of life among PWS. Different cultures have unique stereotypical beliefs towards PWS.What this study adds to existing knowledgeTo the best of our knowledge, no other study has investigated specifically if individuals who live in the same geographical location but have different home cultures, have similar or differing attitudes towards PWS. Results provide preliminary evidence that the home culture of an individual was influential in shaping attitudes towards PWS, but host culture, measured as the length of time living in the current geographical location, did not have a significant relationship with attitudes towards stuttering.What are the potential or actual clinical implications of this workThis study highlights that culturally sensitive clinical practice should not be based on just the culture of the region but should take home culture into consideration as well, and clinicians should discuss cultural perceptions of stuttering with clients in clinical practice. [ABSTRACT FROM AUTHOR]

Abstract: This paper discusses some key findings taken from a qualitative study conducted with gay and lesbian adopters and foster carers in England and Wales. The study examined the experiences of 24 self‐identified lesbians and gay men, who had been involved in adoption or fostering processes since the introduction of the Adoption and Children Act, 2002. This article will explore why participants chose to adopt or foster and their approach to relationships generated through these routes. Findings indicate that gay and lesbian applicants troubled dominant conceptualisations of family and kinship and revealed both heteronormative and nuclear constructions of parenting within adoption and fostering social work. In contrast, participants often demonstrated a reflexive and creative approach to caring for looked after children. This paper will therefore consider how professionals can recognise nuanced or complex relationships, situated beyond traditional frameworks, through drawing upon wider concepts within sociological literature. [ABSTRACT FROM AUTHOR]

This paper reports on an empirical study of child protection services in a local authority where rates of investigations and interventions rose to unprecedented levels during the course of a single year. The aim of the research was to explore explanations for this rise in demand among the providers of children's social care in the area. Using an interpretative qualitative design, a series of focus groups and interviews were carried out with practitioners and managers (n = 25) from statutory services and Early Help. The findings identified a combination of long‐term and short‐term drivers of demand. Long‐term factors emphasized the impact of rising levels of deprivation combined with cuts to community‐based services for children and young people. Short‐term factors ranged from a more proactive approach to child neglect to more effective multi‐agency partnerships and joint decision making. The interaction between these factors was found to be accentuating an underlying shift to "late intervention" across the sector. The findings are contextualized in relation to contemporary debates about the crisis of demand for children's social care and the complex relationship between prevention and protection. [ABSTRACT FROM AUTHOR]

Limited research has been conducted in relation to social work and the impact upon kinship carers' own children in a UK context. This paper argues that pressure from government policy imperatives and organizational priorities creates tension and conflict in the professional self in the context of kinship care and with kinship carers' own children. It will examine the professional self through social work narratives utilising the two concepts economy of performance and ecology of practice. This paper focuses upon data from four focus groups and 16 semi-structured interviews carried out with 29 social workers within one local authority in the north of England. Transcripts were analysed using thematic analysis. Only data related to the professional self are examined. The discussion explores how social workers attempted to navigate the tension in their everyday practice. It illuminates the impact upon their performance in kinship care and implications for practice with carers' own children. The conclusion reveals the need for social workers to create a space within which kinship carers' own children's voices are heard. [ABSTRACT FROM AUTHOR]

This paper reports upon the learning that emerged from a development project which aimed to facilitate improvements in multiagency work in domestic abuse and safeguarding children. The two-year project (2011-13), funded by the Department for Education and led by WomenCentre, a specialist voluntary sector organisation based in West Yorkshire, was undertaken in nine local authorities in the north of England. Activities undertaken during the project included case mapping, service user and professional engagement exercises, observation of local multiagency meetings and provision of training. An evaluative research study examined the work of the project and the learning that emerged. Drawing upon data from telephone interviews with project participants, analysis of case mapping and project reports, this paper discusses some critical issues which emerged from this project. The paper draws attention to the different understandings and priorities which shape interprofessional practice in relation to safeguarding children and domestic abuse, and the complexities of the wider interagency environment including coordination, resources and expertise. Recommendations for improving multiagency work to achieve better outcomes for women and children experiencing domestic abuse are discussed. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Messages Multiagency working in domestic abuse and safeguarding children is complex and could be improved., The impact of professional differences in how cases are understood and managed, particularly in relation to 'risk', as well as different professional priorities and approaches to working with families should be recognised and considered within the multiagency context., Practitioners may want to consider whether 'case mapping' is pertinent to their own safeguarding practices and processes. [ABSTRACT FROM AUTHOR]

Background and aims Regulation of electronic cigarettes has moved to the top of the addiction policy agenda, as demonstrated by the recent focus across the United Kingdom on introducing age-of-sale restrictions. However, the views of those affected by such regulation remain largely unexplored. This paper presents the first detailed qualitative exploration of adolescents' perceptions of existing, and opinions about potential e-cigarette regulation. Methods Sixteen focus groups, including a total of 83 teenagers between the ages of 14 and 17 years, were conducted in deprived, mixed and affluent urban areas in Scotland and England between November 2014 and February 2015. Transcripts were imported into Nivivo 10, coded thematically and analysed. Results Participants critically considered existing evidence and competing interests in regulatory debates and demonstrated sophisticated understanding of the advantages and disadvantages of regulation. They overwhelmingly supported strong e-cigarette regulation and endorsed restrictions on sales to minors, marketing and e-cigarette use in public places. Concern about potential health harms of e-cigarette use and marketing increasing the acceptability of vaping and smoking led these adolescents to support regulation. Conclusions In focus group discussions, a sample of UK adolescents exposed to particular communications about e-cigarettes supported strict regulation of e-cigarettes, including banning sales to minors and use in indoor public areas. [ABSTRACT FROM AUTHOR]

ABSTRACT From the findings of a study examining the perspective of parents using Intensive Family Support Service based in northern England, this paper examines the constituent elements required for effective relationship-based practice. Although the study is based in a single site in England, the findings are more broadly relevant, given both national and international interests in relationship-based practice in child protection. The participants in this study - parents whose children had been assessed as being 'at the edge of care'- were asked to comment on the intervention they had received. Analysis of parents' interviews suggests that the service user-worker relationship was critical to their positive experience of the service. The paper provides an analysis of parents' descriptions of 'positive relationships' and identifies the key themes. It then considers these findings in the context of contemporary children and families' social work practice. Engaging with current debates, the paper makes reference to the impact of modernization, which has served to erode effective face-to-face work with families, given excessive 'backroom' demands of administration and audit. Discussion engages with an emerging emphasis on effective relationship-based practice following reports from Munro and the Social Work Reform Board. In this context, the paper concludes that the views of these families whose children are on the 'edge of care' offers insights into the skills required for relationship-based practice. [ABSTRACT FROM AUTHOR]

The pharmaceuticalisation of sleep is a contentious issue. Sleep medicines get a 'bad press' due to their potential for dependence and other side effects, including studies reporting increased mortality risks for long-term users. Yet relatively little qualitative social science research has been conducted into how people understand and negotiate their use/non-use of sleep medicines in the context of their everyday lives. This paper draws on focus group data collected in the UK to elicit collective views on and experiences of prescription hypnotics across different social contexts. Respondents, we show, drew on a range of moral repertoires which allowed them to present themselves and their relationships with hypnotics in different ways. Six distinct repertoires about hypnotic use are identified in this regard: the 'deserving' patient, the 'responsible' user, the 'compliant' patient, the 'addict', the 'sinful' user and the 'noble' non user. These users and non-users are constructed drawing on cross-cutting themes of addiction and control, ambivalence and reflexivity. Such issues are in turn discussed in relation to recent sociological debates on the pharmaceuticalisation/de-pharmaceuticalisation of everyday life and the consumption of medicines in the UK today. [ABSTRACT FROM AUTHOR]

Despite the growing recognition of the value of mental imagery within the field of cognitive- behavioural therapy (CBT), there is minimal research relating to clinicians' experiences of using imagery. This paper explores recently qualified CBT therapists' clinical experiences of using imagery and their perception of the role of imagery within their practice. Twelve therapists, qualified within the past 4 years, were interviewed using a semi-structured format, and the resulting transcriptions were analysed using Interpretative Phenomenological Analysis (IPA). The analysis identified six superordinate themes: (1) broad and fluid conception of imagery; (2) the importance given to imagery and the varied rationale for its inclusion; (3) varied application; (4) clinician avoidance and apprehension; (5) personal experience of imagery and impact on use; and (6) limited core training and the potential for future use. The themes, as a whole, described a complex and often dichotomous reaction to imagery amongst the therapists. Although a section of participants reported a natural affinity with imagery, other therapists felt that using, and experiencing, imagery was anxiety provoking and problematic. There was, however, unity in the value placed on imagery, the strong rationale for usage and the importance given to imagery-specific training. Avoidance and apprehension regarding imagery were evident in the majority of participants, and the reasons for such responses included personal, clinical and cultural factors. The overall findings highlight the importance of clinician factors in the way in which imagery is utilized and understood, which has positive implications for training, personal development and future research. [ABSTRACT FROM AUTHOR]

This paper describes some of the findings of a qualitative study into the health and illness beliefs of Greek Cypriots living in London. Data were collected through group and individual in-depth interviews and were analysed using the grounded theory approach of constant comparison and saturation. Two of the six themes which were identified are discussed in this paper. The findings provide the reader with important insights into Greek Cypriots' beliefs of health and illness. The paper argues that the understanding of such beliefs from a cultural perspective is vitally important for all those involved in the provision of health care to this group. [ABSTRACT FROM AUTHOR]

The difficulties faced in the recruitment and retention of nursing staff in nursing homes for older people are an international challenge. It is therefore essential that the causes of nurses' reluctance to work in these settings are determined. This paper considers the influence that multiple-source care funding issues have on nursing home nurses' experiences and views regarding the practice and appeal of the role. The methodology for this study was hermeneutic phenomenology. Thirteen nurses from seven nursing homes in the North East of England were interviewed in a sequence of up to five interviews and data were analysed using a literary analysis method. Findings indicate that participants are uncomfortable with the business aspects that funding issues bring to their role. The primary difficulties faced are: tensions between care issues and funding issues; challenges associated with 'selling beds'; and coping with self-funding residents' changing expectations of care. The findings of the study suggest that multiple-source care funding systems that operate in nursing homes for older people pose challenges to nursing home nurses. Some of these challenges may impact on their recruitment and retention. [ABSTRACT FROM AUTHOR]

Obesity is now commonly recognised to be a significant public health issue worldwide with its increasing prevalence frequently described as a global epidemic. In the United Kingdom, primary care nurses are responsible for weight management through the provision of healthy eating advice and support with lifestyle change. However, nurses themselves are not immune to the persistent and pervasive global levels of weight gain. Drawing on a Gadamerian informed phenomenological study of female primary care nurses in England, this paper considers the complex gendered understandings and experiences of being overweight, and of food and eating. The nurses' emotional and injurious experiences of being large is found to be capable of producing embodied caring practices, involving a fusion of horizons with patients over how it feels to inhabit a large body. Yet, even though subjected to similar derogatory stereotypes as patients, they simultaneously reinforce the dominant and damaging individualising psychopathology inherent to anti-obesity discourses. This suggests an urgent need to expose and challenge harmful discourses surrounding women's body size and weight in order to avoid nursing practices that unthinkingly reproduce culturally dominant and gendered understandings of weight, body size, food and eating. [ABSTRACT FROM AUTHOR]

Background The speech and language therapy/pathology (SLT/SLP) profession is characterized by extreme 'occupational sex segregation', a term used to refer to persistently male- or female-dominated professions. Men make up only 2.5% of all SLTs in the UK, and a similar imbalance is found in other countries. Despite calls to increase diversity in the allied health professions more generally, research into the reasons for occupational sex segregation and gender as a potential key factor remains scarce. Aims This study aims to explore the potential role of gender/gendered discourses in people's decision to pursue a career in SLT/SLP. It seeks to illustrate how gendered assumptions/expectations/discourses continue to construct SLT as a 'gendered' profession, and to make some recommendations in this area for SLT recruitment and practice. Methods & Procedures The study adopted a qualitative design which elicited research participants' views, knowledge and experiences (in their own words) in relation to the research questions. Data collection involved two iterative phases: a preliminary data phase-which involved semi-structured interviews with newly qualified SLT graduates and practising SLTs, and the completion of questionnaires by undergraduate SLTs-and a main/focus group phase. In the focus group phase reported in this paper, six focus groups in total were held with SLTs, teachers of SLT, and careers advisors in London, UK. The data were analysed qualitatively using grounded theory principles, thematic analysis and discourse analysis. Outcomes & Results The findings extend our knowledge and understanding of gender as a parameter of people's motivations and perceptions, which can influence their choice of career (e.g. as regards pay and flexibility). The findings also show that discourses around women as carers, nurturers and communicators constitute key ways through which the SLT profession continues to be constructed as 'women's work'. The topic of structural gender inequalities in the profession was also discussed in the data. Some recommendations for change, with implications for SLT recruitment and practice, were made by the participants themselves. Conclusions & Implications Gender imbalance in SLT needs to be researched further in order to help address inequalities, re-evaluate professional practices and develop service delivery in the profession. This area also needs to be researched via analysis that goes beyond gender distribution in numerical terms to consider the complex perceptions or discourses around gender and work. Cross-disciplinary and comparative perspectives in future research would also be fruitful. [ABSTRACT FROM AUTHOR]

AIMS: This paper reports a study evaluating whether expanding a specialist nursing role to provide outreach education and support to stroke patients and carers after discharge from hospital is effective in promoting recovery. BACKGROUND: Building therapeutic relationships with patients and carers is a key component of the nursing role in stroke rehabilitation, although this is limited by the constraints of service organization. METHODS: A pragmatic randomized controlled trial was undertaken. Patients with a diagnosis of stroke were randomized to receive continued support from a stroke nurse (n = 87) or usual care and follow-up (n = 89) after discharge from hospital. Patients were recruited from two hospitals in the north-west of England from November 1999 to April 2001. Patient dependence (Barthel Index), general health (Nottingham Health Profile), activities of living (Frenchay Activity of Living Index), depression (Beck Depression Inventory) and carer strain (Carer Strain Index) were assessed at 3 and 12 months after stroke. RESULTS: The continued intervention of a stroke nurse after discharge was associated with improved patient perceptions of general health at 12 months (median difference 42.6, P = 0.012), and in particular reduced negative emotional reaction (P = 0.037) and perceived social isolation (P = 0.002). In addition, the intervention reduced carer strain at 3 months (P = 0.045), and reduced deterioration in physical dependence from 3 to 12 months (P = 0.049). CONCLUSION: The provision of continued intervention from a stroke nurse after discharge from hospital, focusing on education and support, has tangible benefits for patients and carers. [ABSTRACT FROM AUTHOR]