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ABSTRACT BACKGROUND The Healthy, Hunger-Free Kids Act of 2010 ( HHKA) required schools to make changes to meals provided to children. Rural school districts have limited resources, with increased obesity rates and local food insecurity. In this study we sought to understand the perceptions of rural food service directors and the barriers to implementing the changes. METHODS Food service directors from rural school districts were invited to complete a semistructured telephone interview and online survey. A total of 51 respondents completed both, 6 completed only the online survey, and 16 completed only the telephone interview. Qualitative interview data were analyzed through open thematic coding; descriptive statistics were calculated for the quantitative data. RESULTS Food service directors mostly perceived the changes as negative, challenging, and burdensome. They believed that the changes resulted from concern about childhood obesity, which they did not view as a problem for their students. Diverse challenges were reported related to cost, preparation, and student preference. CONCLUSIONS Food service directors in isolated, rural areas need support to enhance understanding of HHKA requirements, build professional networks to learn from one another, and communicate with students, families, and other stakeholders. Future efforts should focus on changing perceptions and supporting directors in order to make implementation a success. [ABSTRACT FROM AUTHOR]

Background: Aspiration pneumonia (AP) is a subset of pneumonia caused by the aspiration of food and fluids to the lungs and is highly prevalent in the older population. Oropharyngeal dysphagia (OD) is one of the risk factors for AP and it is also associated with malnutrition, dehydration and poor functional outcomes. As pneumonia is the second most common infection in nursing homes (NHs) and OD represents a major concern to NH staff, good practices for the prevention of AP in older adults at risk of OD are needed. Purpose: The aim of this modified e‐Delphi study is to build consensus among a panel of experts regarding a set of recommendations for NH staff on good practices to prevent AP in older adults at risk of OD living in NHs. The objective of this paper is to establish the methodology inherent to the Delphi study. Methods: An online modified Delphi study will be developed in three rounds. Criteria for the Delphi panel participants include holding a master's or doctoral degree in OD or speech and language therapy; or having 10 or more years of experience in OD; or having at least one scientific publication related to OD. A previously described modified Delphi methodology will be used to achieve consensus (75% agreement). An additional round will be performed to collect the experts' perspectives regarding the priority for application of each recommendation previously validated. Discussion: This protocol aimed to describe the methodology of a future Delphi study on the prevention of AP, seeking to fulfil the gap in the literature regarding this topic. The modified Delphi technique is a widely used method for collecting experts' opinion in health sciences, but the absence of standardised guidelines allows some heterogeneity between studies with the same aim. WHAT THIS PAPER ADDS: What is already known on the subject: Aspiration pneumonia (AP) is related to three main risk factors: impaired safety of swallow, impaired nutritional status and poor oral health. It is known that being dependent for feeding is one of the main risk factors for AP and around 50% of nursing home (NH) residents need feeding assistance. Thus, it is important to promote specialised intervention and care by the NH staff for preventing AP. What this paper adds to existing knowledge: It is hypothesised that increasing the knowledge of NH staff regarding the best practices for preventing AP in older adults at risk of oropharyngeal dysphagia (OD) will improve outcomes such as quality of life, incidence of AP and mortality. What are the potential or actual clinical implications of this work?: The recommendations resulting from this study will address a current gap in healthcare practice of NH staff regarding older adults at increased risk for OD and, consequently, for AP. [ABSTRACT FROM AUTHOR]

Background: The implementation science literature acknowledges a need for engagement of key stakeholders when designing, delivering and evaluating implementation work. To date, the literature reports minimal or focused stakeholder engagement, where stakeholders are engaged in either barrier identification and/or barrier prioritisation. This paper begins to answer calls from the literature for the development of tools and guidance to support comprehensive stakeholder engagement in implementation research and practice. The paper describes the systematic development of the Implementation‐STakeholder Engagement Model (I‐STEM) in the context of an international, large‐scale empirical implementation study (ImpleMentAll) aimed at evaluating the effectiveness of a tailored implementation toolkit. The I‐STEM is a sensitising tool that defines key considerations and activities for undertaking stakeholder engagement activities across an implementation process. Methods: In‐depth, semistructured interviews and observations were conducted with implementers who were tailoring implementation strategies to integrate and embed internet‐based cognitive behavioural therapy (iCBT) services in 12 routine mental health care organisations in nine countries in Europe and Australia. The analytical process was informed by principles of first‐ and third‐generation Grounded Theory, including constant comparative method. Results: We conducted 55 interviews and observed 19 implementation‐related activities (e.g., team meetings and technical support calls). The final outcome of our analysis is expressed in an initial version of the I‐STEM, consisting of five interrelated concepts: engagement objectives, stakeholder mapping, engagement approaches, engagement qualities and engagement outcomes. Engagement objectives are goals that implementers plan to achieve by working with stakeholders in the implementation process. Stakeholder mapping involves identifying a range of organisations, groups or people who may be instrumental in achieving the engagement objectives. Engagement approaches define the type of work that is undertaken with stakeholders to achieve the engagement objectives. Engagement qualities define the logistics of the engagement approach. Lastly, every engagement activity may result in a range of engagement outcomes. Conclusion: The I‐STEM represents potential avenues for substantial stakeholder engagement activity across key phases of an implementation process. It provides a conceptual model for the planning, delivery, evaluation and reporting of stakeholder engagement activities. The I‐STEM is nonprescriptive and highlights the importance of a flexible, iterative approach to stakeholder engagement. It is developmental and will require application and validation across a range of implementation activities. Patient or Public Contribution: Patient contribution to ImpleMentAll trial was facilitated by GAMIAN‐Europe at all stages—from grant development to dissemination. GAMIAN‐Europe brings together a wide variety of patient representation organisations (local, regional and national) from almost all European countries. GAMIAN‐Europe was involved in pilot testing the ItFits‐toolkit and provided their views on the various aspects, including stakeholder engagement. Patients were also represented in the external advisory board providing support and advice on the design, conduct and interpretation of the wider project, including the development of the ItFits‐toolkit. Trial registration: ClinicalTrials.gov NCT03652883. Retrospectively registered on 29 August 2018. [ABSTRACT FROM AUTHOR]

In Australia, there are more than 46 000 children in out‐of‐home care (OOHC). Most of these children have been in OOHC for more than 2 years. Similarly, there are more than 407 000 children in the United States and over 80 800 in England who are 'looked after' with approximately one third of these children being in OOHC for more than 2 years. This paper concerns 'looked after' children's rights to contact with their birth parents. The United Nations Convention on the Rights of the Child (UNCRC) requires child protection systems to recognize the rights of children to maintain contact with their families except where this is not in the child's 'best interests'. In this paper, we report on a qualitative study conducted in Australia exploring legal and family support practitioners' perceptions of barriers to contact between children in OOHC and their birth parents. The thematic analysis identified four themes: These were as follows: a focus on systems driven responses; lack of cultural recognition and responsiveness; carers' disconnection from birth parents; and parents' exclusion. We discuss the implications of these findings for understanding and recognizing children's right to contact with birth parents. [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: People with Parkinson's disease (PD) do not always access specialist outpatient services in a timely manner in Ireland. The perspectives of people living with PD, relating to service access, are largely absent in the existing literature. Aim: To explore experiences of PD service access for people living with PD, using a qualitative approach. Methods: Purposive maximum variation sampling was used. Semi‐structured telephone interviews were conducted with 25 service users, including people with PD (n = 22) and supporting carers (n = 3). Informed consent was obtained from all participants. Interviews ranged in duration from 30 to 90 min. Data were managed in NVivo 12 and interpreted inductively using thematic analysis. The researchers were reflexive throughout the research process. The Consolidated Criteria for Reporting Qualitative Research checklist was employed to maximise transparency. Results: The findings highlight several key barriers to and facilitators of equitable and timely service access. Three key themes were identified comprising experiences of PD service access including 'geographical inequity', 'discriminatory practices', and 'public and private system deficits'. Together, these themes illustrate how a two‐tiered and under‐resourced health system lacks capacity, in terms of infrastructure and workforce, to meet PD needs for both public and private patients in Ireland. Conclusions: These findings point to problems for PD care, relating to (i) how the health system is structured, (ii) the under‐provision and under‐resourcing of specialist outpatient PD services, including medical, nursing, and multidisciplinary posts, and (iii) insufficient PD awareness education and training across health settings. The findings also show that telemedicine can provide opportunities for making access to certain aspects of PD care more flexible and equitable, but the feasibility and acceptability of technology‐enabled care must be assessed on an individual basis. Implications for policy, practice and research are discussed. Patient or Public Contribution: The design and conduct of this study were supported by an expert advisory group (EAG) of 10 co‐researchers living with PD. The EAG reviewed the interview schedule and the protocol for this study and provided detailed feedback from their perspective, to improve the methods, including the interview approach. The group also reviewed the findings of the study and contributed their insights on the meaning of the findings, which fed into this paper. [ABSTRACT FROM AUTHOR]

Context As electronic health records ( EHRs) are adopted by teaching hospitals, educators must examine how this change impacts trainee development. Objectives We investigate this influence by studying clinician experiences of a hospital's move from paper charts to an EHR. We ask: how does each chart modality present conceptions of time and data interconnections? How do these conceptions affect clinical reasoning? Methods This two-phase, longitudinal study employed constructivist grounded theory. Data were collected at a paediatric teaching hospital before (Phase 1), during and after (Phase 2) the transition from a paper chart to an EHR system. Data collection consisted of field observations (146 hours involving 300 health care providers, 22 patients and 32 patient family members), think-aloud ( n = 13) and think-after ( n = 11) sessions, interviews ( n = 39) and document retrieval ( n = 392). Theories of rhetorical genre studies and visual rhetoric informed analysis. Results In the paper flowsheet, clinicians recorded and viewed patient data in chronologically organised displays that emphasised data interconnections. In the EHR flowsheet, clinicians viewed and recorded individual data points that were largely chronologically and contextually isolated. Clinicians reported that this change resulted in: (i) not knowing the patient's evolving status; (ii) increased cognitive workload, and (iii) loss of clinical reasoning support mechanisms. Conclusions Understanding how patient data are interconnected is essential to clinical reasoning. The use of EHRs supports this goal because the EHR is a tool for collecting dispersed data; however, these collections often deconstruct data interconnections. Where the paper flowsheet emphasises chronology and interconnectedness, the EHR flowsheet emphasises individual data values that are largely independent of time and other patient data. To prepare trainees to work with EHRs, the ways of thinking and acting that were implicitly learned through the use of paper charts must be made explicit. To support clinical reasoning, medical educators should provide lessons in connectivity - the chronologically framed data interconnections upon which clinicians rely to provide patient care. [ABSTRACT FROM AUTHOR]

Background: Acquired laryngotracheal stenosis (LTS) is a rare condition that causes breathlessness and dyspnoea. Patients have reconstructive airway surgery to improve their breathing difficulties, but both LTS and the surgery can cause voice difficulties. The existing evidence base for management of voice difficulties for adults with LTS focuses on symptoms. There is limited information to provide clinical guidance for speech and language therapists (SLTs) and a limited understanding of the impact of voice changes on adults with LTS. Aim: To investigate the lived experience of adults with laryngotracheal stenosis (LTS), who have had reconstructive surgery; here focussing on voice concerns with the aim of guiding clinical care for SLTs. Methods and Procedures: A phenomenological, qualitative study design was used. Focus groups and semi‐structured interviews were completed with adults living with LTS who had had reconstructive surgery. Audio recordings were transcribed and inductive thematic analysis was used by the research team to identify themes and sub‐themes. Outcomes and Results: A total of 24 participants (five focus groups and two interviews) took part in the study before thematic saturation was identified in analysis. Three main themes were identified specific to the experience of living with LTS: the Medical, Physical and Emotional journey. All participants referenced voice difficulties as they related to each of these overall themes. Sub‐themes directly related to voice included experience of surgery, information provision, staff expertise/complacency, symptoms, symptom management, identity, support networks, impact on life and living with a chronic condition. Conclusions and Implications: In this qualitative study participants have described the integral part voice difficulties play in their lived experience of LTS and reconstructive surgery. This is considered in the context of their clinical care and the need for individualised management and information provision throughout the course of their condition. The broader research literature relating to voice difficulties is explored with links made to people with LTS and recommendations made for future research into people living with LTS and dysphonia. What this paper adds: What is already known on this subject: Adults with laryngotracheal stenosis (LTS) experience voice changes as a result of their condition, and the surgeries necessary as a treatment. These changes can lead to altered pitch, vocal fatigue, loss of pitch range and loss of volume control. Although there are known psychosocial implications both to living with a chronic condition and voice difficulties there has been no research exploring this in adults with LTS, and there is minimal clinical guidance for speech and language therapists (SLTs) working with these patients. What this paper adds to existing knowledge: This research is the first study to explore the lived experience of adults with LTS who undergo reconstructive surgery, focusing on their voice concerns. This study demonstrates the multifactorial impacts of voice changes on all aspects of the lives of adults with LTS and the need for individualised information provision and clinical care to help support them. What are the potential or actual clinical implications of this work?: Adults with LTS want expert SLTs to facilitate their care and support them throughout their LTS journey alongside other support networks. They want to be carefully prepared for reconstructive surgery and given clear information about symptoms and management of their voice difficulties. This has led to the reorganisation of the care pathway at our centre, and the introduction of a patient‐led pretreatment session. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study was to explore and understand the organizational culture of a workplace in terms of support and well‐being for staff experiencing perimenopausal and menopausal symptoms at work. Design: It is widely acknowledged that perimenopause and menopause symptoms are experienced by a large percentage of the female workforce. There is a lack of research into how nurses are supported through menopause (Cronin et al. Issues in Mental Health Nursing, 42, 2021, 541–548). The perimenopause and menopause transition can be a challenging time where many may require symptom management and support (RCN, The Menopause and Work: Guidance for RCN Representatives, 2020). This paper presents a case study research (CSR) approach to examine one healthcare organization. Methods: CSR design was used: A survey distributed to all staff employed, a review of the available documentation on menopause and interviews with managers from different levels of the organization. The COREQ consolidated criteria was used for reporting the qualitative research reported this study. Results: The case study generated both quantitative and qualitative data using surveys, interviews and documentation. Data from the organization (n = 6905) showed a majority female workforce of 81.9% with 40.6% aged between 41 and 55 years old, meaning a third of the organization working through perimenopause and menopause. Survey responses (n = 167) collected biographical and psychometric data on the prevalence of perimenopausal and menopausal symptoms. Seven managers were interviewed highlighting two themes: Access to support and culture of menopause and 13 documents from the organization on menopause were analysed for content. The study design permitted an iterative approach to data collection and providing an in‐depth understanding of the needs and support for those experiencing perimenopause and menopause. The findings help healthcare organizations to understand their workforce and take in to account the larger numbers of female employees particularly nurses with the need to provide person‐centred support mechanisms and an organizational approach for all employees. [ABSTRACT FROM AUTHOR]

Introduction: Older carers or 'care partners' of older people experiencing care needs often provide essential support, at times while neglecting their own health and well‐being. This is an increasingly frequent scenario due to both demographic changes and policy shifts towards ageing in place. Multiple community stakeholders within the care and support ecosystem hold valuable expertise about the needs of older care partners, and the programme and policy responses that may better support their health and well‐being. The aim of this study was to identify the perspectives of stakeholders obtained through the codesign phase of a multicomponent research project investigating new models of care and support for older care partners suitable for the Australian context. Methods: Principles of codesign were used to engage a purposeful sample of older care partners, health professionals, researchers, policy makers and health service administrators. Participants took part in a series of three codesign workshops conducted remotely via video conferencing. The workshops were supported with briefing material and generated consensus‐based summaries, arriving at a preferred service model. Findings: This paper reports the research design and structure of the codesign panels, the range of findings identified as important to support the health and well‐being of older carers of older people, and the resulting service model principles. The codesigned and preferred model of care is currently being prepared for implementation and evaluation in Australia. Public Contribution: This study was conducted using codesign methodology, whereby stakeholders including older care partners and others involved in supporting older carers, were integrally involved with design, development, results and conclusions. [ABSTRACT FROM AUTHOR]

Introduction: Facilitators to implement shared cancer follow‐up care into clinical practice include mechanisms to allow the oncologist to continue overseeing the care of their patient, two‐way information sharing and clear follow‐up protocols for general practitioners (GPs). This paper aimed to evaluate patients, GPs and radiation oncologists (ROs) acceptance of a shared care intervention. Methods: Semi‐structured interviews were conducted pre‐ and post intervention with patients that were 3 years post radiotherapy treatment for breast, colorectal or prostate cancer, their RO, and their GP. Inductive and deductive thematical analysis was employed. Results: Thirty‐two participants were interviewed (19 patients, 9 GPs, and 4 ROs). Pre intervention, there was support for GPs to play a greater role in cancer follow‐up care, however, patients were concerned about the GPs cancer‐specific skills. Patients, GPs and ROs were concerned about increasing the GPs workload. Post intervention, participants were satisfied that the GPs had specific skills and that the impact on GP workload was comparable to writing a referral. However, GPs expressed concern about remuneration. GPs and ROs felt the model provided patient choice and were suitable for low‐risk, stable patients around 2–3 years post treatment. Patients emphasised that they trusted their RO to advise them on the most appropriate follow‐up model suited to their individual situation. The overall acceptance of shared care depended on successful health technology to connect the GP and RO. There were no differences in patient acceptance between rural, regional, and cancer types. ROs presented differences in acceptance for the different cancer types, with breast cancer strongly supported. Conclusion: Patients, GPs and ROs felt this shared cancer follow‐up model of care was acceptable, but only if the RO remained directly involved and the health technology worked. There is a need to review funding and advocate for health technology advances to support integration. Patient or Public Contribution: Patients treated with curative radiotherapy for breast, colorectal and prostate cancer, their RO and their GPs were actively involved in this study by giving their consent to be interviewed. [ABSTRACT FROM AUTHOR]

The safety of practitioners working in the area of domestic abuse is a current subject of research and practice concern, as services endeavour to better understand constantly evolving tactics of violence and abuse and respond appropriately. This paper reports on a subset of findings from a practice‐led research project focussed on capacity‐building workers and their organizations to address domestic abuse, which highlighted the ongoing concerns expressed by practitioners—particularly female practitioners—about their own physical, emotional, and professional safety. Ethnographic notes were taken of Community of Practice discussions in four regions of New South Wales, Australia, involving 69 senior health practitioners from a range of service streams: specialist domestic abuse, mental health, substance use, and child protection. Themes identified through thematic analysis included the following: a tailored approach to practising safely; attending to physical safety; threats to professional identity; promoting emotional well‐being; documentation to support worker safety; and attending to cultural safety. These themes are encapsulated in the practitioner question: Who's got my back?—highlighting the importance of legislation, policy, and practices that provide an environment in which safety and support are embedded in a culture of care at every organizational level. [ABSTRACT FROM AUTHOR]

Background: People with post‐stroke dysphagia often require informal care from family to facilitate safe swallowing, modify food/drink or administer tube‐feeds. Previous survey studies have found dysphagia may increase family caregiver burden. However, the experiences of family members in this population have not been fully explored. Aims: To explore family members' experiences of living with a spouse with post‐stroke dysphagia. Methods & Procedures: This exploratory qualitative study used one‐to‐one semi‐structured interviews to explore family members' experiences. They were asked open questions about previous eating routines, dysphagia onset, their role and future hopes. Interviews were audio‐recorded, transcribed and analysed thematically with an inductive approach to determine key features of family members' experiences. Outcomes & Results: Five spouses aged 70–93 years participated. Their relatives' strokes happened 3 months to 3 years before the interview. Five themes were identified: 'I do all of it'; making sense of dysphagia; emotional responses; reflecting on relationships; and redefining lifestyle. Conclusions & Implications: It is important to consider family members' perspectives as they often provide vital care to loved‐ones with dysphagia. In relation to eating and drinking, maintaining elements of previous routines seems important to families. Healthcare professionals should consider these when making recommendations for rehabilitation. Family members have differing perspectives of the comparative impact of dysphagia; patient and family priorities should be explored for healthcare professionals to provide better‐targeted support. What this paper adds: What is already known on the subject: Informal caregivers, often spouses, play a vital role in supporting the health and well‐being of older people with health conditions. The presence of post‐stroke dysphagia may present increased challenges for the informal caregiver. There are limited studies qualitatively exploring the experiences of informal caregivers in this population. What this paper adds to existing knowledge: Current health and social care provision for this population leaves informal caregivers feeling they have been left to manage dysphagia alone. Informal caregivers demonstrate a breadth of knowledge about their spouse's dysphagia, problem‐solving effective solutions. Informal caregivers have a range of interpretations of the nature and cause of dysphagia; leading to miscommunication with health professionals and complex emotional responses. What are the potential or actual clinical implications of this work?: Healthcare professionals might consider ways in which to support dysphagic patients' families later in their care pathway, through scheduling reviews or running dysphagia patient and family groups. Health and social care professionals and policymakers should learn from informal caregivers' expertise to promote better health and quality‐of‐life outcomes for the patient and caregiver. Equal, open conversations between health and social care professionals and patients/families on their understanding of dysphagia may help informal caregivers to better voice their concerns and support mutual understanding. This has implications for adherence to recommendations, psychological well‐being and patient safety. [ABSTRACT FROM AUTHOR]

Background: Assessing the speech production of multilingual children is challenging for speech‐language therapists (SLTs) around the world. Scientific recommendations to improve clinical practice are available, but their implementation has mostly been described in studies from English‐speaking countries. Aims: This survey aimed to describe the perspectives and practices of SLTs in assessing the speech production of multilingual children in French‐speaking Belgium. Methods & Procedures: An online survey was completed by 134 SLTs in French‐speaking Belgium. Outcomes & Results: SLTs predominantly used norm‐referenced assessment approaches, which are not recommended for use with multilingual children, and lacked necessary training and resources to implement recommended practices in the assessment of speech production of multilingual children. The shift towards more appropriate practices with multilingual children seems to be in its infancy among SLTs in French‐speaking Belgium. Some challenges identified by the SLTs were common to those in other countries and languages, such as the difficulty to distinguish between speech differences and speech disorders. Other challenges were specific to the French language and/or the Belgian context, such as the lack of appropriate tools in French. Conclusions & Implications: Action is required to improve clinical practice in assessing the speech production of multilingual children in French‐speaking contexts: better training for SLTs regarding linguistic diversity, more implementation research in the field of SLT, and advocacy for linguistic diversity with decision makers. What this paper adds: What is already known on this subject: Existing research indicates that assessing the speech production of multilingual children is challenging for speech‐language therapists (SLTs). Scientific recommendations for best practices have been published, and the shift to more appropriate assessment practices may be progressing differently across countries. SLTs' practices have been described in surveys, mostly conducted in English‐speaking countries. Although French is the fifth most spoken language in the world, data about SLTs' perspectives and practices in French‐speaking regions are scarce. What this study adds: The implementation of recommended practices in assessing multilingual children's speech production was limited among SLTs in French‐speaking Belgium. The norm‐referenced approach to assessment was predominant and few SLTs used recommended practices (e.g., criterion‐referenced measures, dynamic assessment, assessment of the child's speech production in the home language). Some challenges were identified that related specifically to practices in French‐speaking contexts (e.g., lack of French tools) and Belgian context (e.g., health policies unfavourable to multilingualism). These findings confirm that specific understanding of a situation is needed to develop context‐ and/or language‐specific solutions—and ultimately improve clinical practice. What are the clinical implications of this work?: SLTs in French‐speaking Belgium require specific training and support to provide appropriate assessment of speech production in multilingual children. Efforts to improve practices in French‐speaking contexts should focus on increasing understanding and consideration of cultural and linguistic diversity at all levels of the child's environment. Evidence‐based knowledge, assessment tools and multilingual resources are available to SLTs on websites in French and in English. [ABSTRACT FROM AUTHOR]

In New Zealand, people receiving care from specialist mental health and addiction services experience poorer health outcomes compared to the general population. Māori (Indigenous) specialist mental health and addiction service users experience disproportionate inequities. This study aims to: (1) Describe and understand mental health staff perspectives on the quality of care delivered to specialist mental health and addiction service users in their service – including specifically for Māori; and (2) Identify areas staff report as opportunities for quality improvement. In 2020, Southern District Health Board (now Te Whatu Ora – Southern) mental health staff were invited to participate in a cross‐sectional study assessing their perceptions of a range of service aspects. This paper presents quantitative and qualitative analyses about quality of care. Among the 319 staff who completed the questionnaire; 272 provided quality‐of‐care responses. Among these, 78% reported the quality of care delivered to service users as 'good' or 'excellent'; only 60% reported this for Māori service users. Participants identified individual, service and broader system level factors influencing the quality of care delivered to service users, including factors specific for Māori. This study has identified, for what appears to be the first time, empirical and concerning differences in staff ratings of the quality of care delivered to Māori and SMHAS users overall. Findings highlight the need for institutional and managerial prioritization of hauora Māori, and incorporating tikanga Māori and Te Tiriti into practice. [ABSTRACT FROM AUTHOR]

The paper presents findings from a qualitative study of four child death reviews published in Australia. The study was informed by the theoretical concept of childism. A critical social research methodology facilitated the exposure of childist dynamics in statutory child protection. The transformation of child protection practices and systems has traditionally relied on the imposition of never‐ending structural changes, policies, and procedures. This paper proposes that transformation and the erosion of childist dynamics is contingent on humane and ethical statutory child protection agencies. [ABSTRACT FROM AUTHOR]

Drawing on the findings from a longitudinal study of vulnerable young people's transitions to adulthood, this paper explores the ideas of shame and recognition. The young people, aged between 12 and 17 years at the first interview, had experienced chronic exposure to adversity from an early age (abuse, violence, mental health issues, addictions, and expulsion from school). They were clients of statutory and non‐governmental services: child welfare, juvenile justice, remedial education, and mental health services. This paper draws on the qualitative phase of the study (n = 107); young people and a trusted other, nominated by the young person, participated in three annual qualitative interviews. Interviews focused on young people's experiences of services, key transitions, their relationships, and the strategies they used to locate support and resources. Experiences of shame, misrecognition, and seeking recognition emerged as dominant themes in the young people's accounts, and these are explored in this paper. The paper concludes with a discussion on responsive social work interventions that generate a deeper understanding of young people's experiences of shame and misrecognition. Central to this practice are critical and relational social work practices that actively support young people to achieve recognition. [ABSTRACT FROM AUTHOR]

Background: People with post‐stroke aphasia (PWA) are more likely to experience serious mood disorders compared with those without. Emotional regulation may be important for influencing life participation after stroke. Understanding emotional regulation in the context of aphasia is important for promoting personally defined recovery, psychological well‐being and life participation. Aims: To explore how individuals experience and regulate negative emotional responses to aphasia as part of re‐engaging with life. Methods & Procedures: In‐depth semi‐structured qualitative interviews with 14 PWA were conducted. The focus and design were developed with public and patient involvement contributors. Reflexive thematic analysis was applied. Outcomes & Results: Analysis generated three themes, which captured inherent diversity across participants in terms of emotional experiences, responses and regulation strategies: (1) emotional upheaval at all stages of recovery; (2) regulating emotional upheaval; and (3) discerning possibilities for life participation. Emotional regulation occurred both within and without the context of formal support services. Conclusions & Implications: Individuals may be differently (en)abled in responding positively, with implications for aphasia psychological support and self‐management interventions. The findings may inform future interventions to optimize well‐being and personally meaningful outcomes for PWA. WHAT THIS PAPER ADDS: What is already known on the subject: PWA experience significant psychosocial upheaval and are at risk of mood disorders. Emotional regulation may be important for influencing one's emotional state, social participation and relationships after stroke. There is a need to better understand the ways in which PWA experience and regulate their emotions to develop better support for personally defined recovery. What this paper adds to existing knowledge: PWA may experience significant and pervasive mood disorders in the long term after stroke. This may be compounded by worries for their children's well‐being. Some, but not all, regulate emotions by drawing on positivity, determination, gratitude or stoicism. Having (supportive) opportunities to experience the impact of aphasia is important for discerning helpful strategies and participation opportunities. What are the potential or actual clinical implications of this work?: Confronting altered abilities requires supportive, responsive opportunities sensitive to emotional responses. Opportunities for peer support and/or meaningful emotional support and compassion from family and friends are important therapeutic targets. Therapeutic input should pay attention to any familial and parenting concerns that may be compounding low mood. Although emotional regulation and recovery may occur without formal support, mental health services must be organized in such a way that PWA can access as needed. [ABSTRACT FROM AUTHOR]

Background: Speech and language therapists (SLTs) and care home activities staff play key roles in managing and supporting the communication needs of older residents in care homes. However, the current practice and perspectives of these two professions in the United Kingdom has not been examined. Aims: To investigate the practice patterns and views of SLTs and activities staff working in UK care homes for older adults in relation to residents' communication needs. Methods and Procedures: Two online surveys, with 63 questions (SLT survey) and 46 questions (activities staff survey) in total, were created using the online platform Qualtrics. Participants were asked to consider their routine practice before COVID‐19. Results were analysed using descriptive statistics and qualitative content analysis. Outcomes and Results: A total of 116 valid responses were received from SLTs and 29 valid responses from activities staff. A high level of communication needs in care homes was reported by both participant groups, as was insufficient time and resources and lack of managerial encouragement in this area. SLTs reported that the majority of referrals to their service from care homes was for swallowing needs (70%). Cognitive communication difficulty was the most commonly reported communication need by SLTs (65%). Most SLTs (73%–87%) provided some level of communication intervention and considered management of residents' communication needs to be both part of the SLT role and a good investment of their time. Lack of confidence setting goals and providing direct intervention for communication needs was reported, with 25% feeling stressed at the thought of this. The main themes from free text responses about SLT service improvement were increased staff training, funding (of resources and specialist posts) and changes to service provision (referral criteria and accessibility/awareness of SLT service). Hearing impairment was the communication need most commonly reported by activities staff (43%). Participants demonstrated relatively high awareness of communication difficulty in residents and reported high levels of knowledge and confidence identifying and supporting residents' communication. Most (79%–89%) considered identifying and supporting the communication needs of residents to be part of their role and expressed interest in receiving further training in communication support. The reported activities staff data set may be positively biased. Conclusions and Implications: SLTs and activities staff were highly motivated to support the communication needs of care home residents. Increased training, time and resources dedicated to managing the communication needs of residents emerged as opportunities for service improvement across both data sets. WHAT THIS PAPER ADDS: What is already known on the subject: There is a high level of communication need amongst older care home residents. Social interaction and relationships are important factors contributing to quality of life in this population and rely on successful communication. Speech and language therapists (SLTs) and activities staff play key roles in managing and supporting the communication needs of this client group, but the current practice and perspectives of these professions in the United Kingdom has not been examined. What this study adds: A high level of communication need in care home residents was identified by both SLT and activities staff and both participant groups were motivated to address, identify and manage this need. However, insufficient time and resources, as well as a perceived lack of encouragement from managers to provide communication support/intervention, were reported by both groups. SLT practice was constrained by referral criteria and care pathways, which differed between services. Suggestions for SLT service improvement are reported. Clinical implications of this study: Targeted, ongoing staff training is required in care homes to improve the communication environment and develop care home staff capacity to support residents' communication needs. There is also a call for service level improvements to increase the range of SLT practice in care homes, including a greater focus on communication needs and more specialist (e.g., dementia) SLT roles. [ABSTRACT FROM AUTHOR]

Aim: To describe activities and professional characteristics of nurses in expanded roles in acute care in Germany and achieve a greater understanding of the current situation of advanced practice nursing. Background: Advanced practice nursing plays an important role in meeting increased demands in healthcare and promoting high‐quality care. Introduction: In Germany, advanced practice nursing is still at an early stage with a lack of studies describing the scope of practice of nurses in expanded roles. Methods: We conducted a cross‐sectional‐study using a paper‐and‐pencil questionnaire. In a nationwide convenience sample, we surveyed nurses with an academic degree, who work in an acute care hospital and take over expanded roles in direct patient care. Reporting followed the STROBE checklist. Results: Of 108 eligible nurses, 84 (77%) completed the survey. The majority had a Master's degree (63.1%) and the average work experience was 18.2 years. Participants carried out activities in all the domains that were queried (direct clinical practice, guidance and coaching, consultation, leadership and research) with differences within and between domains. Foci were on direct clinical practice and coaching and guidance. Discussion: In Germany, qualifications are nearing the international standard of advanced practice nursing. Results suggest that participants partly undertake activities within the scope of registered nurses' practice that do not correspond fully to their formal qualifications. Conclusion and implications for nursing and/or health policy: In order to foster the role development of expanded practice nurses in Germany, political efforts are needed in terms of training (e.g. specific Master's programmes), funding of corresponding positions in practice and control mechanisms (e.g. professional registration). [ABSTRACT FROM AUTHOR]

Background: An increasing number of children in the UK and Ireland are growing up speaking more than one language. The many advantages of bilingualism are acknowledged; however, this increased linguistic diversity presents particular challenges for speech and language therapists (SLTs). The case is often more complex with speakers of minority languages such as Welsh and Irish, which are acquired almost exclusively in bilingual contexts. Lack of appropriate standardized assessments for bilinguals is a key issue for SLTs internationally; however, little is known about the practices, personal perspectives or wider challenges faced by SLTs in assessing minority language skills. We focus on SLTs working with English–Irish bilinguals across Northern Ireland (NI) and the Republic of Ireland (ROI) where status, use and exposure to Irish differ significantly. Aims: To investigate the perceptions and practices of SLTs in NI and the ROI in the assessment of bilingual English–Irish‐speaking children. Methods & Procedures: A 33‐item online survey was distributed to SLTs working with children in community settings in NI and the ROI. Outcomes & Results: A total of 181 SLTs completed the survey. The majority of respondents had bilingual English–Irish‐speaking children on their caseloads; however, less than one‐quarter had assessed Irish language skills. Responses indicate confusion as to whether best‐practice guidelines applied in this particular context where the majority of speakers have English as their first language and limited domains of exposure to Irish outside of the education system. Resources available to assess Irish language skills were found to be limited. Informal analysis of language samples emerged as the most popular assessment tool. SLTs in the ROI had a significantly higher level of competence in the Irish language than SLTs in NI. This reduced the challenge of assessment. Many SLTs reported scoring assessments standardized on monolingual populations when assessing English language skills in bilingual English–Irish‐speaking children. Conclusions & Implications: Our findings highlight the challenges faced by SLTs in meeting best‐practice guidelines in the assessment of speakers of minority languages such as Irish. Further work is needed to ensure clinicians and other professionals have access to information and enhanced training on bilingual language acquisition in minority language contexts and implications for assessment and diagnosis. This study underlines the need for further research on the acquisition of minority languages as well as the development of alternative assessment tools to assist SLTs in meeting the needs of this population. What this paper adds: What is already known on the subject: Existing research indicates that SLTs face challenges in assessing bilingual clients. Lack of assessment resources is a global issue, particularly with respect to minority languages. Emerging research indicates that SLTs and other professionals are dissatisfied with current resources for assessing Irish‐speaking bilinguals and are struggling to meet best‐practice guidelines. What this paper adds to existing knowledge: The status of the Irish language differs significantly between NI and the ROI, while English is the dominant language in both areas. This study provides the first exploration of current assessment practices for bilingual English–Irish‐speaking children as reported by SLTs across both regions. The challenges of assessing bilingual clients in many other countries are mirrored by SLTs in NI and the ROI. The majority of children acquiring Irish are doing so in a specific context: the immersion education setting. This raises uncertainty for SLTs about whether the definition of bilingualism actually applies. Despite clinicians and clients sharing the same majority language, the complexity of minority language assessment remains. What are the potential or actual clinical implications of this work?: SLTs require specific support and resources to help them meet the assessment needs of bilingual English–Irish‐speaking children. Ongoing education and training are required for clinicians and other professionals to facilitate understanding of the complexities surrounding bilingual speakers of minority languages and the application of best‐practice guidelines. A greater understanding of the context in which children are acquiring Irish and the impact this may have on their acquisition of English would further support clinicians in identifying speech, language and communication needs in this population. [ABSTRACT FROM AUTHOR]

Background: Intelligibility and comprehensibility in speech disorders can be assessed both perceptually and instrumentally, but a lack of consensus exists regarding the terminology and related speech measures in both the clinical and scientific fields. Aims: To draw up a more consensual definition of intelligibility and comprehensibility and to define which assessment methods relate to both concepts, as part of their definition. Methods & Procedures: A three‐round modified Delphi consensus study was carried out among clinicians, researchers and lecturers engaged in activities in speech disorders. Outcomes & Results: Forty international experts from different fields (mainly clinicians, linguists and computer scientists) participated in the elaboration of a comprehensive definition of intelligibility and comprehensibility and their assessment. While both concepts are linked and contribute to functional human communication, they relate to two different reconstruction levels of the transmitted speech material. Intelligibility refers to the acoustic–phonetic decoding of the utterance, while comprehensibility relates to the reconstruction of the meaning of the message. Consequently, the perceptual assessment of intelligibility requires the use of unpredictable speech material (pseudo‐words, minimal word pairs, unpredictable sentences), whereas comprehensibility assessment is meaning and context related and entails more functional speech stimuli and tasks. Conclusion & Implications: This consensus study provides the scientific and clinical communities with a better understanding of intelligibility and comprehensibility. A comprehensive definition was drafted, including specifications regarding the tasks that best fit their assessment. The outcome has implications for both clinical practice and scientific research, as the disambiguation improves communication between professionals and thereby increases the efficiency of patient assessment and care and benefits the progress of research as well as research translation. What this paper adds: What is already known on the subject: Intelligibility and comprehensibility in speech disorders can be assessed both perceptually and instrumentally, but a lack of consensus exists regarding the terminology and related speech measures in both the clinical and scientific fields. What this paper adds to existing knowledge: This consensus study allowed for a more consensual and comprehensive definition of intelligibility and comprehensibility and their assessment, for clinicians and researchers. The terminological disambiguation helps to improve communication between experts in the field of speech disorders and thereby benefits the progress of research as well as research translation. What are the potential or actual clinical implications of this work?: Unambiguous communication between professionals, for example, in a multidisciplinary team, allows for the improvement in the efficiency of patient care. Furthermore, this study allowed the assessment tasks that best fit the definition of both intelligibility and comprehensibility to be specified, thereby providing valuable information to improve speech disorder assessment and its standardization. [ABSTRACT FROM AUTHOR]

Background: Big data research requires public support. It has been argued that this can be achieved by public involvement and engagement to ensure that public views are at the centre of research projects. Researchers should aim to include diverse communities, including seldom‐heard voices, to ensure that a range of voices are heard and that research is meaningful to them. Objective: We explored how researchers involve and engage seldom‐heard communities around big data research. Methods: This is a qualitative study. Researchers who had experience of involving or engaging seldom‐heard communities in big data research were recruited. They were based in England (n = 5), Scotland (n = 4), Belgium (n = 2) and Canada (n = 1). Twelve semistructured interviews were conducted on Zoom. All interviews were audio‐recorded and transcribed, and we used reflexive thematic analysis to analyse participants' experiences. Results: The analysis highlighted the complexity of involving and engaging seldom‐heard communities around big data research. Four themes were developed to represent participants' experiences: (1) abstraction and complexity of big data, (2) one size does not fit all, (3) working in partnership and (4) empowering the public contribution. Conclusion: The study offers researchers a better understanding of how to involve and engage seldom‐heard communities in a meaningful way around big data research. There is no one right approach, with involvement and engagement activities required to be project‐specific and dependent on the public contributors, researchers' needs, resources and time available. Patient and Public Involvement: Two public contributors are authors of the paper and they were involved in the study design, analysis and writing. [ABSTRACT FROM AUTHOR]

Background: The focus of this paper is exemplary gerontological nursing interventions that effectively supported families and long‐term care residents in Canada during visiting restrictions resulting from COVID‐19. Objective: The aim was to describe exemplary gerontological nursing interventions that families and long‐term care residents in Canada found supportive during visiting restrictions resulting from COVID‐19. Methods: An analysis of data artefacts including news reports, blogs and social media postings was completed. Results: Thematic analysis resulted in four themes: dedication amidst challenge, innovation and continuous learning, living their nursing values and purposeful knowledge sharing. These themes are described using a framework that depicts four pillars of exemplary nursing practice: professionalism, scholarly practice, leadership and stewardship (Riley, Beal, & Ponte, 2021). Conclusions/Implications for Practice: A link is made between these pillars of exemplary practice and enactment of family‐focused care. Recommendations focused on gerontological nursing approaches that facilitate family‐focused care for older adults residing in long‐term care are included. [ABSTRACT FROM AUTHOR]

Background: Stroke and aphasia can have a profound impact on people's lives, and depression is a common, frequently persistent consequence. Social networks also suffer, with poor social support associated with worse recovery. It is essential to support psychosocial well‐being post‐stroke, and examine which factors facilitate successful adjustment to living with aphasia. Aims: In the context of a feasibility randomized controlled trial of peer‐befriending (SUPERB), this qualitative study explores adjustment for people with aphasia in the post‐acute phase of recovery, a phase often neglected in previous research. Methods & Procedures: Semi‐structured interviews were conducted with 20 people with aphasia and 10 significant others, who were purposively sampled from the wider group of 56 people with aphasia and 48 significant others. Interviews took place in participants' homes; they were analysed using framework analysis. Outcomes & Results: Participants with aphasia were 10 women and 10 men; their median (interquartile range—IQR) age was 70 (57.5–77.0) years. Twelve participants had mild aphasia, eight moderate–severe aphasia. Significant others were six women and four men with a median (IQR) age of 70.5 (43–79) years. They identified a range of factors that influenced adjustment to aphasia post‐stroke. Some were personal resources, including mood and emotions; identity/sense of self; attitude and outlook; faith and spirituality; and moving forward. Significant others also talked about the impact of becoming carers. Other factors were external sources of support, including familial and other relationships; doctors, nurses and hospital communication; life on the ward; therapies and therapists; psychological support, stroke groups; and community and socializing. Conclusions & Implications: To promote adjustment in the acute phase, hospital staff should prioritize the humanizing aspects of care provision. In the post‐acute phase, clinicians play an integral role in supporting adjustment and can help by focusing on relationship‐centred care, monitoring mental health, promoting quality improvement across the continuum of care and supporting advocacy. What this paper addsWhat is already known on the subjectAnxiety and depression are common consequences of stroke, with depression rates high at 33% at 1 year post‐onset. There is evidence that the psychological needs of people with aphasia are even greater than those of the general stroke population. Social support and social networks are also negatively impacted. Few studies have examined adjustment when people are still in hospital or in the early stages of post‐stroke life in the community (< 6 months). Further, many stroke studies exclude people with aphasia.What this paper adds to existing knowledgeAdjustment to living with stroke and aphasia begins in the early stages of recovery. While this partly depends on personal resources, many factors depend on external sources of help and support. These include doctors, nurses and hospital communication, their experience of life on the ward, and their therapists' person‐centred care.What are the potential or actual clinical implications of this work?Clinicians play an integral role in facilitating people with aphasia to utilize their personal resources and support systems to adjust to life after stroke. They can help by focusing on relationship‐centred care, monitoring mental health, promoting quality improvement across the continuum of care and supporting advocacy. [ABSTRACT FROM AUTHOR]

Background: Tele‐collaborative projects serve as invaluable platforms for students from diverse countries to engage in cross‐cultural communication and exchange cultural knowledge. These projects offer immense benefits in terms of fostering intercultural competence among participants. However, one challenge arises when participants engage in spoken communication rather than written. Those who may not share a common first language often rely on a lingua franca such as English for intercultural communication. In such spoken exchanges, varying levels of language proficiency can lead to communication errors that hinder the intercultural learning process and impede the development of intercultural competence in their fellow participants. Objectives: In the present trial study, our primary objective was to tackle the language‐related challenge associated with spoken communication head‐on. Our focus centred on addressing the discrepancies arising in spoken communication, and we aimed to mitigate these discrepancies by utilizing speech‐enabled corrective feedback technology. Methods: In a tele‐collaborative project involving 28 graduate students from the People's Republic of China and Republic of Kazakhstan, the participants engaged in spoken communication and cultural exchange in English via the internet. Given the emphasis on spoken communication and the recognition that English was not their first language, we implemented a speech‐enabled corrective feedback (SECF) technology to ensure effective communication in terms of pronunciation, grammar, and word choice. The SECF technology detected and provided instant feedback on any speech mistakes, enabling participants to make corrections accordingly. The main aim of our study was to explore the potential benefits of integrating SECF technology into a tele‐collaborative project for the development of participants' intercultural competence. Additionally, we sought to gather insights into the students' perceptions of the SECF support. Results and Conclusions: The results of our study revealed significant improvements in the participants' intercultural competence across dimensions such as knowledge, skills, attitude, and awareness. Furthermore, the participants expressed positive perceptions of the SECF technology. Drawing from our findings, we offer valuable implications and recommendations for educators and researchers in the field, enhancing their understanding of the role of SECF technology in supporting intercultural competence development in tele‐collaborative settings. Lay Description: What is currently known about the subject matter: Tele‐collaborative projects are widely utilized to enhance intercultural competence.Low language proficiency of participants often poses a significant challenge in tele‐collaborative projects. What this paper adds: The present study addressed the language barrier by incorporating speech‐enabled corrective feedback (SECF) technology to support our tele‐collaborative project.The study explored how our tele‐collaborative project, supported by SECF, facilitated the development of intercultural competence. The implications of study findings for practitioners: Scholars and practitioners should consider implementing SECF technology to address language‐related barriers in tele‐collaborative projects.Guidelines based on our study can be utilized to design tele‐collaborative projects with SECF support.Training on technology and constant support needs to be provided to participants. [ABSTRACT FROM AUTHOR]

Introduction: A person‐centred model of care, developed in the early days of the HIV epidemic when there were no effective treatments for HIV, led to relatively close relationships between carers and people living with HIV (PLWH). Our study examines the experiences of carers using a relational framework, exploring the traumas and challenges involved, coping practices instigated by carers and the emergence of 'relational traumatic growth' opportunities. Methods: Twenty‐two UK healthcare workers and charity volunteers working with PLWH from the early years of the epidemic were recruited. Semistructured interviews were used to elicit participants' own stories of working with PLWH, from their initial involvement to the present time, and their reflections on the personal impact of working in the field of HIV. Data were analysed using a thematic approach employing relational categories. Results: The impact of care was related to the formation of close relationships, identification with PLWH, high numbers of deaths and the difficulties and challenges encountered relationally. Participants described attempts to cope through informal and formal support, as well as endeavours to manage professional boundaries. Various ways of making sense of experiences were described, ranging from denial to abandoning the HIV field, to intense commitment. For some, traumatic experiences lead to validation, a search for personal meaning and managing the sense of loss with an exploration of further ventures, contributing to the achievement of relational traumatic growth. Conclusion: The intensity of relationships in HIV work, developed through the emotional and practical work of caring for PLWH, led healthcare workers and volunteers to experience a range of psychological consequences, both negative (including distress and emotional exhaustion) and also positive (such as acquiring a sense of purpose). Patient or Public Contribution: People living with HIV and those working with them were involved in the initial study conceptualization and design. The second and fourth authors of this paper were professionals working in HIV throughout the pandemic and have led on all aspects of the study. People living with HIV and those working with them additionally guided participant selection by suggesting participants and supporting recruitment. Narrative transcripts were checked and amended (if necessary) by participants. Initial findings were presented at the AIDS impact conference, where PLWH and those working with them attended and feedback on important ideas that helped to prioritize and shape the study findings. [ABSTRACT FROM AUTHOR]

Background: People with dementia and other forms of cognitive impairment form a substantial proportion of patients admitted to hospitals, but problems in their care are persistent. One widely proposed improvement approach involves the use of systems using visual identifiers to help staff quickly recognise people with suspected dementia, with the goal of supporting more personalised care. The aim of this paper is to identify the identifier systems in use and staff perceptions of their strengths and weaknesses. Methods: We undertook an online survey of staff providing care for people with dementia in acute and mental health hospitals across the United Kingdom. The questionnaire covered different types of visual identifier systems for dementia. It used categorical and open‐response questions to access staff views of their use in practice. Responses were analysed using descriptive statistics, and the Framework approach for free‐text answers. Results: 162 responses were received from staff in at least 48 hospitals. Of these, 128 had direct experience of using visual identifier systems. They reported that multiple identifier systems are in use, including schemes with national scope and locally developed approaches. Most respondents reported that more than one system is in use in their hospital. Different types of identifier were seen to have different strengths and weaknesses. Respondents had a broadly positive view of identifiers, but highlighted risks including lack of reliable and consistent use (linked to competing pressures on staff time), lack of staff training, uncertainty about patient and family views, and unclear consent processes. Conclusions: Our study suggests that a wide range of identifier systems is in use in UK hospitals, with many hospitals using more than one. Further consideration should be given to ensuring that multiple perspectives—including those of patients and carers—are drawn on in optimising their design, resolving ethical issues and supporting implementation. [ABSTRACT FROM AUTHOR]

This paper utilizes data gathered as part of an exploratory study to assess the costs and impact of the Common Assessment Framework (CAF), to examine the impact that the lead professional role had on families and workers. The study found that both families and workers believed the lead professional to be central to the CAF process, providing a range of support, coordinating multi‐agency responses to need and acting as a single point of contact between families and workers. The paper highlights the need for consideration to be given to inter‐agency working, data sharing, training for workers and the capacity implications for those taking on the role. The extent to which the lead professional might be more integrated into the continuum of support for vulnerable children and families is also examined. The paper highlights the need to consider the lead professional's role in not only preventing the need for more intensive services, such as those provided by statutory social work, but also maintaining outcomes achieved once a child protection plan is closed, or a child is reunified with his or her birth family after a period of being in care. The implications of the findings for policy and practice are discussed. [ABSTRACT FROM AUTHOR]

Success of nutrition‐sensitive agriculture programmes targeted to women may be influenced by increased demands on women's and other household members' time and by time‐related trade‐offs to accommodate programme participation. However, evidence of how such programmes impact time use and whether changes in time‐related demands negatively influence maternal or child health and nutrition outcomes is limited. This paper examines the impact of Helen Keller International's Enhanced Homestead Food Production programme in Burkina Faso (2010–2012) on women's and men's time use and associations between changes in women's time use and maternal and child health and nutrition outcomes. We used quantitative data from a cluster‐randomized controlled trial (baseline 2010, endline 2012) and qualitative data from two rounds of process evaluation (2011, 2012). Two‐stage analyses were used to first assess programme impacts on women's and men's time use using difference‐in‐difference impact estimates and second to evaluate whether programme impacts on women's time use were associated with changes in women's and children's health and nutrition outcomes. Programme impacts were considered significant if corrected P < 0.01, and associations were considered significant if p < 0.05 and p < 0.01. Qualitative data were analysed through manual coding and by calculating the means and standard deviations for the time spent by women and men on activities in intervention and control groups. Findings show that the programme significantly increased the amount of time women spent on agriculture in the intervention compared to the control group, but this was not associated with changes in maternal or child health or nutrition outcomes. Process evaluation data supported these findings. [ABSTRACT FROM AUTHOR]

In this paper, we report findings from a qualitative, multidisciplinary analysis of 20 Child Practice Reviews (CPRs) (previously Serious Case Review) in Wales. The reviews were analysed from three different disciplinary perspectives: law, criminology and practice (social work). The following cross‐cutting themes were identified from our coding of the reviews: (i) hierarchy of knowledge, where certain sources of knowledge were privileged over others; (ii) information sharing/recording, where deficiencies of sharing or recording of information were evident; (iii) partial assessment, where certain assessments were not always holistic; and lastly, (iv) voice of the child, where the experience or perspective of the child was not always considered. In addition, our analysis revealed a range of challenges to the CPR process as implemented. This paper is the first to explore themes emerging from (Welsh) CPRs and is also the first to do so from a multidisciplinary perspective. We conclude by highlighting the recommendations for practice, such as the need for greater learning pan‐Wales, regular publication of the major themes emerging from CPRs and the need for deposit of CPRs in a central repository to facilitate learning from reviews. 'Report[s] findings from a qualitative, multidisciplinary analysis of 20 Child Practice Reviews... in Wales' Key Practitioner Messages: There is an urgent need for multidisciplinary training on contemporary data protection requirements as per the General Data Protection Regulation for all safeguarding boards.Creative methods are required to disseminate the messages from Child Practice Reviews more widely.Child Practice Reviews should be deposited and indexed in a central repository to facilitate learning across Wales.Guidance and training for Child Practice Reviews should be revisited, so that the child is repositioned at the centre of the process and the voice of the child is heard. [ABSTRACT FROM AUTHOR]

The COVID‐19 pandemic presented numerous challenges to acute malnutrition screening and treatment. To enable continued case identification and service delivery while minimising transmission risks, many organisations and governments implemented adaptations to community‐based management of acute malnutrition (CMAM) programmes for children under 5. These included: Family mid‐upper arm circumference (MUAC); modified admission and discharge criteria; modified dosage of therapeutic foods; and reduced frequency of follow‐up visits. This paper presents qualitative findings from a larger mixed methods study to document practitioners' operational experiences and lessons learned from these adaptations. Findings reflect insights from 37 interviews representing 15 organisations in 17 countries, conducted between July 2020 and January 2021. Overall, interviewees indicated that adaptations were mostly well‐accepted by staff, caregivers and communities. Family MUAC filled screening gaps linked to COVID‐19 disruptions; however, challenges included long‐term accuracy of caregiver measurements; implementing an intervention that could increase demand for inconsistent services; and limited guidance to monitor programme quality and impact. Modified admission and discharge criteria and modified dosage streamlined logistics and implementation with positive impacts on staff workload and caregiver understanding of the programme. Reduced frequency of visits enabled social distancing by minimising crowding at facilities and lessened caregivers' need to travel. Concerns remained about how adaptations impacted children's identification for and progress through treatment and programme outcomes. Most respondents anticipated reverting to standard protocols once transmission risks were mitigated. Further evidence, including multi‐year programmatic data analysis and rigorous research, is needed in diverse contexts to understand adaptations' impacts, including how to ensure equity and mitigate unintended consequences. Key messages: COVID‐19 CMAM programme adaptations enabled service continuity despite pandemic‐related challenges. Further evidence is needed on long‐term impacts.Family MUAC was well‐accepted and addressed screening gaps from COVID‐19 disruptions. Challenges included sustaining caregiver measurement accuracy; handling inaccurate self‐referrals to encourage health‐seeking behaviours; and limited programme design and monitoring guidance and tools.Modified admission criteria and therapeutic food dosage reduced contact between staff and children and streamlined logistics and implementation. Concerns remained about effects on programme admissions and outcomes.Reduced frequency of follow‐up visits successfully reduced facility crowding and need for caregiver travel. However, infrequent monitoring of childrenmay miss deterioration. [ABSTRACT FROM AUTHOR]

Introduction: British South Asians have a higher prevalence of overweight and obesity than the wider population. Bradford (UK), with its high Pakistani presence and levels of economic deprivation, has exceptionally high instances, especially in deprived areas where many Pakistanis reside. British Pakistani women in Bradford are more likely to be overweight and obese. There is uncertainty on how these women can be aided to manage their weight. Therefore, the objective of this study was to explore the obesity concerns of Pakistani women living in deprived inner‐city areas of Bradford. Methods: Three focus groups interviews were carried out with 23 Pakistani women living in deprived areas of Bradford. Data were analysed thematically. Results: This exploratory study identified a wide range of concerns that women had around managing their weight. Participants disclosed distrust in information given around medication, conflicting dietary information and reported low levels of trust in women‐only organized physical activities. Cultural barriers were identified, which included the gender role of the woman, the lack of culturally appropriate dietary advice, cultural misunderstandings of what constitutes a healthy diet and healthy weight, the lack of culturally suitable exercise facilities and conforming to family and community expectations. Other concerns were language barriers around a lack of understanding, the inability to read Urdu and reliance on others to translate information. Conclusion: These findings have implications for researchers, local authorities, policy makers and others with an interest in reducing the rates of obesity in this population. Recommendations include training health practitioners to be culturally aware of the diet and eating practices of this community, exploring different ways to support socially isolated women to be more physically active at home, addressing physical activity and diet misconceptions and designing obesity management information materials appropriate for a range of literacy levels. Patient or Public Contribution: Public contributors were involved in the development of the interview guide and design of the research. A pilot focus group with participants not included in the present paper was used to help test and refine the focus group questions. Interview transcripts were member checked by participants, and participants assisted with data analysis. [ABSTRACT FROM AUTHOR]

Background: Parent–child interaction therapies are commonly used by speech and language therapists (SLTs) when providing services to young children with language learning difficulties. However, the way parents react to the demands of such interventions is clearly important, especially for those from socially disadvantaged backgrounds. Parents play a central role in the therapy process so to ensure parent engagement, and to maximize intervention effectiveness, parents' views must be considered. Aims: To explore the expectations and experiences of parents from socially disadvantaged backgrounds who had taken part in a parent–child interaction programme aimed at promoting language development in 2–3 year olds with language difficulties. Methods & Procedures: The sample included parents who had a child aged 2–3 years and had attended a parent–child interaction programme to promote their child's language development. Parents were eligible to take part if they were living in the 30% most deprived areas in a city in the North of England that constituted the study site. Ten parents participated in a qualitative semi‐structured face‐to‐face interview in the home. Framework analysis was used to analyse the interview transcripts. Outcomes & Results: Parents' expectations before taking part in parent–child interaction interventions contribute to how they may engage throughout the intervention process. Barriers include parents' uncertainty about the nature of the intervention and differing attitudes regarding intervention approaches and strategies. Facilitators during the intervention process include gaining support from other parents, reassurance from the SLT regarding their child's language development, and their own ability to support their child's language learning, as well as increased confidence in how they support their child's development. Conclusions & Implications: Parents respond very differently to parent–child interaction intervention for children with language difficulties, depending on their expectations and attitudes towards intervention. Thus, it is critical that these different perspectives are understood by practitioners before intervention commences to ensure successful engagement. What this paper addsWhat is already known on this subjectParent–child interaction interventions are widely used to promote child language development. Parents play a central role in the therapy process of such interventions, so to maximize effectiveness, parents must be appropriately 'engaged' in that intervention. This involves attending, fully participating and having appropriate attitudinal and/or emotional involvement. The reciprocal nature of engagement means that parents are more likely to become engaged in intervention over time when they are supported by their SLT.What this paper adds to existing knowledgeParental expectations about the intervention process vary considerably and often need to be negotiated before the start of intervention. Reassurance and supporting positive attitudes to co‐working with their SLT may be particularly important for families living with social disadvantage. Supporting parent engagement in parent–child interaction programmes can contribute to the parents' capability to continue implementing language‐promoting strategies outside the intervention context and beyond the end of therapy.What are the potential or actual clinical implications of this work?Parents have different expectations regarding programme involvement. Therefore, having a two‐way, open dialogue between parents and SLTs from the beginning is clearly important, not only as a way of sharing information but also to build on parents' understanding of what the intervention will involve and trust that the SLT will be able to deliver the intervention in collaboration with the parent. SLTs can enhance parent engagement by supporting parents to feel confident and providing reassurance in terms of their child's development and how they can support their child's language learning. [ABSTRACT FROM AUTHOR]

Background: Communication is at the heart of relationships, especially for couples. When language is altered, as it is in aphasia, communication in couples can be affected. Aims: To explore how members of a couple perceive the impact of aphasia on their communication. Methods & Procedures: Nine French‐speaking couples participated in the study. One member of each couple had chronic stroke‐related aphasia, which varied in type and severity. The 18 participants took part in individual semi‐structured interviews to understand their perspective on communication within their couple. The interviews were recorded, transcribed and analysed with a qualitative thematic analysis. Outcomes & Results: Three main themes emerged: (1) experiencing limitations in conversation; (2) assuming changed speaking and listening roles; and (3) experiencing new emotions, feelings and reactions in communication. Couples experienced diminished frequency and duration of conversations as well as restrained topics after the onset of aphasia. Ten participants reported that each member's communication role of listener versus speaker had changed, and that the person with aphasia became a less active participant. Communication was described as 'positive' before aphasia and 'fine' to 'difficult' following aphasia. Persons with aphasia and spouses expressed experiencing difficulties managing emotions related to communication. Frustration and caution towards the other member of the couple had been associated with aphasia. In addition, five spouses reported that they refrained from initiating discussions on specific topics in order to maintain a positive relationship with the person with aphasia. Conclusion & Implications: The results describe some of the consequences of aphasia on communication in couples. Clinicians could use interviews to understand the impact of aphasia on a couple's communication. This may help to design communication partner training (CPT) that better aligns with the particular needs of couples living with aphasia, acknowledging the importance of emotional dimensions of relationships. What this paper addsWhat is already known on the subjectThe general psychosocial impacts of aphasia on persons with aphasia and spouses are known. Their conversations have been described and used as a focus for CPT. However, CPT may be difficult to implement in clinical settings.What this paper adds to the existing knowledgeThis paper provides in‐depth descriptions of perceived changes in relational or transactional communication by the PWA and their spouse. The frequency, duration and topics of conversations changed and emotions such as frustration and caution appeared. Participants assumed changed speaking and listening roles.What are the potential or actual clinical implications of this work?The participants' description of communication could be used by speech–language pathologists when conducting CPT to illustrate how aphasia affects communication in couples. Emotions emerging as a result of changes in communication following aphasia should be assessed before CPT and could be a starting point to work on communication. This could support clients' commitment in CPT. [ABSTRACT FROM AUTHOR]

Background and context: Breastfeeding peer support is valued by women, but UK trials have not demonstrated efficacy. The ABA feasibility trial offered proactive peer support underpinned by behaviour change theory and an assets‐based approach to women having their first baby, regardless of feeding intention. This paper explores women's and infant feeding helpers' (IFHs) views of the different components of the ABA intervention. Setting and participants: Trained IFHs offered 50 women an antenatal meeting to discuss infant feeding and identify community assets in two English sites—one with a paid peer support service and the other volunteer‐led. Postnatally, daily contact was offered for the first 2 weeks, followed by less frequent contact until 5 months. Methods: Interviews with 21 women and focus groups/interviews with 13 IFHs were analysed using thematic and framework methods. Results: Five themes are reported highlighting that women talked positively about the antenatal meeting, mapping their network of support, receiving proactive contact from their IFH, keeping in touch using text messaging and access to local groups. The face‐to‐face antenatal visit facilitated regular text‐based communication both in pregnancy and in the early weeks after birth. Volunteer IFHs were supportive of and enthusiastic about the intervention, whereas some of the paid IFHs disliked some intervention components and struggled with the distances to travel to participants. Conclusions: This proactive community assets‐based approach with a woman‐centred focus was acceptable to women and IFHs and is a promising intervention warranting further research as to its effect on infant feeding outcomes. [ABSTRACT FROM AUTHOR]

Background & Objective: Epidermolysis bullosa (EB) is the term used for a group of genetic skin fragility disorders. For those living with EB, pain represents a constant challenge, with blistering and tasks such as changing dressings, adding to the distress. This paper focuses on describing and exploring the health‐care needs of children, adults and families who are affected by EB. The specific aim of the paper is to identify the needs of the EB population with a view towards informing the development of a community liaison service to support adults living with EB and the parents/carers of children living with EB. Setting and Participants: Interviews with six adults and the parents of eight children with EB were conducted. The data were analysed thematically. All participants were resident on the island of Ireland and are therefore reflecting on services in this geographic region. Results: Participants' needs were grouped into five themes: support managing physical health‐care issues; access to community/home‐based services; EB‐specific information and psychosocial support; effective interaction with health‐care professionals; and advice regarding benefits and entitlements. Discussion and Conclusions: This article represents the health‐care needs and preferences of a broad spectrum of those with EB, highlighting the need for a comprehensive service regardless of the severity of the condition. [ABSTRACT FROM AUTHOR]

Infant and young child feeding (IYCF) practices are influenced by many context‐ specific factors related to local food systems as well as social and cultural practices. Understanding these local contextual perspectives is essential for designing effective programs and policies. This paper uses focused ethnographic study methods to examine challenges experienced by mothers related to IYCF in two counties in Kenya, a country with considerable heterogeneity in agriculture, food systems, and cultures. A two‐phase qualitative study was undertaken in each of Kilifi County and West Pokot County, entailing interviews and rating activities with mothers, health workers, and vendors. Interviews were audio‐recorded, transcribed, translated into English, coded, and analysed by topic. Results show low levels of dietary diversity in both counties; in West Pokot, the level of adequate meal frequency is also low. Core foods in young child diets included maize porridge and family foods such as ugali (stiff maize porridge), vegetables, beans, fish, and plantains. Food safety, acceptability, and acquisition ease were the main drivers of food choice. Mothers generally felt that all core foods fed to young children are healthy and safe, but there was more variability regarding child acceptance, acquisition ease, cost, and convenience. Common barriers to feeding nutrient‐dense foods to children included child illness, economic constraints, and limited knowledge of modification strategies, skills, or tools to make the foods suitable for young children. Potential actions to address these barriers include sharing information on child‐appropriate recipes; raising awareness on local, affordable nutrient‐dense foods; and improving WASH practices to reduce illness frequency. [ABSTRACT FROM AUTHOR]

Background: As the life expectancy of people with intellectual disability increases, they may now outlive their parents or their parents' ability to continue to care. Siblings of adults with intellectual disability often succeed their parents as primary carers. Little is known about the health and well‐being of this important cohort of carers who will be both caring for and ageing alongside their brother or sister with intellectual disability. The Carer's Study within The Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS‐TILDA) provides a unique insight into the health and well‐being of family carers of older adults with intellectual disability including sibling carers in Ireland. This article reports on the findings from waves 1, 2, 3 and 4 of the IDS‐TILDA Carer's Study. Methods: The IDS‐TILDA Carer's Study surveys family carers of older people (aged 40 years and older) with intellectual disability on a 3‐yearly cycle. The family carers complete a self‐administered, mixed‐methods questionnaire. The qualitative data are analysed thematically, and a descriptive analysis of the quantitative data is conducted using SPSS. Findings: In each wave, sibling carers comprised a significant proportion of the Carer's Study participants: W1 58%; W2: 61.4%; W3: 76.7%; and W4: 45.8%. The siblings were predominantly female, not in paid employment and were caring without the support of a spouse or partner. Across the four waves, siblings reported good general health. However, a high prevalence of particular conditions including back pain, aching joints and stress was also reported, and in each wave, siblings reported feeling completely overwhelmed by their care responsibilities. Although sibling carers reported that they have considered the future, only a minority have progressed to action in this regard. Conclusions: There is evidence of the strong relational and emotional commitment by the siblings to their brother or sister with intellectual disability. However, through the four waves of data, there was also evidence of physical, mental and financial toll. An urgent need exists to identify and engage with siblings to protect their well‐being as they provide care for an increasingly ageing sibling. Accessible Summaries: When the parents of people with intellectual die or can no longer provide care and support, brothers and/or sisters may take over the role.Little is known about the lives of these brothers and sisters and whether they need support.Our study asks brothers and sisters about their lives, their health and the good and more difficult things about being a carer.This paper reports on the results of four surveys over 9 years.Most brothers and sisters felt that their health was good but because many reported health problems, more support should be available to brothers and sisters who are carers. [ABSTRACT FROM AUTHOR]

Background: Taiwan's higher education institutions prioritize interdisciplinary knowledge and cultural competence in cultural design, emphasizing the value of immersion in the local environment to develop cultural competence. However, challenges arise from the disappearance of traditional local lifestyles and limitations of traditional outdoor lectures such as group size and learning environment. Mobile augmented reality technology serves as a personal learning tool to overcome these challenges, enabling learners to uncover hidden knowledge in scenic locations and improving learning efficiency. Objective: The study utilized learning analytics to investigate the impact of using mobile augmented reality on enhancing learners' cultural competence. Methods: The study used both qualitative and quasi‐experimental quantitative research to evaluate the effects of mobile augmented reality on cultural competence. A total of 78 third‐year university students participated in the study, with 37 of them using mobile augmented reality to learn about culture. The researchers utilized both the Mann–Whitney U test and interviews to compare the effectiveness of mobile augmented reality with that of a 'real' tour guide in field courses. Results: The experimental results indicate that learners were able to continuously seek and find information about local culture through field exploration with mobile augmented reality, resulting in similar effects to those of attending a live lecture. Conclusions: It showed that incorporating mobile AR into field visits can create gamified and active learning scenarios that enhance immersion and drive active learning in local culture. The results in greater cultural knowledge and understanding, leading to the development of cultural competence in students. Lay Description: What is already known about this topic: There is a heightened emphasis on cultivating and demonstrating cultural competence across various fields due to the significantly grow of cultural and creative industries.Relying solely on traditional classroom teaching for learning about local culture may result in a diminished impact, as a comprehensive understanding of culture necessitates a keen sense of life.To address the limitations of traditional classroom lectures, educators continuously strive to enhance teaching methodologies by developing innovative approaches, such as experiential learning and community‐based learning, which involve hands‐on activities and real‐world engagement to foster increased learning motivation and improved effectiveness.Augmented reality (AR), a technology that overlays virtual images onto real scenes in real time, has gained extensive usage in diverse fields such as medicine, national defence, education, and entertainment, offering interactive gaming experiences and providing an opportunity to experience the culture and past lives of locals in the field, enhancing learners' understanding of cultural history and creating immersive encounters during visits.Particularly in digital learning, the integration of AR enables learners to engage with additional content through mobile devices, fostering an immersive and gamified learning experience. What this paper adds: The use of the AR app for learning about the local culture yielded comparable outcomes to traditional guided tours.Participants actively engaged in self‐directed learning and demonstrated a sense of initiative while utilizing AR.The flexibility and autonomy provided by field learning, which extended beyond the course period, allowed participants to revisit the field and explore at their own pace using AR.Demonstrates that participants took control and responsibility for their own learning, leading to an enhancement in learner autonomy.Participants who utilized the Roaming Jingliao AR system to explore cultural scenarios exhibited enhanced knowledge and attitudes regarding cultural competence, specifically in areas such as cultural understanding, rice food cultural knowledge, Songjiang folk arts, and skills and practices, which can be attributed to the immersive and autonomous nature of AR‐based knowledge learning in outdoor guided courses, minimizing the influence of external environmental factors and facilitating a deeper understanding of the content compared to traditional guided tours. Implications for practice and/or policy: The findings of this study highlight the importance of considering the limitations associated with a relatively small sample size when conducting research within a university curriculum. To enhance the validity and reliability of future studies, practitioners and policymakers should prioritize the inclusion of larger and more diverse samples, enabling a more comprehensive understanding of the impact of AR technology on cultural learning and informing evidence‐based practices and policies.The study's focus on a specific group of participants and their contextual background highlights the need for future research to include participants from diverse educational settings and cultural backgrounds, ensuring that the findings are more applicable and relevant to a broader population. Practitioners and policymakers should consider the importance of inclusivity and diversity when designing and implementing cultural learning interventions using AR technology.The recognition of technological limitations highlights the importance of considering the specific AR system used in cultural learning interventions. Practitioners and policymakers should be cautious when adopting AR technologies and recognize that different AR systems or platforms may yield different outcomes. Future research should focus on evaluating the effectiveness of various AR systems and platforms to inform decision‐making regarding the selection and implementation of AR technologies for cultural learning initiatives. [ABSTRACT FROM AUTHOR]

This paper presents the findings from a qualitative study that sought to understand the experiences of frontline staff working in Oxfordshire County Council (OCC) Children's Social Care Services and their views on a new family safeguarding model (Family Solutions Plus). Focus group interviews were conducted with 20 frontline staff and managers in different teams across OCC Children's Social Care Services using video conferencing software. Thematic analysis identified three overarching themes: Preparation for the implementation of Family Solutions Plus, staff views on the implemented model, and challenges to its implementation. Staff voiced strong support for the new model, which places a much greater emphasis than previous practice on supporting the whole family, developing parenting skills and keeping children safe with their families. The challenges associated with the transition to a new model were considerable in the short term, partly due to the COVID‐19 pandemic, but there was optimism that the new model could be sustained and stabilized over time. [ABSTRACT FROM AUTHOR]

Background: People with haemophilia A and inhibitors (PwHi) suffer more orthopaedic complications, bleeding and pain than those without inhibitors. The advent of emicizumab as a prophylactic treatment has led to a reduction in bleed frequency and a significant improvement in overall quality of life. No research to date has examined the nature of this improvement on treated individuals and their families. Aims: The Emi & Me study aims to capture the real‐life experience of using emicizumab for PwHi and their families. Methods: Participants were recruited through treatment centres, social media and by word of mouth. Each participant and a family member, if available, took part in a semistructured qualitative interview. All interviews were recorded, transcribed verbatim and analysed thematically. All elements of the study were reviewed by local statutory authorities and informed consent was sought from all participants. Results: Fifteen PwHi, mean age 27.2 years (range 8–63 years), most with a family member, participated in a single qualitative interview online (n = 13), by telephone (n = 1) or in person (n = 1). Mean time on emicizumab was 2.26 years (range 1–5 years). Six major themes emerged: bleeds; pain; treatment burden; control; freedom (for both PwHi and family members) and missed potential. Emicizumab prophylaxis has delivered significant improvements in the lives of the participants. Despite these improvements, some participants felt that their pre‐existing physical disabilities and the lack of physiotherapy provision had prevented them achieving similar improvements in their functional ability. Conclusion: This study shows that in reducing bleeds, pain and treatment burden, emicizumab had given PwHi greater control over their condition, allowing a sense of freedom they had not experienced with factor VIII or bypassing agent prophylaxis. However, for emicizumab to be truly effective, there is a need to ensure the continued availability and accessibility of robust multidisciplinary support services. Without this, it is unlikely that PwHi will realize the life‐changing potential offered either by emicizumab or any other novel treatment approach. Patient or Public Contribution: A patient participant (who did not wish to be included as an author of the paper) was involved in the design of the study protocol and interview guide. [ABSTRACT FROM AUTHOR]

Noticing and interpreting classroom events (professional vision) is an important element of preservice teachers' (PSTs) interpersonal competence. This paper presents a mixed‐method study about a classroom simulation using 360‐degree videos combined with theoretical lectures in teacher education, intended to improve PSTs' interpretations of noticed events. Furthermore, this study examined how PSTs evaluate technological and educational affordances of 360‐degree videos. Results indicate that participating PSTs improved in noticing classroom events and in applying a more theory‐based terminology to describe these events. PSTs perceived observing other teachers teach as an educational affordance for mastering theory and for developing insights about interpersonal teacher behaviour. Concerning technological affordances, mainly physical discomforts and technical hindrances, was reported by PSTs. The results of this study imply that 360‐degree videos can be useful for teacher education to improve PSTs' interpretation of noticed events. Practitioner Notes: What is already known: Professional interpersonal vision is considered an important element of preservice teachers' (PSTs) interpersonal competence.Interpersonal competence can be practiced using computer‐based classroom simulations.One type of content in simulations is video, which can provide PSTs authentic cases.Recent technological developments enable enrichment of video simulations using 360‐degree cameras. What this paper adds: Findings indicate that classroom simulations using 360‐degree videos added with theoretical lectures can improve PSTs' level of interpretations of noticed classroom events as part of their professional interpersonal vision.Technological and educational affordances of classroom simulation using 360‐degree videos evaluated by PSTs. Implications for practitioners: Classroom simulations using 360‐degree are a useful method to prepare PSTs for educational practice.Classroom simulations using 360‐degree videos help PSTs learn theory about interpersonal teacher behaviour.Classroom simulations using 360‐degree videos help PSTs develop insights about teaching styles that influence teacher–student relationships.This study advises good quality VR‐environments to improve the immersive experience. [ABSTRACT FROM AUTHOR]

The peer workforce has increased significantly in recent years; however, structured development and support for the roles are lacking. This paper explores the role of executive and senior management understanding in the employment of peer roles. In‐depth, semi‐structured interviews and one focus group were conducted with 29 participants from a range of nongovernment and public mental health services within Queensland, Australia. Findings of this study suggest management exposure to and understanding of peer work are essential to the development of an effective peer workforce. Exposure and understanding of peer roles reportedly led to greater acceptance and commitment from management. This commitment inspired action in the form of; enhanced support including advocacy/championing, increased development of roles and influenced culture within the organization to be more accepting of peer work. There was a perception that developing an 'accepting' organizational culture supported the integrity and expansion of peer roles including designated 'peer management' positions. Development of peer management positions is suggested as an effective means of improving the impact of peer perspectives, advocating for peer work and providing ongoing and timely supervision. Recommendations include the need for training and information for management on the unique function, purpose and value of peer roles; and the development of networks, including mentoring opportunities, for organizations with limited experience to gain support and advice from those with greater experience developing peer roles. [ABSTRACT FROM AUTHOR]

Background: Treatment of paediatric trauma requires specialized infrastructure, medical equipment, medical staff and ancillary support personnel that have been specifically trained for such tasks. Aims and Objectives: To examine the perceptions and attitudes of physicians and nurses in general and paediatric emergency departments (PEDs) on training, confidence, and management of paediatric trauma in order to facilitate the establishment of an optimal model for admitting and treating paediatric trauma patients. Design: Drawing on published literature and a previously conducted qualitative study that explored the provision of medical care to paediatric trauma patients, we conducted an attitude survey. Methods: A 26‐item paper‐based questionnaire was distributed by nurse managers to all staff working within general EDs and PEDs of 22 medical centres across Israel. Results: Of 843 physicians and nurses who completed the survey, 61.1% considered PEDs the most appropriate facility for treating both minor and severe paediatric trauma, 88.5% believed that minor paediatric trauma should be treated in designated paediatric trauma centres, and 53.6% deemed that paediatric emergency medicine specialists are the most suitable primary decision makers in paediatric trauma. PED teams expressed greater professional confidence for treating paediatric trauma and multiple casualty incident patients. Greater professional confidence was positively correlated with paediatric trauma training, greater exposure to paediatric trauma cases, and working in larger medical centres. Conclusions: The results of the current study suggest that PEDs are perceived to be more appropriate for dealing with paediatric trauma. Also, treatment of severe trauma may be more appropriate in centres that admit large numbers of paediatric trauma cases. Relevance to clinical practice: Emergency medicine teams should undergo training for dealing with paediatric trauma. Such training would develop their skills, increase their confidence, and enhance their emotional abilities to cope with paediatric trauma. [ABSTRACT FROM AUTHOR]

Objective This paper contributes to the literature on relocation for specialist care by providing findings on specific issues impacting on rural farmers and property owners who have to travel to the metropolitan area for specialist care for a haematological malignancy. Design and setting This paper uses descriptive qualitative research based on 45 interviews with patients with haematology in Queensland. The interviews were audio-recorded, transcribed verbatim, coded and thematically analysed. Results In addition to issues of distance, farmers and rural property owners who have to relocate for specialist care must deal with problems associated with the lack of opportunity to take absence from the property because of the inescapable pressure of daily farm and property responsibilities and the high cost of, or lack of opportunity to, outsource daily maintenance. Further concerns include the cost of relocation in the context of continuing drought, serious problems sustaining the travel and time away required, and the lack of choice for some but to deal with treatment alone. Conclusion In recent years there has been considerable progress with regard to overcoming the distance barrier for rural and remote patients with cancer through innovative clinical models using technology and telemedicine. However, there has been limited uptake of such models for patients with haematology. The present findings indicate that from the perspective of rural farmers and property owners there are important reasons why the use of innovative strategies should be fostered and expanded. [ABSTRACT FROM AUTHOR]

Background: Allied health professionals working in rehabilitation often prescribe home exercise programs. Smart technology offers an alternative format for presentation of home exercise programs with potential advantages over traditional paper‐based programs, but how do patients feel about this? Design: This qualitative analysis was part of a convergent mixed methods design, using in depth, semi‐structured interviews to explore the lived experience of patients utilising touch screen tablets to support an upper limb home exercise program post stroke. Methods: Ten male participants with stroke and upper limb impairment who received home exercise programs using video and reminders on tablet computers participated. Interviews were transcribed and analysed thematically. Results: There were three main themes: (1) exercises on the tablet helped patients’ recovery in a variety of ways; (2) everyone could use the tablet for their home exercise program; but (3) not everyone liked using the tablet. Conclusions and significance of the study: Smart technology is increasingly accessible and provides a novel, convenient way to provide home exercise programs post stroke with a number of benefits. This technology is not for everyone, but may be well suited to patients who already own and use these devices in daily life. Automated reminders were not viewed as a useful reminder tool. [ABSTRACT FROM AUTHOR]

Industrialization and urbanization processes have challenged deeply held traditional gender norms and facilitated the emergence of modern ideologies in South Africa. This paper seeks to explore the gendered roles of family members on maternal and child nutrition and investigate indications of perceived change in related practices. A qualitative secondary analysis was conducted of data from nine focus group discussions (FGDs) held with men (n = 3) and women (n = 6) aged ≥18. Data from the FGD were coded and thematic analysis conducted. We found that elderly women seem to have a central advisory role with respect to maternal and child nutrition and that men and elderly women upheld patriarchal gender divisions of labour, which entrust mothers with the primarily responsibility for young children's nutrition. Young mothers relied on elderly women for provision of childcare and nutritious foods for children; however, they demonstrated some resistance to traditionally feminized forms of food preparation. We found that men's involvement in children's nutrition was limited, though they expressed a preference to be more involved in maternal and child nutrition and care practices. A gender transformative approach to policy development, which includes elderly women and men, has the potential to promote more gender‐equitable nutrition practices, increase young women's self‐efficacy and support them to overcome barriers that could be limiting their decision making power in achieving optimal nutrition for themselves and their children. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to report on the seeking of deeply meaningful information, also including embodied information, connected to significant, intensely personal life changes having lifelong impacts. The concepts of "meaning‐making," "transitioning," and information seeking in "deeply meaningful and profoundly personal contexts" are used in order to understand transgender individuals' information seeking in the contexts of gender identity formation. Based on the literature, emotions and information seeking connected to a significant life change were divided into four phases to study how they could be identified in the 25 qualitative interviews with transgender individuals from Finland between the ages of 15 and 72. Based on the findings of this study, in significant life changes, an individual needs reliable, sensible and identifiable information. Serendipitous encounters and embodied experiences characterize information seeking during transitional stages. Peer communities are important for minorities in order to find places where interviewees feel safe to share information and experiences. These communities can also be found online. The concept of "deeply meaningful information" highlights the effect information has on information seekers. Deeply meaningful information can serve as a trigger for life change, helping people forward during the transitions. [ABSTRACT FROM AUTHOR]

The working relationship is considered a central feature of direct practice with human services clients. There are many challenges when it comes time to end a working relationship, yet limited guidance for workers on successful relationship ending. This paper aims to increase understanding of the process of the ending phase of the working relationship for parents and workers working with families where child neglect is an issue. The paper draws on data from a small-scale qualitative Australian study of perceptions of parents, family workers, and supervisors involved in eight parent-worker relationships. Using semistructured interviews, participants were asked to explore how they experienced the relationship. The findings illuminate important aspects about the ending phase of the relationship; in particular, challenging the idea that parents' returning to services for support is a sign that the service has not provided a successful intervention. The paper challenges social workers to consider recurring parent-worker relationships similar to other professional relationships where there are episodes of service but the relationship is there to be reactivated where needed. [ABSTRACT FROM AUTHOR]