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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]

This paper reflects on the value of diary methods in the context of a qualitative, longitudinal narrative inquiry exploring the higher education decision-making of further education students in England. Event-based diaries were used alongside interviews and focus groups over a 14-month period to gain in-depth insights into the reasons and influences informing their decision-making trajectories. I explore the challenges, successful approaches and advantages of employing diary methods with young people in this context. Challenges consisted of maintaining participant engagement, which was overcome by combining methods and incorporating a reactive co-participatory element. Yet, a number of advantages emerged from participants' engagement with diary keeping which enhanced the richness of the data; this inspired deeper reflections on decision-making and influences and provided a private space for participants to disclose personal difficulties that could not be obtained via interviews. [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]

In recent years, Meals on Wheels (MoW) services have been in a state of decline as austerity policies have become entrenched. However, this decline is occurring with little knowledge of the impact withdrawal of MoW services has on the health and well‐being of those who use them. The pandemic has raised awareness of precarity and vulnerability in relation to food that affects many people in the UK and other Westernised countries and this provides further context for the analysis presented. This paper presents findings of a mixed methods ethnographic study drawing on qualitative interviews and visual methods underpinned by social practice theory to explore the household food practices of older people receiving MoW services. Interviews were conducted with 14 older people receiving MoW, eight MoW staff delivering MoW services in the east of England and one expert. The Covid‐19 pandemic interrupted the study, and once the first lockdown began visits to the homes of older people were terminated and the remaining interviews were undertaken by telephone. The study found that a number of threats accumulated to change food practices and moved people towards vulnerability to food insecurity. Threats included difficulty accessing food and cooking due to sensory and physical challenges. The MoW service increased participants' coping capacity. As well as benefiting from the food provided, the relational aspect of the service was important. Brief encounters between MoW staff built caring relationships that developed over time to ensure older people felt valued and cared for. The study demonstrates how MoW services make a positive contribution to food practices, supporting vulnerable adults to continue living well in their own homes and protecting them from food insecurity and ill‐being. Local authorities looking to make cost savings through ending MoW services should consider the impact this would have on the well‐being of older residents. [ABSTRACT FROM AUTHOR]

Developing a deep and contextualised understanding of risk is important for public health responses to young people's alcohol consumption, which is frequently positioned as an outcome of risky behaviour. This paper expands conceptualisations of risk to encompass its wider social and cultural context through a social practice exploration of young people's controlled and managed intoxicated alcohol consumption practice. We report data from a fourteen-month qualitative study of the alcohol consumption practices of 23 young people in England, drawing on group interviews and social media interactions. Our findings provide a nuanced understanding of risk-taking, demonstrating that risk is an important aspect of the ongoing participation and performance in alcohol consumption practice and that health information and advice can be and was frequently incorporated into drinking practice without contributing to fundamental change. This raises new questions about the effectiveness of health interventions that focus on the individual, discussed in the final section of the paper. [ABSTRACT FROM AUTHOR]

This paper explores public health policy implementation through partnership working at the local level by examining how local actors from public health, and the wider workforce make sense of and work on social inequalities in health. An ethnographic case study was used to examine policy implementation in one local strategic partnership in north-west England during a period of significant resource constraint. Semi-structured interviews were the primary method of data generation. Sensitising concepts from figurational sociology were used to develop a theoretical account of how local policy implementation directed at narrowing social inequalities in health tended to give rise to relatively fragmented and short-term services, projects and practices, which focused on lifestyle factors and behaviour change. Theorising partnership work as figurations goes some way to explaining the apparent paradox among participants who expressed a relatively detached appreciation of wider social influences, alongside emotional involvement in their work. This process of individualisation explains how local professionals tended to conceptualise health inequality and the social determinants of health as personal troubles. Individualisation meant that the social reality of working in partnerships on difficult issues was simplified. Thus, any scope for working on the social determinants of health tended to be overlooked. The extent to which this was intentional or a matter of struggling to see opportunities, or a mixture of the two, was difficult to discern. Although the policy landscape has changed, the findings give some insight into understanding how local collaborative processes reproduce local public health work underpinned by lifestyle choices. [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]

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

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]

Objectives: The introduction of medical revalidation in 2012 has been a controversial and radical change to medical regulation in the UK. It involved changes to the way organizations manage medical performance, and to the relationships between doctors, their employers and the professional regulatory body. In this paper, we explore the implementation of medical revalidation, analysing the change process and its consequences for doctors and organizations. Methods: We conducted a qualitative investigation of the implementation of revalidation in 15 case study organizations in 2016–2017, collecting documents and undertaking a total of 80 interviews with medical and non-medical staff. We used Normalization Process Theory to frame and structure the analysis. Results: Revalidation reforms were largely implemented successfully within and across our case study organizations, with evidence of growing acceptance of the purpose and processes of revalidation. There was an emergent shift from securing doctors' compliance towards the use of revalidation to strengthen clinical governance, and towards evaluating revalidation processes and seeking to make them more effective. However, there was substantial variation in the implementation and impact of revalidation; it was still not fully understood by many doctors, and revalidation processes were highly reliant on a few key individuals in each organization. The changes brought about by revalidation have had consequences for the way in which doctors construct their identity and the way they relate to the organizations in which they work. Conclusion: Despite considerable early scepticism and overt opposition in the medical profession, revalidation has become gradually accepted, embedded and even valued over time. Its impact and effectiveness are still questioned by many stakeholders, and the focus of attention has now shifted towards revising and improving the way revalidation works in practice. [ABSTRACT FROM AUTHOR]

This paper reports findings from a study that aimed to explore how practitioners were bringing together the demands of the personalisation agenda, in particular the offer of direct payments (DPs), with the Mental Capacity Act, and to investigate current practices of offering and administering indirect payments for people who lack capacity to consent to them, including the use of 'suitable person' proxies under the new regulations ( DH, 2009). The study adopted a qualitative interview-based design; participants were social work practitioners (67) and recipients of 'indirect' payments (18) in six local authorities in England in 2011-2012. The paper reports on five key decision-making points in the indirect payments process: the decision to take on an indirect payment, the assessment of mental capacity, the identification of a suitable person, the establishment of the care recipient's best interests and the decisions about how to execute the indirect payment. We found that practitioners and suitable people had different experiences of the system, although in both cases, there was overarching support for the benefits of enabling people who lack capacity to consent to a DP to receive their social care funding in the form of an 'indirect' payment via a proxy suitable person. [ABSTRACT FROM AUTHOR]

This paper assesses provision for older people affected by homelessness in England, giving regard to research findings, such as those developed through a pathways model, which show that the experiences of this group are qualitatively distinct when compared to younger households. Current conceptualisations of older age held by Local Authority Housing Option Service professionals are considered, alongside factors relating to government policy and resource issues. It was found that some practitioners adopted an age-blind approach when assessing older groups, despite this being contrary to policy guidance on assessing vulnerability in England. Further, services and housing options aimed at older groups were viewed as inadequate due to a mixture of lack of awareness, targeting and resources. It is concluded that assessment of vulnerability based on older age is complex, as whilst gerontological discourse may discourage viewing age as a number, homelessness scholars stress that rooflessness causes poor health conditions consistent with premature ageing. It is therefore asserted that policy makers must focus greater attention to developing suitable provision for older service users and look to incorporate a richer conceptualisation of how older age may impact upon the homelessness experience. [ABSTRACT FROM PUBLISHER]

Homeless drug and alcohol users are one of the most marginalised groups in society. They frequently have complex needs and limited social support. In this paper, we explore the role of friendship in the lives of homeless drug and alcohol users living in hostels, using the concepts of 'social capital' and 'recovery capital' to frame the analyses. The study was undertaken in three hostels, each in a different English city, during 2013-2014. Audio recorded semi-structured interviews were conducted with 30 residents (9 females; 21 males) who self-reported drink and/or drug problems; follow-up interviews were completed 4-6 weeks later with 22 participants (6 females; 16 males). Data were transcribed verbatim, coded using the software package MAXQDA, and analysed using Framework. Only 21 participants reported current friends at interview 1, and friendship networks were small and changeable. Despite this, participants desired friendships that were culturally normative. Eight categories of friend emerged from the data: family-like friends; using friends; homeless friends; childhood friends; online-only friends; drug treatment friends; work friends; and mutual interest friends. Routine and regular contact was highly valued, with family-like friends appearing to offer the most constant practical and emotional support. The use of information and communication technologies ( ICTs) was central to many participants' friendships, keeping them connected to social support and recovery capital outside homelessness and substance-using worlds. We conclude that those working with homeless drug and alcohol users - and potentially other marginalised populations - could beneficially encourage their clients to identify and build upon their most positive and reliable relationships. Additionally, they might explore ways of promoting the use of ICTs to combat loneliness and isolation. Texting, emailing, online mutual aid meetings, chatrooms, Internet penpals, skyping and other social media all offer potentially valuable opportunities for building friendships that can bolster otherwise limited social and recovery capital. [ABSTRACT FROM AUTHOR]

Participation by children in child protection remains a complex area of practice. This paper presents findings from a qualitative study exploring the views of 26 children, aged 6–17 years, about their participation in the child protection system in England. All of the children were subject to a child protection plan and were living at home at the time of interview. The children's understanding of the child protection process was categorized, and the majority of children, including the youngest, were found be at least partially aware of the child protection process, often struggling to make sense of the professional intervention in their families on the basis of partial information. It is argued that decisions about children's involvement should take into account not only children's age and understanding, but be seen in the context of wider family dynamics. Participation in formal processes such as child protection conferences was experienced as difficult and emotive. The child's relationship with their social worker was central to meaningful participation. [ABSTRACT FROM AUTHOR]

Background Amid concern about the reach and inclusivity of parenting interventions, attempts have been made to culturally adapt programmes for specific ethnic or linguistic groups. This paper describes a novel approach of the religious adaptation of a parenting programme, namely the Family Links Islamic Values course. Methods A small-scale qualitative process evaluation was conducted on one Family Links Islamic Values course for Muslim fathers in the South of England in order to describe the intervention as implemented and its theory of change, as well as the acceptability of the programme to the participants. The data consisted of 13 semi-structured interviews (10 with parents and three with staff), 25 h of observation and reading of programme manuals. Results A logic model is presented to describe the theoretical basis of the intervention. The programme was highly acceptable to fathers who valued the integration of religious teachings and were generally very positive about their experience of attending the course. Post-course interviews with both fathers and mothers mentioned some positive changes in fathers as a result of their attendance. Conclusions It is important to be responsive to the needs of some British Muslims for religiously credible interventions. This small-scale process evaluation needs to be followed by a robust evaluation of programme outcomes for parents and children. [ABSTRACT FROM AUTHOR]

Background: Peer support is reported to be a key method to help build social capital in communities. To date there are no studies that describe how this can be achieved through a breastfeeding peer support service. In this paper we present findings from an evaluation of a voluntary model of breastfeeding peer support in North-West England to describe how the service was operationalized and embedded into the community. This study was undertaken from May, 2012 to May, 2013. Methods: Interviews (group or individual) were held with 87 participants: 24 breastfeeding women, 13 peer supporters and 50 health and community professionals. The data contained within 23 monthly monitoring reports (January, 2011 to February 2013) compiled by the voluntary peer support service were also extracted and analysed. Results: Thematic analysis was undertaken using social capital concepts as a theoretical lens. Key findings were identified to resonate with 'bonding', 'bridging' and 'linking' forms of social capital. These insights illuminate how the peer support service facilitates 'bonds' with its members, and within and between women who access the service; how the service 'bridges' with individuals from different interests and backgrounds, and how 'links' were forged with those in authority to gain access and reach to women and to promote a breastfeeding culture. Some of the tensions highlighted within the social capital literature were also identified. Conclusions: Horizontal and vertical relationships forged between the peer support service and community members enabled peer support to be embedded into care pathways, helped to promote positive attitudes to breastfeeding and to disseminate knowledge and maximise reach for breastfeeding support across the community. Further effort to engage with those of different ethnic backgrounds and to resolve tensions between peer supporters and health professionals is warranted. [ABSTRACT FROM AUTHOR]