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Background COVID-19 brought additional challenges to Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decision-making, which was already a contentious issue. In the UK, reports of poor DNACPR decision-making and communication emerged in 2020, including from the regulator, the Care Quality Commission. This paper explores the experiences of people who discussed DNACPR with a healthcare professional on behalf of a relative during the coronavirus pandemic, with the aim of identifying areas of good practice and what needs to be improved. Methods a total of 39 people participated in semi-structured interviews via video conferencing software or telephone. Data were evaluated using Framework Analysis. Findings results are presented around three main themes: understanding, communication and impact. Participants' understanding about DNACPR was important, as those with better understanding tended to reflect more positively on their discussions with clinicians. The role of relatives in the decision-making process was a frequent source of misunderstanding. Healthcare professionals' communication skills were important. Where discussions went well, relatives were given clear explanations and the opportunity to ask questions. However many relatives felt that conversations were rushed. DNACPR discussions can have a lasting impact—relatives reported them to be significant moments in care journeys. Many relatives perceived that they were asked to decide whether their relative should receive CPR and described enduring emotional consequences, including guilt. Conclusion the pandemic has illuminated deficiencies in current practice around DNACPR discussion, which can have difficult to anticipate and lasting negative consequences for relatives. This research raises questions about the current approach to DNACPR decision-making. [ABSTRACT FROM AUTHOR]

Hope is considered crucial to mental health recovery. However, the manner in which social inequalities shape individuals' meaning of hope has received little attention. Based on a close analysis of the recovery journeys of six Chinese service users in the UK, this paper explores the diverse meanings of hope among service users from non-dominant cultures. Illustrative stories are selected from in-depth life history interviews conducted with twenty-two participants. Based on the capabilities approach and intersectionality analysis, the findings reveal a paradox of hope and show how hope can be embraced, cautiously pursued or held at bay by individuals. Whilst hope is one expression of human agency, service users with reservations about hope maintain agency in other ways, despite their diminished life chances. This paper argues for an increased focus on individuals' agency development to support recovery and advocates for the challenging of inequalities to achieve this. [ABSTRACT FROM AUTHOR]

Background Given the globally ageing population, care homes have an important role in delivering palliative and end-of-life care. Advance care planning (ACP) is promoted to improve the quality of end-of-life care in this setting. While many professionals can be involved in ACP, little is known about what influences multi-professional involvement and how multi-professional working impacts the ACP process in the UK. This study investigated multi-professional practice in relation to ACP in nursing homes. Design and methods An ethnography was undertaken in two UK nursing homes using multiple methods of data collection: observations, interviews and document review. Participants included the following: nursing home residents (n  = 6), relatives (n  = 4), nursing home staff (n  = 19), and visiting health and social care professionals (n  = 7). Analysis integrated thematic analysis, mapping of resident ACP trajectories and documentary analysis. Findings This paper suggests that multi-professional and relatives' involvement in ACP was disjointed. Continuity and coordination were disrupted by misalignment of visiting professional and nursing home organisational structures. Findings show a 'knotworking' approach to teamwork and power imbalance between nursing home staff and visiting professionals, such as general practitioners. While residents wished their relatives to be involved in their ACP, this was not formally recognised, and limited support existed to facilitate their involvement. Conclusion The structure and organisation of multi-professional and relatives' involvement in ACP led to fragmentation of the process. This marginalised the voice of both the resident and nursing home staff, thereby limiting ACP as a tool to enhance quality of end-of-life care. [ABSTRACT FROM AUTHOR]

Background This paper presents insights into patient experiences of changes in workforce composition due to increasing deployment in general practice of practitioners from a number of different professional disciplines (skill mix). We explore these experiences via the concept of 'patient illness work'; how a patient's capacity for action is linked to the work arising from healthcare. Methods We conducted four focus group interviews with Patient Participation Group members across participating English general practitioner practices. Thematic analysis and a theoretical lens of illness work were used to explore patients' attempts to understand and navigate new structures, roles and ways to access healthcare. Results Participants' lack of knowledge about incoming practitioners constrained their agency in accessing primary care. They reported both increased and burdensome illness work as they were given responsibility for navigating and understanding new systems of access while simultaneously understanding new practitioner roles. Conclusions While skill mix changes were not resisted by patients, they were keen to improve their agency in capacity to access, by being better informed about newer practitioners to accept and trust them. Some patients require support to navigate change, especially where new systems demand specific capacities such as technological skills and adaptation to unfamiliar practitioners. [ABSTRACT FROM AUTHOR]

Background vaccination uptake in the UK and increased care home testing are likely affecting care home visitation. With scant scientific evidence to date, the aim of this longitudinal qualitative study was to explore the impact of both (vaccination and testing) on the conduct and experiences of care home visits. Methods family carers of care home residents with dementia and care home staff from across the UK took part in baseline (October/November 2020) and follow-up interviews (March 2021). Public advisers were involved in all elements of the research. Data were analysed using thematic analysis. Results across 62 baseline and follow-up interviews with family carers (n  = 26; 11) and care home staff (n  = 16; 9), five core themes were developed: delayed and inconsistent offers of face-to-face visits; procedures and facilitation of visits; variable uptake of the COVID-19 vaccine; misinformation, education and free choice; frustration and anger among family carers. The variable uptake in staff, compared to family carers, was a key factor seemingly influencing visitation, with a lack of clear guidance leading care homes to implement infection control measures and visitation rights differently. Conclusions we make five recommendations in this paper to enable improved care home visitation in the ongoing, and in future, pandemics. Visits need to be enabled and any changes to visiting rights must be used as a last resort, reviewed regularly in consultation with residents and carers and restored as soon as possible as a top priority, whilst more education needs to be provided surrounding vaccination for care home staff. [ABSTRACT FROM AUTHOR]

Background and Objectives A growing body of work suggests that co- or peer-research may contribute to understanding the complex health and social problems experienced in later life. Yet, only a limited number of studies have involved older persons as partners in the research process. Moreover, in conflict with the philosophy of participatory research, the views of those acting as coresearchers tend to be ignored. This paper gives an "insider" account of the process of coresearch, drawing upon the experiences of older people trained to undertake a community-based research project. Research Design and Methods Eighteen older adults were recruited and trained as coresearchers to take a leading role in a study aimed at developing "age-friendly" communities in Manchester, UK. The coresearchers completed 68 interviews with residents aged 60 years and over who were experiencing isolation within their neighborhood. The findings are based upon four reflection meetings held with the coresearchers, all of which were transcribed with thematic analysis conducted using Atlas.ti. Results Coresearchers identified a range of advantages associated with the coresearch approach, these linked to the recruitment of participants, quality of data, potential for social change as well as personal benefits. They also identified ethical, methodological, and practical issues encountered during the research. Discussion and Implications The study demonstrates the contribution of coresearch for expanding methodological diversity, accessing seldom heard populations, and utilizing the skills and resources of older people. The research also highlights the opportunities for partnerships between older people and local stakeholders to facilitate community change and social action. [ABSTRACT FROM AUTHOR]

Background Despite insistent calls for more and better evidence to inform action to reduce health inequities, applied health research sensitive to these inequalities is rare. Recognising this problem, the Collaboration for Leadership in Applied Research and Care in the North West Coast (England) developed the Health Inequalities Assessment Toolkit (HIAT) to support those involved in health research to integrate equity into their work. Objective This paper reports on an evaluation of the extent to which HIAT enhances the equity focus of the work of users. Methods The evaluation used semi-structured interviews, focus groups and workshops (n  = 131 respondents including Public Advisers, university, NHS and local government partners). Routine data included HIAT feedback forms. Findings HIAT can help to strengthen the equity focus of applied health research by: increasing understanding of how socioeconomic inequities impact on health; building capacity for integrating equity into all aspects of research, implementation and capacity building; stimulating thinking on action to address local structural drivers of health inequalities; and increasing understanding of the positive contribution public involvement can make to research. Conclusion If we are to advance health equity goals delivering research and training needs to be combined with political commitment to create more equal societies. [ABSTRACT FROM AUTHOR]

Background Children's second-hand smoke (SHS) exposure in the home is highest in socio-economically disadvantaged areas. Personalized household air-quality measurements can promote changes in smoking that reduce SHS exposure. The 'First Steps 2 Smoke-free' (FS2SF) intervention is the first to trial this approach delivered as part of health professionals' routine work. This paper reports the findings of qualitative interviews with participants that explored their experiences of the intervention and why outcomes varied. Methods 120 women were recruited from the NHS First Steps Programme, which supports disadvantaged mothers. They received either personalized feedback on their home air quality and advice on reducing SHS or standard SHS advice. Qualitative interviews with 15 mothers were analyzed thematically using the Capability, Opportunity, Motivation, Behaviour (COM-B) model. Results The intervention increased women's capability to change home-smoking behaviour, through increasing awareness and salience of SHS risks to their children, and motivation to act. However, taking effective action was constrained by their limited social and environmental opportunities, including others' smoking in the home. Conclusions The FS2SF intervention was ineffective as it was unable to fully address the precarious, complex life circumstances that make creating a smoke-free home particularly difficult for women experiencing intersecting dimensions of disadvantage. [ABSTRACT FROM AUTHOR]

Introduction process evaluations (PE) are increasingly used in parallel with randomised controlled trials (RCT) to inform the implementation of complex health interventions. This paper explores the learning accrued from conducting a PE within the Falls in Care Homes Study (FinCH), a large UK RCT. Methods in the FinCH study, six purposively sampled care homes provided data for the PE, which followed a realist approach. In this study researchers kept written diaries of their experiences in completing the interviews, focus groups and observations. We have reflected on these and present the main themes for discussion. Findings care home staff were enthusiastic to participate in the PE but researchers found it difficult to collect data due to staff not having time to take part, environmental factors such as no space for focus groups and low levels of research understanding. Researchers found that the expectations of the PE protocol were often unrealistic due to these limitations. Flexible and pragmatic approaches such as interviews in place of focus groups enabled data collection but required a reduced sample size and length of data collection to be accepted by researchers. Conclusion to enable care home staff to participate in successful PEs, researchers should build flexibility into research schedules, spend time building trust, collaborate with all levels of care home staff prior to data collection, increase research capacity in care home staff and co-design research projects. [ABSTRACT FROM AUTHOR]

This paper examines the value of participatory approaches within interventions aimed at promoting mental health and wellbeing in the workplace. Specifically the paper explores data from the thematic evaluation of the Mental Health and Employment project strand within the Altogether Better programme being implemented in England in the Yorkshire and Humber region, which was funded through the BIG Lottery and aimed to empower people across the region to lead better lives. The evaluation combined a systematic evidence review with semi-structured interviews across mental health and employment projects. Drawing on both evaluation elements, the paper examines the potential of workplace-based ‘business champions’ to facilitate organizational culture change within enterprises within a deprived regional socio-economic environment. First, the paper identifies key policy drivers for interventions around mental health and employment, summarizes evidence review findings and describes the range of activities within three projects. The role of the ‘business champion’ emerged as crucial to these interventions and therefore, secondly, the paper examines how champions' potential to make a difference depends on the work settings and their existing roles, skills and motivation. In particular, champions can proactively coordinate project strands, embed the project, encourage participation, raise awareness, encourage changes to work procedures and strengthen networks and partnerships. The paper explores how these processes can facilitate changes in organizational culture. Challenges of implementation are identified, including achieving leverage with senior management, handover of ownership to fellow employees, assessing impact and sustainability. Finally, implications for policy and practice are discussed, and conclusions drawn concerning the roles of champions within different workplace environments. [ABSTRACT FROM AUTHOR]

Background: Ventricular assist devices (VADs) are a relatively new development in the management of advanced heart failure. In the UK, VAD recipients comprise a unique group of less than 200 patients. This is the first paper to explore the experience of VAD communities, the extent to which communities are developed around the device, and how these influence the experience of living with the VAD. Methods: Qualitative interviews were conducted with 20 VAD recipients (implanted as a bridge to transplantation), 11 interviews also included the VAD recipients’ partners. Interpretive phenomenology was employed as the theoretical basis guiding the analysis of the interviews. Results: Four key themes emerged from the data: the existence of VAD communities; experiential knowledge and understanding; social comparisons; and the impacts of deaths within the VAD community. Many of the interviewees valued the VAD communities and the relationships they had formed with fellow recipients. The beneficial impacts of the VAD communities included offering recently implanted patients a realistic view of what to expect from life with a VAD; this could aid them in accepting and adapting to the changes imparted by the device. However, negative impacts of the VAD communities were also reported, in particular following deaths within the group, which were a source of distress for many of the interviewees. Conclusions: In general, the VAD communities appeared to be a beneficial source of support for the majority of interviewees. Consideration should be given to how these communities could be supported by clinicians. [ABSTRACT FROM AUTHOR]

In the UK, Valuing People ( Department of Health, 2001, 2010b) has shaped services for people with learning difficulties for the past decade. Promoting choices and independence are two of the four key principles that underpin this White Paper and its subsequent delivery plans. This paper assesses the impact that these changes had on the availability of mundane choices. It draws on empirical evidence from interviews with adults with learning difficulties. First impressions of the findings indicate that individuals are indeed able to make an increased range of decisions. At closer inspection, it does however become apparent that not all of these decisions are based on an infinite spectrum of options. Under the guise of choice-based policy rhetoric, some people with learning difficulties are at times presented with a pre-arranged ‘menu of choices’. For instance, a person may be free to choose activities at their day centre, but they may have limited control when deciding whether to attend the service in the first place. The wider implications that tokenistic choice-making processes have for the development of personal autonomy are highlighted. It is argued that a lack of control in respect to mundane choices is disempowering and leads to learned passivity. [ABSTRACT FROM AUTHOR]

Focusing on the conceptualization of a whole university approach, this paper reports on an international qualitative study that explored vice-chancellors' and network members' understanding of and commitment to Health Promoting Universities, examined perspectives on leadership and investigated the Okanagan Charter's potential to catalyse whole university leadership and change. A multi-method qualitative approach was used: semi-structured interviews and focus groups were conducted face-to-face with vice-chancellors (n = 12) and Health Promoting University co-ordinators who were members of the UK Healthy Universities Network (n = 8); telephone interviews were conducted with a mix of UK and non-UK Health Promoting University co-ordinators (n = 5) and two online questionnaires were distributed to non-UK network co-ordinators (n = 6) and non-UK Health Promoting University co-ordinators (n = 10). Through thematic analysis, a number of key themes emerged that build a new conceptualization of the whole university approach (see Figure 1): building a broad understanding and framing of health; developing a supportive ethos and culture; embedding health into the university and joining up areas of work; focusing on the whole population and facing challenges and seizing opportunities. The study elicited rich and wide-ranging views from multiple stakeholders from universities and networks across four continents, confirming Health Promoting Universities as a truly global movement. Looking ahead, there are clear opportunities and challenges. First, the media narrative of a student mental health 'crisis' has focused universities' attention on 'health', but from a single issue 'illness' perspective. This risks detracting from the whole system Health Promoting Universities approach. Second, even with the Okanagan Charter inspiring individuals and universities, there are still major challenges in translating the rhetoric of whole system approaches into meaningful action within large, complex and culturally diverse organizations. [ABSTRACT FROM AUTHOR]

Consumer trust in the modern food system is essential given its complexity. Contexts vary across countries with regard to food incidents, regulation and systems. It is therefore of interest to compare how key actors in different countries might approach (re)building consumer trust in the food system; and particularly relevant to understanding how food systems in different regions might learn from one another. The purpose of this paper is to explore differences between strategies for (re)building trust in food systems, as identified in two separate empirical studies, one conducted in Australia, New Zealand and the UK (Study 1) and another on the Island of Ireland (Study 2). Interviews were conducted with media, food industry and food regulatory actors across the two studies (n  = 105 Study 1; n  = 50 Study 2). Data were coded into strategy statements, strategies describing actions to (re)build consumer trust. Strategy statements were compared between Studies 1 and 2 and similarities and differences were noted. The strategy statements identified in Study 1 to (re)build consumer trust in the food system were shown to be applicable in Study 2, however, there were notable differences in the contextual factors that shaped the means by which strategies were implemented. As such, the transfer of such approaches across regions is not an appropriate means to addressing breaches in consumer trust. Notwithstanding, our data suggest that there is still capacity to learn between countries when considering strategies for (re)building trust in the food system but caution must be exercised in the transfer of approaches. [ABSTRACT FROM AUTHOR]

This paper will examine the ways in which ‘textbook’ survey research methods need to be adapted and refined for research with forced migrants, and the ways in which cross-national contexts, as well as research within one national context with forced migrants from different communities, affect the utilization of survey methods. Linked to this, the ways in which survey design issues need to be sensitive to the diversity between and within countries and communities will be explored. The paper will draw on two surveys, one a UK national survey and the other a multi-sited comparative survey in the UK and South Africa, to explore access to forced migrants in different contexts and the appropriateness of different modes of data collection between and within countries and communities (e.g. paper self-completion, face-to-face interviews and web-based surveys). The impact of politics, language and literacy, gender, and immigration status, especially irregular and insecure statuses, will be examined. [ABSTRACT FROM AUTHOR]

This contribution draws primarily on findings of an interview study with a group of young women living in Britain who conceived a pregnancy when aged under 18. Through discussion of their narratives, it aims to provide insights about areas of young women's experience that legal scholars have highlighted as potentially problematic under the current legal framework; namely involvement of parents when those aged under 16 seek medical treatment, and the provision of abortion to under 18s. The broader aim here is to provide comment on the gap between abortion law `on paper', and `in practice'. The paper finds that abortion law in Britain operates in practice in a way that differs from what might be expected on the basis of its terms on paper, in that most young women are unlikely to encounter major difficulties when accessing abortion. Nevertheless a key criticism made of the law by legal scholars - that it medicalizes abortion - emerges as having continuing validity, and the conclusion is drawn that the rules that regulate abortion in Britain should remain subject to challenge. [ABSTRACT FROM AUTHOR]

Aid delivery has been critiqued for its failure to be locality-specific and culturally relevant for recipients. Humanitarian responses to the 2004 Indian Ocean tsunami involved volunteers, professionals, and social work and other students. In this article, we consider students' endeavours in two responses to this tsunami in Sri Lanka. These initiatives involving professionals, academics and students from financially wealthy Western countries working in a less wealthy and powerful country sought to empower victim survivors receiving aid in rebuilding their lives after the tsunami. We draw on a large scale three-year qualitative study of two models which began shortly after this disaster--one institutional, the other professional. The research covered many dimensions of humanitarian aid in Sri Lanka. In this paper, we focus on: students' perceptions of their preparation before going overseas; the support they received while abroad; their debriefing upon return; and implications of their experiences for empowering approaches to humanitarian aid. The research revealed many positives in students' experiences. However, structural inequalities perpetuated inegalitarian relationships, despite individual attempts to the contrary. This paper offers lessons to improve the quality of students' experiences and their contributions to local people's well-being. [ABSTRACT FROM AUTHOR]

The paper explores the views of social work practitioners regarding their ability to explore the emotional content of their practice in formalandin formal forums. The responses from a questionnaire- and interview-based study of a Scottish local authority reveal that supervision is subject to issues of ‘safety', permissions, manageria list approaches and individual relationships. Informal support from peers was valued due to its unrecorded, on-demand and supportive nature. The findings have implications for seeking improvements in supervision as suggested by the Social Work Task Force,and for securing of the validity and place of emotions in practice. [ABSTRACT FROM AUTHOR]

The ‘health-promoting prison’ has been informed by a broader settings-based philosophy to health promotion which conceptualizes health as the responsibility for all social settings. Though in its relative infancy, the notion of a health-promoting prison has gained political backing from international organizations like the World Health Organization, but the implementation of the policy rhetoric has not translated across all prison environments. The aim of this paper is to consider how key elements of health promotion discourse—choice, control and implicitly, empowerment—can apply in the context of imprisonment. These concepts were examined in three category-C (secure) prisons in England, through interviews with 36 male prisoners and 19 prison staff conducted by the first author. Analysis showed that prisoners negotiated the norms, structures and strictures of prison life by both relinquishing control and also by taking control, showing resistance and exercising some element of choice. The paradox is that, as most prisoners are expected to be released at some point they need to exercise some agency, control and choice, but these learning experiences may be constrained whilst ‘inside’. The paper argues that if a settings approach in prison is truly to move forward, both conceptually and practically, then health promoters should seek to embed the key values of health promotion within the prison setting. [ABSTRACT FROM AUTHOR]

This paper explores the use of health impact assessment (HIA) as a means of facilitating community engagement in spatial planning. The paper discusses the background to the development of HIA as a tool for assessing the likely impact of policies and wider changes on health with a view to building those into planning and decision-making, and describes the evolution of HIA into more participatory forms. It then goes on to describe a case-study of plans for a waste incinerator in an inner-city area in the UK, where HIA was used in response to community concerns about the development as a means of building in the views of local people to the decision-making around the plan. We describe in detail how the HIA was conducted and additional research undertaken within a timescale set by the planning processes. We discuss the difficulties involved in conducting any kind of research-based HIA so rapidly and in a situation of multiple, competing stakeholder interests. We argue that although the HIA failed to influence the final decisions in this particular instance it does, nonetheless, provide a model for how to create ‘knowledge spaces’ in which different perspectives and information can be brought around the table to create more democratic approaches to planning for waste. [ABSTRACT FROM PUBLISHER]

This paper examines human-nature interaction and how therapeutic this relationship is by investigating the efficacy of structured outdoor experience. Two walking and solo experience (WSEs) explored university students' (aged 20--43 years) perceptions of walking through and being with nature. The first was a 5-day journey (n = 4; 3 females and 1 male) and the second (n = 5; 3 females and 2 males) took place over two weekends, with a 2-week interval in-between. Pre- and post-experience interviews, journal writing, group discussions and a 9-month follow-up interviews were used to collect data and thematic analysis [Braun and Clarke (Using thematic analysis in psychology. Qual Res Psychol 2006;3:77-101.)] was applied. Both WSEs were considered together during analysis, as well as comparisons made between the two, in order to evaluate implications for practice. Benefits of the WSE that contributed to a general sense of well-being were: (i) gaining a sense of freedom and escape; (ii) gaining a sense of awareness and sensitivity to one's environment and its influence (iii) gaining confidence in being able to cope and take action; (iv) gaining a sense of perspective on and appreciation for life. Furthermore, the meaning participants formed in relation to their environment before, during and after the WSE, and the activity within that environment, played a role in their sense of well-being and in their motivations to re-access nature in other places. Findings suggest that WSEs are a cost effective way to give rise to beneficial and durable experiences, but a more holistic approach to policy is needed. [ABSTRACT FROM AUTHOR]

In order to practise social work in England, all social workers must register with the Health and Care Professions Council (HCPC). Only those who are registered can legally work as or call themselves a social worker. Once registered, if concerns about their practice are raised, social workers may find they are then made subject to a 'Fitness to Practise' (FTP) process. This article reports on the findings from interviews with social workers who were referred to the HCPC for practice issues. Our rationale was to hear and report on the lived experience of those going through the investigatory process. We carried out semi-structured interviews with eight social workers and used thematic analysis to analyse our data. The three main themes to emerge from our findings were organisational issues, representation and cost and emotional toll. This paper discusses these findings in detail. We suggest that the current regulatory system situates social workers in a position of disadvantage during the FTP process, and conclude by making a number of recommendations for consideration if future changes are to be made to the social work regulatory process. [ABSTRACT FROM AUTHOR]

This paper draws on a qualitative study about the work of children's rights workers and social workers with looked after young people in the UK. It highlights some differences in their approach and in their attitudes to young people. Whilst they share many values, in theory, social work is closer ethic of care and interrelationship than rights work, which draws on an ethic of justice and individual autonomy. However, in practice, a more complex picture emerged. The study found that young people wanted professional workers who demonstrated that they cared about them as individuals and who focused on the process of the work. The study suggests that rights workers had a strong care ethic in their individual work with young people but social workers had difficulty in adhering to principles of care in a culture that encouraged them to manage young people's care rather than engage with them individually. There was also strong evidence that it could be detrimental to young people if rights workers adhered rigidly to principles of rights. The paper asks whether consideration of elements of an ethic of care alongside rights in both social work and children's rights work could benefit young people by encouraging a more sophisticated model of advocacy and by emphasising care in social workers' individual work with young people. [ABSTRACT FROM AUTHOR]

This paper examines lay interpretations of lay health worker roles within three UK community-based health promotion projects. It argues that understanding lay health worker roles requires critical analysis of the complex interrelationships between professionals, lay workers and the communities receiving a programme. Findings are presented that are drawn from a qualitative study of lay engagement in public health programme delivery where a key objective was to examine the perspectives of community members with the experience of receiving services delivered by lay health workers. Interviews and focus groups were conducted with 46 programme recipients from three case study projects; a breastfeeding peer support service, a walking for health scheme and a neighbourhood health project. The results show how participants interpreted the function and responsibilities of lay health workers and how those roles provided personalized support and facilitated engagement in group activities. Further insights into community participation processes are provided revealing the potential for active engagement in both formal and informal roles. The paper concludes that social relationships are core to understanding lay health worker programmes and therefore analysis needs to take account of the capacity for community members to move within a spectrum of participation defined by increasing responsibility for others. [ABSTRACT FROM PUBLISHER]

Contemporary child adoption in the UK and USA has been conceptualised as an extended kinship network of adopted children, birth relatives and adopters (Reitz and Watson, 1992; Grotevant and McRoy, 1998). This contrasts sharply with the traditional model of adoption as a form of family substitution. Yet, such a reconceptualisation raises many questions about the meaning of kinship for those involved. This paper draws on data from a series of biographical interviews with twenty-two parents who adopted children within the UK over a twenty-four-year period in order to explore post adoption ‘family relationships’ from the perspective of adoptive parents. It develops an analysis of definitions of ‘kinship’ created by adoptive parents in order to shape family relationships following adoption, particularly the processes through which birth relatives are rendered marginal or integral to adoptive family life. The relevance of current adoption policy and professional practices to these processes are explored. [ABSTRACT FROM PUBLISHER]

In cognitive ergonomics, laboratory experimentation using computer-based simulations (microworlds) has played a significant role in understanding human decision making and reasoning. In this paper, we describe the design and deployment of a social work microworld (BRIGIT), which simulates the electronic recording systems now widely implemented in UK children's services. BRIGIT provides a fabricated but realistic social work environment, enabling the fine structure of professional information processing to be studied in response to experimental manipulations, such as time pressure, etc. A preliminary experiment is described here, which shows BRIGIT to provide a convincing psychological experience and a useful research tool. As well as demonstrating its face and external validity, the results highlight BRIGIT's utility as a way of probing ‘practice culture’ and for examining different patterns of professional sense making. We conclude that the microworld paradigm provides a valuable and innovative approach for researching social work practice. A range of possible applications are discussed, not only in fundamental research, but as a practical tool for use in the workplace, such as for supporting staff selection. There is also obvious potential for ‘design research’ aimed directly at improving the usability and effectiveness of electronic systems, which is important given the widely reported problems of current ICT systems in social work. [ABSTRACT FROM PUBLISHER]

This paper presents findings from a Department of Health-funded study into the emotional well-being of young people seeking asylum on their own in the UK. It discusses how young people accounted for only partly disclosing information about the circumstances surrounding their quest for asylum and subsequent aspects of their lives since arriving in the UK. Foucault's panoptic mechanism and its focus on the effects of power as dispersed through scrutiny are applied as a theoretical framework to contextualise these experiences. The paper shows that young people's decisions about how much of their current or past lives they share with others are more complex than indicated by earlier research. The paper argues that, for many young people, the predominant impetus for selective disclosure was a desire to retain a degree of agency as they navigated their way through immigration, asylum, social care, health and education systems and simultaneously sought to establish themselves in the social world. These findings have implications for how social care (and other) professionals engage and work with young people seeking asylum alone. [ABSTRACT FROM PUBLISHER]

A key issue for the social work profession concerns the nature, quality and content of communicative encounters with children and families. This article introduces some findings from a project funded by the Economic and Social Research Council (ESRC) that took place across the UK between 2013 and 2015, which explored how social workers communicate with children in their everyday practice. The Talking and Listening to Children (TLC) project had three phases: the first was ethnographic, involving observations of social workers in their workplace and during visits; the second used videostimulated recall with a small number of children and their social workers; and the third developed online materials to support social workers. This paper discusses findings from the first phase. It highlights a diverse picture regarding the context and content of communicative processes; it is argued that attention to contextual issues is as important as focusing on individual practitioners' behaviours and outlines a model for so doing. [ABSTRACT FROM AUTHOR]

This paper presents findings from a study that explored the experiences of young people living in foster-care in the UK. Previous research highlights that children and young people in foster-care experience stigma. Qualitative methods were chosen to explore how the young people in this study experience and manage stigma in their day-to-day lives. Findings provide valuable insights into how the participants cope with the challenges of stigma. There were two key ways they did this: (i) by carefully managing the disclosure of their 'in-care' status and (ii) by drawing support from their social relationships. Furthermore, the participants particularly valued support from their peers who were also living in foster-care, as it enabled them to form an in-group, which presented them with a valuable sense of belonging. These findings have implications for practice and this paper proposes two ways to better support young people in foster-care to cope with stigma: first, by valuing the importance of friendship groups and enabling young people to maintain their existing friendships and, second, by developing more opportunities that bring fostered young people together, which enables them to interact with their peers without the pressure of managing stigma. [ABSTRACT FROM AUTHOR]

Professionals express divergent views about whether adults at risk are best served by safeguarding work being incorporated into social workers' casework or being undertaken by specialist workers within local area or centralised teams. This paper draws on findings from the final two phases of a three-phase study which aimed to identify a typology of different models of organising adult safeguarding and compare the advantages and disadvantages of these. We used mixed-methods to investigate four different models of organising adult safeguarding which we termed: A) Dispersed-Generic, B) Dispersed-Specialist, C) Partly-Centralised-Specialist and D) Fully-Centralised-Specialist. In each model, we analysed staff interviews (n = 38), staff survey responses (n = 206), feedback interviews (with care home managers, solicitors and Independent Mental Capacity Advocates) (n = 28), Abuse of Vulnerable Adults (AVA) Returns, Adult Social Care User Survey Returns (ASCS) and service costs. This paper focuses on qualitative data from staff and feedback interviews and the staff survey. Our findings focus on safeguarding as a specialism, safeguarding practice (including multi-agency working, prioritisation, tensions, handover, staff confidence and deskilling) and managing safeguarding. Local authority (LA) participants described and commented on the advantages and disadvantages of their organisational model. Feedback interviews offered different perspectives on safeguarding services and implications of different models. [ABSTRACT FROM AUTHOR]

In 2014, research was undertaken to examine social workers' confidence, understanding and awareness of child sexual abuse (CSA) as it was suggested that a decline in numbers of reported incidents might be due to a decline in levels of understanding and awareness. Semi-structured interviews were conducted with twenty-five first-line, middle and senior managers and two chairs of local safeguarding boards across six local authorities in England. Focus groups were conducted with fifty-four social workers. Key themes revealed a complex array of issues, ranging from the diverse forms of CSA and exploitation that social workers are required to address, the variable support and training available, and the inter-disciplinary nature of much of the work. Although social workers undertake this important work with a strong sense of commitment and concern for children, they face a number of challenges. Paradoxically, whilst their work on these cases is the source of intense scrutiny, the training, support and supervision, and role clarity required to undertake this work well are often overlooked. The aim of this paper is to discuss the research findings and to identify implications for social work practice, training, multi-agency work and future research. [ABSTRACT FROM AUTHOR]

This paper draws on findings from a European project, 'Rights through Alliances: Innovating and Networking Both Within Homes And Schools' (RAINBOW-HAS), conducted in 2013-15. It built collaboration between six EU countries to analyse and improve the rights of children and youth regarding sexual orientation and gender identity in educational settings. The main focus of discussion derives from a secondary discourse analysis following thematic analyses of the qualitative interviews undertaken with a range of different families, schools and community associations across these European countries, which provide a snapshot of contemporary practice. We discuss the relative silence of social work in challenging homophobic and transphobic bullying, given their potential in promoting family and young people's engagement. [ABSTRACT FROM AUTHOR]

The public's perception of the social work profession is a rarely considered perspective and yet a topic that is a concern to front line professionals. This paper explores how social workers experience and attempt to cope with public perception of their profession. It highlights the impact of these concerns on social workers' personal experiences and professional practice. Using semi-structured interviews with sixteen UK social workers, from local authorities and private organisations, we explore the experiences of this group. Thematic analysis of the data identified four concerns: the experience of public perception, drivers of public perception, coping with public perception, and mechanisms to raise the professions profile. Examining public perception through the eyes of social workers provides valuable insights into the lived experiences of these professionals, and offers practical implications at both the micro and macro levels. It reveals two key ways in which the profession can begin to address the prevailing negative perception considered to be emanating from the public: through developing a more co-operative relationship with external sources of public perception (e.g. government and the media) and by engaging in more pro-active self-promotion of the service. [ABSTRACT FROM AUTHOR]

This paper describes the impact that learning about recovery has on mental health carers, exploring the implications of this research for UK social work and beyond. A steering group co-produced a training intervention on recovery that was delivered by the first author and a carer, both with experiences of recovery, to eleven carers. Mainly qualitative data, with supplementary socio-demographic data, were collected to evaluate the impact of this training. Thematic analysis was applied to the data. Findings suggest that being more 'recovery- aware' gives carers increased hope and optimism for the future. Awareness of the impact of caring upon the service user's life helps carers to promote recovery in their relative, and gain confidence in their own expertise-by-caring. Professional care is fundamental to recovery but needs to build on a partnership model. The carers evaluated the training as helpful, and valued its authenticity in being led by trainers with experience of recovery. Carers' expectations of professional practice are highlighted, with different approaches discussed that support effective carer involvement in their relative's care. Recognition of carers' expertise-by-caring demands a new approach to mental health care, with significant implications for British social work practice. [ABSTRACT FROM AUTHOR]

This paper compares the key findings from the first piece of research in the UK to focus exclusively on ‘stress, support and well-being of social work students’ (n = 76), with findings from a cohort of Indian social work students studying in the Tamil Nadu region in Southern India (n = 235), using the same questionnaire. This comparative international study highlights a range of differences in the key outcome variables, namely British students reported significantly higher levels of demands and significantly lower levels of support than their Indian counterparts; however, despite the lower levels of demands and higher levels of support reported by Indian students, they had significantly poorer well-being than their British counterparts. In the Indian study, there were no significant correlations between the main outcome variables of demands, support and well-being; however, in the British study, support was negatively correlated with well-being (measured using the GHQ-12), indicating that those who reported higher levels of support also reported better well-being. This study draws particular attention to the potentially differing contexts of ‘support’ amongst both groups, and raises questions concerning the challenges of using questionnaires to capture culturally specific stressors and support mechanisms. [ABSTRACT FROM PUBLISHER]

The contribution of mental health social work (MHSW) to multidisciplinary care delivery has been subject to political pressures for change since the introduction in the UK of the National Service Framework for Mental Health in 1999 and subsequent New Ways of Working (NWW) initiative in 2003. Culminating in the new 2007 Mental Health Act for England and Wales, Approved Social Workers have been replaced by Approved Mental Health Practitioners (AMHPs) with the role and remit extended to other disciplines. Given this political context, this study uses an ethnographic methodology to draw together qualitative data from four reconfigured mental health teams to describe and debate the MHSW contribution to NWW. This contribution was of particular interest to the authors, as both were mental health social workers by background, with one of the authors having worked as a MHSW in Sri Lanka and the other having practised as an Approved Social Worker (ASW) and supervised ASWs in a multidisciplinary team England. Participant observations of team meetings/activities, together with joint home visits and interviews, provide an understanding of the social work contribution from a range of perspectives. Thematic analysis of data reveals that MHSWs experience a clash between their unique social work contribution and their role as generic care co-ordinators. Furthermore, there is stigma and reduced status associated with being a MHSW when compared with colleagues from other disciplines. Political issues beset the roles and responsibilities of MHSWs impacting at the level of pay and conditions of employment. The paper concludes with recommendations for managing the political schism in a service that is dominated by health and where local authorities play an increasingly peripheral role in managing and supervising seconded staff. [ABSTRACT FROM PUBLISHER]

Workplace violence is a serious occupational hazard for many social care staff. In this paper, we detail the results of an investigation into the levels of client violence experienced by a sample of 363 social care staff working in a UK Shire County Department. We also explore the consequences of such violence upon job satisfaction and self-reported stress symptoms. The results reported show that levels of client violence differ across areas of social care work, with residential staff being the most at risk and home care workers the least at risk. The data presented also show that, as exposure to violence increases, job satisfaction diminishes and the reporting of stress symptoms increases. Fear, or feeling vulnerable, is found to be both an important consequence of client violence and a mediator of its association with diminished job satisfaction and elevated stress symptom reporting. It is concluded that theory and practice in tackling violence in social care should more fully address the important role played by fear. [ABSTRACT FROM AUTHOR]

Drawing on a qualitative study exploring the stories of twenty-four women involved in sex work in the UK, this paper discusses whether it is possible to identify key risk and protective factors influencing involvement. It argues that, although age at first involvement is an important factor in influencing outcome, so also are experiences of childhood and adult adversity. Early damaging experiences, which may increase the likelihood of involvement, also affect the ability to deal with the experience of sex work and simultaneously ‘manage’ other life experiences. What is crucial in identifying who is likely to be the most vulnerable are the accumulation of risk factors in early childhood and the personal and ecological resources available to individuals across the lifespan to manage that pathway. How these factors are managed determines the degree of victimhood or agency, vulnerability or resilience individuals perceive they have and the route taken through sex work as a consequence. The study identified three different groups of women who reported different pathways, reflecting different sources of support and coping strategies. This analysis suggests that there is a need to facilitate the provision of ‘secure base’ interventions for women involved in sex work, whatever their age, which have meaning for them. [ABSTRACT FROM PUBLISHER]

Background The Short Form 36 Health Survey Questionnaire (SF-36) is used to indicate the health status of particular populations, to help with service planning and to measure the impact of clinical and social interventions. Culture-specific data are required to calculate SF-36 norm-based scores. Currently, in the UK normative sources are nearly two decades old, Anglocentric and lack data on the older population. We draw on raw data from the Welsh Health Survey (2007) to provide population norms for the eight SF-36 dimensions for Wales and its regions. Methods We test the SF-36 dimensions for reliability and rating scaling assumptions and construct validity. We compare the Wales’ norms to those reported in existing UK sources and examine the data between countries and by region. Results The scale is reliable and has content validity. The relationships found between the SF-36 domains and a range of variables known to be related to health also demonstrate construct validity. There are differences in population health norms between England and Wales and between the regions of Wales. Conclusions The results suggest that it is imperative that the accurate normative data provided in this paper is used in population studies in Wales to provide an indication of the health status of particular populations. [ABSTRACT FROM PUBLISHER]

Contemporary welfare is closely linked to policies designed to foster individual responsibility and self-development. This agenda, however, encounters problems when adults lack the capacity to make decisions about their lives, and/or are unable to protect themselves from the malign actions of their fellow citizens. These problems are addressed by the 2005 Mental Capacity Act (England and Wales) and adult safeguarding procedures. Specifically, the 2005 Mental Capacity Act (England and Wales) (MCA) introduced a statutory advocacy service, which empowers local authorities to appoint an Independent Mental Capacity Advocate (IMCA) to represent the interests of adult lacking capacity to make decisions about adult safeguarding procedures. This paper presents (i) a general overview of the development of adult safeguarding and the introduction of the MCA's IMCA service into these procedures; (ii) findings from a research project investigating the integration of IMCAs into these procedures; and (iii) a discussion of the challenges facing IMCAs involved in adult safeguarding procedures. [ABSTRACT FROM PUBLISHER]

This paper focuses on policy implementation and, in particular, the workings of ‘street-level bureaucracy’ in a small, marginalised area of welfare provision, namely post-care adults seeking access to their care records. The work arises from research mapping UK service provision in this area, via questionnaires and interviews with key actors in local authorities and voluntary organisations. The study was prompted by widespread but largely anecdotal evidence that practices and service provision for those seeking to access their care records varied enormously. While post-care adults may seek access to records for reasons similar to those of adopted adults (curiosity, information on birth family, medical information, care histories and experiences, search and reunion), there is a lack of comparable legal framework and service provision, with reliance instead on the 1998 Data Protection Act (DPA). The intersection of data protection and (child) welfare gives rise to a number of important tensions that are explored, such as those surrounding ‘ownership’ of files and their content, between rights to information and (paternalistic) welfare considerations, and whether the handling of requests should constitute an administrative or a social work task. Finally, we consider the findings, their wider contexts and implications for legal reform and policy change. [ABSTRACT FROM PUBLISHER]

This paper draws upon case study research to explore deviant social work. This is defined as small-scale acts of resistance, subterfuge, deception or even sabotage that are typically hidden yet scattered throughout parts of the social work labour process. Taking a wide variety of forms that can include recalcitrant attitudes as well as practices, deviant social work can be seen as being distinct from radical social work, most notably due to its implicit, pragmatic, non-idealistic and individual dispositions and strategies that are not rooted within epistemological, professional or other institutionally defined parameters. In contrast, positive deviant social work seeks as its maxim application and tangible support to vulnerable people above theoretical critique, rhetoric or perpetual reflexivity. Just as significant, because of its covert and disparate expressions, deviant social work also largely evades managerial or policy-led forms of location, surveillance and control. It is concluded that only engagement with an eclectic mix of critical theories is likely to help us locate and understand the many forms of resistance that inevitably emerge within an unpredictable, demanding, highly regulated and under-resourced quasi-professional labour process such as social work. [ABSTRACT FROM PUBLISHER]

Purpose: There is a fundamental knowledge gap regarding the experience of dementia within minority ethnic groups in the United Kingdom and elsewhere. The present study examined the subjective reality of living with dementia from the perspective of people with dementia within the 3 largest ethnic groups in the United Kingdom. Design and Methods: This was a qualitative study in which in-depth individual interviews were conducted with 11 Black Caribbean, 9 south Asian, and 10 White British older people with dementia. The lack of information in this area prompted the use of a grounded theory approach. Results: The main theme to emerge from the interviews with the people with dementia was “threat to valued elements of life.” Participants engaged in a process of appraisal in which they assessed the degree to which their condition and support needs interfered with valued elements of life. The analysis revealed that each element of this process was culturally informed. Implications: There is potential for modifying beliefs to reduce the perceived threat of dementia and for family and professional carers to promote the roles, relationships, and activities that each person with dementia values. The findings outlined in this paper can inform the development of a culturally sensitive approach. [ABSTRACT FROM PUBLISHER]

The value of co-produced research is increasingly recognised. This is a case study of a lay conducted, co-produced qualitative research study on the experiences of social workers and Disabled users of their services of using (or not) digital technologies when communicating with each other. We describe the co-production process from inception to dissemination and draw out lessons for future studies. Disabled lay researchers developed interview topic guides, conducted semi-structured interviews with social workers and Disabled users of social work services, analysed the data and led or contributed to study outputs. Several factors contributed to the success of this study. It was co-produced using service user, practitioner and academic knowledge. It is built on existing trusted relationships. Training and support were targeted and relevant, and delivered using a variety of learning methods, including peer support. Disabled lay researchers drew on their lived experiences to develop topic guides and interpret data. The study team was committed to inclusion, capacity building and an assets-based approach, and to carefully managing power relationships. Challenges were the time required to setup the study and to train and support lay researchers, and the bureaucratic and governance systems that were not ideally suited to root and branch co-production. [ABSTRACT FROM AUTHOR]

Background In Europe, more than 15 million people live with heart failure (HF). It imposes an enormous social, organizational and economic burden. As a reaction to impending impact on healthcare provision, different country-specific structures for HF-care have been established. The aim of this report is to provide an overview and compare the HF-care approaches of Germany, Ireland, the Netherlands and the UK, and to open the possibility of learning from each other's experience. Methods A mixed methods approach was implemented that included a literature analysis, interviews and questionnaires with HF-patients and caregivers, and expert interviews with representatives from healthcare, health service research and medical informatics. Results The models of HF-care in all countries analyzed are based on the European Society of Cardiology guidelines for diagnosis and treatment of HF. Even though the HF-models differed in design and implementation in practice, key challenges were similar: (i) unequal distribution of care between urban and rural areas, (ii) long waiting times, (iii) unequal access to and provision of healthcare services, (iv) information and communication gaps and (v) inadequate implementation and financing of digital applications. Conclusion Although promising approaches exist to structure and improve HF-care, across the four countries, implementation was reluctant to embrace novel methods. A lack of financial resources and insufficient digitalization making it difficult to adopt new concepts. Integration of HF-nurses seems to be an effective way of improving current models of HF-care. Digital solutions offer further opportunities to overcome communication and coordination gaps and to strengthen self-management skills. [ABSTRACT FROM AUTHOR]

Background Public Health registrars (SpRs) were an important component of the workforce that contributed to the COVID-19 response. This study explores their contribution and the impact the early stages of the pandemic had on their learning and training. Methods Data were collected from SpRs in the London and Kent, Surrey, Sussex training programme between July and September 2020 through a mixture of questionnaires and semi-structured interviews. A thematic analysis of interview transcripts was undertaken to identify themes. Results 35/128 SpRs responded to the survey and 11 were interviewed. SpRs were placed across a range of organizations and made a significant contribution to the COVID-19 response. Overall, SpRs learned important skills but working on the response may for some have impacted negatively on training. A number of facilitators and barriers to learning were identified. Conclusion The study findings highlight the opportunities for learning created by the pandemic. However, changing projects and the desire of SpRs to contribute to the response meant the impacts on training were mixed. Future deployment of SpRs should consider the balance of responsibility and pace when delegating work, as well as the need to supervise effectively and support remote working to maintain good mental wellbeing. [ABSTRACT FROM AUTHOR]

Background and Objectives Existing research reveals that single men living alone are at a heightened risk of isolation and precarity. This study traced the impact of the pandemic on the daily lives of a group of single men over three waves of the COVID-19 pandemic in the United Kingdom. Research Design and Methods A qualitative longitudinal study with older people aged 50 and older (n = 102), interviewed by telephone in 2020–2021. This analysis focuses on a subsample comprising single men (n = 16) who lived alone and were interviewed three times (n = 48). The men were White British, Black, and Asian, aged 58–88 years, and were identified as facing difficulties in their lives arising from long-term health problems and or/social isolation. Participants were asked about the impact of, and response to, three lockdowns. Data were analyzed using themes identified in the secondary literature using thematic and longitudinal analysis. Results For single men living alone, precarity intensified during the pandemic due to worsening physical and/or mental health combined with restricted access to relationships and activities. Key moments in the life course influenced how these men experienced and viewed the impact of COVID-19. Discussion and Implications This analysis sheds light on the deepening precarity of older men living alone during the pandemic, highlighting the emergence of new vulnerabilities for some. The findings emphasize the need, given the likelihood of future waves of the pandemic, to target support at those living alone, particularly in relation to the provision of community health services, social infrastructure, and combating digital exclusion. [ABSTRACT FROM AUTHOR]

The article provides a novel look at the links between salutogenesis, health promotion, and urban design supported by the findings of recent research on local high streets and their benefits for the well-being of older people. Salutogenesis and the related explanatory concept of sense of coherence (SOC) have provided a theoretical framework for developing healthy settings interventions, shifting the focus from exploring barriers and deficits to assets and resources in promoting people's health and well-being. While these concepts have informed policies and programmes at the level of regions and cities, no attempt has been made to establish more direct links with the disciplines devoted to the organization and design of the built environment at the scale of public spaces and streets. This article advances the idea that the main categories of SOC—comprehensibility, manageability and meaningfulness—have found application in urban design theory. Linking these categories with urban design concepts in a comprehensive framework, it is possible to guide interventions aimed at strenghtening well-being resources available in the public realm. This is corroborated by the findings resulting from a study of the well-being experiences of older people (n = 84) across a range of local high streets in the city of Edinburgh (UK) applying an innovative multi-methods approach. The discussion establishes the links between well-being benefits, SOC constructs and urban design concepts, and underscores the potential of the proposed framework to guide a design-oriented salutogenic approach to the built environment. [ABSTRACT FROM AUTHOR]

This article explores the impact of online Irish traditional singing sessions on health and well-being during the COVID-19 pandemic. Singing sessions are unique facets of Ireland's music tradition that saw dramatic closure, interruption and digital transition in response to COVID-19 social distancing measures. This study highlights a gap in health promotion literature with regard to traditional singing sessions as a group singing activity and examines the potential for online group singing activities to have positive impacts on the health and well-being of participants. While traditional singing sessions foreground solo performances, they are quintessentially group activities, and include community engagement and active participation from singers and listeners alike. Through an online survey (n  = 108), and ethnographic interviews (n  = 3), this study explores potential health and well-being implications of online traditional singing sessions, and reveals four main areas of impact: social connection, enjoyment, cognitive motivation and timekeeping. The study suggests that online traditional singing sessions can promote health and well-being in participants, particularly during times of isolation. [ABSTRACT FROM AUTHOR]