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Compared to the general U.S. adolescent population, young people involved in the juvenile justice system are at greater risk of experiencing substance use (SU) issues. There are critical opportunities across the juvenile justice continuum, at points of interface with community-based treatment services, to screen and assess for SU issues, identify unmet treatment needs, and refer those in need to treatment. The treatment referral process is, however, complex, and contingent on a seamless nexus between juvenile justice operations and the wider treatment provider landscape. Given the lack of successful SU referrals among justice-involved youth and the variable referral rates across jurisdictions, this study's aim is to provide a qualitative, explanatory understanding of the conditions that together contribute to successful referring practices. The study is based on an analysis of a qualitative dataset comprising focus group data with probation and community-based behavioral health treatment staff working in 31 sites in 6 different states as part of the clustered randomized trial of an organizational change intervention known as JJ-TRIALS (Juvenile Justice Translational Research on Interventions for Adolescents in the Legal System). The data contain respondents' narratives on the achievements, successes, and challenges with implementing the intervention. The data were analyzed through a combination of strategies to identify the conditions that both facilitate and impede referral processes between probation offices and community-based SU treatment providers. Participants across sites discussed the positive impacts that the JJ-TRIALS intervention had on their improved ability to communicate, collaborate, and collect data. From the interviews, seven main conditions were observed to contribute to successful SU treatment referral practices: (1) communication (inter-organizational); (2) collaboration; (3) data-driven practices; (4) family engagement; (5) institutionalized policy and referral documentation; (6) efficient referral policies and procedures; and (7) suitable and accessible system of treatment providers. Findings highlight the value of a holistic understanding of successful treatment referrals for justice-involved youth and help inform research and practice efforts to identify and measure the many dimensions of referral-making at the interface of juvenile probation and behavioral health services. • Justice-involved youth experience disproportionate rates of substance use (SU). • The JJ-TRIALS project was an implementation intervention aimed at reducing unmet SU treatment needs. • This paper examines conditions for successful referral practices in the context of JJ-TRIALS. • Findings reveal a mix of 7 conditions that together facilitate treatment referrals. • Future studies should measure and analyze the relative 'weighting' of different conditions. [ABSTRACT FROM AUTHOR]

Due to the global aging trend, the number of older people who will spend the last years of their lives in nursing homes is increasing. However, nursing homes have long confronted negative social and public discourses, including stigmas on dementia and life in such facilities. Nevertheless, the remaining time of residents with dementia holds significance, for them and their families, as they seek respect and the ability to make meaningful end-of-life decisions. To explore how nursing home nurses advocate for the remaining lifetimes of residents with dementia. A qualitative research design. Four nursing homes in Korea from January 2023 to February 2023. Twenty nurses who provide direct caregiving for residents with dementia and have a minimum of two years' experience in nursing homes were recruited. This study employed a critical discourse analysis. Twenty interviews conducted with nursing home nurses were examined to explore the connections between the grammatical and lexical aspects of the language used by the nurses to construct their identities as advocates for residents with dementia and the broader sociocultural context. Four discourses regarding nursing home nurses advocating for the value of life of residents with dementia were identified: (1) Bridging perspectives: I am a negotiator between medical treatment and residents' families with differing views; (2) Embracing a shared humanity: Residents are no different from me; they just need professional help; (3) Affirming belongingness: Residents still belong to their families, even when care has been delegated; and (4) Empowering voices for change: We are struggling to provide better care in a challenging reality. This paper highlights the importance of nursing advocacy in safeguarding the remaining time and dignity of individuals with dementia, challenging the stigma surrounding dementia and nursing homes and calling for greater societal and political recognition of the efforts nurses make to preserve the personhood and well-being of these older adults. [ABSTRACT FROM AUTHOR]

The literature on professional socialization focuses on how students adopt and internalize professional identities and values, and assumes that boundary work is essential to learning how best to practice their profession. However, a focus on boundary work in the context of midwifery training - which is embedded in the gendered and hierarchical landscape of maternity care - is lacking. Thus, this article examines how Canadian student-midwives learn to navigate and negotiate interprofessional boundaries. Grounded in a symbolic interactionist approach, it draws on 31 semi-structured qualitative interviews from a mixed-methods national study on midwifery retention, explores how midwifery students make sense of the tensions among midwives, physicians, and nurses, and describes what strategies they utilize when navigating boundaries. Our analysis, based in constructivist grounded theory, revealed that participants learned about interprofessional tensions in clinical placement encounters via direct or indirect interactions with other healthcare professionals, and that strategies to navigate these tensions included educating others about midwifery training and adopting a learner identity. This article proposes that the process of professional socialization enables to reshape professional boundaries and that students are not only learners but also agents of change. These findings may yield practical applications in health education by highlighting opportunities for improving interprofessional collaborations. • Boundary work is part of professional socialization process. • Professional boundaries are ambiguous in midwifery but they are understudied. • This paper examines boundary work among 31 Canadian midwifery students. • The boundaries were clear with physicians but blurred in communication with nurses. • Learning about boundaries, students recreated them but also became agents of change. [ABSTRACT FROM AUTHOR]

Medical students with chronic health conditions are an underrepresented and often overlooked population in medical education. Previous research describes the dual roles they hold as both healthcare recipients and providers and details challenges they face related to accommodations and accessibility. However, less is known about how having a chronic health condition shapes the day-to-day aspects of medical education. To address this gap in knowledge, I conducted semi-structured interviews with eighteen medical students with chronic conditions and examined data using reflexive thematic analysis. Findings revealed the competing demands students face between medical school expectations and the need to manage their health. They work to reconcile these demands using tools like accommodations and strategic communication and by reconstructing narratives to re-assess self-imposed expectations. These participants understand having a chronic health condition as just one piece of their larger sense of self. Participants approach this understanding in individualized and nuanced ways, yet all share a cohesive view that their experiences having chronic health conditions inform their medical practice for the better through the development of genuine empathy for patients. This paper concludes with recommendations drawn from participant interviews of how medical schools can better support students with chronic health conditions. • Chronic condition management and medical training compete for time and energy. • Demands are reconciled at structural, interpersonal, and intrapersonal levels. • Having a chronic condition influences but does not define medical training. • First-hand healthcare experiences build genuine empathy and improve patient care. [ABSTRACT FROM AUTHOR]

Combining knowledge from research on prosocial behavior, online communication, and (online) social support, this paper examines (1) how online communication shapes the provision of online support and (2) how the provision of online support is related to wellbeing. The focus lies on the underrepresented perspective of those acting prosocially by providing support. To answer these research questions, a qualitative (n = 22) and quantitative study (n = 470) have been conducted. The results of both studies suggest that providing online social support is positively related to people's wellbeing by satisfying basic psychological needs. This relation was partially mediated by beneficence and moderated by autonomous motivation and positive feedback. The qualitative results underline the specific conditions of online communication for providing support. It connects people with shared concerns and enables the autonomous building of anonymous support communities. Moreover, asynchronous communication with reduced cues transmitted may foster positive feedback that strengthens the self-image of those acting prosocially. • This paper focuses on the perspective of those providing support online. • A qualitative and a quantitative study are combined. • Providing online support may be positively related to people's wellbeing. • Mediators and moderators of the relation are examined. • Specific conditions of online communication for providing support are highlighted. [ABSTRACT FROM AUTHOR]

Objectives Interprofessional collaboration between midwives and health visitors working in maternal and child health services is widely encouraged. This systematic review aimed to identify existing and potential areas for collaboration between midwives and health visitors; explore the methods through which collaboration is and can be achieved; assess the effectiveness of this relationship between these groups, and ascertain whether the identified examples of collaboration are in line with clinical guidelines and policy. Design A narrative synthesis of qualitative and quantitative studies. Data sources Fourteen electronic databases, research mailing lists, recommendations from key authors and reference lists and citations of included papers. Review methods Papers were included if they explored one or a combination of: the areas of practice in which midwives and health visitors worked collaboratively; the methods that midwives and health visitors employed when communicating and collaborating with each other; the effectiveness of collaboration between midwives and health visitors; and whether collaborative practice between midwives and health visitors meet clinical guidelines. Papers were assessed for study quality. Results Eighteen papers (sixteen studies) met the inclusion criteria. The studies found that midwives and health visitors reported valuing interprofessional collaboration, however this was rare in practice. Findings show that collaboration could be useful across the service continuum, from antenatal care, transition of care/handover, to postnatal care. Evidence for the effectiveness of collaboration between these two groups was equivocal and based on self-reported data. In relation, multiple enablers and barriers to collaboration were identified. Communication was reportedly key to interprofessional collaboration. Conclusions Interprofessional collaboration was valuable according to both midwives and health visitors, however, this was made challenging by several barriers such as poor communication, limited resources, and poor understanding of each other’s role. Structural barriers such as physical distance also featured as a challenge to interprofessional collaboration. Although the findings are limited by variable methodological quality, these were consistent across time, geographical locations, and health settings, indicating transferability and reliability. [ABSTRACT FROM AUTHOR]

Abstract This paper reports a qualitative study of parents' experiences of participating in an Australian adapted trial of the Strengthening Families Program (SFP). The SFP is an internationally recognised family-based prevention intervention found to be effective in improving child mental health. The study explored parents' perceptions of how the Australian adapted program influenced parent, child and family functioning. A purposive sample of 15 parents who had taken part in the program in 2015 were interviewed, and thematic analysis was undertaken using a general inductive approach. Parents reported benefits experienced through the program based around eight major themes: (1) the anger diminished; (2) making a connection; (3) a shift towards positive dialogue within the family; (4) greater understanding of parenting and the child; (5) "the clouds lifted a little bit"; (6) engagement in school; (7) my child's behaviour improved; and (8) coping and resilience. Themes relating to parent-child connectedness and communication appeared central to improved child behaviour and family functioning. Collectively, the findings are promising, and themes encapsulated familial factors found to be protective of child psychosocial health. Highlights • Parents felt a stronger connection with their child after participating in the SFC program. • By parents' accounts, there was improvement in parent-child communication. • Themes indicated reduced parent and child anger and improved child behaviour. • Parents reported increased awareness and adjustment in parenting expectations. [ABSTRACT FROM AUTHOR]

Objective: The objective of this paper is to understand patient, caregiver and hospice admission nurses needs during the hospice admission conversation so patients and their caregivers can make informed decisions about hospice.Methods: Resulting data set from this qualitative study included 60 h of observation and a total of 30 interviews with caregivers, patients and hospice admission nurses. Participants were from a large non-profit hospice; observation settings included: home, hospital and skilled nursing facility.Results: Four themes were identified: (1) Wide variation in patient knowledge of hospice care prior to the admission conversation, (2) competing expectations and objectives for the admission conversation between patients, caregivers and hospice admission team members, (3) organizational influences around the goals of the admission conversation, (4) importance of integrating the patient and caregiver perspective to improve the quality of admission conversations.Conclusion: Hospice services provided may be inconsistently explained by hospice personnel and therefore, can be misunderstood by patients and families. With the ubiquitous challenges surrounding hospice admission consults, there is a critical need for complete and accurate information during the admission process.Practice Implications: Providing accurate and pertinent information at the time of the admission consult can help mitigate misinformed expectations of services provided. [ABSTRACT FROM AUTHOR]

Background De-escalation techniques are recommended to manage violence and aggression in mental health settings yet restrictive practices continue to be frequently used. Barriers and enablers to the implementation and effectiveness of de-escalation techniques in practice are not well understood. Objectives To obtain staff descriptions of de-escalation techniques currently used in mental health settings and explore factors perceived to influence their implementation and effectiveness. Design Qualitative, semi-structured interviews and Framework Analysis. Settings Five in-patient wards including three male psychiatric intensive care units, one female acute ward and one male acute ward in three UK Mental Health NHS Trusts. Participants 20 ward-based clinical staff. Methods Individual semi-structured interviews were digitally recorded, transcribed verbatim and analysed using a qualitative data analysis software package. Results Participants described 14 techniques used in response to escalated aggression applied on a continuum between support and control. Techniques along the support-control continuum could be classified in three groups: ‘support’ ( e.g. problem-solving, distraction, reassurance) ‘non-physical control’ ( e.g. reprimands, deterrents, instruction) and ‘physical control’ ( e.g. physical restraint and seclusion). Charting the reasoning staff provided for technique selection against the described behavioural outcome enabled a preliminary understanding of staff, patient and environmental influences on de-escalation success or failure. Importantly, the more coercive ‘non-physical control’ techniques are currently conceptualised by staff as a feature of de-escalation techniques, yet, there was evidence of a link between these and increased aggression/use of restrictive practices. Risk was not a consistent factor in decisions to adopt more controlling techniques. Moral judgements regarding the function of the aggression; trial-and-error; ingrained local custom (especially around instruction to low stimulus areas); knowledge of the patient; time-efficiency and staff anxiety had a key role in escalating intervention. Conclusion This paper provides a new model for understanding staff intervention in response to escalated aggression, a continuum between support and control. It further provides a preliminary explanatory framework for understanding the relationship between patient behaviour, staff response and environmental influences on de-escalation success and failure. This framework reveals potentially important behaviour change targets for interventions seeking to reduce violence and use of restrictive practices through enhanced de-escalation techniques. [ABSTRACT FROM AUTHOR]

This paper explores the interaction between peer relationships and sexual health among street youth in three Sub-Saharan African cities: Accra (Ghana), Bukavu (Democratic Republic of Congo), and Harare (Zimbabwe). It begins by conceptualising peer relationships for youth globally and considers why these are pivotal for young people living in street settings. The paper reconceptualizes street peer relationships not as replacement families, but as sharing 'social anchorage' in the street space. It draws on qualitative ethnographic data from Growing up on the Streets, a longitudinal research project with a participatory methodology undertaken between 2012 and 2016 and engaging street youth (aged 14–20 at project outset) trained in ethnographic observations as research assistants (n = 18), following a network of ten peers (n = 229 by 2016), reporting their experiences in weekly interviews with facilitators. A wider network attended focus groups (n = 399). The project engaged a 'capability' approach, with ten capabilities defined by street youth as key to their daily lives. Empirical evidence is from a subset of data qualitatively coded (using NVivo) against capabilities 'Health and Wellbeing' and 'Friendship', across all interviews, focus groups and cities (n = 212 sources). In exploring this intersection, the paper demonstrates beneficial and adverse impacts of peer influence on sexual health, including misinformation about contraceptives and death from an informal sector abortion; highlighting findings from across the three cities around primacy of same-sex peer relations, mistrust between genders and in healthcare providers. The paper finds that while street youth remain subject to cultural norms around gender identities, street peer relationships hold a persuasive power; contributing to both everyday survival and moments of acute need. It concludes that recognising the right of young people to live and seek livelihoods in urban settings, and adopting the social networks they create to advance street youth's sexual health has become even more relevant in a (post)pandemic world. • Young people are the majority living in new urban informality. • A new conceptualization positions street peer relations as socio-spatially anchored. • Peers can play a critical role in the sexual wellbeing of young street people. • Policy, practice and peer social networks can advance sexual health of street youth. [ABSTRACT FROM AUTHOR]

Objectives: Communicating genetic risk is a distressing process for families affected by inherited genetic conditions. This systematic review identifies and explores the challenges faced by parents and their (non)affected or at risk children caused by the (non)disclosure of genetic risk information. Design: Qualitative meta-synthesis and thematic analysis. Data sources: Ovid databases; Ovid 'in progress', British Nursing Index, Embase, Medline and Psychinfo were combined with searches of EBSCOhost databases; CINAHL and ERIC and Web of science and ZETOC databases using truncations of communication, chronic illness and disease and words relating to family with specific genetic conditions; Cystic Fibrosis, Duchenne Muscular Dystrophy, Familial Adenomatous Polyposis, Hereditary Non-polyposis Colorectal Cancer, Huntington's Disease, Neurofibromatosis and Sickle Cell Anaemia. This was augmented with free Internet and hand searches and an exploration of the bibliographies of all included papers. Review method: All papers were quality assessed to ascertain their research quality and methodological rigour. Results: A total of 2033 citations were retrieved. Following the removal of duplicates, irrelevant articles and the application of an inclusion criterion, 12 articles remained. A further three papers were omitted due to poor quality leaving nine papers which focussed on the disclosure of genetic information between parent and child (<18 years). Eight papers were qualitative in design and one used a mixed method approach. Thematic synthesis produced four themes that inform the structure of the paper; disclosure, emotions involved in disclosure, desired disclosure and recommendations. Conclusion: Disclosure of genetic risk information within families is a highly complex and affective process often resulting in delayed disclosure. This can lead to increased family tensions generated by misunderstanding, blame and secrecy. Early, age appropriate disclosure can better prepare children for future considerations such as care planning and reproductive decision-making. It also contributes to effective coping strategies that promote enhanced adaptation and emotional well being. Early disclosure also reduces parental anxieties concerning disclosure from an unwitting source. Research shows that children and young people want their parents to engage in open and honest discussions about the genetic condition. Therefore to help facilitate effective family communication health professionals should provide family centred care and better emotional and informational support. [ABSTRACT FROM AUTHOR]

Objective: This study identifies the types of patient-related information problems (PIPs) that patient-care teams encounter during morning rounds, and how those PIPs are identified and managed. PIPs are any issues related to patient information (e.g., wrong, missing, incomplete information) that affect the patient-care team's ability to perform their work. Not addressing PIPs can lead to workflow challenges, delayed patient-care decisions, and negative impacts to the patient.Materials and Methods: We employed qualitative data collection methods by shadowing patient-care teams during 29 morning rounds resulting in 155h of observation. We observed the interactions between the rounding physicians and other patient-care team members, including: nurses, consulting physicians, care coordinators, pharmacists, social workers, and therapists.Results: This study resulted in identifying seven types of PIPs that occur during morning rounds. Additionally, the study presents the different ways that participants identified and managed the PIPs.Discussion: We discuss the potential negative effects of PIPs on the patient-care workflow. We also discuss socio-technical recommendations for organizational policies and training, as well as electronic health record (EHR) design improvements that could help patient-care teams more effectively identify and manage PIPs.Conclusion: Hospital teams rely on accurate, available, and up-to-date information in order to make informed decisions on patient care. However, PIPs exist in EHR systems, paper documents, and verbal conversations. This study identifies a set of PIPs and how they are currently being identified and managed. [ABSTRACT FROM AUTHOR]

This paper presents a formal definition for a number of distinct cases where the preposition “ em ” (in) can be applied in Brazilian Portuguese. The aim of this work is to establish a mathematical model using qualitative spatial reasoning formalisms within the idea of precisification from supervaluation semantics. Our long term goal is to implement this model into artificial intelligent systems to allow for seamless communication with humans in a common speech. [ABSTRACT FROM AUTHOR]

Many businesses have commenced using social media for crisis communication with stakeholders. However there is little guidance in literature to assist organisational crisis managers with the selection of an appropriate crisis response strategy. Traditional theories on crisis communication may not adequately represent the social media context. This study took a qualitative approach and explored organisational use of social media for crisis communication at seventeen large Australian organisations. An analysis of 15,650 Facebook and Twitter messages was conducted, drawing on the lens of Situational Crisis Communication Theory (SCCT) (Coombs & Holladay, 2002). Findings suggested that when large Australian organisations responded to crises via social media, they lacked an awareness of the potential of social media for crisis communication. Organisations often did not respond to stakeholder messages or selected crisis response strategies that may increase reputational risk. The paper contributes important understandings of organisational social media use for crisis communication. It also assists crisis managers by providing six crisis response positions and a taxonomy of social media crisis messages that stakeholders may send to organisations. Key implications are discussed. [ABSTRACT FROM AUTHOR]

Objective: This paper presents the stigma experiences of children with epilepsy (CWE) and their parents and outlines the relationship between CWE's and parents' stigma perceptions, demographic and seizure variables, and epilepsy-related communication within and external to the family.Methods: A mixed-method design was employed. In phase one, 33 CWE and 40 parents participated in qualitative interviews. In phase two, 47 CWE and 72 parents completed a cross-sectional survey.Results: CWE and their parents experience felt and enacted stigma via social exclusion, activity restriction, teasing/bullying, internalised negative feelings to epilepsy, concealment of epilepsy and parental stigma-coaching. Higher CWE and parent stigma perceptions were significantly correlated with greater epilepsy concealment from others outside the family and greater negative affect around epilepsy-related communication within the home.Conclusion: As CWE and their parents grapple with epilepsy-related stigma they may inadvertently contribute to the silence encircling epilepsy through diagnosis concealment, stigma-coaching and/or by engaging in limited family dialogue about epilepsy.Practice Implications: Healthcare professionals need to be cognisant of broaching the sensitive topic of epilepsy-related stigma during their engagements with families living with epilepsy. Assisting families to appropriately engage in dialogue surrounding epilepsy is likely to improve the psychosocial wellbeing of CWE and their parents. [ABSTRACT FROM AUTHOR]

Abstract: There is increasing interest in using electronic mail and other electronic health technologies (e-health technologies) in patient follow-ups. This study sheds light on patients’ reception of provider-initiated e-health in their everyday environments. In a research project carried out in Norway (2005–2007), an electronic address for a hospital dermatology ward was offered to 50 patient families for improved access to expert advice from the patients’ homes. Drawing on semi-structured interviews with 12 families, this paper explores how the electronic address was integrated into everyday health practice. The research illuminates how the electronic address did not only represent changes related to treatment procedures and frequency or nature of expert contact; it was also important to other practices in the everyday lives of the families of patients with chronic illness. Once in place on the patients’ computers, the electronic address was ascribed at least four different roles: it was used as the intended riverbed for a flow of information, but also as a safety alarm, as a shield to the medical gaze and as a token of competence in care and parenting. The multiplicity in use and reception of an electronic address in patient settings illustrates the need to include patients’ everyday practices in current professional and political discussions of e-mail and other e-health technologies. Thus this paper argues that there is a need for research on electronic patient–provider communication that moves beyond frequency of use and questions on how technology will affect medical encounters. Social science equally needs to investigate how provider-initiated e-health technologies gets involved in patients’ moral and social performance of health and illness in everyday life. [Copyright &y& Elsevier]

Recently, nutrition-sensitive agriculture programs have taken aim at malnutrition's multi-sectoral roots through re-diversifying agricultural production while integrating women's empowerment and nutrition behavior-change communication components. For these integrated nutrition-sensitive agricultural programs, women-led self-help groups have emerged as promising platforms for program delivery. Yet, while well-designed nutrition behavior-change communication has been successfully used in self-help groups, and is central to nutrition-sensitive agriculture, it can take many forms. These vary widely in their theoretical and ethical underpinnings, communication strategies, and theory of change. As nutrition-sensitive agriculture continues to proliferate, it is critical to better understand how women interact with different behavior-change messages and how to engage individuals in ethical, effective ways. This paper analyzes qualitative data collected from a nutrition-sensitive agricultural project in India that used participatory storytelling to generate knowledge and awareness about malnutrition among women. Drawing from data across two sites, the paper analyzes why certain messages generated more discussion among women then others. We find self-help group women were drawn to topics of early marriage and diet diversity because they emotionally connected to them, and felt they were relevant to their lives with high perceived pay-off and actionability. While other topics on gender and health also provoked emotional, lively discussions, the stories were less effective due to their complexity, which were difficult for volunteer facilitators to communicate. We conclude that there is unmet demand among women in rural India for structured spaces to discuss gendered aspects of health and diet, and nutrition-sensitive agricultural programs could benefit from focusing attention here. • Engages debates on health behavior change communication (BCC) ethics and efficacy. • Examines modified participatory learning and action (PLA) run in women's groups. • Finds women were drawn to simple, actionable messages they emotionally related to. • Insufficient investment in volunteers' PLA facilitation skills hampered impact. • There is need for more BCC focused on women as women, rather than mothers. [ABSTRACT FROM AUTHOR]

Background Ability to elicit individuals’ perceptions of complex behavioral processes can be challenging, as it hinges not only upon the skill of the researcher, but also upon assumptions of a shared language and individuals’ ability to recall, analyze, and effectively communicate events. In a case-based qualitative-descriptive study about teens’ experiences of asthma self-management, we found that variations in terminology and descriptions of events, symptoms, and responses made it difficult to understand teens’ experiences of asthma. In particular, teens’ conceptualization of their asthma symptoms and self-management responses differed from situation to situation, from other teens in the study, from the interviewer, and from prior reports in the literature. These differences across many levels made it difficult to identify patterns in individual processes of self-management, and among teens in general.. Objectives To address these challenges, we developed a card sorting activity to facilitate in-depth exploration of teens’ experiences of asthma. Design Case-based qualitative description. Setting: Teen-parent dyads (N=28) were recruited from the community, Emergency Department, Pediatric Pulmonary Department, and prior study subjects of a major medical center. Methods Teens first identified and then sequenced their own unique sets of asthma symptoms and self-management responses. Teens then developed contextually grounded narratives using the card sort they had created as a visual aid. Results This technique not only allowed us to bridge teen-interviewer communication barriers and develop shared terminology, but also resulted in a visible sequence of asthma symptoms and self-management responses. Conclusions The card sort technique facilitated researcher-teen discussion and enabled comparison of self-management patterns across teens in our study. This technique is potentially useful for other areas of research exploring behavioral processes with complex and individual-specific experiences, in particular those involving sequences of events and self-management responses. This paper delineates the development, utility, and potential applications of the symptom-response card sorting technique for research and clinical practice. [ABSTRACT FROM AUTHOR]

Objectives: In the context of HIV clinical care, open discussion regarding sexual health and reproductive plans has become increasingly relevant. The aim of this paper is to explore barriers to communication between providers and women living with HIV regarding childbearing.Methods: In-depth interviews (IDIs) were conducted with 48 HIV infected women receiving ART at 7 different HIV clinics providing comprehensive HIV care services in four districts in Uganda, between July and August 2012. All women were aware of their HIV diagnosis prior to pregnancy or had given birth while living with HIV.Results: Four themes emerged describing barriers to communication, from the HIV-positive women's point of view: (i) provider indifference or opposition to childbearing post HIV diagnosis, (ii) anticipation of negative response from provider, (iii) provider's emphasis on 'scientific' facts, (iv) 'accidental pregnancy'.Conclusion: Existing evidence regarding effective provider-patient communication should be considered for its application for reproductive counseling among HIV infected women.Practice Implications: These data demonstrate the need for current counseling guidelines to explore approaches that encourage open, non-judgmental, non-directive discussions with HIV positive individuals around their reproductive desires and intentions in a health care setting. [ABSTRACT FROM AUTHOR]

Health systems in fragile states need to respond to shifting demographics, burden of disease and socio-economic circumstances in the revision of their health service packages. This entails making difficult decisions about what is and is not included therein, especially in resource-constrained settings offering or striving for universal health coverage. In this paper we turn the lens on the 2017–2021 development of Afghanistan's Integrated Package of Essential Health Services (IPEHS) to analyse the dynamics of the priority setting process and the role and value of evidence. Using participant observation of meetings and interviews with 25 expert participants, we conducted a qualitative study of the consultation process aimed at examining the characteristics of its technical, socio-cultural and organisational aspects, in particular data use and expert input, and how they influenced how evidence was discussed, taken up, and used (or not used) in the process. Our analysis proposes that the particular dynamics shaped by the context, information landscape and expert input shaped and operationalized knowledge sharing and its application in such a way to constitute a sort of "vernacular evidence". Our findings underline the importance of paying attention to the constellation of the priority setting processes in order to contribute to an ethical allocation of resources, particularly in contexts of resource scarcity and humanitarian need. • Describes the process of Afghanistan's latest health system revision. • Examines the complex process of priority setting in a fragile state. • Vernacular evidence is created through expert consultation where data gaps exist. • Unpacking the constellation of expert input is critical in priority setting. • Balanced process facilitation improves discussion around ethical resource allocation. [ABSTRACT FROM AUTHOR]

Introduction: Nurses' work in hospital departments is highly collaborative and includes communication with a variety of actors. To further support nurses' communications, wireless phones, on which nurses receive both nurse calls and ordinary phone calls, have been introduced. However, while they ensure high availability among the mobile nurses, these phones also contribute to an increased number of interruptions. Purpose: This paper aims to discover whether all interruptions caused by the wireless phones are unwanted. Further, it investigates how nurses handle these interruptions in a hospital setting in order to construct a foundation for guidelines to use in designing these types of systems. Methods: Qualitative and ethnographically inspired fieldwork, including workshops with both ordinary and student nurses from a Norwegian hospital, was undertaken. Patients from two hospital departments were interviewed. Results: Nurses struggle to handle interruptions caused by the wireless nurse call system. Deciding whether to abort an activity or not to respond to an interruption is regarded as stressful. The decision is further complicated by the complex nature of the interruptions. At the same time, patients anticipate that nurses are able to make these judgements with limited information. Nurses' work is highly collaborative, and nurses depend on one another to carry out their work and manage interruptions. Conclusion: The dual nature of the interruptions is complex, and whether an interruption is wanted or unwanted depends on many factors. Nurses manage interruptions mainly by making their own activities visible and monitoring colleagues' work. Therefore, nurses' awareness of colleagues' activities is a key factor in how they handle interruptions in the form of nurse calls. [ABSTRACT FROM AUTHOR]

Background: An implementation gap exists between policy aspirations for provision and the delivery of self-management support in primary care. An evidence based training and support package using a whole systems approach implemented as part of a randomised controlled trial was delivered to general practice staff. The trial found no effect of the intervention on patient outcomes. This paper explores why self-management support failed to become part of normal practice. We focussed on implementation of tools which capture two key aspects of self-management support - education (guidebooks for patients) and forming collaborative partnerships (a shared decision-making tool). Objectives: To evaluate the implementation and embedding of self-management support in a United Kingdom primary care setting. Design: Qualitative semi-structured interviews with primary care professionals. Settings: 12 General Practices in the Northwest of England located within a deprived inner city area. Participants: Practices were approached 3-6 months after undergoing training in a selfmanagement support approach. A pragmatic sample of 37 members of staff - General Practitioners, nurses, and practice support staff from 12 practices agreed to take part. The analysis is based on interviews with 11 practice nurses and one assistant practitioner; all were female with between 2 and 21 years' experience of working in general practice. Methods: A qualitative design involving face-to-face, semi-structured interviews audio- recorded and transcribed. Normalisation Process Theory framework allowed a systematic evaluation of the factors influencing the work required to implement the tools. Findings: The guidebooks were embedded in daily practice but the shared decision- making tools were not. Guidebooks were considered to enhance patient-centredness and were minimally disruptive. Practice nurses were reluctant to engage with behaviour change discussions. Self-management support was not formulated as a practice priority and there was minimal support for this activity within the practice: it was not auditable; [ABSTRACT FROM AUTHOR]

With a growing prevalence of social media use worldwide where individuals share varying aspects of their lives, this paper focuses on how individuals with a chronic illness use these communications platforms to discuss their health. This paper aims to provide a qualitative approach to understanding the connection between the technical features offered by Facebook, Twitter and Instagram and the therapeutic affordances experienced. Semi structured interviews were carried out with 38 participants living with Inflammatory Bowel Disease who use Facebook, Twitter and/or Instagram for health-related support. Interview transcripts were analysed systematically to draw connections between platform features and therapeutic affordances. The interview data was thematically coded through an adapted SCENA Model to infer therapeutic affordances, while content analysis identified the technical features discussed. Our findings indicate that most participants (79%) use more than one social media platform for health-related discourse and that features on the platforms offer different therapeutic affordances. Facebook Groups' privacy settings affording self-presentation as individuals feel comforted that other people cannot see what they post, while hashtags afford connectivity on Twitter and Instagram, but not on Facebook. This approach enabled the authors to identify similarities and differences between social media platforms and their technical features. • Multiple social media use common for health-related online support. • Social platforms' interfaces impact on therapeutic affordances differently. • Hidden and sequential affordances realised through multiple features used. • People with chronic illnesses are aware of their online identity. • Identity management important part of online health communications. [ABSTRACT FROM AUTHOR]

Objectives: Cancer treatment can impair fertility. The aim of this review was to investigate (1) fertility information needs, receipt and provision, (2) fertility information preferences, and (3) factors associated with receiving/providing fertility information. Cancer patients' and professional caregivers' perspectives were considered. Design: Mixed-methods systematic review. Data sources: Six electronic databases (PubMed, Web of Science, CINAHL, CRD, Embase) were systematically screened to retrieve articles published between January 2001 and March 2012. Reference lists and conference abstracts were checked for additional publications. Review methods: The principles outlined in the Cochrane Handbook for Systematic Reviews of Intervention were applied. Publications were included if they explored fertility-related information/communication in cancer patients/survivors of reproductive age or professional caregivers. The Critical Appraisal Skills Programme for Qualitative Studies and the Quality Assessment Tool for Quantitative Studies were used to assess the methodological quality. A standardised form based on the Cochrane guidelines for systematic reviews was used to extract the data. Two independent reviewers performed all methodological steps. Results: Of the 1872 papers found, 27 were included in this review. The majority (66- 100%) of the cancer patients wanted information about the impact of cancer therapy on fertility. The need and importance were higher in younger and childless patients, and in patients having childbearing plans. The number of patients receiving this information ranged from 0% to 85%. Several factors were associated with the lack of information receipt, including female gender and age 35 years or older. Patients preferred information via an individual consultation. In the diagnostic phase patients needed information about the impact of the treatment on fertility and preservation options. At the end or after the treatment, information needs shifted towards long term effects. Professional caregivers experienced several barriers in providing fertility information, including caregiver-, patient- and institutional-related factors. Nurses in particular, perceived difficulty in providing fertility-related information due to additional barriers associated with limited responsibility and opportunity in fertility information provision. Conclusion: Professional caregivers experienced multiple barriers that hinder information provision. Further exploration of the role of Advanced Nurse Practitioners/Midwifes and the development of an evidence based intervention to overcome caregiver-related barriers are recommended to improve information provision. [ABSTRACT FROM AUTHOR]

Background: Diabetes mellitus is one of the most common non-communicable long-term conditions in the world and is linked to high mortality, morbidity, loss of quality of life and high social and economic cost. Diabetes presents a serious health challenge, as it is a significant cause of ill health and premature death. Identification of barriers to self-care is critical for finding ways to reduce the adverse effects of this long-term condition. Objective: This review identified issues that influence ability to self-care for adults living with diabetes types 1 or 2. Design: A systematic review of qualitative research studies using the Joanna Briggs Institute (JBI) approach. Data sources: An electronic search of Health Sciences databases for primary published qualitative studies was conducted April 2011. Reference lists of included articles were reviewed to identify other potential papers. Review methods: Studies that investigated issues identified by individuals living with diabetes type 1 or 2 that influenced ability to self-care were analysed using a process of meta-aggregation. Meta-aggregation involves the extraction of findings, the synthesis of findings through grouping or aggregating similar findings into themes and labelling with appropriate names and a statement that defines the theme and meta-aggregating the themes into overarching syntheses. Methodological quality was assessed by two reviewers against the JBI quality appraisal criteria for qualitative studies. Results: Thirty-seven qualitative studies were reviewed. The main issues impacting on an individual's ability to self-care were 'communication', 'education', 'personal factors', 'provider issues' and 'support'. Multiple barriers were found to influence the day-to-day management of diabetes. Key issues related to communication with health care providers, an education programme that allowed for incremental knowledge gain and experiential and vicarious learning and the provision of culturally sensitive care. Conclusions: People living with diabetes face many issues in their day-to-day manage- ment of the disease, compounded by vulnerability to wider situational, cultural and social issues. Self-care ability is a dynamic, evolutionary process that varies from person to person and involves moving from a disease focused existence to maximising life. [ABSTRACT FROM AUTHOR]

Abstract: Achieving the goal of sustainability requires understanding and management of unprecedented and interconnected challenges. A transdisciplinary approach is a key component of sustainability science. However, there are considerable barriers to implementing transdisciplinary projects. We undertake a mixed quantitative and qualitative analysis of peer-reviewed sustainability science studies where the transdisciplinary approach has been applied. We assess the growth and scientific impact of transdisciplinary sustainability research, the methods used and how three key characteristics of transdisciplinarity research—process phases, knowledge types and the intensity of involvement of practitioners—are implemented. While transdisciplinary research is growing there is no common glossary, no focused communication platform and no commonly shared research framework. Transdisciplinary research utilizes a broad, but not clearly defined, set of methods for knowledge production. While the intensity of practitioner involvement varied within the case studies analyzed, very few realized empowerment. Based on our review of transdisciplinary case study papers we conclude that transdisciplinary research must be clearly framed, including the use of a common terminology and the development of a broad suite of appropriate methods. Despite the challenges highlighted here, science needs to move beyond classical disciplinary approaches and should consider interdisciplinary work that engages with practitioners to achieve sustainable transitions. [Copyright &y& Elsevier]

Efforts to prevent intimate partner violence (IPV) have been informed by emerging research on common triggers of IPV and the importance of engaging with couple dynamics. This paper reports on secondary data analysis from the qualitative evaluations of the SASA! intervention in Uganda, (conducted in 2012 involving 40 community members) and the Indashyikirwa intervention in Rwanda, (conducted between 2014 and 2018 involving 14 couples and 36 other stakeholders). It explores the under-researched linkages between romantic jealousy and IPV, and describes how these interventions mitigated it. A qualitative approach using interviews and focus groups with women and men was used. Overall, jealousy was common in both settings, and led to relationship challenges including breakdown of trust; quarrels about resources; conflict, controlling behaviours, and ultimately, physical and emotional IPV. Jealousy was seen to operate through different gendered pathways. Participants described women to question men about their whereabouts and intentions because of jealousy or the suspicion of infidelity, whereas participants described men to be jealous or suspicious of women socialising with, or attracting the attention of, other men and using violence in response. Through gender transformative strategies, SASA! and Indashyikirwa were described by participants to reduce the contribution of romantic jealousy to conflict and violence by encouraging improved relationship faithfulness and honesty; supporting reduced suspicion through improved relationship trust and communication; and identifying jealousy and suspicion of, or real infidelity, as direct triggers of IPV. While these programmes show promising results, gaps remain including a lack of standardised measures of the multidimensional concept of romantic jealousy. Recognition that programmes should be evaluated for their ability to reduce romantic jealousy when identified as a trigger for IPV in a specific context should also be emphasised. More research is also needed on the forms, gendered pathways, and consequences of romantic jealousy to inform context-specific programming. • Linkages between romantic jealousy and intimate partner violence poorly understood. • Jealousy can lead to relationship conflict and intimate partner violence. • Negative impacts of jealousy operate through different gendered pathways. • Contribution of jealousy to conflict and intimate partner violence can be reduced. • Standardised measures of the multidimensional concept of romantic jealousy required. [ABSTRACT FROM AUTHOR]

Abstract: While many explanations of influence have been proposed there is still debate over which is correct even though most are supported by empirical evidence. This uncertainty has been attributed to there being too little evidence of real-world influence networks, and an inability to separate influence from cognitive similarity, that is, a pre-existing like-mindedness, attitude or way of thinking shared among participants. This paper proposes theme resonance, a new metric for measuring both influence and cognitive similarity between and among participants in the same online conversation. Theme resonance is derived from two textual content analysis systems: Centering Resonance Analysis and qualitative thematic modeling. The use of theme resonance is demonstrated by constructing influence networks using online conversations in ten weblogs, allowing the propagation of new conversational themes to be traced from initiator though subsequent propagators. A method of separating influence from like-mindedness is also demonstrated. Depending on the metric chosen influence and its susceptibility were found both to be opposite ends of the same spectrum, and distinct attributes. In either case the majority of blog participants are close to the low end of each characteristic. However, those at the higher ends are shown to be easily and distinctly identified. [Copyright &y& Elsevier]

Objective: This paper describes the methods followed by the Pisa University OCS for collecting, storing and analyzing all health-related articles and database contents. Moreover, an example population survey on the topic of food safety based on such analysis is shown. Methods: Articles published each day since 1999 in Italy's three most popular newspapers are collected and stored in a Data Base Text; on these articles quantitative and qualitative analyses were conducted. On the basis of these results as well as of epidemiological data, a questionnaire survey was carried out about sources of information, knowledge and risk perception of citizens regarding food safety. Results: On a total of 24,434 articles on all health topics, 18% regarded food related hazards: their evolution over time showed peaks on BSE, avian flu and dioxin. A large proportion of the people surveyed declared having changed their food habits, at least temporarily, as a consequence of media information. Most get their information on food safety mainly from television. Most respondents remembered having previously heard news on BSE, avian flu and dioxin, but did not recall having heard of listeriosis, brucellosis or typhoid fever. Conclusions: Newspapers articles facing food related hazards tend to be alarming thus affecting the citizens risk perception. On the other hand people often ignore how to manage their own food safety in a practical way. Practice implications: Analysis of media messages can help to evaluate and correct the negative effects that may result in wrong information. [Copyright &y& Elsevier]

Abstract: This paper presents a qualitative analysis of the human factor concept, more specifically what it means and includes in everyday professional discourse. It is founded on 10 extensive interviews with professional investigators within the road, maritime and rail administration concerning their practical investigative work. General and specific results are generated of interview contributions using a pragmatic communicative approach and discourse analysis. Results show that human factors is an expression tied to individual professional experience, sparks dissatisfaction and demands specification due to recurring indexicality problems. It tends to be used for negative matters. The specific results, listing eight different meanings, indicate that there is no such thing as a professional usage of the human factor but a spectrum of meanings. The study concludes that the meanings of the human factor (a) always evolve in the dynamic process of producing and understanding language, (b) are context-dependent, and (c) emerge through talk, as one type of discourse. Contrary to ordinary conceptions, there is no simple matter as a human factor that may be used in a routine manner. A non-specific use of the notion may even obscure a course of events and prevent necessary investigation, for example, if the human factor simply replaces a factor such as ‘fatigue’. Although contemporary interdisciplinary research focuses peripheral factors, the idea of individual humans and their erroneous acts has survived – and lives – in the practical world of professional investigators. Empirically deduced meanings need to be continuously highlighted and problematised if theory is to approach everyday professional practice. [Copyright &y& Elsevier]

This paper investigates the impact of the Stepping Stones Creating Futures (SSCF) intervention on young women in informal settlements in eThekwini, South Africa. Specifically, whether following participation in the intervention the young women experienced a reduction in intimate partner violence, strengthened agency and shifted gender relations. Where changes occurred, it examines how they occurred, and barriers and enablers to change. SSCF is a gender transformative and livelihoods strengthening intervention using participatory, reflective small groups. Qualitative research was undertaken with fifteen women participating in the SSCF randomised control trial between 2015 and 2018. The women were followed over 18 months, participating in in-depth interviews at baseline, 12- and 18-months post intervention. To supplement these, eight women were involved in Photovoice work at baseline and 18 months and seven were included in ongoing participant observation. Data were analysed inductively. Data revealed many women changed their behaviours following SSCF, including: having more power within relationships, improved communication and relationship skills, increased resistance to controlling partners, shifting relationship expectations, emergence of new femininities and improved livelihoods. Despite these important shifts many women did not report a reduction in IPV. Nonetheless we argue most of the women, following the intervention, became more agentic. Drawing on the notion of 'distributed agency' as developed by Campbell and Mannell (2016), we show that SSCF bolstered the women's distributed agency. Distributed agency recognizes small agentic acts that women take, acts which to them are significant, it further notes that agency is temporal, fluid, dynamic and context specific. Women do not 'either have agency or not', rather being agentic depends on time, context and the particular incident. These findings provide an important contribution to the limited application of distributed agency and femininities work in informal settlements and are critical for policy and intervention science to reduce IPV and support women's agency. • South African informal settlements have high rates of intimate partner violence. • The Stepping Stones Creating Futures intervention strengthened young women's agency. • Women developed new skills, reduced violent confrontations and improved livelihoods. • However, many women remained in violent relationships. • Participatory, group-based, gender transformative interventions can reduce violence. [ABSTRACT FROM AUTHOR]

• Dog-assisted reading program fosters positive reading experiences for students. • Dog-assisted reading program promotes non-judgemental space for students. • Self-reported increases in reading confidence by students reading to therapy dog. • Dog-assisted reading program supports student wellbeing. • Dog-assisted reading program complements student reading related achievements. Wellbeing is a critical aspect of children's development since it holds a significant role in short- and long-term outcomes, including reading and academic success. Educational policies increasingly highlight the important role schools have in promoting children's wellbeing. One approach gaining traction is the implementation of dog-assisted reading programs in schools. This paper reports on the evaluation of a dog-assisted reading program in Victoria, Australia on children's perceived wellbeing. The dog-assisted reading program was the Story Dogs™ reading program based on the successful Reading Education Assistance Dogs program. The evaluation was conducted with primary school children during Term 2 of the academic school year. Qualitative methodologies were used to explore wellbeing over an eight-week period of involvement in the Story Dogs™ reading program. Participants included 11 children aged 7–8 years of age, 8 parents, 8 teachers and 6 dog handlers. Using semi-structured interviews all participants were interviewed at the end of the eight-week period with the aim of generating rich textual data. The thematic analysis of the semi-structured interviews will be reported and discussed suggesting the program may have potentially enhanced children's perceived wellbeing, particularly in relation to promoting positive engagement and a sense of achievement when reading. Limitations are addressed including the timing of evaluation in second term of the school year after the program has already commenced. Implications will be noted including the importance of clear communication between handlers and teachers as well as the importance of larger-scale studies to generate more robust empirical evidence for the use of dog-assisted reading programs in primary school. [ABSTRACT FROM AUTHOR]

Compassion is integral to professional nursing practice worldwide and a fundamental value in healthcare. Following serious care failures at a healthcare provider in the United Kingdom, a government commissioned report (the Francis Report) made several recommendations for strengthening compassion in nursing care and consequently 'intentional rounding' was incorporated into nursing practice in the United Kingdom. Intentional rounding is a structured process implemented primarily in the United Kingdom, North America and Australia, whereby nurses conduct 1–2 hourly checks on every patient using a standardised protocol and documentation. To examine the role of intentional rounding in the delivery of compassionate nursing care in England from multiple perspectives. This paper reports qualitative findings from one phase of a realist evaluation of intentional rounding which used a mixed-methods approach. Individual, semi-structured interviews were undertaken with 33 nursing staff, 17 senior nurse managers, 34 patients and 28 family carers from three geographically spread case study hospital sites in England. Interviews elicited detailed reflections on the contexts, mechanisms and outcomes of intentional rounding and how it impacted the interviewee and those around them. This study found little evidence that intentional rounding ensures the comfort, safety or dignity of patients or increases the delivery of compassionate care. The systematised approach of intentional rounding emphasises transactional care delivery in the utilisation of prescribed methods of recording or tick boxes rather than relational, individualised patient care. It has the potential to reduce the scope of nursing care to a minimum standard, leading to a focus on the fundamentals as well as the prevention of adverse events. Its documentation is primarily valued by nursing staff as a means of protecting themselves through written proof or 'evidence' of care delivered, rather than as a means of increasing compassionate care. This large-scale, theoretically-driven study of intentional rounding – the first of its kind – demonstrates that intentional rounding prioritises data collection through tick boxes or a prescriptive and structured recording of care. Thus, intentional rounding neither improves the delivery of compassionate nursing care nor addresses the policy imperative it was intended to target. This study raises questions about the role, contribution and outcomes from intentional rounding and suggests a need for a wider, international debate within the nursing profession about its future use. If an intervention to increase compassionate nursing care is required, it may be better to start afresh, rather than attempting to adapt the system currently implemented. [ABSTRACT FROM AUTHOR]

Recent years have seen widespread interest in the process of evidence implementation and growth of implementation science. Whilst this work has drawn attention to the challenges and complexities of implementing evidence into everyday practice, for the most part, studies of implementation uphold the ideal of a linear 'pipeline' between research and front-line care. In contrast, this paper adopts a practice perspective on knowledge, and draws on science and technology studies concepts to identify how the socio-material environment contributes to the translation of evidence across multiple organisational and professional boundaries. Findings report on a qualitative case study of implementing fall prevention research evidence at a large teaching hospital in Portugal. Data is from forty-six in-depth semi-structured interviews with clinical and non-clinical staff. The case highlights how linked boundary objects bridge temporally sequential boundaries between research and different practice communities, hence facilitating the translation of research evidence into everyday practice. The initial boundary object (the 'Morse' fall risk assessment scale) contributed to evidence being taken up by specialist nurses within the hospital, while a second boundary object (a pink patient wristband) engendered a change in practice of a wider network of actors. Nevertheless, the symbolic connection between the two linked boundary objects remained precarious, dependent on networks of interaction and communication. The study highlights the role of material objects in the ongoing translation of research evidence into everyday clinical practice. • Brings insights of science and technology studies to implementation science. • Suggests the role of linked boundary objects in knowledge translation. • Linked boundary objects allow collaboration between non-intersecting communities. • Demonstrates the relationship between social relations and material forms. • Presents evidence on the implementation of falls prevention evidence. [ABSTRACT FROM AUTHOR]

Health and care services for patients may improve or harm the wellbeing of their family carers. Formal consideration of these effects (also known as spillovers) in decision-making is advocated, but, to date, little is known about how they occur. This paper presents the first empirical study to determine the mechanisms by which health and care services affect family carers' wellbeing. The study focused on three major health conditions: dementia, stroke, and mental health. Focus groups and interviews were conducted with 49 purposefully sampled care professionals and family carers in the UK between December 2016 and September 2017. Transcripts were coded and analysed thematically, using descriptive accounts and an explanatory account. The analysis generated six over-arching mechanisms by which health and care services affect family carers' wellbeing, through: (i) information (degree to which service delivery informs and trains family carers); (ii) management of care (shifts of responsibility for care between formal and family sectors); (iii) patient outcomes (services changing patient outcomes); (iv) alienation (feelings of alienation or inclusion created by service delivery); (v) compliance (barriers to patients complying and engaging with services); and (vi) timing or location (changes in the timing or location of services). Each mechanism was associated with sub-themes relating to both positive and negative spillovers on the family carers. The six mechanisms can be summarised with the mnemonic 'IMPACT'. The IMPACT mechanisms may be useful in designing and evaluating services to optimise the wellbeing of carers as well as patients. • Identified mechanisms linking patient services and carer wellbeing. • Mechanisms were 'information', 'management', 'patient', 'alienation', 'compliance', 'timing'. • Summarised by mnemonic IMPACT and relevant across conditions. • Each mechanism generated positive and negative spillover. [ABSTRACT FROM AUTHOR]