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Schizophrenia is a global concern, and, this paper, describes the caring roles of health professionals who are mothers of adult children with schizophrenia. A thematic analysis of data from a doctoral study identified a blending of expertise into an informed care model. Caring roles included: constant carer; coordinator carer; watchful bystander carer; and life coach carer. Previous research has not explored these dual roles. This paper elucidates their responsive approaches and contributions to mothering and caregiving roles. Informed by a fusion of professional and mothering knowledges, their insights into mental health care have been forged by their experiences and is an untapped resource. [ABSTRACT FROM AUTHOR]

Islands are significantly on the agenda in Scotland. Media accounts – news, features, and other creative narratives – textually frame the representational terrains of island policy, agency and community. Such mediatization informs and responds to certain ideas and discourses of our island geographies. It typically includes what could be considered good islandness: that is, islands as good lifestyle havens, sites of social resilience and adaptive social renewal. During the COVID-19 pandemic, certain spaces and geographies were notably re-evaluated. Sites of 'isolation', 'remoteness' and places considered 'far from' occupied a heightened position of desirability and potential refuge. A purposive sample of stories and features is presented here to capture case exemplars of how Scotland's island space and place geographies were variously textually framed by media news across the initial lockdown and subsequent significant travel restriction phases (March 2020 to October 2020). The discussion explores how a short-view media framing of Scotland's island spaces specifically during the COVID-19 pandemic spoke to aspects of islandness as refuge and as resilience. The paper offers a longer-view perspective whereby the complexities and complicities of media framing of Scottish rural and island spaces as resilient is considered more broadly. [ABSTRACT FROM AUTHOR]

Scotland is faced with pernicious health inequalities, which stem from inequalities in living conditions and the societal structures that create them. While action is needed to address the wider structural causes of health inequalities, the role of general practitioners (GPs) merits attention due to health care's potential to mitigate or exacerbate health inequalities. Minimal research, however, has explored how GPs understand the fundamental causes of health inequalities nor how they conceptualise their role in mitigating these. This paper aims to fill this gap using in-depth qualitative interviews with 24 GPs working in some of Scotland's most socio-economically disadvantaged, urban areas. Using Raphael's SDH discourse framework, this paper found clear linkages between GPs' perceptions of their patients, how they defined the 'problem' of health inequalities, and what they thought could be done to tackle them in disadvantaged areas. In general, there was convergence on how interviewees viewed their role in mitigating health inequalities through their work with individual patients. However, greater variation was found when describing the boundaries of their role and how far these extended beyond individual encounters. Specifically, only those GPs fluent in discussing structural causes of health inequalities discussed obligations to change local systems via strengthening community linkages and to influence higher level policies related to the SDH. This suggests that while there is a degree of what Metzl and Hansen deem 'structural competency' amongst some GPs working in disadvantaged areas, the scope remains to deepen this competency more broadly. [ABSTRACT FROM AUTHOR]

Service users were interviewed as part of a multi-method evaluation of an alcohol and drug social work service in Scotland. This paper explores service user interviews that were conducted in the evaluation, addressing the following questions: What did the service users feel about the service itself? Leading on from this, what did they see as helpful in facilitating their recovery in general? The research will be contextualised in Scotland’s culture of problematic drug and alcohol use, Scottish drug and alcohol policy and the emerging recovery-orientated approach. The methodology of the evaluation will be explained and findings from the service user interviews will be outlined under the headings: therapeutic relationships, outreach, timeframe, and holistic approach and joint working. The paper demonstrates the importance of service user accounts not only for providing general feedback on social work services, but also for giving specific insight into what is helpful for individuals seeking to recover from substance use problems. [ABSTRACT FROM AUTHOR]

By providing a place in which children can be accessed, the school has long been a site for population-level health initiatives. Recent policy shifts towards health-promoting schools have however re-cast the school from passive host to active collaborator in public health. This paper examines secondary school teachers' views of their roles as partners in Scotland's human papilloma virus vaccination programme. Focus groups were held in seven schools across Scotland. Confusion was evident in relation to this role, with competing understandings of young women's sexuality, concerns about parental perceptions and uncertainty about professional responsibilities. Many teachers sought to distance themselves from the vaccination programme. Evidence was found of a ‘sedimentation of discourses’, as mass models of state-sanctioned health intervention persist alongside contemporary discourses of individual choice. [ABSTRACT FROM PUBLISHER]

Managing risk is a key component of mental health social work practice, with the literature detailing two unique approaches to risk management — the dominant risk minimisation strategies and the less favoured risk-taking approaches. Due to a lack of research it is unclear, however, whether this is a practice reality, how professionals reconcile the tension between the two approaches and practice dilemmas, and the impact of wider factors perceived to influence these decisions. This paper aims to address these questions by drawing on 2010 research that undertook qualitative semi-structured interviews with seven Mental Health Officers in a Scottish local authority. Whilst the study found risk was generally constructed as relating to harm and danger, in practice a more measured approach to risk management was identified, with both approaches being employed, and a new acceptance of risk as potentially positive by organisations and practitioners was recognised. Participants illustrated how decisions are reached, without feeling inhibited by the ‘blame culture’, but clarified that this involved dilemmas and was a fraught area of practice. The paper concludes that more scope for positive risk-taking is desirable and requires the support of the policy context, legislation and organisations. [ABSTRACT FROM AUTHOR]

Background:Deaths associated with alcohol and/or drugs belong to a category of ‘special’ deaths due to three characteristics: traumatic circumstances of the death, stigma directed to both the bereaved and the deceased, and resulting disenfranchised grief experienced by the bereaved. These factors can impede those who are bereaved in this way from both grieving and accessing support. In response to a lack of research in this area this paper reports on an interview study that has aimed to better understand the experiences and needs of this neglected group of bereaved people. Method:Interviews with 106 adults (parents, children, spouses, siblings, nieces and friends) bereaved through substance use in Scotland and England. Results:Five themes describe interviewee experiences: possibility of death, official processes, stigma, grief and support. These findings suggest what is dominant or unique in this group of bereaved people; namely, that living with substance use (including anticipatory grief), experiencing the subsequent death (often traumatic and stigmatised) and the responses of professionals and others (more likely negative than positive) can disenfranchise grief and negatively impact bereavement and seeking support. Conclusions:This article describes a large and unique sample, the largest in the world to be recruited from this population. Our study raises awareness of a hitherto largely ignored and marginalised group of bereaved people, highlighting what might be particular to their bereavement experience and how this may differ from other bereavements, thereby providing an evidence base for improving the availability, level and quality of support. [ABSTRACT FROM AUTHOR]

This paper explores the extent to which students on a vocational postgraduate programme identify with characteristics and competences that define a professional career guidance and counselling practitioner. Literature suggests professionalism in careers work is characterised by a focus on the needs of the client with the practitioner in a facilitative role. Competences are often couched in developmental terms, with practitioners moving from inexperienced to experienced. Students identified the most valued characteristics as adherence to professional values and ethical standards with an emphasis on person-centred practice. They recognised that competence was a developmental process, characterising themselves as at an early stage on completion of their course. Supporting the client took precedence over issues such as advocating for the profession, supporting employers and social responsibility. Generally, students saw completing a programme of study either as a beginning to a process of development of professionalism or as part of their professional development. [ABSTRACT FROM AUTHOR]

Supported self-management (SSM) is an important part of adapting to life after stroke however it is a complex concept. It is unclear what SSM in stroke consists of or how stroke survivors, families, and clinicians can most effectively work together to support person-centred self-management. In this study, we aimed to explore what was most important in making SSM work in community stroke rehabilitation. We conducted a Q-methodology study with stroke survivors (n = 20), community-based stroke clinicians (n = 20), and team managers (n = 8) across four health boards in Scotland, United Kingdom. Participants ranked 32 statements according to their importance in making SSM work. Factor analysis was used to identify shared viewpoints. We identified four viewpoints: (i) A person-centred approach to build self-confidence and self-worth; (ii) Feeling heard, understood, and supported by everybody; (iii) Preparation of appropriate resources; and (iv) Right thing, right place, right time for the individual. Important across all viewpoints were: a trusting supportive relationship; working in partnership; focusing on meaningful goals; and building self-confidence. Differing views exist on what is most important in SSM. These views could be used to inform quality improvement strategies to support the delivery of SSM that considers the preferences of stroke survivors. Clinicians should be aware of their own viewpoint of supported self-management and consider how their perspective may differ from stroke survivors' and colleagues' perspectives of what's important to support self-management. Working in partnership with stroke survivors plus developing a trusting and supportive relationship with them are core components of supporting self-management in the longer term after stroke. Building a sense of self-worth and self-confidence, a focus on meaningful goals, training and support for staff, and tailoring support to people's needs at the right time are important considerations for supporting longer-term engagement in self-management. [ABSTRACT FROM AUTHOR]

We examine how asylum seekers and refugees living in Glasgow use various tactics to survive and navigate everyday challenges within the restrictive UK immigration system. Thirty interviews were conducted with asylum seekers and refugees of various nationalities and personal backgrounds (ethnicity, class, education and migratory circumstances). Twenty state and third sector organisation staff were also interviewed. Participant observation within third sector organisations was also undertaken. While asylum seekers and refugees feel uncertainties and challenges, we found that they actively use various tactics to navigate the often-lengthy UK asylum process. 'Agency in waiting' encompasses the negative impact of a long stagnation period endured while awaiting confirmation of refugee status and the tactics developed despite the difficulties that asylum seekers and refugees face. We consider three ways that tactics are used: to gain familiarity, to engage in meaningful activities, and to establish social connections. [ABSTRACT FROM AUTHOR]

The proposition that teaching is a reflective profession is prominent within educational discourse. Theories that underpin reflection are a critical component of initial teacher education (ITE) programmes. This study aims to assess the reliability of the modified Reflective Practice Questionnaire (RPQ) in a population of ITE students; and to compare the study findings to other studies using the RPQ in other professions. This study reports cross-sectional findings for reflective capacity in ITE students undertaking three different ITE programmes, the Bachelor of Arts (Hons) (BA) Education [n=91], Professional Graduate Diploma in Education (PGDE) Primary [n=209] and Secondary [n=167], in one Scottish university. Findings show that the modified RPQ reliably assesses reflective capacity (Cronbach's alpha 0.82), which differs depending on the programme of study followed. BA students' reflective capacity is higher than that of PGDE (P) but is not different to PGDE (S) students. PGDE (P) students differing from BA students in terms of Reflection-in-Action (RiA), Self-Appraisal (SA), Confidence (general) (CG), and Confidence (communication) (CC), whereas PGDE (S) and BA students differ in terms of SA, CG CC and Stress interacting with Pupils (SiP). This study indicates student teachers' reflective capacity is higher than those found in studies of other professions. [ABSTRACT FROM AUTHOR]

Performance analysis is extensively used in sport, but its pedagogical application is little understood. Given its expanding role across football, this study explored the experiences of neophyte performance analysts. Experiences of six analysis interns, across three professional football clubs, were investigated as multiple cases of new match analysis. Each intern was interviewed after their first season, with archival data providing background information. Four themes emerged from qualitative analysis: (1) “building of relationships” was important, along with trust and role clarity; (2) “establishing an analysis system” was difficult due to tacit coach knowledge, but analysis was established; (3) the quality of the “feedback process” hinged on coaching styles, with balance of feedback and athlete engagement considered essential; (4) “establishing effect” was complex with no statistical effects reported; yet enhanced relationships, role clarity, and improved performances were reported. Other emic accounts are required to further understand occupational culture within performance analysis. [ABSTRACT FROM AUTHOR]

The present study sought the views of stakeholders, including school leaders and statutory stakeholders, on the content and evaluation of a classroom-based alcohol education intervention in a Randomised Controlled Trial in Scotland and Northern Ireland. Purposive sampling was used to ensure that schools from both the Intervention and Control groups were equally represented, and to ensure that similar numbers and grades of stakeholders in both countries were represented. A total of 27 participants (Male = 13 (48%); Female = 14 (52%)) engaged in a semi-structured interview prior to the end of the trial. Results suggest that: schools generally design their own alcohol education programmes; that intervention schools thought highly of the particular intervention tested; and that both groups engaged meaningfully in the research. The threshold for acceptance of the intervention was lower than the successful outcome of the trial. More pragmatic considerations were considered equally important. From the point of view of the statutory stakeholders, funding of an intervention depends on a successful outcome evaluation, but that “success” may mean a positive impact on at-risk groups, and not necessarily at a universal level. School-based participants also focussed on ease of delivery and user friendliness as key determinants of programme utilisation. [ABSTRACT FROM PUBLISHER]

Alcohol consumption by adolescents in the United Kingdom (UK) remains high. School-based interventions are expected to play a key role in preventing adolescent alcohol consumption. A series of focus groups were conducted with pupils who received alcohol education as usual and pupils who received a Northern Ireland adaptation of the School Health and Alcohol Harm Reduction Project (SHAHRP), a universal alcohol education program designed to reduce the harms experienced by young drinkers. This study sought to compare and contrast the participants’ engagement with and enjoyment of the different alcohol education that they had received. Focus groups were completed with 129 pupils in 16 schools in Northern Ireland and Scotland. Alcohol education as usual was viewed negatively and was regarded as unstructured, boring, repetitive, and unrealistic. In contrast, the adaptation of SHAHRP was viewed positively and was regarded as enjoyable and worthwhile, and engaging and relevant to the participants’ experiences of alcohol use. These findings suggest that one reason why alcohol education as usual may not be successful in preventing adolescent drinking and protecting adolescents from negative outcomes may be due to its failure to engage participants. Higher acceptability by pupils means that the adaptation of SHAHRP may be one viable alternative. [ABSTRACT FROM AUTHOR]

Objectives. We explored the role of faith and religious identities in shaping end of life experiences in South Asian Muslims and Sikhs with life-limiting illnesses. Design. Secondary analysis of data from a longitudinal, multi-perspective qualitative study of the experience of life-limiting illness and access to palliative care services among South Asian Sikhs and Muslims in Scotland. Up to three semi-structured interviews were conducted with 25 participants, 15 family members and 20 health care professionals over a period of 18 months. Analysis was informed by Mattingly's theory on hope. Results. Hope emerged as a central construct in the accounts of illness constructed by the participants as they struggled to make sense of and uphold a meaningful life. Clinical encounters and, for some, religious beliefs served as sources of hope for participants. Hope unfolded as an active process that enabled them to live with the personal and in particular the social ramifications of their illness. Changing images of hope were formulated and reflected as illness progressed or treatments failed. These ranged from hoping for cure, prolonged life, the regaining of lost capabilities needed to fulfil social roles, or at times death when suffering and the consequences for the family became too hard to bear. Conclusions. For those suffering from a life-limiting illness, sustaining hope is a complex challenge. The social character of hope is evident as it focuses on envisioning a life that is worth living, not only for oneself, but most importantly for social relations. Continuity in care at the end of life and a holistic approach is important in order to enable patients to articulate complex and changing notions of hope that at times are silenced within families, and for patients to feel confident in discussing the possible role of religious beliefs in shaping personal notions of hope. [ABSTRACT FROM AUTHOR]

Objective: The objective was to explore young mothers’ experiences of seeking and accessing health services, specifically maternity care. Study design: A phenomenological approach underpinned by the work of Husserl and guided by the framework offered by Giorgi. Participants: A purposive sample of seven young mothers took part in audio-recorded unstructured interviews in either the young mother’s home or in a private room at their GP practice. Findings: Six themes emerged from the initial thematic analysis: (1) feeling abandoned, (2) information is vital, (3) feeling judged, (4) family and friends, (5) interference, (6) younger mothers need additional support. After ‘bracketing’ the preconceptions evident in the initial analysis, essential themes describing the young mothers’ experience of accessing healthcare were identified: (1) the need for support and information; (2) fear of stigmatisation and stigmatisation of self. Conclusions: The young mothers in this study experienced a need for support and information, which reflects the findings of previous studies. This study has added to the knowledge base as it also found that these young mothers were hindered from obtaining or making use of available support and information through fear or expectation of stigmatisation and self-stigmatisation. There is a need to improve availability of support and information for young mothers, who may benefit from one-to-one education to help them gain confidence to deal with pregnancy and parenthood issues. Further research on young mothers’ perceptions of maternity service provision will advance understanding of young mothers’ help and support needs during pregnancy, birth and the postnatal period. [ABSTRACT FROM PUBLISHER]

Nurture groups (NGs) are increasingly being established in Scottish secondary schools yet research in this context is limited. The current study explores the purpose, features and value of two NGs in a Scottish secondary school through interviewing current and former NG members, parents/carers, NG staff and other school staff. A thematic analysis of the findings suggests that the two NGs offer young people a smooth transition from primary, prepare them physically and emotionally for learning, encourage friendships and equip them with social skills. However, optimal function and gains are compromised by systemic gaps in formal communication, monitoring and reintegration processes across the school and between school and home, among others. These factors are discussed in the context of their importance in supporting generalisation of skills outwith the NG and the function of the wider organisation. [ABSTRACT FROM AUTHOR]

This article explores the ways that individuals experience recovery from gambling problems. Arguing against reductive, bio-medical models of addiction, we adopt a broadly interpretive epistemology to analyse gamblers' narratives of recovery. Using data from a longitudinal qualitative study of 'gambling careers' we suggest that processes of behaviour change are embedded in wider social relations and revolve around shifting concepts of self-identity. This involves processes of biographical and temporal reconstruction which are grounded in material circumstances, particularly those relating to money and social relationships. Various configurations of recovery exist, but common to all is a dynamic temporal reorientation and an increased sense of agency and authenticity as individuals move into a future that they feel they have some control over. These narratives suggest that experiences of gambling addiction and recovery, and the self-concepts that accompany them, are fluid and contextual and that 'managing' gambling is about re-shaping the self in culturally appropriate ways. It is hoped that aspects of this analysis may be of relevance for understanding the narrative dimensions of addiction and recovery more generally. [ABSTRACT FROM AUTHOR]

Working models of attachment are internal depictions of self relative to others and have been described in terms of two dimensions: (1) attachment avoidance and (2) attachment anxiety. An exploratory qualitative study was carried out to build understandings about women with Turner Syndrome (TS) and the psychosocial impact their infertility has upon salient relationships. In one-to-one semi-structured interviews, five women with TS were asked: How do you perceive your womanhood and infertility status has affected your relationships with: (1) the opposite sex, (2) siblings and (3) peers? In opposite-sex relationships, infertility status was found to arouse fear of ending up alone and anxiety over engaging in romantic relationships. In sibling relationships, jealousy was expressed in relation to disparity with sister(s) more natural maturation to womanhood, and, within peer relationships, consequences from divulging infertility status created attachment avoidance with friends. Further investigation in this area is merited. [ABSTRACT FROM PUBLISHER]

Background: Research exploring the experiences of trainee doctors in remote and rural locations is scarce. Our aim was to gain an understanding of the experiences and perceptions of Foundation Programme (FP) doctors training in placements in remote and rural areas of the north of Scotland. Methods: FP doctors training in remote and rural areas in Scotland took part in a qualitative study (focus groups and individual interviews) exploring their training experiences and career plans. To make sense of a potential multitude of factors, we selected social cognitive careers theory (SCCT) to underpin data collection and analysis. Results: A total of 20 trainees participated. Using data-driven analysis, three themes relevant to the SCCT emerged. These are the educational experience (e.g., opportunities to develop skills, greater responsibility), geographical isolation factors (e.g., the impact of staff shortages, poor accommodation, travel) and personal factors (e.g., social isolation, attitudes towards the experience). Conclusion: Many factors impact on trainees' experience of learning and living in remote and rural medicine (R&R) environments. These experiences can be very positive for some individuals but factors external to the educational environment influence the perception of the overall experience. SCCT helps clarify the interaction between individual and contextual factors in career decision making. [ABSTRACT FROM AUTHOR]