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This paper explores how neoliberal ideologies inform both social and political agendas that influence how social workers can provide support to trans and gender diverse people attempting to access gender-affirming healthcare, using an analysis of social workers' experiences working in mental health in Nova Scotia, Canada. Qualitative semi-structured interviews provide a perspective of the experiences of social workers in Nova Scotia and how their ability to provide mental health services to trans and gender diverse people is impacted by neoliberalism. Most social workers attributed the structural context of working within a bio-medical system as contributing to social workers being disempowered, undermined, and not able to practice according to the values of their profession thus limiting their ability to provide affirming mental health supports to trans and gender diverse people in ways that align with their social work professional ethics and values. Through examining how neoliberal ideologies create notions of ideal social citizens by controlling the body, the paper explores how lived experience of neoliberal practices in mental health social work reinforce transnormativity. This paper highlights the necessity for social workers to resist dominant neoliberal and medicalized discourses which serve as mechanisms of power and control. The paper concludes with recommendations for social work practice with trans and gender diverse populations. [ABSTRACT FROM AUTHOR]

Older adults face distinct challenges amidst changing neighborhood conditions, yet also bring distinct resources to aid their communities. After considering the literature related to well-being in older adulthood, the effects of neighborhood change on older adults, and older adults and social action, this paper explores the experiences of older adults in the Neighborhood Story Project. This action research project engages a group of neighbors to identify a set of research questions about their community, conduct place-based inquiry, and take action based on their learning. This study considers the degree to which the Neighborhood Story Project constitutes a macro therapeutic intervention. Drawing on observational and interview data with participants in seven Neighborhood Story Projects, this study explores the resources older adults brought to the project, what they personally gained from participating, and how their work benefited the broader community. The paper concludes with implications for macro-therapeutic interventions with older adults living through neighborhood change. [ABSTRACT FROM AUTHOR]

As policymakers globally recognize aging in place as the preferred option for most adults, there is a growing need to supplement family or informal caregiving for frail older adults with formal homecare services, particularly for those who require 24/7 care due to significant physical and/or cognitive impairment. The core objective of this qualitative study was to explore family members' experiences in employing live-in care workers, particularly the nature of their engagement and the quality of their relationships with these care workers. Our analysis of semi-structured interviews with 35 family caregivers revealed four themes: 1) challenges in acquiring support and developing dependency; 2) negotiation of roles, responsibilities, and moral dilemmas; 3) shifting emotions between trust and suspicion; and 4) role confusion, expectations, and disappointments. The study suggests that families might benefit from formal guidance regarding fostering and maintaining positive relationships in the homecare environment. This paper provides nuanced knowledge that may inform the development of such interventions. [ABSTRACT FROM AUTHOR]

Previous research has suggested that older trans and gender non-conforming (TGNC) people may face particular challenges related to stigma, social exclusion and discrimination in later life. However, direct data on social support and needs in older TGNC population both internationally and within the UK is limited due to the small, dispersed nature of this population, and the absence of specific data collection on aging TGNC populations. During the UK COVID-19 lockdown in summer 2020, older people and those with long-term health conditions were advised to adopt particular precautions. This study aimed to explore older TGNC people's social support networks, key concerns and unmet needs during the COVID-19 'lockdown'. A UK cross-sectional survey of LGBT + people aged 60+ (n = 375) was undertaken during the lockdown. This paper analyses responses from the subset (n = 38) of TGNC participants. The majority of TGNC respondents described diverse social networks, often centered around friends and non-kin social networks, although partners and adult children were also significant for some. In most cases, those with existing strong networks continued to maintain social connections during lockdown, albeit with some regrets about loss of activities and face-to-face connection. However, a minority of respondents had experienced greater challenges prior to lockdown, and may have been at increased vulnerability during the pandemic, for example indicating that they had no-one to call on for practical support in an emergency. When asked about unmet needs and challenges, social isolation was repeatedly raised as the most frequent concern. Several respondents also mentioned issues specifically affecting TGNC communities, including access to gender affirming care and a perceived rise in social intolerance. Health and social care providers should be aware of the diversity of support networks within TGNC communities. There may also be benefits in community sector interventions to help older TGNC build and maintain strong social networks. [ABSTRACT FROM AUTHOR]

This paper explores the perception of "relatives" during the rehabilitation of young adults with severe acquired brain injury (SABI). This longitudinal qualitative study followed eight young adults with a SABI from hospital discharge to a year and a half after discharge. The design encompassed professional records, interviews, and surveys, including a name generator list completed by the young adults and focus group interviews with both their families and professionals. We apply a sociological theoretical framework concerning friendship, and we employ social network analysis (SNA) methodology to capture, visualise, and analyse the young adults' significant social relations. Social relations engaged as relatives during rehabilitation are to a large extent determined by the perceptions of professionals and the parents of the young adult. These perceptions contain a limited number of social relations, with priority given to biological and juridical ties. This might reflect the reduced social support available for the young adult, who initially had a much larger social network. The authors suggest a professional rethinking of who "relatives" are as well as considering these social ties as dynamic. Rehabilitation professionals must be aware of and pay attention to differing perceptions that exist as to who qualifies as significant social relations in order to reconsider the practical implementation of relative involvement. The perception of who relatives are during the rehabilitation process should be reconsidered and extended to include who the young adult perceive as significant social relations. Relatives are not a fixed entity and should be considered dynamically throughout the rehabilitation process. Social relations of the young adult must to a larger extent be considered during rehabilitation to prevent social isolation in the long run. [ABSTRACT FROM AUTHOR]

Globally, transgender people have been described as a highly marginalised population due to cisgenderism that delegitimises their gender identities and expressions. Despite robust evidence from many countries noting the association of discrimination and stigma for being transgender with heightened mental health risks, qualitative research that examines the nuances of mental health indicators using health equity frameworks has been scant both in Aotearoa/New Zealand and overseas. Using an inductive thematic approach, this paper analysed 222 open-text responses in the mental health section of the 2018 Counting Ourselves: Aotearoa New Zealand, Trans and Non-binary Health Survey. Our findings showed four overarching themes: gender-affirming healthcare, mental healthcare services and accessibility, gender minority stress, and self-affirmation and social support. Participants' narratives described pervasive gender minority stress experiences in gender-affirming and mental healthcare services, including unmet healthcare needs, lack of competency in healthcare delivery, and pathologisation of their genders. In social settings, our participants commonly reported discrimination and violence, although they also reported that self-affirmation strategies and social support offset the impacts of gender minority stress on their mental health. The current findings indicate the importance of exploring mental health outcomes for transgender people in relation to cisgenderism and resultant gender minority stress. [ABSTRACT FROM AUTHOR]

In pregnancy, the attachment relationship between a mother and her baby begins to develop and women are more motivated and willing to make changes to become more engaged and responsive mothers and have better relationships with their children. A transgenerational framework has proposed that dysfunctional relationship patterns are often repeated across generations and this has broadened the understanding of early difficulties in parenting. Despite this there has been little research specifically examining high-risk perinatal women and how their interactions with their infants are related to attachment or relational outcomes. This pilot study aims to evaluate, and to explore the acceptability and feasibility, of participating in the Supporting Transitions, Attachment and Relationships (STAR Mums) program, a psychodynamic attachment-based group intervention, for pregnant women with risk factors for attachment difficulties. The STAR Mums program aims to intervene during pregnancy to assist women with risk factors in the transition to parenthood with the desired outcome to improve the quality of mother-infant emotional interactions, regulation and the attachment relationship. This is a mixed-methods design study incorporating both qualitative and quantitative assessments of five groups of five first-time mothers over a 12-month period. This paper outlines the STAR Mums intervention and protocol for assessing acceptability and feasibility. The STAR Mums program takes a preventative approach and supports early intervention for parents at risk of attachment difficulties with their infants. The results of this study will inform revisions to the current treatment manual and a larger-scale program evaluation to further examine the efficacy of this intervention. [ABSTRACT FROM AUTHOR]

Peer-befriending, where support is offered by someone with shared lived experience, is an intervention that may facilitate successful adjustment in people experiencing post-stroke aphasia. This paper explores the experiences of the peer-befrienders. People with aphasia were recruited as peer-befrienders within the SUPERB trial investigating befriending for people with post-stroke aphasia. The intervention comprised six visits over three months. Peer-befrienders were matched with at least one befriendee and received training and ongoing supervision. They were invited to participate in in-depth interviews which were analysed using framework analysis. All 10 befrienders participated in interviews, reporting on 19 matches. Seven main themes emerged: content of the sessions; befriender–befriendee relationship; negotiating the visits; handling boundaries and endings; positive impact of the befriending for befrienders and befriendees; and beliefs about the nature and value of peer support. While befrienders described challenges, such as negotiating journeys and witnessing distress, the role was perceived as a "secure challenge" due to the support and training received. Befrienders perceived the role as enjoyable and rewarding, and felt they were making a positive difference. They were unanimous in believing that people with aphasia can offer unique and valuable support to others with aphasia. ClinicalTrials.gov identifier NCT02947776, registered 28th October 2016. People with lived experience of stroke and aphasia were able to offer emotional and social peer support to others with aphasia within the SUPERB trial. Although there were challenges, peer befrienders perceived the role as rewarding and satisfying. Peer befrienders valued the training and ongoing supervision and support they received to deliver the intervention. It is recommended that rehabilitation professionals considering offering peer-befriending schemes provide training and ongoing supervision to support peer-befrienders fulfil their role, as well as practical support with, e.g., arranging visits. [ABSTRACT FROM AUTHOR]

This study aimed to explore the perspectives of working-aged adults with post-stroke aphasia (PWA) towards what has or would help them in living well with aphasia (LWA). This paper reports the findings in relation to stroke care and its relevance for LWA. This qualitative study was designed with input from a Public and Patient Involvement advisory group. We conducted in-depth, semi-structured interviews with 14 PWA. Data were analysed following principles of reflexive thematic analysis. Support services and LWA spanned five themes: Inpatient care; Support in the community; Speech therapy; Mental health; and Aphasia education and training. Per the findings, all aspects of stroke care were affected and challenged by aphasia. Access to services and information was variable. PWA of working-age, their families and children need access to person-centred stroke care and information responsive to their changing needs at all stages of recovery. Healthcare workers must be equipped with aphasia competency. The results highlight a need for equitable, transparent, responsive access to services, information and stroke liaison support. The findings extend knowledge of the importance of stroke care for supporting working-aged adults and their families to live well in the context of aphasia. There is a need for equitable, transparent access to a responsive integrated pathway of stroke care to support living well with aphasia. People with aphasia post-stroke and their families need access to person-centred stroke care and information responsive to their changing needs at all stages of recovery. This includes flexible access to mental healthcare and speech and language therapy. In order to access relevant care, people with post-stroke aphasia need access to information and stroke liaison support. Training to improve aphasia competency is imperative for healthcare workers. [ABSTRACT FROM AUTHOR]

This paper presents findings of a study that explored the challenges and coping strategies of parents of children with mental disorders. In-depth interviews were conducted with 35 parents of children with mental disorders at the Psychiatric Unit of the Komfo Anokye Teaching Hospital in Kumasi. Data were analyzed using thematic content analysis. Findings indicated that financial constraints, inability to secure permanent employment, and stigma were the challenges of the parents. Having faith in God and accepting their children's condition were the coping strategies adopted by the parents. However, lack of effective support system makes coping difficult for the parents. [ABSTRACT FROM AUTHOR]

Understanding Twitter by individuals and organizations to raise awareness and give voice to the disability community provides important insight into digital discourse around disability. This study examines #disability tweets shared during National Disability Employment Awareness Month in October 2018. Sourced and cleaned, English language tweets (n = 12,963) were analyzed through a mixed-methods approach. As the title of this paper, a tweet from our dataset, suggests, Twitter discourse reflects disability activism and culture as it exists globally. This work highlights important methodological considerations for differentiating the ways individuals and organizations utilize Twitter and highlights the importance of qualitative analysis in this regard. [ABSTRACT FROM AUTHOR]

Increasing scholarly attention has been paid to the reproductive injustices experienced by Indigenous women. However, the breastfeeding experiences of Indigenous women have infrequently been explored. This study uses a qualitative description research approach to explore the breastfeeding experiences of Indigenous women members of a non-federally recognized tribe in the Gulf South. Key themes included: 1) Shifting generational practices; 2) Lack of institutional resources; 3) Inadequate support from healthcare providers; and 4) Institutional and community supports for breastfeeding. These findings highlight the need for increased institutional and community support, and breastfeeding education, so that Indigenous women can reach their breastfeeding goals. [ABSTRACT FROM AUTHOR]

Purpose: Little is known about the barriers and facilitators to pregnancy, birth and motherhood for disabled women within the New Zealand context. Our study explored this deficit with the aim of improving health care interventions and support for disabled mothers. Methods: This paper reports on the third phase of a mixed-methods study. The first two phases used semi-structured individual and focus group interviews with disabled women, and health professionals, involved in maternity and postnatal care and has been reported elsewhere. Phase 3 utilised a modified Delphi technique with both groups of participants to seek consensus on the prioritisation of recommendations from the study. This article focuses on the disabled women's recommendations. Results: In all, 20 disabled women took part in the Delphi phase of the study (28% of the cohort from Phase 1). In total, 11 key recommendations were identified by the disabled women, with the top seven discussed in detail here. Conclusions: Health professionals and health systems could, and arguably should, utilise a matrix of these recommendations to facilitate a review of service responsiveness to disabled women. [ABSTRACT FROM AUTHOR]

Hospital-based chaplains provide crucial spiritual and emotional care to patients, families, and staff during times of intense life changes and crises. Chaplains are regularly exposed to suffering and their work may result in personal mental and emotional health challenges. To understand chaplains' perceptions of the impact of their work and methods to cope, a secondary analysis of a mixed-methods study on chaplain well-being was undertaken. Qualitative interviews were conducted with nine hospital-based chaplains and data were coded and analyzed using thematic analysis. Results revealed that participants perceive their work as offering both trials and rewards, and their efforts to cope with trials include interpersonal support, intrapersonal resources, and spiritual resilience. Personal insights into chaplains' experiences may help inform organizational interventions to support these essential members of the care team. [ABSTRACT FROM AUTHOR]

This study explored the experiences of the first generation of adolescents who acquired HIV through vertical transmission when disclosing their diagnosis to friends and romantic partners. The study sample was selected by convenience, with 20 patients (13–20 years old) participating in a qualitative investigation using individual interviews (language: Portuguese; duration: 45 minutes). The participants were followed in specialized clinics for the treatment of pediatric AIDS in São Paulo, Brazil. The results suggest that families who live with HIV tend to keep it a secret, and such behavior is learned and accepted unquestioningly as natural. Respect for privacy and the fear of rejection, coupled with the belief that information about their disease will be spread, are the main beliefs with which participants justify their secrecy. In terms of romantic relationships, adolescents were aware that their HIV status should at some point be shared with current or future sexual partners. However, the decision to reveal an HIV diagnosis in romantic relationships is permeated by anxieties, uncertainties about the right time, and fear of abandonment. In any case, telling the truth requires trust, guarantees of the other’s love, and, in some cases, probing romantic partners beforehand to learn their perceptions about the disease. Participants who had experiences disclosing their HIV status shared positive and negative results, including emotional support, acceptance, and understanding, along with ostracism, discrimination, and abandonment by family members. The findings of this paper reinforce the challenges of revealing an HIV diagnosis to third parties. It requires understanding the meaning and importance of the secret for each patient, along with the conflict between the right to confidentiality and the responsibility of treating others exposed to the disease. All these aspects should be discussed extensively with this population and incorporated into clinical practice. [ABSTRACT FROM PUBLISHER]

Purpose: Healthcare staff are on the frontline during disasters despite any personal adversity and vicarious trauma they may be experiencing. Wellness Warrior training is a post-disaster intervention developed in response to the 2019-2020 Australian bushfires to support staff in a rural hospital located on the South Coast of New South Wales, Australia. Method: This study explored the experiences and perspectives of 18 healthcare staff who were trained to provide emotional and peer support to their colleagues in the aftermath of a crisis. All the Wellness Warriors participated in semi-structured interviews between March and April 2020. Data were analysed using the reflexive thematic approach. Results: Healthcare staff reported developing interpersonal skills around deep listening and connecting with others which allowed for hearing the core of their colleagues' concerns. The training also helped staff to feel differently about work and restored their faith in healthcare leadership. Conclusion: Wellness Warrior training provided staff with knowledge and skills to support their colleagues in the aftermath of a natural disaster and later during the COVID-19 pandemic. As such, these findings suggest that peer support programs such as Wellness Warriors could be one way healthcare organisations can attempt to alleviate the psychological impact of natural disasters. [ABSTRACT FROM AUTHOR]

Foster carers have a significant responsibility in caring for vulnerable children. In order to support and facilitate foster carers it is important to understand how they perceive and fulfil this responsibility. A qualitative story-telling study, informed by feminist perspectives, was used to conduct in-depth, semi-structured interviews with 20 women providing long-term foster care in Australia. Thematic analysis revealed these women characterised themselves as mothers, rather than paid carers, to the long-term foster children in their care. Using this maternal self-perception as the starting point, this paper reveals some of the challenges and difficulties participants encountered when mothering within the confines of the child protection system. Implications for nursing practice are discussed. These implications focus on ways that nurses can effectively support foster carers, thus optimising the health and well-being of the vulnerable children in their care. [ABSTRACT FROM AUTHOR]

Patients with a rare cancer often face delays in their diagnostic and treatment trajectory, which may affect their work. In this study, we explored experiences and needs of: 1) patients with a rare cancer regarding return to work (RTW) and work retention, and 2) (health care) professionals (HCPs) regarding work-related support of patients with a rare cancer, throughout their disease trajectory. Semi-structured, in-depth interviews with working-age patients with a rare cancer (n = 16), and HCPs (n = 9) were conducted. During the interviews, a predefined topic list was used. Interviews were transcribed verbatim and analysed by means of thematic analysis. In total, three themes emerged from the interviews: 1) Awareness in patients and HCPs as a first step towards work, 2) Being/becoming an expert is a tough job, and 3) Enhancing employability through early personalized guidance. Patients with a rare cancer are confronted with uncertainties regarding work, due to an overall lack of knowledge and experience with these types of cancer. Raising awareness among patients, HCPs and employers about rare cancer and its implications, and providing timely individualized, supportive occupational care are required to improve rare cancer patients' ability to work. Recognizing and paying attention to the work-related consequences of a rare cancer diagnosis and its treatment is essential to facilitate rare cancer patients' occupational rehabilitation process. Multidisciplinary collaboration and involvement of HCPs specialized in rare cancer are required to provide suitable work-related support. A personalized approach is necessary to adequately address rare cancer patients' RTW and work retention needs. [ABSTRACT FROM AUTHOR]

Social isolation within agricultural communities is prevalent within the United Kingdom (UK). Along with other social and economic determinants, social isolation is considered to be a contributing factor towards the high rates of mental health issues experienced among people working in agriculture. The livestock auction mart is one of the remaining spaces upon which many livestock farmers rely for consistent social interaction and to experience community, both determinants proven to improve physical and mental health. However, the importance of the social contribution of livestock auction marts to farmer wellbeing appears rarely in associated literature. The aims of this study, therefore, were i) to determine levels of isolation experienced by livestock farmers who attend auction marts and ii) to identify the role of the mart as a system of social support, with an emphasis on the informal support system attendees provide for one another. Findings from 90 qualitative interviews demonstrate that the auction mart is an important social site where occupational community and identity can be produced and reproduced for all attending stakeholders, positively impacting upon mental health and wellbeing. The strength of the occupational community among livestock farmers should be considered as a key element among a basket of options approach in the development of support interventions, and as a pathway to negotiating barriers to both help-seeking behaviors and reaching the hard-to-reach. [ABSTRACT FROM AUTHOR]

While the benefits of reflection for students are well documented, there is a parallel body of research pointing to varying levels of engagement with reflection. Students on a four-year business information systems programme have to complete a reflection as part of their placement assessment. Using a constructivist qualitative methodology, this research explores the students' experience of reflecting with a view to identifying what supports could be useful to guide students in the future. Using semi-structured interviews, the students described a focus on description of activities and overall uncertainty on what to write. There are multiple possible interventions which could support the students but some would require significant and high-level support within the university. [ABSTRACT FROM AUTHOR]

We explored how Latino cultural values play a role in perceived caregiving experiences. We conducted a qualitative study that used individual, in-depth, semi-structured interviews with middle-aged and older Latinos who were primary caregivers of family members with Alzheimer's disease and related dementias (ADRD). The interview guide consisted of questions about participants' perceptions of family caregiving and interrelationships between the caregiver and care recipient. The interviews were recorded, translated, and transcribed verbatim. We performed direct content analysis. Participants were caregivers, 50–75 years old (n = 16), and the majority were female. We identified four cultural values that were salient to participants' caregiving experiences: (a) familismo, (b) fatalismo (c) marianismo, and (d) machismo. Latino cultural values influenced the role of caregiving and caregiving roles of family members with ADRD. Future research should consider these values as they affect different familial and health dynamics. [ABSTRACT FROM AUTHOR]

More than 115 million women across the world are borrowers of microfinance loans. However, there is concern that women from poor backgrounds who take loans may suffer from multiple challenges of physical and mental health burdens. In this qualitative study we aimed to identify the types of health challenges faced by active women borrowers of microfinance loans. Open ended questions were asked from 442 women across seven cities and four provinces of Pakistan. Categories were developed through the content analysis approach using NVIVO. We have been able to identify thirteen different health challenges faced by poor women borrowers under two broad headings of "environmental factors" and "healthcare delivery system." We recommend the introduction and expansion of different health and social development services by microfinance provider's to support the health needs of poor women clients. Women also need support from the Government of Pakistan in improving access to education, health coverage, and formal sector work opportunities. Our study implies increased health policy support for disadvantaged women borrowers of microfinance across the world. [ABSTRACT FROM AUTHOR]

Economically disadvantaged communities experience disproportionate health and social challenges relative to more affluent areas. This study describes ways women support and give back to their community in a minority-majority community experiencing social, economic and health challenges. We conducted qualitative interviews with 100 women and human service providers serving women in Flint, Genesee County, Michigan. Using methods aligned with community-based participatory research, a group of community and academic partners analyzed the data. Participants noted several personal characteristics of women they identified as assets including resilience, strength, resourcefulness, creativity, determination, tenacity, wisdom and the ability to nurture others. We think these personal characteristics represent individual assets that help women in Flint survive and build social capital. Women reported developing their social capital through giving, collaborating and sharing their skills with people in their personal networks. Significant personal assets in the form of individual characteristics already exist within Flint. Even in an area characterized as having health and economic challenges, women in this study were able to leverage their personal assets to build social capital and to mobilize resources for their benefit and the benefit of the community. [ABSTRACT FROM AUTHOR]

With the Peace Agreement between Fuerzas Armadas Revolucionarias de Colombia (FARC), Colombia promised healthcare to 13,000 'reincorporating' FARC ex-combatants. Shortages of healthcare workers in reincorporation camps means this promise is in danger of going unfulfilled. More information is needed to determine incentives, disincentives, and recruitment of healthcare providers to address this shortage. Semi-structured interviews were conducted with healthcare providers across FARC reincorporation camps, and a multidisciplinary team conducted analysis in NVivo12 using a team-based coding method. Twenty-four healthcare professionals from 15 camps participated, of which 75% were female. Incentives to work with FARC included improved clinical skills, professional advancement, increased comfort with FARC, and contributing to the peace process. Disincentives included poor living conditions, lack of support, biases, familial commitments, and sacrificing career opportunities. Three-fourths of the sample recommended working with FARC, and 92% reported a shortage of healthcare workers. Recruitment strategies included improved resources and specialised career development for healthcare workers, facilitating interactions between FARC and healthcare professionals outside clinical scenarios, and integrating medicine for vulnerable populations into health education. This study shows the impact that working with FARC ex-combatants can have on healthcare providers and tangible suggestions for increasing provider participation to address the healthcare worker shortage. [ABSTRACT FROM AUTHOR]

The mental health needs of children in low-and-middle income countries (LMICs) often go unmet due to a lack of qualified mental health professionals. Task-shifting the provision of mental health services to teachers may facilitate access to care. Family engagement in task-shifting may support mental health outcomes but is understudied in this context. The current study explored teacher and caregiver perceptions of family engagement within a teacher-led, task-shifted mental health intervention in an LMIC. Primary school teachers from five schools in Darjeeling, India delivered evidence-based, indicated mental health care to children with mental health needs throughout the school day. We conducted semi-structured interviews (SSIs) with teachers (n=17) and caregivers (n=21). SSIs were coded for themes related to family engagement. Teachers and caregivers were compared based on perceived levels of engagement. Participants reported three patterns of engagement: families who fully engaged; families who felt positively about teachers but displayed little engagement; and families with limited engagement. Barriers included logistical challenges and misconceptions about the programme. Many teachers implicated family engagement as a facilitator of the programme, suggesting that family involvement may support intervention outcomes. Future work could involve the development of an intervention component to better facilitate engagement in this context. Trial registration: Clinical Trials Registry India identifier: CTRI/2018/01/011471. [ABSTRACT FROM AUTHOR]

Programs of All-Inclusive Care for the Elderly (PACE) are an effective approach to improve care quality and delay institutional admissions especially for Black and Hispanic older adults who have seen a disproportionate rise in nursing home use. Guided by Andersen's Behavioral Model of Health Services Use and employing focus groups and one-on-one interviews, we qualitatively examined factors influencing access to and use of PACE by Black and Hispanic older adults. The study sample consisted of thirty-two PACE enrollees, six marketing-team members, and four family-caregivers from three PACE sites in a northeast urban city. Informed knowledge, cultural beliefs, and attitudes toward PACE were found to affect access. Community resources, available services, and care quality facilitated enrollment/participation. Barriers identified included poor dissemination of information and inadequate emphasis on staff's sensitivity to enrollees' cultural and disability differences. Findings will help healthcare leaders capitalize on facilitators and address barriers to enhance access and use of PACE by racial and ethnic minority older adults. [ABSTRACT FROM AUTHOR]

Identifying the factors impacting physical activity (PA) among adolescents and young adults with cerebral palsy (CP). Four focus groups were conducted, with a total of 22 participants with CP, aged 14–24 years, Gross Motor Function Classification (GMFCS) I–III. Our qualitative analysis drew on grounded theory and used Atlas software. Findings revealed four categories of factors impacting PA: (1) Musculoskeletal-pain and additional impairments related to activity limitations; (2) knowledge and exercising skills, and life skills such as problem-solving, decision-making, planning and organizing; (3) availability: lack of transportation, professional guidance, adapted and community-based programs, especially enjoyable activities; (4) social support from professionals (mainly physiotherapists) and peer support with socializing opportunities. Many opposed parental involvement. Those who attended special education schools and had moderate to severe learning disabilities saw PA as an opportunity for social contacts, limited by lack of availability. Those in mainstream schools with mild to no learning disabilities used PA for relieving pain and preserving function, limited by difficulty balancing PA and life goals. Service providers should inculcate knowledge and active-living skills during the transition to adulthood. Professional guidance needed to ensure inclusion in communal PA and offer adapted programs for young people with CP. There is a need for ongoing, accessible, adapted, community-based physical activity programs for young adults with CP guided by skilled professionals that can provide them with opportunities for enjoyable activities involving social interactions. When planning treatment interventions for children and young individuals with CP, healthcare providers should be aware of past therapeutic experiences and in collaboration with parents, are encouraged to be sensitive to possible tensions which may exist regarding their body care. Healthcare and educational professionals should provide young people with CP and their families with theoretical and practical knowledge about physical activity and its health benefits, as well as information about exercise options. Developing life skills in young adults with CP is important for helping them to effectively engage in physical activity and develop the competencies needed to achieve long term physical care. [ABSTRACT FROM AUTHOR]

Social networks and social support are important factors in medication adherence among people living with HIV (PLWH). Social networks can provide emotional, logistic, and material support leading to increased overall engagement in care. Certain populations of PLWH may have more limited access to social support, including those reentering community settings from correctional facilities. During periods of incarceration, social connections with family and friends may be frayed, reduced, or lost. This study, conducted in South Africa, explored the role of social support during community reentry among PLWH being released from correctional facilities. We conducted in-depth interviews with 41 community reentrants living with HIV. Qualitative analysis identified the challenges with establishing social support during reentry and the greater need for social support to remain engaged in HIV care in the community compared to in the correctional facility. These findings highlight challenges during community reentry and the importance of social support for these individuals. [ABSTRACT FROM AUTHOR]

Entertainment programming in the United States has long addressed major public health issues. In the present study, we used a culture-centric approach to systematically investigate the role of television storylines in facilitating health-related conversations on social media. In particular, we examined Twitter conversations about sexual and police-involved trauma prompted by portrayals on the fictional television drama Queen Sugar. Guided by the culture-centric model of narratives in health promotion, we classified the tweets (N = 1,671) into four main thematic categories: identification, social proliferation, emotions, and intentions. The analysis also revealed several subthemes, including identification with characters and cultural elements, expressions of pain and joy, information seeking and sharing, and the need to address intergenerational trauma and promote intergenerational conversations. The data suggests that Twitter may provide a vehicle for engaging in difficult conversations. We discuss the theoretical and practical implications of the study for mental health communication with Black Americans. [ABSTRACT FROM AUTHOR]

There is increasing evidence of the social, physical and cognitive benefits of group-singing for people living with dementia and their family carers. However, COVID-19 has necessitated the suspension of in-person group-singing globally. This study explores the impact of COVID-19 on dementia-inclusive singing groups and choirs in Ireland, and their facilitators' responses. It seeks to contribute to the limited literature on online group-singing and music telehealth for people living with dementia and family carers. It strives to provide facilitators with practical information to adapt their programmes for online delivery and continue to support the health and well-being of these populations. This study adopted a qualitative methodological approach. Semi-structured interviews were conducted with facilitators of dementia-inclusive singing groups or choirs in Ireland (n = 12). Four main themes were generated inductively from the data using Thematic Analysis: accessibility of online delivery; online vs in-person delivery; importance of social connection; adaptability and resilience. This study provides a mixed picture of opportunities and challenges arising from online music programmes. Initial evidence indicates the ability of facilitators to successfully deliver online music programmes to a proportion of people living with dementia and family carers and the capacity of members of these populations to engage with them. The findings support the development of sustainable online groups and resources to increase the accessibility of dementia-inclusive singing groups and support community-dwelling people with dementia living in rural and remote areas or with health or mobility challenges. However, challenges of digital inclusion exist. [ABSTRACT FROM AUTHOR]

This study utilizes data initially collected by evaluators at Wisconsin's Department of Health Services to create a secondary data analysis to investigate the opioid use and misuse among Black residents of Dane County. Sociologist Eric Klinenberg defines the term social infrastructure as the physical places and organizations that shape the way people interact. This study analyzes conversations of Black women, men, and youth throughout Dane County as they discuss the role of social infrastructure, specifically Third Spaces, as a contributing factor to drug abuse. Using a phenomenological design to analyze eleven focus groups and interview transcripts, this study helps fill the gap in scholarly literature of first-hand accounts from Black residents who have been impacted by the opioid crisis. Interviewees reveal that opioid use in Black communities throughout Dane County is exceptionally complex and involves multiple systems and structures that reach far beyond individuals' choices and behaviors, which are often alluded to as the root of drug abuse. The first-hand accounts depict the impact of being denied access to spaces and how the absence of social infrastructure has impacted their lives. The results of this study help support arguments for easily accessible social, economic, and political resources in Black communities to reduce opioid abuse. [ABSTRACT FROM AUTHOR]

The current study reports the results of open-ended questions from a follow-up survey of adults with sensory loss and their spouses who had previously taken part in an online study. In total, 111 participants completed the survey (72 adults with a sensory loss and 39 spouses). Open-ended questions asked about the overall experience of living with sensory loss, sensory loss-related challenges, and support and coping mechanisms. Thematic analysis was used to identify dominant themes in participants' responses. Three core themes capturing their overall experience emerged: (1) sensory loss-related challenges, (2) support and coping, and (3) adjustment and readjustment. Sensory loss was characterized as a challenging experience, causing communication and emotional disturbances. Coping strategies reported by both partners included the use of assistive technology, positive re-appraisal, acceptance and/or denial of the loss, while support strategies were mostly derived from the comments of spouses (for AWSLs), family members and peer networks (for both partners). Finally, respondents described sensory loss as an adventurous learning experience. Our findings underscore the significance of considering sensory loss from a social relational/family perspective and highlight the importance of addressing the needs of both adults with sensory loss and their partners in treatment and rehabilitation. Study highlights the need to consider sensory loss from a relational/family perspective. Healthcare professionals should try to increase the involvement of significant others and close family members (e.g., spouses, parents, children) into the rehabilitation process. Greater emphasis should be placed on exploring and reinforcing positive experiences and attitudes associated with sensory loss during counselling/rehabilitation sessions. Improved education about sensory loss for both the general public and health care professionals could minimize the adverse outcomes associated with sensory loss. [ABSTRACT FROM AUTHOR]

The aim of this study was to understand the views of falls service practitioners regarding: their role in supporting self-management of falls prevention; and a transition pathway from National Health Service (NHS) exercise-based falls interventions to community-run exercise programmes. Semi-structured interviews were conducted with physiotherapists, nurses, and rehabilitation assistants (n = 8) who worked in an NHS falls service. Data were analysed using thematic analysis. Certain aspects of supporting patients in self-management were deemed to be within or beyond the scope of falls service practitioners. Challenges in supporting transition to community-run programmes included: practitioner awareness and buy in; patient buy in; and patient suitability/programme availability. Practitioners sought to be patient-centred as a means to engage patients in self-management of falls prevention exercises. Time-limited intervention periods and waiting list pressures were barriers to the promotion of long-term self-management approaches. A disconnect between falls service interventions and community-run programmes hindered willing practitioners from supporting patients in transitioning. Unless falls risk and prevention is seen by healthcare providers as a long-term condition which requires person-centred support from practitioners to develop self-management approaches, then falls services may only be able to offer short-term measures which are potentially not long lasting. Falls rehabilitation practitioners need to take a person-centred approach to engage patients in self-management of falls prevention exercises. Providing information and signposting to exercise opportunities such as community-run programmes following falls service interventions should be viewed as being within the scope of the role of falls service practitioners. Rehabilitation practitioners should consider viewing falls risk as a long-term condition, to promote longer-term behavioural change approaches to ongoing engagement of exercise for falls prevention. [ABSTRACT FROM AUTHOR]

Work-disability following musculoskeletal injury causes a significant burden for individuals and healthcare systems. Research into work-disability prevention has investigated the ability of psychosocial factors to predict return-to-work in workers with musculoskeletal injuries. Recent research indicates that both return-to-work expectations and workplace supports influence return-to-work outcome. However, how these mechanisms operate to influence outcome is still largely unknown. We undertook a qualitative study involving semi-structured interviews with workers from diverse backgrounds who were undergoing vocational rehabilitation in New Zealand following a musculoskeletal injury. Interviews investigated the injured workers' experiences of workplace supports and asked in-depth about what contributed to their expectations of returning to work. Thematic analysis was used to analyse and interpret the data. Analysis identified four key themes. We found that what workplace supports were offered and how they were taken up was related to systemic factors, and trust. We also identified a link between the offer of support from the workplace and return-to-work expectations. Finally, the actions of workers' compensation and healthcare providers during workers' recovery were reported to influence supports, expectations and the confidence injured workers experienced in their return-to-work outcome in both overt and subtle ways. This study indicated that actions of the workplace, healthcare providers and workers' compensation parties can all influence workplace supports, return-to-work expectations and return-to-work outcome. These findings therefore implicate the actions of these stakeholders in work-disability prevention efforts. Positive return-to-work expectations are increasingly shown by research to be related to positive return-to-work outcomes for injured workers. Trust between the worker and the company can underpin the provision of supports for return-to-work, which in turn can influence worker confidence and expectations of return-to-work. Consideration of workplace culture and relationships when healthcare providers interact with employers can be crucial in fostering trust and enabling appropriate workplace supports. The ways in which workers compensation processes are executed can also affect workplace relationships, and therefore influence the provision of appropriate return-to-work supports. [ABSTRACT FROM AUTHOR]

To help enhance participation, the study aims to identify and document a comprehensive list of environmental barriers for people with SCI in the broad travel setting. Semi-structured interviews were conducted among four stakeholder groups: people with SCI (n= 39), caregivers and family members of people with SCI (n= 24), therapists who work with people with SCI (n= 9), and travel professionals specializing in accessible travel (n= 11). Five major categories of travel barrier emerged from the interviews: Partial Accessibility, Systemic Ignorance, Travel Hassles, Poor Service Performance, and Lack of Support. Detailed barriers in each category are described. The analysis of multi-stakeholder perspectives indicates while respondents with SCI offered the most specific information about the barriers, family members/caregivers were most concerned about the impact of systemic ignorance on their loved ones. Therapists focused on offering their clients tools to overcome barriers, and travel agents emphasized their limitations of serving customers with disabilities. Results of the study should help not only health and travel professionals better assist individuals to reintegrate into society after SCI, but also travel and hospitality businesses to better meet the accessibility needs of people with SCI. Travel is important to full participation in society for people after SCI. The study has identified five categories of barriers to travel participation after SCI: partial accessibility, systemic ignorance, travel hassles, poor service performance and lack of support. While traveling is important for participation in society for people with SCI, rehabilitation professionals should work together with policy makers, travel and hospitality businesses and agencies to lower the found barriers. [ABSTRACT FROM AUTHOR]

A qualitative study was conducted in rural New South Wales, Australia, to understand the barriers to help-seeking among young rural men with emergent mental health problems. Participants who had real life experiences of these problems within their families were interviewed. Themes emerged from the data which explained some barriers to early intervention. Despite these barriers, families had developed skills in helping and in providing early mental health help to their sons. The findings of this study showed that a substantial burden on the emotional and social integrity of the family, combined with diminished psychological well-being, caused some parents to question how long they could cope before they reached 'the end of their strings'. This downward spiralling trajectory of mental health and well-being for both the young men and their families has implications for clinical practice. Current models of mental health service delivery do not adequately capture the early help-seeking dynamics of young rural men and their families. A more flexible approach is needed to identify and help the family and the young men, without the pre-requisite for a formal medical diagnosis. Future research should involve health and well-being solution focused service delivery. [ABSTRACT FROM AUTHOR]

Physical activity confers many physical and psychosocial benefits for adolescent and young adult cancer survivors, yet most are not active enough to accrue benefits. Parental support for physical activity may be important to consider when exploring factors that influence physical activity in this population. Explore adolescent and young adult cancer survivors' experiences of parental support for physical activity received and their parents' experiences of support provided. Ten adolescent and young adult cancer survivors (Mage = 17.4 ± 3.2 years; 70% male) and one of their parents (50% fathers) were interviewed separately. Data were analyzed thematically. Participants' experiences were summarized into three main themes: (1) the basics – instrumental, informational, and emotional support, (2) companionship support – doing it together, and (3) role modeling – a double-edged sword. In general, there was congruence between participants' perceptions of the types of support provided and received for physical activity. However, parents felt their role was to provide instrumental, informational, and emotional support, whereas adolescent and young adult cancer survivors emphasized the importance of companionship support. Findings underscore the complexity of parental support for physical activity among adolescent and young adult cancer survivors. Developing and testing resources to empower adolescent and young adult cancer survivors to ask for parental support and to enable parents to support their child's physical activity is imperative. Many adolescent and young adult cancer survivors do not participate in enough physical activity to acquire physical and psychosocial benefits. Parental support may represent a key factor that influences physical activity participation. Rehabilitation professionals should consider the influence parents may have on adolescent and young adult cancer survivors' physical well-being post-diagnosis. Promoting co-participation may be a viable strategy to enhance physical activity participation among adolescent and young adult cancer survivors. [ABSTRACT FROM AUTHOR]

The coronavirus pandemic may be characterized as a disaster because it presents (a) a threat of harm or death to a large group of people, (b) disruption of social processes, and (c) secondary consequences among those affected. Universities may support students exposed to this disaster event by using the trauma-informed care (TIC) approach. Using a convergent, parallel, mixed methods design, this study evaluated the TIC approach that a bachelor's of social work program used at the start of COVID-19 during spring of 2020. A survey measured the extent to which students believed the program exhibited TIC. Focus groups explored how the students benefited from the program's TIC response. Descriptive results showed that the program scored highly in the TIC approach in the following domains: cultural responsiveness and inclusivity (M=2.9; SD=0.07), environment of agency and mutual respect (M=2.83; SD=0.11), and emphasis on strengths (M=2.79; SD=0.05). Qualitative themes were (a) the program's swift and proactive response fostered a sense of safety, (b) the program encouraged students' empowerment and autonomy, and (c) the program created opportunities for human connection and support. Programs should consider TIC as an option to support students during and post-COVID-19. [ABSTRACT FROM AUTHOR]

The social work Grand Challenge to Promote Smart Decarceration's aim is to address the high rates of incarceration in the United States. Purpose: Yet very little is known about criminal justice practitioners in the U.S. Method: In this exploratory study. Practitioners in correctional facilities (n = 38), responded to an online survey asking them about their perceptions of the services they provide and to identify their professional needs working within these settings. Results: Findings include the need for people who are incarcerated to have access to treatment for substance use, behavioral/mental health, and trauma-related issues. In addition, they reported the need for service coordination with agencies based in their home communities. Furthermore, the participants reported that they need more training and support on these topics in order to provide effective services to their clients. Discussion: Implications for practice, research, and policy are discussed, including strategies to address all levels of primary, secondary, and tertiary prevention. [ABSTRACT FROM AUTHOR]

Nonprofit boards of directors are responsible for the governance of their organizations. Despite a wide literature on board governance, empirical studies have focused primarily on board characteristics such as board size, frequency of board meetings, or board member characteristics. Building on prior literature, we use qualitative interview and survey data from nonprofit board members and executive directors, respectively, to develop a board coaching framework to better understand how board dynamics, in particular staff support for board activities, can influence overall board performance. Our findings suggest the need to recognize the central role executives and staff play in nonprofit governance. [ABSTRACT FROM AUTHOR]

Purpose: Yolŋu are Aboriginal Australians from northeast Arnhem Land in the Northern Territory (NT). Machado–Joseph disease (MJD) prevalence in the NT Aboriginal population is the highest in the world. Yolŋu living with progressive dysarthria associated with MJD could benefit from augmentative and alternative communication (AAC). However, there are no aided AAC systems in Yolŋu languages. This research aimed to explore the views of Yolŋu with MJD about communication, speech-language pathology (SLP) services and AAC. Method: A collaborative, culturally responsive research design was informed by Indigenist Research methodology and Constructivist Grounded Theory. Yolŋu with MJD (n = 10) and their interested family members (n = 4) participated in interviews and created visual representations of their social networks. Data were analysed through an oral interpretive process with Yolŋu researchers. Result: A Yolŋu metaphor, Goŋdhu "Building understanding by hand", emerged as a culturally meaningful way to represent the core understandings required for speech-language pathologists (SLPs) to work effectively with Yolŋu with MJD. Elements of this metaphor include seeking to understand the complex lived experiences of Yolŋu with MJD, and working with families to explore the potential benefits of SLP services and AAC. Conclusion: Yolŋu with MJD and their families want to work collaboratively with SLPs to develop bilingual AAC systems and culturally responsive SLP services that build on strengths of Yolŋu culture and kinship to improve communication opportunities and participation. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to understand parent engagement and disengagement in the delivery of occupational therapy to their children. Methods: This study used a qualitative interpretive description methodology. Focus groups and individual interviews were employed. Thirty-two occupational therapists participated in focusgroups or one-on-one interviews. Thematic analysis was used to analyse the data. Results: Thematic analysis of the data revealed two overarching themes which influenced parent engagement and disengagement in therapy: (1) Parent-therapist relationship and; (2) Therapist responsiveness. Within these two themes: parent feelings; time and timing of therapy; levels of engagement and factors influencing parent engagement were evident. Conclusions: Findings contribute to understanding parent engagement and disengagement in therapy. The findings extend current models of therapeutic engagement in occupational therapy informed by self-determination theory (SDT). Autonomy-, relatedness- and competence-supportive SDT strategies to enhance parent engagement in therapy are described. Occupational therapists reported that parents experience a range of feelings when engaged and disengaged in therapy. These feelings related to hopelessness, having confidence in the therapist and feeling supported, validated and empowered. Parent engagement and disengagement in therapy was described by occupational therapists as occurring at different levels: when it works well (engaged); engaged in the idea of therapy but not engaged in the doing of therapy (middle ground engagement); and when it doesn't work well (disengagement). Occupational therapists reported the importance of being aware of how the factor of time and family, service and therapist characteristics can variously impact parent engagement in therapy. Occupational therapists focus on the parent-therapist relationship and being responsive to parent needs and feelings when engaging parents in therapy. Occupational therapists can draw on principles from self-determination theory to guide them regarding the selection of strategies to engage parents in therapy. [ABSTRACT FROM AUTHOR]

Early motherhood may develop various stresses for the teen mothers and have adverse consequences. Current research aims at exploring experiences of teen mothers with stress and stressors of early motherhood. This qualitative study was conducted using conventional content analysis through in-depth semistructured interview. Eighteen Iranian teen mothers, who experienced parenting stress, with maximum variation in the age of first pregnancy, child's age, place of residence, and financial condition took part in this research. Data collection continued until saturation and were analyzed using MAXQDA10 software. Data analysis led to extraction of five categories including "storm of anxiety," "wander identity," "an unaccompanied way," "unarmed combat," and "a tired body." Teen mothers experienced tensions such as fear and worry, isolation and loneliness, regret, shame, depression, and doubt. These tensions originated from identity conflicts, inadequate social support, role inefficiencies, physical problems, and responsibilities. Teen mothers are influenced by various physical, psychological, social, and economic stressors which are in relation with the teenage, motherhood role, and the environment. Nurses are the major source of support for the teen mothers. Nurses should identify stress and stressors in teen mothers and strengthen well-being feeling in the teen mothers and their children through care, educational, consultative, and coordination interventions. [ABSTRACT FROM AUTHOR]

Parent-to-parent support for the families of deaf children has been provided in an East London district as an adjunct to the existing Early Support programme. Two parents of deaf children were employed as Parent Support Workers. They were members of a multi-disciplinary team of audiologists, teachers of the deaf and a specialist speech therapist. A questionnaire was used to obtain the views of the parents of a 10-year cohort of 35 deaf children who had received the peer support. There were high levels of satisfaction. Twenty-two respondents (63%) judged that a parent who had a shared experience was the person best placed to offer help and advice immediately following the diagnosis of childhood deafness with 27 (77%) considering the counselling and guidance of the teacher or therapist as most useful in the pre-school period after this initial period. An overwhelming 34 (97%) would recommend peer support as being useful. Twelve professionals, including five teachers, submitted free text on their views of the support. This was evaluated using thematic analysis. There were concerns about training and governance of the Parent Support Workers, with one teacher considering that the role may conflict with that of the teacher. However, ten professionals considered it to be a beneficial addition to existing programmes and none wanted it withdrawn. Most recognised that the "shared experience" of caring for a deaf child enabled the support workers to get close to families and provide a link with the home, which helped the parents engage with the intervention of the multi-disciplinary team. [ABSTRACT FROM AUTHOR]

Objective: To understand the lived experiences of Significant Others (SOs) of people with ongoing vestibular symptoms. Design: Qualitative semi-structured interviews were conducted and analysed using thematic analysis. Study sample: Ten SOs of people with ongoing vestibular symptoms were interviewed. Maximum variation sampling was used. Results: Four predominant themes were identified from the data: (1) Journey The progression of learning to understand, cope and adapt with a family member's vestibular condition is a unique journey; (2) Ownership Participants reported varying levels of ownership of their family member's vestibular condition. Those who considered the vestibular condition as a joint problem were often more burdened by feelings of guilt and redundancy; (3) Intangibility Participants reported inconsistent advice from healthcare professionals, struggles with understanding, and challenges obtaining a shared understanding with their own support networks; (4) Disempowerment SOs were left feeling powerless due to not knowing what to do for a family member when they experienced vestibular symptoms, and not having a comprehensive understanding of the vestibular condition. Conclusions: Ongoing vestibular symptoms have significant and diverse impacts on SOs. This study reveals a need for tailored support of SOs and supports the practice of family-centred care in this population. [ABSTRACT FROM AUTHOR]

Involving patients and family members in care is a growing area of research and practice as more family members express the desire to participate as constituents of the patient care team. In this study, we aim to understand patients' perceptions of family participation in asthma self-management, particularly concerning health information seeking behavior. Semistructured interviews with 35 patients with asthma were conducted at the Immunoallergology wards of both a central public hospital and a private hospital in Porto, Portugal. Data were collected through the McGill Illness Narrative Interview. Interviews were thematically analyzed as case-based and process tracing-oriented. Asthma in the family history appeared to be a major determinant of two profiles of patientswith asthma: Group 1 (n = 23/35) patients with asthma who are 'nonseekers' of health information and for whom asthma ispart of their family histories and who easily adapt to illness in their daily lives, although they had difficulties controlling theirasthma, given the disease severity; and Group 2 (n =12/35) patients with asthma who are 'seekers' and do not have familyhistories of asthma and whose experiences of illness brought limitations to their daily lives, raising questions of bafflement (Why me?) and control (What can be done?). Asthma patients with family histories tend to be more accepting of their diagnosis but require basic information for daily management. Asthma patients without family histories tend to deny the condition and require more emotional support to cope with it. The family should be considered as integral to the processes of knowledge-sharing and decision-making, and how families experience the disease should be taken into account by health professionals when offering a treatment plan. [ABSTRACT FROM AUTHOR]

Breastfeeding rates in the UK remain persistently low, with a rapid fall off during the first 6–8 weeks. The work of healthcare and public health practitioners impacts on mothers' experiences of infant feeding. Support, promotion and protection of breastfeeding are a national priority. Semi-structured qualitative interviews were undertaken with mothers who had experience of breastfeeding. Participants were engaged with a local Children's Centre (indicating engagement with public health provision) and their babies were up to 6-month old (to increase recall of early experiences). Twenty-four participants were recruited and interviews thematically analysed. Mothers identified matters significant in relation to public health provision for breastfeeding, including three stages of time of significance for breastfeeding impact. These interlinked critical stages impact on a mother's experiences. Joined up public health practice providing breastfeeding support and information before birth, around the time of the birth, and once home is significant in mother's accounts. Breastfeeding support, in both healthcare and public health contexts, needs to be highly attuned to different stages in the experiences of mothers. Breastfeeding continuation is influenced by support experienced antenatally, perinatally, and in early weeks. To enhance the initiation and retention of breastfeeding, public health practice must pay attention to these stages. Breastfeeding support needs to begin prior to birth and be given throughout the postnatal period and beyond. [ABSTRACT FROM AUTHOR]

Objectives: To study the experiences and challenges of type 2 diabetes (T2D) self-management among homebound older adults who regularly receive home-delivered meals and services. Methods: Participants (n = 31) were recruited by telephone screening and were selected by purposive sampling. Semi-structured interviews were subsequently conducted within participants' homes. The interpretive methodology utilized in this study was developed to systematically assess T2D self-management. Results: Thematic analysis shows that participants felt mostly responsible for their health status, but attributed any noncompliance to lack of social and economic assistance. Most of the seniors in this study felt competent, but often did not have the opportunity to engage in protective measures due to a number of economic, physical, and social barriers. Conclusions: These results contribute to a better understanding of how to approach, support, and motivate homebound older adults with T2D while addressing challenges. Findings offer insight into the development of diabetes self-management education (DSME) and interventions for this population. [ABSTRACT FROM AUTHOR]

The purpose of this article is to examine women's perceptions of the patient-provider relationship in the context of medically high-risk pregnancy (MHRP). Sixteen in-depth interviews were conducted with women hospitalized for MHRP on a maternal-fetal medical unit in the US. Tenets of phenomenology guided the data analysis. We found that beyond normative stress related to managing physical aspects of MHRP, women reported added emotional stressors associated with navigating the fragmented health care environment. This study suggests that improved care coordination and systematic integration of psychosocial professionals within the perinatal interdisciplinary health care team are vital to reduce care-related stressors on this vulnerable patient group. [ABSTRACT FROM AUTHOR]

'Non-offending pedophiles' or 'minor attracted persons' are individuals who suppress an attraction to children. Previous analyses of this population's mental illness employed overt self-report methods, limited by social desirability. Additionally, studies assessing the coping mechanisms employed to remain offense-free are underpowered; understanding of these would facilitate the rehabilitation of prior offenders. A thematic analysis of coping mechanisms and mental illness was conducted on 5,210 posts on the 'Virtuous Pedophiles' forum. Four themes emerged for coping mechanisms: Managing risk and attraction to children, Managing mood, Managing preferences prosocially and Friends, family and relationships, with 13 subthemes. Five themes emerged for mental ill-health, including: Addiction, Anxiety, Depression, Self-hatred/Self-harm/Suicide and Other. Self-hatred/Self-harm/Suicide accounted for almost a third of discussed mental ill-health. These results highlight the severity of mental ill-health amongst this population and the coping mechanisms employed to remain offense-free. [ABSTRACT FROM AUTHOR]