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The article focuses on a study in Scotland, United Kingdom of prioritizing protection of children from secondhand smoke exposure (SHSE) in a private space where smoke-free public places are enforced. It discusses the difficulty of political acceptability in enforcing the issue and the intervention over parental autonomy to smoke in their own home. The article also reports on the findings based on the study used called Reducing Families' Exposure to Secondhand Smoke (REFRESH) project.

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]

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]

Creating a learning health system could help reduce variations in quality of care. Success is dependent on timely access to health data. To explore the barriers and facilitators to timely access to patients’ data, we conducted in-depth semi-structured interviews with 37 purposively sampled participants from government, the NHS and academia across Scotland. Interviews were analysed using the framework approach. Participants were of the view that Scotland could play a leading role in the exploitation of routine data to drive forward service improvements, but highlighted major impediments: (i) persistence of paper-based records and a variety of information systems; (ii) the need for a proportionate approach to managing information governance; and (iii) the need for support structures to facilitate accrual, processing, linking, analysis and timely use and reuse of data for patient benefit. There is a pressing need to digitise and integrate existing health information infrastructures, guided by a nationwide proportionate information governance approach and the need to enhance technological and human capabilities to support these efforts. [ABSTRACT FROM AUTHOR]

Aim and objective This paper aims to explore health visitors' accounts of assessment and judgement in health visiting in the context of policy change and an increased focus on risk, which is reshaping practice. Background Assessment and judgement underpin the targeting of support in health visiting practice. Existing literature suggests that needs assessment in health visiting is a complex process which draws on different types of knowledge. Methods The study, upon which this paper draws, was a qualitative exploration which aimed to explore the impact of policy change on health visiting practice and on families. The accounts of sixteen health visitors, who took part in semi-structured interviews, are reported. The interview data were analysed using thematic and narrative techniques. Results Health visitors' accounts of their observations of families' homes, relationships and practices, such as their references to 'dirt', harmful practices and appropriateness, illustrate ways in which assessment and judgement in health visiting practice are shaped by a discourse of risk and notions of ideal parenting. Health visitors problematise this discourse in relation to the potential stigmatising impacts for families. Although health visitors indicate ambivalence towards the use of assessment tools, the findings indicate that they feel the tools provide them with a safety-net at a time when their practice is being reshaped by a discourse of risk. Conclusion This paper identifies that assessment and judgement in contemporary health visiting are shaped by a discourse of risk. A discussion of the role of 'emotion in use' and collective emotions provides an appropriate theoretical lens to consider the impact that risk discourse has on health visiting practice and on families. Relevance to clinical practice This study highlights the need for assessment and judgement in health visiting practice to be highly reflexive, to support families in an era of risk. [ABSTRACT FROM AUTHOR]

Aim To review strategies for successful recruitment in small-scale, qualitative research in primary care by exploring those used in a variety of settings and providing a reflective analysis of the strategies used in one such study. Background Recruitment of participants in small-scale, qualitative research in primary care is problematic. Researchers need to be more aware of the issues involved, but there is little practical guidance available to help them devise efficient strategies for maximising recruitment. Data sources This paper draws on a study conducted in the Highlands of Scotland examining the emotional wellbeing of pregnant and non-pregnant women. This was a qualitative study using diaries and interviews over a period of nine months. Ten women were recruited over a period of more than two years. Review methods The author reviews the strategies for successful recruitment based on both a review of the available literature as well as the experience of one study. Discussion Recruitment of subjects to a study is one of the major elements of a research proposal and requires significant effort, yet there is little to guide researchers through this difficult process. The challenge of recruitment is seldom debated and studies rarely report problems encountered or outline approaches that proved particularly successful. The importance of successful recruitment is discussed and the arguably typical recruitment difficulties encountered by researchers conducting a study in the Highlands of Scotland are outlined. The elements that comprised successful recruitment in this and other studies are appraised. Conclusion Although focused specifically on recruitment in small-scale, qualitative studies in primary care, this paper raises broader issues about the recruitment of participants in all types of research. Recruitment has implications for the trustworthiness and dependability of the data and hence the findings of research. Despite this, there remains a lack of evidence about what enhances research recruitment, leaving researchers to rely on guesswork and anecdotes. In a climate of evidence-based practice, researchers should be encouraged to include a formal evaluation of recruitment strategies in their studies and to report their findings. Implications for practice/research As recruitment has implications for the trustworthiness and dependability of research, researchers need to consider a wide range of recruitment strategies and include a formal evaluation of their recruitment strategies when reporting on their research. [ABSTRACT FROM AUTHOR]

Background and aims Regulation of electronic cigarettes has moved to the top of the addiction policy agenda, as demonstrated by the recent focus across the United Kingdom on introducing age-of-sale restrictions. However, the views of those affected by such regulation remain largely unexplored. This paper presents the first detailed qualitative exploration of adolescents' perceptions of existing, and opinions about potential e-cigarette regulation. Methods Sixteen focus groups, including a total of 83 teenagers between the ages of 14 and 17 years, were conducted in deprived, mixed and affluent urban areas in Scotland and England between November 2014 and February 2015. Transcripts were imported into Nivivo 10, coded thematically and analysed. Results Participants critically considered existing evidence and competing interests in regulatory debates and demonstrated sophisticated understanding of the advantages and disadvantages of regulation. They overwhelmingly supported strong e-cigarette regulation and endorsed restrictions on sales to minors, marketing and e-cigarette use in public places. Concern about potential health harms of e-cigarette use and marketing increasing the acceptability of vaping and smoking led these adolescents to support regulation. Conclusions In focus group discussions, a sample of UK adolescents exposed to particular communications about e-cigarettes supported strict regulation of e-cigarettes, including banning sales to minors and use in indoor public areas. [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]

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]

Abstract: Teenage parenthood is problematised in the UK. Attention is increasingly falling on the potential or actual father yet we still know relatively little about young men’s experiences and attitudes in this area. This paper focuses on the experiences of, and attitudes towards, pregnancy and fatherhood amongst a sample of men incarcerated in a Scottish Young Offender Institute. In-depth interviews were conducted with 40 inmates, aged 16–20, purposively sampled using answers from a questionnaire administered to 67 inmates. Twelve men reported eighteen pregnancies for which they were, definitely or possibly, responsible. All but one of the pregnancies were unplanned. Five of the men were fathers: two were still in a relationship with the mother of their child and were in close contact with her and the child while incarcerated, three, all of whom had separated from their partner before the birth, had had patchy contact with mother and child before and/or during their sentence. All five of the men expressed a strong desire to be ‘a good father’. Amongst the interview sample as a whole, most said they did not feel ready to become fathers. The main reason given was being unable to fulfil what they regarded as the key role of financial provider. Most of the men had given little or no thought to the possibility of a sexual partner becoming pregnant. Contraceptive use was high, however, amongst the minority who reported thinking about this possibility. The paper concludes by considering the cultural context of the men’s attitudes and the potential for intervention development for incarcerated male young offenders in the areas of Sex and Relationships Education and parenting. [Copyright &y& Elsevier]

Rationale, aims and objectives Internationally, health technology assessments ( HTAs) are ubiquitous drivers to health policy. Within Scotland, the Scottish Medicines Consortium undertakes the medicine review process. Input from clinical experts, involved in frontline care, is an integral component of the assessment process. This paper explores the relationship between the clinical experts and the HTA agency within Scotland to better understand what motivates expert clinicians to devote their time to the medicine review process with no remuneration. Methods Twenty-seven clinical experts from 16 different clinical specialties took part in one-to-one interviews at their place of work between October 2011 and March 2012. Data analysis was inductive and comprised the organization of data into a framework and a subsequent thematic analysis. Results Three distinct themes were identified: (1) recruitment, which identified two types of explanations for the experts' appointment: external justification (nominated by another) and internal justification (being recognized as an expert); (2) flexibility of the procedures, with experts able to determine their own response style and negotiate timelines; (3) health care systems, demonstrating that their affiliation to the health system underpinned the relationship and their motivation to be clinical experts. Conclusions The findings of this study provide insight into the elements important to clinicians who voluntarily contribute to HTA processes. Examination of these elements in the context of the organizational citizenship behavior literature provides a foundation on which to improve understanding of this relationship and sustain and improve clinical expert participation in an increasingly intensified clinical environment and within cash-limited HTA systems. [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]

Purpose -- This article seeks to explore the difference that adult support and protection legislation may have made to work with adults at risk of harm in Scotland. Design/methodology/approach -- The article is based upon findings of a joint academic and practitioner qualitative research project that interviewed 29 social service practitioners across three local authorities. Findings -- The legislation was seen as positive, giving greater attention to adults at risk. Views about the actual difference it made to the practitioners' practice varied, and were more likely in new rather than ongoing work. Three differences were noted: duties of investigation, protection orders and improved shared responsibility within the local authority and across other agencies, but to a lesser extent NHS staff. Overall it gave effective responses, more quickly for the adults at risk. Whilst the law brought greater clarity of role, there were tensions for practitioners in balancing an adult's right to autonomy with practitioners' safeguarding responsibilities. Originality/value -- The paper demonstrates that a dedicated law can improve safeguarding practice by clarifying the role of social work practitioners and the responsibilities of other agencies. The right to request access to records and banning orders were seen as valuable new measures in safeguarding adults at risk. As such the study from the first UK country to use dedicated adult safeguarding law offers a valuable insight for policy makers, professionals and campaign groups from other countries, which might be considering similar action. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to report results of a research project which investigated how two UK National libraries categorise their core business purpose together with an assessment of the role and relevance of additional (or value-added) services in their strategic thinking, future planning and performance measurement. Design/methodology/approach – This is a qualitative interpretive study, using a collective case study methodology, with the National Libraries of Wales and Scotland as the core cases. Semi-structured interviews were conducted with senior managers in both institutions, together with focus groups with librarians and library assistants, selected using purposive sampling. All instruments were piloted; data from the respondents were recorded, coded, classified and cross-checked to ensure validity and rigour, using themed interview schedules to facilitate analysis. Findings – It is difficult to be definitive as to core and additional services as individuals have differing interpretations of the terms. Changing customer demands and expectations, technological developments and the impact of a dynamic and complex economic environment suggest it is more meaningful to reconceptualise services according to the extent to which they contribute to achieving basic business purpose at any one time. Originality/value – Libraries must demonstrate efficiency and effectiveness in service provision, and in relation to achieving primary purpose and resource priorities in order to survive. Examining the relevance of defining and distinguishing core and added-value services in relation to performance assessment and strategic vision addresses a gap in existing knowledge. [ABSTRACT FROM AUTHOR]

law j., mccann d. & o'may f. (2011) Managing change in the care of children with complex needs: healthcare providers' perspectives. Journal of Advanced Nursing 67(12), 2551-2560. Abstract Aim. This paper is a report of a descriptive qualitative study of the role and activities of nursing and allied health professionals caring for children with complex needs in a community setting. Background. Health care is changing in terms of service provision and delivery, with an increased focus on person-centred care, prevention and community-based services. The role of nursing and allied health professionals is central to these changes but is not well described in terms of capacity, or the knowledge and skills required to meet increasing demand. Method. Within four Health Boards, semi-structured telephone interviews were conducted in 2007 with three nursing and four allied health managers, followed by four focus groups with 15 nursing and 11 allied health practitioners; in addition, three nurses and one speech therapist were interviewed by telephone. Results. Respondents identified challenges related to communication and information systems, equity of service provision, family-centred care and partnership working. Generic and specialized knowledge and skills are needed, although providing the right skills in the right place can often prove problematic with potential implications for service provision. Conclusion. Findings support the adoption of integrated partnership working, going beyond the identification of key professionals, to developing a set of criteria against which future service provision could be judged. Research priorities were identified; comparative evaluation of services, better understanding of the transition process and a clearer sense of the individual's response to the increasing customization of services. [ABSTRACT FROM AUTHOR]

St Columba's Hospice, Edinburgh, is a busy specialist palliative care unit with 30 inpatient beds. A previous publication reported the first strand of a qualitative exploratory study evaluating the impact of open visiting on patients at the hospice. This paper reports on the second strand, which sought to elicit the views of the hospice staff through focus group interviews. The main themes identified were valuing the family and friends as visitors, involving the family as part of the care team, patient powerlessness over visiting, shared rooms and their impact on visitors and patients, and the staff role as advocates or gatekeepers. Several strategies for developing a flexible and 'patient-controlled' visiting policy were identified, including quiet times without visitors, restriction of visitor numbers in shared rooms, and encouraging breaks from visiting. Since the study was completed, the hospice's visiting policy has been modified to ensure that it is patient-centred and meets the needs of patients and families. [ABSTRACT FROM AUTHOR]

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]