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Purpose: This paper presents qualitative research findings from the evaluation of a Parkinson's Dance well-being venture in the UK. Methods: Qualitative data was gathered to see how bespoke dancing sessions helped people with Parkinson's (PwP) to manage their conditions and improve their lives and prospects. Principles of a participatory approach were incorporated and methods included semi-structured interviewing, researchers participant observation and an elicitation-based activity. Nineteen PwP, six carers, four dance artists and seven helpers participated in the study. Results: Participating in Parkinson's Dance sessions meant that PwP could experience the possibilities to dance, develop a "can do" attitude, experience fun, enjoyment, social connection, exercise, movement to music, improvement and/or maintenance of their balance, suppleness, coordination and confidence with movement, symptoms being pushed back and ability to learn new things. Conclusions: Our findings add to the evidence-base about the benefits of dance for people experiencing Parkinson's and through novel application of the Life-world based well-being framework of K. T. Galvin and Todres (2011) we propose a theoretical basis for Parkinson's Dance as a resource for well-being. There is scope to consider application of the well-being framework to other arts activities and as the basis of an arts and well-being evaluation tool. [ABSTRACT FROM AUTHOR]

Based on the Theory of Planned Behavior, this paper explores the perceptions of the COVID-19 vaccine among South Asian communities residing in the UK. Thirty-eight semi-structured interviews were conducted using a qualitative approach and analyzed using thematic analysis. Participants represented Indian, Pakistani, Bangladeshi, Sri Lankan, Afghani, and Nepali backgrounds. The participants revealed that family and community influence their perceptions of the COVID-19 vaccine. The results suggest that normalizing vaccine acceptance, addressing unknown side effects, and popularizing vaccine efficacy data will increase vaccine uptake within the South Asian community in the UK. [ABSTRACT FROM AUTHOR]

Complementary and alternative medicine (CAM) degrees in Australian and British universities have come under attack from sceptics who argue that such courses teach only 'pseudoscience'. Moreover, CAM academics have themselves been publicly labelled 'quacks'. Comparatively little is known about this group of health professionals who span the two worlds of CAM practice and academia. How do they navigate between these domains, and how are their collective and individual professional identities constructed? Drawing on 47 semi-structured interviews, this paper explores the professional identities of academics working in three university-based CAM disciplines in Australia and the UK: osteopathy, chiropractic and Chinese medicine. By analysing these individuals' accounts, and building on prior research on health professions in the academy, the paper contributes to understanding how contests about professionalism and professional knowledge take place against the academic-practice divide. By focussing on a domain where knowledge claims are conspicuously contested, it highlights the salience of navigating 'epistemic stress' for both group and individual professional identity. [ABSTRACT FROM AUTHOR]

To evaluate the usability and acceptability of the Mental Capacity Assessment Support Toolkit (MCAST) in healthcare settings and whether its use was associated with increased legal compliance and assessor confidence. A mixed methods convergence triangulation model was used. Multidisciplinary professionals used the MCAST during mental capacity assessments for UK hospital patients with diagnoses of stroke or acute or chronic cognitive impairment. Changes in legal compliance were investigated by comparing scores on case note audits before and after implementation of the MCAST. Changes in assessor confidence and professionals' perceptions of the MCAST's usability and acceptability were explored using surveys. Patients' and family members' views on acceptability were determined using semi-structured interviews. Data were integrated using triangulation. Twenty-one professionals, 17 patients and two family members participated. Use of the MCAST was associated with significant increases in legal compliance and assessor confidence. Most professionals found the MCAST easy to use and beneficial to their practice and patients. Patients and family members found the MCAST materials acceptable. The MCAST is the first toolkit to support the needs of individuals with communication disabilities during mental capacity assessments. It enables assessors to deliver high quality, legally compliant and confident practice. Mental capacity assessment practice needs to be improved to maximise patient autonomy, safety and well-being. The MCAST is a paper-based toolkit designed to facilitate and improve mental capacity practice in England and Wales. This study suggests the MCAST would be easy and acceptable to use in healthcare settings and could lead to improvements in assessment quality and assessor confidence. [ABSTRACT FROM AUTHOR]

Evidence suggests that physical activity (PA) programmes promoted via healthcare settings worldwide may not currently meet the needs of many patients and healthcare professionals (HCPs). This paper describes the outcomes of a qualitative enquiry into the perspectives of patients and professionals from multiple healthcare services regarding the role of PA. 19 patients and 22 HCPs were purposively recruited from physiotherapy, podiatry, chronic pain, diabetes and continence services at a community-based healthcare clinic in the United Kingdom. Participants' views were explored using semi-structured interviews and analysed using thematic analysis. Results identified five themes: differences between the social and medical rationales underpinning PA promotion; the impact of the patient-professional relationship on patient activation, self-management and PA; a risk culture surrounding PA; challenges to meet variation in patients' needs and preferences; and lack of formal role for PA as a core part of routine healthcare. The study highlights tensions between needs and aspirations, and the reality of delivering advice and support for PA. Challenges resonated with patients and HCPs across different care groups and were not condition-specific. This highlights a need for sharing good practice across healthcare services and system-level interventions to address organisational barriers to the promotion of PA. [ABSTRACT FROM AUTHOR]

This paper reports on an exploratory study of the role of solicitors acting for parents with intellectual disabilities (ID) in public law proceedings. The paper draws on in-depth interviews with 11 solicitors and a subsequent focus group in which the interview findings were presented and reflected on by six of the eleven participants. Two of the five themes that emerged will be discussed here. They are entitled ‘Attitudes and Influence’ and ‘Legal Processes’ and concern the attitudes and influence of those involved in assessing, supporting and representing parents with ID and the care proceedings processes encountered by parents with ID. [ABSTRACT FROM PUBLISHER]

Experiences of autism-spectrum disorder are now increasingly studied by social scientists. Human-animal relations have also become a major focus of social inquiry in recent years. Examining horse-assisted therapy for autistic spectrum disorders, this is the first paper that brings these fields together. Drawing on participant observation and interviews at a UK horse therapy Centre, this article examines how staff and the parents of riders account for the successes and limitations of equine therapy. To the respondents, horses ‘open up’ autistic children and make possible interactions that seemed impossible before. Horses were regarded as facilitating the emergence of apparently social behaviours, which included eye contact, pointing, and speech. Three key explanations emerged for therapeutic success: the sensorial, embodied experience of riding the horse; the specific movements and rhythms of the horse; and, the ‘personality’ of the horse. Equine therapy can be regarded as enabling a form of multispecies intersubjectivity, with the resonance between rider and horse seeming to make possible a new attunement between humans. Practices of equine therapy, and perceptions of its efficacy, serve in turn to attune social scientists to a version of empathy constituted through lively and sensorial interactions, as opposed to one that is restricted to particular kinds of humans. [ABSTRACT FROM AUTHOR]

This paper explores 'public' attitudes to the use of donated gametes in infertility treatment amongst members of British South Asian communities in the UK. The study included 14 single-sex focus groups with a total of 100 participants of Indian, Pakistani and Bangladeshi origins in three English cities and 20 individual semi-structured interviews with key informants. It explores five themes from the data: childlessness and stigma; using sperm and using eggs; cultural connections; choosing gametes; religion and the use of donated gametes; and disclosure and the management of information. The paper demonstrates that the socio-cultural context of fertility treatment is highly relevant and those delivering services and those consulting the public need to be aware of cultural and gender differences. Third party assisted conception represents a challenge to received ideas of identity and has implications for social reproduction and kinship which go well beyond immediate conjugal relationships. [ABSTRACT FROM AUTHOR]

In Britain, there has been an increased emphasis on the use of risk assessments in mental health services over the past 20 years. Mentally disordered offenders subject to Section 41 of the Mental Health Act 1983 (England and Wales) are defined as posing a serious risk of harm to others. They are thus dealt with by forensic mental health services, which are often seen as specialists in risk assessments. This paper is based on original research in three mental health trusts in the South of England which was carried out between March 2009 and September 2011. The paper examines mentally disordered offenders’ awareness and attitude to formal risk assessments in relation to theories of governmentality. Service users subject to Section 41 of the Mental Health Act 1983 were aware that their level of risk was being assessed by professionals caring for them but were commonly unaware of the content of these assessments. These risk assessments were viewed by participants as a means through which professionals measured and monitored behaviour. Although participants often referred to levels of risk, they did not view risk screening schedules as objective, but rather emphasised the need to persuade staff that their risk had reduced. Despite showing a limited awareness of the content of these risk assessments, participants generally identified more risks, in relation to their vulnerability, than did the professional assessments. However, participants generally identified fewer risks in relation to the dangers they posed to others than did professional staff. [ABSTRACT FROM PUBLISHER]

This paper reports the initial findings from Contemporary Visual Art and Identity Construction—Wellbeing Amongst Older People: a two-year research project that aims to understand how the lives of older people can be improved by examining their use of contemporary visual art in the art gallery and museum. It will focus on data relating to lifelong learning for postretirement people. The paper investigates the impact of engaging with contemporary art on a sample of 43 participants aged 64+. [ABSTRACT FROM PUBLISHER]

This paper explores the contribution of script theory to understandings of animal health risks. Script theory has long played an important role in studies of health and risk, yet the application of script theories is often vague and confused. Theories from different ontological perspectives are conflated resulting in an overly cognitive and asocial understanding of health behaviour with the potential to misinform health promotion strategies. The paper addresses these problems by applying the concept of script formulations to an analysis of farmers' understandings of bovine tuberculosis in farmed cattle. Drawing on interviews with 61 farmers in England and Wales, the paper argues that farmers reveal animal disease to be a scripted event, but that these scripts also order identity and provide a form of moral accountability for farmers' behaviour. This has implications for attempts to communicate animal disease risks and suggests that a more productive approach is to reorganise governance structures and relationships between farmers and government. [ABSTRACT FROM AUTHOR]

Based upon the findings of a qualitative in-depth interview study with 23 women aged 23-72 years recruited from members of the general public and a psychosexual clinic, this paper explores participants understandings of the term 'sexuality'. The findings are set within the context of historical, prevailing and often contradictory perceptions of the term. Data were analysed thematically using the conventions of template analysis within a material discursive framework. This paper questions the assumption that sexuality is an altogether powerful and naturally occurring phenomenon. The ability to isolate and give credence to a definitive meaning of the term is, both for participants and academics alike, an arduous undertaking. Rather than focusing primarily on the material body, the extent to which ideology, culture and power intersect with the former indicate its multidimensional, constructed nature. Given the whole host of meanings evoked by the term, the paper asserts that it is more fitting to talk of multiple understandings of sexuality rather than a singular authoritative one whilst also contingent on social and historical practices. The findings have implications that should be considered when evaluating previous sexological research and conducting future research where this term is used throughout as a focus of academic enquiry. [ABSTRACT FROM AUTHOR]

In this paper, we examine why risk-based policy instruments have failed to improve the proportionality, effectiveness, and legitimacy of healthcare quality regulation in the National Health Service (NHS) in England. Rather than trying to prevent all possible harms, risk-based approaches promise to rationalise and manage the inevitable limits of what regulation can hope to achieve by focusing regulatory standard-setting and enforcement activity on the highest priority risks, as determined through formal assessments of their probability and consequences. As such, risk-based approaches have been enthusiastically adopted by healthcare quality regulators over the last decade. However, by drawing on historical policy analysis and in-depth interviews with 15 high-level UK informants in 2013–2015, we identify a series of practical problems in using risk-based policy instruments for defining, assessing, and ensuring compliance with healthcare quality standards. Based on our analysis, we go on to consider why, despite a succession of failures, healthcare regulators remain committed to developing and using risk-based approaches. We conclude by identifying several preconditions for successful risk-based regulation: goals must be clear and trade-offs between them amenable to agreement; regulators must be able to reliably assess the probability and consequences of adverse outcomes; regulators must have a range of enforcement tools that can be deployed in proportion to risk; and there must be political tolerance for adverse outcomes. [ABSTRACT FROM PUBLISHER]

This paper presents the results of the qualitative phase of Healthy Foundations, a study that groups people according to their motivations to live healthily or otherwise, their lifestyles, and the circumstances that affect this. These segments are ‘Health Conscious Realists’, ‘Balanced Compensators’, ‘Live for Todays’, ‘Unconfident Fatalists’ and ‘Hedonistic Immortals’. The aim was to explore people’s attitudes and motivations to live healthily or otherwise and the targeted healthcare interventions appropriate for each segment. The qualitative phase involved two strands: (i) focus groups and immersion in-depth interviews and (ii) video ethnographic ‘pen portraits’. It provides robust insight into the five segments’ motivations and behaviour and how these are constructed within and influenced by the wider environment. It also enabled the segments to give their views of and design appropriate interventions aligned to their individual requirements, lifestyles and structural environments. It demonstrates the usefulness of the qualitative approach to health segmentations and enhances the case for methodological pluralism, and a critical perspective, to enable development of health-related behaviour change interventions and policy more widely. [ABSTRACT FROM PUBLISHER]

Employment for people with learning difficulties is considered key to their social inclusion. This contradicts the perceived un-employability of people with learning difficulties that has been part of their social identities throughout their history hitherto. The national rate of employment for people with learning difficulties remains extremely low and has barely changed in the 20 years between 1990 and 2010. This paper investigates links between learning disabilities and employment, drawing on interview-based research. It analyses the quality of experience of the minority in employment to consider whether employment can serve the inclusive purpose expected of it. [ABSTRACT FROM AUTHOR]

This paper investigates the occurrence of somatic involvement in spiritual development by exploring transpersonal dimensions of physical illness. Using semi-structured interviews and the qualitative method of heuristic inquiry, the transpersonal experiences of seven people with long-term health conditions are reported. Results expand on current literature by revealing that a spiritual perspective in illness can extend much beyond being a coping mechanism into profound experiences of self-transformation and healing, and by illustrating that the body can be intimately involved in the spiritual process. Participants considered the transpersonal dimension to be central to their experiences and as such understood their physical challenge as a state of potency wherein healing and embodiment of transpersonal influences were inextricably linked. Implications are that the body merits our acknowledgement as an integral part of a greater reality of being, and therefore needs to be fully included in the development of an embodied, holistic, and participatory spirituality. [ABSTRACT FROM AUTHOR]

The standard, deficit-based, approach to health promotion tends to focus on health problems, designing services which are meant to solve these problems, of which members of communities are made the passive recipients. An alternative approach recognises that health problems are complex, having many causal pathways and as a result will require locally tailored interventions, involving multiple service providers workingwithlocal communities. Using empirical research from the development of two transformational community-led partnerships, an experiential learning programme was developed, Connecting Communities (C2). Complexity science is the underpinning theoretical framework for C2, which seeks to create the conditions to transform the health and well-being of disadvantaged communities. C2 focuses specifically on the nature of the relations between the agents in the system and their interactions with the social environment which determine the system’s behaviour. This is because a key tenet of complexity science is that systemic change cannot be externally directed, but occurs as a result of the self-organising interactions and relationships within the system. C2 takes an explicit asset-based community development approach, seeking to facilitate and support the development of local neighbourhood partnerships which focus on the strengths and aspirations of the community, rather than perceived deficits. This paper reports on the development of C2, its delivery, presents a case study of one of the first groups to undertake the Programme, and assesses its subsequent impacts on the participants’ ways of working, and in the local community. [ABSTRACT FROM PUBLISHER]

Medical accounts mostly frame non-suicidal self-hurting as an adverse event, the frequency of which has supposedly increased to a current ‘epidemic’ level, and which can be predicted probabilistically in terms of risk factors. This set of presuppositions gives rise to the common stigmatisation of those who present to Accident and Emergency services as a result of self-hurting. It is now being challenged in a small but growing body of social science literature which emphasises the diversity of self-hurting, and its range of socially situated meanings for those who self-hurt, family and health professionals. The present paper contributes to this research strand by discussing the accounts of their self-hurting given by a sample of 25 UK adults who had not been in contact with health or other services for this reason. The analysis focused on three value issues: the positive gains which motivated research participants to self-hurt; their own active efforts to mitigate associated risks; and the longer-term downsides which some respondents identified. [ABSTRACT FROM PUBLISHER]

This paper explores the role of value judgements in personal risk management through an in-depth case study involving a woman's treatment for anal cancer. Julia (pseudonym) agreed to have her pre-treatment medical consultation recorded, and participated in two subsequent interviews. Delving into a single case makes it possible to understand why an individual makes decisions in relation to the overall nexus of risks and benefits which they identify even though their choices may seem irrational to others. According to the colorectal nurse research interviewer, Julia ‘risked exploding’ as a result of ‘absconding’ (Julia's term) from hospital in order to have sex shortly after undergoing surgery. Although not to be interpreted literally, the above phrase encapsulates Julia’s risk blindness from a clinical perspective. The article will address the question of how one person came to put herself at unnecessary risk. The question will be considered in relation to non-communication about the interconnected web of issues which troubled Julia, including cosmology, mortality, being left with an unclean, leaky body, loss of economic viability and harm to family members and to close relationships. This analytical framework complements the more usual one in which attitudes towards a particular risk object are compared across cases. The article makes a contribution, within the limits of a single case study, to advancing knowledge about the neglected topic of individual risk consciousness. It will be argued that, in the absence of such analysis, personal decision-making about risks cannot be fully understood, appropriate advice given or sensitive policies developed. [ABSTRACT FROM PUBLISHER]

Scientific-bureaucratic medicine (SBM) has been the dominant discourse on evidence-based medicine in the English National Health System (NHS). It has being claimed that SBM has led to new forms of medical professionalism with an emphasis on organisational values and the control of autonomy. This paper explores the medical professions' response to SBM, where SBM is manifested in the form of National Institute of Health and Clinical Excellence (NICE) guidelines. Seventy-four face-to-face informal interviews were carried out with clinicians and managers between 2007 and 2009. Three major themes emerged from the analysis each of which was linked to doctors' receptiveness to NICE guidelines implementation. The first emphasised organisational values, which accounted for conditional acceptance of NICE guidelines. The second was proactive professionalism or entrepreneurial professionalism, which was linked to the rejection of NICE guidelines and the emergence of alternative forms of introducing new ideas for the expansion of their clinical practice. The third was related to the prominence of clinical autonomy linked with doctors' resistance to the use of NICE guidelines. It is argued that this evidence does not reflect a significant emergence of new forms of professionalism but the development of multiple occupational identities. [ABSTRACT FROM AUTHOR]

Young people transitioning from state out-of-home care are arguably one of the most vulnerable and disadvantaged groups in society. Many have been found to experience significant health, social and educational deficits. Most western countries have now introduced specific policy and practice initiatives to improve the life chances of care leavers, but there have been varied conclusions about the efficacy of those programs. This paper argues that a community development support model based on a partnership between professional social welfare workers and local community networks is most likely to enhance opportunities for the social inclusion of care leavers. Particular reference is made to the leaving care and after care support program introduced by St Luke's Anglicare in the Australian rural city of Bendigo which has included key program initiatives around housing, employment and mentoring. Some conclusions are drawn based on the experiences of service users about 'what works' in leaving care programs. [ABSTRACT FROM AUTHOR]

This paper reports on an evaluation of a domestic violence intervention in the maternity and sexual health services of a UK hospital. The intervention encompassed guidelines, staff training, inclusion of routine enquiry for domestic violence with all patients, and referral of women disclosing violence to an on-site advocacy service. An "assumption querying" approach was applied to evaluate the intervention. Programmatic assumptions were identified and tested using interviews with service providers and patients, review of patient records, and pre- and post-training questionnaires. Domestic violence training resulted in changes in health professionals' knowledge and practice in the short-term, but universal routine enquiry was not achieved even in a context of organisational support, guidelines, training and advocacy. Potential and actual harm occurred, including breaches of confidentiality and failure to document evidence, limiting women's ability to access civil and legal remedies. Advocacy support led to positive outcomes for many women, as long as support to maintain positive changes, whether women stayed with or left the violent partner, continued to be given. Maternity and sexual health services were found to be opportune points of intervention for domestic violence services that combine routine enquiry by clinicians, support after disclosure and attention to harm reduction. Cet article décrit l'évaluation d'une intervention en matière de violence domestique dans les services de santé génésique et de maternité d'un hôpital britannique. L'intervention comportait des directives, la formation du personnel, une enquête systématique auprès de toutes les patientes sur la violence domestique et l'aiguillage des femmes révélant des violences vers un service de sensibilisation sur place. L'intervention a été évaluée avec une approche de « questionnement des postulats ». On a identifié et testé les postulats des programmes par des entretiens avec les prestataires de services et les patientes, l'examen des dossiers des patientes et des questionnaires avant et après la formation. La formation sur la violence domestique a changé à court terme les connaissances et la pratique des professionnels de santé, mais n'a pas réussi à les inciter à questionner systématiquement toutes les patientes, même dans un contexte de soutien organisationnel, de directives, de formation et de sensibilisation. On a constaté des préjudices potentiels et réels, notamment des violations de la confidentialité et l'incapacité à réunir des preuves, limitant ainsi la possibilité des femmes d'avoir accès à des réparations civiles et juridiques. Le soutien à la sensibilisation a eu des résultats positifs pour beaucoup de femmes, tant que le soutien s'est poursuivi pour maintenir des changements positifs, que les femmes restent ou non avec le partenaire violent. Les services de santé génésique et de maternité se sont révélés des points précieux d'intervention pour les services de violence domestique car ils associent l'enquête systématique des cliniciens, le soutien après la révélation et l'attention à la réduction des risques. Este artículo resume la evaluación de una intervención relacionada con la violencia doméstica en los servicios de salud materna y sexual de un hospital del Reino Unido. La intervención comprendió guías, capacitación del personal, indagación rutinaria de todas las pacientes respecto a la violencia doméstica y referencia de las que denunciaron violencia a un servicio de promoción y defensa in situ. Se aplicó un enfoque de "investigación de suposiciones" para evaluar la intervención. Las suposiciones programáticas fueron identificadas y probadas utilizando entrevistas con profesionales de la salud y pacientes, revisión de los expedientes médicos y cuestionarios pre- y post-capacitación. La capacitación en violencia doméstica produjo cambios en los conocimientos y las prácticas de los profesionales de la salud a corto plazo, pero no se logró establecer una rutina de indagación universal, ni tan siquiera en un contexto con apoyo organizacional, guías, capacitación y promoción y defensa. Ocurrieron daños posibles y reales, como violación de confidencialidad e incumplimiento de documentar la evidencia; éste último limitó la capacidad de las mujeres para acceder remedios civiles y jurídicos. El apoyo de promoción y defensa llevó a resultados positivos para muchas mujeres, siempre y cuando se les continuara brindando apoyo para mantener cambios positivos, independientemente de que la mujer permaneciera con su pareja violenta o la dejara. Se concluyó que los servicios de salud materna y sexual son puntos oportunos de intervención para los servicios contra la violencia doméstica, que combinan la indagación rutinaria por parte del personal de salud, apoyo después de confirmada la violencia y atención a la reducción de daños. [ABSTRACT FROM AUTHOR]