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Parkinson's disease (PD) is a chronic neurological disease that negatively influences patients' quality of life (QoL). Reduced social interactions are a result of both PD symptoms and impairment in QoL, which is known as social withdrawal. Smartphones are suitable for monitoring social behaviour under the notion of digital phenotyping, as people spend significant time socialising on them. We implement year-long longitudinal research using smartphones to study social withdrawal in PD. In addition to an entire year of 24/7 continuous monitoring on smartphones, weekly social ratings and QoL are provided as self-report ground truth. Twenty-three features are extracted from more than 10 million raw data entries collected from eight participants. These features are then used to build models to reflect participants' self-report ratings. We consider the interactions that happen on smartphones, such as calls, messages and social media, and use smartphone sensors to infer face-to-face interactions. By applying multiple linear regression and Naive Bayes, our model is significantly better than just assigning mean and random guesses. The results suggest that our approach provides a more granular method for tracking social behaviour in people with PD via smartphones, and it could benefit wider communities where the social impact on patients needs attention. [ABSTRACT FROM AUTHOR]

Background: Managing diagnostic uncertainty is a major challenge in primary care due to factors such as the absence of definitive tests, variable symptom presentations and disease evolution. Maintaining patient trust during a period of investigative uncertainty, whilst minimising scope for diagnostic error is a challenge. Mismanagement can lead to diagnostic errors, treatment delays, and suboptimal patient outcomes. Objective: Our aim was to explore how UK primary care physicians (GPs) address and communicate diagnostic uncertainty in practice. Design: This qualitative study used video and audio-recordings. Verbatim transcripts were coded with a modified, validated tool to capture GPs' actions and communication in primary care consultations that included diagnostic uncertainty. The tool includes items relating to advice regarding new symptoms or symptom deterioration (sometimes called 'safety netting'). Video data was analysed to identify GP and patient body postures during and after the delivery of the management plan. Participants: All patient participants had a consultation with a GP, were over the age of 50 and had (1) at least one new presenting problem or (2) one persistent problem that was undiagnosed. Approach: Data collection occurred in GP-patient consultations during 2017–2018 across 7 practices in UK during 2017–2018. Key results: GPs used various management strategies to address diagnostic uncertainty, including (1) symptom monitoring without treatment, (2) prescribed treatment with symptom monitoring, and (3) addressing risks that could arise from administrative tasks. GPs did not make management plans for potential treatment side effects. Specificity of uncertainty management plans varied among GPs, with only some offering detailed actions and timescales. The transfer of responsibility for the management plan to patients was usually delivered rather than negotiated, with most patients confirming acceptance before concluding the discussion. Conclusions: We offer guidance to healthcare professionals, improving awareness of using and communicating management plans for diagnostic uncertainty. [ABSTRACT FROM AUTHOR]

Alcohol is a causal factor in about 10% of breast cancer (BCa) cases, but awareness of this link is low. This study explored how to raise awareness and inform the development of an intervention using the COM-B model (capability, opportunity, motivation, behavior) framework. Eight online focus groups were conducted with 36 participants (6 expert stakeholders,and 30 women aged 40–65). Participants reflected on a package of information about alcohol and BCa and discussed how to impart this information and encourage women to reduce drinking. Thematic analysis of focus group transcripts was undertaken. Three themes were identified: understanding ineffective messaging; transitions and challenges; and message acceptability. Current health information about alcohol was perceived as judgmental and BCa was put down to chance. Mid-life consisted of many challenges that could lead to increased consumption, but menopause transition may be a key moment for alcohol reduction. Barriers and enablers to communicating risk information and encouraging alcohol reduction were mapped onto the COM-B model. Psychological capability (relating to knowledge), social opportunity (in the form of social pressure) and automatic motivation (relating to drinking to cope) were barriers to behavior change. These will be targeted in an alcohol reduction intervention. It is important to tailor information to women's experiences, taking into account the social benefits of drinking, and encourage the development of healthy coping strategies. Acceptable intervention messages may include personal stories, clear statistics, and suggest healthy alternatives to drinking. It is vital that messaging does not appear judgmental or patronizing. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To learn how clinical research projects can lead to improved patient outcomes and enhanced staff morale • To understand the importance of engaging clinical managers in research projects • To find out how clinical managers can contribute to the development of a research culture. There is growing evidence that clinical research activity is linked to better patient outcomes and that staff involvement in research is linked to enhanced morale and retention. Clinical managers have a pivotal role in supporting staff to engage with research, but they are not always given the means to do so and are not always aware of the benefits. In 2021 a research internship scheme was set up as a collaboration between two London NHS trusts and a university, enabling nurses and midwives to undergo training and undertake a range of research activities. Some participants experienced challenges in fitting internship activities around clinical duties despite the fact that the scheme was planned to give them protected time. This article describes the scheme, reports the findings of its evaluation at one of the two trusts, and discusses its implications for clinical managers in terms of how they can be supported to contribute to the development of a research culture. [ABSTRACT FROM AUTHOR]

Aim: Expanding and sustaining student nurse placements outside of the acute sector is a universal challenge. This paper aims to evaluate the Care Home Education Facilitator Role introduced in one area of Wales, United Kingdom, and to report on the outcomes achieved from this novel role. Methods: Semi‐structured interviews were undertaken with key stakeholders including the Care Home Education Facilitator postholder leading the pilot, care home managers, higher education institutions' placement managers/coordinators, student nurses and national health service staff. Results: Five key areas were identified, which included timing of introducing the post and establishing a clear rationale and understanding of the intention of the role. The benefits, challenges and suggested improvements to the Care Home Education Facilitator initiative are provided. Conclusion: Introducing the role of the Care Home Education Facilitator to work closely with key stakeholders resulted in increased placements for student nurses, but investing time in developing relationships with these stakeholders was critical to the success of the role. Summary statement: What is already known about this topic? There is a universal shortage of clinical placements for nursing students, particularly within a care home setting.The number of studies exploring how we might grow the number of nurses needed in this setting is limited. What this paper adds? This study evaluated a novel initiative introduced in South Wales, United Kingdom, that focuses on the development of nursing placements in the care home setting.Engaging with stakeholders involved in the development and implementation of the Care Home Education Facilitator initiative, a roadmap was provided to illustrate the stepped approach required to support an active care home placement including key governance arrangements. The implications of this paper: For those involved in identifying and developing student placements, this study provides valuable insight to a role that can help increase student numbers in a care setting often overlooked.It identifies viable career options for nurses at the point of registration.The role assists with widening networks for the care homes across health and social care sectors. [ABSTRACT FROM AUTHOR]

Introduction: The role of the clinical nurse specialist is complex but is defined differently across the world. The role of clinical nurse specialist stoma care is undefined and it is uncertain what aspects of the role are included in the general day‐to‐day working role. Aims: The aim was to gain consensus opinion to answer the research question: 'What is the role of the clinical nurse specialist in stoma care?' Design: Delphi consensus. Methods: Previous data gained from a scoping review and expert consultation was utilized to form role statements. At a UK conference the 13 statements and 173 sub‐categories were voted upon. Consensus was agreed if 75% of voters voted agree or strongly agree. Two stages of voting occurred with results from the first vote being shared in the second voting session. Results: All 13 statement and most (150/193) statement sub‐categories reached consensus, with 20 sub‐categories added during voting session one. Conclusions: The four pillars of advanced practice were met by the 13 statements with clinical and education reaching higher consensus and agreement than leadership/management and research. The results of the consensus study provide a clearer articulation of the clinical nurse specialist stoma care role, which is complex and multifaceted which has not been described previously. Implications for Practice: Consideration of role evolution is made possible, to gain a greater expertise in the scope of practice it is necessary to include prescribing, management and research which could improve service delivery and optimize patient outcomes. There was no patient or public contribution, which in hindsight would have potentially improved the process but it was considered that patients might not recognize the full role of the nurse, understanding only aspects of the role that were patient‐centred. Patient or Public Contribution: No patients or public were involved in any aspect of this paper—in hindsight this might have been useful. [ABSTRACT FROM AUTHOR]

Background and Aims: Communication is important in determining how patients understand the diagnostic process. Empirical studies involving direct observation of communication within diagnostic processes are relatively limited. This ethnographic study aimed to identify communicative practices facilitating or inhibiting shared understanding between patients and doctors in UK acute secondary care settings. Methods: Data were collected in acute medical sectors of three English hospitals. Researchers observed doctors as they assessed patients; semistructured interviews were undertaken with doctors and patients directly afterwards. Patients were also interviewed 2–4 weeks later. Case studies of individual encounters (consisting of these interviews and observational notes) were created, and were cross‐examined by an interdisciplinary team to identify divergence and convergence between doctors' and patients' narratives. These data were analysed thematically. Results: We conducted 228 h of observation, 24 doctor interviews, 32 patient interviews and 15 patient follow‐up interviews. Doctors varied in their communication. Patient diagnostic understanding was sometimes misaligned with that of their doctors; interviews revealed that they often made incorrect assumptions to make sense of the fragmented information received. Thematic analysis identified communicative practices that seemed to facilitate, or inhibit, shared diagnostic understanding between patient and doctor, revealing three themes: (1) communicating what has been understood from the medical record, (2) sharing the thought process and diagnostic reasoning and (3) closing the loop and discharge communication. Shared understanding was best fostered by clear communication about the diagnostic process, what had already been done and what was achievable in acute settings. Written information presents an underutilised tool in such communication. Conclusions: In UK acute secondary settings, the provision of more information about the diagnostic process often fostered shared understanding between doctor and patient, helping to minimise the confusion and dissatisfaction that can result from misaligned expectations or conclusions about the diagnosis, and the uncertainty therein. Patient/Public Contribution: A patient and public involvement group (of a range of ages and backgrounds) was consulted. They contributed to the design of the protocol, including the timing of interviews, the acceptability of a follow‐up telephone interview, the development of the interview guides and the participant information sheets. [ABSTRACT FROM AUTHOR]

Physical activity and healthy eating are important for physical and mental health, yet long-standing inequalities constrain the ability of ethnic minorities in the United Kingdom (UK) to adopt these behaviours. Programmes aimed to improve these behaviours have also often not been engaged with by these communities. This study therefore aimed to: (1) identify the values underlying the physical activity and healthy eating behaviours of UK ethnic minorities and (2) explore how structural, socio-economic and environmental factors interact with these values to influence their physical activity and healthy eating behaviours. The study adopted a relativist ontological and subjectivist epistemological philosophical assumption. Qualitative interviews were used to address research objectives. A total of 10 group and five individual interviews were conducted with 41 participants. All participants were from an ethnic minority background (Black, Asian or Mixed according to the UK Office for National Statistics classification), recruited purposively and aged between 18 and 86 years and were living in England and Wales. Data were analysed using inductive thematic analysis. Community engagement was embedded throughout the study. We found that culture and family, community and social life, and health are important values underlying the physical activity and healthy eating behaviours of UK ethnic minority communities. External factors, including racism and access (geographical, social and economic), interact with these values to drive health behaviours. Using an illustrative guide, we conclude the paper with policy and practice recommendations on how public health programmes on physical activity and healthy eating can be aligned with these values to ensure relevance for ethnic minority communities. [ABSTRACT FROM AUTHOR]

This study examines transparency in assessment practices within UK higher education institutions (HEIs), addressing a gap in how transparency is framed within policy documents. Employing content analysis on policy documents from 151 HEIs, we explore the multifaceted nature of transparency through techno-rational approaches, socio-cultural practices, and socio-material enactments to offer a nuanced understanding of transparency conceptualization and its intended audience. Findings indicate a predominant focus on techno-rational approaches – emphasizing clear documentation and information dissemination – while often overlooking the socio-cultural and socio-material dimensions crucial for thorough understanding and stakeholder engagement. We propose a nuanced framework integrating these three approaches, urging a shift beyond mere information disclosure to active stakeholder engagement with assessment criteria through dialogue and interaction. This research contributes to the discourse on transparency in assessment by offering theoretical and practical insights. Theoretically, it advances our understanding of transparency as a dynamic and contextually situated practice, challenging static conceptualizations. Practically, it provides a robust basis for refining assessment policies and practices, emphasizing clarity, comprehensibility, and inclusivity. By recognizing the diverse needs of stakeholders – students, educators, and assessors – the study advocates for policy enhancements that promote a deeper, actionable understanding of assessment practices. The findings lay the groundwork for future research on the conceptualization and impact of transparency in higher education, guiding more effective policy development and implementation. This study underscores the importance of comprehensive, well-articulated policies in fostering a shared understanding of transparent assessment practices within HEIs. [ABSTRACT FROM AUTHOR]

This article presents a bibliometric analysis of research on COVID-19 health communication. We reviewed and analyzed 1,851 articles published in 170 peer-reviewed communication journals between January 2020 and November 2022, to identify key bibliometric information and major research topics in this rapidly expanding field of research. The distribution of countries indicates that the United States is the most productive country, and researchers from Spain, China and the United Kingdom also play an important role. Health Communication is the most influential journal in terms of research productivity and impact. The analysis of highly cited references demonstrates the interdisciplinary nature of this research field. The topics generated by structural topic modeling show that scholars have responded to a variety of issues in COVID-19 communication, encompassing different levels of health communication, the effects of information dissemination, the impact on the general public as well as vulnerable populations, health preventive behaviors and communication technologies. This study aims to enhance researchers' understanding of the current state of this research field and provide insights for future studies. [ABSTRACT FROM AUTHOR]

Background: Oral health conditions are common in children and young people (CYP) with kidney disorders. There is currently limited literature on how confident paediatric nephrology teams feel to identify and manage oral health concerns for their patients. Method: An exploratory mixed-method survey was distributed across all 13 UK specialist paediatric nephrology centres with responses received from consultants, registrars, specialist nurses and special interest (SPIN) paediatricians. Results: Responses received from 109 multidisciplinary team members of 13/13 (100%) UK tertiary units. Ninety-two percent (n = 100) of respondents reported they had never received any training in oral health and 87% (n = 95) felt that further training would be beneficial to optimise care for patients and improve communication between medical and dental teams. Most respondents reported that they did not regularly examine, or enquire about, their patients' oral health. Only 16% (n = 17) reported that all their paediatric kidney transplant recipients underwent routine dental assessment prior to transplant listing. Severe adverse oral health outcomes were rarely reported and only 11% (n = 12) of respondents recalled having a patient who had a kidney transplant delayed or refused due to concerns about oral infection. Seventy-eight percent (n = 85) felt that joint working with a dental team would benefit patients at their unit; however, 17% (n = 18) felt that current infrastructure does not currently support effective joint working. Conclusions: Across the UK, paediatric kidney health professionals report lack of confidence and training in oral health. Upskilling subspecialty teams and creating dental referral pathways are recommended to maximise oral health outcomes for CYP with kidney diseases. [ABSTRACT FROM AUTHOR]

Background: Children and young people (CYP) with complex neurodisability experience multiple physical, communication, educational and social challenges, which require complex packages of multidisciplinary care. Part of the holistic care required includes supporting the families and parents/caregivers. The aim of the wider study was to introduce a new programme ('Ubuntu') to parents/caregivers and healthcare professionals (HCPs) in order to test the feasibility and acceptability of the concept and content, with the goal of potential adaptation for the UK in mind. Data collection and analysis uncovered rich data on caregiving journeys, navigation of health services, and perceived service gaps. This paper focuses solely on these topics. Further papers will report on the feasibility and adaptation data. Methods: Two rounds of semi‐structured interviews were conducted with 12 caregivers of CYP with complex neurodisability and six HCPs from a variety of disciplines, recruited from a community child health service in London Borough of Newham, UK in 2020. The interviews included open‐ended questions to explore caregiving journeys, experiences of navigating health services and perceived service gaps. Transcripts were analysed using a data‐driven inductive thematic analysis. Results: Three themes were identified that related to the aim of understanding caregivers' experiences and unmet needs relating to current service provision. These were (1) Caregiver Mental Health, (2) The Information Gap and (3) The Need for Holistic Support. Mental health difficulties were reported, particularly around the period of diagnosis. Priority needs included the provision of clear information about the diagnosis and services offered, opportunities to forge peer support networks and for services across the community to collaborate. Conclusions: The delivery of health services for CYP with neurodisability should encompass the broad needs of the family as well as meeting the clinical needs of the CYP. [ABSTRACT FROM AUTHOR]

Complementing the well-established evidence base on health inequalities experienced by migrants, refugees and asylum seekers in the UK; we examined the extent to which their right to equal non-discriminatory access to health services (promotive, preventive, curative) was upheld during the COVID-19 pandemic. Arksey and O′Malley's scoping review framework. A comprehensive search was conducted on Medline, PubMed, and CINAHL using detailed MESH terms, for literature published between 01 January 2020 and 01 January 2024. The process was supported by a ten-page Google search and hand searching of reference lists. 42 records meeting the inclusion criteria were charted, coded inductively and analysed thematically in an integrated team-based approach. Dissonance between immigration regulation and health governance is illustrated in four themes: Health systems leveraged to (re)enforce the hostile environment; Dissonance between health rights on paper and in practice; Structural failures to overcome communication and digital exclusion; and COVID-19 vaccine (in)equity exacerbated fear, mistrust and exclusion. Migrants, refugees and asylum seekers encountered substantial individual, structural and policy-level barriers to accessing healthcare in the UK during COVID-19. Insecure immigration status, institutional mistrust, data-sharing and charging fears, communication challenges and digital exclusion impacted heavily on their ability to access healthcare in an equitable non-discriminatory manner. An inclusive and innovative health equity and rights-based responses reaching all migrants, refugees and asylum seekers are warranted if the National Health Service is to live up to its promise of ' leaving no one behind' in post-pandemic and future responses. [ABSTRACT FROM AUTHOR]

Background: Global challenges arise from infectious diseases which represent significant challenges to the provision of healthcare, requiring efficient management procedures to limit transmission. Evaluating current outbreak management processes within UK healthcare services is essential for identifying strengths, weaknesses, and potential improvements. Objectives: This study aimed to assess infection prevention and control (IPC) practitioners' access to outbreak management (OM) data. Secondary objectives involved determining IPC practitioners' perceptions of outbreak management processes and the state of digitalisation of OM in the UK. Methods: National cross-sectional survey data were collected to evaluate current outbreak management approaches. To supplement this, information requests were sent to the 10 largest teaching and research NHS hospital trusts in England. Findings: The survey received 55 responses with 53 considered for analysis. Out of 10 NHS trusts, nine provided completed FOI responses, while one was unable to provide data. Discussion: The study offers unique insights into prevailing outbreak management practices within UK health services. Although positive perceptions surround key outbreak management stages, concerns arise, including varying confidence levels in surveillance processes' robustness, efficacy of management interventions, and communication effectiveness. Conclusions: The study highlights challenges with OM processes in the UK, including issues like poor surveillance and delayed outbreak detection. Positive practitioner perceptions contrast with concerns over data collection, follow-up, and limited digitalisation, relying on basic tools like Excel and Word, hindering retrospective learning. [ABSTRACT FROM AUTHOR]

Background: Paediatric critical care (PCC) is a high-pressure working environment. Staff experience high levels of burnout, symptoms of post-traumatic stress, and moral distress. Aim: To understand challenges to workplace well-being in PCC to help inform the development of staff interventions to improve and maintain well-being. Study Design: The Enhanced Critical Incident Technique (ECIT) was used. ECIT encompasses semi-structured interviews and thematic analysis. We identified 'critical incidents', challenges to well-being, categorized them in a meaningful way, and identified factors which helped and hindered in those moments. Fifty-three nurses and doctors from a large UK quaternary PCC unit were consented to take part. Results: Themes generated are: Context of working in PCC, which examined staff's experiences of working in PCC generally and during COVID-19; Patient care and moral distress explored significant challenges to well-being faced by staff caring for increasingly complex and chronically ill patients; Teamwork and leadership demonstrated the importance of team-belonging and clear leadership; Changing workforce explored the impact of staffing shortages and the ageing workforce on well-being; and Satisfying basic human needs, which identified absences in basic requirements of food and rest. Conclusions: Staff's experiential accounts demonstrated a clear need for psychologically informed environments to enable the sharing of vulnerabilities, foster support, and maintain workplace well-being. Themes resonated with the self-determination theory and Maslow's hierarchy of needs, which outline requirements for fulfilment (self-actualization). Relevance to Clinical Practice: Well-being interventions must be informed by psychological theory and evidence. Recommendations are flexible rostering, advanced communication training, psychologically-informed support, supervision/mentoring training, adequate accommodation and hot food. Investment is required to develop successful interventions to improve workplace well-being. [ABSTRACT FROM AUTHOR]

We report on a qualitative Group Survey study involving four healthcare professionals (HCPs) and eight people living with HIV who were recipients of care in the United Kingdom (UK). The survey aimed to bring participants' perspectives into dialogue and establish consensus about how communication between HCPs delivering HIV care and their patients could be improved in the context of the routine care consultation. Responses from both parties were anonymously collated, thematically analysed, and shared back with participants in two subsequent survey rounds to support consensus-building on matters of concern and identify thematic insights. In this paper, we report three themes for informing future designs of tools and services to support communication between patients and HCPs: Patient-clinician relationship for trusted sharing; Self-reporting psychosocial information to support Whole-person care; and Perceived barriers for online trusted sharing with HCPs. Our findings highlight key areas of concern and further investigation is needed to understand how self-reported information may be meaningfully captured, interpreted and processed by HCPs in ways that are trusted by patients who voice privacy and security concerns. [ABSTRACT FROM AUTHOR]

Communication is fundamental to mental health services for every patient, caregiver and clinician interaction. Without adequate communication skills, the aspiration to inclusion, engagement and recovery is likely to fail. Speech and language therapists provide specialist knowledge directly with patients, and indirectly via clinicians and caregivers. The objective of this study was to explore current UK provision and practice of speech and language therapists supporting working age adults with mental health conditions. A ten question online survey was shared on social media and sent to a network of speech and language therapists interested in mental health services in September 2019. Responses were analysed using descriptive statistics supported by free text survey responses. From survey closing in March 2020, 96 responses were received from across the four UK nations describing widely varying services. Respondents reported concerning gaps in SLT provision, other professions not understanding the SLT role, but over 75% of respondents reported multidisciplinary ways of working. Risks associated with communication impairment are often overlooked. The understanding of mental health professionals about the role of speech and language therapists is patchy. Highlighting awareness amongst the mental health workforce about communication impairment will improve access to treatment and care for all patients. [ABSTRACT FROM AUTHOR]

Background: Speech and language therapists (SLTs) and care home activities staff play key roles in managing and supporting the communication needs of older residents in care homes. However, the current practice and perspectives of these two professions in the United Kingdom has not been examined. Aims: To investigate the practice patterns and views of SLTs and activities staff working in UK care homes for older adults in relation to residents' communication needs. Methods and Procedures: Two online surveys, with 63 questions (SLT survey) and 46 questions (activities staff survey) in total, were created using the online platform Qualtrics. Participants were asked to consider their routine practice before COVID‐19. Results were analysed using descriptive statistics and qualitative content analysis. Outcomes and Results: A total of 116 valid responses were received from SLTs and 29 valid responses from activities staff. A high level of communication needs in care homes was reported by both participant groups, as was insufficient time and resources and lack of managerial encouragement in this area. SLTs reported that the majority of referrals to their service from care homes was for swallowing needs (70%). Cognitive communication difficulty was the most commonly reported communication need by SLTs (65%). Most SLTs (73%–87%) provided some level of communication intervention and considered management of residents' communication needs to be both part of the SLT role and a good investment of their time. Lack of confidence setting goals and providing direct intervention for communication needs was reported, with 25% feeling stressed at the thought of this. The main themes from free text responses about SLT service improvement were increased staff training, funding (of resources and specialist posts) and changes to service provision (referral criteria and accessibility/awareness of SLT service). Hearing impairment was the communication need most commonly reported by activities staff (43%). Participants demonstrated relatively high awareness of communication difficulty in residents and reported high levels of knowledge and confidence identifying and supporting residents' communication. Most (79%–89%) considered identifying and supporting the communication needs of residents to be part of their role and expressed interest in receiving further training in communication support. The reported activities staff data set may be positively biased. Conclusions and Implications: SLTs and activities staff were highly motivated to support the communication needs of care home residents. Increased training, time and resources dedicated to managing the communication needs of residents emerged as opportunities for service improvement across both data sets. WHAT THIS PAPER ADDS: What is already known on the subject: There is a high level of communication need amongst older care home residents. Social interaction and relationships are important factors contributing to quality of life in this population and rely on successful communication. Speech and language therapists (SLTs) and activities staff play key roles in managing and supporting the communication needs of this client group, but the current practice and perspectives of these professions in the United Kingdom has not been examined. What this study adds: A high level of communication need in care home residents was identified by both SLT and activities staff and both participant groups were motivated to address, identify and manage this need. However, insufficient time and resources, as well as a perceived lack of encouragement from managers to provide communication support/intervention, were reported by both groups. SLT practice was constrained by referral criteria and care pathways, which differed between services. Suggestions for SLT service improvement are reported. Clinical implications of this study: Targeted, ongoing staff training is required in care homes to improve the communication environment and develop care home staff capacity to support residents' communication needs. There is also a call for service level improvements to increase the range of SLT practice in care homes, including a greater focus on communication needs and more specialist (e.g., dementia) SLT roles. [ABSTRACT FROM AUTHOR]

This paper presents a review of the existing qualitative research literature concerning people's experience of communicating using augmentative and alternative communication (AAC). The aims of conducting this review were to find out more about the values and outcomes that are important to people about the AAC they use to support their communication. This review was conducted to provide a deeper understanding of these experiences to inform the development of a patient-reported outcome measure (PROM). A qualitative evidence synthesis of existing qualitative research literature was undertaken to explore and appraise current knowledge about the experiences of people who use AAC. From 115 qualitative research reports 19 papers were identified that responded directly to the research question and aims of the review. Data were identified that could be organized within an a priori framework consisting of the constructs of values, outcomes, and context. The review has resulted in a deeper, analytical understanding of the experiences of people who require AAC. The results indicate a set of concepts that can be used to inform the development of a PROM. A PROM can be used to assist clinicians and researchers to better understand the perspectives of people who require AAC and evaluate interventions. The results also encourage professionals to reconsider the terminology and methods used when working alongside people who require AAC and to reflect on the multidimensional factors that influence people's experience of communication. Patient-reported outcome measures (PROMs) can be useful tools to support clinician-patient communication, facilitate shared decision making and establish priorities for rehabilitation. It can be difficult to engage people who have complex communication difficulties in decisions about the important outcomes to them from using augmentative and alternative communication (AAC). This qualitative evidence synthesis provides a deeper understanding of the experiences and perspectives of people who use AAC. The results will be used to inform the development of a PROM which can be used to facilitate shared decision-making, and evaluate AAC interventions from the perspective of the people who use these technologies. [ABSTRACT FROM AUTHOR]

Background: Patients from socioeconomically disadvantaged backgrounds are underserved in randomised controlled trials, yet they experience a much greater burden of disease compared with patients from socioeconomically advantaged areas. It is crucial to make trials more inclusive to ensure that treatments and interventions are safe and effective in real-world contexts. Improving how information about trials is verbally communicated is an unexplored strategy to make trials more inclusive. This study examined how trials are communicated verbally, comparing consultations involving patients from the most and least socioeconomically disadvantaged areas. Methods: Secondary qualitative analysis of 55 trial consultation transcripts from 41 patients, sampled from 3 qualitative studies embedded in their respective UK multi-site, cancer-related randomised controlled trials. Patients living in the most and least socioeconomically disadvantaged areas, defined using English Indices of Multiple Deprivation decile scores, were purposively sampled. Analysis was largely thematic and drew on the constant comparison method. Results: Recruiters communicated clinical uncertainty in a similar way for patients living in different socioeconomic areas. Consultations with disadvantaged patients were, on average, half the duration of those with advantaged patients, and tended to involve recruiters providing less in-depth explanations of trial concepts, used phrasing that softened trial arm risks, and described trial processes (e.g. randomisation) using informal or metaphorical phrasing. Disadvantaged and advantaged patients differed in the concerns they expressed; disadvantaged patients voiced fewer concerns and asked fewer questions but were also less likely to be invited to do so by recruiters. Conclusion: Interactions about trials unfolded in different ways between patients living in different socioeconomic areas, likely due to both patient- and recruiter-related factors. We present considerations for recruiters when discussing trials with patients from socioeconomically disadvantaged backgrounds, aimed at enhancing trial communication. Future research should examine disadvantaged patients' and recruiters' experiences of verbal trial communication to inform guidance that addresses the needs and preferences of underserved groups. [ABSTRACT FROM AUTHOR]

Background: Retaining participants in randomised controlled trials (RCTs) is challenging and trial teams are often required to use strategies to ensure retention or improve it. Other than monetary incentives, there is no requirement to disclose the use of retention strategies to the participant. Additionally, not all retention strategies are developed at the planning stage, i.e. post-funding during protocol development, but some protocols include strategies for participant retention as retention is considered and planned for early in the trial planning stage. It is yet unknown if these plans are communicated in the corresponding participant information leaflets (PILs). The purpose of our study was to determine if PILs communicate plans to promote participant retention and, if so, are these outlined in the corresponding trial protocol. Methods: Ninety-two adult PILs and their 90 corresponding protocols from Clinical Trial Units (CTUs) in the UK were analysed. Directed (deductive) content analysis was used to analyse the participant retention text from the PILs. Data were presented using a narrative summary and frequencies where appropriate. Results: Plans to promote participant retention were communicated in 81.5% (n = 75/92) of PILs. Fifty-seven percent (n = 43/75) of PILs communicated plans to use "combined strategies" to promote participant retention. The most common individual retention strategy was telling the participants that data collection for the trial would be scheduled during routine care visits (16%; n = 12/75 PILs). The importance of retention and the impact that missing or deleted data (deleting data collected prior to withdrawal) has on the ability to answer the research question were explained in 6.5% (n = 6/92) and 5.4% (n = 5/92) of PILs respectively. Out of the 59 PILs and 58 matching protocols that both communicated plans to use strategies to promote participant retention, 18.6% (n = 11/59) communicated the same information, the remaining 81.4% (n = 48/59) of PILs either only partially communicated (45.8%; n = 27/59) the same information or did not communicate the same information (35.6%; n = 21/59) as the protocol with regard to the retention strategy(ies). Conclusion: Retention strategies are frequently communicated to potential trial participants in PILs; however, the information provided often differs from the content in the corresponding protocol. Participant retention considerations are best done at the planning stage of the trial and we encourage trial teams to be consistent in the communication of these strategies in both the protocol and PIL. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the experiences of women with kidney disease, residing in the United Kingdom (UK), living through the first 18 months of the COVID‐19 pandemic with specific focus on preconception decision‐making, family planning, and parenting. Methods: We conducted a mixed‐methods study, comprising an online survey and follow‐up interviews, with UK‐resident women aged 18–50. Results: We received 431 surveys and conducted 30 interviews. Half (n = 221, 51%) of the survey respondents considered that COVID‐19 influenced the quality of communication with healthcare professionals and 68% (n = 295) felt that the pandemic disrupted their support networks. Interview participants indicated that delayed and canceled appointments caused anxiety, grief, and loss of pregnancy options. Women's perception of themselves as (good) mothers as well as their capacity to have and raise a child, meet partners, and sustain healthy relationships was negatively affected by the "clinically extremely vulnerable" label. Women's trust in their healthcare was dismantled by miscommunication and variation in lockdown rules that caused confusion and increased worry. Women reported that COVID‐19 contributed to postnatal depression, excessive concern over infant mortality, preoccupation over others following rules, and catastrophising. Conclusion: Some women in the UK with chronic kidney disease lost or missed their opportunity to have children during the pandemic. Future pandemic planners need to look more holistically and longer term at what is and is not classed as an emergency, both in how services are reconfigured and how people with chronic conditions are identified, communicated with, and treated. [ABSTRACT FROM AUTHOR]

In daily interactions, individuals use irony and prosocial lies for various reasons, for example, to be humorous, to criticize, or to be polite. While some studies have examined individual differences in perceiving the politeness of such language, research using naturalistic, context-rich materials is lacking. To address this gap, we utilized short videos to assess politeness perception in literal, ironic, and prosocial lie scenarios while also exploring differences based on age, gender, and geographical location. Our sample included 288 participants from the United States and the United Kingdom. We focused on five different types of language: literal positive, blunt, sarcastic, teasing, and prosocial lies. Participants rated the politeness of these statements and completed surveys on communication preferences (Self-Reported Sarcasm Questionnaire and Conversational Indirectness Scale Questionnaire). While the demographic groups showed similarities, individual factors also shaped politeness perception. Older adults perceived teasing as less polite than middle-aged and younger adults, and male participants rated blunt and sarcastic statements as more polite. Geographical variations were found for prosocial lies, with U.K. participants rating them more polite than their U.S. counterparts. These findings underscore the importance of considering context-rich materials and individual factors in understanding the social functions of irony and prosocial lies. [ABSTRACT FROM AUTHOR]

Interviews with individuals experiencing homelessness can be challenging for various reasons, including mental and physical health issues, substance use, and negative experiences with authority figures. Researchers have used photos to facilitate communication and empower participants during data collection. We analyzed data from a previous study to explore the use of researcher-generated photos during interviews about health with 13 women experiencing homelessness. Conversation analysis revealed clear patterns regarding the use of the photos during the interviews. The photos were referred to 118 times over the total interview length, 6 hours and 23 minutes, with the interviewer making 62% of the referrals and the women accounting for 38%. Fifty-nine percent of the referrals occurred within the first 5 minutes of the interviews. The women used the photos to trigger associations and emotions, to describe photo content, or in a minor role during the interview. Interpretations from an advisory board of six women with lived experiences of homelessness suggested that the photos did not engage participants as intended, highlighting the importance of considering participants' perspectives when designing photo-elicitation methods. The feedback also provided valuable insights into interview locations and incentives in research that may have influenced the women's willingness to use the photos. This study emphasizes the importance of understanding the complexity of choosing researcher-generated photos in interviews with underserved, hard-to-reach populations. [ABSTRACT FROM AUTHOR]

Background Study: Technology‐supported learning environments, act as significant observational and enabling indicators for evaluating and encouraging the digital revolution of education, are of vital importance in current educational research. Keeping track of the dynamics of technology‐supported learning environment research allows for the enrichment of theoretical studies and a prompt innovation of talent‐training environments. Objectives: The present study carried out a bibliometric analysis of the core collection of WoS database over the last two decades. Method: This study is a bibliometric research. We applied CiteSpace and VOSviewer for co‐occurrence and evolution analysis. In addition, we extracted the fundamental ideas and thoughts through reading and analysis. Results: First, the study found that technology‐supported learning environment research is in a growth phase, with core journals such as Interactive Learning Environments or Computers & Education. The findings show that a core research team comprised of such scholars as Hwang Gwo‐Jen, Lester James C. and Wong Lung‐Hsiang. Key nations of publishing and research strength are from China, the United States, the United Kingdom and the Netherlands. Second, the hot topics in research on technology‐supported learning environments were virtual learning environments, technology‐enabled learning environments and interactive learning environments. Nine study specifics were derived from these three topics such as moulding function, generating scenario, stimulating sensation, effect verification, design idea, research reflection, inquiry and research, virtual community, and mixed environment. Lastly, the frontier evolution offers a pattern of development from enhancing performance to changing mode to incorporating experience. Conclusion: Looking ahead, our research recommendations for the field of technology‐supported learning environments include a multifaceted approach. We should aim to enhance research designs and methodologies, develop contemporary guiding theories and strive for a balanced representation across various educational domains, expanding our scope to encompass all academic disciplines. In terms of practical application, it is imperative to focus on the design and implementation of technology‐supported learning environments from three critical perspectives: "change‐demand," "student‐learning" and "online‐offline." These approaches will collectively ensure that technology‐supported learning environments are both innovative and responsive to the diverse needs of the educational landscape. Lay Description: What is already known about this topic: Technology‐supported learning environments are currently a focal and hot research topic in the field of education.Although numerous studies have been conducted on the learning environment of technical support, there has yet to be a systematic and comprehensive review of the related research. What this paper adds: This study provides a comprehensive review of research on the technology‐supported learning environments over the past two decades.This study primarily presents an overview of research on the technology‐supported learning environments over the past two decades, focusing on main literature, research strength, hot topics and frontier evolution. Implications for practice and/or policy: Researchers need to further advance research on technology‐supported learning environments by enriching research designs and methods, constructing up‐to‐date guiding theories and achieving a balance across different educational domains while extending the reach to all disciplines.Educational practitioners need to pay attention to the design and implementation of technology‐supported learning environments from the three viewpoints of "change‐demand," "student‐learning" and "online‐offline." [ABSTRACT FROM AUTHOR]

This article reflects on collaborative research carried out during the COVID-19 pandemic involving indigenous youth co-investigators from different urban settings in Bolivia and a UK- and Bolivia-based research coordination team. Unlike previous studies that highlight the potential of generating a shared co-presence via virtual engagements and digital methods when face-to-face interactions seem less desirable, this article offers a more cautious account. We question the existence of a shared co-presence and, instead, posit co-presence as fragmented and not necessarily mutual, requiring careful engagement with power imbalances, distinct socio-economic and space-time positionings, and diverse priorities around knowledge generation among team members. These considerations led us to iteratively configure a hybrid research approach that combines synchronous and asynchronous virtual and face-to-face interactions with multi-modal methods. We demonstrate how this approach enabled us to generate a sense of co-presence in a context where collaborator access to a shared space-time was limited, differentiated, or displaced. [ABSTRACT FROM AUTHOR]

Introduction: The Covid‐19 pandemic dramatically altered the way cancer care services were accessed and delivered, including for colorectal cancer (CRC). In the United Kingdom, patients were discouraged from presenting in primary care, many consultations took place remotely, investigative procedures and screening programmes were temporarily suspended, and fewer operations and treatments were delivered. People had to face the practical consequences of having cancer during a pandemic and navigate never before seen pathways, often alone. We examined the experience of being diagnosed and treated for CRC during the pandemic, and the implications of this on people's cancer journeys. Methods: Semi‐structured interviews were undertaken with people diagnosed with CRC during the Covid‐19 pandemic (January 2020–May 2021), in the North East of England. An iterative topic guide was used during interviews, which took place remotely (telephone or Zoom), were audio recorded, pseudo‐anonymised and transcribed. Initial transcripts were independently coded by two researchers, and a code 'bank' developed for application across transcripts. Development of themes and overarching analytical constructs was undertaken collaboratively by the research team. Results: Interviews were conducted with 19 participants, analysed and four key themes identified: (1) The relative threats of Covid‐19 and Cancer were not comparable, with cancer seen as posing a far greater risk than Covid‐19; (2) Remote consultations were problematic, affecting patients' abilities to build rapport and trust with clinicians, assess nonverbal communication, and feel able to disclose, comprehend and retain information; (3) Stoma follow‐up care was seen to be lacking, with long wait times for stoma reversal experienced by some; Finally, (4) Being alone during consultations negatively impacted some peoples' abilities to absorb information, and left them without the support of loved ones at an emotionally vulnerable time. However, some participants preferred being alone at certain points in their pathways, including receiving a diagnosis, and most frequently when receiving in‐patient treatment. Conclusion: Being alone brought unexpected benefits, absolving people from undertaking emotions work for others, and instead focus on their recovery, however, remote consultations negatively impacted patients' experiences. This study highlights the complex benefits and burdens of pandemic‐located cancer journeys, including how these shifted at different points across cancer pathways. Patient or Public Contribution: Lorraine Angell, a cancer survivor, has been central to this study from idea conception, contributing to: development of study focus and design; securing funding; production of patient‐facing materials; development of interview topic guides; analysis and interpretation of data; and drafting of key findings and manuscripts. [ABSTRACT FROM AUTHOR]

Introduction: Over a fifth of pregnant women are living with multiple long‐term health conditions, which is associated with increased risks of adverse outcomes for mothers and infants. While there are many examples of research exploring individuals' experiences and care pathways for pregnancy with a single health condition, evidence relating to multiple health conditions is limited. This study aimed to explore experiences and care of women with multiple long‐term health conditions around the time of pregnancy. Methods: Semistructured interviews were conducted between March 2022 and May 2023 with women with multiple long‐term health conditions who were at least 28 weeks pregnant or had had a baby in the last 2 years, and healthcare professionals with experience of caring for these women. Participants were recruited from across the United Kingdom. Data were analysed using thematic analysis. Results: Fifty‐seven women and 51 healthcare professionals participated. Five themes were identified. Women with long‐term health conditions and professionals recognised that it takes a team to avoid inconsistent care and communication, for example, medication management. Often, women were required to take a care navigation role to link up their healthcare providers. Women described mixed experiences regarding care for their multiple identities and the whole person. Postnatally, women and professionals recognised a downgrade in care, particularly for women's long‐term health conditions. Some professionals detailed the importance of engaging with women's knowledge, and recognising their own professional boundaries of expertise. Many participants described difficulties in providing informational continuity and subsequent impacts on care. Specifically, the setup of care systems made it difficult for everyone to access necessary information, especially when care involved multiple sites. Conclusion: Pregnant women with long‐term health conditions can experience a substantial burden of responsibility to maintain communication with their care team, often feeling vulnerable, patronised, and let down by a lack of acknowledgement of their expertise. These results will be used to inform the content of coproduction workshops aimed at developing a list of care recommendations for affected women. It will also inform future interventional studies aimed at improving outcomes for these women and their babies. Patient or Public Contribution: Our Patient and Public Involvement group were involved in the design of the study and the analysis and interpretation of the data, and a public study investigator was part of the author group. [ABSTRACT FROM AUTHOR]

Background: Patient and public involvement and engagement (PPIE) have long been considered important to good research practice. There is growing, yet diverse, evidence in support of PPIE with children and young people (CYP). We must now understand the various approaches to involvement of CYP in research. Aims: This rapid umbrella review aimed to provide an overview of when, how and to what extent CYP are involved in the conduct of health research, as well as the reported benefits, challenges, and facilitators of involvement. Methods: We searched OVID Medline, Embase and PubMed. Published reviews were included if they reported meaningful involvement of CYP in the conduct of health research. Extracted data were synthesised using thematic analysis. Results: The 26 reviews included were predominately systematic and scoping reviews, published within the last decade, and originating from North America and the United Kingdom. CYPs were involved in all stages of research across the literature, most commonly during research design and data collection, and rarely during research funding or data sharing and access. Researchers mostly engaged CYP using focus groups, interviews, advisory panels, questionnaires, and to a lesser extent arts‐based approaches such as photovoice and drawing. Visual and active creative methods were more commonly used with children ≤12 years. The evidence showed a shared understanding of the benefits, challenges, and facilitators for involvement of CYP, such as time and resource commitment and building partnership. Conclusion: Overall, the review identified consistency in the range of methods and approaches used, and stages of research with which CYP are commonly involved. There is a need for more consistent reporting of PPIE in the literature, both in terminology and detail used. Furthermore, the impact of approaches to CYP involvement on research and community outcomes must be better evaluated. Patient/Public Contribution: This review forms part of broader research initiatives being led by the authors. Together, these projects aim to support embedding of child voices in research practice and to explore the desirability and suitability of Young Persons Advisory Groups within birth cohort studies. The findings from this review, alongside public and stakeholder consultation, will inform development of resources such as practice recommendations to guide future involvement of CYP in health research undertaken at the author's respective institutions. [ABSTRACT FROM AUTHOR]

The ability to decode nonverbal cues is essential for effective cross-cultural communication. Despite the significance of nonverbal communication, research in this area has primarily focused on spoken language. This is particularly problematic during indirect communication, where there is a discrepancy between the surface meaning and the true intention (e.g., "Well, there is still room for improvement in your writing skills"). Misinterpretation of nonverbal cues during indirect communication can impede the decoding of true intention and potentially create hostile situations. The present study investigated cross-cultural differences in the use of nonverbal cues in decoding indirect messages. British and Chinese raters watched silent video clips and identified the types of replies from models of their own and the other culture. Results revealed that British raters were able to recognize indirect replies from British models but not from Chinese models above chance level, whereas Chinese raters were able to recognize indirect replies from models of both cultures above chance level. Furthermore, British raters showed higher accuracy and confidence in identifying indirect replies from British models than Chinese models. In contrast, Chinese raters were equally skilled and confident in identifying indirect replies from both British and Chinese models. Additionally, British and Chinese raters employed different nonverbal cues to recognize indirect replies from models of their respective cultures. These findings underscore the importance of cross-cultural differences in identifying indirect replies through nonverbal communication and provide insights to enhance intercultural communication between British and Chinese individuals. [ABSTRACT FROM AUTHOR]

Background and Objectives Personal care interactions can provide vital opportunities for caregivers to engage with a person living with advanced dementia. However, interactions may also be a contentious experience, what makes this so is not fully understood. We aimed to examine features of personal care interactions between caregivers and people with advanced dementia to understand how care may be improved. Research Design and Methods This was a naturalistic observation study using one-off video-recorded observations of personal care interactions between 14 people with advanced dementia and 12 caregivers (n = 7 care-home staff, n = 5 family carers) in the United Kingdom (total observation time 03:01:52). Observations were analyzed with observational video coding to determine the frequency of actions of people with dementia and qualitative content analysis for in-depth examination. Results Refusals of care were present in 32% of video sections. Active engagement of people with dementia was observed in 66% of sections. Rare contentious interactional components were characterized by the person with dementia appearing to show uneasiness and caregivers being flustered and uncertain. However, caregivers typically emanated a nurturing attentiveness, were attuned to the person, and skilled in seamlessly supporting them through care activities. Discussion and Implications Findings draw on real-world empirical evidence to reinvigorate the notion of person-centeredness in dementia care. The findings provide much needed insight into practical ways to improve care interactions for people with advanced dementia and enhance their personhood. Appropriate training/guidance for caregivers could support positive personal care experiences for both the person with dementia and caregiver. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic influenced the way individuals conducted their lives, with consequences relating to mental health deterioration. Whilst researchers explored this outcome in the general population and athletic populations, less focus was on athletes with disabilities. The aim of this study was to investigate how the pandemic influenced the mental health of elite para-athletes in the United Kingdom. Nine elite-level athletes with disabilities participated in semi-structured interviews. Three broad themes were interpreted from the data using reflexive thematic analysis, two themes reflected the negative impact of COVID-19 on mental health and one theme reflected positive outcomes of the pandemic. Athletes explained that losing face-to-face interactions and delays in major sporting events were significant factors in their mental health decline. This population group reported different challenges to able-bodied communities. Differences included increased susceptibility to contract the virus, difficulties in communication where face masks and online interactions became necessary and perceptions of vulnerability relating to shielding protocols. Finally, positive outcomes related to the additional time to recover, to prepare for major events and time to reassess their values. Exploring experiences of a pandemic on this population group warrants further exploration to enhance the effectiveness of mental health support services in para-sporting organisations. [ABSTRACT FROM AUTHOR]

Despite advances in the field of augmentative and alternative communication (AAC), outcomes among children who require AAC remain discouraging. Practitioners may benefit from guidelines to aid decision-making in relation to supporting pre-linguistic communicators. We conducted an open-ended questionnaire of 30 AAC professionals from six countries—Australia, Denmark, the Netherlands, New Zealand, the United Kingdom, and the United States—to determine if consensus existed regarding the assessment information needed, the communication skills to teach, and the instructional strategies to employ to support AAC learning for pre-linguistic communicators. We analyzed the responses using qualitative content analysis in four iterative phases. We provide five statements that reflect areas of consensus and divergence among the participating AAC professionals. These findings provide important insights related to assessment, communicative competence, instructional strategies, decision-making, and communication partner instruction. Findings of this preliminary exploration indicate the need for ongoing and targeted research related to AAC decision-making guidance that attends to context (e.g., languages spoken, service structures) and pre- and in-service training in AAC decision-making. [ABSTRACT FROM AUTHOR]

Background: With increased focus on people being supported to die at home, and increased numbers of people predicted to die in the coming years in the UK, it is recognised that domiciliary carers need to be trained and supported to give end-of-life care. Recent reports suggest that this is not happening. Aim: To introduce and evaluate a training programme to upskill unregulated domiciliary care agency staff and integrate them into the palliative care teams, supporting registered nurses in caring for end-of-life patients. Method: A training course was devised and implemented. This report covers the first 3 years of running the course, and evaluates the difference that it made to the first 210 recipients' ability and confidence in delivering end-of-life care, using a mixed-methods approach. Results: Pre- and post-course confidence questionnaires, evaluations, post-course testimonials, and managers' comments all identified improvements in knowledge, skills and attitudes following training. Agency policies were re-written with up-to-date guidance on how to respond to death in the community. Conclusion: This article demonstrates that this model is effective in achieving its aims. [ABSTRACT FROM AUTHOR]

Following the dramatic evacuation from Kabul airport in August 2021, the UK government proclaimed its commitment to a 'warm welcome' for Afghans. In this paper we draw on original qualitative research to explore the emerging experiences of evacuees, and other recent arrivals, during their first year in London. Using the narratives of our Afghans participants, as well as insights from key stakeholders, we show how they navigated slow, opaque bureaucratic processes and lack of communication with official agencies. As a result of these lengthy processes, many thousands of evacuees remained in temporary hotel accommodation for protracted periods. Drawing on the concept of 'everyday bordering', we explore the extent to which Afghan resettlement policies are achieving their objectives. We consider how such policies are birthed within a punitive immigration system, which is designed to 'wear down' migrants in the UK, regardless of their reason for migration. Moreover, we argue that the ad hoc response of the Home Office and the Foreign Office has created 'false distinctions' between categories of Afghan refugees, reinforcing notions of 'deserving' versus 'underserving' migrants. This distinction allows the government to present itself as humanitarian, 'rescuing' people from Afghanistan, while simultaneously maintaining its commitment to the 'hostile immigration environment'. [ABSTRACT FROM AUTHOR]

Background: Telephone advice lines have been recommended internationally to support around-the-clock care for people living at home with advanced illness. While they undoubtedly support care, there is little evidence about what elements are needed for success. A national picture is needed to understand, improve and standardise service delivery/care. Aim: To explore telephone advice lines for people living at home with advanced illness across the four UK nations, and to construct a practical framework to improve services. Design: A cross-national evaluation of telephone advice lines using structured qualitative interviews. A patient and public involvement workshop was conducted to refine the framework. Setting/participants: Professionals with responsibilities for how palliative care services are delivered and/or funded at a local or regional level, were purposively sampled. Results: Seventy-one interviews were conducted, covering 60 geographical areas. Five themes were identified. Availability : Ten advice line models were described. Variation led to confusion about who to call and when. Accessibility, awareness and promotion : It was assumed that patients/carers know who to call out-of-hours, but often they did not. Practicalities : Call handlers skills/expertise varied, which influenced how calls were managed. Possible responses ranged from signposting to organising home visits. Integration/continuity of care : Integration between care providers was limited by electronic medical records access/information sharing. Service structure/commissioning : Sustained funding was often an issue for charitably funded organisations. Conclusions: Our novel evidence-based practical framework could be transformative for service design/delivery, as it presents key considerations relating to the various elements of advice lines that may impact on the patient/carer experience. [ABSTRACT FROM AUTHOR]

The article discusses the importance of open disclosure in healthcare settings, focusing on the Patient Safety Incident Response Framework (PSIRF) and related guidance in the United Kingdom. Topics include strategies for enhancing patient safety, the role of healthcare professionals in communication training, and the implementation of open disclosure practices to improve transparency and accountability in healthcare.

Aims: This study aimed to investigate the experiences and transitional care needs of Turkish frail older adults living in the UK and determine how this information can be utilized to improve the provision of culturally sensitive care during the transitional period. Design: Qualitative descriptive research with semi‐structured individual interviews. Methods: "The 'Silences' Framework guided the research design, from conceptualizing the research question to structuring the report of final outputs. For this study, semi‐structured, in‐depth interviews were conducted with sixteen older adults living with frailty and five family caregivers between January and May of 2023 in the United Kingdom. Results: Major themes that were identified included: (i) information and communication, (ii) care and support, (iii) the role of culture and (iv) trust and satisfaction. Further analysis, through discussion and immersion in the data, revealed that care transition periods were presented alongside three phases of transitional care: pre‐transition (during hospitalization), early‐transition (the period between discharge and the 7th day after discharge) and late transition (the period between the 8th day and 12th month after discharge). Conclusions: Our study revealed that the communication and informational needs of frail older individuals change during the transition period. While Turkish older adults and family caregivers expressed satisfaction with healthcare services in the UK, many struggled due to a lack of knowledge on how to access them. Impact: The support of family caregivers is a crucial component in facilitating transitional care for frail older patients, as they help in accessing healthcare services and using technological devices or platforms. It should be noted that family caregivers often hold the same level of authority as their elderly Turkish counterparts. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

As part of our series on medicines optimisation in people with additional needs, this article considers the health challenges that Deaf and hard of hearing patients face, and discusses how to improve healthcare access and tailor consultations to optimise health outcomes. [ABSTRACT FROM AUTHOR]

Background: Telehealth for paediatric speech and language therapy became one of the most salient modes of service delivery during the COVID‐19 pandemic. Evidence for speech and language therapy services via telehealth in comparison to face‐to‐face delivery demonstrates promising outcomes, and studies have begun to explore practitioner and client experiences. However, across the literature, many critical elements of services are overlooked, and there is a need to frame the evidence base within a theoretical model that can draw out practical implications that consider the range of factors having an impact on clinical implementation in real‐world contexts. The APEASE (Acceptability, Practicability, Effectiveness, Affordability, Side‐effects, and Equity) criteria offer such a model. The current study explored practising UK speech and language therapists' (SLTs) clinical experience of telehealth through the lens of the APEASE criteria and aimed to identify recommendations for future service provision from the practitioner perspective. Methods: An online survey structured using the APEASE criteria was developed in collaboration with the UK Royal College of Speech and Language Therapists. Quantitative data were analysed using descriptive statistics and qualitative data were analysed using reflexive thematic analysis. Results: Four hundred and thirty‐eight qualified and practicing UK paediatric SLTs completed the survey. Telehealth was broadly acceptable and practicable to SLTs yet there remains some uncertainty about its efficacy and cost‐effectiveness compared to face‐to‐face interventions and how equitable it is for different population groups. SLTs reported that effective implementation of telehealth services was dependent upon several contextual factors; affordability was a perceived barrier to clients having access to telehealth resources, intervention via telehealth was perceived as more acceptable than assessment, and whilst many SLTs welcomed aspects of telehealth, there were concerns about the physical and mental health consequences for practitioners. Six themes for the future development of telehealth in paediatric speech and language therapy were identified: (1) balanced and tailored services; (2) technology and equipment; (3) information and communication; (4) capacity building; (5) monitoring and evaluation; and (6) leadership and governance. Conclusions: Outcomes highlight promising, concerning and uncertain aspects of telehealth in paediatric speech and language therapy. SLTs value a flexible and tailored approach to service delivery and recommend that effective leadership, clear communication, ongoing policy and guidance development, upskilling of users and careful evaluation of impact are required to ensure optimal implementation. The APEASE criteria offer a valuable opportunity to enhance and streamline practice and research to ensure sustainable implementation of telehealth in the paediatric speech and language therapy services of tomorrow. WHAT THIS PAPER ADDS: What is already known on this subject: The COVID‐19 pandemic led to the increased use of telehealth as a main mode of service delivery in paediatric speech and language therapy. Pre‐COVID‐19, evidence for the use of telehealth in this field included small‐scale experimental studies that reported on children with particular disorders and explored telehealth outcomes in comparison to face‐to‐face delivery. The realities of at‐scale clinical practice were not well‐represented, and critical elements of service such as cost‐effectiveness were often overlooked in the paediatric literature. Furthermore, despite emerging global evidence for temporary telehealth responses to the crisis in speech and language therapy, the long‐term and future use of telehealth remains unclear. What this paper adds to existing knowledge: The current study applied the lens of the APEASE (Acceptability, Practicability, Effectiveness, Affordability, Side‐effects, and Equity) criteria, which were used in this case to consider socioeconomic, ecological and cultural factors to capture an overarching understanding of the use of telehealth in paediatric speech and language therapy, and to inform the role of telehealth in future, longer‐term and at‐scale service development. Results indicated emerging trends in UK paediatric speech and language therapists' (SLTs') perceptions of telehealth and SLTs perceived a hybrid approach to service delivery, combining mostly face‐to‐face services with some telehealth, was likely to continue in the future. We identified six themes to guide the future development of telehealth in paediatric speech and language therapy services: (1) balanced and tailored services; (2) technology and equipment; (3) information and communication; (4) capacity building; (5) monitoring and evaluation; and (6) leadership and governance. What are the potential or actual clinical implications of this work?: UK SLTs believe that speech and language therapy services using telehealth should be reflective, tailored and flexible to meet the requirements and circumstances of the children, young people and families served, as well as the physical and emotional needs of practitioners. SLTs recommend that this service development is clearly communicated to all stakeholders and suggested that those using telehealth should be supported through appropriate training, and ongoing effectiveness should be monitored. Telehealth is here to stay and the APEASE criteria offer a unique opportunity to ensure sustainable models of service delivery; to support co‐ordinated leadership at the local, national and international levels and the development of policy and clinical guidance. [ABSTRACT FROM AUTHOR]

Background: Regular physical activity (PA) results in extensive physical, psychological, and social benefits. Despite primary care being a key point of influence for PA behaviours in the UK, research indicates poor application of PA interventions in this context. To address this, the Royal College of General Practitioners' (RCGP) developed and implemented the Active Practice Charter (APC). The aim of the study was to evaluate the perceived impact and acceptability of the APC initiative from the perspective of primary healthcare professionals (PHPs). Methods: An online exploratory cross-sectional survey was designed to assess the perceived impact, experiences, and challenges of the APC initiative, from the perspective of PHPs. The survey was distributed by the RCGP via email to 184 registered APC practices across the UK. Results: Responses were reviewed from staff (n = 33) from 21 APC practices. Initiatives used by APC practices included: educational programmes, partnerships with PA providers, referral systems, and infrastructure investment. Perceived benefits included: increased awareness about PA, staff cohesion, and improved well-being. However, staff felt the APC had limited effect due to implementation barriers, including: a lack of engagement, time, resources, and funding. Conclusion: This is the first evaluation of any nationwide UK-based initiative engaging GP practices in promoting PA. Acknowledging the limitations in response rate, although support exists for the RCGP APC, the evaluation highlights challenges to its implementation. Nonetheless, the wide reach of the RCGP, combined with the cited staff and patient benefits, demonstrates the significant potential of the APC initiative. Given the need to address physical inactivity nationally, further development the APC offers a possible solution, with further research required to overcome the challenges to implementation. [ABSTRACT FROM AUTHOR]

Background: Despite vast levels of underreporting, sexual assault remains an issue at scale in the UK, necessitating the presence of statutory and voluntary organisations in the support of victims. Understanding the experiences of all parties within this context is important for the resilience of support that can be provided at a systems level. This study examines the barriers faced by service providers when working with victims of sexual assault. Methods: Semi-structured interviews took place with eleven professionals working in or in conjunction with a Sexual Assault Referral Centre (SARC) in Southeast England, which were subsequently analysed using inductive thematic analysis. Results: Five themes were identified exploring SARC staff's experiences with (i) communication breakdowns with external services; (ii) delivering support in an underfunded system; (iii) tailoring support to survivors' needs; (iv) the Criminal Justice System fails victims of sexual assault; and (v) reckoning with burnouts and vicarious trauma. Conclusion: Significant gaps in UK service provision for sexual assault victims are identified, particularly within the criminal justice system, where legal and investigative processes are cited as retraumatizing. The results emphasize the urgency of enhanced training, coordination, resources, and trauma-informed practices across organizations to better serve victims and support overwhelmed providers. Prioritizing systemic improvements is crucial to address the complex needs of both victims and service professionals. [ABSTRACT FROM AUTHOR]

Background: Half of mental health problems are established by the age of 14 years and 75% by 24 years. Early intervention and prevention of mental ill health are therefore vitally important. However, increased demand over recent years has meant that access to child mental health services is often restricted to those in severest need. Watch Me Play! (WMP) is an early intervention designed to support caregiver attunement and attention to the child to promote social-emotional well-being and thereby mental health resilience. Originally developed in the context of a local authority mental health service for children in care, it is now also delivered online as a low intensity, scalable, preventative intervention. Although WMP shows promise and is already used in some services, we do not yet know whether it is effective. Methods: A non-randomised single group feasibility study with embedded process evaluation. We propose to recruit up to 40 parents/carers of children aged 0–8 years who have been referred to early years and children's services in the UK. WMP involves a parent watching the child play and talking to their child about their play (or for babies, observing and following signals) for up to 20 min per session. Some sessions are facilitated by a trained practitioner who provides prompts where necessary, gives feedback, and discusses the child's play with the caregiver. Services will offer five facilitated sessions, and parents will be asked to do at least 10 additional sessions on their own with their child in a 5-week period. Feasibility outcomes examined are as follows: (i) recruitment, (ii) retention, (iii) adherence, (iv) fidelity of delivery, (v) barriers and facilitators of participation, (vi) intervention acceptability, (vii) description of usual care, and (viii) data collection procedures. Intervention mechanisms will be examined through qualitative interview data. Economic evaluation will be conducted estimating cost of the intervention and cost of service use for child and parents/carers quality-adjusted life years. Discussion: This study will address feasibility questions associated with progression to a future randomised trial of WMP. Trial registration: ISRCTN13644899. Registered on 14th April 2023. [ABSTRACT FROM AUTHOR]

Step-down intermediate care aims to offer short-term care for people who are medically optimised for discharge but needing a period for further assessment and/or rehabilitation. The aim of this study, which was nested in a larger evaluation project, was to explore the experiences and perspectives of healthcare professionals to understand the implementation of a step-down IC service in Buckinghamshire, UK. The evidence is used to inform the service providers of what elements worked well and what areas require improvement. A qualitative study using semistructured interviews was conducted in May 2022. Ten healthcare professionals participated. Interviews were transcribed verbatim and reflexive thematic analysis was used to analyse the data. The following five core themes were developed: (1) the developmental period of step-down IC, (2) providing care together, (3) perceived functions of the integrated hub, (4) communication, and (5) resources. Findings from the interviews highlighted the excellent working relationships among healthcare professionals from different disciplines, which contributed to their job satisfaction and the efficiency of the service. In addition, healthcare professionals stressed the importance of the integrated hub, as it facilitated the communication between the teams and speeded up the decision-making. Several organisational challenges, such as communication issues, healthcare professionals' capacity, and the need for further funding were also voiced. Involving staff in the evaluation of a step-down intermediate care service has provided useful information on the service's implementation process and will inform the development of a long-term strategy for intermediate care. [ABSTRACT FROM AUTHOR]

The article discusses the evolution of 'just culture' in healthcare, highlighting the shift from 'no blame culture' to 'open and fair' culture, with recent terms like 'safety culture' and 'restorative just culture.' Topics include the emphasis on staff accountability, impact of statutory duty of candour on patient safety, and the debate around 'no-fault' compensation schemes, questioning if current approaches adequately consider patients' needs in fostering a truly just culture in healthcare.

Why you should read this article: • To read about the steps involved in a project that aimed to increase cervical screening uptake among people with learning disabilities • To recognise barriers to accessing cervical screening among people with learning disabilities • To increase your awareness of the legal requirement for assessing mental capacity in people with learning disabilities in the context of cervical screening. The uptake of cervical screening is lower among people with learning disabilities than in the general population. Between 2020 and 2022, a pilot project was undertaken in south west Hertfordshire to increase the uptake of cervical screening among people with a cervix who are eligible for screening and registered with their GP as having a learning disability. The project included the development of an ad hoc reporting and decision-making tool and involved a community learning disability nurse working with ten GP practices to take patients through a preparatory process designed to assess their mental capacity and determine their reasonable adjustment needs. The number of patients who had cervical screening within the project time frame was small, but there were other positive outcomes for the patients and practice nurses involved, particularly in relation to clarifying the benefits of cervical screening and the rules about mental capacity and best interests decisions. [ABSTRACT FROM AUTHOR]

Purpose: This service evaluation aims to understand the experiences of service users (SUs) who accessed an early intervention in psychosis (EIP) service during the Coronavirus pandemic using qualitative and quantitative methodologies and compare these to a previous pre-pandemic study conducted within the same service (Watkins et al., 2018). Design/methodology/approach: This paper collated experiences of individuals accessing an EIP service to inform service development. Questionnaires and individual interviews were conducted to provide quantitative and qualitative data. Descriptive statistics and T-test confidence intervals were created from the results and compared to findings of Watkins et al. (2018). Interviews were transcribed verbatim and analysed using Braun and Clarke's (2006) thematic analysis. Findings: Data showed participants were largely satisfied with all areas of the service with "work or education", "living skills", and "addictions" scoring highest. Though participants reported no overall dissatisfaction, satisfaction levels dropped in "social activities" compared to the findings of Watkins et al. (2018), perhaps due to the national restrictions put in place to manage the spread of Coronavirus during this time. Interview analysis identified three themes of importance consistent with prior literature, highlighting the importance of relationships and validation during recovery. Research limitations/implications: This evaluation did not consider whether participants had accessed the service prior to the pandemic or only during, meaning that some participants could have a point of comparison with the service pre-pandemic, whereas others might not. Similarly, the participants were not the same as those of the Watkins et al.'s (2018) evaluation, meaning that direct comparisons of pre- and post-pandemic experiences were not possible. In addition, this evaluation collected data at only one time point early in the pandemic; therefore, it is unknown if client experiences of services differed as the pandemic and restrictions continued over time. Originality/value: The Covid-19 pandemic has been an unprecedented challenge for health services, and the effects of this are becoming widely reported. This evaluation of clinical services offers a valuable perspective of service user experience of receiving mental health services during a global health crisis further offering a comparison to pre-pandemic services and the experiences of those who used them. [ABSTRACT FROM AUTHOR]

A diagnosis of medically unexplained symptoms (MUS) is made when a person reports a complaint for which no organic disease can be detected. People with MUS commonly present to primary care services in the UK; however, there is no consensus regarding the evidence base for care. This literature review explores the experiences of these patients when they interact with health services. The following themes emerged: experience of diagnosis; expectations; communication; and healthful relationships. People with MUS report negative experiences of health care. Nurses in primary care have an opportunity to provide person-centred care to support these patients, and research could explore the potential contribution of nurses working in primary care in the UK to support them and enhance the evidence base for practice. [ABSTRACT FROM AUTHOR]

Aim: To explore the usefulness of a co‐designed wordless book showing processes of receiving COVID‐19 vaccines designed by, and for, adults with intellectual disabilities. Methods: A qualitative evaluation of the resource using mixed methods. Semi‐structured interviews were conducted with people with intellectual disabilities, carers and health professionals about resource content, and use. This was analysed thematically. A survey was circulated to intellectual disabilities networks to understand resource need, use, sharing and content. Results: Understanding the COVID‐19 vaccine was a process, not a single event using one resource. A visual resource had a place in facilitating conversations about vaccines between people with intellectual disabilities and carers. Differing perspectives were expressed regarding personal needs, existing awareness of vaccine programmes and communication preferences. Changes were suggested to improve the suggested storyline and relevance around COVID‐19 restrictions changing. Conclusion: A visual resource may help conversations about the COVID‐19 vaccine for people with intellectual disabilities. [ABSTRACT FROM AUTHOR]

Background: Children and young people with life-limiting and life-threatening conditions have multidimensional needs and heterogenous cognitive and communicative abilities. There is limited evidence to support clinicians to tailor their communication to each individual child. Aim: To explore the language children and young people use to describe their own condition, to inform strategies for discussing needs and priorities. Design: Positioned within a s ocial constructivist paradigm, a secondary discourse analysis of s emi-structured interview data was conducted incorporating the discourse dynamics approach for figurative language. Setting/participants: A total of 26 children and young people aged 5–17 years with life-limiting or life-threatening conditions (6 cancer; 20 non-cancer) were recruited from nine clinical services (six hospitals and three hospices) across two UK nations. Results: The language children and young people use positions them as 'experts in their condition'. They combine medical terminology with their preferred terms for their body to describe symptoms and treatments, and use comparatives and superlatives to communicate their health status. Their language depicts their condition as a 'series of (functional and social) losses', which single them out from their peers as 'the sick one'. Older children and young people also incorporate figurative language to expand their descriptions. Conclusion/discussion: Children and young people can provide rich descriptions of their condition. Paying attention to their lexical choices, and converging one's language towards theirs, may enable more child-centred discussions. Expanding discussions about 'what matters most' with consideration of the losses and differences they have experienced may facilitate a fuller assessment of their concerns, preferences and priorities. [ABSTRACT FROM AUTHOR]