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There has been an increasing acknowledgement in the UK of the importance of recognising frailty as a condition that leaves older people vulnerable to dramatic, sudden changes in health triggered by seemingly small events. In policy, the approach to managing frailty is often an emphasis on staying well with limited consideration to frailty as an end-of-life phase. Meanwhile, discharge from hospital continues to be complex. Overstretched acute hospitals are juxtaposed with community and social services that struggle to keep up with the demand of those being discharged and the labelling of older people as "bed blockers" at the centre of delayed discharges. This paper reports a study underpinned by constructivist grounded theory methodology, with the aim of exploring the experiences and perceptions of stakeholders. Semistructured interviews were conducted with 57 participants including patients, their informal carer(s), community hospital staff, community health professionals, and care home managers. The core category of "the drive to discharge conveyor belt" was derived from data analysis. A significant finding of this study was that of the carer, their burden, and their intrinsic role in facilitating discharge, filling in gaps in services, coordinating services, and enabling the patient to stay at home, with little consideration of their choices or autonomy. The "drive to discharge" impacts older people, their informal carers, and health professional. This study suggests how they may be supported, through an ethical lens. [ABSTRACT FROM AUTHOR]

This paper reports findings from a national, qualitative study in England that investigated if young adult carers services are facilitating young people's transitions to adulthood, including considering a future beyond caring. Semi-structured, online interviews were conducted in 2022 with a purposive sample of managers or lead workers of eleven young adult carers services in England. We discuss the consideration given in assessments to young people's caring preferences and the availability of support to facilitate them to relinquish their role, if they so wished. The majority of young adult carers services gave young people the opportunity to express their views on this issue. Although the Care Act 2014 aimed to provide choice over caring in adulthood to young adult carers, this was not matched by the necessary service provision to facilitate their preferences. A new national carers strategy is urgently required to ensure that young people, particularly women, have a credible choice over their future lives. [ABSTRACT FROM AUTHOR]

Social care Personal Assistants (PAs) are directly employed by individuals to assist with activities of daily living such as help or support with personal care, shopping, household tasks and community participation. This option is encouraged by UK public funding. In England, disabled people's support organisations initially offered assistance with such arrangements, although numbers doing this have declined. The Covid‐19 pandemic provided the opportunity to ask those remaining organisations providing support for PA employers about their activities during this time and the questions being posed to them by PA employers. This paper reports data from 15 interviews undertaken March–July 2021 with disability support organisation representatives. We identified one overarching theme 'Working to prevent and challenge marginalisation of PA employers', with three related subthemes: (1) Advocating for the voice of a forgotten group; (2) Needing to be proactive and (3) Adapting to new tasks and ways of working. Participant accounts focused on representing the needs of disabled people to the authorities and providing concise, timely and accurate information to PA employers, particularly around the use of public funds during Covid‐19. Remote working amplified the digital‐divide, resulting in these organisations working hard to ensure PA employers received important information about their support options. Befriending services and Covid‐hubs were established by some organisations to reduce isolation and risks of poor mental health amongst PA employers. Many of the challenges facing PA employers existed pre‐pandemic but were perceived to have been heightened during it, reflecting the value of and need for the work of these local support organisations. Our findings suggest areas where effective contingency planning drawn from closer collaboration between disability support organisations and central and local government might usefully be focussed. The potential for specific services or organisations to be commissioned to provide such support is discussed. [ABSTRACT FROM AUTHOR]

Technology‐dependent children are a sub‐population of seriously ill children with life‐limiting conditions who are being cared for at home by their families. Although home‐based care has been the model of care for these children since the late 1980s, there is a paucity of literature about parents' experiences of having home adaptations made to enable their home to be a place of care for their child. Using the findings from auto‐driven photo‐elicitation interviews conducted between August 2017 and June 2018 with 12 parents (10 mothers and 2 fathers) who have a technology‐dependent child (aged 5–25 years) living in England, Scotland and Wales and David Seamon's five concepts of at‐homeness (appropriation, at‐easeness, regeneration, rootedness and warmth) as a conceptual framework, this paper addresses how parents' experienced home adaptations. Thematic analysis generated a meta‐theme of 'Home needs to be a home for all family members' and the three key themes: (1) 'You just get told' and 'you're not involved'; (2) It's just the 'cheapest', 'quickest', 'short‐term' approach; (3) Having 'control' and 'thinking things through.' The need to involve parents in decision‐making about adaptations that are made to their home (family‐informed design) is clear, not only from a cost‐saving perspective for the state, but for creating an aesthetic and functional home that optimises health, well‐being and feelings of at‐homeness for the entire family. [ABSTRACT FROM AUTHOR]

Individuals who experience a traumatic injury or an acute illness are often reliant on initial healthcare assessment and support from a pre‐hospital emergency medical service (EMS). These community‐based support models perform a vital role in the provision of life‐saving support, but research indicates that the availability, accessibility and resources of EMS are not equivalent in rural and urban areas, and there has been little recognition of the issues facing rural EMS provision outside of the USA, Europe and Australia. The purpose of the current study was to examine the lived experiences of Saudi Arabian EMS personnel, defined as emergency medical technicians, paramedics and local station managers. A semi‐structured interview approach was used to collect data from 20 interviewees (10 each with rural and urban personnel) in the Riyadh region of the Kingdom of Saudi Arabia. This methodology was used to identify the key issues that these staff face in their day‐to‐day work practice and ascertain factors that may lead to service delivery issues in rural and urban areas. Data analyses identified three thematic categories impacting EMS delivery; two of these, Personnel Factors and Patient Factors, are the focus of this paper. The participants noted a number of key issues, including a lack of appropriate local training and limited resources in rural areas, as well as general areas of concern regarding the wider EMS staff demographic makeup and poor public awareness about the exact role of the EMS. Three key recommendations arising from this study include specialised training and ongoing accessible education for rural EMS staff to allow for better support for patients; consideration of supplementing the current EMS with additional external specialist staff; and the development and implementation of national public education programmes focusing on the role of the EMS within the community. [ABSTRACT FROM AUTHOR]

Although healthy life expectancy is projected to be increasing among older people in Ghana, a high proportion and number of older people will live with functional disability, warranting their need for long‐term care. We explored the expressions used by older people to describe their needs and preference of care and support. Using the descriptive qualitative approach, 14 older people were engaged via semi‐structured interviews, and the data were analysed thematically. The study found that older people desired a decent accommodation, preferential healthcare, adequate nutrition, and an opportunity to interact with their peers at social functions. A provision of sufficient financial assistance, adequate healthcare, the periodic organisation of social and group events for older people, and the availability of home care and support could help older people address these needs. The paper reveals the need for interventional research on how a model incorporating social, health and environmental factors even during a pandemic can address older people's varying needs. [ABSTRACT FROM AUTHOR]

Making Every Contact Count (MECC) is a national, long‐term public health strategy in England. It supports public‐facing workers to use opportunities during routine contacts to enable healthy lifestyle changes. This paper reports the findings from an external evaluation of voluntary and community sector (VCS) delivery of MECC in the North East of England, which focused on engaging under‐represented client groups. The study aimed to (a) Establish if (and how) MECC had impacted the workforce, including changes to staff knowledge, confidence and behaviour; (b) Identify benefits, challenges and unintended consequences; and (c) Explore outcomes for service users. A multi‐stage qualitative design focused on understanding both process and outcomes. The study utilised three data collection methods, including a journey mapping workshop (n = 20), semi‐structured interviews with delivery leads, VCS workers and volunteers who had accessed MECC training (n = 11), and focus group discussions with clients (n = 22). The findings illustrated positive early outcomes, including improvements in self‐reported staff knowledge and confidence as well as emerging examples of organisational culture shift and individual behaviour change. Alongside this, the data provided a rich picture of barriers and challenges which are examined at different levels—national programme, local programme, VCS sector, partner organisation, worker and client. The research highlights clear successes of the VCS delivery model. However, it is presented as a 'double‐edged sword,' in light of associated challenges such as sector‐level funding uncertainty and accessibility of MECC resources to diverse client groups. The discussion considers issues related to the measurement and attribution of behaviour change outcomes for brief interventions, as well as fidelity, legacy and long‐term sustainability challenges. The recommendations call for system‐level analysis and comparison of different MECC implementation models, to improve our understanding of challenges, opportunities and programme reach for behaviour change intervention programmes—particularly in relation to seldom‐heard client groups. [ABSTRACT FROM AUTHOR]

There is a global recognition that the homeless in different clusters are isolated social groups. They are highly susceptible to loneliness and related psycho‐physical health outcomes owing to their less supportive and fragmented social networks. The conditions are worse in the case of chronic or lifetime homelessness. Beyond this popular notion, other critical perspectives are also there. This paper attempts to analyse the differences in inter‐personal social networks between the chronic and the non‐chronic homeless groups at a railway junction in India. The data have been collected through structured and semi‐structured questionnaires from 28 homeless people (15 chronically and 13 non‐chronically homeless) of Burdwan Railway Junction – a vital railway junction of West Bengal, India. The chronically homeless group displays more supportive and compact inter‐personal networks in this study than the non‐chronic homeless group. Living in the station area for a long time, they have formed a society of their own. Barring some psychological stress and social abuse, the livelihood scenario of these people is relatively stress‐free and social networks relations are more intensive and supportive. Considering the outcomes, instead of the housing‐first approach of rehabilitation, we favour the development of community shelters with minimum basic amenities close to their present location. [ABSTRACT FROM AUTHOR]

Informal caregiving for a person living with glioma can be both rewarding and multidimensionally challenging, given the potential for debilitating symptoms, cognitive impairment or personality changes, as early as diagnosis. There is growing evidence that, due to the demands of care, experiences and feelings of loneliness and isolation among informal caregivers are widespread, and opportunities for quality or meaningful social connectedness are lacking. While considerable research has quantified the causes and effects of loneliness and isolation in informal care contexts, the lived experience of loneliness has received relatively little attention. The aim of this study was to better understand the everyday experiences of a group of home‐based informal caregivers of people living with glioma in Queensland, Australia. Drawing on in‐depth interviews with 32 informal caregivers, purposively sampled, and recruited through a tertiary hospital, in this paper, we explore how the various experiences, demands, and social and relational dynamics in/of informal care (re)produce forms of isolation and loneliness. Using the framework approach to thematic analysis, we derived four themes: (a) the 'need' to be near the care recipient, and the implications for caregiver mobility; (b) the strong sense of responsibility for care, and the virtues of 'good' caring; (c) experiences of loneliness in the company of others and (d) postponement of social connection and minimising the self. The findings, we argue, are reflective of broader social and moral norms and expectations within experiences of home‐based informal care. [ABSTRACT FROM AUTHOR]

Carers of people with dementia can experience reduced health and well‐being, but little is known about how best to support them. There is some evidence to suggest that case management may improve outcomes for carers but less evidence about the features of case management services that can effectively support carers of people with dementia. Admiral Nursing operates a case management approach staffed by specialist nurses and is the only service of its kind in the United Kingdom dedicated to helping people with dementia and their carers. This paper reports qualitative findings from a mixed methods study of Admiral Nursing. For the qualitative strand of the project, data were collected in focus groups and in‐depth interviews with carers of people with dementia (n = 35) and analysed thematically using the framework approach. The aim of this analysis was to understand differences between the experiences of the carers in our sample with and without Admiral Nursing, applying Freeman's model of continuity of care (Freeman et al., Continuity of care, 2000). Participants who had received Admiral Nursing were recruited from two geographical locations and carers without experience of this service were recruited from two different areas. We found that carers in our sample felt 'supported' in circumstances where they received an ongoing service from an Admiral Nurse or other professional with expertise in dementia who was able to develop a meaningful relationship with them over time. We conclude that ongoing support, expertise in dementia and a meaningful relationship are key features of relationship continuity common in carers' reports of feeling supported. Specialist nurses are well placed to provide this continuity. [ABSTRACT FROM AUTHOR]

This grounded theory study sought to explore how older adults' experience the transition from living at home to a care home with a specific focus on the latter part of the first year of the move. The study was carried out within a large Health Trust in the UK between August 2017 and May 2019. Purposive sampling was used in the initial stages of data collection. Thereafter and consistent with grounded theory methodology, theoretical sampling was employed to undertake semi‐structured interviews with 17 individuals from eight care homes between 5 and 12 months after the move. This paper reports five key categories which were: (a) The lasting effect of first Impressions 'They helped me make my mind up' (b) On a Journey 'I just take it one day at a time', (c) Staying connected and feeling 'at home' 'You get something good out of it you know...you get hope'. (d) Managing loss and grief 'It was important for me to say cheerio to the house' and (e) Caring relationships 'I didn't realise that I was lonely until I had company'. Together these five categories formed the basis of the core category 'The Primacy of 'Home' which participants identified as a place they would like to feel valued, nurtured and have a sense of belonging. This study identifies that it is important for individual preferences and expectations to be managed from the outset of the move. Individuals and families need to be supported to have honest and caring conversations to promote acceptance and adaptation to living in a care home while continuing to embrace the heart of 'home'. Key recommendations from this study include the need to raise awareness of the significance of the ongoing psychological and emotional well‐being needs of older people which should be considered in policy directives and clinical practice. [ABSTRACT FROM AUTHOR]

Informal carers provide the majority of care to older Australians and play an essential role in assisting older people with complex care needs to remain living in their own homes. As such, carers are increasingly faced with systemic responsibilities, including coordinating services across multifaceted health and aged care systems and negotiating treatment and supports. The aim of this study was to explore how systemic complexity and associated work is experienced by carers of older adults and what personal capacities carers draw on in managing the systemic work. A descriptive phenomenological approach guided the research. Semistructured interviews were conducted with 16 carers of community‐dwelling older adults with complex care needs recruited through a local health service. Giorgi's phenomenological data analysis methods (1997) was utilised for the data analysis. Two main themes were derived from the analysis: Becoming part of the caring system and Mastering the caring system. The findings indicate that the majority of carers perceived the work of interacting with multiple systems and services as a burden and an onerous obligation. Furthermore, change in the health or social circumstances of the older adult amplified differences in the nature of the systemic work and concomitantly revealed differences in carers' capacities. This paper reveals that the caring system is in some sense disposed to create disparities, as carers' specific capacities were integral to mastering the systemic work. An understanding of informal care work that supports older people to live in the community can assist health care professionals and service providers to better identify carer requirements and assess carer capacity to manage the work. [ABSTRACT FROM AUTHOR]

The aim of this paper was to understand the needs of family caregivers and professionals supporting people living with dementia with eating and drinking difficulties towards the end of life and the strategies they use to overcome them. A total of 41 semi‐structured interviews with family caregivers (n = 21) and professionals (n = 20) were conducted in London and surrounding areas of England. Interviews were audio‐recorded and transcribed verbatim. Four themes were identified: caregivers accessing and seeking help, perceived priorities of care, professionals' supportiveness and educational role, and strategies. Caregivers often struggle as they are not aware of the eating and drinking difficulties associated with dementia's progression. Care can change over time with families prioritising a person's comfort towards the end of life rather than ensuring a particular level of nutrition. Mutual support is required by both professionals and caregivers to enhance the care of the person living with dementia. Cognitive difficulties are often behind initial eating and drinking challenges in dementia, whereas physical challenges take over towards the later stages. Flexibility and creativity are key to adapting to changing needs. There is a need to raise awareness of the eating and drinking challenges associated with the progression of dementia. Professionals can help caregivers embark on the transition towards focussing on comfort and enjoyment of eating and drinking near the end of life rather than nutrition. This is particularly relevant for those caring for a relative living at home. Caregivers' input is needed to tailor professionals' recommendations. [ABSTRACT FROM AUTHOR]

Despite the benefits of utilising community‐based care services (CBS) for people with dementia and their caregiver being well established, people with dementia and caregivers use fewer services in comparison to other people in need of care. While societal, cultural and logistical factors effecting caregiver use of CBS are frequently studied, research of internal emotional barriers, mental limitations created by one's own self that prevents open communication of thoughts and feelings, and their effect on CBS use is limited. This paper explores internal emotional barriers on caregivers' use of CBS within the Irish Healthcare System. Professional Healthcare Providers were also interviewed as a preliminary indicator of their awareness of these internal emotional barriers and their impact on caregivers' use of CBS. Using interpretive description methodology, interviews with 20 caregivers and fourteen dementia professional healthcare providers were transcribed and a thematic analysis methodology applied to illuminate themes/patterns within participants' subjective perceptions of caregivers emotional barriers to using CBS. Four themes emerge: reluctance to question general practitioner (GP) authority; embarrassment during level of care requirement reviews; sense of obligation to provide all care; and fear of stigma. Caregivers interviewed were reluctant to communicate concerns with professional healthcare providers (PHPs), thereby reducing the PHP's awareness of these barriers and delaying/preventing use of CBS. As key gatekeepers within the care pathway, GPs should address the uneven power dynamic with the caregiver through user‐centred models of care, which actively encourage open dialogue, and receive training to identify the indicative behaviours of internal emotional barriers and empower the caregiver to communicate their feelings/concerns directly. [ABSTRACT FROM AUTHOR]

Aims. To understand what domains of acculturation are experienced by Chinese immigrants with cardiovascular disease (CVD) in Australia and how these domains of acculturation influence their CVD self‐care behaviours. Design. A qualitative descriptive design. Methods. Individual phone interviews were conducted among Chinese immigrants with CVD in Sydney, recruited from Chinese Community associations and social media. Inductive and deductive thematic analysis was employed, guided by the Middle‐Range Theory of Self‐Care of Chronic Illness and the conceptual model of acculturation. Results. Twenty participants, mean age 69.9 years, were interviewed. The domains of acculturation in relation to CVD self‐care behaviours encompassed cultural practices, cultural values, healthcare system navigation, and new living environment. Retaining their Chinese culture and integrating into Australian culture regarding dietary practices, social networks, traditional values and family relationships served as both enablers and barriers of self‐care maintenance through factors such as heart‐healthy diets, physical activity, stress management and medication adherence. Many participants denied encountering difficulties to utilize primary care services, but language barriers deterred them from accessing acute services and heart‐health information from mainstream sources. Some preserved beliefs and practices in Traditional Chinese Medicine may complicate their self‐care maintenance (medication adherence) and self‐care management (responding to acute angina episodes). Conclusion. The influence of acculturation on CVD self‐care behaviours among Chinese immigrants is multifaceted and individualized. Clinicians and community health workers should assess patients' acculturation experiences to enable culturally sensitive practices. The lack of culturally and linguistically appropriate heart health information in the community should be addressed urgently to mitigate the cardiac health disparity. Collaboration with Chinese community associations offers an opportunity for co‐design and dissemination of information about Australian healthcare systems and heart health education to upskill CVD self‐care practices and mitigate the health inequities experienced by Chinese immigrants. [ABSTRACT FROM AUTHOR]

Dementia is recognised as one of the major global health and social care challenges of present times. When the onset of dementia occurs in midlife, there is an increased possibility that there are children and young adults involved who are dependent on the parent concerned. The aim of the study was to describe health and social care professionals' experiences of identifying and supporting children and young adults with a parent with dementia. A qualitative descriptive approach was carried out with individual interviews of health and social care professionals, using a semistructured interview guide. Thirteen participants in rural and urban areas in Sweden were interviewed. The overarching theme, advocating a forgotten group with three categories were identified. They combine and reflect health and social care professionals' experiences of identifying and supporting children and young adults with a parent with dementia. Health and social care professionals who encountered children and young adults with a parent with dementia described how they were not sufficiently trained in supporting this group and identified a general shortage of available appropriate support services. The children and young adults were also described as a forgotten and overlooked group in need of affirmation and support in a more systematic way. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has affected all aspects of professional disciplines including occupational therapy; however, little is known about how much of an impact the COVID-19 pandemic affected occupational therapy practice in Ghana. This study examined the impacts, coping strategies, and COVID-19 pandemic lessons for occupational therapy practices in the future. A descriptive qualitative design was employed with a purposive and convenience sampling methods to recruit occupational therapists from four practice settings in Ghana. Semi-structured interviews were conducted with seven participants. Interviews were audio-recorded, transcribed, and analyzed using thematic analysis. Four major themes were identified from the analysis enlightening stakeholders on the impact and preparation for minimizing the impact of future pandemics on the workloads of an occupational therapist. The major themes are (1) impacts of the COVID-19 on occupational therapy practice and practitioners; (2) aspects or domains of work significantly affected by the pandemic; (3) the existing strategies employed to handle the challenges; and (4) strategies to minimize these challenges in the future. The current study has enlightened stakeholders on the need to make alternate preparations including telehealth, continuous support for telehealth infrastructures, training of practitioners, and research to adapt intervention strategies effectively. [ABSTRACT FROM AUTHOR]

Background. One in 5 people in the United States live with disability; however, the public health needs of this community have been largely overlooked. Although U.S. law mandates the availability of accessible medical exam equipment, people with mobility disabilities (PWMD) frequently encounter barriers that require self-advocacy to receive basic primary care. Objective. The purpose of this study was to qualitatively explore the impact of healthcare access barriers—specifically, the experiences of the need to self-advocate and factors that inform decisions to make accommodation requests—for PWMD. Methods. Qualitative semistructured interviews were performed across two phases of data collection with each of the 6 participants. Interpretative phenomenological analysis was used to highlight the essence of participants' experiences in making decisions to request healthcare accommodation. Results. Participants included a purposive sample of self-advocates with physical disabilities (3 men and 3 women). While individual approaches to self-advocacy varied, participants identified a process of "recognizing the normalization of disability discrimination and disability stigma" which necessitates the development of "agency in self-advocacy." This process has a lasting impact on people that includes a shared embodied experience of disability, as well as a sense of empowerment based on their collective and individual identities. Conclusions. Findings have implications for supporting individual disability consumer advocacy efforts as well as the need to address the normalization of disability discrimination within healthcare systems levels. [ABSTRACT FROM AUTHOR]

When older people move into a care home, family members often continue to be involved in caregiving. This can include contributing to discussion and decisions about care and treatment, especially when the resident lacks capacity. However, families may not know what to expect as their relative's condition progresses and may not have a good understanding of their relative's end-of-life care and treatment wishes. Therefore, although often willing, families may feel unprepared for making decisions in advance of or at the time of deterioration and end-of-life. The study aimed to explore the potential role that peer-mentors might have in supporting families to prepare for discussion and decisions about care and treatment and to understand what participants would consider to be important characteristics of an effective peer-mentor and peer-mentoring program. The study was guided by the philosophical assumptions of social constructionism. Data from semistructured interviews with 14 current and 15 bereaved family members and 11 senior members of care were analysed thematically. Findings suggest that peer-mentors could help to empower families to prepare to be involved in discussions and decisions about the types of care their relatives might receive as their health deteriorates and they reach the end-of-life. However, it was seen as important that peer-mentors have lived experience of supporting a relative in a care home, strong interpersonal and communication skills, and the ability to discuss deterioration and end-of-life in a compassionate but factual manner. Although peer-mentoring is often time-limited, introducing mentors to families earlier in the care journey, for example, before admission into a care home, could enable a trusting relationship to develop. This, in turn, could facilitate open discussions about what to expect and different care choices as the person's health changes. [ABSTRACT FROM AUTHOR]

Home care (HC) is recommended for older adults who want to live at home as long as possible despite life-limiting conditions. It is more convenient and cost-effective than institutionalization and hospitalization. However, HC for older adults in Iran faces many challenges. The purpose of this study was to explore the perspectives of different stakeholders involved in HC for older adults about their experiences and suggestions for HC improvement. This qualitative study was conducted based on the explorative content analysis approach between 2021 and 2022 in Tabriz, Iran. The participants were selected using the purposeful sampling method, and the data were collected through in-depth semistructured personal interviews. A total of 27 individuals who participated in individual interviews were family members, HC workers (including nurses and unqualified paid caregivers), heads of counseling and nursing care at home centers, and experts who had clinical or research experience in the field of geriatric care. Collected data were categorized into three main themes: defects in home care governance, concern about the efficiency of home care, and caregivers' job security concerns. These themes reflected the problems of HC, such as conflicts between multiple trustees, lack of evaluation and monitoring, inadequate competence and financial barriers of families and caregivers, and poor integration and coordination of services. Therefore, it is recommended to develop a national model for HC for Iranian older adults and allocation of different financial resources for HC, implementing quality improvement and evaluation tools, enhancing the training of caregivers, providing them with adequate compensation and benefits, and ensuring the safety and quality of services. These findings can inform the policymakers and planners of care services about the needs and challenges of this population and facilitate the collaboration among different stakeholders to provide better HC for older adults. [ABSTRACT FROM AUTHOR]

Gender-sensitised weight management programmes have been developed to encourage more men to access support. Whilst these programmes have proved successful for some groups of men, they are not a panacea, and the views of men who have never attended any form of structured weight management programme remain unknown. The aim of this research was to explore the views of such men towards body weight, health, and weight management programmes. Participants were recruited purposefully at their place of work. Semi-structured interviews were conducted with 16 adult men with a BMI > 25 who worked in routine manual occupations and had no previous experience of attending a weight management programme. Interviews were analysed using an inductive thematic analysis approach. Interview findings were developed into five themes: "the indestructible breadwinner," "avoidance of feminine behaviour," "the body conscious man," "being one of the lads," and "doctor knows best." The findings suggest that these men have high levels of body consciousness, value guidance from GPs, have high levels of agency towards lifestyle choices, and wish to preserve their masculinity. The study identified various factors that help explain low participation in weight management programmes for men and potential ways to improve access. Future interventions should include gender sensitisation of resources and providing men with the opportunity to follow self-directed weight management programmes to increase participation. Individual and population-level interventions to address weight management that includes the perceived and actual needs of men working in routine manual occupations are urgently needed to address health inequalities. [ABSTRACT FROM AUTHOR]

Adverse childhood experiences (ACEs) are traumatic events experienced before the age of 18 and include experiences of abuse, neglect, and household dysfunction. Exposure to ACEs early in life is a risk factor for adverse physical and mental health outcomes in adulthood, which may lead to subsequent child abuse, neglect, and household dysfunction. This study examined a rural community's barriers and facilitators to addressing ACEs in families with young children from the perspective of organizations serving children and families. The Innovation Corps (I-Corps) methodology was used to develop an ecosystem map of 64 community stakeholders, including 12 government, 13 healthcare, 27 early childhood education (ECE), and 12 community-based organizations, involved in the community's system of care for families with young children. Representatives from the stakeholder organizations identified in the ecosystem map were then recruited via purposeful and snowball sampling, and semistructured interviews were conducted with 37 participants. Transcribed notes and direct quotes were analyzed using a constant comparison analysis approach, and five themes emerged from the analysis. Barriers to addressing ACEs included limited mental health resources in ECE settings for both children and teachers, stigma, and limited access to local healthcare, while facilitators included establishing trusted relationships between organizations and families and using strengths-based approaches with families. This study characterized facilitators and barriers to addressing ACEs in families with young children residing in a rural community and provides guidance to inform future community-level ACEs interventions and policies. [ABSTRACT FROM AUTHOR]

In the wake of welfare sector reforms and the increasing marketisation of eldercare services, nursing home first-line managers (FLMs) are confronted with escalating work demands within streamlined organisations. Given this background, the aim was to investigate FLMs' perceptions of their psychosocial work environment and of differences between nursing home ownership types. Nineteen managers from three Swedish municipalities from municipal, outsourced, and private nursing homes participated in semi-structured interviews focused on job demands, job resources, and ownership differences. The FLMs' perceptions were interpreted as forming two themes. Navigating challenges: striving to cope with demands highlighted various challenges, including recruitment, workload, and lack of organisational support. Key stressors encompassed personnel struggles, time constraints, and complex interactions. Influence of ownership dynamics on the work environment explored variation across ownership types. Private nursing home managers enjoyed more decision-making autonomy but faced more scrutiny than did municipal ones. FLMs in outsourced homes described unique stressors, notably uncertainty and increased workload due to the procurement process. These findings underscore the potential need for tailored systemic changes across different ownership types. The policy implications include enhancing communication and support in municipal homes, reducing the span of control in private homes, and revising the procurement process in outsourced homes. These insights suggest that further research outlining differences between ownership types, particularly private and outsourced nursing homes, is warranted. Such research could aid in formulating specific strategies tailored to each ownership type in order to enhance the psychosocial work environment for FLMs in nursing homes. [ABSTRACT FROM AUTHOR]

Background. The issue of identity has been widely explored among migrant populations in western countries in the context of cultural integrations and acculturations. However, there is less evidence on identity as a determinant of health and social wellbeing. This study reports on identity as a determinant of health among the South Sudanese community who arrived as refugees through an Australian humanitarian program in the early 2000s. Methods. A qualitative study was undertaken, underpinned by a phenomenological framework that characterised the lived experiences of adult South Sudanese in Sydney, Australia. Semistructured in-depth interviews explored how 26 participants identified themselves in Australia, including changes in their experiences over time, their social and general life situation in Australia, and how they felt perceived in Australia. Data were audio-recorded using a digital voice recorder, transcribed verbatim, coded, and categorised into themes using interpretive thematic analysis. Results. Participants described a multiplicity of interconnected domains that governed the negotiating and making sense of identity, in turn mediated by other interwoven personal and structural factors that shaped experience and perception. Expressions of hope, pride, and achievement were threaded through several of the interviews, particularly in relation to their children. There were also frustrations related to employment challenges and discrimination that limited identity ownership. Conclusions. The evolving and often conflicting factors identified by participants can shape their sense of belonging, integration, and social and mental wellbeing. A deeper, more nuanced understanding of bicultural identity within a strengths-based framework is needed, with improved partnerships and services to support and strengthen South Sudanese community integration, belonging, and acculturation in Australia. [ABSTRACT FROM AUTHOR]

Background. Community engagement is crucial for effective and sustainable sexual and reproductive health and rights (SRHRs) promotion. Community engagement in community-based health promotion initiatives is contextual and influenced by individual, community, and societal factors. In South Africa, community engagement in SRHR promotion is challenging due to numerous historical and contemporary factors including the socionormative community context and socionormative perceptions regarding SRHR matters. There is little empirical literature to guide community-based practitioners working in health promotion in understanding the contextual influences on community engagement with SRHR promotion generally or in South Africa specifically. Objective. This research aimed to explore the influences on community engagement in community-based SRHR promotion initiatives in the Eastern Cape, South Africa. Methods. An ethnographic and multiqualitative study was conducted in the Eastern Cape, South Africa, involving 78 purposively and conveniently sampled participants. Findings. Three superordinate themes influence community engagement with SRHR promotion in South Africa (i) representations of the issues; (ii) perceived relevance of SRHR issues and SRHR promotion; and (iii) the relational environment, often operating in interactive ways. The themes are presented in a conceptual framework. Conclusions. Influences on community engagement in SRHR promotion in the Eastern Cape of South Africa are highly contextual. The conceptual framework arising from the study's findings could be used in community-based health promotion and primary health care in other settings to develop the understanding of factors influencing community engagement in SRHR or other sensitive or emerging health issues, and inform relevant and appropriate design and implementation of community-based initiatives. [ABSTRACT FROM AUTHOR]

Many cities across the United States are experiencing homelessness at crisis levels, including rises in the number of unhoused emerging adults (18–25). Emerging adults experiencing homelessness may be at higher risk of experiencing negative outcomes, given that being unhoused increases risk for a variety of behaviors. To better understand the current living circumstances of emerging adults with a history of homelessness, as well as their perceptions about associations between housing stability and quality of life (QOL), we conducted 30 semistructured in-depth interviews with individuals recruited from drop-in centers for youth experiencing homelessness. At the time of recruitment, n = 19 were stably housed and n = 11 were unstably housed. Two coders analyzed these data inductively and deductively, using preidentified domains and open coding. Coding reliability was assessed. Three main themes emerged, each with subthemes: (1) housing quality (neighborhood safety, convenience, and housing unit characteristics); (2) QOL before stable housing (physical and mental wellbeing, social wellbeing, and other determinants of QOL, such as encounters with law enforcement); and (3) changes in QOL after stable housing (same subthemes as for prehousing stability QOL). Findings indicated a pattern of perceived relationships between housing stability, housing quality, built and social environments, and QOL in the context of emerging adults who experienced or continued to experience homelessness. However, results were mixed with regard to the perceived effects of housing stability on alcohol and other drug use. Taken together, results indicate several areas of challenge but also highlight opportunities to facilitate improvements in QOL among vulnerable emerging adults who experience homelessness. [ABSTRACT FROM AUTHOR]

An estimated 1.3 million stroke survivors living in the United Kingdom (UK) currently rely on family caregivers for daily support. The needs of stroke family caregivers are, however, not routinely assessed by most clinical services. Early identification of their needs and support is crucial to maintain their well-being and caregiver role. At present, stroke-specific caregiver screening tools are lacking. This mixed method, the multiphase study aimed to develop a Carers' Alert Thermometer for stroke family caregivers (CAT-S) by adapting the CAT, a short screening tool developed in the context of end-of-life care. Underpinned by principles of action research, qualitative and quantitative data were collected sequentially between February 2016 to December 2017 from purposive samples of stroke family caregivers (n = 76) and staff working within stroke services (n = 238) in the UK. Semistructured interviews were conducted to inform the contents of the CAT-S. Key items for inclusion were identified through a modified Delphi survey and consultation with an expert panel. The CAT-S was then piloted in North West England to test its usability and usefulness in practice to identify the needs of stroke family caregivers. Thematic and content analysis were used to analyse qualitative data. Quantitative data were analysed using descriptive statistics. The CAT-S comprises the key challenges that are experienced by stroke family caregivers. Two additional items not present on the original CAT were identified and included; training needs of family caregivers to provide care and support for caregivers' emotional needs. The CAT-S was found to be useful and acceptable by both staff and stroke family caregivers and resulted in action plans and support being provided. The CAT-S is a supportive tool for achieving person-centred care and prioritising stroke family caregivers requiring comprehensive assessments. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the perception of family caregivers in the care process of patients with COVID-19. This study was conducted on 19 family caregivers, who were selected using purposive sampling from 2021 to 2022. Unstructured interviews were used to collect data. The data were analyzed using the Kyngas conventional content analysis approach. The analysis of data led to three main themes, including unremitting efforts in physical care in the light of traditional medicine, accuracy, and intelligence in psychological attention and trying to maintain environmental health. According to the results, family caregivers provide high levels of self-sacrificing, continuous, and comprehensive, combined with fear and loneliness care in different dimensions with little or no support from the family, community, and health team. [ABSTRACT FROM AUTHOR]

Currently, the number of empty-nest elders in China is rapidly increasing, and their overall health situation is not optimistic. The Chinese government has developed a series of policies to promote the community medical-nursing combined model to meet the health and pension care needs of elderly individuals. The demand for community medical-nursing combined services among empty-nest elders plays a decisive role in providing these services and must be fully recognized before these services are offered. However, only a few quantitative studies have focused on the demand for community medical-nursing combined services, and these studies failed to capture the complexity and dynamic nature of this demand. To address this research gap, this study innovatively conducted a descriptive and qualitative study to explore the demand for these services. Following the principle of data saturation, 14 empty-nest elders from communities in Wuhan, Hubei Province, were recruited using the purposive sampling method. Semistructured interviews were used to collect qualitative data. The inductive content analysis approach was used to analyze the data. The results revealed that Chinese empty-nesters' demand for community medical-nursing combined services was diverse and specific and comprised three themes (basic elderly care services, medical and nursing services, and psychospiritual support services), with fifteen subthemes. This study provides insights into the unique demand and implementation strategies for community medical-nursing services among empty-nest elders in China. Recommendations to enhance the intelligent elderly care system, infrastructure construction, and elderly care talent in the future provision of services for this particular group of people are provided. [ABSTRACT FROM AUTHOR]

Community violence, particularly gun violence, is a leading cause of morbidity and mortality in young people in the United States. Because persons experiencing violence‐related injuries are likely to receive medical care through emergency departments, hospitals are increasingly seen as primary locations for violence intervention services. Currently, there is little research on how best to implement hospital‐based violence intervention programs (HVIPs) across large hospital systems. This study explored the factors influencing the implementation of a multi‐site HVIP using qualitative interviews with a purposive sample of 20 multidisciplinary stakeholders. Thematic analysis was used to generate several themes that included: (1) reframing gun violence as a public health issue; (2) developing networks of community–hospital–university partners; (3) demonstrating effectiveness and community benefit; and (4) establishing patient engagement pathways. Effective implementation and sustainment of HVIPs requires robust and sustained multidisciplinary partnerships within and across hospital systems and the establishment of HVIPs as a standard of care. [ABSTRACT FROM AUTHOR]

The English National Overprescribing Review identified that older people often take eight or more medicines a day. The report recommended pharmacists in primary care should take responsibility for addressing polypharmacy. Overprescribing is a safety concern in care homes as approximately half of older care home residents are prescribed at least one medicine that is unnecessary or now harmful. This predisposes them to adverse outcomes including hospitalisation and mortality. Deprescribing is the planned activity of stopping or reducing a medicine that may no longer be appropriate. Deprescribing, when performed by a pharmacist, is a multidisciplinary activity requiring close communication with general practitioners (GPs) and care home staff. A recently completed trial that integrated pharmacists with prescribing rights into older peoples' care homes found significant variation in proactive deprescribing activity. The aim of the current study was to specifically explore beliefs and practices of deprescribing in care homes. A qualitative approach was adopted to examine individual, social and contextual factors that acted as enablers and barriers to pharmacist deprescribing in care homes. Semi‐structured interviews were conducted with participants of the previous study (16 pharmacists, 6 GPs and 7 care home staff from Northern Ireland, Scotland and England). Using thematic analysis, we identified two themes: (a) Structures and systems affecting deprescribing, that is the context in which deprescribing happened, including team involvement and routine practices in GP surgeries and care homes; (b) Balancing risks when deprescribing, that is the perception of individual risk and social barriers were mitigated by understanding the medical background of residents. This supported the clinical understanding that risks from overprescribing were greater than risks from deprescribing. While deprescribing can involve all health professionals in the primary care team, these results suggest the pharmacist is well placed to lead the process; by having both clinical competence and professional willingness to drive this activity forward. [ABSTRACT FROM AUTHOR]

Information and communication technology (ICT) can empower the older people and improve their quality of life by sustaining functional independence and effective communication. Nonetheless, in developing countries like India, technology acceptance and use among the older people is limited. Therefore, there is a need to systematically understand the plausible difficulties limiting technology use and the expectations of the older people regarding ICT use. Hence, the present study is a qualitative inquiry to explore the needs, attitudes and perceived limitations of the ICT platforms among the older people. Twenty healthy volunteers across various states of India, between 60 and 75 years were recruited online via purposive sampling. A brief demographic survey was administered online using Google Forms, followed by telephonic semi‐structured interviews. Thematic Analysis using inductive and deductive coding was employed to analyse the interview transcripts. Thematic analysis yielded four overarching themes‐ (i) Usability of ICT, (ii) Anxiety and privacy concerns, (iii) Self‐perception of technology use and (iv) Need for technology literacy. The emerging themes reflected the perceptions of the older people towards ICT and identified several psycho‐social factors impacting technology acceptance among the older people. The findings suggest that several psychological factors like anxiety, motivation, interest and self‐efficacy play a role in technology acceptance among the older people. Additionally, user‐friendly interfaces and training on technology use may enhance technology acceptance among older users. [ABSTRACT FROM AUTHOR]

The objective of the study was to identify whether creating a responsive, respectful and trustworthy environment that provides free dental care for clients who are homeless using volunteer dental professionals was effective in meeting their oral health needs in Fremantle, Western Australia. Qualitative research conducted between October 2018 and August 2019 was guided by a social constructivist paradigm to gather and analyse data. Semi‐structured interviews were conducted with adults experiencing homelessness accessing a community dental clinic and health providers and other stakeholders involved in its establishment, management and service delivery. An inductive approach to analysis was used to organise themes under the categories of 'establishing the oral health clinic' (OHC) and 'responses to the implementation of the clinic' Thirty‐nine semi‐structured interviews were conducted across eight participant groups: clients, executive management, the oral health clinical reference group, volunteer dentists, employed staff, nursing students, volunteer staff and other stakeholders. Key findings across all groups included positive responses to the establishment and implementation of the OHC, the quality of care and the safe and respectful environment in which services were delivered. Challenges related to sustainability include uncertainty around ongoing funding and recruitment of dental professionals. Whilst volunteer dental services fill a gap in meeting the complex needs of this population group, mainstream services must consider and address issues of equity in this context. Findings can be used to guide this process that includes creating environments of respect and trust where adults who are homeless or at risk of homelessness feel safe, welcomed and more likely to return to the service. [ABSTRACT FROM AUTHOR]

Although Indigenous groups continue to experience extensive health disparities, little research explores the role of structural barriers in contributing to health disparities for state‐recognised tribes, who do not receive healthcare services from the Indian Health Service. In addition, much research focuses on discrete physical health outcomes, without utilising community‐based approaches to allow participants to identify healthcare priorities and needs in their own voices. In partnership with a community advisory board, a qualitative descriptive methodology was used to conduct 31 life‐course interviews with participants of a state‐recognised tribe in the Gulf South region of the United States to explore healthcare experiences. Participants identified unmet healthcare needs and healthcare infrastructure barriers. Some of the most common barriers and unmet healthcare needs included: Long Distance to Healthcare Services and Difficulty in Accessing Specialists, Need for Increased Communication, Long Hospital or Appointment Wait Times, Unmet Mental Health Needs, Need for Substance Use or Abuse Prevention Programs and Need for Health Education. These findings highlight some of the structural barriers that exacerbate existing health disparities and suggest important areas of intervention, such as including a focus on mental health needs. Increased healthcare resources and recognition of sovereignty for this state‐recognised tribe are also needed to begin to address these barriers. In addition, because of the long history of exploitation of Indigenous communities, healthcare interventions should meaningfully include Indigenous tribes in the development and implementation of any healthcare programs. [ABSTRACT FROM AUTHOR]

Anxiety during pregnancy is highly prevalent in low‐ and middle‐income countries. The relative importance of different sources and types of perceived support in the Pakistani context is unknown. We explored social support during pregnancy and the role of social isolation in Pakistani women's experiences of antenatal anxiety. We conducted semi‐structured interviews with 19 pregnant women with symptoms of anxiety and 10 female healthcare providers at a public urban hospital. We used inductive and deductive thematic coding to analyse the data. Many pregnant women reported feelings of physical and social isolation, even when living in joint families with larger social networks. Often fearing censure by their in‐laws and peers for sharing or seeking help with pregnancy‐related anxieties, women reported relying on husbands or natal family members. Normative expectations around pregnancy such as male gender preference, perceived immutability of wives' domestic responsibilities and expectations of accompanied travel by women may serve as sources of disconnectedness in the antenatal period. Providers viewed social isolation and deficits in social support during pregnancy as contributing to worse anxiety symptoms, reduced access to care and poorer health behaviours. One limitation is that the hospital setting for this study may have resulted in underreporting of abuse or neglect and limited inclusion of pregnant women who do not utilise facility‐based antenatal care. In conclusion, husbands and natal families were key in reducing social isolation in pregnancy and mitigating anxiety, while in‐laws did not always confer support. Targeted strategies should enhance existing support and strengthen in‐law family relationships in pregnancy. [ABSTRACT FROM AUTHOR]

Despite steady increases in homelessness in the U.S., only recently has research on transportation needs and use for persons experiencing homelessness (PEH) been the focus of research endeavours. Moreover, limited research has identified how the geographic relocation of homeless community services and resources impacts the transportation needs of PEH and how this process affects access to health and social services. To fill this gap in the literature, using a community‐engaged research approach, we conducted a qualitative research study in which 24 professionals working in planning, transportation, local government, and the homelessness services sector were engaged in in‐depth, semi‐structured interviews. We examined participant perspectives on how PEH transportation needs and use changed after three new emergency shelters replaced a centralised one, and how access to health and social services was impacted. Data were organised into three overarching categories: (1) Changes in transportation need and use following decentralisation; (2) Impact of transportation changes on PEH access to services; and (3) Recommendations for improving transportation access. Findings suggest the need to offer PEH transportation on demand, provide education on transportation and system navigation, and increase transportation‐related funding for homeless service providers and PEH to ensure transportation costs are not a barrier to healthcare and social services. [ABSTRACT FROM AUTHOR]

This qualitative evaluation study examined the impact of unstructured intervention on people with depression in a community mental health centre in Hong Kong. In the intervention, service users initiated groups and designed group activities by themselves, with social workers as facilitators. Semi‐structured interviews were conducted with service users enrolled in unstructured intervention, their family members, and service providers in 2019. Overall, 32 participants were recruited through purposive sampling. The results revealed that peer interactions helped participants to feel accepted and understood. Participants also acquired experience with emotional coping strategies and practised their interpersonal skills, and by learning new skills from peers, they were able to rebuild their self‐esteem and improve their relationships with friends and family. To cater to clients' different needs and concerns, unstructured activities should be diversified. Family and social functioning should also be emphasised in the development of unstructured intervention because the generic skills and knowledge acquired from unstructured activities with peers could help to enhance family relationships, self‐confidence, and the ability to manage issues related to working and socialising. [ABSTRACT FROM AUTHOR]

Chinese immigrants in Australia are overrepresented among people with chronic hepatitis B virus (PWCHB) but experience poor access to healthcare. Given the historical discriminatory policies against PWCHB in mainland China, this study aimed to explore the lived experiences of stigma and discrimination surrounding hepatitis B virus (HBV) among Chinese immigrants originally from mainland China. Semi‐structured in‐depth interviews were conducted by a researcher with a Chinese background in 2019–2020. Sixteen Chinese immigrants living with HBV were recruited across Sydney and Melbourne through advocacy and support groups. This study is positioned in social constructionism. Data analysis was informed by the Health Stigma and Discrimination Framework that highlights the interaction between layered stigmas. This study revealed the historical, social and cultural construction of HBV‐related stigma among PWCHB and demonstrated how this stigma was manifested across socioecological levels in China and Australia. Findings show that HBV‐related stigma has mostly been driven by knowledge deficits about HBV and fear of HBV infection. HBV‐related stigma was mostly demonstrated around social isolation including isolation imposed by family and the community and employment restrictions in the Chinese workplace. In the Australian context, HBV‐related stigma was related to the ethnic and cultural background of PWCHB, and primarily occurred as anticipated stigma in the community and in employment. The findings provide significant insights for crosscutting research and policy endeavours to develop and test cross‐disciplinary initiatives that more broadly address the complex lived realities of Chinese immigrants living with hepatitis B virus. [ABSTRACT FROM AUTHOR]

This research aimed to explore the needs, potential roles and implementation of Bilingual Community Navigators (BCNs) in providing navigation support for patients in general practice settings in Australia. A total of 19 participants (general practitioners, practice managers, practice nurses and receptionists) from five general practices in Sydney where most of the patients spoke a language other than English were interviewed about their views on needs, potential roles and implementation of BCNs in general practice settings. Data were collected between August 2019 and July 2020. The interview transcripts were inductively analysed for themes. Themes emerged across four broad categories: patients' barriers to access health and social care services; potential roles of BCNs; recruitment, training, and employment of BCNs and considerations and anticipated barriers to BCNs' role. Many barriers both at the patient and at the service provider levels in accessing healthcare and social care services were consistent with the Levesque et al. access framework including lack of understanding of the health system, language and cultural barriers, hesitancy to approach general practice and problems navigating services. Participants believed that BCNs would be able to help overcome these barriers through health education, support in booking appointments, arranging transport, providing language and cultural support and improving communication with the health services. Conditions for effective implementation of BCNs in practice included proper training of the navigators to ensure patient confidentiality and addressing organisational/system barriers such as lack of a funding mechanism, a clear role definition of BCNs and acceptance of BCNs by patients. BCNs potential role in facilitating access to appropriate care by culturally and linguistically diverse (CALD) patients in general practice warrants further evaluation in the context of the Australian healthcare system. [ABSTRACT FROM AUTHOR]

In Victoria, Australia, Maternal and Child Health nurses (MCHNs) play a key role in facilitating the timely identification of Postnatal Depression and Anxiety (PNDA). Understanding MCHNs' screening practices, and the factors which impact them, is central to ensuring that future screening policy agendas are evidence‐based and able to support MCHNs in carrying out this critical work. Yet, little is known about this subject. The purpose of this study was to gain an in‐depth understanding of MCHNs' screening practices, and the factors which impact them. Qualitative descriptive design with semi‐structured interviews were used. Participants were MCHNs who had been practicing for a minimum of 6 months and regularly saw new mothers. Purposeful sampling was used to facilitate diversity across participant characteristics. Twelve MCHNs were interviewed between March and May 2021. Thematic analysis was conducted to identify patterns across our data. Qualitative content analysis was then used to identify issues which were most emphasised by MCHNs. Two themes were identified. Theme one, 'variations in screening practices', pertained to MCHNs' various screening practices (i.e., who, when, how) and the factors which influence them. Theme two, 'systemic barriers hinder equitable screening', pertained to factors which hindered equitable screening practices. Results indicate that systemic barriers contribute to inconsistent and inequitable screening practices, with women from culturally and linguistically diverse backgrounds less likely to be screened in line with best practice. Our findings emphasise an urgent need for MCHNs to be allocated with the resources required to screen all women equally, regardless of their cultural background. [ABSTRACT FROM AUTHOR]

The existing psychosocial Support activities in the Northern Territory, Australia, are mostly delivered through individualised outreach and client‐centred Support programs and do not currently have a strong Peer focus. To address this gap, a Peer‐Led Education Pilot was developed and implemented in Darwin, Australia. The pilot was comprised of three separate but overarching stages, and each stage was independently evaluated. In this article, results from Stage 1 will be presented, with a specific focus on the role of Peer‐to‐Peer communication in improving participants' mental health and Recovery skills. This stage involved the delivery of the My Recovery program to self‐nominated participants, and the evaluation was aimed at reporting on the appropriateness and effectiveness of the program. The evaluation was qualitative in design involving individual pre‐ and post‐program interviews with program participants (npre = 14, npost = 16) between August and October 2019. The program was well received by participants and helped build their capacity to understand and self‐manage their mental health and/or alcohol and other drug issues in an inclusive, non‐clinical, non‐judgemental space. The results highlighted the importance of including a strong Peer focus in the existing psychosocial Support services available for people with mental health issues in Darwin. The findings also underscored the inclusion of those with lived experience of mental health challenges in the design and delivery of such programs. [ABSTRACT FROM AUTHOR]

People of South Asian (SA) origin have a higher prevalence of dementia compared with the United Kingdom (UK) population as a whole. Little is known about how family carers of SA origin perceive dementia, manage access to dementia services, and how plans and preparations are made for end‐of‐life for loved ones with dementia. This qualitative study aimed to explore the experiences of carers of people with dementia of SA origin, living in the UK. Through semi‐structured interviews, the perspective of caregivers of a person with dementia was explored from point of diagnosis to end‐of‐life preparation. Sixteen caregivers participated in face‐to‐face interviews. Four key themes are presented (i) lacking awareness at the start; (ii) living with the challenges of dementia; (iii) preparing for end‐of‐life; (iv) preferences for burial. Carers described difficulties in making sense of early symptoms and the behaviour changes they observed amongst their relatives with dementia. They described the tensions in trying to follow their religious and cultural identities of honouring the dignity and choices of the person with dementia. This study reports on the perspectives of SA carers of people with dementia, particularly exploring the end‐of‐life preparation and wishes of people with dementia in the UK. Family carers may benefit from accessing more culturally sensitive support when dementia is diagnosed, including such support when receiving formal day‐to‐day care. Importantly the findings suggest that planning and preparing to provide end‐of‐life for people with dementia should recognise and respect family and cultural contexts and religious beliefs. [ABSTRACT FROM AUTHOR]

Public health responses to the COVID‐19 pandemic, such as business restrictions, social distancing and lockdowns, had social and economic impacts on individuals and communities. Caremongering Facebook groups spread across Canada to support vulnerable individuals by providing a forum for sharing information and offering assistance. We sought to understand the specific impacts of Caremongering groups on individuals 1 year after the pandemic began. We used a convergent parallel mixed‐methods approach that included semi‐structured interviews with group moderators from 16 Caremongering groups and survey data from 165 group members. We used a constant comparative approach for thematic analysis of interview transcripts and open‐ended text responses to the survey. We used source theme tables as joint displays to integrate interview and survey findings. Our results revealed five major themes: providing food, sharing information, supporting health and wellness, acquiring goods and services (non‐food), and connecting communities. Respondents of our survey tended to be 35–65 years of age range, but reported helping adults of all ages. Our findings illustrate the potential of using a social media platform to connect with others and provide and access support. The Caremongering initiative demonstrates a community‐driven, social media solution to issues such as isolation, loneliness and community health promotion. [ABSTRACT FROM AUTHOR]

Due to cultural influences, people from some ethnic minority groups expect to provide caregiving for their family members who suffer from illness. Little is known about the expectations about caregiving and the help‐seeking process among the Korean population in Canada. Thus, the purpose of this study is to examine perceptions of caregiving for people living with dementia and help‐seeking patterns among prospective Korean caregivers who anticipate becoming primary caregivers of their older relatives with dementia. An exploratory qualitative study was conducted in Montreal, Canada. In‐depth semi‐structured interviews were conducted with nine prospective Korean caregivers. The interviews were analysed using a qualitative thematic analysis. This study found four emerging themes: (1) the importance of family care; (2) the ability to find resources outside of the family; (3) the roles of Korean churches as a support system and; (4) the perceptions of service providers and health care settings. The findings of this study suggest that linguistic support services enable family caregivers to access more health and social services. Resources may be more easily accessed by Korean communities when provided through churches. [ABSTRACT FROM AUTHOR]

Black and Latinx youth are disproportionately affected by violence in the United States. Hospital‐based violence intervention programs (HVIPs) have emerged as an effective response to this epidemic; however, participation rates remain low. This study aimed to identify facilitators and barriers to recruitment and engagement amongst black and Latinx youth from the perspective of HVIP staff. Employing a phenomenological approach, a purposive sample of key informants was recruited. Focus groups and semi‐structured interviews lasting approximately 90 min were conducted with representatives (N = 12) from five HVIPs in U.S. cities across the Midwest and Northeast, making up 15% of all HVIPs in the United States. Each interview was recorded and transcribed verbatim. The research team employed rigorous content analysis of the data. Three themes and subsequent categories resulted from the analysis: (1) Interpersonal/Relational Facilitators (building rapport; connecting with youth; enhancing the teachable moment; building relational health); (2) Structural/Systemic Barriers (lack of reinforcement; difficulties connecting after discharge from the hospital; hospital workflow; institutional challenges); (3) Structural/Systemic Facilitators (embedding the HVIP; trauma‐informed practices and policies). Given the limited research on black and Latinx youth and the disproportionate rate of violent injuries amongst these groups, an evidence‐based systematic approach to engage youth is essential to promote health equity. The findings from this study suggest that there are several steps that HVIPs and hospitals can take to enhance their recruitment and engagement of youth and their families. [ABSTRACT FROM AUTHOR]

Hospital discharge for people experiencing homelessness is a perennial challenge. The Homeless Reduction Act 2017 (HRA) places new responsibilities on hospitals, but it remains unknown whether this has affected discharge practices. This qualitative study explores stakeholders' views on the challenges around hospital discharge for people experiencing homelessness, in the context of a deprived English city. Semi‐structured interviews were conducted with 27 stakeholders. Participants were purposively recruited from local authority, third sector and the National Health Service. Interviews were transcribed and thematic analysis conducted. Analysis generated three main themes. First, a need for better planning and communication with the third sector, particularly around medication, prescriptions and information sharing. Second, the need to improve awareness and 'upskill' hospital staff to work more effectively with people experiencing homelessness, including understanding their needs, the wider support available and HRA requirements. Third, there were calls for (re)investment in a different approach to better support this population, based on outreach and flexibility. The need for improved partnership working and investment was emphasised. Whilst recognising the challenges faced by hospitals, especially within the context of funding cuts, this study highlights the need to recognise the third sector's contribution in supporting people experiencing homelessness in the community. Developing site‐specific checklists for practice before discharge (and as early as possible) may help to ensure appropriate measures are in place. Improving legal literacy in the context of what an appropriate discharge is for people experiencing homelessness may help develop staff confidence to challenge the focus on 'quick' discharges. [ABSTRACT FROM AUTHOR]

Allied health assistants (AHAs) are important members of the health workforce and key to meeting population health needs. Previous studies exploring the role and utility of AHAs from multiple stakeholder perspectives suggest AHAs remain poorly utilised in many healthcare settings. This qualitative study explores the experiences and perspectives of AHAs working in healthcare settings to determine the contextual factors influencing their role, and mechanisms to maximise their utility. We conducted semi‐structured interviews using purposive sampling with 21 AHAs, from one regional and three metropolitan health services in Australia, between February and July 2021. We used a team‐based framework approach to analyse the data. Four major themes were identified: 1) AHAs' interpersonal relationships, 2), clarity and recognition of AHA roles and role boundaries, 3) AHAs accessing education and professional development, and 4) the professional identity of the AHA workforce. Underpinning each of these themes were relationships between AHAs and other healthcare professionals, their patients, health services, and the wider AHA workforce. This study may inform initiatives to optimise the utility of AHAs and increase their role in, and impact on, patient care. Such initiatives include the development and implementation of guidelines and competencies to enhance the clarity of AHAs' scope of practice, the establishment of standardised educational pathways for AHAs, and increased engagement with the AHA workforce to make decisions about their scope of practice. These initiatives may precede strategies to advance the AHA career structure. [ABSTRACT FROM AUTHOR]

The prevalence of homelessness among older adults in Ethiopia is growing. While prior studies examined the push factors and challenges of homeless elders, little is known about how older people cope with homelessness in a context of limited ageing services. This study explored the coping strategies of homeless older people in Kobo Town, Ethiopia. Purposive sampling was used to identify 10 homeless older people and four key informants. Thematic analysis was used to analyse the data collected through in‐depth interviews. To cope with the challenges faced on the street, homeless older people used various strategies including begging, holy water, drying leftover food, using river water for hygiene and sanitation, sleeping in church compounds, and creating their own social networks. Despite their best efforts, elders' coping strategies could not overcome the barriers imposed by their resource‐poor environment. The findings call attention to the urgent need for a national response to elders' unmet needs including an income support programme and multifaceted support services for older adults in Ethiopia. [ABSTRACT FROM AUTHOR]

Supported living has been shown to improve functioning and social inclusion in people with severe and persistent mental health problems, reduce hospitalisation and provide secure accommodation in a population where housing needs are often unmet. Conversely, living in supported accommodation has been depicted by some as depersonalising, marginalising and an ordeal to survive. Discussions regarding housing and support often lack a thorough consideration of individual experiences, with a reliance on quantitative surveys. The question remains how to assure that supported accommodations actually are supportive of the residents' ongoing recovery process. The present study sought to shed light on the experiences of residents in an enhanced supported living service in the United Kingdom. Semi‐structured interviews were conducted with nine residents of the service between July 2020 and February 2021. Transcripts were analysed using thematic analysis and indicated three superordinate themes of experiences considered valuable to residents: (1) support from care staff which was readily available; (2), a sense of community and daily activity offered by the residence and on‐site activities; and (3) the experience of supported living as a stepping‐stone in an ongoing recovery process. Findings indicate the power of comprehensive care with supportive staff, peer‐relations, autonomy and fostering hope in empowering individuals in their ongoing recovery. [ABSTRACT FROM AUTHOR]

This study aimed to develop and evaluate a communication tool to guide transitional care for older patients. Using experience‐based co‐design, a communication tool resulted from the triangulation of data collected from three study phases. From 2015 to 2016, semi‐structured interviews and co‐design focus groups were undertaken with older patients, carers and healthcare practitioners across acute, rehabilitation and community settings. The evaluation phase, conducted in 2017–2018, involved use of the communication tool by healthcare practitioners in a multidisciplinary care team with older patients in acute care and semi‐structured interviews with healthcare practitioners about the acceptability and feasibility of the tool. A total of 103 patients, carers and healthcare practitioners took part. In semi‐structured interviews, patients and carers reported needing to become independent in care transitions, which was supported by discussing the transitional care plan with healthcare practitioners. Interviews with healthcare practitioners identified that their need for fast and safe care transitions was supported by team discussion and by engaging patients and carers in their transitional care plan. Co‐design focus group participants identified principles guiding transitional care including patient‐centred communication. Data collected from semi‐structured interviews and co‐design focus groups were used to develop a prototype communication tool to guide conversations about discharge care between healthcare practitioners and older patients. Following use, healthcare practitioners reported that the communication tool was feasible and acceptable although some nurses perceived that transitional care was not their role. The communication tool provides an evidence‐based resource for ward nurses to support transitional care continuity in multidisciplinary models. [ABSTRACT FROM AUTHOR]