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This paper reports the findings of a thematic narrative review of peer‐reviewed articles exploring innovation in UK independent homecare services published between January 2009–August 2021. Our analysis of 15 papers reveals four broad innovation types: personalised funding, operational models, workforce development and assistive technology. We conclude that research focused on innovation in independent homecare offers important insights into the positive and negative outcomes of different types of innovation for providers, care workers and people receiving care. There are, however, also areas which are neglected and need further elaboration, including more robust evidence of outcomes and clearer articulation of innovation processes. [ABSTRACT FROM AUTHOR]

Migrants face several unmet health needs due to the inability of the healthcare system to address their healthcare challenges. As a result, they adopt coping strategies to overcome their healthcare needs. Consequences can include infrequent but severe adverse reactions, dangerous drug interactions, incorrect dosage etc. Little is known in Ghana about the role played by cultural and linguistic barriers in shaping migrants' access to formal healthcare and the coping mechanisms adopted by these migrants to overcome their healthcare challenges. Surprisingly, most of the studies that have been conducted have focused on financial barriers to care accessibility. This presents a loss opportunity for any health programme aimed at addressing this inequity. Thus, the purpose of this paper is to fill this gap by exploring the challenges of healthcare accessibility and coping strategies adopted by migrants to overcome their healthcare needs in the informal urban settlement of Madina, in the Greater Accra Region. The author employed a narrative type of qualitative research design. A purposive and then snowball sampling technique were used to select 20 participants to participate in the study after saturation was reached. Twelve in‐depth interviews (IDIs) and six key informants' interviews (KIIs), as well as two focus group discussions (FGDs), were conducted. The study is consistent with the ecological model, which posits that health is determined by influences at multiple levels. The author found linguistic, cultural, stigmatisation and financial challenges as the main barriers to healthcare accessibility among the migrants. As a result, self‐medication and the use of lay health personnel for addressing healthcare needs were more pronounced. The study also found other means of survival that posed a health risk to the migrants. Based on this, it was recommended that healthcare systems take into account the healthcare needs of migrants who are people with culturally and linguistically diverse backgrounds. [ABSTRACT FROM AUTHOR]

This paper aims to establish strategies of coping with COVID-19 pandemic adopted by the clients of social assistance from the perspective of social workers. The qualitative research among Polish social workers and family assistants was conducted from September to November 2021. Based on 30 in-depth interviews with social work professionals, groups of social assistance clients' behaviours were identified and classified into the theoretical models of reactions to social change by Merton and Giddens. The following types of behaviour have been selected and categorized into four groups of reactions when dealing with social workers in a pandemic situation: coolheaded calculation, defiance, confusion, and adaptation. At the same time, reactions to the situation of social change were categorized into one of the strategies of active or passive behaviour: innovation, contestation, retreat, and acceptance. In addition, we discussed the impact of clients' coping strategies on social workers and established three attitudes of the surveyed social workers: adapting to the pandemic situation and customer behaviour, assuming the role of an emotional buffer and informant, and expecting support from superiors and coworkers. Knowing the behaviour of social assistance clients in a challenging situation makes it possible to adopt tailor-made measures. [ABSTRACT FROM AUTHOR]

Social prescribing (SP) is increasing in popularity in the UK and can enable healthcare providers to respond more effectively to a range of non‐clinical needs. With the NHS commitment to establish an SP link worker in all GP practices, there is a rapid increase in the number of SP schemes across the country. There is currently insufficient evidence concerning the implementation and acceptability of SP schemes. In this paper, we report our analysis of the descriptions of the experiences of SP link workers, regarding the early implementation of SP link workers in two SP programmes in the South West. Data were gathered using the 'Researcher in Residence' (RiR) model, where the researcher was immersed in the environments in which the SP was managed and delivered. The RiR undertook conversations with 11 SP link workers, 2 SP link worker managers and 1 SP counsellor over six months. The RiR visited seven link workers at their GP practices (service 1) and four at their head office (service 2). The RiR met with the link worker managers at their offices, and the RiR spoke with the SP counsellor on the telephone. Data from these conversations were analysed using Thematic Analysis and six codes were constructed to advance our understanding of the components of early implementation of the SP programmes. Training (particularly around mental health), workforce support, location and SP champions within GP practices were found to be key strategies of SP implementation, link worker involvement acting as a conduit for the impacts of these strategies. This paper suggests that the implementation of SP programmes can be improved by addressing each of these areas, alongside allowing link workers the flexibility and authority to respond to challenges as they emerge. [ABSTRACT FROM AUTHOR]

The sustainable development of smart community is the key to China's grassroots governance and also the general trend of China's urban modernization. In the supervision of the smart community, the optimization of the behavior of the regulatory subject cannot be separated. Previous studies have focused more on how subjects participate in supervision and less on the behavior of stakeholders in the game. This paper analyzes the game behavior of regulatory participants in the process of sustainable development of smart community and studies the optimization strategy of regulatory behavior according to the game behavior logic among participants. The results show the following. (i) Government behavior plays a leading role in supervision. (ii) When the government invests resources in the screening of third-party evaluation agencies and service purchase and mainly adopts policy punishment methods for stakeholders with rent-seeking behavior, the probability of regulatory participation stakeholders' positive behavior is the greatest. (iii) The improvements should be made from the aspects of information network construction, the refinement of reward and punishment measures, and the improvement of evaluation party access rules. This not only helps to enhance the good supervision situation of the supervision enthusiasm of the participants but also can realize the self-discipline operation of the smart community and enhance the responsibility consciousness of the evaluation institutions. [ABSTRACT FROM AUTHOR]

Current health and social care systems do not always meet the needs of the dying in our communities. As a result, patients and families are choosing to place their trust in those who can advocate for them or fill the gaps in care. Birth Doulas have been working with women during pregnancy and after birth for many years, and we are now seeing a new role, that of a Death Doula emerging in the end‐of‐life care space. How Death Doulas work within health and social care systems is not understood and we conducted a systematic review to explore the published literature to explore the role and potential implications for models of care delivery. Following the PRISMA recommendations, we searched the literature in January 2018 via bibliographic databases and the grey literature without search date parameters to capture all published literature. We looked for articles that describe the role/work of a death doula or a death midwife in the context of end‐of‐life care, or death and dying. Our search retrieved 162 unique records of which five papers were included. We analysed the papers in relation to relationship to health service, funding source, number and demand for services, training, licensing and ongoing support, and tasks undertaken. Death Doulas are working with people at the end of life in varied roles that are still little understood, and can be described as similar to that of "an eldest daughter" or to a role that has similarities to specialist palliative care nurses. Death doulas may represent a new direction for personalised care directly controlled by the dying person, an adjunct to existing services, or an unregulated form of care provision without governing oversight. [ABSTRACT FROM AUTHOR]

Trauma in early childhood has been shown to adversely affect children's social, emotional, and physical development. Children living in out‐of‐home care (OoHC) have better outcomes when care providers are present for children, physically, psychologically, and emotionally. Unfortunately, the high turnover of out‐of‐home carers, due to vicarious trauma (frequently resulting in burnout and exhaustion) can result in a child's trauma being re‐enacted during their placement in OoHC. Organisation‐wide therapeutic care models (encompassing the whole organisation, from the CEO to all workers including administration staff) that are trauma‐informed have been developed to respond to the complex issues of abuse and neglect experienced by children who have been placed in OoHC. These models incorporate a range of therapeutic techniques, and provide an overarching approach and common language that is employed across all levels of the organisation. The aim of this study was to investigate the current empirical evidence for organisation‐wide, trauma‐informed therapeutic care models in OoHC. A systematic review searching leading databases was conducted for evidence of organisation‐wide, trauma‐informed, out‐of‐home care studies, between 2002 and 2017. Seven articles were identified covering three organisational models. Three of the articles assessed the Attachment Regulation and Competency framework (ARC), one study assessed the Children and Residential Experiences programme (CARE), and three studies assessed The Sanctuary Model. Risk of bias was high in six of the seven studies. Only limited information was provided on the effectiveness of the models identified through this systematic review, although the evidence did suggest that trauma‐informed care models may have significantly positive outcomes for children in OoHC. Future research should focus on evaluating components of trauma‐informed care models and assessing the efficacy of the various organisational care models currently available. [ABSTRACT FROM AUTHOR]

There is a growing interest in English-speaking jurisdictions, including Australia, North America, Canada, the United Kingdom and New Zealand, about the prevention of sexual abuse perpetrated by children against other children. The aim of this review was to identify opportunities for research, policy and practice which could enhance the prevention agenda relating to the perpetration of sexual abuse by children through conducting a Critical Interpretive Synthesis. Eleven electronic databases were searched in the period from 22 April to 23 May 2013 and included: SocINDEX, Social Services Abstracts, Applied Social Sciences Index and Abstracts, Family and Society Studies Worldwide, Project Muse, PsychINFO, Family and Society Plus, Jstor, Expanded Academic ASAP, Web of Science and Google Scholar. Key individual journals were also searched, including Child Abuse and Neglect and the Journal of Interpersonal Violence, as well as the grey literature. The search was guided by the research question: How could the prevention agenda relating to sexual abuse perpetrated by children be enhanced? The systematic literature search yielded 3323 titles, and 34 of these papers were included in the final synthesis. The authors identified five domains operating in the evidence base: characteristics, causes, communications, interventions and treatments. A synthesising construct emerged from the review: prevention-enhancing interactions. This construct referred to the potential for enhancing the prevention agenda which exists as the evidence domains interact with one another, and with the public health model of prevention. The authors consider this review to be a timely contribution to the current agenda pertaining to sexual abuse perpetrated by children. It provides researchers, policy makers and practitioners in the field with an evidence-informed conceptualisation of opportunities for enhancing prevention work. [ABSTRACT FROM AUTHOR]

Self-care is an important approach to the management of long-term health conditions and in preventing ill-health by living a healthy lifestyle. The concept has been used to a limited extent in relation to mental health, but it overlaps with the related concepts of recovery, self-management and self-help. These related concepts all entail individuals having more choice and control over treatment and a greater role in recovery and maintaining their health and well-being. This paper reviews qualitative empirical research that provides information on the nature of self-care in mental health from the perspective of people experiencing mental health problems. Twenty qualitative studies were identified from a systematic search of the literature. The methods used in these studies were critically appraised and key themes across studies identified self-care behaviours and processes supporting self-care. The paper also highlights challenges to this approach in mental health and provides a conceptual framework of the relationships between self-care support, self-care behaviours and strategies, and well-being for the individual. It also highlights limitations in the current evidence base and identifies areas for future research. [ABSTRACT FROM AUTHOR]

This study explores care practices of older people outside formal care and without appealing to predefined relationships. We conducted interviews with 30 independent‐living men and women aged 67–93 in three municipalities in Sweden. The interviews explored how they cared for themselves and other older people who were not family. Interviews were conducted between December 2017 and May 2018 and later transcribed and analysed using grounded theory. Our paper presents one of the first studies on informal care practices among older people that looks beyond the definition of formal care to understand how such care complements formal care services. The findings show that older people participate in several care arrangements to care for themselves as well as for others. The arrangements feature different types of mutuality and include distant relations to other older people and larger more or less formalised groups. The findings highlight the importance of looking beyond conceptualisations of care based on understandings of formal care and specific relationships as a frame for understanding informal care. To promote older people's health by cultivating and supporting older people's care for themselves and others, research and healthcare practitioners need to explore and acknowledge the significance and complexity of older people's everyday care practices. [ABSTRACT FROM AUTHOR]

Worldwide, a growing burden of health and social issues now affect young people. Interagency collaboration and the "integration" of health and social care services are advocated to address the increasingly complex needs of at‐risk youth and to reduce barriers to accessing care. In New Zealand, Youth‐One‐Stop‐Shops (YOSSs) provide integrated health and social care to young people with complex needs. Little is known about how YOSSs facilitate collaborative care. This study explored the collaboration between YOSSs and external agencies between 2015 and 2017 using a multiple case study method. This paper reports qualitative focus group and individual interview data from two of four case sites including six YOSS staff and 14 external agency staff. Results showed participants regarded collaboration as critical to the successful care of high needs young people and were positive about working together. They believed YOSSs provided effective wraparound collaborative care and actively facilitated communication between diverse agencies on behalf of young people. The main challenges participants faced when working together related to the different "world views" and cultures of agencies which can run contrary to collaborative practice. Despite this, some highly collaborative relationships were apparent and staff in the different agencies perceived YOSSs had a lead role in co‐ordinating collaborative care and were genuinely valued and trusted. However without the YOSS involvement, collaboration between agencies in relation to young people was less frequent and rarely went beyond limited information exchange. Establishing and maintaining trusting interpersonal relationships with individual staff was key to successfully negotiating agency differences. The study confirms that collaboration when caring for young people with high needs is complex and challenging, yet agencies from diverse sectors value collaboration and see the YOSS integrated wraparound approach as an important model of care. [ABSTRACT FROM AUTHOR]

There is a growing body of literature on sustainability, but its definition and the factors that affect it are not well understood. This paper focuses on the sustainment of health promotion interventions in community mental health organisations, where the institutional context has been found to play an important role. Normalisation Process Theory (NPT) was used to characterise the extent of sustainment of health promotion interventions and to identify important factors that influence it. The study builds on a previously reported qualitative multiple case design focusing on four Danish community mental health organisations. We aimed to include cases (provider organisations) with varied political‐administrative contexts that were expected to impact sustainment. Data included 27 semistructured interviews with managers and frontline staff. The analysis adopted a thematic approach combining within‐case and cross‐case analysis. One important factor contributing to sustainment was the high degree of coherence generated during and after implementation. Perceptions of meaningfulness and formal tools for external accountability such as municipal activity plans also stimulated the cognitive participation of management and staff in sustaining the intervention. On the practical level of collective action, working with health promotion in a continuous way was particularly supported by two formal tools: internal health policies and municipal activity plans. Sustainment was further aided by reflexive monitoring based on ongoing informal assessments, supplemented by information required for status reports to the municipality on individual users and information from the annual individual user health checks. Future studies should adapt NPT to a broader range of cases to assess more thoroughly its contribution to the literature on sustainment. Future interventions need to pay closer attention to securing continuous and active local management support as well as to political‐administrative contexts as potential external drivers of sustainment. [ABSTRACT FROM AUTHOR]

Carers play an ambiguous role within the personalisation paradigm currently shaping adult social care practice in England. Although carers have rights to assessments and support in their own right, these rights sit uneasily alongside the practices of assessment, support planning and personal budget ( PB) allocation for older and disabled people. This paper reports how 14 dyads of older and learning disabled people with cognitive and/or communication impairments and their carers viewed the roles - desired and actual - played by carers in PBs. Interviews with carers and with older and disabled people were conducted during 2012 as part of a wider study into carers' roles in assessment, support planning and managing PBs. The interviews complemented a survey of reported practice in two English regions - interviews with adult social care services senior managers and focus groups with front-line care managers. Talking Mats© were used to support interviews with some service users. Interviews were transcribed and data analysed using the Framework approach. The interviews indicated that carers played important roles in service users' assessments and support planning, but were less likely to report receiving assessments or support of their own. While carers had the potential to benefit from PBs and support arrangements for service users, this did not reflect practice that aimed to enhance choice and control for carers. The paper draws on Twigg's typology of service conceptualisations of family carers and concludes that, despite the important social rights won by carers in England, current practice continues to regard carers primarily as a resource or a co-worker, rather than a co-client. [ABSTRACT FROM AUTHOR]

Consumer-directed care (CDC) is increasingly widespread among aged care service options in Organisation for Economic Co-operation and Development (OECD) countries. However, the evidence base regarding the programmatic and contextual factors that affect the outcome of CDC interventions is surprisingly small. This paper reports on a self-directed care approach for older Australians with complex care needs. A multimethods longitudinal comparative cohort study was employed comprising 4 survey tools and 56 semi-structured interviews. Participation rates were around 20%. A total of 185 (98 in the intervention and 87 in the control group) older people and carers were recruited at baseline. Eleven months later, 109 participants (59 in the intervention and 50 in the control group) completed the repeat measure. Attrition rates were around 40%. Data collection occurred between July 2010 and April 2012. The data suggest that intervention group participants were likely to be more satisfied with the way they were treated (P = 0.013), their care options (P = 0.014), the 'say' they had in their care (P < 0.001), the information they received regarding their care (P = 0.012), what they were achieving in life (P = 0.031), that the services changed their view on what could be achieved in life (P = 0.020) and with their standard of living (P = 0.008). The evaluation suggests that while only a very small segment of older people is interested in a voucher or cash option, a substantially larger group would like to have greater say over and more direct access to their care, without, however, assuming administrative and financial responsibilities. The paper concludes that a stepped capacity-building approach to CDC may improve the acceptability of CDC to older people and generate synergies that improve older people's care outcomes. [ABSTRACT FROM AUTHOR]

Community engagement (CE) has long been endorsed by policy makers and health practitioners. However, uncertainties remain about the workings and outcomes of CE. This study aims to provide in-depth insights into them. In a multiple case study, we investigated three participatory health promotion projects for families in vulnerable situations in the Netherlands. We adopted a realist approach combined with a theory of change (ToC) model. We then analysed the qualitative data for context–mechanism–outcome (CMO) configurations to refine this ToC. Results show that CE can strengthen social networks, empower families, and increase perceived health. However, specific contexts in combination with CE project approaches may or may not trigger positive responses. Participants may feel that they matter when asked to actively contribute to a project, which in turn can enhance their self-confidence. In another context, we found that families were overwhelmed by the responsibilities given to them in the project, leading to feelings of stress and withdrawal from the project. We present a list of CMO configurations and refine the ToC accordingly. Our main conclusion is that flexibility is key when CE is implemented in health promotion. Also, our findings question physical health outcomes as a realistic ambition for CE projects with groups in vulnerable situations. [ABSTRACT FROM AUTHOR]

The urban blue-green space landscape ecology is an important component that supports the urban landscape ecosystem. In this study, a combination model of the grey system theory (GST), analytic hierarchy process (AHP), and technique for order of preference by similarity to ideal solution (TOPSIS) was used to construct criteria layers from the following four aspects: green space vegetation coverage, ecosystem diversity, air and water quality, social participation, and health. The GST method was employed to screen evaluation indicators, the AHP method was used to calculate the weight of each indicator, and finally, TOPSIS was applied for weighted ranking to verify the scientific and rationality of the evaluation system. The results indicated the following: (1) out of 36 indicator factors, 10 were not selected through the GST method; (2) the weight ranking of the criteria layer was as follows, from highest to lowest: D 2 ecosystem diversity 0.4816 > D 1 green space vegetation coverage 0.2608 > D 3 air and water quality 0.1864 > D 4 social participation and health 0.0713; and (3) the relative closeness and ranking of different regions in Jinan city were as follows: Da Ming Hu area > Shan Da Lu area > Gu Cheng area > Shang Bu area. This study can help avoid decision-making errors caused by subjective factors and provide new approaches for the assessment of the ecological health of urban blue-green space landscapes. [ABSTRACT FROM AUTHOR]

Objective. This study aimed to explore the influencing factors to the practice of cardiovascular disease (CVD) preventive behaviors among rural residents based on socio-ecological model (SEM). Methods. We used a mixed-methods research using the sequential explanatory design. From a total of 109 participants, quantitative data including CVD preventive behavior, self-efficacy, social support, and sense of community were collected using previously developed measurement tools. For quantitative research, descriptive statistics and Pearson correlation analysis were conducted. For quantitative research, descriptive statistics and Pearson correlation analysis were conducted. Questions for qualitative research were constructed based on SEM for the three subareas identified in quantitative research. Qualitative content analysis was conducted on qualitative data collected through focus group interviews from 14 participants. Results. According to quantitative research results, participants had a low level of practice in physical exercise, stress management, and self-checking among seven subdomains. At the individual level, self-efficacy was positively correlated with sleep management, and at the interpersonal level, family support was positively correlated with smoking cessation and support from significant others was positively correlated with stress management. On the other hand, at the community level, sense of community did not show significant correlation with the practice of cardiovascular disease prevention. Next, according to qualitative research results, 8 themes were identified in three levels as obstacles. At the personal level, overwork, loneliness, and lack of knowledge about CVD; at the interpersonal and community level, decreased activities with residents due to increased individualistic tendencies and decreased sense of community; and at the community environmental level, inconvenience of sidewalks, lack of community space, and insufficient functioning of village health clinics. Conclusion. In order to reduce obstacles to health behavior practice to prevent cardiovascular disease, multidimensional efforts are needed in terms of socio-ecological aspects. [ABSTRACT FROM AUTHOR]

Health and social care systems experience difficulty in delivering the continuity of care that service users want. Lack of clarity about what continuity means hinders service organisation and delivery. The NIHR Service Delivery and Organisation programme funded a series of research projects to tackle this conceptual confusion, and subsequently commissioned a review of the projects' outputs. The aim was to assess how the projects had progressed conceptualisation and measurement of continuity, and increased knowledge about what influenced it. This paper concentrates on two questions: what is continuity of care, and what influences it? We reviewed the projects' outputs and extracted data using techniques adapted from systematic reviewing methods. We treated the outputs as 'transcripts' and used the Framework approach to qualitative analysis to handle them. This maintained the coherence of individual projects while allowing cross-project themes to emerge. We then produced a narrative synthesis of findings. Service users and carers valued good relationships with professionals; this did not always mean seeing the same person and encompassed trust, the professional's style and communication skills, and the time made available. Service users and carers also valued understanding the patient's condition and treatment. This went beyond giving information, to include communication that recognised individuals' capacities and that was skilled, given sufficient time, and from a trusted source. Service users valued co-ordination between professionals and services; this covered communication, planning, and services' storage and use of information about them. Co-ordination with carers and others was also important. Experiences of continuity were influenced by service users' characteristics and circumstances, care trajectories, the structure and administration of services, professionals' characteristics, carer participation, the wider context of the 'whole person' and satisfaction. The review highlighted how service users, carers and professionals construct continuity dynamically between themselves. This has implications for both professional training and service users' expectations. [ABSTRACT FROM AUTHOR]

Residents living in residential aged care facilities (RACFs) continue to experience medication-related harm. There is ongoing interest in expanding the role of pharmacists, including on-site pharmacists (OSPs), to help improve medication management in RACFs. The objectives of this mixed-methods study were to explore the extent and ways in which on-site pharmacists (OSPs) were normalised within RACFs as part of a complex intervention seeking to improve medication management. This study consisted of semistructured interviews informed by normalisation process theory (NPT) and a quantitative survey adapted from the normalisation measure development questionnaire (NoMAD) instrument which is underpinned by NPT. Semistructured interviews with prescribers, RACF managers, RACF nursing staff, OSPs, residents, and family members (n = 47) indicated that most participants supported OSPs within RACFs that having OSPs in RACFs made sense and was perceived as beneficial and that participants were invested in working with OSPs who often became part of routine practice, i.e., "normalised." Prescribers, RACF managers, and nursing staff (health care team members) completed the adapted survey, and their responses (n = 16) strongly complemented the positive qualitative findings. Overall, OSPs were positively appraised by health care team members as well as residents and family members and were generally considered to be normalised within their respective RACFs. This study explored the normalisation of OSPs within RACFs. From the perspective of residents, family members, health care team members, and OSPs, OSPs could become part of routine practice within Australian RACFs. The findings of this study also highlighted the value of using theory to guide the evaluation of a pharmacist intervention in RACFs and the utility of applying NPT in a new setting, Australian RACFs. Importantly, the findings of this study could help inform the future role of OSPs working and the rollout of OSPs within Australian RACFs. [ABSTRACT FROM AUTHOR]

Short breaks help maintain caring relationships, enabling people to remain living in their own homes and contributing significant economic benefit to public services. However, relatively little is known about the added social value generated by community-based short breaks. To address this evidence gap, we explored the feasibility of using a social return on investment (SROI) evaluation to explore a day support service in North Wales for people living with dementia and their unpaid carers. Following good practice for evaluating complex interventions, we developed a logic model based on the literature and interviews to understand the mechanisms and outcomes of the day support service. Using questionnaires, we quantified outcomes for the current service cohort, which included people living with dementia, unpaid carers, and paid companions. Seven people living with dementia, three unpaid carers, and four companions completed questionnaires. By following the SROI analysis approach, three key learning points were identified. The first was around ways to capture outcomes from all stakeholder subgroups expected to experience material change. The second concerned the importance of collecting longitudinal data. This included the need to consider how to adapt the SROI method to work with small populations. The third concerned how to value "maintenance" of wellbeing as well as improved wellbeing. [ABSTRACT FROM AUTHOR]

A trauma-informed approach is a framework for organisational (synonym system) change interventions that address the universal prevalence and impact of trauma. This mixed methods systematic review assessed the effects of trauma-informed approaches on psychological, behavioural, and health outcomes in health-care providers and adult patients in primary care and community mental healthcare. We searched five databases and grey literature and consulted experts for reports published in January 1990 to June 2021. The quantitative descriptive and qualitative framework syntheses were integrated through a line of argument and mapped onto a logic model. We included six nonrandomised studies that evaluated eight interventions with varied theoretical developments, components, and outcomes. The most common components were budget allocation, workforce development, identification/response to violence and trauma, and evaluation. Evidence for intervention effects was limited and conflicting. Four studies reported improvement in provider readiness and sense of community, while three reported conflicting effects on provider behaviour regarding delivery of trauma-informed care. Four studies reported some improvement in patient readiness for disease management and access to services; however, the evidence for patient satisfaction was conflicting. Two studies found that patients and providers felt safe. While one study reported improvement in patient quality of life and chronic pain, another found no effect on substance use, and three studies reported conflicting effects on mental health. Intervention mechanisms included a package of varied components, tailoring to the organisational needs, capacities and preferences, staff education and self-care, creating safe environments, and shared decision-making. Intervention effects were moderated by contextual (health system values, policies, governance, business models, trauma-informed movement, organisational culture, and social determinants of health) and intervention factors (buy-in from all staff, collective learning through conversations, equal attention to staff and patient well-being, and sustainable funding). No studies measured adverse events/harm, cost effectiveness, or providers' health. We need more methodologically robust evaluations of trauma-informed organisational change interventions. [ABSTRACT FROM AUTHOR]

Community‐based programmes can support healthcare systems by delivering preventive services and health promotion. This study aimed to determine the nature, range, and extent of theoretical models that guide the development of linkages between healthcare settings and community programmes. A scoping review guided by the Joanna Briggs Institute methodology and the PRISMA‐ScR was conducted. Four databases (MEDLINE, EMBASE, CINAHL and PsycINFO) were searched on August 8, 2020. Two reviewers independently screened articles by title and abstract and divided the remaining articles for full‐text screening. Articles that described the development of a theoretical model to guide the establishment of linkages between healthcare settings and community programmes, were peer‐reviewed, and in English, were included. Articles that solely applied linkage models were excluded. One reviewer extracted data on study and model characteristics (e.g. model purpose, model components and relationships between components from the included articles). Categorical data were summarised using frequencies and percentages. Conventional content analysis was used for variables that had lengthier descriptions and variable terminology. The search identified 8926 records. Six articles describing six unique models were included in the review. Of the four models that described intended users, three (75%) identified primary care. Healthcare settings were identified in all models, with three (50%) focusing on primary care. Models used two or more linkage strategies: (1) agreeing on sharing resources, staff, and information, (2) coordinating services and referral processes, (3) planning and evaluation, (4) leadership, policies, and funding, (5) boundary spanning and (6) brokering. All models used the linkage strategy of agreeing on sharing resources, staff, and information. Findings provide important considerations for healthcare and community programme providers planning linkages. Future research should investigate the role and characteristics of community programmes in linkages, and linkages with other types of healthcare settings. [ABSTRACT FROM AUTHOR]

The present study aimed to develop and validate a conceptual model linking public and internalised stigma to recovery attitudes, processes and outcomes among people with mental illness. Specifically, we sought to examine whether perceptions of public stigma (i.e., perceived stigma) would affect experiences of internalised stigma (i.e., self‐stigma) and thereby influence recovery attitudes (i.e., recovery orientation), recovery processes (i.e., service engagement) and recovery outcomes (i.e., clinical recovery and functional recovery). A total of 205 people with mental illness from Hong Kong, China, completed questionnaire measures on perceived stigma, self‐stigma, recovery orientation, service engagement, clinical recovery and functional recovery. The associations among these variables were analysed using path analyses and bootstrap analyses. Path analyses showed that perceived stigma was related to greater self‐stigma, which was, in turn, linked to lower recovery orientation and then lesser service engagement and ultimately poorer clinical recovery and functional recovery. Bootstrap analyses further demonstrated that perceived stigma had significant indirect effects on recovery orientation via self‐stigma, on service engagement via self‐stigma and recovery orientation and on clinical recovery and functional recovery via self‐stigma, recovery orientation and service engagement. Theoretically, our findings reveal how public and internalised stigma may adversely affect recovery attitudes, processes and outcomes among people with mental illness. Practically, our findings point to the vital and urgent need to develop effective interventions to mitigate stigma and self‐stigma at community and individual levels in order to reduce the deleterious impact of stigma on recovery. [ABSTRACT FROM AUTHOR]

Disability is experienced and understood by Indigenous people internationally in distinct ways from other populations, requiring different approaches in disability services. Furthermore, Indigenous populations access disability services at low rates. In response, policymakers, service providers and Indigenous organisations have developed specific models of care for Indigenous people with disability. Social care services, comprising personal care, transport and social activities, can support Indigenous people with disability to live with their families and in their communities. However, little is known about the range of social care models for Indigenous people with disability. To inform policy and practice, we conducted a scoping review of community‐based models of social care designed to meet the needs of Indigenous peoples in Australia, Aotearoa New Zealand, Canada and the United States. Our methods were informed by best practice scoping review principles and a collaborative approach that centred Indigenous voices within research appraisal and project governance processes. Literature searches (conducted March–April 2021) yielded 25 results reporting on 10 models of care. We identified two over‐arching themes (funding and governance arrangements; service delivery design) that encompass nine key characteristics of the included models. Our analysis shows promising practice in contextually relevant place‐based social activity programs, support and remuneration for family carers and workforce strategies that integrate Indigenous staff roles with kinship relationships and social roles. While more research and evaluation are needed, disability funding bodies and service systems that facilitate these areas of promising practice may improve the accessibility of social care for Indigenous peoples. [ABSTRACT FROM AUTHOR]

Maintaining a high level of adherence to antiretroviral therapy is a challenge among HIV/AIDS patients. The study aimed to explore the process of adherence to treatment with a grounded theory approach to help physicians and planners develop strategies to increase adherence to treatment. We conducted in‐depth interviews and a focus‐group discussion. The data were collected from 2016 to 2018. The participants were 39 HIV/AIDS patients treated with antiretroviral, their relatives (three people) and two treatment staff. The study was conducted at the Behavioural Counselling Center of Imam Khomeini Hospital, located in Tehran, the capital of Iran. The data were analysed at the stages of "analysis for concepts," "analysis for context," "bringing process into the analysis" and "integrating." We obtained a conceptual model to explain the relationship between the categories. "Motivation" was identified as the core variable and the "Becoming resilient" explained the adherence process. Several factors including the interfering factors, contextual factors and resilience factors were identified. The interfering and contextual factors, in the absence of the resilience factors, lead to decreased motivation and increased poor adherence to treatment. The role of motivation in long‐term adherence should be emphasised. We think strategies such as helping individuals with HIV/AIDS to form support networks, empowering and encouraging them to seek spiritual help will motivate them to maintain a long‐term use of antiretroviral medications and, hence, become more resilient. [ABSTRACT FROM AUTHOR]

Extensive studies have explored the factors affecting caregiving stress, but how oral health of care recipients (CRs) associates with caregiving stress and the mechanism behind it are not well‐known. Guided by Stress Process Theory, this study addressed such research gaps. Caregiver services dataset came from the 13th National Survey of Older Americans Act Participants in the United States (N = 1289). Caregiving stress included physical, emotional, and financial stress. The oral health of CRs was self‐rated by a single item. The functional ability of CRs was assessed by activities of daily living (ADLs) and instrumental activities of daily living (IADLs). PROCESS 3.4 for SPSS 26.0 was used to conduct the mediation analyses. Results from the study showed that caregivers reported slightly high levels of physical (M = 3.06, SD = 1.33, Range = 1–5), emotional (M = 3.43, SD = 1.28, Range = 1–5), and financial (M = 2.83, SD = 1.43, Range = 1–5) stress. The results from hierarchical linear regression revealed that poor oral health of CRs was significantly associated with higher levels of physical (B = 0.11, p < 0.001), emotional (B = 0.09, p < 0.01), and financial (B = 0.12, p < 0.001) stress, respectively. The functional ability of CRs mediated such relationships between the oral health of CRs and the caregiving stress of their family caregivers. Findings from this study enrich our theoretical and practical understanding of caregiving stress in aged care and offer programs and policy implications of oral and physical healthcare for community‐dwelling older adults. [ABSTRACT FROM AUTHOR]

In the Netherlands, about one‐third of the adult population provides unpaid care. Providing informal caregiving can be very straining in normal times, but the impact of a public health crisis on caregivers is largely unknown. This study focuses on the question of how caregiver burden changed following the COVID‐19 pandemic, and what characteristics were related to these changes. We use self‐reported data from a sample of 965 informal caregivers from the Netherlands 3 months into the pandemic to investigate how the objective burden (i.e. hours spent on caregiving) and the subjective burden had changed, and what their care‐related quality of life (CarerQol) was. We found that on average the subjective burden had increased slightly (from 4.75 to 5.04 on a 0–10 scale). However, our analysis revealed that some caregivers were more affected than others. Most affected caregivers were women, and those with low income, better physical health, decreased psychological health, childcare responsibilities, longer duration of caregiving and those caring for someone with decreased physical and psychological health. On average, time spent on care remained the same (a median of 15 h per week), but certain groups of caregivers did experience a change, being those caring for people in an institution and for people with a better psychological health before the pandemic. Furthermore, caregivers experiencing changes in objective burden did not have the same characteristics as those experiencing changes in perceived burden and quality of life. This shows that the consequences of a public health crisis on caregivers cannot be captured by a focus on either objective or subjective burden measures or quality of life alone. Long‐term care policies aiming to support caregivers to persevere during a future crisis should target caregivers at risk of increased subjective burden and a lower CarerQol, such as women, people with a low income and people with childcare responsibilities. Such policies should consider that reducing objective burden may not necessarily lead to a reduction in subjective burden for all caregivers. [ABSTRACT FROM AUTHOR]

Social prescribing (SP) has rapidly expanded over recent years. Previously a bottom‐up, community‐led phenomenon, SP is now a formal part of structured NHS policy and practice. This study was designed to ascertain how general practitioners and other primary healthcare professionals (HCPs) within one clinical commissioning group (CCG) perceive and engage with this new NHS model. The research comprised an online survey distributed to HCPs within a predominately rural, English CCG between June and August 2021. Qualitative data were gathered and analysed using reflexive thematic analysis. Positive portrayals of SP were found, although definitions and perceptions varied greatly. Many HCPs reported high levels of engagement with SP services; yet referral rates appeared to remain significantly lower than the previously estimated 20% of primary care attendees referred for social reasons. Moreover, 96% of HCPs reported signposting patients directly to community or external services, rather than referring them to SP. This signposting, which has been positioned as a model of SP, reflects engagement with SP in practice, which is likely to have pre‐dated the introduction of the fuller NHS model. HCPs may be unaware that this could be classed as a social prescription, and this type of SP remains uncaptured within NHS statistics. These results indicate an underuse of the national system set up to deliver one particular model of SP, rather than that SP does not occur. Additionally, despite national guidance issued to accompany the NHS model, practices such as referral and feedback processes, and link worker presence within practices, were not uniform even within this single CCG. Nevertheless, understanding is increasing as SP becomes embedded within primary care. The lack of consistency in referrals between practices warrants further examination in terms of equity of service choices to patients, as does the very low self‐reported referral rate to SP. [ABSTRACT FROM AUTHOR]

The present study investigates the effects of group appraisal and acculturation orientations on burnout of social workers working with immigrants. The study is based on the Threat‐Benefit and the Acculturation Theories. The proposed theoretical model was tested in a sample of social workers working with immigrants from the Former Soviet Union (FSU) in Israel (n = 313). Amongst the study participants, 254 were Israeli born, and 59 were immigrants from the FSU. The results demonstrated that social workers' acculturation orientations mediate the connection between the appraisal of the immigrant group and the social workers' burnout when working with immigrants from this group. Specifically, appraisal of immigrants as beneficial for the receiving society was associated with a stronger orientation towards preserving the immigrant culture (β = 0.22). On the other hand, appraisal of immigrants as threatening the receiving society was associated with a weaker orientation towards preserving the immigrant culture (β = −0.21) and with a stronger orientation towards acquiring the majority culture by immigrants (β = 0.12). A stronger acculturation orientation related to preserving the immigrant culture was associated with a lower level of burnout (β = −0.13) and a higher sense of personal accomplishments of social workers working with immigrants (β = 0.20). Immigrant social workers, compared to their native colleagues, reported a higher level of personal accomplishment (M[SD]IM = 5.08[1.24] vs. M[SD]IS = 4.21[1.39]) but also a higher level of burnout working with immigrant clients (M[SD]IM = 1.88[0.83] vs. M[SD]IS = 1.60[0.63]). The main conclusion following the present study relates to the importance of developing a positive appraisal of immigrants and accepting the immigrant culture for successful work with immigrants. [ABSTRACT FROM AUTHOR]

This study explores the moderating influence of perceived and objective community environments on the relationship between older adults' home‐ and community‐based care (HCBC) needs and their actual utilisation of such care. We selected 5,668 older adults in two cities in China and adopted latent class analysis to descriptively explore the patterns of their HCBC need and utilisation. Structural equation modelling was used to determine factors related to the patterns of need and utilisation of HCBC services, and to explore the moderating roles that the perceived and objective community environments had on the effect of long‐term care need on its utilisation. The results descriptively showed that older adults' patterns of HCBC need and utilisation appear to be embedded within two broader latent categories: a high‐need/use group and a low‐need/use group. Among participants who were satisfied with their community or who lived in areas with high accessibility to HCBC services, HCBC need could predict HCBC use. Our integrated conceptual framework proved to be applicable, thus enriching the theoretical models in explaining HCBC‐related behaviours. The results have strong implications for urban planners, policymakers, and programme managers who seek to support older people and provide elderly care services in communities. [ABSTRACT FROM AUTHOR]

The health behaviours related to chronic diseases experienced by South Asian immigrants are interrelated with their culture and socioeconomic conditions. South Asian immigrants experience a disproportionate burden of chronic disease compared with non‐immigrants Australian‐born general population. The primary aim of this study was to gain an in‐depth understanding of health behaviours and healthcare access in the South Asian immigrant population of Australia. Five focus group discussions (FGDs) were conducted with South Asian immigrants (n = 29; 18 females) aged 27–50 years in Brisbane, Australia. Separate FGDs were conducted for males and females in the English language. Semi‐structured guided questions related to the perception, barriers and facilitators of health behaviours. Data were analysed with Nvivo‐12 following a thematic analysis. A conceptual model is proposed to provide a summarised understanding of barriers and facilitators of health behaviours in South Asian immigrants. The major reported constraints for participating in physical activity were cultural beliefs, lack of time, work stress and high fees of fitness activities, while parks and peer modelling were mentioned as a strong motivator for walking, cycling and participating in group sports activities. The cultural and religious connections, cost of cigarettes and drink driving penalties were the most mentioned facilitators for a healthy lifestyle. The important factors related to unhealthy eating habits were the traditional cooking methods, social interactions and the high cost of fruits and vegetables. Community perceptions and language barriers were also acknowledged as the main factors for the decrease in accessing health care services. This study illustrates that cultural beliefs, high cost of healthy food and facilities and social circumstances are mainly linked with the health behaviours and healthcare access in South Asian immigrant's lifestyles. [ABSTRACT FROM AUTHOR]

Cystic fibrosis (CF) is Australia's most common life limiting genetic condition, characterised by declining health and quality of life (QoL) over time. Despite improvements in treatment, there remains no cure. Adolescents and young adults (AYAs) with CF experience broad impacts to psychosocial functioning and QoL, as well as major transitions in care, all at a time of significant developmental change. The importance of developmentally tailored approaches to youth health care and self‐management for young people with CF are well understood. However, to date, models of youth specific self‐management have been lacking and motivation for young people with CF has not been well explored. This qualitative study, based on a social constructionist epistemological framework, addresses this gap. A total of 21 AYAs aged 15–30 years were recruited through one paediatric and one adult Australian CF centre. Demographic, clinical and distress data were captured to describe health complexity. Semi‐structured interviews were audio‐recorded, transcribed and analysed using thematic analysis. Participants were representative of Australian AYAs with CF by demography and clinical status. Alarmingly, over a third reported clinically significant distress. Two themes emerged. The first Identified impacts to motivation and self‐management resulting from the challenges of managing CF, life and care. These included time and competing priorities, changing health statis, mental health, social factors, unmet needs and health system complexity. The second identified factors that support motivation including: achievement, meaning and purpose; consequence avoidance; and accountability. These results illustrate the importance of AYA specific, theoretically founded, holistic self‐management models which extend beyond current theoretical approaches that aim to understand behaviour change or address barriers, in isolation from motivation. Improved approaches to care based on these findings are essential to foster positive behavioural change, support self‐management and foster the best health outcomes for young people living with CF. [ABSTRACT FROM AUTHOR]

The study examined the relationship between job demands and resources, work engagement, and turnover intentions in a community mental health context. Using path analysis, we tested a conceptual model where we hypothesised that job demands (pressure to produce and role ambiguity) had a negative relationship to work engagement (H1) and resources (team commitment, supervisor relationship, and connection to organisational mission) were positively related to engagement (H2). Furthermore, greater engagement would be related to lower intention to leave the job (H3). Additionally, we hypothesised that there was an indirect effect of job demands and resources on turnover intention mediated via engagement (H4). The study used cross‐sectional data collected in 2018 from a sample of N = 170 mental health providers employed in a community mental health centre in the Southwest region of the United States. The study findings suggest that the job demands tested, pressure to produce and role ambiguity, were negatively related to engagement (H1). Of the job resources tested, only team commitment and connection to mission were positively related to engagement (H2). Work engagement was negatively related to intention to leave (H3). There were indirect effects of job demands and job resources (pressure to produce, role ambiguity and connection to the organisation mission) on intention to leave mediated through engagement (H4). The findings suggest that managers and administrators in community mental health organisations may help promote a more stable workforce by bolstering the resources that lead to greater work engagement and mitigating the job demands that reduce engagement. [ABSTRACT FROM AUTHOR]

Studies on relationships between psychosocial factors and health among North African (NA) women are scarce. This research investigated the self‐perceived psychosocial well‐being of NA women by a structured questionnaire and anthropometric survey examining the possible explanatory variables of their mental health in comparison to a sample of NA migrants. The association of endogenous stress, psychological well‐being, discomfort, and quality of life with migrant/non‐migrant status, demographic characteristics, and adiposity indices was examined. Moreover, the internal consistency of the questionnaire was tested using Cronbach's alpha. A sample of 228 women living in Tunis and Casablanca participated in a survey in Tunisia and Morocco. According to multiple regression models, migrant/non‐migrant status was the best explanatory variable of well‐being and quality of life, marital status, educational level and the number of children were explanatory variables of discomfort and endogenous stress. Among anthropometric variables, central adiposity was a significant explanatory variable of well‐being. The comparison with women who migrated mainly from Morocco and Tunisia to Italy (NA migrants) exhibited higher weight status and central adiposity in NA migrants. The perceived stress and discomfort were the same in the two groups; the migrants, despite reporting lower psychological well‐being, presented a higher quality of life than residents. Our findings emphasise the potential to promote monitoring of the psychosocial health of NA women, planning effective interventions. [ABSTRACT FROM AUTHOR]

As social technologies increase in popularity, there is a growing interest in incorporating them into mental health interventions. Research shows that the use of social technologies may support belonging and mental health. Findings, however, are contradictory and highlight the need to clarify the processes and mechanisms by which this technology may have positive effects. This study conducted a realist evaluation of a web‐based citizen‐to‐citizen platform adopted within community care in a Danish Municipality. It focused on how, for whom and under what circumstances the web‐based platform worked to promote belonging and mental health. The evaluation was structured in subsequent phases of development, testing, and refinement of programme theories. A purposeful sampling frame was developed based on the programme theories, and 27 interviews were conducted. With variations, the platform was found to support its users in meeting their social needs by (a) expanding their access to social networks; (b) allowing them to overcome barriers related to reaching out to new people in real life and (c) providing them with an improved starting point for identification of a relational match. Whether this resulted in improved belongingness and mental health was strongly affected by individual and relational circumstances. Findings suggest that web‐based platforms that aim to enable citizens to locate friends and activity partners can serve as helpful tools in interventions striving to promote mental health in the community, as they may support people to fulfil a need for belongingness. However, the impact of such tools is highly dependent on the individual's abilities to use the initiatives to form relationships of sufficient quality to accommodate these needs. People with previous relational difficulties, and who have struggled to achieve feelings of belonging and citizens with limited digital literacy, may need support to realise the social opportunities provided by these technologies. [ABSTRACT FROM AUTHOR]

The parallel track model is one of the several models that are used in health promotion programmes that focus on community empowerment. It is unique in that it explicitly incorporates an empowerment approach with a top-down health programme. Since its development in 1999-2000 the model has been used in various health programmes in both developed and developing countries. The aim of this review is to examine the nature and extent of the application of this model and its contribution to promoting health. A review of the literature published between 2000 and 2011 was conducted. Nine results matched the inclusion criteria and revealed that the model has been mostly applied to disadvantaged communities to address health determinants, such as poverty and health literacy. This review found that the model had a positive impact on specific health outcomes such as health literacy and community capacity. We concluded that the parallel track model has the most potential for building capacity for community health promotion and appears to be the least useful for interventions focusing on health behaviour change within a limited time frame. [ABSTRACT FROM AUTHOR]

The social and health care educator's role in educating future professionals need to be stronger emphasised and deserves international recognition. The purpose of this study was to develop and test an empirical model of social and health care educators' competence in higher and professional education. The presented research employed a cross‐sectional study design. Data were collected using HeSoEduCo‐instrument from 28 educational institutions in Finland. The model was empirically tested with confirmatory factor analysis through Structural Equation Modelling that applied the Full Imputation Maximum Likelihood estimator. A total of 422 social and health care educators participated in the study. The empirical model of social and health care educators including eight competence areas: leadership and management, collaboration and societal, evidence‐based practice, subject and curriculum, mentoring students in professional competence development, student‐centred pedagogy, digital collaborative learning, and cultural and linguistic diversity. All of the connections between concepts of the empirical model were found to be statistically significant. There were strong connections between most of the identified competence concepts; however, two weak connections were found, namely, the link between competence in evidence‐based practice and competence in subject and curriculum, along with the link between competence in digital collaborative learning and competence in student‐centred pedagogy. The presented empirical model can help stakeholders identify which areas of social and health care educators' curricula should be further developed. The model is also relevant for improving continuous education, allowing educators to assess their competence levels and evaluating educators' performance at the organisational level. [ABSTRACT FROM AUTHOR]

Objective: To identify the barriers and facilitators of managing intimate partner violence (IPV) cases, from the perspective of primary health care (PHC) social workers. Method: Qualitative study through interviews with 14 social workers working in PHC centres in Spain. A thematic analysis approach was applied to identify barriers and facilitators according to the Tanahashi model. Results: The barriers identified by social workers in providing effective coverage to women suffering from IPV included insufficient practical training, a lack of knowledge from women on social workers' roles, a lack of teamwork, and excess IPV case referrals from other professionals to social workers. The identified facilitators were the existence of electronic protocols and good practices including therapeutic support groups and holistic intervention approaches. Conclusions: An excess of referrals to social workers of identified IPV cases following consultation by other members of the PHC team, alongside the lack of interdisciplinary teamwork, does not enable a comprehensive and holistic approach to this problem. Compulsory, practical, and interdisciplinary training in IPV for all PHC professionals and students must be a priority for health agencies and universities in order to facilitate a comprehensive and quality approach for all women suffering from IPV. [ABSTRACT FROM AUTHOR]

This study investigates determinants for offering help to family members, neighbours and friends, based on the Informal Care Model. We do so in pooled representative data for the Netherlands collected in 2014 and 2016 (persons >17 years, n = 13,165). One‐third provides informal care to a person with health problems or impairments: partners (4%, n = 671), parents or children (16%, n = 2,381), distant relatives (6%, n = 858), friends or neighbours (6%, n = 839). Marginal effects show differences in the associations of care‐giving relationships with sociodemographic factors, barriers and beliefs. Helping a partner is related to age, gender (older people and men are more likely to help) and household composition (singles help less often). Care for close family is given often by 45–64 year olds, women, multiperson households and those with strong family beliefs. Helping second‐degree relatives correlates with age (young people help more often), barriers (those living with children help less often) and beliefs (people with professional background in care and people who attend church or mosque helping more often). Providing non‐kin care is associated with age and education level (young people less likely to help, people with a high education more likely), barriers (having a fulltime job) and beliefs (work experience in care, church or mosque attendance and norms). The supply of care to partners and close family is mainly associated with sociodemographic factors and barriers while the provision of care to distant family and non‐kin is also correlated with beliefs. If desirable policy is to create more informal care, investment in the combination of work and informal care, childcare and supportive arrangements for older community living couples is recommended. It also might be worthwhile to enhance beliefs about the usefulness of helping each other in times of need. [ABSTRACT FROM AUTHOR]

Self‐care enables patients in improving quality of life and reducing hospital admissions. Research explored the experiences of patients about breathlessness, sleep problems and complication management in chronic obstructive pulmonary disease (COPD). However, the self‐care experiences and the role of the family in self‐care are underexplored. This study aimed to understand the self‐care experiences of patients with COPD and explore the role of the family in self‐care. An interpretive phenomenological inquiry was used, and 13 patients were interviewed in 2019 from two hospitals in Pakistan. The inclusion criteria were patients above 30 years of age at any stage of COPD, who received a confirmed diagnosis of COPD and were receiving the treatment, and engaged in self‐care at their homes or communities. The interviews lasted for 35–60 min. Ricoeur's interpretation theory was used for data analysis comprising steps explanation, naive understanding and in‐depth understanding. Self‐care emerged as a complex individual and familial endeavour affected by personal, social and economic factors. Poverty was one of the core determinants of self‐care. Patients emphasised the spiritual, cultural and traditional approaches to self‐care. Future research is warranted to develop better understanding of spiritual and cultural self‐care and how these dimensions of self‐care affect patients' self‐care behaviours. [ABSTRACT FROM AUTHOR]

Pharmaceutical practice has evolved significantly from the provision of drugs to a more patient‐centred model. However, the ownership structure of pharmacies may impact the level of cognitive services provided by them. The discrepancy may be observed between pharmacists' opinions on how involved they should get and their actual involvement in health promotion and disease prevention. Given the growing market share of pharmacy chains in Europe, this study aimed to investigate the attitudes of pharmacists employed in them towards their role as health educators. It applies Ajzen's theory of planned behaviour to examine pharmacists' perspectives with the use of semi‐structured in‐depth interviews. A total of 10 semi‐structured face‐to‐face interviews were conducted in May 2017 among Polish pharmacists employed in chains. Obtained results showed that respondents welcomed the possibility of providing health education, but simultaneously they seek physicians' and patients' acceptance for undertaking this task. Competency gaps and unfavourable working conditions may also decrease pharmacists' intention to serve as health educators. Including the role of a health educator to the scope of the pharmacists' practice requires a precise definition of their competencies and responsibilities together with additional training aimed to fill potential gaps in their qualifications. The pharmacists' image as a health educator should also be widely communicated to patients and other healthcare professionals. [ABSTRACT FROM AUTHOR]

There has been limited research into the individual, social, and environmental factors for infection risk among patients in the home healthcare (HHC) setting, where the infection is a leading cause of hospitalisation. The aims of this study were to (1) explore nurse perceptions of individual, social, and environmental factors for infection risk among HHC patients; and (2) identify the frequency of environmental barriers to infection prevention and control in HHC. Data were collected in 2017–2018 and included qualitative interviews with HHC nurses (n = 50) and structured observations of nurse visits to patients' homes (n = 400). Thematic analyses of interviews with nurses suggested they perceived infection risk among patients as being influenced by knowledge of and attitudes towards infection prevention and engagement in hygiene practices, receipt of support from informal caregivers and nurse interventions aimed at cultivating infection control knowledge and practices, and the home environment. Statistical analyses of observation checklists revealed nurses encountered an average of 1.7 environmental barriers upon each home visit. Frequent environmental barriers observed during visits to HHC patients included clutter (39.5%), poor lighting (38.8%), dirtiness (28.5%), and pets (17.2%). Additional research is needed to clarify inter‐relationships among these factors and identify strategies for addressing each as part of a comprehensive infection control program in HHC. [ABSTRACT FROM AUTHOR]

Few studies have focused on homelessness among Operations Iraqi Freedom, Enduring Freedom and New Dawn (OEF/OIF/OND) veterans, especially female veterans. An explanatory model of homelessness was constructed and tested for each gender. Data collected in the United States from 833 OEF/OIF/OND veterans (41.5% female; Mage = 35.22, SD = 8.86) who completed the baseline assessment of the Survey of the Experiences of Returning Veterans between September 2011 and July 2014 were analysed. Path analysis was used to examine associations between risk factors and any lifetime homelessness, stratified by gender. Adverse childhood events (ACEs) and low social support were significantly associated with lifetime homelessness for both genders. Social support mediated associations between ACEs and homelessness, after controlling for sociodemographic factors. While sociodemographic risk factors are often considered in homeless prevention, these findings highlight the importance of social support among male and female OEF/OIF/OND veterans, underscoring the need to target this life domain in preventing homelessness. [ABSTRACT FROM AUTHOR]

Objectives: Metabolic syndrome (MetS) is associated with an increased risk of cardiovascular disease, which is gradually becoming more prevalent due to changes in dietary habits and lifestyle. The aim of this study was to evaluate the association between regional factors and the prevalence of MetS, with a particular focus on access to healthcare providers. Study design: Observational study. Methods: We used data from the annual Korea National Health and Nutrition Examination Survey (2013–2017), which included 24,695 eligible participants. Regional factors that were related to access to care and could affect the prevalence of MetS were evaluated. A generalised estimating equation model was utilised to identify variables associated with the prevalence of MetS. Main finding: In this study, the prevalence of MetS was 25.9% (n = 7,100). Results of the generalised estimating equation model indicated that a higher density of physicians was significantly associated with a lower prevalence of MetS (odds ratio: 0.864, 95% confidence interval: 0.758–0.984). The density of community health nurses was not significantly associated with the prevalence of MetS; however, the subgroup analysis revealed that higher densities of physicians and community health nurses were significantly associated with a low prevalence of MetS in regions with a high proportion of community health centres. Conclusions and implication: Regional factors related to access to care were associated with the prevalence of MetS. Higher physician density and community health centre utilisation rates were associated with a decreased prevalence of MetS. Regional differences in access to care should be addressed to reduce the health gap between regions and prevent the development of MetS. [ABSTRACT FROM AUTHOR]

The mediating effects of psychological resilience on quality of life among older adults were rarely examined empirically. Based on the literature on the relationship between psychological resilience and quality of life and the factors associated with psychological resilience among older adults, a theoretical model was proposed with the hypothesis that psychological resilience would mediate the relationships between both filial support and sense of community and life satisfaction among older adults. The research used a cross‐sectional design. Non‐probability sampling method was applied to recruit 418 community‐dwelling older adults in two adjacent cities in Fujian, China in 2017. A face‐to‐face structured Chinese questionnaire was adopted to collect data. The structural equation modeling showed that psychological resilience mediated the relationships between both filial support and sense of community and life satisfaction. The findings confirmed the positive impacts of psychological resilience on older adults' life satisfaction and highlighted the importance of family and community contexts to older adults' psychological resilience and life satisfaction. Interventions and programmes that aim to promote filial support towards older adults and enhance their sense of community would contribute to both their psychological resilience and life satisfaction. [ABSTRACT FROM AUTHOR]

Up to 40% of general practitioners (GP) consultations contain an emotional component. General practitioners (GPs) have to provide care with limited time and resources. This qualitative study aimed to explore how GPs care for patients experiencing emotional concerns within the constraints of busy clinical practice. Seven GPs participated in three focus groups. Groups were recorded, transcribed and analysed thematically. Three themes were identified. (a) Collaboratively negotiated diagnosis: How patients' emotional concerns are understood and managed is the result of a negotiation between patient and GP belief models and the availability of treatments including talking therapy. (b) Doctor as drug: Not only is a continuous relationship between GPs and patients therapeutic in its own right, it is also necessary to effectively diagnose and engage patients in treatment as patients may experience stigma regarding emotional concerns. (c) Personal responsibility and institutional pressure: GPs feel personally responsible for supporting patients through their care journey, however, they face barriers due to lack of time and pressure from guidelines. GPs are forced to prioritise high‐risk patients and experience an emotional toll. In conclusion, guidelines focus on diagnosis and a stepped‐care model, however, this assumes diagnosis is relatively straightforward. GPs and patients have different models of psychological distress. This and the experience of stigma mean that establishing rapport is an important step before the GP and patient negotiate openly and develop a shared understanding of the problem. This takes time and emotional resources to do well. Longer consultations, continuity of care and formal supervision for GPs could enable them to better support patients. [ABSTRACT FROM AUTHOR]

Young mothers under the age of 20 often have poor nutrition and low levels of physical activity, adversely affecting outcomes for themselves and their babies. The aim of this qualitative study was to explore the experiences of healthcare professionals in supporting young women around eating and moving during and after pregnancy. Seventeen semi‐structured interviews were conducted with midwives, family nurse practitioners and health visitors involved in the care of pregnant and post‐natal mothers under the age of 20 in England and Wales. Data were analysed using thematic analysis and coded within the theoretical framework of the COM‐B model to three areas of capability, motivation and opportunity. For capability, participants were broadly divided between those who had specialist knowledge and training in communication skills to support health behaviours in this population and professionals reliant on tacit knowledge. For opportunity, having enough time was seen as critical because young women's difficult social contexts meant supporting improved health behaviours required relationships of trust to be built. For motivation, participants reported that supporting young women with eating and moving was part of their role. However, the decision to prioritise this support sometimes related to perceived need based on BMI and this was complicated as young women were still growing. Motivation was additionally connected to professionals' own body experiences and health behaviours. Moving habits were less frequently discussed than eating as professionals described how young women tended to walk a lot in their daily lives or found that young women were not interested. Results suggest that to support eating and moving behaviours with young women, professionals need to be trained in communication techniques, enabled with the time to hold space for young women and be able to reflect on their own attitudes and beliefs to support a rounded model of health and wellbeing. [ABSTRACT FROM AUTHOR]

People who sleep rough/experience unsheltered homelessness face barriers accessing mainstream healthcare and psychosocial services. The barriers to service access exacerbate poor health, which in turn create additional challenges for rough sleepers to access health and psychosocial services, including stable housing. The study presents descriptive statistics to identify housing outcomes of people working with a Multidisciplinary Model that comprises integrated healthcare and psychosocial support, and qualitative data with clients and service providers to investigate how the Model is experienced and delivered in practice. Fieldwork was conducted between December 2016 and March 2018 with the Multidisciplinary Team operating in Cairns, in the far north of Australia. Qualitative data are drawn from in‐depth interviews with 26 rough sleepers and 33 health and psychosocial service providers from the Multidisciplinary Team and the wider service system. Descriptive statistics show that 67% of clients who were sleeping rough were supported to immediately access stable housing, and at the end of the program, all clients remained housed. The qualitative findings illustrated how integrated healthcare and psychosocial outreach enabled people sleeping rough to overcome barriers they experienced accessing mainstream healthcare and other services. With the benefit of healthcare, people felt sufficiently well to engage with the psychosocial service providers to have their housing and other psychosocial needs addressed. This article demonstrates how individual responsibility for and control over healthcare is not only a matter of the individual, but also a matter requiring systems change and the active provision of resources to cater for the constraints and opportunities present in people's immediate environments. [ABSTRACT FROM AUTHOR]

Family violence has been highlighted by the World Health Organization as a major public health concern. Although family violence occurs to all genders, a higher prevalence of victims are female. Estimates report around 30% of all women experience intimate partner violence worldwide. Experiencing assault in the family violence context can lead to an acquired brain injury (ABI); however, the connection between these two phenomena has not been well established. The aim of this qualitative study was to explore the extent of, and factors contributing to, ABI and family violence. We conducted 22 semi‐structured interviews and one focus group (n = 4) with practitioners working with family violence victims and/or perpetrators. Thematic data analysis utilised inductive and deductive coding approaches. The Social Determinants of Health Framework was used to guide analysis. Practitioners estimated 30%–40% of the clients on their caseloads had a suspected or diagnosed ABI. They identified that contributing factors were extremely complex. These included acquiring an ABI through assault (past family violence or other criminal act), and transport crashes. Complicating factors of ABI were identified as mental health conditions, alcohol and drug use, and post‐traumatic stress disorder. Additional factors contributing to family violence were recognised as biological (age of parent, twin births, pregnancy, premature births, and children with congenital abnormalities), relationships (intimate partner, father, boyfriend, mother and siblings), previous trauma (family violence), and life stressors (unemployment, financial, and lack of housing). Social determinants of health included cultural (ethnicity, societal attitudes, values, and beliefs) and organisational (legislation and policy) factors which influenced behaviours and outcomes across all sectors. A model of Brain injury Family violence Nexus (BFN) was created to understand the interaction between these phenomena. Utilising the BFN model to understand the interaction can enhance the methods used within health and social services for a more efficacious approach. [ABSTRACT FROM AUTHOR]

Many governments have introduced or encouraged home‐care reablement schemes for older people at home with the aim of improving outcomes and reducing costs. We examined if such schemes have the potential to reduce costs from the perspective of the National Health Service (NHS) and Personal Social Services (PSS) in England. Our study was carried out to inform recommendations of a national guideline. Cost‐minimisation analysis was carried out using decision‐analytic Markov modelling. Home‐care reablement was compared with standard home care. Costs included those of the intervention, home care and hospital admission. Uncertainty was explored using univariate and probabilistic sensitivity analysis. Mean costs per person were £56,499 (95% confidence interval 55,690 to 57,307) in the reablement group, and £58,560 (95% confidence interval 57,800 to 59,319) in the standard care group. The mean difference was ‐£2,061 (95% confidence interval 1,933 to 2,129). The probability that home‐care reablement costs less than standard home care was 94.5% (95% confidence interval 93.1 to 95.9). In sensitivity analyses, this probability remained above 85% in all scenarios. Home‐care reablement can be a successful cost‐minimisation strategy for supporting some older people. More research is needed about the impact of home‐care reablement on health outcomes for different groups of older people; and the effects of different durations of reablement on outcomes and costs for different subpopulations. [ABSTRACT FROM AUTHOR]