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DESIGN AND OBJECTIVE: This paper describes the protocol for a large-scale pragmatic, randomised controlled trial and economic evaluation to investigate the effectiveness and cost-effectiveness of the self-directed E-Couch social anxiety module versus a waiting list control condition, for reducing sub-clinical social anxiety symptoms in the general population. STUDY POPULATION: Community-based adults (aged 18þ) with social anxiety symptoms that do not meet the criteria for social anxiety disorder recruited via a direct-to-consumer advertisement on national websites. INTERVENTION AND CONTROL: Intervention is the self-guided E-Couch social anxiety module. Control group participants are placed on a waiting list to receive the intervention at the end of the trial. Both groups receive email and text message reminders. OUTCOME MEASURES: The primary outcome will be change in self-reported social anxiety score using the Social Phobia Inventory (SPIN). Secondary outcomes will be the changes in the following self-report measures: Brief Fear of Negative Evaluation scale (BFNE-S); depression (CES-D); mental wellbeing (SWEMWEBS); health status (SF36); use of health services; safety events; and adherence, retention, and attrition rates. All measures will be administered at baseline, 6 weeks, and 3, 6 and 12 months. ANALYSIS: A mixed effects model will be used to analyse the effect of the intervention on the primary and secondary outcomes (intention to treat analysis). Secondary analyses will explore moderators and mediators of effect. A prospective economic evaluation, conducted from a NHS and social care perspective, will provide estimates of cost utility and costeffectiveness. An interview study will be conducted with 20 participants to explore issues including acceptability, adherence, retention and attrition.

In recent years there has been an increasing use of visual methods in ageing research. There are, however, limited reflections and critical explorations of the implications of using visual methods in research with people in mid to later life. This paper examines key methodological complexities when researching the daily lives of people as they grow older and the possibilities and limitations of using participant-generated visual diaries. The paper will draw on our experiences of an empirical study, which included a sample of 62 women and men aged 50 years and over with different daily routines. Participant-led photography was drawn upon as a means to create visual diaries, followed by in-depth, photo-elicitation interviews. The paper will critically reflect on the use of visual methods for researching the daily lives of people in mid to later life, as well as suggesting some wider tensions within visual methods that warrant attention. First, we explore the extent to which photography facilitates a ‘collaborative’ research process; second, complexities around capturing the ‘everydayness’ of daily routines are explored; third, the representation and presentation of ‘self’ by participants within their images and interview narratives is examined; and, finally, we highlight particular emotional considerations in visualising daily life.

The concept of learner autonomy (LA) in second/foreign language education has been the central focus for many researchers (Benson, 2007, 2011, 2013; Holec, 1981; Gu & Nguyen, 2013; Little, 2007, 2009 and others) and has become a part of mainstream practice of language education in some educational contexts; however, there is still a high interest in researching language learner autonomy and ways to foster it. Partially, this renewed interest is due to advances in technology and pedagogy such as self-access centers, distance learning, blended learning and Computer Assisted Language Learning (CALL) in general and changes in educational policies (Benson 2011, 2013). Modern language learners are exposed to various choices in their language education such as numerous learning modes and a variety of language learning resources. However, this change means that learners must be capable of making informed decisions about their language education and taking some control over it in order to become successful and maximize their learning experience. There are examples of autonomous learning programs which place autonomy at the center, worldwide. Recently, the Center of English as a Second Language (CESL) at the University of Arizona (UA) created and implemented a new educational practice, Program for Intentional Learning (PIL). The goal of this program is to foster LA as well as equip CESL students with knowledge, skills, tools, and resources to be successful in both language learning and their future American college education. PIL is a hybrid program in terms of combining different approaches to fostering LA: resource-based, technology-based, curriculum-based, learner-based, and teacher-based (Benson, 2011).Responding to Benson's (2011) and Nguyen's (2012) call for more rigor in research on LA and educational interventions to promote LA, this dissertation follows the guidelines proposed by Nguyen (2012): a) having a clear operationalized definition of LA, (b) implementing both

Chronic Obstructive Pulmonary Disease (COPD) is a chronic respiratory disease that gives rise to symptoms of breathlessness, chronic fatigue and cough. The impact of COPD on patients' quality of life has been widely acknowledged, yet it appears that little has been published regarding what really matters to these patients. A first, exploratory phase of this research aimed to explore the issues that matter most to people with COPD, using a qualitative approach. Six patients were interviewed. The main findings informed the development of the second phase, which explored the nature and experience of activity for people living with COPD, and how attending a pulmonary rehabilitation (PR) programme affected this experience. This qualitative, interview based research employed a Grounded Theory approach throughout. In the second phase, 18 patients with COPD (59 to 84 years old; 12 men and six women; COPD severity 'moderate' to 'very severe') were recruited from a) a PR programmes and b) self help groups for people living with chronic respiratory conditions. Interviews were tape-recorded and transcribed. Data were analysed to derive themes of importance to participants. 'Activity' and 'social participation' were the main themes identified as important to people with COPD during the first phase. During the second phase, the two main themes that captured participants' experience of activity were 'stagnation' - as linked to being confined to indoors; and 'movement' - associated with being outdoors. Stagnation affected participants on a physical and psychosocial level and affected their perception of themselves and their breathing. Movement, including physical and psychosocial aspects and perceptions of movement, was perceived as having a positive effect, enabling people to escape feelings of stagnation. Fresh air was identified as the single most important aspect of spending time outdoors and was associated with a sense of freedom from their usual experience of having tight air

Chronic Obstructive Pulmonary Disease (COPD) is a chronic respiratory disease that gives rise to symptoms of breathlessness, chronic fatigue and cough. The impact of COPD on patients' quality of life has been widely acknowledged, yet it appears that little has been published regarding what really matters to these patients. A first, exploratory phase of this research aimed to explore the issues that matter most to people with COPD, using a qualitative approach. Six patients were interviewed. The main findings informed the development of the second phase, which explored the nature and experience of activity for people living with COPD, and how attending a pulmonary rehabilitation (PR) programme affected this experience. This qualitative, interview based research employed a Grounded Theory approach throughout. In the second phase, 18 patients with COPD (59 to 84 years old; 12 men and six women; COPD severity 'moderate' to 'very severe') were recruited from a) a PR programmes and b) self help groups for people living with chronic respiratory conditions. Interviews were tape-recorded and transcribed. Data were analysed to derive themes of importance to participants. 'Activity' and 'social participation' were the main themes identified as important to people with COPD during the first phase. During the second phase, the two main themes that captured participants' experience of activity were 'stagnation' - as linked to being confined to indoors; and 'movement' - associated with being outdoors. Stagnation affected participants on a physical and psychosocial level and affected their perception of themselves and their breathing. Movement, including physical and psychosocial aspects and perceptions of movement, was perceived as having a positive effect, enabling people to escape feelings of stagnation. Fresh air was identified as the single most important aspect of spending time outdoors and was associated with a sense of freedom from their usual experience of having tight air

Background As the landscape of women presenting for maternity care changes, so do the challenges associated with providing quality, informed and compassionate care, particularly for women with complex needs. Aim To explore the lived experience of midwives in facilitating care for women with complex needs who choose to birth at home. Method A qualitative design is employed, using an interpretative phenomenological analysis informed by hermeneutic principles. Purposive sampling is used to recruit midwives through social media and JiscMail. Data are collected via semi-structured interviews. Findings Two interpretative themes arose. A ‘radical midwife’ embraces the phrase ‘radical’ by positioning midwives between traditional beliefs and practices, physiological processes, midwife knowledge and skill set by applying current evidence and professional context. A ‘conflicted midwife’ arises out of this dichotomy and exposes the realities of striving for radicality while the negotiating ‘the system’. Conclusions It is no longer acceptable to assume that home birth for women with complex needs is exceptional. This must be the catalyst to move towards a constructive discourse with midwives, women and the wider team to address and expand the evidence base and pathways to support those who are already facilitating this care and those who will inevitably continue to provide care ‘outside of current guidelines’

Pulmonary rehabilitation has short-term benefits on dyspnea, exercise capacity and quality of life in COPD, but evidence suggests these do not always translate to increased daily physical activity on a patient level. This is attributed to a limited understanding of the determinants of physical activity maintenance following pulmonary rehabilitation. This systematic review of qualitative research was conducted to understand COPD patients’ perceived facilitators and barriers to physical activity following pulmonary rehabilitation. Electronic databases of published data, non-published data, and trial registers were searched to identify qualitative studies (interviews, focus groups) reporting the facilitators and barriers to physical activity following pulmonary rehabilitation for people with COPD. Thematic synthesis of qualitative data was adopted involving line-by-line coding of the findings of the included studies, development of descriptive themes, and generation of analytical themes. Fourteen studies including 167 COPD patients met the inclusion criteria. Seven sub-themes were identified as influential to physical activity following pulmonary rehabilitation. These included: intentions, self-efficacy, feedback of capabilities and improvements, relationship with health care professionals, peer interaction, opportunities following pulmonary rehabilitation and routine. These encapsulated the facilitators and barriers to physical activity following pulmonary rehabilitation and were identified as sub-themes within the three analytical themes, which were beliefs, social support, and the environment. The findings highlight the challenge of promoting physical activity following pulmonary rehabilitation in COPD and provide complementary evidence to aid evaluations of interventions already attempted in this area, but also adds insight into future development of interventions targeting physical activity maintenance in COPD.

Objectives/purpose: This study aimed to determine and understand COPD patients’ perceived facilitators and barriers to physical activity after completion of pulmonary rehabilitation. Pulmonary rehabilitation, a multidisciplinary treatment for COPD incorporating exercise trail. Design: A systematic review of qualitative research. Methods: Electronic databases of published, (MEDLINE, Embase, Web of Science, CINAHL, ASSIA, PsycINFO and SPORTDiscus), non-published data and conference proceedings (DART Europe E theses, EThOS, Open Grey, The New York Academy of Medicine, ProQuest Dissertations and theses), and trial registers (ClinicalTrials.gov and Current Controlled Trials) were searched to identify qualitative studies (interviews, focus groups) including COPD patients following pulmonary rehabilitation. Qualitative data relevant to the research question were synthesised using an inductive, thematic approach. Results: 14 studies (n= 12 published articles, n= 2 theses) including 167 COPD patients (male = 92, female = 75) met the inclusion criteria. Analytical themes were beliefs, motivation and social support, which encapsulated the facilitators and barriers to physical activity following pulmonary rehabilitation. Facilitators included positive intentions, support from health care professionals (HCPs), positive feedback regarding health, access and opportunities to attend physical activity maintenance groups, peer and family interaction. Barriers included negative beliefs, lack of 27 support from HCPs and peers, as well as practical issues surrounding travel and home responsibilities following pulmonary rehabilitation. Conclusions: Our findings reflect the complexity of physical activity behaviour and provide implications regarding the importance of continued social support and feedback in the maintenance of physical activity. These factors should be considered in the development of future interventions that target physical activity following pulmonary rehabilitation in

Background As the landscape of women presenting for maternity care changes, so do the challenges associated with providing quality, informed and compassionate care, particularly for women with complex needs. Aim To explore the lived experience of midwives in facilitating care for women with complex needs who choose to birth at home. Method A qualitative design is employed, using an interpretative phenomenological analysis informed by hermeneutic principles. Purposive sampling is used to recruit midwives through social media and JiscMail. Data are collected via semi-structured interviews. Findings Two interpretative themes arose. A ‘radical midwife’ embraces the phrase ‘radical’ by positioning midwives between traditional beliefs and practices, physiological processes, midwife knowledge and skill set by applying current evidence and professional context. A ‘conflicted midwife’ arises out of this dichotomy and exposes the realities of striving for radicality while the negotiating ‘the system’. Conclusions It is no longer acceptable to assume that home birth for women with complex needs is exceptional. This must be the catalyst to move towards a constructive discourse with midwives, women and the wider team to address and expand the evidence base and pathways to support those who are already facilitating this care and those who will inevitably continue to provide care ‘outside of current guidelines’