Search

In 2023, the UK Government published its long-awaited reform strategy for England's children's social care system. Whilst the strategy set out planned reforms for several aspects of the wider system, an area requiring particular 'priority' was the purported workforce instability seen within child protection social work. However, the strategy has subsequently faced criticism on the basis that the suggested reforms were not satisfactorily informed by the testimonies of practicing social workers. This paper draws from a mixed-method study to report on the lived experiences of a sample of 201 child protection social workers practicing across England, in the context of better understanding the factors which they believed were impacting on workforce stability within England's child protection system. Implications that emerge are the need for an increase in the monetary commitment offered by the UK Government (especially in the context of tackling high caseloads, and improving local authority pay scales to reduce the allure of agency work); a targeted emphasis on challenging local cultures preoccupied with evidencing compliance over time spent with children; and the Government taking a more assertive role in tackling the often-counterproductive commentary perpetuated by politicians and media. [ABSTRACT FROM AUTHOR]

Alcohol marketing influences drinking practices, and this helps shape how gender identities are constructed. This paper presents research exploring how women who are sober manage and negotiate their non-drinking and sober identities in neo-liberal contexts that market alcohol products and consumption as a defining feature of feminine identities. Semi-structured in-depth interviews (n = 15) and online content produced by sober women active in the positive sobriety community on the social media platform Instagram were analysed using thematic analysis. Women negotiated marketing messages within their everyday experiences of sobriety, with associations between drinking and motherhood, female friendship and empowerment, discussed as impacting their drinking, lived experience and sense of self. They negotiated such messages, and created alternative ways of 'doing femininity' as sober women, through distancing themselves from their previous drinking identities; rejecting, reworking and countering marketing that links alcohol use to femininity; and alternative consumption practices. Instagram allowed women to publicly critique and counter marketing messages in ways that unlinked alcohol use, but not consumption more generally, from femininity, in traditional and news ways. Marketing regulation should consider how those experiencing problematic alcohol use may be particularly vulnerable to marketing messages, in ways that are gendered. [ABSTRACT FROM AUTHOR]

Moral thinking and communication are critical competencies for confronting social dilemmas in a challenging world. We examined these moral competencies in 70 college students and graduates from Taiwan, the United Kingdom, and the United States. Participants were assessed through semi-structured written interviews, Facebook group discussions, and a questionnaire. In this paper, we describe the similarities and differences across cultural groupings in (1) the social issues of greatest importance to the participants; (2) the factors influencing their approaches to thinking about social issues and communicating with others; and (3) the characteristics of their moral functioning in terms of moral awareness, moral judgment, moral discourse, and moral decision-making. [ABSTRACT FROM AUTHOR]

With the United Kingdom experiencing a series of 'lockdowns' in 2020 and 2021 that disrupted leisure and socializing, the COVID-19 pandemic presents a 'critical juncture' which has facilitated alterations to – and reflections on – drinking practices. Drawing on online semi-structured interviews and focus groups conducted between the first and second UK lockdowns, we highlight three stages in the development and maintenance of UK drinking practices using critical junctures as a theoretical framework. Firstly, we consider the antecedent conditions – such as dominant drinking cultures - that shape pre-pandemic drinking practices and form the backdrop against which changes to behaviors are made. Secondly, we explore the 'cleavage' or initial moment of disruption which gives rise to shifts in drinking practices and consider how this critical juncture stabilizes and is reproduced. Finally, we examine the possible 'legacy' of the critical juncture. The paper highlights implications for healthcare/policy including the importance of considering wider social context when seeking behavioral change. We also stress that alternative explanations – such as declining drinking rates and the growth of Temporary Abstinence Initiatives – must not be ignored when exploring people's shifting drinking behaviors, even during periods of unprecedented social change. [ABSTRACT FROM AUTHOR]

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

Antimicrobial resistance (AMR) is often referred to as a complex problem embedded in a complex system. Despite this insight, interventions in AMR, and in particular in antibiotic prescribing, tend to be narrowly focused on the behaviour of individual prescribers using the tools of performance monitoring and management rather than attempting to bring about more systemic change. In this paper, we aim to elucidate the nature of the local antibiotic prescribing 'system' based on 71 semi-structured interviews undertaken in six local areas across the United Kingdom (UK). We applied complex systems theory and systems mapping methods to our qualitative data to deepen our understanding of the interactions among antibiotic prescribing interventions and the wider health system. We found that a complex and interacting set of proximal and distal factors can have unpredictable effects in different local systems in the UK. Ultimately, enacting performance management-based interventions in the absence of in-depth contextual understandings about other pressures prescribers face is a recipe for temporary solutions, waning intervention effectiveness, and unintended consequences. We hope our insights will enable policy makers and academics to devise and evaluate interventions in future in a manner that better reflects and responds to the dynamics of complex local prescribing systems. [ABSTRACT FROM AUTHOR]

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

Blended learning (BL) has been widely adopted across the higher education (HE) sector, with a growing body of literature exploring its impact on both students and faculty. However, to date, few studies have examined how students with Specific Learning Difficulties (SpLDs) experience BL. This paper presents the results of a qualitative case study investigating the BL experiences of students with SpLDs in a British HE institution. A thematic analysis of semi-structured interviews conducted with six participants revealed five major themes regarding the BL experience of students with SpLDs: (1) clarity of purpose and instruction; (2) ease of use; (3) accessibility; (4) fear of 'getting it wrong' in online spaces and (5) interaction and staff engagement. The findings underscore the significance of addressing these areas in order to increase the efficacy of BL to meet the learning needs of students with SpLDs. [ABSTRACT FROM AUTHOR]

This paper explores the decision-making processes involved in giving physiotherapy students responsibility on clinical placement and the impact on their developing professional autonomy. The qualitative study, using semi-structured interviews, involved physiotherapy students and clinical educators (CEs) from two higher education institutions, one in Australia, and the other in the United Kingdom (UK). Findings led to the development of a heuristic framework of 'graduated supervision,' a process of progressively less direct observation and monitoring of students as clinical proficiency improved. By focusing on the measured exposure of students to increasing complexity and inverse levels of supervision, the framework captures tacit practices, and consistent, yet varied facilitation strategies adopted across specialties, and evident in clinical education settings in both countries. The framework formalizes, for the first time, assumptions and expectations previously unacknowledged. Factors identified as affecting students' progress toward autonomy include the student/CE relationship, the development of mutual trust through ongoing dialogue, and the importance of formal discussions at the commencement of a clinical placement to establish learning goals, preferred supervision styles and learner responsibilities. Insights have significance for the CE community, and students who at times have to second-guess what is required of them and how they might excel on clinical placement. [ABSTRACT FROM AUTHOR]

Recovery is experienced in both positive and negative ways and this paper attempts to integrate the 'pains of desistance' approach into a recovery capital framework. Pains experienced as a result of negative recovery capital are often thought to stimulate motivations for positive behavioral change, usually through a 'rock bottom' type moment. Whilst recovery capital and barriers to recovery have been explored in the literature, conceptualizing these as push and pull factors, and exploring their dynamic interaction, especially at distinct phases of recovery has not. Toward filling these gaps, we use the life-narratives of 30 people in recovery to explore how the pains of recovery (push factors) alongside different forms of recovery capital (pull factors) impact upon and are managed differentially at distinct phases of the recovery journey. Findings indicate the pains of recovery rarely led to positive changes. Rather, a range of pull factors created and promoted positive changes. However, the life narratives reveal that recovery capital cannot be accrued or sustained without managing (eliminating or reducing) the pains of recovery. Overall, this work highlights the need for policy and practice to help reduce the pains of recovery, especially during early recovery to accelerate transition to more stable phases of recovery. As recovery is neither a linear pathway nor a journey without residual challenges for many people, there is much to be learned about effective ongoing management strategies in preventing a return to problematic use that utilize a push and pull framework. [ABSTRACT FROM AUTHOR]

The recognition of disability as a social construct has aided in providing better access to the built environment for disabled people, through the implementation of accessible spaces. However, access to them is not straightforward for disabled people who do not match stereotypical representations of disability. Drawing on empirical data collected from semi structured interviews and photo elicitation exercises, conducted with people with dwarfism living in the UK, this paper shows how they are often challenged or denied access to accessible spaces, creating a hierarchy of impairments. Building on the notion of 'statuarized spaces' the paper demonstrates how access to accessible spaces is influenced by their representation, which differs from representations of dwarfism, leading to incongruous encounters. These incongruous encounters affect the spatial practices of people with dwarfism. A more varied representation of disability is required in order to provide people with dwarfism straightforward access to accessible spaces. The ideas explored in this paper are based upon research carried out with people with dwarfism living in the UK. Shows how people with dwarfism are told off or challenged by other people when they want to access to accessible spaces. The paper shows some of the ways people with dwarfism gain access to accessible spaces. The paper argues for a broader representation of disability in order for people with dwarfism to be recognised as disabled. [ABSTRACT FROM AUTHOR]

Many migrant groups, particularly those that are politically and economically marginalised, such as asylum seekers and refugees (ASRs), face inequities in access to health care as well as poorer physical and mental health outcomes. The role of post-arrival experiences in contributing to these inequities is increasingly being explored, and it is suggested that being a migrant is itself a determinant of health outcomes. Drawing on the theoretical concept of structural vulnerability, this paper explores ASRs' experiences of health, wellbeing, and health practices in the context of their lived realities in Scotland. 24 semi-structured interviews were conducted with ASRs from Sub-Saharan Africa between January and December 2015. Data were explored using thematic analysis. Experience of the UK asylum system, both alone and in conjunction with other sources of vulnerability including racism, poverty, and language barriers had a negative and ongoing impact on the physical and mental health of ASRs. These impacts continued, even once refugee status was obtained. Efforts to engage ASRs in preventive health programmes and practices must take into account the ways in which the asylum system acts as a determinant of health, affecting both what it means to be healthy and what capacity individuals have to engage with their health. Political choices in how the asylum process is enacted have far-reaching implications for individual and population health. [ABSTRACT FROM AUTHOR]

In order to combat the COVID-19 pandemic, policymakers around the globe have increasingly invested in digital health technologies to support the 'test, track and trace' approach of containing the spread of the novel coronavirus. These technologies include mobile 'contact tracing' applications (apps), which can trace individuals likely to have come into contact with those who have reported symptoms or tested positive for the virus and request that they self-isolate. This paper takes a critical public health perspective that advocates for 'genuine participation' in public health interventions and emphasises the need to take citizen's knowledge into account during public health decision-making. In doing so, it presents and discusses the findings of a UK interview study that explored public views on the possibility of using a COVID-19 contact-tracing app public health intervention at the time the United Kingdom (UK) Government announced their decision to develop such a technology. Findings illustrated interviewees' range and degree of understandings, misconceptions, and concerns about the possibility of using an app. In particular, concerns about privacy and surveillance predominated. Interviewees associated these concerns much more broadly than health by identifying with pre-existent British national narratives associated with individual liberty and autonomy. In extending and contributing to ongoing sociological research with public health, we argue that understanding and responding to these matters is vital, and that our findings demonstrate the need for a forward-looking, anticipatory strategy for public engagement as part of the responsible innovation of the COVID-19 contact-tracing app in the UK. [ABSTRACT FROM AUTHOR]

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

Integrated working can be a means of providing efficient and cost-effective care, which benefits both service users and health professionals. However, it does require readiness of practitioners to work in new and innovative ways to achieve integration. This paper describes the findings of a qualitative study exploring the nature of practice-based education and training underpinning successful integrated care teams using an ecological systems theory lens. Nine teams in the West Midlands region of the United Kingdom (UK) participated in this study. A total of 27 participants were involved in semi-structured interviews during which they shared their views and experiences of learning in practice. Thematic analysis of interview transcripts highlighted the shifting context of working in integrated teams impacting on learning, the influence of leadership on education and training, the nature of in-service training, and the knowledge-sharing culture. The findings highlight that the learning climate is highly dependent on the leadership ethos in the practice context, which influences the allocation of time and resources for training and clinical supervision. Whilst formal education and training has an important role to play in fostering integrated working, informal learning is pivotal to successful integration and potentially has greater impact making it worthy of further study. [ABSTRACT FROM AUTHOR]

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

'Complexity' is theorised as a characteristic of modern food systems that poses a challenge to improving population diets. This paper seeks to explore the discursive deployment of 'complexity' in the context of public health. Doing so helps inform a more critical assessment of commercial and political determinants of health, and of 'complexity' as a prevailing frame for public health issues. Qualitative methods were used to explore 'responsibility' for healthy eating in the food system in the United Kingdom. Discourse analysis was conducted on corporate and government documents, and interviews with industry and government stakeholders. The aim was to examine the implications of 'complexity' within discourses of dietary public health. 'Complexity' was used not only to characterise dietary public health problems but also as a rhetorical device in public health narratives. It performed two main discursive functions: firstly, to represent diet-health problems as so multi-layered and difficult that they are intractable. Secondly, and despite this acknowledged complexity, to deflect from food system actions for improving diet to 'simpler' and non-food interventions, by industry and government. These uses of 'complexity' serve to attribute primary responsibility to individuals for dietary choice and to obscure inaction by government and industry, who have most control over the determinants of those choices. In short, 'complexity' can be used discursively to generate a smokescreen masking policy inaction in addressing public health problems. [ABSTRACT FROM AUTHOR]

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

How are changing times impacting on the possibility of collective agency by actors and agencies responding to domestic violence against women in London? The struggle against the domestic abuse of women was grounded in the 1970s women's liberation movement under the rallying cry of 'the personal is the political'. Over time, the domestic violence (DV) response has become professionalised and mainstreamed, located in public sector agencies and charities, with small feminist groups challenging gender inequalities in different settings. These combined efforts are having no impact on the incidence of DV, and recent years have seen dramatic cuts in DV services. A snowball sample of 25 professionals, policy makers and activists across the DV response engaged in semi-structured interviews exploring their work experiences, particularly experiences of 'multi-sectoral collaboration', the professional instantiation of collective agency. Thematic analysis depicted an exhausted and divided sector. Nearly all informants saw DV as rooted in gender inequalities, and viewed collaborative working as essential for tackling its interlocking individual and social drivers. However, contemporary feminism was seen as completely irrelevant to the daily realities of professionals' work. The paper explores how the current economic, political and cultural contexts of interviewees' work experiences were hostile to the practice of multi-sectoral collaboration. Such contexts actively militated against collaborator solidarity, the inclusion of survivor voices and a social change orientation – preconditions for effective collective agency in tackling such a complex and multi-level social problem. [ABSTRACT FROM AUTHOR]

The concept of 'embodied' risk has been used to understand the experience of being at risk of cancer, yet there has been less engagement of the concept in relation to those who have been diagnosed and treated for the disease. In this paper, I draw on young women's accounts of living with breast cancer with the aim of developing analyses of embodied risk and expanding our understanding of the concept. Twenty women diagnosed with breast cancer while they were aged 18-44 took part in semi-structured interviews in the UK, and I analysed these interview data using social constructionist grounded theory. The findings illustrate how a sense of risk from within the body shaped the young women's experiences and perceptions of their bodies, and how their body as risky was relational, becoming salient in interactions with others. I also explore new dimensions of embodied risk related to the age and social circumstances of the young women. Although the fear of cancer recurrence is well documented, this paper explores it as an embodied experience. [ABSTRACT FROM AUTHOR]

The first cases of Coronavirus (COVID-19) were reported in Wuhan, China in December 2019. Globally millions of people have been diagnosed with the virus whilst thousands have died. As the virus kept spreading health and social care frontline workers (HSCFW) were faced with difficulties when discharging their duties. This paper was set out to explore the challenges faced by different frontline workers in health and social care during the COVID-19 pandemic. The research utilized an explorative qualitative approach. A total of forty (N = 40) in-depth one-to-one semi-structured interviews were undertaken with HSCFW who included support workers (n = 15), nurses (n = 15), and managers (N = 10). Health and social care workers were drawn from domiciliary care and care homes (with and without nursing services). All the interviews were done online. The data were thematically analyzed, and the emergent themes were supported by quotes from the interviews held with participants. Following data analysis the research study found that lack of pandemic preparedness, shortage of Personal Protective Equipment (PPE), anxiety and fear amongst professionals, challenges in enforcing social distancing, challenges in fulfilling social shielding responsibility, anxiety and fear amongst residents and service users, delay in testing, evolving PPE guidance and shortage of staff were challenges faced by frontline health and social care workers during COVID-19 pandemic. The results of the current study point to a need for adequate pandemic preparedness within the health and social care sector to protect both frontline workers and the individuals they look after. [ABSTRACT FROM AUTHOR]

Informed by literature identifying the role of fear in decision making processes, the study upon which this paper is based sought to explore Mental Health Officers' (MHOs) experiences of fear and whether this influences their decisions to use powers of compulsory detention under the Mental Health (Care and Treatment) (Scotland) Act (Scottish Government 2003). Semi-structured interviews exploring the experience of fear in mental health assessments were undertaken with eight MHOs employed by a Scottish Local Authority and findings indicated that it had a marked impact on MHO decision making. Two central themes emerged: first, a fear of doing harm to service users, their families or the wider public though making the 'wrong' decision; second, fear of public and professional scrutiny, should any such harm arise. The findings raise a number of recommendations for policy and practice in the statutory mental health field, in particular, the importance of acknowledging fear and identifying strategies to manage it in training and post qualifying practice for MHOs and equivalent roles in the UK and other jurisdictions. The findings also add weight to calls for additional research exploring the MHO role. [ABSTRACT FROM AUTHOR]

This paper will discuss examples of mental health training developed and co-produced in active partnership with two communities, one in Britain and one in Sri Lanka. This work has taken place in community settings, not within the consulting room. The learning had a bi-directional flow; through these partnerships, both partners/groups shared and developed their understanding of different cultures, idioms of distress, explanatory mental health models and ways of dealing with these. This expanded everyone's knowledge, understanding, and repertoires of practice. The work in Britain was audited through a range of psychometric tests and that in Sri Lanka through questionnaires. Semi-structured interviews also took place with both groups as did meetings with a range of key informants. Working beyond the clinic can benefit people, who have obliquely been labeled, as 'hard to reach' groups and who may find it difficult to access mental health services or who find services inappropriate. Therefore, community groups may be well-positioned to bridge this gap in non-stigmatizing, accessible and culturally appropriate ways. Evidence has begun to emerge suggesting that mental health services developed in conjunction with service users and the wider community may lead to better usage, more appropriate and accessible services, and to an improved sense of inclusivity. The implications of this for the global mental health debate will be briefly considered as will health pluralism and the importance of language and using a mother tongue. [ABSTRACT FROM AUTHOR]

This paper is a report of a qualitative study in which the aim was to investigate how counsellors who identified as practising members of a world religion or faith experienced undertaking counsellor training in the UK. All four participants were final year students on BACP accredited counsellor training programmes and identified as practicing Christians. Data was collated via semi-structured interviews and analysed using thematic analysis. Findings point to trainees experiencing significant anxiety with regard to talking about their faith during training for fear of eliciting negative judgments. As a result, participants either avoided talking about their religion or sought to defend it against negative perceptions. Participants tended to feel more comfortable talking to supervisors or therapists rather than their peers about religion when it was relevant to the client work or to personal issues. All participants reported receiving limited teaching input around religion and mental health on their programmes and felt this was a neglected area in counsellor training. [ABSTRACT FROM AUTHOR]

Background: This paper reports findings from a one-year UK knowledge exchange (KE) project completed in 2015. Stakeholders’ experiences of evaluation were explored in order to develop online resources to strengthen knowledge and capacity within the arts and health sector (www.creativeandcredible.co.uk). Methods: The project used mixed methods, including a survey, interviews and focus groups, guided by a Stakeholder Reference Group comprised of 26 leading UK evaluators, researchers, artists, health professionals, commissioners and funders. Results: The project identified opportunities for arts arising from current health and social care policy agendas. It also identified challenges including the lack of agreed evaluation frameworks and difficulties in evaluation practice. Conclusions: Co-production between stakeholders is needed to strengthen evaluation practice and support the development of the arts and health sector. Effective co-production can be undermined by structural and cultural barriers as well as unequal stakeholder relationships. The paper discusses recent initiatives designed to support best practice. [ABSTRACT FROM PUBLISHER]

Purpose: The telehealthcare sector has been expanding steadily in the UK. However, confusing, complex and unwieldy designs of telehealthcare devices are at best, less effective than they could be, at worst, they are potentially dangerous to the users. Method: This study investigated the factors within the new product development process that hindered satisfactory product design outcomes, through working collaboratively with a leading provider based in the UK. Results: This study identified that there are too many costly late-stage design changes; a critical and persistent problem area ripe for improvement. The findings from analyzing 30 recent devices, interviewing key stakeholders and observing on-going projects further revealed that one major cause of the issue was poor practice in defining and communicating the product design criteria and requirements. Conclusions: Addressing the characteristics of the telehealthcare industry, such as multiple design commissioners and frequent deployment of design subcontracts, this paper argues that undertaking a robust process of creating the product design brief is the key to improving the outcomes of telehealthcare device design, particularly for the small and medium-sized enterprises dominating the sector. Implications for rehabilitation: Product design criteria and requirements are frequently ill-defined and ineffectively communicated to the designers within the processes of developing new telehealthcare devices. The absence of a (robust) process of creating the design brief is the root cause of the identified issues in defining and communicating the design task. Deploying a formal process of creating the product design brief is particularly important for the telehealthcare sector. [ABSTRACT FROM AUTHOR]

Background: In 2009, St George’s University of London (SGUL) replaced their paper-based problem-based learning (PBL) cases with virtual patients for intermediate-level undergraduate students. This involved the development of Decision-Problem-Based Learning (D-PBL), a variation on progressive-release PBL that uses virtual patients instead of paper cases, and focuses on patient management decisions and their consequences. Methods: Using a case study method, this paper describes four years of developing and running D-PBL at SGUL from individual activities up to the ways in which D-PBL functioned as an educational system. Results: A number of broad issues were identified: the importance of debates and decision-making in making D-PBL activities engaging and rewarding; the complexities of managing small group dynamics; the time taken to complete D-PBL activities; the changing role of the facilitator; and the erosion of the D-PBL process over time. Conclusions: A key point in understanding this work is the construction and execution of the D-PBL activity, as much of the value of this approach arises from the actions and interactions of students, their facilitators and the virtual patients rather than from the design of the virtual patients alone. At a systems level D-PBL needs to be periodically refreshed to retain its effectiveness. [ABSTRACT FROM PUBLISHER]

Research about disabled identity reflects diverse perspectives on the merits and challenges associated with such an identity. This paper explores the impact of disabled identity on the inclusion of disabled students in higher education and employment contexts. It considers their experiences of inclusion in a university setting and its associated work-based placements and discusses the extent to which students had to negotiate a range of experiences of disabled identity. The paper suggests that many disabled students, especially those with behaviour-related impairment labels, are subject to continued exclusion in university and, more particularly, work settings, and this contributes to an employment disadvantage compared with their peers. To this end, the paper highlights the importance of enhancing inclusion for disabled students, especially in employment settings, through a focus on reducing destructive identities. [ABSTRACT FROM AUTHOR]

Within homelessness services recent policy developments have highlighted the need for integration and improved collaborative working and also, the need for 'Psychologically Informed Environments' (PIES) in which workers are better equipped to manage the 'complex trauma' associated with homelessness. Drawing on the findings of an evaluation of a multi-site development programme, this paper demonstrates how both these policy aspirations might be implemented through a single delivery vehicle (a community of practice). The paper describes how organizational, educational and psychosocial theory was used to inform programme design and reflects on the utility of these approaches in the light of the evaluation findings. It is reported that communities of practice can deliver significant performance gains in terms of building collaborative relationships and opening-up opportunities for interprofessional education and learning. Filling an important knowledge gap, it also suggested how (professional) participation in a community of practice might work to improve outcomes for service users. Most likely we see those outcomes as being linked to tackling exclusion by sustaining the workforce itself, that is in motivating workers to remain engaged and thinking positively in what is an emotionally challenging and stressful job role. [ABSTRACT FROM AUTHOR]

The study informing this paper set out to reframe evaluation as a collaborative, participatory, dialogical process with a focus on learning rather than accountability. Evaluation, much like reflective practice, has been shaped in terms of individual activity and deficit-based discourses. Using an ‘insider’ approach, an innovative methodology was developed and implemented in a voluntary youth organisation in the UK. Data gathered via semi-structured interviews before and after the implementation were analysed using an inductive thematic analysis approach. The findings suggest that collective spaces for reflection and dialogue are disappearing and yet practitioners highly valued this for its re-energising and restorative properties. Evidence is presented to suggest that narratives, in this case co-constructed stories, enabled collective critical reflection and the development of a shared understanding of practice which in turn supported and strengthened professional autonomy. This paper offers a significant contribution to knowledge in regard to the design and use of participatory evaluation. It is argued that the appreciative, collaborative and reflective aspects of the methodology enabled the learning and development functions to be realised. Evaluation based on collective, reflective dialogue has the potential to provide an evidence base of good practice, enhance staff well-being and improve practice outcomes. [ABSTRACT FROM PUBLISHER]

Communication; cancer; existential; spiritual; religious; general practitioners; vocational training; continuing medical education. Design: The UK Medical Research Council's (MRC) framework for complex intervention research was used as a guide for course development and evaluation and was furthermore used to structure this paper. The development phase included: identification of existing evidence, description of the theoretical framework of the course, designing the intervention and deciding for types of evaluation. In the evaluation phase we measured self-efficacy before and after course participation. To explore further processes of change we conducted individual, semi-structured telephone interviews with participants. Subjects and setting: Twenty practising GPs and residentials in training to become GPs from one Danish region (mean age 49). Results: The development phase resulted in a one-day vocational training/continuing medical education (VT/CME) course including the main elements of knowledge building, self-reflection and communication training. Twenty GPs participated in the testing of the course, nineteen GPs answered questionnaires measuring self-efficacy, and fifteen GPs were interviewed. The mean scores of self-efficacy increased significantly. The qualitative results pointed to positive post course changes such as an increase in the participants' existential self-awareness, an increase in awareness of patients in need of existential communication, and an increase in the participants' confidence in the ability to carry out existential communication. Conclusions: A one-day VT/CME course targeting GPs and including the main elements of knowledge building, self-reflection and communication training showed to make participants more confident about their ability to communicate with patients about existential issues and concerns. [ABSTRACT FROM AUTHOR]

This paper explores how tensions and power differentials within public mental health interact with the practices of media production in entertainment television. I present the findings of a qualitative study involving semi-structured interviews with story consultants from mental health organisations and Senior Executives, Producers and script-writers from UK television series (n = 14). Story advisors welcome the opportunity to reach larger and younger audiences in distinct ways and to share the ‘lived experience’ of mental distress through well-researched characters. They accept their relative lack of power to negotiate dramatic storylines which conflate mental distress with criminality and may undermine their anti-stigma ideals. The ‘medical model’ is prioritised in mainstream television drama and the causes of mental distress framed in biomedical terms. Storylines tend to emphasise the certain benefits of medication and marginalise self-management of conditions. Television industry professionals recognise their anti-stigma public service role and are receptive to working with programme consultants to help create authentic characters. Perceptions of the nature of drama as requiring resolution may help to explain the principal focus on biomedical conceptualisations of mental distress. Medication provides a relatively simple on-screen solution to resolve complex stories. Entertainment television operates within limited ideological frames. Mental distress and stigma are addressed at an individual, not collective level. Debates within the survivor movement and public mental health concerning medication, treatment and recovery tend to be obscured. These might provide a productive alternative vein of storytelling that could broaden our understanding of the social meaning of suffering and thus help challenge stigma. [ABSTRACT FROM AUTHOR]

The paper presents an introduction of a newly developed, avatar-based virtual reality therapy, as an addition to the therapeutic programme, within a therapeutic community prison in the UK. The participants had six group sessions facilitated by a counsellor. The aim of the project was to investigate whether this approach would improve mental health outcomes for the prisoners, interpersonal relationships within the prison and facilitate the achievement of personal goals for the prisoners. The sample size (n = 4) was insufficient to make firm conclusions about the mental health outcomes. However, the qualitative analysis showed a strong engagement with the programme in addressing personal issues, the development of insight and empathy, and improvements in relationships within the participants and with the counsellor. Further research with a larger sample is needed to establish efficacy of this type of therapy with the prison population. [ABSTRACT FROM PUBLISHER]

Background: Health care within the home setting is a vital and growing component of pressure injury (PI) prevention and management. Objectives: To describe the use of health services and pressure-redistributing devices in community dwelling patients with PI's. Design: Mixedmethods collective case study of a defined, diverse geographic postcode area in the United Kingdom. Methods: Quantitative retrospective analysis of electronic and paper medical records of adult PI patients from 2015 district nursing reports. Qualitative semi-structured interviews of community dwelling adult patients receiving, or received, treatment for PI in 2016. Results: Mandatory reports (n = 103) revealed that 90 patients were supplied with a variety of pressure-redistributing devices but only one-third of patients used the equipment as recommended. Qualitative interviews (n = 12), reported to COREQ guidelines, revealed that patients felt reliant on community health services, and were concerned about the consistency of their care. Conclusions: Authentic patient involvement is required to provide care and interventions that are acceptable to PI patients and can be incorporated into self-care strategies and effectively monitored. [ABSTRACT FROM AUTHOR]

Objectives: The current paper aimed to explore doctor-patients' views about their treatment from the Practitioner Health Programme (PHP), a UK-based service treating health professionals with mental health/addiction problems. Aims were to gain insights into the issues most important to patients and consider whether a service specifically for doctors is important in helping to overcome barriers to accessing mental healthcare. Methods: Nine doctor-patients attending PHP took part in semi-structured interviews between September 2010 and June 2011. Thematic analysis was used to explore recurring patterns in the data. 134 written comments from PHP patients were also included. Results: Participants reported difficulties in finding appropriate treatment; problems were often severe by the time PHP was involved. Concerns about confidentiality, judgement and impact on career were obstacles to help-seeking and important issues during treatment. Analysis of written comments provided further support for these findings. Conclusion: Whilst some of the needs of mentally unwell doctors mirror the needs of patients in general – e.g. a supportive and non-judgemental attitude from clinicians – they do have specific needs related to confidentiality and stigma. [ABSTRACT FROM PUBLISHER]

Objective: In this paper, we apply psychological agency theory to women's interviews of their breastfeeding experiences to understand the role of agency in relation to breastfeeding initiation, maintenance and duration. Design: Qualitative, video interviews were collected from 49 women in the UK from a wide range of ethnic, religious, educational and employment backgrounds about their breastfeeding experiences. We undertook secondary analysis of the data focusing on their accounts of vulnerability and agency. Findings: Women's agency was impacted by a variety of factors including their own vulnerability, knowledge, expectations and experience, the feeding environment and the support of health professionals in sharing decision-making and dealing with uncertainty. Conclusion: Health professionals as co-agents with women are well positioned to maintain, enhance or restore women's sense of agency. Breastfeeding goals should be included in women's birth plans. Training related to agency, continuity of care, and staffing and workload management supported by national breastfeeding policies could improve breastfeeding rates and experiences. [ABSTRACT FROM AUTHOR]

This paper is based on anthropological research focused on users of online child sexual exploitation material. The empirical foundations are 17 months of participant-observation in UK group programmes for offenders, and semi-structured interviews with group participants and programme staff. While explanations for offending often emphasise individual-psychological characteristics of offenders, I suggest attention should also be given to offender perceptions and constructions of online spaces. For many in the sample, decision-making and the choice to view material were influenced by perceived boundaries and associated altered features of social interaction, said to demarcate online environments from other contexts. Participants perceived online offending spaces as lacking the interaction and potential gaze of others that normally reinforce social norms. This resulted in a feeling of freedom to break norms of childhood and sexuality online, contrasting offline society where such norms are actively reinforced. The article therefore localises factors for Internet offending in social processes. [ABSTRACT FROM PUBLISHER]

Purpose: The WheelSense project aims to develop a system for assessing the stability and performance of wheelchairs through a user-centred design process. This study sought to capture user needs and define the specification for the system.Method: A mixed methods approach was adopted. An online survey was completed by 98 participants working in wheelchair provision. The results were built upon through 10 semi-structured interviews and one focus group (n = 5) with professionals working in wheelchair provision in three NHS Trusts in the UK.Results: The results provided a picture of the current UK practice in stability testing. Issues with the reliability and usefulness of the existing methods used to assess the stability and performance of wheelchairs were highlighted. Requirements for a new system were ascertained. These included improved accuracy of tipping angles, features to support record keeping, improved client/carer education support and ability to model or predict client–wheelchair system performance in different configurations. Conclusions: The paper concludes that there is a need for improved tools to determine the stability of the client–wheelchair system and support the prescription process, to ensure client safety and optimum equipment performance. A list of requirements has been produced to guide the future development of WheelSense.Implications for RehabilitationThe results of this survey and interview-based study present a picture of wheelchair stability testing practices in the UK, and highlight the need for new, more informative methods for guiding wheelchair prescription.The requirements for the design of a new system, or further development of existing tools to support the stability testing and prescription of wheelchairs have been established. [ABSTRACT FROM PUBLISHER]

Purpose:Very little is known about how older people from black and minority ethnic (BME) groups caring for someone after a stroke access and engage with social care services. This paper explores both the experiences of carers whose relative was receiving social care services in their own home and the value of a theory of humanising care to understand and explain these experiences. Method:Semi-structured interviews were undertaken with 50 carers from five different ethnic groups: Asian Indian, Asian Pakistani, Black African, Black Caribbean and White British. Data were thematically analysed within a phenomenological framework. Results:Five interacting themes emerged: communication and bureaucracy; time and timing; communication and rapport building; trust and safety; humanity and the human dimensions of care. Many of the experiences could be interpreted within a conceptual framework of humanising care underpinned by eight interacting dimensions of what it means to be treated as an individual and a human. Conclusions:Carers from BME and White British groups share many experiences of homecare although language and cultural difference may exacerbate common pressures and stresses. The framework for humanising care is a useful tool to evaluate aspects of homecare that are responsive to dignity and diversity.Implications for RehabilitationExplicitly identifying, describing and valuing the human dimensions of care may support services in responding appropriately to homecare users from black minority ethnic communities as well as those from white majority groups.Unresponsive services and poor communication may lead to loss of trust with care agencies and undermine BME carers’ sense of entitlement and competence in engaging with homecare services.Care worker continuity investing time in building relationships and care worker familiarity is important to many families who access social care services. [ABSTRACT FROM AUTHOR]

Background: Psychiatric ward design may make an important contribution to patient outcomes and well-being. However, research is hampered by an inability to assess its effects robustly. This paper reports on a study which deployed innovative methods to capture service user and staff perceptions of ward design. Method: User generated measures of the impact of ward design were developed and tested on four acute adult wards using participatory methodology. Additionally, inpatients took photographs to illustrate their experience of the space in two wards. Data were compared across wards. Results: Satisfactory reliability indices emerged based on both service user and staff responses. Black and minority ethnic (BME) service users and those with a psychosis spectrum diagnosis have more positive views of the ward layout and fixtures. Staff members have more positive views than service users, while priorities of staff and service users differ. Inpatient photographs prioritise hygiene, privacy and control and address symbolic aspects of the ward environment. Conclusions: Participatory and visual methodologies can provide robust tools for an evaluation of the impact of psychiatric ward design on users. [ABSTRACT FROM AUTHOR]

Background: This paper examines the introduction and operation of a number of support roles in mental health services. This is done in the context of concerns about the effectiveness of CMHTs. Aims: Three questions are addressed: the degree to which concern for the work of consultant psychiatrists informed the introduction of the new roles; what the reforms implied for the work of the psychiatrist and those in new roles; and the impact of any changes on the operation of CMHTs. Method: Data were collected as part of a national-level evaluation. The main means of collection was the semi-structured interview. Results: The study shows: that reform was underpinned by concerns about the workload of psychiatrists; and that while in principle the responsibilities of the psychiatrist were to be distributed across other team members, those in new roles felt themselves to be isolated. Conclusions: Despite the intentions of policy, the creation of the new roles did little to extend the idea of distributed responsibility in CMHTs. [ABSTRACT FROM AUTHOR]

A task carried out in error creates a latent condition that can result in a future undesirable outcome if the error is not detected later. The paper presents a study of the relatively under-researched phenomenon of post-task latent error detection. Focusing on UK naval aircraft maintenance, it was hypothesised that time, location and systems cues influence individual latent error detection amongst naval air engineers who experience the phenomenon. The systems view of human error is combined with a multi-process approach to post-task latent error research, for which findings suggest that distributed cognition across the entire socio-technical system may be influential in post-task latent error detection. Directions for future research will be of benefit to those interested in furthering safety resilience using a systems approach to minimise the consequences arising from latent error. Relevance to human factors/ergonomics theoryThe nature and extent of post-task latent error detection is explored using a systems approach, for which distributed cognition across the entire socio-technical system appears influential. The aim of current research is to develop interventions to further mitigate for latent errors and thus advance the systems application of ergonomics theory. [ABSTRACT FROM PUBLISHER]

This paper investigates young women's alcohol consumption in the United Kingdom within a widespread culture of intoxication in relation to recent debates about postfeminism and contemporary femininity. Young women are faced with an 'impossible dilemma,' arising from the contradiction between a hedonistic discourse of alcohol consumption and postfeminist discourse around attaining and maintaining the 'right' form of hypersexual heterosexual femininity. Drawing on a recent interview study with 24 young white working-class and middle-class women in the South-West of England, we explore how young women inhabit the dilemmas of contemporary femininity in youth drinking cultures, striving to achieve the 'right' form of hypersexual femininity and an 'optimum' level of drunkenness. [ABSTRACT FROM AUTHOR]

Adjustments to working arrangements and the working environment have enabled organisations to recruit and retain valuable staff and helped disabled individuals to work and progress in their careers. The qualitative study reported in this paper indicates that generally good adjustments-related practice across 33 British local authorities was beginning to deteriorate under the impact of government spending cuts; and was at further risk from the dismantling of legal protections. The findings have implications for local authorities, but also for national policy-makers and those wishing to influence them. [ABSTRACT FROM AUTHOR]

Moving to a new country is often seen as a disturbing event in sojourners' lives. Several models of adjustment postulate that the first phase of the sojourn is either categorised by euphoria or anxiety. Using a case study of three Indian Postgraduate students, this paper investigates whether the beginning phase of these sojourners was euphoric or anxious in nature. The findings revealed that they had varied experiences and even mixed experiences that were both pleasant and/or unpleasant which were in turn determined by their individual differences and personal experiences. Another salient finding of this study was that the psychological side of the sojourn starts much before the students have even first set foot in the UK. This could serve as a basis for further research and to conceptualise a model of cultural adjustment that takes into account the impact of the pre-arrival phase on the overall sojourn experience. [ABSTRACT FROM PUBLISHER]

Background: Having access to information and communication technologies (ICTs) is a prerequisite to meaningful participation in society. Objectives: This paper seeks to: i. explore the engagement of homeless drug users (HDUs) with ICTs and ii. discuss the findings with reference to recovery from drug dependence. Methods: The study design was qualitative and longitudinal, involving data collected in 2012-13 via 52 semi-structured interviews with 30 homeless drug users (25 men; five women). Participants were recruited from 17 hostels in two English cities. Interview data were analyzed using Framework. Results: HDUs had access to ICTs, used ICTs, and wanted to engage with them more. Experiences of digital exclusion were a function of participants' inability to afford ICTs, the relatively cheap and poor quality technology available to them, limited knowledge about ICTs, and lack of support in using them. That HDUs were often unable to take full advantage of technology because they had nobody to explain what their devices could do or to show them how they worked was ironic given that using ICTs to (re)establish and maintain relationships were functions of technology that HDUs particularly liked. Conclusions: The physical, human, cultural, and social capital of HDUs influenced their access to, and use of, ICTs. Equally, ICTs were themselves an important recovery resource. Services and others should endeavor to provide HDUs with easy access to good quality technology, as well as offers of support and education so that all individuals have the knowledge and confidence to make optimum use of the technology that is available to them. [ABSTRACT FROM AUTHOR]

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