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Purpose – The ongoing integration of health and social care in Scotland presents both challenges and opportunities. The purpose of this paper is to consider emerging enablers and barriers to integration by focusing on the views of senior stakeholders. Design/methodology/approach – This paper presented an opportunity to gain an insight into the integration movement by considering the views of key stakeholders within Scottish Local Authorities, NHS Boards and other relevant stakeholders. These insights, were collected through a combination of interviews and questionnaires. Findings – This paper highlights a number of factors key to the success of the integration agenda. These include: governing terms and conditions of existing staff; engagement of clinical and professional leads; and synthesising joint outcomes in locality planning. Acts of transformational change such as integration place particular demands upon those in leadership positions. This paper identifies key leadership strengths pivotal to driving forward change, such as effective performance management and influencing skills. Originality/value – This is one of a small number of papers addressing the scale and scope of efforts to integrate health and social care within Scotland. Integration between health services and social care continues to be a priority of the Scottish Government. [ABSTRACT FROM AUTHOR]

Schizophrenia is a global concern, and, this paper, describes the caring roles of health professionals who are mothers of adult children with schizophrenia. A thematic analysis of data from a doctoral study identified a blending of expertise into an informed care model. Caring roles included: constant carer; coordinator carer; watchful bystander carer; and life coach carer. Previous research has not explored these dual roles. This paper elucidates their responsive approaches and contributions to mothering and caregiving roles. Informed by a fusion of professional and mothering knowledges, their insights into mental health care have been forged by their experiences and is an untapped resource. [ABSTRACT FROM AUTHOR]

This paper evaluates the use of self-curated photo elicitation as a new method for exploring self-identity by reflecting on its design and use in a study of Scottish identity. The approach builds on the work of others in the fields of visual analysis and interpretative phenomenological analysis (IPA). Participants were style influencers who were asked to select and discuss a sample of their own Instagram posts that they felt represented their Scottish identity. The approach enabled deep and meaningful engagement with research participants and encouraged further revelations through asking them to reflect on how they went about choosing their posts. Participants spoke passionately and at length about the story behind these and began to understand more about themselves in doing so. Recommendations are made as to how self-curated photo elicitation could be used in future. It is proposed that this method is particularly adaptable to IPA research and studies of self-identity. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to understand the perspectives of frontline health and social care professionals in relation to delays in discharge from community hospitals.Design/methodology/approach A qualitative approach was taken, using semi-structured interviews and non-participant observation, within three community hospitals in NHS Scotland. In total, 12 frontline health and social care professionals were interviewed and observation of the multi-disciplinary team meeting was completed. Thematic content analysis was used to analyse the data produced.Findings The key findings were delayed discharge as an issue, lack of resources and capacity, difficulties in the relationship between acute and community health staff, silo working between health and social care, conflicting pressures on staff, and influence over services and external factors. There were perceived different ways of working within acute health, community health and social work, which were suggested to reduce efficiency, cause tension and ultimately result in delays. All professionals perceived an inability to influence any of the factors causing delays in discharge.Practical implications The internal issues regarding inter-professional working could potentially damage integration, indicating a need to teach collaborative team skills as well as quality improvement training to support staff to challenge and change current ways of working.Originality/value The paper contributes to the evidence base of community hospitals. There are implications for both health and social care policy. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore the impact of implementing an electronic health record system on staff at a Scottish hospice. Background Electronic health records are broadly considered preferable to paper-based systems. However, changing from one system to the other is difficult. This study analysed the impact of this change in a Scottish hospice. Design Naturalistic prospective repeated-measures mixed-methods approach. Methods Data on the usability of the system, staff engagement and staff experience were obtained at four time points spanning 30 months from inception. Quantitative data were obtained from surveys, and qualitative from concurrent analysis of free-text comments and focus group. Participants were all 150 employees of a single hospice in Scotland. Results Both system usability and staff engagement scores decreased for the first two years before recovering at 30 months. Staff experience data pointed to two main challenges: (1) Technical issues, with subthemes of accessibility and usability. (2) Cultural issues, with subthemes of time, teamwork, care provision and perception of change. Conclusions It took 30 months for system usability and staff engagement scores to rise, after falling significantly for the first two years. The unintended outcomes of implementation included challenges to the way the patient story was both recorded and communicated. Nevertheless, this process of change was found to be consistent with the 'J-curve' theory of organisational change, and as such, it is both predictable and manageable for other organisations. Relevance to clinical practice It is known that implementing an electronic health record system is complex. This paper puts parameters on this complexity by defining both the nature of the complexity ('J' curve) and the time taken for the organisation to begin recovery from the challenges (two years). Understanding these parameters will help health organisations across the world plan more strategically. [ABSTRACT FROM AUTHOR]

Purpose: The Public Bodies (Joint Working) (Scotland) Act 2014 set the framework for the integration of adult health and social care services. Teams, organisations and sectors are now required to work in partnership and interdependently to deliver shared outcomes for the people they serve. The purpose of this paper is to explore any features, practices and behaviours that could influence effective partnership working across sectors. Design/methodology/approach: A questionnaire was designed and distributed to a range of stakeholders working in health, social care and the third sector. With reference to the changing health and social care reform agenda, the aims of the survey were to gather views, experiences and perceptions of working across sectors, and any workforce development needs. Findings: The majority of respondents were from the NHS (80.3 per cent, 118/147), and experiences were largely drawn from those working with the third sector. The utility of working with the third sector was positively highlighted; however, there were limited opportunities to fully engage. Whilst formal education and training was welcomed, workforce development needs were mostly related to fostering relationships and building mutual trust. Originality/value: This paper highlights views, perceptions, enablers and barriers to integrated care in Scotland. Whilst the Scottish integration landscape is currently not fully fledged, insights into prevailing attitudes towards integrated care, by a cohort of the Scottish health and care workforce, are offered. In particular, reflections by the NHS workforce to working with third sector services are discussed. [ABSTRACT FROM AUTHOR]

Scotland is faced with pernicious health inequalities, which stem from inequalities in living conditions and the societal structures that create them. While action is needed to address the wider structural causes of health inequalities, the role of general practitioners (GPs) merits attention due to health care's potential to mitigate or exacerbate health inequalities. Minimal research, however, has explored how GPs understand the fundamental causes of health inequalities nor how they conceptualise their role in mitigating these. This paper aims to fill this gap using in-depth qualitative interviews with 24 GPs working in some of Scotland's most socio-economically disadvantaged, urban areas. Using Raphael's SDH discourse framework, this paper found clear linkages between GPs' perceptions of their patients, how they defined the 'problem' of health inequalities, and what they thought could be done to tackle them in disadvantaged areas. In general, there was convergence on how interviewees viewed their role in mitigating health inequalities through their work with individual patients. However, greater variation was found when describing the boundaries of their role and how far these extended beyond individual encounters. Specifically, only those GPs fluent in discussing structural causes of health inequalities discussed obligations to change local systems via strengthening community linkages and to influence higher level policies related to the SDH. This suggests that while there is a degree of what Metzl and Hansen deem 'structural competency' amongst some GPs working in disadvantaged areas, the scope remains to deepen this competency more broadly. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to identify barriers for people with psychotic spectrum disorders accessing CBTp in NHS Lothian. Despite national guidelines recommending CBT for the treatment of schizophrenia (National Institute for Health and Care Excellence Guidelines 2014) and (Scottish Intercollegiate Guidelines Network Guidelines 2013), levels of access to CBTp remain low. The overall goal of the study is to uncover emergent themes regarding barriers to access to CBT for patients with psychosis. In addition, the influence of psychosocial skills intervention (PSI) training for psychosis (Brooker and Brabban, 2006) will be explored and if completion of this training effects referral behaviours and attitudes to CBTp.Design/methodology/approach This study is a quantitative service evaluation project which uses a questionnaire design to explore the factors that influence a clinician's decision to refer a patient for CBTp. Three qualitative questions are included for thematic analysis to allow the respondents to elaborate on their views on potential barriers. All appropriate Community Mental Health Team (CMHT) staff in adult mental health in NHS Lothian were invited to participate in the study.Findings CMHT staff in NHS Lothian hold favourable views of CBTp and would support an increase in access for patients with psychosis. Key barriers to access for CBTp identified in this study comprise of, little or no access to CBTp, lack of integration of services and unclear referral pathways. Further themes emerging from the study also included, improving multi-disciplinary communication and increasing CMHT staff knowledge and confidence in CBTp. PSI training was shown to have a significant effect on referral rates. Further research would be warranted to explore the influence of PSI training on CMHT staff confidence and knowledge in CBTp.Originality/value This is the first paper of its kind to investigate the potential barriers to access to CBTp in Scotland. The paper has highlighted some key barriers and potential strategies to overcome the barriers identified will be discussed. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Nurses in mental health inpatient settings use a range of methods to try and help service users who self‐harmHarm‐reduction approaches are intended to help service users reduce the impact of their self‐harm rather than simply to prevent them self‐harmingHarm‐reduction techniques might be helpful for people who cut themselves because there are some clear ways harm can be minimized such as providing advice about cuttingNo one has previously tried to measure whether harm‐reduction techniques are more or less acceptable to mental health practitioners and service users than traditional methods. What the paper adds to existing knowledge?: The paper describes the development of the Attitudes to Self‐cutting Management scale. It met the criteria required of a good measurement tool.Each method of managing self‐cutting has a unique acceptability profileHarm‐reduction methods like advising on wound care and providing a first aid kit are endorsed by nurses and former service usersNurses providing sterile razors or remaining present during self‐cutting attract more divergent opinions but are preferred to seclusion and restraint. What are the implications for practice?: Nurses should talk through the approaches to management with service users and agree which techniques are preferred. Introduction: Harm‐reduction approaches for self‐harm in mental health settings have been under‐researched. Aim: To develop a measure of the acceptability of management approaches for self‐cutting in mental health inpatient settings. Methods: Stage one: scale items were generated from relevant literature and staff/service user consultation. Stage two: A cross‐sectional survey and statistical methods from classical test theory informed scale development. Results/Findings: At stage one, N = 27 staff and service users participated. At stage two, N = 215 people (n = 175 current mental health practitioners and n = 40 people with experience of self‐cutting as a UK mental health inpatient) completed surveys. Principal components analysis revealed a simple factor structure such that each method had a unique acceptability profile. Reliability, construct validity and internal consistency were acceptable. The harm‐reduction approaches "advising on wound care" and "providing a first aid kit" were broadly endorsed; "providing sterile razors" and "maintaining a supportive nursing presence during cutting" were less acceptable but more so than seclusion and restraint. Discussion: The Attitudes to Self‐cutting Management scale is a reliable and valid measure that could inform service design and development. Implications for practice: Nurses should discuss different options for management of self‐cutting with service users. Harm‐reduction approaches may be more acceptable than coercive measures. [ABSTRACT FROM AUTHOR]

The Mellow Futures programme is a specially adapted parenting programme for mothers with learning difficulties that combines group work with home‐based support. This paper reports on the findings of prospective and retrospective interviews with professionals who had referred mothers to the programme in England or Scotland between 2013 and 2015. The aim was to explore their perceptions of the programme as a whole, and its impact on the mothers they had referred to it. Mothers attending the Mellow Futures programme were invited to consent for a key professional to be contacted as part of the evaluation, generally those social workers who had referred the mothers to the programme. The 'referrers' were interviewed at the start and end of the programme. Thirty referrers contributed their views on the impact of the programme. Twenty‐six were very positive about the impact of the Mellow Futures programme on the mothers: the programme was thought to have increased the mothers' confidence and self‐esteem; supported them to work through issues; and helped them strengthen their relationship‐building skills. Four referrers felt that the programme had not had any impact on the mothers they were supporting. The Mellow Futures programme focused on relationships, rather than parenting techniques, and three fundamentally important relationships in the mothers and babies' lives were targeted: the relationship/attachment between mother and baby; the supportive, ongoing relationships between the mothers in the group; and the mothers' more positive engagement with the professionals concerned with the welfare of their baby. The research confirms that, from the perspectives of referrers, linking group and home‐based support can successfully help mothers with learning difficulties to care for their children. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to reflect on five reasons why personalisation is so contested. It aims to highlight the shared themes that point to common ground between advocates and critics of personalisation. Design/methodology/approach – The paper draws on different academic and practitioner perspectives on personalisation, covering both advocates for and critics of the personalisation reforms. Findings – The paper concludes by suggesting that the development of self-directed support in Scotland has the potential to develop social care change in ways which may be palatable to both sides of the English policy debate. Originality/value – People who support and critique personalisation often write in ways which do not directly engage with the perspectives of the other side. Here the authors engage directly with the points of difference to explicate why such a diversity of perspectives exists, and how there is more common ground than might be assumed. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to report on the implementation of a physical activity (PA) scheme - Let's Motivate (LM) - within private care homes (CHs) in Dumfries and Galloway (D&G), Scotland; aiming to provide an insight into the different factors which might contribute to its success and further sustainability. Design/methodology/approach: A qualitative study is described in which one-to-one semi-structured interviews were carried out with eight key staff involved in implementing the project within two purposively sampled CHs; in order to explore their views and experiences of implementation. Findings: The paper provides an insight into the different factors which stand to both promote and impede the successful implementation of LM, within the two CHs involved. Originality/value: This paper explores a new and innovative PA initiative in CHs in D&G, Scotland. Studies exploring the factors which can both promote and impede implementation are important as they can help to usefully inform the implementation and sustainability of initiatives. [ABSTRACT FROM AUTHOR]

There is renewed interest in the place of direct work and relationship-based practice in social work. This paper explores the day-to-day direct work that happens where children and young people are 'looked after' at home, from the perspectives of children, social workers and those supervising practice. It is based on interviews with eight children and 25 professionals about their experiences. In this paper, I highlight that despite barriers, direct work, which is characterized as meaningful by children and professionals, happens and that the relationships formed between children and social workers are an important precursor to and an outcome of direct work. The research was undertaken in Scotland, and although the legislation, policy and guidance differ from other jurisdictions, the messages about direct work are relevant for practice in other countries. [ABSTRACT FROM AUTHOR]

Background: Two to 4% of emergency hospital admissions are caused by preventable adverse drug events. The estimated costs of such avoidable admissions in England were £530 million in 2015. The data-driven quality improvement in primary care (DQIP) intervention was designed to prompt review of patients vulnerable from currently prescribed non-steroidal anti-inflammatory drugs (NSAIDs) and anti-platelets and was found to be effective at reducing this prescribing. A process evaluation was conducted parallel to the trial, and this paper reports the analysis which aimed to explore response to the intervention delivered to clusters in relation to participants' perceptions about which intervention elements were active in changing their practice.Methods: Data generation was by in-depth interview with key staff exploring participant's perceptions of the intervention components. Analysis was iterative using the framework technique and drawing on normalisation process theory.Results: All the primary components of the intervention were perceived as active, but at different stages of implementation: financial incentives primarily supported recruitment; education motivated the GPs to initiate implementation; the informatics tool facilitated sustained implementation. Participants perceived the primary components as interdependent. Intervention subcomponents also varied in whether and when they were active. For example, run charts providing feedback of change in prescribing over time were ignored in the informatics tool, but were motivating in some practices in the regular e-mailed newsletter. The high-risk NSAID and anti-platelet prescribing targeted was accepted as important by all interviewees, and this shared understanding was a key wider context underlying intervention effectiveness.Conclusions: This was a novel use of process evaluation data which examined whether and how the individual intervention components were effective from the perspective of the professionals delivering changed care to patients. These findings are important for reproducibility and roll-out of the intervention.Trial Registration: ClinicalTrials.gov, NCT01425502 . [ABSTRACT FROM AUTHOR]

The authors of this paper discuss the use of participatory and visual research methods with older adults with daily care needs in the United Kingdom. The comments made by older adults and their caregivers in focus groups provided the narrative for this paper. The authors also discuss how to engage older adults in participatory research. Nursing research and practice both involve evaluating processes to gain a holistic understanding of patients through multiple means of data collection. In other words, how do nurses give voice to otherwise silent older adults, even in cases when their strength and recall is failing? [ABSTRACT FROM AUTHOR]

The global aging demographic is putting pressure on state-delivered health and social care services. As the austerity agenda in the UK cuts state-funded service provision for older people despite increasing demand, social enterprise has become a politically and economically attractive model for the sustainable delivery of some public services. Yet little is known about the impact of social enterprise on the health and wellbeing of older people. In this paper we address this gap in understanding and consider social enterprise activities as complex public health-promoting interventions. Our study aimed to understand what impact social enterprise activities had on the health and wellbeing of participants aged over 50, and also how that impact was created. To achieve this, we conducted qualitative semi-structured interviews with a sample (n = 43) of staff, volunteers, clients and carers aged over 50 who were involved in activities delivered by three social enterprises. Using a thematic analysis to explore manifest and latent themes, two antecedents of subjective younger age emerged explaining how benefit was created, namely downward social comparison and identity. The social enterprise activities we studied benefited participants' health and wellbeing, impacting positively on participants' sense of purpose, social support, connectedness and inclusion. These health and wellbeing benefits can be considered as outcomes of complex public health interventions for older people, and we relate these outcomes to beneficial conditions within the intermediary social determinants of health. We conclude by discussing the future impact of social enterprise activities and current UK policy on the structural determinants of health. [ABSTRACT FROM AUTHOR]

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The professional status of UK healthcare chaplains remains partial, with voluntary accreditation effective in achieving around 50% registration. This study set out to elicit reasons for this by surveying healthcare chaplains working in Scotland. An online survey was created to gather demographic details and chaplains' opinions on the importance of five key elements of professional status: A body of knowledge that underpins practice; A code of professional ethics; An occupational organization controlling the profession; Substantial intellectual and practical training; and Provision of a specialized skill or service. Most respondents (38/43) agreed that chaplains should belong to a professional body in order to maintain standards, ensure accountability and formalize professional development. They said that registration reinforced their professional status, added credibility and a clear governance structure to protect the public. However, a minority felt disconnected from the professionalization agenda. This paper discusses the reasons for this. Further UK and international studies into the professional status of chaplains are planned. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to explore implementation and development of step-down intermediate care (IC) in Glasgow City from the perspective of staff. Design/methodology/approach: The study used qualitative methods. Nine key members of staff were interviewed and three focus groups were run for social work, rehabilitation and care home staff. Framework analysis was used to identify common themes. Findings: The proposed benefits of IC were supported anecdotally by staff. Perceived enablers included: having a range of engaged stakeholders, strong leadership and a risk management system in place, good relationships, trust and communication between agencies, a discharge target, training of staff, changing perception of risk and risk aversion, the right infrastructure and staffing, an accommodation-based strategy for patients discharged from IC, the right context of political priorities, funding and ongoing adaptation of the model in discussion with frontline staff. Potential improvements included a common recording system shared across all agencies, improving transition of patients from hospital to IC, development of a tool for identifying suitable candidates for IC, overcoming placement issues on discharge from IC, ensuring appropriate rehabilitation facilities within IC units, attachment of social work staff to IC units and finding solutions to issues related to variation in health and social care systems between sectors and hospitals. Originality/value: The findings of this study help the ongoing refinement of the IC service. Some of the recommendations have already been implemented and will be of value to similar services being developed elsewhere. [ABSTRACT FROM AUTHOR]

Background: Preschool language and behavioural difficulties impact on multiple domains of the child's early life and can endure into adulthood, predicting poor educational, social, and health outcomes. Highlighting risk factors associated with poor outcomes following language and behavioural difficulties raised in early childhood may facilitate early identification and intervention. Methods: Data from the Growing Up in Scotland national birth cohort study were used. Language and behavioural difficulties were assessed at age 4 years using parent‐reported language concerns and the Strengths and Difficulties Questionnaire. Measures of adjustment were collated into four key outcome domains: attitude to school life, language and general development, behaviour, and general health at age 6 years. Both univariate and multivariate logistic regression models were fitted in order to explore independent associations between language and behavioural difficulties at age 4 years and adjustment to life circumstances at age 6 years, whilst controlling for other risk factors. Results: Language difficulties at age 4 years increased the odds of the child experiencing difficulty with language and general development, poorer health outcomes, and behavioural difficulties at age 6 years. Behavioural difficulties alone at age 4 years were associated with increased odds of the child experiencing all of the aforementioned outcomes and difficulties in early school life. Lone parent family, low income, and male gender were identified as risk factors for poorer outcomes in the domains measured. At age 4 years, there was no additive effect found with the presence of behaviour difficulties on the relationship between language difficulties and language and developmental outcomes at 6 years. Conclusions: This paper demonstrates language and behavioural difficulties are associated with poor social, educational, health, and behavioural outcomes. Taking seriously parent‐reported concerns and identifying risk factors could limit negative outcomes for the child, their family, and society. [ABSTRACT FROM AUTHOR]

This paper analyses how middle managers perform and experience their role in enacting policy in Scottish higher education institutions. The policy focus is the quality enhancement framework (QEF) for learning and teaching in higher education, which was launched in 2003. The data-set was collected between 2008 and 2010, during the evaluation of the QEF by means of focus groups with middle managers at nine Scottish institutions. The metaphor of a policy implementation staircase helps to situate middle managers’ position in enactment, and analyse their experience of the role. Despite the values of collegiality and ownership upheld by the QEF, middle managers’ accounts of their practices reveal that their position at the interface between university management and core academic activities continues to be a delicate one, marked by contradictory allegiances to institutional strategies and the concerns of academic colleagues. While emphasising middle managers’ pivotal role in the implementation of the QEF policy, the data paradoxically suggest that the systemic positioning of middle managers is more influential in shaping their role of mediation than the values of collegiality and ownership promoted by this enhancement approach to quality specific to Scotland. [ABSTRACT FROM PUBLISHER]

This paper presents findings from a qualitative study of a group of 12 teachers in primary special schools in Scotland for children with moderate learning difficulties. It sets out an analysis of classroom observations and interviews that explored teachers' knowledge and beliefs about teaching and learning in mathematics with children with moderate learning difficulties. The teachers were interviewed pre- and post-intervention; this was a research-based professional development programme in children's mathematical thinking ( Cognitively Guided Instruction) which teachers then developed in their classrooms. The findings showed that prior to the professional development, the teachers had a limited knowledge of children's mathematical development with teaching frequently informed by intuitive beliefs and dated and sometimes discredited practices. Most teachers had low expectations of children with learning difficulties. Post-intervention, the teachers reviewed this stance and affirmed that a deeper understanding of children's mathematical thinking provided a more secure knowledge base for instruction. They also recognised the extent to which learners were constrained by existing classroom practices. The paper argues for the commonality of this knowledge base and considers the problematic nature of viewing such knowledge as sector specific. [ABSTRACT FROM AUTHOR]

Purpose - To consider the power of psychological well-being, empathy and coping style in predicting staff attitudes towards young people in looked after accommodation, involved in or at risk of offending behaviour. The purpose of this paper is to understand more about staff attitudes which have a significant role in the care and rehabilitation of this client group. Design/methodology/approach - Psychological well-being, empathy and coping style are discussed in terms of their impact on attitudes towards young people. The predictive power of each factor is considered using multiple regression analysis of participants' responses on an adapted version of the Attitudes to Prisoners (ATP) scale, the General Health Questionnaire (GHQ), the Interpersonal Reactivity Index (IRI) and the Coping Styles Questionnaire (CSQ). Findings - Multiple regression analyses showed that empathic concern (affective empathy) was the only factor predictive of attitudes towards young people. The paper discusses the applied implications for employers, including the possibility of empathy training for staff members and highlights the need for further consideration of the factors impacting on staff attitudes. Practical implications - The outcome suggests that empathy may serve as a protective factor against the development of negative attitudes. This highlights the importance of fostering staff empathy and the possible use of empathy training. Originality/value - The research findings question the robustness of the relationships between staff psychological well-being, empathy, coping styles and attitudes towards their client group. The outcome suggests that empathy may serve as a protective factor against the development of negative attitudes. [ABSTRACT FROM AUTHOR]

Abstract: Health and social care integration has been a long‐term goal for successive governments in Scotland, culminating in the implementation of the recent Public Bodies (Joint Working) Scotland Act 2014. This laid down the foundations for the delegation of health and social care functions and resources to newly formed Integrated Joint Boards. It put in place demands for new ways of working and partnership planning. In this article, we explore the early implementation of this Act and how health and social care professionals and the third sector have begun to renegotiate their roles. The paper draws on new empirical data collated through focus groups and interviews with over 70 professionals from across Scotland. The data are explored through the following key themes: changing cultures, structural imbalance, governance and partnership and the role of individuals or “boundary spanners” in implementing change. We also draw on evidence from other international systems of care, which have implemented integration policies, documenting what works and what does not. We argue that under the current framework much of the potential for integration is not being fulfilled and that the evidence suggests that at this early stage of roll‐out, the structural and cultural policy changes that are required to enable this policy shift have not yet emerged. Rather, integration has been left to individual innovators or “boundary spanners” and these are acting as key drivers of change. Where change is occurring, this is happening despite the system. As it is currently structured, we argue that too much power is in the hands of health and despite the rhetoric of partnership working, there are real structural imbalances that need to be reconciled. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to assess unit manager perspectives on the introduction of a group-based trauma-specific programme delivered across Scotland’s secure estate. As this was the first time such an estate-wide initiative had occurred, it was important to identify the benefits/challenges at a strategic level.Design/methodology/approach An exploratory qualitative case study was utilised involving semi-structured interviews with five senior unit managers in three secure units to discover their perceptions of the benefits and challenges of implementing Teaching Recovery Techniques (TRT). A quasi-qualitative analysis was used to quantify and give meaning to manager responses. Inter-rater reliability of analysis was assessed.Findings Unit managers perceived gains in trauma-informed knowledge for themselves, and knowledge and skills gains for programme workers, care staff and adolescents. Challenges involved: managing a shift in paradigm to include a trauma-specific programme; the limiting context of competitive tendering; short duration placements; and the need for psychoeducation for staff, parents and agencies.Research limitations/implications Large sample sizes are likely to identify further issues for unit managers. Manager perceptions need directly compared with staff and adolescent perceptions and included in randomised control trials of trauma-specific programmes.Practical implications Managers perceived that TRT needed to be delivered within trauma-informed organisations and identified the need for manager training in traumatisation, trauma recovery and organisational implications to guide strategic planning. Managers emphasised the need for psychoeducation for families, staff and agencies.Originality/value The current study is the first in Scotland to explore unit manager experience of introducing a trauma-specific programme across the secure estate. [ABSTRACT FROM AUTHOR]

Smile4life is Scotland's national oral health improvement programme for people experiencing homelessness. Following an oral health and psychosocial needs assessment of 853 homeless people across Scotland, the Smile4life Intervention was developed and rolled out across all NHS boards. Dental health and health and social care practitioners were invited to attend a training event at the launch of the Smile4life: Guide for Trainers -- a training guide for practitioners working with homeless people. This paper presents results from HoPSCOTCH, a pilot study that took place in four NHS boards to examine the benefits of training for practitioners regarding their awareness of homelessness and the oral health needs of homeless people. Dental health (baseline: 10; follow-up: 8) and health and social care practitioners (baseline: 13; follow-up: 12) completed questionnaires about their knowledge, attitudes and behaviours. The results showed that there were increases in practitioner knowledge, confidence and motivation to help service users access dental care, to provide oral health education and to use motivational interviewing. The authors recommend that future training for practitioners who work with homeless people should include communication skills and advice on how to deliver tailored interventions, with the aim of strengthening practitioners' confidence and motivation to deliver the Smile4life intervention. [ABSTRACT FROM AUTHOR]

In the United Kingdom, undertaking continuing professional development (CPD) is required for revalidation with regulatory authorities for general practitioners, general practice nurses and registered pharmacy staff – pharmacists and pharmacy technicians. A survey of CPD preferences and activities of these four professions has been published and this paper focuses on one qualitative question in the survey: 'Please describe any changes that you anticipate in the way in which you will undertake CPD over the next 12 months.' Responses were analysed using content analysis, then codes and themes were developed into a coding framework. 1,159 respondents provided comments to the question and five themes were identified: options for learning, time, appraisal and revalidation, people in transition and use of technology. There was a desire for face-to-face courses, for interactive learning and for variety of learning methods. Respondents valued learning with others and Practice-Based Small Group Learning was considered to be flexible and promoted inter-professional learning and socialisation. Lack of time for learning was seen as a barrier for respondents. Respondents considered that CPD was needed to support them as their roles developed in primary healthcare. [ABSTRACT FROM AUTHOR]

This article explores children's understanding of the role that neighbourhood plays in their health and well-being. Whilst evidence exists on the relationship between the environment and children's health, we have little knowledge of this from the perspective of children themselves. Children's experiences are all too frequently researched through the eyes of adults. Following a Rights of the Child framework, respecting children's views and giving them due weight, this paper reports from a project that worked with children from two relatively deprived urban neighbourhoods in Scotland. Using this framework, the children themselves were the researchers who designed the themes, decided upon the methods, conducted the research and analysed the resulting data. Using focus groups, visual mapping and community walks the children explored their local neighbourhoods and the findings reveal features of the environment that the children perceive as important for their health and well-being. The children selected three themes to explore in the research: safety, littering, and family and friends, through which they elicit their experiences, feelings and attitudes towards the environment and their well-being. The paper reveals that not only do the children have a deep understanding of the link between environment and health, but that they also understand how aspects of disadvantage, including place-based stigma, can limit their social participation and inclusion in society. We conclude with recommendations made by the children themselves, ranging from access to affordable activities, improved open spaces, 'support not stigma' and the need to be heard in local decision making. • Children understand the relationship between neighbourhoods and health. • Three key themes were highlighted: safety, littering and family and friends. • Place-based stigma and exclusion may limit children's social participation. • The 'in place' experiences of children are important for health research. • Children can play a role in creating places to improve their health and well-being. [ABSTRACT FROM AUTHOR]

The comprehensive analysis of social identity cannot simply focus on individuals' cognitive self‐definition. Rather it should also theorize the social conditions that affect individuals' opportunities to act in terms of those self‐definitions. We argue that the social distancing interventions associated with Covid‐19 provide an opportunity to explore the significance of otherwise taken‐for‐granted social factors which routinely support and sustain individuals' identity enactments. Using qualitative data gathered with 20 members of the Scottish Muslim community (19 diary entries and 20 post‐diary interviews), we explore their experiences of restricted access to community‐relevant social spaces (e.g., mosques and prayer rooms). Our analysis shows that while these regulations could result in new opportunities for Muslims' religious identity enactments, they also impeded their abilities to act in terms of their religious identification. Addressing such impediments, we develop our understanding of the contextual factors that shape individuals' abilities to enact identity‐defining norms and values. [ABSTRACT FROM AUTHOR]

Globally, it is recognised that the fundamental causes of iniquitous health outcomes lie within unequal distributions of wealth and power. Internationally, however, policies and interventions persist in individualising the inequalities problem and targeting individual behaviours as the main solution. This approach has been argued to represent 'Fantasy Paradigms'. This paper explores one example of such 'Fantasy' intervention from the perspective of health practitioners. Further, it explores opportunities for deepening practitioner understandings of the socio-political determination of health. Data were collected through in-depth interviews with 47 professionals involved in delivering a social prescribing programme in poor areas of Glasgow, Scotland. Data were analysed thematically across and within transcripts. Narratives highlighted different explanatory types concerning how the intervention could tackle health inequalities including: firm commitment to individualised approaches; hopeful pessimism; the social-determinants-of-health as an unpoliticised and nondeterministic backdrop to poor health; and finally, incomplete understanding of the social gradient as a population concept. Disrupted narratives of the social determination of health were also evident. This paper contributes new insights to existing debates on health inequalities discourse. These are conceptually important and identify opportunities for sharpening practitioner understanding of the social determinants of health which could in turn contribute to better, non-stigmatising primary care. It argues that re-engaging communities of practice with what is meant by determination of health is necessary and that there is a need to de-couple the policy aim of reducing health inequalities from the delivery of structurally competent and equality-focused public services. • Why are individually-focused interventions thought to reduce health inequalities? • From our data, we identify believers, 'hopeful pessimists', and dissonant discourses. • Lifestyle-oriented understandings of health problems and their solutions prevail. • Important opportunities for deliberative dialogue and agenda-setting are identified. • Decoupling health inequalities policy from health mitigation of poverty is advocated. [ABSTRACT FROM AUTHOR]

Objective: To examine experiences of contraceptive care from the perspective of health professionals and women seeking abortion, in the contexts of hospital gynaecology departments and a specialist sexual and reproductive health centre (SRHC).Materials and Methods: We conducted in-depth semistructured interviews with 46 women who had received contraceptive care at the time of medical abortion (gestation ≤9weeks) from one SRHC and two hospital gynaecology-department-based abortion clinics in Scotland. We also interviewed 25 health professionals (nurses and doctors) involved in abortion and contraceptive care at the same research sites. We analysed interview data thematically using an approach informed by the Framework method, and comparison was made between the two clinical contexts.Results: Most women and health professionals felt that contraceptive counselling at abortion was acceptable and appropriate, if provided in a sensitive, nonjudgmental way. Participants framed contraceptive provision at abortion as significant primarily as a means of preventing subsequent unintended conceptions. Accounts of contraceptive decision making also presented tensions between the priorities of women and health professionals, around 'manoeuvring' women towards contraceptive uptake. Comparison between clinical contexts suggests that women's experiences may have been more positive in the SRHC setting.Conclusions: Whilst abortion may be a theoretically and practically convenient time to address contraception, it is by no means an easy time to do so and requires considerable effort and expertise to be managed effectively. Training for those providing contraceptive care at abortion should explicitly address potential conflicts between the priorities of health professionals and women seeking abortion.Implications: This paper offers unique insight into the detail of women and health professionals' experiences of addressing contraception at the time of medical abortion. The comparison between hospital and community SRHC contexts highlights best practise and areas for improvement relevant to a range of settings. [ABSTRACT FROM AUTHOR]

This research examines the tensions experienced by millennials between their desire to purchase fast‐fashion and their growing concern for sustainability. The ethical and sustainable consumption literature has long recognised this misalignment of value, often referred to as an attitude‐behaviour gap. While previous research has explored the reasons behind the attitude‐behaviour gap and the rationales constructed by consumers to alleviate any associated tensions between mismatched values, this has not been framed within Festinger's Theory of Cognitive Dissonance, particularly for fashion acquisition. This seems somewhat remiss, especially given that Festinger's Theory of Cognitive Dissonance has been successfully applied in other consumption contexts and has offered commercial and social marketing opportunities for marketing activity development. The research utilises Festinger's Theory of Cognitive Dissonance on qualitative data collected from 38 millennial participants living in Scotland. Adopting an interpretive approach, a semi‐structured interview template was administered online and data were analysed thematically, revealing that an infusion of eco‐fashion awareness was filtering into millennials' consciousness. While the millennials reported feelings of cognitive dissonance when purchasing fast‐fashion such as 'irritation' and 'guilt', unlike previous research, here they did not attempt to justify their behaviour in order to resolve their feelings of dissonance. Rather, the participants perceived this as an opportunity to reaffirm their preferences for sustainability for future consumption practice. Limitations include the small sample; nevertheless, the data contribute to the overall understanding of millennial eco‐fashion consumption, the attitude‐behaviour gap and the occurrence and resolutions of cognitive dissonance. [ABSTRACT FROM AUTHOR]

Research has highlighted the significance of the family and community in minority language revitalisation, whilst raising concern for efforts solely focused at the school level. This article draws upon research with children in Gaelic Medium Education, in Scotland, to explore their experiences and perceptions of their language use. The findings illustrate the dominance of English language across multiple aspects of children's lives and highlight the opportunities/threats of recent revitalisation efforts to push the bilingual benefits of language learning. The findings suggest the need for a more considered approach, such as translanguaging pedagogies, in order to effectively revitalise Gaelic language. [ABSTRACT FROM AUTHOR]

This essay explores a hitherto unsuspected intellectual relationship among three important thinkers of the Scottish Enlightenment. The great philosopher and economist Adam Smith is known to have had a conception of instrumental music exceptional for his time in its foreshadowing of ideas generally associated with Eduard Hanslick. As I show here, Smith's views were decisively influenced by the psychological theories of his countryman Thomas Reid in all likelihood by way of the extraordinary proto-cognitivist music theory of their contemporary John Holden, in particular the latter's conceptualization of the faculty of attention. The innovative contributions of these writers constitute a compact and suggestive case study in the circulation of ideas about perception and listening between philosophy and music, and suggest that the Scottish Enlightenment attitude to psychology enabled a new kind of theorizing about the musical experience: one that foregrounded the importance of the faculty of attention in the process of perceiving music and sound. [ABSTRACT FROM AUTHOR]

Background A comprehensive smokefree prison policy (SFPP) was introduced in Scottish prisons from November 2018, reflecting concern about inequalities in occupational exposures to second-hand smoke (SHS) and tobacco-related harms among people in custody (PiC). We aimed to address a gap, whereby few studies have sought to understand SFPP from the perspectives of people living and working in prisons. Methods As part of a comprehensive evaluation, focus groups and interviews with staff (n = 99) and interviews with PiC (n = 23) were conducted 6–9 months post-implementation of SFPP in Scotland. Data were analysed using the framework approach. Results Our study found that new restrictions on smoking had been widely accepted by PiC, after a period of adjustment which was less troublesome than participants had anticipated. Benefits of the SFPP for the safety and comfort of staff and PiC who were no longer exposed to SHS, and additionally for the health of PiC who were now smoking-abstinent, were widely acknowledged. Drawbacks of the SFPP, such as difficulties managing without tobacco and use of alternatives (e.g. e-cigarettes and changes in use of illegal drugs), were also reported. Contraband tobacco was not reported to be a major problem following prisons becoming smokefree. Conclusions The findings strengthen evidence that SFPPs can be implemented without causing major disruption and highlight the need for removal of tobacco to be underpinned by careful planning, partnership working and ensuring the availability of support for smokers. Experiences from Scotland may be of interest and some comfort, internationally for jurisdictions considering smoke-free rules in prisons. [ABSTRACT FROM AUTHOR]

This article explores the link between populism and governance arrangements. Adopting a comparative approach between the West Midlands and Scotland, it utilises novel primary qualitative data alongside official results and demographic statistics. Paying particular attention to the perspectives of remain-voters in "left behind" areas and how they perceive their Leave-voting counterparts, the article finds that despite divergent voting patterns both groups perceived a problematic lack of (regional) political agency. Economic disparities and subnational governance arrangements appear important in explaining discontent in those parts of the UK that have been "left behind" by globalisation. Meaningful devolution will be key in addressing these grievances. [ABSTRACT FROM AUTHOR]

Much has been written over the past thirty years within the international social work literature on Family Group Conferencing as a process of decision making. Yet, the theories that frame our understanding of how Family Group Conferencing contributes towards family outcomes are less distinct. This article makes an original contribution to this literature by proposing the use of recognition theory as a beneficial lens for understanding the Family Group Conferencing process. The recognition theory contends that social relations acknowledge and validate personal existence and are pivotal to identify formation; a just society is therefore one where everyone gets due recognition. A retrospective qualitative study will be used to exemplify how Family Group Conferencing can create the conditions within which participants can experience different forms of recognition: care; respect; solidarity and, as such, experience a level of social justice (or not). It is argued that recognition within the Family Group Conferencing process can influence the identity and relationships of those involved in social work services. This article has significance beyond those with an interest in Family Group Conferencing as the recognition theory can shed light on the nature of relationships in social work practice more generally. [ABSTRACT FROM AUTHOR]

Background: The introduction of screening in the UK and other high‐income countries led to a significant decrease in the incidence of cervical cancer and increase in survival rates. Minority ethnic groups are often underrepresented in screening participation for reasons that are poorly understood. Objective: To explore experiences of cervical screening participation and non‐participation of women from minority ethnic populations in Scotland and gain insights to support the development of interventions that could potentially support screening participation and thereby reduce inequalities. Design: Qualitative comparison group study using in‐depth, semi‐structured individual interviews that were thematically analysed. Setting and participants: This study took place in Scotland. Fifty women were purposively sampled from four ethnic minority groups: South Asian; East European; Chinese; and Black African or Caribbean. White Scottish women were also interviewed. Results: Many experiences described were common regardless of ethnicity, such as difficulties managing competing priorities, including work and care responsibilities. However, important differences existed across the groups. These included going abroad for more frequent screening, delayed introduction to screening and not accessing primary care services, language difficulties in health‐care settings despite proficiency in English and not being sexually active at screening commencement. Experiences of racism, ignorance and feeling shamed were also reported. Conclusions: Key differences exist in the experience of minority ethnic groups in Scotland. These offer potential opportunities to reduce disparity and support screening participation including maximizing co‐incidental interactions and developing outreach work. [ABSTRACT FROM AUTHOR]

This study investigates how adolescents begin to demonstrate skills and approaches that help them pursue their aspirations. The qualitative study examined emergent forms of key indicators of adolescent thriving: the 5Cs of positive youth development and sense of purpose. Pre- and post-program interviews with 24 S2 (~seventh grade) Scottish adolescents who participated in a school-based character program explored the presence, absence, and elucidations of each of the 5Cs as well as their conceptualizations of a sense of purpose. Findings showed great variability within the sample, despite participants' similarities in age, race, ethnicity, and socioeconomic status. This work informs future study and measurement of potentially nascent forms of the 5Cs and purpose among early adolescents. [ABSTRACT FROM AUTHOR]

Objective: Few teenagers and young adults (TYA) with cancer participate in clinical trials. Lack of opportunity has been identified as a major barrier. We canvassed health professionals' views on how TYA's access to trials might be improved. Methods: We interviewed 35 professionals with responsibility for delivering or facilitating cancer care and/or clinical trials. We analysed data using a qualitative descriptive approach. Results: Interviewees viewed improving TYA's access to trials as challenging, but possible. They reframed the problem as one of rare disease and surmised that modifying the organisation, administration and resourcing of research (and care) might expand opportunities for both TYA and other patients with low volume conditions. Proposals coalesced around four themes: consolidating the pool of patients; streamlining bureaucratic requirements; investing in the research workforce; and promoting pragmatism in trial design. Conclusion: Accounts suggest there is scope to improve access to trials by TYA with cancer and other patients with rare diseases. Though re‐configuring care, research and resource frameworks would present substantial challenges, doing nothing would also have costs. Change will require the support of a range of stakeholders, and agreement as to the best way forward. Further work, such as priority setting exercises, may be necessary to reach a consensus. [ABSTRACT FROM AUTHOR]

The use of alcohol and other drugs during pregnancy is understood to be an important public health problem. One way in which this problem is expressed and responded to is via the identification and treatment of neonatal abstinence syndrome (NAS). In this article, we demonstrate how the processes of anticipating, identifying and responding to NAS are characterised by significant uncertainty among parents and health and social care practitioners. We draw on interviews with 16 parents who had recently had a baby at risk of NAS, and multidisciplinary focus groups with 27 health and social care professionals, held in Scotland, UK. NAS, and drug use in pregnancy, is a fraught and complex arena. Parents in the UK who use opioids risk losing custody of children, and must navigate a high degree of surveillance, governance and marginalisation. We suggest that considering NAS as a social diagnosis, further informed by Mol's political ontology of 'multiple' bodies/diseases, may help to produce clinical and social responses to uncertainty which avoid, rather than promote, further marginalisation of parents who use drugs. One such response is to develop a culture of relationship‐based care which empowers both service providers and service users to challenge existing practice and decision‐making. [ABSTRACT FROM AUTHOR]

We explored the potential of asthma apps to support self-management and identified preferred features that enable users to live with asthma. We recruited patients from five UK practices and social media; observed their usage of our app, administered a questionnaire and interviewed a purposive sample of patients and professionals to explore preferred features. Thematic analysis of interview was synthesised with quantitative data. A total of 111 patients used our app for 3 months. We interviewed 15 patients and 16 professionals. Participants were interested in a broad range of self-management support strategies, including action plans, monitoring with feedback, allergy/weather warnings and tailor-made running coaching. Professionals wanted to integrate patients' logs with practice records, though were concerned about data overload and risk of patient dependency. We propose a paradigm shift - from apps developed to provide features that are easy to implement technologically, to an approach in which apps are designed to deliver theoretically grounded preferred components. [ABSTRACT FROM AUTHOR]

Background: Person-centred practice is inherently integrated in palliative care. However, it cannot be assumed that its underpinning values are lived out in day-to-day practice in a hospice. At St Columba's Hospice, Edinburgh, the five-year strategy demonstrated commitment to person-centredness and this prompted an 18-month project focusing on the evaluation and development of a person-centred culture, taking a practice development approach. Aim: To implement a person-centred practice development research project to assess, evaluate and enhance person-centred culture within St Columba's Hospice. Methods: The theoretical underpinnings of the programme were based on the Person-centred Practice Framework. A transformative practice development approach was employed to bring about change in individuals and teams. Twelve multidisciplinary team members from different departments across the hospice formed a core research project group, which was allocated 10 protected learning and development days over the 18-month period. To assess the existing culture, data were collected at the beginning of the practice development programme, including observation in practice and real-time interviews with patients and staff. The data were analysed using a participatory approach, with group members mapping the data collected against the Person-centred Practice Framework and undertaking creative hermeneutic analysis. Discussion: The project created and sustained a space to explore and expose person-centredness within the hospice and raised awareness of what person-centred culture means in day-to-day practice. Fourth-generation evaluation highlighted further areas for action, with teams developing their own action plans aimed at enhancing person-centred culture. Conclusion and implications for practice: The context of day-to-day practice in a hospice setting is complex, and developing person-centred culture is an ongoing process. Hospices can help their staff to flourish by providing the necessary space to reflect and for critical awareness of own practices to be heightened. This could encourage staff to embrace the contradictions inherent in the work they undertake and to learn from it in order to improve their own wellbeing. [ABSTRACT FROM AUTHOR]

In the month approaching the 2014 Scottish Independence referendum, we tested the Identity‐Deprivation‐Efficacy‐Action‐Subjective Well‐Being model using an electorally representative survey of Scottish adults (N = 1,156) to predict voting for independence and subjective well‐being. Based on social identity theory, we hypothesized for voting intention that the effects of collective relative deprivation, group identification, and collective efficacy, but not personal relative deprivation (PRD), should be fully mediated by social change ideology. Well‐being was predicted to be associated with PRD (negatively) and group identification (positively and, indirectly, negatively). Unaffected by demographic variables and differences in political interest, nested structural equation model tests supported the model, accounting for 82% of the variance in voting intention and 31% of the variance in subjective well‐being. However, effects involving efficacy depended on its temporal framing. We consider different ways that social identification can simultaneously enhance and diminish well‐being and we discuss ramifications of the model for collective mobilization and separatist nationalism. Findings also suggest new directions for research on social identity, collective efficacy, and collective action. [ABSTRACT FROM AUTHOR]

In the late nineteenth century, Margaret Isabella Balfour Stevenson (1829–1897) accompanied her son Robert Louis Stevenson on his voyage in the South Seas and eventually settled with him and his family in Sāmoa. Two volumes of the letters she addressed to her sister during this period were published posthumously: From Saranac to the Marquesas and beyond; [...] 1887–88 (1903) and Letters from Samoa, 1891–1895 (1906). These epistolary travel accounts form part of the layered textual network created around Robert Louis Stevenson's time in Polynesia. While reflecting the attitudes and beliefs of the Scottish woman far from home, Margaret Stevenson's accounts provide us with a more personal impression of the Pacific Islands. Like the rest of the household, Margaret Stevenson is on the whole a curious and well-intentioned participant in the cross-cultural dialogue in which she engages. Ideas of Scotland and Scottish selfhood are also discernible in her journal letters. [ABSTRACT FROM AUTHOR]

Trafficked people require timely and ongoing access to healthcare services. Yet, many encounter difficulties accessing and utilising healthcare services, both while in situations of exploitation and after their escape. This research investigated barriers that hinder healthcare providers from identifying, providing care and making necessary referrals for trafficked people in the United Kingdom (UK). Semi‐structured, face‐to‐face interviews were conducted with healthcare (n = 23) and non‐health (n = 27) professionals with relevant policy or practical experience related to human trafficking in the UK. Topic guides covered identifying, referring and providing care to trafficked people. Transcripts were analysed using thematic analysis. Four interconnected themes emerged: trafficked persons' entitlements to healthcare, availability of healthcare resources, providers' knowledge about trafficking, and the particular needs of trafficked individuals. Providers explained that policies limiting entitlements to healthcare created significant obstacles to care, as did the inadequate resourcing of interpreter services, trafficking support services, and specialist mental health services. Few healthcare professionals reported having received training on responses to trafficked people and most were unaware of support options and referral routes. Healthcare professionals will be better equipped to serve trafficked individuals if they are provided training to identify and respond to human trafficking, guidance on referral and support options and entitlements to care. Simultaneously, improving trafficked people's healthcare access and use will also require government interventions to ensure they are not unjustifiably denied healthcare. [ABSTRACT FROM AUTHOR]

Background The aim of this study was to assess the prevalence of urinary incontinence in fitness instructors, experience of teaching pelvic floor muscle exercises (PFME), and attitudes to incorporating such exercises into classes. Method An online survey was undertaken of fitness instructors working in Scotland based on the Urinary Incontinence Short Form (ICIQ-UI). Results The survey was at least partially completed by 106, of whom 73.6% (53/72) were female and 52.8% (38/72) were in the 35–54 years age group. Prevalence of UI was 28.2% (24/85), and severity based on ICIQ-UI scores was 'slight' 65.2% (15/23), or 'moderate' in 26.1% (6/23). Leakage of urine was associated with physical activity in 36% (9/25), of whom 31.8% (7/22) had not taken actions to reduce the impact, and 86.4% (19/22) had not sought professional advice or treatment. There was widespread willingness to incorporate PFME into classes if given appropriate training 86.1% (62/72), and 67.1% (49/73) would be happy to recommend a PFME app. Conclusion A significant proportion of fitness instructors are in need of PFME and those who perform PFME do so at a level below that which is recommended. However, many have had some training on PFME or are willing to provide this. [ABSTRACT FROM AUTHOR]

Poverty can have a detrimental impact on the emotional well-being, educational attainment and future life chances of children and young people (CYP). It is known that poverty can also create several barriers to CYP and families accessing services. Furthermore, structural factors such as spending cuts on public services mean that professionals working with people affected by poverty have to ‘do more with less’. Practitioners could fail to acknowledge the impact of poverty if they have little cultural experience of poverty through their professional discourses and training. This could create a social distance between service-users and practitioners, as well as a misalignment of priorities, which could lead to inappropriate interventions being offered and opportunities missed to tackle the impact of poverty. This study gathered the views of 10 Art Therapists working in areas of multiple deprivation as determined by the Scottish Index of Multiple Deprivation (SIMD) in West Central Scotland. The aim was to examine practitioner’s perspectives on poverty and what they notice about its exploration by CYP in art therapy sessions. The study also considered if art therapists working in areas of multiple deprivation adapted their practice to create a contextualised and flexible service that would address the practical as well as the emotional impact of poverty. Data was collected through semi-structured interviews and analysed using thematic analysis. Whilst most participants showed an awareness of the difficulties faced by CYP affected by poverty, there was evidence that there were numerous cultural barriers meaning the indicators of poverty could be missed by some practitioners. Despite this, participants were clear on the various ways poverty is explored in sessions by CYP. Some art therapists adapted their practice on occasions to address the practical impact of poverty. However, several art therapists faced structural barriers to being able to tackle poverty. Therefore, the data suggests that cultural and structural barriers made it difficult for practitioners working in areas of multiple deprivation to consistently adapt their practice to create a contextualised and flexible service that fully addresses the emotional and the practical impact of poverty. [ABSTRACT FROM AUTHOR]

In residential child care, physical restraint continues to be a contentious and high-risk intervention with potential for physical and psychological harm to all involved. Its relationship to catharsis is poorly understood and rarely addressed in policy, practice and literature. Indeed, there is a paucity of application of catharsis theory to residential child care (or social work generally). This article redresses this gap by presenting findings of a large-scale, qualitative study of children, young people and practitioners' experiences of physical restraint and analysing them through lenses of catharsis and containment theories. It offers evidence of cathartic expression in situations involving restraint, as well as a potential relationship between ongoing, repeated restraints and a drive for catharsis. It is argued that catharsis theory, especially when combined with containment theory, has explanatory power in making sense of physical restraint and how to minimise its use while still meeting the needs of children and direct-care practitioners in residential and other relevant settings. [ABSTRACT FROM AUTHOR]