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Aim: To provide insights into the optimal use of virtual reality (VR) in nursing education by evaluating pre-registration nursing students' experiences in conducting holistic patient assessments while interacting with artificial intelligence (AI)-led patients. Specifically, this project evaluation compares the use of two different VR scenarios, one employing a menu-based interface and another using AI voice-controlled technology. Methods: Eleven pre-registration adult nursing students from two UK universities were selected through purposeful sampling to participate in the two VR simulations. Data collection and analysis: This included qualitative insights gathered from three focus group sessions, audio-recorded and thematically analysed to classify and describe students' experiences. Findings: Four key themes emerged: technological literacy, VR as a learning tool, the road of learning, and transition to independence. Advantages across both methods of VR-AI interaction and their particular challenges were identified and described for each key theme. Conclusion: VR with AI-led patient technology in pre-registration nursing education positively contributes to the curriculum by exposing students to problem-based learning situations and use of a multiplicity of skills in a safe environment. Although both methods are relevant for developing proficiencies around holistic patient assessment, there are advantages and limitations to each. Students perceived the voice-controlled technology as more intuitive with a more natural method of communication, whereas the menu-based interaction gave students more structure and guidance. [ABSTRACT FROM AUTHOR]

Purpose: People with functional movement disorders (FMD) are commonly seen in neurology clinics. Despite a recent increase in research, no standardised treatment pathway across the UK exists. Currently only a few qualitative studies in FMD with a focus on psychological aspects and diagnosis have been published. This study aimed to understand people with FMD perceptions of their physiotherapy treatment. Method: Qualitative web-based interviews were conducted with seven participants and an interpretive phenomenological approach was used to identify themes from the data. Results: Four themes were identified; 1) my brain, mind and body are all me, 2) physiotherapy; what helps and what doesn't, 3) what recovery is to me, and 4) barriers to treatment. Participants desired a combination of psychological and physical approaches, which were holistic, individualised, and delivered by experienced physiotherapists. Limited availability and funding of specialist treatments were barriers to recovery. Conclusion: Holistic management combining psychological and physiological systems seems to be crucial for effective management of FMD. Large variations in physiotherapy treatment exist across the UK. It is hoped that increasing the understanding, amongst healthcare professionals will lead to the development of timely and appropriate pathways for patients that otherwise find themselves lost between medical specialities. IMPLICATIONS FOR REHABILITATION: Patients report more positive experiences when a combined and detailed psychological and physiological explanation to their symptoms is given. An individualised approach working with the patient on activities they find challenging is more preferable than group exercise or impairment based (e.g., strengthening/stretching) treatments. Having a physiotherapist who is experienced in treating functional movement disorders or prepared to learn and understand them helped with adherence to treatment. [ABSTRACT FROM AUTHOR]

Background: Despite growing international attention, there remains an urgent need to develop mental health services within low and middle income countries. The Khmer Rouge period in Cambodia saw the destruction of all health services infrastructure in the 1970s. Consequently, Cambodia has struggled to rebuild both its economy and healthcare system, with the number of qualified mental health clinicians remaining disproportionately low. Resultantly, there is a pressing need to develop low-cost community based alternatives of mental healthcare. Methods: Using a mixed methods design, researchers developed an 8-week peer-led intervention, known as a Friendship Group, for adults with physical disabilities using both face-to-face and online delivery methods. The Wilcoxon Signed-Rank test was used to assess changes in pre-post survey scores and qualitative data was collected in form of five focus groups post intervention. Results: 41 participants were allocated across four Friendship groups -- two were online and two face-to-face. Attrition rate was 22% post-intervention (n=32). ITT analyses showed a statistically significant decrease in psychological distress scores [Z =-3.808, p < .001] from pre [Mdn = 20, IQR = 16.5-25.5] to post [Mdn = 16, IQR = 14-18.5] intervention. A Wilcoxon signed-ranks test also showed a statistically significant decrease in PTSD scores [Z = -2.239, p < .025] from pre [Mdn=4, IQR=3-5] to post [Mdn = 3, IQR= 2.75-4] intervention. There was also a statistically significant decrease in worry scores [Z =-3.904, p < .001] from pre [Mdn=5, IQR=3.5-6.5] to post [Mdn = 3, IQR = 3-4] intervention. There were no significant group differences between the face to face and online groups. A number of interconnected themes emerged from focus group data (n=5), these included the mental health benefits of Friendship Groups as conceptualised through knowledge acquisition, skill development and peer support. Conclusions: The Friendship group intervention delivered in both online and face-to-face formats appears feasible and acceptable within the Cambodian context. Initial data revealed positive findings in terms of reduction in psychological distress, worry and PTSD symptoms as well increased feeling as calm. [ABSTRACT FROM AUTHOR]

Background and aims: Autistic children can experience challenges in making and maintaining friendships, and middle childhood (ages 6–12) may be particularly challenging as social networks become more complex. However, a large proportion of research into these experiences is based on adult reports or focuses on the experiences of adolescents, meaning that the voices of younger children are absent. Due to the exclusion of younger children from research, we have a limited understanding of their first-hand experiences of their friendships and the support they receive, which has implications for friendship support and wellbeing. This study aimed to amplify the voices of younger autistic children to explore their first-hand experiences of friendships and highlight areas of social support which may be most beneficial to primary-aged autistic children. Methods: This study used novel creative methods to support interviews with 19 autistic primary school-aged children to explore their experiences of friendship. Parent-led interviews and scrapbooks supported the children in discussing the challenges and strengths of their friendships. Results: Children discussed the challenges and strengths of their friendships including the impact of social norms on the need to have friends and their support needs in this area of life. Children also discussed gaps in their current friendships and how they would like to see these filled. It was clear that not all children required or wanted neurotypical-style friendships, with many valuing companionship and gameplay over intimacy. Analysis highlighted the heterogeneity of autistic children's friendships, especially in relation to gender and age, calling for more tailored and individualized support. Conclusion and implications: Results from the current study show that autistic children can and do have successful friendships but that these friendships may differ from those of their non-autistic peers. The study further adds to the existing literature by showing that younger autistic children can be included in research by using differentiated, accessible and creative methods, and that they are able to voice their opinions on matters surrounding support. It also calls for a tailored approach to supporting autistic children in school and speaking with children to give them autonomy over the support they want to receive. [ABSTRACT FROM AUTHOR]

Background/Aims: Under-representation of pregnant women, their partners and parents from minority ethnic backgrounds has been reported in research involving the perinatal period. This study's aim was to explore the experiences of parents from minority ethnic groups who participated in research during the perinatal period, focusing on barriers and facilitators to participation. Methods: In-depth qualitative interviews were conducted via Microsoft Teams by all three researchers with a purposive sample of 16 parents. Data were analysed using thematic analysis. Results: Seven overarching themes were identified: motivating factors; unique contributions; language, understanding and access; cultural values, beliefs and practices; lack of time and other commitments; facilitators for participation; and experience of the current study. Conclusions: Understanding motivation for participation is essential to developing recruitment strategies that promote involvement of parents from minority ethnic backgrounds. A clear understanding of research goals and perceived benefits, and maximising access to studies, is likely to result in improved recruitment. Implications for practice: Ways to encourage research participation from parents in minority ethnic groups include using a range of advertising techniques and venues, offering a choice of time and place for activities and alternative methods of data collection, and disseminating information on available studies in early pregnancy. [ABSTRACT FROM AUTHOR]

Background: Sport schools are popular environments for simultaneously delivering education and sport to young people. Previous research suggests sport school involvement to have impact (i.e. the positive/negative, intended/unintended and long/short-term outcomes, results and effects) on student athlete's holistic (i.e. academic, athletic, psychosocial and psychological) development. However, previous research is limited by (1) cross-sectional methods, (2) limited multidimensional assessments, (3) lack of consideration for athlete characteristics (e.g. sex) and (4) failure to evaluate how sport school features affect student-athlete impacts. Objectives: The study, using a mixed methods case study approach, aims to (1) longitudinally evaluate the impact of sport school involvement on the holistic development of student athletes, (2) evaluate the impact on holistic development by student-athlete characteristics and (3) explore the features and processes of the sport–school programme that drive/facilitate holistic impacts. Methods: A longitudinal mixed methods design was employed across one full academic school year (33 weeks). Six data-collection methods (i.e. online questionnaire, physical fitness testing battery, academic assessment grades, log diaries, field notes/observation and timeline diagram/illustration) were used to assess the academic, athletic, psychosocial and psychological impacts for 72 student athletes from one sport school in the United Kingdom (UK). Results: Student athletes developed positive long-term holistic overall impacts (i.e. academically, athletically and personally), including maintaining stable and relatively high levels of sport confidence, academic motivation, general recovery, life skills, resilience and friends, family and free time scores. Despite positive impacts, juggling academic and sport workload posed challenges for student athletes, having the potential to lead to negative holistic impacts (e.g. fatigue, stress and injury). Positive and negative impacts were linked to many potential features and processes of the sport school (e.g. academic and athletic support services versus insufficient training load build-up, communication, coordination, flexibility and planning). Furthermore, when considering student-athlete characteristics, females had lower sport confidence, higher general stress and body image concerns and less general recovery than males and student athletes who played sport outside the school had lower general recovery. Conclusions: This mixed method, longitudinal study demonstrated sport school involvement resulted in many positive academic (e.g. good grades), athletic (e.g. fitness development), psychosocial (e.g. enhanced confidence) and psychological (e.g. improved resilience) impacts attributed to the academic and athletic support services provided. However, juggling heavy academic and athletic workloads posed challenges leading to negative impacts including fatigue, pressure, stress and injury. Furthermore, holistic impacts may be sex dependent and further support may be required for female student athletes in sport school environments. Overall, these findings demonstrate the complex nature of combining education and sport commitments and how sport schools should manage, monitor and evaluate the features of their programme to maximise the holistic impacts of sport–school student athletes. [ABSTRACT FROM AUTHOR]

Homelessness is a worldwide health inequality. People with intellectual disability represent a relatively high proportion of homeless people, and for many their intellectual disability is not recognised. The study intended to obtain stakeholder views about how intellectual disability screening can be integrated into the support pathway for people who are homeless. A qualitative approach was taken using Thematic Analysis. Nine staff, who work with homeless people or are involved in the intellectual disability assessment pathway, were interviewed. Analysis produced three themes, each containing two subthemes. 'Current routes to support' investigates experiences of the existing pathway; 'Labels', explores views about making intellectual disability visible; 'Creating a pathway,' outlines ideas about developing and implementing a screening pathway between services. The results help inform how current practices of identifying people with intellectual disability might be improved and the role of screening in this. These results, when combined with other research around screening tools, provide insight into how intellectual disability screening can be integrated within services. [ABSTRACT FROM AUTHOR]

Summary: The James Lind Alliance (JLA) is a nonprofit United Kingdom (UK) organization that builds a set of research priorities for any given topic through the systematic involvement of practitioners, service users, carers, and stakeholders. In 2021/2022, we reviewed the impact of the JLA priority setting partnership (PSP) on adult social work research (2018). Our research question was "How has social work research responded to and changed since the 2018 JLA priority setting report; and where do we need to focus now?" We searched for research which aligned with the published priorities. We then interviewed 23 social work researchers to learn if/how they had engaged with the JLA PSP and what might be needed for future PSP exercises and research. Findings: We discuss our findings with reference to other reviews of JLA PSPs. We conclude that the JLA PSP for adult social work was uniquely suited to the field given the history of person-centered practices, and this may account for some of the positive reviews of the report. The JLA process and ethos were respected and the report potentially raised the profile of adult social work research, while highlighting unaddressed questions. Applications: Though there are many JLA PSP reviews, this study is one of the few to consider impact, we propose a review process could be applied to PSP exercises more regularly. [ABSTRACT FROM AUTHOR]

Summary: The COVID-19 pandemic and subsequent public health restrictions caused an unprecedented impact on long-term care services in the United Kingdom (UK). A qualitative study was conducted in the East Midlands, UK, to explore how home care provision was perceived and experienced, by those organizing, commissioning, or providing care, and those receiving care, during the pandemic. Fifteen semi-structured telephone interviews were conducted between September to December 2020 with people who organize, commission, or provide home care (n = 9), recipients of home care (n = 3), and their informal carers (n = 6). Findings: Three broad themes were constructed through a thematic analysis: (1) positive about home care; (2) fear of infection; and (3) social isolation. In addition to these overarching themes, specific group themes were identified amongst group one: those organizing, commissioning, or providing care, and group two: those in receipt of the care and informal carers. Those in group one spoke about the pandemic creating stressful working conditions, regardless of whether organizing, commissioning, or providing care. Despite working throughout the pandemic, they felt a forgotten part of the essential workforce, when compared to those employed in the National Health Service and institutional care. Those in group two experienced a loss of control with visits cancelled or frequently occurring outside of scheduled times. Dissatisfaction with the visits was directed at the management level, rather than at the staff visiting the homes. Applications: Awareness and understanding of the experiences of home care will provide useful knowledge when commissioning future services. [ABSTRACT FROM AUTHOR]

Purpose: Occupational stress is known to have detrimental effects on health care professionals worldwide. This study aimed to address a research gap by investigating sources and levels of occupational stress in U.K. audiologists. Method: A mixed-methods cross-sectional design and convenience sampling were utilized. The study used the Audiologist Occupational Stress Questionnaire (AOSQ) and an audiological working practices questionnaire. The study included 100 registered U.K. audiologists. Results: The research revealed that over a third of participants reported experiencing moderate or higher levels of occupational stress. Pediatric audiologists and those with a high daily patient load reported significantly higher stress scores than other specialties and those seeing fewer patients per day. Identified sources of stress for U.K. audiologists included clinical demands and time constraints, staffing issues, leadership in the workplace, and equipment availability. Reported impacts of stress encompassed mental health issues, fatigue, social life disruptions, and physical health concerns. Conclusions: The research validated the use of the AOSQ in a U.K. setting, and the findings provided insights into the sources and levels of occupational stress experienced by U.K. audiologists, supporting existing research on occupational stress in audiologists in other countries. The identification of consistent stress themes across the literature underscores the need for targeted support and interventions to ensure the well-being of audiologists and empower them in maintaining their pivotal role in health care. [ABSTRACT FROM AUTHOR]

Objective: The aim of this qualitative study was to examine experiences and meanings of maternal ambivalence in first-time mothers with young children. Background: In contrast with normative expectations surrounding contemporary motherhood, there is growing recognition that becoming and being a mother involves ambivalent feelings, and that these feelings are normal and have positive psychological consequences. Yet, little attention has been paid to women's subjective experiences of maternal ambivalence, and capacity to acknowledge and manage ambivalent feelings. Methods: Eleven semi-structured online interviews, with first-time mothers, were conducted and analysed using Interpretative Phenomenological Analysis (IPA) methodology. Results: Two group experiential themes were identified: Crossing boundaries of acceptable mothering feelings and Mothering from a place of 'enough'. Ambivalent mothering feelings challenged participants' expectations about motherhood and themselves as mothers, producing anxiety, self-doubt and feelings of failure. Distress accompanying maternal ambivalence was especially acute when participants perceived their feelings to be unacceptable. Viewing conflicting feelings with compassion, however, helped participants to cope with their diverse and fluctuating emotional mothering experiences, allowing them to mother with a greater sense of equanimity, agency and competence. Conclusion: The study's findings indicate the potential benefits of providing information about the emotional turbulence of early motherhood as part of routine maternity care, as well as the potential value of offering parenting interventions that promote self-compassion to mothers struggling to manage feelings of ambivalence. [ABSTRACT FROM AUTHOR]

Conspiracy beliefs have been found to have negative real-world consequences that can impact interpersonal relationships; however, this remains an under-researched area. With the current popularity of conspiracy movements such as QAnon, more research into these phenomena is necessary. The present research therefore aimed to explore the impact of QAnon belief on interpersonal relationships. Fifteen participants aged 21–54 (M = 41) with a QAnon-affiliated loved one were interviewed about how QAnon has changed their relationship. Using thematic analysis, four main themes were identified: Malignant Q, Distance, Qonflict, and Attempts at Healing. Participants characterized QAnon as a malignant force in their relationships and communicated with their loved ones less as a result. Although QAnon was a source of conflict and tension for all participants, they were motivated to understand their loved ones. Most participants who still had relationships with their loved ones were motivated to heal or maintain their relationships, while those who no longer did had previously tried many different strategies to save their relationships. These findings provide greater insight into how QAnon can impact relationships, offering fruitful directions for future research examining how individuals can heal from QAnon-afflicted relationships. [ABSTRACT FROM AUTHOR]

The cost-of-living crisis is a public health threat; however, the effects of the rising cost of living were not a policy priority for integrated care systems (ICSs) in early 2022. At the request of ICS leaders, the National Health Service (NHS) Confederation created an online cost-of-living hub in October 2022 to raise awareness of the consequences of the rising cost of living among ICS policymakers and support systems in mitigating these effects. This study aims to investigate the impact of this hub. Mixed methods. To quantify hub utilisation, the hub viewing figures collected by the NHS Confederation website were analysed. A thematic analysis was performed to characterise how cost-of-living features in integrated care strategies, and the results compared to information published on the hub. The pages that comprise the hub were well engaged with, having between 2736 and 6161 views. Alongside this, the impacts of the rising cost of living feature extensively in integrated care strategies, being discussed in 32 out of 37 strategies across four contexts: health, communities, economic, and environmental. The significant majority of subthemes reflect points made by the hub. These results suggest the hub may have raised awareness about the impacts of–and possible responses to–the cost-of-living crisis among ICS policymakers. This may act as an impetus and guide for future public health interventions using policy and practice hubs. Furthermore, the discussion of cost-of-living across a range of contexts implies ICSs are engendering a collaborative, system-wide approach to tackling complex local issues. [ABSTRACT FROM AUTHOR]

Background: Despite increasing evidence of the potential inaccuracy and unwarranted practice of regular GRV measurement in critically in adults, this practice persists within the United Kingdom. Aim: To explore adult intensive care nurses' decision‐making around the practice of GRV measurement to guide enteral feeding. Study Design: A cross‐sectional 16 item electronic survey in four adult intensive care units (ICUs) in England and Wales. Results: Two hundred and seventy‐three responses were obtained across four ICUs with acceptable response rates for most [Unit 1 74 /127 = 58.2%; Unit 2 87/129 = 67.4%; Unit 3 77/120 = 64.1%; Unit 4 35/168 = 20.8%]. Most (243/273 (89%) reported measuring GRV 4–6 hourly, with most (223/273 82%) reporting that the main reason was to assess feed tolerance or intolerance and 37/273 (13.5%) saying their unit protocol required it. In terms of factors affecting decision‐making, volume obtained was the most important factor, followed by the condition of the patient, with aspirate colour and appearance less important. When asked how they would feel about not measuring GRV routinely, the majority (78.2%) of nurses felt worried (140/273 = 51.2%) or very worried (74/273 = 27%). Conclusions: Factors affecting the nurses' decision‐making around GRV were based largely on fear of risk (around vomiting and pulmonary aspiration) and compliance with unit protocols. Relevance to Clinical Practice: Despite increasing evidence suggesting it is unnecessary, nurses' beliefs around the value of this practice persist and it continues to be embedded into unit protocols around feeding. [ABSTRACT FROM AUTHOR]

Objectives: Antenatal education (ANE) is part of National Health Service (NHS) care and is recommended by The National Institute for Health and Care Excellence (NICE) to increase birth preparedness and help pregnant women/birthing people develop coping strategies for labour and birth. We aimed to understand antenatal educator views about how current ANE supports preparedness for childbirth, including coping strategy development with the aim of identifying targets for improvement. Methods: A United Kingdom wide, cross-sectional online survey was conducted between October 2019 and May 2020. Antenatal educators including NHS midwives and private providers were purposively sampled. Counts and percentages were calculated for closed responses and thematic analysis used for open text responses. Results: Ninety-nine participants responded, 62% of these did not believe that ANE prepared women for labour and birth. They identified practical barriers to accessing ANE, particularly for marginalised groups, including financial and language barriers. Educators believe class content is medically focused, and teaching is of variable quality with some midwives being ill-prepared to deliver antenatal education. 55% of antenatal educators believe the opportunity to develop coping strategies varies between location and educators and only those women who can pay for non-NHS classes are able to access all the coping strategies that can support them with labour and birth. Conclusions for Practice: Antenatal educators believe current NHS ANE does not adequately prepare women for labour and birth, leading to disparities in birth preparedness for those who cannot access non-NHS classes. To reduce this healthcare inequality, NHS classes need to be standardised, with training for midwives in delivering ANE enhanced. Significance: What is Already Known on this Subject?: There is no detailed national guidance about the content or quantity of antenatal education that should be delivered by the NHS to patients and, how coping strategies are developed within these sessions is unknown. What this Study Adds?: Antenatal educators believe that quality of antenatal education needs to be improved. Access to coping strategies for labour and birth is hindered by the type of class, the educator's approach and socioeconomic status. This study can be used to support an argument for addressing the inequality in access to antenatal preparation, whilst better preparing all women through higher quality of antenatal education provision in the NHS. [ABSTRACT FROM AUTHOR]

Co‐production is a collaborative way of working which emphasises the exchange of diverse forms of knowledge in an equal partnership for equal benefits. Co‐produced research is a key strategic aim of the UK Research and Innovation (UKRI) Transforming UK Food Systems (TUKFS) Strategic Priorities Fund; this research programme brings together researchers, policymakers, industry and communities to create positive change in the way food is produced, accessed and consumed. However, more generally, there are diverse understandings of co‐production and a lack of consensus on what 'good practice' looks like. Therefore, this study aimed to identify and map examples of co‐production methods employed across the TUKFS programme. Two creative workshops (n = 15 participants), conversations with TUKFS researchers and stakeholders (n = 15), and systematic analysis of project documents were used to critically explore co‐production activities within six TUKFS projects. A range of co‐production activities were identified. Findings highlighted areas of 'messiness' and complexity, challenges associated with applying co‐production approaches and practical solutions. Four key shared principles for co‐production were identified: (1) Relationships: developing and maintaining reciprocity‐based partnerships; (2) Knowledge: recognising the contribution of diverse forms of expertise; (3) Power: considering power dynamics and addressing imbalances; and (4) Inclusivity: ensuring research is accessible to all who wish to participate. Opportunities for reflection and reflexivity were considered crucial across all these areas. Findings contribute important insights towards a shared conceptual understanding of co‐production for food system transformation research. This paper makes recommendations for researchers, practitioners, academic institutions and funders working in this area of research and practice. [ABSTRACT FROM AUTHOR]

Purpose The literature indicates that sexuality education provided in schools/colleges in the United Kingdom (UK) may not be appropriate for people with Autism Spectrum Disorder (ASD). There appears to be a lack of understanding of the subject regarding young people with Attention-Deficit/Hyperactivity Disorder (ADHD) and a dual diagnosis (ASD co-occurring with ADHD). Research also suggests that compared to neurotypical peers, young people with ASD tend to receive less support on sexuality from their parents, who often feel that they lack the appropriate skills to help their children with some sex-related issues. Some young people with ASD and ADHD also report lacking an understanding of the social nuances of dating and intimacy, which is crucial for navigating romantic relationships. Design/methodology/approach This study explored sexuality education and romantic relationships in young people based on a semi-structured interview approach to the topic. Thematic Analysis (TA) was employed to analyze the data. Findings Six themes were developed from the participants' narratives: Societal ideology about sexuality; Substandard school-based sexuality education; The role of adults in sexuality education; Pornography, as a very powerful alternative means of sexuality education; Young people and romance—a complicated world to navigate; Experience of abuse in the young neurodivergent population is a serious matter. Findings revealed that many neurodivergent and neurotypical young people received basic sex education in their schools/colleges and homes and encountered challenges navigating romantic relationships. Neurodivergent young people reported experiencing greater challenges related to their understanding of and building romantic relationships than their neurotypical peers. Originality/value To the researchers' knowledge, this is the first exploration of romantic relationships and sexuality education in neurotypical young people as well as three groups of neurodivergent young people (with ASD, ADHD, and ASD co-occurring with ADHD). [ABSTRACT FROM AUTHOR]

Background: Across the life course, women and girls with learning disabilities and their carers report difficulties in accessing information and support with menstruation, yet their experiences are often overlooked in initiatives to improve menstrual health and wellbeing. Our aim was to collaborate with women with learning disabilities to co‐produce future research priorities in a UK context. Methods: We undertook a two‐part scoping exercise to explore what is known about this topic from a life course perspective, beginning pre‐menarche and extending to post‐menopause support. This combined a rapid scoping review of the literature since 1980 with a stakeholder consultation where people with learning disabilities, family carers, advocacy groups and staff working across education, health and social care were invited to share their experiences of menstruation support. Findings: UK and international literature provided insight across five narrative themes. Seventy stakeholders took part in our consultation, enabling the identification of five key themes. Findings across both highlight examples of supportive practice and valued resources alongside enduring health inequalities and barriers to menstruation support faced by women and girls with learning disabilities across the life course. Conclusion: Our scoping exercise identified multiple gaps in research and practice, ongoing reproductive health inequalities and a need for improved access to peer support, resources and training that take a life course approach. The scoping exercise indicates the need for further empirical research on menstruation and learning disability, with a particular focus on collating people's lived experiences. Accessible summary: We wanted to find out what support and information is available to girls and women with learning disabilities about periods (also called 'menstruation') over a lifetime.This was to help us work out what new research might be needed in the future.Our team included women with and without learning disabilities. We are based in the United Kingdom.We read lots of articles, from the United Kingdom and around the world.We spoke to lots of people who care about this issue and know about it. This included women with learning disabilities, family carers, advocacy groups and staff working in education, health and social care settings.There is not enough guidance about periods for girls and women with learning disabilities.A lot more research is needed about how to support women with learning disabilities with their periods, over their whole life.This must also include women with profound and multiple learning disabilities and women from minority ethnic communities.Our work showed that we need to hear much more from women with learning disabilities themselves. [ABSTRACT FROM AUTHOR]

The number of people in exile is rising. Sexual and ethnic minority refugee and asylum-seeking people present with special needs. This study utilised a collective narrative participatory design to explore how storying collective ways of resisting the effects of trauma, amongst gay and lesbian forced migrant people of Black African and Asian backgrounds in an urban context (London, UK) can be constitutive of healing. To do this, purposeful sampling procedures were pursued. Data collection was through individual and group format story telling sessions. Both sessions were structured around a co-constructed metaphor 'Passport of Life'. Narrative analysis was employed to examine the data, co-shaped with participants. Findings indicate that participants' (collective) storytelling is crafted as a site for resistances to emerge and be re-affirmed. Resistance pathways are inextricably linked to participants' diverse subjectivities. Healing is constituted as a dynamic process, bound by narrated and physical configurations of spaces of togetherness, which have re-definitional, hope-inducing, and social justice properties. The results support the use of participatory and narrative means for expanding (untold) stories of overcoming and supporting opportunities for healing and redress amongst this population. Implications for policy making, research, and psychological practice are considered. [ABSTRACT FROM AUTHOR]

Aim: Black queer men in the UK are increasingly at risk of mental health problems related to anxiety and depression, often triggered by traumatic experiences. This study explored the efficacy of integrative practice with Black queer men who experienced trauma from a decolonised, intersectional and queer‐affirming perspective. Method: One‐to‐one semi‐structured interviews with nine integrative practitioners were completed. Data collected from these interviews were analysed using Braun and Clarke's six stages of reflexive thematic analysis (RTA). Findings: RTA identified four subordinate themes: (1) understanding the experience of Black queer men, (2) developing the working alliance and use of self in practice, (3) effective integrative practice and (4) intersectional differences and considerations. Findings discussed the varying forms of trauma Black queer male clients experienced that impacted their mental health and how developing a strong working alliance with Black queer men was crucial when supporting them to recover from trauma. Additionally, the participants described a breadth of trauma‐informed integrative counselling and coaching practice. A decolonised approach utilising the intersection of race, gender and sexuality of Black queer men was successfully integrated into the approach used by practitioners in this study. Conclusion: Overall, this study evidenced that a decolonised perspective to integrative practice effectively supports Black queer men to recover from trauma. Future research should focus on an integrated approach with Black queer men and other gender and sexual ethnic minority clients who experienced trauma. [ABSTRACT FROM AUTHOR]

Background: Although there is a small area of research exploring how mental health practitioners can support young people with the impacts of social media (SM) on their mental health, no study has researched into practitioners' own relationship with SM. This study aimed to explore counsellor's own relationship with SM, and how such insights contributed into their support to their clients who may be impacted by their engagement with SM. Methods: Counsellors who worked with young people aged 16–25 were recruited and interviewed. A reflexive thematic analysis of the interviews identified three main themes. Findings: The first theme "It's Not Based on Reality" related to counsellors comparing themselves to the unrealistic highlight reel depicted on SM in the same way as the young people they supported. The second theme "All Of a Sudden I'm on Facebook" explored the counsellor's obsessive use of SM yet they believed they were better able than their young clients to recognise when SM impacted their mood and to instigate boundaries by coming offline. The third theme "It's All About Trying to Be Relatable" highlighted counsellors' evaluation of efficacy of their own SM use to their therapeutic practice. Conclusion: Despite the noted parallels in SM use between counsellors and the young people they supported, counsellors believed their experiences of SM differed from their clients. This study provides implications for counsellor training when working with young people and the importance of counsellors' self‐care when using SM. [ABSTRACT FROM AUTHOR]

Identify the perceptions and experiences of how UK entry-level programs educationally prepared pediatric physiotherapists for their first clinical role. Review the extent programs taught essential, recommended, and additional content as per the International Organisation of Physical Therapists in Pediatrics (IOPTP). Mixed methods design involving qualified UK pediatric physiotherapists. Forty-two physiotherapists completed an online questionnaire and nine (21%) completed a follow-up semi-structured interview. All 42 respondents felt they were "Not Well" (median 2, IQR 1.75–2.75) prepared for clinical practice. Not enough curricula emphasis was given to pediatric content (100%), with 31% (n = 13, CI 95% 19–46) reporting no pediatric content throughout their program. Only 15 (36%, 23–51) respondents experienced a pediatric placement. Themes from the follow-up interviews were (1) UK programs are adult focused; (2) placements are the only meaningful opportunity to develop competency; (3) programs lacked non-clinical content; and (4) experiencing pediatric patients was overwhelming due poor preparation. The majority of the IOPTP curriculum guidance is not embedded within UK curriculums. Respondents reported they were not well prepared for pediatric clinical practice. Some entry-level programs did not include any pediatric teaching throughout the entirety of the course. [ABSTRACT FROM AUTHOR]

Children growing up with a parent with mental ill-health are a hidden and vulnerable group. Positioned at the intersection between adult and children services, and health and social care, these children fall between the gaps, rarely acknowledged in policy or practice. This is exacerbated when the young person is excluded under the auspices of patient confidentiality and age appropriateness. This article reports findings from research which captured young carers' retrospective accounts of professional support when caring for a parent with mental illness. Participants in this research study described being 'involved but not included'; they provided significant care to their parent and were relied on by professionals to provide support. However, they were simultaneously omitted from any discussion or understanding of the decisions made. This article explores the relevance of these accounts for current service provision. It concludes with recommendations for involving young carers in care planning and ensuring that young carers have their own needs assessed and acknowledged by professionals. [ABSTRACT FROM AUTHOR]

There has been a long debate about the use of intuition in helping professions, including social work. Often viewed negatively in professional contexts, intuition is nonetheless used as a form of risk assessment. The current research examined methods of identifying child sexual abuse. A mixed methods approach was taken, with 98 participants completing an online questionnaire and 24 taking part in in-depth interviews. The participants demonstrated varied perceptions of intuition and its usefulness. Although some participants were strongly critical of its use, for others, intuition or 'gut feelings' were preferred to formal assessment tools. However, what was discussed as intuition, rather than a form of 'sixth sense', was often based on tacit knowledge; for example, abused young people's observable behaviours combined with known risk factors such as certain family characteristics. Therefore, concerns about the use of intuition may be based on incorrect assumptions. [ABSTRACT FROM AUTHOR]

It is well-established within the hate studies literature that the majority of hate crimes and incidents of targeted hostility are perpetrated by those in the "majority" society. In the UK, academic and official research consistently shows that young White, British males are most commonly the culprits of all forms of targeted victimization, especially racist hate. However, urban areas of "super-diversity" offer researchers an opportunity to understand hate crime victimization and perpetration in a more nuanced and comprehensive way. Hate studies research has slowly begun to highlight instances of people from marginalized and stigmatized groups being targeted on the basis of their identity by individuals who are also members of minority groups, sometimes even the same minority group as the victim. Very little is understood about this particular victimizing dynamic other than it appears to be an attempt by minority group members to "fit in" by adopting what they perceive to be majority group values and attitudes. By drawing from 44 qualitative in-depth interviews exploring the experiences of new migrants and refugees and observations from 20 months of grassroots engagement, this article challenges established theories of "othering" that overwhelmingly refer to binary, static majority/minority tensions. The stories of these too-often "hidden" victims of targeted hostility offer a fresh perspective on the relationships between victims of hate and perpetrators. The article also contributes new explanations as to why those who are often targeted go on to target others. [ABSTRACT FROM AUTHOR]

Aim: To determine whether it was feasible, safe and acceptable for ambulance clinicians to use capillary blood ketone meters for 'high‐risk' diabetic ketoacidosis (DKA) recognition and fluid initiation, to inform the need for a full‐powered, multi‐centre trial. Methods: Adopting a stepped‐wedge controlled design, participants with hyperglycaemia (capillary blood glucose >11.0 mmol/L) or diabetes and unwell were recruited. 'High‐risk' DKA intervention participants (capillary blood ketones ≥3.0 mmol/L) received paramedic‐led fluid therapy. Participant demographic and clinical data were collated from ambulance and hospital care records. Twenty ambulance and Emergency Department clinicians were interviewed to understand their hyperglycaemia and DKA care experiences. Results: In this study, 388 participants were recruited (Control: n = 203; Intervention: n = 185). Most presented with hyperglycaemia, and incidence of type 1 and type 2 diabetes was 18.5% and 74.3%, respectively. Ketone meter use facilitated 'high‐risk' DKA identification (control: 2.5%, n = 5; intervention: 6.5%, n = 12) and was associated with improved hospital pre‐alerting. Ambulance clinicians appeared to have a high index of suspicion for hospital‐diagnosed DKA participants. One third (33.3%; n = 3) of Control and almost half (45.5%; n = 5) of Intervention DKA participants received pre‐hospital fluid therapy. Key interview themes included clinical assessment, ambulance DKA fluid therapy, clinical handovers; decision support tool; hospital DKA management; barriers to hospital DKA care. Conclusions: Ambulance capillary blood ketone meter use was deemed feasible, safe and acceptable. Opportunities for improved clinical decision making, support and safety‐netting, as well as in‐hospital DKA care, were recognised. As participant recruitment was below progression threshold, it is recommended that future‐related research considers alternative trial designs. Clinicaltrials.gov: NCT04940897. [ABSTRACT FROM AUTHOR]

Background: Despite global efforts to improve paediatric clinical trials, significant delays continue in paediatric drug approvals. Collaboration between research networks is needed to address these delays. This paper is a first step to promote interoperability between paediatric networks from different jurisdictions by comparing drivers for, and content of, metrics about clinical trial conduct. Methods: Three paediatric networks, Institute for Advanced Clinical Trials for Children, the Maternal Infant Child and Youth Research Network and conect4children, have each developed metrics to address delays and create efficiencies. We identified the methodology by which each network identified metrics, described the metrics of each network, and mapped consistency to come to consensus about core metrics that networks could share. Results: Metric selection was driven by site quality improvement in one network (11 metrics), by network performance in one network (13 metrics), and by both in one network (five metrics). The domains of metrics were research capacity/capability, site identification/feasibility, trial start-up, and recruitment/enrolment. The network driven by site quality improvement did not have indicators for capacity/capability or identification/feasibility. Fifteen metrics for trial start up and conduct were identified. Metrics related to site approvals were found in all three networks. The themes for metrics can inform the development of 'shared' metrics. Conclusion: We found disparity in drivers, methodology and metrics. Tackling this disparity will result in a unified approach to addressing delays in paediatric drug approvals. Collaborative work to define inter-operable metrics globally is outlined. [ABSTRACT FROM AUTHOR]

Introduction: The COVID-19 pandemic has significantly stretched global healthcare provisions since its commencement in 2019. From the outset, ambulance services in the UK had to adapt and change their working practices to meet distancing requirements, to increase staff numbers and to ease the effects of staff becoming unavailable for work due to self-isolation and illness. One strategy was moving clinicians from emergency operation centres (EOCs) to working from home. Like many international services, UK ambulance services use paramedics and nurses to undertake telephone and video assessments of patients calling the 999 emergency services line in a model known as virtual care or remote clinical decision making. Virtual care is any interaction between a patient and a clinician or clinicians, occurring remotely via information technologies. Increasing evidence is becoming available to suggest that the pandemic caused harm to the wellbeing of healthcare workers, primarily due to the severe stress of regular exposure to death and human suffering. However, there remains a dearth of literature focusing on the well-being of remote and virtual clinicians, especially those who moved from working in EOCs to working at home during the COVID-19 pandemic. Therefore, this study reports the findings of a qualitative analysis of these effects from the clinician's perspective. The authors hope that the findings from this study will inform the operating, well-being and leadership practices of those delivering such services. Methods: A convenience sample of telephone nurses and paramedics from one UK ambulance service where home working had been implemented were contacted. Fifteen clinicians with recent home-working experience responded to the invitation to participate out of a possible 31 (48%). All participants had previously practised remote assessment from within an EOC. Semi-structured interviews took place via video-conferencing software and were recorded, transcribed and thematically analysed. An inductive approach was taken to generating codes, and both researchers separately read the transcripts before re-reading them, assigning initial themes and determining frequency. Results: Five main themes were discovered, with further associated sub-themes. The main themes were: safety; financial implications; working relationships; home-working environment; and anxiety. Conclusions: Few studies explore remote clinicians' health and well-being. This study identified that home-working clinicians felt that there had been no detrimental impact on their health and well-being because of working from home during the initial phase of the COVID-19 pandemic. While some concerns were raised, these were mitigated through the support that clinicians received at home from family members, as well as from colleagues, some of whom had developed new working relationships. Financial implications appeared to have contributed to some concerns for participants initially, but these had been alleviated quickly despite requiring further exploration of the true financial impact of working from home. [ABSTRACT FROM AUTHOR]

Background: Vision rehabilitation services are increasingly being delivered remotely (i.e., telerehabilitation); yet, limited research has explored practitioners' attitudes towards this approach or considered the wider implications of re-designing services. This qualitative study investigates perspectives on delivering telerehabilitation among sight loss support organisations. Methods: Twelve participants from 9 sight loss charities in the United Kingdom took part in a semi-structured interview. Participants were professionals from large national rehabilitation service providers (n = 5), regional charities (n = 3), or local community organisations (n = 4). Qualitative data were analysed using thematic analysis. Results: Four themes were identified (1) Delivery of telerehabilitation; (2) Opportunities associated with telerehabilitation; (3) challenges associated with telerehabilitation; and (4) wider challenges in the vision rehabilitation sector. Greater utilisation of telerehabilitation was viewed positively; however, questions arose regarding cost-effectiveness and the appropriateness of this method of service delivery. Factors such as workforce decline, access to training, and understanding of vision rehabilitation were identified as wider problems affecting the future landscape of vision rehabilitation. Conclusion: Digital innovation has facilitated local and national organisations to provide largely successful and accessible telerehabilitation services. Wider challenges call for investment in strategies and policies to ensure people with visual impairment can continue to benefit from vision rehabilitation services. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To read about the experiences of people with chronic cancer in developing expertise in their condition • To be aware of areas in which CNSs can support people with chronic cancer to develop expertise in their condition • To recognise the need for specialised nurse-led services to support people with chronic cancer to manage and understand their condition. Background: The lifting of the coronavirus disease 2019 (COVID-19) pandemic restrictions in the UK has meant a near-full return to normal life for the general population. However, for patients with chronic cancer, the risk of severe illness from COVID-19 remains high because they are immunocompromised, and they may have various unmet support needs. Aim: To identify areas in which clinical nurse specialists (CNSs) can support people with chronic cancer in the UK to develop expertise in their condition, acting to minimise the risks of anxiety and depression in this population. Method: Narrative online interviews were conducted with seven people with chronic lymphocytic leukaemia. Transcripts were analysed using thematic and narrative methodologies. Findings: Two themes were identified. The first theme, holes in the system, explored the perceived position of chronic cancers at the bottom of the cancer hierarchy, which can cause patients to feel overlooked in terms of NHS service provision. The second theme, co-developed expertise, explored the mechanisms used by patients with chronic cancer to develop expertise in their condition and the role of specialised healthcare professionals in co-developing this expertise. Conclusion: Although the participants often felt let down by the healthcare system, support from CNSs was beneficial and empowered them to develop expertise in their condition. This indicates that there is a need for dedicated nurse-led chronic cancer pathways to minimise the risk of cancer-related anxiety and depression. [ABSTRACT FROM AUTHOR]

Background Police work can be sedentary and stressful, negatively impacting health and wellbeing. In a novel co-creation approach, we used the Behavior Change Wheel (BCW) and Double Diamond (DD) design framework to guide the collaborative design and development of a sedentary behavior intervention in the control rooms of two British police forces. Methods Multiple stakeholders participated in four phases of research. In Phase 1, a literature review, focus groups (n  = 20) and interviews (n  = 10) were conducted to 'discover' the relationship between physical activity and wellbeing in the police. In Phase 2, a steering group consolidated Phase 1 findings to 'define' a specific behavior for intervention. Phases 3 and 4 'developed' the intervention across six workshops with control room workers and six steering group workshops. Results The co-creation process identified contextual sedentary behavior as the target behavior, driven by behavioral regulation, social influence and social norms. The sedentary behavior intervention targeted these drivers and aimed to engage control room workers in short bursts of physical activity throughout their shifts. Key intervention features targeted involvement of staff in decision-making and embedding physical activity into work practices. Conclusions The BCW and DD can be combined to co-create evidence-based and participant-informed interventions and translate science into action. [ABSTRACT FROM AUTHOR]

This study explored the experiences of lesbian, bisexual, and queer (LBQ) students' (N = 9, aged 19–24) of sexual harassment via semistructured interviews. Data were analysed using a thematic analysis. Three overarching themes emerged: (a) the paradox of men's unwanted sexual attention, (b) the negative impact on relationships, and (c) the LGBTQ* community as a refuge. The women reported enduring unwanted heteronormative sexual attention, and heterosexist and homophobic harassment which forced some to conceal their sexuality. Support for the LGBTQ* community was central in developing confidence to call-out harassment. The findings call for the inclusion of LBQ-specific messages in sexual violence awareness and prevention interventions. [ABSTRACT FROM AUTHOR]

Background: Self‐management is a key component of successful chronic kidney disease (CKD) management. Here, we present the findings from the internal pilot of a multicentre randomised controlled trial (RCT) aimed to test the effect of a digital self‐management programme ('My Kidneys & Me' (MK&M)). Methods: Participants (aged ≥18 years and CKD stages 3‐4) were recruited from hospital kidney services across England. Study processes were completed virtually. Participants were randomised 2:1 to either intervention (MK&M) or control group. The first 60 participants recruited were included in a 10‐week internal pilot which assessed study feasibility and acceptability against pre‐specified progression criteria: 1) eligibility and recruitment, acceptability of 2) randomisation and 3) outcomes, 4) MK&M activation, and 5) retention and attrition rates. Semi‐structured interviews further explored views on trial participation. Results: Of the 60 participants recruited, 41 were randomised to MK&M and 19 to control. All participants completed baseline measures and 62% (n=37) completed post‐intervention outcome measures. All progression criteria met the minimum thresholds to proceed. Nine participants were interviewed. The themes identified were satisfaction with study recruitment processes (openness to participate, reading and agreeing to "terms and conditions"), acceptability of study design (remote study participation, acceptability of randomisation, completion of online assessment(s)), and methods to improve recruitment and retention (personalised approach, follow‐up communication). Conclusion: This internal pilot demonstrated the feasibility and acceptability of a virtually run RCT. Progression criteria thresholds to proceed to the definitive RCT were met. Areas for improvement were identified and protocol amendments were made to improve trial delivery. [ABSTRACT FROM AUTHOR]

Background: There are limited tools to measure the burden of disease and effectiveness of medical/surgical interventions in patients with cryptoglandular fistulas. The aim of this study was to explore concepts that are relevant and important to patients with complex cryptoglandular fistulas (CCF) and to develop a patient-centred, disease-specific, patient-reported outcome measure (PROM) to assess symptom burden and impacts of CCF. Methods: A targeted literature review was conducted, followed by one-to-one telephone interviews with five colorectal surgeons (USA, n = 3; UK, n = 1; Spain, n = 1) and 20 US adult patients with CCF to inform the development of a conceptual model and a CCF-specific PROM. The targeted literature review informed the development of the preliminary conceptual model and identified a PROM in the literature that was used as a reference to generate the draft CCF-specific PROM. The colorectal surgeon interviews provided insights on the experience of patients with CCF to refine the conceptual model, formulate probing questions for use in patient interviews, and to develop the draft CCF-specific PROM. Patients' descriptions of their experiences with symptoms and the impacts on their lives and evaluation of the draft CCF-specific PROM in concept elicitation and cognitive interviews were used to develop the final conceptual model and final CCF-specific PROM. Results: Ten symptoms (odour, pain during bowel movement, abscess, post-operative pain, discharge/drainage/leakage, anal/perianal pain, inflammation/swelling, skin irritation, bleeding and itchiness) and 11 impacts (discomfort, inability to exercise, embarrassment, difficulty sitting, worry about disease, adapted life to maintain hygiene, negatively impacted social life/isolation, inability to perform daily activities, reduced interest in sex, negatively impacted intimate relationships and negatively impacted mood) were reported as most salient by patients. The patient experience, clinician perspective, and literature review provided input to item generation. Evaluation of relevance and patient understanding through cognitive interviews with patients provided evidence for the content validity of the new patient-reported outcome measure: the 20-item Complex Cryptoglandular Fistula Questionnaire™ (CCFQ-20™). Conclusion: The CCFQ-20™ is a new clinician-guided, patient-validated, disease-specific patient-reported outcome measure that measures disease impact and quality of life in patients with CCF. [ABSTRACT FROM AUTHOR]

Aim. To explore how Black African international students adjust to their new university environment and gain insight into how they feel supported to engage in physical activity (PA). Background. People from ethnic minority backgrounds have poor physical activity levels compared with white populations in the UK. The Black population is known to have the lowest PA levels among the ethnic minority groups in the UK. This trend is suggested to be the case among university students, but no research has examined this. Ethnic minority students, including international students, encounter adaptation difficulties such as cultural barriers and social isolation which affect their university experiences and health behaviours such as physical activity. Methodology. This was a qualitative method, with in‐depth semistructured interviews conducted with five African students (two males and three females) aged between 21 and 40 years from a university in the West Midlands. The transcribed interviews were analysed using Braun and Clarke's thematic analysis. Results/Findings. Culture and lifestyle of physical activity; knowledge, experience, and self‐motivation; the effect of various social groups, activities, and services at the university; and weather variations and physical settings were the identified themes. The key finding of the study is that respondents engaged in PA to a greater extent at the British university than they did in their home countries. This was due to a combination of factors, including low‐cost gym memberships and events and a general lack of racial or gender‐based discrimination. Conclusions/Recommendations. Participants expressed satisfaction with the cultural and social support systems at their university, such as sports clubs and societies, and mental health support services that encouraged them to learn about and engage more in physical activity. Although some barriers, such as weather variations, were mentioned, various indoor options coupled with cheaper gymnasiums motivated students to remain or become active. Understanding the experiences of minority student groups in physical activity could help in reviewing current provisions and extending them to a wider population. [ABSTRACT FROM AUTHOR]

Purpose: Unaddressed hearing loss can adversely affect employment and day-to-day work-life. Efficient and effective audiology support can help optimise hearing in the workplace. This study explores the audiological rehabilitation experiences of workers with hearing loss (WHL). Materials and methods: Twenty-four WHL with experience of a wide range of audiology services across the UK participated in semi-structured interviews. Interviews were analysed using inductive thematic analysis. Results: Three main themes were generated: Theme 1: mixed experiences with audiology services (subdivided into two subthemes and four sub-subthemes). Theme 2: audiology role in work support (subdivided into three subthemes). Theme 3: "I think support could be improved if..." (subdivided into two subthemes). Conclusion: The audiological rehabilitation for working-age adults with hearing loss needs improvements to deliver sufficient support and quality care. Some of the barriers to having better-functioning hearing healthcare require fundamental standards in healthcare quality, such as access to services, staff (including audiologists) deaf awareness, information and technology support, and personalised care that considers work-life needs. Further research is required to evaluate the feasibility and cost-effectiveness of improvements, such as support that extends beyond hearing aid care, whether from audiology or non-audiology services. IMPLICATION FOR REHABILITATION: Workers with hearing loss need audiologists' support to address their work life needs beyond hearing-aids care. Improving audiologists' competencies, audiology departments' efficiency and developing relevant resources may promote better healthcare for workers with hearing loss. Audiologists, employers, workers, and the healthcare system need to collaborate in developing person-centred solutions to sufficiently assist workers with hearing loss. [ABSTRACT FROM AUTHOR]

Many children with developmental language disorder (DLD) have emotion recognition and regulation difficulties, but there are currently no known interventions enhancing emotional awareness in this population. This study explores the impact of parents' perspectives regarding children with DLD emotional understanding through a parent-led online emotion recognition (ER) intervention. Ten parents of children with DLD aged 6–11 participated in the study. A nonconcurrent multiple baseline design was employed, allowing for a rigorous analysis of changes in parental beliefs over time. Weekly data were collected through the Parents' Beliefs About Children's Emotions Questionnaire. Interviews were also conducted to gain deeper insights into parents' perceptions regarding the ER skills of their children. Results indicated that parents' beliefs about the need for guiding and supporting their child's ER skills increased over the intervention. Interviews also supported this, and three main themes were generated. The intervention program increased parents' awareness of (a) the importance of ER for children with DLD, (b) emotion-focused communication and engagement with their child, and (c) the integration of emotions into daily life. This study is the first known study that explores parents' beliefs about children with DLD ER skills, highlighting the importance of supporting parents through accessible interventions. [ABSTRACT FROM AUTHOR]

The construct of pathological demand avoidance (PDA) is relatively new and contested. Clinical reports indicate a population who obsessively resist everyday demands and have an extreme need for control. Children and adolescents who might experience PDA, and their families, struggle significantly in their daily lives, creating a need for more research into the phenomenon. To assist the developing research field, this scoping review focuses on the methodologies used to study PDA in children and adolescents. A systematic search of six databases and grey literature uncovered 57 unique records after duplicates were removed. 21 documents containing 22 studies were retained for analysis. Of the 22 studies, 21 were from the UK and one was from the Faroe Islands. There were 18 quantitative analyses and 11 qualitative analyses. Half of the studies were cross-sectional and quantitative and almost half used mixed methods. Samples were non-representative and studies often used comparison groups of children with and without PDA. Researcher's conceptualizations of PDA were coded into categories of emotional, socio-cognitive, and neurological differences. Studies of PDA focused mostly on PDA symptoms, mechanisms, and precipitants, with fewer studies of PDA origins and problems resulting from PDA or possible supports for individuals. The EDA-Q and the DISCO were the main measures used to identify PDA. Quantitative data were often analyzed using inferential statistics, and qualitative data were analyzed using thematic analysis, content analysis, and narrative summaries. Implications for future research are discussed. [ABSTRACT FROM AUTHOR]

Background: A surgical team works in a high‐performance environment and is exposed to stress. Mindfulness practice is evidenced to reduce symptoms of stress, as well as burnout, which is high amongst health workers. The operating theatre is unique, with many job‐roles, needs and time‐critical tasks. It is plausible that group mindfulness may benefit the surgical team. This evaluates the take‐5 theatre brief, consisting of a 'check‐in' and short breathwork, when used by two surgical teams as part of the regular theatre team brief. Approach: The take‐5 theatre brief was evaluated using domains of acceptability and implementation. Data were collected at two district general hospitals in the United Kingdom using 5‐point Likert scales hosted on electronic surveys Thematic analysis was performed of participant voice notes, strategic meeting notes and transcripts of interviews between key informants. Evaluation: There were 17 participants. Ten were from site A (59%), with the remainder being from site B (41%) and covered a range of roles within the theatre team. Participants found the take‐5 theatre brief helpful (median Likert 5) and felt that it would benefit themselves (median Likert 5) as well as the team (median Likert 5) and that it fitted into the day easily (median Likert 4). There was a high demand, no financial investment was required and overall it was easy to implement; however, it became challenged in theatre lists that were late to start. Implication: The take‐5 theatre brief is an acceptable initiative for these two operating theatre teams. [ABSTRACT FROM AUTHOR]

Autistic people diagnosed in adulthood often report that the experience can be life-changing, but there are issues with the diagnostic pathway. Few studies consider the views of people currently seeking diagnosis or contextualise the experience of diagnosis around developing an autistic identity. In this qualitative participatory study, we explored experiences of navigating an autism diagnosis in adulthood in the UK. We recruited six women (aged 21–46 years) who were seeking diagnosis, who worked with the academic researchers across four sessions to develop the study, share their experiences and analyse the themes. In one session, they completed a semi-structured interview alongside photovoice, a community-based action method, to explain and reflect on their experiences. We used reflexive thematic analysis to identify patterns, with four key themes identified: (1) 'everything shattered', (2) 'being seen', (3) 'understanding not judgement, please' and (4) 'here's a leaflet, off you go'. The themes reflected a desire for change and improved support for both diagnosis and developing autistic identity. Following photovoice methodology, together we identified actions to improve adult diagnosis, including involving autistic people in making improvements to the diagnostic criteria, for key professional and community groups to listen more to autistic people and for diagnostic support services to be flexible and appreciative of wider neurodivergence and intersectionality. Lots of people seek an autism diagnosis as an adult, and they often say that being diagnosed can be positively life-changing, but the experience of getting a diagnosis can be difficult. We often do not hear the views of people currently looking for a diagnosis, or talk to them about how diagnosis relates to their identity. In our study, we looked at experiences of people currently seeking an autism diagnosis in the UK. We used participatory methods, where six people seeking diagnosis were included as collaborators in the research. They took part in four different sessions, where they helped to shape the research, took part in interviews about their experiences and helped to analyse the patterns in all the interviews. We also used something called photovoice during the interviews, where they could use photos to show how they felt about navigating a diagnosis. We identified four common themes: (1) everyone had experienced some form of crisis before seeking diagnosis; (2) when they realised they were autistic, they felt seen; (3) the diagnostic process and criteria were not working, and they felt judged by clinicians and (4) there was limited support available after diagnosis. In another session, we identified actions that need to be taken which have implications for policy and practice, including improving the diagnostic process and criteria with autistic people, autistic people being listened to more by people like general practitioners and clinicians and diagnosis services needing to be more flexible and appreciate different aspects of someone's identity and neurodivergence. [ABSTRACT FROM AUTHOR]

Several measures have been developed to assess loneliness in the general population. Here, we examined if, and how accurately, widely-used measures capture the experience of loneliness in autistic adults. A total of 203 autistic participants from the UK completed an online survey, which included two widely-used loneliness questionnaires: the University of California, Los Angeles (UCLA) Loneliness Scale Version 3 and the Social and Emotional Loneliness Scale for Adults (SELSA). Participants completed the measures and provided their views on how well they captured their experiences of loneliness. A direct measure, asking participants how often they felt lonely, was also completed. Results demonstrated that scores on the UCLA and SELSA questionnaires positively correlated with the direct measure of loneliness, suggesting that these tools accurately index autistic experiences of loneliness. However, qualitative responses suggested that participants found both scales difficult to complete. Using reflexive thematic analysis, we identified three themes that encapsulated participants' views: (1) failing to distinguish between the characteristics/experiences of loneliness and being autistic, (2) loneliness is not a static trait and (3) inappropriate wording. Given that our sample of autistic participants tended to prefer the UCLA scale to the SELSA, we provide initial recommendations around how the UCLA scale could be adapted for autistic adults. There has been increasing interest in research on loneliness in autistic adults. Much of this research has involved giving autistic adults widely-used questionnaires that are thought to measure how lonely people are. However, these questionnaires have been developed for the general public. We do not know whether these questionnaires accurately measure how lonely autistic adults are. We asked 203 autistic adults to complete an online survey that included two widely-used loneliness questionnaires: (1) the University of California, Los Angeles (UCLA) Loneliness Scale Version 3 and (2) the Social and Emotional Loneliness Scale for Adults (SELSA). We also asked participants to rate how lonely they were from 1 (often/always) to 5 (never). Participants were then asked to give their views on the questionnaires (e.g. what they thought was good, and what they thought was not so good about them). We found that the scores on the UCLA scale and the SELSA aligned with participants' ratings of how lonely they were, which suggests that these two questionnaires accurately measure loneliness in autistic people. However, our participants also identified several ways to improve the questionnaires. This included (1) better distinguishing the characteristics/experiences of loneliness from those of being autistic; (2) better reflecting how loneliness may change at different times and in different contexts and (3) making the phrasing of the questions clearer. Overall, our autistic participants tended to prefer the UCLA scale to the SELSA. Therefore, we present some recommendations about how the UCLA scale could be changed to be more suitable for autistic people. [ABSTRACT FROM AUTHOR]

Therapeutic relationships play a central role in maintaining a positive social climate in forensic settings. The interpersonal difficulties characteristic of Borderline Personality Disorder, alongside the secure environment of forensic wards, can make developing positive therapeutic relationships with this patient group challenging. Qualitative interviews aimed to explore how ward staff understand and experience the interaction of interpersonal relationships and social climate when caring for patients with Borderline Personality Disorder on forensic wards. Interviews with 11 staff members working across UK forensic inpatient settings were analysed using Reflexive Thematic Analysis and reported following COREQ guidelines. Six interrelated themes were generated; three describe relational cycles that occur between ward staff and patients with Borderline Personality Disorder and three describe systemic factors that influence the context in which ward staff operate. From these themes, an integrative model was developed to summarise how factors in the wider forensic system and the interpersonal relationships between staff and patients with Borderline Personality Disorder in forensic wards influence one another, affecting staff experiences of the social climate of forensic settings. The model illustrates how complex cycles within the therapeutic relationships with staff and patients with Borderline Personality Disorder can interact with systemic influences in the wider forensic context to influence staff experiences of forensic settings. Clinical implications of the model are discussed, offering recommendations for improving therapeutic relationships and the social climate on forensic wards caring for patients with Borderline Personality Disorder, to better support staff and patient wellbeing. [ABSTRACT FROM AUTHOR]

Background: Undergraduate nutrition programmes prepare students and graduates for a wide range of employment opportunities. However, little is known about how employers perceive current nutrition education practices in Ireland and how well graduates are prepared for the realities of today's workforce. The present study aimed to explore employers' perspectives of nutrition placement students and graduates' competencies for the workforce. Methods: Interviews were conducted with 12 nutrition employers across Ireland and the UK who currently or have recently employed Irish nutrition graduates or supervised placement students. Interviews were transcribed verbatim and thematically analysed. Results: Three themes were identified including: "adapting to modern workforce needs", "professional competency expectations" and "valuing competency‐based educational and professional systems". Employers reported an overall positive experience with Irish nutrition placement students and graduates. They are perceived as adaptable, willing to learn and professional. Many felt nutrition students and graduates had received quality education with knowledge, skills and attitudes meeting expectations of nutrition education being provided but felt that students and graduates often lacked confidence in their abilities. Employers remarked that graduates who had undergone placements were better prepared for the professional work environment. However, gaps were identified because employers felt nutrition curricula lack training on business skills and digital competencies. Conclusions: Employers had a positive experience with Irish nutrition graduates and students and felt they were competent for the workforce. Addressing the gaps identified by employers to adapt curricula to modern workforce needs would further enhance graduate employability. Key points: Employers reported feeling overall satisfaction with nutrition graduates and nutrition placement student's competency levels entering the workforce environment.Nutrition graduates were perceived as well‐prepared to enter the professional workplace and were seen as adaptable and professional.A lack of confidence in abilities was reported by some employers and they expressed a desire for students to receive further support to build confidence.Employers identified two areas for improvement in nutrition science undergraduate curricula to further support nutrition students and graduates: addition of business skills and digital competency development.Professional accreditation in nutrition and registration as a nutritionist with the Association for Nutrition (AfN) is highly desired by employers. [ABSTRACT FROM AUTHOR]

Background: Optimal maternal nutrition is associated with better pregnancy and infant outcomes. Culinary nutrition programmes have potential to improve diet quality during pregnancy. Therefore, this research aimed to understand the experiences of cooking and the wants and needs of pregnant women regarding a cooking and food skills programme in the United Kingdom (UK) and Republic of Ireland (ROI). Methods: Online focus group discussions with pregnant women and those who had experienced a pregnancy in the UK or ROI were conducted between February and April 2022. Two researchers conducted a thematic analysis. Seven focus groups with ROI participants (n = 24) and six with UK participants (n = 28) were completed. Results: Five themes were generated. These were (1) cooking during pregnancy: barriers, motivators and solutions; (2) food safety, stress and guilt; (3) need for cooking and food skills programmes and desired content; (4) programme structure; (5) barriers and facilitators to programme participation. Overall, there was support for a programme focusing on broad food skills, including planning, food storage, using leftovers and to manage pregnancy‐specific physiological symptoms such as food aversions. Participants emphasised the importance of inclusivity for a diverse range of people and lifestyles for programme design and content. Conclusions: Current findings support the use of digital technologies for culinary nutrition interventions, potentially combined with in‐person sessions using a hybrid structure to enable the development of a support network. Highlights: Thirteen online focus group discussions were conducted across the UK and Ireland.Five themes were generated around cooking during pregnancy and the content and structure of a cooking and food skills programme.There was support for an inclusive cooking programme that included a wide range of food‐related skills.Participants believed the programme should be supported by the health services.There was support for the use of digital technologies, potentially combined with in‐person sessions using a hybrid structure. [ABSTRACT FROM AUTHOR]

Background: Dementia is a global public health challenge. Evidence suggests that individuals from South Asian communities are an at‐risk group for dementia, partly as a result of early and cumulative exposure to known dementia risk factors, such as obesity and type 2 diabetes. There needs to be more culturally appropriate community engagement to increase awareness of dementia and identify better strategies to encourage participation in dementia‐related research. Methods: We aimed to better understand the barriers and facilitators towards engaging with, and participating in, diet and dementia related research among British South Asians. This was achieved using a public and patient involvement (PPI) approach. A community‐based, engagement event involving information sharing from experts and roundtable discussions with South Asian communities (n = 26 contributors) was held in June 2023 in Newcastle‐upon‐Tyne, UK. Collaboration from preidentified PPI representatives (n = 3) informed the content and structure of PPI activities, as well as recruitment. Data were synthesised using template analysis, a form of codebook thematic analysis. This involved deductively analysing data using relevant a priori themes, which were expanded upon, or modified, via inductive analysis. Results: The findings highlighted the importance of trust, representation and appreciation of cultural barriers as facilitators to engagement in diet and dementia risk reduction research. Consideration of language barriers, time constraints, social influences and how to embed community outreach activities were reported as driving factors to maximise participation. Conclusions: This PPI work will inform the design and co‐creation of a culturally adapted dietary intervention for brain health in accordance with the Medical Research Council and National Institute for Health and Care Research guidance for developing complex interventions. Key points: Patient and public involvement activities among British South Asians in the North East of England highlighted the importance of trust, representation and appreciation of cultural barriers as facilitators to engagement in diet and dementia risk reduction research.Language barriers, time constraints and community outreach were driving factors to maximise participation. [ABSTRACT FROM AUTHOR]

Practice-based education is an essential component of pre-registration physiotherapy programs, and there is a need for a contemporary review of practice-based educational experiences. The aim of this study was to explore physiotherapy practice educators' experiences of supporting learners to inform considerations for future workforce development. This was a mixed methods sequential explanatory study based in the United Kingdom (UK). Phase one of the study utilized an online survey disseminated via the Chartered Society of Physiotherapy (CSP) professional networks. Phase two consisted of three semi-structured focus group interviews with participants who expressed an interest via completion of the online survey. All were registered or associate CSP members who actively support practice-based education. A total of 208 participants completed the online survey and a sub-set of 15 participated in online focus groups. Quantitative survey data were analyzed using descriptive statistics. Initial thematic analysis of qualitative data from both phases was undertaken by one researcher. Subsequent analyses were carried out independently by the remaining research team, and comparisons were made to agree on codes, categories, and themes. The practice educator is vital in developing the future workforce (30%, n = 61, strongly agree). Identified challenges included supervising more than one learner (34%, n = 67 not at all experienced) and using technology to provide alternative placement models (45%, n = 87 not at all experienced). Practice educators need accessible opportunities for professional development. Practice-based education should be embedded as an integral component of all staff roles. A team approach is essential to developing the future physiotherapy workforce. [ABSTRACT FROM AUTHOR]

Alcohol is a causal factor in about 10% of breast cancer (BCa) cases, but awareness of this link is low. This study explored how to raise awareness and inform the development of an intervention using the COM-B model (capability, opportunity, motivation, behavior) framework. Eight online focus groups were conducted with 36 participants (6 expert stakeholders,and 30 women aged 40–65). Participants reflected on a package of information about alcohol and BCa and discussed how to impart this information and encourage women to reduce drinking. Thematic analysis of focus group transcripts was undertaken. Three themes were identified: understanding ineffective messaging; transitions and challenges; and message acceptability. Current health information about alcohol was perceived as judgmental and BCa was put down to chance. Mid-life consisted of many challenges that could lead to increased consumption, but menopause transition may be a key moment for alcohol reduction. Barriers and enablers to communicating risk information and encouraging alcohol reduction were mapped onto the COM-B model. Psychological capability (relating to knowledge), social opportunity (in the form of social pressure) and automatic motivation (relating to drinking to cope) were barriers to behavior change. These will be targeted in an alcohol reduction intervention. It is important to tailor information to women's experiences, taking into account the social benefits of drinking, and encourage the development of healthy coping strategies. Acceptable intervention messages may include personal stories, clear statistics, and suggest healthy alternatives to drinking. It is vital that messaging does not appear judgmental or patronizing. [ABSTRACT FROM AUTHOR]

Research shows that, in mental healthcare, empathy and active listening skills play a fundamental role in the therapeutic relationship. Despite this, clinicians receive little training in cultivating these qualities, and there is a dearth of training in therapeutic relationships and relational care in this field more generally. In response to this paucity of training, a new intensive three-day training programme has been developed called Compassionate and Relational Enquiry (CARE). The CARE training programme has recently been delivered to a number of mental health teams in different boroughs of an NHS Trust and has undergone several rounds of redevelopment. This paper outlines the CARE training programme's objectives and mode of delivery, and subsequently presents questionnaire results from recent CARE trainees regarding their experience of the nature and utility of the training. Four main themes emerged from responses to the question of the utility of the training, these were 'A shift towards more person-centred care', 'Strengthens the therapeutic relationship', 'Facilitates more collaborative care with patients and their families' and 'Development of new skills and therapeutic techniques'. The paper concludes by discussing the potential of this training to help forge a substantial shift in the culture of mental health services in a systemic way. [ABSTRACT FROM AUTHOR]

Objective: Elite athletes are at elevated risk for disordered eating and eating disorders; however, little is known about risk and maintaining factors, or barriers and facilitators of help‐seeking in this cohort. This systematic review synthesized qualitative findings regarding possible risk and maintaining factors for disordered eating, as well as barriers to and facilitators of help‐seeking in elite athletes. Method: We conducted a search for qualitative studies that included experiences with body image concerns or disordered eating in elite athletes. A systematic search of CINAHL, PsychINFO, MEDLINE, and Scopus databases identified 828 articles, with 87 retained after title and abstract screening, and 38 included in the review. Quality appraisal was conducted using the checklist for appraising qualitative research (CASP). Data were extracted from each article, including demographic information (e.g., biological sex, age, sport type, level of competition, current, or former athlete) and the text under the "results" or "findings" section. Meta‐themes were identified using inductive thematic meta‐synthesis. Results: The extracted data indicated that most studies sampled female athletes from the United States and UK. Eight meta‐themes were identified: (1) the power imbalance; (2) hyperfocus on body, food, and exercise; (3) rigidity; (4) the athlete's balance; (5) the athlete identity; (6) overvaluation and oversimplification; (7) shame, fear, and stigma; and (8) knowledge, education, and self‐identification. Discussion: These findings highlighted gaps in the demographic representation of specific groups in this research (e.g., males, para‐athletes, and ethnic diversity) and propose hypotheses of how sport pressure might contribute to athletes' experiences with disordered eating. Public Significance: Disordered eating and body image concerns are prevalent and can have debilitating impacts for elite athletes; however, help‐seeking is rare for this population. It remains unclear what factors contribute to disordered eating and/or inhibit help‐seeking among elite athletes versus the general population. Understanding athletes' perspectives will inform the modification of prevention and treatment strategies to address athlete‐specific factors. [ABSTRACT FROM AUTHOR]

Antimicrobial resistance (AMR) is subject to extensive risk reduction approaches. A central strategy is reducing the unnecessary use of antimicrobials across agriculture and human and animal health care without jeopardising health outcomes for all species concerned. A prominent framework is antimicrobial stewardship which seeks to balance access to effective infection treatments with ensuring that effective antimicrobials are available for future generations. Balancing these goals has proven challenging and the consumption of antimicrobials and AMR both continue to grow. To shed light on this situation, we examined the risk reasoning that underpins AMR reduction in interviews with 51 practitioners, scientists and policy-makers working on AMR in Australia and the UK. Important themes in our analysis were that action to reduce infection risks clashed with AMR reduction rationalities. Participants were often not able to explain how treating an infection for an individual patient could harmonise with the longer-term goal of AMR reduction. Due to the potential for patient harm, making decisions to use antimicrobials was narrated as individualised and moralised. We argue that more effective AMR reduction depends on addressing this fundamental tension in AMR risk, and its individualising and moralising effects, as the starting point – not the outcome – of policy and practice for AMR reduction. [ABSTRACT FROM AUTHOR]