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

This paper investigates alcohol consumption within cultures of football fandom through the innovative combination of theories of the carnivalesque and Bourdieu's concepts of habitus, field, and capital. Focus groups (n = 79) were conducted with football supporters in England and Scotland. Semi-structured interviews (n = 15) were also conducted with key organizational stakeholders. Research explored the importance and role of alcohol consumption for supporters when watching or attending matches.. Participants confirmed the cultural significance, perceived normalcy and historical links between football and alcohol consumption. Supporters highlighted the importance of the sociability, friendship, and social capital aspects of alcohol consumption. Participants believed football supporters are perceived differently in comparison with supporters of other sports, arguing that legislation surrounding alcohol consumption at other sports allowed supporters to enhance the carnivalesque by drinking alcohol, whereas football fans were more restricted. Participants agreed the habitus of excessive drinking and violence associated with football supporters led to a bad reputation, however, this view was outdated. Participants also recognized a growing drug culture in football. The findings draw attention to the alcohol-sport relationship and the contested relations, and diverging interests and influences, within the social field of football. [ABSTRACT FROM AUTHOR]

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

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

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

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

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

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

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

There are conflicting theories about the best ways to support behaviour in schools. This paper captures the perspectives of UK primary school staff regarding the advantages and disadvantages of different behaviour support approaches, in addition to exploring the facilitators and barriers to adopting relational-based approaches. Virtual semi-structured interviews were conducted with 15 school staff across three mainstream primary schools. A reflexive thematic analysis identified nine themes. Participants commented on the approaches' flexibility, familiarity, positive long-term behaviour change and emotional wellbeing and relationships. Key facilitators to adopting relational-based approaches included: whole-school training and understanding; quality and type of training; and working together and feeling supported. Key barriers included: changing perspectives; ease of implementation and familiarity; scarcity of resources; and persevering in the face of difficulties. Themes are discussed in light of psychological research and implications for educational practitioners and future research are considered. [ABSTRACT FROM AUTHOR]

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

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

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

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

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

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

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

Minoritised individuals (people identifying as belonging to groups experiencing socially constructed power inequalities) frequently experience mental health inequalities. Mental health services have often, intentionally or inadvertently, perpetuated these inequalities due to historic and ongoing systemic discrimination. To reduce inequalities, mental health services must address ongoing systemic discrimination and improve cultural-sensitivity of clinical staff. One method of improving clinician cultural-sensitivity is through reflective practice groups. This project evaluates a staff Equality Diversity and Inclusion (EDI) reflective space within a community psychological therapies team. A mixed methods approach of survey feedback and semi-structured interviews was used. Staff found the reflective space beneficial for improving their clinical skills relating to issues of EDI and helpful for their own wellbeing. Staff also found the EDI reflective space both acceptable and feasible and were keen to attend future sessions. However, some clinicians highlighted challenges relating to fear of judgment and evaluation from others. Findings are discussed in relation to the growing body of evidence of the usefulness of staff reflective spaces in healthcare generally, and provide specific support for the implementation of EDI reflective spaces. Guidance for developing an EDI staff reflective space for healthcare staff are discussed, alongside limitations and possible future research directions. [ABSTRACT FROM AUTHOR]

In the UK, in the acute in-patient setting, the only information that a patient receives about their medical care is verbal; there is no routine patient access to any part of the medical record. It has been suggested that this should change, so that patients can have real-time access to their notes, but no one has previously explored patient or clinician views on the impact this might have. Semi-structured interviews were conducted with 12 patients and 13 doctors about their experience of information sharing in the context of the acute care setting, and their views on sharing all of the medical records, or a summary note. Interviews were transcribed verbatim, double coded and analyzed using the constant comparative method. Patients were not given written information and did not ask questions even when they wanted to know things. Patients and doctors supported increased sharing of written information, but the purpose of the medical record - and the risks and benefits of sharing it - were disputed. Concerns included disclosing uncertainty, changing what was written, and causing patient anxiety. Benefits included increased transparency. Use of a summary record was welcomed as a way to empower patients, while doctors felt they had a responsibility to curate what information was given and when. A clinical summary for patients would be of benefit to doctors, nurses, patients and their relatives. It should be designed to reflect the needs of all users, and evaluated to consider patient-relevant outcomes and resource implications. [ABSTRACT FROM AUTHOR]

Background: Poor hospital discharge processes can result in the readmission of patients and potentially increase the stress levels of carers. Therefore, this study sought to understand the factors related to the discharge planning process for patients with dementia. Methods: The researchers interviewed 32 carers of patients with dementia and 20 hospital staff who worked on medical wards in a United Kingdom (UK) hospital. The semi-structured interviews were analysed thematically using a systems theory (patient–carer–staff relationships, hospital equipment and policies). Results: The findings indicated that the following factors could either have a positive or negative impact on discharge planning: patient (e.g. cognitive capacity), carer (e.g. preconceived ideas about care homes), staff (e.g. communication skills), policy (e.g. procedures such as discharge meetings), equipment (e.g. type of service provider delivering the equipment) and the wider social context (e.g. availability of specialist dementia beds in care homes). Conclusion: It is important for hospital staff to adopt a systems perspective and to integrate the different elements of the hospital system when planning for patients' discharge. [ABSTRACT FROM AUTHOR]

Bondage/discipline, dominance/submission, and sadism/masochism (BDSM; "kink") are frequently pathologized as derivatives of abuse. Although the link is unsubstantiated, some kink-identified people who happen to be survivors of trauma may engage in kink, or trauma play, to heal from, cope with, and transform childhood abuse or adolescent maltreatment. The present study sought a thematic model (Braun & Clarke, Qualitative Research in Psychology, 3(2), 77–101, 2006) of trauma recovery through kink using a critical realist, inductive approach to inquiry. Participants were eligible if they had experienced early abuse, were adults, and practiced kink. Six superordinate themes were generated from semi-structured interviews with 20 participants from five countries: cultural context of healing (e.g. using BDSM norms and previous therapy to reframe kink and trauma), restructuring the self-concept (e.g. strengthening internal characteristics which had been harmed or distorted), liberation through relationship (e.g. learning to be valued by intimate others), reclaiming power (e.g. setting and maintaining personal boundaries), repurposing behaviors (e.g. engaging in aspects of prolonged exposure), and redefining pain (e.g. transcending painful memories through masochism). Notably, participants only reported retraumatizing experiences prior to learning about the structural safeguards of BDSM. Research and clinical implications are discussed by drawing on general models of trauma recovery. [ABSTRACT FROM AUTHOR]

Supported self-management (SSM) is an important part of adapting to life after stroke however it is a complex concept. It is unclear what SSM in stroke consists of or how stroke survivors, families, and clinicians can most effectively work together to support person-centred self-management. In this study, we aimed to explore what was most important in making SSM work in community stroke rehabilitation. We conducted a Q-methodology study with stroke survivors (n = 20), community-based stroke clinicians (n = 20), and team managers (n = 8) across four health boards in Scotland, United Kingdom. Participants ranked 32 statements according to their importance in making SSM work. Factor analysis was used to identify shared viewpoints. We identified four viewpoints: (i) A person-centred approach to build self-confidence and self-worth; (ii) Feeling heard, understood, and supported by everybody; (iii) Preparation of appropriate resources; and (iv) Right thing, right place, right time for the individual. Important across all viewpoints were: a trusting supportive relationship; working in partnership; focusing on meaningful goals; and building self-confidence. Differing views exist on what is most important in SSM. These views could be used to inform quality improvement strategies to support the delivery of SSM that considers the preferences of stroke survivors. Clinicians should be aware of their own viewpoint of supported self-management and consider how their perspective may differ from stroke survivors' and colleagues' perspectives of what's important to support self-management. Working in partnership with stroke survivors plus developing a trusting and supportive relationship with them are core components of supporting self-management in the longer term after stroke. Building a sense of self-worth and self-confidence, a focus on meaningful goals, training and support for staff, and tailoring support to people's needs at the right time are important considerations for supporting longer-term engagement in self-management. [ABSTRACT FROM AUTHOR]

The aims of this study were to describe how and why adults with CP living in the UK and Ireland accessed and used physiotherapy services; to describe the type of physiotherapy accessed and satisfaction with physiotherapy services and to examine the associations between relevant factors. A cross-sectional semi-structured online survey was employed. Participants were adults with CP aged 18 and above living in the UK and Ireland; able to complete an online questionnaire in English independently or with technical or physical assistance. Data were collected from April 2019 to February 2020. Participants (n = 162) were aged 18–74 years. The majority were female (75%) and lived in the UK (83%). Ninety percent of participants reported a need for physiotherapy but only 35% received physiotherapy services. The most common reason for visiting physiotherapy was mobility decline (62%). Satisfaction with the availability and quality of physiotherapy services were 21% and 27%, respectively. Adults with scoliosis and mobility decline were less likely to report that they received the physiotherapy they needed. Adults with CP did not receive the physiotherapy services that they perceived they needed. There is a need to develop physiotherapy services in collaboration with people living with CP. Adults with cerebral palsy (CP) needed physiotherapy services, but were not receiving the physiotherapy services that they perceive they needed. Adults were not satisfied with the availability or quality of physiotherapy services received. Adults with scoliosis and mobility decline were less likely to report that they received the physiotherapy they needed. There is a need to develop physiotherapy services from a life-span perspective for adults living with CP. [ABSTRACT FROM AUTHOR]

Research has identified an association between poverty and the likelihood of children suffering from abuse. What is less clear is how the experience of living in poverty links to this abuse. This qualitative study investigated individual stories of child abuse and the role of poverty in their lives. Through interpretative phenomenological analysis explanations why children had been abused were elicited from parents and professionals. Poverty as an abstract concept was articulated by parents describing their lived experience, breaking it down into its constituent parts. Social health and environmental contexts and the personal consequences of this emerged from the data. Professionals missed poverty at a macro level by focussing on the micro processes, leading to explanations of the abuse as personal inadequacy rather than systemic issues. [ABSTRACT FROM AUTHOR]

While extensive literature documents how criminalisation harms sex workers' health and rights, limited research has critically examined how interactions between criminal-justice, health, and other systems shape support and justice for and by people who sell sex. We attend to this question by drawing on participatory, qualitative research with a diverse group of sex workers and other stakeholders in East London, UK. In addition to directly and structurally-violent enforcement practices, we identified wider, necropolitical assemblages and practices – across police, local and immigration authorities, health and social services – that disciplined sex workers' lives, responsibilised them for their health, and defunded specialist services grounded in lived realities, amid tensions over sex-work governance. These effects – grounded in notions of community and vulnerability that often privileged residents' concerns over threats to sex workers' safety and health – impacted marginalised and minoritised cis and trans women the most. Those who worked on the street and used drugs, were migrants, and/or women of colour were particularly targeted for enforcement, discounted when reporting violence and impacted by service cuts. Yet participants' appeals for redirection of funds from enforcement towards respectful, peer-led services reflected claims to social justice on their own terms. We recommend (re)commissioning health and support services that respond to sex workers' diverse realities, with and by them, alongside concerted efforts to end policies and practices that criminalise, punish, and blame. This would help to alleviate the health and social harms that we document, in support of inclusive participation in health and broader social justice goals. [ABSTRACT FROM AUTHOR]

To assess the benefits of the Ida Institute's Why improve my hearing? Telecare Tool used before the initial hearing assessment appointment. A prospective, single-blind randomised clinical trial with two arms: (i) Why improve my hearing? Telecare Tool intervention, and (ii) standard care control. Adults with hearing loss were recruited from two Audiology Services within the United Kingdom's publicly-funded National Health Service. Of 461 individuals assessed for eligibility, 57 were eligible to participate. Measure of Audiologic Rehabilitation Self-efficacy for Hearing Aids (primary outcome) scores did not differ between groups from baseline to post-assessment (Mean change [Δ]= −2.28; 95% confidence interval [CI]= −6.70, 2.15, p=.307) and 10-weeks follow-up (Mean Δ= −2.69; 95% CI= −9.52, 4.15, p =.434). However, Short Form Patient Activation Measure scores significantly improved in the intervention group compared to the control group from baseline to post-assessment (Mean Δ= −6.06, 95% CI= −11.31, −0.82, p =.024, ES=.61) and 10-weeks follow-up (Mean Δ= −9.87, 95% CI= −15.34, −4.40, p =.001, ES= −.97). This study demonstrates that while a patient-centred telecare intervention completed before management decisions may not improve an individual's self-efficacy to manage their hearing loss, it can lead to improvements in readiness. [ABSTRACT FROM AUTHOR]

To examine patient and audiologist experiences and perspectives of using a patient-centred telecare tool, the Ida Institute's Why Improve My Hearing? (WIMH) Tool, before and during the initial hearing assessment appointment. A qualitative study comprising individual semi-structured interviews using a maximum variation sampling strategy. The data were analysed using an established thematic analysis technique. Fifteen participants, including ten patients (i.e. adults with hearing loss) and five audiologists, were recruited from Adult Audiology Services within the United Kingdom's publicly-funded National Health Service (NHS). Three themes described the impact of using the WIMH Tool. Theme 1 (i.e. enhanced preparation before the appointment): the Tool helps patients to better understand and accept their hearing difficulties in advance of their first appointment. Theme 2 (i.e. enriched discussion during the appointment): the tool can enhance patient-centred communication, as well as the efficiency of the appointment. Theme 3 (i.e. varied impact on outcomes following the appointment): the Tool can improve patient motivation, readiness, and involvement in decision-making, though it may have limited impact on additional outcomes, such as adherence. The WIMH Tool can be successfully implemented in audiological practice, resulting in benefits before and during the initial hearing assessment appointment. [ABSTRACT FROM AUTHOR]

As the average age of first-time parents continues to rise, there has been a concerted effort by educators, policy makers and several reproductive health groups to improve fertility awareness. This study explored fertility knowledge of lay men and women and healthcare professionals (HCPs) using the same test instrument, providing a new and unique perspective compared with previous studies. Results were obtained from 1082 survey respondents: 347 HCPs, 319 men and 413 women, 105 of whom were trying to conceive (TTC). A total of 35 interviewees were purposively sampled to include 9 HCPs, 13 men and 13 women from the reproductive age range and of varying ethnic and educational backgrounds. Interview data were transcribed and analysed using the framework method. The proportion of HCPs correctly answering the survey knowledge questions was 47.1 (95% CI = 41.7%, 52.5%) compared to 44.4% for women (95% CI = 38.9%, 50.1%); 49.9% (95% CI = 39.0, 59.9%) for women TTC; and 32.5% (95% CI = 27.1%, 37.9%) for men. HCPs were ranked as the most trusted source for seeking fertility information. Overall HCPs did not demonstrate better fertility knowledge than lay participants, with inconsistencies regarding where responsibility lies for providing the right information to patients. HCPs need to improve their knowledge about fertility to help improve patient's fertility awareness. [ABSTRACT FROM AUTHOR]

This article draws on data collected from a qualitative study designed to assess the effectiveness of an early intervention programme aimed to raise awareness of Child Sexual Exploitation (CSE) among young people. The programme was implemented by a large police force area, referred to as Shireland. Drawing on semi-structured interviews with practitioners implementing safeguarding policies within the police service, youth and social welfare work designed to support young people, we focus on the mobilisation of perceptions of risk and vulnerability as they translate in professional practice via a specific preventative initiative. More specifically, we wish to examine the extent to which blurring occurs between constructions of 'risk' and 'vulnerability' in relation to practitioners' understandings of the dangerousness of young people's behaviour. In our analysis, we draw attention to a palpable tension apparent in the interview narratives of those involved in delivering the programme, between expressed understandings which on the one hand universalise vulnerability and, on the other, extricate specific risk factors. [ABSTRACT FROM AUTHOR]

Integrative local health delivery models in the UK, under the framework of Enhanced Health in Care Homes (EHICH), have been developed to improve joint working between health and social care to benefit the patient. Despite this drive toward health and social care integration, research on the barriers, facilitators, and impact of partnership working on role of care home staff is underdeveloped. This study set out to explore views on how closer working between health and social care can impact on the role of care home staff and any barriers to effective integration. Staff from 25 care homes and GPs from their partnered practices were interviewed to explore the impact of the partnership. Homes receiving regular visits from the same health professional found the relationship between the two sectors had benefitted both residents and staff. The development of trusting relationships, access to support and information, and recognition and respect were all seen as facilitating the partnership and enhancing patient care. Regular and effective interactions with health-care professionals were key and had the potential to empower and increase confidence of care home staff in their role around health care. Factors negatively impacting on strength of relationship such as visits by inconsistent professional and high turnover of care home staff were a barrier to successful partnerships. Experiences of poor interactions with those from health-care services where there was an absence of a trusting relationship were disempowering to care home staff and remain a barrier to effective wider health and social care collaboration. [ABSTRACT FROM AUTHOR]

This article reports findings from a large mixed-method study exploring the migration to the United Kingdom (UK) of social workers trained in Australia, Canada, India, Romania, South Africa, the US, and Zimbabwe, and the migration of British trained social workers to Australia. The project aimed at exploring the motivations for migration, the experiences of integration, and the impact of culture on these. This article focuses on the quantitative findings and will use some of the qualitative data to further explain and interrogate the differences between these groups based on their country of origin. The findings show the greater challenges migrants from developing countries have experienced, including lack of recognition of their qualifications and experience, and discrimination. The findings also show that contrary to common assumptions, the migration experiences of social workers coming from Australia, Canada and the US are not as easy as expected. American social workers who migrated to the UK turned out to be the group least professionally satisfied. The British in Australia on the other hand, were the most satisfied. Implications for practice and future research are explored. [ABSTRACT FROM AUTHOR]

Childhood sexual abuse (CSA) can result in devastating and long lasting consequences. Differences in the nature of the abuse differ for males and females and this difference potentially influences recovery. However, studies of recovery from CSA, especially among men, are relatively few, especially for ethnic minority men. The study explored the lived experience of recovery from CSA among African-Caribbean Black male survivors of CSA living in Canada, the United Kingdom and the United States. The theoretical framework was the transactional model of stress and coping, which proposes that stress is an ongoing transaction between the demands of life and a person's psychological ability to address those demands. The study was qualitative in design, using an interpretive phenomenological approach, involving purposeful sampling, in-depth semi-structured interviews, and interpretive phenomenological analysis of the data informed by a critical race theory lens. The results showed that Black male survivors are situated in unique historical/sociocultural interrelationships that complicate recovery from CSA, including institutional racism and discrimination, restrictive narratives of masculinity, and other cultural norms. These findings can be used to influence policy makers, service providers, and communities, to more effectively support and address the needs of CSA survivors and their affected families. [ABSTRACT FROM AUTHOR]

The meaning and significance of gender is currently a focus of heated and, often, polarised debate in the UK and elsewhere. This article provides a new perspective in the gender debate through focused exploration of UK-based non-binary people's perceptions of legal gender status and reform. Binary gender/sex systems, such as the legal gender system in the UK, are underpinned by cisgenderism and are challenged by those whose identity falls outside of the binary of woman and man. In contrast to most lay participants in the Future of Legal Gender (FLaG) project, the majority of non-binary participants reported support for reform (85.5% (n = 165) in favour) to the current UK legal gender system. Over half (57%, n = 110) were in favour of abolishing legal gender (i.e. the state would no longer assign a legal gender status), although this was constructed as 'an impossible dream'. Situating non-binary people's perspectives at the heart of the debate about the certification of gender offers novel insight which could have significant ramifications for how societal structures could support undoing gender in the future. [ABSTRACT FROM AUTHOR]

Research on breaking bad news (BBN) in healthcare has mostly focused on the doctor-patient interaction during a single consultation. However, it has been increasingly recognised that BBN is a wider process that also involves other healthcare professionals. This qualitative study explored non-medical1 healthcare professionals' involvement in BBN to newly diagnosed patients with motor neurodegenerative conditions in the UK. 19 healthcare professionals working with people with motor neurone disease, multiple sclerosis, Parkinson's disease or Huntington's disease took part in individual, semi-structured interviews which were analysed using thematic analysis. Four themes were constructed: dealing with the diagnostic aftermath, unpacking the diagnosis, breaking bad news as a balancing act and empowering patients to regain control over their health and lives. Participants reported being broadly involved in BBN by supporting patients with negative diagnostic experiences, re-iterating diagnostic information and helping patients understand the impact of their condition. The challenges of effectively breaking bad news and how these difficult conversations could help empower patients were also emphasised. BBN was a critical and challenging aspect of healthcare professionals' clinical work with newly diagnosed patients with motor neurodegenerative conditions. Besides providing information, BBN was perceived as a way to educate patients, encourage them to make decisions and prepare for the future. Breaking bad news is a potentially under-recognised but significant aspect in the neurorehabilitation of neurodegenerative conditions. Listening to patients' stories about a long and occasionally unsatisfactory diagnostic journey and allowing them to express their frustration can be critical in regaining patients' trust and building a relationship with them. Newly diagnosed patients have not always received adequate information about their condition at diagnosis or they might have not understood or retained that information. It is, therefore, essential that patients' understanding of their condition is assessed, misconceptions are cleared and appropriate information about the nature and impact of the diagnosis is provided. Irrespective of the length of experience, breaking bad news was perceived as a multi-faceted, challenging, stressful and emotionally demanding task. Formal support and specialised training on breaking the bad news that addresses the incurable, unpredictable and progressive nature of motor neurodegenerative conditions could help professionals with this challenging task. [ABSTRACT FROM AUTHOR]

This study explored audiologists' perspectives regarding their interactions with workers with hearing loss (WHL). Semi-structured interviews were conducted with twenty-five audiologists working in the National Health Service (NHS) and independent companies (IC) in the UK and were thematically analysed. The developed themes and sub-themes (shown in parenthesis) are (1) Current practices and routines (Same approach for most patients; Variations between hearing care services; Audiologists' personal experience of hearing loss) (2) Perceived challenges (Non-routine and challenging cases; The role of hearing technology; Concerns about lack of awareness and knowledge; Communication difficulties between services, Limited funding and resources) (3) Scope for better support (Would like to be informed; Other potential service improvements). This study revealed that audiologists' perceived deficiencies in the hearing rehabilitation for WHL and identified ways to improve it. Key priorities for improvement were found to include addressing audiologists' informational and training needs, facilitating WHLs' access to appointments, improving communication between services, raising awareness in the workplace, developing relevant resources and extending funding for provision of longer appointments and hearing technologies. This is the first time this information has been reported in the literature. Opportunities for conducting further research in this area are suggested. Workers with hearing loss face many challenges in work life and have the option of audiologic rehabilitation to alleviate their difficulties and improve their wellbeing; however, this study suggests that workers' audiological care needs improvements. Audiologists should assess and consider patients' work needs and psychosocial concerns in consultations to provide personalised care. Audiology educational programmes, services, and the healthcare system can assist audiologists in helping workers with hearing loss by providing updated knowledge, continuous training and improved interprofessional communication and patients' access to useful resources. [ABSTRACT FROM AUTHOR]

To address the paucity of research on patient perspectives regarding return to driving after Total Hip and Total Knee arthroplasty (THA; TKA), and how this impacts on return-to-work. Employed participants, who had undergone THA or TKA, took part in semi-structured telephone interviews. They were asked about support received regarding driving, who provided this information, and the impact of this on their return to driving and consequently work. Thirty-eight people were interviewed. Although sources of information and advice were available, patients struggled to know who to approach. Interviewees reported variations and contradictions in the advice given on when they could safely return to driving after surgery. Of note, there was little difference in the advice given to those who had undergone THA compared to TKA. Many participants devised their own plan for returning to driving There is inconsistency in driving advice provided after THA and TKA. Consequently, patients make their own decisions about how and when to drive, and develop strategies to accelerate the process. Greater clarity is required from healthcare professionals on time frames for driving post-surgery and for advising patients on their responsibilities around informing the DVLA and insurance companies of their surgery. Healthcare professionals should be aware of medico-legal requirements when advising patients about their legal responsibilities regarding driving after joint arthroplasty. Given the pivotal role of driving in the resumption of work after joint arthroplasty, there needs to be greater importance placed on the provision of explicit advice and support on driving for those undergoing orthopaedic surgery. As driving is a complex skill, the advice given to patients should be individualised. Factors to be considered should be the type of vehicle driven e.g., automatic/manual transmission; height of the vehicle from the ground; the side of the surgery; any medication prescribed which might impact on driving, and consideration of any comorbidities. [ABSTRACT FROM AUTHOR]

The need for "culturally appropriate" support for racial and ethnic minority (REM) students has prompted several British universities to embrace targeted interventions such as "ethnic matching" to encourage professional help-seeking on campus (i.e., pairing REM students with ethnically similar practitioners). There remains, however, little clarity on what culturally appropriate support entails. This study explores how REM students define culturally appropriate support and the approaches they view to be effective in promoting help-seeking. Semi-structured interviews were conducted with 48 REM students in two British universities. Data analysis was guided by principles of constructivist grounded theory and reflexive thematic analysis. REM students discuss three ways universities can provide culturally appropriate support; via ethnic matching; a broader cultural appropriateness; or a person-specific service. For these students, a service narrowly focusing on race/ethnicity has the potential to remove rather than enhance accountability and engagement within mental health service provision, and not adequately valorize the experience of the student as both individual and racialized. A protocol-driven and instrumental understanding of "culturally appropriate" support may serve to reduce REM student willingness to seek professional help. Universities, therefore, should commit to a student-centred process, combining racial diversification and cultural recognition with a reflexive person-specific approach. [ABSTRACT FROM AUTHOR]

Visual perceptual deficits are frequently underdiagnosed in stroke survivors compared to sensory vision deficits or visual neglect. To better understand this imparity, we evaluated current practice for screening post-stroke visual perceptual deficits. We conducted a survey targeted at professionals working with stroke survivors involved in screening visual perceptual deficits across the United Kingdom and the Republic of Ireland. Forty orthoptists and 174 occupational therapists responded to the survey. Visual perceptual deficit screening was primarily conducted by occupational therapists (94%), with 75∼100% of stroke survivors screened per month. Respondents lacked consensus on whether several common post-stroke visual deficits were perceptual or not. During the screening, respondents primarily relied on self-reports and observation (94%), while assessment batteries (58%) and screening tools were underutilised (56%) and selected inappropriately (66%). Respondents reported lack of training in visual perception screening (20%) and physical/cognitive condition of stroke survivors (19%) as extremely challenging during screening. Visual perceptual deficits are screened post-stroke at a similar rate to sensory vision or visual neglect. Underdiagnosis of visual perceptual deficits may stem from both reliance on subjective and non-standardised screening approaches, and conflicting definitions of visual perception held among clinicians. We recommend increased training provision and use of brief performance-based screening tools. Lack of agreement among clinicians on what constitutes as visual perceptual or sensory vision deficits may prove problematic, as precise and exact language is often required for clinical decision-making (e.g., referrals). Biases for more familiar visual (perceptual) deficits held among clinicians during the screening process may lead to other visual deficits being missed. To avoid problems being missed, clinicians should aim to use standardised assessments rather than stroke survivor self-report and observations of function when screening for visual perceptual difficulties. [ABSTRACT FROM AUTHOR]

Rapid digital transformation is taking place due to the COVID-19 pandemic, forcing organisations and higher educational institutions to change their working and learning culture. This study explores the challenges of rapid digital transformation arising during the pandemic in the higher education context. This research used the Q-methodology to understand the nine challenges that higher education encountered, perceived differently as four main patterns: (1) Digital-nomad enterprise; (2) Corporate-collectivism; (3) Well-being-oriented; and (4) Pluralistic. This study broadens the current understanding of digital transformation, especially in higher education. The nine challenges and four patterns of transformation actors serve as a starting point for organisations in supporting technological choice and strategic interventions, based on individual, group, and organisational behavioural levels. Moreover, five propositions, based on the competing concerns of these challenges, establish a framework for comprehending the ecosystem that enables rapid digital transformation. Strategies, prerequisites, and key factors during the (digital) technology development process benefit the cyber-society ecosystem. As a practical contribution, Q-methodology was used to investigate perspectives on digitalisation challenges during the pandemic. [ABSTRACT FROM AUTHOR]

The purpose of the current review is to synthesize the evidence of patients' perspectives of recovery after hip fracture across the care continuum. A systematic search was conducted, focusing on qualitative data from hip fracture patients. Screening, quality appraisal, and a subset of articles for extraction were completed in duplicate. Themes were generated using a thematic synthesis of data from original studies. Fourteen high-quality qualitative studies were included. Four review themes were identified: recovery as participation, feelings of vulnerability, driving recovery, and reliance on support. Patients considered recovery as a return to pre-fracture activities or "normal" enabling independence. Feelings of vulnerability were observed irrespective of the time since hip fracture and only diminished when recovery of function and activities enabled participation in valued activities, e.g., outdoor mobility. Participants expressed a desire to engage in recovery with realistic expectations and the benefits of meaningful feedback reported. While reliance on healthcare professionals decreased towards a later stage of recovery, reliance on social support persisted until recovery was perceived to have been achieved. Patient perspectives highlighted hip fracture as a major life event requiring health professional and social support to overcome feelings of vulnerability and enable active engagement in recovery. Rehabilitation professionals should ensure expectations and goals are set early in the recovery process. Rehabilitation professionals should ensure goals set with patients are tailored to the individual's pre-fracture activities or "normal" promoting independence. Rehabilitation professionals should monitor goals ensuring they are providing support, motivation, and managing expectations across the care continuum. Rehabilitation professionals should address patients' feelings of vulnerability, particularly in the absence of social support, and ensure appropriate ongoing input to maximize recovery. [ABSTRACT FROM AUTHOR]

COVID-19-related inequities experienced by racial and ethnic minority groups including healthcare professionals mirror wider health inequities, which risk being perpetuated by lower uptake of vaccination. We aim to better understand lower uptake among racial and ethnic minority staff groups to inform initiatives to enhance uptake. Twenty-five semi-structured interviews were conducted (October 2020–January 2021) with UK-based healthcare staff. Data were inductively and thematically analysed. Vaccine decision-making processes were underpinned by an overarching theme, 'weighing up risks of harm against potential benefits to self and others'. Sub-themes included 'fear of harm', 'moral/ethical objections', 'potential benefits to self and others', 'information and misinformation', and 'institutional or workplace pressure'. We identified ways in which these were weighted more heavily towards vaccine hesitancy for racial and ethnic minority staff groups influenced by perceptions about institutional and structural discrimination. This included suspicions and fear around institutional pressure to be vaccinated, racial injustices in vaccine development and testing, religious or ethical concerns, and legitimacy and accessibility of vaccine messaging and communication. Drawing on a critical race perspective, we conclude that acknowledging historical and contemporary abuses of power is essential to avoid perpetuating and aggravating mistrust by de-contextualising hesitancy from the social processes affecting hesitancy, undermining efforts to increase vaccine uptake. [ABSTRACT FROM AUTHOR]

Despite significant research and literature relating to the role of critically reflective practice and staff supervision in 'helping professions', there has been less attention given to probation practice. This article addresses this gap by presenting the findings from a study that explores the implementation of a reflective model of staff supervision in the National Probation Service. Utilising a mixed-methods research design including a survey and semi-structured interviews with managers and front-line practitioners, the study sheds light on probation staff's experience of reflective supervision and manager perspectives of implementing the model. Overall, we find that probation staff are supportive of the ethos and underpinning principles of the reflective supervision model. However, our participants raised important barriers to implementation, most notably a lack of time and perceived tension between the managerial and developmental aspects of the supervisor role. We conclude by arguing that the Probation Service needs to address these barriers to enable reflective supervision to realise its potential to protect practitioner emotional well-being, support-positive outcomes for individuals subject to probation intervention and develop practitioner professionalism, empowerment, and autonomy. [ABSTRACT FROM AUTHOR]

To explore the lived experiences of culturally Deaf British Sign Language (BSL) users who access adult hearing aid services. Semi-structured qualitative interviews were conducted in BSL by the Deaf researcher and analysed using an Interpretative Phenomenological Analysis (IPA) approach. Eight Deaf BSL expert informants who were experienced users of NHS adult hearing aid clinics. Participants expressed dissatisfaction about audiology staff's lack of Deaf awareness and did not feel valued as Deaf signers. Participants' motivations for hearing aid use primarily concerned audibility rather than speech. Mismatch of perspectives on 'hearing' between audiologists and Deaf patients are discussed in the context of culturally sensitive services. Inadequate or uncertain linguistic access during appointments is considered in light of patient agency. This is the first study to explore culturally Deaf signers' specific experiences of adult hearing aid services in the UK and their experiences of hearing aids. There are numerous reasons why Deaf signers wear hearing aids, but access to spoken language is not a priority. Limited Deaf awareness and cultural competence in adult hearing aid services can result in patient frustration and disempowerment. Suggestions for improvement in the Deaf signing patient experience are offered. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine cultural beliefs, attitudes, and practices of Black sub-Saharan Africans (BsSAs) in the UK regarding their type 2 diabetes (T2D) self-management using the concepts of the PEN-3 cultural model. A qualitative study involved 36 semi-structured interviews with BsSAs living with T2D in the UK to examine relevant cultural practices and beliefs that have contributed to the uneven burden of self-management behaviours. A narrative thematic analysis of the data was then conducted for the study using NVivo software and guided by the PEN-3 cultural model, which moves beyond individualistic health behaviour models of diabetes but centralises culture in understanding health behaviours. Cultural perceptions and self-management behaviours of T2D varied among the BsSAs. Systems of self-management and treatment practices that were congruent with their cultural beliefs and personal priorities were seen as essential in the positive response to self-managing T2D. Knowledge and perceptions of non-conventional and alternative remedies linked to cultural beliefs reflected the existential health-seeking behaviours, and the significance attached to BsSAs negotiated cultural identities and collective practices within the communities. Social network supports were seen as enablers while advice and regimens from healthcare professionals (HCPs) were presented as medicalised and devoid of cultural sensitivities to respondents. The study findings highlight the need to be not only aware of the negative impact of diabetes perceptions and health behaviours among the BsSA communities, but also be aware of the enabling factors and collective practices within the communities that are equally critical in influencing the self-management and health-seeking decisions of BsSAs living with T2D. PEN-3 model was significant with exploring not only how cultural context shapes health beliefs and practices, but also how social networks and systems play a critical role in enabling or nurturing positive health behaviours and health outcomes. [ABSTRACT FROM AUTHOR]

Organizational reform has been commonplace in the response to global socio-economic changes. Rising managerialism, consumerism and marketization has accelerated reforms; providing challenges for the healthcare professions. The latest socio-economic challenge, austerity, and its professional implications have scarcely been researched. This study aims to explore the lived reality of austerity as experienced by physiotherapists working on the frontline of the National Health Service (NHS) in the UK. Ethical approval was granted by the University of Nottingham; the study was advertised via the Chartered Society of Physiotherapy online network. Two participants took part; semi-structured interviews were completed, audio recorded, and transcribed. Data was analyzed using thematic analysis. Three themes arose from the data: (1) Fulfilling professional responsibilities; (2) Changing organizational landscape; and (3) Professional reality of rationalizing and accommodating austerity. The clinical implications of austerity included increased length of hospital stay, insufficient community services, constrained resources, and understaffing. Participants demonstrated attempts to preserve their professional status and services through restratification throughout the intra-professional hierarchy, changing division of labor, and re-professionalization. Despite claims that austerity is coming to an end, it remained a reality for these clinicians in the NHS. Physiotherapists in this study used similar methods to preserve practice when faced with exogenous constraints as seen in medicine, such as re-professionalization and restratification. However, this attempt to defend professionalism by a non-medical healthcare profession was met with both successes and losses and has implications for the wider healthcare profession ecology, identifying an area for future research. [ABSTRACT FROM AUTHOR]

The psychological and social impact of hair loss and its ongoing treatment can be considerable. Medical treatments are not always successful, and alternative treatments, such as medical tattooing, are growing in popularity. The aims of this study were to explore adults' motivations, experiences, and self-perceived outcomes in relation to medical tattooing. Individual telephone interviews were conducted with 22 women from the United Kingdom aged 26–67 years who had undergone medical tattooing in the past 5 years related to hair loss. Interviews were transcribed and inductive thematic analysis was performed. Appearance concerns, loss of self-confidence/identity, and the practicalities of daily upkeep were cited as reasons for seeking a semi-permanent solution. Trust in the practitioner and the ongoing costs of tattoo maintenance were important considerations in participants' decision-making process and their overall satisfaction with treatment outcomes. Participants felt the emotional impact of hair loss and the subsequent need for appearance-restoring treatment remains unrecognised. This study provides insight into participants' perceptions of an under-researched and unregulated but widely accessible treatment. Implications for the decision-making process are discussed, and suggestions for health professionals are offered. [ABSTRACT FROM AUTHOR]

Clergy have an emotionally taxing role and are suggested to experience high rates of distress. Prior research suggests clergy utilise religious coping skills and may underutilise support. This study aimed to explore clergy experiences of role-demands, coping, and support, to supplement previous findings, and guide intervention. Nine clergy members participated in semi-structured interviews; data was analysed using inductive-deductive Thematic Analysis. Three major themes emerged from the data; 'the sacrifice you make', 'help along the way', and 'change that's needed'. Clergy-members' most prevalent and salient reported coping strategy revolved around a stable relationship with God. Clergy discussed barriers to support within, and outside of, the church. Clergies' experiences of challenging demands and distress support previous findings. Clergy preference for religious coping suggest future research, or intervention, should account for spirituality. Finally, clergy-members' varied experiences of support suggest practical/cultural changes within the church could reduce barriers. [ABSTRACT FROM AUTHOR]

Evidence suggests that people with facial palsy may experience higher levels of distress, but the reasons for this are yet to be explored. This study aimed to explore people's illness beliefs, emotions, and behaviours in relation to their facial palsy and understand how distress is experienced by this group. Semi-structured individual interviews were conducted in the UK with adults with facial palsy. Interview questions were theoretically informed by the Common-Sense Self-Regulatory Model (CS-SRM). Thematic Analysis was conducted following a combined inductive and deductive approach. Twenty people with facial palsy participated (70% female; aged 29–84). Patient distress was accounted for by illness beliefs (symptoms, cause, control and treatment, timeline and consequences), and four additional themes (coping behaviours, social support, identity and health service provision). Experiences of anxiety, depression, and anger were widespread, and some participants experienced suicidal ideation. The burden of managing a long-term condition, altered self-perception, and social anxiety and isolation were key drivers of distress. There is a need for more integrated psychological support for patients with facial palsy. Within clinical consultations, patient's beliefs about facial palsy should be identified and systematically addressed. Service development should include appropriate referral to specialist psychological support via an established care pathway. [ABSTRACT FROM AUTHOR]

Globally the needs of children differ to those of adults; consequently, the "voice" of children in health care delivery is paramount to its effectiveness as a service. This qualitative study aims to present a contemporary "slice" of life in four children's wards in a typical United Kingdom children's hospital in the 21st century from the perspective of the service user (child) and significant service giver (Registered Children's Nurse). Phase one of the study involved the development of a child research advisory group (CRAG) with five local primary school children (aged 10–11 years) to assist in the co-production of research questions and data collection tool for child participants – two talking cartoon characters (Sprinkle Cupcake and Ronaldo Football) via an app/iPad. In phase two (main study), hospitalized children (n = 18) and Registered Children's Nurses (n = 8) were interviewed on one occasion within their ward setting using a semi-structured approach in July 2017. The emerging broad themes (using thematic analysis), were (1) children – the child's needs, relationships, fears, and concerns, alongside (2) nurses – children's nursing, job pressures, safe and effective care. Themes were then presented as tensions in that they represent the relationship between variables where the different elements in the relationship are held in tension, such that a change in one impacts upon the other. Similarities between the children and nurse participants include issues with the environment, lack of time to care (nurse), effects of nurse-led interventions, and valued role of play. Differences are largely around the role of the parent. The development and work of the CRAG and use of "tensions" to more effectively present the complexity of the findings are unique to this study. In conclusion, this study contributes to the development of a generalized knowledge base for policy, nursing education, and clinical practice by shedding light in how the complex hospital environment can be challenging for the child and children's nurse. [ABSTRACT FROM AUTHOR]