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This paper explores experiences of PrEP, a HIV-prevention intervention, among bugchasers, gay men who eroticize HIV. While PrEP has been hailed as a "game changer" in HIV-prevention, little attention has been paid to why and how some people may discontinue it in the face of HIV risk, such as bugchasers do. This paper relies on interview data with bugchasers themselves to discuss the process of discontinuation and its effects. The paper argues that, for these men, discontinuation is a fluid, complex, and sometimes contradictory process. It also describes how participants perceived themselves as being at different stages of discontinuation. The paper also analyzes how these men see PrEP as a barrier to intimacy, risk, and a tool to negotiate their desires and identity: through discontinuing PrEP, these men are able to reflect on and build their identities as bugchasers. [ABSTRACT FROM AUTHOR]

Background: The Health of the Nation Outcomes Scales for people with Learning Disabilities (HoNOS-LD) is an 18-item measure which provides a structured and standardized approach to rating various clinical and psychosocial outcomes and has been in use nationally since 2002. Aims: To revise and improve the HoNOS-LD's utility in contemporary intellectual disability (ID) services whilst retaining its original objectives and five-point severity ratings. Method: ID clinicians were invited to complete an online survey, rating each item on the existing measure for being fit for purpose, identifying issues and suggesting improvements based on their experience of using the HoNOS-LD in practice. Scales were then assessed and revised sequentially; survey responses were used to inform discussion and revisions to the HoNOS-LD by the Advisory Board. Results: A total of 75 individuals replied. Respondents had used HoNOS-LD for an average of 8.0 years (S.D. 5.28 years) and 88% found the scale to be useful in their practice. On average, respondents used HoNOS-LD ratings to inform care 42.4% of the time (S.D. 33.5%). For each scale there was a significant negative correlation between the percentage of positive/very positive respondent ratings and the number of changes proposed. Common changes included simplifying terms, reducing ambiguity and replacing anachronistic language. Conclusion: The changes outlined in this paper are based on the advisory group's expert consensus. These changes are intended to improve reliability and validity but now need empirical testing as well as review by service users. [ABSTRACT FROM AUTHOR]

Introduction: Osteoporosis remains unrecognised and untreated in patients with fragility fractures, which leads to higher mortality rate, increasing social and economic burden related to subsequent fractures. However, the presence of a coordinated and centralised care pathway for fragility fractures is lacking. The purpose of this paper is to explore the perspectives of health professionals regarding the current management for distal radius fragility fractures, how the care pathway can be optimised for patients with distal radius fragility fractures, and where occupational therapists can contribute. Methods: This paper uses a phenomenological qualitative methodology with selective and purposeful sampling, consisting of health professionals from an Australian Health Service (N = 20). Online surveys (N = 18) and semi-structured interviews (N = 16) were conducted. Content analysis was applied, followed by thematic analysis to identify emerging themes. Results: Eighteen health professionals participated in the presurvey of which 16 were interviewed. The identified themes presented the gaps in the knowledge and awareness of fragility fractures and osteoporosis, as well as a lack of coordination in the system, especially the referral process. Discussion: These findings are consistent with previous studies which also highlight the importance of communication, coordination, collaboration, cooperation, responsibility, and a population approach in achieving integrated care. This study contributes to the global call for a centralised and coordinated care pathway for fragility fractures. The study explores personal experiences of health professionals who expressed interest in fragility fractures management. Exploring patients' perspectives on their journey of fragility fractures management provides opportunity for future research. [ABSTRACT FROM AUTHOR]

Purpose: Historically, clinical reasoning has largely been considered from an empirical, biomedical standpoint. This epistemology, rooted in imperial rule, is influential in how healthcare practitioners practice. An empirical approach to healthcare often oversimplifies the complex nature of clinical reasoning by obscuring the influence of imperial ideologies on decision-making. This can perpetuate inequitable approaches to healthcare delivery which deepen social, political and economic divides globally. This paper aims to explore and challenge this standpoint by exploring how power, imperialism and performativity influences healthcare provision and decision-making amongst healthcare practitioners in dysphagia rehabilitation. Methods: Qualitative exploratory interviews were undertaken with seven South African trained SLPs with experience working in dysphagia. To allow for participation and collaboration from participants, three data collection tools were employed within the interviews: oral histories, cognitive mapping and arts-based tasks. An initial modified thematic analysis followed by a further ideological analysis were undertaken to analyse the data collected. Results: The results suggest that the participants felt influenced by several manifestations of power within healthcare. We argue that this demonstrates that imperial practices can influence knowledge, interaction and context and therefore affect how healthcare practitioners make decisions. Conclusion: By acknowledging the impact of imperialism and power dynamics on healthcare provision and clinical reasoning we can potentially begin to transform the epistemology from which we approach healthcare provision in favour of one which is better suited to the current realities of healthcare to allow for equitable service provision. [ABSTRACT FROM AUTHOR]

Within the framework of the current drive to transform psychology in South Africa, this paper highlights "other" axes of identity that are arguably largely overlooked within the field. The conversation exposes the discipline of psychology – specifically within the South African context – and its many unexamined assumptions concerning "expected" identities of psychologists – specifically, those along heterosexual and able-bodied lines. By engaging in an autoethnographic conversation, the two authors, both "other", practising psychologists – one queer, one disabled – share and reflect on some of their experiences of feeling othered in their chosen profession. Drawing on parts of queer theory, critical disability literature, as well as the theoretical framework of biopolitical power, we start to make sense of our experiences of difference, deviance, and defiance. How the field of psychology marginalises "other" psychologists, and the impacts on those who bear the oppressions, is exposed; and a conversation is begun in which the discipline's assumptions around compulsory forms of identity – straight, not disabled, among others – are disrupted in productive ways. [ABSTRACT FROM AUTHOR]

Background: Social support is a key dimension of personal recovery for patients with severe mental disorders. Although clinicians and health professionals should monitor the social support resources of patients in order to provide effective treatment, no specific tool or intervention exist for that purpose. Egonet is a computer-assisted intervention for health and social services that enables the mapping, assessment and fostering of patients' social support networks. Aims: This paper describes the intervention and evaluates the appropriateness and acceptability of its implementation in a clinical setting. Method: We described the computer-assisted intervention. We used a questionnaire to assess how appropriate and acceptable clinicians found a preliminary version to be. We also collected patients' level of satisfaction with their social support networks before and after the intervention and carried out qualitative interviews. Results: Egonet is made up of four components: (1) a computer-assisted interview for mapping social networks, (2) a remote data server, (3) a data-mining module and (4) a customisable reporting tool. Egonet was implemented for 232 patients by 91 clinicians from five services. The intervention was perceived by clinicians as appropriate and useful for clinical practice, although it was noted that considerable effort was required to obtain its benefits. Patients were slightly more satisfied with their social support after the intervention than before, and expressed the opinion that more attention should be paid to the social support network. Conclusions: EGONET is appropriate and acceptable for use in work related to the social support networks of patients with psychiatric disorders. [ABSTRACT FROM AUTHOR]

Introduction: Trauma registries are a means for improving trauma care in low- and middle-income countries, though a number of challenges for the sustainability of these trauma registries exist. Mobile health applications represent a promising technology for low- and middle-income country trauma registries. The development, implementation and evaluation of a mobile application trauma registry for use at the Mbarara Regional Referral Hospital, Uganda is demonstrated. Methods: A paper-based trauma registry was implemented at the Mbarara Regional Referral Hospital. Based on feedback from local stakeholders, this was developed into an open-source mobile application version of the trauma registry. The mobile application was evaluated by 17 healthcare workers using a modified Unified Theory of Acceptance and Use of Technology questionnaire and qualitative analysis. Results: Unified Theory of Acceptance and Use of Technology scores showed the majority of participants responding positively to the major constructs of Performance Expectancy, Effort Expectancy, Social Influence and Facilitating Conditions, with mean Likert scores (out of 7) of 6.41 (±1.43), 6.25 (±1.41), 5.44 (±1.43) and 5.32 (±1.99), respectively. There was also a young average user age (29.1 years). Qualitative analysis identified response themes of ease of use, efficiency and potential for future research and clinical use; users also suggested expansion of the type of platforms the application was available on. Conclusion: Though a number of challenges exist for sustaining trauma registries in low- and middle-income countries, substantial involvement of local stakeholders and responsiveness to feedback should be used to facilitate the use of these technologies in developing countries. This study demonstrates a potential methodology for developing and evaluating trauma registry technologies for use in low- and middle-income countries. [ABSTRACT FROM AUTHOR]

Objectives: Hospital in the Home models are rapidly expanding in response to increasing bed pressures. This study examined patient and multidisciplinary health professional perceptions of a new geriatric evaluation and management and rehabilitation hospital in the home service in Australia. The service was unique, as adults of all ages with a variety of rehabilitation or geriatric evaluation and management needs were within scope. Methods: A qualitative descriptive approach was used with a consumer co-researcher and a consumer advisor being integral to decision-making. Patient feedback was collected via a paper-based patient satisfaction survey between August 2020 and February 2022. Additionally, interviews with current and past staff were conducted from July to November 2021. Reflexive thematic analysis was conducted for qualitative data and descriptive statistics used for quantitative data. Results: Patient surveys were analysed (n = 199, 42.2% response rate) with 60.8% of participants aged 75 years or over and 26.6% speaking a language other than English. High satisfaction was expressed. Feelings of comfort, familiarity, convenience, and reassurance were voiced. A person-centred approach enhanced involvement in care. Challenges included carer burden and clear communication. Sixteen staff (33% response rate) were interviewed. In general, staff said the service was inclusive and responsive, and the home environment beneficial, particularly for patients from culturally diverse backgrounds. A strong hospital partnership and comprehensive multidisciplinary approach were vital. Challenges included fragmentation due to part-time roles and combining with a pre-existing acute hospital in the home service. Conclusions: This qualitative exploration of staff and patients' perceptions of a geriatrician-led, multidisciplinary geriatric evaluation and management and rehabilitation hospital in the home service demonstrated that it was person-centred and optimised patients' control and ownership of care. The inclusive service parameters ensured responsiveness to diverse needs whilst allowing earlier return home from hospital, both of which are vital for quality patient care. [ABSTRACT FROM AUTHOR]

Introduction: In many jurisdictions internationally, distributed networks of clinical care have emerged as a planning principle to meet the needs of rural communities. Such networks rely on productive relationships between small rural sites and larger regional centres as the mechanism for training and backup and as the pathways for transfer when triage to a higher level of care is required. This paper explores the impact of the Rural Surgical Obstetrical Network (RSON) initiative on regional relationships between networked sites in order to provide data on the efficacy of networked models of healthcare. Implementation of networked care may ultimately lead to better patient care. Methods: This qualitative study involved interviews and focus groups over 4 years with 169 rural healthcare workers and hospital administrators at different RSON sites. Data was analysed inductively using thematic analysis. Results: Findings revealed three primary areas considered in the context of RSON funding: improved relationships (primarily through clinical coaching and the consequent building of reciprocal trust) and increased regional coordination of patient care through more efficient triage pathways and increased involvement of specialists through outreach care in rural communities. Continued lack of engagement with regional specialists was reported by a minority of participants. Discussion: RSON provided a supportive infrastructure that benefitted both rural and regional services namely through funding for clinical coaching and quality improvement initiatives which enabled overall improved provider relationships between sites. This strengthened a regional approach to optimal patient care that should be supported on an ongoing basis. [ABSTRACT FROM AUTHOR]

Migrants living in Europe constitute over half of the world's international migrants and are at higher risk of poor mental health than non-migrants, yet also face more barriers in accessing and engaging with services. Furthermore, the quality of care received is shaped by the experiences and attitudes of health professionals. The aim of this review was to identify professionals' attitudes towards migrants receiving mental healthcare and their perceptions of barriers and facilitators to service provision. Four electronic databases were searched, and 23 studies met the inclusion criteria. Using thematic synthesis, we identified three themes: 1) the management of multifaceted and complex challenges associated with the migrant status; 2) professionals' emotional responses to working with migrants; and 3) delivering care in the context of cultural difference. Professionals employed multiple strategies to overcome challenges in providing care yet attitudes towards this patient group were polarized. Professionals described mental health issues as being inseparable from material and social disadvantage, highlighting a need for effective collaboration between health services and voluntary organizations, and partnerships with migrant communities. Specialist supervision, reflective practice, increased training for professionals, and the adoption of a person-centered approach are also needed to overcome the current challenges in meeting migrants' needs. The challenges experienced by health professionals in attempting to meet migrant needs reflect frustrations in being part of a system with insufficient resources and without universal access to care that effectively stigmatizes the migrant status. [ABSTRACT FROM AUTHOR]

Background: Clinical documentation is a fundamental component of patient care. The transition from paper based to electronic medical records/electronic health records has highlighted a number of issues associated with documentation practices including duplication. Developing new ways to document the care provided to patients and in turn, persuading clinicians to accept a change, must be supported by evidence that a change is required. In Australia, there has been a limited number of studies exploring the clinical documentation practices and beliefs of clinicians. Objective: To gain an in-depth understanding of clinician documentation practices. Method: A qualitative design using semi-structured interviews with clinicians (allied health professionals, doctors (physicians) and nurses) working in a tertiary-level hospital in South-East Queensland, Australia. Results: Several themes emerged from the data: environmental factors, including departmental policy and systemic issues, and personal factors, including verification, clinical reasoning and experience influencing documentation practices. Conclusion: Our study identified that the documentation practices of clinicians are complex, being driven by both environmental and systemic factors and personal factors. This in turn leads to duplication and some redundancy. The documentation burden of duplication could be reduced by changes in policy, supported by multidisciplinary documentation procedures and electronic systems aligned with clinician workflows, while retaining some flexible documentation practices. The documentation practices of individuals, when considered from the perspective of enhancing quality care, are considered legitimate and therefore will continue to form part of the health (medical) record regardless of the format. [ABSTRACT FROM AUTHOR]

For applied psychologists, the goal is to promote positive outcomes among the individuals and groups they serve. Psychological practice takes place within a real-world context, including societal conditions that both harm and support children. Within school and counseling psychology, growing recognition of the impact of society on children has led to efforts to identify social justice as a key framework and set of strategies. Despite the obvious impact of public policy on the lives of children, there is very limited research on pathways and experiences of counseling and school psychologists who are involved in public policy efforts in their capacity as psychologists. This study addresses this gap, interviewing eighteen individuals across the United Kingdom and United States. Key findings include the importance of cultural responsiveness, professional development opportunities, and building and sustaining relationships. Several implications for future research and practice are provided, highlighting the need for multidisciplinary collaboration among those engaged in public policy and social justice efforts. [ABSTRACT FROM AUTHOR]

Background: Community health workers play an important role in linking communities with formal health service providers, thereby improving access to and utilization of health care. A novel cadre of community health workers known as village health workers (VHWs) were recruited to create demand for maternal health services in the Nigerian Subsidy Reinvestment Programme (SURE-P/MCH). In this study, we investigated the role of contextual factors and underlying mechanisms motivating VHWs. Methods: We used realist evaluation to understand the impact of a multi-intervention maternal and child health programme on VHW motivation using Anambra State as a case study. Initial working theories and logic maps were developed through literature review and stakeholder engagement; programme theories were developed and tested using focus group discussions and in-depth interviews with various stakeholder groups. Interview transcripts were analysed through an integrated approach of Context, Mechanism and Outcomes (CMO) categorisation and connecting, and matching of patterns of CMO configurations. Motivation theories were used to explain factors that influence VHW motivation. Explanatory configurations are reported in line with RAMESES reporting standards. Results: The performance of VHWs in the SURE-P maternal and child health programme was linked to four main mechanisms of motivation: feelings of confidence, sense of identity or feeling of acceptance, feeling of happiness and hopefulness/expectation of valued outcome. These mechanisms were triggered by interactions of programme-specific contexts and resources such as training and supervision of VHWs by skilled health workers, provision of first aid kits and uniforms, and payments of a monthly stipend. The monthly payment was considered to be the most important motivational factor by VHWs. VHWs used a combination of innovative approaches to create demand for maternity services among pregnant women, and their performance was influenced by health system factors such as organisational capacity and culture, and societal factors such as relationship with the community and community support. Conclusion: This paper highlights important contextual factors and mechanisms for VHW motivation that can be applied to other interventions that seek to strengthen community engagement and demand creation in primary health care. Future research on how to sustain VHW motivation is also required. [ABSTRACT FROM AUTHOR]

Children with language disorder frequently experience difficulties with vocabulary acquisition, and these difficulties often persist into adolescence. The literature indicates that clinical studies tend to investigate phonological-semantic approaches, whereas educational studies focus on the derivation of meaning within a literacy context. Little is known about whether the practices of speech and language therapists and teachers reflect these findings from the literature. The current paper reports on a survey which gathered information from speech and language therapists and mainstream secondary school teachers, about their current practice concerning vocabulary support for adolescents, aged 11–16, who have language disorder. An online questionnaire was distributed through teaching and speech and language therapy professional networks. The aim of the study was to establish which specific strategies were used in practice by speech and language therapists and mainstream secondary school teachers to teach vocabulary to adolescents with language disorder, and which strategies were the most effective. Responses were obtained from 127 speech and language therapists and 47 mainstream secondary school teachers in the UK. Speech and language therapists were more likely than mainstream secondary school teachers to teach phonological awareness and semantic feature analysis as strategies for developing vocabulary skills. Both professions used literacy-related strategies as well as strategies for independent word learning such as the derivation of meaning from morphology and context. Increased joint working and training opportunities would further develop the knowledge and skills of both mainstream secondary school teachers and speech and language therapists, enabling theoretically-grounded and relevant vocabulary support for this group of adolescents. [ABSTRACT FROM AUTHOR]

Background: The Draft Mental Health Bill proposes removal of both intellectual disability and autism from Section 3 of the Mental Health Act for England and Wales (MHA). This would lead to people with intellectual disability (PwID) and/or autism could not be detained beyond 28 days, in the absence of diagnosed co-occurring mental illness. Aim: To obtain views of psychiatrists working with PwID in England and Wales regarding the proposed MHA changes. This study focusses specifically on the impact on PwID. Methods: A cross-sectional online mixed methodology survey of Likert and free-text response questions was developed, to ascertain perceptions of proposed legislative changes to the MHA. A non-discriminatory exponential snowballing technique leading to non-probability sampling was used to disseminate the survey. Quantitative data was analysed using descriptive statistics, Mann-Whitney and Fisher's exact tests. Thematic analysis was conducted on free text responses. Results: A total of 82 psychiatrists (33%) from approximately 250 eligible completed the survey. Nearly two-thirds (64%) reported good awareness of the proposed changes, with over half (55%) reporting disagreement with the changes. Psychiatrists working in inpatient settings for PwID reported increased awareness of the changes, less agreement with the reforms, and increased expectations of the reforms having negative unintended consequences, compared to their peers working exclusively in the community. Consultants reported greater disagreement with the changes compared to their non-consultant peers. Qualitative analysis identified five main themes: impact on diagnosis and treatment, seeking alternative options, introducing inequities, resources, and meeting holistic care goals through the Care, Education and Treatment Reviews (CETR) process. Conclusion: Psychiatrists working with PwID report widespread disagreement with the proposed changes to the MHA for PwID, with greater levels of disagreement among those working in inpatient services. Caution with respect to the proposed changes, and monitoring of the impact of the changes if implemented, is advised. [ABSTRACT FROM AUTHOR]

Aim: To outline the organisation and responsibility for health and social care provided to older people in Denmark, Finland and Sweden. Methods: Non-quantifiable data on the care systems were collated from the literature and expert consultations. The responsibilities for primary healthcare, specialised healthcare, prevention and health promotion, rehabilitation, and social care were presented in relation to policy guidance, funding and organisation. Results: In all three countries, the state issues policy and to some extent co-funds the largely decentralised systems; in Denmark and Sweden the regions and municipalities organise the provision of care services – a system that is also about to be implemented in Finland to improve care coordination and make access more equal. Care for older citizens focuses to a large extent on enabling them to live independently in their own homes. Conclusions: Decentralised care systems are challenged by considerable local variations, possibly jeopardising care equity. State-level decision and policy makers need to be aware of these challenges and monitor developments to prevent further health and social care disparities in the ageing population. [ABSTRACT FROM AUTHOR]

Background: There is evidence of Indigenous and ethnic minority inequities in the incidence and outcomes of early psychosis. Racism has been implicated as having an important role. Aim: To use Indigenous experiences to develop a more detailed understanding of how racism operates to impact early psychosis outcomes. Methods: Critical Race Theory informed the methodology used. Twenty-three Indigenous participants participated in four family focus group interviews and thirteen individual interviews, comprising of 9 Māori youth with early psychosis, 10 family members and 4 Māori mental health professionals. An analysis of the data was undertaken using deductive structural coding to identify descriptions of racism, followed by inductive descriptive and pattern coding. Results: Participant experiences revealed how racism operates as a socio-cultural phenomenon that interacts with institutional policy and culture across systems pertaining to social responsiveness, risk discourse, and mental health service structures. This is described across three major themes: 1) selective responses based on racial stereotypes, 2) race related risk assessment bias and 3) institutional racism in the mental health workforce. The impacts of racism were reported as inaction in the face of social need, increased use of coercive practices and an under resourced Indigenous mental health workforce. Conclusion: The study illustrated the inter-related nature of interpersonal, institutional and structural racism with examples of interpersonal racism in the form of negative stereotypes interacting with organizational, socio-cultural and political priorities. These findings indicate that organizational cultures may differentially impact Indigenous and minority people and that social responsiveness, risk discourse and the distribution of workforce expenditure are important targets for anti-racism efforts. [ABSTRACT FROM AUTHOR]

Objectives: To explore the challenges that open-source automated insulin delivery systems pose to the encounter between service-users and healthcare professionals and how these challenges might be addressed in the future. Methods: Five adult service-users and six healthcare professionals participated in semi-structured interviews. A six-step thematic analysis was conducted, the focus being on challenges and needs for improvement of the interactions. Results: The analysis revealed three overarching challenges and wishes: (1) Lack of exchange of experiences. Service-users are reticent about disclosing their use of the systems to healthcare professionals. (2) Unclear ethical responsibility. Service-users are aware of their responsibility and guidelines can help to alleviate healthcare professional's legal responsibility; however, ambiguities around ethical responsibility for healthcare professionals remain an impediment to meaningful clinical interactions. (3) Unresolved individual and mutual expectations. Service-users expect better access to technology and focus on psychosocial aspects. In contrast, healthcare professionals fear the burden associated with the rising technical expectations. Conclusion: Transparency and openness towards open-source systems need to be part of service-user and healthcare professionals interaction. Requirements for future care include improved knowledge about the systems, an openminded approach towards user-driven initiatives among healthcare professionals, and a focus on psychosocial aspects in the interaction. [ABSTRACT FROM AUTHOR]

Online harms and the resultant safeguarding approaches are a key challenge for those working in the children's workforce. However, safety narratives and a wish to prevent harm, rather than mitigate risk, have arguably caused a safeguarding environment that is neither mindful of children's rights nor in their best interests. When supporting adopted and looked after children, there are some specific challenges that can result in further caution in supporting children in their use of digital technology. Empirical data presents observations on a professional environment where, with a dearth of training or policy direction, professionals are left to bring their own biases and beliefs into safeguarding judgements and, in the rush to protect, often forget the importance of working across stakeholders rather than trying to resolve issues independently. Plain Language Summary: In this article, we explore the concerns of professionals around the support of adopted and looked after children, addressing fears of online harm. Drawing upon different perspectives (from legal cases, young people and professionals), we highlight a tension between the concerns of these professionals and the challenges that adopted and looked after children face in balancing the importance of online technologies to keep in touch with friendship groups and their offline world, while remaining safe. While clearly the safety of the children is paramount for the professionals, we highlight the potential harms that can arise from excessive concern and personal biases, which are unsurprising given the lack of national coordination and media narratives. We propose a stakeholder model to balance the concerns of those who have safeguarding responsibilities with the rights of the child. [ABSTRACT FROM AUTHOR]

Social and cultural poetics take us beyond language to an embodied sensibility. To explore the relevance of social poetics in medical training, this article uses as an exemplar an innovative program in geriatrics in a residency program in primary care. The program began with a series of meetings in which medical residents consulted community elders invited for their advice and wisdom on healthcare dilemmas as Senior Faculty, effectively becoming co-teachers and co-learners with one another. Through iterative reflection, residents, faculty and community elders all reported feeling struck by the unexpected responses and were often guided and called to action by them to ask new questions, to shift their stance, or offer greater accompaniment and care. These experiences illuminated what might otherwise have passed by unnoticed, particularly in regards to human suffering. The reflecting process made visible what mattered to each actor, shifting from negative assumptions and attitudes about older adults to a positive engagement with them, co-creating new possibilities for participants to articulate their lived experience of illness and healing. These are creative and moral acts, honoring the voices of those seldom invited to speak, resonating with them, acknowledging what matters to each participant, while taking into account wider issues of disparity and social justice. [ABSTRACT FROM AUTHOR]

Background: Recovery concepts were conceived by, and for, people living with mental health issues. Practitioners are key in translating recovery principles into action. Therefore, practitioners' perceptions should be routinely assessed to facilitate in-service training, professional development, and curriculum redesign. Aim: To explore practitioners' and trainees' current perspectives regarding the concept of recovery. Methods: The study used a qualitative exploratory design with in-depth interviews to explore ten fully trained practitioners and eight trainees' perspectives on recovery. Results: The findings revealed a shared understanding of recovery among practitioners and trainees. Many responses explained recovery as a process involving internal and external conditions, however, some revealed medically oriented perspectives and/or were unclear about recovery terminologies. Conclusions: There is convergence and growing acceptance of the recovery practice principles among practitioners and trainees. However, the results suggest that the recovery principles/terminologies have not yet been universally adopted. Implications for practice and research: Continuous training on recovery principles is needed, incorporating emerging terminologies and principles. Also, education providers are encouraged to continue to review their training to incorporate emerging issues and trends in recovery-oriented practice. Finally, research is needed to enhance the development and delivery of recovery-focused practice. [ABSTRACT FROM AUTHOR]

This study aims to analyze Syrian women's experience of violence from the perspective of the service providers by using intersectionality as an analytical lens. Face-to-face interviews were conducted with 13 service providers working in areas highly populated by Syrians in Konya, Turkey. Harmful traditional practices, societal violence reflected in gender-based discrimination, discrimination in work life, and inability to access to complaint mechanisms are the basic findings of the study. Revealing how the intersections and interrelatedness of class, ethnicity, culture, and migration status shape the experiences of Syrian women is expected to contribute to the implementation of anti-oppressive practices of social workers. [ABSTRACT FROM AUTHOR]

In this qualitative exploratory study, we investigated the perspectives of mental health providers in Gaza, Palestine, regarding the primary concerns of their clients who are exposed to low-intensity warfare and structural violence. We conducted qualitative interviews with 30 psychologists, social workers, psychiatric nurses, and psychiatrists providing services to communities in Gaza. Participants were asked to discuss their clients' most commonly occurring mental health problems, diagnoses, and psychosocial conditions. Thematic analysis identified one superordinate theme (Impact of the Blockade on Mental Health and Quality of Life) and four second-order themes (Concerns about Social Problems, General Concerns about Quality of Life, Concerns about the Mental Health of the Community, and Concerns Related to Children's Mental Health). Participants indicated that the social and political dimensions of mental health and the economic, educational, and health-related consequences of the ongoing blockade of Gaza were the main determinants of psychological burden among their clients. Findings demonstrated the importance of adopting an approach to mental health that includes understanding psychological indicators in a broader framework informed by human rights and social justice. Implications for research and clinical work are discussed, including the role of investments in social capital that may provide individuals with access to resources such as social support, which may in turn promote overall mental health. [ABSTRACT FROM AUTHOR]

Objectives: Research suggests that higher Body Mass Index is associated with improved survival in people with Amyotrophic Lateral Sclerosis (pwALS). Yet, understanding of the barriers and enablers to increasing calorie intake is limited. This study sought to explore these issues from the perspective of pwALS, informal carers, and healthcare professionals. Methods: Interviews with 18 pwALS and 16 informal carers, and focus groups with 51 healthcare professionals. Data were analysed using template analysis and mapped to the COM-B model and Theoretical Domains Framework (TDF). Results: All three COM-B components (Capability, Opportunity and Motivation) are important to achieving high calorie diets in pwALS. Eleven TDF domains were identified: Physical skills (ALS symptoms); Knowledge (about high calorie diets and healthy eating); Memory, attention, and decision processes (reflecting cognitive difficulties); Environmental context/resources (availability of informal and formal carers); Social influences (social aspects of eating); Beliefs about consequences (healthy eating vs. high calorie diets); Identity (interest in health lifestyles); Goals (sense of control); Reinforcement (eating habits); and Optimism and Emotion (low mood, poor appetite). Discussion: To promote high calorie diets for pwALS, greater clarity around the rationale and content of recommended diets is needed. Interventions should be tailored to patient symptoms, preferences, motivations, and opportunities. [ABSTRACT FROM AUTHOR]

This article seeks to understand the needs and difficulties of intervention with older people during the first state of emergency in Portugal due to COVID-19. The results show that these professionals faced challenges they never experienced before and necessitated support to carry out their work in an emergency. The difficulties resulted, not only from the chronic vulnerabilities stemming from the disinvestment of public policies in recent years but also from the uncertainty that the pandemic brought to social interventions. Despite all this, social workers have demonstrated their ability to protect themselves and older people and their families, thus leading to overcoming some of these challenges. [ABSTRACT FROM AUTHOR]

The Peel Region of Toronto, Canada is home to over a third of the province's South Asian population. Youth are at a vulnerable time period in terms of their mental health. South Asian youth populations may face additional challenges to their mental health such as acculturative stress, intergenerational conflict, and racism and discrimination. This qualitative study set out to understand the mental health concerns and service access barriers experienced by South Asian youth populations in the Peel Region of Toronto, Canada from the perspective of mental health service providers. In-depth semi-structured interviews were carried out with mental health service providers (n = 22) who work with South Asian youth living in Peel Region. Thematic analysis was used to elucidate themes related to mental health stressors and service access barriers experienced by youth. According to mental health service providers, South Asian youth navigate a number of unique stressors related to the domains of culture, religion, and family dynamics, experiences of discrimination, the impact of migration, beliefs around mental illness and help-seeking, help-seeking trajectories and therapy recommendations, and lastly, sex differences. Mental health service providers outlined steps needed to effectively address the unique mental health challenges, best practice guidelines, and recommendations for working with South Asian youth, families, and communities to provide a practical and nuanced overview on how a multi-level strategy for mental health care can effectively meet the needs of South Asian youth populations. [ABSTRACT FROM AUTHOR]

Objectives: Therapeutic patient education improves numerous health and psychological outcomes in patients with chronic diseases. However, little is known about what makes a therapeutic patient education intervention more effective than another one. This study aims to identify in healthcare professionals the perceived determinants of therapeutic patient education efficacy at the individual level. Methods: Semi-structured individual interviews have been conducted with healthcare professionals (HCP, n =28, including 20 nurses) involved in therapeutic patient education programs (n =14) covering various chronic conditions (kidney and cardiovascular diseases, chronic pain, diabetes, etc.). A thematic content analysis following an inductive approach was used (Nvivo.11 software). Results: Five themes were retrieved for patient characteristics: understanding and education, personality, readiness and motivation, social environment, and misinformation and beliefs. Four themes were retrieved for healthcare professionals' characteristics: medical knowledge, appropriate attitude and relational skills, pedagogical skills, and training. Discussion: Patient personality is rarely discussed in the literature. Patients who are introverted, lack curiosity, or are not compliant might benefit from specific therapeutic patient education practices or formats. All these potential determinants regarding patients and healthcare professionals should be routinely assessed in future studies about therapeutic patient education efficacy to understand precisely what makes an intervention successful. [ABSTRACT FROM AUTHOR]

In both popular and academic discussions of the use of algorithms in clinical practice, narratives often draw on the decisive potentialities of algorithms and come with the belief that algorithms will substantially transform healthcare. We suggest that this approach is associated with a logic of disruption. However, we argue that in clinical practice alongside this logic, another and less recognised logic exists, namely that of continuation : here the use of algorithms constitutes part of an established practice. Applying these logics as our analytical framing, we set out to explore how algorithms for clinical decision-making are enacted by political stakeholders, healthcare professionals, and patients, and in doing so, study how the legitimacy of delegating to an algorithm is negotiated and obtained. Empirically we draw on ethnographic fieldwork carried out in relation to attempts in Denmark to develop and implement Patient Reported Outcomes (PRO) tools – involving algorithmic sorting – in clinical practice. We follow the work within two disease areas: heart rehabilitation and breast cancer follow-up care. We show how at the political level, algorithms constitute tools for disrupting inefficient work and unsystematic patient involvement, whereas closer to the clinical practice, algorithms constitute a continuation of standardised and evidence-based diagnostic procedures and a continuation of the physicians' expertise and authority. We argue that the co-existence of the two logics have implications as both provide a push towards the use of algorithms and how a logic of continuation may divert attention away from new issues introduced with automated digital decision-support systems. [ABSTRACT FROM AUTHOR]

Psychological consultation is one way of reaching a greater number of families with limited resources, yet little is known about the benefits and challenges of this intervention in adoption. We qualitatively explored consultations provided to adoption social workers by clinical psychologists. Six social workers and four clinical psychologists participated in semi-structured interviews. Five themes with supporting sub-themes were identified: (1) A context of highly emotive work with scarce resources; (2) consultations draw on Dyadic Developmental Practice and systemic thinking and involve goal-oriented and interpersonal processes; (3) consultations experienced as valuable despite challenges; (4) consultations facilitate learning for both social workers and psychologists; and (5) a collaborative focus and the 'expert role'. Our findings suggest consultation is experienced positively by social workers and psychologists, that it successfully facilitates the transfer of psychological knowledge, and has the potential to enhance multi-agency working. Future research needs to better understand the impact of consultation on adoptive families. [ABSTRACT FROM AUTHOR]

Objective: Persons with chronic obstructive pulmonary disease (COPD) require complex follow-up by healthcare professionals (HCPs) and may experience several health literacy (HL) needs. This study aimed to explore such needs in people with COPD and the HCPs who care for them. Methods: From October 2016 to August 2017 a qualitative study with four focus groups (FG) were performed in people with COPD (n = 14) and three in multidisciplinary HCPs (n = 21). An inductive thematic analysis was used to investigate HL needs. Results: Four HL needs emerged: 1) strengthening the feeling of security; 2) combating the burden of insufficient knowledge on COPD and lack of informational flow; 3) supporting motivation for endurance and self-management; and 4) strengthening dignity. Discussion: This study highlights a gap between people with COPD who express important HL needs and HCPs' capabilities to care for these needs. For HCPs to increase HL in such cases, HCPs need to improve their own HL. It is essential to find solutions on how to improve HL in HCPs who care for people with COPD and to increase the availability of interventions that increase HL in COPD. Education programs, health organizations, and governments should be aware of HL needs in such situations. [ABSTRACT FROM AUTHOR]

Guided self-help has become an important treatment option in the field of eating disorders as access to in person evidence-based treatments is limited. Given the scant amount of literature published on guided self-help for the treatment of eating disorders in the child and adolescent population, our aim was to describe online GSH-FBT sessions in detail as conducted as part of a larger feasibility study, examining quotations from therapists that illustrate the GSH-FBT stance and also describing how online GSH-FBT differs from FBT delivered by videoconferencing within a descriptive case report. [ABSTRACT FROM AUTHOR]

Background: Globally homeless mentally ill (HMI) individuals are considered one of the most vulnerable populations. An individual-centric, psychopathology-oriented focus of the existing mental health-care system limits the understanding of the HMI individuals through the disability lens overlooking their strengths and resilience that enable them to survive extremely hostile environments. Contemporary mental health research has embraced a paradigm shift that allows researchers to look beyond the predominant medical model to give precedence to a socio-culturally contexted and experientially firm understanding of human behaviour. Aim: Through the theoretical lens of social suffering, this article attempts to understand the lived experiences of the HMI women, the perspective of their caregivers and the standpoint of service providers in the context of homelessness and mental illness. Methodology: A documentary analysis as a qualitative research methodology has been used to reflect upon the concerns mentioned above. Following Figueroa's approach to the analysis of audio-visual texts, the documentary Lapata Zindagi, directed by Radhika Lata Murthy, has woven the stories of four HMI women and their caregivers have been analysed. The two-phased analysis involved constructivist grounded theory procedures. Results: The methodological steps, rigour and the resulting categories (experience of social suffering associated with homelessness among HMI women, denial of care and rights within patriarchy, helplessness associated with the burden of caregiving and roles of NGO and community in building hope and empowerment) have been discussed through the lens of social suffering and how stakeholders might facilitate hope and empowerment amidst it. Conclusion: The article highlights the dire and urgent need to integrate mental health into primary health care and community-based intervention and move beyond clinical recovery to nurture 'hope' to enable recovery and empowerment for such marginalised populations. [ABSTRACT FROM AUTHOR]

Background: The mental health of the population has been negatively affected due to the pandemic. Frontline healthcare workers with increased exposure to COVID diagnosis, treatment and care were especially likely to report psychological burden, fear, anxiety and depression. Aim: To elicit how working as a health professional during the pandemic is impacting on the psychological wellbeing of frontline staff. Method: United Kingdom population of healthcare workers were approached by advertising the survey via social media, NHS trusts and other organisations. Open-ended survey answers were qualitatively explored using content analysis. Results: Survey collected data from 395 NHS staff was developed into three themes; (1) Despair and uncertainty: feeling overwhelmed trying to protect everyone, (2) Behavioural and psychological impact: affecting wellbeing and functioning and (3) Coping and employer support: getting the right help. Conclusion: NHS staff felt enormous burden to adequately complete their professional, personal and civil responsibility to keep everyone safe leading to negative psychological and behavioural consequences and desire for NHS employers to offer better support. As the pandemic progresses, the results of this study may inform NHS employers on how optimum support can be offered to help them cope with negative psychological consequences of the pandemic. [ABSTRACT FROM AUTHOR]

This article presents the results of a study of practitioners' and experts' vision for implementing integrated services that combine healthcare and social work in Bulgaria. Sixty-four respondents (n = 64) were recruited to participate in interviews (n = 17) and focus groups (n = 47). The need for a conceptual clarification and a common vision for integrated social and healthcare services was evident, including the approaches to organization, service provision, management, and funding. More extensive studies about the perspectives for successful integration of healthcare and social services in Bulgaria, based on the analysis of current needs and resources, are required. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the opinions of primary health-care providers and patients regarding the use of the Healthy Heart Score 20-year cardiovascular disease risk assessment tool in the clinical setting. Methods: Semi-structured in person or phone interviews among 20 patients with no self-reported cardiovascular disease diagnoses and 20 health-care providers in Central (Columbus) and Southeastern (Athens) regions of Ohio. The researchers independently coded transcribed interviews, discussed codes to resolve discrepancies, and agreed on common themes. Results: Participants suggested ways to best utilize and improve the tool, including adding graphics for visual reference of serving size. Patients showed interest in cardiovascular disease primordial prevention and expressed willingness to take the assessment prior to seeing a health-care provider. Health-care providers said that they would recommend the assessment to their patients and would be willing to use the tool in their practice. Health-care providers stated few barriers to using the tool, yet discussed numerous challenges to successful primordial prevention. Conclusions: Our findings support the utilization of the Healthy Heart Score as a cardiovascular disease primordial prevention tool in the clinical setting. Additional research implementing the tool into the clinical setting will provide deeper insight into how the tool can impact behavior change and cardiovascular disease prevention. [ABSTRACT FROM AUTHOR]

The focus of this study was on female emergency medical personnel's experiences of treating women who have been raped and on their own experiences of being women themselves working in this situation. We interviewed 12 female medical personnel in four focus groups of two to five participants each. The material was analyzed using inductive thematic analysis. Participants' experiences were structured under two main themes: Prerequisites for care and Effects on oneself. As women, the participants emphasized their understanding of other women and stressed the importance of offering flexible care and taking time with each patient. They described how their work affected them personally, making them increasingly aware of men's violence against women and their need for support from their colleagues. They also discussed structural barriers to both patient care and self-care. If unaddressed, such shortcomings risk negatively affecting raped women seeking medical care and may also be detrimental to the health and well-being of the professional offering care. [ABSTRACT FROM AUTHOR]

Background: Recovery-oriented intersectoral care is described as an aim in mental healthcare to create a holistic framework for planning that provides integration of treatment and rehabilitation. Existing studies show that nurses and other professionals do not take responsibility for the collaborative element of intersectoral care between mental health hospitals and community mental health services. The users of mental healthcare do not experience their patient journey as a cohesive process when they are discharged from a mental health hospital to community mental health services. Aim: The integrative review aims to examine the professionals' experience with recovery-oriented intersectoral care between mental health hospitals and community mental health services. Design: Since the aim was to review user experience, we chose an integrative review as an obvious choice for design. Ethical approval: Not applicable. Findings: Seven studies met the inclusion criteria. The interactive inductive and deductive analysis generated four themes, which clarify the experience of professionals with recovery-oriented intersectoral care between the mental health hospitals and community mental health services, namely 'structurally routine care', 'unequal balance of power between the sectors', 'bureaucracy as a barrier to recovery-oriented intersectoral care' and 'flexible mental healthcare approaches'. Conclusion: This review achieves specific knowledge of recovery-oriented intersectoral care. The studies included show that recovery-oriented intersectoral care is not clearly defined. It is challenging to transfer intersectoral care to an organisation with different structural and linguistic barriers. [ABSTRACT FROM AUTHOR]

Background: The use of complementary and alternative medicine (CAM) has increased in Western societies in recent years. In a national health survey conducted in 2006 in Iceland, 31.8% of the population had used CAM in the past 12 months; however, the trend of CAM use since then is unknown. This study's aim was to describe participants' use of CAM providers in Iceland in 2015 and compare it to the results of the previous survey. The current study explored the relationship between the participants' use of CAM and their background, religiosity, healthcare attitudes, mental and physical health, and physician visits. Methods : The study was based on a national health survey conducted in the Spring of 2015. The questionnaire was mailed to a random sample of Icelandic adults, aged 18–75. Altogether 1599 respondents returned valid questionnaires (response rate 58%). The standardized questions were developed and tested in previous health surveys. Results : Nearly 40% of respondents had used CAM in the past 12 months. This is an estimated 8.4% increase since 2006. Women and people with more education were more likely than other participants to use CAM. Repeated physician visits were related to increased likelihood of CAM use. Individuals with high anxiety were more likely than others to use CAM. Conclusions : Icelanders use CAM providers to a considerable degree, and CAM use has increased in recent years. Most CAM users appear to use CAM to complement care received in the general health system. [ABSTRACT FROM AUTHOR]

In earlier studies we have shown that abuse in health care (AHC) is commonly reported among both male and female patients. In this study, we present an evaluation of an intervention against AHC based on Forum Play. The evaluation was conducted by means of pre- and postintervention interviews with the staff at a woman's clinic. The interviews were analysed using the constant comparative method. The results of this postintervention study stand out in loud contrast to the results of the preintervention studies. Staff had moved from a distant and fluctuating awareness of AHC to a standpoint characterized by both moral imagination and a sense of responsibility. [ABSTRACT FROM AUTHOR]