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This paper illustrates key findings from a qualitative doctoral research project exploring women's experience of infertility. Six women maintained treatment diaries, reflecting on their experiences prior to, during and beyond infertility treatment. The following key themes are identified: hopefulness, adaptation, transitioning and shifting focus. The data suggest that treatment, clinic experience and living a life 'on hold' act as turning points within the individual life course. It is at the intersection between treatment and outcome that difficulties negotiating the expected and anticipated life course become illuminated, revealing limited connectivity and transitioning through and beyond the treatment process. This is a critical focus area and one that sets the scene for effective future adaptation. The data suggest that the accessibility of supportive care moving through and beyond treatment is limited. This paper argues that the infertility clinic is a critical space and place and one where effective supportive care may enable effective transitioning beyond the experience of infertility as an unanticipated life course disruption. [ABSTRACT FROM AUTHOR]

This paper presents a new conceptual framework for the study of supervision, called a ‘semi-open supervision systems model’ or supervision model. It was developed for a research study funded by the Social Care Institute for Excellence (SCIE) in England, UK. The supervision model was needed because the evidence base for supervision was weak and under-developed, and the theoretical base insubstantial. The supervision model was developed using systems theory and was informed by policy developments, which are normally excluded from supervision research. The research team was tasked with collecting evidence of good and/or innovative supervision at a time of significant service transformation across adult care settings in England and Northern Ireland. The research design was informed by the supervision model and researchers used a mixed methodology for data collection and analysis. This paper examines how the supervision model was developed and used in the study, and concludes by reviewing its contribution to the field of supervision study. [ABSTRACT FROM AUTHOR]

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

The mental health of migrant communities is an important public health concern. A growing body of literature suggests that social and cultural determinants of health significantly contribute to the mental health and wellbeing of older migrants in their host countries. Despite the increasing population of older Nepalese migrants in the UK, there is little research exploring the mental health needs of this community. This article explores older Nepalese women’s experiences of drivers of mental distress in London. Data was collected using in-depth interviews with 20 older Nepalese women living in the London Borough of Greenwich. Grounded thematic analysis of women’s narratives identified six overarching factors contributing to their emotional distress that pose potential risks to their mental health: absence of family, language barriers, housing problems, physical illness, lack of appropriate support, fears of death, and inadequate financial resources. In many cases, the impact of these factors was experienced in combination rather than isolation, often influenced by cultural dynamics. Findings highlight that re-settlement in the absence of family is at the heart of emotional challenges for older Nepalese women. The paper concludes with a series of recommendations for supporting processes of settlement to mitigate this risk among older Nepalese women in the UK. [ABSTRACT FROM AUTHOR]

Young people's sexting is an area of increasing concern amongst parents, educationalists and policy makers, yet little research has been conducted with young people themselves to explore their perspectives on the support they need to navigate relationships in the new digital media landscape. To address this absence, an inter-disciplinary team of researchers undertook a participatory study with students, aged 13 to 15, in a UK secondary school. This paper outlines key study findings, including young people's views on sexting, their recommendations for improved education around sexting in schools, their preferred sources of support, and their perspectives on the way adults should respond to young people's sexting. Findings indicate that sexting education needs to be developed within the context of wider relationship issues, such as gender, power dynamics and trust between peers, and improved communication between students and teachers or other responsible adults. Findings may be used to consider ways of designing and communicating messages around sexting to young people within and beyond educational settings. [ABSTRACT FROM AUTHOR]

Experiences of autism-spectrum disorder are now increasingly studied by social scientists. Human-animal relations have also become a major focus of social inquiry in recent years. Examining horse-assisted therapy for autistic spectrum disorders, this is the first paper that brings these fields together. Drawing on participant observation and interviews at a UK horse therapy Centre, this article examines how staff and the parents of riders account for the successes and limitations of equine therapy. To the respondents, horses ‘open up’ autistic children and make possible interactions that seemed impossible before. Horses were regarded as facilitating the emergence of apparently social behaviours, which included eye contact, pointing, and speech. Three key explanations emerged for therapeutic success: the sensorial, embodied experience of riding the horse; the specific movements and rhythms of the horse; and, the ‘personality’ of the horse. Equine therapy can be regarded as enabling a form of multispecies intersubjectivity, with the resonance between rider and horse seeming to make possible a new attunement between humans. Practices of equine therapy, and perceptions of its efficacy, serve in turn to attune social scientists to a version of empathy constituted through lively and sensorial interactions, as opposed to one that is restricted to particular kinds of humans. [ABSTRACT FROM AUTHOR]

Employment for people with learning difficulties is considered key to their social inclusion. This contradicts the perceived un-employability of people with learning difficulties that has been part of their social identities throughout their history hitherto. The national rate of employment for people with learning difficulties remains extremely low and has barely changed in the 20 years between 1990 and 2010. This paper investigates links between learning disabilities and employment, drawing on interview-based research. It analyses the quality of experience of the minority in employment to consider whether employment can serve the inclusive purpose expected of it. [ABSTRACT FROM AUTHOR]

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

In this paper, we examine why risk-based policy instruments have failed to improve the proportionality, effectiveness, and legitimacy of healthcare quality regulation in the National Health Service (NHS) in England. Rather than trying to prevent all possible harms, risk-based approaches promise to rationalise and manage the inevitable limits of what regulation can hope to achieve by focusing regulatory standard-setting and enforcement activity on the highest priority risks, as determined through formal assessments of their probability and consequences. As such, risk-based approaches have been enthusiastically adopted by healthcare quality regulators over the last decade. However, by drawing on historical policy analysis and in-depth interviews with 15 high-level UK informants in 2013–2015, we identify a series of practical problems in using risk-based policy instruments for defining, assessing, and ensuring compliance with healthcare quality standards. Based on our analysis, we go on to consider why, despite a succession of failures, healthcare regulators remain committed to developing and using risk-based approaches. We conclude by identifying several preconditions for successful risk-based regulation: goals must be clear and trade-offs between them amenable to agreement; regulators must be able to reliably assess the probability and consequences of adverse outcomes; regulators must have a range of enforcement tools that can be deployed in proportion to risk; and there must be political tolerance for adverse outcomes. [ABSTRACT FROM PUBLISHER]

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

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

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

ObjectivesHospital chaplaincy in the UK's National Health Service (NHS) is an allied profession that is emerging from its origins as an aspect of Anglican clerical organisation. This paper describes the perceptions and practices of hospital chaplains around end of life care and organ donation. DesignQualitative study involving 19 semi-structured exploratory interviews with hospital chaplains in five NHS Hospital Trusts across two regions in the UK. ResultsChaplains provided generic support for the family around death and in relation to end of life conversations. While chaplains were supportive of efforts to increase awareness of issues around deceased donation they held a range of views on organ donation and had limited knowledge of hospital processes and practices. ConclusionsThere is scope for greater training and involvement of hospital chaplains in hospital work on organ donation, and in developing new forms of community engagement to promote awareness and debate. [ABSTRACT FROM AUTHOR]

This paper present data from the second and third rounds of a three-phase longitudinal research project exploring the ‘lived experiences’ of patients with chronic low-back pain (CLBP) in the United Kingdom. Qualitative, semi-structured interviews were conducted with eight participants 1 and 2 years after the first interviews and after attendance at a medically staffed chronic pain clinic. The transcribed accounts were analysed using interpretative phenomenological analysis and results compared with the data from time one. A main challenge for participants was managing constant unchanging pain experiences and loss across all areas of their lives. Some participants held consistent biomedical understandings of CLBP, continued to focus on the physicality of their pain and adopt a narrow range of behavioural-focused coping strategies and maintained a strong loss orientation. It is proposed that these elements demonstrated embodied experiences and contributed to comprehensive enmeshment of self and pain with little re-establishment of any behavioural activity. In comparison, participants who had experienced pain relief due to physical treatments showed increased use of mind–body strategies, a future orientation and were considered to be less enmeshed in their experiences. These changes were discussed in relation to the relationship between pain remission and illness beliefs. [ABSTRACT FROM PUBLISHER]

Transformation in the structure and delivery of services for children and young people in the UK Children Act (Department for Education & Skills, 2004. The Children Act. London: HMSO) initiated new alliances between statutory, public and voluntary agencies. Traditional relationships and notions of partnership have been extended, necessitating an innovative approach to dialogue and multiple perspectives. Hudson's assertion that although the 'rhetoric on partnering remains strong, the real policy thrust is now about choice and contestability' (2006, Journal of Integrated Care, 14(1), 13-21) exemplifies the dynamic policy context around notions of partnership and the rationale for collaborative advantage. This paper explores the experiences of practitioners working in a relatively new multi-agency context - the common assessment framework (CAF). Envisaged as a standardized approach to the assessment of need and as a tool to facilitate integrated working, the CAF is utilized by practitioners in the UK to improve outcomes for children and young people. We present data from a study that employed an interpretative phenomenological analysis approach and gathered semi-structured interviews with 20 practitioners. Interviews drew upon their experiences of interprofessional working in which diversity, partnership working, and competing aims and objectives emerged as significant themes. The insights that were gained are discussed in terms of their potential impact on service delivery in the UK and their contribution toward responsive practice across dynamic professional boundaries. [ABSTRACT FROM AUTHOR]

Background. Men's involvement in prenatal screening is becoming increasingly important. However, despite the potentially significant role of fathers in haemoglobinopathy screening, their participation is under researched. Furthermore, the portrayal of Black and minority ethnic (BME) fathers tends to be based on persisting stereotypes of men as either absentee parents with limited roles in screening or as controlling decision-makers. Objective. To describe the influence of ethnicity and gender on the process of participation of men in antenatal screening for sickle cell and thalassaemia. Design. A qualitative study, using in-depth interviews and focus groups with 22 pregnant women from a range of socio-economic and ethnic backgrounds, 16 male partners and 15 midwives in a northern city in the UK. Results. Men from BME groups take a pragmatic and equitable role in screening with their partners. White British men on the other hand, while willing to participate in screening, take a more casual view of their own direct participation. Accounts from hospital midwives supported these findings. Conclusions. While acknowledging the importance of material connections between certain BME groups and blood disorders, two key issues are raised. First, BME men's involvement contribute a challenge towards existing assumptions often made about BME fathers. Second, White British men's participation can be useful in determining the genetic status of the foetus and therefore their role should not be neglected. Screening research and practice need to broaden out their focus on issues of gender, ethnicity and screening. [ABSTRACT FROM AUTHOR]

Objective: To understand the perspectives of healthcare professionals and interpreters in relation to working with and caring for non-English speaking families accessing National Health Service paediatric tertiary health care services. Design: Focus group and interview methods were used to elicit the views of healthcare professionals and interpreters at one tertiary paediatric hospital in the United Kingdom. Data were subjected to framework analysis. Results: Participants identified a number of factors affecting communication and their interaction with non-English speaking families in this setting, including time, role uncertainty, and interlinked dimensions of culture and gender. They also described how the nature of this communication could impact on both the delivery of care and the patient and family experience. These findings highlight gaps in services, training, and support for families, staff and interpreters. These need to be recognised and addressed by those in practice to improve care delivery and help tackle health inequalities. Conclusion: Our data show how significant the impact of language barriers can be, and the need to consider not only how communication can be improved, but also how this is situated in the specific context of tertiary paediatric care as well as a wider social context of inequity. [ABSTRACT FROM AUTHOR]

Numerous policy directives highlight the need for planned and well-coordinated support to enable young people with long-term conditions and disabilities to negotiate the transition to adulthood, including making the leap from children-oriented to adultcentered health services. The journey is complex and multidimensional. For young people with a disability, long-term condition, or mental health problem there are additional challenges when transitioning between services with differences in expectations, delivery, and culture. This article explores findings from 6 case studies of young people who have recently experienced transition to adult health and care services, triangulating interrelated perspectives: those of young people, parents, and carers, and where possible the professionals involved. One of the case studies illustrates how the challenges are actually experienced. Analysis of emerging themes across the case studies leads to key messages from families to inform strategic development of services and practice. [ABSTRACT FROM AUTHOR]

United Kingdom (UK) paramedics are in a prime position to identify children and young people who are victims or at risk of sexual abuse. Paramedics have access, by phone, or in person, to unprepared homes and communities which other health professionals such as social workers may not. Little research exists however, investigating UK paramedic confidence in identifying child sexual abuse. This mixed-method explanatory sequential investigation used the self-reported confidence levels of 276 UK paramedics to inform the design of seven semi-structured focus groups with 25 UK paramedics from a large ambulance service with operating models similar to all UK services. Multiple factors contribute to a lack of confidence in identifying child sexual abuse, child sexual exploitation, and female genital mutilation, including a perceived lack of exposure to sexual abuse, the perceived hidden nature of sexual abuse, and the lack of physical symptoms and examination. An overarching lack of knowledge is the most significant contributor to a lack of confidence which in turn perpetuates misinformation surrounding prevalence, location, and the signs and symptoms of sexual abuse. These findings suggest a lack of sufficient training and a need for further research evaluating the content of current training and its method of delivery. [ABSTRACT FROM AUTHOR]

Undocumented migrant families experience high levels of food poverty, exclusion from mainstream benefits, and sometimes from social work services. This is an under-researched area for social work in the UK, and there is no statutory guidance for social workers on supporting undocumented migrants. Practitioner research is one way of 'visibilising' their experiences. Six migrant families accessing a voluntary sector stay and play project were interviewed using a practitioner research model of semi-structured interviews on the themes of food, access to services and children. The research found that families responded to their situation with a seemingly contradictory strategy of resignation and resilience. The implications for practitioners working with this user group are considered, and suggestions for support services for this group of families are offered. [ABSTRACT FROM AUTHOR]

Objective:This study aimed to explore health visitors’ (HVs) views on the acceptability and potential implementation of internet-based postpartum anxiety interventions in their practice. Background:Internet-based self-help has been shown to be effective and acceptable for postpartum depression. Recently, an internet-based intervention has been developed for postpartum anxiety. Before implementing new anxiety interventions in postpartum care, it is important to determine the acceptability and ways of implementing such interventions. This study therefore explored HVs’ views on this, as they are the some of the key healthcare professionals supporting women postpartum. Methods:Semi-structured interviews were conducted with 13 HVs across the UK. Audio-recorded interviews were transcribed verbatim and analysed using thematic analysis. Results:Five themes emerged – suitability; benefits; concerns; importance of one-to-one support; implementation. Internet-based interventions were seen as suitable as an additional option for a sub-group of postpartum women. Identified benefits included increased availability of a treatment tool for postpartum anxiety and treatment anonymity and flexibility. Reported concerns were the women’s state of mind, decreased human and professional contact, as well as IT access and literacy and language skills. HVs considered the most feasible way to implement internet-based interventions would be to have flyers for HVs to include with other information provided after birth or to hand out and discuss during their visits. The need for sufficient evidence of treatment efficacy and appropriate training was highlighted. Conclusion:This study highlights the opportunities and challenges that need to be considered before implementing internet-based interventions for postpartum anxiety in the postpartum care. [ABSTRACT FROM PUBLISHER]

Many studies of blood donation have looked at the motives of donors, their relationship with the wider society and corresponding values such as gift-giving, altruism and responsibility. These underpin a rhetorical representation of person-to-person donation that neglects the many technical processes that take place between donation and eventual use and the material nature of blood itself. This ethnographic study, conducted in four UK blood donation sites, describes the various practices involved in routine sessions, rather than the motives or values or donors or staff. It focuses on the procedures and equipment that not only ensures blood is collected safely and efficiently, but the extent to which they determine the nature of the collected blood itself. Taking our cue from posthuman approaches, we argue donated blood as something that is ‘made’ only when it leaves the body; in other words, it is not simply extracted, but is constructed through specific practices. We illustrate how, as blood is separated from the body, it is increasingly depersonalised and reconstituted in order to have biomedical value. In this way, rather than reproducing the essentialist claim that blood is what social scientists often described as a ‘special kind of substance’, we point to the ways in which donated blood alters as it moves in time and space. We argue that such transformations occur in both symbolic and material realms, such that the capacity of blood to have both cultural meaning and clinical value is dependent on the fact that it is never stable or singular. [ABSTRACT FROM PUBLISHER]

The youth-to-senior transition in professional soccer within the UK is challenging, yet previous work has focused on perspectives of a limited range of within-sport stakeholders. We conducted semistructured interviews with coaches (n =12), sport science support staff (n =10), and parents of players (n =6), exploring their perceptions of transition demands, resources, and barriers. Emergent themes highlighted role-specific support provision and that athletes progress through a period of adaptation, requiring a diverse set of characteristics and resources (e.g., knowledge of the transition process, social support), developed through a number of preceding transitions. [ABSTRACT FROM AUTHOR]

Objective: This study explored the psychosocial experiences of adults with hearing loss using the self-regulatory model as a theoretical framework. The primary components of the model, namely cognitive representations, emotional representations, and coping responses, were examined. Design: Individual semi-structured interviews were conducted. The data were analysed using an established thematic analysis procedure. Study sample: Twenty-five adults with mild-moderate hearing loss from the UK and nine hearing healthcare professionals from the UK, USA, and Canada were recruited via maximum variation sampling. Results: Cognitive representations: Most participants described their hearing loss as having negative connotations and consequences, although they were not particularly concerned about the progression or controllability/curability of the condition. Opinions differed regarding the benefits of understanding the causes of one’s hearing loss in detail. Emotional representations: negative emotions dominated, although some experienced positive emotions or muted emotions. Coping responses: engaged coping (e.g. hearing aids, communication tactics) and disengaged coping (e.g. withdrawal from situations, withdrawal within situations): both had perceived advantages and disadvantages. Conclusions: This novel application of the self-regulatory model demonstrates that it can be used to capture the key psychosocial experiences (i.e. perceptions, emotions, and coping responses) of adults with mild-moderate hearing loss within a single, unifying framework. [ABSTRACT FROM AUTHOR]

Interpretive phenomenological analysis was used to investigate the experiences of six African immigrant mothers living in the United Kingdom with a child diagnosed with an Autism Spectrum Disorder (ASD). The mothers took part in one-off, semi-structured interviews. Four themes were identified: caring for a child we did not expect, the pain of stigma and rejection, frameworks of meaning, and negotiating conflicting cultural beliefs. Many aspects of the mothers’ experiences appear related to their position as immigrants from cultures with contrasting belief systems regarding child development and disability. Conflicts between African cultural beliefs and a western, medical understanding of ASD appeared to create a feeling of cognitive dissonance for the mothers. The strategies used to negotiate this appear to map onto Berry’s acculturation strategies, suggesting that the experience of having a child with ASD impacts upon the acculturation process. Implications for clinical practice and policy are discussed. [ABSTRACT FROM PUBLISHER]

Objective:Despite the benefits of physical activity (PA), only one-third of older adults meet the recommended levels. The present study focused on psychosocial determinants of PA following retirement. Social cognitive theory (SCT) was used to better understand pre- and post-retirement adults’ thoughts about PA, the reasons why some individuals are more active than others, and how PA is incorporated into daily life after retirement. Design:Seven focus groups of older adults (N = 37,M = 64, SD = 5.20; males = 20) representing a range of PA levels and retirement length participated in one of seven focus groups. Results:Aligned with SCT, self-efficacy beliefs along with perceptions about barriers and benefits of PA were among the major determinants of PA. Findings highlighted the importance of social support, positive outcome expectations and self-regulatory strategies as motivators. The lack of structure in retirement was a hindrance to incorporating PA into daily routine but, when incorporated, PA provided a sense of purpose in the lives of retired individuals. Conclusion:It is important to understand the meaning of retirement as a life transition and how it affects beliefs about PA to inform SCT-based health promotion interventions targeting individuals in retirement age. [ABSTRACT FROM PUBLISHER]

Many long-term care systems are seeking to address problems of growing demand, increasing expense, and higher user expectations. For many of them fostering care at home and private care arrangements are attractive options. The long-term care sector in England is typical of these systems. Over the last 2 decades, government policy in England has placed stronger emphasis on people’s choice and control when receiving care services. People with care and support needs may be eligible for public funds to employ care workers or to use them in other ways promote their well-being. These financial transactions are a major part of the policy of personalisation in adult social care, as confirmed by the Care Act 2014. Drawing on findings from life story interviews with 31 migrant care workers who had worked for disabled or older people in England, conducted 2011–2013, we note the potential for expanding the sociologically inspired concept ‘personalised risk’. This necessitates an appreciation of risks potentially faced by the multiple parties in the care relationship and a differentiated set of structural risks. Applying a multilevel analysis we highlight the potential risks of ‘informality’ of employment conditions experienced by directly employed care workers, the ‘emotional’ content of care worker-employer relationships, and ‘intimacy’ of employer/employee roles. In this article, we offer an empirical based contribution to the wider discussion of risks and risk theory derived from policy changes being adopted by many developed countries that increasingly emphasise individual responsibility for personal welfare within an uncertain and mobile social world. [ABSTRACT FROM PUBLISHER]

Chlamydia is a common sexually transmitted infection that has potentially serious consequences unless detected and treated early. The health service in the UK offers clinic-based testing for chlamydia but uptake is low. Identifying the predictors of testing behaviours may inform interventions to increase uptake. Self-tests for chlamydia may facilitate testing and treatment in people who avoid clinic-based testing. Self-testing and being tested by a health care professional (HCP) involve two contrasting contexts that may influence testing behaviour. However, little is known about how predictors of behaviour differ as a function of context. In this study, theoretical models of behaviour were used to assess factors that may predict intention to test in two different contexts: self-testing and being tested by a HCP. Individuals searching for or reading about chlamydia testing online were recruited using Google Adwords. Participants completed an online questionnaire that addressed previous testing behaviour and measured constructs of the Theory of Planned Behaviour and Protection Motivation Theory, which propose a total of eight possible predictors of intention. The questionnaire was completed by 310 participants. Sufficient data for multiple regression were provided by 102 and 118 respondents for self-testing and testing by a HCP respectively. Intention to self-test was predicted by vulnerability and self-efficacy, with a trend-level effect for response efficacy. Intention to be tested by a HCP was predicted by vulnerability, attitude and subjective norm. Thus, intentions to carry out two testing behaviours with very similar goals can have different predictors depending on test context. We conclude that interventions to increase self-testing should be based on evidence specifically related to test context. [ABSTRACT FROM PUBLISHER]

Background: There is evidence that newly qualified doctors do not feel prepared to start work. Aim: This study examined the views of first year Foundation doctors (F1) and supervisors regarding how prepared they felt newly qualified doctors were for the early weeks of work. Methods: Fifty-two F1s took part in a focus group or individual interview during their first year of Foundation training. Twenty-two supervisors took part in an individual interview. Results: The F1s struggled with new responsibilities, decision-making, time management, prioritizing tasks and the large administrative component to their role. They felt unprepared for making diagnoses, prescribing and acting in an emergency. Supervisors felt F1s were generally well prepared to start work, with skills improving through experience. However, F1s needed more practical experience with real patients and more opportunities to take responsibility, make decisions and perform some clinical skills. Supervisors did not feel that F1s accessed senior support appropriately. F1s indicated they preferred to go to peers for assistance in the first instance, and felt unsupported by seniors, particularly at weekends and on night shifts. Conclusions: Specific areas of unpreparedness were identified by both F1s and supervisors; leading to recommendations to enhance effective transition from medical student to F1. [ABSTRACT FROM PUBLISHER]

The stand-up comedy landscape has been transformed in recent years with an increased number of disabled comedians performing. Using semi-structured interviews with disabled comedians, this article provides a thematic analysis of the material and ideological motives, intentions and lived experiences of disabled comedians. Two themes are discussed: comedy management and control; and affirming disability through comedy. These themes are characterised by complexity and contradictions. The article concludes that, although not a straightforward process, stand-up comedy enacted by disabled comedians is potentially a powerful tool through which hegemonic norms around disability can be challenged and renegotiated. [ABSTRACT FROM PUBLISHER]

This is the first study undertaken in the UK that investigates the notion of professional identity among practitioners who work with asylum seekers and refugees. Drawing on a social constructionist epistemology and a Foucauldian theoretical and methodological framework of power and discourse, I analysed extracts from semi-structured interviews that were conducted with eight specialist professionals who have worked with this population. The findings of this study suggest that the notion of professional identity among these practitioners envelops a social and political activist stance and a deep sense of commitment towards promoting social change within the wider community. Likewise, clinical work with refugees combines professional knowledge and values with a politicised involvement that fosters a psychosocial perspective on clients' distress and difficulties. [ABSTRACT FROM PUBLISHER]

The research aimed to investigate the national Improving Access to Psychological Therapies (IAPT) programme, from the perspective of ‘non-IAPT’ counsellors and psychotherapists working within IAPT services. Semi-structured interviews were carried out with therapists who were currently working within IAPT services, but had no formal ‘IAPT-compliant’ or ‘IAPT-accredited’ training. Foucauldian discourse analysis was used to analyse interview transcriptions and the study examined the various discourses used by participants to speak about IAPT. Findings indicated that participants drew upon dominant discourses in attempts to fit in or belong, yet paradoxically, the way in which the discourses were used seemed to create subject positions that were outside to, or excluded from, the IAPT services they worked at. IAPT and non-IAPT discourses emerged simultaneously – a possible indication of the discursive junction where different ideologies were in conflict with one another. Implications of the power relations that may be operating within this setting are discussed and suggestions made for further research. [ABSTRACT FROM PUBLISHER]

There is increasing recognition that cultivating compassion for oneself and others can act as an antidote to feelings of threat, shame, humiliation and paranoia. This study aimed to explore the further development of a narrative-based measure of compassion. We hypothesised that greater compassion would be associated with lower levels of positive symptoms, negative symptoms, cognitive disorganisation, excitement and emotional distress. Participants were 29 individuals with psychosis. Greater narrative compassion was associated with less negative symptoms, less cognitive disorganisation and less excitement. We found no correlations between narrative compassion and the Self-Compassion Scale. Notwithstanding the methodological problems of our study, our findings have important implications for developing an attachment-based understanding of compassion and the use of compassion to support recovery from complex mental health problems such as psychosis. [ABSTRACT FROM AUTHOR]

The purpose of this case study was to understand the personal experience of a female athlete (aged 24 years) undergoing a significant change-event from a team sport (rugby) to an individual sport (weightlifting) at an elite level. Two in-depth informal interviews were conducted. A number of change-events were experienced in several contexts, including a change of sports, a change in academic status, and a reoccurring injury. The findings provided empirical support for the use of the scheme of change for sport psychology practice (Samuel & Tenenbaum, 2011a) for understanding the change process and the associated coping strategies athletes may adopt. [ABSTRACT FROM AUTHOR]

ObjectiveTo explore the barriers to initiating and maintaining regular physical activity (PA) among UK Indian, Pakistani and White British adults in their 60s. DesignAn exploratory qualitative approach was utilised using 15 focus groups and 40 in-depth interviews. Purposive sampling was used to recruit participants with different experiences of participation or non-participation in PA. ResultsMisunderstandings about the value of exercise in later life, particularly for those with ongoing healthcare problems, were identified in UK South Asian and White British older adults' accounts of their experience of the barriers to initiating and maintaining regular PA. Both groups and genders said that PA could exacerbate pre-existing health problems and result in physical harm. Although most beliefs were similar to those of the White British, ethnic-specific factors, such as language barriers, religious beliefs and cultural practices could act as additional barriers to undertaking and maintaining PA among UK South Asian older adults. Conclusions and implicationsUnderstanding the multiple levels of influence on older adults' PA behaviour can provide the basis for developing comprehensive approaches to health promotion initiatives aimed at increasing PA levels. Healthcare providers need to understand the characteristics and specific barriers faced by these groups of older adults; work with older people from these groups to develop culturally appropriate PA programmes and address the misunderstandings and misconceptions about the value of exercise in later-life, particularly in those with ongoing health problems. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this article was to describe socio-emotional themes in the stories of 16 Centenarians living in the United Kingdom. Methodology: Sixteen Centenarians were recruited and interviewed face-to-face by members of the research team. Participants were invited to tell the story of their lives in line with the principles of participatory action research (Koch and Kralik, 2006). The resultant story was returned to the Centenarian and their significant others for their validation and ownership. Stories were further analysed alongside verbatim interview transcripts. The first author wrote her psycho-social interpretation of the socio-emotional content in each person s life. These psycho-social interpretations were combined to provide commonalities in experience. Findings: These six common experiences or themes were: Engagement in the world, Happiness and describing a good life, Stoicism, Sources of support, Sources of frustration and Talking about death. All participants had strong interests. They reported their lives as having been ‘good’ or ‘happy’. They were resilient in the face of stress. Their frustrations pertained to visual or mobility impairments. While they were accepting the death of spouses, siblings and significant others, they were silent about the proximity of their own. In this article, we consider these themes in the light of previous empirical findings and theories. Conclusion: Centenarians indicated that life had been worth living and that it felt good to be 100 years of age. We explore the limitations of this study and discuss implications of the findings for those involved with the oldest old. [ABSTRACT FROM PUBLISHER]

Despite their essential role in the National Health Service, there is limited research on the experiences of refugee interpreters. To explore Kurdish refugee interpreters' experiences of working in UK mental health services. Six participants were interviewed and data collected were analysed using interpretative phenomenological analysis. The results showed that interpreters often felt overwhelmed by the emotional impact of interpreting in mental health services, particularly at the beginning of their careers. Interpreters struggled to negotiate complex and unclear roles and responsibilities. Interpreting for refugees with shared histories was particularly challenging. The study recommends that interpreters working in mental health services receive training on mental health issues and self-care and are assisted by frameworks to help make sense of the impact of the work, such as supervision. [ABSTRACT FROM AUTHOR]

Recent publications raise concerns about meeting the treatment needs of an ageing drug-using population. At Bristol Drugs Project (BDP) we noted the absence of older users attending services beyond health centre-based opiate substitution therapy (OST). Twenty drug-users aged 55 or over were interviewed about their experience of treatment, barriers to further treatment, and what might encourage participation in our community drugs project. Thematic analysis revealed barriers as reluctance to be associated with younger drug users and a sense of shame at 'still using at this age'. Assumptions that health professionals would interpret asking for medical help with other age-related symptoms as 'merely seeking more medication' prevented some from getting adequate pain relief and there was a tension between fear of detox and fear of drug dependency in old age. Most reported positive relationships with general practitioners (GPs) and BDP Shared Care workers in respect of their drug use, but others had felt stigmatized and inadequately treated within Tier 4 (mainly hospital) services which they attributed to their drug-user status. A focus group developed ideas for an age-specific support group to be piloted. Advocacy work and training for health professionals should be ongoing to improve treatment for older drug users. [ABSTRACT FROM AUTHOR]

The Olympic environment has been identified as particularly stressful and unlike any other in terms of the media attention and focus placed on the competition. While the potential negative consequences of stress for coaches and their athletes have been explored, relatively little is known about the factors underpinning successful Olympic coaching performance. We explored elite coaches' perceptions of the factors that enable them to coach in a stressful Olympic environment. Eight coaches from one of Great Britain's most successful Olympic teams (i.e. consistent medal winners in the previous three Olympics) were interviewed. Inductive content analysis indicated that psychological attributes (e.g. emotional control), preparation (e.g. strategic approach), and coping at the event (e.g. team support) were factors that coaches perceived as important for successful Olympic coaching. In addition, coaches offered specific suggestions for training and development. Key themes included coach interaction (e.g. mentoring, formalizing contact) and simulating Olympic pressure. These findings offer suggestions for the education of developing coaches on the pathway to elite sports coaching. [ABSTRACT FROM AUTHOR]

This article discusses an oral history project funded by the Heritage Lottery. It recorded the memories of eight people with learning difficulties during the Second World War in Cumbria, UK, before their personal histories were lost forever. This qualitative, inclusive research project was supported by various organisations. The process of emancipatory research is examined in relation to the main project findings. There is an accessible website exhibition linked to this article. Some difficult issues were experienced by the team, such as the ill-health and death of participants, negotiating access with gatekeepers and concerns around decision-making. Cumbria experienced limited war activity, but people’s lives changed in subtle ways. This led to discussion around false/given memories; formal/informal interview processes and transcription/recording issues. The unexpected revelation of the study was the knowledge created around approaches to inclusion. [ABSTRACT FROM AUTHOR]

Background. From clinical work and research it is clear that people suffering from borderline personality disorder (BPD) often complain of psychotic symptoms including hallucinations, yet little is known about how service users experience these symptoms. Aims. The aim of this study was to examine the experience of psychotic symptoms in people with BPD and to establish how mental health professionals responded to reports of psychotic symptoms. Method. Seven semi-structured interviews were carried out with service users with BPD who had been known to present with psychotic symptoms. In parallel, medical case notes of these service users were analysed. Results were subjected to qualitative analysis using techniques of grounded theory. Results. Psychotic symptoms were often long standing and interfered with physical and emotional functioning. There were no clear distinctions from psychotic symptoms described by patients suffering from schizophrenia. Treating doctors had no common language to describe these symptoms. Furthermore, the language that was used had the implication that the symptoms were not real or true and could therefore be perceived as pejorative. Conclusions. It is suggested that the diagnostic category of BPD requires revision to include psychotic symptoms. Terminology such as pseudo- and quasi-psychotic symptoms are confusing and use of these terms should be revised. [ABSTRACT FROM AUTHOR]

Objective: This study aims to explore the experience of childless men and the desire for fatherhood. Background: There is little research exploring the desire for fatherhood, with most studies concentrating on couples in infertility treatment. Of those, the majority focus on the women's experience, a factor that may reflect the gender stereotype and cultural identification of childlessness to women. Methods: A qualitative approach was adopted. A convenience sample of 10 biologically childless men were recruited through the snowball method and interviewed individually. The interviews were transcribed verbatim and transcripts were then analysed using Grounded Theory. Results: A core category, 'Lifescape's of childless men: enduring anticipation and expectation in an uncharted world', divided into three meta themes: Emotive Forces, Extant Agency, and Life Course. The desire for parenthood appeared to peak in the 30s, gradually reduced, but did not cease. The participants also revealed a sense of 'outsiderness' in familial, social, and work relationships. Conclusion: Involuntarily childless men reported similar experiences to those in, or who have had, infertility treatment. These included a sense of loss, depression, exclusion, isolation, and risk-taking behaviour. Over the life course the men also found ways to adapt and reappraise their beliefs concerning themselves emotionally, psychologically and socially. To help understand this process, gender-role therapy is presented as a possible approach for working with childless men. [ABSTRACT FROM AUTHOR]

Career decision-making research has focused primarily on occupation change as a discrete event and emphasised occupational mobility. Not all of those who consider changing occupation do so though, and this study explored the narrative accounts of nine female teachers who had considered leaving the profession, but remained teaching at midlife. Narrative plotlines illustrated how this decision-making process evolved across the career span and revealed individual experiences ranging from reconciliation to on-going disaffection with teaching. Thematic analysis identified factors associated with occupational embeddedness in understanding why these women stayed and the potential for embedding issues to constrain women's occupational mobility. Implications for career counselling include exploring occupational decision-making across the career span, recognising the impact of embedding forces on women's teaching careers and supporting those who feel unable to leave this demanding occupation. [ABSTRACT FROM AUTHOR]

There has been curiously little empirical investigation into the experiences of psychotherapeutic practitioners undertaking a mandatory training therapy. We present results from a qualitatively-driven mixed-methods study designed to explore the way in which counselling psychologists' attachment status and levels of reflective function intersect with how they experience the therapeutic relationship within their personal therapy. Participants were interviewed twice: once using Main and Goldwyn's (1998) Adult Attachment Interview (AAI) to explore representations of early childhood relationships; and subsequently using a semi-structured interview format, analysed via Interpretative Phenomenological Analysis (IPA), to explore experiences of personal therapy. Meshing results from both sets of data showed that insecurely-attached participants experienced their personal therapy differently from secure or earned-secure participants, and were more troubled by a perceived disparity of institutional and interpersonal power within the therapeutic relationship. Results are considered in terms of the power dynamics within training therapy. Implications for training and future research in this neglected field are briefly discussed. [ABSTRACT FROM AUTHOR]

Of the 293,600 cancers diagnosed annually in the UK, 11% occur in the 15- to 49-year age group. Fertility preservation options exist for those faced with the loss of fertility as a consequence of radiotherapy or chemotherapy. The aim of this study was to explore experiences, attitudes and perceptions of fertility advice and treatment among cancer survivors, and the subsequent impact upon their lives. Eighteen people aged 19–42 years with a diagnosis of cancer made more than 5 years earlier and, registered with general practices in North East England, were interviewed using a grounded approach. Survival was the universal focus of patients at the point of diagnosis and they commonly failed to appreciate the effect of treatment upon future fertility. A positive experience was linked to the quality of information about fertility preservation or action offered, but this needed to be tailored to the patients' age, stage in their life course, relationships and fears. Possible loss of future fertility only becomes important beyond survival but patients wanted their potential future fertility addressed sensitively at the time of diagnosis and backed up by access to written or web-based patient information, or a fertility specialist. [ABSTRACT FROM AUTHOR]

Widowhood forces women to reconstruct their identities. This article discusses how this reconstruction occurs. Interviews were conducted with 65 older widows exploring their experiences: Of those, 81% spoke about identity. This reconstruction can be understood in terms of continuing bonds with the deceased, loosening bonds, and personal growth. Women discussed these transitions in four ways: personal struggle, resistance to social expectations, empowerment, and using rhetoric. The reconstructed identity is not that of wife but rather that of an augmented identity of wife/widow. The tensions between how the widows see themselves, and how society sees them are explored. [ABSTRACT FROM AUTHOR]

Migration of African-trained health workers to countries with higher health care worker densities adds to the severe shortage of health personnel in many African countries. Policy initiatives to reduce migration levels are informed by many studies exploring the reasons for the original decision to migrate. In contrast, there is little evidence to inform policies designed to facilitate health workers returning home or providing other forms of support to the health system of their home country. This study explores the links that South African-trained health workers who now live and work in the United Kingdom maintain with their country of training and what their future migration plans may be. Semi-structured interviews were conducted with South African trained health workers who are now living in the United Kingdom. Data extracts from the interviews relating to current links with South Africa and future migration plans were studied. All 16 participants reported strong ongoing ties with South Africa, particularly through active communication with family and friends, both face-to-face and remotely. Being South African was a significant part of their personal identity, and many made frequent visits to South Africa. These visits sometimes incorporated professional activities such as medical work, teaching, and charitable or business ventures in South Africa. The presence and location of family and spouse were of principal importance in helping South African-trained health care workers decide whether to return permanently to work in South Africa. Professional aspirations and sense of duty were also important motivators to both returning and to being involved in initiatives remotely from the United Kingdom. The main barrier to returning home was usually the development of stronger family ties in the United Kingdom than in South Africa. The issues that prompted the original migration decision, such as security and education, also remained important reasons to remain in the United Kingdom as long as they were perceived as unresolved at home. However, the strong residual feeling of identity and regular ongoing communication meant that most participants expressed a sense of duty to their home country, even if they were unlikely to return to live there full-time. This is a resource for training and short-term support that could be utilised to the benefit of African health care systems. [ABSTRACT FROM AUTHOR]