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BACKGROUND: Black ethnic groups are disproportionately affected by sexually transmitted infections (STIs). This review aimed to identify interventions designed to increase engagement with sexual healthcare among people of Black ethnicity as determined by rates of STI testing, adherence to sexual health treatment, and attendance at sexual healthcare consultations. The behaviour change techniques (BCTs) used within identified interventions were evaluated. METHOD: Four electronic databases (Web of science; ProQuest; Scopus; PubMed) were systematically searched to identify eligible articles published between 2000 and 2022. Studies were critically appraised using the Mixed Methods Appraisal Tool. Findings were narratively synthesised. RESULTS: Twenty one studies across two countries were included. Studies included randomised controlled trials and non-randomised designs. Behavioural interventions had the potential to increase STI/HIV testing, sexual healthcare consultation attendance and adherence to sexual health treatment. Behavioural theory underpinned 16 interventions which addressed barriers to engaging with sexual healthcare. Intervention facilitators' demographics and lived experience were frequently matched to those of recipients. The most frequently identified novel BCTs in effective interventions included information about health consequences, instruction on how to perform behaviour, information about social and environmental consequences, framing/reframing, problem solving, and review behavioural goal(s). DISCUSSION: Our findings highlight the importance of considering sociocultural, structural and socio-economic barriers to increasing engagement with sexual healthcare. Matching the intervention facilitators' demographics and lived experience to intervention recipients may further increase engagement. Examination of different BCT combinations would benefit future sexual health interventions in Black ethnic groups.

Background. The Black Caribbean population have a disproportionately high burden of sexually transmitted infections (STIs) compared with other ethnic groups. The aim of this study was to explore barriers to engagement with STI testing within a UK-based young adult Black Caribbean community. Methods. Semi-structured interviews were carried out with 14 young adults from the Black Caribbean community and six sexual healthcare professionals. Data were analysed thematically. A focus group of five young adults was conducted to refine themes. Results. Data analysis generated three themes: (1) culturally embedded stigma; (2) historically embedded mistrust; and (3) lack of knowledge. Perceived as ‘dirty’, particularly for females, infection with STIs was stigmatised by religious conceptions of ‘purity’ and shame. This presented challenges in terms of cultural acceptability of talking about STI testing with partners, friends, and family. Legacies of colonialism, medical racism and malpractice compromised young people’s trust in medical intervention and confidentiality of data management. A lack of knowledge related to STIs and their treatment, and in how to access and perform STI tests further served as a barrier. Culturally tailored interventions targeting these factors and delivered by radio, podcasts and social media were highlighted as having potential to improve engagement with STI testing. Discussion. Engagement with STI testing by young adults from the Black Caribbean community is impacted by historically and culturally embedded teachings, practices and beliefs inherited through generations. Targeting these factors within culturally tailored interventions may be effective for increasing STI-testing, and thus reducing rates of STI-infection in this population.

Phenomenology focuses on how we experience and interact with phenomena in the world. Phenomenologically inspired methods have long been applied to the study of health and care as a human science. However, generating the kinds of rich, experience-near data that supports the phenomenological project requires careful and considerate methods which attend to the needs of the research population. Presenting and discussing examples of our empirical work, we demonstrate compatibility and complementarity between a phenomenological methodology and creative methods of data generation. Participant creations of written descriptions, art, photovoice and relational mapping are explored. Covering topics such as men’s experiences of migraine, coping with body dysmorphic disorder, living with ‘unseen’ health conditions and parenting young people with intellectual disabilities, we demonstrate how the quality of the data collected is improved through the integration of creative methods of data collection in qualitative psychological research. Through giving the platform and freedom for participants to express themselves beyond spoken words, we argue that these methods shift the power balance of the typical researcher-participant dynamic. Data created through creative methods has the potential to reach, and resonate with, wider audiences; moving ‘beyond’ traditional approaches to generating data becomes a means of enacting material change.

Objective: To synthesise qualitative research exploring the care-giving experiences of parents of young people with profound and multiple learning disabilities (PMLD) and complex healthcare needs, in the transition to adulthood years. Method: Four databases were systematically searched: Scopus, WoS Core Collection, Medline and SciELO. Included papers were assessed for quality and thematically synthesised. Findings are presented in the form of free-verse poems. Results: Nineteen papers from eight countries were included. Analysis generated three themes: interdependency of parent and child, where parents retained responsibility for their child’s care; apprehension regarding sharing and shifting responsibility between parents and professionals; an uncertain future in terms of care provision. Conclusions: Parents are concerned about the future care of their children. Training professionals in alternative and effective communication is fundamental to successful transition. Encouraging discussions about advanced care planning may also alleviate parental concerns and ensure good outcomes for young people with PMLD.

Following bereavement, continuing bonds (CBs) include engaging with memories, illusions, sensory and quasi-sensory perceptions, hallucinations, communication, actions, and belief that evoke an inner relationship with the deceased. To date, the literature has been unable to confirm whether retaining, rather than relinquishing, bonds is helpful. A mixed studies systematic literature search explored how CBs affect grief. Studies on the effect or experience of CBs on adjustment following bereavement were eligible for inclusion. Six computerized databases were searched. A total of 79 of 319 screened studies were included. Three themes were derived from the thematic analysis: (1) comfort and distress, (2) ongoing bonds and relational identity, and (3) uncertainty, conceptualizing, and spirituality. Themes describe the role of CBs for the accommodation of the death story, transformation of the relationship, meaning reconstruction, identity processes, and affirmation of spiritual belief. Results shed light on the adaptive potentials for CBs.

This study’s primary objective was to establish differences in beliefs about medicines, levels of asthma-related anxiety and diet and exercise behaviours between parents of children with well controlled and poorly controlled asthma. Secondary objectives were to explore how asthma control might shape relationships between parental cognitions and parenting practices concerning paediatric asthma. Parents of children with asthma aged 10–16 years ( N = 310) completed standardised questionnaires measuring beliefs about medicines, parental asthma-related anxiety, parenting attitudes towards child activity, parental feeding and asthma control. Parents of children with poorly controlled asthma reported significantly greater asthma medication necessity and concern, asthma-related anxiety, control of child activity, pressure to exercise and unhealthy feeding practices. Moderation analyses indicated that the relationship between parental concern about asthma medicine and parental control of child activity was strongest in children with poorly controlled asthma. Also, the relationship between parental asthma-related anxiety and use of food to regulate child emotion was only significant when asthma was poorly controlled. Parental beliefs about asthma medicines and asthma-related anxiety may indirectly influence asthma outcomes through unhealthy parenting practices around exercise and diet. Eliciting and understanding parents’ perceptions of asthma medications and anxiety may facilitate personalised interventions to improve asthma control.

Background: Missed sexual healthcare appointments lead to inefficiencies and wasted resources, longer waiting times and poorer outcomes. The aim of this research was to identify factors influencing non-attendance at sexual healthcare appointments and to make recommendations for interventions. Methods: Semi-structured interviews were carried out with UK-based sexual health service-users with experience of booking and missing appointments and sexual health professionals (n = 28). Interviews were analysed using a thematic framework approach. Results: Perceptual, practical, and organisational factors were found to influence missed appointments. Perceptual factors included beliefs about the outcomes of attending; sense of responsibility to attend; and concerns about privacy and security. Practical factors included competing demands and disruption to daily life; ability to attend; and forgetting. Organisational factors included mode of appointment delivery and availability of appointments. Conclusions: Interventions should combine strategies shown to be effective for overcoming practical barriers to attendance (e.g. reminder systems) with novel strategies communicating the benefits of attending and risks of missed appointments (e.g. behaviourally informed messaging). Text reminders containing behaviourally informed messages may be an efficient intervention for targeting perceptual and practical factors associated with missed appointments. Offering appointment modalities to suit individual preference and enabling service-users to remotely cancel/reschedule appointments maight further support a reduction in missed appointments.

Objectives Treatment adherence in adolescents with Inflammatory Bowel Disease (IBD), ranges from 2%-93%, with the frequency of non-adherence ranging from 3%-57%.1 Non-adherence to a prescribed treatment regimen has significant clinical consequences. This research aimed to develop a novel, user-centred and theory-driven behavioural intervention to support young people (aged 13–18) with IBD adhere to their treatment plan. Methods Findings from a systematic review evaluating treatment adherence interventions for young people with IBD were synthesised with findings from exploratory, qualitative interviews with young people with IBD, parents of young people with IBD and healthcare professionals. Findings were then mapped to psychological constructs from relevant behaviour change theories and behaviour change techniques selected. Following a Behaviour Change Wheel approach,2 a novel intervention was developed, specifically addressing the treatment adherence needs of young people (aged 13–18) with IBD. A series of co-development workshops were conducted with young people (aged 13–18) with IBD. Within these workshops, young people provided feedback on the proposed intervention’s components and delivery, using a variety of participatory methods. Young people’s ideas were incorporated into a revised version of the intervention, aiming to improve its acceptability and feasibility. Further revisions were made in response to feedback collected from parents of young people with IBD. Results A prototype behavioural adherence intervention was co-developed with young people and parents to support treatment adherence in young people with IBD. Ten interactive online modules aimed to increase young people’s confidence to adhere to their treatment plan, support resilience to overcome adherence barriers, assist in the development of health communication skills and generate optimism about the future. Interactive online modules and components within each module can be tailored by the user

Background: Attending a sexual health consultation is integral to the effective prevention and treatment of sexually transmitted infections (STIs). However, individuals who may be at risk of STIs do not always do so, leading to an increased risk of STI complications and transmission of infection to others. This systematic review aimed to identify interventions implemented to increase attendance at a pre-booked sexual health clinic appointment and to identify behavioural theory and behaviour change techniques (BCTs) which form the basis for such interventions. Methods: Articles were identified through a systematic search of four electronic databases (Web of Science; ProQuest; Scopus; PubMed) and included if they aimed to increase attendance at a pre-booked, synchronous sexual health consultation. The quality of included studies was assessed independently by two researchers. Findings were synthesised narratively. Results: Thirteen studies were included from three countries; eight non-randomised before-after study designs and five randomised controlled trials. Behavioural interventions increased attendance at pre-booked sexual health consultations. Text messages were the most frequently used mode for intervention delivery. A total of 19 BCTs were identified but only three studies mentioned behavioural theory. The most frequently used BCTs in effective interventions were: using credible sources, employing prompts/cues and the provision of information about health consequences. However, these BCTs were also identified in interventions that were not effective, meaning that optimal content and theoretical underpinning of effective interventions remains unclear. Conclusions: Behavioural interventions can increase attendance at sexual health consultations. Further research is needed to examine the effectiveness of different BCT combinations.

Objective: To explore factors that influence professionals in deciding whether to withdraw treatment from a child and how decision making is managed amongst professionals as an individual and as a team. Study Design: Semi-structured interviews were conducted with a purposive sample of health professionals working at a UK Children's Hospital, with children with life-limiting illnesses whose treatment has been withdrawn. Data were transcribed verbatim, anonymized and analysed using a thematic framework method. Results: A total of 15 participants were interviewed. Five interrelated themes with associated subthemes were generated to help understand the experiences of health professionals in decision making on withdrawing a child's treatment: (1) understanding the child's best interests, (2) multidisciplinary approach, (3) external factors, (4) psychological well-being and (5) recommendations to support shared decision making. Conclusion: A shared decision-making approach should be adopted to support professionals, children and their families to make decisions collectively.

Objective: Children and young people living with asthma have an increased risk of overweight/obesity, leading to increased severity of asthma symptoms. Weight management has been recommended to improve asthma symptoms, however, there is limited understanding of how this is experienced or how children and young people with asthma and their families wish to be supported. The aim of this study was to explore parents and children/young people’s views and experiences of managing weight while living with asthma, and to identify acceptable strategies for support. Methods: A qualitative methodological approach was taken to facilitate rich understanding of families’ insights into weight management while living with asthma. In-depth interviews were conducted with nine families living with pediatric asthma (n = 9 parents, 9 young people). Data were analyzed using a Framework approach. Results: Findings indicated that family engagement with weight management behaviors was primarily influenced by perceptions of risk regarding asthma outcomes and beliefs about asthma control. Families also reported weight management engagement to be influenced by perceptions of the food environment, perceptions of the exercise environment (e.g. weather, anticipated social outcomes) and the availability of weight management support. Participants sought tailored support which gave consideration to the asthma-obesity interaction. It was suggested that this would help reduce perceptions of weight stigma in consultations, thereby supporting behavioral changes. Conclusions: Individualized weight management plans that consider families concerns about asthma-related risk are needed to manage weight in children and young people living with asthma.

Background: Healthcare professionals are ideally placed to discuss weight management with children and families to treat and prevent childhood obesity. The aim of this review was to collect and synthesize primary research evidence relating to health professional's views and experiences of discussing weight with children and their families. Methods: Systematic searches were conducted using the following databases: MEDLINE (OVID), Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE (OVID), PsycINFO (OVID) and Healthcare Management Information Consortium (HMIC). Twenty-six full text qualitative studies published in English Language journals since inception to October 2019 were included. Papers were quality assessed and synthesized using an inductive thematic analysis approach. Results: Data analysis generated five themes: sensitivity of the issue, family–professional relationships, whole systems approach, professional competency and sociocultural context. Conclusion: Supporting behaviour change through discussion of healthy weight with children and families is an important part of the health professional's role. Tailored information for professionals, including resources and training, facilitates them to confidently talk to children and families about weight prioritized within interventions. The success of such interventions requires commitment from a range of professionals to ensure healthy weight is tackled through a whole system approach.

Background: Electronic prescribing (ePrescribing) or computerised provider/physician order entry (CPOE) systems can improve the quality and safety of health services, but the translation of this into reduced harm for patients remains unclear. This review aimed to synthesise primary qualitative research relating to how stakeholders experience the adoption of ePrescribing/CPOE systems in hospitals, to help better understand why and how healthcare organisations have not yet realised the full potential of such systems and to inform future implementations and research. Methods: We systematically searched 10 bibliographic databases and additional sources for citation searching and grey literature, with no restriction on date or publication language. Qualitative studies exploring the perspectives/experiences of stakeholders with the implementation, management, use and/or optimisation of ePrescribing/CPOE systems in hospitals were included. Quality assessment combined criteria from the Critical Appraisal Skills Programme Qualitative Checklist and the Standards for Reporting Qualitative Research guidelines. Data were synthesised thematically. Results: 79 articles were included. Stakeholders’ perspectives reflected a mixed set of positive and negative implications of engaging in ePrescribing/CPOE as part of their work. These were underpinned by further-reaching change processes. Impacts reported were largely practice related rather than at the organisational level. Factors affecting the implementation process and actions undertaken prior to implementation were perceived as important in understanding ePrescribing/CPOE adoption and impact. Conclusions: Implementing organisations and teams should consider the breadth and depth of changes that ePrescribing/CPOE adoption can trigger rather than focus on discrete benefits/problems and favour implementation strategies that: consider the preimplementation context, are responsive to (and transparent about) organisational and stakehold

Objectives: To explore paediatric nurses’ experiences and perspectives of their role in the medication process and how this role is enacted in everyday practice. Methods: A qualitative case study on a general surgical ward of a paediatric hospital in England, one year prior to the planned implementation of ePrescribing. Three focus groups and six individual semi-structured interviews were conducted, involving 24 nurses. Focus groups and interviews were audio-recorded, transcribed, anonymized and subjected to thematic analysis. Results: Two overarching analytical themes were identified: the centrality of risk management in nurses’ role in the medication process and the distributed nature of nurses’ medication risk management practices. Nurses’ contribution to medication safety was seen as an intrinsic feature of a role that extended beyond just preparing and administering medications as prescribed and placed nurses at the heart of a dynamic set of interactions, practices and situations through which medication risks were managed. These findings also illustrate the collective nature of patient safety. Conclusions: Both the recognized and the unrecognized contributions of nurses to the management of medications needs to be considered in the design and implementation of ePrescribing systems.

The involvement of parents in their child’s hospital care has been strongly advocated in paediatric healthcare policy and practice. However, incorporating parental worries about their child’s condition into clinical care can be difficult for both parents and healthcare professionals. Through our “Listening To You” quality improvement project we developed and piloted an innovative approach to listening, incorporating and responding to parental concerns regarding their child’s condition when in hospital. Here we describe the phases of work undertaken to develop our “Listening To You” communications bundle, including a survey, literature review and consultation with parents and staff, before findings from the project evaluation are presented and discussed.

Health service reforms in the United Kingdom have sought to ensure that children and young people who are ill receive timely, high quality and effective care as close to home as possible. Using phenomenological methods, this study examined the experience and impact of introducing new, community-based paediatric outpatient clinics from the perspective of NHS service-users. Findings reveal that paediatric outpatient ‘care closer to home’ is experienced in ways that go beyond concerns about location and proximity. For families it means care that ‘fits into their lives’ spatially, temporally and emotionally; facilitating a sense of ‘at-homeness’ within the self and within the place, through the creation of a warm and welcoming environment, and by providing timely consultations which attend to aspects of the families’ lifeworld.

Objectives - In line with a national policy to move care ‘closer to home’, a specialist children's hospital in the National Health Service in England introduced consultant-led ‘satellite’ clinics to two community settings for general paediatric outpatient services. Objectives were to reduce non-attendance at appointments by providing care in more accessible locations and to create new physical clinic capacity. This study evaluated these satellite clinics to inform further development and identify lessons for stakeholders. Methods - Impact of the satellite clinics was assessed by comparing community versus hospital-based clinics across the following measures: (1) non-attendance rates and associated factors (including patient characteristics and travel distance) using a logistic regression model; (2) percentage of appointments booked within local catchment area; (3) contribution to total clinic capacity; (4) time allocated to clinics and appointments; and (5) clinic efficiency, defined as the ratio of income to staff-related costs. Results - Satellite clinics did not increase attendance beyond their contribution to shorter travel distance, which was associated with higher attendance. Children living in the most-deprived areas were 1.8 times more likely to miss appointments compared with those from least-deprived areas. The satellite clinics’ contribution to activity in catchment areas and to total capacity was small. However, one of the two satellite clinics was efficient compared with most hospital-based clinics. Conclusions - Outpatient clinics were relocated in pragmatically chosen community settings using a ‘drag and drop’ service model. Such clinics have potential to improve access to specialist paediatric healthcare, but do not provide a panacea. Work is required to improve attendance as part of wider efforts to support vulnerable families. Satellite clinics highlight how improved management could contribute to better use of existing capacity.

Background: The Framework Method is becoming an increasingly popular approach to the management and analysis of qualitative data in health research. However, there is confusion about its potential application and limitations. Discussion. The article discusses when it is appropriate to adopt the Framework Method and explains the procedure for using it in multi-disciplinary health research teams, or those that involve clinicians, patients and lay people. The stages of the method are illustrated using examples from a published study. Summary. Used effectively, with the leadership of an experienced qualitative researcher, the Framework Method is a systematic and flexible approach to analysing qualitative data and is appropriate for use in research teams even where not all members have previous experience of conducting qualitative research.