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Zimbabweans are the largest migrant group in South Africa, and many of them are women who end up working informally as domestic workers (DWs). This study investigated the way that Zimbabwean single mother migrant domestic workers (MDWs) experience and cope with the burden of care. Specifically, it looks at women who have decided at some point in their migrancy experience to bring their children to raise in South Africa. The purpose of this research was to understand how they are managing to care for their children given their circumstances, and why they have chosen to do so as a family unit in South Africa rather than mothering from a distance - the norm as shown in international and Southern African migration literature on DWs. Due to financial troubles and social isolation associated with migrancy, single motherhood, and domestic work, their ability to cope with the burden of care is limited. This study is rooted in the theory that mothering in not a universal path, and that every woman will approach it differently based on her own familial, financial, cultural, racial, and personal circumstances that determine how she is able to practice mothering. This was a qualitative study and data was gathered via semi-structured, in depth interviews from a purposively-snowballed population sample of 13 women. This study found that the support networks of Zimbabwean single mother MDWs are actually quite limited, contrary to the existing literature base which highlights social support in migrant coping experiences. The social support that they receive - such as emotional support and/or informally compensated reciprocal child-watching arrangements - relieves some burden, but is insufficient, thus their childcare options are insufficient. Their coping mechanisms are primarily emotion focused, individual activities to tolerate their hardships, such as crying or listening to gospel music, because there are no practical solutions at this time. Choosing to bring their children to South Africa is a coping mechanism in itself which aims to reduce expenses associated with remittance and to alleviate the pain of family separation. Their deviation from the traditional Southern-African migrant norm of mothering from a distance indicates the possibility of evolving notions of motherhood and family in migrant and single parent contexts, as women follow their own individual paths in facing their unique circumstances of the burden of care. The findings of this study have serious implications for family and child welfare. Understanding single mother migration patterns is very important, and research in this area, like this study, may someday be able to inform policy, guide NGOs, and help to generate solutions for women facing a disproportionate burden of care.

Breast milk is the best food for babies aged 0-6 months and can be given until two years old with complementary food after the baby is 6 months old. Exclusive breastfeeding is a condition when a baby only receives breastmilk for six months. Exclusive breastfeeding is still a global problem because of the low coverage of exclusive breastfeeding. It can be optimized through social support, especially practical support. This scoping review aimed to map the literature, identify knowledge gaps, and review scientific evidence on practical support for breastfeeding mothers in achieving exclusive breastfeeding. The method of this review applied the Arksey and O'Malley’s framework. Four databases such as PubMed, Wiley Online Library, EBSCO, ScienceDirect and grey literature from google scholar were used to search relevant articles by using PEOS. The articles obtained were 1384 articles, and five articles matched the inclusion criteria. The critical appraisal for the five articles indicated four Grade A articles and one Grade B article. The research methods found in the articles were qualitative (60%), quantitative (20%) and mixed method (20%). In addition, three themes of the articles were found in this scoping review, namely the diverse forms of practical support, the benefits of practical support and the expected practical support. Practical support from husbands, families, health workers and communities is suggested for the mothers to achieve exclusive breastfeeding.

Background The postnatal period is associated with new needs for mothers. Four categories of needs were highlighted in a previous study: for information, for psychological support, for the sharing of experiences and for practical and material support. To ensure that these four needs are inherent to the postpartum period, the aims of this study is to examine these needs by comparing recent mothers’ needs with the needs of pregnant women. Methods The 4 needs previously identified were cross-sectionally investigated by online self-reported questionnaires completed by women in their last trimester of pregnancy and by mothers who had a child between 0 and 6 months of age. Results The 4 needs were largely present during the postpartum period. The need for information seemed to be more present during pregnancy (92.4 %) than during the postpartum period (84.6 %, p = 0.03), but women used the Internet significantly more often to search for information after childbirth (54.8 %) than during pregnancy (41.2 %, p p p p = 0.01) were also higher during the postpartum period than during pregnancy. Finally, the need for practical support was also more pronounced during the postpartum period than during pregnancy (p = 0.01). Conclusions All mothers seem to meet the 4 identified needs during the postpartum period but at different levels of intensity. Trying to meet these needs could offer an opportunity to improve mothers’ quality of life.

Background: Studies on the experiences of consumers with Motor Neurone Disease Associations at end of life and bereavement are lacking, and their role and capability within the broader sectors of health and disability are unknown. Objectives: To ascertain the experiences and views of bereaved motor neurone disease caregivers with Motor Neurone Disease Associations about service gaps and needed improvements before and during bereavement and to propose a model of care that fits with consumer preferences and where Motor Neurone Disease Associations are effective enablers of care. Methods: A national bereavement survey was facilitated in 2019 by all Motor Neurone Disease Associations in Australia. A total of 363 respondents completed the section on support provided by Motor Neurone Disease Associations. A mixed-method design was used. Results: Respondents were generally positive about support received before bereavement (73-76%), except for emotional support (55%). Positive experiences related to the following: information, equipment advice/provision, advocacy/linking to services, showing empathy/understanding, personal contact and peer social support. Negative experiences included lack of continuity in case management and contact, perceived lack of competence or training, lack of emotional support and a lack of access to motor neurone disease services in rural areas. Suggested improvements were as follows: more contact and compassion at end of life and postdeath; better preparation for end of life; option of discussing euthanasia; providing referrals and links for counseling; access to caregiver support groups and peer interaction; provision of a genuine continuum of care rather than postdeath abandonment; guidance regarding postdeath practicalities; and more access to bereavement support in rural areas. Conclusion: This study provides consumer perspectives on driving new or improved initiatives by Motor Neurone Disease Associations and the need for a national standardised approach to training and service delivery, based on research evidence. A public health approach to motor neurone disease end-of-life care, of international applicability, is proposed to address the needs and preferences of motor neurone disease consumers, while supporting the capability of Motor Neurone Disease Associations within a multidisciplinary workforce to deliver that care.

Background: There is an international drive towards increasing provision of community-led models of social and practical support for people living with advanced illness. Aim: This feasibility project aims to develop, implement and evaluate a model of community volunteers, identified as Compassionate Communities Connectors, to support people living with advanced life limiting illnesses/palliative care needs. The aims also include the development and evaluation of a training programme for volunteers and assessment of the feasibility, acceptability and preliminary effectiveness of this model of care. Methods: The approach seeks to map and mobilise people’s personal networks of care through the Connectors enlisting Caring Helpers (community volunteers). Up to 10 Connectors will be trained to work with at least 30 families selected by the palliative care service as requiring support. The primary outcome is the effect of the intervention on social connectedness. Secondary outcomes are the intervention’s effect on unplanned hospital utilisation, caregiver support needs, advance care plans and satisfaction with intervention for patients/carers, volunteers and service providers. Conclusion: It is expected that this intervention will enhance patient, carer and family social, psychological and practical support and reduce the need for dying people to be admitted to a hospital.

Objectives Social support influences adherence to treatment in chronic illness, but there is uncertainty about its facilitators and constraints. This study explored the forms, processes, and responses associated with mobilization of informal support across three life contexts amongst patients with Xeroderma Pigmentosum (XP), a condition requiring rigorous photoprotection to reduce cancer risks. Design Qualitative interview study. Methods A total of 25 adults with XP participated in semi-structured interviews conducted face to face. An inductive thematic analysis was applied using a framework approach. Results Practical support, involving both assistance with recommended photoprotection and adjusting daily activities to reduce exposure, was the key form of support provided by family and friends. However, responses to this support differed with two groups identified based on the relative priority given to photoprotection in daily life and processes of disclosure. For 'positive responders', support aligned with their own priorities to photoprotect, conveyed feelings of being cared-for and was facilitated by talking openly. In contrast, for 'negative responders' support conflicted with their priority of living 'normally' and their limited disclosure hindered receipt of helpful support in personal, clinic, and work interactions. Fears of workplace stigma also reduced disclosure amongst participants open in other contexts. Conclusions Practical support conveyed psychosocial support with positive effects on adherence. This suggests the traditional separation into practical and emotional support is overly simplistic, with measures potentially missing important aspects. Interactional processes contribute to the effects of support, which can be addressed by targeting disclosure, stigma, and other barriers at individual and organizational levels. Statement of contribution What is already known on this subject? Social support can be both a facilitator and a hindrance to treatment adherence. Practical support is identified as the most important form of support in the context of adherence. The processes of support underpinning its relationship to adherence are unclear. What does this study add? Variations in the provision and impacts of support are influenced by participants' disclosure and attitudes to photoprotection, with two key groups comprising 'positive responders' and 'negative responders'. The influence of emotional support on adherence may be underestimated through neglect of the ways in which practical support often conveys feelings of being valued and cared-for. Barriers to mobilizing effective adherence support extends across life spheres, with fears of stigma and discrimination in work settings highlighting the need to intervene at individual and organizational levels.

The Advancing Quality Alliance (AQuA) is an NHS membership organisation based in the North West of England. AQuA has extensive experience of supporting member organisations with integration and latterly the development of Accountable Care Organisations (ACO). We will describe the experiences of a number of AQuA members from involvement in the Integrated Care Discovery Community in 2012-14 through to the development and implementation of integrated or accountable care organisations in 2017. We will highlight the practical application of AQuA’s Integrated Care Assessment Framework and the development of a complimentary framework to support ACO implementation. In particular, we have been working with our members to understand how the interplay between complexity, improvement science, large scale change, leadership and culture can support the successful implementation of integrated/ accountable care and new models of care deliverey. Through this work we have recognised some emerging themes for successful integration and development of Accountable Care Organisations: robust system leaders able to lead in volatile, uncertain, complex and ambiguous contexts. strong, collaborative relationships between system leaders built on trust a compelling narrative and purpose for their “place” AQuA’s work over the last two years has focussed on supporting system leaders to develop these radically different leadership skills and enabling systems to develop trusting relationships. The experience of several AQuA members who started their integration journey as part of the Discovery Community in 2012 and are now in the process of implementing ACO-type organisations has demonstrated the benefit of sustained support from AQuA. AQuA has continued to evolve the integration support offer to members and customers based on the learning and outcomes of members across the North West, ensuring the applicability and transferability of this support. Targeted population and stakeholders: The presentation will be of interest to NHS Leaders and clinicians working in Primary Care, Commissioning, Acute hospitals, Mental Health, Community and Specialist services , Social care leaders.

Background: Social relations and depressive symptoms are intertwined. They both predict subsequent dementia, but only few studies on the association between social life aspects and subsequent dementia exist. Methods: The risk of subsequent dementia was estimated over 2 follow-up assessments, each 18 months apart, depending on leisure activity, social support (general scale and the 3 factors emotional support, practical support, and social integration), and depressive symptoms, using proportional hazard models in a cohort of elderly patients (n = 2,300, with a mean age of 82.45 years) recruited for the study by their general practitioners. Results: Higher depressive symptoms and lower cognitive and physical activity were associated with an increased risk of subsequent all-cause dementia and Alzheimer's dementia (AD). While neither social engagement nor the general social support scale was associated with subsequent dementia, a higher level of social integration was associated with a lower dementia risk. In combined models, the results for activity variables remained similar, but the strength of the association between depressive symptoms and the subsequent risk of dementia decreased, and the association with social integration disappeared. Conclusions: Depressive symptoms increased and activity variables decreased the risk of subsequent dementia; however, activity variables, namely cognitive and physical activity, partly mediated the effect of depressive symptoms on the subsequent risk of all-cause dementia and AD. In many cases, social support was not associated with a risk of subsequent dementia.

Background Pregnancy and childbirth are two critical stages in a woman’s life. Various studies have suggested that psychological distress is common during the year after childbirth. The objectives of this exploratory study were (1) to explore the needs of mothers in the year following childbirth; (2) to compare these needs between mothers who did not have the feeling of living a psychological disorder or a depression and mothers who lived a psychological disorder or had the impression of living a depression; and (3) to compare the needs expressed by mothers with the perception of professionals and fathers about the mothers’ needs. Methods First, we proceeded to 22 individual qualitative interviews followed by one focus group, with mothers, with and without experience of psychological distress. Then, we conducted 2 focus groups: one with professionals and one with fathers. Results Needs of mothers after childbirth have been indexed in four categories: need of information, need of psychological support, need to share experience, and need of practical and material support. Women do not feel sufficiently informed about this difficult period of life. They do not feel sufficiently supported, not only from a psychological point of view but also from a more practical point of view, for example with household chores. They need to share their experience of life, they need to be reassured and they need to feel understood. It seems that some differences exist between mothers’ and professionals’ experiences but also between mothers’ and fathers’ experiences. Conclusion Young mothers apparently feel a lack of support at different levels in the year following childbirth. This study provides ways to meet women’s needs and to try to prevent the risk of postpartum psychological distress during this period of time.

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For most people, home is the preferred place of care and death. Despite the development of specialist palliative care and primary care models of community based service delivery, people who are dying, and their families/carers, can experience isolation, feel excluded from social circles and distanced from their communities. Loneliness and social isolation can have a detrimental impact on both health and quality of life. Internationally, models of social and practical support at the end of life are gaining momentum as a result of the Compassionate Communities movement. These models have not yet been subjected to rigorous evaluation. The aims of the study described in this protocol are: (1) to evaluate the feasibility, acceptability and potential effectiveness of The Good Neighbour Partnership (GNP), a new volunteer-led model of social and practical care/support for community dwelling adults in Ireland who are living with advanced life-limiting illness; and (2) to pilot the method for a Phase III Randomised Controlled Trial (RCT). The INSPIRE study will be conducted within the Medical Research Council (MRC) Framework for the Evaluation of Complex Interventions (Phases 0–2) and includes an exploratory two-arm delayed intervention randomised controlled trial. Eighty patients and/or their carers will be randomly allocated to one of two groups: (I) Intervention: GNP in addition to standard care or (II) Control: Standard Care. Recipients of the GNP will be asked for their views on participating in both the study and the intervention. Quantitative and qualitative data will be gathered from both groups over eight weeks through face-to-face interviews which will be conducted before, during and after the intervention. The primary outcome is the effect of the intervention on social and practical need. Secondary outcomes are quality of life, loneliness, social support, social capital, unscheduled health service utilisation, caregiver burden, adverse impacts, and satisfaction with intervention. Volunteers engaged in the GNP will also be assessed in terms of their death anxiety, death self efficacy, self-reported knowledge and confidence with eleven skills considered necessary to be effective GNP volunteers. The INSPIRE study addresses an important knowledge gap, providing evidence on the efficacy, utility and acceptability of a unique model of social and practical support for people living at home, with advanced life-limiting illness. The findings will be important in informing the development (and evaluation) of similar service models and policy elsewhere both nationally and internationally. ISRCTN18400594 18th February 2015.