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While UK universities see group work as essential to building higher order intellectual and team skills, many international students are unfamiliar with this way of studying. Group work is also a focus of home students' concerns. Cultural differences in the interpretation of space for learning or how spatial issues affect group work processes has not been much explored in the internationalisation literature. The research described in this paper used data based on Chinese and home students making models of a good group work space. The data showed no marked cultural differences in visual taste. However, Chinese students were more concerned with the emotion of group work while home students were task focussed. All designs opted for a neutral office style design, rather than celebrating diversity. The paper supports the value of creative visual methods in exploring difficult to articulate topics, as part of a package of qualitative research methods.

Purpose: This study aims to highlight the value of stressful and challenging environments as a strategy to enhance learning and to provide an inventory of strategies for use in cases where participants experience anxiety-related blockages to learning. Design/methodology/approach: This article adopted a qualitative research strategy which consisted of a literature review which was then triangulated with a survey and practitioner interviews. Findings: This paper describes the behaviour of anxious learners when faced with a stressful learning environment. It then reviews suggestions from the literature which indicate theoretical solutions to debilitating anxiety and, finally, reports on the techniques that trainers actually use when helping delegates to overcome anxiety-related blockages to learning. The Yerkes-Dodson law, and not Rohnke, would appear to be the foundation for the various "comfort-stretch-panic" models. Moderate levels of stress would appear to encourage and stimulate learning. Research limitations/implications: The findings are presented as an initial investigation only, and further work would be required to indicate if the experiences of this small sample are representative of the wider population of training and development practitioners. Further work is being undertaken to categorise approaches to resolving debilitating learner anxiety and to develop a simple practitioner-oriented model which may assist trainers who face this issue. Practical implications: Anxiety is idiosyncratic and therefore it is difficult to design programmes which provide optimum development opportunities for all delegates. The article provides practical guidelines for trainers who wish to make use of challenging activities but who, as a result, need occasional recourse to strategies to alleviate any temporary debilitating state anxiety that delegates might experience. Originality/value: This paper investigates the role of anxiety on learning and makes the case for the inclusion of carefully-managed challenging learning environments in contrast to the majority of articles which advocate supportive learning environments. (Contains 2 tables and 1 figure.)

Outdoor practitioners widely embed reflective practice (RP) into the delivery of experiential education, but its contribution to their continued professional development remains under developed; by default, claims of its worth to the experiential education, they deliver must be approached with caution. Although the value of RP has been established in other domains, undergraduates on vocational outdoor leadership courses, in common with many other students, find engaging with RP problematic. This might be attributable in part to a focus on practicality and "doing rather than thinking" but also to obstacles encountered in their work experience where data are captured for later critical analysis. This paper sets out to establish the barriers to RP experienced by undergraduates during one season's summer employment. Data were gathered from focus groups, externally checked by two critical friends and subjected to interpretative phenomenological analysis. Extracts from reflective journals were used to illustrate the emergent themes. The results highlighted several commonly perceived barriers to RP in the outdoor workplace and have been used as discussion points in class to help students understand the nature of work in the outdoor sector and to identify and develop appropriate coping strategies.

The field of management education has been the focus of much debate in recent times. Issues relating to the real world and a lack of relevancy in business schools have caused much of this debate. In particular, questions have been raised regarding why business schools should endeavour to bridge this relevancy gap? However, it is important to define what is meant by relevance. How we define relevance has implications for all stakeholders of management education. As a result, this raises questions about the content and process of management education. For example, how applicable are the alternative approaches to management education such as action learning. How does such an approach translate into the professional practice of educators? What are the benefits and challenges of engaging in such an approach? In particular, what impact does it have for both management educators and their students? When we question what and how we teach it has the potential to open up new questions to be explored and insights to be revealed. This paper reveals a side of management education that is ever present in the philosophy and practice of action-learning practitioners. By exploring the impact of their practice it can inform our understanding and shape future practice. Management education like all education should be open to such exploration. Such an exploration is both timely and relevant for today's educators, students, managers and ultimately society.

Background: The COVID-19 pandemic placed a huge strain on healthcare services around the world, including community services. Students also faced substantial disturbance to educational programmes. Student district nurses are usually employed members of staff and can be recalled to the workforce, whereas pre-registration students cannot. Aims: This paper explores the feelings and experiences of student district nurses during the first UK national lockdown of the COVID-19 pandemic. An interpretative phenomenological approach was taken. Method: A semi structured 1:1 interview and focus group was held via zoom in July 2020. A total of eight student district nurses, who were all registered adult nurses, took part. Data was analysed using the Braun and Clarke model to identify themes. Results: The findings related to their experience of being a community adult registered nurse on the frontline, while also being a student district nurse. Three themes were identified from the analysis: anxiety and uncertainty, management of risk and teamwork. Conclusion: This study highlights the contribution that community nurses made in the clinical response to the COVID-19 pandemic. It adds to a paucity of literature available from this clinical setting and specifically from the viewpoint of a student district nurse. There is much written on the strains on hospital care, but it should be remembered that district nursing is the service that never shuts its doors because it has reached capacity. This study found that a lack of communication and uncertainty about their future as students contributed to heightened stress and anxiety. Teamwork and camaraderie are a vital aspect of any team and one that can support resilience in times of heightened stress. A lack of face-to-face interaction can lead to team members feeling isolated. Digital technology can be used to reduce this feeling when possible. [ABSTRACT FROM AUTHOR]

This paper focuses on the experiences of children and young people whose parents employ personal assistant(s) (PAs). It describes findings from a UK‐based qualitative doctoral research study which explored the significance, influence and meaning of the PA role in supporting family life. Ten children and young adults aged 8–28 years with lived experience were interviewed face to face as part of this study, which also explored the perspectives of disabled parents and PAs. Findings reveal that PA support can alter both the quality and nature of the parent/child relationship. The provision of personal assistance can support family life and prevent children from becoming 'young carers'; however, it can also create tension, anxiety and even destabilise family life. [ABSTRACT FROM AUTHOR]

The first cases of Coronavirus (COVID-19) were reported in Wuhan, China in December 2019. Globally millions of people have been diagnosed with the virus whilst thousands have died. As the virus kept spreading health and social care frontline workers (HSCFW) were faced with difficulties when discharging their duties. This paper was set out to explore the challenges faced by different frontline workers in health and social care during the COVID-19 pandemic. The research utilized an explorative qualitative approach. A total of forty (N = 40) in-depth one-to-one semi-structured interviews were undertaken with HSCFW who included support workers (n = 15), nurses (n = 15), and managers (N = 10). Health and social care workers were drawn from domiciliary care and care homes (with and without nursing services). All the interviews were done online. The data were thematically analyzed, and the emergent themes were supported by quotes from the interviews held with participants. Following data analysis the research study found that lack of pandemic preparedness, shortage of Personal Protective Equipment (PPE), anxiety and fear amongst professionals, challenges in enforcing social distancing, challenges in fulfilling social shielding responsibility, anxiety and fear amongst residents and service users, delay in testing, evolving PPE guidance and shortage of staff were challenges faced by frontline health and social care workers during COVID-19 pandemic. The results of the current study point to a need for adequate pandemic preparedness within the health and social care sector to protect both frontline workers and the individuals they look after. [ABSTRACT FROM AUTHOR]

Aim The aim of this paper is to report on the role of an action researcher in a study investigating the change process in a health service context where a new assessment clinic was developed to manage the excessive waiting list for that service. Background For effective organisational change in health, there is a suggestion that change agents need to be emotionally intelligent; recognising the emotional state of individuals, reconciling that with the organisational drivers and making an assessment of readiness for organisational change. Anxiety features throughout this literature and there is a suggestion that being aware of anxiety and managing anxiety is within the emotionally intelligent change agent's repertoire, but there is a gap in the literature that explains this relationship in detail. Methods Data were generated to investigate the discrete nature of the role of the action researcher during this organisational change that spanned two years, through three methods: participant observations in the field captured in field notes ( n = 72); observations of team meetings that had been recorded and transcribed ( n = 13); interviews with key informants pre- and postintervention ( n = 14); a reflexive diary one document of 8920 words ( n = 1). Findings The data illuminating the interaction between the action researcher and participants were synthesised into two broad themes: how the action researcher introduced anxiety into the system; how the action researcher facilitated the participants to tolerate change anxiety. Discussion/relevance to clinical practice The findings from this study can be applied in clinical practice where change in practice is planned. Part of the requirement of a change agent in the NHS might be to be sufficiently emotionally literate to understand anxiety in the participant system and manage it to effect change. [ABSTRACT FROM AUTHOR]

Little is known about how children themselves understand their moves to and between foster homes. The data presented in this paper come from a study that sought children's views on becoming and being a foster child. A key finding of that study was how children's accounts of being fostered illustrated a high level of anxiety and concern about their moving to live with a foster family. This paper firstly explores the key issues about looked‐after children's moves. It then describes the research study undertaken, before exploring the data generated from children's accounts of their moves to a new foster home. Lastly, there is a discussion of the implications for social work practice in this area. [ABSTRACT FROM AUTHOR]

Objective: Feasibility test a co-developed intervention based on Acceptance and Commitment Therapy to support psychological adjustment post-stroke, delivered by a workforce with community in-reach. Design: Observational feasibility study utilising patient, carer, public involvement. Setting: Online. UK. Participants: Stroke survivors with self-reported psychological distress 4 + months post-stroke. Interventions: The co-developed Wellbeing After Stroke (WAterS) intervention includes: 9-weekly, structured, online, group sessions for stroke survivors, delivered via a training programme to upskill staff without Acceptance and Commitment Therapy experience, under Clinical Psychology supervision. Main measures: Feasibility of recruitment and retention; data quality from candidate measures; safety. Clinical and demographic information at baseline; patient-reported outcome measures (PROMs) via online surveys (baseline, pre- and post-intervention, 3 and 6 months after intervention end) including Mood (hospital anxiety and depression scale (HADS)), Wellbeing (ONS4), Health-Related Quality of Life (EQ5D5L), Psychological Flexibility (AAQ-ABI) and Values-Based Living (VQ). Results: We trained eight staff and recruited 17 stroke survivors with mild-to-moderate cognitive and communication difficulties. 12/17 (71%) joined three intervention groups with 98% attendance and no related adverse events. PROMS data were well-completed. The HADS is a possible future primary outcome (self-reported depression lower on average by 1.3 points: 8.5 pre-group to 7.1 at 3-month follow-up; 95% CI 0.4 to 3.2). Conclusion: The WAterS intervention warrants further research evaluation. Staff can be trained and upskilled to deliver. It appears safe and feasible to deliver online to groups, and study recruitment and data collection are feasible. Funding has been secured to further develop the intervention, considering implementation and health equality. [ABSTRACT FROM AUTHOR]

The past decade has seen substantial changes in the configuration of services for children and families in the UK. Most notably, the inquiry into the death of Victoria Climbié raised serious questions about the professional systems designed to safeguard children and the importance of professionals working effectively together to protect children. The research informing this paper was undertaken with a group of childcare social work practitioners and explored their everyday work experiences of the post-Climbié introduction of the Every Child Matters agenda and Integrated Children's Services. Through the application of psychodynamic and systemic concepts to the research findings, the paper identifies new perspectives on barriers to effective integrated working and makes suggestions for working practices that may overcome them. [ABSTRACT FROM AUTHOR]

Aims Whilst there is a considerable body of literature examining the pharmacology of conscious sedation, the social tasks required to successfully provide conscious sedation have not been reported. This paper discusses data regarding the interpersonal work integral to effective conscious sedation provision, from a larger qualitative study exploring how patients and clinicians engage with secondary care conscious sedation provided within the UK. Method Semi-structured interviews were conducted with 13 conscious sedation providers and nine patients within UK-based secondary care sedation settings. Digital audio-recordings were transcribed verbatim and subsequently analysed using a constant comparative method within NVivo Data Analysis Software. Results Four main themes of interpersonal work were reported by participants: displaying care, containing emotions, demonstrating competence and maximizing the effect. Conclusion This study shows that performing conscious sedation requires more than technical delivery, and involves the projection of attributes in a literal 'performance.' The importance of managing outward emotional appearance reflects previous dental research. The need to manage outward appearance, and the emotional impact this has, is of relevance to all clinicians. [ABSTRACT FROM AUTHOR]

Introduction: With increasing attention to models of transitional support delivered through multisectoral approaches, third-sector organizations (TSOs) have supported community reintegration and independent living post-hospitalization. This study aimed to identify the core elements of these types of programs, the facilitators, and barriers to service implementation and to understand the perspectives of providers and recipients of their experiences with the programs. Methods and Analysis: A collective case study collected data from two UK-based 'Home from Hospital' programs. An inductive thematic analysis generated rich descriptions of each program, and analytical activities generated insights across the cases. Results: Programs provided a range of personalized support for older adults and addressed many post-discharge needs, including well-being assessments, support for instrumental activities of daily living, psychosocial support, and other individualized services directed by the needs and preferences of the service user. Results suggest that these programs can act as a 'safety net' and promote independent living. Skilled volunteers can positively impact older adults' experience returning home. Conclusions: When the programs under study are considered in tandem with existing evidence, it facilitates a discussion of how TSO services could be made available more widely to support older adults in their transition experiences. [ABSTRACT FROM AUTHOR]

Moving to a new country is often seen as a disturbing event in sojourners' lives. Several models of adjustment postulate that the first phase of the sojourn is either categorised by euphoria or anxiety. Using a case study of three Indian Postgraduate students, this paper investigates whether the beginning phase of these sojourners was euphoric or anxious in nature. The findings revealed that they had varied experiences and even mixed experiences that were both pleasant and/or unpleasant which were in turn determined by their individual differences and personal experiences. Another salient finding of this study was that the psychological side of the sojourn starts much before the students have even first set foot in the UK. This could serve as a basis for further research and to conceptualise a model of cultural adjustment that takes into account the impact of the pre-arrival phase on the overall sojourn experience. [ABSTRACT FROM PUBLISHER]

AimThis paper is a report of part of a study that explored the ways in which health visitors manage uncertainty and anxiety when working with clients across cultures.BackgroundInternationally health care professionals are required to deliver a high standard of culturally appropriate care to increasingly diverse communities and yet problems persist. Research evidence informing cultural ‘competence’ is focused largely around student experience and consequently little is known about the day-to-day experiences of health professionals in diverse community settings. Anxiety and uncertainty are increasingly recognised as important emotions experienced by a variety of health care professionals when working across cultures and yet the ways in which anxiety and uncertainty is managed in practice is less well understood.DesignGrounded theory methodology was used and 21 semi-structured interviews were conducted with participating health visitors in the North East of England between May 2008 and September 2009. All participants described themselves as white.FindingsThis study identified three different positions adopted by the health visitors to manage uncertainty and anxiety in their work across cultures. Identified as, ‘Fixing a culture’, ‘Reworking the equality agenda’ and ‘Asserting the professional self’, these strategies identify the ways in which health visitors try to manage the uncertainty and anxiety they feel when working in diverse communities. All of these strategies attempt in different ways to negate cultural difference and to render culture as static and known.ConclusionGiven that health professionals report anxiety and uncertainty when working across diverse community settings, identification of the strategies used by health visitors to manage that anxiety is important for both policy and practice. New strategies need to be developed to help health professionals to manage uncertainty and anxiety in ways that promote both cultural safe care and health equity. [ABSTRACT FROM PUBLISHER]

Background: Mental ill-health in older adults (aged 60 years and over) is often underdiagnosed and undertreated. Older adults are less likely to access mental health services owing to perceived stigma and fear of being a burden. Non-traditional providers of health care, such as the Fire and Rescue Services (FRS), provide a possible solution to facilitate early detection of problems and help-seeking among older adults, especially in the context of pressured statutory services. Aim: To examine whether and how FRS Home Fire Safety Visits (HFSV) could be optimised to include detection and signposting for mental health problems -- particularly anxiety and depression -- in older adults. Design & setting: This mixed-method qualitative study took place in the West Midlands, UK in 2022. Method: This study involved focus groups (n = 24) and interviews with FRS staff (n = 4) to develop an in-depth contextual understanding of he acceptability and feasibility of expanding HFSV to include identification of anxiety and depression. Results: FRS staff were open to expanding their HFSVs to include mental health, provided they had sufficient training and support from partner agencies in primary and social care settings to accept referrals for service users presenting with symptoms of anxiety and/or depression. Conclusion: The positive reputation of FRS staff and engagement with older adults suggests that HFSV could support the detection of anxiety and depression in older adults, and appropriate signposting to other services including primary care. [ABSTRACT FROM AUTHOR]

Research has shown that those men who are dissatisfied with their bodies will mask these concerns in sports practices. Accordingly, men's body dissatisfactions are documented less frequently because the practices drawn upon to conceal them are perceived as routine forms of public masculine behaviour. This paper examines whether a group of British Rugby Union males, aged 18-30 of varied ethnic origins, participating in a 1st XV Team at a British sports university, experience body anxieties and use rugby and health-related sports acts to overcome and conceal them. It moves away from some of the existing methods used in sports research examining men's body dissatisfactions, as it combines collaborative visual research methods with conventional qualitative methods. All of the rugby men expressed varying degrees of body anxieties and compared their bodies to their teammates whom they perceived to possess better attributes in this domain. Aspects of the rugby masculinity, adeptness, aggression and the tough body were relevant for understanding the development and management of the rugby men's body anxieties.There were limited intimate dimensions for these men to express their body anxieties in Rugby Union, without ramifications for their masculine identity and sports performance. A competitive culture between the men, led them to use the sport, and health-related acts, to conceal and work to overcome their body anxieties. Visual research methods combined with conventional qualitative methods made it easier for these men to verbalise their body anxieties in more intimate dimensions. More research is needed to examine these dimensions as they are significant for understanding rugby men's body anxieties and the impact their relationships with other rugby men have to these concerns. The implications are that visual research methods could be used in sports research, as they can assist in encouraging other sportsmen to express these types of concerns. Furthermore, they could help to understand the unnatural extremes in the sporting body; the drugs and over-exercise which may be used to produce these extreme effects. [ABSTRACT FROM AUTHOR]

There is increasing policy recognition that the alleviation of social isolation and loneliness in older people should be prioritised. Recently, technology, such as telephone networks and the Internet, has received attention in supporting isolated and lonely older people. Despite lack of evidence, telephone befriending has been considered an effective low-level method to decrease loneliness among older people. This study evaluated the impact of a national befriending scheme for isolated and/or lonely older people, involving eight project sites across the UK 2007-2008. The purpose was to assess the impact of different models of telephone-based befriending services on older people's health and well-being. A mixed methods approach was used. This paper reports on the findings from 40 in-depth interviews with older service recipients. The most important finding was that the service helped older people to gain confidence, re-engage with the community and become socially active again. Three topics were identified: why older people valued the service, what impact it had made on their health and well-being and what they wanted from the service. In addition, nine subthemes emerged: life is worth living, gaining a sense of belonging, knowing they had a friend, a healthy mind is a healthy body, the alleviation of loneliness and anxiety, increased self-confidence, ordinary conversation, a trusted and reliable service, the future - giving something back. In conclusion, the findings present in-depth qualitative evidence of the impact of telephone befriending on older people's well-being. Befriending schemes provide low-cost means for socially isolated older people to become more confident and independent and develop a sense of self-respect potentially leading to increased participation and meaningful relationships. [ABSTRACT FROM AUTHOR]

Objectives: The impact of having a child with diagnosed obsessive–compulsive disorder (OCD) can reportedly cause significant disruption to caregiver routines and negatively affect their mental health. Less is known about the impact to other first‐degree relatives such as siblings due to limited research. It should not be assumed that findings in the caregiver literature can simply be applied to siblings. This study, therefore, aimed to explore the experiences and responses of cohabiting siblings of a brother or sister with an OCD diagnosis. Method: Eight participant siblings were recruited from a UK specialist OCD NHS clinic and interviewed via telephone about their experiences co‐habiting with a brother or sister with OCD. Interviews were transcribed and subjected to interpretative phenomenological analysis (IPA). Results: Two superordinate themes of 'OCD as a dangerous dictator' and the 'unifying/polarising influence of OCD on relationships' were interpreted from the eight participant experiences. Siblings spoke to OCD creating a dictatorial environment characterised by sibling loss, helplessness and adjustment. This fragile domestic environment seemingly pushed non‐anxious siblings to the periphery of the family or conversely centralised their position through parentification. Conclusions: Many of the sibling experiences of frustration, distress avoidance, helplessness and symptom accommodation are mirrored in the burgeoning caregiver literature. Longitudinal studies are required to track sibling experiences over the course of their siblings OCD journey and expand our knowledge in this area. Counselling services, sibling support groups and inclusion in family assessment, formulation and treatment are possible avenues of exploration for siblings of those with an OCD diagnosis. [ABSTRACT FROM AUTHOR]

Context: The challenges faced by health care professionals working with people living with dementia amid the COVID-19 pandemic in the English West Midlands region. Objective: This study explored the challenges faced by health care professionals working with people living with dementia amid the COVID-19 pandemic. Methods: This study utilised an in-depth qualitative study guided by a phenomenological approach. The participants included 30 (n = 30) health and social care professionals who were working in care homes with people living with dementia. In-depth interviews were used to collect data through online platforms, including Zoom, WhatsApp, and Microsoft Teams. A thematic approach was used to analyse the data. Findings: The study found that challenges such as enforcing social distancing, communication, increased anxiety and restlessness, safeguarding dilemmas, safe staffing, and emotional labour affected health care professionals during the COVID-19 pandemic. Limitations: This research was only carried out in the Midlands. Research encompassing other regions in the UK will be ideal to enable comparisons of different regions. Implications for practice: In the future, there is a need to monitor all admissions coming into the care home to make sure that they are not infected by the virus, as this will safeguard vulnerable residents in the care home. Also, the provision of adequate staffing in dementia care homes to manage and enforce all safeguarding protocols and regulations to make sure that the vulnerable people they look after are adequately protected is crucial in the future. Support and guidance that is relevant to people living with dementia should be made available, especially during a pandemic. [ABSTRACT FROM AUTHOR]

In response to the COVID‐19 outbreak, the British government introduced a lockdown resulting in country wide restrictions on movement and socialisation. This research sought to explore individuals' experience of the first lockdown in the UK. A qualitative online survey was conducted between April and June 2020. Using a convenience sample, 29 individuals participated in the study. Data were analysed using thematic analysis. Four themes were identified: 'health and well‐being', 'social connectedness and belonging', 'employment and finances' and 'personal and collective values'. Participants' experiences involved both challenges and opportunities. Participants reported challenges to their physical health, mental health, sense of connection to others as well as their employment and finances. However, they also viewed the lockdown as an opportunity to reassess their goals and values, and define a 'new normal' for society. Lockdown restrictions threatened individuals' well‐being on many aspects of their lives. As anxiety, loneliness and a compromised grieving process may lead to severe mental health issues, early interventions are needed to prevent these and promote well‐being. Interventions may include traditional therapies (e.g. Acceptance and Commitment Therapy), or focus specifically on developing social networks and social support (e.g. mutual help groups). These interventions may also be conducive to the experience of growth reported by some participants. [ABSTRACT FROM AUTHOR]

This article explores men's experiences of using peer support groups for coping with mental distress. Support groups are organised groups in which people come together to mutually support each other with a shared health concern. There has been increasing research on men's mental health help seeking, but men's use of support groups for mental health difficulties, and the ways support groups could benefit men, is not well understood. Drawing upon 19 interviews from a South Wales, UK qualitative study which explored men's mental health help seeking, coping and management, this article explores the perceived benefits of support groups for men experiencing emotional difficulties. Findings highlight how men who attended groups valued the sense of shared understanding of experiences and the mutual respect that group settings presented them with. Support groups provided a safe space with opportunities to reconstruct traditional masculine norms through reciprocating unique and tailored mental health support to others and developing a certain role within that group. This gave men a sense of purpose which further facilitated mental health management. Findings also indicated the social benefits that support groups can have to men who may have limited social networks or be experiencing isolation. This article adds to the growing literature that focuses on men's mental health experiences and illustrates the benefits of support groups for men in distress. The author suggests that primary services need to be aware of how support groups can positively support men and promote them as an opportunity for connection and unique support. [ABSTRACT FROM AUTHOR]

Since the onset of the Covid‐19 pandemic, the UK, like many countries, has had restrictions on social contact, and injunctions of 'social distancing'. This study aimed to generate new insights into men's experiences of loneliness during the pandemic, and consider the ramifications of these for continued/future restrictions, the easing of restrictions, and the future beyond the pandemic. Twenty qualitative interviews were conducted with men between January and March 2021. A maximum variation purpose sample frame required at least three non‐white men, three LGBTQ+men, three men with a university education, three without a university education, three 18–30 years old, and three aged 60+. Thematic analysis, focused on semantic themes, was employed as part of a 'grounded' epistemology whereby the stated perspectives of the interviewees drove the content of the study. Seven themes were constructed: (i) lost and new activities and routines; (ii) remote social interaction; (iii) narrowed social spheres; (iv) rethought and renewed recognition of what is important; (v) loneliness with a purpose; (vi) anxiety of social contact; and (vii) easier for themselves than others. Lost routines, fewer meaningful activities, and a reduction in face‐to‐face interaction, were framed as challenges to preventing loneliness. Solo‐living gay men seemed particularly negatively affected. However, many men displayed new, more covid‐safe routines and activities. Remote forms of interaction were often utilised, and though they were imperfect, were constructed as worth engaging with, and held capacity for improvement. A moral need to reduce transmission of SARS‐COV‐2, and a fear of catching it, became important features of participants lives that also affected loneliness. Men at higher risk of health complications from Covid‐19 were particularly likely to highlight anxiety of social contact. Reducing restrictions alone may not return everyone to pre‐pandemic levels of loneliness, particularly if the pandemic remains a significant public health issue. [ABSTRACT FROM AUTHOR]

Since the closure of the UK asylums, ‘the community’ has become short hand for describing a variety of disparate and complex spaces, in which service users manage their experiences of distress. An examination of such spaces here forms the basis of an analysis of the way in which service users move through and within space, to establish agency and dis/order while distressed. Seventeen participants, with various experiences of mental distress took part in a qualitative study, and a further textual analysis was conducted on eight published autobiographies. In the context of the interviews, participants presented drawings of the spaces they occupy during times of crisis, wellbeing and recovery. All texts were analysed using a thematic approach, informed by theories of embodiment and relational space. In this paper, the focus is directed towards two key patterns of movement, in order to explore ways in which participants experiencing various forms of mental health crisis used space in order to maintain and manage feelings of agency. Firstly, incidents where participants described moving towards fluid, outside spaces are explored, with agency being established through seeking, and utilising, greater possibilities for action and engaging others. In addition, the opposite pattern of movement is also explored, using incidents where participants described moving indoors, using the private space of the home to establish order and restore feelings of agency and strength, in contrast to overwhelming experiences in public space. Connections between these patterns of movement and particular forms of distress are discussed. It is argued that community and private spaces are integral to the ways in which selfhood, agency and action is experienced in mental distress, which in turn has implications for policy, treatment and community action. [ABSTRACT FROM AUTHOR]

How do people respond to the news that they are HIV positive? To date, there have been few published qualitative studies of HIV diagnosis experiences, and none focusing on Caribbean people. Twenty-five HIV-positive Caribbean people in London, UK, related their diagnosis experience and its immediate aftermath in semi-structured interviews. Diagnosis with HIV caused profound shock and distress to participants, as they associated the disease with immediate death and stigmatisation. The respondents struggled with 'biographical disruption', the radical disjuncture between life before and after diagnosis, which led them into a state of liminality, as they found themselves 'betwixt and between' established structural and social identities. Respondents were faced with multifaceted loss: of their known self, their present life, their envisioned future and the partner they had expected to play a role in each of these. A minority of accounts suggest that the way in which healthcare practitioners delivered the diagnosis intensified the participants' distress. This research suggests that healthcare practitioners should educate patients in specific aspects of HIV transmission and treatment, and engage closely with them in order to understand their needs and potential reactions to a positive diagnosis. [ABSTRACT FROM AUTHOR]

The Camden and Islington Personality Disorder Service (PDS) increasingly provides clinical consultation to external services. There is a dearth of research on the experience of clinicians delivering such consultation. Interviews were conducted with clinicians from the PDS, and a semantic Thematic Analysis was conducted on transcripts to answer the question, 'What is the experience of Personality Disorder Service staff providing input to staff in external services?' 13 sub-themes under four overarching themes were identified (these latter were: Anxiety, Fragmented Co-working, Task Difficulty, and Positive Outcome). These themes provide an overview of the experience of consulting clinicians. Themes are explored through Kleinian psychoanalytic theory, with reference to Bion's work on containment and groups. Findings suggest that staff need to retain thinking space to work effectively, to feel safe and recover a sense of competence when it is attacked, highlighting the need for access to structures such as supervision. The responsibility for trying to reduce distress, risk (to self, to and from others) and functional disability of people with a diagnosis of personality disorder cannot belong to one person or service but services need to be able to think together to gain a better understanding and have an agreed cross-service response. [ABSTRACT FROM AUTHOR]

This article reports findings from the first empirical study in the United Kingdom on forced-to-penetrate cases, where a man is forced to penetrate a woman either orally, vaginally, or anally with his penis and without his consent. Using an online survey, data were collected in relation to the physical and emotional impacts experienced by 154 men following their most recent forced-to-penetrate experience. Quantitative and qualitative data were collected through the use of closed and open-ended survey questions, where participants were asked about the context and circumstances of their most recent experience and whether they had suffered any physical injuries. A unipolar scale was used to measure the emotional impact on participants, with an open-ended follow-up question gathering qualitative data. The majority of participants did not report suffering physical injuries, but those that did suffered injuries to their genitalia and upper bodies. Participants most frequently indicated that their most recent forced-to-penetrate experience had had a severe negative emotional impact on them. Negative emotional impacts disclosed by participants were complex, ranging from anxiety and depression, to self-harm and suicidal thoughts and attempts. Quantitative analysis highlighted that when certain variables were present, participants more frequently reported physical injuries, as well as higher average levels of emotional harm. The findings from the study challenge existing understandings of masculinity and rigid sex and gender roles, which assume that men will always consent to sexual activity with a woman and that they cannot or do not experience emotional or physical harms at the hands of a woman. The findings are also considered in relation their implications for law and legal discourse, where evidence of harm is used as a justification for the criminalisation of certain behaviors and the severity of the legal response through sentencing. [ABSTRACT FROM AUTHOR]

Study Question: What is it like for women to be involuntarily childless in midlife?Summary Answer: Involuntarily childless women may be suffering from prolonged grief due to its ambiguous and intangible nature; however, they are also striving to find ways of dealing with their internal pain in order to live with their loss.What Is Known Already: Many studies examining issues around human reproduction have tended to place childlessness in the realm of medicalised infertility and report generalised mental issues, such as depression and psychological distress, existing amongst women undergoing fertility treatments. Few studies, however, have focused on the individual with regard to the experiential significance of involuntary childlessness and living beyond the phase of trying for a baby.Study Design, Size, Duration: A phenomenologically oriented person-centred qualitative design was used. In-depth semi-structured interviews were conducted with 12 White British women, who identified themselves as involuntarily childless, recruited via three leading childless support networks in the UK.Participants/materials, Setting, Methods: In order to retain an idiographic commitment to the detailed account of a person's experience, a homogeneous and purposive sampling was used applying the following criteria: women aged between 45 and 55; in long-term heterosexual relationships with no adopted children, stepchildren or children of a partner from a previous marriage or relationship; and no longer trying to have a child. Considering the homogeneity of ethnic background and wishing to respect cultural differences, this study focused on White British women living in the UK. Of the 12, one woman was found to not meet the criteria, and therefore, the experiential data of 11 interviews were used for the study and analysed using interpretative phenomenological analysis (IPA).Main Results and the Role Of Chance: Two higher-order levels of themes that illustrate intrapersonal features were identified: the intrapersonal consequences of loss and confronting internal pain. The former explicated the depth of internal pain while the latter revealed ways in which the participants deal with it in their everyday lives. The important finding here is that both themes are co-existing internal features and dynamically experienced by the participants as they live with the absence of much-hoped-for children.Limitations, Reasons For Caution: Given the homogeneous sampling and the small number of participants, which is consistent with IPA, we want to be cautious in generalising our study findings.Wider Implications Of the Findings: This study offers the view that there might be potential mental health issues surrounding involuntary childlessness that are currently overlooked. Particularly because the loss of hope cannot be pathologised, and the grief is ambiguous and intangible, it might make people's grieving process more complicated. An ongoing sense of uncertainty also may persist in that involuntarily childless people may develop symptoms similar to those diagnosed with prolonged grief disorder (PGD). The overall findings elucidate the need for clinicians, counsellors and health professionals to be aware of the possible association with PGD and promote long-term support and care in helping to maintain psychological well-being for people dealing with involuntary childlessness. Furthermore, this research points to an educational application for younger people by offering information beyond an explanation of infertility and fertility treatment, helping to understand the lived experience of involuntary childlessness.Study Funding/competing Interest(s): No funding was obtained for this study. The authors have no conflicts of interest to declare.Trial Registration Number: Not applicable. [ABSTRACT FROM AUTHOR]

Emplaced health promotion interventions, delivered by community health workers are increasingly being used internationally. However, the application of epidemiological risk knowledge to individuals within such communities is not straightforward and creates tensions for community health workers who are part of the communities that they are serving. Situated qualitative interview data were co-produced with community health workers employed in a superdiverse, deprived, post-industrial region of the United Kingdom, using photo-voice methods, to develop an account of how they made sense of the challenges of their work. The analysis draws on and develops theories of risk work and resilience work, which draw on practice theory. The key findings were that, first, being a critical insider enabled community health workers to make sense of the diverse constraints on health and lifestyles within their community. Second, they understood their own public health role as limited by operating within this context, so they articulated their occupational identity as focused on supporting clients to make small but sustainable changes to their own and their families’ lifestyles. Third, the uncertainties of translating population based risk information to individual clients were (at least partially) resolved at an embodied level, with the community health workers identifying as accessible and trusted role models for the value of changed lifestyles. The article is important for policy and practice as it provides a critique of a rapidly evolving new mode of delivery of public health services, and insights on the development of this new public health workforce. [ABSTRACT FROM AUTHOR]

The challenge of transition from service to civilian life is explored through the experiences of a sample of 225 UK army veterans between 1945 and 2000. All subjects had a war pension for a psychological disorder, and most had served overseas in combat roles. Statements about issues of adjustment and health were analyzed by the constant comparison method. Although 20 themes were identified, three ('anxiety, nerves and depression', 'enduring illness attributed to combat exposure', and 'illness interferes with the ability to find or keep employment') accounted for 46% of the total and were reported by between 53% and 86% of subjects. Consistency was observed in the ranking of themes over time. In content, they replicate those reported by veterans of recent conflicts, suggesting that the core issues of transition have an enduring quality. Most statements (66%) date from the 1940s, a time when the application process for a pension required the veteran to provide an explanation for his illness. A rise in the number of statements during the 1980s and 1990s reflected wider cultural acceptance of post-traumatic illness and veteran population entering retirement with time to reflect on defining experiences. [ABSTRACT FROM AUTHOR]

Background: Student mental health is a global issue. Macaskill reported that the second year was associated with the most significant increases in psychiatric symptoms in UK students. Qualitative data were collected to explore this further. Method: Twenty-three second-year undergraduate students were interviewed using a narrative interviewing method to explore their experience of their second year of study. They also completed the General Health Questionnaire-28. Students were grouped according to their psychiatric caseness scores, giving two groups, a well group with scores ≤5 and a clinical case group with scores ≥6 and their interview data were compared. Results: Using thematic analysis, various themes and subthemes were identified. While both groups identified the same issues namely, the first-year concerns impacting on the second year, course issues, careers and future employability and student debt, the groups reported very different coping styles. Conclusion: There were shared anxieties across both groups. The majority related to institutional practices and the unintended impact they may be having on student mental health. While specialist interventions would help the clinical caseness group, arguably the anxiety levels of both groups would benefit equally from relatively easy to implement, inexpensive institutional changes and/or additions to current practices in universities. [ABSTRACT FROM AUTHOR]

Aims and objectives: To evaluate the impact of lipodystrophy on body image and how this affects patients’ daily lives. Background: Lipodystrophy refers to a group of rare conditions characterised by generalised or partial lack of body fat and is associated with severe metabolic problems, for example, severe insulin resistance, diabetes and pancreatitis. In addition to its metabolic effect, lack of adipose tissue may have a major impact on appearance and cause distressing physical changes. While global research has focused on diagnosis and management, there is no published work investigating the psychological effects of lipodystrophy on body image. Methods: Following ethical approval, participants with lipodystrophy were purposively sampled from the National Severe Insulin Resistance Service in Cambridge, UK, and invited to take part in a semi‐structured interview. Eleven (10 female, one male) interviews were conducted and digitally recorded. Data were analysed using an inductive thematic approach. Results: Four main themes were identified in the data set; “Always feeling appearance was different,” “a better understanding of lipodystrophy is needed,” “feeling accepted” and “there's more to lipodystrophy than managing symptoms.” Participants spoke of distressing cosmetic effects related to lack of fat tissue and other changes related to lipodystrophy, contributing to negative body image. For some, negative body image led to feelings of worthlessness impacting daily life and adherence to treatment. Psychological support was lacking but desired by participants. Conclusion: Lipodystrophy contributes to negative body image affecting patients’ daily lives. Patients wanted psychological support alongside medical management. Further research is needed to determine how best to deliver psychological support and to evaluate its impact on well‐being and metabolic management. Relevance to clinical practice: The effects of rare diseases such as lipodystrophy on appearance can be distressing for patients. Support beyond medical management is needed to improve patients’ daily lives and help them to live well with appearance‐altering conditions. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore the experiences of patients readmitted due to potential ischaemic heart disease symptoms within six months of primary percutaneous coronary intervention. Background Following myocardial infarction and primary percutaneous coronary intervention, some patients experience potential ischaemic heart disease symptoms that may lead to readmission. Symptoms may be related to cardiac ischaemia, reduced psychological health or a comorbid condition. Design A qualitative study involving semistructured, in-depth interviews conducted once, mean 196 (50-384) days following readmission (at least six months following original ST-elevation myocardial infarction and primary percutaneous coronary intervention). This is the qualitative part of a mixed methods study. Methods Participants were purposefully selected, and concurrent sampling, data collection and data analysis were performed. Data were organised using framework analysis; constant comparative analysis involving deduction and induction led to identification of cogent themes and subthemes. Results Twenty-five participants (14 men, 27-79 years) experienced 1-4 readmissions; discharge diagnoses were cardiac, psychological, indeterminate, pulmonary and gastric. Three main themes emerged: (1) anxiety, uncertainty and inability to determine cause of symptoms, (2) fear of experiencing further myocardial infarction and (3) insufficient opportunity to validate self-construction of illness. Conclusion Fear of dying or experiencing a further myocardial infarction led to patients seeking help at the time of potential ischaemic heart disease symptoms. Participants were anxious and lacked understanding regarding symptom attribution at the time of readmission and generally following their heart attack. Additionally, original heart attack symptoms were used as a comparator for future symptoms. Participants reported feeling well immediately after primary percutaneous coronary intervention but later experiencing fatigue and debilitation often linked to potential ischaemic heart disease symptoms. Relevance to clinical practice Increased education and information related to symptom attribution post-primary percutaneous coronary intervention and postreadmission are worthy of exploration and may lead to increased understanding and reassurance for this patient group. [ABSTRACT FROM AUTHOR]

Background: One-in-five people in the UK experience anxiety and/or depression in later life. However, anxiety and depression remain poorly detected in older people, particularly in those with chronic physical ill health. In the UK, a stepped care approach, to manage common mental health problems, is advocated which includes service provision from non-statutory organisations (including third/voluntary sector). However, evidence to support such provision, including the most effective interventions, is limited. The qualitative study reported here constitutes the first phase of a feasibility study which aims to assess whether third sector workers can deliver a psychosocial intervention to older people with anxiety and/or depression. The aim of this qualitative study is to explore the views of older people and third sector workers about anxiety and depression among older people in order to refine an intervention to be delivered by third sector workers. Methods: Semi-structured interviews with participants recruited through purposive sampling from third sector groups in North Staffordshire. Interviews were digitally recorded with consent, transcribed and analysed using principles of constant comparison. Results: Nineteen older people and 9 third sector workers were interviewed. Key themes included: multiple forms of loss, mental health as a personal burden to bear, having courage and providing/receiving encouragement, self-worth and the value of group activities, and tensions in existing service provision, including barriers and gaps. Conclusions: The experience of loss was seen as central to feelings of anxiety and depression among community-dwelling older people. This study contributes to the evidence pointing to the scale and severity of mental health needs for some older people which can arise from multiple forms of loss, and which present a significant challenge to health, social care and third sector services. The findings informed development of a psychosocial intervention and training for third sector workers to deliver the intervention. [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]

Background: Nine out of 10 patients undergoing urgent cancer investigations receive an 'all-clear' diagnosis.Aim: A qualitative approach was used to evaluate the impact of investigations that did not result in cancer diagnosis on subsequent symptom attribution and help seeking for recurrent or new possible cancer symptoms.Design and Setting: A survey of symptoms, help seeking, and past investigations was sent to 4913 individuals aged ≥50 years from four UK general practices. Of 2042 responders, 62 participants were recruited still reporting at least one cancer 'alarm' symptom in a 3-month follow-up survey for a nested in-depth interview study (ensuring variation in sociodemographic characteristics).Method: Framework analysis was used to examine the in-depth semi-structured interviews and identify themes related to previous health investigations.Results: Interviewees were on average 65 years old, and 90% reported investigations within the previous 2 years. Most often they reported gastrointestinal, urinary, and respiratory symptoms, and 42% had waited ≥3 months before help seeking. Reassurance from a previous non-cancer diagnosis explained delays in help seeking even if symptoms persisted or new symptoms developed months or years later. Others were worried about appearing hypochondriacal or that they would not be taken seriously if they returned to the doctor.Conclusion: An all-clear diagnosis can influence help seeking for months or even years in case of new or recurrent alarm symptoms. Considering the increasing number of people undergoing investigations and receiving an all-clear, it is paramount to limit unintended consequences by providing appropriate information and support. Specific issues are identified that could be addressed. [ABSTRACT FROM AUTHOR]

Background: Recovery has become a central concept in mental health service delivery, and several recovery-focused measures exist for adults. The concept's applicability to young people's mental health experience has been neglected, and no measures yet exist. Aim: The aim of this work is to develop measures of recovery for use in specialist child and adolescent mental health services. Method: On the basis of 21 semi-structured interviews, three recovery measures were devised, one for completion by the young person and two for completion by the parent/carer. Two parent/carer measures were devised in order to assess both their perspective on their child's recovery and their own recovery process. The questionnaires were administered to a UK sample of 47 young people (10-18 years old) with anxiety and depression and their parents, along with a measure used to routinely assess treatment progress and outcome and a measure of self-esteem. Results: All three measures had high internal consistency (alpha = 0.89). Young people's recovery scores were correlated negatively with scores on a measure used to routinely assess treatment progress and outcome (r =0.75) and positively with self-esteem (r = 0.84). Parent and young persons' reports of the young person's recovery were positively correlated (r = 0.61). Parent report of the young person's recovery and of their own recovery process were positively correlated (r = 0.75). Conclusion: The three measures have the potential to be used in mental health services to assess recovery processes in young people with mental health difficulties and correspondence with symptomatic improvement. The measures provide a novel way of capturing the parental/caregiver perspective on recovery and caregivers' own wellbeing. [ABSTRACT FROM AUTHOR]

When children move from foster care into adoption the transition tends to take place within a tight timeframe, usually between seven and 14 days, with no contact between the child and the foster carer for several months after the move, if at all. Very little attention or research has been aimed at understanding the rationale for these procedures. Together with social work colleagues in a Looked After Children’s team, two child psychotherapists carried out a piece of qualitative research, interviewing foster carers, adopters and social workers to analyse in detail five children’s moves into adoption. We found that the emotional experience of the child, particularly their experience of losing their foster carer, became less prominent in people’s minds during this transition. It is a highly anxious time for the adults and in the grip of these anxieties they can lose sight of what is happening emotionally for the child. The child’s outward compliance with the move and lack of obvious emotion at losing her or his carers can be interpreted as signs that they are ‘fine’. These research findings are explored in the light of our understanding of attachment and loss in childhood, and of individual and organisational defences against pain and loss. Implications for future practice are discussed. [ABSTRACT FROM PUBLISHER]

Background: Although research has shown that significant burden and adverse psychological impact are associated with caring for a child with brain injury, limited knowledge exists concerning the qualitative experience and impact of this burden. Objective: To provide an account of the experiences of mothers who care for a childhood survivor of brain injury. Research design: Postal survey. Methods and procedures: A self-report questionnaire was sent to a consecutive sample of mothers ( n = 86) of children (aged 2-28) with acquired brain injury, registered with a UK children's brain injury charity. Five essay style questions enabled mothers to reflect on and describe at length their caring experiences, with particular emphasis placed on the perceived impact on emotional well-being. Main outcomes and results: Thematic analysis identified five key themes: Perpetually Anxious, The Guilty Carer, The Labour of Caring, A Self-Conscious Apologist and Perpetually Grieving. Collectively, these themes highlight two core processes shaping mothers' caring experiences and concomitant mental well-being. First, the collective and enduring nature of caregiver burden over time. Second, the crucial role played by socio-cultural values in perpetuating caregiver burden. Conclusions: Societal norms, particularly those relating to the nature and outcome of brain injury and motherhood, serve to marginalize mothers and increase feelings of isolation. Findings suggest the value of peer support programmes as an effective means of providing appropriate social support. [ABSTRACT FROM AUTHOR]

Primary objective: This is the first qualitative study that elicited the perceptions of both psychological therapists and their clients in the use of Clinical Outcomes in Routine Evaluation with computer software (CORE‐Net), where instant visual feedback for session tracking was given on a computer screen in the therapy room at each therapy session. The study also examined how therapists viewed its potential value in supervision and provides suggestions for improving training. Research design: The study adopted a convenience sample of four therapists in a primary care counselling setting (PCC – General Practitioner referrals) who were experienced in using CORE‐Net, and five therapists in an NHS employee/occupational support counselling service (OH) who had just begun to use CORE‐Net for session tracking with 10 of their clients. Method: A qualitative methodology was used and interview data were collected from the therapists via focus groups; the clients were interviewed individually face to face. All data was analysed inductively. Findings: The study identified six overarching themes: (i) therapists were initially anxious and resistant; (ii) therapists adapt 'creatively'; (iii) outcome measures help the client/therapist relationship; (iv) clients perceive visual measures as helpful; (v) CORE scores inform supervision; and (vi) proper and ongoing training/support of therapists is necessary. The main limitations are comparability of data and the generalisabilty of results. Conclusions: The implementation of routine outcome measurement (ROM) is a challenge but can be made easier with proper training and supervision. Clients appear happier than their therapists when routine outcome measurement is used. [ABSTRACT FROM AUTHOR]

The aim of this research was to investigate the feasibility of achieving Improving Access to Psychological Therapies (IAPT) for people from Black, Asian and Minority Ethnic (BAME) communities living in the UK, with specific reference to Bengali, Urdu, Tamil and Somali speaking communities. Focus groups were carried out with each of the communities to investigate how they conceptualise and experience ‘mental health issues’ and what they do when faced with what they regard as these issues. A thematic analysis of the data suggested that participants did not fully understand common conceptualisations about mental health issues, nor did they know how to seek mental health support. Implications of cultural barriers and recommendations for IAPT outcomes for the four communities are discussed. [ABSTRACT FROM PUBLISHER]

African Caribbean women are under-represented within mental health services in the United Kingdom, despite sociocontextual vulnerabilities which may increase emotional distress. This qualitative study aimed to explore individual explanatory models of experiences of distress, coping and help-seeking choices, with a view to improving cultural relevance of services. Participants were recruited following their self-referral to self-help community wellbeing workshops. Interpretative phenomenological analysis was carried out following semi-structured interviews with seven African Caribbean women in central London, who reported previously experiencing emotional distress. The study was conducted during 2009. Five super-ordinate themes emerged from the data: explanations of distress, experiences of distress, managing distress, social and cultural influences and seeking help. Each super-ordinate theme consisted of several subthemes which described participants' experiences. Gender roles and a cultural legacy of being strong and hiding distress emerged as influential in participants' beliefs about managing personal difficulties. However, this was balanced with an acknowledgement that intergenerational differences highlighted an increasing acceptance amongst the community of talking about issues and seeking professional support. The findings offered support for the notion that understandings and responses to personal distress are subject to broad-ranging and interwoven influences. This complexity may be conceptualised as an 'exploratory map' where individuals make links between their current and newly encountered knowledge and experience to guide their personal route to coping and help-seeking. The study provides support for tailoring services to individual needs using a flexible approach which empowers individuals from black and minority ethnic groups by valuing explanatory models of distress alternative to the westernised medical model. Furthermore, findings emphasise the importance of readily available and accessible information about statutory and non-statutory community resources which use language relevant to the communities they are aimed at engaging. [ABSTRACT FROM AUTHOR]

Background: Loneliness is associated with negative outcomes, including increased mortality and is common among people with mental health problems. This qualitative study, which was carried out as part of a feasibility trial, aimed to understand what enables and hinders people with severe depression and/or anxiety under the care of secondary mental health services in the United Kingdom to participate in the Community Navigator programme, and make progress with feelings of depression, anxiety and loneliness. The programme consisted of up to ten meetings with a Community Navigator and three optional group sessions. Methods: Semi-structured interviews were carried out with participants (n = 19) shortly after programme completion. A co-produced two-stage qualitative approach, involving narrative and reflexive thematic analysis, was undertaken by members of the study's working group, which included experts by experience, clinicians and researchers. Results: The narrative analysis showed that individuals have varied goals, hold mixed feelings about meeting other people and define progress differently. From the thematic analysis, six themes were identified that explained facilitators and challenges to participating in the programme: desire to connect with others; individual social confidence; finding something meaningful to do; the accessibility of resources locally; the timing of the programme; and the participant's relationship with the Community Navigator. Conclusions: We found that people with severe depression and/or anxiety supported by secondary mental health services may want to address feelings of loneliness but find it emotionally effortful to do so and a major personal challenge. This emotional effort, which manifests in individuals differently, can make it hard for participants to engage with a loneliness programme, though it was through facing personal challenges that a significant sense of achievement was felt. Factors at the individual, interpersonal and structural level, that enable or hinder an individual's participation should be identified early, so that people are able to make the best use out of the Community Navigator or other similar programmes. [ABSTRACT FROM AUTHOR]

Improving breastfeeding outcomes is a global priority; however, in the United Kingdom, continuation of breastfeeding remains low. Growing empirical evidence suggests a free breast pump service might be an acceptable and feasible incentive intervention to improve breastfeeding outcomes and reduce heath inequalities. To inform intervention development, we conducted an online survey with women recruited via social media using snowball sampling. Data were analysed descriptively (closed questions) with qualitative thematic analysis (free text). The survey was completed by 666 women, most of whom had recently breastfed and used a breast pump. Participants agreed that free pump hire (rental/loan; 567 women; 85.1%) or a free pump to keep (408; 61.3%) should be provided. Free text comments provided by 408 women (free pump) and 309 women (free hire) highlighted potential benefits: helping women to continue breastfeeding; express milk; overcome difficulties; and pump choice. Concerns are possible effect on breast milk supply, reduced breastfeeding, pumps replacing good support for breastfeeding, and pump hire hygiene. Personal and societal costs are important issues. Some suggested a pump service should be for low‐income mothers, those with feeding difficulties or sick/preterm infants. A one‐size service would not suit all and vouchers were proposed. Some suggested fees and deposits to prevent waste. To our knowledge, this is the first study reporting views about the acceptability of providing a free breast pump hire service. Mothers support and wish to have a say in breast pump service development. Future evaluations should address impact on feeding outcomes, professional support, hygiene for hired pumps, and costs. [ABSTRACT FROM AUTHOR]