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IntroductionMusic and dance are increasingly used as adjunctive arts-in-health interventions in high-income settings, with a growing body of research suggesting biopsychosocial benefits. Such low-cost, low-resource interventions may have application in low-resource settings such as Uganda. However, research on perceptions of patients and healthcare professionals regarding such approaches is lacking.MethodsWe delivered taster music and dance for chronic respiratory disease (CRD) sessions to patients and healthcare professionals. We then conducted an exploratory qualitative study, using thematic analysis of semi-structured interviews with the healthcare professionals and patients regarding i) the role of music and dance in Ugandan life and ii) the perceived acceptability and feasibility of using music and dance in CRD management in Uganda.ResultsEleven patients with long-term respiratory conditions and eight healthcare professionals were interviewed after selection by purposeful convenience sampling. Four key themes were identified from (interview) analysis: Music and dance: 1) were central components of daily life; 2) had an established role supporting health and wellbeing; 3) had strong therapeutic potential in respiratory disease management; 4) the importance of modulating demographic considerations of culture and religion, and age.ConclusionMusic and dance are central to life in Uganda, with established roles supporting health and wellbeing. These roles could be built on in the development of music and dance interventions as adjuncts to established components of CRD disease management like pulmonary rehabilitation. Through consideration of key contextual factors, and co-development and adaptation of interventions, such approaches are likely to be well received.Summary Box: Key QuestionsWhat is already known?Music and dance are increasingly being used as adjunctive components of CRD management in high resource settings, with a growing body of research suggesting such approaches are effective, well-received, and can be delivered at low cost. However, the perceptions of patients and healthcare professionals about potential application of such approaches in low-resource settings, such as Uganda, is not known.What are the new findings?Music and dance have central roles in the social, religious and cultural life in Uganda, including a clear view that participation supports both collective and individual health and wellbeing. In this study, both healthcare professionals and patients saw great potential for the use of music and dance as interventions for people with CRD, and highlighted important factors for consideration for successful implementation.What do the new findings imply?Music and dance interventions for people with long-term respiratory conditions in Uganda are likely to be accepted with enthusiasm due to the existing role of such activities in daily life. Delivery is likely to be feasible, but interventions would need to be co-developed with patients, their family members, and healthcare professionals, considering a number of key factors. Suggested approaches to address these considerations are provided. More generally, this study highlights how genuine co-design processes can provide valuable insights into health intervention development.

Evidence is emerging of the potential of person-centred approaches to create partnerships between professionals and patients while also containing healthcare costs. This is important for enhancing outcomes in individuals with complex needs, who consistently report poor experiences with care. The shift towards person-centred care (PCC) is, however, a radical departure from the norm, with increased expectations of both professional and patient. Although there have been studies on the ways in which health care professionals can modify practice to enhance PCC, not all patients welcome changes to their care delivery or understand the aim of the new approach. Without engagement and understanding from the patient, a PCC approach will fail to initiate. Few studies explore how, why and in what circumstances patients become more involved in their care and what professionals can do to enhance participation. We conducted a secondary analysis of qualitative data to examine this issue. Data were collected between 2014 and 2018 from primary care-based PCC projects across the southwest of England. Supported by people with experience (practitioners and those receiving treatment), theory building workshops developed an explanatory framework that identified contextual factors and mechanisms likely to contribute to effective engagement. Our results show that engagement in a care partnership is achieved through trust and a patient's sense of candidacy. Shared understanding of purpose, clarity of expectations and power sharing were found to facilitate trusted relationships between professional and patient and encourage candidacy. Only then is it possible to develop goals that are meaningful to the patient. Our theory of engagement applies to professionals and patients alike but places the initial burden of responsibility on those who hold the most power: the professional and the system. This theory has the potential to explain patient engagement in PCC and a range of other service interventions, treatments and intervention research.

In resource-stretched emergency departments, people accompanying patients play key roles in patients’ care. This article presents analysis of the ways health professionals and accompanying persons talked about admission decisions and caring roles. The authors used an ethnographic case study design involving participant observation and semi-structured interviews with 13 patients, 17 accompanying persons and 26 health care professionals in four National Health Service hospitals in south-west England. Focused analysis of interactional data revealed that professionals’ standardization of the patient–carer relationship contrasted with accompanying persons’ varied connections with patients. Accompanying persons could directly or obliquely express willingness, ambivalence and resistance to supporting patients’ care. The drive to avoid admissions can lead health professionals to deploy conversational skills to enlist accompanying persons for discharge care without exploring the meanings of their particular relationship with the patients. Taking a relationship-centered approach could improve the attention to accompanying persons as co-producers of health care and participants in decision-making.

Background: The growing number of people living with multiple long-term conditions is increasing demand on Global Health Systems at a time of fiscal constraint [1]. To meet this challenge, new models of primary care aiming at enhanced coordination and person centred care have been proposed to improve efficiency and patient outcomes by breaking with paternalistic models of health and encouraging increased self-management within the community [2]. Lack of implementable evidence and guidance has led to the development of local ‘implementation experiments’. We evaluated a number of these ‘experiments’ across southwest England against four routines for practice developed by the Gothenburg centre for person centred care [3]. Methods: To develop theory about how best to engage people in new interventions for the development of person centred coordinated care we conducted a secondary, inductive analysis of qualitative data. This comprised of data generated from structured interviews, focus groups and observations with patients and practitioners that formed part of our service evaluations. Theory was co-produced in workshops involving patients and practitioners. Results: Our data revealed that initially some patients were suspicious of the motives for their inclusion in novel interventions, or did not understand the new model’s rationale. In these cases participants found it difficult to develop a narrative routine one and some individuals declined participation. This was due to underdevelopment of programme theory and inexperience of practitioners in articulating programme aims when introducing the intervention. Evidence suggested that older individuals with more complex care needs may find it more difficult to engage with the new approach, resulting in lack of shared decision making during subsequent goal setting and care planning routines two and three. Co-production was an unintended consequence of bringing participant groups together which produced mechanisms reframing interactions and further developing participants’ narratives. Developing a trusting relationship with practitioners over time also promoted engagement and was more likely to result in development of authentic, holistic narratives and goals. Discussion: Evidence shows that person centred care increases wellbeing and self-management in patients and co-production supports personalised practice [4]. This study gives exemplars of how these principles operate in practice. Personal narrative development is a significant departure from traditional health service encounters in which topics and solutions are defined by practitioners. It may be challenging for patients and practitioners. Conclusions: The establishment of a meaningful patient narrative depends on clear explanations of new interventions and the formation of relationships with practitioners trained in eliciting these conversations. This ‘pre-context’ is fundamental to person centred care since it establishes rules of engagement for the subsequent routines of decision-making and care planning. Lessons learned: Clarity of programme theory and staff training on effective communication and narrative development are imperative to the delivery of person centred care. Limitations: Data was limited to those agreeing to be interviewed, observed, or take part in focus groups; the views and experiences used to develop theory may not be wholly representative of more marginalised individuals. Suggestions for future research: Testing the developed theory in controlled or other well-designed research programmes.

AimTo explore the factors influencing the completion of the IB113 form for the Department for Work and Pensions (DWP), as an exemplar of how general practitioners (GPs) manage and report patient information to external bodies.BackgroundIn UK, GPs complete IB113 forms for their patients approaching longer-term sickness absence, who may be exempt from the incapacity benefit linked medical examination. The DWP has expressed concerns about the quality of such reports, and GP organizations have raised objections to completing such forms. The content of returned forms is variable, and may be subject to a number of influences.DesignQualitative interviews with purposive sampling of GPs and practice managers (PMs).SettingPrimary Care practices in the North East of England.MethodGPs and PMs were interviewed using a semi-structured topic guide about completing IB113 forms for the DWP about their patients entering long-term incapacity. The transcribed data were analysed thematically using the framework analysis method.ResultsWhilst the IB113 appears superficially straightforward to complete, our results demonstrate levels of overlapping complexity that add ranges of subjectivity and selectivity onto factual reporting, including practice protocols, the gathering and managing of information, the doctor–patient relationship, and doctor’s personal views on systems.ConclusionsThe recording and reporting of patient related data by GPs is subject to complex influences, which need to be understood and managed to improve the relevance and quality of reports to third parties.