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Loneliness is considered to be a global public health challenge, impacting a range of physical and mental health conditions. Social prescribing, whereby service users are signposted into community-based activities and social groups by a community link worker, has been suggested as one mechanism to reduce service users’ loneliness and social isolation. This paper reflects on service users’ experiences of accessing a national social prescribing scheme. Drawing on qualitative findings from interviews with service users who were receiving support through a social prescribing programme between October 2017 and December 2018 (n = 26, with n = 12 interviewed a second time), we reflect on their experiences of the programme. We consider some of the complexities of providing short-term support with a focus on signposting people into local activities, when many service users prefer the companionship of their link worker. Furthermore, we highlight some of the difficulties in ending short-term support. Crucially, we highlight the importance of considering the intersection of the social determinants of health. We suggest that social prescribing schemes may exacerbate inequalities if consideration is not given to the ways in which people are (dis)advantaged in accessing the social capital necessary for their initial and continued involvement.

Background The relationship between obesity and health-related quality of life (HRQoL) may be confounded by factors such as multimorbidity. The aim of the study was to explore this relationship, controlling for long-term conditions and other health, lifestyle and demographic factors in a general adult population. There was specific interest in the impact of high weight status, measured by body mass index (BMI) levels (obesity, morbid obesity) compared with individuals of normal weight. Methods Health, lifestyle and demographic data were collected from 64,631 individuals aged 16 years and over registered in the Yorkshire Health Study; a long-term cohort study. Data were collected in 2 waves: from patients attending GP surgeries in the South Yorkshire region; and using online recruitment across the entire Yorkshire and Humber area. Univariable and multivariable regression methods were utilised to identify factors associated with HRQoL as measured by the EQ-5D summary score. Long-term conditions were tested as both covariates and mediating factors on the causal pathway between obesity and HRQoL. Results Increasing levels of obesity are associated with reduced HRQoL, although this difference is negligible between those of normal weight and those who are overweight. Individuals with obesity and morbid obesity score 4.9 and 11.3 percentage points less on the EQ-5D summary scale respectively than those of normal weight. Concurrent physical, and particularly mental health-related long-term conditions are substantively related to HRQoL: those with 3 or more reported mental or physical health conditions score 29.8 and 14.6 percentage points less on the EQ-5D summary scale respectively than those with fewer conditions. Long-term conditions can be conceptualised as lying on the causal path between obesity and HRQoL, but there is weak evidence for a partial mediating relationship only. Conclusions To conclude, in agreement with the established literature we have found a clear inverse relationship between increasing weight status and decreasing HRQoL and confirmed the mediating role of long-term conditions in the reduction of HRQoL in people with obesity. Nevertheless, a high BMI remains independently related to HRQoL, suggesting that ‘healthy people with obesity’ may be in transition to an unhealthy future.

Loneliness is considered a global public health issue because of its detrimental impact on physical and mental health but little is known about which interventions can reduce loneliness. One potential intervention is social prescribing, where a link worker helps service‐users to access appropriate support such as community activities and social groups. Some qualitative studies have identified that social prescribing may help to reduce service‐users’ loneliness. Given this, the British Red Cross (a third sector organisation) developed and delivered a national social prescribing service in the United Kingdom to support people who were experiencing, or at risk of, loneliness. Service‐users could receive up to 12 weeks of support from a link worker. A mixed methods study was conducted to understand the impact of the support on loneliness, and to identify the facilitators and barriers to service delivery. The study included: (a) analysis of quantitative data collected routinely between May 2017 and December 2019 (n = 10,643) including pre‐post analysis of UCLA data (n = 2,250) and matched comparator work to measure changes in loneliness; (b) semi‐structured interviews with service‐users, link workers and volunteers (n = 60) and (c) a Social Return on Investment Analysis. The majority of the service‐users (72.6%, n = 1634/2250) felt less lonely after receiving support. The mean change in UCLA score was −1.84 (95% CI −1.91 to −1.77) of a maximum change of 6.00 (decrease indicates an improvement). Additional benefits included improved wellbeing, increased confidence and life having more purpose. The base case analysis estimated a social return on investment of £3.42 per £1 invested in the service. Having skilled link workers and support tailored to individual needs appeared key. However, challenges included utilising volunteers, meeting some service‐users’ needs in relation to signposting and sustaining improvements in loneliness. Nonetheless, the service appeared successful in supporting service‐users experiencing loneliness.

Background and Aims\ud \ud This study evaluates a specialist weight management service and compares outcomes in participants referred to the service undergoing either surgery or non-surgical routes to support weight loss.\ud \ud \ud \ud Methods\ud \ud Four hundred and forty eight participants were assessed on various weight-related outcomes (body mass index [BMI], psychological distress, quality of life, nutrition, weight-related symptoms, physical activity) on referral to the service and on discharge. The effect of group (surgery or non-surgery) and time in the service were facilitated by doubly multivariate analyses of variance models.\ud \ud \ud \ud Results\ud \ud Between referral and discharge, participants improved significantly on a combination of outcomes (P

Background: Older people with an acute illness, many of whom are also frail, form a significant proportion of the acute hospital inpatient population. Attention is focusing on ways of improving the physical environment to optimize health outcomes and staff efficiency. Purpose: This article explores the effects of the physical environment in three acute care settings: acute hospital site, in-patient rehabilitation hospital, and intermediate care provision (a nursing home with some beds dedicated to intermediate care) chosen to represent different steps on the acute care pathway for older people and gain the perspectives of patients, family carers, and staff. Methods: Semi structured interviews were undertaken with 40 patient/carer dyads (where available) and three staff focus groups were conducted in each care setting with a range of staff. Results: Multiple aspects of the physical environment were reported as important by patients, family carers, and staff. For example, visitors stressed the importance of access and parking, patients valued environments where privacy and dignity were protected, storage space was poor across all sites, and security was important to patients but visitors want easy access to wards. Conclusions: The physical environment is a significant component of acute care for older people, many of whom are also frail, but often comes second to organization of care, or relationships between actors in an episode of care.

Background\ud \ud Age-related macular degeneration (AMD) is the major cause of blindness for the older population in the developed world. Geographic atrophy (GA) is an advanced form of AMD. This progressive degenerative disease causes loss of visual function but unlike exudative AMD there are currently no approved therapeutic treatments for GA. Instead management of the condition is through supportive care. The aim of this study was to conduct exploratory qualitative research to develop a further understanding specifically of the impact of geographic atrophy (GA) on the quality of life for both patients and their families, and to explore the resources GA patients most frequently access.\ud \ud \ud \ud Methods\ud \ud Two focus groups were conducted where participants were assigned to “better” or “worse” group based upon their level of visual acuity. The data were analysed using the principles of thematic analysis. Transcripts were coded using an a priori framework. Emerging themes and subthemes were added, and transcripts recoded to reflect this. Transcripts were coded by one researcher, and the emerging themes and subthemes discussed and agreed prior to transcript recoding.\ud \ud \ud \ud Results\ud \ud Nine participants were recruited to the study (n=5 “better group” and n=4 “worse group”). Six overarching themes were identified. These are: experience of symptoms and understanding of GA; impact on activities; feelings and emotions; relationships and informal support; accessing formal support; and information needs. \ud \ud \ud \ud Conclusion\ud \ud Key findings indicated that: participants had little knowledge of the mechanisms of GA, but were aware of their prognosis; activities impacted by GA were management of daily activities and reading; emotions experienced included fear and frustration, and these frequently crossed over into their relationships with others; and access to formal support was mainly practical and information needs were largely unmet, with peer support being identified as important. Management of GA should include signposting to appropriate support agencies, such as low vision services and charities.

Loneliness is a global public health concern linked to a range of negative health outcomes (Cacioppo & Cacioppo, 2018. The Lancet. 391(10119), 426). Internationally, this has led to the development of a number of interventions, but these are rarely implemented or evaluated on a large scale. This paper is one of the first of its kind to describe elements of an evaluation of a large‐scale national social prescribing scheme to reduce loneliness, deploying individual link workers to signpost people to community activities. Reporting on findings from interviews with staff (n = 25 of which 6 were repeat interviews) and volunteers (n = 9) between October 2017 and December 2018 in localities across the United Kingdom. We reflect on the complexities of the link worker role, the challenges of service delivery and the importance of community infrastructure. There was evidence that highly skilled link workers who had developed positive relationships with providers and service‐users were key to the success of the intervention. As well as providing an effective liaison and signposting function, successful link workers tailored the national programme to local need to proactively address specific gaps in existing service provision. For social prescribing services to be successful and sustainable, commissioners must consider additional funding of community infrastructure.

Aim: To develop a theoretical framework to inform the design of interpersonal touch interventions intended to reduce stress in adult intensive care unit patients.\ud Design: Realist review with an intervention design‐oriented approach.\ud Methods: We searched CINAHL, MEDLINE, EMBASE, CENTRAL, Web of Science and grey literature sources without date restrictions. Subject experts suggested additional articles. Evidence synthesis drew on diverse sources of literature and was conducted iteratively with theory testing. We consulted stakeholders to focus the review. We performed systematic searches to corroborate our developing theoretical framework.\ud Results: We present a theoretical framework based around six intervention construction principles. Theory testing provided some evidence in favour of treatment repetition, dynamic over static touch and lightening sedation. A lack of empirical evidence was identified for construction principles relating to intensity and positive/negative evaluation of emotional experience, moderate pressure touch for sedated patients and intervention delivery by relatives versus healthcare practitioners.

Background Multimorbidity is increasingly being recognized as a serious public health concern. Research into its determinants, prevalence, and management is needed and as the risk of experiencing multiple chronic conditions increases over time, attention should be given to investigating the development of multimorbidity through prospective cohort design studies. Here we examine the baseline patterns of multimorbidity and their association with health outcomes for residents in Yorkshire, England using data from the Yorkshire Health Study. Methods Baseline data from the Yorkshire Health Study (YHS) was collected from 27,806 patients recruited between 2010 and 2012. A two-stage sampling strategy was implemented which first involved recruiting 43 general practice surgeries and then having them consent to mailing invitations to their patients to complete postal or online questionnaires. The questionnaire collected information on chronic health conditions, demographics, health-related behaviours, healthcare and medication usage, and a range of other health related variables. Descriptive statistics (chi-square and t tests) were used to examine associations between these variables and multimorbidity. Results In the YHS cohort, 10,332 participants (37.2 %) reported having at least two or more long-term health conditions (multimorbidity). Older age, BMI and deprivation were all positively associated with multimorbidity. Nearly half (45.7 %) of participants from the most deprived areas experienced multimorbidity. Based on the weighted sample, average health-related quality of life decreased with the number of health conditions reported; the mean EQ-5D score for participants with no conditions was 0.945 compared to 0.355 for participants with five or more. The mean number of medications used for those without multimorbidity was 1.81 (range 1-13, SD = 1.25) compared to 3.81 (range 1-14, SD = 2.44) for those with at least two long-term conditions and 7.47 (range 1-37, SD = 7.47) for those with 5+ conditions. Conclusion Patterns of multimorbidity within the Yorkshire Health Study support research on multimorbidity within previous observational cross-sectional studies. The YHS provides both a facility for participant recruitment to intervention trials, and a large population-based longitudinal cohort for observational research. It is planned to continue to record chronic conditions and other health related behaviours in future waves which will be useful for examining determinants and trends in chronic disease and multimorbidity.

Rationale After the move of responsibility for public health to local government in 2013, Public Health England estimated there were 15 million people in the wider workforce who could potentially contribute to health improvement. In order to inform future initiatives to develop and extend the public health role of the wider workforce, we analysed data from the evaluation of two programmes designed to enhance the health promotion role of council employees, from a range of occupational groups. We explored the issues that need to be addressed to ensure this potential public health capacity can be appropriately harnessed. Methods Qualitative data was collected from a) 12 staff focus groups undertaken during evaluation of ‘Making Every Contact Count’ (MECC) training offered to council staff b) in-depth interviews with 21 neighbourhood housing officers undertaken for the evaluation of a new ‘Housing+’ service, which required them to provide holistic health and wellbeing advice to council housing tenants. The data was analysed thematically to identify potential barriers and facilitators to the engagement and development of the wider public health workforce. Results The sample included staff from ten occupational groups with a wide range of roles and experience. Whilst most staff were positive in principle about engaging with health and wellbeing issues, occupational groups varied in their attitudes to the appropriateness of taking on a specifically health promoting role and a range of barriers and obstacles were identified. Obstacles included a lack of time and opportunity costs; conflict with other roles such as managing complaints and rent arrears; lack of capacity in other services they could refer clients to when urgent needs identified; and a concern they were being expected to replace other overstretched or non-existent community services. The range of views expressed on the feasibility and appropriateness of engaging clients or customers in discussion of health and wellbeing related issues, particularly health-related behaviour, suggested that implementation of training received, and the delivery of an extended role more generally, was likely to be highly variable. Conclusion If the potential contribution of the wider workforce to maximising population health is to be achieved, the best way to engage staff and develop their role is likely to vary between occupational groups and the opportunity costs, potential unintended consequences and additional training needs must not be underestimated. Effectiveness and cost-effectiveness cannot be assumed in the absence of evaluation of the wider impact of role development in terms of both intended and unintended consequences.

Background: Health technologies are being developed to help people living at home manage long-term conditions. One such technology is “lifestyle monitoring” (LM), a telecare technology based on the idea that home activities may be monitored unobtrusively via sensors to give an indication of changes in health-state. However, questions remain about LM technology: how home activities change when participants experience differing health-states; and how sensors might capture clinically important changes to inform timely interventions. Objective: The objective of this paper was to report the findings of a study aimed at identifying changes in activity indicative of important changes in health in people with long-term conditions, particularly changes indicative of exacerbation, by exploring the relationship between home activities and health among people with heart failure (HF). We aimed to add to the knowledge base informing the development of home monitoring technologies designed to detect health deterioration in order to facilitate early intervention and avoid hospital admissions. Methods: This qualitative study utilized semistructured interviews to explore everyday activities undertaken during the three health-states of HF: normal days, bad days, and exacerbations. Potential recruits were identified by specialist nurses and attendees at an HF support group. The sample was purposively selected to include a range of experience of living with HF. Results: The sample comprised a total of 20 people with HF aged 50 years and above, and 11 spouses or partners of the individuals with HF. All resided in Northern England. Participant accounts revealed that home activities are in part shaped by the degree of intrusion from HF symptoms. During an exacerbation, participants undertook activities specifically to ease symptoms, and detailed activity changes were identified. Everyday activity was also influenced by a range of factors other than health. Conclusions: The study highlights the importance of careful development of LM technology to identify changes in activities that occur during clinically important changes in health. These detailed activity changes need to be considered by developers of LM sensors, platforms, and algorithms intended to detect early signs of deterioration. Results suggest that for LM to move forward, sensor set-up should be personalized to individual circumstances and targeted at individual health conditions. LM needs to take account of the uncertainties that arise from placing technology within the home, in order to inform sensor set-up and data interpretation. This targeted approach is likely to yield more clinically meaningful data and address some of the ethical issues of remote monitoring. [J Med Internet Res 2017;19(6):e231]

The objective was to explore women’s long‐term experiences and perspectives on their terminations of pregnancy (TOP) when perimenopausal. Eight women attending a menopause clinic who had experienced termination a minimum of 10 years previously (mean 24 years) completed semi‐structured interviews. Transcripts were analysed using Template Analysis. Five TOP themes were identified: ‘Impression left’ involved sadness, regret, and guilt which affected women’s self‐perceptions. ‘Judgement’ encompassed judgement on themselves and how censure was feared from others. ‘Growth and development’ noted the development of resilience and compassion for others. ‘Coming to terms and managing effects’ identified beliefs in the correctness of the decision, but effortful avoidance of thoughts still intruding into life. ‘Contradictions’ identified dramatic inconsistencies within almost all individual accounts indicating lack of resolution and full acceptance. Considering menopause and TOP together revealed a further three them...

Background There is a widely held assumption in the literature that a well-established link exists between postnatal depressive and premenstrual symptoms. However, on examination of existing research, certain methodological limitations were identified including inadequate methods of assessment and a heavy reliance upon the retrospective assessment of either postnatal or premenstrual symptoms, giving rise to concern regarding the validity of any conclusions. Methods A community sample of 63 women completed a daily menstrual symptom diary for two consecutive months. Women's Edinburgh Postnatal Depression Scale score, recorded 1–3 years previously, was provided by their Health Visitor. Results Only one participant showed evidence of both postnatal and premenstrual distress when using an EPDS cut-off of > 12 and defined criteria for premenstrual symptom assessment. When scores were treated as a continuum, there was no association between postnatal distress and psychological premenstrual symptoms and only a trend towards significance between postnatal distress and physical premenstrual symptoms. Limitations Due to the recruitment method, there is some uncertainty regarding the overall response rate. Although this was not a large sample, it compares favourably with many other studies where daily data are collected. The particular focus was examining whether postnatal depressive symptoms predict premenstrual distress (not vice versa). Conclusions This study found little evidence to support the widely held assumption of a clear relationship between postnatal distress and premenstrual symptoms.

Objectives:Many studies have examined the role of self-esteem and its influence on mental health. This has been raised as of particular interest in the women’s health literature spanning both the postnatal and premenstrual milieu. There are, however, a lack of quick and easy to complete, self-discrepancy measures available. Based on Higgins, Klein and Strauman’s (1985) ‘Selves Questionnaire’, a 14-item scale was developed to focus on the discrepancy between two self states, actual/own and ideal/own, which would be applicable to women with children.Design:Phase one of this study outlines the process of scale development, whilst phase two presents the results of the scale’s performance utilising a large community sample of women with young children (who were not involved in phase one).Results:The scale has sound internal and test-retest reliability and appropriate content validity as it is grounded in women’s own descriptions the person they believe they are and would ideally like to be. Furthermore, correlations with a well-validated perfectionism scale and an anxiety and depression measure supports the scale’s construct validity. To lend weight to the scale’s overall validity, a Principal Components Analysis revealed a clear differentiation between actual and ideal self-concept items.Conclusions:Unlike many self-concept measures, this scale is not dependent upon the presence of the researcher for its completion and would be of benefit for both clinical and research purposes.

A review of measures of menstrual cycle symptoms is provided. This will enable researchers and clinicians to make the appropriate choice of method for their study requirements. In recent years, these measures have taken the form of retrospective questionnaires (rating severity of symptoms from memory) and prospective diaries (daily checklists of symptoms). Many of these draw on aspects of the well-known retrospective questionnaires, the Menstrual Distress Questionnaire and Premenstrual Assessment Form, in their development and validation. Each measure will be briefly described, followed by comments on its development, psychometric properties and finally an evaluation of its strengths and weaknesses. It concludes with an examination of the implications arising from the review, and some recommendations that menstrual cycle researchers and clinicians may wish to consider, as they decide upon the most appropriate measure for their needs.

Background Technology has the potential to provide support for self-management to people with congestive heart failure (CHF). This paper describes the results of a realist evaluation of the SMART Personalised Self-Management System (PSMS) for CHF. Methods The PSMS was used, at home, by seven people with CHF. Data describing system usage and usability as well as questionnaire and interview data were evaluated in terms of the context, mechanism and outcome hypotheses (CMOs) integral to realist evaluation. Results The CHF PSMS improved heart failure related knowledge in those with low levels of knowledge at baseline, through providing information and quizzes. Furthermore, participants perceived the self-regulatory aspects of the CHF PSMS as being useful in encouraging daily walking. The CMOs were revised to describe the context of use, and how this influences both the mechanisms and the outcomes. Conclusions Participants with CHF engaged with the PSMS despite some technological problems. Some positive effects on knowledge were observed as well as the potential to assist with changing physical activity behaviour. Knowledge of CHF and physical activity behaviour change are important self-management targets for CHF, and this study provides evidence to direct the further development of a technology to support these targets. Electronic supplementary material The online version of this article (doi:10.1186/s12911-014-0109-3) contains supplementary material, which is available to authorized users.

Objectives. This study aimed to compare and contrast detailed accounts of a community sample of women, with prospectively defined low or high premenstrual symptoms, highlighting differences/similarities. Methods. Semi-structured interviews were conducted with 16 women (9 with ‘low’ and 7 with ‘high’ symptom levels) and analysed using template analysis. Results. ‘Low symptom’ women perceived themselves as generally laid back but demonstrated a need for organization and control in the family environment. They accepted less than perfect relationships, compared themselves favourably to others and perceived themselves as having strong support networks. There was a negative perception of the introduction to menarche but this was coupled with strong maternal support. ‘High symptom’ women showed patterns of perfectionism, an emphasis on self-sacrifice and unfavourable comparison of self with others. They reported feeling alone, overwhelmed by tasks and experienced relationships as characterized by unresolved tensions. Menarche was viewed as a positive experience but accompanied by low maternal support. Both groups viewed their symptoms as irrational and controllable outside the home, but vented on partner, close family and children. There was acknowledgement of difference from ‘normal’ (‘low’) with an emphasis on the all-encompassing nature of symptoms (‘high’). Conclusions. Women with high and low menstrual cycle symptoms viewed aspects of themselves and their relationships with others in both similar and different ways. A major issue for high symptom women was that they struggled to tolerate imperfections, both in their own performance or in their relationships with others, potentially emphasizing the role of cognitive appraisals in interventions.

Objective This study aimed to explore the role of psychological factors such as perfectionism, need for approval, timidity, and social support from key individuals such as a woman's mother and partner in relation to premenstrual symptoms in a community (non-help-seeking) sample. Methods A large sample of women completed a questionnaire to assess whether these proposed factors were associated. Premenstrual symptoms were assessed via daily ratings for a period of more than 2 months. Results Perfectionism and low levels of maternal support were associated with premenstrual symptoms. In addition, social support from both the mother and partner moderated the impact of perfectionism on physical symptoms. Conclusion The quality of the relationship with one's mother and perceptions of support may play an important role in the experience of cyclical symptoms in ‘normal’ non-help-seeking women. This may interact with preexisting personality factors such as perfectionism. Such understandings may ultimately be of value in community-based preventative psychoeducational programs.