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Abstract Background In the UK, bariatric surgical patients are followed up for 2 years post‐operatively in hospital settings, before being discharged into General Practice for long‐term follow‐up. Presently, there is ambiguous guidance as to what should be included in a community‐based bariatric surgical follow‐up service. The aim of the study was to understand, from both patient and professional perspectives, what is needed to support the long‐term management of bariatric surgical patients in community‐based settings. Methods Post‐surgical bariatric patients and General Practice staff were recruited from an area in the UK which has an National Health Service (NHS) hospital providing a high‐volume and established bariatric surgical service. Data was collected through semi‐structured interviews. A thematic analytic framework was used to construct eight themes which illuminated the participants' experiences. The study took place between March and December 2021. Findings Thirty participants (14 patients and 16 healthcare professionals) were recruited to the study. The study revealed the lack of a framework for delivery of a long‐term follow up service was frustrating to both patients and professionals. Patient participants reported needing more support, especially dietetic and psychological input, and professionals stated they had little knowledge about bariatric surgical care, and what was needed to provide optimal care, but wanted to provide quality patient care. Conclusion Long‐term follow up of bariatric surgical patients is an important issue which needs addressing. This study illuminates both the patient and professional perspectives on developing a pragmatic, community‐based service which meets the needs of patients and considers the need to incorporate such a service into existing infrastructures without adding additional demands on General Practice.

Abstract Background The first year of the Covid‐19 pandemic saw drastic changes to bariatric surgical practice, including postponement of procedures, altered patient care and impacting on the role of bariatric surgeons. The consequences of this both personally and professionally amongst bariatric surgeons has not as yet been explored. Aims The aim of this research was to understand bariatric surgeons' perspectives of working during the first year of the pandemic to explore the self‐reported personal and professional impact. Methods Using a retrospective, two phased, study design with global participants recruited from closed, bariatric surgical units. The first phase used a qualitative thematic analytic framework to identify salient areas of importance to surgeons. Themes informed the construction of an on‐line, confidential survey to test the potential generalizability of the interview findings with a larger representative population from the global bariatric surgical community. Findings Findings of the study revealed that the first year of the pandemic had a detrimental effect on bariatric surgeons both personally and professionally globally. Conclusion This study has identified the need to build resilience of bariatric surgeons so that the practice of self‐care and the encouragement of help‐seeking behaviors can potentially be normalized, which will in turn increase levels of mental health and wellbeing.

Abstract Objectives To examine discrepancy rates over multiple annual cycles in reporting by consultant radiologists for the interpretation of acute Computerized Tomography (CT) examinations. Methods A prospective audit with peer review and second reading of acute CT scans was implemented in one radiology department in the UK. A longitudinal audit over 5 years was performed to determine the discrepancy rate of acute and emergency CT scans conducted on weekends. The examinations comprised CT head, thorax, abdomen and pelvis, CT Kidneys, Ureters, and Bladder (CT KUB), and CT angiography scans. Discrepancies were scored as no discrepancy (zero), minor discrepancy (one), moderate discrepancy (two), or significant discrepancy (three). Seventeen consultants took part in the audit as primary reporters and second readers. All consultants were on‐call radiologists, and the allocation of cases was randomized depending on the on‐call rota. Results were reported annually to one consultant radiologist. Results A significant discrepancy rate of 1.2% (p = 0.026) was found for consultant radiologists, interpreting acute CT examinations based on 2951 s read CT scans. Conclusions To the best of our knowledge, this is the first study to establish significant discrepancy rates among consultant radiologists, interpreting acute CT examinations over time.

Abstract Introduction Obesity is a known risk factor for the development of cancers, and a significant proportion of the population may be at risk of developing cancer owing to their weight status. There is acknowledged societal stigma towards people living with obesity, which can influence health behaviors and deter help seeking, such as cancer screening. Healthcare professionals’ attitudes and views toward people living with obesity may adversely affect the patient–professional interface and treatment. Methods A systematic review was carried out which aimed to explore the impact of living with obesity on the uptake of three main cancer‐screening services: breast, cervical, and colorectal. Results Ten studies were included in the review. Three main areas were identified from both a patient and healthcare professional perspective: barriers and challenges to screening, gender issues, and disparities in the population living with obesity. Conclusion Further research is needed to improve uptake of cancer screening services, and for education on weight bias, which is often unconscious, to be considered for healthcare professionals working in cancer screening services. This may help to increase the incidence of early differential diagnosis of potential cancers and improve health outcomes for people living with obesity.

Introduction: The experience of structural violence impacts not only patients but also GPs who deliver their primary care. Farmer (1999) claims that 'sickness due to structural violence results from neither culture nor pure individual will, but historically given and economically driven processes and forces that conspire to constrain individual agency'. I aimed to explore qualitatively the lived experience of GPs in remote rural areas who cared for disadvantaged populations selected from the Haase-Pratschke Deprivation Index (2016). Methods: I visited ten GPs in remote rural areas, did semi-structured interviews, explored the hinterland of their practices and observed the historical geography of their locality. In all cases, interviews were transcribed verbatim. NVivo was used for thematic analysis using Grounded Theory. Findings were framed in the literature around postcolonial geographies, care and societal inequality. Results: Participants were aged from 35 years to 65 years; half were women and half were men. Three main themes emerged: GPs value their lifeworld; they feel at high risk from over-work, inaccessible secondary care for patients and under-acknowledgment of their work; and they experience satisfaction in providing lifelong primary care. They fear that difficulties recruiting younger doctors may terminate the continuity of care that creates a sense of place. Discussion: Rural GPs are linchpins of community for disadvantaged people. But GPs suffer the effects of structural violence and feel alienated from being their personal and professional best. Factors to consider are the roll-out of the Irish government's 2017 healthcare policy, Sláintecare, changes wrought by the COVID-19 pandemic in the Irish healthcare system and poor retention of Irish-trained doctors.

Introduction: The health of women in rural communities is adversely impacted by increased rates of tobacco use linked to socio-economic disadvantage (SED) and by limited access to services. We Can Quit (WCQ) is a smoking cessation programme delivered by trained lay women (community facilitators) in local communities, which was developed using a Community-based Participatory Research (CBPR) approach and tailored to women living in SED areas of Ireland.Methods: The We Can Quit2 (WCQ2) pilot cluster randomised controlled trial with an inbuilt process evaluation was conducted in four matched pairs of urban and semi-rural SED districts (8-10,000 women per district) to assess feasibility. Districts were independently randomised to WCQ (group support +/- nicotine replacement therapy), or to individual support delivered by health professionals.Results: Findings showed that that the WCQ outreach programme is acceptable and feasible to implement for smoking women living in disadvantaged neighbourhoods. A secondary outcome of smoking abstinence (self-report + biochemical validation) demonstrated 27% abstinence in the intervention group versus 17% in usual care at end of programme. Low literacy was highlighted as a major barrier to participants’ acceptability.Discussion: The design of our project provides an affordable solution for governments in prioritising outreach smoking cessation in vulnerable populations in countries with rising rates of female lung cancer. Our community-based model using a CBPR approach empowers local women to become trained to deliver smoking cessation programmes within their own local communities. This provides a foundation to create a sustainable and equitable way to address tobacco use in rural communities.

Experiences of transition into civilian life after active service differs widely for military personnel. For those who experience issues in this process of transition, life can often be characterized by perceptions of loneliness, social isolation, poor mental well-being, and a functional dependency on alcohol, alongside other negative behaviors, for coping with post-traumatic stress disorder. This research employed action research methodology and the implementation of participatory action research methods. Both facilitated a systematic and pragmatic process of revealing new understandings about how social prescribing could act as a driver of transformation for veterans and their families (51 participants engaged across 18 individual workshops). This iterative exploratory process enabled a guided understanding of complex individual and collectively-shared experiences of veterans transitioning from military back to civilian lives. The facilitated collective arts experiences for veterans and their families were undertaken by specialist artists to foster a sense of active citizenship. The study revealed that participants transitioning from military to civilian life reported an increased sense of well-being because of engaging in collective creative practice. Participants attributed this to the opportunity of learning new skills, gaining a sense of creative expression, and engaging in reflection on their military heritage and contribution to service alongside peers. Knowledge gained from this research enables consideration of how principles of participatory action research may have potential transferability to other similar contexts which serve to support veterans in their transition from military to civilian life.

Abstract Objective Marginalised populations are less likely to take part in health research, and are sometimes considered ‘easy to ignore’. We aimed to describe our approach and results of recruiting parents who experience disadvantage, for focus groups exploring infant feeding on the island of Ireland. Upon receiving ethical approval, we implemented recruitment strategies that included building rapport with community organisations through existing networks, targeting specific organisations with information about our aims, and utilising social media groups for parents. Results We approached 74 organisations of which 17 helped with recruitment. We recruited 86 parents/carers (one male) for 19 focus groups (15 urban/4 rural). Seventy two percent met at the eligibility criteria. Most participants were recruited through organisations (91%), and the remainder on social media (9%). Recruitment barriers included multiple steps, research fatigue, or uncertainty around expectations. Factors such as building rapport, simplifying the recruitment process and being flexible with procedures were facilitators. Despite comprehensive, multi-pronged approaches, the most marginalised parents may not have been reached. Further alternative recruitment strategies are required for recruiting fathers, rural populations, or those without the capacity or opportunity to engage with local services.

Abstract Background Translating research findings into service improvements for patients and/or policy changes is a key challenge for health service organizations. The Health Service Executive (HSE) in Ireland launched the Action Plan for Health Research 2019–2029, as reported by Terrés (HSE, Dublin, 2019), one of the goals of which is to maximize the impact of the research that takes place within the service to achieve improvements in patient care, services, or policy change. The purpose of this research is to review the literature on knowledge translation theories, models, and frameworks (TMFs) and to assess the suitability of the TMFs for HSE use, selecting one or more for this purpose. The aim is to produce guidance for HSE researchers and other health services staff, validate the usability of the framework(s) with researchers, and review and implement the guidance. It was hoped that identifying a suitable methodology would provide the means to increase the uptake and application of research findings, and reduce research wastage. This paper reports on the first part of the study: the review, assessment, and selection of knowledge translation TMFs for a national health service. Methods An interdisciplinary working group of academic experts in implementation science, research wastage, and knowledge translation, along with key representatives from research funders (Health Research Board) and HSE personnel with expertise in quality improvement and research management, undertook a three-stage review and selection process to identify a knowledge translation TMF that would be suitable and usable for HSE purposes. The process included a literature review, consensus exercise, and a final consensus workshop. The review group adopted the Theory Comparison and Selection Tool (T-CaST) developed by Birken et al. (Implement Sci 13: 143, 2018) to review knowledge translation theories, models, and frameworks. Results From 247 knowledge translation TMFs initially identified, the first stage of the review identified 18 that met the criteria of validity, applicability, relevance, usability, and ability to be operationalized in the local context. A further review by a subgroup of the working group reduced this number to 11. A whole-group review selected six of these to be reviewed at a facilitated consensus workshop, which identified three that were suitable and applicable for HSE use. These were able to be mapped onto the four components of the HSE knowledge translation process: knowledge creation, knowledge into action, transfer and exchange of knowledge, and implementation and sustainability. Conclusion The multiplicity of knowledge translation TMFs presents a challenge for health service researchers in making decisions about the appropriate methods for disseminating their research. Building a culture that uses research knowledge and evidence is important for organizations seeking to maximize the benefits from research. Supporting researchers with guidance on how to disseminate and translate their research can increase the uptake and application of research findings. The use of robust selection criteria enabled the HSE to select relevant TMFs and develop a process for increasing the dissemination and translation of research knowledge. The guidance developed to inform and educate researchers and knowledge users is expected to increase organizational capacity to promote a culture of research knowledge and evidence use within the HSE.

NHS England designs and administers improvement and assurance schemes that include elements to incentivize prudent use of antimicrobials, optimise patient outcomes, minimise avoidable exposure to antimicrobials, and reduce selection pressure for antimicrobial resistance (AMR). These schemes include the NHS System Oversight Framework, the Pharmacy Quality Scheme for community pharmacies, the NHS Standard Contract, and the Commissioning for Quality and Innovation (CQUIN) framework. This report describes the schemes implemented from 2021 to 2022, and it reports the scheme performance of NHS commissioners and healthcare provider organisations. A summary of improvement and assurance schemes from 2022 to 2023 is also provided.

Abstract Background Prolonged sitting, a significant risk factor for increased morbidity and mortality, is accumulated mostly in the workplace. There is limited research targeting specific at-risk populations to reduce occupational sedentary behaviour. A recent study found that professional males have the longest workplace sitting times. Current evidence supports the use of multi-level interventions developed using participative approaches. This study’s primary aims are to test the viability of a future definitive intervention trial using a randomised pilot study, with secondary aims to explore the acceptability and feasibility of a multicomponent intervention to reduce workplace sitting. Methods Two professional companies in Dublin, Ireland, will take part in a cluster randomised crossover pilot study. Office-based males will be recruited and randomised to the control or the intervention arms. The components of the intervention target multiple levels of influence including individual determinants (via mHealth technology to support behaviour change techniques), the physical work environment (via provision of an under-desk pedal machine), and the organisational structures and culture (via management consultation and recruitment to the study). The outcomes measured are recruitment and retention, minutes spent sedentary, and physical activity behaviours, work engagement, and acceptability and feasibility of the workplace intervention. Discussion This study will establish the acceptability and feasibility of a workplace intervention which aims to reduce workplace SB and increase PA. It will identify key methodological and implementation issues that need to be addressed prior to assessing the effectiveness of this intervention in a definitive cluster randomised controlled trial.

Abstract Background Eating outside the home contributes to poor dietary habits worldwide and is associated with increased body fat and weight gain. Evidence shows menu labelling is effective in promoting healthier food choices; however, implementation issues have arisen. The purpose of this systematic review was to synthesise the evidence on the perceived barriers and facilitators to implementation of menu labelling interventions from the perspective of the food service industry. Methods Peer-reviewed and grey literature were searched using databases, specialised search engines and public health organisation websites. Screening reference lists, citation chaining and contacting authors of all included studies were undertaken. Primary research studies relevant to direct supply-side stakeholders were eligible for inclusion. There were no restrictions on menu labelling scheme or format, study methods, publication year or language. At least two independent reviewers performed study selection, data extraction and quality appraisal. The results were synthesised using the ‘best fit’ framework synthesis approach, with reference to the Consolidated Framework for Implementation Research (CFIR). Results Seventeen studies met the eligibility criteria, with the majority rated as average quality (n = 10). The most frequently cited barriers were coded to the CFIR constructs ‘Consumer Needs & Resources’ (e.g. lack of customer demand for/interest in menu labelling, risk of overwhelmed/confused customers) and ‘Compatibility’ with organisation work processes (e.g. lack of standardised recipes, limited space on menus). Frequently cited facilitators were coded to the CFIR constructs ‘Relative Advantage’ of menu labelling (e.g. improved business image/reputation) and ‘Consumer Needs & Resources’ (e.g. customer demand for/interest in menu labelling, providing nutrition information to customers). An adapted framework consisting of a priori and new constructs was developed, which illustrates the relationships between domains. Conclusion This review generates an adapted CFIR framework for understanding implementation of menu labelling interventions. It highlights that implementation is influenced by multiple interdependent factors, particularly related to the external and internal context of food businesses, and features of the menu labelling intervention. The findings can be used by researchers and practitioners to develop or select strategies to address barriers that impede implementation and to leverage facilitators that assist with implementation effort. Trial registration Systematic review registration: PROSPERO CRD42017083306 .

Background: Brief behavioural interventions offered by healthcare professionals to target health behavioural risk factors (e.g. physical activity, diet, smoking and drug and alcohol use) can positively impact patient health outcomes. The Irish Health Service Executive (HSE) Making Every Contact Count (MECC) Programme supports healthcare professionals to offer patients brief opportunistic behavioural interventions during routine consultations. The potential for MECC to impact public health depends on its uptake and implementation. Aim: This protocol outlines the ‘Making MECC Work’ research programme, a HSE/Health Behaviour Change Research Group collaboration to develop an implementation strategy to optimise uptake of MECC in Ireland. The programme will answer three research questions: (1) What determines delivery of MECC brief interventions by healthcare professionals at individual and organisational levels? (2) What are patient attitudes towards, and experiences of, receiving MECC interventions from healthcare professionals? (3) What evidence-informed implementation strategy options can be consensually developed with key stakeholders to optimise MECC implementation? Methods: In Work Package 1, we will examine determinants of MECC delivery by healthcare professionals using a multi-methods approach, including: (WP1.1) a national survey of healthcare professionals who have participated in MECC eLearning training and (WP1.2) a qualitative interview study with relevant healthcare professionals and HSE staff. In Work Package 2, we will examine patient attitudes towards, and experiences of, MECC using qualitative interviews. Work Package 3 will combine findings from Work Packages 1 and 2 using the Behaviour Change Wheel to identify and develop testable implementation strategy options (WP 3.1). Strategies will be refined and prioritised using a key stakeholder consensus process to develop a collaborative implementation blueprint to optimise and scale-up MECC (WP3.2). Discussion: Research programme outputs are expected to positively support the integration of MECC brief behaviour change interventions into the Irish healthcare system and inform the scale-up of behaviour change interventions internationally.

Abstract Background Tobacco use is the leading cause of preventable death in Ireland with almost 6000 smokers dying each year from smoking-related diseases. The ‘We Can Quit2’ (WCQ2) study is a pilot pragmatic two-arm, parallel-group, cluster randomised trial that aims to explore the feasibility and acceptability of trial processes including recruitment and to estimate parameters to inform sample size estimates needed for an effectiveness trial. This future trial will assess the effectiveness of a community-based smoking cessation intervention for women living in disadvantaged areas on short- and medium-term cessation rates. Methods/design Four matched pairs of districts (eight clusters) selected by area level of deprivation, geographical proximity, and eligibility for free medical services will be randomised to receive either WCQ (behavioural support + access to Nicotine Replacement Therapy (NRT)) delivered over 12 weeks by trained Community Facilitators (CFs) or to a form of usual care, a one-to-one smoking cessation service delivered by Smoking Cessation Officers from Ireland’s national health service, the Health Service Executive (HSE). Within each cluster, 24–25 women will be recruited (97 per arm; 194 in total) in 4 phases with consent obtained prior to cluster randomisation. The outcome measures will assess feasibility and acceptability of trial processes, including randomisation. Outcome data for a future definitive intervention (biochemically validated smoking abstinence) will be collected at end of programme (12 weeks) and at 6 months. WCQ2 has an embedded process evaluation using both qualitative and quantitative methods. This will be conducted (semi-structured client and CF interviews, intervention delivery checklist, and diary) to explore acceptability of trial processes, intervention fidelity, trial context, and implementation. Trial processes will be assessed against domains of the PRECIS-2 wheel to inform a future definitive trial design. Discussion Data from this pilot trial will inform the design and sample size for a full cluster randomised trial to determine the effectiveness of an intervention tailored to disadvantaged women in improving smoking cessation rates. It will provide transferable learning on the systems and implementation strategies needed to support effective design of future pragmatic community-based trials which address health promotion interventions for women in disadvantaged communities. Trial registration Concurrent to publication. Controlled trials ISRCTN74721694.

Abstract Background Sedentary behaviour (SB) has been linked with detrimental effects on morbidity and mortality. This study aims to identify the individual, social and environmental correlates of total sedentary behaviour and the contexts in which sitting time accumulates in an Irish adult cohort. Methods Cross-sectional analysis of data from 7328 adults of the nationally representative Healthy Ireland Survey. Ordinal regression analyses were used to examine participants’ socio-demographic characteristics, lifestyle factors, physical and mental health status, perceived neighbourhood environmental factors, and their association with total daily sitting times and sitting times across the domains of occupation, leisure screen-time and transportation/leisure. Results Overall median of sitting time per day was 450 min (7.5 h). Male gender, and living in an urban location were associated with increased total-, occupational, and screen-time sitting (p

Introduction: Concomitant with the rate at which the United Kingdom’s population is aging, the increased number of older adults with dementia, and the decrease in relatives who are available to care for these older adults, there has been an exponential rise in the need for healthcare assistants in the workforce. Since the workforce now comprises of a significant number of migrant healthcare workers, some of whom originate from developing countries like Nigeria, it is important to understand some sociocultural factors that may influence the quality of caregiving provided for older adults with dementia in the United Kingdom. Objective: To gain an in-depth understanding of dementia perceptions and experiences of Nigerian migrant formal dementia caregivers. Setting: North East England. Participants: Six Nigerian migrant healthcare workers employed in long-term care facilities (e.g., nursing homes) that have older adults with dementia. Methods: Qualitative descriptive method embedded in symbolic interactionism, following a purposive sampling technique and recruitment to the study was used. Semi-structured interviews and thematic analysis were conducted for data collection and analysis respectively. Results: Cultural specificity, dementia awareness, and empathic witnessing were identified as the three major themes in the findings. The findings suggest that meanings given to dementia symptoms are influenced by sociocultural factors and they may ultimately affect the way people with dementia are cared for. Discussion: Minimal knowledge about dementia consequently results in minimal appreciation or regard for the seriousness and importance of dementia. When people from communities with different meanings of dementia and little knowledge of the condition become caregivers in developed countries, there may potentially be new psychological burdens that originate from the differing contextual significance of dementia and caregiving for persons with dementia. Keywords: Care, Culture, Dementia, Dementia perceptions, Migrant dementia-caregivers, Nigeria, Psychological burden, Qualitative study, United Kingdom

Abstract Background Older people can struggle with revealing their depression to GPs and verbalising preferences regarding its management. This contributes to problems for GPs in both detecting and managing depression in primary care. The aim of this study was to explore older people’s accounts of how they talk about depression and possible symptoms to improve communication about depression when seeing GPs. Methods Adopting a qualitative Interpretivist methodological approach, semi-structured interviews were conducted by IG based on the principles of grounded theory and situational analysis. GPs working in north east England recruited patients aged over 65 with depression. Data analysis was carried out with a process of constant comparison, and categories were developed via open and axial coding and situational maps. There were three levels of analysis; the first developed open codes which informed the second level of analysis where the typology was developed from axial codes. The typology derived from second level analysis only is presented here as older people’s views are rarely reported in isolation. Results From the sixteen interviews with older people, it was evident that there were differences in how they understood and accepted their depression and that this influenced what they shared or withheld in their narratives. A typology showing three categories of older people was identified: those who appeared to talk about their depression freely yet struggled to accept aspects of it (Superficial Accepter), those who consolidated their ideas about depression aloud (Striving to Understand) and those who shared minimal detail about their depression and viewed it as part of them rather than a treatable condition (Unable to Articulate). The central finding was that older people’s acceptance and understanding of their depression guided their depression narratives. Conclusions This study identified differences between older people in ways they understand, accept and share their depression. Recognising that their depression narratives can change and listening for patterns in what older people share or withhold may help GPs in facilitating communication to better understand the patient when they need to implement alternative approaches to patient management.

ObjectiveTo explore the attitudes towards, and perceptions of, primary care healthcare staff and patients, regarding the role of clinical pharmacists in the provision of oral health advice and collaboration with dentists in general practice.DesignInterpretivist methodology using qualitative semi-structured interviews and focus groups.Participants22 participants; 10 pharmacists; 3 general practitioners; 2 nurses; 1 practice manager; 6 patients.SettingPrimary care general medical practices in the North East of England and the University of Sunderland Patient Carer and Public Involvement group.MethodsOne-to-one semi-structured interviews were performed with primary care healthcare staff. An iterative approach using constant comparative analysis facilitated the ongoing enrichment of data; salient themes were identified using Framework Analysis and related back to extant literature. A focus group was held with patients to further explore key themes.ResultsFour salient and inter-related themes emerged: enhanced clinical roles; indicating rapidly changing roles of pharmacists working in general practice, increased responsibility and accountability of pharmacist prescribers and the delivery of advanced clinical services; limited knowledge; indicating basic understanding of appropriate oral health advice, but limited insight and provision of advice to patients with regards to links with systemic diseases and medication; geographical/situational isolation of the dental team; indicating the disparate contexts and challenges of multidisciplinary working in oral health, and patients’ attitudes towards dental care; integration of oral health advice; indicating the potential of pharmacists to integrate oral health advice into current roles and to target specific patient groups in practice.ConclusionsThe lack of integration between oral and general healthcare services potentially impacts negatively on patient care, requiring further interprofessional oral health education. The developing role of the pharmacist in general practice represents an opportunity to integrate oral health advice and/or interventions into the management of patients in this setting.

Tobacco use is the leading cause of preventable death in Ireland with almost 6,000 smokers dying each year from smoking-related diseases. Amongst younger Irish women, smoking rates are considerably higher in those from socially disadvantaged areas compared to women from affluent areas. Women from poorer areas also experience higher rates of lung cancer. To our knowledge, there are no peer reviewed published systematic reviews on the effectiveness of interventions tailored to reduce smoking rates in women from disadvantaged areas. This systematic review protocol will aim to examine the effectiveness of such interventions and to describe trial processes such as recruitment, follow-up and dropout prevention strategies, as well as barriers and enablers of successful implementation. A systematic review will be conducted of peer-reviewed randomised controlled trials and associated process evaluations of smoking cessation interventions designed for women living in socially disadvantaged areas. If the search returns, less than five studies are review criteria will expand to include quasi-experimental studies. A number of databases of scholarly literature will be searched from inception using a detailed search strategy. Two independent reviewers will screen titles, abstracts and full-text articles to identify relevant studies using a pre-defined checklist based on PICOS. In the case of disagreement, a third reviewer will be consulted. The quality of included studies will be assessed using the ‘Grading of Recommendations Assessment, Development and Evaluation’ (GRADE) criteria. Quantitative data will be extracted and, if comparable, will be assessed using meta-analysis. A narrative meta-synthesis of qualitative data will be conducted. This review aims to synthesise information from relevant studies on smoking cessation interventions tailored for women from socially disadvantaged areas. The evidence obtained from studies and presented in this review will help guide future research in this area. Registration: This review will be registered with International Prospective Register of Systematic Reviews (PROSPERO).

Abstract Background Menu labelling is continuing to gather public and legislative support as one of the potential environmental strategies for addressing the obesity pandemic. However, issues relating to implementation have been reported in countries where menu labelling has been introduced on a voluntary or mandatory basis. The aim of this mixed methods systematic review is to synthesise the empirical evidence on the barriers and facilitators to implementation of menu labelling interventions to support healthy food choices. Methods This review will use the ‘best fit’ framework synthesis approach to synthesise qualitative, quantitative and mixed methods evidence. Peer-reviewed publications will be accessed through PubMed, EMBASE, CINAHL, PsycINFO, Web of Science and Scopus. Grey literature will be accessed through Google Scholar, OpenGrey, RIAN, EThOS, ProQuest, WorldCat, Networked Digital Library of Theses and Dissertations, Open Access Theses and Dissertations, and public health organisation websites. Screening reference lists, citation chaining and contacting authors of all included studies will be undertaken. There will be no restriction on menu labelling scheme or format, publication year or language; however, only primary research studies relevant to supply-side stakeholders will be eligible for inclusion. Study quality will be assessed using the Mixed Methods Appraisal Tool. At least two independent reviewers will perform study selection, data extraction and quality appraisal; if consensus is required, another independent reviewer will be consulted. A combination of deductive coding, using the Consolidated Framework for Implementation Research as the a priori framework, and inductive analysis, using secondary thematic analysis, will be used. The overall process will assist in the construction of a new evidence-based conceptual model regarding the implementation of menu labelling interventions. The new model will be assessed for bias and a sensitivity analysis performed. Discussion Given the growing consensus that a systemic, sustained portfolio of obesity prevention strategies, delivered at scale, is needed to address the obesity epidemic, greater understanding of the practical issues relating to implementation of such strategies is required. Findings from this review will be used to develop a set of best-practice guidelines to enhance the adoption, implementation and sustainability of menu labelling interventions across countries worldwide. Systematic review registration PROSPERO CRD42017083306

The level of ambiguity in describing glycan structure has significantly increased with the upsurge of large-scale glycomics and glycoproteomics experiments. Consequently, an ontology-based model appears as an appropriate solution for navigating these data. However, navigation is not sufficient and the model should also enable advanced search and comparison. A new ontology with a tree logical structure is introduced to represent glycan structures irrespective of the precision of molecular details. The model heavily relies on the GlycoCT encoding of glycan structures. Its implementation in the GlySTreeM knowledge base was validated with GlyConnect data and benchmarked with the Glycowork library. GlySTreeM is shown to be fast, consistent, reliable and more flexible than existing solutions for matching parts of or whole glycan structures. The model is also well suited for painless future expansion.

Abstract Background The uptake, implementation, and maintenance of effective interventions promoting physical activity (PA) and a healthy diet and the implementation of policies targeting these behaviors are processes not well understood. We aimed to gain a better understanding of what health promotion professionals and policy makers think are important factors facilitating adoption, implementation, and maintenance of multi-level interventions and policies promoting healthy eating and PA in Belgium, Germany, Ireland, Norway, and Poland. Methods Six interventions and six policies were identified based on pre-defined criteria. Forty semi-structured interviews were conducted with stakeholders from various sectors to elicit information on factors impacting adoption, implementation, and maintenance of these interventions and policies. All interview transcripts were coded in NVivo, using a common categorization matrix. Coding in the respective countries was done by one researcher and validated by a second researcher. Results Active involvement of relevant stakeholders and good communication between coordinating organizations were described as important factors contributing to successful adoption and implementation of both interventions and policies. Additional facilitating factors included sufficient training of staff and tailoring of materials to match needs of various target groups. The respondents indicated that maintenance of implemented interventions/policies depended on whether they were embedded in existing or newly created organizational structures in different settings and whether continued funding was secured. Conclusions Despite considerable heterogeneity of interventions and health policies in the five countries, stakeholders across these countries identify similar factors facilitating adoption, implementation, and maintenance of these interventions and policies.

Foodborne diseases are a global burden, are preventable, and young people are a key population for behaviour change as they gain autonomy. This study aimed to explore young people’s needs across several European countries in relation to learning about and implementing food hygiene and food safety. Qualitative focus groups and interviews were conducted in rural and city regions across England, France, Hungary and Portugal. Data were collected to attain data saturation, transcribed, thematically analysed, and mapped to the Theoretical Domains Framework. Twenty-five out of 84 schools approached (29.8%) participated, with data collected from 156 11–18-year-old students. Students had good knowledge of personal hygiene but did not always follow hygiene rules due to forgetfulness, lack of facilities or lack of concern for consequences. Students had limited understanding of foodborne microbes, underestimated the risks and consequences of foodborne illness and perceived the “home” environment as the safest. Young people preferred interactive educational methods. Addressing gaps in young people’s food safety knowledge is essential to improve their lack of concern towards foodborne illness and motivate them to follow food hygiene and safety behaviours consistently. Findings have been used to develop educational resources to address gaps in knowledge, skills, attitudes and beliefs.

Background: Promotion of good nutrition is essential for reducing the risk of chronic disease and premature death. Evidence shows menu labeling interventions should be implemented in workplaces as part of a comprehensive approach to improve employees’ dietary habits; however, implementation challenges have arisen. This article describes a protocol for a multiple case study to explore the factors that impact on implementation of a calorie menu labeling policy in Irish public hospitals. Methods: Using a multiple case study design, comprising four Irish acute public hospitals, this study will draw on multiple perspectives and sources of evidence (observations followed by interviews, focus groups, and documentary analysis) to allow for a comprehensive depth and breadth of inquiry. Data collection and analysis will be guided by the Consolidated Framework for Implementation Research, bringing together constructs from implementation theories to understand the complexity of implementing policies. Hospitals will be categorized into high and low implementers of the policy based on quantitative data obtained from structured observations. Using framework analysis, within- and cross-case analyses will be performed to identify factors influencing policy implementation and to identify distinguishing patterns across high and low implementers and across hospital direct and indirect stakeholders. Strategies will be employed to ensure rigorous case study research, for example, triangulation, audit trail, reflexivity, and thick descriptions. An integrated knowledge translation approach, where researchers work with stakeholders throughout the research process, will be adopted to facilitate the translation of research into policy and practice. Discussion: This protocol highlights methodological insights in utilizing case study research to gain a greater understanding of the menu labeling implementation process. Study findings will be relevant to policy makers and other stakeholders involved in the rollout of such interventions and will provide a foundation to select and tailor implementation strategies to assist with scale-up of calorie menu labeling across the health service.

IntroductionChildhood obesity is a public health challenge. There is evidence for associations between parents’ feeding behaviours and childhood obesity risk. Primary care provides a unique opportunity for delivery of infant feeding interventions for childhood obesity prevention. Implementation strategies are needed to support infant feeding intervention delivery. The Choosing Healthy Eating for Infant Health (CHErIsH) intervention is a complex infant feeding intervention delivered at infant vaccination visits, alongside a healthcare professional (HCP)-level implementation strategy to support delivery.Methods and analysisThis protocol provides a description of a non-randomised feasibility study of an infant feeding intervention and implementation strategy, with an embedded process evaluation and economic evaluation. Intervention participants will be parents of infants aged ≤6 weeks at recruitment, attending a participating HCP in a primary care practice. The intervention will be delivered at the infant’s 2, 4, 6, 12 and 13 month vaccination visits and involves brief verbal infant feeding messages and additional resources, including a leaflet, magnet, infant bib and sign-posting to an information website. The implementation strategy encompasses a local opinion leader, HCP training delivered prior to intervention delivery, electronic delivery prompts and additional resources, including a training manual, poster and support from the research team. An embedded mixed-methods process evaluation will examine the acceptability and feasibility of the intervention, the implementation strategy and study processes including data collection. Qualitative interviews will explore parent and HCP experiences and perspectives of delivery and receipt of the intervention and implementation strategy. Self-report surveys will examine fidelity of delivery and receipt, and acceptability, suitability and comprehensiveness of the intervention, implementation strategy and study processes. Data from electronic delivery prompts will also be collected to examine implementation of the intervention. A cost–outcome description will be conducted to measure costs of the intervention and the implementation strategy.Ethics and disseminationThis study received approval from the Clinical Research Ethics Committee of the Cork Teaching Hospitals. Study findings will be disseminated via peer-reviewed publications and conference presentations.

ObjectiveTo explore general dental practitioners’ (GDPs’) perceptions of, and attitudes towards, the risks of medication-related osteonecrosis of the jaw (MRONJ) and the current/potential multidisciplinary approach(es) to prevention of the condition.DesignInterpretivist methodology using a grounded theory approach and constant comparative analysis to undertake an iterative series of semistructured interviews. Ritchie and Spencer’s framework analysis facilitated the identification and prioritisation of salient themes.SettingPrimary care general dental practices in the North East of England.Participants15 GDPs.ResultsGDPs are aware of the risk of MRONJ with commonly implicated medicines; however, they report limited collaboration between professional groups in person-centred avoidance of complications, which is a key requirement of the preventive advice recommended in extant literature. Four salient and inter-related themes emerged: (1) perception of knowledge; indicating the awareness of the risk, limited knowledge of implicated medications and experience of managing the condition; (2) risk; indicating the importance of accurate medication histories, the treatment of low risk patients in primary dental care, counselling of poorly informed patients, the fear of litigation and perceived low priority of oral health in the context of general health and well-being; (3) access and isolation; referring to access to general medical records, professional isolation and somewhat limited and challenging professional collaborative relationships; (4) interprofessional working; indicating oral health education of other professional groups, collaboration and communication, and a focus on preventive care.ConclusionsPatients continue to be at risk of developing MRONJ due to limited preventive interventions and relatively disparate contexts of multidisciplinary team healthcare. Effective collaboration, education and access to shared medical records could potentially improve patient safety and reduce the potential risk of developing MRONJ.

Background: Issues with questionnaire completion introduce bias and limit examinations in trials. Improving communication with participants about trial processes, such as outcome and questionnaire development, may improve questionnaire completion and response rates. Providing information about the involvement of stakeholders in the development of core outcome sets (COS) measured in trials may improve responding by tapping into subjective norms and behaviour change mechanisms. The aim of this Study Within a Trial (SWAT) is to examine if questionnaire response rates and participants’ attitudes towards questionnaire completion are impacted by providing information about COS use in a trial of a complex intervention. Methods: This is a randomised, single-blinded, parallel group intervention SWAT, embedded within a feasibility trial of an infant feeding intervention to prevent childhood obesity. The SWAT intervention consists of a brief written description and explanation about the development and use of a COS of infant feeding outcomes to prevent childhood obesity, used in the trial. Participants are parents or caregivers of infants aged two months at questionnaire completion. Participants will be randomly assigned to receive the SWAT intervention prior to questionnaire completion (SWAT Intervention), or not (SWAT Comparator). The primary outcome of interest is response rates, which will be measured as proportion of questionnaire completion and individual item response rates. Participants’ attitudes will also be assessed using closed-ended and an open-ended question to evaluate participants’ attitudes about questionnaire completion. Discussion: We hypothesise that providing information about development and use of a COS will increase questionnaire response rates and attitudes toward questionnaire completion relative to the control condition. Findings will indicate the potential usefulness of this strategy for improving participant attitudes and response rates in trials. Trial Registration: This SWAT is registered on the Northern Ireland Hub for Trials Methodology: Research SWAT Repository ( SWAT57).

Using a Participatory Action Research (PAR) approach, this evaluative research study gives an insight into the implementation of a pilot study of a newly implemented Peer Assisted Student Support (PASS) and Supplemental Instruction (SI) Programme. The focus of the study involved six postgraduate PhD students delivering a PASS/SI scheme to cohorts of MSc Public Health, MSc Nursing and MSc Psychosis and Complex Mental Health Interventions students, all undertaking their final dissertations.The study was used to illuminate the degree to which PASS and SI were perceived to impact on the overall student experience as part of a quality enhancement initiative. Findings of the study revealed that the programme had positively impacted on both PASS/SI leaders and participants of the scheme, who reported increased confidence and an increased sense of social inclusion and belonging to the institution respectively. Being facilitated by students who had experienced the same academic pathway was perceived to have widened networking opportunities and to have positively impacted on the capacity of the participants and leaders to build relationships and prepare skills of direct relevance to the requirements of an employer such as teamwork and initiative.

We are a group of researchers and academics with decades of experience in the protection and promotion of public health. We are writing to raise our concerns about how conflicts of interest are reported in public health nutrition research. We highlight examples of why it is important to accurately declare such conflicts, as well as providing examples of situations in which conflicts of interest have been inadequately reported. We call on researchers, and others, to be transparent about conflicts of interest in research. Journal editors in particular have an important responsibility in fully understanding how conflicts of interest can impact on research findings and interpretations. They need to agree and adopt clear guidelines on conflicts of interest and ensure that authors abide by these to facilitate trust in the scientific process and the credibility of published articles.

Introduction: Type 2 Diabetes Mellitus (T2DM) is often a preventable type of Diabetes Mellitus (DM). However, if developed, can be managed effectively, even at a low-or-no cost. A critical evaluation of the literature on T2DM management in Nigeria reveals sparse evidence-base surrounding external and internal context-specific factors influencing T2DM management in public hospitals across Nigeria. Identification of these factors is crucial to health policy, research, and patient management. This review provides holistic evidence about the influencing factors in public hospitals across Nigeria. Methods: We synthesised quantitative studies on T2DM management, published between 2006 and 2016 in Nigerian public hospitals. Searches of PsycINFO, EMBASE, and Google Scholar databases were undertaken, alongside the African Journals Online (AJOL) and the Cochrane Library resources. The websites of the World Health Organisation African Region (WHO, AFR) and International Diabetes Federation African Region (IDF, AFR) were also searched. The Critical Appraisal Skills Programme (CASP) and Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) checklists were used for quality appraisal and report. Results: This review revealed factors such as non-adherence/non-compliance (20 studies), self-care related (9 studies), psychological-related (6 studies), social-related (6 studies), cost-related (6 studies) and drug-related (3 studies). Impacts of these factors on patient health outcome were elevated glycaemic levels, poor self-management skills, early development of DM complications, and loss of trust in clinical management as well as high mortality rate. Conclusion: The outcome of this review offers practical recommendations for policy review and suggestions for potential change implementation to improve T2DM patient management in the context of clinical practice. Keywords: Factors, Influencing, Type 2 Diabetes Mellitus, Management, Nigeria

We are a group of researchers and academics with decades of experience in the protection and promotion of public health. We are writing to raise our concerns about how conflicts of interest are reported in public health nutrition research. We highlight examples of why it is important to accurately declare such conflicts, as well as providing examples of situations in which conflicts of interest have been inadequately reported. We call on researchers, and others, to be transparent about conflicts of interest in research. Journal editors in particular have an important responsibility in fully understanding how conflicts of interest can impact on research findings. They need to agree and adopt clear guidelines on conflicts of interest and ensure that authors abide by these to facilitate trust in the scientific process and the credibility of published articles.

Purpose: The aim of the study is to explore perceptions of the impact of assessment feedback by international undergraduate nursing students. Research to date indicates that summative assessment feedback may impact significantly on student achievement but if it is undertaken sub optimally or does not provide students with the opportunity to engage with the process and reflexively respond, it can also be exceptionally damaging to the learning experience. Design/methodology/approach: A scoping exercise of overall student feedback experience was initially collated via the adoption of an Interpretive Phenomenological Approach (IPA). Participants were recruited via purposive sampling and the LEGO® Serious Play® method was used to collect data. Analysis with Quirkos software was used to examine the salience as well as commonality of findings as an integral part of a recognised five-step thematic analytical approach. Findings: Feedback was perceived, by students, as significantly impacting factor in relation to their overall progression, attainment and retention rates. Themes generated from the findings evidenced student perceptions that summative feedback is a positive driver and source of motivation for academic success and progression. It was perceived that levels of attainment were related to the clarity, quality and individualised nature of feedback that students received and that this was perceived to be evident in their final grades. These were accompanied by perceptions that feedback clarity also determined the potential of breaking down perceived student barriers to learning, their perceived capacity for effective assignment planning and preparation and the likelihood of them having any positive collective or individual interpersonal relationships with their tutors. Summarised, students perceived that feedback ought to lead to student empowerment in managing their studies and as such it ought to be clear, straightforward and non-ambiguous. Research limitations/implications: The methodological design of the study means that generalisability from its findings was never intended or possible. However, there may be the potential transferability of findings to similar institutions and contexts of nurse education with students who have similar demographic profiling. The study was also a means of providing an insight into the lived experience of students which could be used in the prospective adaptation of feedback mechanisms for staff at a local level within Higher Education. Practical implications: The study reveals the perceived impact of gamification as a mechanism of summative assessment as conveyed by a designated group of students. Whilst specific recommendations for change can only be made within the context specificity of the research, there may be aspects of the findings which are potentially transferable to other similar contexts of Higher Education delivery whose pedagogical approaches mirror those in operation at the institution where the research was undertaken. It became apparent that the standardisation of feedback approaches offered many opportunities to improve existing systems. The issue of monitoring workloads is also of significance in terms of the level and degree of summative assessment and feedback that academic staff can undertake. Originality/value: The study revealed the perceived magnitude of assessment feedback on progression, attainment and retention rates, alongside the perceived need for a universal feedback template and the opportunity to provide audio-video feedback. This study adds to existing knowledge in the field of pedagogic practice about both the execution of LEGO® Serious Play® as a research methodology and why the perceptions of feedback as articulated and illuminated by a group of contemporary nursing students ought to matter in the context of Higher Education.

Acknowledging retrospective experiential learning as a unique contribution to knowledge in the context of the workplace is the fundamental focus of the work-based professional doctorate. This report details an evaluation of a 'Second Generation' professional doctorate programme. The programme provides a mechanism for both learning development and the acknowledgement and development of pre-existing, discipline-specific, professional practice. Evaluation was used as a means of highlighting how the theory-praxis gap might be bridged via translational knowledge construction. Semi-structured interviews were undertaken with eleven doctoral candidates to explore their experiences and perceptions of the programme. The interviews were then transcribed and thematically analysed during which a 'base superstructure model' was identified. This model identified the underpinning skills of critical reflection, investigation and adaptive capacity necessary to inform and facilitate the research phase of the professional doctorate programme. The facilitation and upskilling of doctoral candidates in the use of emergent technology was identified as the basis for the development of professional and academic practice. The role of the doctoral supervisor, as a facilitator of the development of these skills, was also established as pivotal to learning development for doctoral candidates; in terms of developing their 'base super-structure' to become independent, reflective and adaptive learners.

This study reports on the findings of a mixed methods study that was undertaken to establish student perceptions of academic learning environments and the perceived impact of these on their articulation of employability skills. This was so student perspectives on employability could be used to inform reflection on pedagogic practices for their educators in higher education. Using a purposive sample of 250 students based in a recently modernised Sciences Complex Building in a Higher Education Institution (HEI), the study was cross sectional and descriptive by design. The social learning spaces researched were perceived by participants to provide optimal academic learning environments for their development of knowledge, skills and professionalism through certain signature pedagogies as they progressed through their programmes of study. Students also expressed the view that their acquisition of functional skills were significantly more important than any personal attributes/characteristics that they brought to programmes. What also mattered was whether the importance of certain graduate skills to the workplace had been made explicit to them so that they could see the relevance of their studies to practice. In defining 'graduateness', in employability terms the research concluded that it was necessary to consider how it was shaped by the context of delivery of subject disciplines, stages of academic progression, and the use of social learning spaces, as they all had a significant impact on the perceptions students held about their potential employability upon completion of their academic programmes.

Children frequently refrain from disclosing being bullied. Early identification of bullying by healthcare professionals in children may prevent adverse health consequences. The aim of our study was to determine whether Health Care Utilisation (HCU) is higher in 9-year-olds who report being bullied and factors influencing type of HCU. The study consists of cross-sectional surveys of Child Cohort of Irish National Longitudinal Study of Children (Wave 1), 8,568 9-year-olds, and their carers. Being bullied was assessed by a self-reported questionnaire completed by children at home. HCU outcomes consisted of the following: visits to GP, Mental Health Practitioner (MHP), Emergency Department (ED), and nights in hospital by parent interview. Bivariate logistic regression and gender-stratified Poisson models were used to determine association. Victimisation by bullying independently increased visits to GP (OR 1.13, 95% confidence interval (CI): 1.03 to 1.25; p = 0.02), MHP (OR 1.31, 95% CI: 1.05 to 1.63; p = 0.02), though not ED visits (OR 0.99, 95% CI: 0.87 to 1.13; p = 0.8) or nights in hospital (OR 1.07 95% CI: 0.97 to 1.18; p = 0.2), adjusting for underlying chronic condition(s) and socio-demographic confounders. Victimised girls made higher GP visits (RR 1.14, 95% CI: 1.06 to 1.23; p < 0.001) and spent more nights in hospital (RR 1.10, 95% CI: 1.04 to 1.15; p < 0.001). Victimised boys were more likely to contact MHPs (RR 1.21, 95% CI: 1.02 to 1.44; p = 0.03). 9-year-old bullied subjects were more likely to utilise primary care services than non-bullied 9-year-olds. Different HCU patterns were observed according to gender and gender differences in the presentation of victimisation. Our findings may lead to the development of clinical practice guidelines for early detection and appropriate management of bullied children.

This paper explores autoethnography within the context of the professional doctorate and argues that it is an excellent way of linking theory to the practical situation. The paper commences by defining the ââ¬Ësecond generationââ¬â¢ of professional doctorates (Maxwell, 2003) where the focus is directed primarily to work-based learning and the development of work-based practice. Candidates are expected to demonstrate the development of practice and their contribution to this in a fundamentally original approach. The researcher is central in the practical or work-based situation and the process of autoethnography can structure and guide the research process, by providing structure to the process of reflexivity. The paper considers two broad approaches to autoethnography: the traditional approach and the post-modernist approach. The post-modernist approach presents challenges in the ways in which the work is presented: a central argument of the paper is that despite the novel ways of presentation, the work should have a strong theoretical base. The paper concludes by summarising the role of autoethnography in the professional doctorate: autoethnography provides a factually accurate and comprehensive overview of the professional doctorate candidateââ¬â¢s career trajectory. It should act as a driver of self-explication for the professional doctorate student thus providing a degree of both catalytic and educative authenticity, and provide an insight for the reader of the professional doctoral thesis.

This study reports on the evaluation, using a phenomenological approach, of a hybrid model of PBL, implemented with a cohort of fifteen students. Semi-structured interviewing provided an interpretive basis for the lived experience of teaching and learning in the context of a Masters Degree programme designed specifically for multidisciplinary postgraduate healthcare education. The findings point towards a differentiation of attitude from behaviour and are grouped into three themes of ââ¬ËProfessionalism and the Value of Characterââ¬â¢, ââ¬ËPerceived Cognitive Development and Meaningful Learningââ¬Ë and the ââ¬ËSituatedness of Learning and Knowledge Transferââ¬â¢. àIt was perceived by students that professionalism could be learned through the process of PBL, although they did not necessarily feel familiar or comfortable when this process was new to them. They perceived the major benefit of using a hybrid PBL as a teaching strategy was that it afforded all students in the cohort a means of being valued in their contribution to the sessions and in their wider contribution to a multi-disciplinary workforce. The significant degrees to which both interprofessional learning and the adoption of a multidisciplinary approach had impacted upon student engagement were the two most salient outcomes of the study