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Background The prevalence of psychological morbidity among asylum seekers and refugees is high, but these groups encounter extensive barriers to accessing health and social care. The aim of the PROSPER study was to assess the feasibility of conducting a randomised controlled trial in the UK of Problem Management Plus (PM+), an evidence-based psychosocial intervention delivered by lay therapists for distressed and functionally impaired asylum seekers and refugees. Design We undertook a feasibility study of PM+, which included a pilot study of the design features of a future definitive randomised controlled trial and economic evaluation. The feasibility study involved the adaptation of PM+ based on evidence drawn from literature synthesis and local stakeholder engagement, and a two-stage training procedure for lay therapists. These were followed by a pilot trial designed to assess the feasibility of conducting a three-arm randomised controlled trial of five 90-minute sessions of PM+, delivered individually or in groups, with 105 participants randomised 1 : 1 : 1 to individual PM+, group PM+ or a control intervention. Primary health outcomes were anxiety and depressive symptoms at 3 months; other outcomes included post-traumatic stress disorder symptoms, quality of life, progress with identified goals and service use. Findings We demonstrated that the form and content of PM+ could be adapted to meet the needs of asylum seekers and refugees. Twelve people with lived experience of the asylum process were successfully trained as lay therapists to deliver this targeted, low-intensity psychosocial intervention in local asylum seeker and refugee communities. The pilot trial was affected by governance issues. It began in December 2019 and was cut short by the COVID-19 pandemic. We were not able to complete recruitment and follow-up as planned; 11 out of 105 (10%) participants were recruited to the pilot trial (individual PM+, n = 4; group PM+, n = 3; control, n = 4); 8 out of 11 participants were followed up at 13 weeks and 7 out of 11 participants were followed up at 26 weeks. (Preliminary data were gathered on recruitment and retention, intervention fidelity and acceptability of study measures, including service use measures.) Limitations Protracted delays due to governance issues, followed by the COVID-19 pandemic, meant that we were unable to complete the pilot trial or to provide evidence regarding the feasibility of group PM+. The complexities of working with multiple languages and cultural groups were noted. There were mixed views on how successful PM+ might prove, and we had insufficient evidence to provide clear conclusions. Future work Future research could explore how technology can be used to improve the acceptability, feasibility, efficacy and potential cost-effectiveness of scalable mental health interventions and well-being support for distressed asylum seekers and refugees. The use of mobile phone and/or app-based forms of support may help to increase asylum seekers’ and refugees’ willingness to engage in research of this type. Conclusions Although it was not possible to specify the parameters for a full randomised controlled trial of PM+ for asylum seekers and refugees in the UK, our findings offer guidance on strategies that may be of value in future studies of this nature. Trial registration This trial is registered as ISRCTN15214107. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 10, No. 10. See the NIHR Journals Library website for further project information.

Background The increasing call for real world evidence has resulted in a diverse range of studies being conducted using the broad “real world” descriptor. We conducted a critical review of how researchers are incorporating the real world in their evaluation of health innovations. Our aim was to develop a framework to categorise existing research approaches and to establish a more precise lexicon for real world health research models.Methods Five electronic databases were searched in July 2021 (PubMed, MEDLINE, Web-of-Science databases, Cochrane library and SCOPUS) for primary research articles presenting validations, evaluations, evidence or data drawn from real world, pragmatic or realist studies for health related innovations. 1762 records were identified. Two authors independently screened papers by title and abstract (n = 291), followed by a full-text screening (n = 104). 33 included studies were critically reviewed to determine the nature of the “real world” elements used in each of the research studies.Results It was shown that whilst authors used a wide variety of terms to describe their studies, they could be grouped into three categories according to the aim of the study. Two of the categories, the pragmatic study and the proof of concept study were derived from current published definitions. We identify the need for a category that provides evidence on the population using an innovation, rather than as an evaluation of the innovation itself.Conclusions We propose a fourth category – real world validation – and explain why it should be reserved for evidence meeting very specific criteria.

Background Children and young people (CYP) from underrepresented communities in the Liverpool and Sefton regions (UK) experienced an increase in mental health needs, pre-pandemic. The “CYP as One” online platform was introduced via a co-creation schedule, to support the uptake of service users into child and adolescent mental health services. However, post-pandemic, the risk of poor mental health for CYP further increased. The current study co-customised the “CYP as One” platform to facilitate the wider access and inclusion of CYP from underserved communities into relevant mental health services through ensuring their viewpoints are sufficiently represented in the referral process. Methods The co-customisation schedule utilised the Living lab approach. Service user feedback was extracted from the “CYP as One” platform and data was generated via seven online focus groups conducted over two months. The focus groups included 16-19-year-old young people; parents of under 16-year-old children and health service providers. Content analysis was conducted on service user feedback, which was covertly presented to focus group participants to aid the conversations during the focus groups. The final data analysis involved conducting a thematic analysis on service user feedback and focus group data. Findings The thematic analysis on service user feedback and focus group data returned seven themes. Contrasting preferences of referral methods; the importance of inclusive access to a wide range of platform users; the relevance of demonstrating empathy and sympathy via non-face-to-face referrals; perspective taking aids in the mutual understanding of the needs of stakeholders involved; digital content should account for age and social-development related differences in this context; CYP and parents require timely and relevant mental health information; digital means of referral methods may integrate fragmented services. Conclusions Involving insights from service users; the public and health service providers allowed the in-depth exploration of everyday challenges service users may face when using the “CYP as One” platform. The solutions identified by participants to such issues represent a reliable improvement to the platform. Ensuring that the digital content can replace in-person referral processes is of utmost importance to support CYP who previously experienced difficulties in engaging with mental health services.

Background: Preventing falls in elderly care homes is a significant public health policy goal in the the United Kingdom. The 2004 National Institute for Health and Care Excellence Clinical Guideline (CG21) recommends risk detection and multifactorial fall prevention interventions. Digital technology allows individualised monitoring and interventions. However, there is no certainty of the impact of multifactorial interventions on the rate of falls. One in three adults over the age of 65 and one in two adults over the age of 80 will experience a fall a year. Falls account for a considerable cost burden for the National Health Services. Methods: A retrospective multi-centre case-control study using real-world data was developed to trial the effectiveness of a falls prevention application in 32 care homes in the Northwest of England. The study aims to assess if a multifactorial fall-prevention digital app leads to a reduction in falls and injurious falls in care homes. Main outcomes measures were the rate of patient falls per 1000 occupied bed days in care homes for 12 months. A digital multifactorial risk assessment, and a tailored fall prevention plan linking each risk factor with the appropriate preventive interventions were implemented/reviewed monthly. Results: The secondary outcome was the rate of injurious falls per 1000 occupied bed days.There were 22.30% fewer falls in the Intervention group (M=6.46, SD=3.65) compared with Control (M=8.69, SD=6.38) (t(142.67)=-2.686, p=0.008). The intervention had 35% lower low harm injurious falls ratio per 1000 occupied bed days (M=3.14, SD=4.08) (M=6.64, SD=6.22) (t(144)=-3588, pConclusions: In this real-world validation, the implementation of a multifactorial fall-prevention digital app was associated with a significant reduction in falls and injurious falls.

Living Labs (LL) are a novel and potentially robust way of addressing real-life health challenges, especially within the dementia field. Generally, LLs focus on co-creating through implementing the quadruple helix partnership as a user-centric approach to co-creating. In the context of this paper, the users were people with dementia and their informal carers. LL are not necessarily environments that evaluate these co-created innovations within the real world. Considering this disconnect between co-creation and real-world evaluation, this paper, as a critical commentary, will reflect on the methodological lessons learnt during the development of an LL model aimed at addressing this discrepancy. The LL at Liverpool John Moores University (LJMU) was commissioned to co-create and then evaluate a new Dementia Reablement Service. The case study findings revealed that the Dementia Reablement Service had a positive impact on the quality of life of people with dementia, suggesting that the service is a catalyst for positive change. In addition, the critical learning from this case study highlights the potential role of LLs in seamlessly co-creating and then evaluating the co-created solution within the real world. A benefit of this way of working is that it provides opportunities for LLs to secure access to traditional research funding.

Childhood neglect is the most ubiquitous and prevalent form of adverse childhood experiences (ACEs). Given the significance of cognitive function and its malleability in retort to environmental stimuli, there is significant relevance in understanding the impact of child neglect on cognitive domains. Furthermore, examining the cognitive domains individually enables a more nuanced understanding of the impact of childhood neglect. This article details a scoping review undertaken to explore the relationship between childhood neglect and cognitive function, with the aim to recognize the observable cognitive qualities in neglected children, in the absenteeism of other ACEs. Cognitive function was divided into five domains: executive function, academic achievement, language, memory and intelligence. The findings demonstrated that executive function (working memory and attention shifting), language and intelligence were associated with childhood neglect, and there was no association between executive function (spatial planning), academic achievement, memory and childhood neglect.

As people live longer, rates of long-term conditions such as dementia are increasing and healthcare costs are exponentially increasing. Dementia services recognise there is a need for change; this paper provides an example of how people interacting within an architectural-led care system can positively influence this need for change. The adopted method within this paper is the ‘thinking, making and living’ approach underpinned by a one-time post-occupancy evaluation. The architectural-led care system, the Humanitas© Deventer in the Netherlands, is a good example of a new paradigm of care built on sustainable collaboration, which positively contributes to the well-being of the recipients of care – people with dementia.

Edited byMichelle Cleary, PhD, RNSchool of Health Sciences, University of Tasmania, Sydney, NSW, AustraliaDementia is a long-term medical condition, which affects not only the person with dementia ...